Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2025

Debate between Lord Scriven and Lord Kamall

Monday 10th February 2025 Grand Committee

[Lord Scriven (LD)]

My Lords, again I thank the Minister for clearly and aptly outlining what the statutory instrument is for. I am not going to go over the reasons for this but, broadly, these Benches support what is happening and understand why the streamlining is required. However, like all streamlining where common sense seems to take the central point, it is worth testing just how common and sensical the requirements are, and whether the Government have thought through some of the consequences—or unintended consequences—of what may happen. Although the intention to maintain regulatory oversight and uphold care standards is obviously commendable, several points warrant further investigation and probing. I hope that the Minister will answer in her normal way; she is usually quite thorough and detailed.

The Explanatory Memorandum notes that a post-implementation review conducted in July 2022 had limited responses, providing insufficient evidence to suggest that the 2014 regulations did not meet their original objectives. Could the Minister elaborate on the steps taken to engage stakeholders during this review? What measures will be implemented to ensure that, when statutory instruments are extended in future, more comprehensive stakeholder participation will be sought? The amendment mandates having a review every five years. Given the dynamic nature of health and social care, how will the Government ensure that the regulations are monitored and remain responsive to emerging challenges and innovations within the review period?

Removing the expiry date also extends the regulations indefinitely. Have the Government assessed the potential long-term impacts of this permanency on service providers and the CQC’s regulatory capacity? I think the noble Baroness knows why this question is being asked. Although I heard what she said about the operational issues that the CQC is undergoing at the moment, the regulatory changes that we are discussing may have some operational impact on the CQC.

In particular at the moment, when the CQC’s backlog is significant and its chief executive has said that it has no idea how it will deal with it—indeed, there are certain things stuck in the computer system that they do not know how to get out—how will the Government ensure in the interim that any application made to the CQC regarding this instrument is dealt with in a timely and safe manner?

Finally, on the policy areas that the Minister said were outwith these regulations due to further consultation and the sensitivity required, when will the statutory instrument be laid before Parliament? What is the timescale? Are any interim measures being put in place to ensure that any safety issues or regulatory issues with these sporting events are dealt with before the statutory instrument is laid before Parliament?

With those questions, we are, as I say, very supportive of this instrument in a broad sense, but the Minister’s normal detailed response would be welcome.

[Lord Kamall (Con)]

My Lords, I once again thank the Minister for the statutory instrument before us. We understand the reason for it: making sure, in particular, that this continues to be in effect after March this year, and setting the next review for 2028. Maybe that is where some of the questions arise—the noble Lord, Lord Scriven, alluded to some of these concerns.

We have just finished debating an SI on adapting for innovation—particularly in relation to speeding up clinical trials, which is to be welcomed. It showed that we need to be flexible with the emergence of new technology, knowledge and capabilities in health and social care. But, like the noble Lord, Lord Scriven, we wonder about a five-year review cycle, which may not allow for sufficient flexibility, given some of the fast-paced developments in healthcare. We have seen massive strides in digital health and mental health services. In our debate earlier in the Chamber, we asked about the use of AI in analysing data that the NHS already has. Will five years be too long to wait? Could it slow down the adoption or reviews, if you like, of some of these new technologies? Could the delay in reviewing regulations lead to some important issues being unaddressed for far too long? There may be new awareness of some emerging patient safety risks, for example. I just wonder: how do we get the right balance? I understand why the Government have extended this for five years, but we want to make sure that, within those five years, the Government, the NHS, the regulations and the CQC are flexible enough to take account of innovations.

The absence of interim mechanisms for addressing pressing issues during this review period could also foster a sense of regulatory stagnation. There may well be a case where providers and stakeholders feel that concerns are not being acted on quickly enough, especially as challenges arise before that next review. Although we understand the need for a stable framework, we want to understand how to get the balance between stability and responsiveness right. Could that delay necessary regulatory adjustments?

The other point here is extending the scope of the regulations to all patients being assessed or treated for a mental health disorder in a mental health unit. Obviously, this coincides with the debate that noble Lords are having on the Mental Health Bill. In this case, it extends beyond only those with learning disabilities and autism. This expansion is generally welcomed, but, once again, it raises questions—which were raised on the last SI—about resources and capacity. I know that the Minister has heard this a number of times, particularly during the passage of the Mental Health Bill. Will there be sufficient support for providers so that they can meet these expanded requirements? How will the Government monitor and address any challenges that may arise from this broader scope?

Fortunately, the Minister pre-empted one of the questions that I was going to ask about the regulations’ provisions on temporary healthcare settings, particularly at large sporting and cultural events. We understand the need to remove those regulations, but what thought has been given to the unintended consequences of doing so? I am generally supportive of removing regulations, but I understand why we need them: to make sure that enough account is taken of safety but also that someone is held responsible and there is some accountability when things go wrong.

