(1 day, 12 hours ago)
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Madam Deputy Speaker (Caroline Nokes)
I confirm that nothing in the Lords message engages Commons financial privilege.
Schedule 2
Nominated persons
The Minister for Care (Stephen Kinnock)
I beg to move, That this House agrees with Lords amendments 19B and 19C.
It is a privilege to return to the Mental Health Bill in this House for what I hope will be the final time in its passage. Thanks to the constructive and collaborative approach from Members across this House and noble Lords in the other place, we have been able to reach an amended and improved version of the Bill so that we can begin our vital work on the code of practice. In particular, I pay tribute to my ministerial colleague, Baroness Merron, for her outstanding work on this Bill.
The Bill sits alongside the 10-year plan, which sets out our ambitious reform agenda to transform the NHS and make it fit for the future. We know that there is much more to do to improve outcomes, to tackle unacceptable waiting times for care and to fully meet the needs of the population in a tailored, personalised and timely way. We will overhaul how mental health support is delivered in England to drive down waits and improve the quality of care, backed by a whole-of-society approach to preventing mental illness and to intervening early.
Last week, we announced the launch of an independent review into prevalence and support for mental health conditions, attention deficit hyperactivity disorder and autism. We are launching this review to understand the rises in prevalence and demand on services, to ensure that people receive the right support at the right time and in the right place. People who need it will access high-quality and compassionate mental health support at an earlier stage, and more people will recover or live well with mental illness.
We will go further to improve the quality and transparency of care, working with experts and people with lived experience. We will publish a new modern service framework for severe mental illness, setting consistency in clinical standards across the country so that patients and families get the best-quality, evidence-based treatment and support.
Jim Shannon (Strangford) (DUP)
First, I welcome what is coming forward. I ask for clarification on something that has been brought to my attention. I seek the Minister’s advice and support. Lords amendment 19B relates to the appointment of a nominated person where no local authority holds parental responsibility for the patient. Does the Minister agree that there must be more emphasis on the voice of the child in the legislation, and that the child should have some preference when it comes to representation?
Stephen Kinnock
Yes, we absolutely do agree. As the hon. Gentleman will hear as I proceed with my speech, we have three options in respect of what will happen in exactly the scenario that he has mentioned, and that has been very much the spirit of the amendment on which we have agreed with the other place.
We will put patient feedback and outcomes front and centre by improving the transparency of reporting across in-patient and community mental health services. We will introduce an early warning system so that we can intervene earlier, using patient and staff feedback and clinical information to identify services that are at risk of providing poor-quality care. That is alongside our commitments to roll out mental health support teams in schools and colleges to full national coverage by 2029, to employ an extra 8,500 mental health workers by the end of the Parliament, and to pilot new 24/7 neighbourhood mental health centres across the country. Once implemented, this long-awaited and transformational Bill will give patients greater choice and autonomy and enhanced rights and support, and will ensure that everyone is treated with dignity and respect throughout their treatment.
Let me now briefly outline some of the commitments made by my ministerial colleague Baroness Merron in the other place. In response to the amendment tabled by Baroness May, the Government announced plans to launch a consultation on emergency police powers of detention. The consultation will look at in particular, but will not be limited to, sections 135 and 136 of the Mental Health Act 1983, as well as exploring joint working approaches across organisations. We have committed ourselves to working with stakeholders as we define the scope of the consultation.
In the other place, following engagement with Baroness Berridge, the Government tabled amendments in lieu regarding the appointment of a nominated person for a child under 16 who lacks competence. The amendment states that if no local authority has parental responsibility, an approved mental health professional—an AMHP—must appoint a person who has parental responsibility, a person named in a child arrangements order as a person with whom the relevant patient is to live, or a person who is a special guardian. If there is no suitable person with parental responsibility who is willing to act, the AMHP must consider the child’s wishes and feelings when deciding whom to appoint.
This amendment clarifies whom AMHPs should appoint as the nominated person, and gives priority to those with parental responsibility. We intend to use the code of practice to outline what factors and nuances an AMHP should consider when making the appointment decision. If the AMHP later discovers that another of those on the list is more suitable to act as the nominated person, the legislation allows him or her to terminate the appointment of the nominated person and appoint the special guardian instead.
I thank Members on both sides of the House for their support for the Bill, and look forward to hearing their contributions.
Dr Luke Evans (Hinckley and Bosworth) (Con)
I have talked about roads and bridges throughout the duration of the Bill. We have now reached the end of the long road that was, of course, embarked on by Baroness May in 2018 with the independent Wessely report, which was the foundation of this legislation. It constitutes a cross-party, cross-departmental look at how we can improve the lives of people with the most serious mental health issues.
