Medical Devices (Amendment) (Great Britain) Regulations 2025

Lord Kamall Excerpts

Tuesday 6th May 2025 Grand Committee

Finally, I think that the Minister said that existing EU regulations will remain in force in Northern Ireland, but will that not potentially create trade barriers across the Irish Sea, although—I accept—it will prevent them occurring between Northern Ireland and the EU? Therefore, would not a UK-EU-wide regulation make much more sense in future?

[Lord Kamall (Con)]

My Lords, I thank the Minister for introducing this statutory instrument. I want to be clear that we on these Benches recognise the need for this measure, since, without it, key regulatory provisions would expire at the end of this month, as the Minister explained. That would create uncertainty and risk disruption to the oversight of medical devices in Great Britain.

We understand that this instrument is, in essence, a stopgap, as the Minister said, and that the MHRA’s consultation, particularly with small and medium-sized enterprises and clinicians, demonstrated strong support for continuity. But while the measure preserves the status quo for now, it has provoked some questions about the Government’s long-term strategy. I am grateful to the Minister for reassuring us that this is definitely a temporary stopgap and that they are looking for a longer-term and more pro-innovation solution than when we were in the EU.

As the Minister said, this revokes the sunset clauses in four areas in particular: performance standards for diagnostic devices, electronic instructions for use, the regulation of devices containing animal tissue and the designation and oversight of approved bodies. These are not mere technical footnotes; they are essential to ensuring safety, clarity and public confidence in the medical device sector, so we understand that revoking their expiry is necessary to avoid disruption.

Can the Minister add any more detail at this stage to what she has already said? This first phase, focusing on pre-market regulation, is expected in 2026. What further reforms are expected to follow? I know that she explained some of that in brief—I suspect that she did not elaborate as much as she could have for reasons of time—but can she say a bit more about the future plans for this regulation? If she cannot now, perhaps she will write to me, because that was a very welcome move. I was going to ask lots of questions about whether the short-term fix will remain in place for the long term, but the Minister has reassured us. Nevertheless, perhaps she could set out some more details either today or in writing.

I do not believe in regulatory divergence for divergence’s sake, but let us be clear that neither should we agree with regulatory alignment for the sake of regulatory alignment. I understand the concerns of the noble Lord, Lord Rennard, but I recall that, when I was a Health Minister, many a supplier—regardless of whether they supported the UK leaving or remaining in the EU —asked me, “Now that we’ve left, can we take advantage of our independence and develop a more pro-innovation approach than the EU?” In technology—I spent 14 years in the European Parliament—the EU was known as an area for regulation; if you wanted innovation, that was in the US. We have to get a better balance between the two. Whereas the EU focuses more on the precautionary principle and less on innovation, perhaps we can get a better balance in this country, so that we do not align for alignment’s sake.

The Minister also mentioned Northern Ireland. As we know, as a result of what noble Lords, said there are some concerns in Northern Ireland but, given that the EU is seen as an area generating regulation, should the EU impose additional regulatory burdens on businesses in Northern Ireland? What steps will the Government take to support them to protect their competitiveness? That is one of the concerns I know from the most pro-innovation businesses in Northern Ireland.

Finally, on international trade, not strictly within the remit of these regulations, so I hope the Minister and her officials will forgive me—this does not have to be answered straight away—has the Minister or the department assessed the impact of recent US tariffs on medical device imports? Does the UK import a substantial number of medical devices from the US? I know that we talked about the importance of the US as an export market. Will these tariffs have an impact on medical devices from the US, particularly those that have been made with components imported from outside the US into the US before being re-exported? Does that have a price implication? Have the Government made any assessment of the implications for availability, cost and affordability, particularly for NHS procurement? Clearly, as the noble Lord, Lord Rennard, and others said, there is the impact on medical device suppliers exporting to the USA. Has any assessment been made of that market? Across the House, we all want a thriving life sciences sector in this country, but we should be assessing the impact of the proposed tariffs. I know some of them have been in abeyance.

I recognise that I have asked many questions, and I do not expect the Minister to have all the answers straight away, despite the advances of iPad technology and wireless communication. Maybe one day that will extend to telepathy. Perhaps the Minister can write to me on the questions that she is unable to answer today. In drawing my remarks to a close, I will be clear that noble Lords on these Benches support this measure as a necessary step to prevent regulatory disruption, but the real test follows. I hope the Minister, in answering the questions, is able to share a clear timeline for the programme for reform as we hopefully move towards a more pro-innovation approach.

[Baroness Merron (Lab)]

I am grateful to noble Lords for their valuable contributions and the way in which they have raised issues relating not just to the statutory instrument before us but this whole area of important work. I am also grateful for the support more broadly on the need to get the legislation right in order to protect patients, get the best medical technology within our grasp and support innovation. I am sure we will return to this subject. I will respond to a number of the points, and I will come back to noble Lords on anything significant that I have not responded to.

I reiterate that this SI is essential if we are going to prevent what I would call significant disruption. The words used were “a stopgap”. I think that is a fair legal term in this setting. It will preserve the status quo as we progress to more comprehensive regulation, which I know is what noble Lords are interested in.

The noble Baroness, Lady Finlay, asked for an assurance that we would not jeopardise not just the European market but other markets because we need to export technology. That is a fair point. I can say in response that over recent years we have learned important lessons from the implementation of new medical devices regulations in the EU as well as the global approach to regulation. How has this informed our approach to regulatory reform? It is why the Government are taking a phased approach to the delivery of these regulations to support the sector and adapt to the changes. It is also the reason why we are in continued discussion and are working closely with the sector.

We recognise the benefit of international harmonisation of medical device regulations in order to reduce, as we would all like, unnecessary regulatory burden or duplication of assessment for manufacturers, which is something that has been raised many times with me and I am sympathetic to. This means that, where sensible, we will align with the regulations of other jurisdictions, including those in the EU. Any reform to assimilated law will be to support domestic priorities and the Government’s national health and economic growth missions.

The noble Lord, Lord Rennard, raised a number of points. He raised the issue of products being subject to EU and UK regulations and whether this would make tech companies less likely to innovate. I believe the noble Lord also argued that we should be in line with the EU, and he raised the important issue of Northern Ireland. On these points, we will seek to align with international best practice and EU regulations where they are sensible, support manufacturers and support where we want to get to on patient safety and the contribution of medical technology.

On Northern Ireland, the MHRA is the competent authority for devices placed on the Northern Ireland market. It continues to have oversight of medical devices across the whole of the UK. We will continue to monitor any risks to the supply of devices to the whole of the UK market. I can give the assurance that, at present, the supply is stable and processes are in place to identify alternatives if needed. My final reassurance is that the SI before us today will not have any impact on the supply of devices to Great Britain or Northern Ireland.

The noble Lord, Lord Kamall, also raised a number of key points and requested more detail on what further reforms are expected to follow. He also raised regulatory alignment, making the point that, in his opinion, the EU can be more cautious and asking how we as a country can be more innovative. The noble Lord also asked about Northern Ireland and about the impacts that US tariffs have in respect of medical devices.

On plans for regulatory reform, the MHRA has published plans to introduce several SIs to amend the framework for medical devices. The post-market surveillance SI, which will come into force in June as noble Lords may recall, represented the first significant step in this reform. That legislation will put in place strengthened legal requirements for how manufacturers monitor and report on their devices once they are being used.

In November last year, the MHRA launched a consultation on further aspects of regulatory reform which will inform a subsequent pre-market SI that introduces, among other things, a new international reliance scheme, measures to improve traceability of implantable medical devices, more risk-proportionate changes to the classification of certain devices and the prohibition of misleading claims. We expect that legislation to come into force in 2026. I think that all those will put us in a much better place than we are currently, because they will allow us to keep pace with changes in the market.

The MHRA also continually monitors the UK’s medtech landscape for developments that could affect patient safety and the implementation of regulations. Details of further regulatory proposals will be communicated when available, and I look forward to bringing those before your Lordships’ House.

On US tariffs, there are ongoing discussions, and I will not seek to pre-empt them. The MHRA will monitor any impacts once they become clearer. That is very much under a watching brief.

I hope I have demonstrated the need for these regulations, not just for the public currently but as being key to the forthcoming 10-year plan. I hope that the Committee will agree that we are continuing with this assimilated law to prevent significant disruption to the current framework and to ensure that patients, device users and the economy are all protected.

