Tobacco and Vapes Bill

Baroness Fox of Buckley Excerpts

Committee stage
Monday 3rd November 2025 Grand Committee

[Lord Naseby (Con)]

My Lords, I have never smoked. Having said that, I was for some 15 years in marketing and advertising. I do not think that the proposal here is at all practical. Cigarettes are very narrow so to read something in six-point type—which is what we are talking about—will be difficult and will have next to no effect at all. We have proper health warnings on the pack itself. We should concentrate on those and do more work on how well they are being communicated; that may take us further forward. Amendments 141 and 143 are, frankly, for the birds.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I worry that this group of amendments indicates that, in the name of public health, state overreach can get completely carried away with itself. I ask that we take a step back and consider the state’s ability to interfere in the manufacture and R&D of legal products, which is completely disruptive to those products’ manufacture and design; if the state is going to do that, there needs to be a very good reason.

I want to look at some of the reasons that we have heard in relation to either a ban on or alteration of the use of filters. There seems to be some confusion as to whether this is an environmentalist issue or a public health issue. Is it litter, or is it plastic? What is it? This is a debate about tobacco and vaping, so let me concentrate on that. There is an idea that one in four adults does not know that filters are not healthy. As a long-standing smoker, I have to say that, while there are arguments about filters, I have never heard a smoker say, “I use a filter because they’re healthy”. There are a whole range of discussions about the use of filters—

[Baroness Bennett of Manor Castle (GP)]

I thank the noble Baroness for giving way. By way of correction, in case I was not clear, 75% of smokers do not know that filters do not have any health benefits; the stat is the other way round.

[Baroness Fox of Buckley (Non-Afl)]

The point I am making is that it is true that the majority of smokers do not sit around and discuss whether filters have a benefit to their health. I am quite sure that, had you asked me in that survey, I would not have had a clue. You would then say that I was being conned into using a filter. However, I would be indifferent because that is not the basis on which people smoke, either with or without filters. I am particularly bemused by the idea that, as a woman, if I saw a white filter, I would immediately think “purity” and be forced to smoke a white-filtered cigarette. I mean, goodness me—have we all gone mad?

I want to talk also about the idea of health warnings on actual cigarettes, which, again, is completely disruptive to product design and so on. It is completely petty. Sometimes, I feel as though the public health people have done everything and anything they possibly can and have run out of things to do, so they are now down to the narrowest possible thing: the cigarette itself.

It is interesting that this idea is aimed especially at young people who might be given one cigarette at a party; and that people seem to be saying that, if only such people saw that written warning, it would be enough to stop them. Were we ever young? Were we ever at a party? Did we ever read anything on the side of a cigarette that stopped us? The point I am making is that, as it happens, the majority of young people know that smoking is bad for you; many young people even give adults like me lectures on how smoking is bad for you. The idea of a written warning is not, I think, very helpful.

I just wonder what the health warning would say. Would it say, “Tobacco kills you”? What is it going to say? I have had an idea. Public perceptions on the difference between smoking and vaping are at their all-time worst. Only a minority of current adult smokers—29%—are able to recognise accurately that vaping is less harmful than smoking. So I have an idea: if we are going to have a message on the side of individual cigarettes, perhaps we could say, “Vaping is cheaper and less harmful than smoking”. That is a good message. Why do we not say that? We could even say, “Vaping is good for you”. The point I am making is that that is not where we should be putting messages; we have heard confused messages in this Committee so far.

My final thought is on the success of Canada and Australia in dealing with smoking, which has been cited and thrown into the conversation. Let us look at what is actually happening and today’s front-page headlines in Australia. The only success of Canada and Australia has been the huge growth of a black market in cigarettes and vapes. It is a disaster. Many people in public health are now saying, “Maybe we went too far”. So, before we start emulating them, maybe we should take different lessons. The front page of the Australian newspaper The Age today is about the fact that people are panicking about what they have inadvertently done. This group of amendments is the kind of thing that could lead us in completely the wrong direction.

[Baroness Grey-Thompson (CB)]

My Lords, I wish to speak to Amendment 34 in the name of the noble Earl, Lord Russell, to which I and the noble Baroness, Lady Walmsley, have added our names. I declare an interest as the president of the Local Government Association. I thank ASH—Action on Smoking and Health—for its briefing, in which it laid out these amendments clearly. It supports the amendments in the name of the noble Baroness, Lady Bennett of Manor Castle, though not the one in my name; however, it raises some really interesting points around what we are trying to do and how far we need to go.

It is important to raise the issue of greenwashing and to look at better solutions than the one we currently have. Although this amendment does not go as far as some want, it is a step forward. I came to this amendment, which looks at the equivalent number of plastic straws that are in each cigarette—it is two plastic straws—because I worked on the impact of the ban on plastic straws on disabled people. Disabled people were vilified for daring still to want to use plastic straws, whereas people who smoke do not seem to have that same level of pressure against them.

The noble Baroness, Lady Fox, always makes really interesting speeches and asks really interesting questions. Are we doing this from the point of view of public health, the environment or littering? I would say, “All of them”. As somebody who has never smoked—I question how interesting any of the parties I went to as a teenager were—I presumed that filters were safer. It is only when you do the research that you realise that people have been deceived into thinking that they are safer than they actually are. The number of butts that are littered worldwide—4.5 trillion—is absolutely horrendous; it is the equivalent of 1.69 billion pounds of toxic trash. Look at the impact on the UK: a minimum of 3.9 million butts are littered every day. I am also interested in the fact that cleaning up these cigarette butts costs local authorities around £40 million a year; I think that that money could be spent far better in different ways.

Tobacco and Vapes Bill

Baroness Fox of Buckley Excerpts

Committee stage
Thursday 30th October 2025 Grand Committee

[Lord Crisp (CB)]

My Lords, as this is the first time I have spoken in Committee on this Bill, I want to reflect for a moment on the extraordinary lengths to which tobacco companies will go to sell their products, including getting children addicted to nicotine. When I look at this Bill and the amendments to it, I see the extraordinary lengths to which government must then go in order to combat that.

Turning to the amendments in this group, we have heard three excellent speeches. I do not want to repeat any of the points made but wish to pick up one made by the noble Baroness, Lady Walmsley. It concerns the importance of the government side of this combat, if you like, between the tobacco companies and government. Put simply, the Government should have the data that is available so that they can hone their arguments in the continuing wrestle that we are seeing around this set of topics.

I very much support that amendment. I also support the amendments in the names of the noble Lord, Lord Young of Cookham, and the noble Earl, Lord Russell, on the “polluter pays” principle. Again, this seems practical to me; we heard the Minister refer to it as such at an earlier period, I believe. However, there are three terribly simple arguments, although I do not want to add to the detail. First, there is the principle that the polluter should pay for the damage. That is a very simple statement; it has, as the noble Lord, Lord Young of Cookham, said, been used in other circumstances. There is very considerable damage, and it is very easily measured.

The second argument is to reduce the incentives for tobacco companies. As I have commented before, if only we could get the tobacco companies to use all their guile and manoeuvring to improve health rather than damage it. Perhaps there are things that government can learn from the way in which tobacco companies seek to influence the public.

The third argument is, of course, to support public health. Another good reason for this is to provide that money to support public health and at the same time the public purse. Finally, I note that tobacco companies probably come under the category of those with broad shoulders, so I ask the Minister whether we might expect to hear a line or two about this in the forthcoming Budget.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I stand with some trepidation on this one, but I will give it a go. I have some reservations about this series of amendments. On Amendment 12, I have a lot of sympathy with having more transparency as a general principle, but I ask the noble Baronesses, Lady Northover and Lady Walmsley, how we would deal with having a dangerous precedent on the commercial confidentiality and sensitivities, for any company, and what can and cannot be revealed. Asking for information is one thing; mandating it is a whole different ball game. Many companies hold data close to themselves, as they are allowed to, because they are private entities. It is a legal thing to do and there are reasons, beyond malevolent ones, why that might occur.

I am particularly concerned about Amendments 192 and 194. As the noble Earl, Lord Russell, noted, tobacco companies already pay, or are responsible for, substantial duties that are collected. I am not sure that I entirely agree with the “polluter pays” principle—or, at least, it is quite complicated. It sounds virtuous, and in some instances I might well support it, but when I was reading these amendments I kept thinking, perhaps because of my left-wing, Marxist background, “Oh my God, this is a new form of legal wealth distribution by force”. It felt to me as though we were saying: “Forget economic growth. We’re just going take more from legal companies, but it’s all right because they are evil companies”.

In the words that the noble Earl, Lord Russell, used about his more specific amendments on what the money should be used for, if I may put it that way, I recognised an argument that I came across from Cancer Research. It has been very helpful in its briefings on the Bill and, in many instances, I agree with what it is putting forward. But in this instance, it said:

“At a time when funding for public health initiatives is limited, this proposal raises money without directly costing the taxpayer. Given the current economic challenges, this presents an opportunity for the Government to act decisively, should it choose to seize it”.


I kept thinking of this as a way of avoiding crises in public health, or in the NHS, by simply not resolving what should be an adequate health service for everyone while turning to private companies instead and trying to compensate for that. That is a dangerous precedent. Private companies should not let the state off the hook for what it should be doing, because those public health services should be provided by the state, regardless.

The fact that there is an economic crisis at the moment cannot just be meted out to companies that we do not like. I realise that tobacco companies have for some time been treated as especially evil, malevolent and harmful, but if you enter other debates and read the briefings of lobbying groups on other issues, you will hear similar moralistic arguments used about sugary foods, junk food, alcohol, gambling and even fossil fuels. I read a fascinating paper the other day which basically said that fossil fuels were killing us all and should be closed down, and so on. That is the kind of language being used.

I therefore worry about setting a precedent for a moralised hierarchy of legislators deciding which are the evil companies, and who gets to decide that, with a punishment then meted out. I say this because, briefly, I was a bit disturbed the other day at some mention of a report by KPMG. The data in it was dismissed as being from a report produced for Philip Morris, the tobacco company, as if that somehow closed down any possibility of a discussion—that having said that, the report could be laughed off. The idea that all you have to do is say the name of a tobacco company, and then close down valuable information, is quite dangerous.

It thought that was particularly unfair on KPMG. I am not necessarily a great fan of the big four accountancy firms, but they certainly have reputations. To write them off as being in bed with the evil Philip Morris, so that we take no notice of what they do, seemed a little unfair. If that were the case, have the Government let KPMG know that this is their view of it—especially since KPMG is a supplier to the Government, as I understand it, focusing on Civil Service training and economic matters? KPMG might have a case to answer on those things, but it should not be written off as a company because it has done some work for Philip Morris.

Neither is it appropriate for our discussions to always assume that everything a tobacco company says or does is evil because of the nature of the product. The product is harmful and contributes to cancer in many people—I know that—but if this Government believe that the tobacco companies are so uniquely evil that they are killing the population, they should have the courage of their conviction, make them illegal and ban them, not take their taxes and have it all ways.

