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

Baroness Merron Excerpts

Monday 10th February 2025 Grand Committee

Moved by

[Baroness Merron]

That the Grand Committee do consider the Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2025.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, this SI amends the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which are due to expire after 31 March this year. It removes that expiry date and amends the five-year period from which the regulations are required to be reviewed. Prior to laying this SI, the principal regulations required review every five years from 1 April 2015. The first post-implementation review was delayed until 2022 due to the pandemic. We therefore wish to conduct the next review in 2028.

This SI does not change any existing policy. The 2014 regulations set out the activities that are regulated by the CQC and the fundamental standards with which all health and social care providers registered with it need to comply. This is coming before your Lordships’ Committee because, if we do not amend the 2014 regulations, they will automatically expire and the CQC will have no powers to fulfil the requirements in the 2008 Act. Neither will there be an obligation on providers, which are currently required to register with the CQC, to comply with the fundamental standards set out in the 2014 regulations.

I am aware that there may have been an expectation to see further changes following the report by Dr Penny Dash into the CQC’s operational requirements, which uncovered significant failings in the CQC’s internal workings. However, dealing with those operational failings does not require changes to legislation; as we have debated in the Chamber on previous occasions, measures have been put in place by the CQC’s new chief executive, Sir Julian Hartley, to urgently address the failures, including the introduction of new governance at the board level.

Noble Lords may also have observed that this SI is silent on provisions relating to the use of restraint and the regulation of medical care at temporary cultural and sporting events, on which we also consulted last year. I can give an assurance that these sensitive areas have not been overlooked and that we are continuing to progress work on finalising these policies.

The consultation responses on the proposal to make restrictive practices notifiable to the CQC within 72 hours showed support for the measures but highlighted a number of practical concerns, primarily that the proposed timeline could place an additional burden on staff, with the potential risk of impacting patient care. As the Government said in their response to the consultation, further work is needed to ensure that we have the right definitions, systems and processes in place before proceeding with legislative changes.

I can tell the Committee that the Government will lay a statutory instrument to remove the exemption relating to regulation of medical care at temporary and cultural sporting events. With this change, providers of such care will be required to register with the CQC for the first time. I hope that will be helpful in setting out what this SI is, and is not, about. I beg to move.

[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.

--- Later in debate ---

On the whole, we welcome this instrument, but we want to understand whether there is flexibility within the five years and whether there have been any unintended consequences from the removal of the regulations. This is an important step towards ensuring the continuity of the regulatory framework, but we want to get the right balance between flexibility and being innovative and nimble to respond to changes in the landscape. I look forward to the Minister’s response.

[Baroness Merron (Lab)]

I thank noble Lords for their thoughtful contributions and questions. The summary of the noble Lord, Lord Kamall, of what we are looking for is exactly right. It is all about balance: we need efficiency and speed, but it has to be right. I certainly share that view. As I set out in my opening remarks, the dual purpose of this SI is to remove the expiry date of the 2014 regs and to amend the five-year period from which they should be reviewed. As I mentioned, this is to ensure that health and care providers will continue to be required to register with the CQC and comply with the fundamental standards set out in the 2014 regulations after 31 March this year, and also, as we all agree, to ensure that services will continue to be required to provide a safe and high-quality standard of care.

I turn to the points raised by noble Lords. If I find, on review, that I have not adequately answered or have inadvertently missed any questions, I will of course write with the requisite information.

The noble Lord, Lord Scriven, referred to the post-implementation review of the 2014 regs. That review ran from May to July 2022, and there were 86 responses. Interestingly, there was insufficient evidence in the responses to suggest whether the objectives of the 2014 regulations remain appropriate and whether there is an alternative system of regulation that would impose less regulation on the health and social care sector. I think we can safely say that it was not conclusive in pointing us in a particular direction.

The noble Lord, Lord Scriven, also asked when the statutory instrument to remove the exemption relating to the regulation of medical care at temporary cultural and sporting events will be laid. I can say to him that it will be in the summer.

The noble Lord, Lord Scriven, also raised the question of the performance of the CQC, which I completely understand. He asked what is happening, how we are dealing with the backlog of registrations and what is our assessment of its long-term impact on regulatory capacity. I understand that. I re-emphasise that the chief executive of the CQC has commissioned an independent review to look specifically at the CQC’s technology. That will help reduce the backlog, which can be tracked back to 2023, when there were a number of difficulties that now need to be resolved. I absolutely agree that the backlog in registrations is a problem particularly for small providers trying to set up a new care home or service. That problem can mean lost revenues and investment, and that has a knock-on impact on capacity, which we very much need to expand.

[Lord Scriven (LD)]

It is really helpful that the Minister says that, but a review in itself does not solve the problem. Have the Government given the CQC a timescale, not just regarding a review but for when they expect the operational difficulties to have been addressed? It is important for those who are registering to understand that. What is the timescale, not for the review but for dealing with the consequences of the backlog?

[Baroness Merron (Lab)]

The noble Lord has raised this with me in the Chamber and in a Parliamentary Question, if I am not mistaken. While I cannot be specific, as I have mentioned before, the fortnightly meetings with CQC—after which a report also goes to the Secretary of State—are an example of focus which, I hope, give some sense of the pace and intensity in putting this right. The CQC not being fit for purpose is an unsustainable situation which is causing great difficulty. When I can update your Lordships’ House about timelines, I will be very pleased to do so.

The noble Lord, Lord Kamall, asked about interim plans being in place. This is kept under review. We are working with the CQC on its recovery and will review whether further changes are needed. There is nothing to stop us from reviewing regulations in the interim. Five years is the statutory requirement, but it does not mean that we cannot act sooner. It is a point well made about time. Similarly, the noble Lord asked whether the reviews being every five years would slow down the adoption of technology. The intention is that it would absolutely not. The reason for keeping the regulations under review is that that would not be regarded as getting the right balance which we all seek.

Regarding capacity issues to meet the expanding requirement, we are very conscious of the consequences. The Government will work with the CQC, NHSE and its partners on a workable mechanism for notifying restraint within 72 hours, which was the point raised.

With that, I thank noble Lords for their contributions. Perhaps I can assure them that, in some ways, this is for me a work in progress, on many sides. We will continue to do that.

Motion agreed.

Valdo Calocane: NHS England Report

Baroness Merron Excerpts

Thursday 6th February 2025 Lords Chamber

[Lord Balfe]

To ask His Majesty’s Government whether they plan to publish a full version of NHS England’s report regarding Valdo Calocane.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, I offer my sincere condolences and, I am sure, those of all in your Lordships’ House, to the bereaved families of Barnaby Webber, Grace O’Malley-Kumar and Ian Coates. Our thoughts are also with the three survivors who sustained serious injuries in the horrendous attacks that took place in Nottingham. Yesterday, NHS England published in full the report of the independent investigation into the care and treatment provided to Valdo Calocane.

[Lord Balfe (Con)]

I thank the Minister for her reply and associate myself with her condolences to the families and the other injured persons. This is a thorough report of 300 pages. Short of naming any names, I do not think there is anything more to be said. However, I have three points. First, the report indicates the difference in the balance between patient rights and community safety, and I would like the department to take that point firmly on board. Secondly, it appears that some of the treatment decisions were taken by individuals but could probably have been better taken by multidisciplinary teams to test the individual judgment against a wider group of experts. Thirdly, the report mentions equality, diversity and inclusion factors and the extent to which they cut across medical decisions. Will the Minister come back to this House, perhaps in six months’ time, having asked her services to look at these three points and any others because there are far too many lessons-to-be-learned reports from which lessons never seem to be learned?

[Baroness Merron (Lab)]

I assure the noble Lord that officials are working with NHS England and partners to set out the next steps regarding how future mental health homicide reports should be published and to ensure that we act as transparently as possible in line with our legal obligations and with engagement for families. That is very important for the future. The three points the noble Lord raises are very relevant and are being dealt with thoroughly in Committee as we take the Mental Health Bill through this House. I am confident that your Lordships’ House is on top of this matter, as are the department and all concerned. There has already been progress on the CQC report published previously, and all the recommendations in this report have been accepted in full.

[Lord Scriven (LD)]

My Lords, these Benches share in the condolences to all those affected by this tragedy. This is a watershed moment, but I am not sure whether the culture of the NHS has changed, given that yesterday a senior official said,

“the system got it wrong”.

No. Individuals in the system got it wrong. What extra mechanisms will the Government put in place to ensure that every individual is held accountable for this and future tragedies in each ICB area?

[Baroness Merron (Lab)]

I understand the seriousness of the points the noble Lord makes. As he is aware, the report to which we are referring is concerned with the care and treatment provided by health services to Valdo Calocane rather than questions of culpability. More broadly, I remind your Lordships’ House that the Prime Minister has committed to establishing a judge-led inquiry into these attacks. We absolutely understand the importance of an inquiry. Having met the families myself, it is crucial to provide families with answers and ensure that this cannot happen in the future.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, the Calocane report is a devastating mix of horror at state failures. It echoes everything from the grooming gangs to Southport, and you just think, “How could this have happened?”. The Minister said that we are dealing with this in Committee on the Mental Health Bill. I query that because the report has only just come out, and it seems to me that the Mental Health Bill will need to change to reflect the lessons learned, as the noble Lord, Lord Balfe, said. Otherwise, we are ignoring it. Will the Minister reflect on how that is happening?

Secondly, did she notice the worrying detail that staff were nervous about forcing treatment because debates here in Westminster on racism in the mental health system meant that they stayed back—they were silent—because this patient was black? Can the Minister assure us that those kinds of politicised issues should now be swept away from all service provision and that we will tell staff that the ethnicity of the patient does not matter and that they have to act according to procedures?

[Baroness Merron (Lab)]

I thank the noble Baroness for the opportunity to clarify that my reference to the Mental Health Bill discussions was in relation to the three points raised by the noble Lord, Lord Balfe, rather than the detail of the report. As I said, the recommendations have been accepted in full, and there is a programme of work to take them forward and for full reporting back. In respect of the further comments the noble Baroness made, it is of course the care of the patient that matters and protection for both the patient—whoever they are—and the public.

[The Earl of Effingham (Con)]

My Lords, it is a tragedy that, on average, 120 people are killed every year in Britain by people suffering mental illness. As the noble Lord, Lord Hanson of Flint, flagged last night on a different but relevant topic, the risk of tragedy can never be zero, so mitigation of risk is key. I hope the Minister will commit, perhaps in the Mental Health Bill, that full and complete reports on crimes committed by those who have been treated under the Mental Health Act 1983 should always be published because that is the best way to decrease the likelihood of them happening again. I should flag that in 2006 the High Court refused a request to have a patient’s medical history deleted from a published report.

[Baroness Merron (Lab)]

I am grateful for the reflections of the noble Earl. I said earlier and am happy to emphasise again that the department is working with NHS England and partners to set out the next steps regarding how we will do exactly what he is speaking of, which is how future independent mental health homicide reports should be published, because it is so important to be transparent. Transparency is key, not just for bereaved families but to ensure that it drives improvements to services to help prevent tragedies. I certainly share the intention of the points raised by the noble Earl.

[Baroness Browning (Con)]

The Minister will know from the Mental Health Bill discussions that there is quite a strong feeling about the abolition of community treatment orders, which were introduced into the 1983 Act by the 2007 amendments. I had reservations about them when I sat on that Bill in another place. I continue to have reservations about them, and this case is indicative of the difficulties and dangers of trying to administer strong medications to people in the community.

