Lords Chamber

Monday 31st March 2025

(began 7 months, 1 week ago)

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None Portrait Oral questions: Legislation establishing the Auditing Reporting and Governance Authority and whether it will account for the principle of separation of powers
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Second Oral Question. Paper.
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None Portrait Oral questions: How the Employment Rights Bill will “support the Government’s mission to increase productivity”, as stated in their factsheet for the bill, and what evidence they have to suggest that it will increase productivity
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-- For my noble friend. Paper.
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None Portrait Business of the House
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Business of the House.

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Business of the House. I beg to move the motions standing in my name on the Order Paper. The Question is this motion be

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The Question is this motion be agreed to. As many as are of that opinion, say, "Content". Of the contrary, "Not content". The contents have it. We now come to some instance previously debated in Grand Committee. Disclosure (Scotland) Act 2020 (Consequential

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Provisions and Modifications) Order. I beg to move the motion standing

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I beg to move the motion standing

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in my name on the Order Paper. The question is this motion be agreed to. As many as are of that opinion, say, "Content". Of the opinion, say, "Content". Of the contrary, "Not content". The contents have it.. Electronic Communications (Networks and Services) (Designated Vendor Directions) (Penalties) Order.

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Directions) (Penalties) Order. I beg to move the motion standing in my name on the Order Paper.

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The question is this motion 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. Town and Country Planning (Fees and Consequential Planning (Fees and Consequential Amendments) Regulations. 2025.

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I beg leave to move the motion standing in my name on the Order Paper.

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Paper. Question is this motion be agreed to. As many as are of that opinion, say, "Content". Of the contrary, "Not content". The contents have it. I think it might be a good moment to have a short pause to allow people
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None Portrait Urgent Question Repeat: Future of Scunthorpe Steelworks
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My My Lords,
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Lord Livermore Portrait Lord Livermore, The Financial Secretary to the Treasury (Labour)
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reason is sufficient. On that basis I hope the noble Lords are content not to insist on these amendments. not to insist on these amendments. Turning to emotion D, the other place disagreed with amendment 20 1B. For the reason the government and OBR have already outlined the and OBR have already outlined the and OBR have already outlined the effect of the policy change. Let me make clear that I have no doubt the amendments tabled at previous stages amendments tabled at previous stages of this bill, by the noble Baroness of this bill, by the noble Baroness is and the noble Lord Londesborough were well-intentioned and I am grateful to them for ensuring these important matters have been addressed during these debates.

More broadly I would like to assure the broadly I would like to assure the noble lords we are giving careful consideration to and properly assessing the impact of this bill and it is a priority for this government and I can commit on behalf of the government to continuously monitor and assess the impacts and effect of these policies going forward. Specifically regarding Special Educational Needs and Disabilities, the subject of The government recognises the challenges in the SEND system where outcomes for children and young are often poor.

The government understands the change is urgently needed. We are committed to delivering long-term sustainable change. On the issue of transport, the government does not expect changes to national insurance to have a significant impact on home to school travel for children with SEND. But I can confirm these issues will be fully considered as part of the forthcoming spending review. On that basis I hope the noble Lord will be content not to insist on these amendments. I beg to move.

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The question is the motion is

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The question is the motion is I write simply to thank the noble Lord the Minister and to thank all who have been involved in the passage of this Bill. Especially passage of this Bill. Especially those who have supported myself and my noble friend Lord Altrincham. We my noble friend Lord Altrincham. We have had seven days of debate in the House and nine successful votes in collaboration with other ventures. That demonstrated the serious That demonstrated the serious concerns about this Bill right across the House.

-- Other benches. There is a strong feeling echoed in our hospices, in hospitality and in the High Street and in many other places that this Bill is not the best way to meet the challenges the country faces. And that will -- that it will endanger the growth we need so badly. However, this is a house of scrutiny and other place has taken a different view. As a responsible opposition, we will not seek to defeat this Bill, no matter how deeply we feel about it.

His Majesty's Government must be able to set its tax policy and of course we respect that. But I should add that I'm grateful to the Minister for his closing words, especially his closing words in relation to SEND transport. And for his undertaking to monitor, I think he said the impact and effect of the Bill going forward. We will hold him to that. Moreover, he knows that I and one or two others of us will continue to encourage the Treasury to learn from all of this and experiment with all of this and experiment with fuller sectorial assessments in the future.
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Baroness Kramer Portrait Baroness Kramer (Liberal Democrat)
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that we recognise we have come to the end of the road on this Bill. And we will not press for any further amendments. I will just make further amendments. I will just make a couple of comments. One is I have just come from a fairly extensive just come from a fairly extensive meeting with R3, the insolvency and restructuring professionals body. restructuring professionals body. And they are already were telling me just around the table the cascade of small businesses that are coming in now, going into voluntary insolvency, because of the increasing costs they are facing this April.

And I hope when he says he will look at evaluating and looking for the impact of this Bill, he will make sure that his view casts across that territory because it is obviously absolutely fundamental to the agenda for growth. And indeed also within those discussions of course there were many of the private social care providers. And a number of the smaller ones, at least three of the practitioners around the table, were dealing with insolvencies triggered over the last few weeks. I hope from what he said that he will be and his government will recognise that they now need to use other means to step in and shore up where axillary -- the absolutely key sectors that are based with costs they cannot sustain and are therefore closing services that we absolutely need and we hope very much his perspective, his commitment to ongoing evaluation will incorporate all of that.

And I hope that evaluation will also become quite granular. I think we were quite hopeful when we heard his words on SEND transport because that is quite granular issue, that it will be granular rather than the overarching type of evaluations that we have been dealing with in this House. But he has always been gracious. I understand this has been exceedingly difficult, that the Government faces very difficult and strenuous times. We do recognise that at this point we can take this Bill no further.

We thank everyone who has participated from all of the benches and all of the people in our

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back offices and Whips offices who have provided so much support. My Lords, I to thank the Minister
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Baroness Browning Portrait Baroness Browning (Conservative)
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to speak to amendment one which is in my name and in the same group I will then speak to amendment four, to which I have added my name. Amendment one is exactly the same amendment that I tabled at committee stage and I have brought it forward yet again. Because I felt it was so important. And I did not feel really that we went into as much detail as we should to recognise the real challenge that the Mental Capacity Act could make to the Mental Health Act, as amended by this Bill that we are debating today.

And I am enormously grateful to the Minister, she has not only had a one-to-one meeting with me specifically about this clause but also has sent me a letter. And I hope it will be appropriate for me to quote from some of the letter the Minister has sent me. The reason why I am concerned, as are others, including many charities and I refer to my... The charities I'm registered to in the record, the National Autistic Society, Mencap and of course the Law Society, who I'm grateful to black who actually drafted this particular amendment.

-- I am grateful to who. The difficulty with the Mental Capacity Act is if we prevent, as we wish to under this legislation, people with autism and learning disabilities who have no additional mental health identified condition, that they should not be deprived of their liberty, the worry is that under the existing Mental Capacity Act, the Mental Capacity Act will be used instead to take away their liberty and for them to be admitted to a mental health hospital. And we know of the history in this area, which we have debated many times in this House.

In my discussion with the Minister, I did raise with her the fact that the NHSE service model for commissioners sets out very clearly what the service model states. And it says that 4.3 alternative short-term accommodation available for a few weeks and we are talking about just a few weeks, should be available to people as and when it is needed to be used in times of crisis or potential crisis, as a place where they can go for a short period, preventing unavoidable admission into a hospital setting.

It might also provide a setting for assessment from teams providing intensive multidisciplinary health and care support, principle seven. Where that assessment cannot be carried out in the individuals home. I think we all recognise that there will be some circumstances under which people will not be able to remain wherever they are, either in the domestic home or their normal place of residence, but nonetheless, they should be -- there should be alternatives to them being admitted to a mental health hospital.

To detain them under the Mental Capacity Act has... The dolls deprivation of Liberty safeguards also has other consequences. Because including in those rights in the Mental Capacity Act include the rights of the nearest relative or nominated person to check to discharge, accessible and automatic referral to tribunals, independent reviews of medical treatment, statutory care and treatment plans and of course, section 117 after- care. -- To object. It is not just a question of the Mental Capacity Act being used to deprive people of their liberties, there are associated issues which one would say are almost taking away even more rights from the individual.

As I mentioned, the Minister and I have discussed this in some detail. I'm very grateful to the Minister, in her letter to me, for agreeing first double that she has and I believe she has genuine concern about this area. -- First of all. And in order to mitigate what might happen under the Mental Capacity Act, she has shared in her letter, I was going to say to the Minister I hope this does not seem impertinent, it is such a good letter, I do hope she is going to put it in the library because I'm sure it would be of interest to many people in the House.

But she does give me a lot of data about how the Government is already and will make sure that there is proper monitoring of people who are detained under the Mental Capacity Act who may have autism or a learning disability but who do not have an associated mental health condition. In bold letters in this letter it says, "Ahead of the changes to part two and section 3, we commit monitoring the data on the number of people with a learning disability and autistic people detained under the Mental Capacity Act and will include a line on this in our standard publications." Also the existing data shows that the number is very few, it is actually in single figures.

Although it is in single figures, the act that we had to put on the statute book actually doesn't want anybody, we don't even want one person detained, as they have previously under the Mental Capacity Act we hope will not be used. In addition to this commitment, in bold, in this letter from the Minister, I am somewhat comforted, well I'm half comforted, because the other half of this equation, is that if people are to stay in the community but in specialised environments and with specialised staff to deal with what might be a crisis, and we have mentioned particularly with autistic people, they could have been a meltdown and we know that can be quite traumatic, both for the individual and for the people around them dealing with it.

But it is not a psychotic incident. And autistic meltdown is not a psychotic incident, it does not warrant automatic admission to a mental

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How are we to identify suitable

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How are we to identify suitable places when these are needed? Again, the Minister has made some commitments to the services that commitments to the services that should be available in the community for people with autism and learning disabilities to make sure those services and facilities are services and facilities are available. It is at this point I take a deep breath. Because the take a deep breath. Because the Minister will know that she has already indicated at committee stage that many of the facilities that are needed and expected as a result of this legislation need to be in place before this legislation is going to be enacted.

We are already at the time we are debating it expect that this is going to get Royal assent and acted on quickly. There are going to be delayed while -- delays while services are implemented. I have to say to the Minister that in terms of these alternative facilities to what I would describe as incarceration, we need to be quite sure there is going to be the resources for them and that this will not be something that will not be enacted for many years.

I am not expecting it this year. I would be probably surprised if it was next year. But after that I would be getting worried if that facility was not available. So when the Minister replies, I hope she will be able to give some more tangible examples of how she feels these facilities will go ahead, and who will be responsible for them. So I say to the Minister that I am grateful. She has taken great care and run into a great deal of detail on the data and the collection to make sure people are not caught in the Mental Capacity Act trap and also she has made it very clear that she is expecting, as a result of the legislation, facilities to be available to deal with this in a competent and humane way.

My Lords, may I then move on to say a few words about amendment four in the name of my noble friend Baroness Hollins? I have added my name to this amendment. This also looks at the sort of services and facilities that will be available to autistic people and people with learning disabilities. It is at this point that I wish to say something to the Minister which I hope, if she has not investigated, will agree to investigate. Upstairs in the committee at a timely hour in the chamber debating this is a committee looking into the autism act, and I know some of us are on that committee but unable to attend this afternoon because we are here in the chamber.

In 2009, when I served in the House of Commons on that autism bill, we then under the private members' bill from the late Dame Cheryl Gillan MP, we put in statute the 2009 act, the only act of Parliament other than the health that itself, which is particular to a specific condition. My Lords, we had a lot of compromise in getting the act onto the statute book. But one of the good things we got was a bit of a guarantee from the Minister about the duties to provide services for people with autism.

I would just like to put it on record. Because it is a very short bill and I am holding the whole act of Parliament in my hand at the moment and I am going to read section 3, small paragraph two. "Local authorities and NHS bodies, duty to act under guidance. Guidance or advised guidance is to be treated as if it were general guidance of the Secretary of State under section 7 of the local authority social services act 1970.

The local authorities to exercise social services functions under the services functions under the guidance of the secretary of state ." And underneath it for the purpose of that guidance, so to NHS bodies. So health and social services unusually come within the remit of this guidance which has been in statute for a long time. Basically what this is saying is that if it is not provided, if it does not come up to scratch, the secretary of state under this local authority act, as the power to call in either the local authority or health to question them as to why these services for people with autism have not been provided.

I shockingly have to tell the House that over the years since the act went on to the statute book, I have periodically put down written questions to ask ministers how many times the secretary of state has called in From health or local authorities, because their services to the autistic community have been wanting. I can categorically say no Secretary of State has ever exercised the power in the autism act. What I am worried about, and the Minister will get the point, I am worried commitments in the act we are talking about today will somehow fall into the same black hole this has gone down.

This is one of the main reasons why I was anxious this House should post leisure play review the autism act 2009. -- Post legislation. I hope when the Minister rises to respond to this group of amendments, if she has not read the autism act or is unfamiliar with this part of it, she will be able to give some commitment that whatever promises are made about services in the mental health act as being debated that this is not something Secretaries of State are going to ignore, and that we can be sure those services will be in place before the act is enacted.

My Lords, I beg to move.

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Amendment proposed. After clause 3, insert the new clause as printed 3, insert the new clause as printed on the Marshall list. The question is this amendment is agreed to.

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is this amendment is agreed to. I will speak to a member -- a number of amendments in my name and number of amendments in my name and I think noble law to have added their support. I also support the noble Baroness's amendment. I thank the Minister for helpful meetings and correspondence about the outstanding issues my amendment
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Baroness Hollins Portrait Baroness Hollins (Crossbench)
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seeks to rectify. I apologise for the lengthy explanation that follows and I declare my interest. I have and I declare my interest. I have Royal College of psychiatrists Parliamentary scholar system and I have the support of a PhD student from King's College London. I used to be chair of the oversight panel to review the use of seclusion and segregation for adults with learning disabilities and autism. I am disabilities and autism. I am grateful to panel members for advice related to long-term segregation.

The key message of the report published by the panel called "my heart breaks " said segregation has no therapeutic benefit. Indeed it can traumatise already traumatised people. When the Mental Health Act came in the 1980s, our understanding was limited and therapeutic interventions were inadequate and not properly trialled. The input of trauma into the development of behaviour, behavioural responses and of mental illness was poorly understood. Regrettably during the 2007 review, the appalling conditions experienced by patients subject to long-term segregation had yet to gain public awareness.

So these people were again overlooked. Harmful restrictive practices persisted unchecked. We now have a much clearer understanding about the nature of learning disabilities and autism and we know they cannot be cured by medication or short-term therapies. But we understand the harmful impact of restrictive practices. We know that therapeutic community based settings often have better outcomes where they exist, enabling people to lead fulfilling, productive lives. Community care is more cost-effective than prolonged in patient stays. I acknowledge the introduction of the act of 2018 but this legislation alone cannot address the deep systemic issues I have encountered in my work.

This bill is an opportunity to add the necessary external scrutiny and strict safeguards needed for long- term segregation. Without this, we More a record-keeping tool rather than a catalyst for real change. The bill relies heavily on the Mental Health Act code of practice, which is guidance and not law. In practice we know services do not always follow it. It is a large document. I reckon most psychiatrists have probably not read it. It is huge already. We are going to add more to it.

The amendment I have proposed address these shortcomings directly. Amendment 55 would require notification of long-term segregation within 72 hours. Significantly strengthening oversight from the beginning of this restrictive practice. The noble lady the Minister has told us that the CQC is already looking for the best way to introduce notification. I hope she can say more about that. The noble lady is not minded to place this in Primary Legislation so please can we have an estimate of when this restrictive practice will, the notification will actually be brought into practice.

Amendment three looks at immediate investigation safeguarding reviews when minimum standards, which would need to be outlined in the code of practice are breached, or where long-term segregation is prolonged or repetitive. Given the profound deprivation of liberty involved, I believe these safeguards are vital. The Minister accepts, if the Minister accepts no other amendment please accept this one. You might argue a safeguard is already in place. We actually found there are certain conditions of what safeguarding is and being in a long-term segregation for long periods of time was not one of them.

Amendment 56 mandates independent reviews which would provide external oversight within 28 days of a patient being placed in long-term segregation. Experience shows independent evaluations, especially in multidisciplinary, one of the most effective mechanisms for obstructing inertia, and preventing prolonged, unnecessary segregation. The introduction of independent reviews by the government in 2019 has already demonstrated the value of external scrutiny. But they are only funded until the end of the current year. My Lords, these reviews have exposed and addressed issues which have been tolerated or overlooked within the system for years.

The impact is clear. When independent professionals review cases, inappropriate long-term segregation is far more likely to be challenged and addressed. Given the success, I believe independent reviews should be a statutory requirement. If the noble lady is not minded to accept amendment 56, could she reassure your Lordships' House that these independent reviews will continue to be funded for as long as long-term segregation exists? We already have statutory oversight mechanisms for other hospital interventions. Medication and a second opinion doctors under the CQC system yet long-term segregation, one of the most restrictive interventions possible lacks the equivalent scrutiny.

Tribunal's do ever see a detention under the act but they rarely examine specific treatment decisions such as segregation will stop -- oversee. A formal system could be built into structures such as CQC without requiring significant adjustments. But there are workforce shortages in the short term of course. The cost of independent reviews is definitely lower than the human rights cost of keeping patients in long-term segregation for years. The government plans to advise on the Code of Practice. Amendment 52 six mandatory updates to provide clear guidance about the minimum standards of accommodation minimum standards of accommodation used and strict standards for the initiation and determination of the enforced social isolation which is euphemistically called long-term segregation.

