Lords Chamber

Monday 24th February 2025

(began 8 months ago)

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None Portrait Introduction(s): Lord Rees of Easton and Baroness Caine of Kentish Town
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Charles Charles III, Charles III, by Charles III, by the Charles III, by the grace Charles III, by the grace of Charles III, by the grace of God of the United Kingdom of Great Britain and Northern Ireland and of our other realms and territories King, Head of the Commonwealth, Defender of the Faith, to all Lords Spiritual and Temporal and all other our subjects whatsoever to whom these present shall come, greeting. Know ye that we of our especial grace, certain knowledge and mere motion, in pursuance of the Life Peerages Act 1958 and of all other powers in that behalf us enabling, do by these presence advance, create and prefer our trusty and well and prefer our trusty and well beloved, Diana Elizabeth Kane, commander of our most excellent Officer of our most excellent order of the British Empire.

Baroness Caine of Kentish Town. To the state, degree, style, dignity, title and honour of Of Kentish Town in our London Borough of Camden. And for us, our heirs and successors, do appoint, give and grant unto her the said name, state, degree, style, dignity, title and honour of Baroness Caine of Kentish Town to have and to hold unto her for her have and to hold unto her for her life. Willing and by these presence granting, for us, our heirs and successors that she may have, hold and possess a seat, place and voice in the Parliaments and Public Assemblies and Councils of us, our heirs and successors, within our United Kingdom, amongst the Barons.

And also that she may enjoy and use all the rights, privileges, preeminences, immunities and advantages to the degree of a Baron, duly and of right belonging, which Barons of our United Kingdom have heretofore used and enjoyed or as they do at present use and enjoy. In witness whereof we have caused these our letters to be made patent, witness ourself at Westminster in the in the afternoon of the 30 of our rain. In the third year of our reign.

By warrant under the King's sign-manual. I can Baroness Caine of Kentish Town do swear by Almighty God that I will be faithful and bear true allegiance to His Majesty King Charles, his heirs and successors,

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Charles Charles III, Charles III, by Charles III, by the Charles III, by the grace Charles III, by the grace of Charles III, by the grace of God

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Charles III, by the grace of God of the United Kingdom of Great Britain and Northern Ireland and of our other realms and territories King, Head of the Commonwealth, Defender of the Faith, to all Lords Defender of the Faith, to all Lords Spiritual and Temporal and all other our subjects whatsoever to whom Know Know ye Know ye that Know ye that we Know ye that we of Know ye that we of our Know ye that we of our especial grace, certain knowledge and mere motion, in pursuance of the Life Peerages Act 1958 and of all other powers in that behalf us enabling do, by these presence advance, create and prefer our trusty and Marvin Reece, Officer of our most excellent order of the British To the state, degree, style, dignity, title and honour of Baron And And for And for us, And for us, our And for us, our heirs And for us, our heirs and successors, do appoint, give and grant the said name, state, degree, style, dignity, title and honour of Baron to have and to hold for life.

Willing and by these presence granting, for us, our heirs and successors that may have, hold and possess a seat, place and voice in the Parliaments and Public Assemblies and Councils of us, our heirs and successors, within our United Kingdom, amongst the Barons. And also that may enjoy and use all the rights, privileges, preeminences, immunities and advantages to the degree of a Baron, duly and of right belonging, which Barons of our United Kingdom have heretofore used and enjoyed or as they do at present use and enjoy.

In witness whereof we have caused these our letters to be made patent, witness ourself at Westminster. In the afternoon of the fourth day of February. In the third year of our reign. By warrant under the King's I do swear by Almighty God that I will be faithful and bear true allegiance to His Majesty King Charles, his heirs and successors,
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None Portrait Oral questions: The Emergency Service Network programme
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Act. Water (Special Measures) Bill act. First Oral Question, Lord Hogan-Howe. I beg leave to ask the question
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None Portrait Oral questions: Re-offending rates of domestic abusers
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Question for the Noble Lord Bishop of Gloucester.
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None Portrait Oral questions: Violence against women and girls on trains
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Baroness Morgan. Paper.
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Lord Hendy of Richmond Hill Portrait Lord Hendy of Richmond Hill, Minister of State (Department for Transport) (Labour)
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I would say that with modern railway stock it is for more difficult to partition relatively small places. I also am old enough to remember the women only compartment was to compartment trains were very undesirable in the whole pile of ways, including a variety of isolation of people in different compartments. These days (just whilst the not always be welcome if you are reading a good allow at least to be in relatively open circumstances stop you would like to think perhaps it would discourage people I think that noble Baronesses suggestion is quite a difficult one given the configuration of railways stock, but if we go back to the noble Baroness Malcolm Coates original point actually designing out those nooks and crannies in railway compartments, those dimly lit places on railway stations is where we ought to go in order to reduce the opportunities for terrible violence

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against women and girls. That concludes Oral Questions for

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Terrorism, Terrorism, protection Terrorism, protection of Terrorism, protection of premises

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Terrorism, protection of premises bill. Order of consideration, Lord Hanson of Flint.

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Hanson of Flint. I beg to move that the motion sunny and many of the Order Paper be approved. This question is that the motion be approved. As many as are of that be approved. As many as are of that opinion, say, "Content", Of the contrary, "No", The contents have contrary, "No", The contents have it. We now come to two instruments previously debated in Grand Committees. Gambling regulation 2025 and one of emotion, Baroness Troy Cross.
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Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (Liberal Democrat)
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the success the proposed reforms laid out in the bill. It is an amendment that ensures not only accountability but also the continuous assessment of costs and implement evaluation timelines related to the vital provisions of the bill. In short, it is a costly plan. It's grouped with various other important amendments some of which I strongly support. The issue we have repeatedly encountered in both mental health policy and community care is that we end up with community but very little actual care within it.

This gap leads to preventable health crises, placing individuals and services under immense. Therefore we must do everything to avoid this outcome. Yet so far during our committee staged discussions I do not think we have really had the necessary reassurances that adequate visions will be in place, nor that they have been properly costed and strategically planned for community care. At its core, this amendment champions that need for transparency in the investment and execution of mental health care. Specifically within community settings where the demand will be most needed when the changes in this legislation are brought forward.

We cannot afford to enact these mental health reforms without a clear understanding of their financial and structural impact on the Health and Social Care Act system. The justice system. Local authorities. And, most importantly, the lives of those who rely on these services. In short, this amendment requires the Secretary of State to play a report before Parliament within four months of the passage of this bill and on an annual basis thereafter. The report will provide a detailed assessment both for monetised and non-monetised costs associated with the provisions of the bill.

And specifically it will outline the national commitments necessary for the training of NHS staff and approved mental health practitioners. The expansion of community care services and the vision of adequate housing and care. For individuals with autism or learning support difficulties. And the amendment ensures that the quality care provision is adequately resourced to uphold the highest standards of mental health provision. These are fundamental requirements because without a clear trust framework and implementation plan we risk leaving individuals in crisis without the support they need.

But, and I think this is an important point, this amendment is not simply about numbers. It is about real lives. The monitoring and evaluation strategy included within this proposal will ensure that reforms are not just theoretical but do deliver tangible improvements in patient care. So, it requires the Secretary of State to assess patient outcomes, collect user feedback, and measure the effectiveness of those safeguards and support mechanisms. If we fail to scrutinise and report on the costs and impact of this legislation, we risk underfunding critical services, delaying implementation, and, ultimately, failing those who are most vulnerable.

Mental health services, particularly those delivered in the community are a necessity, not a luxury. They prevent hospitalisations, support recovery, and uphold the dignity of those living with mental health conditions. This amendment ensures that the services not only establish but are adequately funded, effectively implemented, and continuously improved. I turn very briefly to Lord Stevens amendment 163 and 164, which I see as complimentary of reinforcing the amendment 130, in particular amendment 164 will ensure that the mental health funding is not cut as a share of overall health service funding until this act is fully implemented.

This amendment supports the principal of parity of esteem by putting a floor under the aggregate mental health service funding share in England, essentially training the mental health investment standards in law, something that we very much support. Sorry, I beg to move.

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Amendment proposed. After clause 50, insert the following new clause, "The question is that this amendment
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Baroness Bennett of Manor Castle Portrait Baroness Bennett of Manor Castle (Green Party)
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be agreed to. In rising chiefly to speak to amendment 153 that appears in my name, I will be very briefly saying name, I will be very briefly saying that I very much agree with what the nobility Baroness Twycross just said. And also I support as the Noble Lady said there other related amendments that come after this. They actually interrelate with an amendment of mine which was discussed earlier in committee. About looking at the funding of community services, funding is the great issue rate across-the-board.

And I think it is essential that in some way we put on the face of the bill addressing that. And I think that my amendment, although it looks a lot different to the others in this group is actually very closely related to this because as the Noble Lady Baroness Tyler said we have to be concerned about the implementation of this bill. Not just the nature of this bill. And what my amendment 153 does is say is that for-profit companies should not be delivering under this bill and it does that into ways.

It says any new facilities or organisations created for the provisions of this bill must not be operated by for-profit companies. And it says within five years of the day in which this is passed the Secretary of State must have ensured that what is now for- profit in this space is transferred to not-for-profit. Why is that? Why are mice in that? Why do I say that is essential to implementation is not I will put it into three categories. The first is the cost of paying profits for what should be provision money that is going to the provision of services.

The second is quality issues, associated with for-profit companies which, after all, are given their directors, their management have a duty to maximise return to shareholders. That is the way for-profit companies are set up in this country. I certainly are issues of stability. So, to go into those in a little more depth, I suspect it will surprise minimum is of the public to know that last year the NHS spent more than £2 billion on private mental health hospitals. That was a figure up from 279 million in 2023.

And that reflects, of course, after And that reflects, of course, after

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This is not a competitive market situation. The significant players generated over 500 million each in revenue last year and account for revenue last year and account for more than 68 % of what is being described as the market in our described as the market in our private healthcare. There has been concerns about the level of service concerns about the level of service is not running through a long list, but I'm sure the noble Lord in the committee are aware of those issues.

There is also of course the issue that many patients are being placed into out of area placements. Facilities are being set up in places cheap to run but not necessarily in the vicinity of homes, families, the kind of social setup that might support people. It is interesting to note in the context of the healthcare sector that the majority of hospital sector Spending 2.3, 2.4 billion on mental health in 2023, compared to 3.5 billion on in-house NHS bids.

That is very costly. There is a quality problem and also a huge stability issue. I point to the fact in the middle of last year, a leading provider of private mental health services narrowly avoided liquidation. This causes an issue we have also seen happening in the care home sector on multiple occasions. We see ownership with private equity, based on a model of heavy loads of debt. As is quite unsurprising, we have seen significant rising interest rates significant rising interest rates after a period of low interest rates recently.

That has created instability in the sector. What happened in the middle of last year? The active care group cares for hundreds of vulnerable patients in the NHS and an administrator was appointed on May 29, and there have been financial problems ongoing for months which we are aware of within the company but it was only in those months NHS England finally heard about them. Although they can be dated back to the end of 2022. NHS England ordered ACG not take on any new patients and provide updates daily on the situation.

Eventually there was a rescue carried out. But this is a kind of instability that we really cannot afford to have. The whole foundation does not work if we , a handful of private companies dominating our services. Not providing good quality of care. Not providing care where it is needed. I am well aware and I have to acknowledge the general response will very much be, well, we have got ourselves into this mess, how do we get out of it? The reason I put down this amendment is to say that we have to acknowledge this is an unstable, inadequate position where people are not getting the care that they need.

We need to set out a roadmap to a different situation, where we have healthcare delivered for public good, not private profit. For the good of the patient. For the good of the community. This is setting out a roadmap. I am not saying that we do not have the power in this House to say how the government should spend money, but this is a principle that says we

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have to move in this direction. Building on many of the important

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Building on many of the important
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Lord Stevens of Birmingham Portrait Lord Stevens of Birmingham (Crossbench)
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others for their support for these two modest proposals. Parsimonious league drafted but nevertheless potentially impactful if adopted. The first quite simply says that we will do away with tomorrow, tomorrow when it comes to implementing this bill we spent so much time on. Advocates are keen to see this adopted. By putting a five year backstop from the date of which the bill becomes an act, through to commencement. Commencement must happen no later than five years after the bill gets Royal assent.

I think the logic for that is we all believe that on balance by the time the bill has gone to Parliament, it ought to be injecting improvement into mental health services, so why delay? Part of the answer is there are some limitations described elsewhere, including in the impact assessment. If we go through the assessment and say, what are the specific things it is suggested will not be possible and will not be ongoing until year six, after Royal assent? It is a relatively modest number for those that want to take a look.

Table 1 on the impact assessment, page 17. There are some changes to the CTO and CTP and so on but if you look at the note impact at the end of year six and beyond, and the extra staffing from that and the extra staffing from that point, it is incredibly modest compared to the overall size of mental health spending we are going to be incurring. I think incremental costs beyond year five somewhere between 15 and 25 million on a budget running to billions.

I do not believe in the real world if we strain every sinew it ought not to be possible. I believe it will be possible to get this thing done possible to get this thing done within five years. There is another reason for thinking it is useful to have a statutory backstop to implementation in the act. And that is the unfortunate tendency that I think we have seen in various other pieces of legislation, that when push comes to shove, the decision is made to kick the can down the road a little further.

I think it is fair to say both principal parties have criticised each other for doing so. With legislation that has been the We had some measures before on obesity and junk food and it never quite saw the light of day despite Parliament deciding it would be a good thing. The then government was criticised for that. Likewise we put the time in to create the higher education freedom of speech act. I think the main opposition criticised the government for delays in implementation, despite the cause requiring social care reform which we have been happily kicking down the track, legislation which has been edited and delayed with for over two decades.

That should not be the fate here and this simple amendment 163 will put a backstop to save ourselves from ourselves. Parliament is sovereign. If we want to get it done, there is no reason to think we cannot make these changes in less than the time it took this country to fight and win World War II. So that is the rationale for amendment 163. As far as 164 is concerned, again this simply says that during the intervening period, while this act is being implemented, it would be unreasonable to shrink the size of the pie going into mental health services.

For all the reasons we have heard throughout committee stage of this bill. So to make sure that there can be no data on the drafting, in terms of how this is laid out, we have lifted the wording exactly from the health act as it currently is in statute around the proportion incurred by NHS England related to mental health and it must not force a share of expenditure taken together on all services. And there is a little kick to stop the Department marking its own homework and the National Audit Office will review after each year and provide a report we can all scrutinise.

Here are some reasons why the government should not object. First, it does not tie their hands on the overall sum of funding allocated to the national health service. That is a decision for the executive in negotiation each year. Nothing here would constrain the ability of the government to increase or indeed cut expenditure on the national health service. Nor does it constrain the ability of each Integrated Care Board to make a judgement on their own priorities. It simply says in the round, taking the 42 ICBs and NHS England together, it would be unreasonable to think that a share of health service spending on mental health will go down at a time of this incredible gap between need and treatment and at a time when we are trying to implement this legislation.

Fortunately just before Christmas, I think the secretary of state signalled his support for the mental health investment standard and therefore this is the opportunity to provide legislative cover for that announcement. It is possible the current Secretary of State will not be imposed for the totality of this Parliament. Nobody has a crystal ball. And looking at five years and beyond Royal assent, it is possible that year five will be the first year of a new Parliament. So it is reasonable for Parliament to support the Secretary of State's intent by legislating in the way set out at amendment 164.

Not least because there are some concerning signals from around the NHS but actually for the first time since the mental health investment standard was introduced, it is possible that the share of funding on mental health is going to be going down and not up taken in the round. We do not have the figures yet but maybe the Minister can confirm whether that is correct or not. In any event that serves to underline the importance of putting the safety net provision in place to make sure the financial firepower is present to get the act done.



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I apologise for my absence from the debate at the earlier stages of committee. I want to speak very briefly in support of these amendments. My noble friend said we need to save ourselves from ourselves. Actually we need to raise ourselves. Actually we need to raise aspirations to change the culture
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Baroness Fox of Buckley Portrait Baroness Fox of Buckley (Non-affiliated)
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I wanted to briefly support particularly amendment 130 with the noble Lord Scriven. I have been concerned as we discussed this build that cost are likely to spiral and not objecting to that, but it does seem to be the elephant in the room seem to be the elephant in the room and unless we know, it will become a white elephant because people will say we cannot afford to do it. I think it is better to have the transparency as has been argued. Second, I particularly wanted to oppose amendment 153.

I actually do not think we should prohibit the idea of any for-profit entities being involved in this endeavour. I think for a number of reasons. The suggestion is if we remove the profit motive all will be well. A word of caution. Not for profit organisations are not necessarily the most efficient and virtuous organisations as we might imagine. I think if you look at what has happened in the charitable sector, there are worrying trends of a rather self-indulgent, money spent on starving and all manner of extraneous and sometimes politicised endeavours.

We know that. We have seen the emergence of EDI, equality and diversity and policies, and the Health Minister himself has worried about it happening in the state sector. We have seen that absolutely become rampant in the charitable and not for profit sector. I want us to concentrate on those people for whom this bill is designed to help and not therefore have our own political idea that only the state can deliver. I do not believe that is true. And the exact of that is having worked in prisons for a period of time, I have also worked in both private and state run prisons.

And let me tell you some private prisons are awful and some state run prisons are worse. In other words, and by the way I have worked in brilliant state run prisons and brilliant private prisons, and what I think we should do is judge on the basis of quality of care and the service they provide, not some prior presumption that because they make profit they might be useless or somehow evil or
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Earl Howe Portrait Earl Howe (Conservative)
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I am right behind the noble Lords given and Baroness Lady Tyler in their amendment 130. We know, and I believe by and large that we accept that the fort as intended by the Government to hold out the prospect of instantaneous changes to the delivery of mental health care. What it sets out and what it offers is a series of amendments that over a period of years should make a material difference to the well- being of a wide-ranging of mentally ill people who require treatment in a secure mental health setting or in the committee.

The noble Baroness the Minister has spoken of the need to view these measures in the broader context of the NHS 10 year plan. And certainly from the government's point of view that is a perfectly reasonable position to take. However, if that is the government's policy does make the whole mass of questions around implementation and funding. For example, what do the Government see as the immediate high priority measures that they wish to introduce. Which measures are they proposing to defer and for how long? And what are the costs associated with these changes? Both to the NHS and as the Noble Lord run as Lady Tyler has pointed out, the changes to the justice system.

And the local Government. And bearing in mind Treasury constraints, when realistically do they believe ATR timeline for change will emerge? That is we have the impact assessment but how far can we rely on that? If those questions, for the time being, have to remain hanging in the air, as I suspect there will, I do share Baroness Tyler's view that Parliament in the not too -- distant future needs to be taking into account what the longer term future looks like.

In a way that reflects not only the government's current thinking but as time goes on how their thinking evolves. As it surely will stop and I therefore think there is a very strong case for a report to Parliament sometime in the next few months and an annual basis thereafter. Making clear that both the timeline of ambition as well as the timeline of what in reality is being delivered. I am conscious that we all need to keep our remarks succinct and to the point, so I will comment only briefly on the other amendments in this group.

I cannot, I am average, some of the noble Baroness Lady Bennett amendment 153 because I have always believed that what matters most in healthcare is not without a service is delivered by a public or a private organisation but rather the quality of care to patients and where the good outcomes are achieved at an acceptable cost. Finally, my Noble Friend Lord Kamal added his name to amendments three and four. These amendments stand absolutely full square with the theme. And unlike Noble Friend behalf I expressed my full support for them.

The Noble Lord Stevens has said it all. Just as we expect that might accept that we will not get any instant changes arising from this bill, by corresponding the Government cannot take that as a free pass from Parliament to defer implementing the bill and we cannot have a situation in which prior to implementing the provisions the principal the parity of the esteem is quietly put to one side. I hope the Minister will have reassuring words to say on those very important

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points of principle. I am most grateful to the noble

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I am most grateful to the noble Lords for their contributions to this first debate today and let me
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Baroness Merron Portrait Baroness Merron, The Parliamentary Under-Secretary for Health and Social Care (Labour)
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this first debate today and let me start by saying how glad I am and I am sure other noble Lords will say this to glad I am to see the Noble Lady Baroness Hollins in her rightful place. And I certainly heard her support for the amendments that we are discussing today. Before I turn to specific amendments, it may be helpful to your Lordships house if I briefly set out some of the high-level plans for implementation of these reforms.

And I am grateful for the understanding about that and the Noble Lord Earl made this point for the understanding that this, that time is required. And I also understand is required. And I also understand the emphasis that noble Lords are putting on pace and, of course, we try to match those two things together. But I know that we are all agreed that the need to get this bill in the right place in the act also of delivering. So, let me say the first priority will be to draft an to consult on the code of practice and we will be engaging with people with lived experience and their families and their carers, staff and professional groups, commissioners, providers and others in order to do this.

The code will be laid before Parliament before final publication and I committed to working with noble Lords to ensure that we get this crucial piece of work absolutely right and we expect this process will take at least one year. Alongside the code we will be developing secondary legislation, again, which will be laid before Parliament. With more detail on areas like statutory care and treatment plans and we then time to train the existing workforce on new act regulations and the code. This will, lately, be in 2026 and 2027 and we intend to commence the first major phase of reforms in 2027.

Of course some reforms are going to take longer as the noble Lords will appreciate. And the Noble Lady tempted me to go even further than five years and I thank the Noble Lady for the temptation. And I will not be able to please her on this occasion but it does of course take time to train doctors and clinicians, so as set out in the impact assessment we do believe it will take 10 years to fully implement the reforms. But I would emphasise that these timelines are indicative and we will reiterate these plans as we get more certainty on future funding and the wider workforce plans.

And of course I would say to noble Lords that I fully appreciate the importance of parliamentary scrutiny and accountability of this work that was crucial and I am committed to getting the House throughout the implementation period. Turning now to the specific amendments, I will start with amendment 130 in the name of the Noble Lord Scriven. Which was kindly introduced by the Noble Lady Baroness Tyler. Let me say in response to the proposals within this amendment that any implementation plan, as is proposed in the amendment that will be published four months after Royal assent would be very unlikely to contain more detail than is already in the impact assessment.

It is important to prioritise drafting the new code and the secondary regulations after broad ascent. I would also like to confirm to your Lordships house that we will commission an independent evaluation of the reforms alongside existing monitoring and reporting by the CQC. And as I previously said I fully expect and would like to update the House during the planning and delivery of the reforms. However, it requirement of primary legislation to publish annually and within four months of Royal assent would, I believe, be somewhat premature.

Turning now to amendment 153 tabled by the Noble Lady baroness Bennett. Which would prohibit not-for-profit companies from delivering provisions of the act. I did listen closely to the concerns raised by the Noble Lady. I have to say I am not somebody that shares the view that a ban on for-profit providers is the right approach. I do not feel it is the answer for the reasons also set out by the Noble Lord and the Noble Lady Baroness Fox.

It should indeed be our focus that we have high quality and good value for money services. But I can issue with the Noble Lady Baroness Bennett that we are already investing insignificant quality transformation program and piloting new models of care to ensure that care is focused on the individual with maximum therapeutic benefit. That is where our priority lies and for that there is the reason we are resisting this amendment. I now turn to amendment 163 and I am grateful to the noble Lords Stevenson and Lord Kamall and the noble Baronesses for bringing this issue before the committee.

As I said in my opening remarks I also want to see the benefits of these reforms coming into play quickly and effectively. We intend to commence the reforms in phases because some can be implemented more quickly than others because others do need more time. This is not just about money. But it is also about building system and workforce capacity. For example, the impact assessment estimates that we need over 400 additional second opinion appointed doctors and over 300 additional approved clinicians.

Many of these will be psychiatrists who would already need to have commenced training prior to the legislation for us to fully implement the bill within five years as required by this amendment. So, rather than having a fixed deadline, as is proposed, what we do intend to do is to monitor the impact of investment and test readiness to commence new powers on an ongoing basis commencing each phase when we are confident it is safe and effective to do so.

Finally I will turn to amendment 164 in the name of the Noble Lord Stevens supported by the Noble Lord, and the noble Baronesses Lady Tyler of Enfield and Lady Neuberger. I want to associate myself with the comments we have heard in this debate about commitment to treating physical and mental health equally together. And that is in line with this government's manifesto commitments. The mental health investment standard does require ICB spending on mental health to grow at least in line with overall funding reallocation.

Based on total planned spend four 2024 and 25, we expect all ICBs to meet that standard this financial year. There are already mechanisms to ensure spending, to ensure that mental health is prioritised. And I refer noble Lords to section 12 F of the NHS act 2006. Which requires that the Secretary of State for Health and Social Care lay before Parliament and annual document that sets out whether the expect NHS England and ICB spending on mental health to increase in the next year.

The Secretary of State will publish this statement before the end of this financial year. My Lords, funding for mental health spend does, as several noble Lords referred to, does go beyond the scope of the Mental Health Act. Which does aim to improve the care and treatment of individuals that have a mental illness and a need to be detained in hospital subject to restrictions in the community. Therefore I would respectfully suggest to noble Lords that this is not the appropriate mechanism for holding the Government to account on mental health spend.

For these reasons I ask noble Lords to withdraw their amendments.
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Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (Liberal Democrat)
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I would like to thank the Noble Lady the Minister for her very comprehensive response and also the noble Lords that have spoken. I found I think it was very helpful that the Noble Lady the Minister in her response started out by setting out some of what I think she called the high level plans on implementation. It was good to hear about what is going to happen on the code of practice. Plans to bring secondary legislation. And I think I got this right, I hope I did, that it will be 2027 when we see the first major sort of stage of these forms actually starting on the ground.

