Mental Health Bill [HL]

Lord Stevens of Birmingham Excerpts

Report stage
Wednesday 2nd April 2025 Lords Chamber

I conclude by emphasising that legislative backstops and reporting duties are necessary to ensure that the implementation of the Bill is timely and effective. That is underlined particularly by the delays in the implementation of both the Mental Health Units (Use of Force) Act 2018 and the liberty protection safeguards introduced in the Mental Capacity (Amendment) Act 2019, to replace the deprivation of liberty safeguard systems, neither of which have been taken forward. Both are very relevant to patients affected by the Mental Health Act. I beg to move.

[Lord Stevens of Birmingham (CB)]

My Lords, this Bill has been years in gestation, and we have heard, in Committee and on Report, that it is going to be years in implementation. The Government, not unreasonably, have pointed to two principal rate limiters for that: workforce and funding. As we have just heard in the powerful speech from the noble Baroness, Lady Tyler of Enfield, her Amendment 50 is responsive to the staffing constraints and concerns, and my Amendment 59 tackles the funding question. I am grateful for her support and that of the noble Baroness, Lady Bennett of Manor Castle, and the noble Lord, Lord Scriven.

In a nutshell, as the noble Baroness says, this amendment does not seek to tell the Government, or indeed the House of Commons under its privilege, how much to spend on the NHS. All it says is that there should be a floor on the share of that total going to mental health for a time-limited period while the Act is being implemented; in other words, the Government would continue to decide the size of the NHS pie. The Government, of whichever complexion, could decide to grow or shrink it, but the slice of that pie devoted to mental health would be protected for a time-limited period, not only at the local ICB level but nationally.

We had a debate on this in some detail in Committee, so I will not repeat the arguments in favour, but I will update the House on two developments since then. First, in consultation with the Public Bill Office, this Report amendment is more tightly drawn, focusing specifically on the mental health services that are in scope of this Bill and are required for its implementation. Secondly, as the noble Baroness, Lady Tyler, has just noted, since we debated this point in Committee, new evidence has emerged, sadly, as to precisely why this amendment is needed. Previously, Ministers have argued, in good faith, that the Government are committed to protecting the mental health share anyway, whereas last Thursday, the Written Ministerial Statement disclosed that the Government now intend to shrink the share of NHS funding on mental health services in the year ahead.

The Written Ministerial Statement says:

“This is because of significant investment in other areas of healthcare”.


That is not a justification; it is a mathematical tautology. It reveals a preference entirely antithetical to what will be required over the years to get this Bill implemented.

It may be argued that it is a small percentage reduction, even though it is an important negative new precedent that has been set. However, a small percentage reduction on a large pound note number itself constitutes a large pound note number. Mental health services will be missing out on hundreds of millions of pounds more, not only in the year ahead but over the decade that it will take to implement the Bill. If that is not corrected in subsequent years, over £1 billion of funding has, in effect, been removed from mental health services and the implementation of the Bill as a consequence of that decision.

In summary, there are, sadly, real grounds for concern about whether the implementation of this Act will be properly and expeditiously resourced. If the Government want to argue that this amendment is unnecessary, because they are going to do what it says anyway, it is not clear why they would therefore object to its inclusion in the Bill. But if the Government’s argument is that they do not support the amendment because they would like the flexibility to cut mental health funding shares, then, to my mind, that really points to the necessity of the amendment.

[Baroness Bennett of Manor Castle (GP)]

I rise briefly, having attached my name to Amendment 59 in the name of the noble Lord, Lord Stevens, and backed by the noble Baroness, Lady Tyler, and the noble Lord, Lord Scriven. We saw in Committee multiple amendments all trying to address the resource issue. We have focused on this one because it is both an elegant solution, as the noble Lord, Lord Stevens, just outlined, and it is—emanating from the Cross Benches—a moderate solution that can and I think will attract wide support from around the House.

As the noble Lord and the noble Baroness have said, parity of esteem has never been achieved and, on the current figures, is currently going backwards, in the wrong direction. We have to focus on the fact that the waiting lists for community mental health care for adults and young people and children are twice as long as those for physical healthcare. That is the outcome of the inequality of esteem with which mental health is being treated. I note that the Rethink Mental Illness Right Treatment, Right Time report found that most people living with a severe mental illness experienced worsening mental health while waiting for treatment, with 42% requiring urgent care and 26% being hospitalised. We are aiming to shift from hospital care—in-patient care—to community care, but we are actually forcing things in the other direction because people reach such a state of crisis. I have to preface the horror of what I am about to say with a warning. The Right Treatment, Right Time report found that 25% of people whose mental health deteriorated while waiting for treatment attempted suicide, which highlights how the lack of funding for mental health care impacts on that awful statistic.

This is a step to create a framework that heads in the right direction. As noble Lord, Lord Stevens, said, how could you possibly oppose this?

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[Baroness Merron (Lab)]

My Lords, I am grateful for all the contributions and considerations this evening, to which I have listened closely.

I first turn to Amendment 50 in the name of the noble Baroness, Lady Tyler. Workforce is absolutely a critical factor in enabling these reforms and we have committed to recruiting 8,500 more mental health staff over the course of this Parliament. The impact assessment sets out our expectations for the additional workforce that is required to deliver the Bill.

However, there are already various mechanisms in place to monitor and address concerns about the mental health workforce. The amendment would be duplicative and unnecessary. Providers registered with the CQC—both NHS and independent services—are required to deploy enough suitably qualified, competent and experienced staff, as outlined in Regulation 18 of the Staffing of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. If CQC finds a breach in Regulation 18, it can take action.

