My Lords, I will speak briefly in support of all these amendments, including Amendment 114 in the name of the noble Baroness, Lady Whitaker. I apologise for having to scratch my name from the speakers’ list at Second Reading, as I had been struck down by the dreaded virus.

In all areas of healthcare, communication between patient and healthcare professionals is extremely important for diagnosis and treatment, and to achieve the necessary outcomes. This is drummed into medical students and other health professionals daily.

I declare an interest: I am an honorary fellow of the Royal College of Psychiatrists—an honour awarded to me by the noble Baroness, Lady Hollins, who is not in her place, when she was its president.

The citation of unknown accomplishments in mental health on my part was read out by the noble Lord, Lord Alderdice, who is also not in his place.

I remember, however, that although my professor at the time, Sir Ivor Batchelor—a well-known psychiatrist—was a quiet man, during our psychiatry clinical attachments he used to drum into us that not all mental health patients can communicate well.

We had to be patient to learn and understand their ways of communicating to help them communicate their problem. I had forgotten that I was taught that; at the time, I think he hoped that he would make us all psychiatrists, but that did not happen.

The noble Baroness, Lady Whitaker, has highlighted the extent to which patients with mental health problems have communication disability, difficulty or difference.

NHS Digital research has shown that children and young adults with mental health problems are five times more likely to have communication problems, and that in 81% of children with social and emotional needs their needs remain unidentified.

Even without communication disability, difficulty or difference, people with chronic acute mental health problems also show communication problems. As the number of people with complex mental health needs increases, so does the need for more speech and language therapists.

Very few multidisciplinary teams include such professionals and, where they do, most of the professionals work in in-patient settings. NHS Digital research suggests that there are about 256 such professionals, mostly working in in-patient secure settings.

The provision of such services in community settings is patchy or non-existent, leading to long waits.

My Lords, I shall speak to Amendment 49 on this issue. I do not disagree with anything that has been said about the vital need for communication and to ensure that the patient understands what is happening and has access to specialist help.

But I particularly want to comment on the proposal that speech and language therapists should become responsible clinicians. The role of responsible clinician under the Mental Health Act is really quite onerous.

Of the 50,000 or so clinicians who take on the role and are appointed the responsible clinician when somebody is detained, the vast majority are consultant doctors. Fewer than 100—0.002%—have been psychologists or nurses.

The appetite for taking on this role is low and, of all the members of the team who could take it on, it would be appropriate only in a very small minority of cases for it to be speech and language therapists.

I do not want to rule them out because I know how valuable these people are, but we must see that, in practice, this will probably not fly very far. It is important that we concentrate on how we get proper communications, but this particular amendment would probably not find favour.

I do not think that profession is yet trained to the full extent of what would be required for that role. Although I hope that it will be one day, this Bill is maybe too early for it.

My Lords, with the greatest respect to the noble Baroness, I did not suggest—and I did not hear any other noble Lord suggest—for a minute that language and speech therapists would become clinicians in their own respect.

I said that they would be part of a team that would help to establish appropriate communication. As doctors, we are not the best people for that—so I do not see how the amendment cannot fly, when there is a need for such people.

I entirely agree with the noble Lord. However, the reality is that the responsible clinician, as mentioned in Amendment 49 to Clause 10, has a wide range of roles. It is very onerous and specific, so this is not likely to be a good idea for a speech and language therapist.

I agree with the rest of what everybody has said.

In supporting Amendment 1, I am delighted that the noble Baroness, Lady Tyler, began Committee with this focus on the impact of the Mental Health Act on racialised communities, because that is where this whole journey began, with the noble Baroness, Lady May, when she was Prime Minister, announcing it in that context—and then, of course, it became a wider reform of the whole Act.

I served on your Lordships’ Joint Committee with the other place, scrutinising the Bill. In the course of that, I became aware of the relative strengths of civil society among some of the groups.

There were excellent civil society groups speaking on behalf of people with learning disabilities and autism; they were highly professional and articulate.

We had one evidence session on the effect of the Mental Health Act on racialised communities, but I saw that the strength of civil society and of media coverage in that area was less—so I am sympathetic to Amendment 1, which would give a profile to one of the main issues under the legislation.

On whether the table should be in the Bill to be in the code or in the Bill sitting as primary legislation, I have sympathy for that proposition. We have learned that the code of practice merely reflects primary legislation.