So, that is the good. I think that the good side of this debate. And I do think this is incredibly important because I think it is one of those issues were actually the implementation is as important as the policy. And that is why it is right, I think, that we why it is right, I think, that we

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I was pleased there was cross-

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I was pleased there was cross- party support for my amendment. I party support for my amendment. I think what is so important is that we have a way of understanding what the priorities are. We understand it cannot all happen in one go. It is understanding the priorities and the understanding the priorities and the sequencing. I think that was one of the key reasons for actually the key reasons for actually bringing forward this amendment. I understand of course that the wording of these amendments may not have been perfect.

I'm sure they have been perfect. I'm sure they could be improved. But I think the thinking behind them, the need for a statutory backstop to the legislation, which would prevent the can being kicked further down the road, all signs of the cake that goes into mental health services being shrunk during implementation is incredibly important. For me personally, the notion of having some sort of legislative cover for the mental health investment standard is exceptionally important. All of those things linked together do provide, I think the noble Lord Stevens said the financial firepower to get the job done.

That is what this group is all about. While I think we heard important messages and reassurances from the Minister, I feel that we will need to return to this at report stage. Because as was said, it is service users who do not want any unnecessary delay. I think that is what we need to focus

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on. But for now I beg leave to withdraw. Is it the pleasure of your Lordships this amendment be

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withdrawn? By leave withdrawn. 131, Baroness Tyler of Enfield. I am sorry, my lord. It is me again. This amendment, 131, would establish a mental health Commissioner for England as a new Commissioner for England as a new statutory office in government. I am statutory office in government. I am conscious it is a long and detailed amendment. To my mind that reflects amendment. To my mind that reflects the importance of it with the successful implementation of the overall act and the pivotal role a commissioner would play.

I am very grateful to the noble Lord Bradley and the noble Baroness is, Murphy and Baroness Bennett for adding their names to my amendment which I think gives a sense of strong crossbench support. The joint committee recommended creating a statutory mental health Commissioner to help drive the ongoing process of system reform, and ensure accountability for implementation. I always felt that was one of the seminal recommendations. I believe a mental health Commissioner would provide sustained leadership for mental health, complementary to the existing rules and structures that we have, as well as monitoring the effective implementation of the act.

The commissioner would operate inside government and in the wider inside government and in the wider public sphere, giving the role I think real teeth. They would have influence in government and the NHS but also have the freedom to speak out when they consider it necessary, to lead a debate and challenge stigma and breakdown boundaries and taboos. They could galvanise actions across departments and systems to improve mental health and ensure people are treated fairly and equitably in every part of life. It could bring about a much needed transformation in mental health services.

By establishing it in statute, mental health would no longer be a topic that waxed and waned in profile. And its importance in government, reliant upon short- term interest will sometimes one- on-one attention. And reflecting on the important debate we had on reducing racial inequality, I consider assessing and taking action on inequalities in mental health would also be a vital role for the commissioner. I think a commissioner would be well placed to take responsibility for the oversight of a new Responsible Persons role for addressing and reporting on racial disparity in mental health units as we debated earlier on amendment 133.

I think we have an excellent example and model to follow in the way the Children's Commissioner operates. I know from my work on children's issues how effective and influential the role has been particularly in a period of a change of government. It has generally shifted the dial. Yes, I get the fact it may not always feel 100% comfortable for the government of the day but I do think they should embrace and welcome the additional scrutiny, ideas and recommendations, based on engaging directly with people with lived experiences about their concerns.

That is how it happened with the Children's Commissioner who I think has also done excellent work on mental health. I know how it has proved to be empowering for children and young to feel their voice is being heard at the top table. I want that same opportunity in place for people with mental illness and I think it has the potential to make this act a truly groundbreaking piece of reform. Mental health commissioners already exist in a number of international jurisdictions. Scotland, Ireland, Canada, New Zealand and Australia.

There are some helpful pieces of research showing the value of such roles in other countries. I do feel I can already anticipate the Minister's response. In the second reading debate the Minister said the commissioner may duplicate the work of the Care Quality Commission. I do not think that is the case as the rules would be complementary. As the Children's Commissioner complements the work of OFSTED, and the functions of the two are different. Different powers and responsibilities. But between them providing extra benefit to the public not achieved by one alone.

Both have the powers of entry to inspect services working with children, but their roles and the outcomes they seek to provide are very different. The Children's Commissioner statewide advocacy role across the whole of government, as well as civil society more broadly in a way that OFSTED cannot possibly do. So I do hope the Minister will be willing to discuss this with me when we meet later this week and indeed with other noble lords who

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have expressed support to discuss how we can make this fly. I beg to move. Amendment proposed, articles 50 inserts the new clause as printed on
16:23
Lord Bradley Portrait Lord Bradley (Labour)
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inserts the new clause as printed on the Marshall list. My Lords, I rise to strongly support amendment 131, which I have support amendment 131, which I have added my name to as stated. I will be brief because of the comprehensive nature with which my noble friend Baroness Tyler has introduced this amendment. But just to note my register of interests as this is probably the last in committee on the bill. The establishment of a mental health Commissioner was recommended by the joint Scrutiny Committee of which I was a member.

It was with great disappointment that it was not included by the government in this bill. As I said during the second reading debate, a mental health Commissioner should be a voice at national level, promoting the interests of those who are detained or likely to be detained under the mental health act together with the interest of their families and carers, raising awareness of their needs, and challenging stigma and stereotypes. Crucially the commissioner should be at the forefront of tracking and scrutinising the implementation of scrutinising the implementation of reforms.

There is widespread support for establishing a commissioner, both inside and outside Parliament. From statutory, nonstatutory and charitable organisations. For example the Centre for mental health, for whom I am an ambassador stated a mental health Commissioner would offer sustained leadership for mental health, complementary to existing roles and structures of government. They would operate both within the machinery of the state and the media and wider public sphere. They would have influence within government and the NHS, but with the freedom to speak out where necessary to lead debate, challenge stigma and break boundaries and taboo is.

I totally agree with this view. However, in reply to this proposal at second reading, supported by many noble lords, the Minister pushed back on it, stating " there are concerns about the proposal of a mental health Commissioner and their functions and they would potentially duplicate that of existing bodies and functions and nobody would want to risk dilating accountability or cause confusion". The Minister went on to say that as the noble Lord will know, a doctor has been asked by the Secretary of State to assess if the current range and combination of organisations within the of organisations within the healthcare regulatory landscape is affected and to make recommendations of what might be needed and I think it is important we await these recommendations.

The key word here I think is "regulation". I do not agree with this. Since the second reading debate I have looked at the terms of reference of commissioners and regulators in various areas of public policy and I believe these roles are quite distinct. I agree with Baroness Tyler that the roles of the Children's Commissioner and the separate role of the education regulator OFSTED is a good comparison. I do not think these two roles die loot accountability or cause confusion.

I cannot remember if it has ever been suggested that these roles should be amalgamated or that the Children's Commissioner should be abolished. In fact I believe there is widespread support particularly in this House for the valuable independent work undertaken by the Children's Commissioner. I also think the Minister herself has made a persuasive case for a mental health Commissioner in her many constructive responses to the amendments already debated. Especially today. My noble friend has noted among other things the complexity of the legislation and the relationship with the Mental Capacity Act.

The need for significant investment in community services. The development of a skilled and complex workforce. And the number of years it will take to implement the provisions of the bill. This will need rigourous, robust and consistent oversight of implementation and wider health policy and service development over the next decade and beyond. The establishment of a mental health Commissioner would ensure transparency and accountability and introduce a force for good, to develop and deliver high quality mental health services across the country.

I hope the Minister will now agree and support this amendment before the house.
16:28
Baroness Bennett of Manor Castle Portrait Baroness Bennett of Manor Castle (Green Party)
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In following two eloquent contributions, I can be extremely brief but I will begin by thanking the noble Baroness Tyler for a clearly major piece of work in producing this amendment. I attached my name to it because I thought the issue of creating a mental health Commissioner so important but it was crucial there was as wide a possible demonstration of support and a full slate of support even at committee stage, as I am sure that there will be if this comes back at report stage, unless the Minister said she think it is a great idea and goes ahead with it now.

I'm just going to add one other point of comparison. Something with which I have been a bit involved myself. The Patient Safety Commissioner. Which noble Lord will remember was a case made from the then government backbenches by the noble Baroness Cumberlege, who had spent a couple of years fighting to finally get the Patient Safety Commissioner. If we see some of the work the commissioner has done since the post was created, we have seen detailed work on the issues of the journal mesh, sodium valproate, and these are digging into the detail and supporting a fight to get something done that is really only these Independent Commissioners can do.

Otherwise often it falls to underfunded non- government organisations and perhaps Members of Parliament enlisted in a cause but have many other causes on their time as well. We have discussed again and again how difficult it will be to bring the bill into effect. As Baroness Tyler said, to address the issues of discrimination and inequality which we know are already there. This is surely an obvious thing to do to help make sure, as we have said that

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Before I make my remark, my noble
16:31
Lord Kamall Portrait Lord Kamall (Conservative)
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Before I make my remark, my noble friend and I come at the Earl Howe and I are glad to see Baroness and I are glad to see Baroness Hollins back in her place. Can I start by thanking Baroness lady Tyler of Enfield for moving this amendment, to establish the statutory mental health Commissioner. One of the motivations behind some of the amendments in my name and that of noble friend, oh how is to probe the Government and the recommendations from the legislative Joint Committee that did not meet this draft bill.

As unable also be aware and as a Lord Attlee said this is one such recommendation of the joint committee, that did not make the cut. We do consider taking a similar amendment ourselves, but have to admit that the noble Lady, Bannatyne's amendment was very well and did not need to duplicate that. I've spoken to the noble Lady and also her noble friend, Lord Scriven. They are many other noble Lords feel a very passionately about and I know today listening to Baroness Tyler, she has made a very good case for a commissioner and her noble friend Lord Scrivens also spoke of the need for central coordination to ensure the provisions of this bill.

Something else referred to in the last group of amendments. And I pay tribute to my noble friend, because I know within the NHS, I am aware of the problems delivering at scale. I also have to admit that I have some reservations with the mental health Commissioner and while I understand the arguments in favour I am also concerned by the noble Lady, the Minister about the creation of a new bureaucracy that could possibly bureaucracy that could possibly duplicate functions.

In its response to the recommendation of the joint committee, the previous government noted and I quote, "The Government does not believe that a statutory mental health Commissioner would add significant value, within the framework, currently provided by existing bodies. The Joint Committee pointed out that a mental health commission was established,, in the Mental Health Act, which it did stand alongside the healthcare commission and the social care inspection. In 2009, the then Labour government took the decision to combine these three bodies into one integrated regulator, with the responsibility for all Health and Social Care.

I say that not as a political point, but as an observation. Since then we know that the CQC have done the function of previous to healthcare at commissioners, it's remit extends to protections for those detained under the act, or her subject to a Community Treatment Order. To do this CQC has a number of Mental Health Act reviewers, who can visit patients hospital and can raise concerns about trip or detention, with managers and they report back to the commission, the CQC also has a dedicated team to assess complaints about the use of the Mental Health Act, including issues around detention and the use of the CTO.

I also understand the CQC provides a second opinion pointed doctors for patients, who do not have the capacity to consent to treatment under part four of the treatment under part four of the act. This bill strength and is that safeguards, around a second opinion appointed doctors, such as creating a clinical checklist that must be certified by that second opinion doctor. Also, we know that the functions of the CQC, local authorities and the ICBs to provide independent health and mental health advocates.

We have debated those in earlier groups. And the Department of Health and Social Care also gives the funding to local authorities to commission health services, of which I understand there are about 152, across the country. Healthwatch is another statutory organisation that gathers impact from its users and ensures NHS leaders incorporate that feedback. As we have seen, the Parliamentary and Health Service Ombudsman, alongside the CQC does support individuals and to raise complaints. Said to the NHS and all public health authorities. The point I'm trying to make is that there doesn't appear to be an upper floor of public services and bodies that

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oversee the Mental Health Act? There does appear. Trying to make sure that patients have a voice in their care and treatment. Well I do appreciate the sum of the proposed duties of the Commissioner will be unique, there does appear to be unique, there does appear to be elements of duplication with that role and the roles of existing public bodies. I'm also very conscious of the point that the conscious of the point that the noble Baroness Tyler made about being complimentary. While I hear being complimentary.

While I hear the arguments, on both sides, I am still slightly sceptical about whether we need a mental health whether we need a mental health Commissioner. To be fair we haven't completely made up our minds yet. My noble friend and I, Earl Howe and I are weighing up the arguments here. For this reason perhaps I could ask the noble Lady the Minister to perhaps help these deliberations by addressing a few points, for clarity. First, can the noble Lady do the Minister confirm whether the CQC will take on the role of implementing the provisions of this implementing the provisions of this bill? Perhaps more importantly how will it be able to fulfil this function effectively, given the comments by the noble lady Tyler and noble Lord Bradley and other noble Lords, about the concerns and the strong feeling, in favour of an independent mental health Commissioner.

And what actual, the Department of Health and Social Care, to ensure oversight of the CQC role, regarding the implementation of this bill, when it becomes an act, if the government remained opposed,-the noble Baroness assure the House how implementation of the provisions in this bill and implementation will be addressed by the existing bodies, without the need for a standalone mental health Commissioner? I hope that noble Baroness is able to give these assurances. Otherwise I'm sure, given what was said today, by other noble Lords, that we will come back

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to this issue at report stage. I am grateful to the noble Lady, Baroness Tyler for bringing forward
16:37
Baroness Merron Portrait Baroness Merron, The Parliamentary Under-Secretary for Health and Social Care (Labour)
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Baroness Tyler for bringing forward amendments and a 131, supported by noble Lady's Baroness Bennett, and Baroness Murphy and my noble friend, Lord Bradley. As noble Lords are aware, I do understand the intent behind this amendments. And we have carefully considered the proposed functions of the Commissioner, as outlined in this amendment. And we do recognise that improvements are needed to ensure the system doesn't work effectively. But, as noble Lords are aware, we do not feel that it is the answer.

As the noble Lord, Lord Kamall said this may only duplicate existing functions, rather provide the clarity and leadership that I know everybody is seeking and I was particularly interested to hear the noble Lord, Lord Kamall give his reflections on the opinions of the previous government. In respect of the proposed mental health Commissioner. To pick up some of the points about overseeing implementation of the reforms, this is the role of the Department for Health and Social Care healthcare, working with NHS England, the Minister of Justice and the sea see, in England and the Healthcare Inspectorate in Wales -- the CQC.

In terms of the interaction between this act and the Mental Capacity Act, we are committed to keeping this under close review to minimise the challenges that are potentially faced by front-line professionals. The proposed annual report, in this amendment of the promos Commissioner would overlap with the CQC overall annual monitoring the health act report. This doesn't reflect the CQC annual statutory reporting, does reflect the views of thousands of patients interviewed, each year, by CQC. Many of the issues that the Commissioner would assess and report on, such as the accessibility of advice and quality of services are already reported on by the CQC.

It is proposed that the Commissioner would examine the cases of people detained under the act. This clearly overlaps with the functions of the CQC and health Inspectorate Wales, which have a statutory duty to monitor and where appropriate to investigate. The act also provides similar powers, for example together Them being independent investigations, into patient safety concerns, across England, to identify ways to improve mental health care and patient safety. They have just concluded a series of investigations into in patient mental health care and are currently undertaking further work.

With regard to the proposed commissioners general powers, it is the government's role, within NHS England to ensure that there is capacity and resources in the system. It is the role of the NHSE's national director, for mental health and the mental health director, for mental health and neurodiversity, which was a newly established last year, to oversee and take forward improvements to mental health services. It is already the role of the regulator to safeguard the rights and welfare of patients, while other organisations, independently investigate complaints.

I would say, to noble Lords, that to minimise duplication, with these organised functions, would require significant remodelling of the system, which would interact in going problems and possibilities that are important to the smooth delivery of the Mental Health Act reforms. Having said that, I can say to noble Lords that we do recognise that improvements need to be made in the quality of care patient safety landscape and we are committed to that goal and intend to overhaul the healthcare system, to make it better for all patients.

The CQC has already begun to implement the recommendations by Dr Penny and Professor Sir Mike Richards, with a new chief inspector, for mental health. The new inspector will use their independent voice to amplify responses to the experiences and outcomes to people who use the services and implementation of the Mental Health Act reform will be at the top of their to-do list. In terms of the wider landscape, we do soon expect to hear from Dr, who is unable also referred to is it reviewing a broad range of organisations that the impact on quality and safety.

Many of which I have a mention today. It is due to report on whether great value could be achieved through different delivery models. In the debate, there was of course, reference to the role of the Children's Commissioner. And the noble Lady, lady Tyler in particular focus on that. To that point, I would like to place on record my gratitude to the Children's Commissioner, for the work they have done on children's mental health. I would say in reflecting on the debate, earlier, that that Children's Commissioner is operating in a rather different landscape.

The mental health Commissioner, which is proposed, would have a much narrower perfused. That, for the reasons I have stated do risk overlapping with existing organisations, in a way that Children's Commissioner does not. I do understand why the Children's Commissioner is being looked to, but I cannot draw the direct comparison, for myself. The challenges we have heard, in this debate, have highlighted areas that we need to further focus our efforts on. I do look forward to speaking to the noble Lady, Baroness Tyler, more about this topic, this week and I am sure that I will be having further conversations about this.

It is of all of these reasons that I ask the noble Baroness to withdraw amendment 131. 131.
16:44
Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (Liberal Democrat)
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I would like to thank the noble Lady, the Minister for her response and thank other noble Lords for their support. In some cases a strong support, in other cases support up to a point, if you know support up to a point, if you know what I mean. I have to say, for myself, the noble Lord, Lord, was quite right to say, on these benches, we feel absolutely passionate about this. We think this is the thing that has the real potential to make such a difference, to transform a mental health services.

Looking right across the spread of mental health services. Yes, absolutely at the crisis end, at the detention end, but looking at how the whole of the mental health landscape actually works. I will just say, in response, that I am slightly surprised that the Minister considers, or the Government considers that the current arrangements are satisfactory. The Joint Committee clearly did not. The Joint Committee had spent a lot of time looking into this. And they made a recommendation, they made a recommendation, I think, for a reason.

The issues of duplication, I do not think our nearly as serious, as have some had been saying. The issue that really concerns me the most, if I can be frank is that the alliance at that some noble Lords have been placing on the Care Quality Commission. -- Reliance was that I have to say it is at the Care Quality Commission the back here on 29 July, last year, the Secretary of State was treating described as, "Are not fit for purpose. " After a damning report that found significant failures with the regulator.

I quite understand that a lot of work is taken place, I know that there is a new management in place. I know that a lot has happened since then. It seems to me that the Care Quality Commission would actually be well advised to concentrate on its core business, which is that the inspection of social care providers, improving its current rating system, which has been found to be very relate negligent. I have to say some of the publicity, over the weekend, about some of the abuse of residents in care homes.

Which again, the CQC, if it had been operating properly would argue, I think, might have been able to pick up. That, in my view is aware the Care Quality Commission should be focusing its attention, rather than thinking of a new area like this. I'm sure the new inspector who was mentioned, mental health, is a excellent person. Can we honestly say that the Care Quality Commission has got that expertise? In depth? To do the role? Which some have been suggesting that it could and should do.

I think, to be honest, we are going to have to agree to differ on this one. I remain of the view that giving a voice to users, of the mental health system is incredibly important to stop I am absolutely sure that we will be returning to this at report stage, but on that basis I beg leave

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to withdraw. Is it your Lordships pleasure that the amendment be withdrawn? Amendment by Lee were drawn.
16:47
Baroness Parminter Portrait Baroness Parminter (Liberal Democrat)
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Amendment by Lee were drawn. For those adequate placements for those with severe eating disorders, both those sectioned and not sectioned. The need for it is because general acute mental health hospitals are not appropriate if we are going to ensure best outcomes for people with eating disorders and there is just far too few beds out there at the moment. Let's adjust that first point., The last point first. In the UK, there are 450 adult birds, accommodation of both NHS and private beds, 450 adult birds and less than half of that for children.

-- Adult beds. Last year there were 30,000 hospitalisations for people with eating disorders, which is a fourfold increase to 2010 when there were 7,000. It is meaning people are being placed in inappropriate settings, be that in general acute hospitals, in a general hospital down the road, or in out of area placements. All of those will deliver non-optimal recovery rates and will result in more costs in the long-term to the country as well as greater suffering to individuals and their families and carers.

It's pretty obvious to most people that eating disorders require a specialist star. It's not rocket science, people with eating disorders, if they are very severe, will need gastric tube feeding, a specialist skill. They will need to be issues of refeeding syndrome being avoided and the risk of cardiac devices. It's very clear why there is a need for specialist staff and indeed the APPG eating disorders did a report on the issue called the right to health which looked at why specialist eating disorder nurses are required, and those provisions are not in general medical mental health hospitals or indeed in new general physical health hospitals down the road.

It's pretty clear to most people that you need specialist staff. What's not so clear if you're not familiar, is about physical constraints of a general mental health facility are not appropriate, or not optimal for people with eating disorders. If you have severe eating disorders you need feeding six times a day. Six times a day will stop and you will have people who very anxious about eating and they will need to be supervised one to in a very calm environment. That is not what you get in a general mental health facility.

Those people will also need to be supervised, one-to-one, for a period of those meals, to help them keep that food and again, in a calm, spacious environment so they can be managed one-to-one. Those individuals will all have diets, weekly prepared, specially for them but will require a specialist canteen, not only will you need special staff to facilitate those visions offers meals, but you also need an area where people with eating disorders can be helped over a period of weeks to re-familiarise themselves with preparing food and being less anxious about touching preparing food.

You will need physically a second kitchen. The provisions in the general mental health facility are not optimal for people with specialist eating disorders. The legislation at the moment only asks the ICBs to focus on general mental health facilities. I'm not making the case that eating disorder sufferers are somehow special. Please don't think that. I'm in the case that they are different and for too long they have not had the focus on their needs, which is why we have so few eating disorder beds in this country at the moment.

This is properly a very poor attempt, it's my attempt, to ensure that ICBs are given a gentle nudge by the government to do what I think the government does want to do, which is clearly treatment majority of people with eating disorders in the community for those people who require beds, the ICBs at the appropriate time ensuring that there are those beds in the future. And not just relying on general mental health facilities which will not produce the outcomes we need. I beg

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to move. After clause 50, insert the new clause, as printed in the marshalled list.

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list. I rise to support Baroness Parminter, both in the particular Parminter, both in the particular that she raises as far as eating disorders are concerned, in her amendment, but on a more general
16:52
Baroness Browning Portrait Baroness Browning (Conservative)
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amendment, but on a more general point, in an earlier debate, I try to make the case that people being diagnosed with autism by clinicians should be seen by clinicians who specialise in autism. And I was reminded Fremont, when the Minister was responding to an earlier amendment -- I was reminded Fremont. When she talked about the parity of esteem between the physical health provided and the mental health. In the world of physical health, if you were to see an orthopaedic consultant, you wouldn't necessarily see the same consultant depending on the condition that you had.

The same applies today with cardiology where cardiologists now have more specialisms within cardiology and you would see the appropriate person, and of course the point Baroness Parminter was rising, the facility which go with this specialised treatment and assessment is very, very important. And I must just put to the Minister, wanted by Baroness Parminter and that ministers own words, it really is about time that as far as mental health is a generic term is concerned, that we stop regarding it as they did, within my lifetime, of just whatever the condition, just lock them up in a Victorian institution and they'll get the same treatment, the same facilities and so on.

Today, without increased knowledge of little help and medication for mental health, -- our increased knowledge of mental health and medication for mental health, and specialisms you're aware of, in particular eating disorders, it's about time that mental health was treated, if it is truly to be parity of esteem, like physical health is treated, and that the specialisms that occur and the specialists that are there to work within those specialisms are given the weight within their legislation that they specialists can be provided.

Because we know they are not. The very fact that at the heart of this bill before us is that we are taking autism and learning disability out of the 1983 Mental Health Act is because they were all treated the same and all lumped in together, treated by the same clinicians that they had specialism or not. This is an opportunity for the Minister and government to make sure that there is true parity of esteem and that conditions like eating disorders are treated in the way in which they

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should be respected. There was a case I remember of a

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There was a case I remember of a friend whose daughter who was 17 were suffering from an eating disorder. Had to go into hospital disorder. Had to go into hospital where she was not treated at all well. Where she was being criticised
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Baroness Merron Portrait Baroness Merron, The Parliamentary Under-Secretary for Health and Social Care (Labour)
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My Lords, I'm grateful to the noble Lady Baroness Parminter for bringing amendment 132 1322 Lordship's House. And for raising this important issue and indeed, as the noble Lord Lord Kamall said, for sharing personal experience of her daughters treatment at second reading and indeed, for showing today her overall experience with the provision of services. And the noble Lady Baroness Browning made the important point about different conditions needing different provision and support. And that was provided by the noble and learned Lord Baroness Lady Butler-Sloss as well as the noble Lord Lord Kamall.

It is of course the case that eating disorders are serious mental health challenges. And it is vital that those with eating disorders can access effective help quickly and we will continue to work closely with NHS England to improve access to the right and timely care and treatment for those with an eating disorder. But if I could in looking at this Pacific amendment refer to section 140, the purpose of that section is to ensure that improved mental health professionals have the services that are available to help them to locate hospital beds and special cases.