[Lord Scriven (LD)]

My Lords, it is a great pleasure to follow the noble Baroness, Lady Fox. Normal service is probably about to be resumed. I am on a different page from her on this issue.

These amendments give me the opportunity to clarify my position on the Bill. I fear that my previous opposition to the age-escalator provision in the Bill, meaning that some adults will never be able to purchase tobacco legally, has been misrepresented by some as a general objection to any form of regulation or restriction on tobacco. I state clearly that that is not the case. That is why I support all amendments in this group—Amendments 12 and 148, tabled by my noble friend Lady Northover, Amendment 192, tabled by the noble Lord, Lord Young, and Amendment 194 in the name of my noble friend Lord Russell.

I come back to something the noble Baroness, Lady Fox, said regarding the point made by my noble friend Lady Northover about data. If this was unique, some of those issues would need to be explored further, but this is not a first. For example, the water and energy companies have to give to the regulator investment details, asset details, investment plans and details of their costs and profits. This happens without commercial sensitivities going by the way. The amendments, particularly Amendments 192 and 194, generally represent a necessary and proportionate intervention to correct a profound fiscal and health imbalance, which is weighted too heavily in favour of the tobacco industry. The tobacco industry in the UK operates with a near monopoly, as many noble Lords have said, on selling an addictive product. The market structure allows them to generate excessive profits. They extract nearly £900 million per year in profit, while contributing little in terms of corporate tax to the Exchequer.

Simultaneously, the societal costs of smoking are vast, as the noble Lord, Lord Young, and my noble friend Lord Russell identified, with the NHS bearing the immediate cost of approximately £1.8 billion per year. The current system places the entire tax burden on the consumer and the taxpayer, while the manufacturer enjoys excessive returns. That is not only a moral wrong but an economic failure that government has a duty to correct.

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[Lord Patel (CB)]

My Lords, I support this amendment. We know that nicotine is highly addictive. In fact, it is one of the most addictive substances there is, even in small quantities. The noble Lord, Lord Kamall, made the point that people use it for cessation of tobacco or cigarette smoking. That is true, but the dosage, even of 20 milligrams, is too high. High doses of nicotine cause serious diseases, as mentioned by the noble Baroness, Lady Grey-Thompson. But apart from that, in older people it causes higher risk of cardiovascular disease, not just by increasing heart rate and blood pressure but by making platelets stickier and leading to higher levels of fibrinogen, which increases the risk of forming a clot. This is a good amendment and there is no reason, to my mind, why the Minister should resist it.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, the noble Lord, Lord Kamall, and the noble Baroness, Lady Grey-Thompson, have made some interesting cases probing the issue of the high nicotine content of pouches. However, it is worth noting that Cancer Research does not support these amendments. It says that there may well be a need for a deeper dive into the evidence, but it stresses something that has been missed in some of the debates we have had so far, certainly at Second Reading: it is tobacco that is the cancer-causing ingredient in cigarettes.

Nicotine patches do not contain tobacco. Nicotine is addictive, but the overall evidence does not support a direct causal link between nicotine and cancer: it is not carcinogenic. That is what the scientific evidence seems to show, and it comes from anti-tobacco lobbying groups and people whom I would not necessarily usually cite. It is noted that nicotine products and pouches are being used as recreational products, but they are also helpful for smoking cessation.

We have to consider what we are doing with the Bill. The NHS itself calls nicotine “relatively harmless”, and, in his 2022 review, Dr Javed Khan said that

“the government must facilitate access to the various already available safer alternative nicotine products such as nicotine pouches”.

We therefore have to be careful about demonising these things, because it is not straightforward.

There is a danger throughout the Bill—it will come up in other groups—of a constant slippage between tobacco and nicotine. Sometimes that occurs through a discussion around addiction. I would be interested to know what the Minister thinks about this—she talked about the problems of addiction on our first day in Committee—because the Bill is not necessarily tackling addiction; it is tackling harms. There is a danger that we get confused between that addiction, which, as I say, many people in the health professions do not see as a problem per se, and what we are targeting. I am worried that that slippage between nicotine and tobacco, between vapes and smoking cigarettes, leads to an unscientific mishmash of misinformation that, ironically, can damage public health.

In relation to young people using pouches until they vomit, young people use lots of things until they vomit. They can overuse a range of things, not helpfully, but it does not necessarily mean that the product itself is always the problem: sometimes, it can be youthful lack of restraint, which one might want to intervene in but not necessarily through the law.

[Baroness Watkins of Tavistock (CB)]

My Lords, I broadly support these amendments but also agree with my noble friend Lord Patel that there is probably no reason to have oral pouches at all. It is something that we could carefully consider deleting from our society. If you are trying to withdraw from tobacco, nicotine patches are just as effective as pouches and do not cause the problems that have been so readily described today. While the debate has been going on, I looked back, and it was 1950 when Sir Richard Doll proved the relationship between tobacco and lung cancer. It has therefore taken us 75 years to get to this point, with the Bill. There is sufficient evidence in relation to pouches for us not to decide that we need a 75-year prospective trial to show their damage.

[Baroness Finlay of Llandaff (CB)]

My Lords, I too support the amendment, and I have a question for those who have tabled it, which relates to proposed new subsection (2)(b), saying the product is

“not intended to be inhaled or chewed”.

I am afraid that as someone who has been looking at tobacco control measures for many years now, through legislation, I am slightly concerned that, as we get rid of one thing, the nicotine manufacturers will find another way of bringing in a substance that is, in effect, addictive, which is promoted to young people, and is a way to get them started on the inevitable chain of addiction that leads to promotion.

When we look at the evidence around nicotine, we see that, yes, it is highly addictive, but the other thing that happens with an addictive substance is that you become tolerant to the effect, to that boost. Therefore, the addict seeks higher and higher doses to get a greater and greater hit. In the long term, as my noble friend Lord Patel pointed out, it is not only blood pressure and so on; there is a problem with platelet stickiness. We do not know what this will do in the microvasculature in the brain in the long term, because these high-dose nicotine products have not been around long enough and we have not had enough brains that have come to post-mortems—I am sorry to put it so bluntly—of people who have been using them for a long time. The hit that they get is greater than they would get from smoking a cigarette.

[Baroness Fox of Buckley (Non-Afl)]

I want to clarify how we make policy based on evidence if that evidence is unknown unknowns about what might possibly be the problem with something. It is absolutely the case that, where there is proof of harm, evidence is given and medical papers are produced. They have not been produced on this issue—I have looked—so it would be useful to see lots of peer-reviewed evidence that showed harm. To suggest that something could be a harm because we have not had long enough to find out whether it is a harm does not seem to be the basis of sensible evidence-based policy.

[Baroness Finlay of Llandaff (CB)]

I completely take that criticism; it is a fair comment. However, we know the damage to the brain microvasculature from smoking over the long term and that these substances are highly addictive. We also know that when we previously took through tobacco control measures, we never anticipated vapes or pouches. The evidence therefore is that those producing nicotine products are very imaginative and creative, and there is concern about this being used as a gateway to further addictive products. That is why I question whether proposed new subsection (2)(b) is necessary or adds anything to Amendment 13, which otherwise should be strongly supported.

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16: Clause 10, page 5, line 16, leave out “age of 18” and insert “voting age, as defined in section (1)(d) of the Representation of the People Act 1983 (parliamentary electors: voting age)”
Member’s explanatory statement
This amendment seeks to probe the reasoning for the minimum age prescribed in Clause 10, in the light of the Government’s intention to extend the franchise to 16 and 17-year-olds.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, the noble Lord, Lord Parkinson, is not able to be here to move this amendment. For me, this amendment falls in a slightly odd group. I thought that it would be in the first group; then I thought that it was going to be in the group before. It has ended up in this group. I shall talk briefly about this amendment; I will then speak on what this group is actually about, which is a different set of concerns.

The point of this amendment is to ask whether lowering the voting age to 16 would add a layer of complexity to the discussion around any age-gating that is happening in relation to either the generational smoking ban or the sale of vapes and so on. This issue obviously intersects with questions around autonomy, responsibility and any kind of consistency that we might have in relation to how we treat young people.

A lot of concerns have already been raised today, in our debate on the first group, about young people and whether they are mature enough—that is, the vulnerability of young people and so on—but, if 16 year-olds are deemed mature enough to vote and to influence laws that affect society, that strengthens the argument against denying them the right to make personal choices about a range of things; those things could include smoking, let alone vaping. Denying them such a right when they have the right to vote—which implies, we hope, a level of rational decision-making capacity—would seem to be contradictory. So this amendment in the name of the noble Lord, Lord Parkinson, is a probing one; it would be interesting to hear the Government’s response to it. There is a danger of there being confusion around age, and around whom we think we are protecting from harm, with this contradiction in terms of a different government policy on voting.

I will now talk about the amendments in this group that make a bit more sense to me. I am very supportive of, and put my name to, Amendment 18 from the noble Lord, Lord Moylan. It looks at the issue of a ban on all vending machines and whether there can be some exemptions. I urge the Government to engage with a wide range of stakeholders to prevent the unintended consequences I believe there will be if the legislation carries on with this ban. Surely this law wants to ensure that safer alternatives to smoking are available, especially in environments where they might help people resist having a cigarette, such as hospitals and, in particular, mental health settings.

I am reluctant to push this too much because it is the noble Lord’s amendment, but I cannot work out how else I can speak to it. I ask the Minister whether there is a danger that we are imposing measures on tobacco and vaping—this follows on from what we have just been talking about—without clarity about the differing relative harms of each product. The ban on vaping machines talks to a conflation of products, which I am concerned about.

Vending machines containing vaping products have been used very successfully in mental health settings, providing patients who would otherwise be smoking with a route to giving up. Therefore, an exemption to the vending machine ban for healthcare settings—which, by the way, is supported by the Mental Health and Smoking Partnership, which is a coalition of 27 health and mental health organisations and includes some of the major royal colleges—seems to be something of a no-brainer, as they say.

I started my professional life working in mental health and went on to work in education in psychiatric hospitals for a period. When you first start working with people with severe mental health conditions, who may be sectioned into hospitals, or those with terrible debilitating illnesses such as schizophrenia, the thing that you notice—I remember noticing this when I was young—is just how much they smoke. Chain-smoking is almost part of the condition. All of us who worked with the mentally ill were always concerned that not only were they suffering these terrible psychotic illnesses, but they were smoking so much. The irony was that you also knew that it was part of calming them down; that was how they were able to cope with the heavy medication, the psychosis and so on.

I am not making a case here for smoking cigarettes, because it is fantastic—is it not?—that we have found a substitute for smoking cigarettes for a group of people in society who are already suffering terrible mental health problems, which is vapes. We are therefore talking about a group of people who, by the way, are often locked up in hospitals, having access to those vapes. That is what the vending machines for vapes mean, and it is why, I think, so many people are very enthusiastic about this. There are a couple of amendments so I will just say quickly that that is why this amendment is really important.