[Baroness Merron (Lab)]

I am grateful to the noble Baroness and for all her contributions to the Mental Health Bill. Perhaps I could use this opportunity to say, in answer to her question but also to a previous question, that improving patient rights is not in conflict with public safety. That is something that I know we are very mindful of about the Bill. As the noble Baroness is well aware, and as we have debated many times in this Chamber, there is a case, when to protect people from themselves and to protect the public, action must be taken, and that should not be shied away from.

[Baroness Berridge (Con)]

My Lords, as the terms of reference of the inquiry are developed, could the Minister outline whether they will cover the key questions that have been raised about the criminal justice system? Do we need to look, for instance, at renaming the offence “manslaughter on the grounds of diminished responsibility”, with the cry that he has got away with murder? Will it look at the sensitive issue of, when somebody is not culpable for getting as ill as he did, which is what the court found in the unduly lenient sentence judgment, whether we need to explain to the public why we do not send people to prison but only to hospital in those circumstances?

[Baroness Merron (Lab)]

As the noble Baroness is aware and as I have already confirmed, the report is totally focused on the care and treatment of Valdo Calocane. The questions about sentencing are of course a matter for the courts, but I am sure that my colleagues in the Ministry of Justice will be interested in the noble Baroness’s comments.

Care Homes: Safety Ratings

Baroness Merron Excerpts

Wednesday 5th February 2025 Lords Chamber

[Baroness Pitkeathley]

To ask His Majesty’s Government what assessment they have made of the remarks by Sir Julian Hartley, the new chief executive of the Care Quality Commission, that the public can no longer trust the safety ratings given to care homes.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, the CQC has assured the department that Sir Julian Hartley, the new chief executive, did not use the exact words attributed to him in the interview with the Sunday Times recently. However, the chief executive gave a very honest assessment of the Care Quality Commission’s operational failings as a regulator and the challenges that face it in regaining public confidence. We welcome his candour, as well as his actions.

[Baroness Pitkeathley (Lab)]

My Lords, it seems that available reports about care homes, which are needed, may be four years out of date, which is a serious shortcoming. At a time when the pressure is on to discharge people who need social care, as opposed to medical care, does my noble friend agree that the serious problems in the inspection regime are a barrier to any kind of progress with hospital discharge, and that the aim must be to make the CQC the trusted organisation it once was, on which families can rely when arranging care for their loved ones?

[Baroness Merron (Lab)]

My noble friend is quite right in her observations. Indeed, serious shortcomings are at play. As for the age of the assessments, to which she refers, that is of scant help to those who are seeking to make decisions for either themselves or those who they care for. The CQC, under its new leadership, is prioritising tackling the oldest assessments. The first order of priority is to reduce the registration backlog, which at present is over 10 weeks, and address issues with the registration portal. An independent review has been commissioned to look specifically at the technology that will help reduce the backlog and provide the very necessary up-to-date assessments.

[Baroness Tyler of Enfield (LD)]

My Lords, can the Minister say what urgent steps are being taken to restore public confidence in the CQC’s ratings, and, in particular, what measures are being taken to ensure that the voice of both the patient and their families is given far greater weight in the way that these judgments and ratings are made by the regulator?

[Baroness Merron (Lab)]

I agree that public confidence is absolutely crucial. That is why honesty is very important and why the Secretary of State accepted in full the recommendations of Dr Dash’s review into the CQC, which was published in October. In addition to new executive leadership, a recruitment process is under way for new non-executive leadership, including the chair, which is very important. I agree with the noble Baroness on the importance of the patient voice, because that will lead to greater confidence. There is a long road to go down, but I am absolutely confident that we are well on the way.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, organisations such as the Medical Defence Union report that new healthcare providers are facing severe delays registering with the Care Quality Commission. These delays are slowing down the process of registering new patients to access services. Can my noble friend the Minister outline what discussions the Government have had, or will have, with the Care Quality Commission to resolve this issue?

[Baroness Merron (Lab)]

I assure my noble friend that the department has discussions with the CQC at fortnightly meetings. Those discussions are about performance, including clearing the backlog of registration of new providers, and this will continue in order to make the necessary improvements that my noble friend seeks.

[Baroness Monckton of Dallington Forest (Con)]

My Lords, does the Minister agree that a lot of the problems in care homes would be alleviated if becoming a carer in a care home required certified training, supervision and a defined career path, rather than it being a job of last resort for itinerant job seekers, as it seems to be in many homes at the moment?

[Baroness Merron (Lab)]

I certainly agree with the noble Baroness that the workforce is absolutely crucial, and I very much value the contribution that is made by those who work in care homes. Perhaps it would be helpful to say that, just last month, we announced that the care workforce pathway, a new national career structure for adult social care, will be expanding to support opportunities for career progression and development. This is the direction of travel that we want to take.

[Lord Patel (CB)]

My Lords, whether or not the newspapers were correct in reporting what the CEO said, I am sure we would agree that the Care Quality Commission has been found deficient in its performance. With particular reference to the reports on maternity services, which are now in crisis, what are the Government going to do about properly evaluating maternity services?

[Baroness Merron (Lab)]

I absolutely agree that the CQC has been deficient in its performance. We can look back to 2023 for the roots of that, when a new single assessment framework for assessing providers, coupled with a new IT system and changes in the CQC’s staffing model, were all brought into play. That produced a stark reduction in its inspection activity, as well as causing huge problems in the time taken to carry out re-inspections. In all of the ways that I have already mentioned, in addition to discussions on reducing the backlog and looking at the technology, staffing structure and improving governance within the CQC, this will be a root-and-branch change and will greatly improve inspection for maternity units and others.

[Baroness Stedman-Scott (Con)]

My Lords, Sir Julian Hartley, in the Health and Social Care Committee hearing, said that the new IT system introduced by the regulator had been a complete failure. What steps will His Majesty’s Government take to ensure that public bodies, not just the CQC, have adequate and effective rollouts of digital systems, so that they can deliver on their performance targets? On 6 January, the Secretary of State announced that the Government were launching an independent commission on social care reform, with the intention of forming a national care service. Can the Minister please update the House on the progress made towards this commission?

[Baroness Merron (Lab)]

To take the second question first, the commission will start its work in April. The noble Baroness, Lady Casey, has agreed to lead that review. The terms of reference will be published, and the first report will be with us next year. On the important point about IT, as I mentioned in response to the noble Lord, Lord Patel, that problem arose in 2023. The CQC has acknowledged, as we have, that there have been huge challenges with the provider portal and the regulatory platform. The Dash review talked about poorly performing systems hampering ability. This is not how the system should work. As we move towards the 10-year plan, and from analogue to digital, we will have that front and centre in how we work.

[Lord Scriven (LD)]

My Lords, the Secretary of State in July said that

“the CQC is not fit for purpose”.

Given the systematic failings still within that organisation, what timescale have the Government given the CQC to become fit for purpose?

[Baroness Merron (Lab)]

The Secretary of State did indeed say that, and he was right to do so, in the spirit of transparency. The fortnightly meetings which I mentioned will be a constant assessment until we have met the necessary timeframes that are only reasonable to assist people in making decisions. All of that—how might I put it?—deep focus on the CQC will continue. I do not think this will be quick, but it will be thorough.

[Lord Sikka (Lab)]

My Lords, 30% to 40% of public money given to corporate-owned care homes vanishes in profits, leaving little for front-line services. Almost all care homes forcibly closed between 2011 and 2023 were operated by for-profit companies. The Government’s promised crackdown on care home profiteering probably will not even be as effective as that on water companies. What will it take for the Government to recognise that profit and care cannot easily be combined?

[Baroness Merron (Lab)]

The independent sector, which is not just the private sector but the charitable sector, is an important part of the provider framework. We will continue to work with it to provide the right quality of services for those who need them.

Women’s Health Strategy

Baroness Merron Excerpts

Tuesday 4th February 2025 Lords Chamber

[Baroness Stedman-Scott (Con)]

My Lords, nearly 600,000 women are waiting for treatment on a gynaecological waiting list in England. Labour’s 2024 general election manifesto made a commitment that:

“Never again will women’s health be neglected. Labour will prioritise women’s health as we reform the NHS”.


Why, then, are the Government removing the requirement on integrated care boards to implement women’s health hubs? The Answer given to this Urgent Question by the Minister in the other place stated that at least 90% of ICBs already have women’s health hubs, which is terrific. If they have been rolled out so effectively, why not complete the job and follow through to reach 100%? Perhaps the Minister could tell us what exciting plans she has to do this.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

I would be glad to give information to the noble Baroness, whom I thank for reminding your Lordships’ House of the situation that we inherited—600,000 women on gynaecological waiting lists—and the challenge before us. My honourable friend in the other place was quite right about the planning guidance, but I commend the effort of the noble Baroness’s Government for pump-priming the introduction of women’s health hubs to the point where there are some 80 across the country—in nine out of 10 areas, there is at least one. It was never a long-term planning situation. The noble Baroness will also be aware of the informed observation from the noble Lord, Lord Darzi, that planning guidance has too many specifics. We therefore needed a new approach, which is what we have done. The planning guidance is not the catalogue of all the levers, nor of all that happens, in the NHS.

[Baroness Barker (LD)]

My Lords, women’s health hubs have proved enormously popular with practitioners, who are able to give multiple treatments in one session, and with women, who no longer have to take time off on different days to go to different clinics for different procedures. Given this, why are the Government not backing this cost-effective strategy, not least because it prevents women showing up at A&E, which is far more expensive?

[Baroness Merron (Lab)]

We are not closing women’s health hubs—it is important to put that on record. I have already said how successful the pilot has been; it therefore does not require a further target. I hope that noble Lords have seen that the changes to the planning guidance move away from the old centralised operating model to give more control and direction locally. As I said, the decision not to mandate women’s health hubs reflects a new approach to the guidance: fewer national directives and more empowerment of local leaders. Women’s health hubs are also described in the elective reform plan, which is one example of another area where their importance is recognised and boosted.

[Baroness Sugg (Con)]

My Lords, the Minister will know that women’s health hubs are vital in reducing gynaecological waiting lists. We have seen that through their success in areas such as Birmingham, Tower Hamlets and Liverpool. I hear what the Minister has been saying, but there is strong concern from the sector that many of the existing hubs are in their infancy or are not yet operational. They will not progress unless there is operational guidance for the NHS or formal commitment to them from the Government. With their removal from the planning guidance, what actions is the Minister taking to ensure that every ICB has a women’s hub? Given what she said about local decision-making, what steps are being taken to make sure that we learn from the success of the highest-performing hubs and share it with others?

[Baroness Merron (Lab)]

We continue to learn from the best. I am committed to speaking with the leadership of ICBs about the importance of women’s health hubs, not least because it is about improving women’s healthcare. Having visited a women’s health hub myself, I can testify to the points that the noble Baronesses have made. However, I gently repeat that we need to look not just in the planning guidance but in the elective reform plan, which states about the NHS that:

“In gynaecology we will support … innovative models offering patients care closer to home”.


That is exemplified by the women’s health hub. The Neighbourhood Health Guidelines, published just last week, include women’s health hubs as an example of a neighbourhood health model.

[Baroness Blackwood of North Oxford (Con)]

My Lords, the history of health policy through successive Governments has been one of too many priorities and targets which are not delivered, so I support the Government in this analysis. It has also been one of poorer outcomes for women and minorities. Given the shift in leadership from the Department of Health and others, how will the Government ensure better outcomes for women and minorities? How will those be monitored? Will they intervene early if they do not see that direction of travel?