The intention of the amendment is to extend the duty on health authorities to notify local authorities of arrangements for urgent cases in under 18's to include specialist eating disorder units. Perhaps I could say two Lordship's House that section 1 does apply to arrangements for people who need inpatient treatment in hospital and that does include specialist eating disorder units, where they provide inpatient treatment in hospital setting and are appropriate for someone to be detained in them. Therefore, whilst I absolutely understand the points that are being made, I would say in respect of the amendment that it is not necessary to specify that section 140 applies to specialist eating disorder units

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and I hope that the noble Baroness will feel able to withdraw her amendment. I'm grateful to members around
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Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (Liberal Democrat)
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Baroness Tyler. It is me again. I'm rising to

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It is me again. I'm rising to move amendment 134 and I'd like to thank my noble friend Scriven and a noble Baroness Bennett adding their names. Of course we have names. Of course we have acknowledged already that the provisions included in this bill rely heavily on having a strong effective community provision in place. There are real concerns within the sector. Community provision is not currently sufficient to support the changes are set out in the bill. And in my view the new duties are placed on local authorities and Integrated Care Boards, to ensure, "An adequate supply for community support, lack teeth and a real accountability To ensure that this duty is being fulfilled.

Was quite my amendment at 134 places a general duty on Integrated Care Boards to ensure that services in the community at the necessary level of resources to meet demand for services. It is a very closely related, I think, to the amendments in group 1. We have already debated. And indeed I'm not quite sure. This one wasn't included in group 1. So I should just carry on. It is worth noting I think that the Equality and Human Rights Commission in their response to the Joint Committee recommended that the Government should, in line with the recommendation of the independent review ensure that they were sufficient, high quality community- based mental health services and proper pathways to meet the needs of all adults, children and young people.

And they stress that this should include therapeutic alternatives to detention, preventative support, to minimise the risk of crisis and wider community services that enable good mental health recovery. Something I will be returning to in a later amendment in a later group. Is that the noble Lady the Minister able to say what consideration the Government has given to that specific recommendation? And the EHRC also felt that the current bill needed strengthening to ensure sufficient community-based services in practice, so as to end inappropriate intentions and this was highlighted, in the most recent annual review, the Mental Health Act, by the Care Quality Commission.

Which stated, "while we support the government's objective to reduce hospital admissions, for people with a learning disability and autistic people, under the Mental Health Act, this can only be achieved by an increase in community support, including trained staff and high Now, I just want to finish, by particularly focusing on workforce aspects. Following the previous government's 2021 White Paper, the Royal colleges countries an independent assessment of the impact of the proposed changes on a psychiatric workforce, to better understand how many additional psychiatrists would be required to deliver the report.

And the proposed year of implementation, indeed 10 years later. Based on that White Paper, the research found that by 2023/24, an additional 334th full- time psychiatrists would be needed in England, costing 14 million per year, by that year. By 2003, 34, a further 164 equivalent psychiatrists would be needed. While these figures would be needed. While these figures were not necessarily, I think actually affect the exact numbers of psychiatrists are needed to deliver the reforms we are talking about in this bill, the current timelines in the legislation, I think they do demonstrate very clearly the impact of the workforce, the workforce which is already understaffed and carrying the high vacancy levels.

Now, NHS England set targets, back in March 2016, have an additional 1040 consultant psychiatrists, in post, in England by March 2024. And based on these targets, I think as of July, last year, there was a short form of some hundred and 70. There is a big short. The impact assessment, as far as I can see is silent on where these people are going to come from., The people no longer admitted to hospital. It also estimates some 5.5 The people no estimates some 5.5 billion worth of savings from a fewer overall admissions and you are detentions people with a learning disability or autism.

Both go on to say that the benefit should not be understood as cash benefits. Sick of the noble Lady the Minister say what specific mechanism will be used for diverting more money, into community services. Psychiatrists of course are only critical, they are only one part of the wider mental health force, which also includes mental health nurses, clinical psychologist, social workers, occupational therapists and others. Could the noble Lady the Minister responding say whether detailed plans to grow the overall mental health workforce will be contained in the 10-Year Plan, in the upcoming spending review.

I'm conscious of being asked by quite a lot of detailed questions. The noble Lady the Minister will refer with her response, that's fine. I'm sympathetic to the aims of 157 in the name of the noble Lord Davies, about to move.

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After clause 15 insert the new clause printed on the marshalled List.
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Baroness Bennett of Manor Castle Portrait Baroness Bennett of Manor Castle (Green Party)
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List. Is a pleasure to follow Baroness Tyler of Enfield and offer support to the noble Lady. I will be a very brief, because there has already brief, because there has already been a comprehensive introduction. I And see how perhaps that we might look, when we get towards report stage in some kind of composite to. This amendment places, the reason why I signed it, places a general duty on Integrated Care Boards to ensure that services, in the community had the adequate level of resource.

Of course, who gives the resources to the Integrated Care Boards? Ultimately that is the government. My earlier amendment sort of the regular processes of reports and parliamentary oversight. I would suggest that what we actually need is both, I think this is a very strong and good amendment, to give the duty to the ICBs, but we also need to see that there is the oversight that the ICBs have the capacity given to them to support

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the duty that they are being given. I plan to move the amendment in

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I plan to move the amendment in my name, 157. This amendment seeks to clarify the responsibilities of to clarify the responsibilities of Integrated Care Boards and local health boards to find beds for health boards to find beds for patients admitted under section 140 of the Mental Health Act, in a of the Mental Health Act, in a timely manner. I'm going to argue
17:08
Lord Davies of Brixton Portrait Lord Davies of Brixton (Labour)
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that this amendment goes to the heart of why we've got the bill in the first place. It was because of the practical problems experienced, in obtaining a proper care, for people that was a large part that led to the introduction of the bill, to Sir Simon Wessely's review and the committee. It reflects an important aspect of the transformation that has taken place, in understanding, in the understanding and treatment of mental illness. It reflects the importance of timely and effective care for people experiencing crisis with their mental health.

The current bill seeks to fill in gaps in mental health care that can mean the difference between rapid intervention and needless delay. My proposed amendment to section 140 is both necessary and overdue. It would amend the section to place a clear responsibility on every Integrated Care Boards and local health board to ensure that patients who assess as requiring hospital admission under the act receive it in a timely and appropriate manner. In particular, to that end, it mandates a clear line of responsibility, by requiring the appointment of a designated officer, charged with overseeing these admission arrangements.

As outlined in the act and established that they are not only established, that they function effectively on a day-to-day basis. This isn't a mere administrative adjustment, it is an important change aimed at addressing real- world issues that affect the lives of countless individuals. Mental health crisis occur without warning and do not adhere to schedules or bureaucratic timelines. The local health boards and the Integrated Care Boards are the crucial link, between community services and hospital care.

By placing a clear statutory duty on these organisations. There will be a clear line of responsibility to ensure that no patient is left waiting whenever immediate care is needed. The appointment of a designated officer will further enhance accountability and operational efficiency. Just to emphasise the point an independent individual with the specific responsibility of overseeing these arrangements will provide a robust mechanism to promptly address any issues that arise. To ensure every patient's admission is swift and appropriate.

It is important to understand the boulder implications of this amendment. Timely admission to hospital is not merely a procedural matter, it is a critical component of effective mental health care. Early intervention can be the difference between a manageable crisis and a catastrophic decline in a patients condition. By ensuring that patients are admitted properly we are investing in early treatment, reducing the likelihood of complications and ultimately alleviating the burden on our healthcare system. This proactive approach will lead to improved outcomes for patients, greater satisfaction among healthcare professionals and a more sustainable model for mental health service delivery.

To conclude. My amendment is a necessary step forward, it provides clarity, reinforces accountability and ensures that our mental health system remains responsive and effective. I urge my noble friend the Minister to respond positively to my amendment, not merely as a change of policy but as a commitment to the well-being and dignity of every individual who depends on our mental health services.

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I write to support amendment 134. I'm hoping I get the etiquette right as this is my first contribution to
17:13
Baroness Ramsey of Wall Heath Portrait Baroness Ramsey of Wall Heath (Labour)
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as this is my first contribution to committee stage and I know a noble Lords will probably write me if I get it wrong. Disabilities and autism are generally detained because there is insufficient community support available to keep them another say. Amending the Mental Health Act will prevent from being detained under this provision shall be ineffective unless it is covered by serious investment and support. Without such investment it can actually be worse for people with learning disabilities and autism, because of community support is an available, doctors and social workers will keep other ways to keep them safe is that they may be tempted to use the Mental Capacity Act there by taking away almost all agency and rights, not just those in respect of treatment.

They may be tempted, they may find themselves tempted to get prosecutors involved in response to challenging behaviours. Simply because the Criminal Justice System means that they can use it under the amended MHA. What an irony that would be that the consequences of amendments to the Mental Health Act designed explicitly to reduce the tension led to the worst forms of detention. Integrated Care Boards ensure that resources are made available to secure the necessary support is absolutely vital for the bill to be effective.

And I mention here, it is relevant that I support the spirit of Lord Stevens and others, noble Lords amendments, 163 and 164. And if the necessary investment is made by Integrated Care Boards, the future of learning disabilities and autism could be so much brighter. I have seen was a wonderful different this can make. I will never forget, my work visit in relation to young people with learning disabilities and autism, to estate special school in the London Borough of Islington, part of the British trust for those with severe autism and other special needs.

How well supported they were by integrated teams and social workers, health and educational professionals. I asked the chief education officer, sorry the chief Executive officer, Dr Barrett, who set the school up, how it started? She told me that she had been listening to the news one day and heard a report about a boy with autism his behaviour was so challenging that he was being held down by seven people, in A&E. Her background, as a special needs teacher and that she knew that the next step for him it was bound to be a long-term segregated detention.

And she was inspired in that moment to do something about it, the special school was born and wonderfully that young man is now one of its pupils. There is unease were as great as ever, with no language, expert care and support, from loving professionals meant that he was having a fulfilling life, in a room with other people's, no detention, no segregation. So let us legislate to make clear that this is

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I would like to welcome

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I would like to welcome particularly the contribution from the noble Lady Baroness Ramsay. This
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Lord Stevens of Birmingham Portrait Lord Stevens of Birmingham (Crossbench)
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Inspired by the last two contributions I wonder if I can briefly pick up the point that Baroness Tyler made in respect of Baroness Tyler made in respect of amendment 134. A particular question of the availability of psychiatrists which she pointed to. I think the noble Lady the Minister referred to the longer training times for psychiatrists than for other mental health professionals as one of the limiting factors that would affect the speed with which the measures in this bill could be implemented.

My request to the noble Lord the Minister is, given it's really quite hard in the impact assessment to tease out what the government think the incremental requirements for psychiatry art year by year over the fermentation period, and in fact slightly perversely, uses a mixed currently, I think I remember her responding to amendment 163 by saying there was a requirement for 400 additional psychiatrists for the second opinion service but actually when you look at the table, it says that the headcount number, driven by the whole time equivalent number, whereas for the rest of the whereas for the rest of the workforce as a whole time equivalent number.

It would be good to nail what is the incremental requirement for psychiatrists year by year, on the whole time equivalent basis so the whole time equivalent basis so Psychiatrists, Psychiatrists, that Psychiatrists, that would Psychiatrists, that would be

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supremely helpful. To try to draw together some
17:19
Baroness Barker Portrait Baroness Barker (Liberal Democrat)
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To try to draw together some strands that we have been discussing all afternoon, in this debate, I all afternoon, in this debate, I want to ask noble Baroness when she responds to share with the committee the thoughts on the departments, the government's thoughts on planning, on workforce planning, and the modelling that they use for production of demand. As I sat and listened to my noble friend Baroness Parminter, introducing her amendment, so eloquently, it brought to mind one or two instances of friends of mine who have been in a position where the child has been diagnosed with a very severe eating disorder.

And they had then been told, but you are not sufficiently ill for anything to happen. And nothing, from that stage, nothing happens. If it was a physical illness there would be some kind of process. Maybe not a care pathway. I'm sorry I'm one of those people who is very cynical about care pathway, that is a very overused phrase throughout the whole of health, but I think the diagnosed and then just left until they become so ill that it is in impossible to ignore.

We have seen the trends in the number of young people with eating disorders which Baroness Parminter has says come. What is the Department doing to forecast the demands for specialists of that nature in future? I want to also return to some of the conversations that were sparked a debate sparked by the noble Lord Lord Davies of Brixton. We know that the police are going to withdraw from being the first respondents and people are in crisis. What modelling is the government doing in terms of community provision that is needed to deal with the people who will still be in crisis? There not going to stop having crises? The problem will be more likely to sharpen hospitals actually than ever before because that's where people go in the middle of the night when they have crises.

This is the sort of argument that the noble Baroness Baroness Tyler was trying to get to. In her discussion of having a mental health Commissioner. He is going to be the person who is in a position to take the government to task for its planning and preparation, for demands on the health service in the future? That's the kind of thing we are trying to get to. All of us in

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various different ways have been trying to get to it all afternoon. Can I just say that I didn't talk

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Can I just say that I didn't talk about a care pathway. Perhaps I should have said patient journey. I was talking about the patient pathway, the actual experience of the person. It's not separated in their lives.

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their lives. I will be brief on this one, can I thank the noble Lady Baroness Tyler this amendment and also noble Lord so I think it very valid Lord so I think it very valid points. It's clearly another sensible proposal highlighting the importance of making sure the ICBs commission sufficient mental health services in the community to meet the demand. As noble Baroness
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Baroness Merron Portrait Baroness Merron, The Parliamentary Under-Secretary for Health and Social Care (Labour)
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Let me thank noble Lord for their contributions on the debate on both these amendments and I will first turn to amendment 134 on the name of noble Baroness Lady Tyler, spoken to noble Baroness Lady Tyler, spoken to by my noble friend Baroness Ramsay and the noble Lady Baroness Barker, both of whom shared real-life examples to illustrate what is being spoken about here. This duty to consider mental health needs as well as the needs of those with learning difficulty and autistic people, the duty to consider those needs in the community as well as in hospital is already covered by ICBs under the National Health Service act 2006, as amended by the Health and Care Act 2022.

And ICB just -- must arrange for the provision of services to Date as it considers necessary to meet the reasonable requirements of the people for whom it has responsibility. ICBs and their mental health trusts are also required to prepare a joint forward plan that describes how the ICB will arrange for NHS services to meet their populations physical needs, mental health needs and the needs of those with learning disability and autistic people. Perhaps if I can make a general point with regard to the long-term workforce plan, noble Baroness Barker, raised this, that will report in a few months time, later in the year, which I hope will give a lit lot more substance to the kind of questions being raised, and the noble Lord Lord Stevens asked about incremental requirements for psychiatrists on a year by your whole time equivalent basis.

To that noble Lord, but I would say is the impact assessment sets out the best estimate at this point. But the plans do need to be seen as somewhat iterative. With regard to further specific questions including those raised by the noble Lady Lady Tyler, I will indeed be glad to write. Turning now to amendment 157 in the name of my noble friend Lord Davies and spoken to by the noble Lady Baroness Bennett, as we have already Baroness Bennett, as we have already discussed in relation to amendment 134, there is already a duty on ICBs to provide sufficient hospital and community services under the National Health Service Act 2006.

Furthermore Chapter 16 of the Mental Health Act code of practice already states that local authorities, NHS commissioners, hospitals, police forces and ambulance services should have local partnership arrangements in place to deal with people experiencing crises in mental health. We do accept that there are issues with bed capacity and patient By part of what happens to patient and they are linked. That is why the recent NHS planning guidance shows local systems with reducing the length of stay in mental health wards and have committed £26 million to improve mental health crisis care with a further £75 million to reduce inappropriate out of area placement.

All of this is already enshrined and does not suggest a requirement for primary legislation, so if -- for these reasons I ask these amendments be withdrawn.
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Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (Liberal Democrat)
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I would like to thank the Minister yet again for her response. It seems to me that we have had a number of discussions so far this afternoon in this sort of very broad general area and indeed was alluded to on a previous committee day as well. They are interrelated, it's quite hard to separate out sometimes the individual groups. I think at the heart of all of the discussions we have had, is concerned on two things, firstly how we will ensure that there is sufficient provision within the community, to provide the sort of services which we all hope to see and which are fundamental to the successful implemented ocean of this bill.

And secondly, I think what really came out very clearly, was the need for really good work cross planning and to understand that work cross planning on a year by year basis. I was encouraged to hear from the noble Lady the Minister that we can expect to see the long-term workforce plan. I think she said it in a few months time. Very much look forward to that. Hope that it does include some of the modelling, the workforce planning and modelling that might noble friend Baroness Barker was referring to.

And hope amongst all things that it's likely clearer than the impact assessment which I have to be honest, it may just be me, it might have been late at night when I was looking at it but I found it somewhat on the opaque side. I'm really hoping for greater clarity, when we see the long-term workforce plan. I just think this issue isn't going to go away. So in what form we return to it at report stage, I'm not quite sure. But for the moment, on that basis, I beg leave to

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withdraw the amendment. Is that you pleasure that this

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Is that you pleasure that this amendment be withdrawn? It is by amendment be withdrawn? It is by
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Lord Davies of Brixton Portrait Lord Davies of Brixton (Labour)
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amendment be withdrawn? It is by And moving amendment 135, I feel grateful for the support for the grateful for the support for the amendment, from Baroness Tyler of Enfield, Baroness Bennett Amana Castle. I'll be a little bit disappointed if I do not get some support from Lord Kamall. This amendment would require the established and successful procedure, the mental health crisis breathing space should be offered automatically, to those detained under longer term sections of the Mental Health Act.

This is the final one out of a set of three amendments to the Mental Health Bill, in my name that have addressed the financial implications for people who struggle with their mental health. In these debates I've previously referenced that I'm on the advisory board of the money advisory board and this is based on the Institute's work. I would like to take the opportunity to briefly thank my noble friends for her engagement on Amendment 79 121 which are also in my name.

Would seek to ensure that routine enquiries on financial matters are embedded in care treatment plans and that advanced choice documents stop I'm grateful for the Ministers acknowledgement and understanding on these issues. This amendment 135 calls for mental health crisis breathing space to be automatically offered to those detained under sections 3, 37, 41, 47 of the Mental Health Act. Out of the three amendments in this set on financial issues, it is this one which perhaps has the greatest scope for reducing the financial harm is that people experience, when they are facing a mental health crisis.

The mental health crisis breathing space mechanism is a vital tool that can protect people, in a mental health crisis, from the impacts of a problem debt, by pausing enforcement action and contact from creditors and freezing interest and charges on any debts. These protections are provided for as long as the treatment lasts. Plus another 30 days afterwards. When people access this scheme, it can be life changing. It can be the difference between people leaving hospital, after a mental health crisis, to find that bills and debts have escalated, thus putting their recovery in jeopardy.

While having the space they need to get back on their feet. I would just like to share the words of one of money and , with personal experience of accessing the scheme he said, "Breathing space has totally changed my experience from feeling hounded and persecuted, to supported and valued. It took away a much fear and sleepless nights, coupled with dire days of depression. " But in its current provision, use of the scheme is a significant below its potential and the numbers are forecast by the government.

When introducing the scheme in May 2021, the Treasury anticipated that 27,000 people would use it, in its first year. Yet, the most recent figures from last November show that only 4404 have accessed it in total. This underutilisation is not due to a lack of demand, or need to. Instead it is due to how the scheme is designed and delivered. Existing NHS guidance on acute inpatient mental health care, already states that wars should offer mental health crisis breathing space to those who need it.

This is a well-intentioned, but does little to drive the take-up of the scheme. In practice, thousands of people who would benefit from the support of this are missing out. Simply because nobody asks. On top of this, awareness of the mechanism is extremely low among mental health care professionals. Meaning that even where financial difficulties are spotted, that doesn't always result in people accessing the protections the mechanism affords. My proposed addition to the legislation would ensure that there is a statutory obligation to offer this mechanism and for those who need it most stop requiring the services to be more thorough in its implementation, with greater levels of accountability.

Specifically, automatically offering a breathing space, to people detained for potentially long-term conditions will ensure that those whose incomes are likely to be adversely impacted by extended emissions can be supported. This intervention would target the core group that the mechanism was intended for. Now the possible reach of such targeted interventions, 23/24, there were a potential of 11,000 detentions under the relevant sections of the act, representing 1/5 of all detentions. Formalising 1/5 of all detentions. Formalising the automatic offer of a mental health crisis breathing space, to this targeted group, would go a long way towards ensuring the mechanism supports a number of people the Treasury forecast to serve.

Crucially, after the breathing space. Has ended, people would then have the opportunity to be offered formal debt advice, with a specialist support for those who need it, to ensure that financial difficulties are resolved, on a long-term basis. Less legislation for the team to be automatically offered to those detained under the longer-term provisions of the act, would be a genuinely transformative in preventing more people from experiencing the acute financial harm is that too often accompany a mental health crisis.
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Baroness Bennett of Manor Castle Portrait Baroness Bennett of Manor Castle (Green Party)
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I beg to move. and to offer the strongest possible support. These are issues that the noble Lord and I, the noble Lord are very much in the lead, me following along in support have engaged with financial services and it was previously. They are crucial issues for people's well-being and the well-being of our whole society. I think Baroness Hollins, in the last group was talking about the patient journey. If we think about the journey of someone who has become ill, is seeking treatment and has the weight of debt sitting on their shoulder.

How much damage that weight of debt can be to the whole experience of the patient journey. I think it is worth thinking about how this interacts with issues around discrimination, issues around unequal outcomes we have looked at in other terms of parts of the bill, the intersectional pressures that people can experience. In preparing for this I was looking, the middle of last year, mental health awareness week, the Women's Institute focusing specifically on the impact of energy debt and 14% of the people in the study were in that stage, in a debt to their energy supplies.

Nearly 1/3 said that they were worrying seriously about this. 1/5 said they had suffered sleepless nights. If we think about the people who are suffering under debt pressures, single parents, very often women, people from disadvantaged communities who are already economically disadvantaged. All of these things are feeding together. This is simply a measure. The term breathing space I think is so evocative of the sense of it to take off that pressure and allow people the chance to focus on their own recovery, to focus on their own treatment, rather than just worrying away that debt.

I really cannot see why the Government or anyone would

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oppose this very modest measure. I should have declared interest
17:39
Baroness Neuberger Portrait Baroness Neuberger (Crossbench)
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I should have declared interest before, as chair of University before, as chair of University College London NHS trust, Whittington he. I was a vice chair of the review of the Mental Health Act, reported in 2018, which is relevant, because I very strongly support this amendment to which I've added my name. It is some that the review did not actually address. We should have done, I just think that we didn't have it raised sufficiently strongly with this, by service users to whom we talked a great deal.

In fact I think that was an omission. I do believe that it is very important we do this. I hope that the noble Lady and the Minister will be able to say that this is something that will be included in the legislation in its final form. Except this amendment or something already drafted along these lines. I would be very grateful to the wonderful money and policy Institute and I paid full tribute to Lord Bradley. Am immensely grateful for the briefings.

When they conducted a piece of research were 200 people who received care, from secondary mental health services. That was back in 2022. Looking at their finances, they really found, quite unsurprisingly that the majority of the people who responded had the people who responded had experienced an income drop, was receiving support from mental health services and struggle to pay for their mortgages, all food, all missed a payment on energy, or rent, or council tax or whatever it might be. This was a problem that kept coming back.

They kept talking about. The majority also expressed real support for the idea of making plans ahead of time of how to deal with their finances, how this will all be managed, when they are unwell, as many people have episodic periods of being unwell. It is seems to me that that piece of work is a cast-iron argument, in itself, in favour of the breeding space and tackling these issues. -- Breathing space will stop I hope the Minister will be able to support this.



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I write very briefly to add my support to this amendment. I have
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Lord Kamall Portrait Lord Kamall (Conservative)
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In speaking to this amendment can I pay tribute to the work of the noble Lord, Lord Davies, in raising this issue in this House. And through the noble Lord to work with the mental health policy Institute, the noble Lord Davies has hope very much that he would get my support, I can assure him of that. Today and in previous answers, related to advance choice documents. The noble Lord spoke powerfully about the need to understand the link between financial problems and mental health problems.

And it also reminded us of that while it may not be seen as a priority for people to take out the Mental Health Act. It is not difficult to see why they main neglect their personal finances. During this time, debt will grow. This could lead to debt collectors or bailiffs being called and only making the situation far worse. I was particularly struck by the personal testimony that the noble Lord, Lord Davies read out from a person who was helped by the health policy Institute.

About not being asked if there was anyone who could open their mail and keep on top of their day-to-day living. Then, as a their day-to-day living. Then, as a Lord Davies told us it was a spiral of treatment to find that their finances were in a bigger mess. It is a bigger mess, it in these two terror, shame, guilt and did undo the work of the treatment that they originally went in for. Also, as Baroness Bennett said, I think the phrase a breathing space is very evocative of what we're asking for here.

I think it's worth repeating. This amendment does not necessarily require healthcare professionals to offer financial advice. We are not asking them to be financial advisers, what to do with issues. It is about empowering them to identify people in need and refer them to the
17:46
Baroness Merron Portrait Baroness Merron, The Parliamentary Under-Secretary for Health and Social Care (Labour)
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I I thank I thank him I thank him for I thank him for amendment I thank him for amendment 135, I thank him for amendment 135, supported by noble lady's Baroness Bennett, Baroness Neuberger, and Bennett, Baroness Neuberger, and Baroness Tyler and also spoken to by the noble Lady Baroness Watkins and supported by the noble Lord Lord Kamall. I would certainly agree that breathing space can indeed be what could be described as a lifebelt for people in problem debt.

Especially where this is worsening or is indeed a trigger for their mental illness, as my noble friend Lord Davies spelt out. And the noble Lord Lord Kamall endorsed. Individuals who are detained in hospital for assessment of treatment under the Mental Health Act are eligible for the scheme as well as those receiving Crisis treatment in the community from a specialist mental health service. And approved mental health professionals can refer eligible individuals to protect them from debt enforcement. These professionals are often the first on the scene when a person is in crisis and are responsible for arranging assessment under the act.