Dementia and Alzheimer’s Treatments

Lord Kamall Excerpts

Thursday 1st May 2025 Lords Chamber

[Baroness Merron (Lab)]

We are abolishing NHSE. It is the biggest quango, and we are finding immense duplication. At this stage, I cannot comment on the exact matter to do with the team, but I can say that dementia work continues to be a very high priority, as I hope the noble Lord heard from my commitment to the noble Lord, Lord Evans. Indeed, we are keen to support not just those at risk of dementia but those who care for them. This is an expanding area of work. We have much good practice to draw on and we are extremely active, as the noble Lord has heard, in developing research to move further forwards more quickly.

[Lord Kamall (Con)]

My Lords, I thank my noble friend Lord Evans for raising this issue. We know that, often when a new drug is developed, even though some patients may benefit, it may initially be too expensive for NICE to recommend, based partly on a cost-benefit analysis. We know that eventually the price falls to a level which the NHS can afford and which can then be seen as good value for taxpayers. Given that this happens with many new drugs, have the Government considered convening a group of philanthropists, foundations, charities and other civil society organisations that might be willing to fund treatment for some, if not all, patients when new but expensive breakthrough drugs such as those my noble friend Lord Evans referred to are available but are considered too expensive initially?

[Baroness Merron (Lab)]

We are very open to all sorts of creative ways of dealing with the matter, but it is important to say on the drugs that we are discussing that lecanemab and donanemab can only slow the progression of the disease by between four and six months. The challenge is not just whether it is available on the NHS but how helpful it is. We have a lot of progress to make, and that is why we are committed to ensuring that new treatments can quickly become available and that prevention is key.

Prosthetics for Amputees

Lord Kamall Excerpts

Thursday 1st May 2025 Grand Committee

[Lord Kamall (Con)]

My Lords, I congratulate my noble friend Lord Mackinlay of Richborough for securing this debate. I also pay tribute to him for his courage in the various battles he has faced in recent years, and for his determination to come back and return to public life. I have to say that I am simply in awe of him, but I hope that does not come across as patronising or putting him on a pedestal either. Based on his own experience, he is fighting for the causes dear to him, and he can talk about it in a meaningful way based on his own experience.

I also thank my noble friend Lord Shinkwin for warning us about placing disabled people on a pedestal, something that I think we ought to be aware of, and for adding the issue of orthotics to this debate, which is very important. I thank my noble friend Lord McColl for explaining his experience. I think in those days the official term was artificial limbs, when he worked on that group, when asked by the Prime Minister at the time, Margaret Thatcher. I thank the noble Baroness, Lady Ludford, for sharing her experience based on diabetes and living with someone with diabetes.

I have two early experiences of prosthetics or artificial limbs—whatever language it was, given that I was born in the late 1960s—and one is storybooks and Long John Silver. In some ways, from what my noble friend Lord Mackinlay said, the service has not really moved on from that. We talk about Captain Hook and people are still being asked to have hooks. The second experience was a friend of my brother who was deaf and had type 1 diabetes. During the time we knew her she went blind, lost limbs and sadly died far too early. I really relate to the point the noble Baroness made. One of the issues for all type 1 diabetics—I say that, having a type 1 diabetic in my family—is to look after your limbs and the extremities of your body and get regular check-ups, as well as controlling and monitoring sugar.

Having heard the speakers, I think this is a matter of both policy and principle. Ensuring that amputees receive timely and appropriate prosthetics is more than simply a healthcare issue; it is a matter of dignity, independence and fairness. Those who require access to these services are those who have faced illness, trauma and those who may have suffered injuries while serving their country in many ways. My noble friend rightly raised the issues with current NHS provision of prosthetics. In this speech, I will look at two main challenges.

First, there is the issue of the workforce, which seems ironic; I see a smile from the Minister. As my noble friend said, skilled prosthetists are not being replaced quickly enough. The provision of high-quality prosthetic care is heavily reliant on a skilled workforce. I thank my noble friend for going into the details and making us all understand the importance of that. My noble friend highlighted training deficits in the field of prosthetics and orthotics. Noble Lords will know that Health Education England has acknowledged these challenges and is working to improve the education and training of prosthetists and orthotists.

I remember, when I was a Minister, the noble Baroness who is now the Minister and others rightly raised issues about the workforce and workforce planning. After pressure from noble Lords at the time, including from the noble Baroness who is now the Minister, the previous Government eventually published the NHS Long Term Plan to address some of these workforce challenges. But in this area, if we look at the numbers, the baseline training intake for 2022 was 57. The workforce plan looked to increase that to 89 per intake. It identified that between 25% and 50% of prosthetists could be trained via the apprenticeship route as part of an expansion of apprenticeships for allied health professionals. This is, as anyone can see, only part of the solution, and there is always more that needs to be done.

Can I ask the Minister to inform noble Lords how the Government will build on some of that work? Going from 57 to 89 clearly, for many, is not enough. What work is being done and what thought is being given to increasing that capacity and to making it an attractive career? One hears about the latest technology being used, such as computer aided design, so maybe there is a way of attracting the best engineering students who may never have thought about going into that career. They may have thought about designing cars or aeroplanes, but they might realise that they could put their skills to good use in improving the health, well-being and mobility of many of our citizens.

I know that the 10-year plan is going to be published at some stage. I am not necessarily asking the Minister to tell us what is in the plan, but does she know what consideration is being given to this specific area in the plan? If so, can she share that with the Committee at the moment?

The second issue to highlight, clearly, is inequality of care. Concerns have been raised. Some noble Lords have raised their concerns around a postcode lottery of care for amputees; others have raised other issues. As noble Lords have said, there have been innovations in the technology and expansions in access. Other noble Lords have referred to the NHS providing multi-grip bionic arms since 2022, using electrical impulses from the brain to control movement and representing what is considered the cutting edge of that technology.

However, we have to confront a painful irony: we can have the best technology out there but it is not much good if people cannot get it in the first place or have to jump through a number of hoops to do so. My noble friend Lord Mackinlay spoke about the stages that one has to go through before qualifying for the very latest technology; I wonder whether we can look at those. Is there a cost involved in patients going through all those stages? Could getting them to that final stage be more cost effective? Hopefully, the technology is always evolving anyway, but could we get them to the last stage quicker, rather than them having to jump through all those stages? Is there a way of making it more efficient?

As my noble friend Lord McColl said, it is about looking at the best technology in the world. Rather oddly, I remember a very interesting man I met. He used to be the rabbi of Richmond Synagogue, and he and I got on very well. As a sideline, he started a business based on the latest Israeli technology on prosthetics. In the end, the rabbi gave up, and he and his company developed to sell prosthetics based on Israeli technology to countries in central Asia. I noticed that he is still doing that; it just shows that there is really good technology around the world. It is great that Britain could be at the leading edge, I hope, but it is important that, when you need these devices—limbs or prosthetics—you get the latest ones. It is all very well us being proud of them being built in Britain or whatever, but surely it is better to get the latest technology.

We also understand—this is one of the challenges that we faced in government—the issues of funding for a trained workforce and the extra, increasing demands on health and social care. How do we challenge those? We know that, for example, veterans have in many cases been able to receive care due to dedicated funding streams—we pay tribute to those programmes and support both their continuation and their strengthening—but we have to ask: what can be done for civilians? What can be done for children and the elderly, who face longer-term waits or limited options? In one region, an amputee may receive a personalised limb with integrated sensors; in another, in certain circumstances, they might wait months for a basic replacement. Do the Government know about or understand the reasons for some of these disparities? Have they looked into disparities and understood them, or is it simply about having the workforce in the right area? Is it about the way in which resources are allocated? What steps are the Government taking to reduce some of this unequal geographic access to prosthetics? One of the challenges when I was a Health Minister was that there were always health variances. In some cases, they were the same for all types of health, but, in other cases, it was specific to a particular health or care issue.

This is not just about prosthetics and orthotics; it is also about opportunity. It is about having the ability to walk your child to school or to return to work. It is about having the ability not just to live but to survive—indeed, to thrive—having gone through a very traumatic experience. It is important, whatever our politics, that we think about how we can empower individuals to live their fullest lives. For amputees, that power begins with access to the right limb or limbs at the right time and with the right support. Our amputees deserve no less.