Medicines for Human Use (Clinical Trials) (Amendment) Regulations 2024

Debate between Lord Scriven and Lord Kamall

Monday 10th February 2025 Grand Committee

[Lord Scriven (LD)]

My Lords, I start by congratulating the Minister; I hear her sniffles. She has been a champion of her brief in having to deal with two statutory instruments, as well as a Statement in the House. I thank her for being here.

As the Minister said, the reforms proposed in this statutory instrument aim to create a more streamlined and flexible regulatory environment for clinical trials in the United Kingdom, while balancing safeguarding the interests of trial participants. The amendments seek to uphold the paramount importance of participant safety, ensuring that their rights and well-being remain central to the regulatory framework. By refining the evaluation and development process for new or improved medicines, these changes aim to expedite the delivery of therapeutic benefits to patients and society at large, and we on these Benches recognise that.

The instrument will formalise the combined review process, which has been piloted since 2018 and become the exclusive route for clinical trial applications. This process offers a single application pathway and co-ordinated regulatory and ethics committee review, ending in a unified UK decision for clinical trials. That would be helpful for practitioners and those seeking to innovate, but there are still points that require clarification, and while the objectives of these amendments are commendable, I seek clarification from the Minister on several aspects.

What measures are in place to ensure that the Medicines and Healthcare products Regulatory Agency and the ethics committees will be adequately resourced to manage the anticipated increase in workload resulting from the streamlined process? If no impact assessment has been made, what working assumptions are the department and NHS England working to regarding the workload that this new process will bring?

Can the Minister provide detailed guidance on how the risk-based approach will be operationalised to ensure consistency across different types of trials? I note that she talked about international alignment, but how do the Government plan to align these regulatory changes with international standards to facilitate seamless multinational trials? What frameworks will be established to monitor the impact of these regulatory changes on trial efficacy and patient safety, which is really important? How will these findings be reported locally within the NHS? Will they be reported to Parliament at any point?

Finally, can the Minister explain and elaborate on the consultation process undertaken with key stakeholders regarding these changes, including patient groups, industry representatives and academic researchers, in the development of these amendments? Were there any differences that emerged from the stakeholders and how have the Government dealt with them?

In conclusion, while we on these Benches support the intention behind these regulations, it is imperative to ensure that the implementation is robust and effective. I look forward to the Minister’s responses on the matters I have raised—less croaky responses, I hope.

[Lord Kamall (Con)]

My Lords, I thank the Minister for the laying of this statutory instrument. Like the noble Lord, Lord Scriven, I commend her on her valour and robustness, as well as the speed at which she managed to transport herself from the Chamber to here after the Statement repeat, having prepared for that and having been briefed by her officials.

Like many other noble Lords, we welcome these regulations, which are grounded in the review by my noble friend Lord O’Shaughnessy and the subsequent consultation with stakeholders, including the Medicines and Healthcare products Regulatory Agency and Health Research Authority, aimed at modernising the regulatory framework that governs clinical trials in the UK. We know that the landscape for clinical research in the UK faced significant disruption during the Covid-19 pandemic, but we also know that we learned quite a lot from trying to get vaccines out very quickly in terms of ways to speed up trials and to make sure that we get the right balance between efficiency and processes, as well as making sure that people are safe. We need to make sure that we can boost the volume of clinical trials and boost patient recruitment.

The O’Shaughnessy review identified the need for a more flexible and risk-proportionate approach to clinical trials. One very important point is that, while we cannot eliminate risk altogether, we can manage it. Where there is low risk, we should maybe not be placing so much emphasis on processes as compared with when there is high risk, but I also know that there may always be unintended consequences.

Stakeholders such as the Association of the British Pharmaceutical Industry were vocal in their support for these reforms and had in fact been calling for them. The ABPI 2024 report, The Road to Recovery for UK Industry Clinical Trials, highlighted that the number of pharmaceutical industry trials initiated in the UK increased—it was just over 400—between 2022 and 2023, although that still remained 36% below the 2017 level. We therefore understand the need to bring forward these regulations to make sure that we improve the regulatory environment to further increase clinical trial activity.

I turn to the detail of the regulations. One major change that noble Lords have already alluded to is the consolidation of the regulatory and ethics review process, enabling researchers to submit a single application for both regulatory approval and ethics review. While this change is aimed at improving efficiency—which we completely accept and welcome—there is a concern that any changes from consolidating these processes may put additional pressure on the regulators and ethics committees. The noble Lord, Lord Scriven, referred to that. If the single application process becomes overloaded, we risk delays in review times rather than the acceleration that was intended by these measures in the first place. It is essential that we have the resources and infrastructure in place to handle the increased workload effectively. Can the Minister therefore say how the Government will make sure to avoid that sort of overload? We completely understand why they want to consolidate the processes, but will it add extra pressure and will the resource be there to make sure that they are not overloaded and we do not just end up going back to square one, or even make things worse?