Therefore when a person is admitted to hospital, they may have already been enrolled in the scheme, on the scheme. And if not, NHS England guidance eight out of the financial support including referral to breathing space, should be offered to patients receiving acute inpatient mental health care, whether detained or voluntary. I can say to your Lordship's House that we do intend to make this an explicit requirement in the Mental Health Act code of practice. I feel that's particularly important as the noble, my noble friend Lord Davies raised the point about.

And certainly I would recognise that uptake has been lower for the scheme than originally anticipated. So whilst we don't believe this is a representation of the scheme significantly underperforming, I can assure my noble friend we will continue to keep the scheme under review to ensure it is working effectively for those who need it, and needed indeed it is. So it's for these reasons I hope that my noble friend will withdraw the amendment.
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Earl Howe Portrait Earl Howe (Conservative)
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ill Howell. I rise to move amendment 142 and I will speak to amendments 143 and 144 standing in my name. These amendments are about one critical issue, an issue that has proved seemingly intractable despite best efforts for many many years. That is the way that the mental health system looks after child patients. I'm not just talking about child patients who have been compulsorily detained under the Mental Health Act although they are the subject of amendment 143.

I'm referring also to children admitted to Mental Health Units Act as inpatients, for any reason at all which is the subject of amendment 144. Those noble Lords who are veterans of the last Mental Health Bill in 2007, and I can see one or two, will remember that the late Lord Williamson of Horton, former convener of the crossbench peers, who made this issue, his crusade, unfortunately then with only limited success, we are still living with the problem, the current Mental Health Act code of practice says it is government policy for under 16's not to be admitted to an adult ward, which is fine as far as it goes.

Although in my book, and we are talking about children, we should be including young people aged 17 and 18. The government promised to eliminate the appropriate -- inappropriate use of beds in adult wards but that has not happened. Last year, the CQC happened. Last year, the CQC Children me with first-hand accounts from children and people placed on adult mental health wards who have been some -- been through some harrowing experiences. One has said "as a child I spent over 50 days in a mixed gender crisis unit, there were some very scary stuff that happened, during my first unit I witnessed a team of police dressed in riot gear with white shields and dogs during a drugs search.

At one point my bedroom was next door to a man who wrote a students nurse's nose and smeared his own bodily fluids of his bedroom wall. I was constantly scared and on edge and the ward was constantly unsettled. The staff on the ward were not trained on child restraint. So I often ended up really hurt. It would be like really big men who are used to going up to forensics to restrain people, and then coming to restrain me.

The little girl the time, basically. It was horrific. ". That may be an extreme case and one trusts it is. But there are many cases that fall not far short of that level of emotional damage. And it isn't that extreme with regard to complete absence for a child of any therapeutic benefit. Another witness said "the worst thing about adult wards is you can't access any intervention at all. No art therapy, no psychiatry because you are under 18, so they say they don't have the appropriate training to work with you.

When I was an adult ward or medication went and reviewed. I wasn't allowed to Ask for ANI thing, not even allowed outside ". What is the best way of solving this problem? The coach taken in these amendments is to say that when a person aged under 18 is in desperate need of inpatient mental health treatment, the clinical decision- making around admitting that person to a mental health should as rigourous as it can be to avoid as far as humanly possible admitting that patient into an adult ward.

So there has surely to be a determination around best interests. And they need to be procedural safeguards so that if it is decided that an adult ward is the only available option in a particular case, there is appropriate transparency around that decision, such that the local authority is informed of the fact in the hospital itself publishes statistics in its annual report recording the number of instances during the year when this has occurred. I'm also suggesting a report to the local authority is equally appropriate, in a situation where a child is accommodated in a hospital or mental health you that is situated outside the local authority area in which the child is ordinarily resident.

In one of our earlier debates we talked about the particular vulnerability of children who were treated in hospital far away from home. Letting the child protection officer would go somewhere at least to mitigate the risk of the child self harming. There may be some members of the committee who think I have been far too lenient in tabling amendments and feel I should have taken more stronger amendments opposing the outright abolition of placements involving children in adult wards. I quite deliberately haven't done that, for the reason touched on in earlier debates which is that we have to work with the world as we find it, not as we ideally like it to be.

We have to recognise that in a few cases, sometimes desperate cases, a temporary stay on an adult mental health ward could be the only of saving a child from death or serious injury, and in those cases, I suggest it isn't for us in Parliament to prohibit the practice outright. Let me touch funny and amendment 142. A child being treated in a mental health inpatient unit who also has a physical disability, can sometimes get a very raw deal. If the unit they are on has areas that are in practice inaccessible, to that child, that simple fact can have a huge impact on their access to treatment.

One member of Looming And rule to speak to the psychologist was upstairs in the unit and there was no way for me to access that space. I kept being told she would come down to see me somewhere else during my stay but it didn't happen so for me, my physical impairments meant I didn't get equal access to the support. This isn't the sort of amendment that I would choose in the normal way to bring back a report but the questions that it raises are important enough for me to ask the Minister with the Department and NHS England are sufficiently aware of that kind of problem and what if anything is being done to address it.

I beg to

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move. Amendment proposed after clause

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Amendment proposed after clause 15, insert the new clause printed on
17:58
Baroness Berridge Portrait Baroness Berridge (Conservative)
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the marshalled list. I rise to speak to amendments 51

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I rise to speak to amendments 51 cup 159 and 160 that I have in this group. In relation to amendment 159 it is similar in vain to the amendment 143. It's merely a different notification procedure where a child has been present on an adult ward but it is also to the local authority and also applies to out of area placements which were noble friend Earl Howe mentioned. It's really important that information is given to the local authority as it rates to speak to amendment 160.

They have the duty to safeguard and particular Children In Need. I want to join with my noble friends comments around how the bill is treating those who are 16 and 17 and we have in relation to other areas of the bill raised these issues that actually, in law, they are children and they are treated as children by the professionals as the example outlined of the psychiatrist saying, I don't have the training to do this. Under 18's are treated as vulnerable young people and children.

And one can also draw attention to the fact that under 18's on a longer allowed to marry in our country. The increasing coming in line with the fact you are a child and have the protection of the law until you are 18. In relation to amendment 160, this relates to Children In Need. The section 17 of the Children Act. This was a the Children Act. This was a recommendation made by the review, at number 117, which said the Children Act should be amended to clarify that any child or young person admitted to a mental health facility is regarded as a child in need under section 17 of the Children Act, so parents can ask for services from their local authority, and that will be particularly important if the child is placed out of area.

That's recommendation was rejected by the government in its published response to the review. But I note the review also asked for the child, for this revision to be, if the child is admitted. That means is a voluntary patient as well as being admitted under the act. I have played this amendment to clarify the government's response to this. At response stated that basically this isn't necessary to amend the Children Act. Because disabled children which include children suffering from a mental disorder are deemed already to be Children In Need.

So there is no need for this recommendation. As I believe Children In Need are dealt with by children social in any local authority. The government response to the Wessely review rejecting this goes on to recommend amendments to the statutory code of practice, working together to safeguard children. It states that the guidance should be amended to ensure it is clear that hospitals which are responsible for children in this situation should consider whether a referral to children's social care When one then states that a referral seems to introduce some form of discretion.

Is this an additional process that there should be some referrals above and beyond Children In Need? Because if you are already deemed to be a child in need and that is the case for disabled that is the case for disabled children. That children suffering, but children are deemed to be Children In Need. There is no need to amend the Children Act. Children will already be automatically a child in need. The latter part of the government's response seems to introduce this a form of discretion.

Is this the case that it is automatic. It is important here, because the local authority makes an assessment as to whether a child is in need. You can imagine for parents, additional assessment, are we a child in need. The government doesn't seem to be children that are detained, are they automatically a child in need? Or is there some form of discretion at the hospital or some official process at the hospital has to go through to ensure that there is a referral.

That is important for parents. Although they do not have a right to the additional resources, which can even include accommodation, under section 17 of the Children Act. It does give them a power of the local authority and it does enhance that the powers of rights parents rights to ask for additional support. Could the noble Lady the Minister clarify what is the position here? Is this automatic or is there a discretion and can she outline whether those amendments to the statutory code of practice, working together to keep children safe guarded have actually been made.

made.
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Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (Liberal Democrat)
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I rise very briefly to add my support to amendment 143, 144 in the name of the noble Earl Howe. I added my name to these amendments. I'm also very sympathetic to the other amendments, in this group, both 142 and the amendments Baroness Berridge has just referred to. The noble Earl Howe introduced these amendments, compelling and moving and comprehensively. In a way I do not feel there is much for me to add. I will say that I did have to think, quite hard.

There was a part of me who wanted an out right prohibition. I did recognise the state of the mental health services we have at the moment and the fact that there are just times, where unfortunately, hopefully in a few, as I think the noble Earl said, a few desperate cases for a very short time. These sort of measures have to be taken. As undesirable as I think it is, we do need to recognise, I think, that the world in which we live.

I would also like to underline the importance. Because most of the debate so far has been a children in adult wards, which is obviously adult wards, which is obviously Also children are placed out of the area. That is so often the weather isn't as suitable or available bed. It goes back to the issues raised by my noble friend, Lady Parminter. About eating disorder beds. Hugely detrimental, I think, for Children and Young Persons Act, to be placed out of area. Away from their support networks, their family and their friends, who they are so desperately need, as part of their recovery, at a time as a real crisis.

And so, I just wanted to underline the importance of that, as well, as the importance of real transparency and rigour, when a child, very unfortunately is placed in, hopefully for a very short period of time, in an adult ward.
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18:09
Baroness Merron Portrait Baroness Merron, The Parliamentary Under-Secretary for Health and Social Care (Labour)
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My Lords, let me first turn to amendment 142, one turn to amendment amendment 142, one turn to amendment 142, 143 and 144 in the names of the noble Earl, Lord Howell and supported by the noble Lord, Lord Kamall and also joined by the noble Lady, Baroness Tyler and amendment Lady, Baroness Tyler and amendment 143 and 144. I also wish to turn to amendment a 159 in the name of the noble Baroness, Lady Berridge. And let me start by thanking the noble Earl, Lord Howell, for the way in which he introduced this subject.

And for the understanding and shock shared by my noble Lord Berkeley and the noble and learned Baroness, Lady Butler-Sloss. I'm sure we would all share the thoughts and views that they have expressed. To the noble Lord, Earl Howe, would also thank him for his reference, I would certainly like to recognise the important work that they do and the way in which he introduced their observations and experience really highlighted the reality we are here to deal with.

On amendment 142, it is crucial that people with physical disabilities have equal access to mental health services. Under the Equality Act 2010, those who are providing mental health services, including under the mental health act must make reasonable adjustments to ensure that people with disabilities are not at a disadvantage. Therefore, the aims of disadvantage. Therefore, the aims of this amendment are already covered, by existing legislative requirements. I did hear what the noble Lord said, about an example of where this was not the case and I can only add my comments to say, of course, this is not accept the ball.

And is not at all how legislation would expect a provider to act. Let me say to your Lordships' House, we will review the guidance of how to support individuals with the disability, including children will be consoled on the revised code of this and as part of NHS a new service specification which will set out requirements for children and people's mental health services. I hope that will be helpful to meet the points raised, within amendment 142. Turning an hour to amendment 143, 144 and 149.

The policy of NHS England is clear that children and young should be able to access the right type of services as close to home as possible and in the least restrictive environment. We do not want to see Children and Young Persons Act on adult wards or placed far from home and are working to secure the necessary investment to expand support and specialist beds to prevent this from happening. I'm grateful to the noble Lord, Earl Howe, for referring to we must deal with where we are, rather than where we might want to be.

That is what we are also intending to do. There are already provisions in the act, which seek to limit inappropriate placements for Children and Young Persons Act. 131A, hospital managers must ensure that the patient environment is suitable, having regard to their age. We do believe And nuance involved in determining any circumstance where it is in the child's best interest to be treated on an adult ward, or an out of area placement, if it is better, in the revised code of practice, rather than legislation, and which would apply fix roles that could not be adapted to individual circumstances or service provision.

We will provide additional guidance on the process determining reviews, throughout a child's detention and treatment that the environment in which they are accommodated continues to be in their interest. Such matters can be addressed through a new service specification of specialised Children and Young Persons Act mental health services. There are already, I can assure your Lordships' House clear operational processes in place to identify and monitor Children and Young Persons Act, inappropriate placements. And it is a statutory requirement for the CQC to be noticed within 48 hours, if a child or young person is placed on an adult ward.

CQC report on the number of people under 18 admitted to adult wards, as part of their monitoring a Mental Health Act reforms. The CQC project called improving regulation for children, inappropriately placed will identify what CQC can do to prevent children being cared for by providers who cannot meet their needs and reduce their needs are being exposed to poor quality care. I can assure your poor quality care. I can assure your Lordships' House, we will review the process for who should be notified and in what circumstances.

In the new service specification, for specialised Children and Young Persons Act mental health services and in the revised Mental Health Act, code of practice. Turning an hour to amendment a 116 table by the noble lady, Baroness Berridge on the extension of 16 and 17 of the children act, 1989, to include children detained under the mental health act. Section 17 places a duty on local authorities to provide support for children who are unlikely to reach or maintain a satisfactory level of health, or development, or health or development will be significantly impaired, without the provision of services, or the children, or child is disabled.

Local authority children's services are responsible for assessing cases where a child is determined to be a child in need. Under section 17, disabled children are automatically classed as in need, by virtue of their disability. The definition of disability, under the children's act, expressly includes children with a mental disorder. Therefore any child detained under the Mental Health Act is already considered a child in need and in scope of section 17 and there is no uncertainty about this.

For these reasons I hope noble Lords
18:16
Earl Howe Portrait Earl Howe (Conservative)
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I am grateful tour noble Lords who spoke in this short debate, and for the support expressed for the amendments, both mine and the other amendments in this group. My noble friends Lady Berridge to my attention to an inadvertent slip of the tongue that I committed in my early contribution, when I sought to define a child. I meant of course to say we should include young people aged 16 and 17. But in that regard, I was particularly grateful for the powerful interventions from the noble Baroness Lady Butler-Sloss, the noble Lord Lord Berkeley, citing their own experiences.

I much appreciate the Minister's comments in response to these amendments, particularly one for three and 144. I believe from what she said that she and I are on the same page when it comes to age-appropriate settings for child patients. It was reassuring to hear from her what is contained in the current code of practice. And what is intended to be included in the revised service specification. I'm also pleased to hear that the CQC have it as part of their role to report on these very important issues.

I will if I may study what she said in Hansard and consider what's best to do, but for now I leave to withdraw the amendment.

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the amendment is widely

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the amendment is widely withdrawn. Amendment 143. Not moved. 144 not moved. Hundred and 45 not 144 not moved. Hundred and 45 not moved. Amendment 146.

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moved. Amendment 146. I beg to move amendment 146 standing in my name and that of my noble friends Lord Kamall. In the noble friends Lord Kamall. In the previous group of amendments I cited the experience of a child being held the experience of a child being held on an adult mental health ward being subject to restraint. Where on GeForce supplied by the staff involved, causing unnecessary pain and distress to the patient. The incidence of restraint being used on children, being treated in mental health settings, and indeed general hospitals, come to that, is alarmingly high.

This fact was recognised in the Mental Health Units Act use of force act 2018. Which came into effect in 2022. However, despite the provisions of that act, not only has there been no drop in the number of restrictive interventions that children are subject to, there's actually been an increase. In 2023/24 a total of 84,000 or so restrictive interventions were carried out, which is a 51% increase on the year before. That is the highest number of restrictive interventions recorded since figures were made available in 2019.

Despite what appears to be a drop in the number of children being treated in mental health units. It isn't only that restraint is being applied in all these cases. All too often because there is a physical struggle involved in the process of restraining someone, that patient ends up with an injury. What lies at the root of this? Blooming change belief restraint amounting to abuse is entrenched in the system. Unfortunately, that's rather depressing view was borne out by the Independent newspaper last August which reported that children in a mental health inpatient unit in Coventry were captured on CCTV "being dragged across the floor".

That surely has to be, there surely has to be something here around the need for staff in all mental health settings to receive training in the different techniques for the escalating crisis. Physical restraint being regarded as a last resort. In fact, with the two very welcome principle set out in clause 1 of the bill, leased restriction and therapeutic benefit, training of staff inappropriate techniques of control to priority than before. I hope the Minister can let me have

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some reassurance on this very troubling set of issues and I beg to move. Amendment proposed articles 50,

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Amendment proposed articles 50, insert the new clause recording of use and force on mental health
18:21
Baroness Hollins Portrait Baroness Hollins (Crossbench)
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patients.

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I should declare my interest, my experiences as a retired psychiatrist working with people psychiatrist working with people with learning difficulties and with learning difficulties and autistic people. In 2019 the Secretary of State asked me to oversee an important review of the use of another restrictive intervention, long-term segregation, intervention, long-term segregation, known as LTS, with people with learning difficulties and with learning difficulties and with autistic people. And His Majesty's Government published the oversight panel is report of this review simultaneously with their quite positive response to its recommendations in November 2023.

So amendments 155 and 156 in this group address critical issues highlighted in the report about the use of LTS and the measures needed to eliminate its use for people detained under mental health legislation. So the amendments aim to improve oversight and accountability in its use, while pointing to the urgent need for appropriate security services to prevent delayed discharges. The proposed changes are not merely administrative. They are a necessary response to urgent human rights questions raised by the use of LTS and indeed these are the restrictive interventions covered by Earl Howe whose amendment I support.

The report aptly titled My Heart Breaks found the mental and physical health of both children and people and adults detained in long-term segregation deteriorates as a direct consequence of an. Isolation. In Madsen we call this iatrogenic comment is unacceptable. LTS is also often used in association with other The substantial research evidence pointing to the harms of such enforced social isolation, including in conditions of solitary confinement, nor does it have therapeutic benefits. Oversight panel members consider that LTS should actually be renamed solitary confinement to avoid normalisation of this practice in healthcare settings.

But the current way in which rather less clear terminology is used, perhaps to disguise what is really actually happening in practice. It's interesting to note that not all psychiatric hospitals have rooms in which to detain people. The type of accommodation used is sometimes totally unacceptable. People being detained in rooms with no natural light, with the mattress on the floor, with no toilet facilities. This is unacceptable. Amendment 155 would require notification of LTS the CQC within 72 hours of its commencement.

It would require that CQC must initiate an investigation, if LTS is used for more than 15 days within any 30 day period. If it's used for a person under the age of 18, or for a disabled whose condition would be exacerbated by its use, for example an already psychologically traumatised person who would be further traumatised by the sensory and social deprivation caused by its use. That's probably most people. The amendment would require that the code of practice introduces standards for LTS, including access to natural light, outdoor space, and meaningful human contact, as I'm sure most noble Lords will agree, these are basic necessities for dignity and well-being.

Psychiatric hospitals are still using LTS will be required to appoint a responsible officer to review upon its use to CQC, they would also be required to comply with recommendations from Independent Care (Education) and Treatment Review's, as they relate to LTS. Amendment 1566 to ensure therapeutic alternatives to LCS have been properly considered by requiring independently chaired reviews for any person detained in reviews for any person detained in LTS. Since the end of the Department of Health's programme of IC(E)TRs in 2023 which reviewed hundred 91 cases between 2020 and 2023.

The CQC was commissioned to restart the program. The new program precludes that the chairs, the independent chairs, must follow-up to see whether the recommendations have been implemented. But finding has only been committed to the end of this current year. Last LTS continues. These reviews must be kept in place until the use of LTS comes to an end. Or as long as it is in existence. So it would require IC(E)TRs to be continued and it outlines the role responsible at ease and authority of the independent reviewer.

I do hope that the noble Lady the Minister will be able to reassure the House that this continuation of this independent, these independent reviews, will be funded. By limiting the duration of LTS, and mandating international oversight and require alternatives we could protect people's rights and lay groundwork for effective repossession and integration back into people's communities. I think not meeting minimum standards, and classifying such education as solitary confinement, rightly would underscore its appalling and often inhumane nature.

I notice a term that many clinicians dislike because it is equated with punishment. But it describes the conditions that we sometimes saw. Excuses often given that LTS is a last resort the person. But in fact it's usually the first resort. It's usually the first response because no appropriate care and is provided. I have seen systemic failures due to insufficient community-based support. While commissioners and clinicians are also -- often acting with good intentions, they really are, they lack the coordination, resources and expertise to deliver the care that is needed to keep people safe.

So these amendments simply aim to ensure therapeutic care close to home, and would require that by monitoring the continued use of LTS, and understanding the various to eliminating its use, that the CQC will be able to identify the themes, the trends and the changes that are taking place every time and the use of this particular restrictive intervention. I urge the Minister to support the amendments. I beg to

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move. My Lords, I rise to support

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My Lords, I rise to support amendments 155 and 156 to which I'm adding my name. If approved the Care Quality Commission would require to Quality Commission would require to ensure independent reviews of the suitability of continued segregation, with a particular focus on the potential for community support to be preferable. The amendments also increase transparency and set minimum transparency and set minimum standards both of which I'm sure noble Lords will wish to support.
18:29
Baroness Ramsey of Wall Heath Portrait Baroness Ramsey of Wall Heath (Labour)
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noble Lords will wish to support. When I chaired NHS England's transforming steering group, transforming careful children and young people, with learning disabilities or mental health problems and challenging, I heard heartbreaking testimony from parents whose teenage and young adult children were segregated for weeks and months on end. Of the sort referred to by the noble Lady Baroness Hollins. I visited for example a non-NHS provide out of London who had kept one young adult woman who appeared, her story in social media the time, you may remember, she had been captain segregation in a room with no windows, no natural light, and past food to her through a hatch.

She was completely alone. As I and other noble Lords have argued, investment in the right type of community support is the only humane way forward. To ensure this investment is made proper use of, we shall send out a clear message we expect unity services to be used wherever possible, rather than segregation. And the way to do this is for the quality care commission to oversee a process of Independent Review in any case of segregation of young person under 18 or anyone with learning difficulties or autism, or indeed anyone who segregation exceeds 15 anyone who segregation exceeds 15

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I have been pleased to add my name to the amendments of 155 and 156 in the name of the Noble Lady Baroness Hollins. She has already spoken on this subject and I think
18:31
Baroness Browning Portrait Baroness Browning (Conservative)
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spoken on this subject and I think it would be remiss of me not to just say that the report that she mentioned which is, of course, in her name and authorship, entitled my heart breaks, is a title chosen for a purpose. This is a heartbreaking situation. And on this piece of paper I am holding in my hand, headed golf.uk, Baroness Hollins final report, it says my heart breaks. Solitary confinement in hospital has no therapeutic benefit for people with a learning disability and autistic people.

As we have heard, it is not just that it is not therapeutic, it is actually harmful. And the terminology that other speakers have already spelt out as to why they sort of dumbed down the real core facts of the language that they used to describe this type of incarceration, for that is what it is, remains one of prisons. It remains one of prisons. And look at the legal structures that are needed to somebody into a prison. And yet people who are ill, who are sick, are treated in the same way as prisoners.

I can remember many years ago visiting a school for autistic children, and it was many as ago. And they had a room, a single room, where they took children who were having a meltdown. It was a padded room at the thought that was the appropriate treatment for children. And yet here, and we know from any of the debates we have had in this House for people who have been held for extended periods of time in mental health hospitals, that the damage it does, and the difficulty it is when these practices are in place, but ironically this does not happen everywhere.

You have to ask why does it happen in some It is because places they understand the problem, they have sufficient training and resources and training of personnel is absolutely key in all of this. Particularly seeing the personnel because of the person in charge says this is what we are going to do, very few people in the structure below them are going to challenge it and that is what they do and then that becomes the norm. So, I would say to Baroness Hollins who only 15 months ago produced this report which now bears the Government approval and the golf.co Department of Health and Social Care on it, it is really time now for the Government to adopt Ernest Hollins amendments and her recommendations.

It is a wealth of experience that we can only admire. And I urge the Minister please accept these recommendations. They come from the very highest level. We are very lucky in this House to have the expertise that we have in my dear friend Baroness Hollins.

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Very briefly, and on a slightly related topic, I wanted to talk about a different group of people who are in long-term segregation who
18:35
Baroness Fox of Buckley Portrait Baroness Fox of Buckley (Non-affiliated)
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who are in long-term segregation who are not sectioned and often do not get mentioned. And that is prisoners. One of the things that has happened is that long-term segregation is used, mentally in prison are not transferred to hospital and nobody knows what to do with them and they are put into isolation and their left there very often psychotic, delusional, forgotten. And, effectively dumped. Now, noble Baroness Browning alluded to prisons. But even prisons should not be treated like prisoners sometimes and the confusion and conflation of punishment and treatment outside of prison is no less shocking when it is inside a prison.

Because you are not meant to punish somebody doubly because they are in prison and they happened to get ill or what have you. It is also are you know the chief inspector of prisons Charles Taylor has actually made the point that the segregation units are completely unsuitable for people who are severely unwell. There also a significant drain on hard-pressed staff by the way because very often the constraints of people literally go out of their mind and not getting any medical attention at all requires multiple offices and the chief inspector to unlock cells even just to deliver than meals, so I was going to ask if it was possible for the Minister to give any thoughts on that but also this could appeal to the Noble Lady Hollins if she might consider she takes this amendment forward it might bring that into the situation.

I know I am slightly squeezing it in because I have got an amendment 160 under review. The only other thing that I wanted to just add on the end in relation to amendment 146 is I absolutely agree with the amendments in relation to the need to keep records, that is obviously the case. I suppose the nightmare for us is always many of you will know this the misuse. And this is the stuff of nightmares. And when other people are very ill and very psychotic, sometimes appropriate force is necessary.

