Baroness May of Maidenhead:

Moved by Baroness May of Maidenhead

37B: Clause 5, page 11, line 16, after “detained” insert “by a constable or other authorised person”Member’s explanatory statement This Amendment and others in the name of Baroness May seek to introduce a new category of “authorised person” who can carry out detentions under the 1983 Act to offer better inter-agency response. The proposed amendments would remove the need for the presence of police at mental health incidents in the absence of any risk.

My Lords, the amendments in this group standing in my name, Amendments 37B, 38C, 42C, 42F and 128B, are all intended to widen the definition of those who can attend a mental health incident and act to detain an individual in a variety of circumstances.

It is a pleasure to speak after a number of noble Lords who have a considerable wealth of experience on the issues in this Bill. I can claim no such breadth of experience, but the amendments I have tabled speak to one issue, which I have dealt with in the past: that of who can attend a mental health incident and particularly the attendance of the police at such incidents.

Back in 2010, it became clear to me, as I spoke to more and more police officers in my role as Home Secretary, that there was one issue that was at the forefront of their mind, and it was the problem they had in dealing with people at the point of mental health crisis. Their concern was understandable: they had no training in mental health, they were not professionals in this area, yet they were being called out to situations. They were being expected to determine whether someone was at the point of crisis or not, and what should happen to that individual; more often than not that meant taking that individual to a police cell as a place of safety. For the police officer, there was concern that they were being asked to deal with something for which they had no training or knowledge.

Of course, the police presence was often not good for the individual concerned. Inevitably, it meant they were not being given the healthcare support they needed at that point in time; but more than that, the very essence of a police presence—somebody in the uniform coming to deal with them—could actually exacerbate their mental health situation, and a police cell is not designed to improve somebody’s mental health. Finally, for the police force, of course, it meant that it was taking up resource which could have been used elsewhere, and which was, in many cases, inappropriate; often if somebody was in a police cell as a place of safety it meant that an officer had to sit outside the cell to ensure that they did not harm themselves.

The issue of the use of a police cell as a place of safety is dealt with in other parts of the Bill, but they do not deal with this wider question of the police resource that is being used. Even if the police are lucky enough to get somebody to a hospital, they still could have to have an officer in A&E sitting with the individual to make sure they do not harm themselves or cause harm to others. Indeed, the Metropolitan Police, in its evidence to the Joint Committee on the draft Bill, cited a case study where a patient was required to be guarded by the police in A&E to prevent them becoming a high-risk missing person, and eight Metropolitan Police officers had to attend that individual for over 29 hours. Police officers were worried about the job they were doing, the individual concerned was not being treated or dealt with in the way that was appropriate for their mental health needs, and police resource was used unnecessarily.

Over the years, I and others have tried to address this situation, initially with some success. But what often happens in government, as noble Lords and the Minister will find over time, is that an initial success is turned back because over time people revert to the previous behaviour or mode of operation. That is what we have seen in this case, and it came, of course, to the point where the Commissioner of the Metropolitan Police said that the force would not give an ultimatum and would not turn up to these mental health incidents.

As drafted, the Bill has the capacity to at least maintain, if not exacerbate, this problem, but the Government could accept amendments or amend it in a way that would improve the situation. I should say that, of course, if there is an immediate risk to life or serious injury, the police will always have a role to play; but they are clear that they want to see mental health repositioned as a health matter and not seen through the lens of crime and policing-related risk. This is the position that the National Police Chiefs’ Council took in its letter on the Bill to the current Secretary of State for Health, which said:

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

That concern that the focus and statutory footing of the police as the primary responder to incidents of mental health should be removed from the Bill is what has led to my amendments—it is what they are intended to deliver.

I see similarities between my amendments and Amendment 158 in the name of the noble Lord, Lord Davies of Brixton. If I may be so bold, I think we are both trying to achieve a situation where the expected response to someone in mental health crisis is not limited to police; in other words, “right care, right person”. My amendments are intended to widen the description of those who can attend mental health incidents beyond a constable, but they specify that a police officer—the holder of the position of constable under the Crown—can respond if there is a genuine need for a police presence.

Recognising that we do not want to see healthcare professionals put at risk, the amendments specify that the authorised person attending an individual should have been

“trained and equipped to carry out detentions” and by carrying out that function should

“not be put at unnecessary risk”.

It is worth noting, perhaps at this point, that the College of Policing’s mental health snapshot 2019 found that almost 95% of calls that police attend that are flagged as a mental health response do not require a police response.