In addition, for low-risk trials, automatic regulatory authorisation will be granted, which will further streamline the approval process and free up resources for the more complex, higher-risk trials. Once again, while this makes sense, we have to be aware of possible unintended consequences or concerns that will be raised. The automatic approval of low-risk trials could, for example, raise concerns over oversight and monitoring. The intention to expedite the approval process for those with lower-risk profiles is laudable, but will there be clear criteria in place to ensure that the appropriate level of scrutiny is maintained, particularly in ensuring patient safety? As I said, while we support the intention, particularly for low-risk trials, we must always be aware of unintended consequences or unforeseen complications. Nevertheless, we completely understand why this is being done, and it is something to be welcomed.

National Cancer Plan

Debate between Lord Scriven and Lord Kamall

Monday 10th February 2025 Lords Chamber

[Lord Kamall (Con)]

My Lords, I thank all those who work tirelessly to treat and help others who are suffering from cancer—not only the wonderful clinicians and medical professionals but also the many cancer charities, some of which I have met, which support people living with cancer and fund the important research that has led to significant increases in survival rates for some cancers and will lead to the future breakthroughs that we all want to see. Their dedication is an example to us all. We owe them a great deal of gratitude; it is something that we can all be proud of.

Cancer will affect us all in some way or another. Almost everyone knows someone who has been diagnosed with it or may have had to live with the big C themselves, so it is vital that we do everything we can to beat this disease. It is highly reassuring that cancer care and treatment are constantly improving. Over the past 50 years, the survival rates for all cancers have doubled. The one-year survival rates for cancer increased by almost 6% between 2010 and 2020, while the five-year survival rate has increased by more than 4%. However, we know that more can and must be done. Despite these improvements, we are not in the place we all want to be in. We should be honest about that.

These Benches welcome the fact that the Government are taking steps to try to improve cancer care and research. It is welcome that there will be a greater focus on prevention and early diagnosis, which we know to be one of the best ways of improving quality of care. We are also grateful to this Government for continuing the rollout of community diagnostic centres started by the last Government.

When I was a Health Minister, I was advised by officials that 80% of those on the waiting list were waiting for diagnosis. That statistic may no longer be true but more community diagnostic centres are clearly needed, not just for early diagnosis but because their being placed in local communities might help reluctant patients who are scared or worried about going to hospital or who suffer from white coat syndrome to seek a diagnosis—at a more friendly place such as their local sports centre or shopping centre, so it does not become a daunting task. We welcome the fact that the Government will continue to roll these centres out.

Technology will be an accelerator for cancer treatment. Coupled with innovative methods of utilising data, machine learning and AI, there are real opportunities to drive better outcomes. If we can identify those who are more at risk or likely to be at risk from certain types of cancer and streamline them into treatment pathways using the best data available, then we could increase our survival rates further. Can the Minister reassure your Lordships that there will be a strong focus on harnessing new technologies in the cancer plan when it is published and will the Department of Health and Social Care engage with the many innovative companies—start-ups and others, and rollouts and spin-outs from many research places—that produce such technologies and can help the NHS synthesise and restratify the available data?

While we welcome the Government’s commitment to cancer care, we have questions about the timescale. I appreciate that the Minister has been honest that some announcements by the Government are aspirations while others are firm commitments. I note that this announcement launches the call for evidence for the national cancer plan, but we have already heard that the Government have launched a number of other reviews and plans. We have the NHS 10-year plan, the elective reform plan, the commission on building the national care service and the review of the new hospital programme. I believe noble Lords would like to know when we will see action from these plans, and today in particular from the cancer plan. If the Minister cannot give further details now, can she give an indication of when we can expect them? That would be greatly appreciated when it comes to understanding the Government’s commitment to this plan.

Finally, while we have made great progress in tackling certain types of cancer, what more could be done to speed up treatment of the hard-to-treat or less survivable cancers? I recently met Pancreatic Cancer UK, which told me that one of the reasons for lower survivability is that, by the time the cancer is spotted, it has often reached a late stage: stage 3 or 4. It also told me about a breath test being trialled that captures vapours and gases which can be analysed to detect the presence of biomarkers of certain cancers. To be clear, I appreciate that this is being trialled, but I wonder what changes to processes the Government and the NHS may be looking at to speed up the rollout of such innovations, especially relatively low-cost tests. I appreciate that there might be unintended consequences, false negatives or false positives, but could the Minister write to noble Lords with more details of such forthcoming breakthroughs and trials in England? I look forward to her response.