Defining minimum standards is vital given the appalling conditions in which some people are detained. Amendment 57 mandates the appointment of an independent responsible officer to proactively monitor and address these issues to ensure compliance with independent recommendations and actively promote less restricted alternatives. This could also be brought into practice very quickly. Because of the independent review and obligations on hospital managers These These services These services are These services are needed These services are needed to These services are needed to enable the bill to be switched on.

This has been revised in the light of the Minister's response. They require the government to consult with stakeholders to develop and publish a costed plan to ensure that integrated care board and local authorities can provide the right services as needed by people with disabilities and autistic people. There are still more than 2,000 people in patient unit in February and the process is slow and targets have been missed to get people out of these systems. The increase in the number of inpatients in the last 10 years and a wide variation progress across the country means provisions in this bill could make a real difference to ending the inappropriate detention for people with a learning disability and autistic people.

Campaigners and people with lived experience have serious concerns and I share them that without a plan to develop sufficient services, pessimistic sufficient services, pessimistic The key point here is that people with a learning disability and autistic people will be treated the same way as any other person under the act, they will no longer be detained for treatment under section 3 of the Mental Health Act when they don't have a coexisting mental illness, which is right, isn't it? But it only switches on this required...

When His Majesty's Government judges that sufficient community support is in place. Some have been concerned that without a fully costed and comprehensive plan to build resources in the community, this vital change will be delayed indefinitely. Delayed indefinitely, not implemented, that is the worry. I don't think this amendment restricts the ability of His Majesty's Government to make progress anyway, all this is asking for is a plan. If the amendment is not considered necessary, what plans is the noble Lady putting in place to consult on and to publish robust replacement for the building the right support action plan, which is now out of date and has failed to achieve the promised transformation? Furthermore, my amendment five would require the government to publish a yearly report on progress being made against the targets within the plan.

Pace of change would be stepped up by requiring the government to make a plan before government within one year of this being granted Royal assent and for the Secretary of State to review and revise the plan as needed, until the relevant changes with respect to section 3 are switched on by the Secretary of State. There is still time to consult with stakeholders, with charities and crucially, with people with a learning disability and autistic people. And to ensure a comprehensive and sufficient plan is drafted.

All that could and should be happening now. This is all needed to end the inappropriate detention of people with a learning disability and or autistic people who do not have a coexisting serious mental illness will stop amendment 68 simply requires that section 3 comes into force after two years. I urge the noble Lady the Minister to support these important amendments, to assure essential protections for people with learning disability and autism. And to redirect resources

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towards humane community-based care. I beg to move. Can arise to speak very briefly

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Can arise to speak very briefly to the issue of people with autism and learning disabilities being and learning disabilities being detained. In hospital. If we look at clause or section 3, subsection 4, schedule one, what this does is to amend the Mental Health Act to prevent people from being detained under section 3 i.e. For six months if they have autism or learning if they have autism or learning disabilities. And I want to raise the question as to whether this really should also be preventing detention of such people, people with autism and learning difficulties, at all, for 28 days, for example.

It seems to me that limiting this restriction to section limiting this restriction to section 3 is unhelpful for those people suffering with these disabilities. suffering with these disabilities. So a small point to raise with the Minister. Minister.
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Lord Crisp Portrait Lord Crisp (Crossbench)
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the concerns of the Government about timing and costs but believe nevertheless this Bill should nevertheless this Bill should provide legislative pressure to deliver community services or autistic people and people with autistic people and people with learning disabilities. There is little point for using this Bill to set out a new legislative framework set out a new legislative framework if this does not include some... Of if this does not include some... Of plan or timetable. The service will simply fall back into establish patterns of non-therapeutic containment if this is not included.

And I fully endorse the point made by the noble Lady, Baroness Browning, about... Or one of the witnesses to the autism committee has recently said, this is a pretty good... But where is the action? Where is the intimidation? And I think that is a point here, that we need some kind of insurance on a plan been forthcoming within a very reasonable timeframe. Let me then turned to long-term seclusion. I suspect that most members of the public would be surprised to know that what amounts in some cases, I use it deliberately in the majority of words, solitary confinement, is used for such long periods in our institutions.

We are talking about 15 days at a time here and potentially more than that over a month... If the 15 days and in the next 14 days or whatever. So we should be particular concern about what happens out of sight within these institutions, where what should be a very rare occurrence, at best, can become all too easily routine. These amendments open integrated scrutiny and control, they may not prevent it happening altogether, they will help make the rarer occurrence than it is today.

It in particular referred to amendments, neither of which I have my name against, but that is my mistake, rather than anything else. Amendment number three and amendment number 53, which both referred to the kind of practice, and which require that if people are kept in long-term seclusion for 15 days or indeed to or the majority think it is of 30 days, that these will first of all be monitored very clearly but subsequently there will be active intervention to take account of that.

It seems to me these are entirely reasonable and don't seem to be an issue about funding or indeed about timing or anything else. They seem to me to be a matter of ensuring there is proper scrutiny of what is happening to vulnerable people within some of our institutions. In saying that, I am reminded of reading the report that I quoted in the second reading, a young people's organisation, which describes problems with safety and quality, in which they describe as being injured during restraint, been drugged and restrained, been scared all the time.

And a terribly sad quotation, "Hospital makes it worse." Going into hospital with one problem and going it and coming out with trauma,... Ptsd, it's awful. Seems to me we should be able to move in ensuring the code of practice on long-term seclusion is adhered to, and where it isn't, it is properly investigated.

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I rise to speak on a number of amendments that I have added mining to, particularly in the name of the noble Lady Baroness Hollins. And
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Lord Scriven Portrait Lord Scriven (Liberal Democrat)
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noble Lady Baroness Hollins. And during committee stage, the whole area of people with learning disabilities and autism, I think, created quite a number of concerns and I note that the noble Lady the Minister has gone some way to deal Minister has gone some way to deal with some of those and I think it is tribute to the listening and action skills of the noble Lady the Minister that progress has been made. But I think it would be fair to say that there are still some concerns on benches across the House, with regards to potential unintended consequences that could happen if the Bill in its present form goes through, for people with learning disabilities and autism.

And in some other areas I would describe it as a statement from the noble Lady the Minister is that it will be all right on the night and sometimes we know it is not all right on the night and things will happen. And in particular, the noble Lady, Baroness Hollins, raises I think quite an important base for long-term segregation is that there is no evidence that it creates a long-term therapy of benefit to people who have learning disability or autism.

And yet the provision for it still being there, without laser focus monitoring and intervention, I think is a weakness. And it's an area that I think the noble Lady the Minister really does not have to convince the House that the Government has got a plan to deal with this. And the worry I think about having too much faith in the code of, as we found out during committee stage, is that simple words such as should and must have very different meanings about statutory obligation on an organisation or not.

And it would be interesting to hear the noble Lady the Minister's view about the focus within the code of practice and may be strengthening words. I then move on to amendment particularly four, which I have my name on. Which I think is a real focus that the House Committee should really understand. That that is throughout the history of implementation of improvements in mental health and other areas where community care has come in, it is always fallen down on implementation, always.

On implementation. The lack of funding or lot of resources lack of resources. What amendment four typically does, I believe, is really focus on implementation. As the noble Lord Crisp has just said, in the committee on autism that we were just dealing with, listening to witnesses upstairs, they said there is a play through a policy, it is always the plan and implementation that fails. Like a plethora policy. What the noble Baroness Hollins amendment does I think is both focuses on that implementation, in the terms of the government to have a real plan to do that.

Because it has been worrying as we have gone through committee, the noble Lady, particular when issues were raised with regards to the impact assessment and the figures and the assessment and the figures and the numbers within their, pointed out they were indicative. And I think the reason why the noble Baroness Hollins amendment is now required, if we take a look at the trend of the percentage of total healthcare spend that has been allocated to mental health, it is now two years, including the Government's announcement last week, where the total spend will be reduced.

That means that at risk potentially are some of the good things and some of the good ideas that we think the Government have mentioned with regards to the implementation of this Bill and community services. I don't know whether the noble Lady is going to push through the amendment that she will have the support of these benches because we believe it is vital and we are not quite... Unless the noble Lady so something from the Dispatch Box, we are not convinced that that crack and that witness has been dealt with.

-- Says something.
16:29
Lord Kamall Portrait Lord Kamall (Conservative)
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Before I begin remarks, I wonder whether I could express my gratitude both to the noble Lady the Minister but also the officials for their engagement with not only me but other noble Lords between Committee stage and now. I know I'm not alone when we appreciate the amount of time and work that both the noble Lady the Minister and officials have put into meeting with us, addressing our concerns and even having follow-up meetings. It is something that is very much appreciated.

I will briefly speak to amendment one in the name of my noble friend Baroness Browning and briefly address some of the other amendments in this group. We supported my noble friend Lady Browning's intention to re-table this amendment, which seeks to address the loophole which could lead to the use of the Mental Capacity Act to detain patients with learning disabilities but without a co-occurring condition. As noble Lords have acknowledged, both Committee stage and today, once the legal basis for detention under Mental Health Act is removed those patients, there is a profound risk of them falling under the deprivation of Liberty safeguards.

Nobody wishes to see extra safeguards introduced into the Mental Health Act for that to be simply replaced with detention by another act. I understand my noble friend, my noble friend has said today, has received further assurances from the noble Lady the Minister and we are grateful for those assurances. As my noble friend is no longer mind to test the opinion of the House. Had she reminded to test the opinion of the House, the noble Lady would have had our full support but I'm very much grateful for the assurances the noble Lady the Minister has given to ...

The ... The noble ... The noble Lady ... The noble Lady has ... The noble Lady has tabled ... The noble Lady has tabled her own amendment those lenders abilities and autism. We are synthetic to their intentions, in fact I recall that one of my first debates when I was a minister was addressing this issue of detention. -- Sympathetic to their intentions. We had horrific examples of people being detained for many years, there was a story a few weeks ago of someone who have been detained for 40 years.

Even though we are sympathetic, we do feel that some of the amendments are, I'm afraid, bit too prescriptive, so we will not be supporting them if they are called to the vote. Amendment 56 does seem sensible to us and the Government does have some explaining to bring forward how they are planning to ensure greater safeguards for those subject to long-term segregation. So if the noble Lady, Baroness Hollins, is not... By the response of the noble Lady the Minister, on

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amendment 56 is called... Throughout this report stage and

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Throughout this report stage and also for the contributions they have also for the contributions they have also for the contributions they have made today and also the generosity and the time and expertise of noble and the time and expertise of noble Lords across the House, I have greatly appreciated it. To turn to
16:33
Baroness Merron Portrait Baroness Merron, The Parliamentary Under-Secretary for Health and Social Care (Labour)
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greatly appreciated it. To turn to the specifics now, amendment one, as she is aware, I do agree with the principle behind amendment one, that there are limited circumstances in the act, to ensure patients get the right support and I'm glad the noble Lady welcomed my... Helpful. For people who have recently received treatment for psychiatric disorder under the Mental Health Act, the Mental Capacity Act may be required to continue to support the individual in hospital in the short term while placement is being arranged.

Monitoring our reforms is crucial and NHS England assuring transformation dataset collect data with the number of people detained in mental health inpatient settings under the Mental Capacity Act and as the noble Lady herself referred to, the current number is fewer than five, but nevertheless it is, as she said, important. So perhaps I could reiterate from this Dispatch Box that ahead of reforms to part two, section 3, we commit to monitoring the number of people with a learning disability and autistic people who are detained under the mental capacity act and will include a line on this in the standard publication.

Should we see an increase in this number following reforms and discover that the Mental Capacity Act is being used, we will ensure Act is being used, we will ensure that appropriate action is taken. Baroness Hollins, if I could thank her for her work on... And many members have raised this, to the matters of facilities and community resource and, I will address this when I returned later in my comments. I now turn to amendment four, five and six and also the four, five and six and also the I I emphasise I emphasise it I emphasise it is I emphasise it is been I emphasise it is been done I emphasise it is been done for I emphasise it is been done for all patients, allowing the regulator to take prompt action.

Practical concerns were raised with a consultation that was held, which we are legally required to consider. I hope noble Lords will understand that I can't commit to mandating reporting, or to give the timeline I reporting, or to give the timeline I was asked for. However, noble Lord's can rest assured I understand the urgency. My officials have written to CQC to commission them to develop proportionate reporting as referred At At least At least weekly At least weekly by At least weekly by the multidisciplinary team.

CQC has received funding to continue the programme of independent care, or care, education and treatment reviews for two years and refused to recommence from May 2024. We need to consider the program's impact on the outcome of the spending review before future decisions are taken. Doing this outside of legislation does allow for flexibility. The independent care and treatment review model has evolved as we've review model has evolved as we've learnt about what works best.

To amendment 52, we will review the guidance in the Code of Practice on the use of long-term segregation during unavailable evidence and this does not require primary legislation. To my point on drawing unavailable evidence, we will be using the report of the noble Lady Baroness Hollins, alongside other evidence to consider changes that need to be made to the Mental Health Act Code of Practice, which we will be reviewing as part of the implementation of the Mental Health Act reforms of the Royal Assent.

We do hope that this alongside other actions we are taking, including the continuation of ICT ERs and the transformation programme will make progress to reduce long-term segregation. There were points made about amendment 53 and I believe we about amendment 53 and I believe we will return to that in group 5. On to amendment 57, it is our belief that this duplicate existing requirements. The use of force act 2018 once fully implemented will require mental health units to have a Responsible Persons, who must keep a record of any use of force by I absolutely understand the concerns many noble Lords have raised about the community support that this has driven amendments for, five and six.

And I also recognise the need for accountability and scrutiny of these reforms. Again, a point that has been made several times. And I could say to the Noble Lord Scriven I hope I vow to do better by him and it will be all right on the night and the Noble Lord as ever will be able to judge that, but I am pleased with what I am able to commit. Which is that within one year of Royal assent and each year subsequently we will lay written Ministerial statements in both houses.

This will include setting out details of the work that is being done over the preceding 12 months to implement this legislation and plans for how we will implement future reforms. This will include progress on the learning disability and autism reforms and plans for community provision. And regarding amendment 68, to the Noble Lord Chris, we have heard concerns about a possible unintended consequences, such as the potential romanisation of individuals or detention via other legislatures roots. To avoid such scenarios we will only commence changes to section 3 once there are strong community services in place which is safe to do so, because, my Lords, flexibility is essential.

I do hope that with these commitments that they will satisfy noble Lords to withdraw their amendments.

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We must ask the question, the plan that is proposed that will be plan that is proposed that will be laid before Parliament every year, will that be something which will that be something which parliamentarians would hope to question and amend? Because I think question and amend? Because I think it is the lack of ability to be able to influence that process and that plan which concerns noble Lords.

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I say to the Noble Lady that, for me, what I have heard from noble Lords is that they are concerned to have transparency, they are have transparency, they are concerned to hold the Government to account, and they are concerned to account, and they are concerned to be updated on what the situation is and in all of those I absolutely and in all of those I absolutely agree which is why I am pleased to make that commitment, but Parliament has a number of routes available to it to hold the Government to account.

I have just outlined the manner in which we will be transparent and the way in which it will hold Government to account by the act of actually having to do this. The parliamentarians, as always have the ability to scrutinise in many ways. scrutinise in many ways.

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We have heard a lot of very salient and not just helpful but wise words in this particular group wise words in this particular group of amendments this afternoon. And I must thank the Minister for standing at the despatch boxes and making at the despatch boxes and making commitments which are now on record for this act. When people say what for this act. When people say what was Parliament's intention machine has left us, in no doubt, and some particularly important points, particularly my own amendment concerning the need to monitor the use of the capacity acting respect use of the capacity acting respect of autistic people and people with learning disabilities and I am grateful she has done that and I
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Baroness Browning Portrait Baroness Browning (Conservative)
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think I heard her make a similar commitment in terms of the concerns that Baroness Hollins had, so we are that Baroness Hollins had, so we are grateful for that. And I would just grateful for that. And I would just finally ask her she has not given us exact dates as to when implementation will take place. We imagine it may be staged, it may not be all in one go, but before the end of this Chair of the Committee stairs will report on the Post- legislative scrutiny and that will legislative scrutiny and that will cover the wide range of losses, particularly to people with autism and I hope perhaps in her deliberations with respect to visit when she sees something that I cannot predict what the outcome of that would be but I hope she will take those into account as.

Because for certain services that are provided under the autism act, if they are provided in a timely way, will reduce the number of services that would be needed under the Mental Health Act. It is not rocket science. It is pretty basic but if you provide those services, that downward spiral of mental health is reduced. With that, noble Lords, I beg leave to withdraw my amendment. Wye is a deal or chips pleasure that this amendment be withdrawn? The amendment is, I leave, withdrawn.

Amendment two, Baroness Butler- Sloss. Sloss.

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I have three amendments in this group. Amendment two, amendment 25, and amendment 27. The first one, and amendment 27. The first one, they all relate to the relationship of parents special guardians and other people with parental other people with parental responsibility, and the bill. And I have to say, first of all, I am extremely grateful to the Noble Lady extremely grateful to the Noble Lady that minister and to her team for the fact we have been allowed to try these on several occasions.

