Mental Health Bill [HL]

Lord Kamall Excerpts

Committee stage
Monday 27th January 2025 Lords Chamber

[Baroness Tyler of Enfield (LD)]

Just the 16. Anyway, it is a long time to wait.

The amendments aiming to make it clear, as the noble Lord said, when the clock starts ticking are really important, so that there is real accountability injected into the system. Often, when things go wrong it is where no one really feels responsible for something, so it does not happen. I will also be interested to hear what the “exceptional circumstances” do and do not include—I hope we will get some examples—because if they include just things such as shortage of staff or beds, we will not get very far at all, given the current state of mental health beds.

I understand the rationale behind the amendments tabled by the noble Lord, Lord Stevens; the reciprocity is a really important point to make. I just have slight concerns that we might be saying that this cannot happen in the way that the noble Lord, Lord Bradley, wanted to see, because we know that we have not got the scarce and specialist beds. They are just not available; it is very important to be practical about it.

It comes to the heart of the matter of this whole Bill: we know that, unless proper resource is put into the implementation of the Bill, it is not going to work at all. We know that, with mental health provision, particularly a secure unit, particularly with the state of the estate, the shortage of staff and all of that, there has to be wholesale investment in it for these things to work. I think the time has come. I simply add my voice to others to say that I hope the noble Lord practises patience—but I think he has waited long enough so I hope his patience will not be tested any longer.

[Lord Kamall (Con)]

My Lords, I thank all noble Lords who spoke to the amendments. I also thank the Government for allowing the Minister for Prisons, Probation and Reducing Reoffending to reply to this group. That is very much welcomed by the Committee. I think it was the noble Lord’s father who once said, “Kindness is good for business”. In this case, he might find that kindness is good for his noble friend the Minister. Given how hard she has been working on the Bill, I think she deserves some respite, so I am sure that that is very welcome.

So far, we have debated the importance of limiting detentions for those with autism or learning disabilities without co-occurring mental disorders. We have also debated the community treatment orders. But until now, we have not covered the provisions of the Bill relating to this new statutory 28-day time-limited period for transfers from prisons to hospitals. As the noble Lord, Lord Bradley, has said, he has been very patient. Therefore, the Government enshrining this target in law is welcome. Unfortunately, progress towards the goal of 28 days, as set out in the 2021 guidance and the White Paper, has been slower than anticipated.

His Majesty’s Inspectorate of Prisons, in its 2024 report The Long Wait—I am sure the noble Lord is aware of this—said that

“people linger in prison for weeks, often months and even, in the worst cases, for more than a year waiting for their transfer to be completed”.

Unfortunately, even though the 28-day guidance was there from 2022-23, only 15% of patients in that period were transferred to hospital within that timeframe. Sadly, the average wait was 85 days, and one prisoner was identified as waiting 462 days for transfer to hospital.

These Benches welcome the 28-day limit being put on a statutory footing, but, as other noble Lords have said—not only on this group of amendments but on others—once again, there is an issue of implementation here. Just because it is in legislation does not mean it will deliver the improvements that are necessary.

The noble Lord’s colleague—the noble Baroness, Lady Merron—has been very candid with noble Lords, saying that not everything in the Bill will be delivered now, and that there is a 10-year timetable for implementation. Given that, will the Minister say, at this stage, whether the 28-day limit is an aspiration or something that could be delivered immediately? If, at this stage, it is an aspiration and—understandably so—awaiting future spending reviews, is he able to give an indicative timeframe? Is the hope for the next 12 months, the next five years or, perhaps, up to 10 years? That information would be very welcome to noble Lords. Many noble Lords have been asking this throughout this debate. We understand that not everything is going to be solved overnight, but it would be good if we could have as much information as possible on the Government’s intentions and aspirations, including indicative timetables, where they are possible. We also understand that not everything is going to be clearly tagged at this stage.

Another finding from the prison inspectorate’s report was that there were serious flaws with the data held on patients who were awaiting transfer. I understand that there is no publicly available data describing the access and waiting times for beds. The Minister might be able to correct me on that. Some of the data on the numbers of prisoners awaiting transfer obtained from providers had significant gaps, due to a lack of consistent and accurate reporting, and some data contained errors and unreliability. This might also impact on Amendments 97 and 98 from the noble Lord, Lord Stevens.