[Lord Scriven (LD)]

My Lords, I thank the Minister for the Statement. Like the noble Lord, Lord Kamall, I thank those individuals who work day in, day out with people who have been diagnosed with cancer, and with their families, for the great work they do. This cancer plan represents an opportunity to make significant progress in the country’s fight against this terrible disease. The Statement and the plan, while containing some promising elements, require careful scrutiny. In the view of these Benches, further action is required if we are truly to make the necessary strides in the fight against this devastating disease.

Cancer, as we all know, touches every family in the country. It is a relentless adversary and our response must be equally determined. The plan before us rightly acknowledges the importance of early diagnosis and I commend the focus on initiatives such as the expansion of screening programmes and the innovative use of technology to detect cancers earlier. Early detection is, without question, the single most powerful tool we have to improve patient outcomes.

However, we have some concerns. While the rhetoric around early diagnosis is welcome, the plan lacks sufficient detail on how we will address the very real workforce shortages that plague the NHS. We cannot diagnose cancers early if we do not have the radiologists, pathologists and oncologists to interpret results and deliver timely treatment. The Government need a concrete plan for recruitment and retention of these vital professionals. I urge them to address these critical gaps and ask the Minister exactly how these gaps will be plugged.

Furthermore, the plan’s ambition for personalised medicine is laudable, but it seems somewhat detached from the realities on the ground. Access to cross-cutting treatments and clinical trials remains uneven across the country. We must ensure that one’s postcode does not determine a patient’s access to the most innovative therapies. This requires not only increased funding for research and development but a streamlined process for bringing new treatments to patients as quickly and safely as possible. What plans do the Government have to ensure that these treatments are brought forward quickly across the country?

Another area of concern is the plan’s approach to palliative care. While the focus on early diagnosis is crucial, we must not forget those for whom a cure is no longer possible. Palliative care is not simply about end-of-life care; it is also about maximising quality of life for patients and their families throughout their cancer journey. What are the Government doing to ensure a renewed focus on funding and resourcing for palliative care services, ensuring that every patient receives the compassion and holistic care they deserve?

We need to do more to tackle what is happening. I will ask two further questions and give the Minister a suggestion that may be taken forward. First, it is pleasing to see that radiotherapy is in the Statement, which is a step forward. However, evidence shows that currently the United Kingdom allocates only 5% of its cancer budget to radiotherapy, compared with the OECD average of 9%. This discrepancy is a contributing factor to the UK’s low cancer survival rates, particularly in cancers such as lung and colorectal. Countries such as Australia and Canada, which allocate a higher percentage of their cancer budgets to radiotherapy, have seen improvements in survival outcomes. Will the Minister commit to addressing this funding gap and set specific targets for cancer budget allocation for radiotherapy to ensure better survival rates for patients in the UK?

Secondly, with over 500,000 people waiting more than two weeks for vital cancer treatment, how do the Government intend to tackle these extensive delays in the immediate term? What concrete measures will be taken to ensure that the national cancer plan leads to real improvements, rather than remaining a set of unmet promises?

I wish to give the Minister a suggestion, which I hope she will take forward. Many of us in this House understand the significant difference in outcomes between early and late-stage diagnosis of cancers. On these Benches, we are strong advocates of utilising AI in early detection. The UK, with its unique history of the National Health Service, benefits from a collection of historical tissue samples. Given this, would the Government implement a programme in which AI performs a retrospective analysis of these samples in order to identify patterns that would improve the speed and accuracy of cancer diagnosis in the future?

I urge the Government to listen to the concerns raised by healthcare professionals and, most importantly, by patients and their families during the consultation period. These insights will strengthen this plan and ensure that it delivers real and lasting improvements to the lives of those affected by cancer.

New Hospital Programme Review

Debate between Lord Scriven and Lord Kamall

Tuesday 28th January 2025 Lords Chamber

[Lord Kamall (Con)]

My Lords, when we have Statements such as this, it is easy to fall into the old-fashioned debate of the Opposition condemning the Government for every change to policy that they announce, and the current Government blaming the previous Government. I hope that the Minister will appreciate that, as the shadow Health Minister, I have tried to act in a more constructive manner—I see her nod—by supporting the Government when we agree, and by asking questions to understand their reasoning and ambitions.

We all want a system of health and care that is fit for the future, fit for today and patient-focused. We welcome the Government’s focus on their three principles. I shall not test the Minister on them, because I know that she can reel them off. They are: hospital to community, analogue to digital and sickness to prevention. Indeed, when I was a Minister in the department, part of my job was to push the digital agenda in health and care.