I am these on several occasions. I am afraid I did not make a great deal of progress but I am hoping that I made just a little, so I do not propose to ask for the view of the House on any of these three amendments but I am hoping that they will go into the Code of Conduct.
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Baroness Butler-Sloss Portrait Baroness Butler-Sloss (Crossbench)
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Amendment to relate to the Amendment to relate to the preparation of reports. And those with responsibility, currently, are not referred to. The whole of this not referred to. The whole of this bill, very ugly to me, has very little relationship with the Children Act. Since we have those Children Act. Since we have those under 18 who are children, and particularly those under 16. What concerns me about this bill is that it does not seem to have recognised it does not seem to have recognised for parents and other people with parental responsibility or ought to Not a veto, but they should be consulted.

And on the face of the bill, except for 1 Very Minor Pl, they are not consulted et al.. The first one is amendment number two, the preparation of reports. The second one is the ability to apply second one is the ability to apply to the county court to ensure a nominated person cannot take that job. That their name should be job. That their name should be terminated. It doesn't include anyone with parental responsibility. And since it is quite likely that the child under 16 can nominate somebody without consulting the parents and without the parents having any opportunity currently under the bill to say that is not a suitable person.

Let me take an example that when or that unusual. A child under 16, 14 or 15, quite right, who already has a boyfriend, who has got an unsuitable boyfriend. Nothing unusual about that. Other people can go to the County Court and say that boyfriend is unsuitable and should not be denominated person, but on the face of the build the parents with whom the child has been living does not have any opportunity to be consulted or go to the County Court and asked them to rethink this nominated person.

And under amendment 27, when they have the formalities of the appointment the formalities of the appointment ... There is a witness and the witness has to consult various people. Among the people to be consulted, and my goodness me, there is quite a long list, it is not the parents, special guardian anyone with parental responsibility. Quite simply the children's act is being ignored. However, having had the very interesting and helpful discussion with the noble Lady the minister, who is to be congratulated for putting up extremely late into the evening me going to talk to her, and I am hoping that she is going to say when she replies that this will be in the Code of Practice.

If we can get that parents, special guardians, other people with parental responsibility, where a court has not in fact said that there is a parental responsibility that should be terminated or reduced, if ordinary decent parents can at least be referred to and expected to play a part, if that is in the Code of Practice, that is second best, but it is absolutely better than nothing. And the other amendment I just wanted to refer to was amendment 34, which actually puts into effect what I have been asking for, which is being put asking for, which is being put

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Baroness. In clause 4, page 7, at 932

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In clause 4, page 7, at 932 insert the words as printed in the Marshalled List. The question is

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that this amendment be agreed to. I rise to speak to amendment 34

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I rise to speak to amendment 34 in this group and I do thank the noble Lady Lady Tyler for putting her name to this amendment. I'm grateful to the noble Lady the Minister for ensuring that this Minister for ensuring that this doesn't conflict with the children's act. This amendment 34 will ensure that the mental health practitioner appointing the person for a child who lack... Or the child with whom the parent lives under a child arrangements order.

His Majesty is government's amendment reflects the current position under section 37. This amendment reflects section 38. The nearest relative becomes a nominated person and moves from a mast in the Mental Health Act to a should in the Code of Practice. His Majesty is government wishes to give discretion to appoint someone other than that nominated person. Both Parental responsibility. A special guardian takes all effective day- to-day decisions for the child and parents according to the Children Act 1989 are only left with consent to a change of name, or if the child is to leave the jurisdiction.

A kinship care of foster carer is given parental responsibility by way of a court order after a report that has to be produced by the local authority to the court. Under a child arrangements order the matter of who the child lives with or sees is decided by a court order. Reaching that order is contempt of court, or a breach of court order as is normally said. Many of these submissions of sick children who have no capacity are in the evenings or at the weekend.

That is what I was informed last Thursday by Dominic Bali. Their clear view is they do not want to be foisted with this discretion that His Majesty's Government offers them. Why? Because quite simply they are not equipped, unlike the family courts, to assess that there is no risk of harm to a child, to appoint somebody other than the special guardian the parent with whom the child resides. At 10pm on a Saturday night how can they assess daily life of that child, that it is no longer what was outlined in the special guardianship order.

The child now lives with that parent without problems, even though that parent may have a history of not being able to care for that child due to illness or a history of violence, but has now recovered or reformed sufficiently. How can they assess that the parent who was ordered not to have contact after a week-long trial of the evidence in the family court is in fact safe to have contact with the child as the nominated person? They are simply not equipped to delve into complex family issues already determined by the family court, nor when they are
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Baroness Berridge Portrait Baroness Berridge (Conservative)
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trying to do a mental health assessment of a sick child do they want to be distracted by this. And want to be distracted by this. And the remedy is as the noble and the remedy is as the noble and learned lady Butler-Sloss outlined, to enable the reformed parent in either of those cases to go to the County Court under the nominated persons process, which often hears persons process, which often hears cases within 24 hours. There is also the remedy to go back to the family the remedy to go back to the family court, but that will take longer.

It is for that court to assess hopefully with the family judge what the position is and if that parent is now safe to be involved in the child's life as a nominated person. It is unfair to put that responsibility on them. These cases are not straightforward, they've been subjected to an order in the family court. They would almost certainly need His Majesty's Government to provide specialist legal advice across England and Wales out of hours to help them do this in this matter would be open to litigation.

Staff at the unit should not have the responsibility or discretion. What if a father he has a no contact order is given access and harms the child? Even if that does not happen, I cannot help wondering candy mother go to the family court and say dad is in breach of the no contact order, or in contempt of court biasing the child as the nominated person and can dad defend that? This seems to be getting expensive and complicated. Family court order should be respected so the nominated person should be on the face of the bill.

This eradicates the risk of harm to a child by a parent who has been found by a court to be a risk to their child getting in contact with them getting access is the nominated person until another court determines otherwise. Court orders are amended by court orders, not other organisations. After eight years of looking at the Mental years of looking at the Mental Health Act to reform it there are still significant conflicts between this bill and the children's act. I am left wondering why.

Despite the considerable engagement that other noble Lords have mentioned by the Minister which I know is appreciated, as of last Thursday His Majesty's Government has not met with the lead network I have outlined that represents over 90% of local authorities in England and Wales and has been in existence for over 20 years. They are not aware of any other professional network that is in existence. They were promised by the last government that before a bill was produced to Parliament they would be met with.

His Majesty's Government has also not consulted with the British Association of Social Workers who have a special interest group. Why not? The noble Lady the Minister point out who has met with them. The network I have spoken to is concerned about this discretion? The Minister has immunity whilst being a servant of the Crown. This organisation and staff of a secure mental health unit do not. DHSC have responsibility for the Mental Health Act and DfE for the children's act.

It's not their expertise. I hope I am not attaching that these Hansard to a coroner, a CQC enquiry if the child is harmed or killed in a secure unit by a parent. Governing is about deciding and without amendment 34 His Majesty's Government has in my view decided to take an unnecessary risk with the safety of some of our sickest children. And as noble Lord may be aware, I do intend to divide the House if necessary, but I hope

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the noble Lady will concede. I would like to support the

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I would like to support the amendments of Lady Butler-Sloss and the amendment just spoken to by
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Earl Howe Portrait Earl Howe (Conservative)
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Lords. Approved mental health professionals carry with them a huge responsibility for the well-being of those whose interests they are called upon to protect. Any child or young person suffers a mental health crisis, it is the job of the AM H Pieter make the right assessments to make the right decisions, follow the right procedures under the law to make sure that young person is looked after appropriately and swiftly, and to do that he or she think needs a clear set of ground rules to follow.

We need to imagine the situation such as the one my Noble Friend posited, in which the child's mental health, mental and emotional condition is such that they lack decision-making competence and AM HP is then called in. In that situation when it comes to appointing the nominated person for the child, the scope for confusion, and indeed delay, is enormous. Who should be appointed? Is it their mother? Is it the father? Is there someone else who should take precedent? The Minister has acknowledged through the government's amendment before us that when there is a care order for the child AM HP should have no choice but to appoint the local authority as the nominated person for the child.

That is a welcome step forward because my Noble Friend has rightly said what if there is a the obligation of making a decision about if it is the wrong one that could leave them open to the challenge. I do very much hope that the Minister will be receptive to the powerful arguments that my Noble Friend and the noble Baroness Lady Butler-Sloss have advanced on these significant issues.
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Baroness Merron Portrait Baroness Merron, The Parliamentary Under-Secretary for Health and Social Care (Labour)
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I thank all noble Lords for their contributions in this important area. And I thank the noble and learned Lady Baroness Butler-Sloss for amendment to. To that point, I can say that a copy of the report made following a care and treatment review must be sent to those who have a legal duty to have regard to the review recommendations, so that they are implemented appropriately. We do agree that the parents play an important role, however it may not be appropriate for the report to be sent to parents in every case.

For example, where there are safeguarding concerns being raised, inappropriate sharing of information could result in the patient withdrawing their consent to the review, so we will provide statutory guidance on the role of the parent to assist the responsible Commissioner, in considering who to involve in care and treatment reviews. To amendment 25 I was also tabled by the noble and learned Lady Baroness Butler-Sloss, the bill already allows anyone involved in the patient's care or welfare which does include parents to apply to the County Court to terminate the appointment of a nominated person.

And I can assure the Noble Lady today that we will make this clear in the code of and an Explanatory Notes for the bill. It is an important point that she has raised. To address amendment 27, we are concerned that making the requirement for parents to always be consulted when a nominated person is chosen could put undue pressure on a child to choose a parent, however we do agree that the witness should consider the views of parents and others who may have insight into the suitability of the nomination, and so I can say to your Lordships house that we will therefore set out in the statutory code of how the views of family and others should be fed into the witnessing process.

I have also heard the noble Baroness Lady Berridge is concerned around the nominated person regarding children who lack competence. In response to this is the Noble Lady which I have tabled Government amendments 29 to 33 to make it clear who an approved mental health professional must appoint in certain circumstances. For an over 18 lacking capacity and approved mental health professional must appoint a competent lasting power of attorney or protection deputy if they have one. All under 18 lacking competence where there is a care order they must appoint a local authority who has parental protection for them, or, if relevant, the competent court of detection deputy.

And where there is no care order, improved mental health professionals can appoint a person who does not have parental responsibility, 16 and 17-year-olds. This allows for suitable alternative relations for example alternative kinship arrangements for young people that live independently. I hope that this reassurance and commitment on my behalf does provide the further Claffey does not clarify the Noble Lady has been advocating for. Finally in relation to amendment 34, we do agree that in the vast majority of cases we would expect a parent or whoever has parental responsibility to be appointed.

This would include consideration of special guardians in child arrangement orders. As I have set out before, we do not agree that a person with residual parental responsibility should always be locked from being a nominated person. The child arrangement order or special guardianship may be in place for reasons other than the parent being a risk to the child, for example the parent might struggle with their own health issues, but could still be an effective nominated person. The situation is different in the case of a care order because the local authority has been given parental responsibility.

And we have engaged with the children's Commissioner on this point and that Noble Lady I believe may be aware that I recently met with the children's Commissioner on a whole range of issues, including discussions about the Mental Health Act. If there are no relevant people approved mental health professionals must follow the patient's past and resent wishes and feelings about deciding who to appoint. We do not believe that the oldest person should be given preference as this represents an outdated assignment of responsibility.

And I can assure that Noble Lady Baroness Berridge that I have been that advised that the officials met with the lead the term I understand is the lead of the AM HP lead network last November. I can't make a further commitment which I hope will be useful to your Lordships house. I am committing to establishing an expert task. Support the development of the statutory code of to still provide clear guidance for professionals involved in the nominated person appointment process for children and young people.

Views will be very much welcomed for part of this and I have already invited the Noble Lady Baroness Berridge and the noble and learned Lord Lady Burt and Baroness Butler-Sloss to make suggestions as to who may be part of this. With these reasons, I hope that noble Lords can support our Government amendments and withdraw their

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amendments. Once before the Noble Lady sits

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Once before the Noble Lady sits down, can she confirm, because the information I have is that Dominic of the network has not met with a of the network has not met with a draft of the bill that was to go before Parliament. And that the before Parliament. And that the Noble Lady has outlined that the Noble Lady Minister has outlined that there can be an assessment of ill-health that was already before courts, is the Noble Lady Minister confident in legislating when a confident in legislating when a group of officials are saying they are not competent to assess the illness or otherwise of that parent, that matter already determined by a court needs to go back to a court to be re-evaluated.

That they are not competent to do what you are asking of them.

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I do note and hear what the Noble Lady said and we have discussed these issues a number of times, both these issues a number of times, both in the chamber and outside. The situation in the second point is as situation in the second point is as I have outlined and I do not feel I should go further today. These are should go further today. These are the points I wish to bring before your Lordships house. I am happy to take up their points she raises a take up their points she raises a separately, however to the point that those are the exact details of that those are the exact details of the meeting, to be quite honest, I cannot give that level of detail.

I am very happy to find out more from

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officials, but the Noble Lady originally asked has there been a meeting and I answer to that point and the answer is yes. Before the Minister sits down,

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Before the Minister sits down, she will know that I pledged right
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Baroness Buscombe Portrait Baroness Buscombe (Conservative)
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she will know that I pledged right at the beginning before this bill came to this House that I would do all I can to help with this passage. I made that pledge to your Secretary of State. I am just wondering, given the continued conflict as we see it with the children's act, whether the Minister would be prepared to come between now and third reading, rather than dividing the House on this, at a later point this evening, whether it would make sense for there to be a little more discussion on this particular issue.

Because we discussed it at great length during our enquiry into the draft Mental Health Bill. And, to us, it was a significant point which, to my mind, does not appear to have been properly resolved. In terms of is wanting to support the Government in making sure, as my Noble Friend has said, that it is not opening itself to legal challenge, and to ensure a safer passage of the bill, can I put that to the noble Baroness the

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Minister? That possibility. I am grateful to the Noble Lady, not least of all because she also not least of all because she also gives me a bit of time to be able to add to my earlier answer to the Noble Lady Baroness Berridge, about Noble Lady Baroness Berridge, about the meeting of the lead of the AM HP the meeting of the lead of the AM HP lead network last November, that meeting took place after the bill meeting took place after the bill was published.

To the point raised was published. To the point raised by the Noble Lady, I think the issue about whether the House will be divided will be a matter for the Noble Lady Baroness Berridge and others no doubt to decide, but of course I am always happy to have discussions and if the Noble Lady wishes to do that, I will be very wishes to do that, I will be very
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None Portrait Amendment:7 Lord Kamall (Conservative)
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the individual to a police cell as a place of safety, an issue addressed place of safety, an issue addressed in other parts of the bill. But police officers continue to be concerned that they are asked to deal with something for which they deal with something for which they have no or insufficient training or knowledge. As my noble friend reminded the House, a police presence is often not good for the presence is often not good for the individual. Only is that individual not being given the healthcare support they need, but the presence support they need, but the presence of an officer in uniform coming to deal with them could exacerbate deal with them could exacerbate their mental health situation.

And even if the police officer is able to get someone to the hospital, they might still be required to sit with an individual to make sure they do not harm themselves or others. My noble friend Baroness May cited the Metropolitan Police's evidence to the joint committee bill where they gave an example of a patient in A&E that was required to be guarded by eight Metropolitan Police officers over 29 hours to prevent them from being a high risk missing person. The National Police Chiefs Council was concerned that the law as it was concerned that the law as it currently stands arguably raises disproportionality, adverse outcomes for people suffering with poor mental health, as well as increasing stigma attached to mental health.

I want to be clear that while this amendment removes the statutory demand on the police to be the prime respondent, whether it is an immediate risk to life or injury, the police will still have a role to play. The authorised person attending the individual should have been trained and equipped to carry out detention and by carrying out that function, should not be put at unnecessary risk. This is in line with the College of Policing's mental health snapshot of 2019 that found almost 95% of calls that police attend that are flagged as a mental health response do not require a police response.

The noble Lady the Minister will be aware that in the joint Home Office and Department of Health review and survey of section 135 and other powers, 68 % of respondents agreed that all or part of these powers should be extended so healthcare professionals can use them, providing they are not putting themselves at risk. Paramedics particularly supported the change. This is not just about the interests of the police and healthcare professionals. We need to focus on the individual at the point of mental health crisis.

They deserve the right response, the right care, the right person. I note that the noble Lady the Minister in our conversations, and I appreciate that she has been given forewarning of this. The amendment as it stands appears to give the police more powers. I have discussed this with Baroness May before I came to this chamber he was surprised that this. In fact, she said it was somewhat disappointing giving the constructive meetings that have been had. But also the Metropolitan Police were supportive of this.

There's clearly a difference of opinion. We appreciate that we need to find a way forward. I know that Lady May is open to discussion with the Minister to ensure the principle behind these amendments are met. Can I ask that she gives a guarantee to meet with my noble friend and following these discussions back and forth whether she will be able to bring back an amendment Third Reading? The fundamental principle here remains unchanged, that the role of police in detention under The Mental Health Act must be reduced, for the patients benefit and the workers benefit.

I hope the Minister will be able to give the assurances that I my noble friend The noble Lady the Minister is

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unable to do this, we will have to test the opinion of the House, but hopefully we can find a way forward. I assume the noble Lord would like to move his amendment. I beg to move.

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I beg to move. Amendment moved. Insert the words a constable or other authorised person.

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person. I am pleased the opposition spokesman has moved his amendment. I will not be voting for it, but I am
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Baroness Barker Portrait Baroness Barker (Liberal Democrat)
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Like the noble Lord Lord Davies of Brixton I find myself in exactly the same place. We all know that, we all know why the police have said that they are not the appropriate people to be first responders when somebody is having a mental health crisis and presenting either a danger to other people or to themselves. But we also know that not putting anything in place, or not putting the right people in place will not necessarily mean that somebody who is having a crisis will be seen by an appropriate person.