I am afraid that I cannot support Amendment 21 in this group in the names of the noble Earl, Lord Russell, and the noble Baroness, Lady Walmsley, on minimum pricing of vaping products. The noble Earl assures me that his £30 vape is ultimately cheaper than constantly restocking. He also says it is easier to use. I have two thoughts on that. First, £30 as a minimum price is rather an expensive upfront cost for the people whom we keep hearing that everybody cares about: poor people. Generally, the problem with poor people is that they have not got enough money. We should have a thriving economy where they can earn money through jobs.

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[Lord Young of Cookham (Con)]

My Lords, I will speak very briefly to this group of amendments. Amendment 16 is about age. My noble friend Lord Moylan said that young people are sensible. I agree with that. I think it follows from that that they are sensible enough to understand that Parliament may have prescribed different age limits for different activities, so I do not find that argument wholly conclusive but, on a more conciliatory note, I agree with what my noble friend said about Clause 12.

“A person commits an offence if the person has the management or control of premises on which a vape vending machine … is available for use”.


However, there is no provision for any exceptions.

My noble friend made a case for those mental health hospitals that have vending machines that enable patients to remain smoke free. Is it the case that, when the Bill becomes an Act, they will have to take those vape machines out and go through the whole process of licensing to be able continue to sell vaping products? Is it the case that, under Clause 16(3)

“The Secretary of State may by regulations create exceptions to the prohibition in subsection (1) or (2)”.


Is that the “get out of jail” card we need to solve the problem my noble friend rightly drew attention to?

My noble friend also touched on Amendment 17A, which relates to vaping machines in non-age-gated premises. The explanatory statement says that the amendment

“would permit the sale of vapes and other nicotine products through vending machines in only those premises that are already restricted to adults only”.

I wonder what those premises are, because younger people can go into pubs and clubs. What are these age-gated premises? I can think of nightclubs and the Chambers of the House of Lords and the House of Commons, but it would be helpful to hear in slightly more detail exactly what these exemptions might be.

I am cautious about any exemptions, because I see vaping products as a smoking-cessation tool. Allowing vaping products to be made available in pubs, clubs, restaurants, or wherever, tends more towards the recreational use of vaping, which I think we all want to downplay. I give way to the noble Baroness, who will explain what these age-gated premises are.

[Baroness Fox of Buckley (Non-Afl)]

The point of vape vending machines in a lot of nightclubs and late-night premises—of which I hear tales and know nothing—is that, when people are out and about, very often they recreationally smoke. That is how a lot of young people start smoking: they have a cigarette with a drink. The idea therefore is that people should at least have the option of vaping. Young people are actually lobbying for this. I know how keen everyone is on giving young people what they want. That is the deal.

[Lord Young of Cookham (Con)]

The noble Baroness destroys her own argument by saying that nightclubs are premises where young people go for recreation and then saying that they might use the vaping machines and start vaping. The last thing we want is for young people, who do not want to smoke, to start vaping because they are in a recreational atmosphere where other people are vaping and there is an opportunity for them to join in. I repeat the point that I see vaping as a smoking-cessation tool, not a recreational exercise.

Finally, while I am normally on the same page as the noble Earl, Lord Russell, on this, I find his argument—that we need to fix a price that is so high that it is out of the reach of young people with pocket money, but so low that we do not penalise those in poor communities where smoking is prevalent—to be an impossible circle to square. He indicated some flexibility, but flexibility does not solve the problem, because the easier we make it for the smoking communities to start vaping, the easier it is for young people. I am not sure that price control is an area that is going to solve the problem, but I accept the environmental consequences that he spoke so fluently about.

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[Baroness Merron (Lab)]

I will be happy to check exactly what I said but, to be clear, we are not continuing discussions about vapes in hospital and mental health settings, in respect of vending machines. As I said, that is in the Bill. I hope I was making the point that discussions are continuing in respect of vape-free places, and that will be a matter for regulations. I assure the noble Lord that NHS England was in full consultation with the relevant parts of the services. It does provide services and it is the right organisation. As the noble Lord knows, we are bringing NHSE into the department in any case in the future. I am sure he will welcome that, as I certainly do.

[Baroness Fox of Buckley (Non-Afl)]

This has been a wide-ranging debate and I thank the variety of noble Lords who spoke. There has been some clarity: it might not be clarity that I am happy with, but we heard the noble Earl, Lord Russell, say that his aspiration is a nicotine-free generation, not just a tobacco-free one. There has been some confusion about the conflation of tobacco and nicotine. The Bill, at least, makes a distinction between those things. It is possible that the Minister—and every other Lord who wanted to get rid of that distinction—wants to challenge the nature of the very core of the Bill, but I assure them that the Bill makes that distinction. If that is not true, it would be interesting to hear what has happened there.

Also, medical scientific discussion on this makes the distinction very clearly and endlessly, particularly, by the way, by oncologists. Those who work with people who have developed cancers from smoking are very enthusiastically promoting nicotine products. As I understood it—as I was assured at Second Reading by the Government and noticed in other communications —we should not be fearful that vaping was a target of prohibition from the Bill. But the more the conversation goes on, and the more it is treated the same, then that is the direction of travel. I would still argue that when one says that the evidence is not in on whether something is helpful, it is not a scientific way of approaching it. The evidence is not in on a wide range of things that are happening in the world. It is evidence that we base evidence-based policies on, not the lack of it.

In the discussion on young people, we ended up discussing whether we are protecting children in a variety of the amendments, through to 20 and 30-somethings in a nightclub who should not be let near a vending machine with vapes in it. My point was not that they would be recreationally vaping because they would be having a good time and therefore it was very dangerous. Although, I have to say that having a good time in a nightclub is not yet, I think, illegal. Having a drink and a cigarette outside a nightclub is, as yet, not illegal—although it might well be by the end of the Bill. The point about vaping was that young people having a good time will often have a social cigarette, and the vaping vending machine might encourage them to do something less harmful. That was my point, rather than me trying to get them all vaping or forcing them to vape.

The conflation of children and young adults needs to be sorted out. In that sense, although I am sure I did not do remotely as good a job of moving Amendment 16 as the noble Lord, Lord Parkinson, would have, we need to be clear that voting in elections is not a technical matter; it is philosophically about saying that someone is an autonomous adult. Therefore, we have a conflict in who we consider children and adults when it comes to health.

I finish by saying I am genuinely, totally disappointed by the attitude to mental health provision and vending machines. Many mental health charities are concerned about this. The age-gating issue is not an issue in mental health hospitals. This idea that there will be hordes of children wandering around accessing vapes from a vending machine—it just seems cruel and inhumane. I do not understand why that exception would not be made. It is true that mental health charities and family groups have suggested that having the odd vending machine in a hospital where people are restricted from leaving would be helpful. It would be kind and compassionate. I beg leave to withdraw my amendment.

Amendment 16 withdrawn.

--- Later in debate ---

[Baroness Fox of Buckley (Non-Afl)]

Vaping, as a mechanism for smoking cessation, is now recommended by NICE as the first-line quit method. It has been endorsed by the NHS and it has formed the backbone of the Government-funded and the already discussed and, indeed, boasted about Swap2stop scheme for local authorities. Vaping is very much part of government policy, it seems to me.

Vaping has enabled millions of UK smokers to quit over the last five years. The way that that has happened and that single-use vapes revolutionised smoking cessation was through being easy and cheap enough to swap to quit. Inevitably, with such a revolutionary success story in innovation on the horizon, what did the Government do? They banned them.

As I explained at Second Reading, the ban on single-use vapes, which the noble Earl, Lord Russell, explained very well in relation to his amendment, was brought in for environmentalist, green reasons. That is fair enough, but health did not even come into the ban on single-use vapes; it was not even discussed. I think that that shows that although, in some of the discussions, it is as though, whatever the freedom or civil liberty considerations, the most important thing is always public health, suddenly, there are things where public health is given secondary consideration to a different set of political priorities.

I am therefore opposed to Amendment 22. Even though we have now banned single-use vapes, the amendment intends to ban the reusable vapes that are on the market and actually being sold. The amendment is interesting because it is at least honest—the noble Earl, Lord Russell, has been honest throughout the day—because, in the heading of his amendment, the word “prohibition” is used. Absolutely. Noble Lords might be delighted to know, because my own person experience might fuel these prohibitionists, that I objected to the ban on single-use vapes. Now, of course, because we are no longer able to buy them, I use reuseable vapes, but, guess what, I use them as disposable. Because nobody really thought beforehand what the point of this ban was. Despite huge inconvenience to manufactures—and just to clarify, not all manufacturers of vapes are tobacco manufacturers—all sorts of independent of vape makers have had to completely redesign everything; it has completely disrupted a successful, innovative product that was a brilliant smoking cessation tool. We have gone through this big law change, and not very much has happened.

This brings me to my amendment, which suggests that the single-use vape ban, which was brought in as a piece of legislation, should be assessed before we discuss what we are doing with the Bill in relation to vaping. It is vital that the ban on single-use vapes is subject to a comprehensive impact assessment as to its impact on public health and any effects that the ban has had on public health. According to the figures, 17% of people are purchasing illegal single-use vapes that are still being sold on the black market where I live, and in other places too. Some people have now given up on those vapes, because they saw all the kerfuffle about single-use vapes, and reverted to smoking.

So it is imperative for the Government, before the Bill is passed, to review the outcome of the single-use vape ban, as proposed by my Amendment 145. It happened and I do not think it has made the kind of difference that the Government anticipated—but nobody ever talks about it any more. If you go into a corner shop or whatever to buy a vape, you will see similar-looking products that are reusable, but many people use them as if they were disposable—and even I think that that was not quite what the Government had in mind, so they should at least consider the outcome.

[Earl Russell (LD)]

I did not want to speak to the noble Baroness’s amendment before she had spoken to it but, now she has, I will briefly respond. I have no problem with her overriding concern that there should be a review of the ban on disposable vapes. Information is important. Obviously, the regulations were done by Defra, so I do not quite know where we are with that.

I will make two further points. The first is in relation to Swap to Stop; it is really important that the Government continue to fund that programme and that people are given proper, long-term vapes, because that is what they need.

With respect to the noble Baroness, I think she is the exception. On the one hand, we have had the ban on disposable vapes, but the problem is that there has not been that much change, as she says. I think we need to go further and move to proper, reusable vapes that cost slightly more but are a one-time purchase that give consumers long-term value. The trouble is that we have not gone that far; this has been a bit of a fudge. If we had a clearer distinction between what was once a one-time, disposable product and what we need to move towards, which is a long-term, reusable product that you would save money from by not needing pods and things like that, we would end up in a clearer and better place.

[Baroness Fox of Buckley (Non-Afl)]

The noble Earl, Lord Russell, is good at advertising the product that he is promoting. If anyone is interested in doing PR on anything, this is your man.

[Baroness Walmsley (LD)]

My Lords, I support Amendment 22 in my name and those of my noble friend Lord Russell and the noble Baroness, Lady Grey-Thompson. As my noble friend said, it seeks to prohibit pre-filled single-use vaping pods, mainly for environmental reasons. These things have been the tobacco industry’s response to—indeed, its pre-emption of—the ban on single-use vapes that was introduced in June this year. Single-use vapes were such an effective entry point into vaping for young people and such a terrible blight on the environment.