[Baroness Merron (Lab)]

I thank the noble Baroness for her welcome for the new approach in the planning guidance. As she commented, and as noble Lords opposite will know, just because something is in the guidance does not mean that it will happen. For example, despite targets for A&E performance or ambulance response times being written into planning, they were not delivered. This is not where we want to be. We will continue to work with NHS England; for example, to ensure that women’s health is key. I should also emphasise that, as we move towards the 10-year health plan, women’s health will feature not as an adjunct but run throughout.

[Baroness Hussein-Ece (LD)]

My Lords, I welcome the Minister’s comments. We know that black women are three to four times more likely to die during childbirth and that the rate of maternal deaths in the UK has risen during the past 10 years, which I am sure she will agree is a national disgrace. Does she therefore accept that women—and especially women of colour—have been ill served for many years? How will the Government reverse this trend?

[Baroness Merron (Lab)]

I agree with the noble Baroness. It is a disgrace that there is such a huge inequality in maternity care. Maternal mortality rates are some 2.3 times higher for black women and 1.4 times higher for Asian women, while those living in the most deprived areas have a maternal mortality rate nearly twice as high as that for those who live in the least deprived areas. That cannot be acceptable in 2025. I am glad that we have taken a number of actions to ensure that trusts who fail on maternity care are robustly supported. We will set an explicit target to close black and Asian maternal mortality gaps. Trusts are also required to publish a suitable plan to tackle this and to put it into action. It is a challenge, but not one that we shy away from.

[Baroness Blackstone (Lab)]

My Lords, I declare my interest as set out in the register. What is the Government’s timetable for a revised or updated version of the women’s health strategy? Can the Minister also assure the House that there will be adequate funding for its implementation when it is brought in?

[Baroness Merron (Lab)]

Let me assure my noble friend and other noble Lords that there are no plans to cancel the women’s health strategy. I know my noble friend did not say that, but it is very important to put that on record. We continue to implement it; for example, since I have been in post, through measures such as supporting pregnancy loss through a full rollout of baby loss certificates, introducing menopause support in the workplace, and boosting women’s participation in research and clinical trials. As I said, our priorities for delivering the strategy will be through the 10-year plan. Funding decisions will be announced in due course.

[Baroness Hodgson of Abinger (Con)]

My Lords, given that one-third of all new breast cancer cases occur in women over the age of 70, will the Minister consider extending automatic screening for those women? At the moment, it stops at that age.

[Baroness Merron (Lab)]

Women over 70 can request an assessment if they feel it is appropriate for them. We act on and apply the scientific advice and evidence that we are given. On World Cancer Day, perhaps it would be appropriate to say to the noble Baroness that some 700,000 women across the country will take part in a world-leading trial to test our cutting-edge AI tools, which will be used to catch breast cancer cases earlier. This morning, I was at the Royal Marsden Hospital in Sutton with Minister Vallance to see the incredible contribution that AI is making to improved cancer services, including for women.

Mental Health Treatment: Waiting Times

Baroness Merron Excerpts

Monday 3rd February 2025 Lords Chamber

[Baroness Warwick of Undercliffe]

To ask His Majesty’s Government what plans they have to reduce the waiting time for access to mental health treatment.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, I am pleased to be answering this Question during Children’s Mental Health Week. To ensure that high-quality support can be accessed in a timely manner, among other actions we are committed to recruiting 8,500 more mental health workers to cut waiting times, introducing access to specialist mental health professionals in every school and rolling out young futures hubs in every community.

[Baroness Warwick of Undercliffe (Lab)]

My Lords, I thank the Minister for that helpful reply. There has been a 33% rise in mental health referrals since 2019 and it is particularly severe for children and young people, with an increase from 12% to 20% for those experiencing mental health conditions. This has not been matched by an increase in investment in services or additional staff to enable early intervention and speedy help. Many children have been forced to wait till their conditions escalate, putting a lot more pressure and exceptional demand on school counsellors and on community care. Can the Minister say exactly what the Government are doing to address these pressures, particularly on young people? How will she ensure that funding at local level will focus on their needs?

[Baroness Merron (Lab)]

I agree with my noble friend’s assessment of the impact of what is a totally unacceptable situation, particularly for children and young people. On the point about ensuring delivery locally, I refer your Lordships’ House to the NHS planning guidance, published last week, which not only confirms our commitment to the mental health investment standard but sets out an objective to increase the numbers of children and young people under 25 accessing services in the forthcoming year compared to 2019.

[Lord Carlile of Berriew (CB)]

Does the Minister agree that the long delays experienced by released prisoners in accessing necessary mental health care simply oil the revolving door of their return to prison? Will the Government give high priority to dealing with that problem?

[Baroness Merron (Lab)]

We are extremely aware of the point the noble Lord helpfully makes. The matter of severe mental illness in prisoners has come up repeatedly in Committee on the Mental Health Bill, and we will continue to work to address the points he raised.

[Baroness Tyler of Enfield (LD)]

My Lords, I welcome the fact that the new NHS operational planning guidance, which the Minister just referred to, includes targets for improving mental health care, learning disabilities and autism. What assurances can the Minister give that these targets will be properly reflected in the forthcoming spending review, the NHS 10-year plan and the updated NHS workforce plan to ensure we really do see parity of esteem between physical and mental health?

[Baroness Merron (Lab)]

I can confirm the commitment of the Government to parity of esteem between mental and physical health services, as was outlined in our first programme of legislation confirmed in the King’s Speech. It will have absolute regard in all the areas the noble Baroness refers to. I know she is aware that I cannot comment specifically on spending reviews, but all that will be announced publicly in due course.

[Baroness Meacher (CB)]

My Lords, ADHD affects lots of children and, though treatable, it is often not treated. Can the Minister assure the House that treatment for ADHD will increase substantially to ensure children can get back to school and get on with their studies?

[Baroness Merron (Lab)]

It is important that children with ADHD receive the right education and the right support. We are working with the Department for Education to make sure that happens.

[Lord Davies of Brixton (Lab)]

I welcome my noble friend the Minister’s replies to the questions asked. I know she is personally committed to improving the services provided to people suffering from problems with their mental health. However, is she aware of the concern that has been expressed by the Royal College of Psychiatrists that the increased autonomy allowed to local health authorities will, without clear guidance, lead to inadequate investment in mental health services? Can she provide some reassurance for the royal college?

[Baroness Merron (Lab)]

I am grateful to my noble friend for raising this. There are whole areas in which we are seeking to turn this round, and I know my noble friend is aware of the challenges we face. To highlight just one, I refer him to the fact that the Government have chosen to prioritise funding for talking therapies and to deliver that expansion. That is really important because, in all of this, we have to make the move from dealing with sickness to prevention, and I believe this is a very strong example of how we can do that.

[Lord Laming (CB)]

My Lords, does the Minister agree that, in mental health services, the gap between referral and treatment is getting longer and longer, and that delay is leading to a marked deterioration in the patient’s experience? So far as young people are concerned, the delay has become incredibly long. Can the Minister assure the House that thought is being given to reducing the gap between referral and treatment?

[Baroness Merron (Lab)]

The noble Lord makes a very important point. This is one of the many areas where long waiting lists and delays in people receiving the necessary service are creating additional pressures on the individual, communities and the NHS. We are doing work in a number of areas, such as ensuring that NHS 111 can provide for those in crisis, or those concerned about a family member or loved one, so they can speak to a trained mental health professional. We are constantly looking at and providing new ways for people to get more instant access.

[Earl Howe (Con)]

My Lords, do the Government see a role for employers in promoting the mental health of their respective workforces?

[Baroness Merron (Lab)]

I certainly do, and with the NHS being such a large employer, that is one of the areas that we will be attending to. The long-term workforce plan will provide its report around the summer of this year and there will be much detail on how the workforce will be but also on the ways that we can improve its health and retention as well as recruitment.

[Baroness Winterton of Doncaster (Lab)]

My Lords, my noble friend Lady Warwick spoke particularly about young people and provision in schools. Does my noble friend the Minister agree that there is a key role for educational psychologists and school nurses in ensuring that diagnosis can take place early? Does she believe there could be a greater role for academies and schools working together at local level to provide that type of provision?

[Baroness Merron (Lab)]

I agree with my noble friend’s suggestions. Of course it is a team that provides the mental health support that is necessary, but I am particularly pleased that we are working to deliver a mental health professional in every school. That is a starting point, not necessarily the end point, so my noble friend makes some very helpful suggestions.

[Lord Markham (Con)]

I appreciate from my own time as Health Minister how difficult it is to meet the expanding demand, so I wonder if we are still looking at other methods to expand capacity, particularly digitally, both in terms of early diagnosis but also some of the digital mental health treatments which are quite impressive?

[Baroness Merron (Lab)]

I am glad for the understanding of the noble Lord. NHS England is encouraging the local use of digital tools, for example digitally enabled therapies, and it is an extremely helpful way also of managing waiting lists so people are not just left waiting but they are held and supported, often through digital means.

[Lord Paddick (Non-Afl)]

My Lords, I declare my interest as set out in the register. A policy of the police not attending mental health incidents, called “right care, right person”, was developed by Humberside Police and adopted by the Metropolitan Police. What assessment has been made of the impact of this policy on those suffering from mental health issues?

--- Later in debate ---

[Baroness Merron (Lab)]

I thank the noble Lord. Again, this is an area which has been explored in Committee on the Mental Health Bill and we are looking at the results of how that is working out, because we have to get the balance right between supporting people in crisis and also ensuring that the right professionals are in place.

Musculoskeletal Health

Baroness Merron Excerpts

Thursday 30th January 2025 Lords Chamber

[Lord Black of Brentwood (Con)]

My Lords, in begging leave to ask the Question standing in my name on the Order Paper, I note my interest as co-chairman of the APPG on osteoporosis.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, improving health outcomes for the more than 17 million people in England with musculoskeletal conditions forms a key part of this Government’s missions to build an NHS fit for the future and kick-start economic growth. We are making a start by delivering a joint programme with the DWP—entitled Getting It Right First Time, the MSK community delivery programme—and working with integrated care board leaders to reduce NHS community waiting times and to improve data metrics and referral pathways.

[Lord Black of Brentwood (Con)]

My Lords, osteoporosis is one of the gravest musculoskeletal conditions, because fractures ruin lives and kill people. Can the Minister understand the frustration so many feel that, after years of promises, there is still no prospect of universal access to life-saving fracture liaison services in England? Each time this House debates osteoporosis, there is unanimous support and Ministers of both parties stand here and promise action. Each time there is an election, commitments are made, including one by the Secretary of State that rollout would be one of his first acts in post. Well, it was not, and 1,100 people have died since then. Will the Minister, without prevarication or diversion about widening access, specifically restate the Government’s commitment to universal rollout of FLS in England by 2030? If not, could she explain to thousands suffering often intolerable pain or grieving loved ones why they have reneged on it?

[Baroness Merron (Lab)]

I pay tribute to the noble Lord’s campaigning, which is impressive in maintaining focus on what I regard as a very important area. He may be aware, but I draw it to his and your Lordships’ House’s attention, that a Written Ministerial Statement about addressing urgent challenges was laid today. It outlines the fact that planning guidance is soon to be published—it was not published as I entered the Chamber—and will reflect patient priorities that are important to those who have to contend with osteoporosis. These include cutting waiting times, improving access to primary care—bearing in mind that 30% of GP appointments are related to MSK—and improving urgent and emergency care. On the point the noble Lord asks about, as I have said before, we are working closely to consider a whole range of options to provide better quality and access to important preventive services as part of ending the postcode lottery. I will be pleased to keep him informed.