I am aware, of course, that the independent review came up with those four principles, and this fifth one was not part of that. I expect to hear the Minister say that it is already in the Equality Act, so we do not need to put it in the Bill—but I am persuaded of the merits of the amendment.

During the whole process of an independent review, a White Paper, a response to a White Paper, a draft Bill, a Joint Committee and now the Bill before your Lordships’ Committee, it has become clear to me that many of the changes that ethnic minority communities need to see are in practice.

They are in resources and training—people would not look to the Bill and see their needs as the first or an important priority in it.

I would be grateful if the Minister would take seriously this consideration of putting this equity principle in the table and putting it in the Bill, full stop, and not within the code.

My Lords, I feel it necessary to start, instead of talking about the Bill, by offering our condolences to the noble Baroness, Lady Hollins, on the very recent loss of her dear husband, and to thank her, as I know all noble Lords will do, for her close engagement on these reforms over many years.

I say to the noble Baroness, who said she would be watching if she could, that we absolutely understand why she cannot be with us today. We miss her and I know that the thoughts of all noble Lords will be with her at this very sad time.

If I may make a few general points, as we know, this legislation has been in development for many years. I put on record my thanks for the collaborative and constructive nature of that work and the discussions I have held in my post over the past few months with Peers on all sides of the House.

I extend my appreciation to the former Prime Minister, the noble Baroness, Lady May of Maidenhead, for her highly significant role in commissioning the independent review which informed this Bill and to Sir Simon Wessely and all those who worked on this landmark review, which provided a blueprint for this Bill.

Like other noble Lords, I am very pleased to have got to this point.

I apologise for interrupting my noble friend’s eloquence, but it is not the case that speech, language and communication difficulties are a protected characteristic. Can she absolutely assure us that they do come under the Equality Act?

I am grateful for my noble friend’s intervention. I will later make specific points about speech and language therapists.

The revised code of practice will give guidance for decision-makers and those involved in care and treatment on how to support individuals with communication needs to make sure that their voices are heard.

Following Royal Assent, we will draft, and consult on, a code of practice, and it will be laid before Parliament. In addition to the code, we will lay secondary legislation to support the reforms set out in the delegated powers memorandum.

I am committed to sharing papers setting out further details on this, including what we expect the content of care and treatment plans to cover, some of which is highly relevant to this debate.

Amendment 3, in the name of the noble Baroness, Lady Tyler, and also spoken to by the noble Lord, Lord Kamall, would mean that the individuals and organisations referenced in Section 118(1) of the Mental Health Act 1983 must have regard to the code of practice when making decisions.

It seeks to probe whether the principles set out in the table in Clause 1 of this Bill—under new Section 118(2B) of the 1983 Act —will be statutorily binding. Practitioners are already under a statutory obligation to take account of the code when making decisions under the Act.

Anyone who must have regard to the code of practice under Section 118(2D) must therefore also have regard to the statement of principles that the Secretary of State must include in the code when carrying out specified functions under the Act. That includes all those referenced in Section 118(1).

The Government expect practitioners to follow the code. Anyone seeking to depart from it must have compelling reasons for doing so.

Reasons for any departure must be recorded clearly, as courts have the power to scrutinise such reasons to ensure that there is sufficiently convincing justification for not following the code.

I believe that this is the right approach, because relevant individuals and organisations must have regard to the code and, in turn, the principles.

But the system is not so inflexible that a principle must be followed irrespective of the circumstances, because there could be very rare cases whereby it could create a risk that an individual is not being treated according to their own particular needs, which is not the intention of the Bill.

I think the Committee would understand that if it was to do with a therapeutic intervention. This is about the principles according to which clinicians and others have to work when dealing with the Act.

First, can the Minister enlighten the Committee as to which principles, as a framework, would not be suitable for a particular patient? It is a principle.

Secondly, my noble friend tabled this amendment because case law on codes of practice in the public sector goes back to 1998 and Regina v Islington Borough Council, in which the court made it very clear that public bodies have the right to deviate on admissible grounds where there is good reason.

I can see no reason, unless the Minister can give one, why deviating from a principle is acceptable. That is why my noble friend wants the principles to be in the Bill. I could understand if it was a restrictive practice, but it is not; it is a principle.

To add to what the noble Lord, Lord Scriven, has said, I am having a problem understanding why the code is not statutory.