These liquid pods are single-use vapes by another name. Just because you have to insert the pod does not mean that this is a multi-use product. They are cheap and available and have turned out to be just as bad for the environment as the single-use ones were, for all the reasons outlined by my noble friend. Indeed, they have introduced a new litter problem, which is that the removable sticker from the liquid container is appearing everywhere, stuck on to waste bins and pavement furniture after people have peeled them off to insert the pods. Local authorities have to spend time removing those, as well as the discarded vapes. They are just as much of a litter hazard as their predecessors were. Perhaps the Minister will tell us why they should not be treated in the same way as the original single-use vapes.

I say to the noble Baroness, Lady Fox, that the industry has only itself to blame for the ban on single-use vapes, because it used them, via its egregious marketing, to attract young people to addictive nicotine products. So the Government were quite right to ban them.

The problem with Amendment 145 is that single-use vapes were immediately replaced by the devices we are talking about in this group. There is no point reviewing the effect of the ban on the original single-use vapes alone, because they are all mixed up with the emergence of these products at pretty much the same time. A review would only cause a delay to the introduction, by this Bill, of measures to reduce youth smoking and vaping and to assist smokers to quit—which is an objective to which everybody who I have heard speak so far is committed.

--- Later in debate ---

[Baroness Fox of Buckley (Non-Afl)]

I can clarify that she has answered her own query in a way. My concern is that lawmaking—and bans—should not be rushed through without any cost-benefit analysis. That is what happened with the ban on single-use vapes. Many of us knew—and warned—what would happen without a review or process, but nobody took any notice.

The consequence of that ban was a huge amount of disruption for retailers, corner shops and people who work in the retail business, who had to completely empty their shelves and bring in new products. Product designers had to be brought in. That was a complete faff for absolutely nothing—for rushed lawmaking and a rushed ban—which happens all the time. I am simply suggesting that we should have a cost-benefit analysis, maybe retrospectively, of what has happened, before we bring in more bans of more products without thinking through what the consequences might be. It is a probing amendment, you might say.

--- Later in debate ---

These amendments are about ensuring that the Government, and hopefully even some of the well-intentioned campaign groups, listen and take the time to hear from those whose livelihoods, expertise and long experience will be directly affected by the legislation that is before us. I hope that the Government will want to achieve the right balance between reducing and stopping smoking, which is clearly the intention of the Bill, while working with small retailers and specialist manufacturers, so that they believe that their voices are being heard and that they can continue to contribute to our economy. I beg to move.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I am pleased to see this group of excellent amendments. They have been so well explained and motivated that I do not need to add very much more.

I support them for a couple of reasons. In my dealings with different groups of people who represent convenience stores—shopkeepers—they have made it clear that they do not feel that they have been consulted at all. Ironically, the quotes always come from the British Retail Consortium. I have nothing against the British Retail Consortium—it has said some interesting things on the Bill—but shopkeepers feel that there are specific issues that are not being picked up, particularly around convenience stores.

Convenience stores are often a community asset; they are part of the community. I know that the Government understand this, because they are bringing in a new law—although I do not know whether it is necessary—to protect retail workers from assault. As I pointed out in the debate on that Bill, I hope that we already have a law protecting retail workers from assault, but it would be a double whammy if we have two. This indicates that the Government care about retail workers. Part of the motivation for that was the increase in assaults and violence. However, people from those different organisations have contacted me because of my Second Reading speech, where I made similar points. They have pointed out that they are most worried about the age verification that will come with the generational smoking ban and the economic hit that will come from the regulations that will come in with this Bill. These are some of their big fears.

When we talk about cost-benefit analysis and really weigh up what matters, we keep saying, “Health, health”, or “Public health, public health”, but let me tell you that, if you are running a small convenience store, a different thing can affect your health, and that is worrying that you will go under because of new laws and changes. So consultation with the wider group is very important.

I also want to back up the point about the peculiar position on manufacturers. We have constantly heard about everything being big tobacco, which I know is an easy way to close down a debate. I do not actually think that it would be wrong to talk to those manufacturers, but there are lots of manufacturers involved in lots of different products that will be affected by this Bill. We cannot just write them all off as “big tobacco”. Having that nuance is something on which I hope the Minister and the Government will listen.

The most important amendment of all, though, is Amendment 150 because it stresses that this consultation is not to be just a box-ticking exercise. It would insert the words,

“and take into consideration the views of”—

words that the Minister should welcome, because a consultation must listen properly. You must take into consideration the views of the people you are consulting and not have just a box-ticking exercise. I would like a broader range of organisations to be consulted; I would also like the Minister and the Government to listen to them when they are consulted.

[Baroness Walmsley (LD)]

My Lords, as I understand it, following the Royal Assent of this Bill, there will be more consultations on many of the regulations the Government plan to bring forward. The call for evidence, which was published on 8 October, is already seeking evidence on some of the more technical aspects of the Bill.

I point out to those who tabled these amendments that the UK Government are a signatory to Article 5.3 of the WHO’s Framework Convention on Tobacco Control, which aims to protect health policy-making from tobacco industry influence. That is why I think that there should be no further mandation for consultation with those who have a vested interest in producing or selling tobacco products, as long as we keep an eye on small retailers. As far as the bulk of their sales of products containing tobacco—I choose the way I express it very carefully—are concerned, there will be a small impact because only a one-year cohort at a time, which is a relatively small amount, will be prevented from being sold these products. As I said on our previous day in Committee, that will give small retailers plenty of time to adjust their sales models. We will deal with things such as age verification, as well as other issues that may cause small retailers concern, in our debates on other groups; we must do that rigorously.

I point out that there is nothing to stop tobacco companies responding to past and current government consultations on proposed regulations, but, of course, all respondents are required under the WHO convention to be transparent about their direct or indirect industry links. This is appropriate given their commercial conflicts of interest, which are sometimes in direct conflict with the Government’s public health objective to eliminate smoking over a generation.

Tobacco and Vapes Bill

Baroness Fox of Buckley Excerpts

Committee stage
Monday 27th October 2025 Grand Committee

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I do not want prohibition and I do not want smoking to be illegal, but I feel that I would be having a more honest discussion if that was what was being proposed. I feel that, in the end, this is a Bill about prohibition. One reason I am so uneasy about the generational smoking ban, which is only part of the Bill, is that it restricts individual autonomy by ultimately denying adults the right to make their own choices about a legal activity, whatever its harms. We are asked to focus our eyes on young people, but those born in 2009 will grow up to be adults who are then denied the choice. In the end, that restricts adult freedoms—and that is a problem.

I appreciate that that is a matter of principle that some people do not think very important. By the way, one reason I am nervous about the specific amendments proposed by the noble Lord, Lord Murray of Blidworth, is that I am not convinced that moving the legal age from 18 to 21 helps my conscience matter at all, however well motivated the amendments are. I understand their intention but they muddy the waters around adult autonomy.

I was interested in the points made by the noble Baroness, Lady Carberry, about polling saying that the public are all behind this. In fact, in one poll in August 2025, 59% of respondents thought, because the question was posed differently, that if a person can vote—and that age, as we know, is getting ever younger—drive a car, join the Army, buy alcohol and possess a credit card, they should be allowed to purchase tobacco. In other words, they could see that when asked that, they thought that. By the way, only 29% thought it should not be permitted and 11% said that they did not know. Mind you, the same polling asked about the 10 most important Bills, this being one of them, and this Bill came ninth on the list of what should be seen as important, progressing through the House. The 10th, by the way, was the hereditary Peers Bill. I thought that might appeal to some people; I was playing to a certain crowd. No, but anyway, that is what the polling said.

One thing I want to ask the Minister, in all seriousness, because I still cannot understand it, is: how can the Government justify a ban that creates an unequal application of the law, whereby one group of adults, born before a cut-off date, can legally purchase tobacco while another group, born after, cannot? I just do not understand how that arbitrary cut-off point is not discriminatory by treating people solely based on their birth. I asked that at Second Reading and nobody answered me.

I also wanted to ask whether it is realistic to think that this will stop young people smoking. At the moment, young people are not allowed to smoke. However, according to ASH, in 2023 11% of 11 to 15 year-olds—400,000 people—had tried smoking, 3%, or 120,000 people, had carried on smoking, and 1% were smoking regularly. In other words, even though it was completely against the law for them to do it, they carried on smoking. The idea that the Bill will magically stop that seems a little ambitious.

Terminally Ill Adults (End of Life) Bill

Baroness Fox of Buckley Excerpts

2nd reading
Friday 19th September 2025 Lords Chamber

[Baroness Fox of Buckley (Non-Afl)]

My Lords, as legislators, all sorts of laws pass through our hands—the good, the bad and the ugly. All are consequential for our fellow citizens, but rarely does a Bill weigh as heavily as this one. Wherever we stand, this law change could have a seismic impact on social attitudes to life, illness and death. Our task is formidable because of how many norms the Bill will overturn; I will mention a few.

The Bill unsettles centuries-old medical ethics. It rebrands assisting someone to die as a medical treatment, upending its understood meaning. The Bill rewrites the role of doctors. They will no longer be guided by the “Do no harm” ethos of preserving and protecting life; instead, the Bill mandates that they actively engage in taking a patient’s life by supplying lethal drugs that will kill them. The Bill especially shakes the foundations of society’s attitudes to suicide—and, yes, that is the accurate word; we know this because, at present, intentionally assisting someone to end their life is a criminal offence. So the Bill is forced to amend the Suicide Act 1961 to allow medical professionals to plan, prepare and assist in intentionally ending the lives of a particular group of citizens.

My greatest dread is that this state licensing of suicide could unleash a regressive culture change. For decades, we have made concerted efforts to deter people from taking their own life; this was brilliantly documented last week by the noble Baroness, Lady May, and the noble Lord, Lord Jackson.

Now, I pause. Any of us who have known family or friends who have committed suicide know that it is gut-wrenchingly tragic; it brings an especially visceral, raw grief. This is compounded by guilt as loved ones endlessly soul-search, totally unfairly blaming themselves: “What more could we have done?” This is why, if we see someone about to jump from a bridge, even if they give us 100 objective reasons why their life is not worth living or even if they have only a few months to live, we do not just shrug and walk on—we cling on to them and plead, “Don’t do it. Don’t jump”. All this reflects our deep humanistic intuition that, when a person acts to end their life, it should be resisted with all the energy society can muster. What happens culturally, though, when the state shouts, “Jump”, or agrees with those who say that ending their life is a compassionate choice?