Rather, we think, and a number of us have looked at this and talk to people in the field, we think that what will happen is there will be a response by somebody who is on the front nine of the health service, either in an A&E department, which is where a lot of people would go, or more likely an ambulance. We think that this is going to put the ambulance service under even greater strain and pressure than it is now.

It is the hope of those who have been involved so far and it is the intent of Baroness May, who is the prime mover behind this, that we don't do that. That we don't wait until there is a really terrible incident in which somebody is badly harmed. I rather suspect that around harmed. I rather suspect that around the country, since the police have taken the decision they have, frontline health services have had to come up with new ways of responding to this because the issue has not gone away.

People are still going to have mental health crisis in which they are either a danger to themselves or presenting a danger to others. Therefore what I think I would like to suggest is we do follow the suggestion from Lord Kamall that there be further discussion, preferably with people from mental health organisations and from different parts of the NHS, as well as the police. To see whether we can come up with something which will plug what is going to be a very obvious gap.

As I have said before during the passage of this bill, this is the last chance for about the next 10-to 15 years to pass legislation on this subject and their need to have hay diligently and to have taken appropriate action now and not live to rue the day in

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the future. Let me start by thanking Lord

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Let me start by thanking Lord Kamall for tabling these amendments. The table amendments would amend The table amendments would amend section 2 which relate to admission section 2 which relate to admission for assessment. Section 3 relating to assessment for treating and section 4 relates to detention for
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Baroness Merron Portrait Baroness Merron, The Parliamentary Under-Secretary for Health and Social Care (Labour)
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section 4 relates to detention for six hours painting application admission. The is currently no ability to detain under sections 2, three and five of the act. These amendments, as the noble Lord has referred to and we have discussed earlier, will give police additional powers. The noble Lord will be aware and I have mentioned that we too not support extending police powers in this way and I understand that the police do not support an extension either.

I am happy to continue discussion with Baroness may's office, as I have done previously. I know that my noble friend Lord Gold Davis also welcome discussion, which I am very happy to commit to and let me just say that with regard to amendments on Third Reading, which the noble Lord asked for, they are of course to clarify any remaining uncertainties, to improve drafting and enable the government to fulfil undertakings given at earlier stages of the bill.

So I am sure the noble Lord will understand that amendments are therefore restricted to technical points and so I say that in answer to that. So for all those reasons obviously I cannot give the agreement that he sought about an amendment at Third Reading. It is not within scope to do so. My Lords, with regards to the ambition to reduce police attendance at mental health incidents, we do of course recognise the pressures that the police are facing, as noble Lords have highlighted and agree that in many cases this is far preferable for those in mental health crisis to be responded to by health and care.

However, action is already under way to address this. Almost all police forces in England and Wales are implementing the right care, right person approach, which is a police led initiative to reduce inappropriate police involvement in cases where people have health or social care needs. I can report to your Lordships House that there has already been a 10% decrease in section 136 detentions last year. We are also already taking steps to improve mental health services to avoid people reaching a crisis in the first place, which is a far more preferable position to be in.

So to avoid people reaching crisis were police involvement may be required and that includes through the government commitment of £26 million of capital investment to open new mental health crisis centres, which are far more suitable environments for those mental health crisis to receive care and treatment. So extending these legal powers currently held by the police to other professionals would represent a major shift in roles and responsibilities for Health and Care Act professionals.

It would place significant additional pressures on the NHS and lead to staff patient public health issues which mental health and emergency care leads have already raised significant concerns about. It is for all of these reasons that I asked the noble Lord

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Just before my Noble Friend sits
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Lord Scriven Portrait Lord Scriven (Liberal Democrat)
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It It is It is a It is a genuine It is a genuine thank It is a genuine thank from It is a genuine thank from these benches on this and other issues as benches on this and other issues as well. I want to thank my noble well. I want to thank my noble friend for giving her life lived experience of Community Treatment Orders when at Committee stage. I think there was a huge divide in this House about whether they this House about whether they What might amendment tries to do is to deal with what I see as the major floor and whether we have a review of the treatment orders.

The way that these Community Treatment Orders are implemented, whether they are effective or not, there seems to be a revolving door which people find, some people find impossible to get out of. It has led to a number of issues about whether they therefore have therapeutic benefit and actually the treatment is effective. They have also been huge issues to do with racial disparities and the length of time people are on Community Treatment Orders. I Community Treatment Orders.

I To... To ensure the initial community treatment order is fundamental and should be kept to 12 months. If they are to be reviewed they should be reviewed not just the consultant he has treated the individual, but also another GMC psychiatrist who has to agree in writing that there is therapeutic in effect for the Community Treatment Order to continue and every six months review in effect for the Community Treatment Order to continue and every 6 Months Review Takes Pl.

It doesn't stop Community Treatment Orders, but I believe it gives an absolute firm process that needs to be on the face of the bill. Not in the Code of Practice, but on the face of the bill to ensure that the individuals on Community Treatment Orders have certainty about the length of time and review and also that a second Dr's written agreement about the therapeutic benefit of reviewing and continuing the treatment order. I do understand that the noble Lady did Minister has said that the bill has moved forward said that the bill has moved forward and there are certain elements that help with the review of treatment orders and people being put on treatment orders.

So, for example, the community Dr has to be consulted. There is a difference between being consulted and giving agreement. That is why my amendment talks about agreement of a second Dr and consultation in itself does not mean that they can and in some cases are indefinite. I do believe that my amendment is practical. I believe it solves the problem that there is and as my noble friend Baroness Barker has said, we tend to get legislation about The Mental Health Act once every 15 years.

I believe we cannot wait another 15 years to deal with this anomaly. I will be supportive as these benches will be supportive of a review of Community Treatment Orders and the evidence coming about whether they are effective in the grand sense, but the practical pragmatism is that people will continue to be put on Community Treatment Orders and even with the changes that are in the bill, that the government have put on the face of the bill, it still means that people will be there indefinitely and I do believe opinion of the second Dr would help to ensure that there were therapeutic benefits.

I will not say much more. I believe it is practical and it will get the balance between service providers and those on a community to order to deal with some of the unintended consequences we have found since they have introduced. It's a practical step to ensure we get these correct and right, even if and if recourse takes place. I beg to move.

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Clause 6, page 12, line 40, insert the words as printed on the Marshalled List.

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Marshalled List. Is a pleasure to follow the noble Lord and to agree with everything he
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Baroness Bennett of Manor Castle Portrait Baroness Bennett of Manor Castle (Green Party)
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under part three, including statutory review of CTOs with a provision to abolish them unless the provision to abolish them unless the government legislate to keep them. My amendment doesn't go that far but My amendment doesn't go that far but Of its likely to be at least 15 years before legislative attention returned to The Mental Health Act. returned to The Mental Health Act. That is a very long time. It's a very long time in the health of people who are going through people who are going through experiences and I should stress here that it is not essentially my initiative that this amendment forward.

It was Mind, the organisation, that encouraged me to do that. I quote from a couple of people who they have spoken to about CTOs. We have to think about the lived experiences alike. Being on the CTOs like been cornered. It is good that you are out of hospital, but only a little better because it is so intrusive. Another quote collected by Mind. Someone who had been on a CTO said it could feel like a tag that nobody can see, but she knows that it is around your mind.

Now, we have three debate on this bill considered entirely getting rid of CTOs and as the noble Lord said, Baroness Parminter did make a powerful case. There may be circumstances and conditions where they are appropriate, but what my amendment does is call for a statutory review so that we do not wait 15 years and then say as we have been saying about so many aspects of what we are trying to fix now, this has been terrible for so long, we really need to do something long, we really need to do something about this.

And I spoke considerably extensively, and I have to say to Lord Kamall I am still planning on arranging that meeting, but I haven't got there yet. To look at community or eternity is essential. There are models around the world where that has been achieved. Also .2, part three of the amendment which looks at the impact on people from different ethnicity backgrounds, these and other things are there to be considered within a reasonable period of time so we can be affecting people's treatments and improving them within a foreseeable time, not sentencing them to 15 time, not sentencing them to 15 years.

So it is not my intention to divide the House. I am very much hoping this might be something that this bill will continue to work on, that the arguments for including a statutory review will become evident as the bill progresses. So on that basis I really urge noble Lords and particularly the noble Lady the minister, and I echo the points of Lord Scriven, my engagement between different stages of the bill tends to be limited by the fact that I have a great many bills that I am juggling at the same time, but I know and I have heard reports of how the noble Lady the Minister has been engaging.

I hope she will bring that open mind, the departments and ministers will this open mind to CTOs. They have been so many questions and concerns. It is not something we should be sentencing people to 15 more years off without a statutory review. On that basis, I hope we might be able to move My Lords, I rise briefly indeed to support this very important set of support this very important set of amendments. I think as my noble friend Lord Scriven has set out in his amendment 11, which I very strongly support, the case I think
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Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (Liberal Democrat)
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for having some conditionality around Community Treatment Orders is around Community Treatment Orders is really overwhelming. To have them first full-time Ltd and secondly, first full-time Ltd and secondly, for a second medical opinion, a for a second medical opinion, a second Dr's certification about their therapeutic benefit. I think both of those are very hard to argue against and I think they do get the against and I think they do get the right balance between those as we heard in the early stages who wanted to get rid of the orders and those who wanted to tighten up the conditions.

The other two review amendments are important as well. I would simply say to finish, we need to remind ourselves as we did at second reading and Committee stage that black people are seven times more likely to be on a Community Treatment Order and other members of the population and that is why this is so important.

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Let me begin by addressing amendment 11 in the name of Lord amendment 11 in the name of Lord Scriven. I thank the noble Lord for the excellent way he introduced the amendment and I fully support amendment and I fully support everything the noble Lord said. The issue of suitability of Community issue of suitability of Community Treatment Orders is one that has featured heavily in discussions on this bill so far. Many of us came to this debate thinking at the this debate thinking at the beginning of the bill, having read
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Lord Kamall Portrait Lord Kamall (Conservative)
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the Joint Committee's pre- legislative report, there will be sympathy for the abolition of CTOs. There were two interventions that gave us a reason to pause and think. One was the personal story from the noble Lady Baroness Parminter and also the other noble Baroness who felt they should be abolished, but are appropriate for a small number of cases. One of the principles of this bill is the least restriction. Maybe they are the least restrictive for some incidents.

Having said that, there are serious concerns about their use in current form. Myself and other noble Lord spoke at Committee stage about the overrepresentation of black males. This is what my amendment 62 was intended to address. It is a shame I thought that our deliberations on this particular issue came so late at night, but can I thank the noble Lady the Minister for her engagement, and also her officials. Why are three simple questions. What is it that we know about why black people are disproportionately detained? What is it that we don't know and what research are we conducting and what work is being conducted? I know it's PhD research thesis to generate questions, but what is the gap in research, as it were? I was very assured by the responses from the noble Lady the Minister and her officials that they do take this seriously and they will set out in detail the work they are doing.

The noble Lady the Minister put a lot of that in her letter to me. It would be unfair to ask her to say exactly precisely what is in the letter because we would be have quite a few hours, but I ask if she could share some of those assurances with the House as it would be helpful to understand that given that letter, I will not be pushing my amendment to a vote. I think the noble Lord Scriven has struck the noble Lord Scriven has struck the right balance.

There are issues with CTOs, but it is really important that in every case there is a review and 12 months would seem an appropriate time for that review, rather than just forgetting about them, or people been caught up in other casework or falling behind the filing cabinet, or if there was another analogy I could use. Given that, if the noble Lord Scriven decides to divide the House, these benches will support him. I look forward to hearing some of the assurances that the noble Lady the Minister gave to me and others on the racial disparities.

I hope she can also address the concerns of the noble Lord Lord Scriven.

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My Lords, I thank the noble Lord Lord Scriven for raising amendment 11 and speaking to it today, as did the noble Baroness Lady Tyler. I can the noble Baroness Lady Tyler. I can say at the outset that it is already the case that Community Treatment Orders can only be renewed under Orders can only be renewed under specific conditions, which does align, I believe, with the intent and also the direct request of the noble Lord Lord Scriven. Alignment with the code and the four with the code and the four principles is already achieved by section 118, 2D, which will require clinicians before placing somebody on a Community Treatment Order to
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Baroness Merron Portrait Baroness Merron, The Parliamentary Under-Secretary for Health and Social Care (Labour)
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have regard to the statement of have regard to the statement of principles in the code. Clause 6 ensures that a patient can only be put on a Community Treatment Order if there is a risk of serious harm if there is a risk of serious harm without it and a reasonable prospect without it and a reasonable prospect of it having therapeutic benefit. A community treatment order cannot be community treatment order cannot be extended beyond six months unless the conditions including therapeutic benefit continue to be met.

The community to order can then be extended for a further six months and then a subsequent 12 months, but only if these conditions continue to be met. The current Code of Practice states that before renewal the responsible clinician should consult with the multidisciplinary team, the patient, the nearest relative, which in future will be the nominated person, and an advocate. So I put it to your Lordships House that we are going further than Lord Scriven's request by introducing a new requirement for the patients community clinician, he must be an approved clinician, overseeing the patient's care as a community patient to be consulted before a community treatment order is renewed beyond six months.

And I heard the noble Lord Lord Scriven's concerns that the bill just requires the second opinion the second appointed Dr to be consulted. Whereas the amendment requires the extension to be agreed with them. In response to that I can assure the noble Lord that in addition the community clinician must provide a statement that it appears to them that the Community Treatment Order criteria Community Treatment Order criteria We are increasing the frequency of automatic referrals to the tribunal, to ensure patients can come of Community Treatment Orders when they are no longer benefiting.

The tribunal will also have a power to recommend that the responsible clinician reconsider whether a CTO condition is necessary. And to elaborate further, in view of the points raised, this does mean that in following an initial tribunal referral at six months, another referral is required after the six- month, followed by a mandate to referral 12 months after that, if the patient has not made an appeal themselves. The tribunal will have to agree with the CTO criteria, including that therapeutic enough it, the requirement of a pen -- of a therapeutic benefit is met.

We are therefore already meeting the requests the noble Lord Scriven has rightly made and in some cases actually going further than we have actually going further than we have Turnout to amendment 23 tabled by Lady Bennett, as I said to a similar amendment tabled by noble Lords on the opposition frontbench and committee, CTO's remain a valuable intervention, albeit the do need reform, as I more than acknowledge, but accept. So, I can say that we will review these changes as part of our ongoing monitoring of implementation and the reforms and after two years I do feel it would be premature as it would be based on data from before any reforms were actually commenced, so I can say to the Noble Lady and your Lordships house that we will instead commit to review the impact our forms make as part of our wider during evaluation of the bill as it is implemented.

Turning now to amendment 62 in the name of the Noble Lord Lord Howell we are as that Noble Lord acknowledged committed to addressing racial disparity under the act from the Noble Lady Tyler was concerned about, so I was very pleased to host a session a couple of weeks ago reading to academics and a number of officials from the Department and members of this House. And we discussed in detail what is known and what further evidence is required. I can give the assurance that the work of the Noble Lord has already kindly acknowledge work is already under way and we will continue to explore this issue, so I am therefore happy to commit to undertake further investigation into inequalities under the act.

The scope is to be developed further, but may involve synthesising findings of existing research, conducting a review of recent literature, and exploration of potential evidence gaps that require future research with experts and academics. Further research will, of course, be subject to receiving sufficiently high research applications and will be subject to the outcome of the spending review. I hope that Noble Lord will understand that we therefore prefer not to commit to a timescale of primary legislation, but to allow time to develop a delivery research to ensure the best quality evidence is extremely important in this area.

I hope that the noble Lords will

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withdraw their amendments. I would like to thank the Noble Lady the Minister for that helpful Lady the Minister for that helpful explanation and description regarding the treatment orders. regarding the treatment orders. Despite all words, whatever the independent research has been done by the CQC, whether it is by the Joint committees, whether it is by
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Earl Howe Portrait Earl Howe (Conservative)
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41. To set the scene, there is a theme running through all the amendments in this group. Not only my amendments. That is the theme of patient empowerment. All of us I am sure welcome the fact that patient empowerment is already written large in the substance of this bill and as the changes that the bill makes are taken forward, I am certain they will be hugely beneficial to patients. However, as we heard in committee, there remain features of mental health law and practice that give cause for real concern.

My contention, which I am sure is shared, is that we should try to do all we can to make sure that procedures, the procedures, the clinical practice and if possible the cultures are made as good as they can possibly be in the way that this legislation is drafted. My amendments 12 and 13 are identical to amendments that I tabled in committee. The point of them is to signal something important about the culture of mental health care. Many of us may take for granted that the aim and purpose of treatment in a mental health unit is to promote psychological well-being and recovery, and to minimise distress.

But we know that there are many, many patients undergoing treatment for whom distress and psychological trauma are ever present features of inpatient care, particularly children and young people. Lord Crisp reminded us of that earlier on. My amendment 58, which we will debate in a later group, is designed to tackle this problem in a practical way. The same applies to my amendment 41, that brings us back to an issue that received strong support in committee. That is the need to look at advanced choice documents.

They are a great idea and I'm delighted the government has recognised their potential for enhancing patient well-being. We know from research that they have the potential to reduce compulsory detention rates, appreciably, as well as reducing time spent in hospital. However, as the bill is now expressed, patients will not be guaranteed an opportunity to create an advanced choice document if that is their wish. We have in clause 42 is a provision to allow commissioners to make information on ACDs available to people for whom they are responsible.

