NHS: Patients with Allergies

Baroness Merron Excerpts

Thursday 12th December 2024 Grand Committee

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

My Lords, I start by congratulating my noble friend Lady Ramsey not only on securing this highly relevant debate but on shining a light on this important matter. I thank all noble Lords for their considered contributions, which were given through experience and with empathy.

As noble Lords have observed, there has been a significant rise in hospital admissions for anaphylaxis over the last two decades and it is clear how increasingly significant this matter is. That means that it is incumbent on us to lift our commitment to improving outcomes.

Anyone with an allergy, and anyone close to somebody with an allergy, knows only too well the considerable challenges and risks in everyday life, as we have heard. Very sadly, there are tragic cases of those who die from severe allergic reactions that could have been prevented. On behalf of all noble Lords, I give my heartfelt condolences to those who have lost a loved one because of a severe and sudden allergic reaction.

I thank my noble friends Lady Ramsey and Lord Mendelsohn for speaking about their children’s allergies and their experiences as parents. I also thank my noble friend Lady Keeley for making reference to her own experience. Noble Lords understand just how serious allergies can be, and the worry and anxiety, rooted in reality, that parents and loved ones feel. I too want to pay tribute to then outstanding charities that support people living with allergies in the UK, including Allergy UK, Anaphylaxis UK and the Natasha Allergy Research Foundation. They all do vital work in raising awareness, providing information and support, and funding research.

Work is ongoing across government, the NHS, voluntary organisations and patient representative groups to consider how allergy care and support could be improved. Noble Lords made reference to the Expert Advisory Group for Allergy, which was established last year, met again just last week and continues to bring together all key stakeholders in order to inform where we go next. I am most grateful to that group.

In addition, last year the MHRA launched a safety campaign to raise awareness of anaphylaxis and provide advice on the use of adrenaline autoinjectors, which have also been mentioned in the debate. A toolkit of resources for professionals to support the safe and effective use of AAIs has also been produced, along with new guidance on their use. The guidance clearly states that prescribers should prescribe two AAIs to ensure that patients always have a second dose available.

I am very pleased that Palforzia, a new treatment for peanut allergy, was approved by NICE in 2022 for those up to 17 years old to help reduce the severity of allergic reactions. The NHS is now legally required to fund this medication for eligible patients, in line with the recommendations of NICE. That means it is opening up a way for thousands of children and young people to access the medication through the NHS.

This Government are committed to improving care for people with allergies and ensuring that they get the care and support they need at the right time and access to the latest treatments. I am aware of the inequalities that my noble friend Lady Ramsey referred to in accessing allergy services. I very much acknowledge the points raised by noble Lords, particularly in respect of the workforce, delays to treatment and care, and lack of information and support that some patients have unfortunately experienced. I consider that to be a situation that cannot continue.

Noble Lords have referred today to the 10-year health plan to reform the NHS, and I am glad that noble Lords, including the noble Lord, Lord Scriven, spoke about the move from treatment to prevention. It is also about moving healthcare from hospital to the community, as well as analogue to digital. A core and central part of our 10-year plan will be the workforce, as referenced correctly by my noble friend Lady Keeley and the noble Lord, Lord Scriven, among others. In our work to prepare for the workforce that we need now and in future, it is vital that we train and get the right staff, technology and infrastructure in place. In acknowledging the points made, I absolutely recognise the need for a multidisciplinary-team approach in this area. That will be part of our considerations.

I remind the Committee that this Government have made a commitment that 92% of patients should wait no longer than 18 weeks from referral to treatment within the first term of this Government. That includes those waiting for allergy treatments. As a first step towards this, following the Budget, we will be delivering an additional 40,000 appointments this week to cover operations and scans and appointments themselves.

With regard to the point about the national lead on allergy services, I understand that there is a need to do more, as raised by the noble Lord, Lord Scriven, my noble friends Lord Mendelsohn and Lady Keeley, and the noble Lord, Lord Kamall. I am absolutely aware that there is no national lead with overall responsibility for allergy services, and of the reasons why noble Lords have raised it. My colleague Minister Gwynne is putting this under active consideration and I will certainly ensure that I raise not just this point, which has been made so regularly to him, but the other points raised in this debate. I will also raise with him the reference made by the noble Lord, Lord Scriven, to rolling out a pilot.

On the point about a meeting, raised by my noble friend Lady Ramsey, I am glad to say that Minister Gwynne met the Natasha Allergy Research Foundation just last week to discuss how care and support can be improved. The department is obviously working closely with Professor Sir Stephen Powis, the national medical director at NHS England, and, as I said, there is active consideration of the point about a national lead. I will alert my honourable friend Minister Gwynne to the point about further meetings.

Once diagnosed, and with a management strategy in place—my noble friend Lady Healy spoke to this point —patients with allergies may be able to be cared for through routine access to primary and secondary care. The Royal College of GPs has added allergy training to the new curriculum and, to support existing GPs, it has developed an allergy e-learning resource. As noble Lords will know, this Government seek to bring back the family doctor, especially for those who would benefit from seeing the same clinician regularly; obviously, that includes those with allergies.

On the transition from paediatric to adult services, which was raised by a number of noble Lords, including my noble friend Lord Mendelsohn, I absolutely acknowledge the challenge there. NICE has published guidance on the transition that we are speaking about, including recommendations on transition planning, support both before and after the transfer, and the development of transition infrastructure.

I turn to some of the additional points made in the debate; I will be pleased to write to noble Lords on the ones that I do not answer. My noble friend Lady Ramsey mentioned research. Research into allergies is funded through NICE—no, it is not. It is funded through the NIHR; I am on it. It always welcomes funding applications. We have also invested in research infrastructure; for example, Southampton Hospital is participating in a three-year trial funded by the Natasha Allergy Research Foundation.

My noble friends Lady Ramsey and Lady Healy, as well as the noble Lord, Lord Kamall, referred to a strategy on allergies. Let me clarify the situation: the National Allergy Strategy Group is developing a strategy, which will come to the department. We will consider it, and its recommendations, carefully.

The noble Baroness, Lady Burt, mentioned appropriate provision in schools in order to protect children with allergies. The Department for Education recently reminded schools of their legal duties and highlighted the Schools Allergy Code. Regulations now allow schools to obtain and hold spare adrenaline autoinjectors, and there is guidance on that.

On the important matter of prevention, as noble Lords will know, we are committed to moving from treatment to prevention. Some research shows that feeding the most common allergy-causing foods to babies and infants before the age of 12 months may prevent or reduce the chance of them developing food allergies. We will continue to look at that.

I am most grateful for this debate, which has shone an important light on this issue. I can commit to us continuing to work on this matter to improve things for those who suffer from allergies and those who are near to them.

Anti-depressants: Cost, Risks and Ramifications

Baroness Merron Excerpts

Wednesday 11th December 2024 Lords Chamber

[Lord Kennedy of Southwark (Lab Co-op)]

My noble friend Lady Merron is now here.

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

I apologise to your Lordships’ House and am grateful to my noble friend the Chief Whip, as ever.

In 2023-24, 8.7 million identified patients were prescribed anti-depressants at a cost of £220 million, compared with 2015-16, when the cost was £270 million for prescriptions to 6.88 million people. The NHS Business Services Authority reports patient prescribing data on an annual basis rather than a running total. All licensed anti-depressants meet robust standards of safety, quality and efficacy, constantly reviewed by the MHRA.

[Lord Alton of Liverpool (CB)]

My Lords, I thank the noble Baroness, Lady Merron, for her reply and for facilitating and attending our meeting with the Medicines and Healthcare products Regulatory Agency. Has she had the chance to read the correspondence I shared with her from the bereaved family of Thomas Kingston, who, like Olivia Russell, committed suicide while using anti-depressants? Has she noted that the coroner intends to issue a prevention of future death report to the MHRA? In the light of this tragedy, what can the Minister do to create a more rigorous approval regime, including greater definition of risk? Given that hundreds of millions of these drugs are issued, at a cost of hundreds of millions of pounds, will the Government establish a longer-term inquiry to ask searching questions about root causes—what is leading to endless repeat prescriptions and driving such widespread reliance on anti-depressants?

[Baroness Merron (Lab)]

I extend my deepest sympathies to the family of Thomas Kingston after his very tragic death earlier this year. We await the findings of the inquest and will act on any recommendations by the coroner as appropriate. While there has been an increase in prescribing, as the noble Lord observes, anti-depressants, for example, are often prescribed for a wide range of reasons—not just for the treatment of depression but for migraine, chronic pain, and ME, among other conditions. The other possible reason for the increase is because of the stigma associated with seeking mental health treatment, but prescribing anti-depressants is never the first port of call—it is just one of the tools in the box to assist people. There are no current plans to conduct a review.

[Lord Patel (CB)]

My Lords, the noble Lord, Lord Alton, did not mention whether we were discussing specific anti-depressants, but the case he mentioned does refer to a group of anti-depressants called selective serotonin reuptake inhibitors. They treat the patient by increasing serotonin levels, but they run the risk of patients having suicidal ideation—the feeling of wanting to commit suicide. In a meta-analysis carried out using 29 research reports, it was found that they are beneficial in the early phase of the treatment of depression, but in later phases the data is less reliable. Are the MHRA and the NIHR working together to look at the evidence available and to produce the appropriate guidance? To avoid a high risk of suicide in people using this group of drugs, it is important to have proper monitoring, which means controlled visits to appropriate health specialists.

[Baroness Merron (Lab)]

I assure the noble Lord that NICE keeps all its clinical guidance under active surveillance to ensure that it can respond to any new evidence that is relevant, including relevant clinically related literature, that could possibly impact on its recommendations. More broadly, guidance recommends that suicidal ideation should be monitored in people with depression who are receiving treatment, particularly in the early weeks of treatment. That includes specific recommendations on medication for people at risk of suicide.

[Baroness Pidgeon (LD)]

My Lords, a study in 2019 found that a third of women were prescribed anti-depressants by their GP to combat symptoms of the menopause. What are the Government’s current assessment of this situation and of adherence to NICE guidance in this area? If the Minister does not have full details to hand, perhaps she can write to me.