I worry especially about what message this sends to the young, who are already often nihilistic and prone to anxiety, self-harm and mental health problems. When we debated the censorious Online Safety Bill, those of us who raised its negative impact on free speech were metaphorically slapped down and hectored. The one indisputable reason for that law was to close down suicide sites—something echoed by the Prime Minister only yesterday. We had to protect the young from malign online suicide influencers, but I worry that this Bill is the legislative embodiment of a suicide influencer. What do we think will happen when we tell newly franchised teens that, in some instances, taking your own life equates to dying in dignity? Saying that it will be restricted to those with a terminal illness just will not wash with a generation immersed in the language of rights and entitlements: “Why not assist me when I am suffering so much? Why am I being discriminated against?”

That brings me to my final point. We have heard some fine speeches from supporters of the Bill, stressing the importance of autonomy and giving people control of their life. I usually champion such sentiments in a political sense, but not when they are used to justify the state having a role in ending human life—forgive my squeamishness. For those who state passionately, “My body, my life, my choice”, why back a Bill that limits that choice to the terminally ill? Surely logically that right should apply to anyone who wants to kill themselves. No doubt this logic will lead to demands to expand the law—God help us once human rights lawyers get involved. As I say, we have a weighty responsibility to ensure that such nightmarish unintended consequences do not become a reality.

Tobacco and Vapes Bill

Baroness Fox of Buckley Excerpts

2nd reading
Wednesday 23rd April 2025 Lords Chamber

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I say many thanks to the noble Lord, Lord Teverson, for such an interesting speech. It has been quite refreshing today to hear members of the Liberal Democrats talking about liberalism—something of a shock to the system, but I am delighted. It is also a bit dispiriting that a Government who promised change keep introducing cut-and-paste Bills from the previous Tory Administration, only worse. The ministerial power grab in the Tobacco and Vapes Bill means that democratic accountability could be going up in smoke.

Ministers from both parties have boasted that this law, which bans all future generations from purchasing tobacco, is world-leading, but what if the world has not gone that way for good reasons? There is certainly no evidence that this is a workable policy. The Bill’s own impact assessment admits that there are no international case studies to follow. This is all a gamble, based on academic modelling. Has the Minister read the document from Trading Standards Wales that challenges the efficacy of such an “aggressive prohibitionist approach”, noting that the New Zealand Government abandoned its version as unenforceable? Meanwhile, in Malaysia the Attorney-General rejected a similar ban as unconstitutional on the grounds that it denies citizens equal treatment under the law. How would it be different in the UK if a future 40 year-old will be legally able to buy cigarettes whereas his 39 year-old sister will be criminalised if she does the same? How is that not discriminatory?

We also have to be honest about just how illiberal this legislation is, and I am delighted the noble Lord, Lord Scriven, reminded us of why that matters. We should drop the F-word a lot more in this Chamber, even if it offends some, but querying the state’s criminalising of adults’ freedom—that F-word—to buy legal products is not some sign of a dangerous, mad, libertarian ideologue or because we are in hock to big tobacco, as has been suggested by some, which, to be frank, is a cheap and insulting avoidance of debate. It is because, in a democratic, free society, we should be careful not to be careless with civil liberties.

Regardless, let us take the Bill’s motives at face value: to stop people smoking for the sake of their health. Luckily, some innovative geniuses have invented vapes, with unambiguous evidence that they actually work and have enabled millions to quit. Even the NHS Better Health web page includes the message that you are roughly twice as likely to quit smoking if you use nicotine vapes compared with other nicotine replacement products. But instead of celebrating this success and seeing vaping as an opportunity, this Bill irrationally treats it as a threat.

I know the Government say that the Bill is targeting youth vaping, but hugely disproportionate regulation, such as the proposal to make it illegal to publish any marketing materials for vapes or nicotine products, can only create an information void and ensure that adults will be confused by scaremongering misinformation about the dangers of vaping. Alarmingly, over half of adults who smoke mistakenly believe that vapes are equally or more harmful compared to smoking.

Similarly, why, oh why, are the Government so fixated on demonising flavoured vapes? Does the Minister really believe that only children like sweet things? Has she not noticed the exponential rise in the flavoured gin market for adults? Research shows that 65% of adult vapers find fruit and sweet liquids preferable—ironically, often because of the perceived difference to the tobacco they are quitting.

Let me tell you a story. Once the proud winner of the smoker of the year award, I quit smoking 18 months ago after 40 years of chain-smoking. It was tough, but, advised by no less than two doctors, I tried disposable vapes. Banana and strawberry worked a treat, and now I am smoke-free. But rather than patting me on the back, along comes Defra, which, with scant regard for public health, has prioritised the environment. I now live in dread of 1 June and an outright ban and I am stocking up. Now we have this Bill’s counterproductive attack on flavours, despite the evidence that four in 10 vapers say that if there are no flavoured vapes, they will return to smoking. Indeed, in America, in 375 localities that adopted permanent restriction on vape flavours, the results were increased sales in cigarettes.

On the theme of counterproductive outcomes, over Easter the Government issued flashy filmed adverts promising a new law against assaulting shop workers. I am not sure that law is necessary—it is not legal to attack retail staff now, surely—but did the Government consider that this Bill is guaranteed to make matters worse? The latest British Retail Consortium crime survey reveals 130,000 instances of shop workers being verbally and physically assaulted every day in 2024—a 340% increase since 2020—and a significant number of these attacks followed requests for age verification. There is unanimous agreement among retailers that a law which will force staff of convenience stores at the heart of our local communities to increase proof-of-age ID checks on tobacco buyers of any age will trigger a huge escalation of violence and abuse.

The cost-benefit analysis of this Bill means there are massive costs for many people. Just saying we want to stamp out smoking is not good enough. In Committee, we should ensure that we follow and track those costs and do not allow unaccountability to happen, at least here before it gets passed.

Mental Health Bill [HL]

Baroness Fox of Buckley Excerpts

Report stage
Wednesday 2nd April 2025 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, it is a pleasure to follow the noble Baroness, Lady Tyler. I have attached my name to the noble Baroness’s Amendment 49. As the noble Baroness said, like Amendment 48 it addresses one of the primary reasons for reviewing the Mental Health Act in the first place. Black people are over 3.5 times more likely to be detained under the Mental Health Act than white people, and over seven times more likely to be placed on a community treatment order. Their experiences and outcomes are worse. All of those are facts. As the noble Baroness, Lady Tyler, said, the Bill somehow does not seem to be addressing that. We are taking an overall systemic view but not addressing the issues of a particular population. The reason I chose to sign Amendment 49—we are going to come shortly to the amendment in the name of the noble Lord, Lord Stevens, looking at the resources being put into the Mental Health Act—is that this is another way of putting resources into what everyone agrees is a crucial issue. This is a different way of allocating resources.

The noble Baroness, Lady Tyler, has made the case that PCREF is not the same thing. The Care Quality Commission does not have the same kind of situation. We are talking about people at a local trust level here; that is where the responsible person would be. As the noble Baroness said, if there is already someone, because of local arrangements, fulfilling this role, they can simply adopt this along the way. It does not have to be any kind of duplication. I note that the campaign group Mind very strongly backs this amendment. It delivers where we started from on this whole Bill.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I will speak to Amendment 61, which calls for a review into the causes and consequences of the huge spike of diagnoses of mental disorders. It should also investigate the impact of this on the availability of services that we envisage treating people with a mental disorder that this Bill seeks to help.

If, in our best efforts to provide alternatives to detention for the severely ill, we hope to ensure that adequate care in community settings exists, we must look at the phenomenon that threatens to squeeze out those who most need access to such services. Implicit to this endeavour is to ask if, inadvertently, some aspects of policy set in train a self-fulfilling prophecy. Rebranding any deviation from the norm, troublesome behaviour, anxiety or even, according to the Government’s curriculum review, GCSE exam stress, under the therapeutic language of mental health has consequences. As Tony Blair has noted recently:

“you’ve got to be careful of encouraging people to think they’ve got some sort of condition other than simply confronting the challenges of life”.

Yet the young especially are prone to internalising the narrative of medicalised explanation and adopt an identity of mental fragility and illness. This can create a cohort of citizens demanding official diagnoses, NHS intervention and treatment.

This week, the media has featured the new book by Dr Alastair Santhouse, a neuropsychiatrist from Maudsley Hospital. In the book No More Normal: Mental Health in an Age of Over-Diagnosis, Dr Santhouse argues that it has become crucial to reassess what constitutes mental illness:

“so that we can decide who needs to be treated with the limited resources available, and who can be helped in other ways”.

He worries the NHS has

“buckled under the tsunami of referrals”.

Other state services are straining to the point of dysfunction as well. Despite the fact that the number of children with education, health and care plans has more than doubled in less than 10 years, parents are still desperately complaining about waiting for years for autism and other assessments. In other words, the demand is just galloping.

All of this is leading to at least 18 councils being at risk of insolvency, according to the Guardian on Monday. The present row over PIPs and the welfare system collapsing under the costs of ever greater numbers claiming disability payments for mental disorders is now a major political issue. I have been partly inspired to table this amendment by the Health Secretary Wes Streeting’s concern about overdiagnosis of working-age adults leading them to be “written off”, as he said. It is especially tragic that this is happening overwhelmingly among young people.

My concern, and the point of this amendment, is that this can skew NHS provision. A Savanta poll of 1,001 GPs for the Centre for Social Justice’s report Change the Prescription reported that four in five, 84%, of GPs believe that the ups and downs of normal life are now wrongly being redefined by society as mental disorders. Of those GPs, 83% now believe that anti-depressants are too easily prescribed to patients. But the GPs are under so much pressure from patients demanding treatment that they prescribe them. Similarly, in 2013 and 2014 just 1,800 adults were prescribed drugs for ADHD, but last year 150,000 adults were prescribed with ADHD medication. Waiting lists keep growing and lots of anger continues.

When I last spoke on this topic in the Mental Health Bill debate, the media picked up on it and I was inundated with emails, largely from people furious with me for challenging overdiagnosis; I had a tsunami of hate mail. There was even a formal complaint sent to the standards committee of the House. People said, and I understood it, “How can you say there is an issue with overdiagnosis when I can’t get a referral for myself” or “for my child” and so on. It is true that a GP cannot formally diagnose ADHD as it requires specialist assessments. The average waiting list for an ADHD referral on the NHS is now three years. This lack of formal diagnosis is not necessarily stopping service provision becoming overwhelmed and distorted, and I think this mood will have a very damaging impact on what we want this Bill to do.

I will finish with an apocryphal tale from the University of Oxford’s disability report from 2022-23. It reveals that the university has, under pressure from students, agreed to

“accept a wider range of disability evidence”

as a key to giving 25% more time in exams and the use of computers in exams. The university’s explanation is telling. It talks of

“a wider context of extensive and ever-growing waiting times for ADHD and autism diagnostic assessments”,

so it aims to reduce “administrative burdens and barriers” for disabled students.

--- Later in debate ---

[Baroness Browning (Con)]

Before the noble Baroness sits down, she mentioned autism several times, but the whole purpose of the Bill is to remove autism and learning disability from mental health, where it previously was. In fact, I served on the Bill Committee, as did others in the Chamber, in 2005-06, when I was really opposed to autism being added to the 1983 Act. But it was added, and now it is being taken out, I am very pleased to say.