With that, I am equally sure the Minister also welcomed the opening in April last year of the new Dyson Cancer Centre in Bath, as well as the completion of the Greater Manchester Major Trauma Hospital in May 2024. We are disappointed that the Government have delayed the new hospital programme, and it was also disappointing to see the Secretary of State criticising some of the aspects of the new hospital programme.

We completely understand that the Government have felt it necessary to reassess the timeline for delivering the hospital building programme, but may I press the Minister on those changes? Having delayed some of these new hospitals and the rebuilding of existing hospitals, are the Government still committed to building the same hospitals on the same sites? Is there a possibility that they will change the criteria for where the hospitals will be built?

We also want to understand how this fits into the Government’s other ambitions. The Government are committed to building 1.5 million new homes. Where these new houses are concentrated will inevitably create new areas of pressure on health and care services. Will the Government be considering the impact of their housebuilding targets on the location of these new hospitals, and will that affect the hospital programme?

I have one final point. Brand new, state-of-the-art, large-scale hospitals are all well and good, and we certainly need more hospital capacity, but I know the Minister will agree that they should be supplemented by an increase in primary care facilities. I know the Government have committed to doing just that. The noble Lord, Lord Darzi, was unequivocal in his support of this in his recent report. Have the Government allocated funding for new primary care centres, such as the one mentioned by the Minister in Oral Questions today, and community health and care centres that could offer some secondary care services, taking pressure off the hospitals, but also better rehabilitation for people in their local community, also taking pressure off the larger hospitals? I look forward to the Minister’s responses.

[Lord Scriven (LD)]

My Lords, I extend my gratitude to the Minister for the Statement on the pressing issue surrounding the new hospital programme review. This initiative, inherited from the previous Conservative Government, who overpromised and underfunded, was a significant letdown for countless communities and patients across England. While the ambition to modernise hospital infrastructure is commendable, the current trajectory raises serious concerns that demand urgent attention.

Such concern was raised in a recent email from the chief executive of Leeds Teaching Hospitals NHS Trust, which showed the impact on both patients and staff of such a delay for capital investment in the hospitals that he leads. Recent data paints a worrying picture: hospitals facing delays under the new hospital programme reported over 500 infrastructure-related incidents in the past year alone. These failures led to the loss of 32 days of clinical time, directly impacting patient care.

This is not just about numbers, it is about real people unable to recover, return to work or resume their daily lives because of these delays. Alarmingly, nearly 100 flooding events occurred in these hospitals that have now been delayed for repair and rebuilding, representing a quarter of all such incidents across NHS England, despite these hospitals accounting for less than 1% of the total NHS estate. Helen Morgan MP, the Liberal Democrat spokesperson in the other place, aptly described these hospitals as “hanging by a thread”. She rightly criticised postponement of essential projects as a “false economy” that jeopardises patient safety. Delays not only inflate cost, forcing hospitals to allocate more of their stretched budgets to essential maintenance, but allow estates to deteriorate further, leading to closed clinics and clinical facilities, extending waiting times and possibly leading to poorer health outcomes for patients.

Therefore, I ask the Minister: have the Government conducted an impact assessment of these delays? If so, will she release a comprehensive evaluation detailing the risk to patients’ well-being, the additional maintenance cost anticipated between now and 2039 for these hospitals, and the financial implications of delaying investment? Specifically, have the Government considered whether to adopt an invest-to-save model, offsetting the cost of borrowing against the escalating maintenance burden and the economic inactivity for some patients caused by estate failures? This could provide a more sustainable way of building these hospitals.

The Autumn Budget of 2024 announced a £3.1 billion increase in the health and social care capital budget over the next two years. While welcome, this figure falls far short of the £6.4 billion per year experts say is necessary to address the NHS’s growing challenge. Over recent years, the maintenance backlog has more than doubled in real terms, rising from £6.4 billion in 2015-16 to a staggering £13.8 billion in 2023-24. This includes urgent issues such as crumbling roofs, outdated electrical systems and failing heating and ventilation—conditions that no hospital staff or members of the public should endure.

The King’s Fund has highlighted a troubling practice. Despite planned increases in capital investment, financial pressures have driven the reallocation of capital budgets to cover day-to-day spending. This undermines the long- term investment urgently needed to maintain and upgrade our healthcare facilities. In light of these alarming facts, I pose the following questions to the Minister. What specific measures have been implemented to ensure that delays to hospital building programmes do not compromise patient safety? How do the Government plan to bridge the gap between the £3.1 billion and the £6.4 billion per year experts say is required to address the NHS hospital maintenance backlog? Will the Government publish a detailed impact assessment of the delayed projects, outlining the risk to patient care and safety? What strategies have been put in place to ring-fence capital budgets, ensuring they are not diverted to cover day-to-day expenses? How do the Government intend to address critical maintenance issues, such as failing roofs and outdated electrical systems in hospitals that will not see rebuilding until the mid to late 2030s?