I look forward to the response from the Minister.

Self-harm: Young People

Lord Kamall Excerpts

Monday 28th April 2025 Lords Chamber

[Baroness Merron (Lab)]

The right reverend Prelate makes some key points. I can certainly assure her that I am working with the MoJ on the area she describes, where risk is indeed high, despite the numbers. We must be very alert to that.

[Lord Kamall (Con)]

My Lords, we all know the importance of evidence in driving and developing better policy. Regarding the data, what do we know, what gaps in knowledge are the Government aware of and what are they doing to fill those gaps to drive better policy?

As an aside, how is the department working with, say, local community civil society projects, which may well be working in local communities with people who have self-harmed and survived or who are in danger of self-harming?

[Baroness Merron (Lab)]

The role of civil society is crucial. I have had a number of very helpful meetings and visits, including most recently with the Samaritans. We very much believe that that sector supports the delivery of not just the national suicide prevention strategy, of which tackling self-harm is part, but tackling self-harm where it is not linked directly with suicide.

I refer the noble Lord to the work being undertaken by the multi-centre study of self-harm, which I know will be of interest. It has a long-standing research programme to keep an eye on—more than keep an eye on—and examine self-harm trends, and the findings also inform NICE clinical guidance. Recent research has looked at different ethnic minority groups, the characteristics and outcomes for children under 13 who self-harm, and patterns and risk factors for self-harm among university students—and that is just a snapshot.

Tobacco and Vapes Bill

Lord Kamall Excerpts

2nd reading
Wednesday 23rd April 2025 Lords Chamber

[Lord Kamall (Con)]

My Lords, I begin by declaring my interests as set out in the register. I am an unpaid member of the Academic Advisory Council of the Institute of Economic Affairs and have written for the Politeia think tank, both of which have published on health issues. The former has also examined some of the evidence published by the Government and others on the Bill. As a professor of politics and international relations at St Mary’s University, Twickenham, I am helping it set up its new medical school and am giving it advice on that. I am a visiting scholar at the Vinson Centre at the University of Buckingham, which also has a medical school. I am also an unpaid member of the advisory council of the Startup Coalition, some members of which are health-related start-ups, and some are perhaps even related to smoking cessation. I just wanted to be clear and get all that out.

This has been a long but excellent debate with many speakers—so long, in fact, that I suspect that noble Lords who are members of the informal Terrace smoking club will be longing to reach for their cigarettes or vapes. In detaining them a little longer, I thank all noble Lords who took part in today’s Second Reading. I am also grateful to the Minister for introducing the Bill in her usual clear way, and to her officials for meeting us earlier.

We have heard a range of views. At one end of the spectrum, there are those who believe that smoking should be banned as soon as possible and in as many places as possible. At the other end, there are those who see the debate in terms of freedom of choice and the right to smoke despite knowing the harm that it causes. Earlier today, when I was discussing this with another noble Lord, he quoted Kingsley Amis to me:

“No pleasure is worth giving up for the sake of two more years in a geriatric home”.


I respect the range of views, but in doing so, I think there are probably a few truths on which I hope we can agree. First, smoking is not good for you. That might sound like British understatement; maybe I should go stronger and say that smoking kills and nicotine is addictive. Secondly, the current evidence suggests that vaping is safer than smoking. The current evidence also suggests that not vaping is healthier than vaping. In recognising these three truths, I appreciate that the Government are trying to achieve a difficult balance—or, as the Minister said earlier, a “nuance”—between these two positions. The first is that vaping is a useful pathway away from smoking. The second is: how do we stop young people from taking up vaping and encourage current vapers to quit? The noble Lord, Lord Rook, very eloquently put the case of how we need to tackle youth vaping.

To achieve this difficult balance, we on these Benches want to see the Government making laws based on evidence, but also in a way that is effective, accountable and pragmatic. My noble friend Lord Howe raised the Government’s additions to the previous version of the Bill, especially the huge number of delegated powers. I thank my noble friend Lord Blencathra, a former chair of the Delegated Powers and Regulatory Reform Committee, for highlighting his concerns over criminal offences being made by secondary legislation or even just by delegated powers. That is something that we will probe from this side.

Among these delegated powers are the new powers in Part 7 to expand smoke-free places and impose further restrictions on where people can vape. We will want to probe whether it would be more appropriate to put it on the face of the Bill to make healthcare settings, children’s playgrounds and educational establishments smoke-free, rather than relying on the intention of some future Government. We should also consider the evidence for expanding vape-free areas, given the current lack of evidence about the harms of second-hand vape inhalation, and as that evidence evolves, we should find ways of reacting. I can understand that as an argument for delegated powers, but we have to get that balance right and not use it as an excuse.

We will also want to probe the possible unintended consequences of being seen to treat vaping and nicotine products in the same way that we treat tobacco products. As the noble Baroness, Lady Fox, mentioned, research has shown that approximately 50% of all UK adults believe that vaping is as harmful as, or even more harmful than, smoking. We know that current evidence does not suggest that. This is despite the fact that the NHS website says:

“In 2022, UK experts reviewed the international evidence and found that ‘in the short and medium-term, vaping poses a small fraction of the risks of smoking’”.


It also says:

“Vaping has not been around for long enough to know the risks of long-term use. While vaping is less harmful than smoking, it is unlikely to be totally harmless”.


We will probe whether placing similar restrictions to those on cigarettes on vaping and nicotine products will unintentionally deter current smokers from switching to less harmful vaping products.

A number of noble Lords, including the noble Lord, Lord Dodds, raised the impact of the Bill on small businesses, as did many of my noble friends, including my noble friend Lord Sharpe. Small independent retailers and convenience store owners have faced increased costs, such as the increase in national insurance contributions and the national minimum wage. Whatever their merits, the cost of those increases has clearly been passed on to small businesses.

Some worry about the cost of the Employment Rights Bill and now there is the additional licence fee for implementing the generational sales ban and the advertising ban on nicotine products. There will also probably be further regulations and restrictions under the number of secondary powers in this Bill.

I will quote Gurpal Jhutty, who runs a Nisa local in Leamington Spa. In a submission to the Public Bill Committee in the other place, he said:

“Look, I’m not a lobbyist. I’m not a politician. I’m just a shopkeeper trying to make a living, and I’m writing to you today because the proposed Tobacco and Vapes Bill has me seriously worried about the future of my business. You can consider this a retailer’s plea for common sense … I’m tired of being ignored. Retailers are on the front lines of this issue, and we have valuable insights to offer. Let’s ditch the bureaucratic nonsense and work together to create a policy that actually makes sense”.


Let me be clear: we are not asking to ditch this Bill, but we will probe it to create a Bill that is workable and makes sense.

The noble Lord, Lord Scriven, and the noble Baroness, Lady Fox, have rightly raised concerns about personal liberty, problems with prohibition and the practicality of the measures, especially age differentiation. We have heard both sides of that debate.

Noble Lords, including my noble friend Lord Brady and the noble Lord, Lord Teverson, have pointed out that smoking cannabis is illegal but is pervasive in many parts of London. The point is that this is not a Bill against smoking; it is a Bill against the sale of tobacco and vape products. We have to be clear about that.

Having said that, Inga Becker-Hansen of the British Retail Consortium told the Public Bill Committee on 7 January:

“in 30 years’ time if you have someone who is 45 versus 44 from the date of January 2009, it may lead to ID for each sale of a given product … Points of sale can be a flashpoint for violence and abuse against retail and shop workers, so it is a real concern for retailers”.—[Official Report, Commons, Tobacco and Vapes Bill Committee, 7/1/25; col. 58.]

We will also probe the impact of this Bill on the illicit trade in tobacco and vaping products. HMRC has estimated that in 2022-23 illicit tobacco accounted for 14.5% of the total UK market. Current estimates show that illicit vapes account for about 30% of the total vaping market. A 2024 report by the Home Office’s National Business Crime Centre found that the provisions in this Bill mean that

“the demand for illegal tobacco products is set to grow dramatically”.

We have to be careful about these unintended consequences.