I hope that the noble Baroness will accept that there is a piece of legislation about this on the statute book: the Autism Act 2009, which is being reviewed by the House at the moment. Autism is not some fad, something that people just make up, or something temporary; it is a lifelong neurological condition. I raise the failure to provide the right services for people with autism who are in that part of the spectrum where they need support. Not everybody does: it is a spectrum, and I quite agree that there are people on the spectrum who cope quite well with life, knowing that they have autism and not needing that sort of support. We have discussed that support a lot in the course of this particular Bill, and if you do not provide it where it is needed—this is the weakness that we are looking at in the current Autism Act—that leads to quite serious mental health conditions, including suicide. Of all the conditions that the noble Baroness mentioned, among the autistic community the suicide rate is the highest.

[Baroness Fox of Buckley (Non-Afl)]

I genuinely appreciate that intervention. That is what I think too. It is precisely the inappropriate use of terms such as autism in relation to this overdiagnosis that concerns me, because it is too glibly used. That is part of what I am talking about. I absolutely want those people who need the intervention to get it, but my concern is if it becomes widely used socially, in the way that I did not want to go into in great detail, on university campuses or in society in general. I note the TikTok phenomenon of people getting diagnoses and that being used, and so on. My concern is that the label, the labelling process and the demand for diagnosis and treatment squeeze out the very people that the noble Baroness is talking about.

I too have spent many years trying to distinguish between autism and mental illness. It drives me mad that people do not know the difference. My problem is that, in the debate about this issue, they are very often all lumped together in a way that is medically not clarifying, but the demand for a medical label can mean that people are not even that choosy about which one they get. That is where I have tried to raise an issue.

[Baroness Browning (Con)]

I am very grateful for that response. The noble Baroness said that autism is different; it certainly is different, which is why it has its own Act of Parliament.

--- Later in debate ---

[Baroness Bennett of Manor Castle (GP)]

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

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

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

[Baroness Fox of Buckley (Non-Afl)]

My Lords, very briefly, I will say that I absolutely support this amendment. I think it is worth clarifying what I said earlier about overdiagnosis. The danger is that that can be interpreted as meaning that I want cuts; what I actually want is targeted intervention for the right people, rather than saying, “Oh, everybody’s been calling themselves mentally ill, so let’s cut the services”.

I completely agree with the noble Baroness, Lady Tyler of Enfield, that, if we do not sort out the amount of community provision, what we have done over the last few weeks, never mind the years preceding it, will have been a waste of our time, because the Bill will not be worth the paper it is written on—that is the danger. It is very tempting, in a period of intense economic difficulties, to suggest that this might be one of the first things to go—so I do think this is a very good amendment.

I will remind the House of a discussion we had late the other evening on the plight of prisoners. If there is no community resource for people leaving prison—ex-prisoners—they will deteriorate and end up becoming very ill in the community and being incarcerated again. I discussed that in great detail. In other words, this is essential if we are serious about saying that we do not want to lock people up but, instead, want to treat them appropriately.

[Lord Scriven (LD)]

My Lords, I rise very quickly to support the amendment from the noble Lord, Lord Stevens, and have put my name to it.

I will add a couple of extra things to the noble Lord’s very well-argued case. Modest as it may be, I think it is an effective measure—and this is why I think it is and why the House should support the noble Lord’s amendment if he decides to push it to a vote. It is not that the Secretary of State has announced that the percentage will decrease next year; the percentage decrease happened during this financial year, going down from 9% to 8.78%. So we are now on a trend for the percentage of National Health Service spend on mental health.

Furthermore, one has to question the priority of the Government when they look at the national planning guidance and some of the targets that have been dropped from it. There are no plans to target the 2 million long waiters waiting for mental health care. It would be slightly disingenuous of the Minister, in response, to talk just about the mental health investment scheme, because all it refers to is ICB spend. The uniqueness and cleverness of the amendment from the noble Lord, Lord Stevens, is that it talks about all health service spend, including non-ICB spend, specialised commissioning and other elements that need to be there.

Mental health takes up 20% of illness treated by the NHS, which will probably be spending 8.7%. Because of the trend that is happening, the amendment from the noble Lord, Lord Stevens, is absolutely vital to ensure not just that the percentage is maintained but that the community facilities within this will be funded and implemented.

Mental Health Bill [HL]

Baroness Fox of Buckley Excerpts

Report stage
Monday 31st March 2025 Lords Chamber

[Lord Bradley (Lab)]

My Lords, I declare my interests as listed in the register.

In Committee, I moved an amendment that would require a specified accountable person to be appointed by the relevant referring body to ensure that the specified 28-day transfer period is met. This proposal was based on the fact that many agencies are involved in arranging prison transfers. From my experiences in helping to develop services across health and justice, I believe 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

“‘accountability for all agencies involved in the transfer process to meet’ … the deadline”.

It is important to note again that this is supported by

“Sir Simon Wessely’s independent review, which stated that it would help … ‘unblock the institutional barriers and … give … the teeth it needs to push the transfer through’”.—[Official Report, 27/1/25; col. 61.]

At the conclusion to that debate, first, the noble Lord, Lord Kamall, from the Opposition Front Bench, commented that my amendment

“again, speaks to the point of implementation”

of provisions in the Bill, and said that this

“could be a sensible way of holding providers to account and working with them to address the shortcomings in patient transfers”.—[Official Report, 27/1/25; col. 66.]

Secondly, and most importantly, the Minister, my noble friend Lord Timpson, helpfully reminded the House that the previous Government had run a public 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 work

“continues between health and justice partners”

on this issue. He suggested that a non-statutory approach

“will ensure that the interests of patients are considered while providing the flexibility required, given the complexity of the process”.—[Official Report, 27/1/25; cols. 67-68.]

Very helpfully again, the Minister offered to meet to discuss this further and for that to be undertaken before Report. I am very pleased that such discussions have taken place, and thank not only the Minister but the excellent officials in both the Ministry of Justice and NHS England for their very constructive engagement with me.

I still strongly believe that we need effective oversight of the transfer process, hence I tabled Amendment 38, which proposes that either an accountable person “or body”—a slight 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. I look forward to his response at the end of this short debate and will listen carefully to it. I beg to move.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, in Committee, a number of us stressed the importance of those sections of the Bill relating to its application for prisoners suffering mental disorder. I continue to push to ensure that the parts of the Bill that relate to the responsibilities of the MoJ in relation to the Department of Health and Social Care are not neglected once the Act becomes law.

In Committee, I focused on calling for a government review of the impact of the Bill on prisoners, but, from listening to the thoughtful response from the noble Lord, Lord Timpson, I saw that this could become yet another bureaucratic report. I therefore commend Amendment 38 from the noble Lord, Lord Bradley, as an elegant way of ensuring that the crucial provision of a transfer to hospital within 28 days is more than an “if only” paper aspiration.

My Amendment 40, which I am delighted is supported by the noble Baroness, Lady Bennett of Manor Castle, is also a practical proposal. It is designed to tackle problems that 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 prison estate rather than in secure hospitals. The question then is what happens to their mental health care when they are released. If this aspect is neglected, these ex-prisoners could well become increasingly unwell and deteriorate, and therefore be in need of future detention.

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 further, creating new risks to both them and the public. This is a real risk. Estimates from a 2023 report from the Centre for Mental Health, based on a survey of 75% of prisons and young offenders’ institutions in England, found that one in seven prisoners receive mental health support while in custody—the figure is one in four among women. However, continuity of that care collapses after release. Research led by the University of Manchester recently found that, of 53 prisoners who had been in touch with in-house services due to severe and enduring mental health conditions, only four were in touch with community health services six months after release.

It is perhaps understandable why this happens. When leaving prison, both the authorities and prisoners may focus on practical challenges, such as lack of housing and how to earn money and a living, and therefore mental health support can and does slip down the priority list. It is also the case that leaving prison can present a shock to the system, and that affects this. Prisoners will be leaving a structured environment, focused on routine, and, in many instances, returning to more disorganised and chaotic conditions. Freedom may mean an arbitrary end to an effective course of treatment, someone having waited perhaps months or even years to access services, such as therapy or specialised groups, in which they have started to open up about traumatic experiences—all in-prison services. Suddenly, on release, there is an abrupt end to such support. Targeted interventions, prescribing regimes and the 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 multiple and complex needs, and can be wary of accessing care in the community because of a lack of trust in state institutions that means that they are less likely to proactively seek out help. Ex-prisoners report that they fear that disclosing mental health challenges to, for example, probation staff will draw attention to their vulnerabilities. Then there is the dread of recall—an especially acute fear for IPP prisoners: a fear of being sent back to prison if they appear too ill to cope, or a dread of that other detention mechanism, sectioning.

All that this amendment seeks is to ensure a smooth handover between prisoners and community services. Without such ministerial reassurance, I fear that this will undermine core parts of the Bill unless it is taken into account. The stock reply to such concerns is that prison mental health services send on information to prisoners’ GPs, but in the real world this is often nonsense. Prisoners often do not have a fixed address on release, so they are discharged with just a medical letter. Prison nurses explain that they do not know where their patient will be released to, beyond a hostel somewhere, making it impossible to connect that person to even primary care. Prison-led medical staff complain that often they are not informed of the impending release until very shortly beforehand—sometimes a 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 with services or even to conduct proper assessments of individual patients before their release. Clinical needs are therefore deprioritised, and prisoners fall through the net of statutory services.

What is needed, and what this amendment envisages, is that a relevant detention authority is responsible for discharge packages which will, for example, register prisoners with GP services in the precise area a person is discharged to, and liaise with relevant third-party organisations and community provision to make arrangements. Prisons and health authorities would work together to prevent deteriorating mental health and the potential for behaviour on the outside that would mean yet more contact with the criminal justice system for the ex-prisoner and, possibly, emergency intervention and detention.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I support Amendment 40, tabled by the noble Baroness, Lady Fox, and have added my name to it—probably not a combination that you will see very often. This amendment, as the noble Baroness set out with practical, clear evidence, makes such a lot of sense that I had to back it.

My particular interest when it comes to prison policy is women in prison. More and more shocking figures are emerging all the time about what is happening in our women’s prisons. A third of women in prison are now self-harming, which is a 29% increase in the last quarter, and 82% of women in prison report mental health problems. As the noble Baroness said, one in four women in prison are receiving help from mental health services. That is not to say that there are not enormous issues around male jails as well—the figure for male jails is one in seven—but I want to take a moment to paint a picture.

Six in 10 female prisoners are serving sentences of less than six months. Their life is torn apart and they are put into prison, where maybe they start to get help from the mental health services. Here are some other figures: seven in 10 women in prison report being victims of domestic violence; 53% report that they were victims of child abuse. We have a huge and often acute need for mental health services here, yet, as the noble Baroness set out, these women are thrown out, virtually on to the street, and the chances of continuing care and support being there are utterly unrealistic.

I suspect the Minister will say that the Government are trying to improve the situation. I respect and understand that. None the less, this is a practical, sensible measure that it would be common sense for the Government to take on board.