I do not think that is good enough. I turn now to my amendment 15 and in doing so, focus on an issue that has been brought to my attention by the Law Society relating to nasogastric tube feeding of patients in mental hospitals. The central concern here is the 1983 Mental Health Act contains no specific safeguards for situations where nasogastric tube feeding of a patient is being proposed. That is because it is considered to fall under section 63 of the act, which does not require a second opinion appointed doctor.

I am suggesting that this is unsatisfactory. In January of this year alone, according to the most recent data, there were 1975 uses of restraint to facilitate nasogastric feeding in England. Furthermore a recent comprehensive audit of inpatient mental health units in England reported that the duration of nasogastric tube feeding under physical restraint ranged from a single feed to 312 weeks, with a mean duration of 29.1 weeks. In other words, this is an invasive procedure and the degree of invasiveness can be measured not just by the amount of force that is used, but also by the length of time that the treatment last fall.

The significant gaps have been identified in a 2019 article which highlighted the need for regulations to and the use of nasogastric tube feeding in order to achieve a more patient centred approach to what is quite a drastic medical intervention. The same issue was previously raised in 2007 by the Joint Committee on Human Rights, he pointed out that forcible feeding is potentially breach of article 3 and article 8 of the convention and they also questioned why it is not subject to regulation in the same way as ECT is under section 58 of the Act.

The response at that time was that the provisions were compliant with the ECHR. However, this was before the decision in X versus Finland. The European Court of Human Rights found that Finland violated the rights of X. They were in voluntary admitted to an institution and forcibly subjected to nasogastric feeding. The judge X could not challenge the medication, but the court didn't find a violation of her right to a fair trial under article 6.

The Law Society have put it to me that it highlights the wider need for safeguarding as patient X did not have significant challenges for challenging nasogastric tube feeding. They strongly contend, and I agree, this bill presents an opportunity for making a change to the law regarding safeguarding, that are consistent with the safeguarding around electro-convulsive therapy which is what my amendment seeks to achieve. Finally, I direct the attention of the House to amendment 27. The patient voice in mental health care is inherently weaker than it is in other fields of healthcare.

The patient experience that much more determinative of outcomes. That really does matter because as we know from evidence provided by the CQC, and many patient representative groups, the care of patients in mental health settings is frequently under resourced. It therefore carries with it a heightened degree of risk that acceptable standards of care are not always maintained. In this amendment which replicates the amendment I tabled in committee, I am putting forward the idea that if every patient discharge from a mental healthcare setting were to be given the opportunity to rate, to comment on, to provide constructive feedback on the treatment they received whilst in hospital, the value to the system and the potential value to the patient could be very significant.

I know that the Minister does not take issue with this and indeed I assure she is sympathetic to what I have said. What I must question though is the premise of her response to me in committee. In that response the Minister sought to argue that the visits and interviews with patients carried out by the CQC fulfil a function that in terms of transparency and empowerment of patients is identical to the kind of debriefing that I am arguing for. My Lords, having heard what I have heard from well informed patient groups, I must to disagree.

The reality of the CQC's encounters and interviews with patients is an evidence gathering process that is all too often skewed. Here are some of the comments from patients that have been relating me. I know when we had a CQC visit the nursing staff would steer CQC in the direction of patients who would reflect positively about the ward. Someone else said a lot of the time you speak to the CQC they have staff present at the same time so you cannot be honest.

Patients have also expressed doubts about the effectiveness of the CQC's monitoring process in general. A couple of typical comments, there have been examples of where it took to, three, four years for the CQC to do something about a particular mental health unit. If the process of the CQC was working, young people will be having an better experience. It has been put to me that one of the differences between the processes adopted by the CQC and the debriefing process my amendment is proposing is that the CQC doesn't take an individual as -- I'm sure the CQC wants to speak to people about their poor experience of hospital care, but in practice people have said they feel dismissed when speaking about what they have experience.

There is a wider point here as well. In the words of another patient, debriefing isn't just complaining. It's discussing events during admission and the patient's experience to learn from it. A complaint is given and then dealt with behind-the-scenes, whereas a debrief is a reflective discussion between multiple people with the young person is a multiple participant in discussing their own experience. Another said, it gives people the ring to process things. In practice it would the independent mental health advocate who will take responsibility for the debriefing process.

The Minister expressed concern about that and more especially about the risk of overburdening those individuals. I appreciate that concern. In reality I would suggest a conversation with the patient or former patient taking the form of the debriefing is squarely in line with the existing role of an independent mental health advocate. It will not be asking him or her to be doing appreciably more than they do already. As one patient put it, the debriefing is technically what they already do, but there isn't a formal name to the Is technically what they do I genuinely believe that providing a mental health patient with the opportunity to reflect and relative tranquillity upon the recent hospital experience would not only benefit any future treatment they may receive, not only help to hold institutions accountable, but it could also in itself constitute part of the healing process for that patient.

That would help them offload a burden that they carry and thus move on. I am arguing as much as the bill does already for greater patient empowerment and greater transparency around what is done to patients in our mental health hospitals. And if the case I have tried to make resonates at least to some degree with the Minister, I

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very much hope she will agree to consider it. I beg to move. Amendment proposed. Clause 8,

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Amendment proposed. Clause 8, page 14, 919. At the end insert the words as printed.

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I rise to 1st reflect on the noble Lord as the introduction to this group. I found it deeply moving this group. I found it deeply moving and as many of you know, I am a mental health nurse and I worked in mental health nurse and I worked in both locked units and acute units. Some of the things you have just
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Baroness Watkins of Tavistock Portrait Baroness Watkins of Tavistock (Crossbench)
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described happened 30 years ago, what is so sad is that they still what is so sad is that they still happen now. I rise to speak to the happen now. I rise to speak to the three amendments in my name. 14, 42, and 43. I think other noble Lords and 43. I think other noble Lords who have added their names. These amendments being drafted with the amendments being drafted with the help and supported by several mental health patient user groups, health patient user groups, charities that work with the rental health APPG in particular.

The purpose of amendments 14 and 42 designed to ensure that advance choice documents are aligned with the existing best practise on providing such documents. Amendment 43 seeks to ensure that clinicians of relevant bodies have a responsibility or duty to consider the information provided in the advanced choice documents and use it to inform care into treatment towards its given under the Mental Health Act. This is really important that the time is needed for clinicians and nurses and social workers, to undertake the responsibility of sharing what is in those documents, and trying to design, not always being able to, but trying to design care that reflects what people have asked for before.

As we know, we continue to have a shortage of staff in mental health, and very tight budgets, compared to some other parts of the health service. I think if this is put as a duty on the Mental Health Act, it will help resolve some of those issues. I do hope that the noble Lady, the minister, is able to support the amendments so some of the most vulnerable patients from all ethnic groups in this country, their rights are strengthened in the documents and the right to ensure that staff have enough time to deliver what is in the documents.
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Baroness Bennett of Manor Castle Portrait Baroness Bennett of Manor Castle (Green Party)
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It is a pleasure to follow that sort but extremely powerful contribution informed by so much professional experience. I very much would like to acknowledge that. I think the whole house would like me to acknowledge that. The American appears in my name in this group is amendment 63, which is about the powers of tribunals to determine challenges in treatment decisions. In many ways, the argument follows from what was just said by the noble Lady Barras Watkins, things go wrong, however much we are trying to improve the treatment of people with serious mental illness through this bill, I am afraid we all acknowledge that things are going to continue to go wrong.

One -- what is a moment seeks to do, I am bringing this forward, this does not create any sort of automatic rate. What it does, the Secretary of State may make regulations in provisions about appeals. It is setting up the framework to make this possible. We had extensive discussion of this at committee. I will not rehash all that again, but I think what we are trying to do is make a common justice, create ways forward and possibilities. We are acknowledging that so much of what is in this bill, will not be delivered in a year or even two years.

It is trying to create the frame to make that possible. I think that is a very strong argument for that. The Royal -- the noble Lady Barras Watkins, I thought it was so important I should have a full slate on me. I briefly want to address 13, they are also attached to my name. It was breakthrough committee stage, it kept occurring to me and I never found the place to reflect it. When you search the bill with trauma, it does not appear once currently on the face of the bill.

I was really surprised when I was thinking about debate I had, anything several times, I go back to the domestic abuse bill, now act, in these bills that never became an act under the previous government. There was a lot of discussion about the need for trauma informed environments. Trauma informed care. Yet, I think there is a general sense of intention that this is one of the things that we're thinking about. There is nothing written there on the face of the bill.

What this amendment rights onto the bill is seeking to minimise the patient's distress and recovery from any childhood trauma. I think that is possibly a bit narrower, and I hope this is something the noble Lady minister might take away and think about afterwards. The fact there is really nothing there on the bill that talks about so many of the patients we are talking about. People who have been through hideous traumas. Childhood abuse, domestic abuse. People who have been in war situations.

People who have been tortured. All kinds of circumstances. And to actually put on the face of the bill, I think more broadly than this amendment, but it is a chance to raise this issue. Let's make sure we put an awareness of the need to think about trauma. I think we are all thinking this, but let's make sure it is written down there.
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Baroness Hollins Portrait Baroness Hollins (Crossbench)
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I agree with the noble Ladies points about trauma. I will speak about and 53. I credit my parliamentary scholar with writing it. His experience confirms my experience of many years ago before I retired as a psychiatrist. Too often, the factors are ignored or inconsistent, leaving vulnerable patients without essential safeguards. A review of independent reviews and the use of long-term segregation is from previous government found that around one third of providers were not reviewing long-term segregation in complying with current codes and requirements.

Unfortunately this problem extends beyond that and is evident with the settings included acute care for individuals with personality disorder. This is often a disconnect between the guidance and policy achieve and the reality of frontline psychiatry. A strategist once said, no planes provide contact with the enemy. In this contents, I guidance provide contact with the complexity and pressures of day-to-day care. That is precisely why guidance is not enough. Despite the guiding to have regard to the code, which is frequently challenged, again and again we see this in the law, not just guidance is needed to ensure guidance for patients rights.

Entertain patients, I am not in a position to take on provided to court if the treatment is not in line with the code. This is why this amendment introduces a statutory Ability mechanism for non- compliance. It establishes enforceable obligations on providers, ensuring that failure to adhere to the code carries real consequences that compliance is not optional, in the hospitals will be held accountable when failure to follow the code results in harm or breaches of the patient's rights. My Lords, legislation typically drives funding priorities.

We have seen time again that whether lower mandates actually, resources follow. Section 2 of the Mental Health Act with his detention to 28 days. This timeframe was merely guidance, would it be student needed? The statute to require it with the same level of resource protecting against mental health tribunal. When the maximum detention period under section 136 was reduced from 72 hours to 24 hours, we have seen a crime in 2017. We saw an immediate and dramatic change in practise across the country.

I.you would have seen such swift and universal compliance. Prior to the 19 E3 Mental Health Act, clients can be detained with minimal safeguards and little external oversight. The introduction of statutory time limits and legal protections under the 1993 act had a turning point, contributing to the decline of long-term institutional care, and supporting importantly the rise of community-based mental health services, rights-based community care. Without statutory backing, there is no guarantee that revisions to the code of this will be fermented or enforced.

I beg to move.
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Baroness Barker Portrait Baroness Barker (Liberal Democrat)
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At this stage I don't wish to detain the House for very long. I civilly reflect on the fact that when we debate mental health legislation, we are almost always trying to do two things. One is to, three things actually. One is to update current thinking in legislative circles on what patients want and need. The second is to try to gently confront, sometimes conservative disposition of practitioners by pushing for progress.

And the third thing that we try to do, is that we try to avoid the situation where the biggest imperative of legal change is avoided. That is scandal and a crisis when something goes wrong. And the amendments in which the noble Baroness Baroness Warwick -- noble Baroness Barras Watkins put forward, they have reflected on what has been seen over the last 10 to 15 years, in terms of both patient experience and the most progressive aspect of professional development.

And that has been around the growing acceptance that patients can have making informed insight into their condition, even if they are at times very very ill. That is why a number of practitioners have admittedly in the face of some professional resistance in other quarters, have gone down the route of advanced choice directives. The thing I would say to the noble Baroness is this. It is always difficult in mental health to come across evidence which is up to the same standards as we would have in physical health, i.e., randomised controlled trials.

Actually, there have been randomised controlled trials of advanced choice documents. There have been a number of different voices around the world, but in the United Kingdom, where they might not has always been called advanced choice documents. All the findings from those say that these are really effective, cost- effective interventions, but we know that they will not be widespread. They will not be widespread in will not become paying attention to what people have put in those choice documents.

They will not become standard practise unless it is in law. That is why the noble Baroness Watkins has been right to put this Watkins has been right to put this

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My My Lords, My Lords, let My Lords, let me My Lords, let me thank My Lords, let me thank noble Lords for their contributions and I Lords for their contributions and I will take each amendment in turn. To the points on trauma, which have been extremely well made and sensitively made, amendments 12 and sensitively made, amendments 12 and 13 do recognise the impact that childhood trauma can have on psychological well-being. This is psychological well-being.

This is indeed so, and given, however that this doesn't apply to all patients, that is the reason that we do not wish to restrict decision-making by giving particular reference to this in legislation. I can point to clause 8, which already requires decision-makers to consider the nature and degree of the disorder, and all other circumstances which could include childhood trauma. The definition of medical treatment under the act is broad, as noble Lords will have seen, therefore we would expect it to cover interventions aimed at minimising
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Baroness Merron Portrait Baroness Merron, The Parliamentary Under-Secretary for Health and Social Care (Labour)
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strict safeguards to the provision of artificial nutrition to patients detained under the act. The noble detained under the act. The noble Lord Earl Howe referred to nasogastric feeding, the importance of combating its use. I would say we do recognise that artificial feeding in this way is extremely serious as noble Lady Baroness and also spoke to, but I would make the point that it can sometimes be a life-saving treatment. And so, as ever, and local decision-making is key.

My Lords, there are already regulation making powers in the act that can be used to place treatment under different safeguards. But, I can say today that we are committed to engaging with stakeholders on whether revisions do need to be made on this front including in relation to artificial nutrition, and I hope that would be welcomed. With regard that would be welcomed. With regard to amendment 37, there are systems in place for capturing and action in service user feedback.

As under the patient and carer race equality framework, some may not always work effectively, a preference is to work to improve existing mechanisms stop. Dr Dash is currently with health watch to improve service improvement, we do look forward to Doctor Dash's recommendation to have improvement in this area. The noble Lord Earl Howe referenced his view that CQC doesn't take an individualised approach to monitoring, and in practice, sadly, people could feel dismissed. Perhaps I could respond to that by saying the CQC interview thousands of patients as part of their monitoring, the MHA reports.

And I emphasise this should be done in private unless there is good reason not to do so. So I am sorry to hear of the feedback that the noble Lord references from patients who say that there have been occasions where the evidence that has been given may potentially be skewed to refer to the point the noble Lord said, and I do plan, and I can give this assurance to the incoming chief inspector of mental health Doctor chopper-- Chopra when they are in office.

Now especially one that places great burdens on mental health benefits I don't think will achieve the desired different, but we are willing to work with ballooning change and other noble Lords-- blooming change and the other noble Lords and the support with blooming change, and we continue to gain from expertise. I do recognise the concern that noble Lords have around events choice documents. However it is felt that members 14, 42 and 43 would reduce legibility in the bill.

The flexibility that exists to support patient choice and autonomy. Turning to amendment 41 we continue to be of the view that a right to an advanced choice documents is unlikely to improve the uptake. However, I have listened very carefully to concerns raised today and during committee. We do agree that the bill could go The success of advanced choice documents. So I am pleased to announce we are exploring how we constrain and clarify the duties on health commissions relating to advanced choice documents and we intend to bring forward legislative amendment in the Commons.

I'm also pleased to commit setting out in regulations, the need for clinicians to include a plan to help patients make an advanced choice documents make an advanced choice documents wherever appropriate, as part of the statutory care and treatment plan and we do believe this will facilitate the uptake of advanced choice documents, something that I know the noble Lords are keen to see. More details on the intended coverage of the care and treatment plan can be found in the policy paper that I circulated before report stage.

Turning now to amendment 50 Turning now to amendment 53, code of practice does offer statutory guidance for functions under the act with the legally binding duty to follow it unless there is strong reasons not to do so. There will be cases and I know that noble Lords understand this where departing from the code is necessary to achieve the best outcome. This is, of course, the advantage of guidance of the legislation. However, such cases should be rare and should be strongly justified.

CQC monitors the Plamen taken of the code of practice and raises concerns to the monitoring reports and inspections. Breaches of CQC regulations that depart from the code will affect a provider's rating. When a patient's rights or safeguards are breached, resulting in harm, remedial actions including legal and disciplinary including legal and disciplinary measures are in place, regardless of whether the breach stems from departure from the code. In the noble Lady Baroness Hollins spoke noble Lady Baroness Hollins spoke with me earlier today about ensuring compliance with the code of practice which is a point very well made.

In response I can say the code does set out who must have regard to the code under current arrangements under the 2008 Health and Social Care Levy, registered providers must ensure staff have appropriate training to carry out their role. But looking to the future, the Department will work with NHSC, social work England and other partners to develop appropriate training for staff on these reforms. Once the code of practice has been updated, professionals working under the act will be required to undergo training to maintain their competence and their awareness of the act.