[Baroness Merron (Lab)]

I would be very pleased to write further to the noble Baroness. This is a very important point about support for women during the menopause. However, a prescription is made only after discussion with the patient about it and other alternatives, and the clinician has to follow and comply with the guidelines. Patient choice is absolutely key here. Every individual is an individual, and only what is appropriate should be prescribed—if needed.

[Baroness Blackwood of North Oxford (Con)]

My Lords, as the Minister pointed out, SSRIs can be the right choice for some patients, but for there to be patient choice, there has to be the capacity for those therapeutic options. In April 2024, around 1 million people were recorded as waiting for mental health services, 340,000 of whom were children, and over 100,000 had waited for more than a year. The Government have pledged to provide an additional 8,500 mental health staff. Can the Minister say what she will do to increase patient choice and build that capacity?

[Baroness Merron (Lab)]

We have already made a number of commitments, but the noble Baroness is quite right to observe the excessive numbers on the waiting list. We are deeply aware of the distress and continuing difficulty that this causes for many. The noble Lord, Lord Darzi, in his independent investigation, confirmed that about 1 million people are waiting for mental health support as of April 2024. Moving to the 10-year plan will be an opportunity to put mental health services in a different place. In addition to the commitments that the noble Baroness has mentioned, we are providing access to a specialist mental health professional in every school and providing open-access Young Futures hubs.

[Lord Kamall (Con)]

My Lords, I am grateful to the noble Lord, Lord Alton, for organising a recent meeting with the Minister, the MHRA and some psychiatrists, who raised the issue of SSRIs and their side-effects. One concern was that patients need to be aware that one side-effect of SSRIs is to have suicidal thoughts. Therefore, I was surprised to see on the NHS website’s page on the side-effects of anti-depressants that you have to scroll down four or five pages before seeing the warning signs about suicidal thoughts. While we await the review from the MHRA which it discussed with us, will the Government and the NHS look at the advice on the website so that those who are prescribed SSRIs are clearer about the risk of suicidal thoughts?

[Baroness Merron (Lab)]

I would be happy to look at that. However, there have been warnings on the leaflets accompanying medication for some 20 years. It is always a cause to review to ensure that it is most effective. There are at least two sides to this. One is the clinician doing their job to discuss side-effects, including on withdrawal from the medication, but it is important that patients understand it as well.

[Lord Hacking (Lab)]

Is my noble friend the Minister aware of the work of the Charlie Waller Trust, whose directive is to apply awareness among teachers, tutors and so forth of the danger of suicide in the work that they perform?

[Baroness Merron (Lab)]

I am not specifically aware, but I will be glad to look into this.

[Lord Crisp (CB)]

My Lords, I want to raise the issue of dependency on anti-depressants. As the Minister will know, a lot of people have great difficulty coming off these anti-depressants. It is striking that for those using drugs illegally or with substance abuse, there are many services, but there are no services in the NHS for those seeking to withdraw from anti-depressants. This is a major problem. With that in mind, I ask two questions. First, will the Government consider the delivery of a helpline, which has been called for in a number of reviews, so that people can have some access to help? Secondly, will they support an NHS project designed to introduce withdrawal services within the NHS?

[Baroness Merron (Lab)]

The noble Lord makes an important point about the effects of withdrawal from any medication. I am not sure that this is an exact answer but there is the 111 helpline, which has been expanded to refer to mental health services, so people can ring and ask those questions. However, I take his point about withdrawal. We may wish to consider this as we go towards the 10-year plan.

Bread and Flour Regulations 1998

Baroness Merron Excerpts

Wednesday 11th December 2024 Lords Chamber

[Lord Rooker]

To ask His Majesty’s Government, further to the answer by Baroness Merron on 11 September (HL Deb col 1562), whether it remains their intention to lay regulations before Parliament to amend the Bread and Flour Regulations 1998 in 2024.

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

My Lords, I am delighted to be able to say that, a month ago, this Government laid the legislation to introduce the mandatory fortification of non-wholemeal wheat flour with folic acid. We are the first European country to do so, providing pregnant women with protection for their unborn babies from neural tube defects and the devastating impact on families. I pay great tribute to my noble friend and many others in this House who have championed this momentous intervention over a number of years.

[Lord Rooker (Lab)]

My Lords, I thank my noble friend for that Answer. Will she formally thank the Opposition, who spent six years saying no and five years organising the consultations that have led to this decision—just a few minutes ago, I was looking at four Ministers who had answered Questions on this? I do not want to be too negative but, in the department’s extensive press release on the day it published the regulations, why was there not a single reference, even in footnotes, to the Medical Research Council’s work of 1991, which over 80 countries have already followed? Has the Secretary of State picked up the phone to talk to Nicholas Wald, the research scientist who led that work in 1991, which has been followed by so many countries and now, belatedly but welcomely, by his own country, the United Kingdom?

[Baroness Merron (Lab)]

I am glad my noble friend welcomes the announcement that I am making today. With respect to any phone calls made by the Secretary of State, I will gladly find out; I certainly cannot comment at this Dispatch Box. I thank previous Ministers and officials who, over the years, have contributed to where we are. In respect of the delay, all I can say is that I am very glad to be the Minister announcing it today.

[Baroness Manzoor (Con)]

My Lords, I welcome the announcement; I think it is very good news. I also welcome the tenacity of the noble Lord, Lord Rooker. He has done an amazing job, so well done to him. For me, it is important to have a widespread strategy to include folic acid in flour and to look at previous programmes to, say, reduce rickets, to ensure that we do not increase inequalities by not thinking about the outcomes—for instance, ensuring that folic acid is included in chapatti flour.

[Baroness Merron (Lab)]

The addition of folic acid is to non-wholemeal products. Flour is not just used in baking but is in all sorts of other products. That is part of the reason for it being a 24-month transition, and of course industry can act quicker than that. The reason that it is in non-wholemeal flour is that wholemeal is already a higher source of folate. In respect of chapattis, all products will be considered. I should add that some of the transition time is due to the labelling changes that will be required. We are not stopping industry acting quicker, but we are being realistic about how long it will take.

[Lord Krebs (CB)]

My Lords, I congratulate the Government on introducing this legislation and the noble Lord, Lord Rooker, on his tenacity. However, I would like to ask about another vitamin. We know that between one in five and one in six people in the country have low vitamin D levels; the previous Government had a consultation on this back in 2022. Will the Minister update us on what the Government’s policies will be to try to address the issue of low vitamin D levels?

[Baroness Merron (Lab)]

I will be glad to look into that and to update the noble Lord and your Lordships’ House on the matter.

[Baroness Walmsley (LD)]

My Lords, I congratulate the noble Lord, Lord Rooker, on his persistence; these Benches have always supported him. I welcome that more NTDs will be prevented. However, given that we have to wait yet another two years and that the Government’s guidance for women who wish to become pregnant or who are pregnant is to continue taking folic acid supplements, are the Government looking at creative ways of making it easier for them to do that —for example, having them available for free in antenatal clinics or at family hubs?

[Baroness Merron (Lab)]

As I mentioned earlier, while 24 months is a realistic transition, not everything will wait that long. It is the case, as the noble Baroness says, that there is still advice to women who could become pregnant to take folic acid supplements, and it is important that we keep that message going. However, 50% of pregnancies are not planned, so it is not possible to prepare by taking supplements. We are looking at all ways of effectively getting the message across.

[Lord Kamall (Con)]

My Lords, I congratulate the Government on publishing the regulation. I pay my own tribute to the noble Lord, Lord Rooker—although he may not welcome it—for his tenacity on this particular issue. One of my frustrations when I was a Minister on this was how long the processes and consultations took. For future reference, if other supplements are to be introduced into our food, I wonder whether the department has looked at ways in which it could possibly shorten the process without compromising patient safety.

[Baroness Merron (Lab)]

Patient safety is at the forefront of this. I do not want to look backwards, but I gently suggest that there are all sorts of reasons for delays. Still, we are where we are now, and what is important is moving ahead. We are working closely with the Chief Medical Officers across the UK. We are very much in lockstep with the devolved Governments, and I think that will also assist.

[Lord Winston (Lab)]

Given the Government’s excellent initiative to reduce the serious risk of neural tube defects, which cause such despair to so many people, will they tell us where we have got to with fluoride addition to the water supply to prevent dental disease?

[Baroness Merron (Lab)]

My noble friend is right, and we anticipate that this policy will reduce the number of neural tube defects in pregnancy by around 200 a year. Those are life-changing brain and spinal defects, such as spina bifida. The question about fluoridation goes a little wider than I had anticipated.

[Lord Winston (Lab)]

I am sorry.

--- Later in debate ---

[Baroness Merron (Lab)]

Please do not apologise. We are seeing through all the measures that are possible to reduce dental decay as part of our prevention policies, and that includes introducing supervised toothbrushing for young children. I know that a number of noble Lords are interested in the matter of fluoridation—they have raised it with me in discussions about dentistry—and I will be pleased to write to my noble friend.

[Lord Patel (CB)]

My Lords, the noble Lord, Lord Rooker, is right to mention Nick Wald; he pioneered the study that I was part of when I was on the steering committee of the MRC. The important point I want to make is that it is before pregnancy starts and in its early phases that folic acid is most important; it is not about prescribing it once the pregnancy is established. I speak as someone who had to look after many mothers who had neural tube defects, such as anencephaly.

[Baroness Merron (Lab)]

The noble Lord’s observation is, obviously, right. Folic acid contributes, for example, to tissue growth during pregnancy, as well as to the normal function of the immune system and to reducing tiredness and fatigue. As for the point I made earlier, one of the strong reasons for this policy is that 50% of pregnancies are not planned. Therefore, it is about ensuring that folic acid is available in a diet before pregnancy, whether or not that pregnancy is planned. That is vital.

[Lord Dodds of Duncairn (DUP)]

My Lords—

--- Later in debate ---

[Lord Dodds of Duncairn (DUP)]

I warmly welcome what the Minister has said. I thank the noble Lord, Lord Rooker, for his work on this, as well as those who worked with me when I had the honour to co-chair the all-party group on this in the other place. On working in partnership with the devolved Governments, can the Minister commit to continue that work of implementation and enforcement through to 2026, so that families will be spared the pain of having babies born with neural tube defects, which is a particular issue in Northern Ireland?