I thank noble Lords for their interventions, for which I am grateful. They give me the opportunity to say now what perhaps I should have said at the outset: I will of course reflect on all the points that are raised as we move forward.

I will be honest and say that I am not sure that what I am about to say will do justice to the points that have been raised. Overall, the real concern is about making very complex legislation even more complex.

We are wrestling with our attempt to update the Mental Health Act—we are not starting from scratch. That is the point I would like to like to move on to.

The noble Baroness, Lady Tyler, raised a comparative point about the Mental Capacity Act and asked why, if that could include principles, it is not possible for the Mental Health Bill to.

To extend what I have just said, it is because the Mental Capacity Act was structured around principles from the outset when it was drafted and did not have to meet the challenge that we are trying to debate today.

As I said, we are currently looking at amending the existing Mental Health Act, which has not been designed or structured around statutory principles. In my language, I would say that we are starting from an entirely different place.

I hate to interrupt the Minister’s flow, but we are going to come back to the code of practice again and again. Can she outline whether we will get to see a draft of that code?

If the argument from the Government is that it needs to be in the code and not on the statute, it would be very helpful to see a draft code of practice before Report, at the very latest.

Those of us who were here in 2006 listened to the Minister’s predecessor at the Dispatch Box making pretty much the same speech that she has made now, and nothing has changed in the meantime. We are trying to do what we can to make sure that we do not have the same situation for the next 20 years.

I take the point that the Mental Health Act 1983 was not built on principles.

Does the Minister accept that it is time that we moved forward to a situation where both the Mental Health Bill and the Mental Capacity Act are built on principles, including that the people who are subject to them have rights to dignity and so on, as we have seen set out in different places, and that if they are not treated in that way they have the right to take people to court?

I thank noble Lords for their interventions. I will take the point from the noble Baroness, Lady Berridge, first. Following Royal Assent, we will be drafting and consulting on a revised code of practice, which will be laid before Parliament.

We will be working with key partners to ensure that everyone is trained in the new Act before the first major phase of reforms. I hope that that will be helpful. I hear the disappointment in the comments of the noble Baroness, Lady Barker.

On her request for specific examples, I will need to write to noble Lords on that. I hope noble Lords realise that not having the principles in the Bill, as the amendment refers to, does not mean that there is less intention that they apply.

For me, it is about the way of getting there, rather than the commitment to it. However, I hear the question about that point.

Amendment 49, on the matter of speech and language therapists, is in the name of my noble friend Lady Whitaker, supported by the noble Lord, Lord Patel, and my noble friend Lord Bradley. I turn first to the question raised by my noble friend Lady Whitaker.

It is true that not all speech and language difficulties or differences would count as a disability under the Equality Act 2010, so my noble friend makes a relevant point.

The definition of who can and cannot be approved as an approved clinician was spoken to by the noble Baroness, Lady Murphy, and the noble and learned Baroness, Lady Butler-Sloss.

That definition is set out not in primary legislation but in instructions issued by the Secretary of State, under the power in Section 12ZA of the current Mental Health Act.

These instructions have the same status as secondary legislation, so it is our belief that it would not be appropriate to specify in primary legislation that speech and language therapists can be approved clinicians, because all other professional groups are covered only in the instructions.

For that reason alone—but noble Lords should bear with me—we will seek to reject this amendment.

However, I can commit that we will be revising the statutory instructions under Section 12ZA following the passage of the Bill, and we are very happy to consider extending the criteria to include speech and language therapists.

I offer an invitation to the royal college to discuss this matter with the department and to consider how it can work to support and encourage those of its members who may be interested in this role. I am aware that time is not on my side.

I wonder whether I can be of help to the Minister. The timing is advisory so, if there are important points that the Minister wishes to make, she should please go ahead.

I have never had so much encouragement to carry on speaking. Noble Lords will be glad to know that the flashing clock always makes me very nervous. I thank the noble Lord, Lord Kamall.

Can I just add to what the noble Lord, Lord Kamall, just said? I have never before sat through a Committee where the Minister has been restricted in going beyond any advisory time. She should say what she darn well likes.

She may have to respond to an awful lot of complicated spots in this; there is no reason at all why she should not carry on, in my view—and that of everyone else in the Committee, I think.

I thank the noble Baroness for her extremely comprehensive but very helpful response to all the amendments, and I am happy to withdraw.

The noble Baroness asked me a question. Was it rhetorical? I wonder whether she could accept that autism is different.