[Baroness Donaghy (Lab)]

My Lords—

--- Later in debate ---

[Baroness Donaghy (Lab)]

I am a member of the APPG on osteoporosis, and we are very worried that fracture liaison services have been deprioritised in the recent NHS planning guidance. We know that the pump-priming transformation fund works because we have seen it working in Wales. It saves lives, as the noble Lord, Lord Black, said, releases people into the labour market, releases beds in hospitals and improves quality of life for thousands of people. Can the Minister give us an assurance? If this milestone has been missed in the planning guidance, we need urgent clarity on how the 2030 target will be reached.

[Baroness Merron (Lab)]

My noble friend raises a number of important points. In reference to the planning guidance, I hope she will understand that at this stage that is leaked information and I am therefore not in a position to comment. The Secretary of State has confirmed that planning guidance will be published in due course. I agree that patients around the country are waiting too long for care and treatment. I draw my noble friend’s attention to the plan for change, which will get the health service back on its feet. Part of the elective recovery plan, published just a few weeks ago, sets out funding to boost DEXA, which is bone density scanning capacity to support improvements in bone health and early diagnosis, including for osteoporosis. That will provide an estimated 29,000 extra scans per year, so I hope my noble friend will take heart from that node of direction.

[Lord Pannick (CB)]

My Lords, I declare a family interest in this condition. Will the Minister recognise that the failure to roll out the much-needed early diagnostic service, which, as the noble Lord, Lord Black, said, was promised during the general election campaign, will inevitably result in greater cost to the NHS in the years to come?

[Baroness Merron (Lab)]

I certainly agree with the noble Lord that without the right services in place at the right time and in the right location, there is additional cost—not just to the NHS but to the economy and to individuals. We have found that musculoskeletal community services have the largest waiting lists in England, and I refer the noble Lord to our forthcoming 10-year plan on the move from hospital to community. That will be a key part of cutting waiting lists, and the measures I have already announced will also assist.

[Lord Lexden (Con)]

My Lords, did not the Health Secretary give an unequivocal commitment at last year’s general election that there would be universal fracture liaison services by 2030, with implementation starting immediately? Does that commitment still stand?

[Baroness Merron (Lab)]

I thank the noble Lord for allowing me to reiterate that the department is working closely with NHS England to look at a whole range of options to provide better-quality care and access to those important preventive services. I emphasise that this is part of ending the postcode lottery. I remind your Lordships’ House that integrated care boards are responsible for the delivery of these services. We will continue with the further actions that we are taking, some of which I have already referred to, which will ensure that patients are getting the service they need.

[Baroness Burt of Solihull (LD)]

Integrated Care Journal has indicated the potential to improve access pathways, giving an example of an AI physiotherapist service at home and covered by CQC. Will the Government develop and adapt something like this?

[Baroness Merron (Lab)]

The noble Baroness raises an interesting point and I will be happy to look into what she suggests. I know she is aware that one of the main pillars of change will be about analogue to digital, and in that I put the contribution of AI. Just this afternoon I will speak to a conference about the role of AI in respect of women’s health, and osteoporosis will be very much part of that.

[The Senior Deputy Speaker (Lord Gardiner of Kimble)]

My Lords, I invite the noble Lord, Lord Campbell-Savours, to speak remotely.

--- Later in debate ---

[Lord Campbell-Savours (Lab) [V]]

As a sufferer of ankylosing spondylitis, a painful spinal musculoskeletal condition aggravated by a lack of physical movement, I can report that inactivity in underemployment can severely aggravate the condition. Would the state benefits system not be far better served if multi-patient group physio services and collective patient gyms—even open-air ones, as in the Far East—were available on a wider scale? Greater collective patient activity for this and other similar groups in large public venues would save money in the benefits system.

[Baroness Merron (Lab)]

My noble friend raises a very important point from a position of a lot of experience. I can confirm that we recognise the importance of regular physical activity for those with MSK conditions. It helps to reduce pain and disability as well as improving well-being and helping with other conditions. The existence of MSK hubs with a non-healthcare workforce delivering physical activity-based interventions has been extremely helpful, and we will continue to encourage that and explore the role that hubs can play.

[Lord Kamall (Con)]

My Lords, we should pay tribute to my noble friend Lord Black for all his hard work in this area. I do not think the Minister answered his Question. On Tuesday evening she told the House she wanted to be honest, so in that spirit can she tell your Lordships whether the Government have agreed new dates, first, to begin the rollout and, secondly, to achieve universal fracture liaison services? If so, what are those dates? If not, can she tell us when we will have those dates, so that all the people waiting for these services are clearer about what they can look forward to?

[Baroness Merron (Lab)]

I am afraid I cannot give the noble Lord the dates that he seeks, but I will be pleased to keep him updated on the development of services.

New Hospital Programme Review

Baroness Merron Excerpts

Tuesday 28th January 2025 Lords Chamber

[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.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, I am grateful for the reflections and questions from the Opposition Front Benches, although I noticed a difference in the level of understanding of where we are between the noble Lord, Lord Scriven, and the noble Lord, Lord Kamall—I note his disappointment with what he refers to delay and reassessment, and I will return to that.

Perhaps I might make a few points that might be helpful to frame some of the responses, and then go on to some of the specific questions that were asked. I note the disappointment of the noble Lord, Lord Kamall. I cannot, however, accept his assessment, because of where we started. It is impossible to ignore that. As we know, the independent investigation by the noble Lord, Lord Darzi, found the NHS to be starved of capital—indeed, the noble Lord, Lord Scriven, spoke to that. There was some £37 billion of underinvestment in the 2010s, and the fact is—this is borne out by the National Audit Office, which confirmed it—that we were not going to be seeing 40 new hospitals by the date set, so, in my view, it has been independently verified. The new hospital programme was announced by the last Government in October 2020 to deliver 40 new hospitals by 2030. The fact is the schedule for delivery was repeatedly delayed and, on top of that, unfunded beyond March 2025.

That is why, when we came into government, the Secretary of State within weeks commissioned an urgent review into the new hospitals programme. That, I am glad to say, was carried out at pace over the summer of 2024. What was that all about? It aimed to put the programme on a firm footing with sustainable funding. I do not accept that that was simply a delay. I can understand disappointment—I would like it to be different—but we have been dealt the hand we have. The outcome of the review, which was announced on 20 January in the Statement that we are discussing tonight, provided a credible plan and timeline to deliver schemes, and that is set out in the published New Hospital Programme: Plan for Implementation. It is backed with investment, which is expected to increase to £15 billion over each consecutive five-year wave. That is averaging around £3 billion a year from 2030. Funding will, of course, as with all government funding, be confirmed at future spending reviews.

The current wave of new building is under way, and there are a further three waves. The first wave consists of 16 schemes beginning construction between 2025 and 2030; wave 2 has nine schemes beginning construction between 2030 and 2035; and wave 3 has nine schemes beginning construction between 2035 and 2039. That is like chalk and cheese compared with where we were before. We had a promise of new hospitals when, in fact, many of them were not new hospitals, whereas this sets out quite clearly what will be built, when it will be built and the funding. To me, this is actually honesty; it may not be where we want to be, but it is saying that this is the honest situation, and this is what we will do.

The new hospital programme provides a mix of new builds and/or refurbishments, new-build extensions and refurbs. That is under that programme, and I can also confirm to the noble Lords that we will be appointing a programme delivery partner in the coming weeks to support this delivery.

I was asked about other capital projects, and I shall just mention a few. Capital spending is increasing this year, rising to £13.6 billion next year. That includes £1.5 billion for new surgical hubs, diagnostic scanners, beds across the estate and new radiotherapy machines to improve cancer treatment. That will also help greatly towards tackling waiting lists.

Reinforced autoclaved aerated concrete, or RAAC, is an area of great concern. Over £1 billion has been allocated to tackle that and address the backlog of critical maintenance, repairs and upgrades across the NHS estate, to which the noble Lord, Lord Scriven, referred. Importantly—because we often discuss this—over £2 billion will be invested in NHS technology and digital infrastructure, because it is not just physical build but about making sure that we are building for the future.

In general terms, I believe that the new hospital programme is finally, as it was not before, on a sustainable footing. The plan is realistic, credible and transparent, so we will be held to account. It is part of our determination to rebuild the NHS and rebuild trust—because I feel, sadly, that trust went.

The noble Lord, Lord Kamall, rightly raised the point that it is not all about large-scale hospitals, and I certainly agree with that—not least because it is one of our pillars, as the noble Lord said, to shift the focus of the NHS out of hospitals and into the communities. We understand that, if patients cannot get a GP appointment, for example, they are going to end up in A&E, which is worse for them and expensive for the taxpayer. At the Autumn Budget, we established a dedicated—and I stress “dedicated” in answer to the question about funding from the noble Lord, Lord Scriven—capital fund of £102 million for 2025-26 to deliver around 200 upgrades to GP surgeries across England that will support the improved use of existing buildings and space, boost productivity and enable the delivery of more appointments. I would absolutely agree that that is very important.

I was asked about other funding, and I have mentioned the health capital spending that is needed. I say to the noble Lord, Lord Scriven—and I know he is aware of this—that we inherited a monumental backlog of maintenance. I refer also to a couple of other points that the noble Lord raised. I do not want to put words into his mouth, but one of them was about whether we can review. I know that this is an issue, and there are certain schemes that people wish to advocate for and are particularly concerned about. The fact is that the decisions have been made, and they were made while taking into account all the necessary criteria in a fair and open way. The Statement outlines the lists, and they will not be changing. For those who are not on the waves, we are working with them to look at what is needed, so people are not being ignored. I also emphasise that my colleagues in the House of Commons, the Secretary of State and, particularly, the Minister, Karin Smyth, have engaged widely and very quickly with every constituency MP, in the waves that are outlined in the Statement and those that are not mentioned, because we understand people’s concern.

The noble Lord, Lord Scriven, also asked about an assessment of the impact of the new delivery schedule. It is now available on GOV.UK with the plan for implementation— and I hope that is helpful. I definitely echo the noble Lord’s concerns about continuous switches between capital and revenue, and I can assure him and your Lordships’ House that the Government’s now updated fiscal rules will stop future switches from capital to revenue. I also reassure both noble Lords that the Government are committed to all hospitals in the new hospital programme. No scheme has been added or removed, and we are working with each trust in the programme to determine the most appropriate site in line with local needs and the needs of the individual scheme.

If I may make just one last point, the noble Lord, Lord Scriven, asked about consideration of invest to save, and I have to say that the Statement outlines exactly how we will proceed in this regard.

We know that we have to underline the under- capitalisation of the past; that is essential if we are going to fix the foundations of the NHS and if we are going to make it fit for the future. I hope that noble Lords will accept that this Statement represents a change. It is deliverable, manageable, transparent and will provide what it says it will do on the tin.

[Lord Mott (Con)]

My Lords, I welcome the £102 million that the Minister referred to for the upgrade to GP estates. May I ask how many of those will be in Cambridgeshire? Has any assessment been made of the pressure that the upgrade of those GP estates will take off the NHS? The Minister said that often people cannot get a GP appointment and therefore tend to go to A&E. Has any assessment been made of how much pressure will be taken off and, more importantly, the quality of care given to people who are able to go to their local GP instead of having often to go to A&E?

[Baroness Merron (Lab)]

While I cannot answer exactly on Cambridgeshire, which the noble Lord raises, I can say that the department and NHS England are working with integrated care boards to ensure that there is a priority on high-impact projects where investment will unlock all the things we are all looking for, which are significant productivity gains and additional usable space from existing buildings. Of course, ICBs are responsible for that. I perhaps should also make the point that this is the first dedicated national capital fund for primary care since 2020. The noble Lord rightly quoted me back about the benefits of investing in GP practice. We are probably all familiar with that. There have been a number of reviews, including, of course, the independent review of the noble Lord, Lord Darzi, which spoke to the point about the need for capital investment in primary care.