I referred to the reasons behind my amendments in relation to the police, but there is support among healthcare professionals for such changes. In the joint Home Office and Department of Health review of Section 135 and Section 136 powers, 68% of respondents to the survey, alongside the review, agreed that all or part of Section 135 and Section 136 powers should be extended so that healthcare professionals could use them provided they were not putting themselves at risk. Paramedics particularly supported the change, with 93.3% of paramedics agreeing and 61.1% strongly agreeing.

Beyond the interests of the police and healthcare professionals, of course, we must also remember the interests of the individual at that point of mental health crisis. They deserve the right response, the right care, the right person—and I do not believe that that is always a police officer. This Bill should reflect that and enable a wider range of authorised persons to attend mental health incidents. I beg to move.

My Lords, this is an area where I feel I have the possibility of a solution or part of a solution, while supporting very much what my noble friend has put forward in her Amendment. My solution comes from knowledge that we have gained from the world of palliative care. It is a subject matter that we covered in detail on the joint scrutiny committee, because the whole issue of the police turning up to such an incident where somebody is absolutely in crisis can, in many instances, lead only to an increase in the fear and extraordinary pain that that person is feeling when they are in crisis. It is not the fault of the police; it is just the situation that they find themselves in.

Evidence was given to us by Dr Lucy Stephenson and Professor Claire Henderson about an amazing app developed for the world of palliative care that somebody towards the end of their life can have attached to their phone—I believe that in the United States they even have a way of attaching it to a person’s clothing—so that, if they collapse in the street or are in crisis, the app can provide an immediate way for whoever is responding, whatever that person’s position, to find out everything they need to know about that person. It links to the advance choice documents, which I know the Minister knows I have a passionate view on in addition to the need for data on all this.

If an advance choice document in digital form is attached to a person’s mobile in the form of an app, it can show that person’s name, where they live, what their financial circumstances are, which I noticed is in later amendments, what their likes and dislikes are, what their condition is and what their needs are. So, immediately, the person who is helping the person in crisis can be aware that there is an issue and can talk to that person, using their name, and be able to help them in a way that could help to calm them down and take them to the next stage. We even gave a presentation on this to a plethora of officials at the Department of Health and Social Care in March 2023. Several months later, I got a response to say that the palliative care app did not quite work. Of course it did not—it has to be applied differently in order to ask the right questions and give the right information for somebody with mental health issues.

Nothing has happened in developing that app, which is a tragedy because nearly two years have already gone by. It does not require primary legislation, would be inexpensive and could be rolled out across the country in the same way as the palliative care app, which has supported so many people who have been in difficulty in a similar way, by either collapsing in the street or having a crisis in front of a stranger. That stranger becomes almost a friend in that moment by knowing who the person is and how to support them. That is something on which I hope the Minister will have more luck than I did in persuading officials that we can get on and start developing it. There are companies out there. I could give a list of those that could develop this app for the Government and the NHS, which could make an enormous difference to everybody with mental health issues.

Can the Minister also kindly update us on the National Partnership Agreement: Right Care, Right Person policy paper, published in July 2023, which committed to reducing the unwarranted involvement of police in supporting people with mental health needs for all the reasons raised by my noble friend, such as the time, situation and, of course, the extraordinary pressures on police in other spheres.

I make two pleas. First, can we think about an app that could be part of the solution to this? Secondly, can we know more about whether this national partnership agreement is making progress? Both pleas require no change to the legislation.

My Lords, in speaking to my Amendment 49A, I thank the noble Baroness, Lady May, for her amendments. Those of us on the joint scrutiny committee spent a lot of time focusing on the fact that, in truth, a lot of what happens to people who are having mental health crises depends entirely on where they are, who is there and who somebody passing in the street and tries to help them thinks is the right person to call at a moment of emergency.

We are all in agreement that the police have for too long been the default answer to a problem but are not the right answer to a problem. The police know they are not the right answer to a problem—I say that as somebody who has lots of police officers in my family. A lot of people having a mental health crisis will end up in A&E just because the lights are on and that is where people go. We are still dealing with one of the problems the Wessely review touched upon, and that is lack of timely access to an accurate diagnosis.