From the time that Kanner first identified autism, which is what a lot of psychiatric bases are based on—we then had Asperger and others, and the very good, more recent documentation from Lorna Wing, with whom I am sure she is familiar—autism has been different.

If people doubt that, it is important to note that, apart from the Mental Health Act, the only other condition, however you label it, to have its own Act of Parliament is autism.

In the Autism Act 2009, this Parliament unanimously agreed—in both Houses—that autism is different and deserved its own Act of Parliament.

I would say that all mental disorders are different but that they cannot all have their own Acts of Parliament. I do not accept that autism is different.

I will make a slightly cheeky intervention, if I may, on the noble Baroness. I am not weighing into the debate that is taking place but simply make this point. Does she accept that the fact that a condition is listed in the DSM or the ICD is not itself definitive?

Until 1973, homosexuality was listed as a psychiatric condition in the DSM and until 1990 it was, I believe, included as a psychiatric diagnosis in the ICD. Therefore, that is not the strongest evidential basis for her claims.

I agree with the noble Lord, but the reality is that we use DSM-3 and ICD-11 in the international classification of disorders. If we in Britain are to go outside that, for reasons of our own, then we had better have some pretty good ideas why that should be. I am not so sure that we have them.

The Wessely review rejected the notion because, as the noble Baroness, Lady Berridge, said, it carried serious risks that individuals would be extruded and neglected, the opposite of what is intended.

Similar anxieties were expressed in the development and creation of other Acts—I am sorry that I am going to go on longer than the advisory—so as not to exclude anybody from this group, because we want mental disorder to be an inclusive thing and not to exclude whole groups of people.

Their protections are gone if we exclude them. I accept that almost all the developments for autism and learning disabilities in the Bill are very positive.

They will really improve the way that people think about autism and will have an extremely beneficial effect on trying to develop services and improve training, but there is no evidence that changing the criteria under the Act will do anything to improve it.

Getting money into services and service design is what we need and not a change in the legislation for criteria. As the Royal College of Psychiatrists’ group of specialists in learning disabilities have pointed out, the vast majority of them do not want this change in legislation.

We should think very carefully before we submit people to something when we do not know what will be unleashed as a result.

What does the noble Lord think will happen to the people in the gap?

As I said, the noble Baroness, Lady Bennett, pointed out what happens internationally, in Trieste in Italy, for example, and I therefore suggest that good international comparisons and practice could be enacted in legislation to ensure that the needs of as many people as possible are met in the community, rather than them being held in detention because the provision is not there.

That is exactly what will happen unless this gap is dealt with by looking at what is required rather than looking at the gap and continuing detention.

I wrote the amendment in a terrible hurry as a compromise amendment when I could not table the amendment that I really wished to table, which was seeking to get back to having clarity about the diagnostic criteria.

I apologise if that was not the provision that the noble Lord wanted in the Bill—I am not sure that I want it very much either. I do not have any great devotion to the proposed new clause; it was just a way of trying to address this leaving of the gap. We used to do that, by the way.

After the 1983 Act, noble Lords will remember that we dropped alcohol addictions and drug misuse from the Act, saying that we could not detain people for those reasons alone.

What happened was that there was total neglect for the next 20 years until voluntary organisations and local authorities got moving and said, “This won’t do—we must do something”. Noble Lords should remember that that is what happens.

If you leave somebody out of protective legislation, they will not be included; they will be neglected and they will end up in prison. That is what Sir Simon Wessely thought and it is what the noble Baroness, Lady Berridge, has been talking about.

I can guarantee that nobody will be interested in autistic meltdowns if there is no way in which to intervene to save a family from having that person with them, seven days a week and 24 hours a day, during the period of this terrible disturbance. Community services are great.

I urge noble Lords to visit Trieste, as it has brilliant services in a tiny area; it is one of the very few in Italy, and it continues to work very well. It is cited all over the world, and that is very good.

But this is Britain, with 80 million people and massively underfunded services, and it ain’t going to happen. I want to know what will happen to those people noble Lords would like to see neglected until such time as the Government produce some alternative provision.

Perhaps I can clarify. I think that the noble Baroness’s amendment is to some extent based on the spirit of the Joint Committee’s report, which was about providing some kind of mechanism, after the 28 days—I am glad to see the noble Lord, Lord Bradley, nodding.

There would be a specialist tribunal, and we said that it should be composed of people with experience of learning disabilities and autism, so that there was not a get-out for clinicians that they had not done the assessments properly.