The noble Baroness, Lady Merron, may well tire of hearing me repeat the importance of collecting accurate and complete data, but, as I and many other noble Lords have said on many occasions, we really cannot solve many of the problems we face without data that is as accurate and timely as possible. Therefore, I urge both Ministers to take up the issue of data reporting for patients awaiting transfer from prison to hospital with their respective departments.

Turning to Amendment 96C in the name of the noble Lord, Lord Bradley, which creates an accountable person who will be appointed to oversee the transfer process and ensure that the statutory 28-day limit is completed, I think this, once again, speaks to the point of implementation. This could be a sensible way of holding providers to account and working with them to address the shortcomings in patient transfers. Given the Government’s 10-year timeframe for implementation, noble Lords have raised the importance of oversight and accountability. Therefore, in the remarks from the Minister and in any subsequent letter, I hope that the Government will be able to address the issue of implementation and to give an indicative timetable. I look forward to the Minister’s response.

[The Minister of State, Ministry of Justice (Lord Timpson) (Lab)]

My Lords, this is the first time that I have helped take a Bill through Committee, so I am grateful to noble Lords for bearing with me while I acquaint myself with the procedures. I appreciate the questions and suggestions from noble Lords because this is a subject that is very close to my heart, as someone who has recruited many of the people whom we are talking about, over many years. I have always thought it was very sad when colleagues whom I had recruited often had to leave because of their mental health problems and other complexities that they then found themselves in within the system.

Amendment 96, tabled by the noble Baroness, Lady Murphy, would remove the change to the detention criteria in Clause 34, provided for prisoners who become mentally disordered in prison and require transfer to hospital. This would mean that a physical hospital place must be identified before the detention criteria are met for transfer from prison to hospital under the Act. This differs from how “available” treatment is interpreted across the rest of the Act, and therefore risks delaying access to treatment. It would also affect the implementation of the statutory time limit in Clause 35, as the Secretary of State would not be able to issue a transfer warrant until a bed is identified, regardless of the patient’s needs.

Clause 34 aims to correct a divergence in the detention criteria, as opposed to creating one. I appreciate that the noble Baroness is seeking further clarity on how Clause 34 will operate and the intention of the wording. My officials would be happy to hold a teach-in with the noble Baroness on this. I therefore ask the noble Baroness to withdraw her amendment.

I turn to Amendments 96A to 96C, tabled by my noble friend Lord Bradley. We have known each other for nearly 10 years, six years after the important topic came on to his radar. Amendment 96A would place a legislative time limit on the referring body to issue a referral notice within two days of receiving a request for an initial medical report to assess whether an individual meets the criteria for transfer. The timing of the statutory referral notice being issued will not impact when the time limit begins. This starts from the day that the healthcare team requests the assessment, referred to in the Bill as “the initial request”. This amendment would therefore not benefit transfer timeliness. Additionally, placing a statutory time limit on the healthcare team in a detention setting to issue a referral notice would not be operationally viable, because not all services operate seven days a week. The current wording of “as soon as practicable” accounts for this and encourages the referral notice to be issued at the earliest point for each case.

Amendment 96B would place a duty on all relevant agencies to ensure, as opposed to “seek to ensure”, that the transfer is completed within 28 days. Due to the multiagency co-ordination required in the transfer process, there is no one body that could ensure punctual transfers. This is why we softened the duty, so that those in receipt of a referral notice must seek to ensure that the patient was transferred within 28 days. Having consulted with relevant agencies, we are confident that this is appropriate, given the complexities in the transfer process.

Amendment 96C, also mentioned by the noble Lords, Lord Kamall and Lord Bradley, would introduce a “specified accountable person”, appointed by the healthcare provider for the relevant place of detention, who would be responsible for ensuring that people are transferred within the 28-day time limit in Clause 35.

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Moved by

[Lord Kamall]

99: After Clause 37, insert the following new Clause—
“Duty to record patients not in the criminal justice system escorted to hospital by police(1) The Secretary of State must by regulations make provision to require the police and hospital trusts to record the number of patients who are not in the criminal justice system but are escorted to accident and emergency departments in hospitals by the police for treatment for mental disorder.(2) A statutory instrument containing regulations under this section may not be made unless a draft of the instrument has been laid before and approved by a resolution of each House of Parliament.”