My amendment, which I admit was suggested by practitioners in the field, tries to deal with the fact that we do not have an abundance of consultant psychiatrists who are there at the drop of a hat to make assessments. The amendment probes whether we might help things by opening up the eligibility to make diagnoses under Section 12 to people who are health professionals but not necessarily medical practitioners. Back in 2006-07, we had the massive argument about bringing in approved mental health professionals. That was a big battle and there was a lot of rearguard action on the part of consultant psychiatrists, who saw it as a downgrading. Approved mental health practitioners are now very much part of our mental health services and they are a good part of our mental health services.

The amendment is trying to open up the making of assessments, simply in order to speed up access to appropriate services. We all understand, and are talking about, the fact that, although we can see the effects of waiting lists and so on on physical health services, waiting lists and the lack of access to appropriate treatment in mental health services are much more hidden. People end up in limbo unless and until there is some kind of outrage, or, to go back to the noble Baroness’s point, until they do something sufficiently serious.

We ought to be freeing up the capacity of consultant psychiatrists in particular, because not only is demand growing but there are also particular areas of specialist demand—young people with eating disorders, for example. I frequently hear of worried parents being told that their children are not sufficiently ill to get treatment. They are not alone; there are other people in that same situation. My modest amendment is an attempt to open up and make better use of the skills we have within the NHS workforce.

This is the first time I have spoken in Committee on the Bill, so I declare my interest as a member of the advisory panel of the Money and Mental Health Policy Institute. I shall speak to my Amendment 158, which, as the noble Baroness, Lady May of Maidenhead, said, covers essentially the same ground as hers, and they both aim at the same endpoint. Her elegant and compelling speech has left me in the position of just having to emphasise issues; the case made was compelling, and I hope the Committee will agree. In particular, I hope the Minister will be able to make some sort of positive response.

This proposal does not flow specifically from the independent review, but it is in the spirit of what was in that review. The background to the changing nature of mental health services is the significant material increase in the demand for mental health services over the past few years, and the growing number of people on the mental health waiting list or seeking community support.

This unmet need has consequences, which are felt by front-line medical staff. My amendment seeks to address that by giving additional powers to paramedics and appropriate mental health professionals. It would extend the reach of Section 136 of the Act, currently confined to constables—or police officers, as I say in my amendment. As previous speakers have said, that needs to be shared more widely.

The unfortunate reality of the current situation is that those detained under Section 136 get suboptimal care; we just do not have the resources available for them. There is inadequate provision of suites for Section 136 detention, and there are simply not enough clinicians. We all applaud and support the practice of “right care, right person”, but we must acknowledge that that only increases the demands on the service.

The result of all this is that, as we have heard, police officers are taken away from front-line policing duties for many hours. That is bad for everyone involved—for the police officers, for the health service, and particularly for the patients. At the same time, the skills of non-medical health service staff have increased. They are now moving towards the sort of training that equips them to handle such situations. Obviously, giving staff extra powers will not resolve the situation, but we can learn from experience abroad, especially in Australia and New Zealand, where a range of health service staff have a practice called emergency care orders, with the intention of providing greater dignity, removing the sense of criminalisation, and providing appropriate care.

As my noble friend the Minister said, what we are looking for is beneficial interventions at the earliest possible stage. A key element in achieving that aim is extending the powers under Section 136 to wider professions. That is not to say that there is no role for police officers—there will always be occasions when their Intervention is required—but saying that the single source of entry to services of someone suffering an acute mental health problem is through the intervention of the police is just wrong.

There have always been concerns when the powers of medical staff are extended, but this will be an issue of training, guidance and codes of practice—clearly, those will have to be provided—so that the additional powers can be used effectively.

To conclude, I emphasise the point that the noble Baroness, Lady May, made in opening the debate. We have moved beyond the point when the powers in Section 136 were essentially about public order—which is, quite rightly, a role for the police. We must ensure that now, commitments under Section 136 are the first stage of a process of medical treatment, in which the unfortunate individual suffering an acute problem with their mental health must be considered first. This is not about public order; it is about appropriate healthcare, where a range of health service professionals can exercise their trained judgment to the benefit of the patient.

My Lords, I support this group of amendments in principle, but I want to make two points. We talk about powers a great deal, but the therapeutic relationship is not about power; it is about collegiate working with patients and users of the service. I appreciate that there are times when we need to intervene when the patient does not want Intervention, but we must be careful about the nomenclature as we redraw elements of the Bill.