And I would emphasise the failure to have regard to the code may give rise to legal challenges as noble Lords are aware. Courts will scrutinise reasons for departing from the code, to ensure there is sufficiently convincing justification in the circumstances that have led to this circumstances that have led to this departure. Finally, if I can turn to amendment 63, this amendment significantly changes the tribunal's role. Which currently focuses on reviewing detention not treatment decisions. The previous administration did consult on a similar recommendation from the independent review.

And may recall the serious concerns were in fact raised. The tribunal is not designed for dealing with complex treatment disputes, which need specialist input, and established their pubic relationships between the patient and the organisation. But the emphasis on the reviews benefit and it" here will see the tribunal pays particular attention to the patient's care and treatment and whether it is proving effective as part of discharge decisions. For these reasons, I do hope noble Lords can withdraw their amendments.
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None Portrait Government Spokes Baroness Blake of Leeds (Labour)
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act. These situations arise when the regulator determines their exceptional circumstances delaying the appointment of a second opinion Doctor, and the treating clinician teams urgent electroconvulsive therapy necessary to save the patient's life. In recognition of the seriousness of the situation, the new process will also ensure these exceptional cases are monitored and reported on by the regulator. In Amendment 64, 65, 66 and 67 ensure that where regulations are made under the power to make consequence of provisions set out in clause 52 to amend or repeal primary legislation, they will be subject to the affirmative scrutiny procedure.

Amendment 65 extends this to clause 53 which confers equivalent power on Welsh ministers in areas of devolved competence. Turning back to amendment 16, this addresses concerns from stakeholders that the bill was not explicit on whether urgent electroconvulsive therapy is permitted when the person 's consent lacks capacity, but treatment is not in conflict with decision to refuse it as is currently the case under the act. This amendment makes clear treatment in these scenarios is still permitted, addressing any possible risk of misinterpretation.

Turning to amendments 20 and 22, the bill is introduced only expressly permits remote assessment by the second opinion Doctor service for urgent compulsory electroconvulsive These amendments clarify that remote interview and examination are permitted for all second opinions provided by people appointed by the regulator. Remote interview and examination may only be used where deemed appropriate. If not, these functions must be conducted in person, specific guidance will be provided in the kind of practice. Turning to amendment 26, approved mental health professionals have raised concerns that the requirement for the nominated person to sign an appointment instrument in the presence of a healthcare care professional witness could have delays in having a nominated person in place which could undermine the safeguard and place geographical restrictions on who can take the This could mean that patients placed in our area hospitals have greater delays in appointing a nominated person.

Amendment 26 therefore removes the requirement for the nominated person to sign the instrument in the process of the witness, whilst maintaining the safeguards of the witnessing process. The witness must sign a statement confirming they have no reason to believe the nominated person lacks capacity or confidence. That fraud or undue pressure has occurred, or that the person is unsuitable. They are expected to meet with the nominated person to ascertain this. In most cases, this is expected to be done in person, but the amendment allows for the signature to be done remotely, if appropriate.

Further guidance will be provided in the code of practise and as my noble friend at the Minister has announced, we are committed to establishing an expert task force to support the developments of the code of practise to provide clear guidance for professionals involved in the nominated persons appointment process for children young people. This will include the witness process. For these reasons, I hope
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Earl Howe Portrait Earl Howe (Conservative)
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The House will be grateful to the Minister for this group of government amendments, which she has made clear coming to principal policy issues. I have two sets of queries. The rules for authorising electroconvulsive therapy, I am sure it is not the government's intention to water down the safeguards surrounding the ministry. In relation to amendments 16 and 17, taken together, can the Minister reassure me, the bill as modified by the proposed amendments were deposited there could be circumstances in which a patient who has the capacity to consent to ECT, but who has not consented to it, could nevertheless find the refusal to treatment overridden by the decision of a single treaty -- treating clinician.

Even with the judgement of the clinician was ECT is necessary to save the patient's life, it seems to be a significant change from the current law, whereby the decision of a second opinion appointed Doctor is required in all cases where it is proposed to administer ECT to a non-consenting and capacities patient. Amendment 17 makes clear that the regular Tory authority of CQC may only give permission for ECT to be administered on the single doctor, were a so at is not available in exceptional circumstances apply.

I want to ask the Minister to define exceptional circumstances might consist of, but it is to be assumed that a primary example might be when time is of the essence, and not so at could be located soon enough to avoid exacerbating the risk of harm or death. My questions have to be first, has this proposed change in prompted by a general awareness across the Mental Health Act, that the availability can frequently prove a problem in circumstances, where urgent decisions are needed.

To put it bluntly, are we being asked to change the law because of habitual shortcomings in NHS communication arrangements? I would be concerned if that were the case. Secondly, what guidance if any, will CQC formulate themselves to ensure that when the decision is sought, to temporarily waive the requirement for a so at. They will not do on the basis of it being available. But it will also commit themselves to a standard procedure whereby they will seek at least some background detail from the treating clinician of the case before him or her, such as the reasons why they considered that the ministry ECT to that particular patient carries particular urgency.

In which it can be assured that the treating clinicians are subject to at least a modicum of testing and cross questioning before the CQC issues the go-ahead for ECT to be administered. I hope so, because anything short of that could turn into a tick box exercise. The other government amendment in which I would appreciate further equivocation is a member 26, which changes the process for appointing a nominated person. One of the changes proposed is the various statements and signatures required for appointing the nominated person, no longer have to be contained in the same instrument.

The other is, the nominated person signature no longer has to be witnessed. What this implies, I should say I was grateful for the measures Mark I was grateful for the Minister's explanation. The instrument appoints the nominee the person and is signed by the patient in the presence of the witness, can be executed without the nominee the person themselves being in the law anywhere near, but the moment the bill says the instrument appointing the nominee a person must contain a statement signed by the nominated person in the presence of the same person as witnesses the signature of the patient.

I previously assumed the reason for that provision was the responsibility that the bill places upon the witness, quite a serious responsibility to ensure as far as possible that the nominated person, whoever they are, is a proper person to act in that capacity. It would appear now with this amendment that there is no need for the witness to clap eyes on the individual who is nominated. How could that be right? Without at least meeting the nominated person, how can any self-respecting witness certify hand on heart in the words of the bill, to think that the of the bill, to think that the nominee person lacks capacity or ability, or that the nominee person is unsuitable to act as a number person.

I basically meant to take the patient's word for it? I have to say, this alteration in the wording does raise all sorts of question marks in my mind, given the concerns expressed by noble Lords in committee about misplaced loyalty towards a particular individual, naivety on the part of a child or young person, or even some degree of psychological manipulation in a young person. For example, someone who makes the business to set a child against their own parents. In committee, the Minister herself emphasised the need for the Lord to prevent exportation in manipulation.

Whilst I did not at the time think that this was a completely the response was completely reassuring, I release it as an acknowledgement that the role of the witness could not be fulfilled properly without some sort of contact with the nominated person. Was I right or wrong on that? It would be helpful if the Minister could explain how my misgivings in this area might be allayed in a way that the nominated person procedure comes to be fermented in practise.



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And I think the noble Lord for his comments, it also for the many his comments, it also for the many contributions made from noble Lords contributions made from noble Lords around the house. The noble Lord has some questions. I think the main thrust of his comments are looking thrust of his comments are looking for reassurance that due diligence has gone into other areas he raises.
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None Portrait Governmernt Spokes. Baroness Blake of Leeds (Labour)
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has gone into other areas he raises. I am not sure I can answer every line in detail, but I just want to particularly reassure him about the nominated person question, which he, I know has caused him a concern. In addition to what I have said, I would just like to emphasise that there is no intention at all to water down the safeguard, and that the amendment 26 will make sure that patients get access to a nominated person quicker, and other rights and powers that entails, meaning the safeguards provided by the role will not be delayed.

I think that is the crucial point that we have to factor in, as to why these amendments are deemed to be necessary. This is particularly important for patients. Those in particular that may be subject in and out of placements. The change that we are bringing in is that the nominated person signature does not need to be witnessed in person. Actually, none of the safeguarding cheques are changed in any way like this. We would expect an answer to his concern.

But in the majority of the cases, the witness would still be a number person face-to-face. In exceptional circumstances, this is not possible, we believe it is better to be able to appoint a nominated person subject to all the appropriate safeguarding cheques, then you have to wait. Then to have to wait until a person can have their signature witnessed. What I would like to say as a second appointment, Doctor, is not currently required for urgent and compulsory electroconvulsive therapy.

This is new under the bill. I think that is the point I need to emphasise this point. What the amendment does, is that of the exceptional circumstances where a second opinion appoints a doctor, sorry, this is a mouthful. It is not required. I hope that gives simplification. -- I hope that gives some clarification. We have to make sure these rules taken in the round. In they do want to reassure the noble Lord and Lords across the chamber, many of these are regarded to be due to exceptional circumstances where time is of the essence.

As to whether some of these provisions are based on failure, I think it is from that experience and bringing everyone together who has a view and to make sure that everything we bring forward is in the best interest of the patient. I think that is the absolutely crucial thing. This is where the detailed work that is going to be done under the code of practise, bringing together all the different parties in a measured way. It will take a few months to do this.

I think this is absolutely critical, so we can be reassured that the processes are brought into play. I can understand the concern about making sure that communication is there in situations of stress. But I believe these amendments are absolutely designed to address this issue. As I say with the patient's interest, absolutely in the forefront, there will be opportunities as the code of practises put together for us to make sure that our endeavours are followed, bringing the best opinions with the best interest of the
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Lord Meston Portrait Lord Meston (Crossbench)
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Member proposed plan to pay 74 insert Mental Health Act tribunal, Lever County Court.

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We have input of the noble Baroness for bringing this point I Baroness for bringing this point I Baroness for bringing this point I began. We the reference to the County Court in schedule two, is the only place in this jurisdiction where the County Court is given where the County Court is given anything to do. And it does seem to anything to do. And it does seem to me now to be an anomaly and inaccuracy, it is simply carrying forward the use of the County Court forward the use of the County Court from the 1959 act and the 1983 and, which provided for that court to deal with applications to displace nearest relatives.

I do not believe that if the mental health legislation was now being started afresh, it would refer to the county courts. The County Court is, in any event now greatly overburdened, but that is not the only reason to replace it. A mental health tribunal or indeed the court for protection are better equipped to deal with

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these cases, having specialist expertise and judiciary. My Lords, I would like to support this amendment, particularly what this amendment, particularly what the noble Lord, Lord messenger said, the noble Lord, Lord messenger said, of County Court, which I don't of County Court, which I don't currently have, but what concerns mean, if it is sent to the county mean, if it is sent to the county courts to adjudge who is not family courts to adjudge who is not family charge, there would be considerable difficulties for that judge.

So
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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, let me first of all thank the noble Baroness Lady Berridge for her amendments 24, 28 and 35. These amendments would mean the mental health tribunal would handle termination of appointment of the nominated person, rather than the County Court. My Lords, the County Court already has place, already has a role in displacing the nearest relative. It has the expertise, procedural tools and legal framework to handle sensitive disputes involving external parties, such as conflicts of interest or allegations of abuse.

The first Tier Tribunal mental health in England in the mental health review Tribunal for Wales, focused on reviewing detention under the Mental Health Act. This would add additional burden on the tribunal, risking undermining their core function and delaying detention reviews. The noble Lady Baroness Berridge raised the issue of legal aid. So, to that point I can say the County Court mental health cases are largely limited to applications for the displacement of the nearest relative. Currently, legal aid is available to a person seeking the displacement of the nearest relative except where the person bringing that application is doing so in a professional capacity.

And to the nearest relative themselves. This would also apply for the nominated person, which will replace the nearest relative. Legal representation is available where the applicant meets the means test, unless they are under 18 and the relevant merits criteria and if there are any other from the point of clarification I would be pleased to make them to any noble Lords who have raised points today, including to the noble Lady. So as we do not feel the mental health tribunal is the right place for this, as I was referring to before I went on to legal aid, I do ask the noble Lady to withdraw this amendment.

to withdraw this amendment.
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None Portrait Division:Amendment:34
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My My Lords,

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My Lords, the My Lords, the question My Lords, the question is My Lords, the question is that

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My Lords, the question is that amendment 30 4B agreed to. As many of that opinion say content. The contrary not content? The contends will go to the right by the throne, will go to the right by the throne,

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The The question The question is The question is that The question is that M The question is that M and The question is that M and 34 The question is that M and 34 we

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The question is that M and 34 we agreed to. -- question is the amendment 34 question is the amendment 34 question is the amendment 34 question is the amendment 34 question is the -- the question is that amendment 34 -- the question is that amendment 34

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There There have There have voted There have voted content There have voted content is There have voted content is 218,

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There have voted content is 218, not contents 143. The contents have

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The The question The question is The question is that The question is that amendment

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The question is that amendment 33 as amended too, as may the also content, the contrary not content. The contents have it. Just. Amendment 35, Baroness Berridge, not moved. Amendment 36 moved forwardly, Baroness Barran? The question is amendment 30 6B agreed to --

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amendment 36 be agreed to. Listened carefully to the

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Listened carefully to the ministers reply. Around the proposal ministers reply. Around the proposal that I made to give mental health nations an automatic opportunity to nations an automatic opportunity to avail over a debriefing process after leaving hospital in the after leaving hospital in the interests of patient empowerment and greater transparency for the system greater transparency for the system generally. We do wish to test the
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None Portrait Orders and regulations: Chancel Repair (Church Commissioners’ Liability) Measure Church Funds Investment Measure; Church Funds Investment Measure
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the house doesn't adjourn. Many will say content? Not content? The contents have it. now have to find contents have it. now have to find where I am. (Church Commissioners' Liability) Measure Lord Bishop of
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Lord Bishop of Chichester Portrait The Lord Bishop of Chichester (Bishops)
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My Lords, I beg to move the motion standing in my name on the order paper. My Lords, this measure rationalises the legal basis on which the church are obliged to provide funds to repair the chances of certain parish churches, existing law in this area has the history before the dissolution of monasteries in the 16th century, the ruler generally applied in England was the people of the parish were responsible for maintaining the nave of the parish church, the main part of the church were the people generally stand or kneel during services and the of the parish was responsible for the chancel, the easternmost part of the church which easternmost part of the church which has the altar and sees the clergy.

Legislation of several centuries beginning in the 1530s and concluding with the establishment of the church can nursing 1947, has resulted in the commissioners inheriting some of the land that had once formed part of the endowment of the wreck degree. That ownership carries with it the rector's liability to keep in repair the chancel of the relevant parish church. The commissioners land carries liability for around 350 parish churches, in some cases the commissioners have the whole liability will stop in other cases, they share it with other landowners.

In 2023 they incurred net expenditure of around £354,000 on Chancel Repair's is considerably down on £608,000 which occurred in 2022. They expect expenditure for 2024 and 2025 to be in the region of 1.2 million for each of those years. Cathedral chapters also carry liability for the chancel is of around 200 parish churches, their grants to cover this liability. In 2023 parishioners made great for this purchase meeting the entire of Cathedral chapters lability in this regard.

One land which carries Chancel Repair liability is sold, the purchaser takes on that liability, provided it is registered liability, provided it is registered against the title of the land before the sale takes place. That has the potential to reduce the value of the land in question and result in lower sale proceeds that would otherwise be a case. If the liability is not registered against the title of the land, the purchaser takes the land free of liability in which case the parish loses out because the liability effectively disappears.

This measure will cut through some of those complex issues. It will detach chancel liability for many land that currently belongs to the church,, and turn it into a freestanding statutory obligation on the commissioners to make the relevant payments. That will mean that parishes will no longer need to go to the trouble of registering Chancel Repair liability for which commissioners are responsible. Those perishes will continue to be entitled to receive payments from the commissioners to maintain the chancel's of their churches in the commissioners will be able to sell land without having to reduce the sale price to take account of a liability having been registered against the title.

The measure also helps Cathedral chapters instead of having to rely on grants from the commissioners to offset the liability. To repair the tonsils of various parish churches, chapters will no longer carry the liability at all. It will be transferred to the commissioners who will become subject to a direction statutory obligate-- direct statutory obligation to be the liability is that until now have fallen on cathedrals. As the noble Lords will be aware from its report in ecclesiastical committee has considered the measure and found it to be expedient.

I beg to move.

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Question is that this motion be agreed to. My Lord, Baroness Harris agreed to. My Lord, Baroness Harris of Richmond is taking part remotely and I invite noble Lady to speak.
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Baroness Harris of Richmond Portrait Baroness Harris of Richmond (Liberal Democrat)
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and I invite noble Lady to speak. My Lords, I will be brief. The ecclesiastical committee under our ecclesiastical committee under our excellent share, the noble and learned Baroness Lady Butler-Sloss considered these measures as we heard on 3 February this year after they had gone through all the sin of scrutiny,-- scrutiny. I must declare I am high Steward of Britain Cathedral in Yorkshire three cathedrals as we heard also mentioning the measure and note I have a nephew on the parish priest-- at Isle of Man, that's divorce from these particular measures at the moment.

This is about enforceable liability to repair or contribute to the repair of the Chancellor of parish church. Essentially, it will detach the church parishioners liability entered into a freestanding statutory reliability as Lord Bishop of Chichester has said quite clearly. This will enable church to sell land free of responsibility for the repair of any chancel liabilities. The commissioners will continue to be liable to repair the chancel and the continuing statutory duty even after they sell any land for which there is Chancel Repair liability.