[Lord Liddle (Lab)]

My Lords, will my noble friend the Minister and the ministerial team at health accept my congratulations that they have had the courage to come up with a realistic programme, whereas what we had before was fantasy? This is very important. I read the Darzi report, and it has been clear that for years capital money has been used in order to fill revenue gaps at the end of the year because, basically, the whole system was underfunded. It is also clear that, as well as wanting to put the estate and buildings right, there is a tremendous need for investment in hospital equipment, scanners and all the rest in order to improve quickly the effectiveness of delivering good services to patients, and that the Government have to balance these pressures. It looks to me as though they are doing it right.

[Baroness Merron (Lab)]

I am, of course, delighted to accept the thanks from my noble friend, and I will indeed share it with the ministerial team. As has already been raised by the noble Lord, Lord Scriven, and as my noble friend has pointed out, robbing Peter to pay Paul does nothing; productivity, safety, quality of care and providing services, including tackling waiting lists, requires investment in capital and dealing with the state of buildings and the estate. I am sure that we have all seen many examples of where failure to invest has not helped at all. I am glad that my noble friend welcomes the investment that we are making, not just in new surgical hubs but scanners, beds and new radiotherapy machines to improve cancer treatment. All these are about tackling the waiting lists because we inherited the highest ever waiting lists and the lowest-ever patient satisfaction, and we are determined to turn that around.

[Lord in Waiting/Government Whip (Lord Cryer)]

My Lords, the annunciator tells me that Report is not due to begin again until 8.07 pm. Since the Statement fell short of the anticipated 40 minutes, I beg to move, from a packed House of Lords, that we adjourn during pleasure until 8.07 pm.

Young Disabled People: Social Care Services

Baroness Merron Excerpts

Tuesday 28th January 2025 Lords Chamber

[Baroness Monckton of Dallington Forest]

To ask His Majesty’s Government what plans they have to address demand for support from young, disabled people and their families, particularly in relation to provision of social care services, as they transition to adulthood.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, the Government recognise the difficulties that young disabled people and their families can face when they transition into adult social care. This has been a neglected area, which is why the Department of Health and Social Care is now working across government to identify opportunities to better support young people and their families at this crucial stage in their lives. My ministerial colleague, the Minister for Care, Stephen Kinnock, has recently met his counterpart at the Department for Education to discuss how the two departments can make progress on this issue.

[Baroness Monckton of Dallington Forest (Con)]

My Lords, for many people with learning disabilities, transition into adulthood is purely chronological. Their needs and care requirements remain exactly the same. Parents have described this transition into post-18 services as like jumping off a cliff.

I was approached by the parents of Cameron, a young man with severe learning disabilities. Melanie, his mother, was a nurse for 30 years, and his father, David, was a Royal Marine commando who fought in three wars. Their professional life serving the community and their country has not prepared them for the battle they are facing with Somerset Council to get the right accommodation for their son. Melanie told me that the day he turned 18, all support fell away. Will the Minister accept that these are the same people, with the same condition and the same continuing needs, and that, as part of adult social care reform, there needs to be a separate category for people with learning disabilities, who are so neglected? In this spirit, would His Majesty’s Government consider a Minister for learning disabilities?

[Baroness Merron (Lab)]

I understand and am sympathetic to the points that the noble Baroness makes about Cameron and his family. I listened very closely to the concerns that she raised. As I mentioned in my Answer, we are very aware and absolutely accept that the services are not in the places they need to be. That is why I made the commitment to work closely with the relevant department.

Looking to the future, as recently as November we published what I regard as a very ambitious and wide-ranging whole-system plan, called Keeping Children Safe, Helping Families Thrive. It seeks to break the cycle of crisis intervention and to rebalance the system back towards earlier help for families, which I hope would have been helpful in the situation the noble Baroness describes. All local authorities, including Somerset, have to set out the support available for those with special educational needs and disabilities as they move into adulthood.

[Baroness Walmsley (LD)]

My Lords, the duty of local authorities to carry out a transition assessment includes whether the child, or their carer, is likely to have needs for care and support after the child in question becomes 18. In the light of that, what resources and guidance are the Government giving to local authorities about the needs of the carers of those transitioning to adulthood? Does the complexity of this whole issue not indicate the need for care co-ordination?

[Baroness Merron (Lab)]

It certainly does. The noble Baroness has been positive about the plans that we have for the independent commission, led by the noble Baroness, Lady Casey, to resolve once and for all, on a cross-party basis, adult social care. The noble Baroness makes a very good point about the role of carers. Indeed, when we think of a young carer particularly, it is crucial that their needs are considered and that support is given. It is part of the whole way in which we support someone who needs social care, no matter what their age.

[Lord Laming (CB)]

My Lords, when the Public Services Committee took evidence on the transitional arrangements for young people with disabilities, we experienced two extremes in that evidence. One was that the transfer from education services to social care services was badly handled in a lot of authorities. As the noble Baroness, Lady Monckton, said, it felt like falling off a cliff, with young people then described as unemployable. The second, which was quite inspiring, was where local authorities had established a local hub where employers could meet these young people. They discovered there things that could benefit both sides, and that the young people blossomed in work. Will the Minister do everything possible to encourage the second?

[Baroness Merron (Lab)]

The noble Lord is correct to reference the committee’s findings. People should not be written off as unable to work. It is about getting the right support in place, with the right provisions and at the right time. I certainly share his view. That is why we are working across government to achieve the very thing that he talks about.

[Baroness Pitkeathley (Lab)]

My Lords, I was with someone this morning who has a son at this stage and was told that the earliest time when they could have a transition interview would be December 2026. In the meantime, the only support they are getting is from the local branch of Mencap. As well as co-operation between health and social care, will the Government commit to supporting the voluntary sector, which provides such important services in this regard?

[Baroness Merron (Lab)]

I have direct experience of the value of charities such as Mencap, and I thank it and all the other third sector organisations involved. I agree with my noble friend about the need to incorporate all sectors. That is the only way that we will provide the right provision in a timely fashion.

[Lord Kamall (Con)]

My Lords, we know it is true not only for this care service but for many health and care services that there is often concern when, upon reaching adulthood, the patient has to move from paediatric care to adult services—we have had a number of debates on that in this House. Often, that can involve a change of medical staff, from a clinician or caseworker who knows the patient to someone who is a stranger, as it were. Can the Minister tell noble Lords what guidance there is for the clinician or the health worker looking after the child, as well as for the clinician who will be looking after the child when they are an adult, whereby they talk to each other to ensure as smooth a transition as possible?

[Baroness Merron (Lab)]

The transition assessment has to cover the whole range of provision, including healthcare, as the noble Lord rightly says. That is already embedded. I refer back to the point of my noble friend: it is indeed true that there are long waiting lists for transition assessments, which is far from ideal. This means that people are suffering from late planning and insufficient support, which we want to put right, no matter where the requirement comes from, whether it is in health, education or employment.

[Lord Alton of Liverpool (CB)]

The Minister may recall that, in 2022, the Down Syndrome Act was passed by your Lordships’ House, having been introduced in another place by Sir Liam Fox MP and in this House by my noble friend Lady Hollins. Can the Minister tell us how far we have got in implementing the terms of that Act, especially in helping those with Down syndrome to find employment in the workplace?

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[Baroness Merron (Lab)]

It is a good point. I will be pleased to look into it in greater detail and write to the noble Lord.

[Baroness Uddin (Non-Afl)]

My Lords, I had not intended to speak but I want to reach out to the noble Baroness, Lady Monckton, as I understand her frustration and why she is upset. I declare an interest as a mother of a child in this situation—he is now an adult, at 46 years old. That is precisely what happened to my family and my son; the service was no longer fit for purpose. There are hundreds and thousands of parents feeling exactly the same angst. Will the Minister’s review therefore build in space for advocacy on behalf of parents in any forward-looking strategy that the Government are considering?

[Baroness Merron (Lab)]

The role of advocacy is extremely important. I take on board what the noble Baroness is saying.

[Baroness Bull (CB)]

My Lords, can the Minister say what the Government are doing to persuade employers of the value of employing a diverse workforce, including those with learning disabilities?

[Baroness Merron (Lab)]

I would be pleased to get some specific detail, but I agree with the noble Baroness—there are huge benefits both ways, as was said earlier. We are keen to promote and support this, to get as many people into employment as possible, and to let employers benefit. I will gladly write to the noble Baroness.

Community Pharmacy Closures

Baroness Merron Excerpts

Tuesday 28th January 2025 Lords Chamber

[Baroness Bakewell of Hardington Mandeville]

To ask His Majesty’s Government what plans they have to prevent community pharmacy closures.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, the Government recognise that pharmacies are integral to the fabric of our communities. They provide an easily accessible front door to the NHS and are staffed by highly trained and skilled healthcare professionals. We have now recommenced the consultation with Community Pharmacy England on funding arrangements, which was not able to be concluded before the general election.

[Baroness Bakewell of Hardington Mandeville (LD)]

I thank the Minister for her response. Since 2017, there has been a net loss of 1,200 pharmacies in England, with 35% of closures occurring in 20% of the most deprived areas. The annual funding shortfall in England stands in excess of £100,000 per pharmacy—a rise from £67,000 since 2023. Between September 2022 and June 2024, the annual loss of pharmacy access was 3.4 million hours. Given this, does the Minister believe that pharmacies are in a healthy state to support the Pharmacy First service?

[Baroness Merron (Lab)]

Some 98% of pharmacies are signed up to Pharmacy First and I am glad about how it is developing. On the noble Baroness’s very real points, the majority of recent closures were the result of large pharmacy chains optimising their portfolios. As she is aware, community pharmacies are private businesses, although they earn most their income from the NHS. Those business models vary significantly.

Local authorities are required to undertake a pharmaceutical needs assessment every three years to assess whether the population is being served. Integrated care boards have to give regard to those needs assessments when they review applications from new contractors and seek to fill any gaps. This continues to be work in progress to which we must be alert, but it is also important to look at some of the reasons for the closures.

[Lord Fowler (CB)]

My Lords, is it not true that we have not used community pharmacies in this country to their full potential? That impression was confirmed for me when I was chairman of such a group. Should our policy not be to develop community pharmacies so that they make an even bigger contribution to public health in this country? Would it not be better if pharmacists’ income came from that kind of effort, rather than from asking them to rely on the sale of cosmetics and other over the counter, commercial products?

[Baroness Merron (Lab)]

Commercial over the counter products will have a part to play. However, I take the point that the noble Lord makes. I am sure it is true that their vital role, and the opportunities that they offer, were not exploited as much as they could have been—when I say “exploited”, I mean that in a positive way. The Minister for Care, Stephen Kinnock, issued a press release today. In his last point he says:

“I am committed to working closely with Community Pharmacy England to agree a package of funding that is reflective of the important support that they provide to patients up and down the country. I am confident that together we can get the sector back on its feet and fit for pharmacies and patients long into the future”.

[Baroness Winterton of Doncaster (Lab)]

My Lords, the Government are on the right track in recognising the role that community pharmacists can play in public health by preventing illness and reducing the number of people turning up at A&E. However, is my noble friend the Minister aware of reports that some GPs have been unwilling to direct patients to community pharmacists, even under the Pharmacy First programme? Will she look at whether further action is needed to ensure that GPs work with community pharmacists to deliver services to patients?