In particular, I welcome the phrase that the noble Lord has just used, which is used so frequently in New Zealand and Australia: emergency care orders. We should think carefully about the fact that what we need is emergency assessment and care orders. People who work regularly with patients over a long period are often the best people to recognise a change in a patient’s behaviour earlier.

I fully support the idea that this should be extended beyond police constables, as the noble Baroness, Lady May, outlined, but I also recognise that there will be healthcare professionals, be they psychologists, nurses or social workers, who do not want to take this on. We must make certain that we do not lose some of our valuable team by making it compulsory to take on that extended responsibility.

I shall make a few points in response to the amendments that we have been discussing in this group. The noble Baroness, Lady May, made, very powerfully, an incredibly compelling case. The point she made about police officers sitting in A&E for many hours is so important. Not only is that a waste of police resources, it is often completely inappropriate for the person suffering from acute mental health problems. It can also be incredibly alarming for others in A&E. We all know that, sadly, far too many people are waiting for far too long in A&E, in the sort of environment that is in no way conducive to their overall health, physical or mental. That is my first point.

My second point relates to something that the noble Lord, Lord Davies, said. There will still sometimes be a role for police officers. I know from personal experience how much a police presence can be required when a person suffering a very acute mental health crisis is likely to harm both themselves and others. Those others can often be family members who are trying to support the person suffering from the crisis but are also pretty scared for their own safety. It is important that we are talking about widening the range of people who can be that primary responder, but we are not saying that it should never be the police.

I agree that if we have a wider primary responder, that individual must be prepared to do it, happy to do it and appropriately trained. We heard a lot in earlier groups about the importance of good training. I was particularly taken with the statistic that the noble Baroness, Lady May, raised about the views of paramedics and how many of them support this, because they are the people right at the sharp end. I cannot quite remember the number who support it, but it was very large, and so I think it is something that we should take seriously.

Finally, I want to lend my support to Amendment 49A in the name of my noble friend Lady Barker. Speeding up access to appropriate services is important, as is making the best use of the workforce that we have. For those two reasons, the amendment that my noble friend put forward is important.

My Lords, I hesitate to interrupt, but I want to make much the same point that the noble Baroness has made based on my experience of a trip to A&E last year. I mentioned it anecdotally at Second Reading. There was a very disturbed person in A&E when I was having to wait there for some three hours. The hospital staff were struggling to contain the person in one room, as he kept leaving. He was not violent, but he was obviously distracting the hospital staff and worrying the other people present, who included children. As soon as anybody asked the staff what they were going to do, they said that they had to wait for the police. I have no doubt that the whole episode that I witnessed was prolonged by the need to wait for the police. Clearly, if this Amendment or something like it is approved, it will widen the range of those who could be called upon to deal with such a crisis.

My Lords, there is little for me to do following the persuasive speech of my noble friend Lady May, other than to say how much I support her in putting forward her amendments. I hope that the Minister will approach the proposals my noble friend has made in a receptive and constructive way.

I was struck by the case put forward by my noble friend Lady Buscombe about how technology could assist in the handling of mental health incidents. I hope equally that the Minister will wish to follow up on my noble friend’s suggestions.

The question of whether police officers, and only police officers, should exercise the powers under the Act to remove a person suffering from a mental health crisis to a place of safety is one that, as my noble friend Lady May said, has been simmering in the Home Office and the Department of Health and Social Care for a decade or more. Extending those powers to suitably trained healthcare professionals would be a change that I suggest goes with the grain of this Bill as regards the emphasis that it places on looking after mental health patients in the best possible way. That is not a criticism of the police in any sense. The police do a magnificent job in tackling anything that they are called upon to do, but, as we have heard, the police themselves say that the vast Majority of instances in which they are called upon to deal with a mental health incident do not require a policing response.

The issue of risk is important to consider. Statistically, as my noble friend said, most mental health incidents present no risk whatever to the police attending. Admittedly, it is not always possible to tell in advance how risky a particular encounter is likely to be, but I agree with my noble friend that, provided that a paramedic is suitably trained and equipped, they will have the necessary skill set to deal with any risk to their own safety, bearing in mind that if a police presence turns out to be necessary, they can always call for one.

I very much hope that, between now and Report, the Minister will agree to meet my noble friend, if that is what she wishes, to map out a way forward that will lead to a broadening of the Sections 135 and 136 powers.

My Lords, this has been an interesting debate, with much agreement across the Committee. I noted the support from both the other Front Benches, from the noble Earl, Lord Howe, and the noble Baroness, Lady Tyler, for much of what has been said.