Like my noble friends Lord Naseby and Lord Leicester and the noble Baroness, Lady Hoey, we will want to probe whether restrictions on vaping products could lead to an increase in the illegal trade, leading to a risk of more dangerous and unregulated products being used and finding their way into circulation. We are all united in wanting to tackle illicit and illegal products.

Noble Lords, including my noble friend Lord Murray, have expressed concern that the Government appear complacent about the illicit tobacco trade. While they rely on figures that show a drop in illicit tobacco sales, a Europe-wide report from KPMG—based on looking at discarded tobacco packages, rather than on assumptions and mathematical formulae—reported an increase in illicit consumption in the UK in 2023. I understand why these figures have been dismissed, because the report was funded by a tobacco company; I completely understand that reasoning.

However, I would be interested in understanding whether the Government will commission similar research looking at discarded tobacco packets as a method of understanding the illicit tobacco trade. If they will not, can they explain why—not immediately, but in writing? Could they explain why they have doubts about this methodology and prefer the formula used by HMRC, which has been criticised by many people for the assumptions it makes around smoking? We will be probing the Government on this and on what action they will take to tackle this rise in illicit sales. We know that all noble Lords will agree on tackling illicit sales of illegal products.

Finally, I am a huge believer in the role of local community non-state initiatives that improve people’s health. I have worked with organisations that help to tackle obesity and local financial and other problems. We will probe the Government on what they have learned and can learn from local community initiatives that have reduced smoking. We have not heard enough today about local community initiatives, the people who understand their local communities and the projects in those communities that could reduce smoking. Most of it has been about top-down measures to try and reduce smoking.

Whether noble Lords smoke or not, I hope we are united in our desire to reduce the incidence of smoking-related deaths and share concerns over the rise in youth vaping. I am also sure many of us will want to help the Government achieve an appropriate balance based on evidence, pragmatism and proportionality. I thank all noble Lords who spoke and look forward to the many days of debate ahead.

Mental Health Bill [HL]

Lord Kamall Excerpts

3rd reading
Wednesday 23rd April 2025 Lords Chamber

[Baroness Merron (Lab)]

My Lords, it has been an extraordinary honour and pleasure to take this Bill through the House with my noble friend Lord Timpson. As we are all aware, numerous aspects of the Mental Health Act 1983 are not serving us today. Over the decades, we have seen racial inequalities, inadequate care for individuals with learning disabilities and autism, and insufficient empowerment of patients who have not had an adequate voice.

Reform to the Mental Health Act is therefore long overdue. Many of the processes in the Act are out of step with a modern mental health system and with society at large. It has been a privilege to advance these reforms to deliver the Government’s manifesto commitment to modernise the Act to give patients greater choice, autonomy, enhanced rights and support, and to ensure that everyone is treated with dignity and respect throughout treatment, while ensuring that patient and public safety is paramount.

As noble Lords will be aware, this Bill is the product of the combined effort, over many years, by Members of both Houses and many outside Parliament who have worked for change and to whom thanks are due. I express my sincere gratitude to members of the former Joint Committee on the Draft Mental Health Bill: the noble Baroness, Lady Buscombe, as chair, as well as my noble friends Lord Bradley and Lady McIntosh of Hudnall, and the noble Baronesses, Lady Barker, Lady Berridge and Lady Hollins. The work and careful consideration that went into their rigorous scrutiny of the draft Bill, along with the constructive recommendations made, have undoubtedly strengthened it.

I pay tribute to the former Prime Minister, the noble Baroness, Lady May, who identified the need for modernisation and set up the independent review of the Act in 2017, chaired by Sir Simon Wessely and supported by the noble Baroness, Lady Neuberger, as one of the vice-chairs. Without this, we would not be here today.

I extend my heartfelt thanks to all Peers who have engaged with the Bill’s reforms. In addition to those previously mentioned, gratitude is due to both Front Benches—to the noble Lord, Lord Kamall, the noble Earl, Lord Howe, the noble Lord, Lord Scriven, and the noble Baroness, Lady Tyler. I am grateful to all noble Lords from across the House who have spoken during the various stages of the Bill and engaged with me and my officials over the past few months.

Because I would like to think that I am wise, I also thank my Whip, my noble friend Lady Blake, and my previous Whip, my noble friend Lord Cryer. I thank the Chief Whip and the whole of the Whips’ team and the team in the Leader’s office, including Ayeesha Bhutta and Michael Bleakley. My appreciation, as ever, goes to the clerks, doorkeepers and staff of the House.

I extend my heartfelt gratitude to all the officials who have played a crucial role in the progression of this Bill, and hope your Lordships’ House will indulge me while I give them the honour of mentioning them by name, because I believe they deserve it. Special thanks go to Phillip Dunkley, our Bill manager, and his dedicated team, Callie Mulligan, Sam Monday, Emily Bouldero and Rhys Jose. I am deeply appreciative of the Bill’s senior responsible owners, Kathy Smethurst and Caroline Allnutt, as well as the DHSC officials, including Esther Horner, Hannah Coaker, Alice Devlin, Matt Siddons, Tabitha Mufti, David Nuttall, Jennifer Rhodes, Megan McIvor and Mihiri Seneviratne, and their teams.

Additionally, I want to acknowledge the invaluable contributions of the Government Legal Department officials, Matt Smith, Lizzie Rattee, Nicky Richardson and Tim Spencer Lane, and their wider team, along with my private office staff, including Carl Plane and Yetunde Agaga, as well as Diggory Bailey and Victoria Griggs from the Office of the Parliamentary Counsel.

While I cannot list every individual, I express my appreciation to all officials who have played a part, including officials from the Ministry of Justice. Their unwavering support and dedication have been instrumental in the successful advancement of the Bill, and their work with Peers—as noble Lords across the House will testify—has been exemplary. I am confident that this legislation will make the Mental Health Act fit for the 21st century and give greater and better support to people when they need it. I look forward to it receiving support in the other place. I beg to move.

[Lord Kamall (Con)]

My Lords, as the Minister has said, debating the passage of the Bill through your Lordships’ House has been a pleasure. We have seen a genuine spirit of constructive engagement with a Bill that we all acknowledge will help patients who encounter mental health services, as well as a cross-party desire to improve the Bill. This was not a particularly political Bill; we found alliances across political lines and did not play political games. We wanted to improve the Bill and make sure that patients receive the best possible care. That is a wonderful demonstration of the value of this House.

I extend my thanks to all Peers who took part. I also thank the members of the pre-legislative committee whom the Minister acknowledged. Like the Minister, I acknowledge my noble friend Lady May of Maidenhead, the former Prime Minister, who we have to thank for beginning the process that led to this Bill. My noble friend identified the issue of racial disparities in the use of community treatment orders and wanted to reduce the involvement of police where they are not needed. Even though my noble friend was unable to be in her place to speak to her amendments on Report, I am grateful to all noble Lords who supported them, and I am delighted that the House has decided that they should be inserted into the Bill. We look forward to how that will be debated in the other place.

It was also welcome to see the House rally behind my noble friend Lady Berridge’s amendment to ensure that the process for appointing nominated persons for patients under 16 aligns with the Children Act 1989. My noble friend was crystal clear that there has to be consistency between different Bills, and that we do not want people falling between Bills and into harm’s way. She highlighted this and gave some harrowing examples of what could happen if we do not align these Bills. We have to make sure that we align them as much as possible.

I also thank the noble Lord, Lord Scriven, and the noble Baroness, Lady Tyler, for their dedication to improving community treatment orders and addressing racial disparities. Noble Lords will remember that this is probably the issue that was closest to my heart, and we probed the Government heavily on it. There are still too many racial disparities. We understand that it is a complicated issue, but the Government assured the House that they are looking into the data around this. What do they know? What do they not know? How will they fill that gap and what will they do to address racial disparities? I hope that is something that all noble Lords can agree on.

Of course, I have to thank my noble friend Lord Howe for his stalwart support and advice on this Bill, and for his experience not only of parliamentary procedure but of previous iterations of this Bill. I appreciate his sagacity, and I am grateful whenever he agrees to work with me on Bills—sometimes to curb my schoolboy enthusiasm and keep me on the right path. I am grateful that he has agreed to work with me on the Tobacco and Vapes Bill, which your Lordships will debate later today.