The measure also makes provision for the conversion of the current statutory Chancel Repair duty of the chapter of each Cathedral into a statutory duty of the commissioners. It doesn't abolish Chancel Repair liability, or change the liability of third parties to pay contributions to any Chancel Repair that is needed. And we were happy, as the Bishop has already told us, we were happy to accept this measure as proposed by the Synod.
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Lord Bishop of Chichester Portrait The Lord Bishop of Chichester (Bishops)
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I beg to move the motion stating my name on Order Paper, my Lords this is another piece of reform legislation that updates legislation dating from 1958 which inviable is very Church of England bodies to invest in pooled funds, these known collectively as the CBF Church of England funds. Approximately 11,500 church bodies invest in these funds, they include support of finance, church councils and cathedral church councils and cathedral chapters, the funds in the range of £3 billion.

Legislation offering these pooled investment funds, Church Funds Investment Measure 1958, is out of date and prevents these funds being regulated funds. To address this the measure provides for the transfer of the CBF Church of England funds to what is known as a charity authorised investment a charity authorised investment fund. The structure of this kind of fund is created in 2016 by the Financial Conduct Authority working with the Charity commission. It has significant advantages for investors. First, charity authorised investment funds are jointly regulated by the Charity commission and Financial Conduct Authority.

This offers investors greater protection and reassurance that the funds are regulated and overseen in accordance with industry best practice, while maintaining their charitable status. Second, no VAT is payable on the fees of the managers of these funds, resulting in a modest saving for charities who invest in them. The measure permits the trustee of the CBF Church of England funds to transfer the assets of those funds to a charity authorised investment fund. The results will be the CBF Church of England funds, instead of being unregulated, as is currently the case, will become authorised and regulated jointly by the Financial Conduct Authority and Charity commission.

Value-added tax will also cease to be payable on investment managers fees resulting in a cost saving to church investors. Again, the ecclesiastical committee has found the measure to be expedient. I beg to move. Speaker question a second motion of Lord Chartres to be agreed to, as much as that opinion would say content? Content? Contrary, not content? The Content? Contrary, not content? The contents have it. contents have it.
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None Portrait Amendment:38 Lord Bradley (Labour)
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Bradley. My Lords, arise to move my Amendment 30 a dance declare my interest in the register. During the interest in the register. During the committee's stage of the bill, move the amendment require a specified the amendment require a specified accountable person to be appointed accountable person to be appointed by the relevant body to ensure the specified 28 day transfer period is met. This proposal was based on the fact many agencies are involved in arranging prison transfers.

My belief, from my experiences in helping to develop services across health and justice, that there could be significant merit in creating a single role. A dedicated official whose primary function would be to ensure efficient transfers with the ability and power to liaise and intervene with the various agencies at the most senior level where necessary. As I said in that debate the amendment would clarify and enhance accountability and transparency, and support the desire expressed in the impact assessment of the bill to increase, and I quote, accountability for all agencies in the transfer process.

To It is important to note again that this is supported by Sir Simon Wessely's independent review which means it would help to unlock the institutional barriers and give the teeth it needs to push the transfers through. At the conclusion to that debate, first Lord Kamall from the opposition frontbench commented that my amendment again speaks to the implementation of provisions in the bill. This could be a sensible way of holding providers to account and working with them to address the shortcomings in patient transfers.

Secondly, and most importantly, the Minister and Noble Friend Lord Timpson helped to remind the House that the previous Government had run a consultation, seeking views on the effective way to establish this role. But no consensus was reached. Further, a cross agency working group was established to scope out the role and that war continues between help and justice partners on this issue. The Minister suggested that a nonstatutory approach would ensure that the interests of patients are considered, while providing the flexibility required.

Given the complexity of the process. Very helpfully again the Minister offered to meet to discuss this further, and that to be undertaken before the report stage today. I am very pleased that such discussions have taken place, and would not only like to thank the Minister but also the excellent officials in both the Ministry of Justice and NHS in for it the very constructive engagement with me. I still strongly suggest that we need effective oversight of the transfer process and hence I tabled amendment 38 for today which proposes that either an accountable person or body as site extension to my original amendment is established for the purpose and of course to ensure accountability and transparency to Parliament on this matter.

I hope the Minister will now support this proposition and I look
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None Portrait Deputy Lord Speaker. Baroness Garden of Frognal (Liberal Democrat)
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forward and will listen carefully to the Minister's response at the end

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of this short debate. Does the Noble Lord wish to move

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his amendment? I expect he does. Yes. I beg leave. Thank you.

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I beg leave. Thank you. Laws 39 and 25 I insert the words

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Laws 39 and 25 I insert the words on the Marshall list. A machine stage in number of lords stressed the importance of lords stressed the importance of those sections of the bill relating to his application for prisoners suffering mental disorder. I suffering mental disorder. I continue to push to ensure the parts of the bill that relate to the responsibilities of the emoji relating to the Department of Health are not neglected once the act becomes law. At committee, I focused on calling for a Government review of the impact of the bill on prisoners.

But listening to the thoughtful response from the Noble Lord Timpson, I saw that this could become yet another bureaucratic report. I therefore commend amendment 38 of the Noble Lord Bradley is an elegant way of securing that crucial transfer to hospital within 28 days provision is more than an if only paper aspiration. My amendment 40, which I am delighted is supported by the noble Baroness Lady Bennett a man that Castle is also a practical proposal. It is designed to tackle problems directly pertain to the bill broadly because regardless of this legislation, the reality is that there will continue to be large numbers of prisoners suffering mental disorders who are incarcerated within the business state rather than secure hospitals.

Then what happens to their mental health is the question. There mental healthcare when they are released. If this aspect is neglected, these ex-prisoners could well become increasingly unwell and deteriorate, and therefore are in need of future detection. I think it would be a real mistake to neglect any policy or practice associated with this bill. That fails to address the need for bespoke, ongoing support in the community. In which ex-prisoners mental health is not allowed to fall mental health is not allowed to fall further, creating new risks to both themselves and the public.

And this is a real risk. Estimates from the 2023 report centre for mental health based on a survey of 75% of prisons and young offenders institutions in England found that one in seven prisoners received mental health support while in custody. One in four amongst women. However, continuity of that can collapses after release. Research led by the University of Manchester recently found that 53 prisoners who had been in touch with in-house services due to severe and enduring mental health conditions that only four were in touch with community health services six months after release.

The reasons are understandable, why this happens. When leaving prison, both the authorities and prisoners may well focus on practical challenges such as lack of housing, how to earn money and a living, and therefore mental health support can and does slip down the priority list. But leaving prison and it is also the case that leaving prison can present a shock to the system that affects this. Prisoners will be leaving a structured environment focused on routine and, in many instances, returning to more disorganised and chaotic coalitions.

Freedom may be an arbitrary end to an effective course of treatment. Maybe having waited for months or years even to access services such as therapy or specialised groups in which they have started to open up about traumatic experiences, all in prison services. Then, suddenly, on release, there is an abrupt end to support. Targeting interventions, prescribing regimes, access to medication inside, are no longer guaranteed on the outside. I understand that ensuring continuity of care can be incredibly difficult. People leaving prison often have
20:38
Baroness Fox of Buckley Portrait Baroness Fox of Buckley (Non-affiliated)
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multiple and complex needs. Can themselves be wary of accessing care in the community because of a lack of trust in state institutions that of trust in state institutions that means that there are slightly too proactively seek out help. Ex- prisoners also report that they fear that disclosing mental health challenges to, for example, challenges to, for example, probation staff, will draw attention to their vulnerabilities. And then there is the dread recall. there is the dread recall. Especially in the fear for IPP prisoners stop a fear of being sent prisoners stop a fear of being sent back to prison if they appear to ill to go, or the threat of other detention mechanism sections.

So, all of this amendment seeks to do is to ensure a smooth handover between business and community services. Without such ministerial reassurance, I fear that this would undermine core parts of the bill unless it is taken into account. The stock reply to such concerns as the prison mental health services send an information prisoners GP, but in the real world this is often nonsense. Pearson is often do not Address upon release, so they just discharge them with a medical letter. Prison nurses explained that they do not know where their patient prisoners will be released to be under a hostel somewhere, making it impossible to connect that person to even primary care.

Prison led medical staff also complain that Of the impending release until very shortly before hand, sometimes one week or days. And this is especially acute in relation to the present early release scheme. There is not enough time to set up appropriate community provision to communicate the services or even to conduct proper assessments of the individual prisoners/patients before their release. Clinical needs are therefore de-prioritised and prisoners full through the net of statutory services will stop what is needed and what this amendment envisages is that a relevant detention authority is responsible for discharging packages that will, for example, register prisoners when they leave with GP services in a precise area.

A person that is easily discharged can then, sorry, to the person, sorry, GP services and the precise area person is discharged to liaise with relevant third party organisations and community provision to make arrangements. That is that prisons and health authorities work together to prevent deteriorating mental health and a potential for behaviour on the outside that would mean yet more contact with terminal justice for the ex-prisoners and possibly emergency intervention and potential.

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I rise briefly to follow the

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I rise briefly to follow the Noble Lady Baroness Fox back to amendment 40 in her name. It is a amendment 40 in her name. It is a Combination you will see very often. Combination you will see very often. At this, as the Noble Lady just sat out with practical, very clear evidence, is an amendment that discreetly makes quite a lot of sense that I thought I had to back it. A particular area when it comes to prison policy is women in prison.

And there are just more and more and more shocking figures emerging all
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Baroness Bennett of Manor Castle Portrait Baroness Bennett of Manor Castle (Green Party)
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of the time about what is happening in prisons. 1/3 of women in prison in prisons. 1/3 of women in prison are now self harming. 29% increase are now self harming. 29% increase in the last quarter. 82% of women in prison report mental health problems. And as the Noble Lady problems. And as the Noble Lady said, one in four are actually in prison receiving help for mental prison receiving help for mental health services. That is not to say that there aren't enormous issues that there aren't enormous issues around mail gels as well, that figure was one in seven male jails, but I really want to take a moment to pay particular attention, six in 10 of those female prisoners that are serving sentences of less than six months, their life is torn apart.

They're putting is on. Maybe they just start to get some help from mental health services and discover the other figures are seven and 10 out of women in prison report their victims of domestic violence, 53% report they were victims of child abuse. We have a huge amount of need for mental health services here and often very, very acute mental health services. And yet, as the Noble Lady set out, they are thrown out virtually onto the street and the chances of continuing care, continuing support being there, is just utterly unrealistic.

At the moment, I suspect they will say that trying to very much improve the situation and I respect and understand that but nonetheless I think this is a really practical, sensible measure, that would just make common sense for the Government make common sense for the Government to take on board.
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Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (Liberal Democrat)
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I just want to say briefly to make a couple of contributions to this debate, and in so doing I reflect on the fact that we have not actually spent much time talking about the criminal justice side of this bill and I just wonder why that is, actually. Just very briefly to say on the Noble Lord Bradley's amendment I think that it makes eminent sense to ensure that there is an accountable person or I think we set or body responsible for ensuring the transfers to hospitals occur within 28 days.

I have a quite sort of simple view of the world and that is if you want to make sure that something gets done, you need to ensure that someone is in charge and that person is held to account. And I think is the Noble Lady the Minister knows where quite keen, actually, and responsible people, particularly in relation to this bill, to make sure that things do get done. Hence I support it. And I have just heard, I was very interested to hear the arguments put forward by the Noble Lady Baroness Fox on her amendment, firstly on ensuring that prisoners treated for a mental disorder have access to continued mental health treatment once they are back in the community.

Just seems to me it is such common sense stop it is such an obvious thing to do, if we are to stop repeat admissions, repeat detentions, and the whole thing becoming a revolving door. And I think that we all know it is not easy when you are in the community, at the best of times, frankly, to get access to the treatment you need, particularly mental health treatment, particularly difficult I think for people who have recently been released from detention.

And also, I think bearing in mind as we all know the episodic nature of many mental health conditions. I just think it is just really good commonsense.
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Lord Kamall Portrait Lord Kamall (Conservative)
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My Lords I will speak ruefully. I have to say one of the things about being a politician is that when you say when the noble Lord, Lord Bradley told me was about quote me in his contribution I think whatever side now. I am grateful to Noble Lord Bradley for warning me as well and not being too harsh on me. I think as the Noble said its a sensible amendment and I'm sure hopefully we will get a positive response from the noble Lord minister.

The second point is turning to the amendment in the name of the dynamic duo of Lady Fox and the noble Lady, Baroness Bennett. It the noble Lady, Baroness Bennett. It is an important issue here that we know that when you speak to charities that help offenders and ex-offenders one of the things they say behind reoffending is the support you get when you leave prison in the first place, not just for mental health issues but generally. Life is not very much money and where do you find housing and reintegrate back into the immunity.

All that shock the noble Lords have said already. It seems that this amendment is sensible. It does seem to me that we cannot have a scenario where a person is treated for mental conditions while they are serving a custodial sentence, once they are released they are left without any help. Given the variety of conditions those in prison may have what we cannot have is a cleavage of support that can cause harm to the individual but also lead to that person causing harm to others in the community.

There is something of a parallel here with the amendment 37 vote by my noble friend Earl Howe and the table toward the committee. These are all about issuing proper continued of care. In this important thing. Not just a bit of care here in care there. We got to make sure we've got a proper continuity of care. I think the noble Baroness and Mr use the word pathway previously if I've done my homework in remembering what the noble Lady and minister said.

It's really important that we have this pathway between being treated under the mental health act and moving to community services to ensure the individual and the treatment is effectively continued for as long as they need it. As both the noble Lady and speaker have said we cannot ignore the experience and treatment of prisoners from this process so we all and I look forward to the comments from the noble Lord and minister.
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Lord Timpson Portrait Lord Timpson, The Minister of State, Ministry of Justice (Labour)
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And grateful to the noble friend Lord Bradley for bringing this discussion before the House today and his commitment to improving outcomes for patients at the publication of Bradley reporting 2009 which highlighted the need to ensure transfers between is an insecure hospital take place in a timely manner. Also think the noble Lord for his kind words about my team and minister of justice. This government is committed to addressing the necessary delays some patients experience which can cause significant distress to individuals, families and those charged with their care.

Transparency and accountability, as the noble Lord, Lord Davies and the noble Baroness Tyler expressed clearly are essential to the success of the imitation of this reform and introducing more broadly. Like to think noble Lord Bradley for the constructive conversations with my officials since committee days make sure we get this oversight mechanism right. I'm pleased to hear that this government was recently established a health injustice strategic advisory group which will bring together key partners with responsibility for the various parts of the transfer process.

This group will be chaired by national clinical director who will report regularly to ministers and be responsible for agreeing of a joint work plenty sporting limitation of statutory time limit identifying solutions to common barriers to timely transfers and holding partners to account. I'm confident this group will provide effective oversight by bringing together operational leaders across health and justice with leaders necessary to effect change when inviting challenge for critical friends such as the care quality commission and his Majesty's prison Inspectorate to ensure scrutiny.

I will continue to work with Baroness Merron to ensure the long-term future of the strategic advisory group remains a priority. As announced by my noble friend, Baroness Merron earlier today the government is providing an annual report for the implementation of reforms. This reporting mechanism I will update Parliament on the implementation of the statutes in time limit the strategic advisory group and provide data on transfer timelines when is available for publication. I hope this reasserts the noble Lord of this government's commitment to improving timely access to treatments.

I urge him to withdraw his amendments. Turning to the amendment 40. Table by the noble Baroness Fox and supported by the noble Baroness Bennett of Penner Castle this will ensure that prisoners released into the community of previously been treated can continue to receive access to treatment in the community. Section 117 of the mental health act places a duty on health and social care services to provide after-care to patients under specific criminal justice sections of the act who are released from hospital to present, or into the community.

The services aim to use the risk of deterioration of the patient's condition and accordingly the risk of them requiring admission to hospital again for treatment. The noble Baroness Bennett is right that the women's prison has many women who are many unwell. That's why we have set up the women's Justice Board to reduce the number of women in prison and help divert many women away from custody in the first place. I hope this reassures the noble Lady Baroness Foster -- Baroness Fox will be pleased to know that after-care that's available for those detained at the mental health act of prisoners who have engaged in any form of treatment while in prison regardless of whether they have been detained under the mental health act have access to services in the community when they are released.

To strengthen the links between substance misuse and health services in prisons in the community, to support access to treatment we have recruited 57 health and justice partnership coordinators and managers across all promotional regions in England and Wales. NHS England to reconnect with care after custody service supports prison neighbours with vulnerabilities including mental health needs to engage with the right health services in the community through referrals and peer support. The noble Lord Kemalist right, to the gate continuity is crucial and the successful pathways how we reduce reoffending and help people unwell.

Hope this reassures the noble Lady that there is already sufficient provision in the act to ensure that prisoners have previously been treated for mental disorder can continue to receive access to treatment in the community. I urge you were -- I urge her to withdraw the amendment.

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I don't doubt in any way that the prisoners can access that community care. The problem is they are not care. The problem is they are not accessing that community care. The reassurances of new schemes is reassurances of new schemes is positive, but the idea was that we would make this more than just an abstract wish list and that we would make sure that something actually practical happens. So, if that's what the new scheme will do, although it doesn't exist yet, that although it doesn't exist yet, that is reassuring but it's certainly not

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what is happening now. The noble Baroness has visited

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The noble Baroness has visited many presidents as I have an oh so complex they can often be, but one complex they can often be, but one of the main points of the bill is to make sure that our partners we are make sure that our partners we are often working with third sector
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20:57
None Portrait Amendment:Gov.46 Baroness Merron, The Parliamentary Under-Secretary for Health and Social Care (Labour)
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noble Lords around the placement of children and young people at committee we would indeed like to go further than where we started. It is further than where we started. It is statutory requirement to be notified statutory requirement to be notified when a person under 18 is placed in an adult psychiatric unit for longer an adult psychiatric unit for longer than 48-hour. See QC take action to assess risks and ensure that child is being safeguarded. I can say to noble Lords that government amendment 46 will now require the Secretary of State to review whether current notification requirements should be extended to other incidents and whether the 48 time, 48-hour time period remains appropriate.