Let me first discuss Amendments 37B, 38C, 42C, 42F and 128B in the name of the noble Baroness, Lady May, along with Amendment 158 in the name of my noble friend Lord Davies of Brixton. I am most grateful to the noble Baroness and my noble friend for bringing this issue before the Committee today. Amendments 37B, 38C, 42C and 42F would add a new category of authorised persons and would provide that police constables and such authorised persons may detain a person under Sections 2, 3 and 5 of the Act.

I share the recognition from the noble Baroness, Lady Barker, of the noble Baroness, Lady May, who I commend for her work to pave the way and dramatically reduce the use of police cells as a place of safety for those who are experiencing a mental health crisis. I listened carefully to the noble Baroness’s words of advice to all government Ministers; all I can say is that I cannot think how much better we could be advised than by a former Home Secretary and Prime Minister.

I thank the noble Baroness, Lady Watkins, for what I might call her notes of caution in respect of extending provisions, and the noble Lord, Lord Meston, for sharing his first-hand experience to add to the debate today.

We understand the broad intention of these amendments and of Amendment 128B, also in the noble Baroness’s name, to reduce police involvement in mental health cases for all the reasons that were said, including the extra distress that an officer may—inadvertently, of course—bring to a very delicate crisis situation.

The noble Baroness, Lady May, asked how the Bill will ensure that pressure is not placed unduly on police resource. I understand that that is very much a driving consideration, so let me say a few things on that matter. We recognise the pressure on the police, who are responding to a very large volume of mental health-related incidents, although—this is not to dismiss the point—detentions under Section 136 have decreased this year by 10%, and we are removing police cells as a place of safety to reduce some of this burden. We recognise, in particular, that police time in health settings should be reduced. I give an assurance that we have committed to look at this issue and to update the code of practice to clarify the handover process between police and health, including in A&E, which the noble Baroness, Lady Tyler, spoke about. We recognise the confusion around the application of the legal framework that can tie up police time when it would be lawful for them to leave a patient with health staff.

To the point about police involvement being stigmatising for those experiencing a mental health crisis, it should be avoided unless absolutely necessary, such as when exercising the powers specific to the police under Sections 135 and 136. The police do not currently have the ability to detain under Sections 2, 3 or 5 of the Act. We do not support extending police powers in this way.

Amendments 128B and 158 would introduce a new category of “authorised person” under Sections 135 and 136 of the Act respectively. These functions of the Mental Health Act can currently be carried out only by the police. The two amendments propose different lists of who could be considered an “authorised person” for the purposes of these sections. Under Section 135, the role of the police is to support mental health professionals to enter someone’s home, by force if necessary, with a warrant, where there are concerns about their mental health and then keep the person at home or take them to a place of safety. Extending the ability to health and social care professionals to enter someone’s home without their permission would be a major shift in their roles—the noble Baroness, Lady Watkins, alerted the Committee to that—and it would impact on relationships between patients and health and care staff.

On the amendments from the noble Baroness, Lady May, whose intention is to ensure better interagency response and remove the need for the presence of the police at mental health incidents in the absence of any risk, we feel that Section 135 already represents positive interagency working, with police supporting health professionals to gain access to a property when there is cause to suspect that a person suffering from a mental disorder is, for example, being ill-treated or neglected and when access to the property has been denied. Of course, if health professionals can gain access with the permission of the patient, there is no need to involve the police.

Section 136 allows the police to remove someone to, or keep them at, a place of safety, by force if necessary, if they appear to be suffering from a mental disorder and need immediate care or control. Again, extending this power to health and social care staff would represent a major shift in their relationship with patients and the public. While in some cases approved mental health practitioners already have these powers—they can, for example, normally enter properties with permission—for other professionals, such as midwives or paramedics, the amendment would be a much more significant change.

The noble Baroness, Lady May, cited a number of statistics and I appreciated those. We have explored the proposals from the NPCC. I noted the significant concerns articulated so well by the noble Baroness, Lady Watkins, but we have heard considerable concerns expressed also by health and care professionals and therefore we need to be minded in that respect. There are also concerns about the potential impact on staffing in an already stretched workforce, which has been discussed already in this Chamber. Any consideration of changes in these powers would need extensive engagement with other professional bodies, patients and the public, as well as an assessment of impact and costs.