I just think that it needs to be recorded. And when I say first, I obviously do not mean violence and I do not mean not within the grounds of professional intervention. But just that sometimes we forget how ill people can be. How violent they can be, how difficult it is for people who work with them, and therefore I think that we should record every instance that we should record every instance of the use of force but be wary of demonising or damming every use of force in every instance because it is not quite as simple as that, I

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think. I stand to support all three of the amendments in this group, but I want to make the point that a lot of want to make the point that a lot of NHS care is now commissioned into the independent and charitable the independent and charitable sector. And it is vital that records
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Baroness Barker Portrait Baroness Barker (Liberal Democrat)
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Baroness Hollins, for some very thoughtful amendments in the way that she introduced them. But I want to turn our attention to amendment 146 which is in the name of the noble Earl. It was as a colleague of Norman Lamb who was formerly a minister in the Department was one of the people who was most, as a minister, most active in addressing this issue of the overuse of force in mental health. The campaign that he has gone on to and continued to develop in his chairmanship, it is a subject that I am very glad that we are focusing on again because we all understand that there are times anybody who has visited a mental health facility which people having acute episodes know that there are times where the safety of the person and the safety of others, it is necessary sometimes to use restraint.

But is that noble Earl was alluding to in his introduction, the overuse, the frequent use of force is often an indicator of sub- standards of care, and therefore it is very important that the incidences of use of force, the reasons for it, in his very carefully crafted amendment and the reasons for it are recorded. There are just two things that I want to pick up with you. His amendment is very carefully crafted. In his introduction he preferred throughout two children stop but his amendment does not.

As amendment does not relate just to children. It relates to all mental health patients. And for that reason I therefore wish to concentrate particularly on clause 9 of his amendments. Clause 9, subclause eight, says that, subclause nine says that in this subsection for relevant characteristics in relation to a patient. It then lists all of the protected characteristics within the equality act on admission, gender reassignment. And I therefore wish to ask him simply why do people undergoing gender reassignment not merit the same protection as everybody else?
18:43
Baroness Merron Portrait Baroness Merron, The Parliamentary Under-Secretary for Health and Social Care (Labour)
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Can I thank noble Lords for their contributions today? And let me first turn to amendment 146 tabled by the noble Earl Lord Howell supported by the Noble Lord Kamal. And the amendment does largely replicate duties under section 6 of the mental health units, (use of force) 2018 for all patients in NHS mental health units. And let me say that we do recognise that the data suggests that use of force for children and young people is still far too high.

And I can say to the Noble Lord that we are working with NHS England to address this. Although that section that I have referred to has not yet been commenced, the guidance is published, the data is already being recorded and we plan to commence the duty family later this year. Looking at the particular amendment it would capture it much broader range of patients that the use of force act does. For example, all patients who are being treated for dementia or delirium in an acute hospital.

Furthermore, it is not clear what use will be made of that data. Therefore the volume of new data collection processes could be significant, but the benefits that would result from this are somewhat unclear. Turning now to amendments 155 and 156, which have been put forward by the noble Baroness lady Hollins regarding long-term segregation and the amendments supported by Lord Crisp and the noble Ladies Baroness Brown Inc and my Noble Friend Baroness Ramsay, both of whom made important contributions to the debate.

Firstly, let me like other noble Lords, thank the noble Baroness Lady Hollins for her work on this issue over many years. Including her significant report my heart breaks which the Noble Lady baroness Browning brightly referenced. We are here today, I believe in no small part to the tenacity of the noble Baroness Lady Hollins and also others who have fought for better outcomes for people under the Mental Turning to proposed amendments before us, seclusion and segregation in mental health units is already recorded and reported under the use of force act, despite the fact the relevant provisions of the Use of Force Act have not yet been commenced.

Amendment 155 would go further to make that notifiable to the CQC, within 72 hours. The Department of Health and has already consulted on making this and other practices notifiable within 72 hours. However, practical concerns were expressed regarding the additional burden on staff that could impact patient care and a lack of clarity on the purpose, and what would happen after notifying CQC. So, it is the case that further policy work is therefore needed. My officials have written to CQC to commission them to develop a viable proportionate reporting mechanism for the use of restraint, seclusion, and segregation.

Drawing on the views of NHS providers and NHS England. These changes can be made in regulations, so we can continue this work in parallel to the passage of this bill. This amendment goes further in specifying an investigation could be initiated for any child or young person or persons learning disability and autism, subject to long-term segregation, or anyone subject to segregation for more than 15 days. It also creates a new responsible person to review all cases of long-term segregation, and prolonged detention.

It is however you that further policy work is needed to ensure the right definitions, the right systems, and the right processes are in place before any requirement to notify CQC is introduced. Additionally, the code of practice contains guidance on the use of segregation and seclusion in chapter 26. And we will be reviewing this when we update the code to an appropriate timescale. code to an appropriate timescale. Amendment 156 would require CQC to initiate an independent care treatment review, once notified, the personal subject of long-term segregation.

The existing process applies to people with a learning disability and autism only. And builds on the existing framework of care, education, and treatment reviews. This amendment would apply to all patients under the Mental Health Act, the majority of whom do not have care, education and treatment reviews. So, we would need to create a new infrastructure for mental health patients. It is worth saying independent care and treatment reviews are resource intensive. There are 195 people in long-term... There were 195 people in long-term segregation in November 2024.

So this would be a significant new requirement for staff. Through this bill, we are expanding duties for improved clinicians, second opinion appointed doctors and other experienced workforce groups, who would potentially Chair these reviews, so we would need to consider resourcing. So, given these practical considerations, we do need to carefully consider if independent care and treatment reviews are in fact the right approach for everyone. We would like... We would also like more evidence on the impact of the reviews and officials have provisioned CQC to report on this.

And the noble Lady, Baroness Hollins, asked about funding, and I thank her for that. For that point. What I would say to the noble Lady, before decisions on funding are made, we do need to consider the impact of the program. The current independent care and treatment reviews program has not required primary legislation, so not including it at this time is no barrier, if future policy work shows that they would be an effective tool. Turning to some of the points that were raised in the course of this discussion.

Noble Lady, this discussion. Noble Lady, Baroness Fox, asked for a comment on prisoners. And I can say to the noble Lady, as she did already alluded to, but segregation of people in prison, which is outside the Mental Health Act, is subject to separate rules and safeguards, including review and approval by segregation review boards and notification to the independent monitoring board. And the noble Lady will of course observe that my noble friend, Lord Timpson, is in his place and will have heard the points that he made.

And to the noble Lady, that he made. And to the noble Lady, Baroness Warwick, the amendment varies -- Baroness, the amendment varies in the use of force act, in that he only applies to NHS facilities. Whereas the use of force act also applies to independent mental health hospitals, treating NHS patients. My Lords, for these reasons, I hope the noble Lords will feel able to withdraw the amendments.

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I just wonder if I could ask whether, there seemed to be an assumption that long-term assumption that long-term segregation would continue and segregation would continue and perhaps ICTRs are not affected. At one of the things that emerges from an independently chaired review is some learning about the barriers that are in place. And the reasons that are in place. And the reasons that are in place. And the reasons why LTS is being used, other than more therapeutic options.

And that is the reason for this kind of oversight being necessary. It is not necessarily that the ICT itself only to recommendations being implemented, in my report, we found the recommendations were not being followed through. That they were made and not being followed through. And there needs to be much more effort to try to learn from what is happening. And begin to change the culture of accepting LTS is an OK response to somebody's distress.

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I do understand that point. And the noble Lady makes the point very well. And I was simply perhaps refer well. And I was simply perhaps refer her to the points I made about her to the points I made about needing to look at evidence, needing to look at the outcomes, needing to to look at the outcomes, needing to look at the value of those reviews, and about whether they are the right approach for everyone. I do take on approach for everyone.

I do take on board the point the noble Lady made. But I think my comments probably tell your Lordships house that we feel there is more work to be done

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in this area. My Lords, once again I express my appreciation to all noble Lords who have contributed to this debate. And have contributed to this debate. And I would like to highlight in particular, the speech from the particular, the speech from the noble Baroness, Lady Hollins, which I found, as in other noble Lords, extremely powerful, and persuasive. extremely powerful, and persuasive. My Lords, it strikes me that this is an especially appropriate grouping of amendments. The overuse of restraint in mental health settings and the use of completely own a and the use of completely own a therapeutic long-term segregation -- Non-therapeutic and long-term segregation are equally pressing and emotive concerns.

The noble Baroness, Lady Barker, pulled me up slightly on the issue of protection for those undergoing gender reassignment. The concern that I had in drafting the amendment was to cover protected characteristics across the piece, but she has drawn my attention to it, and I am very grateful. I was somewhat disappointed with the Minister's reply on the issue of restraint. In mental health patients. Which is the noble Baroness, Lady Barker, pointed out, is an issue affecting adult patients as well as children and the amendment was drafted with precisely that in mind.

The point that I was seeking to make is that despite the statute local in which the Minister referred to, -- Statute law. The issue of restraint on children in particular has rocketed. And I do think this raises questions about clinical practice, staffing, training, around the code of training, around the code of practice. And it was, to my mind, a pity that the Minister had little to say about those possible areas for practical follow-up. I shall read practical follow-up.

I shall read again what she said my amendment. -- About my amendment, between now and report stage, and for now I beg

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leave to withdraw the amendment. Is at your Lordships pleasure the amendment 146 is withdrawn, the amendment is by leave withdrawn.
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Baroness Keeley Portrait Baroness Keeley (Labour)
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My Lords, I rise to explain the significance of amendment 149 in my name, which aims to ensure the human rights act 1998 protect individuals whenever the NHS, local authorities, or other state bodies, outsource mental health treatment or after- care to private providers. It also seeks to secure human rights protection whenever people are deprived of their liberty, connected with mental disorders, by private health or social care providers. I should start, my Lords, by saying I am not in any way a legal expert, so I thank the doctor and the professor for raising the need for this amendment.

I also thank them for their health -- Help in drafting the amendment and their expertise on the issue, and working with a number of noble Lords and the bill team on it. I also thank Baroness Barker for support to the amendment, and adding her name to it. The growing issue of mental health treatment and social care is growing in the private- sector, but human rights protection does not necessarily follow. When Parliament enacted the human rights act 1998, it was intended to reply to private organisations, delivering public functions on behalf of the state.

However, the courts have narrowly interpreted public functions. In 2007 case, with Birmingham City Council, the House of Lords drew that, working for profit, they were not performing public funders even by providing state commission and funded care services. This interpretation appears contrary to Parliament's intent. But it remains legally binding. Parliament partially addressed this issue with section 15 of the Health and Social Care Levy 2005. And later, with section 73 of the care act. These provisions states that private care providers commissioned by local authorities under the care act 2014 or equivalent legislation in Scotland, Wales and Northern Ireland, are performing public functions as defined by the human rights act.

This ensures that individuals whose care is arranged by the care act are protected by the human rights act, regardless of whether their care is provided directly by the local authority or outsourced to a private provider. However, the recent High Court case shows that mental health patients, and many other uses of outsource health and services, were still not protected. Mr Salmond has schizophrenia, after being discharged from hospital, he was placed in a private mental health nursing home, using section 117 after-care.

He developed constipation and a NOMCOM location of the antipsychotic medication he was taking. After his death from bronchopneumonia, large intestinal obstruction, his family alleged very serious clinical negligence. And what a claim argument his human rights were violated. However, their claim is unsuccessful because the judge held the Human Rights Act did not apply because the care was arranged under section 117 of the Mental Health Act 1983. Not under the care act. This judgement highlights the narrow limitations of the human rights act, as a remedy for those using outsourced public services, such as private care provision or mental health treatment.

This raises concerns about the human rights protection of thousands of people who are deprived of their liberty and private health and settings in connection with their mental disorders. This amendment addresses gaps in human rights protection for three groups Him, seeking after-care from private providers, any patient receiving inpatient mental health services where the subject of the Mental Health Act or not, anybody who is deprived of their liberty in connection with a mental disorder, by a private provider of health or social care.

Now, it hasn't been possible in this amendment to include all the other groups whose By this case, so it doesn't include children's social care, as it is not within the scope of this bill. And it doesn't include people receiving NHS considering healthcare or other outsourced health or social care, not arranged under the care act. But amendment 149 will ensure better protection for people with mental disorders in private care settings. And I know that the Doctor and Professor are also working on raising the issues that I just mentioned in relation to other bills, including the Children's Wellbeing and Schools Bill, so that they will also ensure human rights protection for those who are drawn outsourced care and support.

My Lords, I commend this simple but important amendment and I hope it can be supported.

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Amendment proposed, after clause 50, insert the new clause printed on 50, insert the new clause printed on

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50, insert the new clause printed on Firstly, apologies for the committee for my not being able to speak at second reading and for seeking to intervene on one seeking to intervene on one amendment only in such an important bill that is the amendment of my Noble Friend Baroness Keeley who supported by Baroness Barker. I declare an interest as a
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Baroness Chakrabarti Portrait Baroness Chakrabarti (Labour)
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declare an interest as a councilmember of justice the NGO that will no doubt have been sending briefings to many members of the committee of this important amendment. Amendment 149 is a no- brainer which I believe warrants support and adoption by the Government and welcome from every political representative in your Lordships house. There is no surprise to the committee I am sure that we are a supporter of the Human Rights Act, protecting vulnerable people and their families including in mental health facilities.

These are some of the most potent stories about the Human Rights Act in the near quarter-century. Contracting out services will always be a matter of high politics in a democracy. It is literally the drink of left right debate over social and economic managing. This was demonstrated in an earlier group in the contributions by the noble Baronesses Bennett and Fox and the noble Earl, in Noble Friend the Minister respectively. But no one in that debate ever advocates for either public or private provision on the basis that vulnerable people should be less well treated and protected.

So, it is my contention that everyone in the committee should support 149 which ensures human right protection for publicly arranged mental health care, whether delivered by a public or a private provider. No social Democrat or Liberal can prove a public authority being able to contract out of constitutional protection. And no Conservative can improve of public authorities being able to avoid responsibility, negligence or harm individuals and their families. Especially where coercive power is involved. Finally, I sure all members of this committee believe in equality before the law, so this amendment proposes not so much a loophole but a glaring omission of legal protection as exposed as we have heard by my Noble Friend exposed by the case law and also Joint committees human rights and I

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commend it to the committee. Thank you for the amendment. I
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Baroness Jones of Whitchurch Portrait Baroness Jones of Whitchurch, Parliamentary Under Secretary of State (Department for Science, Innovation and Technology) (Labour)
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into each of these categories must comply with additional duties. With category 1 services having the most category 1 services having the most duties placed upon them. These duties are in addition to the core duties, which apply to all user to duties, which apply to all user to user and search services in scope, including illegal content duties, including illegal content duties, and child safety duties. All and child safety duties. All categorised services must comply with transparency report of duties, they must also have terms on parents they must also have terms on parents ability to access information about how their child use the service, in the tragic event that their child dies.

Category 1 and category 2A services also have additional duties services also have additional duties to tackle fraudulent advertising. They will also have to comply with enhanced risk assessment and record-keeping duties. The most additional obligations will fall on category 1 services. These are the services with the most users and which spread content easily, quickly and widely. To the extent that it is proportionate to do so, category 1 services must give adults more choice about who they interact with, and the content they see.

That includes suicide, self-harm, and hate inciting content. Additionally, category 1 services must protect category 1 services must protect journalistic and use public content. Of democratic importance. The duties will also hold these companies to account over their terms of service, making sure they keep the promises they make to their users. The act requires that specific factors must be taken into account by the Secretary of State, when deciding the thresholds for each category. The threshold conditions for user to user services category 1 and category 2B, must be set on user numbers, functionalities, and any other characteristics or factors, related to a user using part of the service that the Secretary of State deems relevant.

The category 2A, they must be set on the number of users of the search engine, plus any other factors or characteristics. For category 1, the key consideration is the likely impact of the number of users of the user to user part of the service and its functionalities, on how quickly, easily, and widely, regulated user generated content is disseminated by means of the service. The category 2A, the key condition is the likely impact of the number of users of the search engine on the level of risk of harm to individuals who search content illegal or harmful to children.

And for category 2B, the key consideration is the likely impact of the number of users of the user to user part of the service, and its functionalities, on the level of risk to harm... Risk of harm to individuals of illegal content and content that is harmful to children, disseminated by means of the service. These considerations form the basis of Ofcom's independent research and advice. Publishing March last year, which the Secretary of State had to consider when setting threshold conditions.

Was in force, these regulations will enable Ofcom to set up a public register of categorised services which they expect to publish this summer. Ofcom will then consult on the remaining draft codes of practice and guidance where relevant for the additional duties. My Lords, inlaying these regulations before Parliament, the Secretary of State has considered Ofcom's advice and decided to follow it. My Lords, I know this decision will not please everyone. So let me set out why it was made.

Ofcom's research concluded that as the number of users of the service increases, so does how widely content spreads. The statutory consideration of category 1 under the act is " How easily, quickly and widely regulated user generated content is disseminated by means of the service." Therefore, it was concluded that user numbers should not be a note -- Not be ignored. Setting thresholds for category 1 take into account the size of each of the services is also essential to make sure we avoid inadvertently categorising hundreds of small low-risk services.

My Lords, I now turn to the motion of regret that the noble Lord, Lord Clement-Jones, has tabled before the House. I have to say, it is disappointing a regret motion has been tabled. I understand it is because of the noble Lord's view that risk should be the main consideration for category 1. He would ideally like to see the so- called small but risky services, such as small suicide forums, brought into scope. I also want to acknowledge Baroness Morgan's successful amendment made it possible to create a threshold combination by reference only to functionalities and other, any other factors and characteristics.

However, in practice, this was difficult to do but this time. In setting the threshold conditions, the Secretary of State must act within the legal framework, which means he still must consider easy, quick and wide dissemination of user generated content for category 1. He generated content for category 1. He must also act within the powers afforded to him in setting the threshold, which is not allowed. Delegation to outside -- Does not allow for sub- delegation to outside parties, such as Ofcom.

Also was considered, unintentionally categorising hundreds of small risk services. My Lords, I want to be very clear through this, that the government did consider options to bring small but risky services into scope, including those proposed by many thoughtful people on what is a complicated issue. But ultimately, a workable and robust condition for capturing small but risky services was not found. My Lords, I understand some disagree with this and die, of course, like many others, have heard the horrifying stories about these sites and I share the Lord's sentiment that we must stop vulnerable people to falling victim to them.

But I want to ensure those in this House that these types of services will not be overlooked by the legislation. All regulated user to user and search services, including small but risky ones, will be subject to the existing illegal content duties and, where relevant, the child safety duties. The categorisation duties. The categorisation Was also pleased to see that Ofcom set out in December last its approach to tackling small but risky services. This included a dedicated supervision task force and a commitment to move to rapid enforcement action where necessary.

The task forced purpose is to respond effectively, promptly, and proportionately to new or growing harms and risks, focusing on the most credible and high severity issues where they can have the greatest impact. I am confident that the regulatory framework, alongside this this book task. I will work to keep all UK citizens safe online. Of course the Government will not hesitate where needed to keep people safe. I must also stress that the Secretary of State will be keeping these thresholds under review going forward.

Under section 17 forward. Under section 178 of the act he must review how effective the regulatory framework is two to five years after key provisions of the act Coming into force. This will be published as a report and laid before Parliament. If there is evidence that the categories have become outdated, he will look at updating the threshold where possible. Reviewing the legislation. I look forward to the contributions from all noble Lords on what is a very important debate.

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The question is that this point be agreed to, amendment.
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Lord Clement-Jones Portrait Lord Clement-Jones (Liberal Democrat)
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be agreed to, amendment. I beg to move man to the Government at into you said that this has regrets that the this has regrets that the regulations do not impose due duties available under the parent act on small high-risk platforms where harmful content often easily accessible to children is propagated, calls on the Government to clarify which smaller platforms will no longer be covered by Ofcom's legal content and which measures they will no longer be required to comply with and calls on the Government to withdraw the regulations and establish a revised category 1.

I am very pleased to see the noble Baroness minister back in her place today and I thank her for her introduction to this SI. May I say that her disappointment at my regret of the motion is only exceeded by my own disappointment at the statutory instrument. And I hope, however, that she will provide the antidote to the Governments alarming tendency to unnecessary fights on so many important issues. And a number of them are overseen by her department.

Those of us who were intimately involved with its passage hoped that the Online Safety Act would bring in a new era of digital regulation, but the Government and Ofcom's handling of small but high- risk platforms threatens to undermine the fundamental creating a safer online environment and that is why I am moving this regret motion today and I am grateful to all noble Lords present undertaking part. The Government position is rendered even more baffling by their explicit awareness of the risks.

A cluster to buy the Secretary of State personally communicated concerns to Ofcom about the proliferation of harmful content. Particularly regarding children's access. Yet despite this acknowledged awareness the regulatory framework remains fundamentally flawed in its approach to platform categorisation. The Parliamentary record clearly shows that cross-party support existed for a risk-based approach to platform characterisation which became enshrined in law. I very pleased to see placed in her amendment specifically changed the requirement for category 1 from the size and functionality threshold to a size or functionality threshold.

This modification was intended to ensure that Ofcom could bring smaller high-risk platforms under appropriate scrutiny, subsequently the Noble Lord Parkinson and I pleased to see him in his place today in September 2023 on consideration of Commons amendments as the Minister responsible for the bill made it clear what the impact was. I grateful to my Noble Friend was. I grateful to my Noble Friend for her continued amendment on small but high-risk platforms, the Government were happy to accept her proposed changes to the rules of determining the conditions established which services will be designated as category 1 or to be services.

In making the regulations the Secretary of State will now have the discretion to decide whether to set a threshold based on either the number of users or the functionality offered or on both factors. Previously, the threshold had to be based on a combination of both. I do not think that could be clearer. This Government, and Ofcom's decision to ignore this clear parliamentary intent is particularly troubling. The Southport tragedy serves as a stark reminder of the real world consequences of inadequate online regulation.

When hateful content feels violence and civil unrest, the artificial distinction between large and small platforms becomes a dangerous regulatory gap. The Government and Ofcom seem to have failed to learn from these events. At the heart of this issue seems to lie a misunderstanding of how harmful content proliferates online. The impact on vulnerable groups is particularly concerning stop suicide promotion forums, incel communities and platforms spreading racist content continue to operate with minimal oversight due to their size rather than their risk profile.

This directly contradicts the government's stated commitment to halving violence against women and girls and protecting children from harmful content online. The current regulatory framework create a dangerous loophole that allows these harmful platforms to evade proper scrutiny. The duties avoided by these proper platforms are not trivial. They will escape requirements to publish transparency reports, enforce their terms of service and provide user empowerment service and provide user empowerment tools. The absence of these requirements create a significant gap in user protection and accountability.

Perhaps the most damning is the condition between the government's draft statement of strategic priorities for online safety which was published last November which emphasises effective regulation of small but risky services and there and Ofcom's implementation have categorisation thresholds that explicitly exclude these services from the highest level of scrutiny. Their advice expressly disregarded discounted is the phrase that day used that flexibility brought into the act by the amendment and advised that regulations should be laid that only large platforms in category 1.

There are overcautious interpretation of the act creates a situation where Ofcom recognises the risks but fails to recommend for itself in full range of tools necessary to address them effectively. This is particularly important in respect of high-risk sites such as suicide and self-harm sites or sites which propagate racist or misogynistic abuse, where the extent of harm to users is significant. The Minister, I hope, will have seen the recent letter to the Prime Minister from a number of suicide mental health and antihero charities on the issue of characterisation of these sites.

This means that platforms like 4chan, 8chan and Telegram, despite their documented role in spreading harmful content and coordinating malicious activities escapes the full force of regulatory oversight. Simply due to their size. This creates an absurd situation where platforms known to pose significant risk to public safety receive less safety than large platforms with more robust safety measures already in place. The government's insistence that platforms should be saved by design while simultaneously exempting high-risk platforms from category 1 requirements based solely on size metrics represents a fundamental contradiction and undermines what we were all convinced and still are that the act was intended to achieve.

The letter in the aftermath of Southport, surely it is evidence enough of the dangers of some of these high risk smaller platforms. Moreover, the Government approach fails to account for the dynamic nature of online risks. Harmful content and activities naturally migrate to platforms with lighter regulatory requirements by creating a two-tier system they have effectively signposted escapers for bad actors seeking to evade meaningful oversight. This shortsighted approach could lead to the proliferation of smaller high-risk platforms specifically designed to exploit these regulatory gaps.

Ofcom has, as the noble minister and the baroness minister has mentioned, establish the supervision of the task. Other small but risky services. But this is no substitute for imposing the full force of category 1 duties on these platforms. The situation is compounded by the fact that whilst admitting the small but risky sites category 1 seems to be sweeping up sites that are universally accepted as low risk, despite the number of users. Many sites with over 7 million users a month, including Wikipedia, a vital source of open knowledge and information in the UK, might be treated as a category 1 service.

Regardless of actual safety considerations. Again, we raise concerns during the passing of the bill and received ministerial assurances. A PDF are particularly concerned about an obligation particularly on them if classified in category 1. To build a system that allows verified users to modify Wikipedia without any of the Wikipedia without any of the customary peer review in section 15.10, all verified users must be given an option to prevent unverified users from interacting with content that which that user generates or shares on the service.

They say that doing so would lead them open to widespread manipulation by actors since Wikipedia depends on constant peer review by thousands of individuals around the world who would face harassment, imprisonment, or physical harm if forced to give their identities, purely to continue what they have done so successfully for the last 24 years. This makes it doubly important for the Government and Ofcom to examine and make use of the powers to more appropriately tailor the scope and reach of the act and the categorisations to ensure that the UK does not put low-risk law resource socially beneficial platforms in untenable positions.