I also thank the Minister—and of course her noble friend, the noble Lord, Lord Timpson—for taking time at the Dispatch Box, and for the fact that the Minister and her officials were always available to meet us to try to iron out some of the disagreements or find compromises. That is very much appreciated by all noble Lords in this House. I thank Ben, the special adviser in her office, for his input, and, in our office, our adviser Jamie Tucker, who was amazing in his understanding of the Bill.

I will end by mentioning a quote that was sent to me and my noble friend Lord Howe from the charity Blooming Change. On hearing that the House had voted in favour of my noble friend’s amendment on mandatory debriefing for mental health patients, a younger person told the charity:

“I genuinely for the longest time felt like I didn’t matter, to anyone or anything, that the universe didn’t need to hear my voice, that what I went through didn’t matter. It took so long to build my confidence and to find my voice … I’m glad I decided to use my experiences to fight for change and I’m so happy our words have made a difference. We will keep fighting for more changes, little by little”.


As the Bill now progresses to the other place, I hope all Members involved will heed those wise words.

[Baroness Tyler of Enfield (LD)]

My Lords, it has been a privilege to be involved in scrutinising and improving this vital Bill, for which we had waited so long. Our debates have been, rightly, exhaustive, and at times—again, quite rightly—passionate. I will make one general observation, which is a point that was made on a number of occasions throughout our deliberations. You get only one chance about every 15 years to reform and modernise mental health legislation, so it is really important to get it right and to include all the relevant issues before the ship sails. Some would like to have seen more fundamental fusion legislation between mental health and incapacity, but that was not on the table, so you work with what you have.

Funerals: Death Certificate Delays

Lord Kamall Excerpts

Thursday 3rd April 2025 Lords Chamber

[Baroness Merron (Lab)]

I do not have the figures to hand, but I would be very pleased to write to the noble Lord. As I said, this is a complex area. The reforms were introduced in September, and it is very difficult to make before and after comparisons. Since 2001, a long-term trend has shown an increase in the median time between death and registration, and that cannot be attributed to death certification reforms. In addition, the reforms are about the introduction of statutory medical examiners as opposed to the non-statutory arrangements that existed before—and there was even more regional variation before September than we are finding now. I assure your Lordships’ House that I am working very closely with officials to understand the reasons for this so that we can take more action.

[Lord Kamall (Con)]

My Lords, I thank the noble Viscount, Lord Stansgate, for the conversation we had about this Question. As we all know, when a loved one passes away, it is a distressing time, and surely delays can only add to that distress. I am sure that noble Lords understand why these reforms were brought about in the first place: they were introduced after a qualified doctor, Harold Shipman, murdered his patients and signed the death certificates himself. In a recent Written Answer on these delays, the Minister for Public Health in the other place said:

“The expectation on doctors and medical examiners is clear … they should complete certification as quickly and efficiently as possible, and the Government is working with all stakeholders to make sure this is the case”.


Can the Minister explain to your Lordships what that means? Is the department simply asking them to complete the certificates, or is it identifying blockages or misunderstandings in the system to help unblock them in order to speed up the process?

[Baroness Merron (Lab)]

The noble Lord’s observations are correct. As I said, it is so important to be timely and sensitive at a time of bereavement. Governments and Ministers have been working to bring in the system over the last 50 years—in fact, it has been overdue for reform for that long, so I am very glad to have taken this action. Introducing this robust system means working with medical examiners as well as the bereaved, so that we hear from them about what has happened. We also work very closely across government, including with the MoJ and the Home Office. As the noble Lord will know, the medical examiner system is led by NHS England through the office of the National Medical Examiner. I reiterate that delays are not due solely to this introduction; it is very important to unpick this issue. We now have better data and get weekly reports, which is helping greatly.

NHS Pensions

Lord Kamall Excerpts

Thursday 3rd April 2025 Lords Chamber

[Lord Kamall (Con)]

My Lords, in the other place, in response to a question from the honourable Member for North Shropshire, the Minister there said:

“HMRC has also confirmed that self-assessment late filing penalties will be waived on appeal in certain circumstances where a member receives a delayed pension savings statement as a consequence of the implementation of the McCloud remedy”.—[Official Report, Commons, 1/4/25; col. 166.]


One of the frustrations that people sometimes have when dealing with government or large organisations is that their advice is not always clear. I want to ask the Minister two questions. Can she explain to your Lordships the specific “certain circumstances” where the penalty will be waived, and can she explain the thinking behind the Government deciding not to waive the penalty for everyone affected, given that responsibility for delays is with the NHS and not with those affected?

Mental Health Bill [HL]

Lord Kamall Excerpts

Report stage
Wednesday 2nd April 2025 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, I have attached my name to Amendment 47, in the name of the noble Baroness, Lady Tyler, and I raised this issue at Second Reading.

A powerful case has already been made for a mental health commissioner, so I am just going to make one comparison here. At the same time as this Bill has been going forward, in the other Chamber I have been dealing with the Armed Forces Commissioner Bill. An Armed Forces ombudsman was created, which in some ways has parallels with the Chief Inspector of Mental Health and the CQC. It was found that that was not effective or strong enough, and now the Government themselves are going for the Armed Forces commissioner model.

There is another parallel. One of the reasons why it is felt so strongly that there needs to be an Armed Forces commissioner model is that members of our Armed Forces do not have the same rights. They have certain responsibilities laid on them and are treated differently from other members of society, which is why they need a special advocate. The parallel with people who are potentially subject to the Mental Health Bill is obvious.

In the health space, I have been heavily involved over the years with the Patient Safety Commissioner, which was initially resisted by the Conservative Government of the time. Eventually the fight was won, and it is now seen to be a huge success. This is a model that we can see working and that is seen to be necessary.

The Government have expressed a desire to get rid of arm’s-length bodies and make decisions themselves. The Government devolve decision-making to those so-called quangos—the arm’s-length bodies—but that is not the case with the Patient Safety Commissioner; there is no parallel here. They are a person who is there as an advocate and to have oversight; they are not making decisions. I do not think the Government can shelter under that umbrella.

[Lord Kamall (Con)]

My Lords, I thank the noble Baroness, Lady Tyler, for, as others have said, the eloquent way in which she introduced her amendment.

I know this is a topic that noble Lords across the House feel strongly about, and I appreciate the arguments in favour of the creation of a commissioner. Indeed, as other noble Lords have said, it was a recommendation of the pre-legislative Joint Committee.

Having listened keenly to what the noble Baroness has said, and having discussed this issue with her and her noble friends, I have to say that I agree with the noble Lord, Lord Bradley, when he says that the landscape has changed. We are now at a time when the Government are looking to reduce duplication and arm’s-length bodies—something that I believe a responsible Opposition should support. We believe it should not be necessary to have a new, separate, independent mental health commissioner.

We were going to group this amendment with the ideas about strengthening the CQC, but that has been ungrouped and we will talk more to it in the next group. When I had some conversations with those who supported the independent mental health commissioner, they said I should look to Children’s Commissioner as an example. I looked at the Children’s Commissioner; it does a great job, but it has a staff of 25, a temporary staff of 31, and expenditure of £3 million. That may not sound a lot of money but I wonder whether that amount of money could be better invested in strengthening the CQC. One of the things about any bureaucracy is that they grow and have more non-essential roles as other bits of legislation bring them in. I worry about the cost and duplication of functions.

I completely understand the argument from those who say that the CQC has not been doing its job and those who have criticised it for being ill-equipped. That is why we tabled our amendment, which will be discussed in the next group, about strengthening CQC functions. However, rather than saying all that now and repeat it in the next group, I do not wish to detain the House any longer. I believe there should be a comprehensive review of the CQC and proper accountability, and I hope we can achieve that without an independent commissioner.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, I thank all noble Lords for their contributions on this fiercely and keenly debated proposal. Amendment 47, in the name of the noble Baroness, Lady Tyler, leads me to say that we continue to be of the strong view that the functions of the proposed commissioner, as set out in the amendment, would clearly overlap with the existing responsibilities of other organisations, most notably the CQC. I must respectfully disagree with the noble Baroness: the CQC has a statutory role in monitoring the Mental Health Act. It publishes an annual report that serves to drive policy improvements in this area.

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[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.