All that said, we absolutely recognise that there is much more to do to support better handover to health services when the police are involved, particularly in A&E, as the noble Baroness, Lady Tyler, spoke about. This was something that the PLS committee identified, so we will continue to engage with police and health and social care partners around better management of patients in A&E and the reduction of the role of the police.

On the point made by the noble Baroness, Lady May, about the provision of services to people while being looked after by the police, we are committing £26 million in capital investment to open new mental health crisis centres, to which I referred in an earlier group, which will aim to provide accessible and responsive care for individuals in mental health crisis. The purpose extends beyond reducing A&E attendance. Evidence from systems with established crisis centres indicates that they can help streamline urgent mental health care pathways and reduce unnecessary conveyance to A&E by ambulance, health-based transport or the police.

Let me turn to the code of practice. It is clear that health professionals, police and others should have partnership arrangements to support people in mental health crisis and ensure they receive care from the most appropriate service as soon as possible. When the police are involved, I absolutely agree that they must be able to hand over to health professionals as quickly as possible. As I said, in looking at the revised code of practice, we would hope to make progress in this regard.

The noble Baroness, Lady Buscombe, asked for an update on Right Care, Right Person. I can say that almost all forces in England and Wales have rolled this out. Nationally, rollout, including concerns around implementation, continues to be reviewed and discussed at the RCRP oversight group. That forum brings together those with clinical, operational and policy expertise to review and discuss the concerns that have been reported in relation to implementation, to record any risks or delivery issues and to identify potential actions needed to address concerns, including at national level. I know that my colleagues at the Home Office are, obviously, very engaged on this. It is something that we also liaise with them about.

Finally, I turn to Amendment 49A in the name of the noble Baroness, Lady Barker. The amendment intends to allow non-medic approved clinicians, such as nurses, psychotherapists, social workers and occupational therapists, to be automatically approved to provide the medical recommendations needed under Section 12 to detain someone or receive them into guardianship under certain provisions of the Act. First, let me put on record my thanks for, and recognition of, the increasingly important role that non-medic approved clinicians play in the operation of the Mental Health Act. Psychologists, nurses, OTs and social workers bring a wealth of expertise and alternative professional perspectives that strengthen the role of approved clinicians as a whole. They will continue to play a vital role in the implementation of the reforms set out in the Mental Health Bill. However, it is important to recognise the distinction between the role of an approved clinician once a patient is detained and the purpose of the “medical recommendation” at the point of detention, as set out in Section 12, which is, as noble Lords will be aware, mainly about the medical recommendation required for initial detention. At this point, it is sometimes not known whether a patient has a mental health condition. There may be other medical reasons why a patient is presenting in a way that has triggered a Mental Health Act assessment.

A Section 12 doctor provides an experienced and expert medical recommendation as to whether there is a mental disorder that warrants detention, to inform the decision of the approved mental health professional. We believe that this should remain a judgment for someone with the appropriate skills and competency, such as a registered medical practitioner.

I noted in preparing for this group that neither the independent review nor the Joint Committee made any recommendations to change this part of the detention process. This amendment would fundamentally change the medical recommendation on the detention process without a strong enough rationale.

I turn to the point raised by the noble Baroness, Lady Buscombe, about digitalisation and the possible solutions. I was grateful to her for already having raised this in our previous engagement. As the noble Baroness referred to, we are keen to ensure, and will ensure, that the digital version of the advance choice document will be available at the point of need. We are currently working with NHS England to identify what investment is needed and how this may be possible. We can draw on the example led by the South London and Maudsley NHS Foundation Trust, King’s College London and Bipolar UK. Our aim is to ensure, through a digital format, that people can express their wishes and feelings using a range of means, in a way that best suits them. This is, of course, a very strong aspect of that. With that, I hope that the noble Baroness will feel able—

I thank the Minister for her characteristically full and attentive response. I understand why she is not too enamoured by my Amendment, and I do not intend to push that much further. However, having listened to her response to the noble Baroness, Lady May, I cannot help but arrive at the conclusion that, while we are quite content, because we all agree, to see police officers being taken away, we are not going to change anybody else’s roles or responsibilities to plug what will be an inevitable gap. I return to something I have said today and previously: this will be the only mental health legislation for 20 years. If we let this go through, in the certain knowledge that we are creating a big gap which will not be filled by existing roles or the deployment of people within the NHS, we are being quite negligent. We are consigning a lot of people to finding themselves without appropriate support at moments of distress, and that goes for staff who happen to be around at the same time.