He questions that wiki media believe the Government should answer as the platform called by the functionality criteria? So long as it has any form of content recommended system. Anywhere on UK accessible parts of the service. No matter how minor and frequently used and ancillary that feature is. The scope of functionality for users to forward or share regulated content forward or share regulated content on the service with other users is unclear, although it appears very broad. The draft regulations provide no guidance.

What does the Government mean by this? Is Ofcom going to able to reliably determine how many users a platform has? The act does not define user and the draft regulations do not clarify how the concept is to be understood. Notably, when it comes to counting nonhuman entities incorporated in the UK as the teams to say would be necessary. The noble Baroness the Minister sent in her letter that the Government is open to keeping the categorisation thresholds under review, including the main consideration for category 1 to ensure the regime is effective as possible and she repeated that today.

But at the same time the Government seems to be denying that there is a legally robust or justifiable way of doing so under schedule 11, how can both of those propositions be true? Can the Minister set out by the regulations as drafted not follow the will of Parliament? Accepted by the previous Government and written into the act that thresholds and categorisation can be based on risk or size. The advice to the secretary of state contained just one paragraph explaining why it had ignored the will of Parliament, or as the regulator called it, the recommendation that a note for the categorisation of services by reference exclusively to functionality and characteristics.

Did the Secretary of State ask to see the legal advice on which this judgement was based? And decent lawyers provide him with their own advice on whether the position was correct? Especially in light of the Southport riots. How does the Government intend to assess whether Ofcom's regulatory approach to small but high harm sites is proving effective? And have any details been abided on the scheduled research about social sites? Does the Government expect Ofcom to take enforcement action against small but high harm sites? And how does it make an assessment of the likely timescales for enforcement action? What account of the Government and Ofcom take of the interaction and interrelations between small and large platforms? Including the use of social priming through online superhighways as evidenced in the anti-Semitism policy trust report which shows that a cross-platform inks are being weaponised to lead users from mainstream platforms to resist violent and anti-Semitic resist violent and anti-Semitic It demands a fundamental rethink of how we assess and regulate online risk.

A truly effective regulatory framework must consider both the size and risk profile of platforms, ensuring those capable of causing significant harm face appropriate scrutiny, regardless of the user numbers and those that are do not. Anything less would, as many others across the House and these benches, believe bring into question whether the government's commitment to online safety is genuine. The government should act decisively to close these regulatory gaps before more harm occurs in our increasingly complex online landscape. I beg to move.



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The original question is the

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The original question is the questions laid before the House be approved, since when the amendment has been removed by Lord Clement Jones, in the words set out on the Jones, in the words set out on the order paper. The question I therefore have to put, is is this
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Baroness Morgan of Cotes Portrait Baroness Morgan of Cotes (Non-affiliated)
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amendment agreed to? I must start by thanking the noble Lady, the Minister, for her noble Lady, the Minister, for her engagement, not just with me but I think with members across the House on this issue. It has been very much appreciated, including of course, when she wasn't here, when she was dealing with her own health issues. When I talk about what we do here in the House of Lords, one of the great successes .3 was the scrutiny this House gave the Online Safety Act.

The fact that we did it in a cross- party way, eventually managing to persuade the government, as well as Ofcom, about the changes that were needed. The factors changes were taken back to the House of Commons, and ministers there conceded them. I think as a result of that working together, we ended up with a much stronger bill that will do much to protect vulnerable, young, and those most at risk of harmful content online. It is a matter of great regret to me that actually, the first time we are really debating a first time we are really debating a statutory instrument of substantive interest, in this act, that we are having to, all of us, I suspect tonight, stand up and say we are deeply disappointed by the drafting that we saw.

On the 19th July On the 19 July 2023, I did move, and was very grateful to the House for its support, a very small amendment. I said about time that actually one word, one change from and to all was a small amendment, but it was a powerful one. And the Lord, Lord Clement-Jones, has set out brilliantly incomprehensible why the change was so important, so when the time available, I am not going to repeat what he said. But the House clearly voted for change.

In the Minister's own party supported that change. And I was deeply grateful for that. And the other interesting thing is that Ofcom said to me, they did not object to that change. But in that note today, Ofcom said, they talked about the approach they are following, in terms of legislating and recommending to government how and recommending to government how they source legislated of the act. -- Should legislate under the act. It rings hollow when, through their interpretation of the interpretation given the government, I have ridden roughshod overlooking the risk of the small but high home platforms.

-- Hi harm platforms. The instrument is absolutely based on the number of users and this House and its amendment made it very clear that actually, the harmful platforms is not just about the number of users that they have, it is absolutely about the content and the functionalities and the risk that those sites will raise. Ofcom, as we have already heard, of a lion, the noble Lady set out, on schedule 11, paragraph 1, subparagraph five, looking at how easily, quickly, and widely regulated user generated content is disseminated by means of the service.

But that paragraph says the Secretary of State must take into account those things for supper does not say the Secretary of State is solely bound by those criteria. I think criticism tonight, of the statutory instrument, is not just the fact Ofcom have chosen to take those words, and I would alter, I would say that actually I feel, with Ofcom not objecting to my amendment, they were being disingenuous if they already knew there were going to rely on that subparagraph. But the bigger question for the noble Lady tonight is the fact the Secretary of State did not have to accept the advice Ofcom gave them.

The noble Lord, Lord Clement-Jones, and no doubt others, will talk about the risk and harm we have seen from platforms. We will talk about the fact the Southport victims, only need one person to be radicalised by the site they are looking at, to cause untold misery and devastation for families. The House voted recently on the harm caused by deep fake pornographic abuse. Again, it doesn't take many people do utterly ruin a victims life. And what about those platforms that do promote suicide and self-harm content.

It is not sufficient to say this act will impose greater burdens on illegal content. We all know from the debate on the act there is content which is deliberately not illegal, but deeply, deeply harmful. Both the victims and to the vulnerable. As Jeremy White MP said when the debate on these regulations, in the committee of the House of Commons, the government is going to want or need these category one powers applying to small platforms before long. And indeed, the government- owned strategic statement published last year specifically says, the government would like to see Ofcom keep this approach, i.e.

The approach they have to small risk services, under material review and to keep abreast of new emerging small but risky services which are causing harm to users online. The government and Secretary of State already know there are small but high harm platforms causing immense risk, which will not be caught by these regulations. As we have also heard, the flight therefore, to these small and high harm platforms, absolutely will happen, to those wanting to pump out harmful content, seeking to find platforms that are not bound to the most rigid regulations.

I will stop there because I know there are others who wish to speak. I will support the regret motion tonight, should the noble Lord, Lord Clement-Jones, decide to put it about. But I would seriously ask the Minister, despite the fact this is taken far too long to get this point, but I understand the government's desire to make progress with these regulations but the regret motion says at the end, it calls on the government to withdraw the regulations and revise a standard edition of category 1 services.

I would ask the Minister to take that opportunity, because I think at the moment, these regulators absolutely do not reflect the will of this House and that amendment and that itself is to say is a great source of disappointment, given the cross-party work we all did, to make sure the Online Safety Act was as compressive as it could be. -- Comprehensive. be. -- Comprehensive.
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Baroness Kidron Portrait Baroness Kidron (Crossbench)
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My Lords, I remind the House of my interests, particularly as Chair of 5Rights and adviser to the Institute of ethics and AI at Oxford. I wholeheartedly agree with both of the previous speakers. And in fact, they have put the case so forcefully. I hope the government is listening. I wanted to use my time to speak about the gap between the act that we saw pass through this House, and the outcome. What worries me the most is how we should understand the purpose of an act of Parliament and the hierarchy of the instructions it contains.

And I ask this because as the noble Lord, Clement Jones, the noble Lady Baroness Morgan have said, the government of the day, with the express support of members of this House, including the frontbench of the Labour Party, agreed that categorisation would be a question of risk or size. Not simply size. That was the decision of the House, it was supported in the other place, it is the text of the bill. So it would be useful to understand in the view of His Majesty's government, whether the text on the face of an act, and separately, whether a statement made by a government minister from the Dispatch Box has any authority at all.

Because if it does, then I cannot understand how it is that Ofcom is allowed to overturn it, or how the Secretary of State, without taking action to amend the act, has been able to allow them to do so. My Lords, to get a clear answer from the Minister, about the status of the text of the act, is essential, because this is a pattern of behaviour. Where the regulator and government appear to be cherry picking which bits of the Online Safety Act are convenient.

And ignoring the ones they consider too difficult, too disruptive. Or I really hope not, to owner a tech companies. -- To owner us for tech companies. Because Ofcom have not determined the provisions, about functionalities contained throughout the act, for example in section 9, part five, section 10, part four, section 11, part six, I could go on. An extended use section 11 six, F, and on the requirement to consider the needs of children in different age groups, which, like functionalities, run through the act like a golden thread.

Ofcom's own Risks guidance states, and I quote, " Certain functionalities stand out as proposing significant risk because of the prominent role they appear to play in the spread of illegal content and the commission and facilitation of offences." Off, then says is revelatory framework is intended to ensure service providers is put in place safeguards, to manage the risks posed by functionalities. It lists the end- to-end encryption, pseudo-anonymity, live streaming, content recommending systems, and quite rightly, generative AI. All is functionality it considers to be high risk.

it considers to be high risk. Specifically in relation to grooming functionalities, Ofcom considered risky, including network expansion prompts, direct messaging, connection lists and automotive information displays. Despite acknowledgement that functionalities create heightened risk. Despite a clear statement that addressing risk forms part of the regulatory duties, and despite the clearly expressed intent to Parliament, and the wording of the act, Ofcom has failed, hence of the address functionalities. It has chose to overrule Parliament by ignoring, to consider functionalities in determining which services should be designated as category 1 services.

Meanwhile, section 4, A, seven, it Crystal clear that he is a services should be designed in such a way the different needs of different children of different ages are taken into account. Ofcom has chosen to ignore this. Volume 5 of its draft children's code includes that our proposals focus, at this stage, and setting the expectation of protections of all children at the age of 18 or under the age of 18. My Lords, any child, any parent, anyone, who has spent time with children, knows that five and 15 are not the same.

The assertion from Ofcom in its narrative about the children's code is blinding in its stupidity. And if common sense cannot prevail, then perhaps 100 or more years of child development study that sets out the ages and stages, by which children can be expected to have the emotional and intellectual capacity to understand something could inform the regulator as similarly, the age and stage, by which we cannot expect a child to understand or have the intellectual capacity to deal with something.

Because the whole basis for child protection is because we should support the children on their journey from dependence to autonomy because we know they don't have the capacity to do it for themselves and no contexts. Because of the vulnerabilities associated with ages and development stages. Ofcom knows the access should reflect this, but somehow feels empowered to ignore or overrule the will of Parliament. Just like the categorisation that Similarly Ofcom has resolutely insisted that addiction is not covered by the act, and yet, section 11 6F requires regulated services to consider the different ways in which the service is used, including functionalities or other features of the service, that affect how much children use the service.

Brackets, for example a feature that enables content to play automatically. And the impact of such use on the level and risk and harm that might be Spike that that some online architecture choices can be designed to encourage users into maximising the frequency of time spent .G. Internet schooling, autoplay et cetera evidence shows that the risk to children of encountering humble content on a service increases with the time and frequency of use. Ofcom has again failed to include a single measure to address the choice of architecture that makes it hard for children to manage their use of service.

And once again it has ignored Parliament. I simply do not understand how the regulator is allowed to turn its back on the act as agreed by Parliament and I and wilted that Government lawyers who joined the passage of the bill were so determined to pin everything down, has advised the new Government that it was OK for them also to kindly ignore what was so hard one. So, I will be grateful to hear from the Minister what legal advice the Department has had that allow the Secretary of State to agree to the recommendation that the overruled the will of Parliament.

If such advice exist, would she commit to making that legal advice available to noble Lords? If no legal advice was taken, would she commit to getting an opinion on whether categorisation is set out by Ofcom meets the minimum of the Online Safety Act as written and indicated by Ministers. I would like to ask that the Minister is prepared to say whether a regulator has the right to pick and mix on an act that has received Royal consent and if it is not correct for the regulator to pick and mix well the Minister say what actions the Government will take in relation to the parts of the act that Ofcom has chosen to ignore.

And, finally, many of us are bewildered by the change in tune for those who when in opposition were clear that technology should be accountable and respect the needs of those with whom it engaged and the markets it operated in stock indeed, Labour ran on these very prices during the election. And I would like to ask if the Minister would voice her support for a committee of both houses on digital regulation. Our regulators are feeling. And we now have no one to advocate for UK citizens, including children and vulnerable users, or even the act itself.

itself.
20:04
Lord Pannick Portrait Lord Pannick (Crossbench)
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With regret and conduct of Ofcom, the conduct of the Government on this matter is surely deeply regrettable. For all the reasons that I have been given by the Noble Lord claimant Jones Baroness Morgan, and Baroness Kidron. The treatment of small but high risk services in these regulations simply frustrates Baroness Morgan's amendment to schedule 11 which was approved by this House and accepted by the Government. It contradicts what the Minister said in the Commons when he accepted the amendment of Baroness Morgan's amendment approved by this House.

And it fails to address the mischief in this context which Lord Clement-Jones and others have clearly identified. I too would like to see or even to understand what possible legal advice has led to this lamentable position. The impact of the service does not, it cannot depend, only in the number of users. That was the whole point of Baroness Morgan's recommend movement. And the Minister suggested that two arguments, as I understood it, but it is not good enough for the Minister to see if I may respectfully say so that small services are still unable to act in an illegal manner.

The act, of course, is designed to provide further regulation. And especially further regulation. And especially so because the criminal law is, regrettably, a slow instrument. And no I persuaded by the Ministers suggestion that it is simply too difficult to draft regulations to address small but high risk services. We simply do not accept that the experts of the Department of the Parliamentary Counsel cannot come up with appropriate regulation come up with appropriate regulation

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to address this mission. I wish to speak to a point made by the Noble Lord claimant Jones in by the Noble Lord claimant Jones in relation to Wikipedia in particular. relation to Wikipedia in particular. Noble Lords who took part in the committee on this bill will recall
20:06
Lord Moylan Portrait Lord Moylan (Conservative)
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committee on this bill will recall that I asked the Minister and in fact my Noble Friends sitting on the front bench of the opposition front bench I asked him several times whether PDO would be in the scope of the regulation and, if so, would it have consequences that would make it impossible for Wikipedia, a charity, to continue with its existing moral? And my Noble Friends was unable at the time to say that but said it would be a matter for the regulations and indeed for the regulator.

And here we are years later and we have some regulations and I have the same question to put to the Noble Lord that Minister on the Treasury bench today. Because it appears to make, and I must say I had interest to be fair that I am a veteran user of a PDF that it seems to me as the Noble Lord Clement- Jones said that we are left still in a state of confusion about this, what looks in paragraph 3 at the instrument for a large site, those with more than 34 million users, two criteria have to be met.

One is that they have a number of views and the other is that users content recommended system if a look at subsection 2 of that paragraph we see that a content recommended system is so broadly defined, for example it says that it is not simply algorithms which have machine learning, it is by machine learning other techniques. And the is not simply determines, but determines or otherwise affects the way in which regulated users generated content for the user whether alone or with other content they encountered by other users in the service.

No, Wikipedia does indeed use techniques for sending people articles and information that relate to what they have shown an interest in the past. What is the consequence of Wikipedia being caught? There are many, but I would like to test on our noble Lords. I do not claim that this is definitive because, of course, much of the act will need, I suspect, to be determined by the court before we know what the definitive interpretation is, but take for example the case of some loathsome foreign dictator or other such character whose article on Wikipedia is less flattering than he might wish it to appear.

And he has, at the moment, a complaint about this. Wikipedia will consider it and then probably throw it in the wastepaper basket. And if he seeks by some means to change the content of the article then, of course, the editors Wikipedia who are distributing it will intervene to change it back and try to ensure it still reflects what is known to be reality. But under section 64 of the Online Safety Act one may apply to become a verified user. Obviously, do not expect the loathsome person themselves to apply to become a verified user.

It will be some stooge, some student, some trainee, some character, somewhere, willing to register on their behalf. But who could then change the article? Because they are a verified user under section 15.10 a of the act they would acquire immunity to peer review what they wrote on Wikipedia, what could be changed by the editors, because they were a verified user and had their protection. I offer that as a genuine possibility. A real possibility, as I say, I am not a lawyer and noble Lords know that.

I think that this could be tested in the courts and found otherwise. It appears that sort of consequence would approve. I come back to asking the same question that I have been asking to no real effect now for two years. After Noble Lord, the noble Baroness when she comes to reply, could give me a definitive answer. Yes Wikipedia in school of this regulation? Is it covered by section

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3 or not? Who would like to know? Often in this House one is

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Often in this House one is tempted to wonder down memory lane
20:11
Lord Stevenson of Balmacara Portrait Lord Stevenson of Balmacara (Labour)
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tempted to wonder down memory lane and we are filled with wonderful memories of good times and shared experiences. But none so present as the one brought from the noble Baroness when she spoke earlier about the online safety bill. I felt resonances up and down my back as I remember the moment at which I decided there was no point in reading my speech which was full of sound and fury, anger, things that I was determined to see in the bill. And realising that actually we all agreed about it and the best thing to do was just to say simply when we work together try to get the best bill we can, resources available across the House, and as we heard today, that worked.

Or it did until today. And I am very sad about the fact that I feel I am going to have to support the Noble Lord Clement- Jones in the despatch boxes. Only my second appearance because I felt very strongly that we had an agreement, signed, sealed and signified by both houses. Agreed to by the Noble Lord in his place. In airway in which a successor Government is bound to operate within the terms of that act. I find it egregious that the Government is seeking a way of not doing that and for reasons that I can only guess seem to know more about friends in strange places across the Atlantic than it is for seeking the best for our people and particularly children in the United Kingdom.

There is an irony that I think there would have been a way of avoiding this. I do not want to embarrass the Noble Lord Parkinson again, but we adopted towards the end of the bill in Parkinson's rural I called it and rightly so. I felt he was brave and proposing it was not the convention of the time and it was not a structure or a system that fits well within our current procedures in this House. But the intention was to recognise the complexity and difficulty in the online safety bill, the act, and to invite the Government to share with the select committees of both houses in the Commons and the digital committee drafts material relating to the online safety bill because we had a hunch that there would be issues that would need to be hammered out more clearly and more effectively and arrangements for treating secondary and low station currently allow in this House.

That might change. But until does, there's no way in which we could debate and discuss accept through written or indeed as we might have intended to do in this on the fatal motion on an instrument which clearly has come out wrong. Which does not affect the issues of the House and may do damage at the end of the day to people's lives. If they do not listen to what we are seeing today. The Parkinson role was accepted by the Noble Lord Parkinson and I quote not entirely because there are some reservations I want to skip over but I sure they can be skipped.

The Government will ensure that the relevant committees in each house will have the power to play a part in living consultations by informing them, that is good. We will wear possible share draft instruments directly with the relevant before the formal link process. That will be on a case-by-case basis considering what is appropriate and recently practical. That system has not been implemented by the Government and I wrote about Noble Friend Baroness Jones while she was away on leave and she very kindly respond to me.

Sorry, when she was ill. She very kindly responded to me and she says that she feels that in the spirit of the agreement is, paraphrasing, it has actually been carried out in the way that they told both committees. That there were statutory instruments on the way and that the war, again, sufficient to meet the implications of the rule. Given that three days gnosis was again for the rural I do not think that meets the requirement and I ask her today if she will meet with me and others who wish to discuss whether or not there is still some way that we can make this work because this sort of debate, these sorts of issues, the emotions that have been raised, should not be bottled into a debate about the regret motion stop they need to be taken as they occur.

They need to be reasoned through. We need to be able to explain and we need to hear and listen to what the arguments are that are so powerful in Government that they do not seem to fit the way in which this bill was framed. I hope that we can find a way forward. This is a bad decision and it is against the will of Parliament and the consequences are that the noble Lords have already injured it is Lords have already injured it is

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I rise briefly to try and illustrate why we are as concerned as we are. One of the platforms that as we are. One of the platforms that would not come under the categorisation that we would wish it
20:17
Lord Russell of Liverpool Portrait Lord Russell of Liverpool (Crossbench)
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categorisation that we would wish it to is a telegram. In 16 January last month, a young man, a 19-year-old called Kamron Finnegan, who is a member of a satanic extremist group call 764, was sentenced to six years in prison on charges including encouraging suicide, and possessing 764 originates in the United States. And Telegram has been used to disseminate 764 across the Atlantic. And this is the FBI's description of this group, 764. A network of violent extremists who seek to normalise the production, sharing, and possession of child pornography and gory material, to desensitise and corrupting youth towards future acts of violence.

Members of 764 gained notoriety by systematically targeting, grooming, and extorting victims through online social media platforms. Particularly the small ones. Members demand that victims engage in and share media of self- mutilation, sexual acts, harm to animals, acts of random violence, suicide and murder, all for the purpose of accelerating chaos and disrupting society and the world order. On that basis, my Lords, you can understand completely why Ofcom thinks this is fine. My Lords, this is unacceptable and the government really should look at this again.

Above all, I do think it is incumbent on Ofcom to recognise two apparently, woefully, diverge from the clear stated will, and what is written in the face of the act, is not simply inappropriate,, but has other noble Lord suggested, may well be illegal and I do think that be illegal and I do think that be illegal and I do think that

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I will be incredibly brief, having not been part of the collective of peers who worked on the parent act in the statutory
20:19
Baroness Penn Portrait Baroness Penn (Conservative)
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the parent act in the statutory instrument, but I think the key question highlighted is what is the government's interpretation, now interpretation, of the powers in the act? The government's interpretation of the time it was passed, and the official opposition's interpretation of the time it was passed, is that it had the power to include category 1, providers on the basis of risk, not size. I'm a concern, because in the debate in the Commons, the ministers seemed to say, in fact did say, and I quote, that as things stand, the Secretary of State does not have the power to include them.

That is small but risky providers. Actually, was slightly outraged at the implication that they were not acting where they should otherwise be doing so. So, could the noble Lady, the Minister, clarified -- Clarify for this debate, whether it is the government's decision, if they would like to include them, that is what the intention that they thought the act had given them. They would like to include them but they cannot under the law as it is written. Or that they do have the To, which is our understanding of the decision-making.

And the reason it is so important is that the noble Lady, the minister, is committed to reviewing these thresholds in future. But such reviews will have very little power of the act itself is faulty and doesn't give them the ability to designate on the basis of risk. All the review is pointless, because they already have the powers, they already have the evidence of the risks of these providers, they are choosing not to act. Another point on legal advice, the Minister committed to writing, including a letter from government lawyers, setting out in great detail what she was saying in relation to the powers of the Secretary of State in setting the categories.

I.e. Clarifying for people what the interpretation that is so shifted from the original debate is from the government. I may have missed that letter, maybe it was placed in the House of Commons Library. But perhaps, the noble Lady, the minister, could say whether that letter was written and share its contents with this chamber also. Because I think that gets to the heart of what we are regretting today from the government.

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I will just very briefly say, having served alongside my noble
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20:23
Lord Parkinson of Whitley Bay Portrait Lord Parkinson of Whitley Bay (Conservative)
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My Lords, I'm very grateful to the Minister for introducing the regulations and to the noble Lord, Lord Clement-Jones, for tabling his amendment and moving it in the way he did because it has given us the opportunity to have this very important debate on this landmark act of Parliament. My noble friend, Lady Morgan, is right to begin her remarks by reminding your Lordships that the passage of that act is a shining example of this House doing that job very well indeed, giving very careful, considered and non- partisan scrutiny to legislation before us.

As a noble Lord again rightly recalls, the cross-party spirit that he did so much to foster from second reading, and it was a pleasure working with noble Lords across the House in that spirit, to make sure the act find its way to the statute book in the way it did. The reason we are here tonight is because of a number of amendments that were made to the bill, as it went through this House. The Delegated Powers and Regulatory Reform Committee reform committee of your Lordships house, in its report on the bill, recommended that the first regulation for the category 1 thresholds should be subject to the affirmative procedure.

I was very glad to accept that recommendation, when I was the Minister taking the bill through. And I'm very glad to be here for the debate on it, albeit speaking from a different Dispatch Box. The noble Lord, Lord Stevenson, does indeed embarrass me by citing the Parkinson rule, as I think I said at the time, I think Cyril Lord Parkinson has the better repetition for Parkinson's laws, but again, that undertaking was an important one that I was happy to make, in order to ensure Parliament had the ongoing scrutiny.

But we all recognise, as we passed this law, that this was a fast-moving area of technology. Where legislations across the world were struggling to keep up and it was important for the legislation to take place in the agile and consensual way that we had sought to bring the act about. Of course, we are also here because of an amendment made to the bill by my In your Lordships house, and she and the Lord, Lord Clement-Jones, were too gracious to recall it took me a little longer to get there.

That amendment was made despite my arguments to the contrary, and my noble friend press tour amendment, defeated me, the previous government changed the bill. It was when the bill was in another place, that the government accepted her point. But I was helped along the way in that legislative journey by very clear On the bench in opposition. In the debate, on my noble friend, Lady Morgan's amendment, on 19 July 2023, the noble Lord, Lord Knight of Weymouth, who I'm delighted to see in his place, albeit on the backbenches now, said Lady Morgan's amendment was a no-brainer.

He pointed out that the bill, as it stood, requires Ofcom to be mindful of size, but argued we need to be more nuanced and it was right to give Ofcom leeway or flexibility in the categorisation and to bring providers into the safety regime. These were points that were echoed in another place by Alex Davies- Jones, the member for Parliament for Pontypridd, now a minister at the Ministry of Justice, with responsibility for tackling violence against women and girls, rape, and serious sexual offences, child sexual abuse, and many other very serious matters.