[Baroness Merron (Lab)]

I am aware of the reports that my noble friend refers to. This is a new service; it needs to bed in. NHSE is working closely with ICBs, GPs and the community pharmacy sector to improve referrals. Funding has also been provided to ICBs for primary care network engagement leads, who should be well placed to support GP teams to refer into the service. We are aware of my noble friend’s point; we are acting on it and we will continue to keep it under review.

[Lord Lansley (Con)]

Further to that important point, will the Government guide ICBs to commission additional services from pharmacies? They have often not been commissioned with a sustainable funding model. Dispensing is not enough. They can provide important preventive services and minor illness services. However, they need the commissioning revenue to enable them to sustain their position.

[Baroness Merron (Lab)]

That point is understood, which is why I thought it important to bring to your Lordships’ House the announcement in the media release from my ministerial colleague Stephen Kinnock. As I mentioned in answer to an earlier question, integrated care boards have a role to play. They should—in fact, they are required to—have regard to the pharmaceutical needs assessment conducted every three years by local authorities. That ought to identify where there are gaps and allow consideration of how to fill any such gaps.

[Baroness Finlay of Llandaff (CB)]

My Lords, given the estimate that community pharmacies save some 38 million consultations that would otherwise have been in general practice each year, and the fact that 97% of pharmacy staff report shortages in accessing different medicines as prescribed, how are the Government planning to allow community pharmacies to adjust medicines—as has been recommended by Community Pharmacy England—so that they can modify prescriptions, rather than spend time recontacting the GP when they are themselves familiar with the items?

[Baroness Merron (Lab)]

The noble Baroness raises a good point and work is continuing to resolve that. It might also be helpful to say that NHS England has commissioned an economic analysis of the cost of providing pharmaceutical services and that will inform future funding arrangements. I say that in answer to the point the noble Baroness made about the potential savings that can accrue if we maximise the role of pharmacies.

[Lord Kamall (Con)]

My Lords, I understand the point that the Minister made about large chains rationalising their portfolios of premises. Have the Government and the NHS looked into whether the extra money made available to pharmacies from the Pharmacy First programme can make these pharmacies viable where they would not have been before? Secondly, what conversations are NHS England and the department having with retailers, community hubs or, where feasible, GP surgeries to provide local community pharmacy services in partnership with them?

[Baroness Merron (Lab)]

The economic analysis by NHS England that I just referred to will be helpful in informing where we go next. I confess that I did not get all the detail of the noble Lord’s second point, so I will look at it in Hansard and I will be pleased to write to him.

[Baroness Humphreys (LD)]

Community pharmacy owners rated medicine supply instability as the most severe pressure their businesses face. This instability puts operational pressures on pharmacies and financial pressures on businesses, and for patients it can mean alarming delays. What measures are the Government taking to address the problems of medicine supply and their impact on hard-pressed community pharmacies?

[Baroness Merron (Lab)]

I recognise that, as the noble Baroness says, there are some difficulties with the supplies of certain medicines. That has been going on for some time. We are therefore working to ensure that the supply chain is secure and robust and can meet the demands on it, which requires a detailed look. Work will continue, and I look forward to continuing to update your Lordships’ House about that.

[Lord Watts (Lab)]

My Lords, is it not the case that the present health structures are not suitable for purpose? Do we not need to look at providing health centres that include a pharmacy, dentists, doctors and all other services in one place to get the maximum resources to the public?

[Baroness Merron (Lab)]

My noble friend will be glad to know that bringing services together under one roof and designing them around the patient is exactly where this Government are going. I ask him to keep an eye out for the 10-year plan, which will address many of the points that he is making.

Mental Health Bill [HL]

Baroness Merron Excerpts

Committee stage
Monday 27th January 2025 Lords Chamber

I urge the Minister to see what can be done to ensure that the provisions of this Bill relating to the appointment and role of nominated persons can be made fully compatible with the provisions of the Children Act, and, most especially, the best interests test that that Act lays down as the iron principle governing this entire field of law.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, I thank noble Lords for an extremely helpful debate. I want to say how much I understand the concerns around the nominated person regarding children and parents, and the great need to get this right in the way that noble Lords have rightly unpicked today.

It is very important that parents are involved in a child or young person’s care. I say to noble Lords, as this has come up before, that we do not intend or wish to undermine the rights or responsibilities of parents. In the vast majority of cases, the nominated person for a child or young person will be their parent or whoever has parental responsibility, either because they have decided that themselves, with the relevant competence or capacity, or because they are appointed by the approved mental health professional.

For under-16s the Bill sets out that if they lack competence to make this decision, the approved mental health professional must appoint a parent, or a person or local authority with parental responsibility. The Bill aligns with the Mental Capacity Act on decision-making capability, with young people aged 16 and over considered to have the capacity to make relevant decisions. We think it is important, as I know noble Lords do, that children and young people have the right to choose a nominated person, and I understand the need to get the nominated person right. Some 67% of over 1,200 respondents to the White Paper consultation supported extending this right to under-16s.

We must have the right processes and safeguards for all patients, and additional protections for children and young people. These safeguards will cover the nomination process and the ability to overrule the nominated person or remove someone from the role if they are not acting in the patient’s best interests. The noble Baronesses, Lady Bennett and Lady Berridge, and the noble Lord, Lord Meston, have all put forward amendments to give responsibility to the tribunal or the Court of Protection in these matters. The county court already has a role in displacing the nearest relative. We believe that it has the expertise, procedural tools and legal framework to handle sensitive disputes involving external parties, such as conflicts of interest or allegations of abuse. I emphasise the word “sensitive”. I believe that the debate today has acknowledged that we are in very sensitive territory and that we need to get this right.

The noble Lord, Lord Meston, mentioned the training of judges. I can confirm that we will be working with the county court to ensure that it is aware of and can fulfil the requirements of the new provision.

The noble Baroness, Lady Berridge, asked for figures on county court applications, and I will be very glad to write to her and answer her fully. Similarly, I will be very pleased to write to her in detail on the matter of legal aid.

The Act and the Bill allow for someone who is not acting in the interests of the patient to be overruled or removed from this role. On Amendment 68 specifically, the Bill enables the responsible clinician to overrule the nominated person on the grounds included the amendment, so I am grateful for its being brought before us today. This will be quicker and will avoid burdens on the tribunal.

On Amendment 69, transferring the role of the nominated person to the Court of Protection would expand the court’s remit to under-16s. Currently, the court can deal only with the financial affairs of under-16s. The Court of Protection makes decisions for those lacking capacity, but patients need to have capacity to have appointed their own nominated person. Where they lack capacity or competence, the approved mental health professional will appoint, and the Bill sets out the grounds for them to terminate the appointment.

On Amendments 77 and 84, the noble Baroness, Lady Berridge, asked about the concept of a temporary nominated person. This is in recognition that such an appointment by an approved mental health professional is only until the person concerned has the relevant capacity or competence to choose their own—that is what is meant by the word “temporary” here.

The First-tier Tribunal (Mental Health) in England and the Mental Health Review Tribunal for Wales are focused on reviewing detention under the Mental Health Act. The provisions of the amendments would add additional burden on that tribunal. My concern is that it would risk undermining its core function and delay detention reviews, which I know is not something that noble Lords would wish.

Amendment 70, tabled by the noble and learned Baroness, Lady Butler-Sloss, would specify that parents, guardians and anyone with parental responsibility can apply to the court to displace a nominated person. The Bill already allows anyone involved in the patient’s care or welfare to apply to the county court to terminate the appointment of a nominated person. This includes parents, guardians and anyone with parental responsibility, as her amendment seeks.

On Amendments 72 and 73, in the names of the noble Earl, Lord Howe, and the noble Lord, Lord Kamall, I wholeheartedly agree that the law has to prevent exploitation and manipulation. The nomination process is indeed intended to ensure that the decision is the patient’s own. I recognise the circumstances that the noble Earl, Lord Howe, and other noble Lords described as possibilities. We have to consider all the potential scenarios, which are very real challenges to us. A health or social care professional, or an advocate, must witness the nomination and confirm in writing that the nominated person is suitable and that there has been no fraud or undue pressure. On the point the noble Earl raised, the code of practice will include guidance on how to determine this.

Amendment 76 was tabled by the noble and learned Baroness, Lady Butler-Sloss. We understand the desire to involve parents in the decision, and for the vast majority this will be appropriate. We are concerned that the amendment’s requirement to consult a parent, guardian or someone with parental responsibility could risk undermining the principle of giving children and young people a choice. It could also, in a different way, pressure the child into choosing the parent, in circumstances that might be far from desirable. Although we do not think that we should require consultation with the parents in all circumstances, we would expect the witness to discuss the nomination with parents and others with interest in the welfare of the child as part of the assessment of suitability. We will consult on guidance in the code on how practitioners should encourage the child or young person to involve their parents, even if they are not the nominated person, unless it is inappropriate.

On Amendment 82, tabled by the noble Baroness, Lady Berridge, I agree that parents and carers are to be given information about the care and treatment of their child. If a child nominates a person other than their parent as their nominated person, their parents retain legal rights under parental responsibility. These rights include the right to be consulted on certain decisions and to receive information about the child’s care. The Bill also introduces a duty on the responsible clinician to consult with people involved in the child’s welfare on care and treatment planning, which includes parents and carers.

With those comments in mind, I ask noble Lords not to press their amendments.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I thank the Minister for her careful and detailed response to an important group of amendments. It may affect only a small number of cases, but they are cases where we really need to get this right. Those two adjectives apply very well to this whole debate.

I will make a couple of comments in response. We have had three suggestions about where the applications to remove the nominated person should be. Personally, I do not have a strong view. I thought the point from the noble Baroness, Lady Berridge, about legal aid was important. Justice unfunded is justice denied, so it really is important that there is that full and necessary support, wherever they end up.

With that, I pick up the important point made by the noble Earl, Lord Howe, about the witness being such an important person to ensure that this process goes well. The noble Earl talked about making sure the guidance is right. I add that we have to make sure that the resources are there, thinking about our overstretched mental health services. We need to ensure that the person who will be the witness has the time to put in the resources to ensure that they can properly be a witness. It may not be a subject of law, but it certainly needs to be thought about.

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[Earl Howe (Con)]

My Lords, in this group of amendments my noble friend Lady Berridge has raised an armada of issues which I think it is clear to all of us cannot be ducked. These issues, as she said, were examined at length both during the independent review and by the Joint Committee, but it has to be said that in both instances it proved too much of a challenge to identify a satisfactory resolution to them. For that reason, as we observed in our debate on the previous group, the weight of these matters now rests on the shoulders of this Committee and of the Government.

In summary, we need arrangements that are robust enough to ensure that a nominated person’s appointment can be effectively challenged, and that, in certain circumstances, where necessary, the exercise of their powers can be legally contested and blocked. Without those measures, we shall leave an unacceptable lacuna in the law and, more pertinently, run a high risk of exposing children to personal danger.

My noble friend is to be thanked for assisting this Committee’s deliberations with the clear way in which she has set out the challenge, and I hope and trust that the Minister will wish to grip the challenge with her usual vigour.

[Baroness Merron (Lab)]

My Lords, like the noble Earl, Lord Howe, I am most grateful to the noble Baroness, Lady Berridge, for introducing an appropriately wide range of scenarios, questions and testing. That is important for the Committee but also for our ongoing work. As the noble Baroness, Lady Tyler, said, to describe this area as complex is to use too small a word, and I think we are all wrestling with that to get it in the right place. I know that noble Lords are aware that the work is ongoing, and I thank them for their engagement and interest in this issue. As I said previously, I very much understand the need for a robust process to keep children and young people safe and ensure that only appropriate individuals can take on the role of nominated person, while giving children and young people that right to choose.

