Mental Health Bill [HL]

Lord Bradley Excerpts

Report stage
Wednesday 2nd April 2025 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, Amendment 47 would establish a mental health commissioner for England. The role would fill a major gap in the operation of the Mental Health Act and the rights of people with mental health difficulties. I believe this role is essential in ensuring oversight and advocacy for people affected by the Mental Health Act.

Unlike existing bodies, the commissioner would have a strategic, cross-government focus working to promote mental health, tackle inequalities and be a powerful advocate for the rights and well-being of those living with mental health problems, who would finally have a voice at the top table. The commissioner would also play a vital role in the public sphere, tackling stigma and discrimination and championing policies that support good mental health across society. The commissioner would have the independence to comment on the implementation of the reformed Mental Health Act and any subsequent changes or issues that arise. International evidence highlights the impact such a role can play in improving outcomes.

I know concerns were raised in Committee that the commissioner would duplicate the CQC’s Mental Health Act responsibilities. I simply do not believe this is so. The CQC is an arm’s-length body that has a statutory responsibility to inspect and regulate health and care services and intervene in cases of abuse of people’s rights, and it has powers to tackle poor practice in providers. Its work is essential, but its ability to oversee implementation is limited and it absolutely does not have a policy advisory function. I welcome the announcement of a new chief inspector for mental health at the CQC, who will lead the inspection of mental health providers. It is long overdue. However, like the CQC, the new chief inspector will have no role to work across government to take a view on public health policies or their implementation and to speak publicly on them, so the roles of the new chief inspector and the commissioner in my amendment are separate and distinct.

The commissioner would complement the CQC in the same way as the Children’s Commissioner complements Ofsted. I was very pleased to hear that the Minister recently had a productive meeting with the Children’s Commissioner, including, as I understand it, a discussion on children and young people’s mental health. I look forward to hearing more about that. I am sure that the Minister understands the distinct role that the Children’s Commissioner has in championing the rights of children with mental illness and that it is separate from the role of Ofsted.

Finally, I know that some concerns have been raised about resources. I emphasise again, as I did in Committee, that I envisage the commissioner having a very small secretariat, similar perhaps to the Domestic Abuse Commissioner or the Victims’ Commissioner. I believe the latter has around 10 staff. Of course, the commissioner would prioritise their work sharply. For a small investment, I believe that the commissioner could transform the way government and public services support our mental health, bringing a deep understanding of mental health into the heart of government, with statutory authority and independence that will enable them to inform policy, support delivery and oversee progress. They can bring government departments together to make the best use of resources and advocate for mental health in the public sphere. I beg to move.

[Lord Bradley (Lab)]

My Lords, I will speak briefly to Amendment 47, so eloquently moved by the noble Baroness, Lady Tyler. As the House will know, the establishment of a mental health commissioner was a recommendation of the joint scrutiny committee on the Bill, of which I was a member, but, disappointingly, it was not included in the Bill. As I have said on a number of occasions, I believe that a commissioner could be a voice at a national level, promoting the interests of those who are detained or are likely to be detained under the Mental Health Act, together with the interests of their families and carers.

There will be a need for rigorous, robust and consistent oversight of the implementation of the Act, wider mental health policy issues and service development, particularly workforce capacity, over the next decade and beyond. The establishment of a mental health commissioner could ensure public confidence, transparency and accountability during that period.

However, since Committee, the landscape has shifted somewhat. First, throughout the passage of the Bill, as we have heard, the Minister has made the case that the CQC, as the regulator, already has responsibility for the range of activities proposed for a mental health commissioner. This view was recognised by the Official Opposition. I still have considerable doubts about it but, as we have heard, the CQC has now created the role of Chief Inspector of Mental Health, because it at last recognises the crucial importance of mental health services in supporting people to lead fuller, healthier lives, and the need for specialist expertise in regulating those services. The eminent doctor, Arun Chopra, has been appointed. I hope to meet him as soon as possible, to be clear about his role and the range of activities that he sees it as his role as regulator to undertake. I hope that may go some way towards allaying my concerns.

Secondly, and importantly, the Secretary of State, Wes Streeting, has stated that, in future, he is determined to be directly accountable to Parliament for the performance of the health service—obviously, including mental health. To achieve that, he wishes to reduce arm’s-length bodies. As we all know, he has already announced the abolition of NHS England. Clearly, that will lead to significant uncertainty during the reform process, and the establishment of a mental health commissioner at this time would be unlikely to land favourably. It is clear to me that primary legislation might be required, yet again, to implement the NHS reforms that the Secretary of State is advocating, so Parliament may have a further opportunity to consider the new architecture of the NHS and then determine whether to bring forward plans for, among other things, enhanced advocacy and oversight of the implementation of the Act, and to support the policy development that a mental health commissioner, as we have heard, could bring to the table.

In the meantime, I will continue to take every opportunity to hold the Government to account, as the Secretary of State has assured us he will welcome. The Secretary of State should be looking particularly at the implementation of this Act and the capacity of the service to deliver it in a timely way. I will be looking at further developments of mental health policy, particularly the interface between health and the criminal justice system in the future.

[Lord Meston (CB)]

My Lords, I support the introduction of a commissioner. There seem to be three basic arguments that suggest it would be a good measure to take at this stage.

The first is the proven value and quality of work done by other independent commissioners, particularly the Children’s Commissioner, the Domestic Abuse Commissioner and the Victims’ Commissioner, as already mentioned. The second is the need for a commissioner to oversee the prolonged implementation of this Bill when it is enacted and the wide-ranging scope of work to be covered by the new legislation. Thirdly, a commissioner will enable standards of good practice to be maintained and raised. The existence of a dedicated commissioner should in fact remove, or at least reduce, the need for periodic statutory reviews of specific areas of work and functions in the field of mental health.