I was pleased to hear the Minister start to talk about the difference between mental health and mental wellbeing. That is fundamental when it comes to dealing with our policies and how we will take the country forward, because while not everyone has a serious mental health problem, everyone has problems with their mental wellbeing. Ensuring that we have that distinction worked out will be vital to providing the right support for the right people in the right place, and, ultimately, that is what the Bill is dedicated to doing. I have talked in the House about why that is so important. This Bill, above all others, deals with the most vulnerable people in society—those who are seriously mentally unwell—so I am pleased that we have reached a stage at which we can take it forward and put it into law.
I was also pleased to hear the Minister comment on the amendment from the other place, and the concerns raised by Baroness Berridge. I understand the points that he has tried to make and the clarifications that the Government have tried to introduce in relation to the amendment. He has said that he will look at the code of conduct in respect of the seriously difficult positions in which mental health professionals might find themselves during an evening of dealing with a parent who is contesting with a child the question of who is to be the nominated person. I am glad that the Government are looking at the code of practice, and we will not be dividing the House tonight.
That being said, as with the 10-year plan that the Government have brought forward, there is a synergy here. The synergy is this: Members on both sides of the House agree with the thrust of the 10-year plan and this Bill, but the problem is that there is no delivery chapter. That was the Opposition’s concern when the Government were taking the Bill forward. As the Minister conceded in Committee, it will be a challenge, but without a delivery plan it becomes very difficult.
Tom Hayes (Bournemouth East) (Lab)
Before I was elected, I ran mental health and complex needs services for five years. I saw a landscape that had pretty much been devastated under the Conservatives, and one way in which it had been devastated was through the loss of Sure Start. The Institute for Fiscal Studies produced a report this year that showed that Sure Start led to a 50% reduction in hospitalisations for 12 to 14-year-olds. The shadow Minister talks about the ways in which we can deliver better mental health. Does he agree that Labour’s roll-out of a revamped Sure Start is just one of the many ways in which we are helping to improve children’s mental health?
Dr Evans
The hon. Gentleman makes a very good point, but he has also missed the point. He gives me the opportunity to point out that one way in which the previous Government dealt with this issue was by bringing forward the mental health investment standard, under which the proportion of spending on mental health had to mirror the spending on physical conditions. That was starting to lead to real change. Alas, under this Government, there is a concern that the standard has not been met. We know that the proportion of mental health spending has fallen under this Government, according to the written ministerial statement that they put out.
That leads me on nicely to the point that I wanted to raise: how will we fund the models that are coming forward? That is the crux of the matter that people outside the House will be looking at; it is a direct question, and it is the only one that I have in this debate. We on this side of the House have raised this issue in the debates we have had on both palliative care and mental health, and I raised it with the Minister only last week. The Chair of the Health and Social Care Committee, the hon. Member for Oxford West and Abingdon (Layla Moran), has raised this question again and again. Are the Government committed to the investment standard or not? Is it something that they have dropped? The House and the wider public need to know, so that we can plan for service provision. If the Government are dropping it, that is on them, and they need to explain the reasons why they are doing so. Maybe there is alternative investment, but as a starting point, the investment standard will be crucial in dealing with the mental health challenge, which is growing despite the pandemic and all the investment that has already gone in.
Tom Hayes
I have written more mental health investment standard funding applications than I care to remember. Although investment is obviously important, one major challenge with that stream of funding was that I had to apply on an annual basis. There was no certainty around multi-year settlements, so I was repeatedly setting up projects for which I could not find the funding to keep them going. That created more disruption in mental health support. We need to have stable, continuous funding settlements that actually meet the need that has been identified by the data and patient experience. That is what the Government are delivering, and to latch on to a particular funding stream and claim that somehow it is not being provided with support, when actually there is the wider of goal of tackling mental health through different methods—
Madam Deputy Speaker (Caroline Nokes)
Order. The hon. Gentleman will know that there is ample opportunity for him to contribute to the debate. That was a very long intervention.
Dr Evans
I am grateful to you, Madam Deputy Speaker, for stepping in on that basis. We have had plenty of chances to debate this Bill, both in Committee and many times in the mental health debates that I am partial to. We could go through why the last Government changed the interventions of NHS England and brought in integrated care boards to allow for a joined-up structure to be put in place. We now see a new iteration coming forward but, yet again, we do not know how much it will to cost to get rid of NHS England. We do not know the redundancy packages for the ICBs and how much they will cost. That is fundamental.