[Lord Kamall (Con)]

My Lords, as I said on the previous group, I will start by speaking to the amendment in my name and that of my noble friend Lord Howe. It would require the Secretary of State to conduct a review into the ability of the CQC to effectively fulfil its role

“in carrying out its duties under the Mental Health Act 1983, and … in regulating the provision of mental health services”.

We have also included proposed new subsection (3), which would ensure that the review of the CQC’s functions will also include an assessment of whether it will be able to “effectively carry out” its new duties under the Bill.

As the Minister will know, in May 2024, Dr Penny Dash was commissioned to conduct the independent review of the operational effectiveness of the CQC. The full report, published in October, found

“significant failings in the internal workings of CQC which have led to a substantial loss of credibility within the health and social care sectors, a deterioration in the ability of CQC to identify poor performance and support a drive to improved quality—and a direct impact on the capacity and capability of both the social care and the healthcare sectors to deliver much needed improvements in care”.

In addition, my noble friend Lord Howe raised the issues arising from his meetings with the charity Blooming Change on a number of occasions. It has raised serious concerns about the CQC’s monitoring activity. We also know that the Secretary of State himself has claimed that the CQC is not fit for purpose, and that there are some fundamental issues with how the CQC oversees the mental health care system.

As we have heard from other noble Lords, one solution would be to have an independent mental health commissioner. Our solution is to call for a review of the CQC that specifically focuses on its mental health functions, to make sure that it does its job properly. The review conducted by Dr Dash comprehensively assessed the CQC’s ability to regulate primary, secondary and community care, but it did not focus on the sufficiency of mental health care regulation. I thank the Minister for the brief meeting with my noble friend and me earlier this week, in which she indicated that she would be able to give greater assurances on this particular issue. I look forward to what the Minister has to say on it, because this is part of our justification for not supporting the mental health commissioner: we want to see a strengthened CQC. We do not want duplication, but, in avoiding duplication, we want to make sure that the CQC does the job it is supposed to do. I hope I can get that assurance from the Minister when she speaks.

I have some sympathy with Amendment 61, in the name of the noble Baroness, Lady Fox, in line with the comments of the former Prime Minister, Tony Blair, but I also have some sympathy with what the Secretary of State said. We thought about whether we could find an appropriate amendment to table on this. We have to be very careful and sensitive about this issue: we in Parliament or officials in Whitehall cannot hope to pronounce on the issues individuals face in their homes or communities. It is about getting the balance right.

The noble Lord, Lord Alderdice, also spoke about the concerns about overdiagnosis, but we cannot just make a generalisation. We have to make sure that the mental health professionals are doing their job, with the right guidance, to ensure that we understand the needs of each individual. For that reason, I thought it was far too difficult—and it would have been insensitive —for me to lay an amendment on this topic. I did not want to go there for that reason. This is an issue that has to be discussed, but we have to do it in the most appropriate way—in a sensitive way that understands those who suffer seriously from mental health conditions.

Let me turn to the amendments tabled by the noble Baroness, Lady Tyler. She and I have both raised the issue of racial disparities. In Committee, I went in very strongly on it—this is the issue that matters to me personally very much, and I shared some of my own experience of racial discrimination. I am as frustrated as everyone else that we still have not resolved the problem to this day; we still do not understand why, disproportionately, black men in particular are subject to detentions and community treatment orders. I asked questions at the time. What do we know? What do we not know? What are we doing to fill that knowledge gap? Once we have filled that knowledge gap, what are we going to do about it? Once again, I thank the Minister and her officials for the detailed meetings that they had with us when they laid out some of the things that they are doing. Could I tempt her to share with noble Lords some of that discussion and her letter, to assure us all that the Government really are on top of that issue, know what they are doing and are going to address these problems?

I was unsure about how effective the provision in Amendment 49 would be. I know that it is not very fashionable for politicians to say, “I don’t know”; we are supposed to make a firm decision one way or the other and agree or strongly disagree. But I wanted to reflect on whether that amendment would represent an additional burden on the healthcare professional, additional cost or additional bureaucracy. Given that we cannot, at this stage, say for sure how this will turn out, I support the suggestion of the noble Baroness, Lady Tyler, to pilot a scheme of a senior responsible person to address racial disparities. If we could pilot it in some places, it would give us the data to understand whether a responsible person would be effective in addressing those disparities. We all know that more needs to be done. We have had successive Governments of all political colours, and we still have not solved this problem. Let us be determined, as a House, whichever party we are, to tackle this problem of racial disparities, and let us make sure that we do it in the most effective way.

I am grateful for what the Minister said on Monday, but I hope that she will give some consideration to what the noble Baroness, Lady Tyler, said about piloting a responsible person to see whether that works. Maybe it will not work, but at least we would have the data and evidence. I would appreciate the Minister giving a more detailed explanation of some of the research that is being conducted to fill that gap, so we can understand why there are still racial disparities and what Governments of any political colour would have to do to address them.

[Baroness Merron (Lab)]

My Lords, I thank all noble Lords for their contributions on this important and somewhat wide-ranging group of amendments.

I turn first to Amendment 48, tabled by the noble Baroness, Lady Tyler. We very much recognise that there are inequalities in the use of the Act between different demographic groups, and particularly that there are significant racial disparities. The noble Lord, Lord Kamall, has rightly expressed some frustration with the fact that we all find ourselves where we are today.

To those points, I would say that these inequalities are explored in the impact assessment published alongside the Bill. I reiterate how grateful I am to Peers who recently attended our round table to examine research findings and ongoing work to address racial disparities under the Act. I am glad to hear that the noble Baroness, Lady Tyler, found it helpful—as indeed I did.

I offer the assurance that NHS England already publishes the Mental Health Act Statistics annual reports, broken down by ethnicity and other demographic information, including gender, age and index of multiple deprivation decile. We are improving the data through the patient and carer race equality framework, and we will monitor these inequalities as part of the overall monitoring and evaluation of the reforms.

Furthermore, as I announced on day one of Report, I commit to update Parliament annually on our progress with implementation, including racial disparities. I also committed to undertake further investigation into racial inequalities under the Act. As far as possible, we want to better understand where disparities are most significant across the patient journey, what drives those disparities and, most importantly, where we can most effectively intervene to reduce those inequalities. I very much look forward to keeping Peers updated on those findings, as the noble Lord, Lord Kamall, has rightly requested.

--- Later in debate ---

I say to the noble Baroness, Lady Fox, that this is an important area, and we are keen to take a closer look and, as ever, follow the evidence. We are looking into the best way of getting into these questions and addressing these issues. I hope that my words and promised actions have given reassurance—

[Lord Kamall (Con)]

I am sorry to interrupt. Just to go back to my amendment on the CQC, one of the arguments for those who believed in creating an independent mental health commissioner was that they would be a voice for the patients. With that strengthened role for the CQC, where is that voice for the patients? That was one of the justifications for those arguing for creating a mental health commissioner. We decided not to support that because we thought that function should be part of what the CQC does. Could the Minister reassure us on that point?

[Baroness Merron (Lab)]

For me, it is about not just somebody speaking for others but getting those voices heard. I hope that the noble Lord and all noble Lords have heard my acknowledgement of the importance of that. Those with lived experience need to be properly heard and their voice amplified. I have given a number of reassurances on that point.

With that, I hope that the noble Baroness can withdraw her amendment.

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[Lord Scriven (LD)]

My Lords, because of the lateness of the hour I will be very brief. These Benches support the aim of the amendment in the name of the noble Baroness, Lady Bennett of Manor Castle. It is important that, throughout all this, there is an element not just of treating the acute phase of mental ill-health but trying to ensure that prevention is there within the health service and across the whole of government, national and local. We believe on these Benches that a mental health commissioner would have been really helpful for that, as they could highlight elements that could help with prevention—but the House has made its decision on that.

I have only one question for the Minister. One of the three shifts of the Government is towards prevention. How do the Government see prevention of mental ill-health fitting into that shift, not just in NHS services but, as I said, across the whole of government, including local government, to determine how they can use their resources and levers to bring about what the noble Baroness, Lady Bennett of Manor Castle, is trying to achieve?

[Lord Kamall (Con)]

My Lords, this will probably be the last time I speak on Report—and I am sure many people are grateful for that. Before I make my last remarks, I want to put on record my gratitude to the Minister, her officials and the Whips for the amount of time they have given us in discussing a lot of these amendments. It is certainly appreciated by our side and, I am sure, by other noble Lords.