There would have to be grounded reasons to go beyond the 28 days and, in exceptional circumstances, you could authorise the detention, to make sure that the law covered that gap or group of people.

No one wanted to see people detained for the reason that there was no community provision—that is ridiculous.

I accept that the reality is probably going to be that clinicians will find a mental disorder diagnosis to use the powers under Part II to do what is in the best interests of that person and their family at the time.

But the law should also cover that situation and not force clinicians into those diagnoses—hence the need for accurate data, so that we can track what is happening when the law is enacted.

I have not spoken in this debate so far, but I have listened intently to everything that everybody has said, including the noble Baroness, Lady Murphy.

Members of the Select Committee will remember—they could not forget—the evidence given to us by particular witnesses who have autism and have been through the trauma of being detained.

They made to us, unforgettably, the point that there are some people with autism and learning disabilities for whom detention is an aggravating factor.

I happen not to agree completely with the noble Baroness, Lady Bennett, that there should be an end to all detention, although I have some sympathy with her arguments.

I believe there are people for whom detention is necessary—both for them and for the safety of others—but they should be held in mental health facilities and not the criminal justice system. I listened intently to the noble Baroness, Lady Murphy.

I understand that it may be absolutely correct to define people with autism and learning disabilities as having a disorder, but we have moved on over 20 or 30 years to understanding that their manifestations and treatment are different from those of other mental health conditions.

There is therefore a problem in having the diagnosis and treatment carried out by the same people. I hoped that she would explain, but she did not, why keeping people within the definition would improve their care.

Does the noble Baroness accept that, in talking about treatment, we are talking about care, education and training in social circumstances?

Treatment is not about medication, which may be totally inappropriate, but about looking at the individual’s developmental needs as a whole, which include a whole raft of things.

I agree that it is not just about psychiatrists or psychologists; it can be about teachers, people with a special understanding of speech and language, and so on. I would never deny that you have to encompass the whole thing—I would promote it.

I will be pleased to come back to that point. I think agreement broke out for a moment, which I would share, on the fact that detention takes many forms. It is about getting the right form and being sensitive to the needs of the individual, which is what the Bill is all about.

I am grateful for those comments. To pick up my point about the expert consultation that has taken place, a decision was taken to retain the ability to divert people who are autistic or have a learning disability, who have committed a crime, from prison to hospital under Part III of the Act.

Without this safeguard, the only alternative to detention in hospital is detention in prison. Noble Lords have referred in this group to how, often, this would be inappropriate in meeting those people’s needs and would exacerbate and manifest distress.

On balance, we believe it is right to retain the ability to divert such patients to hospital, where they are much more likely to access the right kind of support and care that they need. The noble Baroness, Lady Bennett, raised concern about resourcing implications for local authorities.

I refer her to the impact assessment, which sets out anticipated costs, including a breakdown of costs for councils. I assure her that we will do further work with MHCLG to assess any new burdens on local authorities created by the Bill. We are very alive to that situation.

The Minister will not be surprised to hear that I like what she just said. Is there no way she can put that in the Bill under a government amendment?

I am grateful for the invitation, as always. Government amendments will be considered as we progress through Committee, but I say that as a broad point, as I know the noble Baroness understands.

The intention of the provisions in the Bill on registers and commissioning is that people with a learning disability and autistic people are not detained but supported in the right way.

The proposed changes to Part II, Section 3 will be commenced only where there are strong community services in place.

I am aware of how much time the Minister has given and how generous she has been in allowing interventions. If she is minded on Amendment 5, can she outline whether she is proposing that there would be the special tribunal that the Joint Committee outlined?

If so, how would she then deal with these issues for under-16s in respect of DoLS and for vulnerable adults? When there is no legal basis at all, it is then left for clinicians to detain anybody after the 28 days.

I became a little worried, listening to the noble Baroness, Lady Berridge, that perhaps I had been a bit too generous.

No.

I agree. The amendment seeks to strengthen and to clarify, rather than to make changes that would be completely different to what is intended in the Mental Capacity Act.

I am grateful for the noble Baronesses’ comments. I will come back with some examples before I sit down, because that is a very good suggestion. If I fail to do so, I will gladly provide them in writing.

Amendment 35, tabled by the noble Baroness, Lady Murphy, intends to provide a route to detain people with a learning disability and autistic people who do not have a diagnosed psychiatric disorder.