In conclusion, while the Government’s commitment to improving hospital infrastructure is evident, the current capital allocations are insufficient to address the pressing needs of these facilities. Without sustained investment, the Government risk compromising both patient safety and quality of care. I urge the Government to reassess their funding priorities and consider an invest-to-save model to secure safe and effective hospital environments for patients and professional staff alike. I call on the Minister to address these concerns with the seriousness that they deserve.

Mental Health Bill [HL]

Debate between Lord Scriven and Lord Kamall

Committee stage
Monday 27th January 2025 Lords Chamber

[Lord Scriven (LD)]

My Lords, I will be very brief because of the time. As with the previous group of amendments from the noble Lord, Lord Bradley, we are very supportive of the intention to try to tease out of government what the implementation plans are. It is really important to understand that being supportive of Clause 47 does not necessarily mean that we believe it will come into implementation in a timely fashion.

By supporting the noble Lord’s amendments, we wish to tease out of government the exact timing and resources that have been allocated; the planning the Government will have to do in terms of the number of provisions that will be required to implement this clause; the gap between the number of those facilities in place and those needed; and the estimate the Government have of when they would seek to put those facilities in place.

As the noble Lord, Lord Bradley, said, the location of those facilities—where there are gaps geographically and where they need to be filled—is very important. It is important that the Government furnish the Committee with those details so that we can fully understand not just the intention of implementation but the scale of the implementation plan required for this clause.

[Lord Kamall (Con)]

My Lords, just like in the last group, I will speak to and support the amendments in the name of the noble Lord, Lord Bradley. They follow the amendments in the previous group.

These Benches welcome Clause 47—another positive move—which addresses the issues arising from the current situation. As the noble Lord, Lord Bradley, said, bail can be refused solely on the basis of a mental health condition where it might otherwise have been granted.

In simple terms, as the noble Lord, Lord Scriven, said, this amendment returns to the theme that he, and many other noble Lords, have pushed the Government on—and I like the words used by the noble Lord—to “tease out” the plan and timetable for implementation from the Government, since it requires the Secretary of State to prepare a report on how they plan to implement these changes within the time period proposed in Amendment 163C.

We have to remember that the impact assessment states, in regard to the changes to remand for a person’s own protection, that:

“Departments are working together to ensure there are clear pathways and provision in place to safely enact these reforms and the timeline for implementation will depend on the conclusion of this work”.


That has been manifested this evening with the presence of a Minister from the Department of Health and Social Care and a Minister from the Ministry of Justice. However, there is currently no set date for the commencement of Clause 46, so it is all contingent on internal departmental assessments. We all understand how government works—how long it takes for things to happen, to get write-round and to get support across government—so I gently suggest to the Minister that the 12-month implementation timeline would be a useful target for the Government to work towards. It could help them to answer some of the questions that many noble Lords have asked in Committee on the plans for, and stages of, implementation. That is not to force the Government to move faster than they want to go, but just for us to understand the various milestones along the way in developing what is in the Bill.

It would also be helpful if the Minister could set out how much progress has been made both in the Ministry of Justice and the Department of Health and Social Care on establishing the pathways and processes to enable these remand reforms to go forward. This is especially true since the impact assessment also states—this is quite an interesting point—that:

“We expect the number of people on remand solely for mental health reasons to be low and therefore health and justice costs relating to this change are likely to be negligible, and therefore have not been monetised”.


We understand the challenges that the Government are often talking about—they have to wait for spending reviews, et cetera—but the impact assessment states that the number of people affected will be low. Can the Minister say whether either his department or the Department of Health and Social Care know what that means and how many people that will be? Does he know how many will be impacted by this change? If he accepts what is in the impact assessment—that the costs will be negligible—this could be a quick win for the Government in relative terms, depending of course on what other processes he feels have to be put in place before they can deliver this. I hope that the Minister can be a bit more helpful on his noble friend’s amendments, given that the costs are low.

We look forward to the Minister’s response, and I would be grateful if he could give an indicative timeframe or an indication of when a timeframe will be in place.