[Baroness Merron (Lab)]

I am grateful for the comments of the noble Lord, who himself has brought much to this campaign. I am glad that, in Northern Ireland, the legislation was laid a few days later, on 20 November. I assure him that we will continue to work with the devolved Governments on this matter; it is crucial that we do. I finish by thanking again all noble Lords, including my noble friend Lord Rooker, who has led from the front on this to ensure that we could announce it today.

Health: Quad-demic

Baroness Merron Excerpts

Tuesday 10th December 2024 Lords Chamber

[Baroness Morgan of Drefelin]

To ask His Majesty’s Government what steps they are taking to reduce the impact of a potential “quad-demic”, involving high prevalence of influenza, respiratory syncytial virus, COVID-19 and norovirus, following the warning of Professor Sir Stephen Powis, the NHS national medical director.

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

My Lords, levels of hospital admissions due to flu and norovirus are higher, while Covid hospitalisation rates are lower and RSV hospitalisation rates are about the same as the same time last year. The impact of these infectious diseases can be reduced through our annual vaccination programmes for flu and Covid-19, as well as the new year-round vaccination programme for RSV, and by observing good hygiene measures. Some 16.6 million flu vaccinations, 9.3 million Covid-19 vaccinations and 1.2 million RSV vaccinations have been delivered so far this winter.

[Baroness Morgan of Drefelin (Lab)]

My Lords, I thank my noble friend the Minister for that comprehensive Answer. I have to say that “quad-demic” was a new phrase for me and so I was very keen to understand what the Minister made of the announcements from the NHS national medical director, Sir Stephen Powis. From my point of view, it is vital that we learn the lessons of the last pandemic and I know a huge amount of work is being done to understand the implications of the recommendations from Module 1 of the inquiry. But, as I understand it from Sir Stephen’s announcement, the uptake of NHS vaccine programmes is much lower than last year, so I am concerned for us to be reassured that if uptake does not improve in the run-up to Christmas, we are ready and we have learned the lessons from last time and we will not panic and start making foolish decisions about PPE acquisition, for example.

[Baroness Merron (Lab)]

We are absolutely committed to learning the lessons from Covid in order to build resilience. The recommendations of the independent review of procurement by Nigel Boardman have already been implemented and a Covid Counter-Fraud Commissioner has already been appointed to scrutinise contracts to learn the lessons and recover money for taxpayers. Professor Sir Stephen Powis, who I have spoken to about this, was not suggesting that there is a pandemic but more that four infectious diseases are coalescing to create a situation and that vaccination is crucial. His comments were a call to the public to get vaccinated, which I also endorse.

[Lord Patel (CB)]

My Lords, currently the RSV vaccination is available to the older age group of 75 to 79 year-olds—of course, it is available to a younger age group for vulnerable people—unlike in the CDC advice, which is that over-75s should get the immunisation. Older people are more susceptible to RSV and end up with more severe disease and hospitalisation, so why is the advice in the United Kingdom that the over-80s should not get immunisation? It has been suggested that the trials had insufficient evidence. The two trials for Moderna and Pfizer showed that efficacy was maintained in the older age group and therefore the JCVI’s interpretation is rather narrow in scientific terms —or is it to save money?

[Baroness Merron (Lab)]

I listened carefully to the noble Lord. The JCVI considered that there was less certainty about how well the RSV vaccine works in people aged 80 and over when the programme was introduced in 2023, and that is because, as the noble Lord said, there were insufficient people aged 80 and older in the clinical trials. The JCVI continues to keep this under review, including looking at data from clinical trials and evidence in other countries, and there will shortly be an update to your Lordships’ House in respect of research and clinical trials.

[Lord Bethell (Con)]

The Minister says that we are determined to learn the lessons of Covid. During Covid we had vaccination rates of 90% but, as she said, only 16 million—just 25%—of our citizens have had the flu jab and vaccination rates among children are also deteriorating at a rate. I say this with some personal interest because there was an outbreak of the quad-demic in my own household at 2 am today. There are three times as many people in hospital today with flu than in this week last year. Can the Minister please explain what she is doing to increase vaccination rates, particularly among children?

--- Later in debate ---

[Baroness Merron (Lab)]

We are aiming communications —I know the noble Lord will be familiar with this from his previous role—particularly at groups that are less represented in terms of vaccinations. From my discussions with the national medical director, I do not recognise the reference that the noble Lord made to hospitalisations; they are as I set out in the Answer to my noble friend. However, we are far from complacent and continue to push vaccination. We will get vaccination rates up because they are the best line of defence against infectious diseases.

[Lord Scriven (LD)]

My Lords, the chief medical officer at the UK Health Security Agency stated last week that NHS staff should get the flu vaccination. The Government’s own statistics show that last week, in the largest trust in the country, only 7.9% of those eligible had had flu jabs, and on average the number is in the lower 20%. Why has this happened? What are the Government doing urgently to improve the take-up of the flu vaccine by NHS staff?

[Baroness Merron (Lab)]

I must be honest: I cannot explain here the exact reasons why NHS staff are not taking it up, but I assure the noble Lord, as I have assured other noble Lords, that our focus is on getting vaccination rates up. That is why the national medical director made the comments that he did, as well as assuring me that we are not nearing a pandemic.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, undoubtedly the vaccination programme has had an important influence and impact on our National Health Service as well as our economy. What further vaccines and vaccination programmes will be accelerated on to the national immunisation programme this year and in further financial years?

[Baroness Merron (Lab)]

My noble friend has campaigned tirelessly for the vaccine rollout in respect of RSV, for which I thank her, and I know that many others would wish to thank her for that too. With regard to the other vaccines about which my noble friend asked, we will continue to work with the JCVI and, as there are further developments, I will update your Lordships’ House.

[Lord Kamall (Con)]

If the spread of any of the four viruses listed by the noble Baroness, Lady Morgan, were to turn into a pandemic, hospital capacity would be an issue of concern. Hospital capacity is already an issue in most winters. With that in mind, figures released last week show that NHS hospitals are operating at 95% capacity. Therefore, what discussions are the Government and the NHS having with the independent healthcare sector to utilise its spare capacity to help to alleviate the pressures, both this coming winter and in the face of future pandemics?

[Baroness Merron (Lab)]

The noble Lord will be aware that being prepared for winter is crucial. It has felt for too long as though winter crises have almost become normalised. Certainly, our move towards a 10-year plan will ensure that we have an NHS that can provide all year round. To give one statistic on Covid, in the week beginning 1 December there were 1,390 hospital beds occupied by confirmed Covid-19 patients per day, which was 41% lower than in the same week last winter. However, we are absolutely aware of this issue and we are not expecting a difficulty in respect of beds.

[Baroness Finlay of Llandaff (CB)]

My Lords, in her original Answer the Minister spoke about hygiene measures. I wonder whether she could expand on the advice that will be given to the public about considering washable face masks that can be recycled; about improving handwashing because of norovirus; and, particularly as we go into the Christmas season, about not washing poultry, which causes the droplet spread of campylobacter in kitchens and can lead to severe gastrointestinal infections. These will all increase the workload on the NHS if combined with the other infections that we have spoken about.

[Baroness Merron (Lab)]

Prevention is key, rather than just focusing on cure. Communications thus far are focusing on handwashing; I will discuss the other points the noble Baroness raises with the department.

Physician and Anaesthetist Associate Roles: Review

Baroness Merron Excerpts

Thursday 5th December 2024 Lords Chamber

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

My Lords, I congratulate the noble Baroness, Lady Bennett, on securing this debate. This is an important issue, as we have heard today. I thank all noble Lords for their invaluable and varied contributions.

I shall start with the toxicity of the debate. I emphasise this Government’s support of and gratitude to all staff. That absolutely includes physician and anaesthetist associates who work hard to treat and care for patients in the NHS. As the noble Lord, Lord Kamall, said, the debate has been not just toxic but polarised. As the noble Lord, Lord Scriven, acknowledged, we have seen bullying, which is unacceptable; as the noble Lord, Lord Kamall, said, we need to look at the toxic culture as well as the toxic debate. I absolutely associate myself with the comments made by the noble Lords from their respective Front Benches. At times, not just the debate but the activity around the subject has been deeply abusive, not just in words or on social media, and has been aimed at PAs and AAs. There is no excuse for this and it will not be tolerated. They are valued team members, as is everybody who works in the National Health Service, and deserve our respect and support.

Let me assure noble Lords that this review—I am glad that it has been welcomed—will be an independent, end-to-end review. It will cover training, recruitment, day-to-day work, oversight, supervision and professional regulation. It will assess the safety of the PA and AA roles relative to existing professions, the contribution that the roles can make to more productive use of professional time in multidisciplinary teams and whether the roles deliver good-quality and efficient patient care in a range of settings. All these matters, among others that noble Lords have rightly flagged today, will be considered.

The noble Baroness, Lady Bennett, asked about resources, support and co-operation for the review. I can assure her that this review is properly resourced and, importantly, that stakeholders across the health and social care system have already indicated that they will actively support its work. I agree that this is vital to Professor Leng’s work. As the noble Lord, Lord Kamall, identified, Professor Leng is a champion for patient safety who brings a thorough understanding of healthcare in this country. She is one of the UK’s most experienced leaders in it and I am most grateful to her for her work. I will draw key points from this debate to her attention, including the matter that the right reverend Prelate and the noble Lord, Lord Scriven, raised about getting information to the public. I take that point and will draw these aspects of the debate to the attention of my ministerial colleagues and Professor Leng.

As the Secretary of State highlighted when he announced it on 20 November, the review will gather available evidence and data on the PA and AA professions. It will also engage with relevant professions, the public, employers and researchers. In response to a number of questions raised today, I am committed to ensuring that noble Lords are kept informed as the review progresses. As has been identified, it will report in spring 2025 and we will publish our findings and update your Lordships’ House on the next steps.