Detention could be authorised only with the approval of the tribunal in “exceptional circumstances”, with power to provide guidance on what those circumstances will be in the code of practice.

The amendment seeks to address the needs of those with a learning disability and autistic people, with whom I know the noble Baroness is concerned, where a considerable risk is being posed in the community, but who do not also have a diagnosed psychiatric disorder warranting detention for treatment under Part II, Section 3.

Our clear intent throughout the Bill is that people should be detained beyond Section 2 only when they have a psychiatric disorder that requires hospital treatment. It is our feeling that this amendment runs contrary to that intent.

I am also grateful to the noble and learned Lord, Lord Hardie, for his comments on Amendment 35. We also have some concerns about the scope of the “exceptional circumstances”, which would potentially result in a position no different to the current effect of the Act.

It is unclear, in advance of the code of practice being developed, how broadly this might be defined. There would be considerable scope for different, divergent approaches in comparable cases, which, again, I know is not the intent of noble Lords.

I am sure that the noble and learned Baroness’s yawn speaks for many.

I apologise.

There is no need to apologise.

I am pleased to provide the reassurance that the proposed changes to the Section 3 detention criteria mean that it would no longer be possible to detain someone with a learning disability or an autistic person under Section 3, unless they have a psychiatric disorder.

Additionally, the Act already requires a statement of rationale for detention and statutory forms.

The registered medical practitioner will have to confirm that the patient meets the criteria for detention, including that they are suffering from a psychiatric disorder requiring hospital treatment and not just that the patient has a learning disability or is autistic.

I hope that will be of reassurance to the noble Baroness. For the reasons I have set out in respect of all the amendments—I thank noble Lords for them—I ask the noble Baroness to withdraw hers.

The noble Baroness referred to the Trieste model, and I thought that led to quite a deal of interest from noble Lords across the House. Could she share some details on the Trieste model with other noble Lords but especially the Minister and the department, so we can all start learning those lessons?

I should absolutely stress at this point that I am not an expert, but I will certainly do my best to secure as much information as possible and share it with all noble Lords. The Minister may also have access to resources that may not be available to me.

Reflecting on the intervention of the noble Lord, Lord Kamall, perhaps we could even arrange some kind of discussion—it might be useful—and perhaps even hear some testimony, because that would really inform our consideration of the Bill. But in the meantime, I beg leave to withdraw the amendment.

My Lords, I should like to speak to Amendment 9, following on from the noble Lord, Lord Scriven, on Amendment 8. We are dealing with the responsible commissioner making arrangements for the care (education) and treatment review meetings and the report.

I do not know whether I am a lone voice speaking in this House but I am a mother and a grandmother, and there is not a single word in any part of this Bill about parents or guardians—not a word.

I could find references to parental responsibility only in new Schedule A1 and Schedule 2, although I may be wrong. Can I just suggest something to noble Lords?

Where you have a child—here, I am dealing specifically with a child—with autism or physical or mental disabilities, it is quite probable, if not most likely, that that person will be living with their family and their parents.

I must say, my experience as a family judge led me to believe that only about 5% to 10% of parents who came through the courts were not suitable to look after their children full time.

But according to Clause 4—which inserts new Section 125A—the one group of people who will not be told what the future care (education) and treatment review given to their child will be includes the people with whom that child has been living for all their life.

I cannot understand why this Bill seems to think that parents, guardians and other people with parental responsibility do not matter. That is why I have raised this issue. I feel intensely strongly about it, as a mother and a grandmother.

I too am supportive of the spirit and intention behind Amendments 19 and 20, but I want to raise two textual questions relating to whether they would give effect as was intended.

In respect of Amendment 19, I am not sure that the explanatory statement accurately characterises what the amendment proposes.

It says that the amendment ensures that ICBs and local authorities would “have a duty to carry out”, whereas at the point at which those words would be inserted it appears that the duty would also then fall to the patient’s responsible clinician.

Amendment 19 by itself would essentially see CETRs overriding the judgment of the responsible clinician, which I think is quite a significant step to take. In any event, I wonder whether Amendment 20 undoes any of the good work that Amendment 19 proposes in the first place.

It says that you can ignore the exhortations of Amendment 19 if there is a “compelling reason” to do so.

My question to the drafters of Amendment 20 would be: what statutory interpretation should be placed on “compelling reason” and how might the courts be expected to adjudicate in the event of judicial review?