In opposition, following this debate, she made the point that categorisation of services based on size, rather than risk of harm will mean the bill will fail to address some of the most extreme harms on the internet. And I wonder what Miss Davies Jones says now that she is at the Ministry of Justice. I am very grateful to Ofcom. I had a very helpful phone Ofcom. I had a very helpful phone call last week with Robert Brown and Mark Ponting of Ofcom, to understand their approach will stop and my criticisms are directed at the government, not at Ofcom.

And without wanting to rehearse my job, I will help the Minister by pointing out many of the concerns raised are covered by the bill, the bill is very clear, the duties act on legal content and protect children, flying to services of every size. Some of the points made, including the very moving and harrowing examples given by the noble Lord, Lord Russell. Lord Russell of Liverpool. May will be covered by the legal duties and protection of children duties. As the noble Baroness, the minister, was right to point that out.

But there is a shift here in the approach from the commitments that I made at the Dispatch Box, when I was a minister. At the decision Parliament took in back in my noble friend, Lady Morgan's, amendment. And I'm interested in why the government has changed its mind, particularly having been so strongly in favour of making those changes to the bill, when it was in opposition. In her opening remarks, the noble Baroness, the Minister, use the ubiquitous phase unintended consequences -- Phrase unintended consequences.

The government didn't want to unintentionally categorise a number of small but non-risky services, would necessarily be the case? Surely a granular case-by-case categorisation wouldn't bring in so many hundreds. It seems that she and the government are leaning rather heavily on other parts of the act, talk about the quick, easy, and wide dissemination of material online. And I wonder whether the 'and wide' part of that is doing a lot of the heavy lifting here, making connection to the size, the width of dissemination, is that what is driving the policy decision here.

And it is a policy decision. The government is not bound to follow the advice that Ofcom has provided. It can disagree with it. And the It can disagree with it. And the debate in another place on these regulations, my right honourable friend, so Jeremy White, former law officer, said it wouldn't be right for the government to provide legal advice, for its add-on on these matters. But like the noble Lord, Lord Pannick, I would be interested in seeing that. I wonder whether the noble Baroness, the Minister, is able to say a bit more about the legal basis on which it is decided it is unable to disagree or not inclined to agree, disagree with Ofcom.

I hope she will be able to give a very clear answer to the very clear question posed by my noble friend, Lady Penn, who put very well the question on legal advice and the I hope in responding she will follow not just the commitments that I made when I was in her place in the previous Parliament. Also the spirit that ushered that onto the statute book. It was a great example of cross party working in this House. I feel rather existential.

Lady Gudrun asked at the dispatch box if it is worth it. Lord Stevenson has pointed out that the Parkinson rule has been honoured more than in the observance of the pie had been responding to the regrets been voiced, in all corners of the house, the noble Baroness will in the spirit that gave us this landmark act and will continue to scrutinise it to make sure that it does indeed make the UK the safest place to be online.
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Baroness Jones of Whitchurch Portrait Baroness Jones of Whitchurch, Parliamentary Under Secretary of State (Department for Business and Trade) (Labour)
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Firstly, I should absolutely acknowledge all the hard work that acknowledge all the hard work that went into creating and the cross- party consensus that went into creating the Online Safety Act. For all the things we are raising today it is seen as being a global leader in online safety. It is certainly nothing that we should be ashamed of. And it is and I still believe this, it is going to be transformative went it begins to be rolled out as it is going to be in the next few weeks and months, where it really will begin to have an impact.

I pay absolute tribute to all those that did all of that work at the time. Can I also say before I get into the detail there has been a suggestion that we can't tell you how many days and weeks, the office, the Secretary of State office have pulled over the detail of this, to make sure that we feel we are doing the best we can to implement the act in the way that it was intended. Those of whom who have read the draft statement of strategic priorities, which were sent to Ofcom.

We will see that we are reiterating a lot of the issues that those around the chamber are raising today. They are our priorities as well. The issue that came down to the practicalities of some of the issues that we were being asked to enforce and I hope, in my responses that I can address some of those questions. I, firstly, can I say that I should be specific about the user number thresholds that have been chosen and in response to the noble Lady Baroness Morgan and Lord Parkinson and others, Ofcom, just to put on the record, off, recommended a category 1 threshold, combinations of either, user numbers of more than 7 million UK users, in addition to the functionality, or forwarding or sharing user generated content and character using others met the user numbers are more than 34 million and a content system to be met.

Ofcom specifically set out, in their research and advice that was published last month that it considered that this counted a recommendation that allowed for the categorisation of services for category one. I reference exclusively to functionalities and characteristics. This was because it indicated that user REACH had an important role to play in the content discrimination. Ofcom made a regulatory judgement on where to set the user number thresholds, based on an assessment of what comprised targeted and proportionate regulatory action.

Ofcom also undertook sensitivity threshold on the testing. In this debate it has been clear that some, such as the noble Lord, Lord Clement-Jones, think there will be services, particularly as we been debating small but risky services which will evade the core duties of the act. I want to assure the noble Lord that the legislation doesn't allow for that. All are regulated user to user and search engines no matter what will be subject to the illegal content duties and relevance, the child safety duties, the categories don't change that.

The codes on illegal content duties relating Parliament have passed the objection period and may be issued by Ofcom. The duty should be in effect next month. They were all full service put in place systems and processes to tackle illegal content and require services to name a senior person accountable for compliance. If a service is likely to be access by children, the child safety duties will require services to conduct child safety risk assessment. Safety measures for all child users.

We expect these duties will come into effect this summer on the basis that the codes for the duties will be passed by them. Together, the illegal content and the child safety duties will mark the biggest material change in online safety for UK citizens since the internet era began. By Ofcom's own assessment, the app may cover up to 100,000 services of various sizes, showing at the legislation which is far and wide to ensure important protection for users, particularly children. The noble Lord Lord Clement-Jones, Lord Stevenson, Lord, Lady Baroness and Morgan and Baroness Kidron raised the question of why category 1 thresholds are not.

The categorisation of thresholds as per Ofcom's thresholds, rather than deviating from their research was as follows. When the OSA was introduced, category 1 thresholds were due to be assessed, based on the risk of harm to adult content disseminated by means of the service was that as a noble Lords will know, this was removed during the passage of the act, by the then government and was replaced with consideration of the likely impact of a number of users and its functionalities and how easily, quick play widely user generated content is disseminated.

And this was significant that while the risk of harm and may seem to be a more relevant factor, this is the position under the act as it now stands. As I've acknowledged, Baroness Morgan's successful amendment, which was raised by the noble Lord, Lord Clement-Jones and the noble Lord Parkinson did make it possible to require threshold petitions of functionality and characteristics to be met without user numbers. As I set out the considerations within the act of, based on Ofcom's research and advice, the risk of unintended consequences have meant that it is not currently workable to ignore when working the threshold category I'm grateful to the noble Lady and she's setting out a very, a clear case, which at the time and many others within this House disagree with.

Can I just cut to the chase. I think what she has just said is that the government understands the amendment on 19 July, 2023. It has decided on the advice of Ofcom that amendment doesn't work and therefore should be ignored. We should be clear that is what happened, the government should own that decision and therefore the House will decide whether that is acceptable way to behave or an unacceptable way to behave. Speak can only reiterate whatever Reddy said is that we took Ofcom's advice, after a great deal of scrutiny of why they had come to that piece of advice.

Their advice was that the issue about easily, quickly and wide dissemination one of the key factors that would be taken into account. So that is the

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basis on which we made that decision. Sorry to interrupt the noble

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Sorry to interrupt the noble Baroness. Just, to return to Baroness Morgan's point. It is the Baroness Morgan's point. It is the government's position that although the law says it is permissible and the law says it is permissible and indeed was expected that in making its decision about category 1, the Government would require Ofcom to ensure that both reach and risk were taken. The Government have decided that only risk will take part. Speak Ofcom's advice was that the issues about easily, quickly and wide dissemination were the key factors to make the judgement.

And I can't

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say anything more than that. I'm sorry to interrupt that maybe this would be a good moment to this would be a good moment to answer my question about the hierarchy of texts in an act, versus hierarchy of texts in an act, versus the regulators advice. It was my understanding when the House agreed to that amendment that that was an instruction to the regulator, rather than a nice to have if you decide later you do not like it.

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later you do not like it. Well, the best line that we have before us today is the, based on Ofcom's advice is the best way that we can find, in terms of practicality of enforcing what was written into the act. This is the

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way that we have found... Does the noble Lady in the Minister except that also within the act, it doesn't oblige the Secretary of State to follow Ofcom's advice, of State to follow Ofcom's advice, that the government has a separate decision-making moments, process to consider that and it reaches a decision. It is not on Ofcom and is decision. It is not on Ofcom and is on the government. The government think this is the correct way forward is to ignore what has previously been put in the act.



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previously been put in the act. The noble Lady is quite right, the secretary of state and obviously, the Secretary of State duly reflected and decided we would abide by Ofcom's, it was the Secretary of State's decision, that is why we have this SI.

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Briefly. She heard the example I gave. The harm that was made by using the small channel telegram. The harm it does not need to be widely disseminated. These are disseminated through a very small disseminated through a very small group of hard-core believers, in some of these strange cults and that is how the harm is done. The fact that it is not widely disseminated that it is not widely disseminated is completely irrelevant. One person who takes that on board and then does something unmentionable should be against the act as it was written be against the act as it was written and as we understood it would be legislated for, with the approval of both Houses of Parliament.

The Brett and extent of dissemination and the number of users is irrelevant.

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This is an issue. The issue that the noble Lords are raising is the noble Lords are raising is the noble Lords are raising is absolutely, it is hugely close to our hearts. We have engaged in Ofcom, we oppress them to take more Ofcom, we oppress them to take more action. The sorts of services, our view is it doesn't necessarily have to be dealt with under the to be dealt with under the categorisation process. There are other ways and Ofcom have assured us, in the way that they have come back to us that there are other ways that they are taking to address these.

It is not as though they have been guarded. It is priority for this government that we addressed the risky issues and we are doing so. We are working with Ofcom to make sure that that is followed through. As I said when I opened the debate earlier, the fact is that we work with Ofcom, the setting up a task force. We are separately looking at these issues. What more can we do. The decision at the moment, in terms of the rollout of the SI and the characterisation.

The reality was Ofcom's research and advice said that the risk of unintended and the risk of unintended consequences has amended is not currently workable to user numbers when setting the category for category 1 and so on. Speak the Minister rightly says currently and even if that is the case. Why is the government closing the door to having this option available to it and Ofcom. She is right Ofcom is doing a lot of work other than characterisation.

Surely the government can see that this is a useful tool to have in the armoury against the sorts of harms that noble Lords have been raising. Why the regulations written so tightly as to close that off? And to avoid taking the concession that was so hard one by my noble friend, Lady hard one by my noble friend, Lady

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I can only say what I have already set on this, we are looking already set on this, we are looking at small but risky, we are working hard on this and so is Ofcom. We can review whether or not the process is review whether or not the process is working. As I have already set out, that option is available to us further down the line. At the moment, as with other parts of the Online Safety Act, we felt we needed Online Safety Act, we felt we needed to get on with it and put these measures into place.

Already the categorisation provisions will take another year or 18 months to come into effect. It's not as though that is the most imminent part of the implementation of the act. I hear what you said, none of these issues are off the table, we just wanted to get the act rolled out in the quickest and current form we could. If I could move on, in response to questions raised by Baroness Kidron, Lord Pannick and Lord Parkinson, I am not able to share the legal advice, but as I have said, the Secretary of State must act within the legal framework and the current threshold are legally valid and have been considered by the Joint Committee on Statutory Instruments.

In addition to small but risky services, even though in principle there is a provision that allows a user number threshold not to be met, it does not for example allow for some delegations to other parties such as coroners which was of the concern of Baroness Morgan's amendment. The decision on the categorisation thresholds has led some to assume that certain small high-risk services are being overlooked by the legislation, however this is not the case as they will be subject to the stringent illegal Harmon child safety duties.

I know members are aware that the categorisation of small but risky services will also not prevent or deter users who are determined to access harmful content on dedicated forums. Moreover, the noble Lord raised the question of small but risky services evading the core duties such as user empowerment. Services that exist solely to host abusive or pro-suicide content will not have terms of service banning such content, so enforcing those terms would be ineffective in terms would be ineffective in reducing harm.

In addition, the user empowerment tools will enable adult users of Category 1 services to avoid certain types of content such as harmful suicide content. We anticipate these duties will be most beneficial when services have commercial incentives to permit harmful content and were users see content they might otherwise see, but not where they are actively seeking out content. I hope that begins to explain the Secretary of State's decision. I have to say, it was a difficult one and whilst we acknowledge the possibility of deviating from Ofcom's advice and utilising the option to set threshold combinations without a user number, this would not have had the effect of meaningfully reducing harm on small but risky services, but would risk regulating hundreds of small low risk services.

Regarding Ofcom's small but risky supervisor task force, which Lord Clement-Jones asked about, I am confident that Ofcom can effectively use that task force to address these issues. Ofcom have already had plans to ensure compliance with first duties which go live under the act, these include using targeted enforcement action against small risky services where there is evidence of a significant ongoing harm -- ongoing risk of harm to users, especially children and an apparent lack of safety measures in place.

In serious cases, Ofcom can seek a court order imposing business disruption measures if there is evidence of continued noncompliance. This could mean asking 1/3 party to withdraw from the service or asking an internet service provider to limit access. I hope that the child safety and illegal content duties come into force this year and the work of the task force begins, those of you in this House who are concerned will be able to see how these services will not evade responsibility.

With regards to the issue of Wikipedia in response to the questions raised by Lord Clement joins -- Lord Clement-Jones and Lord Moylan, the government is not a position to confirm which services will be designated as category 1. This is Ofcom's statutory regulation once they are passed and enforced. It is worth noting that many of the duties on categorised services are subject to the principal of proportionality. This requires Ofcom to consider measures which are technically feasible to providers of a certain sizable capacity.

Where a code of practise is relevant to a duty, Ofcom must have regard to a principle of proportionality. And what is proportionate for one kind of service might not be proportionate for another. Lord Clement-Jones and Lord Moylan also queried how Ofcom could make assessments against the definitions of Sultan -- certain functionalities and user thresholds in a Statutory Instrument. Once the regulations have been approved by parliament, Ofcom will issue a request and will start assessing services against the threshold conditions.

I also understand there has been concern that small forum such as local community forms are being overburdened by the act and its duties. I must reiterate that these platforms often run by a small number of users, will not be captured by the categorisation thresholds debated today. At the same time, I acknowledge that the new illegal content and child safety duties will require some additional work from these types of services. I want to assure those today that the principles of proportionality and risk are embedded into the duties on services and on Ofcom in relation to the codes of practise.

This means that small and low risk services should not be overburdened by the duties in the Online Safety Act. In efforts to ease the pressure for services, Ofcom are providing support for online services to help them to understand their responsibility under the UK's new online safety laws. These can be found on Ofcom's website. Lord Stevenson raised the question of engagement with relevant committees. I agree about the importance of parliamentary scrutiny of implementation of the Online Safety Act and welcome expertise to members of both houses bring.

The government agrees that it's vital they are accountable for their services including through annual reports and reporting requirements. We will continue to work with the House of Lords communication and digital committees and the House of Commons science, innovation and technology committee to support their ongoing scrutiny, as well as any other parliamentary committees you may have an interest in the act. -- Who may have. I am happy to meet with Lord Stevenson to discuss how that can be progressed further.

In response to the noble Lady, Baroness Penn, I want to put on record that a letter was shared with the Delegated Legislation Committee in response to concerns raised during the Commons debate. I must again stress that the Secretary of State will be holding these thresholds and the wider regulatory framework under review going forward. The government will take whatever action is necessary to tackle risky services of any size. I would finally like to thank all those who have contributed today, Lord Clement-Jones, Baroness Morgan, Baroness Kidron, Lord Pannick, Lord Moylan, Baroness Penn, Lord Parkinson who continues to put valuable work, expertise and energy into making the UK a safer place both online and in the material world.

I would specifically like to thank user safety groups who have engaged with government on this matter. And also, Lord Clement-Jones for his dedication to work on these issues. I recognise there are some who would like to see changes to this instrument. There are some who believe the decisions of the government do not align with the intentions of the act. I hope that they understand that every decision made by this government is made with the intention of bringing about the act in an important and timely matter -- way.

For too long, children and adult in this country have had to grapple with an unsafe online environment and the instrument we have debated today shows real progress. I don't shy away from the challenge we face in navigating the changing online world. I also recognise that the act is imperfect, however it is not the destination, but it is a significant step in the right direction. There will always be more we can do. Years that, consider the time pressure, but consider the fact that we have to get on with the rollout of the act and I urge noble lords to approve this vital piece of legislation today.

I beg to move.

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I raised a number of questions and I would be grateful if she is not going to answer them in the not going to answer them in the moment, she could write to me about the joint committee and about the the joint committee and about the hierarchy of the act and statements from the dispatch box, versus this decision and other decisions.

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If I haven't covered any issues, I will of course write to noble lords on matters that are
20:56
Lord Clement-Jones Portrait Lord Clement-Jones (Liberal Democrat)
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outstanding. I'm going to be extremely brief, can I thank all noble lords who have contributed this evening. The noble Lord Stevenson use the expression emotions raised. That's exactly what this regret motion has done. There is real anger about the way that this Statutory Instrument has been put together. We were, and I think many noble lords involved in the bill, were extremely proud of our work as has been expressed, but I'm afraid the noble Baroness has made a valiant attempt, but she's been given a hospital pass effectively.

It's quite clear that the Secretary of State did not have to accept the advice from Ofcom. Ofcom's advice, as Baroness Kidron made clear about functionalities and the evidence that Lord Russell of Liverpool put forward as well, not to mention the evidence from the antisemitism foundation. All that indicates that there is considerable belief around this House that we are not dealing with the high risk, but smaller sites such as Telegram and 4chan. In these circumstances, we believe, I believe that the government have got this completely wrong and it does need rethinking and therefore I would like to test the opinion of the House on a regret motion.



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The question is that the amendment in the name of Lord Clement-Jones be agreed to. As many as are of that opinion, say, as are of that opinion, say, "Content". Of the contrary, "Not content". The question will be decided by a division, I will advise
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21:11
Baroness Fox of Buckley Portrait Baroness Fox of Buckley (Non-affiliated)
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bit of an anti-climax. I will carry bit of an anti-climax. I will carry I rise to move my amendment at 160 A, which is calling for a review of the impact of the Act on the prison estate and the ongoing treatment of mentally disordered people, in a prison setting. A year after the Act passes. We all welcome the bill's commitment to using prison cell cycle places of safety. Some of us have already noted in an earlier group, the promise of, for example transfer to hospital and hospitals are facing acute crisis, within 28 days, is widely viewed by criminal justice stakeholders as unlikely to happen.

We need to review if such cynicism is merited. Prison reform aspects of this bill are not minor, they should be treated as the Cinderella clauses, they are to my mind a crucial. -- They shouldn't be. We can't pass this Act any prisoners who ought to be in hospital beds abandon in squalid conditions in jails and additionally it is not fair to prison staff, to quote Andrew Neilson from the housing, a quick or overcrowded prison system which has been asked to do so much, with too little, for too long is not adequate for those requiring help for their mental health.

With my academy of ideas how Tom, the new leadership team provided some fantastic work on a purposeful rehabilitation activities. And we hope to do a joint project on matters, beyond I chatted to the team more generally and worked in a variety of prisons and they all noted that the time and emotional strain on staff, when dealing with a psychotic, very poorly prisoners and the worrying examples of inmates from, examples such as eating their own faeces, very bloody attempts at self-harm have been totally demoralising on for for officers.

One of the reasons we have heard people using low segregation orders. They have had a destabilising and frightening impact on other prisoners. Sharing space with those with paranoid delusions presents a violent threat to themselves and others, it is no joke. It is making prisoners difficult for everyone. It is crucial we get there, we get this right in the context of an overstretched prison crisis and the specific view, in my mind. I also think we can't let this bill passed into law, without acknowledging that there is considerable public disquiet about the relationship between criminal justice and mental health care.

What we do about the detention of those convicted of serious crimes, due to diminished responsibility, were professionals see hospitals is more appropriate than prison. I'm sure we can all recognise other for many victims and their families, this hospital option can feel like an injustice. I am of course thinking of the high-profile and controversial case. According to the recently published independent investigation, it was repeated failures to treat paranoid schizophrenia and violent outburst that left him free to kill Barnaby Webber, Grace Alec Umar and Ian Holmes in June 2023.

More presently in relation to the bill, the families of these tragic terms of fear that he may have been spared prison, due to incomplete evidence, presented in court, especially about mental capacity. This is now exposed in the 302 page investigative report and the families say this was a man who actively avoided his medication and treatment, knowing when he didn't take his medication he would become paranoid and violent. This is of course interesting for our deliberations, because we now know that doctors responsible for his case reportedly ignored nurses treating him in the community, who begged for him to be put on a CTO, to ensure he took a long acting antipsychotic drugs.

And why were they ignored? It seems that the clinical team at Notts health trust. "Influenced by the drop Mental Health Bill of 2022. " They were very conscious of legislation down the line that seeks to raise the threshold of detention, reduce the use of CTO's and the call for a reduction of compulsion of medicated patients, in the community. Then there's patient rights, looking to take medication, because he didn't like needles. Staff were told they were acutely aware of the bill highlighting the disproportionate use of restrictive practices on a black African black Caribbean patients.

And so on and so forth. So surely and the reason I raise at this, we need to ensure that this bill doesn't lead to such misinterpretations, with the tragic unintended consequences. When I asked, the Minister, how the findings of the investigation would impact on the SLORC? Her answer, I think seemed unclear to me, in terms of timelines. If lessons will be of timelines. If lessons will be learnt, it is be more than that, perhaps this amendment would give the Government a chance to review the impact of the axe on the criminal justice and mental health in general.

And the whole dispute about prisoner versus hospital, the about prisoner versus hospital, the What we will also need to review is how the act will interact with the prison estate and not an imaginary one. Regardless of the 28 day rule, there will still be mentally ill people incarcerated in prison. One complication is some prisoners will be likely to deteriorate in jail, so much so they arrived at a key crisis phase. This is because in some instances of the inadequacy of mental health service provision in prison.

One evidential marker of this relates to recent revelations that 4/10 prisoners have taken their own lives in custody in recent years did so because they were denied adequate healthcare before their death. I want to give huge credit to the journalism of Amy from the independent. She exposes scale of neglect showing 104/233 self- inflicted deaths investigated by the prisons watchdog between 2020 and 2023 showed the lack of mental health care in jail. I will focus on a couple of cases to illustrate the point.

They heard of one prisoner who took his own life, 37-year-old Jason McCaig who did not eat or sleep for three days and begged for help after being put in one of those segregation units we discussed earlier. His family repeatedly warned he was going to take his own life but he still wasn't seen by any mental health clinician in the 72 hours before his death. No wonder they described his treatment is medieval. Similarly, at another inquest, in December, the prisoner Jeffries, it was found that it was neglect and a failure to procure basic medical attention that contributed to his death.

He took his own life in February 2023. Shortly before his death he was observed naked on all fours in his cell barking like a dog. In the throes of severe depression and suffering acute psychosis. Yet staff did not provide him with any medical attention. That is of course shocking, but perhaps more shocking is that his mental health rapidly deteriorated after he was recalled to prison having successfully rebuilt his life on the outside. The recall, based on the unproven and later withdrawn allegation, was under the terms of that discredited and abolished sentencing regime IPP.

Once more, the coroner noted that the postponed parole hearings, more than minimally contributed to the development of psychosis due to psychological stress. Complaints about the inequities of IPP sentences are familiar in the South and to the Minister -- 's house. Yet the state still incarcerates 2,600 people indefinitely. And although there is now brilliantly being reform of the draconian IPP recall regime, still there's a whole body of evidence to suggest that mental distress is one of the most pervasive and intrinsic factors associated with IPP sentences.

And not because of the existing mental health issues, but a distinctive characteristic of the specific sentences health over and above the experience of imprisonment. The way the sentence is psychologically toxic is well documented in the literature, assessed in valuably entitled the mental health of people serving indefinite services and public protection. Pertinent to our discussions of this bill, IPP prisoners... Or ask for help from prison staff, because poor mental health is regularly cited as a reason to not back there parole.

This can lead to untreated illnesses becoming more acute and in need of the provisions of this legislation. It also suggests that some of these IPP prisoners are effectively being detained by the state because of their mental health challenges. Without that being acknowledged. This could be seen as a sort of section by the back door. These Catch-22 situations were IPP prisoners are illustrated by the harrowing plight of Thomas White, the father who spent 13 years in prison for the Street robbery of a phone which I raised at second reading.

Two medical reports last year laid bare the toll of his IPP jail term on the 42-year-old Mr White, warning that his lengthy incarceration hat trick -- had created impermeable barriers to his recovery. Since then, the latest news from his family is just awful. He is totally disengaged and has lost hope. The cause is the denial of a hospital transfer, the very key part of this bill. His sister explains the dilemma, she says, if I took him to a and E and sat there for three hours, he would be admitted to hospital.

I thought three hours was optimistic myself. But prison staff ins dead would have to display three months of instability in prison to be reassessed for a hospital transfer. A man with paranoid schizophrenia has to pretend he hasn't got it in order to get hospital care. That is ludicrous and it does seem to me that that's the kind of problem that this review and special audit that I am suggesting in my amendment would allow us to look at and look at the particular impact on IPP prisoners as a specific group.

Finally, I want to raise an issue that threatens to confuse our aim of reducing the use of prison as a place of safety. That is the contesting diagnosis of personality disorder. Often used to define and label people as dangerous or risky and potentially masking multiple -- mental health problems. It's been used in relation to IPP prisoners whose failure to accept inequities of their sentence could be pathology ice is anti- sociability, but it's also a syndrome prevalent in the women's estate.