I will address the concerns of the noble Baroness, Lady Bennett, and other noble Lords on interim action. NHS guidance remains in place on PA and AA deployment while the review is ongoing. Furthermore, NHS England continues to engage with NHS organisations to ensure that this guidance is adhered to. On the pace of the review, we are committed to it moving quickly to provide clarity, while ensuring that it has sufficient time to consider all available evidence.

The right reverend Prelate spoke of the value of a skills mix and the need for it in providing the kind of healthcare that we need into the future. My belief is that it is recognised—the noble Lord, Lord Scriven, also spoke to this—that the mix of professions required to deliver the right kind of care has evolved continually since the birth of the NHS. As the right reverend Prelate said, on previous occasions there have been many other criticisms and concerns; it is the nature of change. However, I want to be clear that the premise behind the use of PAs and AAs as part of the multidisciplinary team is absolutely sound. To give some context, PAs and AAs have been practising in the NHS for over 20 years, as the noble Lord, Lord Scriven, said. It is not a recent development.

The numbers we are speaking about are small. I will give some context to your Lordships’ House. There are 14,000 full-time equivalent doctors in anaesthetics in England and 170 AAs in the whole of the UK. There are 146,000 full-time equivalent doctors in England and 1,600 PAs. There are 38,420 full-time equivalent GPs and 2,105 PAs. I would not want your Lordships’ House to labour under any misunderstandings.

PAs support doctors to diagnose and manage patients —“support” is the operative word. They are not and should never be used to replace doctors. Similarly, AAs are qualified to administer anaesthesia but only under the supervision of a medically qualified anaesthetist. These roles always have to work under the right supervision. Concerns have been raised by medical professionals about blurred lines of responsibility and whether, in some cases, PAs and AAs are being used to replace doctors. So I understand the need for a comprehensive view of how these roles are being deployed and how effectively. I am confident that the review will address this.

I am acutely aware of the rare but deeply tragic incidences where patients have lost their lives following treatment by an associate. I offer sincere condolences—I know other noble Lords will too—to family and friends. They deserve answers and the assurance that we are listening—and indeed we are. My noble friend Lady Keeley spoke so movingly about the cases of Emily Chesterton and Susan Pollitt, which are deeply tragic. As the noble Lord, Lord Scriven, said, it is so important not to lump every PA and AA together, just as it is not right to do that for any other group. The noble Lord, Lord Kamall, rightly observed that tragic death happens when care is provided by other health professionals. Our job is to reduce that as far as we possibly can, which is what we are working to do.

The noble Baroness, Lady Bennett, highlighted a reference to legal action and redundancies, as well as the systematic impact that uncertainty has created for employers, GP practices, NHS services and individuals. That is why this review is so vital. It enables us to take stock of the evidence, establish the facts and provide absolute clarity for patients, professionals and employers.

As the noble Baroness, Lady Bennett, acknowledged, there has been significant debate on the scope of practice, especially for PAs. The review will cover all aspects of PA and AA roles, including their deployment and scope of practice. The issue will therefore be considered as part of the review, and I will not pre-empt its outcome on this or any other aspect. Many questions were rightly asked about what happens in the meantime. NHS England’s guidance on the deployment of PAs and AAs should continue to be followed.

On the important points about patient confusion, the GMC has published interim standards for AAs and PAs in advance of regulation. That will make clear that professionals should always introduce their roles to patients and set out their responsibilities in the team. The Faculty of Physician Associates has produced guidance, which includes an example of what a good initial introduction should look like. The review will also consider the professional regulation of these roles, which, as was set out, the GMC will commence next week.

The noble Lord, Lord Kamall, and the noble Baroness, Lady Bennett, asked about the action that will be taken in advance of the review concluding. It is important to note, as the noble Lord, Lord Scriven, did, that regulation by the GMC will begin in a very short while. As the noble Baroness, Lady Bennett, set out, I am aware that concerns have been raised about the GMC as the regulatory body for the roles. But we can be assured of the benefit of statutory regulation in helping to ensure that all PAs and AAs meet the very high standards expected of—and I emphasise this—every healthcare professional. Where these standards are not met, action can be taken.

This has been a challenging period for the PA and AA workforce, and it is vital that, like all NHS staff, they are treated with respect. It is therefore incumbent on all to do this. I look forward to the review, and I wish Professor Leng well. I thank noble Lords for their valued contributions to this debate. I look forward to PAs and AAs playing their part in providing improved healthcare in this country.

Fracture Liaison Services

Baroness Merron Excerpts

Wednesday 4th December 2024 Lords Chamber

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

My Lords, I congratulate the noble Lord, Lord Black, on securing this important debate and pay tribute to his very effective campaigning over many years. I am always touched when he refers to his mother; personally, I always feel that his campaigning shows great respect to his mother, and I am sure that the whole House appreciates that. I also enjoyed, as I am sure the noble Lord, Lord Kamall, did, his reminder to me and the now Opposition Front Bench of what we said when we were on the other side, and we are suitably—not chastened exactly—brought to book by his comments.

I thank other noble Lords for their many insightful and accurate contributions. As I am sure noble Lords will be aware, I have much sympathy with many of the points that have been made. I know this is an issue close to many, either because of their own experience or that of those to whom they are close.

As we have heard, including from the right reverend Prelate the Bishop of London, inequalities in access to and the quality of fracture liaison services have a significant impact on so many people across the country. Over half a million people in England alone suffer a fragility fracture every year. More than 40% of those will suffer another fracture within a decade. As the noble Lord, Lord Black, so powerfully illustrated, fracture liaison services can play a vital role in reducing the risk of refracture, improving quality of life and, importantly, increasing the number of years that can be lived in good health.

Many noble Lords referred to the postcode lottery, including my noble friend Lady Quin and the noble Lord, Lord Rennard. Noble Lords spoke of the difference in access coming at a substantial cost. I agree; it is not only a cost for the NHS and social care, but there are also many personal costs of life-changing injury and increased mortality and morbidity. This cannot continue.

Today’s debate refers to the progress towards universal provision by 2030. The noble Lord, Lord Black, and other noble Lords powerfully advanced the case for moving swiftly and the potential consequences of not doing so. It was suggested that there was funding from the previous Government for the expansion of fracture liaison services. All investigations show that no funding was ever confirmed or announced, including as part of the Major Conditions Strategy. I remind your Lordships’ House that the 2030 ambition for the rollout of fracture liaison services was first announced by the previous Government on the day after the election was called. On that point, I am very grateful for the understanding of a number of noble Lords, including the noble Lord, Lord Kamall, and my noble friend Lady Quin, that these are early days for the Government, but I will attempt to be helpful.

This mission-led Government will expand access to fracture liaison services, alongside, importantly, delivering 40,000 more appointments each week and increasing diagnostic capacity to meet the demand for diagnostic services. Why? It is because fracture liaison services play a vital role in the mission to build an NHS for the future, where waiting times are reduced and more care is moved to the community, closer to where people need it. We have to be honest about the scale of the action needed, as noble Lords will know that this Government have been. I will make some points about the background and the challenges ahead. As the Chamber will understand, it will not be solvable overnight.

My right honourable friend the Secretary of State commissioned an independent investigation into the NHS as one of his first actions in government. The findings by the noble Lord, Lord Darzi, laid bare the fact that the NHS currently has the longest waiting lists, the lowest patient satisfaction and a deterioration in the nation’s underlying health, with widespread problems for people accessing services. This includes fracture liaison services.

In response, the Government announced the 10-year plan, which will be published next spring. The plan will be shaped by input from the public, patients and health and care staff through an engagement exercise—on which noble Lords heard me answer a Question from the right reverend Prelate earlier this week, who was good enough to raise it again today. The exercise was launched as:

“The biggest national conversation about the future of the NHS”.


It will include consideration of the three fundamental long-term shifts for health reform, as emphasised by my noble friend Lady Quin and the right reverend Prelate: hospital to community, analogue to digital and changing from sickness to prevention. I agree with noble Lords that fracture liaison services encapsulate all three. This is a long-term challenge and will take time to deliver, so the plan will consider what immediate actions are needed to get the NHS back on its feet and get waiting lists down, as well as long-term changes.

We are continuing our close working relationship with NHS England to tackle issues related to provision of fracture liaison services, which are a crucial prevention service. The noble Lord, Lord Black, my noble friend Lady Donaghy and the noble Baroness, Lady Bull, along with other noble Lords, suggested a number of potential solutions. We are considering a wide range of options as we seek to identify the most effective ways of improving the quality of and access to the fracture liaison service model and the interventions it provides. I look forward to continuing work with noble Lords and being able to bring more information to this House.

My noble friend Lady Ritchie referred to the role of ICBs, and this point was raised several times helpfully in the debate. As noble Lords are well aware, fracture liaison services are commissioned by ICBs and are making decisions according to local need. National expectations of ICBs and trusts for the next financial year will be set out in the 2025-26 NHS planning guidance. I know that the matter of finance has been raised a number of times, including by the right reverend Prelate.

Along with many noble Lords here, we have benefitted from continuing engagement with the Royal Osteoporosis Society and a number of partners. The noble Lord, Lord Brownlow, rightly paid tribute to the role of Her Majesty the Queen. I felt that was an extremely important recognition with which I want to associate myself. In our engagement with our stakeholders, we are looking at the best ways to support the systems that work.

The noble Lord, Lord Shinkwin, raised matters relating to those of working age. It is the case that osteoporosis and the risk of repeated fragility fractures remain significant contributors to economic inactivity. I was pleased to hear the noble Lords, Lord Black and Lord Shinkwin, recognise the significance of musculo- skeletal conditions as drivers of long-term sickness absence. It is absolutely the case that those conditions are the second leading cause of sickness absence and the leading cause of a reduction of years lived in good health and employment.

There is much joint working going on between DWP, DHSC and NHS England under the Getting It Right First Time teams to deliver a programme, working with ICBs to reduce waiting times and improve data and referral pathways. The recent Get Britain Working White Paper included an announcement of £3.5 million in funding for this year to provide a model for musculo- skeletal community services to kick-start economic growth.