Given the time, I will not take another hour. The sentiment behind this amendment is unquestionable. During my time as Minister, I was repeatedly reminded of the need to focus on prevention, and of course I agreed to that. As we know, the noble Lord, Lord Darzi, in his report on the state of the NHS, repeated his emphasis on the shift to prevention. If we believe in parity of esteem, where possible, this should be applied to mental health.

If we can shift from a situation where we are treating patients and repeatedly detaining them, such that they are detained for longer, to a scenario where we can treat and prevent those conditions worsening, our mental health system will be better for it. I am sure that all noble Lords can agree with this. So we strongly agree with the intent here, which is in line with one of the Government’s other intentions: a shift from hospital to community.

However, when I have discussed this amendment with others, I have heard one concern that I am still reflecting on. This amendment states that ICBs, local health boards and local authorities must implement preventive policies. It has been suggested to me that this might be too prescriptive or may place a duty on smaller bodies that may not necessarily have the resources to implement such policies. Those who suggest this tell me that it may appear more reasonable to place that duty on the Secretary of State or the Department of Health and Social Care, which have the capabilities and resources to implement preventive measures. Such a policy could work if the department had to work with ICBs and local authorities, as well as local community non-state civil society organisations, to move towards preventive care. As I said, I am still reflecting on this, but I do not wish to detain the House while I make up my mind. So, with that, I look forward to the response from the Minister.

[Baroness Merron (Lab)]

My Lords, I thank all noble Lords for their contributions on Amendment 63A in the name of the noble Baroness, Lady Bennett. I am grateful for the appreciation of the noble Lord, Lord Kamall —and the appreciation shown throughout Report—for the whole team. Similarly, I reciprocate thanks to all noble Lords and their offices for their assistance in improving the Mental Health Bill.

As the noble Baroness observed, we agree with the intention of the amendment: there must be a focus on prevention and the commissioning of services must reflect the needs of the local community. However, we do not feel that it is necessary to place this requirement in statute. As the noble Baroness knows, the Government are currently co-developing the 10-year health plan with the public, staff and patients. As part of this, we are exploring ways to stimulate the shift from sickness to prevention so that we can deliver an NHS fit for the future.

I turn to the points raised by the noble Lord, Lord Scriven. First, progress is already being made to transform community mental health services. In the last 12 months, more than 400,000 adults have received help through new models of care that aim to give people with severe mental illness greater choice and control over their care. We are going further by piloting the 24/7 neighbourhood mental health centre model in England, building on learning from international exemplars such as those in Trieste, which I know the noble Baroness, Lady Bennett, has taken a great interest in. Six early implementers are bringing together their community, crisis and in-patient functions into one open-access neighbourhood team that is available 24 hours a day, seven days a week. This means that people with mental health needs can walk in or self-refer, as can their loved ones.

ICBs are already required to have policies that reflect their communities under the National Health Service Act 2006, as amended by the Health and Care Act 2022. Section 3(1)(i) of the NHS Act 2006 also specifies the duty of an ICB to commission certain health services, including

“such other services or facilities for the prevention of illness”.

An integrated care board must arrange for the provision of services

“to such extent as it considers necessary to meet the reasonable requirements of the people for whom it has responsibility”.

ICBs and their partner NHS trusts and foundation trusts, including their mental health trusts, are also required to prepare a joint forward plan, which describes how the ICB will arrange for NHS services to meet their population’s physical and mental health needs.

Given that these duties already exist, given the Government’s commitment to a shift from sickness to prevention, and given the progress being made on community transformation and expansion of crisis services, we do not consider that it is necessary to create any additional duties within the Mental Health Act and I hope the noble Baroness will feel able to withdraw her amendment.

Mental Health Bill [HL]

Lord Kamall Excerpts

Report stage
Monday 31st March 2025 Lords Chamber

[Lord Scriven (LD)]

My Lords, I rise to speak to a number of amendments that I have added my name to, particularly those in the name of the noble Baroness, Lady Hollins. In Committee, the whole issue of people with learning disabilities and autism caused a number of concerns. I note that the Minister has gone some way towards dealing with some of those concerns, and it is a tribute to her listening and enaction skills that progress has been made.

I think it would be fair to say that there are still some concerns on Benches across the House about potential unintended consequences for people with learning disabilities and autism if the Bill goes through in its present form. In some areas, I would describe the statement from the Minister as, “It’ll be all right on the night”—but we know that, sometimes, it is not all right on the night, and things will happen.

The noble Baroness, Lady Hollins, puts forward quite an important base for long-term segregation. There is no evidence that it has a long-term therapeutic benefit for people who have learning disabilities and autism, and so the provision for it still being there, without laser-focused monitoring and intervention, is a weakness. The Minister really has to convince the House that the Government have a plan to deal with this.

The worry about having too much faith in the code of practice, as we found out in Committee, is that simple words such as “should” and “must” have very different meanings for whether or not there is a statutory obligation on an organisation. It would be interesting to hear the Minister’s view on the focus in the code of practice and on strengthening the words used.

Amendment 4, to which I have added my name, is something that the House should focus on and understand. Throughout the history of implementation of improvements in mental health and other areas where community carers come in, they have always fallen down on implementation, due to a lack of either funding or resources. Amendment 4 focuses on implementation. As the noble Lord, Lord Crisp, has just said, in the Autism Act 2009 Committee, we heard from two witnesses who said there is a plethora of policy but it is always the plan on implementation that fails. The amendment in the name of the noble Baroness, Lady Hollins, focuses on that implementation and asks that the Government have a real plan to do that.

It was worrying as we went through Committee, particularly when issues were raised about the numbers in the impact assessment, that the Minister pointed out that they are indicative. The amendment in the name of the noble Baroness, Lady Hollins, is required because, if we take a look at the trend of the percentage of total healthcare spend that has been allocated to mental health, including the Government’s announcement last week, we find that there have now been two years in which the total spend will be reduced. That means that some of the good ideas that the Government have mentioned with regard to the implementation of this Bill and community services are potentially at risk.

I do not know whether the noble Baroness will press her amendment, but, if she does, she will have the support of these Benches. We think this is vital, and we are not quite convinced, unless the Minister says something to that effect from the Dispatch Box, that that crack—that real weakness—has been dealt with.

[Lord Kamall (Con)]

My Lords, before I begin my remarks, I express my gratitude to the Minister and to officials for their engagement with not only me but other noble Lords between Committee and now. I know I am not alone in appreciating the amount of time and work that the Minister and officials have put into meeting with us, addressing our concerns, and even having follow-up meetings; that was very much appreciated.

I will speak to Amendment 1, in the name of my noble friend Lady Browning, and briefly address some of the other amendments in this group. We supported my noble friend Lady Browning’s intention to retable this amendment, which seeks to address the loophole which could lead to the use of the Mental Capacity Act to detain patients with learning disabilities but without a recurring condition.

As noble Lords have acknowledged, both in Committee and today, once the legal basis for detention under the Mental Health Act is removed for these patients, there was always a profound risk of them falling under the deprivation of liberty safeguards. Nobody wishes to see extra safeguards introduced into the Mental Health Act for that to be simply replaced with detention by another Act. My noble friend said today that she has received further assurances from the Minister—we are grateful for those assurances—and that she is no longer minded to test the opinion of the House. Had she been minded to test the opinion of the House, she would have had our full support, but I am grateful for the assurances that the Minister has given to my noble friend.

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Moved by

[Lord Kamall]

7: Clause 5, page 11, line 22, after “detained” insert “by a constable or other authorised person”
Member’s explanatory statement
This amendment and others in the name of Lord Kamall seek to introduce a new category of “authorised person” who can carry out detentions under the 1983 Act to offer better inter-agency response. The proposed amendments would remove the need for the presence of police at mental health incidents in the absence of any risk.

[Lord Kamall (Con)]

My Lords, these amendments in my name and that of my noble friend Lord Howe are really amendments from my noble friend Lady May, who unfortunately cannot be in her place today. As my noble friend told the House in Committee, when she was Home Secretary, a recurring concern raised by police officers was being called out to situations where they were expected to determine whether someone was at the point of crisis and what should happen to that individual. As we know, that usually meant taking the individual to a police cell as a place of safety—an issue that is addressed in other parts of the Bill. But police officers continue to be concerned that they are asked to deal with something for which they have no, or insufficient, training or knowledge.