My main query is whether those put on the offending personality disorder pathway, which does not require a formal diagnosis by medical staff, doesn't muddle up those prisoners who might need more direct mental health treatment and instead just get the label of behaviour disorder. I hope at least at the level of probing that the government can explain how we can ensure that the parts of this legislation relating to prisons are not provisions that might take a box, but actually get neglected and they will have a real impact, at least a review would help that we

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keep our eye on prisons and I beg to move. Proposed after class 50, insert

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Proposed after class 50, insert the new clause review impact of this act on the prisoner state.

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I had not actually intended to come in on this particular group,
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21:25
Lord Kamall Portrait Lord Kamall (Conservative)
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During the passage of this bill, both Baroness Fox and Lord Bradley have been very passionate about the issue of people with mental health issues in prison. Before I go issues in prison. Before I go further, I should say as well that I further, I should say as well that I know Lady Fox referred to a case for the government has instigated an inquiry. That case was the motivation between other amendments in a later group to which my noble friend will speak.

During the earlier debates around this, both at second reading and at Committee stage, I was particularly struck by the remarks of Lady Fox speaking about chief inspector Charlie Taylor's graphic description of seriously mentally ill people in prisons being akin to a Victorian nightmare. After that debate I read some of what he said, particularly about his visit in 2022 to Eastwood Park where he witnessed, bloodstains on the floor and scratch marks on the walls. Evidence of the levels of distress of the women being held there.

Baroness Fox also told the House that the experience of prison staff, saying one of the most difficult things is the dangers that prisoners with mental health issues posted themselves, other prisoners and staff. In reading some of Charlie Taylor's quotes, he told of an incident where staff were unable to stop one inmate from repeatedly running into a brick wall due to a lack of suitable training. These are very important issues that she is raising. And many others have raised.

Given the importance of this, I know one reason the Minister was appointed to this position was his experience and passion for prison reform, it seems reasonable to ask the Secretary of State to publish a review of the impact of this act on prisons and to assess whether the act provides for adequate support for ongoing treatment and care in those settings, including adequate training for staff. I'm sure this will not only be of help for the Secretary of State of the Department of social care, but also the Ministry of Justice.

I look forward

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to his response. I'm grateful to Baroness Fox for

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I'm grateful to Baroness Fox for bringing this discussion before the committee today. This amendment would introduce a new clause making would introduce a new clause making it a requirement for the Secretary of State to publish a review of the impact of an assessment for impact of an assessment for provisions of the act which relate to care and treatment of mentally disordered persons in prison. This includes underage teens and young includes underage teens and young offenders institutes, IPP prisoners and female prisoners within 12 months of the date is past.

The aim of the criminal justice reform just to speed of access -- speed up access for patient care and ensure people with severe mental health needs are able to access effective and timely support in the most appropriate setting. We are committed to understanding the impact of these provisions as we monitor any available data. However, these reforms will not come into effect until at least 18 months post Royal assent. This is to ensure the necessary operational improvements have been made to enable them to be safely implemented.

We are working closely with health and just as partners to ensure there is a robust implementation plan in place and we will scope the feasibility of assessing the impact on all prisoners, including under 18's in young offenders institutes, IPP prisoners and female prisoners. Our expectation is that the number of these cohort effective in prison setting will be small and are likely to show up in administrative -- unlikely to show up in administrative data sets. However, I would like to reiterate that everyone in our care is important and I think Lord Kamall for his comments about the importance.

We are committed to supporting everyone's rehabilitation making sure people stay out of prison by leaving in good health. I am pleased on feedback on the noble Lady's visit to HMP five wells. I've also seen ill prisoners there and many other prisons. That's why this bill is so important in the work we're doing to improve our prisons and the chances of prisoners leaving with a one-way ticket, not a return ticket, are so important. I would like to reassure the noble Baroness that
21:30
Lord Timpson Portrait Lord Timpson, The Minister of State, Ministry of Justice (Labour)
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there is already robust scrutiny landscape in place. We are landscape in place. We are accountable to several key stakeholders and bodies including His Majesty's Inspectorate for prisons, independent monitoring prisons, independent monitoring boards, the Care Quality Commission and health Inspectorate whales. We and health Inspectorate whales. We are committed to learning from what works and where we can improve support for vulnerable inventors -- offenders with severe mental health offenders with severe mental health conditions. There is other important work taking place alongside our work taking place alongside our reforms.

The Chief Medical Officer is undertaking an independent review of offender health which will include young offender institutions, IPP prisoners and female prisoners. This will help us get better understanding of the specific health challenges faced by offenders and to work with the Department of health and social care, NHS England and other health providers to improve support available to them. Alongside these legislative reforms. Additionally, NHS England will be undertaking a full review of the mental health service specification and pathways of care.

The tragic murder of three innocent victims is horrific. The independent criminal court, including the Court of Criminal Appeals have past sentence on him and the department properly does not comment on the decisions of the independent judiciary. The Prime Minister has announced a statutory and judge let inquiry into the case. It will look at how different agencies, including health and social services, the police and the Criminal Justice Bill him work together and it will examine any multiagency feelings that take place in the lead up to this tragic in the lead up to this tragic It will also establish his involvement with public services.

Addressing the mental health needs of offenders as a critical element of tackling offending behaviour. It is the upmost importance of this government. I hope this reassures of the noble Baroness that we agree on the importance of ensuring that those with severe mental health conditions receive the necessary support and that we are committed to continuing to review and improve this area, in the future. It is for these reasons that I urge the noble Baroness to withdraw her amendment.
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Baroness Fox of Buckley Portrait Baroness Fox of Buckley (Non-affiliated)
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Only very briefly, to note that thank you very much to the Minister, Lord Timpson. Obviously he has an intimate and very empathetic relationship with the prison estate and the issues of that I am raising. I do appreciate that he and I share a very similar concerns. I think the difficulty is, I do not think it is just the hour, that this bill does say is going to resolve things in relation to prison, but actually, the discussion around prisons is rather been neglected.

I understand rather been neglected. I understand why. But actually, the reason I mentioned this is because a lot of the issues in the community, a lot of the public debate, in a way about mental health is the notion of people being ill, wandering around, not being safe and so on and so forth. I couldn't think of another way of raising that here. It then does affect the prison estate, because then people phoned the police and then they get taken to prison, or in fact they've been let out of prison and they are mentally ill and so on and so forth.

That is one thing. It requires a much greater scrutiny and debate, not just through this bill, but in general in parliament, that's the first thing. I also think that we haven't got public opinion on our side on this, in many ways. People are not sure why people are sent to prison and some instances in hospital in another. I do not expect the Minister to reply, but I think that needs to be acknowledged. Secondly, I would like to note that even though I used the example of five was a prison, if all of the awful things were not happening there, it was based on the experience of being prison officers in many places.

I do not want to put the prison into difficulties. They are doing a very good job, in very difficult circumstances. I will just say that I think that on paper, this will make a small impact, this bill. I think there is a much further it I think there is a much further it could go. I am pleased to hear it is taken seriously. I would draw the amendments, but I think we have got a long way to go to so I will keep pursuing this.

I would like to thank noble Lords who spoke Port. I really appreciate that. Smegma Is it your Lordship's pleasure that amendment 160 AB were drawn? Amendment is Bollywood drawn. Hundred and 60 B, Baroness Tyler of Enfield?
21:34
Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (Liberal Democrat)
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There has been discussion about committee stage about whether this act, or our deliberations should strip sticky to detention or range wide. I know there are different views on this issue. I have said, throughout a debate that we need to see more we can do to prevent people from reaching the point where the only option is being forcibly detained. I feel that a key omission at the moment is a power around prevention. Given the cost of statutory inpatient admissions under mental health legislation and the stated Secretary of State to reduce hospitalisation.

I have brought forward a simple amendment that would give relevant authorities the power to promote mental ill health prevention, in their communities. Whilst of course being realistic about current financial realities. So my amendment and a 160 B seeks to explicitly grant relevant bodies, included Integrated Care Boards, public health bodies, mental health boards, in Wales, the power to commit mental health prevention, within their communities. It would also empower organisations, such as social care in the voluntary sector to take proactive steps in reducing the likelihood of individuals reaching a crisis point, requiring detention under the Act.

I was pleased, recently to have the opportunity to discuss others, with the approved mental health professionals, leeks and network, who are very much involved in this. They expressed their support for such an approach. I think we all understand that the causes of mental health issues are complex and can be, as much around societal issues, employment, housing, poverty, as clinical issues. And that is clearly recognised in the outer role, which acknowledges that whilst a clinical perspective is always appropriate, other perspectives can be equally valuable.

And as I had it explained to me, the core of the improvement of the mental health professionals role is to explore less restrictive methods to detention in crisis. It is then quoted a number of times in this chamber, but recently the Secretary of State has said, a quite publisher 10-Year Plan, early next year, that was set out how we will deliver three big shifts in the focus of the NHS. From analogue to digital, hospital to community, sickness prevention. " I see this piece of legislation and indeed this amendment as an opportunity to make a reality of that statement.

In relation to mental health. So whilst of course there will always need to be provision for statutory interventions, for those who present a severe risk to themselves. It is surprising to me that this journey from hospital to community and sickness to prevention, that there is no explicit mention of the promotion of good mental health, in the bill. There is plenty of evidence of the links between prevention and reducing detention. I was going to give some examples, but the hour is late, so you were pleased to hear that I'm not going to.

There is also plenty of examples of sorts of alternative approaches to detention, they might be things like Crysis cafes and so spaces, community crisis, response teams. Mental health and social care professionals who respond to individuals in crisis. Networks, centuries and respite services. All of these have shown to be effective in reducing the need for hospital admissions. So, to conclude, both formally giving relevant bodies at the power, that apparent a duty to promote mental health prevention. This amendment encourages a proactive, rather than a reactive approach to mental health care and support.

There by, I hope, reducing reliance on crisis interventions, reliance on crisis interventions,

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including voluntary detention. I beg to move. Articles 50, insert a new clause, a duty to promote mental health and well-being. 160 B.
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Lord Kamall Portrait Lord Kamall (Conservative)
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well-being. 160 B. My Lords, I think it is true, I

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My Lords, I think it is true, I thank the noble Baroness, Baroness Tyler for introducing this amendment. I think it is quite clear that noble Lords, across the House agreed with the government's commitment to move the emphasis from sickness prevention. This clearly is an amendment aimed at that, as the noble Baroness said. During my time as a health editor, I have met with a number of community and civil society projects, charities and to help professionals who share the amazing work being done in local communities across the country to improve the well-being of their communities.

I should put on the record my thanks to the noble Baroness, and Lord Howarth for introducing me to the wonderful world of health. Also introducing me to the national centre for creative help. The work addresses the theme of early amendments. From the noble Lord Hollington Lord Crisp on the overprescribing of antidepressants. Looking at alternatives. We are not saying that medication is a bad thing. It is very appropriate in some cases, but there are alternatives in terms of social prescribing. The late noble Baroness, introduced me to a wonderful organisation called Generational Musicmaking..

I want to put the record my thanks for their work and invite them to take part in a music hub in December. Despite a music hub in December. Despite being handed a guitar to play along, it was inspiring to see the difference in music can make, in improving well-being. Also bringing people of all ages together, including some children from a learning disability charity. Noble Lords will also no of the equally amazing work done by many social prescribing organisations, music, art, drama and green spaces.

A career in creative health operas more opportunities for budding actors who can train as drama and music therapist, while waiting for their big break. Many don't wish to be stars and actually find their work and combine their passion, with improving mental well-being. However, one of the criticisms I hear is one of those amazing workers in different settings of different Different care systems across the country. How do we spread the best practice, across our system of health and care? While recognising that what works in one area may not always be an off-the-shelf solution, in another locality.

Here I think Lady Tony's amendment, that local authorities and commissioning bodies must publish an annual report, outlining the steps taken to discharging a duty to promote one- two health well-being may be a way to address the concern. I hope it is an amendment that the government will consider and if not, perhaps of the noble Baroness the Minister can tell you Lordship's House the government intends to encourage the share of best practice in improving mental well-being, across our system of health. Particularly across the different communities with different needs and different constraints.

In order to improve the mental well- being of the nation.

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My Lords, I would like to thank the noble Lady, Baroness Tyler for the noble Lady, Baroness Tyler for tabling amendments 160 B and to say that we do recognise the importance of local organisations, taking of local organisations, taking collective action to promote mental
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Earl Howe Portrait Earl Howe (Conservative)
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One. 160 BA. I beg to move high did and 60 BA, and speak to amendment hundred and and speak to amendment hundred and 60 BB. Tabling my name and Lord Kamall, stemmed directly from the harrowing case of the murder of three people, in Nottingham. The Minister and indeed other others that may subject the propriety referring to an individual case. I do believe that this is one case where it is legitimate to do so. The amendments have been drafted in the light of the facts that have emerged, from the four independent investigations into the care and treatment of the months leading up to the tragic events of June 2023.

There have also been press articles and a report by the independent office of police conduct, the IOPC, which identified 11 mistakes, in the which identified 11 mistakes, in the There is a great deal about the case that is known and not disputed, given the magnitude, I think it would be remiss of this committee not to spend a little time considering its implications. Before I go further, there are two things I need to say, the first is to acknowledge the government has agreed to a judge led public inquiry, that will start in a matter of weeks.

Secondly, on that account, I will do my utmost to avoid saying anything that would undermine that inquiry. It does seem to me that there are a number of issues arising from the treatment of him that are directly relevant to this bill because they are of wider application. The report of the independent investigation recounts the timelines associated with his treatment. His first contact with mental health services was on 24 May 2020 when he was arrested for criminal damage and a mental health act assessment was undertaken.

That assessment indicated he was experiencing the first episode of psychosis brought on by sleep deprivation and social stressors. During this first contact he was not detained for treatment as he acknowledged that he required help for his condition. However, after returning home, he was arrested again and was considered not to have capacity to consent and was consequently detained under section 2 of the Mental Health Act. After this episode of treatment, he was then detained under the Mental Health Act again on 13 July 2020, this time under section 3.

Upon discharge, he was considered to have a primary diagnosis of her annoyed schizophrenia -- paranoid skits of premium was to continue with antipsychotic medication -- paranoid schizophrenia. He was detained again under section 2 of the act and continued treatment in the community. He began missing appointments with his care coordinator and mental health care team from July 2022. On 4 August, the care coordinator attempted to make a home visit, but the given address was incorrect and on 17 August, the care coordinator attempted to reach him at a new address which received no response.

The report then states that on 23 September 2022 it was documented that as no contact had been made with VC, a decision was made on 22 September two discharge VC back to his GP due to nonengagement. A letter to his GP was written the same day outlining noncontact and that he had been discharged. The key aspect of all this is the problematic last line which states that there was no contact between VC and mental health services or his GP between the state and the tragic incidents in June 2023.

For a whole nine months prior to the killings, there was no contact between any health services and him. What this demonstrates is that the coordination between the community aspect of his care was clearly inadequate. After he began to miss appointments, it appears there may not have been sufficient attempts at outreach and there were evidently issues with maintaining contact between mental health services and the patient. It is this issue that my amendment 160 B be attempts to address, it takes the form of a report on continuity of care to ensure that all options can be explored.

I don't profess to have the answers, but as subsection 2 of this amendment makes clear, subclause two, such a report must include discussion on the possibility of creating some form of duty placed on ICBs or hospital managers to maintain contact with patients who are known to have a mental disorder. This is not too far from one of the recommendations of the independent investigation which said NHS England and other national leaders, including people with lived experience, should come together to discuss and debate how the needs of people similar to VC are being met and how they are then able to be supported and thrive safely in the community.

The point is that somewhere along the line the mental health care system failed him and ultimately his victims and the wider public. As we debate this bill, we have the opportunity to address these potential failures in the hope we can make progress towards minimising the number of patients who slip through the net in this way. The second issue to arise from the case relates to the publication of the investigation. Noble lords will remember that controversy arose when the NHS Trust responsible refused to publish the full version of the independent investigation into the treatment of him due to patient confidentiality.

We all know the NHS did subsequently publish this investigation, I just referenced above, but this was not about -- without significant pressure. There are questions to be answered about whether or not patient confidentiality rules should apply in cases like this when there is a significant public interest. Of course, there should always be adequate safeguards to ensure that a patient's medical records are protect, but as my amendment sets out, where they have clearly been significant institutional failings regarding a patient who has been treated under the Mental Health Act and who is then gone on to commit a violent offence, it may very well be in the wider public interest for such investigations to be published in full.

I am under no illusion that this amendment may not be the absolute best solution to the problem, but I do hope it at least starts a conversation and pushes the government to review its approach to publication. There are a number of concerns raised by these harrowing events. We must do better and I would like to ask the Minister whether in the light of the published report she believes that there are any measures which could and should be taken now prior to the report of the judge led inquiry.

I thank the noble Baroness in advance for the considered answer I know she

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will give. I beg to move. After clause 50 and through the new close, duty to publish
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Baroness Fox of Buckley Portrait Baroness Fox of Buckley (Non-affiliated)
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I was pleased to see these amendments as well. He has explained why they are important. He has conceded and I tried to apply the same in my own amendment, that it's not necessarily clear how best to raise these issues, but that we need to and that if we are seeing by the public as discussing a Mental Health Bill and going to the whole thing, one of the controversies of time which was a mental health issue, it will discredit the bill as an act.

I wanted to note in relation to the wanted to note in relation to the NHS Trust to publish the investigation as the excuse given that it was seen very much as an excuse given by the families of the victims who were very angry about that. It then in a way doesn't help us in relation to having a discussion with people in the public about mental illness because it then seems as though murder was committed is somehow mental illness was used as an excuse.

We have all heard that argument being used, that's why I referred to the fact that there was some dispute about the fact that whether he should be sent to prison or to hospital. I think more openness we give this, the less stigma and confusion. We need to have this debate in the open. Finally, I will just ask, the judge led inquiry and what we already know from the investigation by the trust, how will that impact this act? How will it impact? What practically how are we going to be incorporating -- how will we incorporate into that model whole new legislation on mental health and it would seem we need to be able to take on board some of the recommendations of the inquiry, but even now what we know from the investigation by the trust.

from the investigation by the trust.
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Baroness Merron Portrait Baroness Merron, The Parliamentary Under-Secretary for Health and Social Care (Labour)
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I would like to thank Lord Howell for tabling amendments 160 B letter a and 160 BB supported by Lord Kamall, spoken to by Baroness Tyler and Baroness Fox. Let me at the outset say that I understand the deep concerns raised today by noble lords. I would like to take this opportunity to express my sincere condolences and I am sure the whole of your Lordships House, to the families of the victims. The Secretary of State and I have met with the bereaved families and following these horrific killings and rightly important actions have been taken, which the noble Lord Earl Howe spoke about and we have to look at how improvements must be made both at the trust and across the country.

To take this further, NHS England and Nottinghamshire foundation trust have accepted all of the recommendations made following the section 48 CQC review into this incident and action has started on implementation. The recently published independent investigation into the care and treatment provided to him also makes a series of recommendations which NHS England and Nottinghamshire healthcare NHS Foundation Trust have accepted. Let me reiterate once again that the government does again that the government does expect to see Swift action to ensure the regulations are enacted as soon as possible.

As the Prime Minister has confirmed and the noble Lord Earl Howe acknowledged, there will be a judge led statutory public inquiry into this tragic incident. Turning specifically to the Turning specifically to the amendments. To amendment 160 B a, we recognise transparency around patient's care to enable a full understanding of what went wrong and how learning can be applied as a result. The courts already have legal powers to request and where appropriate compel disclosure of relevant reports ensuring judicial access to relevant information.

In criminal and civil proceedings, courts can make orders that particular information be provided or issue witness summonses wall corners can obtain documents as part of an inquest. There is no clear evidence that courts face systemic barriers in accessing necessary information. There are also existing mechanisms to provide robust over bus transparency NHS incidents response framework sets out clear guidelines for responding to serious incidents involving patients who are detained under the mental health act. Additional scrutiny is provided through investigations by the Health Services safety investigations body and oversight from the CQC.

If information is not disclosed, interested parties already have mechanisms to access information, including judicial review, freedom of information requests and the So whilst courts have the power set out in this amendment. I would say we absolutely recognise the importance of openness and mental health services. Which is why officials are working with NHS England to ensure the information from the investigations is as transparent as possible. Something that all noble Lords have rightly referred to. And specifically to a refer to the investigation of the public investigation in Nottinghamshire.

NHS England were following at the legal advice that they had received in relation to publishing the report. However the strong wishes and feelings of the victim's family, the decision to not publish the full report was reviewed. And a risk-based decision was taken to publish the full report, in this particular case, as much of Valdo Calocane's medical information was already in the topic information was already in the topic domain. I now turn to amendment 160 BB and wish to agree that good continuity of care is absolutely vital.

Proving this is a key objective of these reforms. The bill introduces a statutory care and treatment plans, which aim to ensure that patients of the clear and personalised plan in place, to progress them towards recovery. We intend for this plan to cover how the patient will be supported and the services that they will need, in the community, after discharge and the content of the plan will be set out in regulations. We will be commissioning an independent evaluation of the impact of these reforms and therefore do not feel that a separate report is required.

More broadly, the community mental health framework is intended to help remove what are referred to as cliff edges of care, between a secondary and primary care services. This includes a named key worker, for all service users, they clear multidisciplinary team approach, to both assess and to meet the needs of service users. With reference to the specific point about a duty to maintain contact with patients known to have a mental disorder, where a patient does not engage with treatment, Community Treatment Orders already exist to ensure that patients comply with treatment, for their mental disorder in the community.

Following the horrific killings in Nottingham, NHS England have asked all ICBs, in, through the 2024/25 planning guidance to review their services to ensure that they do have clear policies and practice, in place, for patients with serious mental illness. Who require intensive community treatment and follow-up. But where engagement is a challenge. To support system reviews, NHS England has also published guidance, setting out the key principles in this area that should be reflected in local policies and practices. And, in addition, I can confirm that the NHS England natural director for mental health has written to all ICBs, to make it clear that it is vital that they did not -- the DNAs are never used as a reason for discharge from care from this vulnerable patient group.

For these reasons I would urge the noble Lord to withdraw these amendments.
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Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (Liberal Democrat)
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not lose. Clause 61,

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I wish to speak to hundred and 60

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I wish to speak to hundred and 60 C and 160 D in the name of my noble friend, Lord Scriven. These amendments ensure that any changes to this piece of primary legislation, introduced through prime secondary legislation, not prime secondary legislation, not properly considered before they take effect, 160 C makes clear that certain provisions in subsection 5 should not be included under the general powers in clause 51. general powers in clause 51. Amendment 160 D strengthens parliamentary oversight, by requiring that any statutory instrument, amending or revoking this primary legislation must be approved by both houses before it comes into force, i.e.

Using the affirmative procedure. I believe that this is a matter of scrutiny. Prime legislation is carefully debated before it becomes law. I think as we have demonstrated, throughout, this committee stage and any later changes should not be made too easily, without full consideration. If a statutory industry instrument camera meant or remove the act without approval, there is a risk that important legal protections could be altered without proper deliberation. And I think this is particularly important in the context of mental health legislation, where the law directly affects highly vulnerable people's right to personal liberty and their treatment and care.

I hope that the Government will recognise these amendments, which are completely in line with the recommendations of a Delegated Powers and Regulatory Delegated Powers and Regulatory Reform Committee. Simply ensure that when Parliamentary legislation is

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As As in As in the As in the first As in the first place, As in the first place, my As in the first place, my Lords, As in the first place, my Lords, I beg to move. Clause 51, page 63, line 29, at the beginning insert, "Other than provision mentioned in subsection 5.
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Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (Liberal Democrat)
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My Lords, I do indeed very much welcome the statement we have just heard from the noble Lady, the Minister. I think it is a very, very good point on which to finish our deliberations tonight. We will hand this over to Earl Howe.

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Is it your Lordship's pleasure this amendment be withdrawn? The this amendment be withdrawn? The amendment is by leave withdrawn. 160 D, Baroness Tyler, not moved. The question is clause 51 stand part of question is clause 51 stand part of the bill? As many as are of that opinion, say, "Content". Of the contrary, "Not content". The contrary, "Not content". The contents have it. After clause 51, amendment 161, moved formally? The amendment 161, moved formally? The question is that in them at 161 be agreed to? As many as are of that opinion, say, "Content".

Of the contrary, "Not content". The contents have it. The question is that clause 52 stand part of the bill. As many as are of that opinion, say, "Content". Of the contrary, "Not content". The contents have it. Clause 53, a member to 162, Baroness Merron, moved formally? The question is 162 be agreed to? As many as are of that opinion, say, "Content". Of the contrary, "Not content". The contrary, "Not content". The contents have it. 163, Lord Stevens of Birmingham, not moved.

Amendments 160 3A, 160 3B and 160 3C, Lord Bradley? Not moved. Amendment 164, Lord Stevens of Birmingham, not moved. The question therefore is clause 53, as amended, stand part of the bill? Jens Galschioet. Of the contrary, "Not content". The contents have it. The question is that the amendment 54 stand part of the bill. As many of that opinion say content. Of the contrary, "Not content". The contents have it. The question is that this be the title of the bill? As many as are of that opinion, say, "Content".

Of the contrary, "Not content". The

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contents have it. That concludes that the committee's proceedings, the House

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committee's proceedings, the House My Lords, the committee of the whole House to which the Mental Health Bill was committed has gone through the same and has directed me through the same and has directed me to report it to your Lordships, with amendments.

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amendments. My Lords, I beg to move and the House do now adjourn.
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None Portrait Introduction(s): Lord Rees of Easton and Baroness Caine of Kentish Town
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