Mental Health Bill [HL]

Debate between Lord Scriven and Lord Kamall

Committee stage
Wednesday 22nd January 2025 Lords Chamber

[Lord Scriven (LD)]

I am grateful to the noble Baroness for giving way and sorry for interrupting her flow again. The point about having a staging report after two years is to get ahead and upstream of what is happening rather than retrospectively being able to do stuff after it has gone on. Two years in management terms to be able to determine trends of intended or unintended consequences and then put different things in place is really important. I believe that this amendment, with a report back to Parliament, would send a very strong signal and allow the Government, the department and NHS England to pick up trends, even if it was not the total picture, which would determine different policies and practices and potential changes in the code as well as management action. I think that is what lies behind the noble Lord’s amendment.

[Lord Kamall (Con)]

I am sorry to interrupt at this time. I note that the noble Baroness thinks that 12 months is too short, and many noble Lords can perhaps see the point that two years is too short. Does the department have any idea of what a reasonable timeframe is? There has to be some accountability, as the noble Lord, Lord Scriven, said. We could accept the warm words and the intentions of the Minister here tonight, but what happens if nothing changes? Where is the accountability? Can the Minister think about asking the department whether there is a reasonable timeframe for some meaningful research? I have supervised academic theses over time. You can have the one-year and then you go on to the three-year for PhD, and sometimes that is quite comprehensive data. There might be a meta study that could be done of lots of existing studies. First, what is a reasonable time? The noble Baroness does not have to answer now; it can be in writing. Secondly, if we let this go, how do we make sure there is accountability? How do we come back to this in three years or four years or five years? I look forward to the answer.

Mental Health Bill [HL]

Debate between Lord Scriven and Lord Kamall

Committee stage
Monday 20th January 2025 Lords Chamber

[Lord Scriven (LD)]

I am reading the impact assessment, and the annual amount is between £6 million to £7 million, and not £81 million. Perhaps the Minister could clarify that when she responds, as the impact assessment that I am reading is different from the £81 million that the noble Baroness, Lady Murphy, and the noble Lord, Lord Kamall, are referring to.

[Lord Kamall (Con)]

I thank the noble Lord, Lord Scriven, for that, as I would not want to be using inaccurate information. Maybe the Minister can check with her officials, thanks to the wonderful use of technology, to ensure that we have an accurate figure by the time that she gets up to respond to our points. Whichever number is accurate for the cost of extension, it does have an impact on how noble Lords may feel if these amendments come back on Report.

The study that the noble Baroness, Lady Murphy, shared with us contained two statements which I picked up on, and which I hope the noble Baroness will correct if I am wrong. First, patients found the process was a positive experience. But, secondly, the study found no evidence that it had any impact on the outcomes of the care and treatment. That is an important point to make. Once again, what is effective, and what works? Sometimes, feeling better and being more positive is part of a treatment, and we should not dismiss that.

I do not want to sound too negative, as I thought that the North Carolina study was very positive, and the noble Baroness and I corresponded about this over the weekend. It was interesting that it found that black mental health patients benefited from having an independent mental health advocate, especially if the advocate was also black, as patients felt better supported, and more confident that they would be listened to by someone. The crucial point was that it appeared to reduce the rate of repeat detentions. This is one of the crucial issues throughout the Bill. This is one of the reasons why my noble friend Lady May asked for the Wessely review.

Health and Adult Social Care Reform

Debate between Lord Scriven and Lord Kamall

Tuesday 7th January 2025 Lords Chamber

[Lord Kamall (Con)]

My Lords, I begin by echoing the comments made by my right honourable friend the shadow Secretary of State in the other place in support of all those who worked in the NHS and social care sectors over the Christmas period. They sacrificed their time, which could have been spent with their friends and families, to care for those most in need.

On the NHS app, we support the digitisation of health and care to modernise the NHS, and support digital patient records to allow joined-up health and social care to deliver better outcomes for patients and to inform patients. However, the NHS app already sends appointments and updates on treatment to some patients, while some GP surgeries prefer patients to use their own website, not the app. I would be grateful if the Minister could expand on how the updated app will differ and offer up further information to your Lordships’ House. Also, where your GP cannot see you, is the plan to allow all patients to book an appointment with another GP without having to deregister from their current practice and reregister with another practice? Will that be allowed with the updated app? One of the problems was always where there were GPs who could not see their patients but other GPs in the same area had spaces on their lists.

In the Statement, the Secretary of State said:

“We are rewarding trusts that cut waiting times fastest”,


and the carrot of “extra capital investment” is used as an incentive. This appears to make sense, but noble Lords will know that I have always been interested in potential unintended consequences. If the Government reward trusts with extra investment if they cut waiting times fastest, what will happen to those trusts that are not able to cut their lists as quickly? Will they see reduced investment, and will that simply lead to them continuing to perform poorly? What is the solution? Will hit squads—in the best possible terms—be sent in to turn them around? What other plans are there to tackle underperforming trusts which do not qualify for these extra incentives? How do the Government and NHS intend to avoid perverse incentives such as trusts prioritising certain patients over others—not necessarily based on medical needs—to cut waiting times to win this extra cash? How do we avoid that?