The noble Baroness, Lady Bull, and the right reverend Prelate raised women’s health. The noble Lord, Lord Black, was kind enough to draw attention to my previous interest in the issue of fracture liaison services. That now chimes in very well with one of my responsibilities, as I am the Minister for women’s health. I am dismayed at how often women’s health needs are not considered when designing services, and even worse are the additional stark inequalities referred to by the right reverend Prelate. I assure your Lordships’ House that it is a priority for us to ensure that all women receive the high-quality care that they deserve.

I close by restating our commitment to expanding access to these vital fracture liaison services. The work continues, and I look forward to updating noble Lords a number of times as we make progress together.

NHS Plan: Consultation

Baroness Merron Excerpts

Monday 2nd December 2024 Lords Chamber

[The Lord Bishop of London]

To ask His Majesty’s Government what steps they are taking to ensure the consultation for the NHS 10 Year Plan reaches all communities, including those who have least interaction with the health service.

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

My Lords, we want to ensure that the voices and experiences of patients are at the heart of our plans to make the NHS fit for the future, especially those voices that often go unheard. We are working with charities, faith groups, health and care providers, local government and others to ensure that we hear from those that national government often fails to reach. We will monitor this closely and target underrepresented groups before the engagement exercise concludes in spring 2025.

[The Lord Bishop of London]

I thank the Minister for her reply, and I am encouraged by the Government’s consultation on the NHS 10-year plan. However, does she agree with me that, if we are to move from sickness to prevention, any engagement ICBs have with their communities has to be long term and systematic? If so, what are the Government doing to resource ICBs to make sure that their engagement with communities is long term and systematic?

[Baroness Merron (Lab)]

I agree with the right reverend Prelate. Integrated care systems, which are responsible for reflecting the needs of the community and its spending, must follow guidance, and it is important that we identify the seldom-heard groups. We have built into the consultation plans a “workshop in a box”—a toolkit to support discussion in local communities, which ICBs are rolling out. It is a good way of encouraging ICBs to talk directly to local communities.

[Baroness Coussins (CB)]

My Lords, will the consultation be published in languages other than English, with proactive efforts to encourage responses from people whose first language is not English? Secondly, will the department make sure that it consults with public service interpreters working in NHS settings?

[Baroness Merron (Lab)]

I can confirm that both the online portal and the “workshop in a box” to which I just referred will be available in easy read and British Sign Language versions, and in other languages. Attention has been given to those for whom English is not their first language; in-person events can be tailored to their needs—for example, by having smaller groups. The staff to whom the noble Baroness refers are a major group being asked to provide input; indeed, they are taking part in online workshops and can respond online.

[Baroness Pitkeathley (Lab)]

My Lords, does my noble friend the Minister agree that one of the groups that sometimes finds it difficult to interact with health service professionals is unpaid carers? Despite the huge contribution that they make, they often have their needs ignored by those providing services. Does she therefore agree that it is very important that the voice of the unpaid carer is heard in the consultation process?

[Baroness Merron (Lab)]

I agree with my noble friend: we have to hear from unpaid carers, because that will strengthen the exercise. We are constantly monitoring which groups are responding and which are not, and that allows us to tailor our approach to the underrepresented groups who are not coming forward. If that includes unpaid carers, the consultation absolutely will make special, tailored efforts to reach them.

[Lord Scriven (LD)]

My Lords, the life expectancy of people with learning disabilities is, on average, 20 years less than the general population’s. Research has shown that a major contributor to this is a lack of access to appropriate healthcare. What will the Minister do to ensure that this group of people will be not only consulted but listened to, and that the 10-year plan will provide appropriate services tailored to them?

[Baroness Merron (Lab)]

This is indeed one of the groups for whom we need to ensure absolute inclusion. As I mentioned, the work with integrated care systems will be particularly helpful in running the workshop. We train organisations to work with it, and it is designed so that it is easy to use. It can be used in events to reach the seldom-heard voices in communities, including those with learning disabilities. It is vital that we hear from them as we design an NHS fit for everybody for the future.

[Lord Turnberg (Lab)]

My Lords, one of the biggest causes of inequality is where you live in the country. If you live in the north-east or north-west, you live two, three or four years less than if you live in the south-west or south-east. Far fewer resources are available for people in those deprived areas: there are fewer doctors, nurses, physios, dentists and so on. What can the Government do to redress this gross imbalance?

[Baroness Merron (Lab)]

My noble friend allows me to say—and I hope your Lordships’ House will agree with this—that our approach will of course focus on addressing the social determinants of health. The goal will be to halve the gap in healthy life expectancy between the richest and the poorest regions. We are not just going to be moving from sickness to prevention as one of our three pillars, important though that is; we are also seeking, across government, to address the root causes of health inequalities. Again, that is being highlighted as part of the consultation.

[Lord Bailey of Paddington (Con)]

What special efforts will be made to speak to young people, who are often very far away from the health system—those leaving care, those who have just left prison and those from very poor communities? What effort will be made to hear their voices? They are often far away from the NHS because they do not need it yet, but they will in the future.

[Baroness Merron (Lab)]

I thank the noble Lord. Yesterday, I was at an in-person event in Folkestone, and as with all such events up and down the country, it had used systems to find a wide range of people, including young people, who, as he rightly says, are often unlinked with the health service. I emphasise our continued monitoring and our efforts to reach the groups he speaks of. So far, we know that men, those aged under 35, and black Asian and black British people have engaged least with Change NHS. We are now stepping up our efforts.

[Baroness Winterton of Doncaster (Lab)]

My Lords, will my noble friend the Minister look at the role that pharmacists might play in any consultation? While they may not be an obvious source of reaching out, they are embedded in communities and talk to patients and users frequently. If they could be harnessed, it would much improve the consultation.

[Baroness Merron (Lab)]

I am very grateful to all those, including pharmacists, who have used all their networks and contacts to spread the word. That is why we have had over 60,000 responses and more than 1 million visits in what is the largest ever consultation in the history of the NHS. I call on all groups to continue their efforts to ensure that voices across all communities are heard loud and clear.

[Lord Kamall (Con)]

During the vaccine programmes for Covid, the NHS and the last Government put a lot of effort into looking at ways to reach people who are vaccine hesitant—often from some black and Asian communities and other excluded communities. What lessons have been learned by the Government and the NHS to ensure that the consultation on the 10-year plan reaches as many people as possible from these communities, so that their voices are heard?

[Baroness Merron (Lab)]

The lessons that have been learned are that there has to be a whole range of ways of consulting: in person around the country; online, where people can access the website; and through toolkits such as the “workshop in a box”. As I mentioned in an earlier answer, the consultation also needs to be tailored to the needs of those who need to speak up. We are asking the public, staff and organisations what is important, and we want, as the Prime Minister said, their fingerprints all over the 10-year plan.

[Baroness Bull (CB)]

My Lords, people living with homelessness often have chronic and multiple health needs which go untreated, and they are also more vulnerable to substance misuse. Appreciating the difficulty, what are the Government doing to ensure that the needs of people living with homelessness are addressed and heard through this consultation?

[Baroness Merron (Lab)]

We have identified those who are homeless as one of the specific seldom-heard groups, and that is why we are working so closely with integrated care systems: to ensure that we reach them on their territory. The other groups include, for example, sex workers, young people, those with learning disabilities and some ethnic minorities.

Drug-related Deaths in England and Wales

Baroness Merron Excerpts

Tuesday 26th November 2024 Lords Chamber

[The Lord Bishop of Newcastle]

To ask His Majesty’s Government what assessment they have made of data published by the Office for National Statistics on 23 October indicating that the number of drug-related deaths in England and Wales was higher in 2023 than in any other year since records began in 1993, and what steps they are taking to reduce the number of such deaths.

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

My Lords, drug-related deaths are tragically at record highs, especially in deprived areas. We are committed to tackling this problem, including by correcting the years of disinvestment in treatment services as highlighted by Dame Carol Black in her independent review. I was glad to lay legislation that widens access to naloxone, a life-saving opioid reversal medication, and this Government will continue to work across health, policing and the wider public services to prevent drug use and address the causes of inequality, including in Newcastle.

[The Lord Bishop of Newcastle]

I thank the Minister for her Answer. The ONS data revealed that the north-east has been the English region with the highest proportion of drug-related deaths for the 11th consecutive year—three times higher than the lowest rate, in London. Can the Minister say a little more about what targeted steps His Majesty’s Government are taking to reduce drug-related deaths, particularly in the north-east?

[Baroness Merron (Lab)]

The right reverend Prelate is absolutely right to highlight the situation in the north- east. I can assure her that funding is allocated on the basis of need, and that includes the rates of drug-related deaths. I hope it was helpful that senior officials from the department recently met with the drug and alcohol service commissioners, the police and crime commissioners and the directors of public health from across the north-east to discuss synthetic drug threats. We will certainly continue to work with local areas, including the north-east, to tackle this very real issue.

[Lord Bird (CB)]

Can we accept the fact that a lot of the people who are dying are homeless, and a lot of them are the people who are on our streets? We know that drug addiction and bad health on the streets are a cocktail of death. Can we see some effort by the Government to put in place the rehab, detox and therapeutic communities that are necessary to get the demons out of the lives of people who are on the streets and in homelessness?

[Baroness Merron (Lab)]

I understand the point that the noble Lord is making. We are funding the rough sleeping drug and alcohol treatment grant, which gives targeted treatment and wraparound support services to those who sleep rough, or who are at risk of doing so, in 83 local authorities. That includes a whole range of things. In addition, we are funding the housing support grant and working across government, including with the Deputy Prime Minister, who has brought together a dedicated interministerial group to tackle the very real problem that the noble Lord describes.

[Lord Mendoza (Con)]

My Lords, the Minister mentioned synthetic opioids. We all know the terrible scourge that they have wrought in America, with something like 75,000 deaths a year from synthetic drugs such as fentanyl and nitazenes. Can the Minister assure us that we are monitoring the supply of these drugs into this country so that we are spared the terrible scourge and loss of life among young people that has been experienced in America?

[Baroness Merron (Lab)]

I understand what the noble Lord is saying. Synthetic opioids, as he will know, are certainly more potent, and indeed can be more deadly, than other forms of drugs. We are working with other government departments to enhance the surveillance to which he refers and to improve early warning in response to the threat of synthetic opioids, and we will continue that work.