The noble Baroness, Lady May, is a fan of Geoffrey Boycott. I hope that she goes in to bat again and does not give up. There is an enormous gap here and we have just made it worse.

I appreciate the contribution of the noble Baroness. None of us, including the Government, wishes to create a gap, either intentionally or unintentionally. I should have said in my remarks that the noble Earl, Lord Howe, asked whether I would meet the noble Baroness, Lady May, should she so wish. The answer is yes. I was glad to do so previously with the Secretary of State; it was extremely helpful.

I assure the noble Baroness, Lady Barker, that there is no intention to create a gap, and we would be happy to elaborate further. She is absolutely right to say that we should be cautious and that it would not be good legislation to do that. The challenge is whether the amendments before us are the answer. I hope that this is a helpful comment.

I have listened very carefully to the debate on this set of amendments. Those in the name of the noble Baroness, Lady May, would create a specialism within the relevant professions which is not there at the moment, based on a change of law. The Minister’s response was focused on the skills of people now, based on their generic roles. My question is this: in responding to the noble Baroness, Lady May, did officials and the Minister look at the potential change that would happen to the skill set, and at the skills and professionals that would be specific for this purpose? In practice, if the law changed, that is exactly what would happen to those professions: a subset of skills would develop, which would allow the gap to which my noble friend alluded to be closed.

With your Lordships’ permission, I want to respond to what the noble Lord has just said. On the front line in this are the paramedics; they are the ones who will have to deal with this issue, most of the time. They need recognition for the additional work that they are already doing. The noble Baroness referred to the gap—the gap is being filled, but in a very inefficient and unrecognised way. We need to recognise that this is something that needs to be dealt with properly, with the staff involved being given the appropriate powers to deliver.

To add to that, the key thing about paramedics is that they do not have long-term therapeutic relationships with the people we are talking about. Therefore, an Intervention is totally appropriate.

I too want to add, equally with great care, to this very interesting discussion. I am concerned about the police. I have not quite understood from the Minister her thoughts on a point that has been made twice now by the noble Lord, Lord Meston about everybody waiting for the police. Are the Government thinking of making it unnecessary for the police regularly to attend?

I thank noble Lords for their interventions. To the noble and learned Baroness, Lady Butler-Sloss—how can I put this?—I say that the police should be there only when they are needed because they are the police. It is true—the point was made very well in the course of the debate introduced by the noble Baroness, Lady May—that it often goes beyond that. That is why “right care, right person” is something that colleagues are working on with police forces, as well as looking at the whole connection with health services. It is well understood.

I heard the comments of my noble friend, as well as those of the noble Baroness, Lady Watkins, following on from the noble Lord, Lord Scriven. When the noble Lord, Lord Scriven, was speaking, the words that came into my head were “chicken and egg”, about legislation and skills. We looked at skills, but—these are not quite the right words—not at the expense of addressing the question of whether the law is in the right place. They are connected, but I refer the noble Lord to the points made earlier, by me and the noble Baroness, Lady Watkins, about the response we have had from health and care professionals. It is about finding the right way. I take the point that there is a gap now. We do not want to make it worse, and we know that it is not acceptable.

My Lords, may I say how grateful I am to all those across the House who have supported my amendments. When the Minister first stood up and started to respond, I got quite excited and hopeful. I thought the points had landed, but then, as she carried on speaking, my hopes were dashed as I realised that, in a very elegant way, she was actually rejecting all the points that I had made in my amendments.

The Minister emphasised the code of practice and dealing with the issue of the handover between police and medical professionals. The whole point of my amendments was to ensure fewer handovers between the police and medical professionals, because there would be fewer times when the police were called as the first responders to a mental health incident. The Minister kindly said she would meet with me, and I hope she might be willing for the noble Lord, Lord Davies, also to be part of that discussion.

The noble Baroness, Lady Barker, referenced my admiration for Sir Geoffrey Boycott. One thing about Sir Geoffrey Boycott was that his centuries tended to come quite slowly. Maybe the response and government reaction to this will be a little slower than I had anticipated; but, on the basis that I anticipate that that reaction may come and the century may be scored, I beg leave to withdraw the Amendment.

Amendment 37B withdrawn.

Amendments 37C to 41 not moved.

Amendment 42 had been withdrawn from the Marshalled List.

Amendments 42A to 42F not moved.

Clause 5 agreed.

Clause 6: Grounds for community treatment orders

Amendments 42G and 42H not moved.