I will respond collectively to the amendments put forward in this group. As I set out earlier, we agree that in the vast majority of cases there is an expectation that a parent or whoever has parental responsibility would take on this role, and that would include consideration of special guardians and child arrangement orders. We also agree that, where parental responsibility has been removed due to care proceedings, in the vast majority of cases it is unlikely to be appropriate for such a person to take up this role. My reference to this being a complicated area—

[Baroness Berridge (Con)]

My Lords—

[Baroness Merron (Lab)]

Perhaps the noble Baroness will let me make a bit of progress.

[Baroness Berridge (Con)]

I think I need to clarify a point of law—I am looking to the noble Lord, Lord Meston. In care proceedings, is parental responsibility removed? I do not believe it is; it remains with the parents. That is very important.

[Baroness Butler-Sloss (CB)]

It is shared.

[Baroness Merron (Lab)]

I thank noble Lords for that exchange, which brings me to my repeated point about the complicated area in which we are treading.

As was highlighted by the pre-legislative scrutiny committee, we will set out our expectations in the code of practice as to whom approved mental health professionals would appoint, or the witness would confirm suitability of, in a range of circumstances, including in the more and most complex cases. We will consult on this to ensure that we cover as many scenarios as we can.

I can confirm to the noble Baroness, Lady Berridge, that we are working with NHS England, the Department for Education, the Association of Directors of Children’s Services and others to ensure that our policy and guidance reflect what can be a very complex arrangement for some children under the Children Act.

The Bill is clear that where an approved mental health professional is appointing a nominated person for an under-16 they must appoint someone who has parental responsibility, and the amendments extend this approach to all under-18s. As I said previously, we are allowing more flexibility for 16 and 17 year-olds rather than prescribing in legislation who this must be.

While the amendments put forward a wide range of circumstances, we all know—and the noble Baroness, Lady Berridge, demonstrated this—that there will be nuanced and complex cases, especially for 16 and 17 year-olds. Someone outside the proposed list, such as a step-parent, may be the most appropriate person, or a kinship care arrangement may be in place. These amendments propose regulatory powers in recognition of this but we feel that updating statutory guidance will allow us to keep this up to date and in review as new policy is implemented.

The noble Baroness, Lady Berridge, asked about differences between special guardian orders and special care orders. The Bill says that the approved mental health professional must appoint the local authority or anyone else with parental responsibility as the nominated person. The special guardian, as someone with parental responsibility, would be appointed if a special guardianship order was in place. In relation to the proposal for two people to take on this role, as the nominated person exercises specific statutory functions under the Mental Health Act, we feel it is right that only one person has these limited powers, to avoid the potential for disagreement and confusion about who can exercise the relevant power.

We recognise that there will usually be more than one person with parental responsibility and that the approved mental health professional will need to determine who should be the nominated person. Under the current system, this would be the older parent, which we do not think is necessarily appropriate. We will provide guidance for approved mental health professionals in the code of practice. This may include which of the parents is recorded as the child’s next of kin, who the child lives with and who is accompanying the child.

The noble Baroness, Lady Tyler, helpfully inquired about the status of the nominated persons paper that was sent out in an attempt to be helpful. It was developed very much to support the debate, which it certainly has done, and we intend to develop it further. I very much welcome the further engagement from Peers and we will continue to formally consult as part of the code of practice so that it is an aid to the considerations of noble Lords. I hope it is doing that.

In the current nearest relative provision, only one parent will hold this role. As I mentioned in the previous debate, this will not exclude the other parent from being involved in their child’s care. Whether or not they are the nominated person, parents and carers should be given information about the care and treatment of their child, unless it is inappropriate. This is reflected in the Bill. We absolutely agree that someone should be removed as the nominated person if they are not acting in the interest of the patient. Criteria are included in the Bill for when an approved mental health professional may terminate an appointment, one of which is when the person is

“otherwise not a suitable person to act as a nominated person”.

On the points made by a number of noble Lords, suitability includes whether there is any risk to the patient. This may include if the person is behaving in a way that indicates they are unsuitable for the role; for example, if they are exercising their powers without due regard to the welfare of the person.

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[Baroness Browning (Con)]

Reflecting on what the Minister has just said, would that close the Bournewood gap, which we tried to close in earlier legislation, where a professional carer cared for an autistic man who was not able to articulate for himself, but was overruled by the clinician? I am just trying to get my head round what she has just said because that was the Bournewood gap and, as the Minister will know, it ended up in the European Court before it was resolved.

[Baroness Merron (Lab)]

We need to be considering that as one of the scenarios and I would certainly be very glad to give the noble Baroness and noble Lords a more considered response to the very important point that has just been raised.

Under this policy, an approved mental health professional would terminate their appointment if the nominated person is not acting in line with the patient’s interests. I really wish to emphasise this.

For all these reasons and the responses I have given, I hope that the noble Baroness will feel able to withdraw her amendment.

[Baroness Berridge (Con)]

My Lords, I am grateful to noble Lords who have spoken and for the considered nature of the response and the clarification regarding the special guardianship. However, as we have outlined, other people remain having parental responsibility and it seems that under the Bill, as it is only one person, it could be that the residual person still has parental responsibility. It could just be that person under the Bill and not, in that situation, who is appointed.

I am concerned, not only by the outline at the beginning in relation to parental responsibility being removed. I just feel that there is a lack of understanding—with all due respect to the Minister’s diligence, thoroughness and engagement with colleagues—about the depth of the issue that we have here. She mentioned “would” appoint. That seems something that can be under the Mental Health Act code—“would” seems to be that as long as you document your reasons for that, you can move. It seems that from the situation I have outlined, in which the 16 or 17 year-old has been removed from the dad’s care because he has been shown to be, and proven by the family court to be, a danger, he could be appointed as the nominated person. Then we are relying on a speedy process in the county court—which we are not sure we always get legal aid for—to remove him. I am concerned by phrases such as “more flexibility for 16 and 17 year-olds”. Does that include the 16 and 17 year-olds who are under special guardianship or where there is a care order?

It seems that there is a conflict, based on what the co-leader of the AMHPs is saying, what the review has said and what the response says. We have a conflict between two pieces of legislation that we must continue to grapple with. On phrases such as “working with the DfE”, I asked specifically whether there had been a meeting with the Minister for Children and Families. The responsibility for a serious case review sits with that department. If we are to some extent right, this risk to children will manifest itself in an imperfect system. Obviously, there are professionals and clinicians, but we all know of cases that have gone wrong and ended up in inquiries.

I remain concerned by the lack of clarification on legal advice. Legally, in some ways this is fascinating—but it is not fascinating because it involves child protection. I welcome the engagement and I am sure that we will meet again in regard to this, but the severity of the risks that we are exposing, and allowing young people and AMHPs to go behind findings of fact in the family courts made under the Children Act is an incredibly serious issue. I hope that the Minister will be furnished with that kind of geeky legal advice, because for the children’s sake we need that.

However, I am grateful for the manner of her engagement and of course beg leave to withdraw the amendment.

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Moved by

[Baroness Merron]

87: Clause 31, page 42, line 37, leave out paragraph (a)
Member’s explanatory statement
This amendment, my other amendments to Clause 31 and my new clause inserted after Clause 31 would provide for commencement two months after Royal Assent of provisions about tribunal reviews concerning patients subject to conditions amounting to a deprivation of liberty.

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Moved by

[Baroness Merron]

94: After Clause 31, insert the following new Clause—
“References: restricted patients not subject to deprivation of liberty conditions(1) The Mental Health Act 1983 is amended as follows.(2) In section 71 (references by Secretary of State concerning restricted patients), for subsection (2) substitute—“(2) The Secretary of State must refer to the appropriate tribunal the case of any restricted patient detained in a hospital if—(a) the patient’s case has not been considered by the appropriate tribunal within the last 12 months, whether on the patient’s own application or otherwise, and(b) there is no pending application or reference to the appropriate tribunal in relation to the patient’s case.” (3) In section 75 (applications and references concerning conditionally discharged restricted patients)—(a) before subsection (2C) (as inserted bysection 31(3)(a)of this Act) insert—“(2B) Where a restricted patient has been conditionally discharged, is not subject to conditions amounting to a deprivation of liberty and has not been recalled to hospital, the Secretary of State must refer the patient’s case to the appropriate tribunal on the expiry of—(a) the period of two years beginning—(i) in the case of a patient who has previously been subject to conditions amounting to a deprivation of liberty, with the date on which the patient most recently ceased to be subject to such conditions, and(ii) in any other case, with the date on which the patient was conditionally discharged, and(b) each subsequent period of four years.”;(b) in subsection (2D), after “subsection” insert “(2B) or”;(c) in subsection (2E) omit “, is subject to conditions amounting to a deprivation of liberty”;(d) in subsection (2F), after “subsection” insert “(2B),”;(e) in subsection (2H), after “subsection” insert “(2B),”;(f) in subsection (3), after “subsection”, in the second place it occurs, insert “(2B),”.(4) The amendments made by this section apply in relation to any person who is a restricted patient within the meaning given by subsection (1) of section 79 of the Mental Health Act 1983, or is treated as a restricted patient as a result of that subsection, whether the person became such a patient (or treated as such a patient) before or after the coming into force of this section.”Member’s explanatory statement
See the explanatory statement for my amendment to Clause 31, page 42, line 37.

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[Baroness Merron (Lab)]

My Lords, I thank all noble Lords for their amendments and considerations, including the noble Baroness, Lady Barker, for her observations on the group before us.

On Amendment 99, tabled by the noble Lord, Lord Kamall, services already capture data on instances of police using relevant powers to take patients to emergency departments. The Home Office collects national policing data on detentions under Section 136 of the Act and removal to a place of safety, including the number of times that A&E has been used. NHS England’s emergency care dataset includes data on mental health, including how patients are referred to hospital and their conveyance methods. I understand the points that the noble Lord was seeking to probe, but we feel that it is not necessary to create a new legislative requirement.

My response to Amendment 137, also tabled by the noble Lord, Lord Kamall, will focus on the position in England, because I imagine that that is what the noble Lord is particularly interested in, and of course different arrangements apply in Wales. We recognise the importance of preventing illegal drug use in mental health units and take the issue extremely seriously. All units must have robust policies in place to prevent the introduction of illegal drugs. To pick up the point that the noble Lord put to me about the recording of drug-related incidents, I assure him that such incidents would be recorded as a patient safety incident. While published data does not break down the nature of an incident to get an aggregate view at national level, details of incidents will nevertheless be shared with NHSE and the CQC to allow appropriate action then to be taken.

As I have referred to, providers must inform the CQC of certain events affecting their services. Inspectors review all reported concerns, as I have said, and that is important to determine the necessary follow-up actions. Issues that relate to the introduction and use of illegal drugs in an in-patient setting would be reflected in the CQC’s regulatory inspection findings where concerns have been identified, with potential consequences for ratings and for regulatory sanctions. We believe that there are already processes in place for the CQC in England to receive information about drug-related incidents. We feel that this is a better use of the capacity—which is not infinite, as the noble Lord knows—of the regulator, rather than having a national report on the overall efficacy of the systems that are in place.

Amendment 151 was tabled by the noble Baroness, Lady Bennett of Manor Castle, and spoken to by a number of noble Lords, and I am grateful for their input. A number of other amendments have called for statutory reports on current community services. As I have said previously in response to those debates, we recognise that reducing detentions cannot be achieved by legislation alone, and will absolutely depend on the right services in the community. The CQC publishes an annual survey on community mental health support, and we will be publishing a 10-year plan for the NHS later this year. Progress in community mental health services is already being made. In the last 12 months, more than 400,000 adults have received help through new models of care, which aim to give people with severe mental illness greater choice and control over their care. However, we recognise that more needs to be done.