[Baroness Pinnock (LD)]

My Lords, many charities that support those with drug addiction are raising concerns about the increased costs that they will have to fund as a result of the increases in national insurance charges. What assessment have the Government made of the impact on those critical services being able to support those with drug addictions?

[Baroness Merron (Lab)]

The noble Baroness will have heard me say before that we had to take some tough decisions at the Budget to fix the foundations in the public finances, and that enabled a settlement for the Department of Health and Social Care of some £22.6 billion. As she knows, the employer national insurance rise will be implemented in April 2025, and in due course the department will set out further details of the allocation of the funding I referred to for next year.

[Lord Kamall (Con)]

My Lords, I know this Government take drug-related deaths seriously, as did the previous Conservative Government when we awarded 12 projects a share of a £5 million fund to reduce rates of fatal drug overdoses, adopting a similar approach to that of the Vaccine Taskforce to tackle health challenges. Has there been any evaluation of how successful those projects were? What plans are there to continue or expand them?

[Baroness Merron (Lab)]

Our continuing work in this area is part of the Office for Life Sciences programme. This Government continue to fund research into wearable technology, virtual reality and artificial intelligence, all in a bid to support people with drug addictions. Since coming into office, we have awarded £12 million to projects across the UK that are showing innovation in respect of technology, because we want to support people with addictions.

[Baroness Meacher (CB)]

My Lords, what steps are the Government taking to support vulnerable children in schools who, without support, are likely to become addicted to drugs, in order to ensure that they reduce the numbers of drug deaths?

[Baroness Merron (Lab)]

I assure the noble Baroness that education on drug use is an essential part of harm reduction and prevention. It is a statutory component of relationship, sex and health education.

[Baroness Blackwood of North Oxford (Con)]

My Lords, the two-year review of the LGA’s 10-year drugs plan has made a number of recommendations to improve the response. On the question of synthetic drugs, it recommended the implementation of early-warning systems so that changes at street level can be responded to in real time and samples of new substances can be tested as soon as possible. Can the Minister please look into those recommendations and see what support can be provided by the Government?

[Baroness Merron (Lab)]

I will indeed be doing that, not least because our work with other departments continues to take account of the early warning to which the noble Baroness refers. That is in respect of the threat of synthetic opioids, which we know is extremely real and pressing.

[Lord Foulkes of Cumnock (Lab Co-op)]

The right reverend Prelate the Bishop of Newcastle is absolutely right: there is a direct relationship between poverty and drugs deaths, which is why it is vital that we increase our resources for fighting poverty and why we need to raise taxes on wealthy landowners such as James Dyson and Jeremy Clarkson.

[Baroness Merron (Lab)]

As always, I pay close attention to the contributions of my noble friend, who makes helpful observations. We do indeed need to continue our work in this area. It is quite important to look back at the history that Dame Carol Black reported on. She talked about one of the difficulties being that funding for community drug and alcohol services was subsumed into the public health grant in 2013, which meant that by 2019-20 funding for those services had been reduced by over a third. That is a £212 million disinvestment. The result of all this is that drug use has increased, with all the major indicators of its harm. This is something we need to turn around.

[Lord Patel of Bradford (Non-Afl)]

My Lords, I echo what the Minister has just said. The last Labour Administration set up the National Treatment Agency for Substance Misuse and ring-fenced £800 million to provide treatment when drug users needed it. It reduced drug-related crime, drug use plateaued, and drug-related deaths were at an all-time low. Sadly, this funding was pulled suddenly, which resulted in the highest level of drug-related deaths ever, with drug use on the increase and drug-related crime going up. Can we go back to some of the sensible ideas we had about providing treatment for drug users?

[Baroness Merron (Lab)]

My ministerial colleague Andrew Gwynne will be looking at how we improve drug and alcohol addiction services. In the light of recent Office for National Statistics data, the Office for Health Improvement and Disparities has an action plan to reduce drug and alcohol-related deaths. Because of this recent data showing major increases, it will review the plan to make sure it is properly grounded and effective.

NHS: Dentistry Provision

Baroness Merron Excerpts

Monday 25th November 2024 Lords Chamber

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

My Lords, 28% of the population of England needs but cannot access NHS dentistry. We want to ensure that everyone who needs a dentist can get one, including by providing 700,000 more urgent dental appointments and recruiting dentists to areas that need them. Government approval is not required to establish new dental schools; we encourage prospective providers to approach the General Dental Council, and we will work with partners to assess the best distribution of training places.

[Lord Fuller (Con)]

My Lords, I live in Norfolk which, alongside its neighbouring counties, is the only part of our nation not to have a school of dentistry. Even the Secretary of State says that our county is the “Sahara of dental deserts”. It is important: poor oral health is the principal cause of admission to hospital for children of primary school age, and incidences of mouth cancer are being missed locally. The last Government announced plans to recruit 1,000 more dentists a year and to build completely new schools of dentistry in which to train them alongside hygienists. Will these plans be taken forward by the new Government? Does the Minister agree with me that, where entirely new schools of dentistry are to be established, it makes much more sense to put them where we do not have very many dentists, rather than to have even more schools where we do have them? I hope she will say that the Government look favourably upon the proposals from the University of East Anglia to establish a brand-new school of dentistry and oral hygiene in Norwich.

[Baroness Merron (Lab)]

I commend the noble Lord for raising his long experience of facing and dealing with these problems locally in Norfolk. I note the report in September that the Norfolk and Waveney area has the worst ratio of NHS dentists to patients in England, with 1,000-plus people having to attend Norfolk’s casualty department last year due to serious dental issues, so this is a serious point. We are aware of the University of East Anglia’s interest in this area, and my colleague Stephen Kinnock, the Minister responsible for this area, recently met with east of England MPs to discuss this matter. However, as I have said, it is not the Government who make these decisions, although we encourage those new dental schools to be in areas of particular need. I encourage the University of East Anglia to take its proposals to the General Dental Council.

[Lord Scriven (LD)]

My Lords, has any extra allocation been made in-year—this year—from the Budget’s NHS allocation for the extra appointments the Government wish to see in dentistry, or is this expected to be bought from existing ring-fenced dentistry budgets?

[Baroness Merron (Lab)]

My Lords, the Government are investing around £3 billion in dentistry each year. As the noble Lord will be aware, I cannot yet confirm 2025-26 dentistry budgets, but they will be confirmed in planning guidance published by NHS England in due course. I know that the noble Lord will be aware that, despite the tough fiscal circumstances the Government have inherited, the Budget set out a big increase in day-to-day spending for health and social care. Regarding the process, and our planning, it is entirely normal that we set out matters in planning guidance. We are, of course, keen to reform the dental contract with a shift to focusing on prevention and the retention of NHS dentists. That work is immediately under way.

[Lord Fowler (CB)]

My Lords, no one fought harder for the elimination of dental deserts than Lord Colwyn, who died recently and whom most of us in this House remember. Would not the best memorial to Lord Colwyn be to place a new priority on dental services particularly for children? As well as making that a priority, and to show that it is, should we not allocate it a budget?

[Baroness Merron (Lab)]

I would like to associate these Benches with the comments made by the noble Lord about the late Lord Colwyn, whose contribution was indeed considerable. I agree that that would be a very appropriate legacy to his memory. The fact is that we are in the position that the previous Government’s dentistry recovery plan did not go far enough and, as we all know, there are too many people struggling to find an NHS appointment. As part of our 10-year plan we are working to assess the need for more dental trainees in areas including the east of England, which the previous noble Lord referred to, because many people continue to struggle. This cannot go on, not least because prevention is absolutely crucial as we move towards making an NHS fit for the future.

[Lord Harris of Haringey (Lab)]

My Lords, I refer to my interests in the register as chair of the General Dental Council. I am grateful to my noble friend the Minister for twice referring to the General Dental Council, but she has, perhaps inadvertently, given the impression that all that is required for a new dental school is that somebody rocks up to the General Dental Council and says they would like to open one. What consideration has she given to where the resources will come from for the training of extra dentists through a new dental school? Can she say what is being done to look at the best use of the number of dental professionals that exist around the country in order to make the best use of the skills mix between dentists and dental care professionals?

[Baroness Merron (Lab)]

My noble friend makes, as ever, very important points, and I am grateful for the opportunity to clarify that it is not a matter of just rocking up to the General Dental Council. However, we may find—I am sure that we will—that, in order to deliver our workforce ambitions, we need to work with partners such as NHS England and the GDC to explore the creation of new dental schools in currently underserved areas of the country. We have already had one such example. Provided that a prospective dental school meets the requirements of the GDC and the Office for Students, it will be considered for future government-funded training places. I absolutely agree with my noble friend that there are a number of layers to this, and I also agree that we need to look at the whole dental team, including dentists. There are a number of people involved in care, and it is crucial that the workforce plan can deliver on that.

[Lord Kamall (Con)]

My Lords, the Minister said that it was not only about rocking up to the General Dental Council, as the noble Lord, Lord Harris, said, but about having conversations. Can the Minister confirm what specific conversations the Government have had with the NHS, with the General Dental Council and with other dental bodies to encourage the opening of schools of dentistry in so-called dental deserts, especially in areas such as Norfolk, which my noble friend Lord Fuller described as the Sahara of dental deserts?

[Baroness Merron (Lab)]

As the noble Lord will know, we are very keen to see that the areas that are most underserved—as I know from my own experience in Lincolnshire—are targeted. One of the reasons is the problem of recruiting and retaining dentists, as there is not a dental school to call upon. That point is well understood. We are keen to target the areas that need the most, as well as providing additional urgent dental appointments. Early conversations have also taken place with the Minister for Care, Stephen Kinnock, about reforming the dental contract, which is absolutely key, and that work will continue at pace.

[The Lord Bishop of Newcastle]

My Lords, the Child of the North report, published in September, on the crisis in oral health in children, reported that 20% of children in the north-east have tooth decay in their permanent teeth. What plans do the Government have to implement one of the report’s recommendations—namely, to have a national strategy for children’s oral health, of which the establishment of new dental schools could be a part?

