Mental Health Bill [HL]

Baroness Neuberger Excerpts

Monday 25th November 2024 Lords Chamber

[Baroness Neuberger (CB)]

My Lords, I declare interests as chair of University College London Hospitals NHS Foundation Trust and Whittington Health NHS Trust, and as a member of the North Central London Integrated Care Board. I am delighted to be able to speak in support of the Bill today, which has been a long time coming. As noble Lords know, I was one of the three vice-chairs of Simon Wessely’s review. It seems a long time from when we published that in 2018.

I pay particular tribute to the noble Baroness, Lady Buscombe, and her team for their pre-legislative scrutiny, which did so much to clarify and to push the draft legislation nearer to what our original review had said, but your Lordships will not be surprised to hear that there are still some areas of concern. I say that as I pay tribute to the Minister for all her engagement, both formal and informal, with members of the review team.

The Government have published the impact assessment for the Bill, showing what they believe will be the costs of the improvements that we all wish to see happen, but have said absolutely nothing about how they will pay for all of this. If we are going to make these reforms work, we are going to need money in the system. Other noble Lords have said precisely that, notably the noble Lord, Lord Alderdice, and the noble Baroness, Lady Watkins, on the subject of staff. You have only to speak to people working in this field to realise that they are desperate for resources, beds and staff—particularly nurses—alongside alternatives to detention that provide real care and do not leave people on the streets. That goes back to the issue of community treatment orders, which we will no doubt come back to in Committee, because this is a really serious concern.

We all know that public finances are under huge pressure but I urge noble Lords, and particularly the Minister, to push as hard as possible for funding for these reforms and the mental health system as a whole. It really is needed and if we do not do that, whatever we legislate will make precious little difference to what happens. That is what we ought to worry about. It is also vital that this House notes the commentary from the Royal College of Psychiatrists whose president, Dr Lade Smith, warns us that these reforms must not make worse the racial disparities already associated with the use of the Act. We need to take heed of that, as many other noble Lords have said.

I want to thank some people in particular, notably Sir Simon Wessely, the chair of the review and, one might argue, the architect of these reforms, and my co vice-chairs Mark Hedley and Steven Gilbert, for their essential contributions. I want also to pay tribute to the Civil Service teams in the Department of Health and Social Care and the Ministry of Justice, particularly Matthew Lees, who put in huge amounts of hard work and showed astonishing devotion to the cause. Some of them have seen it all the way through.

We are delighted that the Bill includes the new guiding principles that we devised and recommended, as well as provisions to promote the use of advance choice documents; but as the noble Earl, Lord Howe, and the noble Baroness, Lady Berridge, have said, there is something very peculiar about the way this is framed. Advance choice is not given as a right to patients; it is a duty upon the ICBs. When we get to Committee, we need to push that one quite hard.

We also remain disappointed that the Government have not been able to include measures relating to our recommendation that the tribunal consider appeals from patients whose expressed preference for a particular kind of treatment has been overturned by doctors. We believe that that would be an uncommon occurrence; nevertheless, it is an important safeguard for patients’ rights—a right to be involved in decisions to do with your own care. I really hope that the Government will reconsider this proposal, ideally before we end consideration of the Bill.

We are living in a time of increasing tolerance and understanding of mental ill health and decreasing stigma surrounding it, but that is not what many people in the system experience. Many people are most distressed not by the detention itself but the way in which they are treated and made to feel helpless, ignored and stripped of their dignity and self-worth. That is why the review identified—and this is key—a clear gap when it comes to supporting and valuing patient autonomy. It is why we argued that we must move away from what we heard all too often: the default position of clinical staff rejecting what the patient wants. Many of the independent review’s recommendations therefore aim to shift the dial in favour of greater respect for the wishes, choices and preferences of patients. It was also clear that when people were—rightly, in their own view—being deprived of their liberty, they were also all too often being deprived of any say in how they should be treated. As one service user who was part of our core team told us when we started on this process:

“I am sure being detained saved my life, but did it have to be such a terrible experience?”


In one significant respect, the Bill goes beyond any recommendations that we made, proposing, in effect, to exclude learning disability and autism from the scope of the Act, except for short-term admission. Other noble Lords around the House have spoken on that; however, we were and remain concerned that exclusion from the scope of the Act might not solve the problem—although it should—but instead simply shift it elsewhere. The noble Lord, Lord Alderdice, I believe, was hinting at that too.

This Bill, unlike its predecessors—I am a veteran of 2008 as well—enters Parliament with a considerable level of agreement from all the political parties, professionals, media, the charitable sector, service user groups, and in particular stakeholders representing ethnic minority communities, although there are considerable worries.

So there are some concerns, and we know about that. I very much hope that the Minister will be able to meet once again with the team from the Royal College of Psychiatrists and with some user groups, particularly people with autism and other disorders who are expressing major concerns—all of us will have had some of those emails. I hope that that can happen as the legislation goes through, so that we can see if any further fine tuning can be done. But this is without doubt the right time—one might even say it is overdue—to modernise the Act, and I very much hope that the House will support it.