I support and have added my name to Amendment 13, tabled by the noble Baroness, Lady Tyler, around communication issues. As she rightly pointed out, this could have been linked to Amendment 2, which has already been debated at some length.

I will not repeat the same arguments, but they apply to this amendment, which is why I support it. I also very strongly support the amendment on housing tabled by the noble Baroness, Lady Barker.

I am chair of NHS England’s health and justice advisory board and have worked on the development of RECONNECT, the service to support people coming out of prison back into the community, which is very much a health-based initiative.

Unless their housing needs are met at that point, their treatment, their support and their care plan can fall apart very quickly. Consequently, they are very quickly back in the criminal justice system. The same comparison can be made with this amendment.

I strongly support housing being at the core of all issues relating to health and social care.

My Lords, I am grateful to noble Lords for their amendments and contributions today. It seems a while ago that the noble Baroness, Lady Barker, originally spoke, but I put on record that I hear her frustration about having been here before.

I certainly acknowledge that; and I am grateful for the contribution and time that noble Lords have given to this really important matter, so that perhaps, finally, we will not have to keep going where we have been before.

I entirely understand what the Minister has just said, although I do not agree with her, but the point she made about other persons is not contained in the clause that I was complaining about.

I am grateful to the noble and learned Baroness for making that point, and I will gladly review this in the light of it.

To return to the specific amendments, they would ensure that the patient, the patient’s nominated person, the independent mental health advocate and the parent, guardian or other person with parental responsibility receive in all cases a copy of the report following a care and treatment review meeting—or a care (education) and treatment review meeting for children and young people.

The current drafting of the Bill is intended to make clear that a copy of the review report must be provided to those who have a legal duty to have regard to the review recommendations, so that any recommendations are implemented as appropriate.

We recognise that there may be individual circumstances that mean it is appropriate for the report to be provided to other people, including the patient themselves.

For children and young people, this report is most likely to be shared with a parent, guardian or other person with parental responsibility, but it is important that the legislation does not inadvertently create a legal requirement that must be complied with, which would not be appropriate for every person.

A longer list of people with whom the report must be shared, in every case, may increase the chance of an individual withdrawing the consent for a review to be held if they do not wish for some or all the people to see the report.

There may also be circumstances in which the report should reasonably be shared with other people in addition to those set out in the amendments—for example, a family member who has been part of the review process with the patient’s consent but is not the patient’s nominated person or someone with parental responsibility.

We have tabled a government amendment to make it clear that the arrangements may include provision authorising or requiring a copy of the report to be given to other persons, so that the patient may also ask that a copy be provided to others or decide to provide it to others.

Statutory guidance will help assist the responsible commissioner when exercising its functions, including when considering other persons who are to receive the report.

We wish to allow flexibility for this, so that individual circumstances can be taken into account based on the needs of the patient and their wishes, rather than by providing a prescriptive list of people to whom the report is to be sent in every circumstance.

For clarification, is the Minister therefore saying that the Government’s amendment will lead to some statutory instrument, or will it be just at the discretion of the Minister to determine a list and change it without any scrutiny?

I am approaching this without going down the amendments’ route of having a fully prescriptive list, which might have unintended consequences.

I really need to understand the intent of the Minister’s Amendment 17 “authorising … a copy of the report to be given to other persons”.

How do the Government intend to draw up that list, to change it and to make it public, so that people know that they are appropriate persons and might be able to get the report?

I have listened very carefully to the Minister about flexibility. Why is 12 months in the Bill? All I am trying to do is to change a statutory timeframe that the Government have put in the Bill to six months. That flexibility is not there because 12 months is in the Bill.

I am trying to move that fixed point from 12 months to six months, regardless of what guidance says.

The noble Baroness, Lady Barker, is absolutely right. Any amendment I might put forward in future would have to allow for that, as there must be some parents who would not be suitable.

It is getting late, and people wish to have their dinner because they been here a long time. I think we have had a partial response from the Minister.

I believe that care and treatment plans and reviewing them are sufficiently important that some of us will want to go away to see whether, on issues that we may not have got technically right, we can come back, perhaps in discussion with the Minister, to satisfy ourselves.

When I review all of the debates, particularly where there are areas where we need further discussion or information, I will be glad to pursue that. I give that assurance to the Committee.

I thank the Minister and welcome that. I beg leave to withdraw the amendment.