[Baroness Merron (Lab)]

The right reverend Prelate makes a very good point. The fact is that the overall state of our children’s oral health is very poor, including in the north-east, as she rightly identifies. One of the shocking facts is the impact on children’s ability to sleep, eat, play, socialise and even learn. It is also shocking that tooth decay is still the most common reason for hospital admission in children aged five to nine years. We will indeed look at the report, but we do have a strategy, including the introduction of supervised toothbrushing for young children in disadvantaged areas.

Mental Health Bill [HL]

Baroness Merron Excerpts

2nd reading
Monday 25th November 2024 Lords Chamber

Moved by

[Baroness Merron]

That the Bill be now read a second time.

Relevant document: Report of the Joint Committee on the Draft Mental Health Bill, Session 2022-23. Welsh legislative consent sought.

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

My Lords, it is an honour to move the Second Reading of the Mental Health Bill—a Bill which Members of both Houses have been waiting for and working on for some considerable time.

There is much consensus that our mental health laws are not fit for the 21st century. Many elements of the Mental Health Act 1983 are outdated. Its operation is associated with racial disparities and poor care for people with a learning disability and autistic people, and it fails to give patients an adequate voice. Modernising the Mental Health Act is a vital manifesto commitment for this Government, so I am proud to introduce reforms that will ensure that care is appropriate, compassionate and effective; give patients more say over their care; improve support to help patients understand and exercise their rights; and protect the safety of the public, staff and patients.

The wait has been too long. I know that a number of noble Lords were involved when the Act was last amended substantially in 2007, but, although attitudes to mental health have, thankfully, changed since then, the law has not kept up. The Bill is the product of the combined effort over some years by Members of both Houses and many outside Parliament, and all parties have rightly come together to support it. Sincere thanks are due to many, but I will highlight just a few, starting with Members of your Lordships’ House who served on the pre-legislative scrutiny committee in 2022: the noble Baroness, Lady Buscombe, as chair, as well as the noble Baronesses, Lady Barker, Lady Berridge, Lady Hollins and Lady McIntosh of Hudnall, and the noble Lord, Lord Bradley. All have given a huge amount of time, expertise and energy, which has informed and motivated this Government to strengthen the Bill. I confirm that we have improved the previous draft Bill by heeding the committee’s recommendations to include guiding principles and advance choice documents in this revised Bill.

I pay tribute to the former Prime Minister, the noble Baroness, Lady May, whom I had the pleasure of meeting earlier today with the Secretary of State. The noble Baroness, Lady May, identified the need for modernisation and set up the independent review of the Act in 2017. Without this, we would not be here today. I thank the independent review chair, Sir Simon Wessely, and his vice-chairs, including the noble Baroness, Lady Neuberger, who made the case for change and provided the blueprint to follow. I know they will continue to be champions for reform. I also thank the many stakeholders and parliamentarians who have engaged with us ahead of Second Reading and over the years, and those with lived experience, who have bravely told their stories.

The Bill will complement other major reforms that this Government have announced. The Budget announced £26 million to be invested in new mental health crisis centres to reduce pressure on accident and emergency departments. To cut mental health waiting lists, we will go further still, recruiting an additional 8,500 staff. As part of our mission to reduce the number of lives lost to suicide, these NHS workers will be specially trained to support people at risk. We will improve support for young people, with walk-in hubs in every community, making support workers more accessible to children, and a specialist mental health professional based in every school. The NHS has asked every provider of mental health services to review its offer for serious mental illness. By focusing on early intervention—prevention is the key—we seek to prevent people reaching crisis and to reduce the need for detentions in the first place.

I turn to what the Bill seeks to achieve. The Mental Health Act is there to protect people. Its core purpose is, and will remain, to be able to intervene, detain and treat when someone is so unwell that they present a risk to themselves or others. The overall aims of these reforms are to improve the care and treatment of people with severe mental illnesses when detained under the Act, to improve patient outcomes and recovery, and to protect the public, patients and staff. The existing Act confers certain rights on people who are detained, including the right to appeal their detention at a tribunal and a right to an advocate as well as to a medical second opinion in certain circumstances. The Bill seeks to strengthen and expand these rights. It will require the inclusion in the statutory code of practice of the new and revised guiding principles recommended by the independent review, which in turn informs professional practice around the Act. By doing this, we aim to improve things for patients and support a change in culture.

We are strengthening and clarifying the detention criteria to make clear that people will be detained only if they pose a risk of serious harm to themselves and/or others, and if there is a reasonable prospect that they will benefit from the proposed treatment. We are reforming the use of community treatment orders—CTOs—to reflect the revised criteria, to increase oversight and scrutiny of decision-making, and to improve the transfer of patients under a CTO from hospital to community services. We are also introducing statutory care and treatment plans for patients detained under the Act, except when under very short-term sections, to provide a clear plan for a patient’s recovery and a path to discharge.

Where the patient’s voice has previously been unheard, the Bill will place them at the centre of their care and treatment. We are introducing a new clinical checklist requiring clinicians to, as far as possible, involve patients in decisions about their care and to take their feelings and wishes into account.

We are making sure that patients know they can create an advance choice document and that appropriate support is available to help them do so, allowing those at risk of detention under the Act to outline their wishes and decisions while they are well. This document helps them retain control over decisions about their admission, care and treatment if they later become too unwell to communicate these preferences. Last week I saw and heard about the differences that these can make on my visit to the South London and Maudsley, where the words of welcome from service users about these measures highlighted the contribution that advance choice documents can make, particularly to tackle racial inequalities.

We are allowing patients to choose a nominated person to look out for them and their interests when detained and will be increasing their powers. The independent mental health advocacy service was a notable success of the 2007 reforms to the Act. It is a thriving sector, with advocates and volunteers working for excellent organisations such as VoiceAbility, making sure that people are involved with decisions about their care.

We are now looking to expand these services in two ways. First, we are making sure that patients who come into hospital voluntarily can access an advocate to help them understand their rights and be involved in decisions about their care. Secondly, for detained patients, access to advocacy will be on an opt-out basis, ensuring that patients are proactively offered this support when detained to improve advocacy uptake among detained patients.

I know only too well that noble Lords are acutely aware that for some people with a learning disability and autistic people, detention is both non-therapeutic and unnecessarily long. In order to better meet people’s needs in the community, we will limit detention so that people with a learning disability and autistic people can no longer be detained beyond 28 days, unless they have a co-occurring mental health condition that requires hospital treatment. This will affect only civil patients. Hospital will remain an option for those in contact with the criminal justice system, where the only alternative to detention in hospital is prison.

For people with a learning disability and autistic people, the right measures and support are very much needed alongside this change. That is why the Act will require that when people are detained, there is a care (education) and treatment review to be given due weight in decision-making. We are also creating new duties on commissioners to hold registers to help manage the risk of people going into crisis and being detained, and to better meet the needs of people through appropriate community services.

I am grateful for the work of the Ministry of Justice Minister, my noble friend Lord Timpson, and his department, to improve access to mental health care and treatment for people in the criminal justice system. The Bill will end the use of both prison and police cells as places of safety. It will end the use of remand for own protection under the Bail Act where the court’s sole concern is the defendant’s mental health.

We will introduce a statutory 28-day time limit for transfers from prison and other places of detention to hospital when a person requires treatment for their mental health under the Act. We will also introduce a subset of conditional discharge, called supervised discharge, to support the small number of restricted patients who are no longer benefiting from being in hospital.

We are aware that there have been concerns about public safety and are therefore ensuring that our reforms do not weaken the ability to detain people who could pose a risk of serious harm to themselves or others. I assure your Lordships’ House that these reforms do not change the core function of the Mental Health Act. Clinicians will remain able to intervene, to detain, and to treat whenever someone with severe mental illness presents a risk to themselves or others.

We are confident that this is the right package of reforms. However, the Bill further strengthens the measures in respect of public protection. The Bill improves on the previous draft Bill by: first, accepting the Joint Committee’s recommendation to remove “how soon” from the new detention criteria, making sure the Act cannot be misinterpreted to mean that a harm must be imminent to justify detention and early intervention; secondly, introducing a new requirement for the responsible clinician to consult another person when they are making a decision about whether to discharge a patient; and thirdly, strengthening the code of practice’s guidance on discharging patients and promoting the need for discharge planning tailored to the individual needs of patients and their circumstances. We will consult on changes to the code.

I am very grateful to noble Lords across the House for their ongoing support for and interest in the Bill. It has been a long time coming, and I know that we all want to get this on the statute book, which is why it is a priority piece of legislation for this Government. There has been a failure to reform, but today we begin to change that. I look forward to what I know will be a collegiate and constructive debate, which many will follow—inside both Houses and outside. I beg to move.

--- Later in debate ---

[Baroness Merron (Lab)]

My Lords, I put on record my gratitude to all Members of your Lordships’ House for contributing to what was widely agreed, I am sure, to have been an excellent debate—excellent not just because of the level of engagement but because of the detail. I really feel that spirit of wanting to improve the legislation and the support for the Bill thus far. I will endeavour to respond to as many themes as possible; I am very grateful to the noble Lord, Lord Kamall, for his sympathy, which I accept, but I regard that as a good thing. I regard it as admirable that I will not be able to answer all the questions, because that is the purpose of being here. It sets us up for Committee. It is obviously going to be a very rich Committee, and I very much look forward to it.

I hope noble Lords will understand that I look forward to following up on the many points that I will not get a chance to address in the time I have and doing a proper review of the debate today, picking up points as needed. I pay tribute to the dedication and the detailed attention to the Bill that noble Lords have already given. I am very glad to see my right honourable friend the Secretary of State gazing on. The reason I say that now is that the Secretary of State knows only too well—and not just from me—the contribution that your Lordships’ House makes and will continue to make. I for one certainly appreciate it, as I know he does.