I want to pick out a particular focus on innovation in this amendment. The noble Baroness, Lady Bennett, referred to the fact that the impact assessment does not include costs for community services. That is not quite the case. There are significant costs associated with the changes to learning disability and autism, which are included in the impact assessment. I agree that wider reforms in community mental health services are needed for the reforms to achieve their intended benefits in full, but they are not a direct consequence of this Bill. That is why they are not costed in the impact assessment. I hope that will be a useful clarification for the noble Baroness.

As I mentioned last Monday, NHS England is already piloting the 24/7 neighbourhood mental health centre model in England, building on learning from international exemplars, some of which have been brought to the attention of your Lordships’ House by various noble Lords, and I have welcomed that. Six early implementers are bringing together their community crisis and in-patient functions into one open-access neighbourhood team that is available 24 hours a day, seven days a week. That means that people with mental health needs can walk in, or self-refer, as can their loved ones or concerned professionals. We are currently commissioning an evaluation of these welcome pilots, which is due to report in June 2026.

The noble Baroness, Lady Bennett, referred to reports last week of an increase in the number of young people admitted to general hospital wards with mental health concerns. NHS England is in the process of developing a new model for specialised children’s and young people’s mental health services, supported by a new service specification and quality standards. That new model would support the delivery of specialist services in the community and in-patient settings to ensure that children and young people are treated in age-appropriate in-patient environments, as well as the least restrictive environment close to the child’s or young person’s family and home. The noble Baroness’s point is well made, and I hope that will be helpful.

[Baroness Bennett of Manor Castle (GP)]

I welcome what the Minister has said about the pilots and the significant changes being made to existing mental health services. Short of someone putting down an Oral Question or securing a debate, how will Parliament be able to monitor that? We know that, in the health service and more broadly, successful pilots happen but then disappear without trace and never get implemented. How will Parliament be able to assess progress from the pilot stage to implementation, along with broader changes? What mechanisms are there?

[Baroness Merron (Lab)]

The noble Baroness makes a fair point, and that is something I shall return to later in Committee. I am keen, as I hope noble Lords know, to speak in your Lordships’ House about progress that is and is not made, and I will continue to do that.

Overall on this group, given the amount of plans and reporting already in place, we do not think that additional statutory review, particularly in relation to Amendment 151, is necessary. For all the reasons that I have put to the Committee, I hope noble Lords will be good enough not to press their amendments.

[Lord Kamall (Con)]

My Lords, I thank the Minister for her response and thank all noble Lords for their contributions to this group. I should have also mentioned that I am very sympathetic to the intention behind Amendment 151 from the noble Baroness, Lady Bennett. Noble Lords throughout this debate have been speaking about community resources and accountability for those resources; indeed, I have a related amendment in the seventh group. In some ways, the Minister has partly answered that probing amendment.

I am grateful to the noble Baroness, Lady Barker, and will reflect on the points she made. As the noble Baroness, Lady Tyler, said previously, this was a probing amendment to see what data was being collected. Noble Lords will understand that, if we want to improve a situation, we need to collect data. It may not be perfect, and perhaps we can have some conversations between now and Report about that. I am very grateful that the Minister said that this data is collected. I wonder if she could write to us with links to where it can be found. That could address some of the concerns raised by stakeholders who wrote to us, which led to this amendment being tabled.

I remember that, when I read the work of the pre-legislative scrutiny committee, the Metropolitan Police service’s submission said that, in 2021, for the first time more patients were conveyed to a health setting in a police vehicle than in an ambulance. I wonder if that is still true or if that situation has been reversed. The purpose of these amendments was to seek what data was available, so that we can address the problems that Amendment 99 and 137 sought to address. With those comments, I beg leave to withdraw the amendment.

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[Baroness Butler-Sloss (CB)]

In the absence of the noble Baroness, Lady Murphy, I will just say that I support all these amendments. I expressed concern about under-16s and those aged 16-18, but that does not stop me thinking that these advance choice documents are an excellent plan. However, I am concerned about the point that the noble Baroness makes with Amendment 120. An independent mental health advocate would be extremely helpful, because there may be quite a lot of people who really would not know how to make an advance choice document, would be very concerned about it and might write down some really not very sensible things, when they could have help as to what they really wanted. I strongly support the noble Baroness’s amendment.

[Baroness Merron (Lab)]

My Lords, I am grateful for all the contributions in this group. I will start with Amendment 115, tabled by the noble Earl, Lord Howe, and supported by the noble Lord, Lord Kamall. Under the Bill, services should not only offer individuals who are likely to benefit from making an ACD information and support to do so, they should proactively support such individuals. This is functionally equivalent to a right to request an advance choice document.

The amendment applies to large groups. We have concerns that, for example, it may be practically challenging or sometimes inappropriate to contact people who were detained some time ago. We intend to identify groups in the code of practice that services should target; it can then be updated in response to changing best practice and emerging research.

On the point raised by the noble Earl, Lord Howe, and referred to by the noble Lord, Lord Stevens, and the noble Baroness, Lady Browning, about how advance choice document information is made available to patients, we will set out in the code of practice detailed guidance on how services should discharge their duties under the Bill to inform and support individuals to make an ACD. Any failure to implement the duty in this aspect of the code could ultimately be challenged in the courts. I hope that gives some indication of the strength of that provision in the Bill.

The noble Lord, Lord Stevens, raised the implementation timeline, as outlined in the impact assessment. We want to ensure that there is appropriate resource in the system before ACDs can be brought in. I am sure noble Lords understand that this is critical, for ACDs to have the right level of impact. For example, the effect of ACDs is dependent on the expansion of the second opinion appointed doctor service. In the meantime, services can, of course, progress with putting ACDs that deal with patient needs and wishes overall should they become detained. That would very much build on the work that South London and Maudsley, and others, have done.

I turn to Amendments 117 and 125 in the name of the noble Baroness, Lady Barker. I confirm that we are committed to mitigating the barriers that get in the way of creating an advance choice document. The code will make it clear that commissioners should provide accessible information in response to individual needs, with flexibility around how individuals make their preferences known—the point that the noble Baroness raised. We plan to create a standard advance choice document template for people to complete, with supporting guidance. That should prompt thoughts about the things that an individual may wish to consider and decide before they become unwell. I can assure noble Lords that the template will be available digitally as well as in hard copy. Our intention is that a digital version of the document will be created for easy access by professionals as needed.

Amendment 120, tabled by the noble Baroness, Lady Murphy, and spoken to by the noble and learned Baroness, Lady Butler-Sloss, has the stated intention that mental health in-patients create an ACD. While the Bill does not prevent this, in most cases it will not be the best time, as patients may be very unwell and lack capacity. Insights from the South London and Maudsley NHS Foundation Trust with King’s College London suggest that encouraging people to create an advance choice document after discharge—when their health has improved and the support network can help—can be useful. The person’s community mental health team is best placed to provide support, rather than an independent mental health advocate whose role is to support people who are detained. The duty on commissioners in the Bill is intended to focus on the community and other contexts outside of hospital. We feel that this is more likely to increase the uptake of advance choice documents.

[Baroness Barker (LD)]

The crucial question that the noble Baroness is asking is around which staff can access this information and where. That means that the information in the ACD has to be always available to whoever is seeing the patient, wherever they happen to be. Does that mean that, as in palliative care, the ACD will become part of an electronic patient record, and that there will be an expectation that all practitioners, wherever they are, will refer to it all the time?

[Baroness Merron (Lab)]

The noble Baroness makes a good point. I am sure she is aware that one of the main pillars of change as we move towards the 10-year plan is shifting from analogue to digital. I am sure that this will be part of those considerations.

I now turn to Amendment 121, tabled by my noble friend Lord Davies of Brixton and supported by the noble Baronesses, Lady Tyler and Lady Neuberger. The noble Baroness, Lady Tyler, spoke to this very amendment. We know that financial problems can worsen or trigger mental illness. We agree that individuals should be encouraged to include in their ACD any care and support to help them manage their financial circumstances when unwell. The code of practice will include guidance from professionals on this point, while the template will prompt people to consider financial matters.

On Amendment 122, tabled by the noble Baroness, Lady Browning, and supported by the noble Lord, Lord Patel, it is important for practitioners to be aware of, and, where applicable, to consult with, the person’s attorney. However, we do not agree with requiring people to include all of the information contained in the lasting power of attorney in their ACD. The document is owned by the individual, who should be free to include what matters to them. Some of the information in a person’s lasting power of attorney may not be relevant, and copying over its contents may introduce inaccuracies due to human error. We intend to encourage service users to include the existence of an LPA where applicable in their advance choice documents, and practitioners can then be made aware and take the relevant steps.

On Amendment 123, tabled by the noble Baroness, Lady Browning, we agree with the aim that is stated here. The code of practice will set out all of the groups which services should proactively target to make an advance choice document, including people on the dynamic support register. The code can be updated in line with emerging research and best practice, as I have said a number of times before, and can include detail and nuance that is not possible in primary legislation.

With those remarks from me in mind, I hope that noble Lords will feel able not to press their amendments.

[Lord Scriven (LD)]

I have one very quick question. Throughout the whole of Committee, since day one, the Minister has referred to the code of practice being updated. Can she tell us the date by which it will have been updated? It is quite important for implementation and some dates that the Minister keeps referring to. If she cannot let us know now, she could write to the Committee.

[Baroness Merron (Lab)]

I would be very glad to share the date if I could put a date on it. It will be after Royal Assent, and I will keep noble Lords updated.

[Earl Howe (Con)]

My Lords, I very much appreciate the support from around the Committee for my Amendment 115. I support all the other amendments in this group, each of which is designed to bolster the rigour and thoroughness of the advance choice document process.

It is good to hear from the Minister that the code of practice will include guidance on how information on ACDs will be made known to relevant would-be patients. I shall need to reflect on this, but I confess I retain a worry in this area. The CQC in its annual report of 2020-21 on monitoring the Mental Health Act reported that many patients do not have their rights explained to them during their treatment. This is despite the existing requirement in the Mental Health Act code of practice for hospital managers to provide information both orally and in writing. Clearly, if someone without an existing ACD is admitted to a mental health unit for treatment, it will be too late for them to execute a valid ACD during that episode of care. The time to be informed that an ACD could be an appropriate thing for them to draw up is once they are discharged, to cater for possible future contingencies.

I suggest that the CQCs finding is still relevant, its point being that the NHS is not all that good at providing information to patients in a timely or appropriate way. Therefore, I think that creating a duty to do so would add value—perhaps not in the precise terms I have used in the amendment, but in similar language. That could, incidentally, be achieved quite easily if mental health patients were automatically invited to complete a debriefing report following discharge from hospital in the way that I suggested in an earlier amendment.

The prize, let us remember, could be significant. I refer noble Lords back to remarks by the noble Baroness, Lady Murphy, in an earlier debate, where she indicated that independent advocates have been proved as central to the success of advance choice documents—a facilitator, in other words. She referred to a study in North Carolina that showed that providing a facilitator in the form of an independent advocate increased the number of people making a psychiatric advance directive from 3% to 60%. That is a very powerful set of figures.

I hope the Minister will be open to further discussion on this and the other amendments in the group between now and Report. Meanwhile, I beg leave to withdraw my Amendment 115.

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Moved by

[Baroness Merron]

127: Clause 43, page 55, line 35, after “provided” insert “or arranged”
Member's explanatory statement
See the explanatory statement for my amendment to Clause 4, page 5, line 20.