As my noble friend reminded the House, a police presence is also often not good for the individual, as not only is that individual not being given the healthcare support they need, but the presence of an officer in uniform coming to deal with them could exacerbate their mental health situation. Even if the police officer is able to get somebody to a hospital, they might still be required to sit with an individual to make sure they do not harm themselves or others. My noble friend Lady May cited the Metropolitan Police’s evidence to the Joint Committee on the draft Bill, where it gave an example of a patient in A&E who was required to be guarded by eight Metropolitan Police officers over 29 hours to prevent them being a high-risk missing person.

In its letter to the current Secretary of State, the National Police Chiefs’ Council was concerned that the law as it currently stands

“arguably views mental health through the lens of crime and policing related risk, which raises … issues including disproportionality in the criminal justice system, discrimination, adverse outcomes for people suffering with poor mental health as well as increasing stigma attached to mental health”.

I make it clear that, although this amendment removes the statutory demand for the police to be the primary responders to incidents of mental health where there is an immediate risk to life or serious injury, the police will still have a role to play.

The amendments specify that the authorised person attending an individual should be

“trained and equipped to carry out detentions”

and should not be

“put at unnecessary risk by carrying out those functions”.

This is in line with the College of Policing’s 2019 mental health snapshot, which found that almost 95% of calls that police attend that are flagged as a mental health response do not require a police response.

The Minister will be aware that, in the joint Home Office and Department of Health review and survey of Sections 135 and 136 powers, 68% of respondents agreed that all or part of Sections 135 and 136 powers should be extended so that healthcare professionals could use them, provided that they were not putting themselves at risk. Paramedics in particular supported a change, with more than 90% agreeing and more than 60% strongly agreeing.

However, this is not just about the interests of the police and healthcare professionals. More importantly, we need to focus on the individual at the point of mental health crisis. They deserve the right response, the right care and the right person.

I note that the Minister, in our conversations—I appreciate her giving forewarning of this—discussed how the amendment as it stands appears to give the police more powers. I discussed that with my noble friend Lady May before I came to the Chamber, and she was surprised at this and said that it was somewhat disappointing, given the constructive meetings that the Minister and my noble friend have had, and given that the Metropolitan Police said that they were supportive of this move when my noble friend met representatives last year.

There is clearly a difference of opinion here, and we appreciate that we need to find a way forward. I know that my noble friend Lady May is open to discussions with the Minister to ensure that the principle behind these amendments is met. Could the Minister give a guarantee to meet my noble friend and that, following these discussions back and forth, she will be able to bring back an amendment at Third Reading?

The fundamental principle remains unchanged: the role of police in detentions under the Mental Health Act must be reduced, and it must be reduced for the patients’ and the workers’ benefit. If the Government can accept the principle but not necessarily the precise wording, I hope that the Minister will be able to give the assurances that I and my noble friend Lady May have asked for. I am afraid that, if the Minister cannot give the assurance that she can bring forward an amendment at Third Reading, having had discussions with my noble friend Lady May, we will have to test the opinion of the House. I hope that the Minister can help to find a constructive way forward with my noble friend.

[Lord Davies of Brixton (Lab)]

I am extremely pleased that the noble Lord, Lord Kamall, has moved his amendment for the Opposition. I will not be voting for it, but I am pleased that it has been moved because in Committee I moved amendments along the same lines.

I know that my noble friend the Minister agrees with the suggestion that there is a challenge here for the Government—she told me so. This issue is not going to go away, and it would be a constructive way forward for there to be a meeting—I would ask to be included in any such meeting. We are clear about where we want to get to, and that the appropriate phrase is “right care, right person”. I do not think that that is currently being delivered, so something needs to be done. I hope that we can move to a better system, in a constructive way.

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[Lord Kamall (Con)]

My Lords, I am grateful to the Minister for addressing the points that were raised, and I listened carefully to what she said. I had hoped that she would be open to resolving this issue, as I know she is with my noble friend Lady May. However, once again, there is a difference of opinion. As I understand it, amendments brought forward at Third Reading do not have to be only technical amendments and I had hoped that the Minister would give an undertaking to bring back an amendment at that stage. Given that we have a disagreement of interpretation on two issues, I am afraid I think it best to test the opinion—

[Baroness Merron (Lab)]

It might be helpful for your Lordships’ House to know that to fulfil what the noble Lord says, there would be a need for collective agreement to offer a commitment to bring forward an amendment at Third Reading, which I do not have. I emphasise the point made by my noble friend on this.

[Lord Kamall (Con)]

That is entirely understandable. I know the Minister always means well in our discussions and always tries to find a solution, but, given that, it may be helpful to finding a solution if I test the opinion of the House.

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Moved by

[Lord Kamall]

8: Clause 5, page 11, line 33, after “detained” insert “by a constable or other authorised person”
Member’s explanatory statement
This amendment and others in the name of Lord Kamall seek to introduce a new category of “authorised person” who can carry out detentions under the 1983 Act to offer better inter-agency response. The proposed amendments would remove the need for the presence of police at mental health incidents in the absence of any risk.

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[Baroness Tyler of Enfield (LD)]

My Lords, I will very briefly speak in support of this very important set of amendments. As my noble friend Lord Scriven set out on Amendment 11, which I very strongly support, the case for having some conditionality around community treatment orders is overwhelming, including making them time limited and having a second doctor’s certification to confirm their therapeutic benefit. Both are very hard to argue against. They get the right balance between, as we heard in earlier stages, those who want to get rid of the orders altogether and those who feel that we need to tighten up the conditions. The other two review amendments are also very important.

Finally, we need to remind ourselves, as we did at Second Reading and in Committee, that black people are seven times more likely to be on a community treatment order than other members of the population. That is why this is so important.

[Lord Kamall (Con)]

My Lords, I thank the noble Lord, Lord Scriven, for the excellent way he introduced his Amendment 11. I fully support everything that he said.

The suitability of community treatment orders is an issue that has obviously featured heavily in the discussions on the Bill so far. I think that many of us came to the debates on the Bill, having read the Joint Committee’s pre-legislative scrutiny report, thinking that we were going to support the abolition of community treatment orders or be very sympathetic to that idea. However, two contributions gave us a reason to pause and think. One was the personal story from the noble Baroness, Lady Parminter; the other was hearing the noble Baroness, Lady Barker, say that she previously believed that they should be abolished before realising that they are entirely appropriate for a small number of situations or cases. In fact, given that one of the principles of the Bill is imposing the least amount of restriction, maybe they are the least restrictive solution for some incidents.

Having said that, very serious concerns obviously remain about the use of community treatment orders in their current form. Other noble Lords and I spoke in Committee about the overrepresentation of black males, which is what my Amendment 62 intends to address. It was a shame that the deliberations on this issue came so late at night, but I thank the Minister and her officials for their engagement. I asked three simple questions: what do we know about why black people are disproportionately detained? What do we not know? What research and work are we conducting—I know this sounds like a PhD research thesis seeking to generate the research questions so that someone can go from an MPhil to their PhD—and what is the gap in research to generate the questions for the primary research?

I was very reassured by the responses from the Minister and her officials that they take this seriously. They set out in detail the work that they are doing. In fact, the Minister put a lot of that in a letter to me. It would be unfair of me to ask her to read out precisely what is in that letter, because we would be here for quite a few hours, but can she share some of those assurances with the House? It would be very helpful for other noble Lords to understand why, given that letter, I have decided that I will not push my amendment to a vote.

As I said, the noble Lord, Lord Scriven, has struck the right balance. The amendment acknowledges that there are issues with CTOs and allows for their continued use, under restrictions. It is really important that, in every case, there is a review, and 12 months would seem an appropriate time for that review, rather than cases just being forgotten about, people being caught up in other casework or cases falling behind the filing cabinet—if there was another analogy I could use, I would. If the noble Lord, Lord Scriven, decides to divide the House, these Benches will support him.

I look forward to hearing some of the assurances the Minister gave to me and others on racial disparities. I hope also that she can address the concerns of the noble Lord, Lord Scriven.