--- Later in debate ---

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

I am grateful to my noble friend Lord Bradley for bringing this discussion before the House today and his commitment to improving outcomes for patients since the publication in 2009 of the Bradley Report, which highlighted the need to ensure that transfers between prison and secure hospital take place in a timely manner. I also thank him for his kind words about my superb team in the Ministry of Justice.

The Government are committed to addressing the unnecessary delays that some patients experience, which can cause significant distress to these individuals, their families and those charged with their care. Transparency and accountability, as the noble Lord, Lord Davies of Brixton, and the noble Baroness, Lady Tyler, expressed clearly, are essential to the successful implementation of this reform and to reducing delays more broadly. I thank my noble friend Lord Bradley for the constructive conversations with my officials since Committee to ensure we get this oversight mechanism right.

I am pleased to share that this Government have recently established a health and justice 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 a national clinical director, who will report regularly to Ministers and be responsible for agreeing a joint work plan to support implementation of the statutory time limit, identifying solutions to common barriers to timely transfers and holding partners to account. I am confident that this group will provide effective oversight by bringing together operational leaders across health and justice with the levers necessary to effect change, while inviting challenge from critical friends such as the Care Quality Commission and His Majesty’s Inspectorate of Prisons to ensure external scrutiny. I will continue to work closely with my noble friend Lady Merron to ensure that the long-term future of the strategic advisory group remains a priority.

As my noble friend announced earlier, the Government have committed to providing an annual report to Parliament on the implementation of the Mental Health Act reforms. Through this reporting mechanism, I will update Parliament on the implementation of the statutory time limit and on the strategic advisory group, and provide data on transfer timelines when available for publication. I hope this reassures my noble friend of this Government’s commitment to improving timely access to treatment. I urge him to withdraw his amendment.

Amendment 40 tabled by the noble Baroness, Lady Fox, and supported by the noble Baroness, Lady Bennett of Manor Castle, would ensure that prisoners released into the community who have previously been treated for a mental disorder can continue to receive access to treatment in the community. Section 117 of the Mental Health Act already places a duty on health and social care services to provide aftercare to patients under specific criminal justice sections of the Act who are released from hospital into prison or into the community. These services aim to reduce the risk of a deterioration of the patient’s mental condition and, accordingly, the risk of them requiring admission to hospital again for treatment.

The noble Baroness, Lady Bennett, is right that our women’s prisons have many women who are mentally unwell. That is why we have set up the Women’s Justice Board—to reduce the number of women in prison and to help divert many women away from custody in the first place.

The noble Baroness, Lady Fox, will be pleased to know that, in addition to the Section 117 aftercare that is available to those detained under the Mental Health Act, all 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 and in the community, and to support access to treatment, we have recruited 57 health and justice partnership co-ordinators and managers across all probation regions in England and Wales. NHS England’s RECONNECT, a care after custody service, supports prison leavers with vulnerabilities including mental health needs to engage with the right health services in the community through referrals and peer support. The noble Lord, Lord Kamall, is right: through-the-gate continuity is crucial. The successful pathway is how we reduce reoffending and help people who are unwell.

I hope this reassures the noble Baroness that there is already sufficient provision in the Act to ensure that prisoners who have previously been treated for a mental disorder can continue to receive access to treatment in the community. I urge her not to move the amendment.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I do not doubt in any way that prisoners can access that community care; the problem is that they are not accessing it. The assurances about new schemes are positive, but the idea was to make this more than just an abstract wish list and make sure that something practical happens. If that is what the new scheme—although it does not exist yet—will do, that is reassuring, but it is certainly not what is happening now.

NHS England Update

Baroness Fox of Buckley Excerpts

Wednesday 19th March 2025 Lords Chamber

[Baroness Merron (Lab)]

Nobody should worry about data or their privacy. Our job is to improve our ability on data, and this change will not affect that. Indeed, part of the 10-year plan will include a move from analogue to digital, because we recognise the importance of data and digital change in improving healthcare. This change will give us a better opportunity to implement that.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I congratulate the Government on removing a powerful and unelected body—the world’s largest quango. What the Government have done is so important democratically, given that the Secretary of State says, “The buck stops here”. However, it is not a silver bullet. There is no NHS England in Wales—my neck of the woods—and the buck stops with the Senedd, but the Welsh health service is in a terrible state, with wastage of money, red tape, bureaucracy, and smoke and mirrors about where money is being spent. Does the Minister agree that that can happen even when the buck, apparently, stops with the politicians?

[Baroness Merron (Lab)]

I am not sure if that was a question about politicians or Wales. We work very closely with the devolved Governments, as the noble Baroness will be aware. On her point about politicians, we take our responsibilities very seriously. That is why we have recognised the problem and are acting.

Mental Health Bill [HL]

Baroness Fox of Buckley Excerpts

Committee stage
Monday 24th February 2025 Lords Chamber

Moved by

[Baroness Fox of Buckley]

160A: After Clause 50, insert the following new Clause—
“Review: impact of this Act on the prison estate(1) Within 12 months of the day on which this Act is passed, the Secretary of State must publish a review of the impact of provisions in this Act related to the treatment and care of mentally disordered persons on—(a) under 18s in youth offender institutions,(b) IPP prisoners,(c) female prisoners, and(d) any other such persons they deem appropriate.(2) In the review, the Secretary of State must assess whether, in their view, the Act provides adequate support for ongoing treatment and care of mentally disordered persons in a prison setting.”Member’s explanatory statement
This amendment requires the Secretary of State to publish a review of the impact of the provisions of the Act on prisons and to assess whether the Act provides for adequate support for ongoing treatment and care in these settings.

--- Later in debate ---

[Baroness Fox of Buckley (Non-Afl)]

My Lords, after all that excitement, I fear I may be a bit of an anticlimax, but I will carry on regardless—and let people walk out. My Amendment 160A calls for a review of the impact of the Act on the prison estate and the ongoing treatment and care of mentally disordered people in a prison setting a year after the Act passes. We have all welcomed the Bill’s commitment to ending the use of prison cells as so-called places of safety, but as some of us noted in the debate on an earlier group, the promise of, for example, a transfer to hospital for prisoners facing acute crises within 28 days is widely viewed by criminal justice stakeholders as unlikely to happen. We need to review whether such cynicism is merited, because the prison reform aspects of the Bill are not minor. They should not be treated as Cinderella clauses: they are, to my mind, crucial.

We cannot pass this Act and leave prisoners who ought to be in hospital beds abandoned in squalid conditions in jails. Additionally, it is not fair to prison staff because, to quote Andrew Neilson from the Howard League:

“Our overcrowded prison system that has been asked to do much, with too little, for too long, is ill-equipped to help people who require intensive support for their mental health”.


I recently visited Five Wells prison in Wellingborough with my Academy of Ideas hat on. The new leadership team at Five Wells is doing some fantastic work on purposeful rehabilitation activities, and we hope to do a joint project of Debating Matters Beyond Bars with it there. I chatted more generally to the team members, who have worked in a variety of prisons over the years, and they all noted that the time and emotional strain on staff when dealing with psychotic and very poorly prisoners—they gave gory examples of prisoners eating their own faeces or making very bloody attempts at self-harm, et cetera—have been totally demoralising for officers. It may have been one of the reasons for the use of the segregation units I talked about earlier. But these things have also had a destabilising and frightening impact on other prisoners. Sharing space with those with paranoid delusions and who present a violent threat to themselves and others is no joke; it makes prison difficult for everyone. So it is crucial that we get this right in the context of an overstretched prison crisis, and a specific view would focus minds.

I also think that we cannot let the Bill pass into law without acknowledging that there is considerable public disquiet about the relationship between criminal justice and mental health care. What do we do about the detention of those convicted of serious crimes due to diminished responsibility, where professionals see secure hospitals as more appropriate than prison? I am sure we can all recognise that, for many victims and their families, this hospital option can feel like an injustice.

I am, of course, thinking of the high-profile and controversial case of Valdo Calocane. According to the recently published independent investigation, it was repeated failures to treat Calocane’s paranoid schizophrenia and violent outbursts that left him free to kill Barnaby Webber, Grace O’Malley-Kumar and Ian Coates in June 2023. More pertinently in relation to the Bill, the families of these tragic victims fear that Calocane may have been spared prison due to incomplete evidence presented in court, especially about his mental capacity. This is now exposed in the 302-page investigative report, and the families have concluded:

“This was a man who actively avoided his medication and treatment, knowing that when he didn't take his medication he would become paranoid and violent”.


This is interesting for our deliberations, because we now know that the doctors responsible for Calocane’s case repeatedly ignored the nurses treating him in the community, who begged for him to be put on a CTO to ensure that he took long-acting anti-psychotic drugs. Why were they ignored? It seems that the clinical team at Nottinghamshire Healthcare Foundation Trust made decisions “influenced” by the draft Mental Health Bill 2022. Those medics were very conscious of legislation down the line that seeks to raise the threshold of detention and reduce the use of CTOs, and of the call for a reduction of compulsion in medicating patients in the community. Then there is the issue of patient rights, in Calocane’s reluctance to take medication because he did not like needles. Staff were, we are told, acutely aware of the Bill highlighting the “disproportionate” use of restrictive practices on black African or black Caribbean patients—and so on and so forth.

--- Later in debate ---

Addressing the mental health needs of offenders as a critical element of tackling the root causes of offending behaviour, which is of the utmost importance to this Government. I hope this reassures the noble Baroness that we agree on the importance of ensuring that those with severe mental health conditions receive the necessary support and that we are committed to continuing to review and improve this area in future. It is for these reasons that I urge her to withdraw her amendment.

[Baroness Fox of Buckley (Non-Afl)]

Briefly, I say thank you very much to the Minister, the noble Lord, Lord Timpson, who obviously has an intimate and empathetic relationship with the prison estate and the issues that I was raising. I appreciate that he and I share very similar concerns. The difficulty is—I do not think it is just the hour—that the Bill says it will resolve things in relation to prisons but, actually, the discussion around prisons has been rather neglected. I understand why.

The reason I mentioned Mr Calocane is that a lot of the issues in the community and a lot of the public debate about mental health concern the notion of people being ill, wandering around, not being safe and so on and so forth, and I could not think of another way of raising that here. That then affects the prison estate, because people phone the police and then people get taken to prison—or they have been let out of prison when they are mentally ill, and so on and so forth. That is one thing. It requires much greater scrutiny and debate, not just through this Bill but in general in Parliament: that is the first thing. I also think that we have not got public opinion our side on this, in many ways. People are not sure why people are sent to prison in some instances and to hospital in another. I do not expect the Minister to reply, but I think that needs to be acknowledged.

Secondly, I note that, even though I used the example of Five Wells prison, if all the awful things were not happening there, it was based on prison officers’ experiences in many places. I do not want in any way to put the prison into any difficulties, because it is actually doing a very good job in very difficult circumstances. I will just say that I think that, on paper, this Bill will make a small impact, but I think there is much further that it could go. I am glad to hear that different groups will be taken seriously. I withdraw the amendment, but I think we have a long way to go and I will keep pursuing this. I thank noble Lords who spoke in support; I really appreciate that.