The Mental Health Act Code of Practice also states that local authorities should ensure that there are sufficient approved mental health professionals and independent mental health advocates. All staff in CQC-registered providers must receive the appropriate training that is necessary to enable them to carry out their duties under Regulation 18 of the Health and Social Care Act Regulations 2014.

At a national level, CQC reports on workforce sufficiency as part of its monitoring of the Mental Health Act report. We would argue that this is a much better process than requiring integrated care boards to mark themselves on how well they are fulfilling their duties.

Furthermore, as I said on Monday and wish to reiterate, we are committed to laying an annual report on implementation, which will set out progress made and future plans for implementation. This will include information on the expansion of the workforce, including second opinion appointed doctors, Section 12 doctors and approved clinicians. It will also include details of the key statistics and outcomes under the Mental Health Act, including detention rates, community treatment order rates and other key metrics, such as racial disparities and outcomes for children and young people, all of which noble Lords rightly seek. I hope this annual commitment will be welcomed by your Lordships’ House and that this, combined with the existing workforce monitoring I have referred to, will allow the noble Baroness to withdraw her amendment.

On Amendment 59, I also understand —as does the noble Earl, Lord Howe—the intention of the noble Lord, Lord Stevens, which is to ensure that we invest in delivering these reforms. I want to be clear: as I said in Committee, there are already mechanisms in the NHS Act to prioritise mental health spend to deliver these reforms.

To reiterate the point that I made previously, we believe that this amendment is not the right mechanism to ensure that we do that. I will return to the three main reasons for that, but I want first to refer to the point the noble Lord, Lord Stevens, made when he spoke of “shrinking mental health spend”.

[Lord Stevens of Birmingham (CB)]

It was the shrinking share of mental health spend.

[Baroness Merron (Lab)]

I thank the noble Lord for that correction from a sedentary position. Perhaps I could provide some more clarity, which the noble Earl, Lord Howe, also asked for.

The proportion of spend is almost exactly the same as it was last year, with a difference of just 0.07%. We understand concerns that the share of overall NHS funding for mental health will reduce slightly. However, this does not mean that mental health funding is being cut, and I would not want noble Lords to think that to be the case. To be clear, spending on mental health support will increase relative to 2024-25 and is forecast to amount to £15.6 billion—an increase of £680 million in cash terms, and equivalent to £320 million in real terms.

Perhaps it would be helpful for me to return to the three main reasons for not supporting this amendment. The first is—as the noble Earl, Lord Howe, helpfully referred to—what I would call a point of principle. Primary legislation should not be used to constrain spending in this way. Multiyear budgets for government departments will be set by the established spending review process, which considers spending in the round and in the context of the Government’s policy priorities. Additionally, it is Parliament that is responsible for scrutinising government spending and approving spending set by departments for the current financial year as part of the estimates process.

Secondly, the amendment as drafted applies only to spend under the Mental Health Act. The mental health system, as noble Lords will appreciate, does not structure its accounts based on the legal framework under which a patient is held. A single ward, for example, could contain a mix of patients under the Mental Health Act and informal patients who would not usually be considered to be under the Mental Health Act. Likewise, community services will support a mix of people, some on community treatment orders and others who are not. It would be impractical to require services to split costs based on the ever-changing patient mix within their care.

The third reason for not accepting this amendment, and perhaps the most fundamental point, is that the share of spend on the Mental Health Act could reduce over time, which is not undesirable. I will explain why. The genesis of these reforms is the review initiated by the noble Baroness, Lady May, to address the rising rates of detention. We all want to see more people cared for effectively in the community so that the need for the use of the Act is reduced. This would require more investment in preventive community services, which, I put to noble Lords, is surely the preferable model for supporting severe mental illness. In creating a legal requirement for the share of spend specifically under the Mental Health Act not to decrease, this amendment would actually preclude the shift from detention to prevention that I know we all want to see.

So, while I absolutely understand the intention, and I can commit that we will invest to deliver these reforms, we cannot support this amendment, which, for the reasons I have outlined, we believe is fundamentally flawed. For these reasons, I hope that the noble Baroness will withdraw her amendment and the noble Lord will not press his.

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Moved by

[Lord Stevens of Birmingham]

59: After Clause 30, insert the following new Clause—
“Consultation: bus funding formula(1) Within six months of the day on which this Act is passed, the Secretary of State must publish a report detailing a proposed bus funding formula for consultation.(2) The report published under subsection (1) must include—(a) the Secretary of State’s rationale for proposing that formula,(b) an evidence-based assessment of the distributional effect of that formula between various transport authorities in England, and(c) any alternative funding formulas that the Secretary of State has considered but chosen not to pursue.” Member’s explanatory statement
This amendment requires the Secretary of State to publish a proposed bus funding formula for consultation, including their reasoning, an assessment of its impact on different transport authorities, and details of alternative approaches considered but not adopted.

[Lord Stevens of Birmingham (CB)]

My Lords, I am grateful to the Minister for her response to Amendment 59. I accept that there are some philosophical differences of view that she expressed. However, I do not think it was right to say that the scope of Amendment 59 does not include any community and preventive mental health care, since the Bill itself includes provisions that relate to those types of services. In any event, now is not the time for further relitigating. I wish to test the opinion of the House on Amendment 59.