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

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

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

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

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

Amendment 49, also in the name of the noble Baroness, Lady Tyler, seeks to create a new role of a responsible person. We agree that there is a need to improve organisational leadership, improve data collection and change culture across the mental health system. This is exactly what the patient and carer race equality framework is designed to achieve; it requires a nominated executive lead at board level, who is accountable for the delivery and oversight of the framework and implementing culturally appropriate care. This is now part of the NHS standard contract and, I am glad to say, applies both to the NHS and independent providers of NHS-commissioned care. It builds on the duties that apply already under the Equality Act 2010.

These existing duties and contractual requirements cover all the key responsibilities of the proposed responsible person role. The added benefit of having many of these requirements set out in the patient and carer race equality framework is that it can be updated more regularly than primary legislation. This allows us to take a more agile and iterative approach throughout the implementation of the Bill, to ensure that we do what noble Lords want the legislation to do: that is, capturing, reporting and acting on the right data and information from front-line services.

I appreciate the suggestion of the noble Baroness, Lady Tyler, for pilots. We believe that the points that I have just raised go further than the suggested pilots and, as the noble Baroness will be aware, that the addition of a responsible person in the legislation is duplicative and unnecessary.

I turn to Amendment 60, tabled by the noble Earl, Lord Howe, and the noble Lord, Lord Kamall. Two major independent reviews into the CQC have reported under this Government in the last few months. One was by Dr Penny Dash, on the CQC’s operational effectiveness as a regulator of all health and social care providers, including mental health, and the other was by Professor Sir Mike Richards, on the CQC’s single assessment framework. These reviews were prompted by very significant concerns that the CQC was no longer fit to spot poor performance, resulting in quality and safety concerns falling under the radar, which is not acceptable. We are most grateful to Dr Dash and Professor Sir Mike Richards for their recommendations, which the CQC has accepted in full.

As I have already mentioned, we particularly welcome the appointment of Dr Chopra, the CQC’s first Chief Inspector of Mental Health. As I have said, this is a very significant milestone, and one which will improve the voice of mental health patients and help to see that their rights are better upheld. To offer further assurance to the noble Lord, Lord Kamall, the Chief Inspector of Mental Health will carefully explore how to strengthen the focus on Mental Health Act compliance in regulatory assessment of providers and how to ensure that the CQC has the capabilities and systems to ensure effective monitoring of providers’ compliance with all aspects of the Mental Health Act, including the reforms. On top of that, the CQC is working to strengthen the expertise in its workforce and improve how it carries out assessment of services. Under the leadership of a new chief executive, Sir Julian Hartley, it is working to build the foundations for good regulation, including looking at the organisation’s purpose and value.

I reiterate the point that I have made to the noble Lord, Lord Kamall, in previous meetings that the department’s director-general of secondary care and integration has been meeting the CQC’s chief executive and his team every two weeks to monitor progress, with regular reports made to the Secretary of State so that he can keep abreast of developments. These changes will see that the CQC is better placed to regulate mental health services.

On the CQC’s specific role in relation to the Mental Health Act, I have listened carefully to the concerns raised by noble Lords and I am pleased to announce that we plan to report on the CQC’s monitoring functions under the Act in the first of the Government’s annual reports on implementation of the Bill. We will also invite the new chief inspector of mental health to provide their reflections on the CQC’s statutory functions and their role as a partner in the delivery of these reforms, which will feature in our report. This will draw on the chief inspector’s valuable professional background in the field, both in the delivery of front-line clinical psychiatric care and as medical director of the Mental Welfare Commission for Scotland. The report will be laid before both Houses of Parliament.

Finally, I turn to Amendment 61. I was interested to hear that the noble Baroness, Lady Fox, was inspired by the Secretary of State’s comments to bring forward this amendment. As she rightly said, the Secretary of State has set out previously that he believes that there is an issue with overdiagnosis of some mental health problems. I thank the noble Baroness, Lady Browning, for her helpful intervention to shine more light on the discussion that was had. There is no doubt that too many people in this country are being written off and not getting the support that they need, which is why the Government’s shift from sickness to prevention is so important. We know that, if support can be provided to people much earlier, the onset of mental illness and deterioration of mental health can be prevented. That is why, as one of a number of measures, we are rolling out mental health support teams to schools in England.

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