Amendment 160A withdrawn.

--- Later in debate ---

[Baroness Tyler of Enfield (LD)]

My Lords, I rise quickly to say that I am very sympathetic to the aims behind these two amendments. They have been set out very powerfully and comprehensively by the noble Earl, Lord Howe. I feel, particularly, that an obligation to publish a report of an investigation of the type we have just heard about is absolutely essential if we are to avoid a repetition of these terrible events. There must be a way of learning lessons from this, and transparency and publication are an important part of that.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I was pleased to see these amendments as well. The noble Earl, Lord Howe, explained why they are important. He has conceded—I tried to imply the same in my own amendment—that it is not necessarily clear how best to raise these issues, but that we need to. If we are seen by the public discussing a mental health Bill, going through the whole thing and refusing to acknowledge one of the big controversies of recent times, which was a mental health issue, it will discredit the Bill when it becomes an Act.

In relation to the reluctance of the NHS trust to publish its investigation and the use of patient confidentiality, I note that the families of the victims saw this very much as an excuse and were very angry about that. It does not help us to have a discussion with the public about mental illness because it then seems as though murder was committed but, somehow, mental illness was used as an excuse. We have all heard that argument being used; that is why I referred to the fact that there was some dispute about whether Calocane should be sent to prison or to hospital. The more openness that we can give this, the less stigma and confusion there will be. We need to have this debate out in the open.

Finally, I have a question on the judge-led inquiry and what we now know from the investigation by the trust. How will that impact this Bill? How, practically, will we be able to incorporate what we have learned from that into our discussion on a whole new piece of legislation on mental health? It would seem that we need to be able to take on board some of the recommendations of the inquiry and what we now know from the investigation by the trust.

[Baroness Merron (Lab)]

My Lords, I thank the noble Earl, Lord Howe, for tabling Amendments 160BA and 160BB, supported by the noble Lord, Lord Kamall, and spoken to by the noble Baronesses, Lady Tyler and Lady Fox.

I say at the outset that I understand the deep concerns raised today by noble Lords. I would like to take this opportunity to express my sincere condolences, and I am sure those of the whole of your Lordships’ House, to the families of Grace O’Malley-Kumar, Barnaby Webber and Ian Coates. The Secretary of State and I have met the bereaved families following these horrific killings, and, rightly, important actions have been taken, which the noble Earl, Lord Howe, asked about. Indeed, we have to look at what improvements must be made, both at the trust and across the country.

To take this further, NHS England and the Nottinghamshire Healthcare NHS Foundation Trust have accepted all of the recommendations made following the Section 48 CQC review into this incident, and action has started on implementation. The recently published independent investigation into the care and treatment provided to Valdo Calocane makes a series of recommendations, which NHS England and the Nottinghamshire Healthcare NHS Foundation Trust have accepted. I reiterate that the Government expect to see swift action to ensure that the recommendations are implemented as soon as possible. As the Prime Minister has confirmed, and as the noble Earl, Lord Howe, acknowledged, there will be a judge-led, statutory public inquiry into this tragic incident.

I now turn specifically to the amendments, and first to Amendment 160BA. We recognise the importance of transparency when there are concerns around a patient’s care, to enable a full understanding of what went wrong and how learning can be applied as a result. The courts already have legal powers to request, and where appropriate compel, disclosure of relevant reports, ensuring judicial access to relevant information. In criminal and civil proceedings, courts can make orders that particular information be provided, or issue witness summonses, while coroners can obtain documents as part of an inquest. There is no clear evidence that courts face systemic barriers in accessing necessary information.

There are also existing mechanisms to provide robust oversight and transparency. NHS England’s patient safety incident response framework sets out clear guidelines for responding to serious incidents involving patients who are detained under the Mental Health Act. Additional scrutiny is provided through investigations by the Health Services Safety Investigations Body and oversight from the CQC.

If information is not disclosed, interested parties already have mechanisms to access information, including judicial review, freedom of information requests and the coronial process for deaths in detention. While courts have the powers set out in the amendment, we absolutely recognise the importance of openness in mental health services, which is why officials are working with NHS England to ensure that information from investigations is as transparent as possible—something that all noble Lords have rightly referred to.

Mental Health Bill [HL]

Baroness Fox of Buckley Excerpts

Committee stage
Monday 24th February 2025 Lords Chamber

[Baroness Neuberger (CB)]

My Lords, I will speak very briefly in support of Amendments 163 and 164, to which I have added my name, and particularly about the length of time, the five years.

We first started talking about the reforms to the mental health legislation eight years ago, when we set up the review of the legislation under Sir Simon Wessely, and I was the vice-chair. It reported in 2018—seven years ago—and it was not even a very radical rethink of our mental health legislation. Yes, it will make a lot of difference to a lot of people—service users are very keen for this to come about, and they certainly do not want to wait longer than five years to see all the measures come into force—but this is relatively gentle stuff. At some stage we will need a much more radical rethink of our mental health legislation. Five years is quite a long time, so I rather hope the Minister can give us some comfort by saying that most of it will be done in two years, or perhaps three years at the outside.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, first, I support Amendment 130 in the name of the noble Lord, Lord Scriven. I have been concerned, as we have discussed this Bill, that costs are likely to spiral. I am not objecting to that, but it seems to be the elephant in the room. Unless we know, the Bill will become a white elephant because people will just say that we cannot afford to do it. It is far better to have transparency, as has been argued.

Secondly, I oppose Amendment 153. For a number of reasons, I do not think we should prohibit for-profit entities being involved in this endeavour. The suggestion is that if we remove the profit motive, all will be well. A word of caution: not-for-profit organisations are not necessarily the most efficient, virtuous organisations, as we might imagine. In the charitable sector there are some worrying trends of money being spent, rather self-indulgently, on staffing and on all manner of extraneous and sometimes politicised endeavours.

We have seen the emergence of EDI—equality, diversity and inclusion—policies, which the Health Minister, Wes Streeting, has worried about happening in the state sector, and we have seen them become absolutely rampant in the charitable and not-for-profit sector. I want us to concentrate on the people the Bill is designed to help and therefore not to have our own political idea that only the state can deliver well—I just do not believe that is true.

For example, I have done work in prisons over a period of time—that also relates to the Bill—and have worked in both private and state-run prisons. Some private prisons are awful and some state-run prisons are worse—and, by the way, I have worked in some brilliant state-run prisons and some brilliant privately run prisons. We should judge on the basis of the quality of the care or the service that they provide, not some prior presumption that because they make profit they might be useless, somehow evil or not attending to their core mission.

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[Baroness Browning (Con)]

My Lords, I too was pleased to add my name to Amendments 155 and 156 in the name of the noble Baroness, Lady Hollins. She has already spoken on this subject, and it would be remiss of me not to say that the title of the report she mentioned, My Heart Breaks—which is of course in her name and authorship—was chosen for a purpose. This is a heartbreaking situation, and on the piece of paper I am holding in my hand, headed GOV.UK, it says: My Heart Breaks—Solitary Confinement in Hospital Has No Therapeutic Benefit for People With a Learning Disability and Autistic People.

As we have heard, it is not just that it is not therapeutic; it is actually harmful. On the terminology, other speakers have already spelled out why they have dumbed down the real raw facts of the language that they use to describe this type of incarceration—for that is what it is. It reminds one of prisons. Look at the legal structures needed to put somebody into a prison, yet people who are ill are treated in the same way as prisoners.

I remember visiting a school for autistic children many years ago. It had a single room where they took children who were having a meltdown. It was a padded room, and they felt that was the appropriate treatment for children. We know, from the many debates in this House about people who have been held for extended periods in mental health hospitals, the damage it does and the difficulties when these practices are in place.

Ironically, this does not happen everywhere. You have to ask why it happens in some institutions and not in others. There is an answer to that. It is not because of a different profile of patients in these two different types of settings but because in some places they understand the problem and have sufficient training and resources. Training of personnel, particularly senior personnel, is key. If the person in charge says, “This is what we are going to do”, very few people in the structure below them are going to challenge it, so that is what they do and it becomes the norm.

Fifteen months ago the noble Baroness, Lady Hollins, produced this report, which now bears government approval and GOV.UK and the Department of Health and Social Care on it. It is now really time for the Government to adopt the amendments from the noble Baroness, Lady Hollins, and her recommendations. It is a wealth of experience that we can only admire, and I urge the Minister to please accept these recommendations. They come from the very highest level. We are very lucky in this House to have the expertise of my dear friend, the noble Baroness, Lady Hollins.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I will speak very briefly and on a slightly related topic. I want to talk about a different group of people who are in long-term segregation who are not sectioned and often do not get mentioned—prisoners. Long-term segregation is used when very mentally ill people in prison are not transferred to hospital and nobody knows what to do with them. They are put into isolation and left there, psychotic, delusional and forgotten—dumped, in effect.

The noble Baroness, Lady Browning, alluded to prisons, but even prisoners should not be treated like prisoners sometimes. The confusion and conflation of punishment and treatment outside prison is no less shocking when it is inside prison. You are not meant to punish somebody doubly because they are in prison and happen to get ill.

The Chief Inspector of Prisons, Charlie Taylor, has made the point that the segregation units are completely unsuitable for people who are severely unwell. They are also a significant drain on the hard-pressed staff, because very often the restraints are of people literally going out of their mind. They are not getting any medical intervention at all. According to the chief inspector, it requires multiple officers to unlock the cells even just to deliver meals.

Is it possible for the Minister to give any thoughts on that? Also, in a way, this is an appeal to the noble Baroness, Lady Hollins—if she takes this amendment forward—to bring that into the situation, even though I know I am slightly squeezing it in because I have Amendment 160A on reviewing prisons.

On Amendment 146 and the use of force, I absolutely agree with the mover of the amendment in relation to the need to keep records. That is obvious. I suppose the nightmare for us all is the misuse of force. It is horrifying—the stuff of nightmares—when people are ill.

I do not want to be naive. I know that when people are very ill and very psychotic, sometimes appropriate force is necessary; I just think it needs to be recorded. When I say force, I obviously do not mean violence or anything not within the realms of professional intervention. Sometimes I think we forget how ill people can be and how violent and how difficult it is for the people who work with them. We should record every instance of the use of force but be wary of demonising or damning every use of it, because it is not quite as simple as that.

[Baroness Watkins of Tavistock (CB)]

My Lords, I support all three amendments in this group but make the point that a lot of NHS care is now commissioned into the independent and charitable sectors. It is vital that records are kept in any care setting that is paid for by the NHS, not just by NHS facilities. I also believe that recording will reduce these kinds of behaviours because it will make people think much more carefully, particularly in long-term segregation. As you get to 10 days, people will be thinking, “How can we change the care we are delivering to avoid that 15-day reporting sanction?”. It really is imperative that we do this. We are treating some of the people who have the greatest needs in our society really badly.