I also thank the noble Baroness, Lady Parminter, for her bravery in sharing her and her family’s experience and anguish of eating disorder. I say the same to my noble friend who shared her experience about her sibling. It is not always easy to do that, but it really brings a lived experience of those around the person we are often thinking about, and it is so important that we do that. This debate has confirmed to me what I knew already—but it is always worth doing it again. It is the product of persistence and of a number of investigations and recommendations. It is also inspired and underwritten by the tireless campaigning that many have undertaken to improve the rights and experiences of people with mental health conditions and learning disabilities and autistic people.

It also reflects the input of those with lived experience, which was first raised as necessary in the debate by the noble Baroness, Lady May. It is about striking the right balance between getting the details of a framework of legislation right, along with the urgent need for reform, and the point that noble Lords have raised about how that is going to be done.

Attitudes and knowledge, as many noble Lords have acknowledged, have changed radically. Mental health is increasingly out of the shadows, and through the Bill we can make sure that legislation does a much better job of keeping up with a shift in societal attitudes and expectations and the development of treatment.

Regarding the role of your Lordships’ House, like the noble Baronesses, Lady May and Lady Barker, I recognise the relevance of this House. I too welcome that the Bill has started its passage through Parliament here because I believe your Lordships’ House will do the job that it is here to do, which is to improve legislation, and this debate today has certainly confirmed that.

In looking at what we are trying to achieve, I am reminded of the words of Professor Sir Simon Wessely in his foreword to the independent review’s final report, where he said that

“we want the Mental Health Act to work better for patients, the public and professionals. We hope that the result will be to reduce the use of coercion across the system, whilst giving service users more choice, more control and better care, even in the event that detention is still required. And we particularly hope that the end result will be to reduce the inequalities and discrimination that still remain”.

Almost six years after the former Prime Minister, the noble Baroness, Lady May, commissioned that independent review, the draft legislation before us speaks to those aspirations as well as delivering our manifesto commitment to modernise the 1983 Act.

On the reduction of detentions, I certainly agree with the noble Baroness, Lady Murphy, and other noble Lords that reducing detentions cannot be achieved by legislation alone. It will depend on having the right services in the community.

New models of care in the NHS are already giving over 400,000 adults greater choice and control over their care. We are also trialling new models of care through six early implementers, bringing together community crisis and in-patient functions into one neighbourhood team that will be available 24 hours a day, seven days a week, to increase access and improve continuity of care in the community. I know from the debate today that many noble Lords are looking for that sort of development and good practice.

As we know, the Bill makes a number of improvements in respect of patient experiences and care, and of the increase of choice and autonomy. It seeks to tackle racial discrimination and provide safety for public, staff and patients, and to provide better support for those with autism and learning disabilities.

I turn to some of the main themes that have been raised. I say to the noble Baroness, Lady Tyler, that we continue to be committed to engaging with those with lived experience. Part of the point of the Bill is that, where those with lived experience have not had their voices heard, I believe our continued engagement will allow that.

On racial inequalities, many have spoken passionately about this matter, including the noble Baronesses, Lady Watkins and Lady Buscombe, and the noble Lord, Lord Adebowale. The racial disparities associated with the operation of the current Act were one of the many drivers of reform, and rightly so. The changes in this Bill will give patients greater say in their treatment and encourage more collaboration and less coercion in care and treatment planning, which are all crucial to reducing inequalities. This will include increasing oversight and scrutiny of community treatment orders, where racial inequalities are at their most acute. It will also be about encouraging the uptake of advance choice documents, where those with lived experience, as I said in my opening remarks, have been very generous in their reference to their use in reducing inequalities. Legislating so that people can choose their own nominated person will also protect rights.

Inequalities in outcomes are not just a result of how the Act has been applied but also due to wider social and economic factors. We will therefore be working across government to ensure that the Bill’s provisions are effectively implemented, aiming to reduce those racial disparities in decision-making under the Act, starting with using the code of practice to make clear which actions can be taken in the application of the Act. We are also taking forward non-legislative reforms recommended by the independent review, including the Patient and Carer Race Equality Framework and also piloting culturally appropriate advocacy models to support those from minority ethnic backgrounds to understand their rights under the Mental Health Act and to give voice to their individual needs.

On the mental health commissioner, I have heard many comments, including those expressed by the noble Baronesses, Lady Murphy, Lady Barker, Lady Buscombe and Lady Berridge, and the noble Lord, Lord Bradley, and others. That is quite a group to address, but I will have a go. It is true that we have not taken forward the pre-legislative scrutiny committee’s recommendation to establish a statutory mental health commissioner. We recognise that improvements need to be made to the quality of care and the patient safety landscape. However, the concerns are that the proposed mental health commissioner’s function would be potentially largely duplicative of existing bodies and functions, and nobody wants to risk diluting accountability or causing confusion. As noble Lords will know, Dr Penny Dash has been asked by the Secretary of State to assess if the current range and combination of organisations within the healthcare regulation landscape is effective and to make recommendations of what might be needed, and I think it is important that we await her recommendations.

Learning disability and autism were raised by a number of noble Lords, in particular by the noble Baronesses, Lady Hollins, Lady Buscombe and Lady Browning, my noble friends Lady Keeley, Lady Ramsey and Lord Touhig, and the noble Lords, Lord Scriven and Lord Adebowale. This is a very important point and I recognise that we want to improve care and support for the over 2,000 people who are currently detained, as well as anybody who may need support in the future. We know from the NHS’s safe and wellbeing reviews that four in 10 people who are detained in this group have needs which could have been met in the community with appropriate support. That is why we are going to be focusing on developing community services and improving the quality of care, which will happen alongside the Bill’s reforms.

Through the Bill, we will be taking forward a package of measures for those with a learning disability and autistic people, so there will be a significant programme of work, alongside investment. I will be pleased to engage with expert stakeholders and those with lived experience, including parliamentarians, and to update your Lordships’ House as we progress.

With regard to the recommendations of the pre-legislative scrutiny committee, there is no doubt in my mind that the Bill has benefited greatly from undergoing scrutiny in 2022. It is a better Bill for that and we have tried to incorporate more of the Joint Committee’s recommendations within it. Many of those recommendations relate to the statutory code of practice and we will consider how we take these forward following Royal Assent.

On the important point of implementation, raised by many noble Lords, including the noble Lords, Lord Adebowale and Lord Bradley, the truth is that we estimate that the full implementation of these reforms will take around 10 years. The speed at which we can implement will be limited by the time that we need to expand and train the workforce. This goes to the point raised by the noble Lord, Lord Kamall, and I am grateful for his honesty in the way that he described previous work on the workforce. I thank him and his ministerial colleagues—predecessors of mine—who have worked on this.

The reality is that while some reforms can commence much sooner than others, we will need to commence powers under the new Bill in phases. Implementation will depend on what happens during the passage of the Bill and the reality of future funding settlements—to the point raised by the noble Lord, Lord Stevens—as well as other developments, such as the 10-year plan, but I can briefly give an indicative timeline.

A small number of reforms relating to the criminal justice elements of the Bill will commence within two months of Royal Assent. In the first year after Royal Assent, there will be a focus on updating the code of practice and creating the necessary secondary legislation to enable implementation. We will need a further year to train existing staff on the reforms and ensure that processes are in place. We would therefore hope to commence the first phase of significant reform in 2027, and to commence further reforms as and when there is sufficient resource in place to do so. In the spirit of honesty, the truth is that for what I would call the most burdensome reforms—for example, the increased frequency of mental health tribunals—those would not be likely to commence before 2031-32.

Alongside the passage of the Bill itself, we are looking closely at implementation in relation to learning disability and autism. Again, the exact timing of implementation of the reforms will depend on future funding. I know that noble Lords will understand that I am limited in what I can say on that, but we have already demonstrated our direction of travel by: treating and resourcing mental health seriously, including having a mental health professional in every school; introducing open-access Youth Futures hubs; recruiting 8,500 mental health workers; and having £26 million in capital investment. Indeed, there is the priority that many noble Lords, including the noble Lord, Lord Crisp, have acknowledged of bringing this Bill forward as a matter of urgency.

The noble Lord, Lord Meston, and the noble Baroness, Lady Berridge, raised the disparity of treatment between children and adults. It is true that there are a small number of reforms which do not apply to children and young people, as was also raised by the noble Baroness, Lady Watkins. It is the case that there is a difference; nevertheless, we are committed to improving children and young people’s autonomy over their care and treatment. We still believe that these reforms will go some way to achieving this. Like adults, under-18s should be supported to share their wishes and feelings by the clinician when it comes to care and treatment decisions.

On the issue of prison transfers, which was raised by the noble Baroness, Lady Watkins, and the noble Lords, Lord Scriven, Lord Bradley and Lord Adebowale, we recognise that operational improvements are needed to ensure the safe and effective implementation of the statutory 28-day limit. NHS England is indeed taking steps to address some of the barriers to timely transfer of patients. The wording in the Bill, which refers to the need to “seek to ensure” a transfer within 28 days, should be sufficiently robust to provide accountability for a breach of that time limit, while recognising that there are multiple agencies involved.

As we know, while this legislation—

[Baroness Berridge (Con)]

I hate to interrupt, given the lateness of the day and the lateness of the hour, but the point that a number of noble Lords were making in relation to children is that this Bill potentially does not sit with the principles under the Children Act. If the Government intend impliedly to repeal parts of the Children Act, then it would be good to have that clarification from the Dispatch Box.

[Baroness Merron (Lab)]

I look forward to coming to that point in Committee. The marrying up of legislation will be important, as is making progress on the Bill. That applies to the point of the noble Lord, Lord Alderdice, and others about fusion. We do not want to hold up this Bill while we make progress, but we will be mindful of the interface with other legislation.

In this Bill we are starting with the most overdue reforms to make the law fit for the 21st century. I very much look forward to working through the Bill in much greater detail in Committee. I am most grateful to all noble Lords who have not just spoken this evening but worked to get us to this point.

Bill read a second time.

--- Later in debate ---

Moved by

[Baroness Merron]

That the Bill be committed to a Committee of the Whole House, and that it be an instruction to the Committee that they consider the Bill in the following order: Clauses 1 to 3, Schedule 1, Clauses 4 to 23, Schedule 2, Clauses 24 to 38, Schedule 3, Clause 39 to 54, Title.

Motion agreed.