On social care, I appreciate the candour of the Statement in acknowledging that Governments of all colours, for decades, have not really dealt with this problem of long-term social care. As my right honourable friend the shadow Secretary of State said in the other place, we will work with the Government and the commission. However, I will put a few observations to the Minister. For decades, successive Governments have known about the ageing population, and Governments of all colours have commissioned report after report, which mostly gathered dust on the shelf. Although I have the greatest respect for the noble Baroness, Lady Casey, given that most commentators on social care agree that everything to be written about funding social care has already been written, I am curious to know what the Government expect to achieve by initiating yet another commission.

A solution was proposed in the Health and Care Act 2022. Noble Lords welcomed that we finally had a solution but disagreed on some of the details. But we had a solution to which the Treasury agreed. I remember the Opposition criticising the Government not for introducing the social care cap but for not doing it earlier, and they also suggested a number of tweaks. The incoming Government could have tweaked the numbers to address the concerns that they expressed at the time, and they could have grasped the nettle, but I am afraid that the announcement looks like yet another Government kicking the can down the road. So will the Minister write to noble Lords with the terms for the commission led by the noble Baroness, Lady Casey? This time, will the Department of Health and Social Care continue to work with the Treasury to ensure that whatever solution is finally proposed, even if it is likely not to be a new solution, has the agreement of the Department of Health and Social Care, other government departments and the Treasury? If not, it will simply find itself kicking the can down the road yet again when it comes to 2028.

My final point is on how to cut the backlog. These Benches welcome the Government continuing the policy of the last Government in opening new surgical hubs and community diagnostic centres at weekends and evenings. But, when we were in government, we found a potential workforce issue in opening community diagnostic centres at weekends and evenings. Of course, there are only so many staff who can be employed to keep these services open for longer, so have the Government made an assessment of how many staff they envisage will be available to keep these centres open for longer hours? What is the plan? Will it be a redeployment of existing staff, will existing staff be asked to work longer hours and overtime, or will they recruit new staff?

[Lord Scriven (LD)]

My Lords, we on these Benches welcome the Statement and can see some positives in the way forward, but we have some reservations about timescales and unintended consequences in the implementation that I would like to explore with the Minister.

On social care, we have already called for cross-party talks, as many noble Lords will know. Social care is in crisis and at a tipping point, and it is an unbearable pressure for many families. But we cannot understand why the review will take until 2028 and full implementation will probably not happen until 2029-30. It is a bit like calling the fire service when your house is on fire and asking it to attend once it is out. So what specific components of this review that are not already in the public domain have the Government already determined will take until 2028 to be dealt with? Will the review tackle all forms of social care, including continuing care and young people’s services?

The NHS elective reform plan marks a significant initiative for reducing waiting times and enhancing patient access to elective care. The plan introduces some welcome measures, but many are not new, such as the expansion of the diagnostic and surgical hubs, increased utilisation of digital platforms such as the NHS app and a commitment to meeting the 18-week referral to treatment standard by the end of this Parliament. Although these proposals are commendable, I have been of the view for many years that elective and emergency care need to be provided in different, and probably separate, ways. Several critical concerns warrant attention to ensure the plan’s success and sustainability.

A primary concern is that the plan focuses predominantly on elective care, potentially overlooking the broader health and social care ecosystem. The Nuffield Trust emphasises that, for the plan to be sustainable, there need to be concurrent reforms in social care, significant investment in community services and attention paid to the determinants of ill health, such as housing and education. The focus on throughput measures will mean that it will be focused purely on those. What outcome measures will be put in place, not just for the quantity and speed of care but for the clinical outcomes for patients?

The emphasis on meeting elective care targets should not overshadow other clinical priorities. It is critical to ensure that resources allocated to elective procedures do not detract from urgent and complex care needs. Indeed, the financial model set out in the plan on tariffs will create incentives to focus on elective cases when budgets are stretched. What measures will be put in place so that the expanded diagnostic and surgical hubs, along with the extra reported 3.5 million procedures in the independent sector, will avoid pulling staff away from urgent care and complicated patient needs? This must be based on a fully costed workforce plan, so when will that be presented?

The plan has been announced with little firm detail on funding, especially considering that the £3 billion ring-fenced for cutting waiting times this financial year will not be available from April. Will this ring-fenced scheme be reintroduced? While we welcome the thrust of this plan, there will be some unintended consequences, and we really need to see a detailed implementation plan to ensure that elective care does not overshadow emergency care and those seeking social care.