[Lord Kamall (Con)]

My Lords, I beg to move Amendment 99 in my name and to speak to my further Amendment 137; both are also in the name of my noble friend Lord Howe.

Our Amendment 99 places a duty on the police and on hospital trusts to record the number of patients not in the criminal justice system who are escorted to accident and emergency departments by the police for treatment for a mental disorder. The reason behind this amendment is that a number of people are taken into accident and emergency by the police because they exhibit behaviour that is a cause for concern, resulting from a diagnosed, or even an undiagnosed, mental disorder or learning disability. These patients are not necessarily placed under arrest, since they may not have committed any crime, but they are escorted to hospital by police.

Once in A&E, it is quite common that they could wait for six, 12 or even more hours before they see a clinician. This is obviously not an efficient use of police time; I know that my noble friend Lady May spoke to this earlier in Committee. More importantly, a police officer escorting a patient who is demonstrating challenging behaviour could exacerbate the problem. Also, a patient who arrives with or without a police officer may behave in a way that is seen as threatening by other patients, which could lead to their being arrested, as they are seen as at risk of harming themselves or others. The patient then finds themselves in the criminal justice system.

To avoid situations such as this, we are probing the Government to try to understand how often the police take patients into hospital for treatment for a possible mental disorder when they are not under arrest. This data should help us to understand how much police time is being spent accompanying these patients. This is not to take a particular view one way or the other; rather, it is to say that we need to have this information available so that we can fully assess the situation.

Our Amendment 137 states that the Care Quality Commission

“must publish a report on the efficacy of systems designed to prevent the introduction of illegal drugs into mental health units”.

Hospitals are entitled to prohibit patients from misusing drugs or alcohol on their wards, but what they can do to enforce those requirements is less clear, especially with detained patients. We accept that informally admitted patients can be asked to leave by hospital managers or even escorted off-site by security if they do not abide by a hospital’s rules on illegal drug use. However, patients detained under the Mental Health Act cannot be forced off premises for violating these rules.

The risks of illegal drugs being used in mental health units are obvious and severe. There is a possibility of those drugs interfering with prescribed medication, which could make that medication ineffective or even harmful to a patient’s physical or mental health. Further risks include the effects—such as psychosis or aggravating effects—of certain drugs, which could potentially lead patients to become more violent and cause harm to themselves or to staff. Whatever the result, the use of illicit drugs in mental health hospitals does not contribute to the treatment or therapeutic benefit of patients; I suspect that is a British understatement.

Much of the information and literature on substance misuse in in-patient mental health settings seems to be out of date. The major studies that we looked at were conducted in the early 2000s; these included a paper published by the Psychiatric Bulletin in 2000. I am happy to be corrected if there is more up-to-date data, but it seems that we do not have enough adequate and up-to-date data available concerning the prevalence of illegal drugs in mental health units. Can the Minister tell us whether the department has up-to-date figures? If not, does it have any intention of collecting these figures? Once again, this would help us to understand the scale of the problem.

Whether or not we are fully aware of the prevalence of illegal drugs in mental health units, there must be adequate safeguards in place to ensure that their use is as limited as possible. This amendment probes the Government for some answers on how they are trying to achieve this. By requiring the CQC to publish an annual report on this matter, we hope that a fuller picture could emerge, which would, we hope, inform the development of procedures and processes to reduce the harms related to illicit drug use. I beg to move.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I shall speak to Amendment 151 in this group, which is in my name. It is a slightly diverse group, in that the noble Lord, Lord Kamall, has just set out his two amendments, which are very focused on specific areas, while mine is a very general one. However, they fall under the grouping as provided to us by the Whips; they are about monitoring and reporting, so there is some kind of sense here.

I start with the words of the noble Baroness, Lady Tyler, who in the previous group said that, without proper resources, this Bill is not going to work at all. That is what this amendment aims to address. I think the reason why it was regarded as within the scope of the Bill without any wrestling from me is that, specifically, the aim of this Bill is to have fewer people sectioned and fewer people under compulsory treatment orders. It aims to reshape and have earlier interventions, so that we do not see problems get so bad that we get to that point.

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[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.

Amendment 99 withdrawn.