A report on the findings of this review must be laid before Parliament within two years. I'm also pleased to announce today that NHS England will use existing powers under the NHS Act 2006 to require ICB's to provide information, firstly on accommodation services for patients under the age of 18, and secondly on any instance where a person under the age of 18 is placed in a setting that is clinically appropriate but is outside of the natural clinical flow will not specialise children and young people's mental health ward.

These requirements will be set out in the new service specification and made clear in the revised code of practise. Collecting this information is crucial to enable NHS England to monitor risks and make the case for changes in local capacity to meet population needs. And finally, I am pleased to announce we will lay regulations under existing house to require ICB's to provide information which CQC reasonably requests and public actions treatment were directed to do to CQC. This will strengthen CQC oversight on your mind as patient act in local areas such as the duty on ICB's under section 140 to notify local authorities specifying hospitals where arrangements are in place for the provision of accommodation and facilities for children and young people.

I hope the noble Lords will feel able to support this amendment.

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After clause 51 insert the new
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21:00
Lord Meston Portrait Lord Meston (Crossbench)
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circumstances also in this group. This is the same amendment I put forward at the committee stage to provide a statutory basis for determining the competence of a child under 16 to make decisions for the purposes of this bill and the the purposes of this bill and the mental health act 1983. I should emphasise that it is not concerned with the consequences of such decisions but the determination of competence for the purposes of those decisions. I will not repeat any lengthy arguments of committee stage, but would remind the House that this amendment was prompted by the report of the joint committee on the draught bill which referred to the complexity of the law in this area concerning those under 18 years of age.

And referred to the absence of consistent criteria to establish capacity or competence. 16 and 17- year-olds are subject to the Mental Capacity Act and have the benefit of a statutory presumption applicable to adults. Children under 16 are covered by this bill do not have the existing Mental Capacity Act does not apply to them. The competence or otherwise of those under 16 to make decisions is considered by reference to the principles decided judicially by the House of Lords in the case of Gillick to which the Minister referred to when rejecting my amendment.

However, Gillick did not actually set out a new test for assessment of competence or a new method for such assessment. It simply provided that a child under 16 could consent to medical treatment if considered by professionals to have the maturity and intelligence to understand what is involved. There was no indication of how the broad notions of maturity and intelligence were to be assessed. This has left professionals, legal and medical, with what is being called uncertainty.

This bill creates a range of situations in which professionals will have to assess the child's competence but it is silent as to how that is to be done. In rejecting this amendment the Minister suggested that it could cause confusion if it would seem to be a different test than that established by Gillick. The more that I and others have thought about that and analysed the argument the harder it has been to accept it. First, as I said Gillick does not establish any methodical test.

The House of Lords in that case did not have to set out how competence is to be assessed. Secondly, this amendment does not conflict with or undermine Gillick. In the contrary it is intended to provide a workable approach for problematic assessments which professionals sometimes have Amendment provides a clear, structured test for determination for child's confidence to fill the gap in the bill and to address the uncertainty to which the Joint committees refers. And I therefore suggest that rather than create uncertainty or confusion as by suggested by the Government it will actually reduce or remove it and will provide a clear statement of parliamentary tension is to relevant considerations to be brought to bear.

The Minister has been kind enough to write to me recently explaining further the Governments reasons for not supporting my amendment, and by stating concern it could have unintended consequences, however I have to say that by their nature unintended consequences are unknown, unforeseeable, and may never happen. I therefore have found it difficult to understand the Governments concerns, particularly as my amendment is expressly limited, referring only to decisions under this bill and under the existing statute. The Government also suggests that it may have the effect of restricting the ability of children to exercise choice and autonomy.

I have to say that I do not understand how that could be suggested, on the contrary I would think it would facilitate the exercise of choice and ensure respect for article 12 rights which respect for article 12 rights which are expressly referred to in the amendment. The exact terms of article 12 of the UN Convention require that a child who is capable of forming his or her own views is assured of the right to express those views freely and that those views are given due weight according to age and maturity.

In short, do not see the problems suggested by the Government and accordingly I beg to move on this particular amendment.
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Baroness Butler-Sloss Portrait Baroness Butler-Sloss (Crossbench)
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I agree with all three amendments we are considering at the moment, but I in particular support amendment 51 and agree, respectfully, was everywhere the Noble Lord has said. He has put it out extremely carefully and extremely clearly. Despite meeting the most helpful minister and discussing this as well as other matters in this bill, I absolutely cannot understand why the Government does not realise that the absence of any information to help medical professionals looking at a 14 or 15-year-old with medical health issues which is why they are in hospital but appears otherwise to be very bright, how on earth are they to judge whether or not that particular child has the degree of competence that is necessary for the professionals to listen carefully to what the child has to say? If you are over 16, you are included in the Mental Health Act of 2005.

And under 16's have not been included. And I would like to emphasise the point made by the Noble Lord, Gillick, which is very long winded, absolutely unreasonable for any medical professional looking at the child of 13 or 14, 15, to settle down and read the judgements of the House of Lords to find out that they say that Gillick should be applied but absolutely do not see how it should be applied. This is why we have this amendment.

And if, in fact, the Government decides that they're not prepared to do it, for some confusion, I do not see the letter, that the Noble Lady the Minister sent, but I cannot understand why there is any understand why there is any confusion. I cannot understand why a form of a vice to mental health professionals in dealing with under 16-year-olds in mental health conditions should be something that might be applied in any other circumstance, in any other litigation.

It does not apply. And I have been completely unable to understand, having spoken not only to the Noble Lady the Minister but also a very helpful team that surround her, as to what on earth they are really worried about. I would be, and I would like the Government to become that much more worried about anyone over 16. There is primary legislation telling anyone how to judge that someone over 16 has, indeed, the ability to make decisions. But there is nothing to tell anybody about anybody under 16.

There will be, in my view, a serious gap in the law, very unhelpful, particularly to the mental health professionals. What on earth they going to do with a child, as I say, as bright and cheerful, despite what his or her mental health problems are. How on earth are they going to approach has their child got the sort of confidence that over 16's have? And I find it very difficult that what is contained in this excellent clause contained in this excellent clause by the Noble Lord is seen as somehow confusing or going to be used in the wrong circumstances or anything like that, so that if I have to say amendment 51 is not going to be accepted, Orton me I ask the Noble Lady the Minister what help are you expecting to give to mental health provision or professionals dealing with under 16-year-olds?
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Baroness Bennett of Manor Castle Portrait Baroness Bennett of Manor Castle (Green Party)
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I rise very briefly following that brief expert explanation following amendment 51 from the Noble Lord and the powerful reinforcement from the Noble Lady Baroness Butler-Sloss. I attach my name to the amendment simply because I thought it was such an important amendment following our basic committee and I thought we should have a full slate of signatures there and put this is broadly around the House as possible class I do not claim any particular expertise here but it was my intention to really strengthen and I think this is quite notable, I am sure many noble Lords will have received the joint briefing from the society Mind and the children in mental health professionals coalition, a briefing explicitly on this amendment 51, which I think just shows that level of concern, how much this issue is being concerned.

And I think it is worth saying, it is kind of stating the obvious but as the briefing notes we consider that the test should be on the face of the bill, not on the code of practice as the Government suggests this is because codes have made practice that they should reflect the law and cannot create the law. Now, as a legal layperson that sets out very clearly that is where we are. And as the briefers say, the joint briefing sees a clear and consistent approach to appropriately assessing a child confidence can only be achieved by a clear test in the bill.

The code is

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not the right place. I also rise briefly as I also

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I also rise briefly as I also added my name to this amendment, amendment 41 in the name of the
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Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (Liberal Democrat)
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amendment 41 in the name of the Noble Lord. And I, at Committee stage, I went on hard about this issue. And at one stage was I think thinking that perhaps more consultation was required, but having listened to the arguments and also having had, it was very helpful indeed to think and listen from the briefings we have received, I am now very firmly of the view that this is a real gap in the current bill and we have got this opportunity and it has been said to or three times so far today we did not get that opportunity very often.

It might be once in every 10 or 15 years we get the opportunity to look at a piece of mental health legislation like this. I therefore come strongly to you that we actually need to make the most of this opportunity, so that there is a proper test for decision-making or a competence test within the bill. And in coming to that view I have sort of taken two or three things into consideration. One is that it would only apply when the bill requires that a child's competence is to be considered and then I thought very importantly that this is presented with the child's ability to decide, not what happens once that has been determined, and finally that the amendment, which I think is an excellent amendment, specifically limits this test decision-making under the bill and under the previous Mental Health Act of 1983, so in short it only applies to the legislation, so it is tightly drawn and I think that the noble and learned Lady buttress loss has sort of set out the need and the case for this in a way that I could not possibly do, but I just wanted to explain how my thinking had evolved since our discussions at Committee stage and just maybe whilst I am on my feet I was always very supportive of the amendment by the Noble Lord Earl for the strengthening of safeguards for those admitted to adult wards and out of area placements, I think it is a really important issue.

I should be very interested to hear what he has to say on the subject. I did here and I was very interested again to hear the Noble Lady the Minister talk about the amendment that she is about the amendment that she is putting forward in relation to this. And so I am hoping that progress is being made in this report area and I would be very interested to hear what the noble Lords reaction is to that.
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Earl Howe Portrait Earl Howe (Conservative)
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May I begin by joining other noble Lords in expressing my full support for Lord West and is amendment 51 and a very compelling case put forward by both him and the noble Baroness Lady Butler-Sloss. I would also like to thank the Minister every quickly for her amendment 46. And for her helpful explanation of what it is likely to entail as regards the process that will flow from it. It is reassuring to know that, committee debates and age-appropriate treatment for children and young people are being seriously considered by the Minister, I put on record my appreciation of the advanced notice she gave me of her intention to meet the noble Lords concerns in this Not only by the amendment but also my own amendment 58 with it.

My Lords, the mental health act states that hospital environments should be suitable to the age of the patient and the mental health code of practise states clearly that admissions of children to adult wards are only permitted under exceptional circumstances. Yet as I indicated in committee with the aid of some stark and very troubling examples we still have a very considerable problem in this whole area of mental health practise. The essence of my amendment is to say that we do need to strengthen the safeguards against inappropriate placements.

The independent review of the mental health act agreed with that. They recommended that when a child or young person is placed on an adult ward the CQC should be informed within 24-hour is, at the moment it is 48-hour. They also said that the reason for the placement and the duration of the placement should both be recorded. Correspondingly the joint committee on the draught Mental Health Bill recommended a tightening up of duties replaced on hospital managers. My Lords, it was welcome to hear from the Minister that the government in intends to review the practise as well as the specification for children and young people's mental health care.

What I was hoping for, however, was that the bill itself might now be amended to contain, in an unequivocal way, some of the strengths and safeguards that I just referred to. My amendment is rather lengthy but its key positions can be summarised quite briefly. First of all there should be much stricter and more explicit duties for hospital managers. Whenever a child is admitted to an adult ward should be laid down process of the manager to record the fact of the admission, record the justification for it, to record what the hospital is going to do to look after the child safely and to record with they propose regarding transferring the child to a more appropriate setting.

And then if a child continues to be accommodated in an adult ward for an extended period the director of Children's Services in the appropriate local authority should be notified. In Wales as the director of social services. My Lords, I'm also suggesting this procedure shall apply when a child is placed out of area and is held for an extended period. In other words, the whole issue around children and mental health hospital runs wider and it isn't just a CQC that should be under the spotlight.

It should also be the local authority whose job it is to ensure that children's wellbeing is protected. Welcome therefore as the government amendment is it doesn't, to my mind, go nearly far enough. As well as the pledged to review procedures with a CQCI devolution contained some indication that the government recognised the need to review duties placed on hospital managers and in addition to the issue of children being admitted to an adult ward I also wish there were mention made of children placed out of area.

Can the Minister reassure me that in parallel to the review that the amendment is heralding there will also be a concerted effort to look at these other directions. Whether that involves updating the mental health code of practise, the training of staff, perhaps more fundamentally if we recall our debates in the first group of amendments today what needs to be done in many more areas of the country to provide inpatient or outreach mental health services that are suitable for children and young people.

It is of course the absence of such facilities in the first instance that gives rise to the problems we are now discussing. I look forward to hearing what the Minister has to say.
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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 think all noble Lords across the House during the debate of this group, last group of the evening. I am glad that both frontbenchers to welcome government amendment 46, although I did hear the noble Lord Earl Howe say he had hoped we would go further. I am glad there was welcome to the other commitments made at the start of the debate. Let me first turn to amendment 58 tabled by the noble Earl Lord Hall and supported by noble Lord Kamall.

We do agree with the intention of this amendment but do not believe that placing more limitations on descriptions and legislation is the best vehicle to reduce the placement of children in certain settings. At committee I set out existing measures to address this issue. The latest data from CQC monitoring mental health act report for 2023/24 shows that they were notified of 128 instances where a person under 18 was admitted to an adult ward which was 38% decrease compared with 2022/23.

I also committed to set out guidance in the revised code on the process to determine whether placement is in a child's best interests and to ensure that there are safeguards in place and NHS E, and I will return to this point for noble Lady Baroness Browning, will do this in the new service specification. I hope that the additional commitments we made in this debate show that the government takes this matter seriously and that we are committed to continuing to work on and address this issue.

To the point the noble Lady Baroness Browning made about NHS E I can assure the novel lady that as we work to bring the two organisations together we will ensure that we continue to evaluate impacts of all kinds and the functions which are currently undertaken by an HSA to continue along with that change and it will take two years for the full process including legislation to take effect. However, admin changes are happening more immediately but the main thing I wanted to assure the noble Lady is the change into the future does not affect the commitments that we have given.

They will continue and without duplication as well. Let me now turn to amendment 51. Although before I am going to do that if I may go back to the noble Lord Earl Howe who asked about whether we would undertake concerted effort to look at other directions of the issue. For example, training, suitable inpatient or out patient mental health resources for example. In response I can say the subject to securing further investment NHS England are developing a new model for specialised children and young people's mental health services which will be supported by new service specification and quality standards and the priority for the services is to transform and expand community services to make sure there are local accessible community alternatives and reduce the need for admission on dependence on inpatient beds as well as reduce the length of stay and keep young people close to home.

I hope the noble Lord will appreciate that we are in the same place on this is a matter of actually putting it into action. Returning to the point of amendment 51 tabled by the noble Lord, Lord Meston spoken to by the noble Lady, noble and learned Lady Baroness Butler-Sloss and other noble Lords. The mental health act it is believed is not the upload rate legislated vehicle to set out statutory test for competence for under 16. Nor would it be appropriate to seek to establish a test in a single setting.

We are not satisfied that hospital invocations of mental health and settings where Gaelic is applied have yet been fully explored. The principal of Gillick confidence is established noble Lords not be aware any statutory test should reflect existing case law and would not necessarily override the application of Gillick outside of the act. The design of this test is partly aligned with the test set out in the Mental Capacity Act. There is no consensus in the courts as the noble Lords will be aware and whether it is appropriate to apply these tests to test competence in children under 16.

The noble Lord, Lord Meston raised the question about unintended, to which I am able to respond that the creation of any test which doesn't consider the interaction with existing case law could inadvertently limit the ability of children to attend under the act to exercise choice and autonomy under their care and treatment. That is the reason all the concerns about unintended consequences. We are also greatly concerned with seeking to provide clarity on assessing competence in mental health settings DoLS different tests could be created.

This is likely to cause further confusion and a risk of legal challenge before decision- makers in mental health settings and potentially in any setting or Gillick is applied this could have, and I will use the word again, unintended consequences on the ability of children to exercise choice and autonomy as I have already mentioned which is counter I do here to the noble Lords intention. The noble Lord will understand that we cannot comment on or prevent how, as I say, courts will interpret the tests or whether there will be further calls for similar tests.

The courts may even go as far as to apply this test in other settings. That is what we mean when we say the introduction of a test for decisions under the act will or may cause confusion and uncertainty in other settings. We don't think that the consequences of this have been given proper consideration nor has the risk been, nor can this risk be properly We will consult on the guidance, as I have mentioned in the code for practice and I hope that will meet the intention to provide further clarity, and the noble and learned Lady Baroness Butler-Sloss asked about what additional support would be provided to clinicians in engaging with children and young people as we are rejecting this amendment, to which I can respond that the Mental Health Act code of already does provide guidance on establishing confidence in under 16 is, and as I have said we will consult on this guidance in the revised code of practice and I do want to emphasise it is better, we feel, to focus on the practical element rather than create and risk further confusion.

I hear that there are differences of opinion, I am sure that what I say will not completely satisfy noble Lords who have raised concerns, but I hope it gives a sense of where we have got to under reasons. I am hopeful that these reasons will enable noble

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Lords to withdraw their amendments. Does the Noble Lady wish to

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formally move amendment 46? I formally move amendment 46 with thanks.

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thanks. The question is that amendment 46 be agreed to. As many as are of that opinion, say, "Content", Of the contrary, "Not content", The

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contents have it. I beg to move that further consideration on the report be adjourned.
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None Portrait Oral questions: Impact on the privacy of Apple customers of the company’s decision to withdraw their advanced data protection service in the UK
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