One thing we do know is that, as the chair of the Royal College of Psychiatrists has said, the change to the investment standard alone will cost the sector £300 million. That is investment that could have made a difference to mental health provision. I do not want to get into the heated politics any further, and I do not want to delay the House any further this evening, but the Government’s position on the mental health investment standard is crucial when it comes to delivering this Bill.
I thank the Minister for his constructive approach, and for the way in which he has taken ideas forward and looked through the Bill in fine detail. I know he cares deeply about getting this right, as do many Members of this House. It is imperative to ensure that compassionate, modern care is delivered to those who need it most when it comes to dealing with serious mental health conditions.
Dr Danny Chambers (Winchester) (LD)
I thank Members across the House for the constructive way in which they have all contributed towards this long-awaited Bill. In the last 40 years, attitudes to mental health and the treatments available have changed significantly, so these reforms and updates are very much needed and very much supported by everyone here.
On Lords amendment 19B, we welcome the important addition. All children and young people deserve appropriate care and support when undergoing treatment for mental health problems, including the safeguarding of a nominated person. Each and every child going through the system deserves to be properly represented by a responsible adult, so we are grateful for the amendment and we are pleased to lend it our support. While we understand that the remit of this Bill very much focuses on in-patient mental health care, we cannot ignore the wider context in which this Bill needs to operate. Even the best in-patient system will struggle if we fail to invest in the preventive and early intervention services that keep people well in the first place.
The hon. Member for Hinckley and Bosworth (Dr Evans) mentioned the difference between mental wellbeing and mental health issues, and ensuring that we protect people’s mental wellbeing before they go on to develop mental health issues. If we are serious about preventing people from reaching crisis point, we need to ensure that the many community-based initiatives, which the Minister and others have spoken about, are strengthened. That is why we will continue to champion walk-in mental health hubs, having a mental health professional in every school and a sort of mental health MOT check-up at key points in individuals’ lives.
It has been an honour to contribute to this Bill. I want to thank the Minister for his meaningful engagement with all Members across this House for the best part of a year. My one ask of him tonight is to again consider restoring the suicide prevention grant to voluntary, community and social enterprise organisations, because I keep meeting charities and organisations that have benefited from it. It is really important that we support community organisations that can help identify when someone is reaching crisis point, because so many people who take their own lives are not in contact with NHS services.
Finally, I pay tribute to all the frontline workers in mental health in clinical and community settings. Nurses, counsellors, psychiatrists, doctors, therapists, support staff, carers and charities prop up a system that is complicated, underfunded and challenging to work in, and we want them to know that we appreciate all the efforts that they continually make. The Liberal Democrats will keep pushing until mental health is given the same urgency, care and attention as physical health.
Stephen Kinnock
With the leave of the House, I will make some brief concluding remarks. I am very grateful to Members of this House for their contributions both today and throughout the passage of this Bill. I believe that by drawing on the lived experience of both Members and our constituents, we will be able to strengthen the intended impact of this legislation on people with serious mental illness and their loved ones. The passage of this Bill has seen the best of parliamentary commitment and co-operation, and the conduct of Members and peers has been collaborative and well-intentioned throughout.
For too long, mental health reform legislation has sat on the shelf. This Government made a manifesto commitment to modernise the Mental Health Act 1983, and we have delivered that within our first Session, providing an opportunity to transform the way we support those with severe mental illness and providing patients with greater choice and autonomy. I am reminded of what a patient in the 2018 independent review said:
“I felt a lot of things were done to me rather than with me”.
This Bill takes forward many of the changes put forward by the independent review, the recommendations of which were rightly shaped by the views of patients, carers and professionals.
Many have asked about next steps and implementation. Post-Royal Assent, our first priority will be to draft and consult on the code of practice. We will engage with people with lived experience and their families and carers, staff and professional groups, commissioners, providers and others to do that. The code will go to public consultation, as well as being laid before Parliament before final publication. Alongside the code, we will develop the necessary secondary legislation. We will then need time to train the existing workforce on the new Act, regulations and the code. We estimate full implementation will take around 10 years due to the time needed to train the workforce and the need to ensure that the right community support is available. This timeframe necessarily spans multiple spending review periods and multiple Parliaments, so we are limited in the detail we can give about future spend and timelines. But we have committed to an annual written ministerial statement on implementation. This commitment will last for the 10 years or until the Bill is fully implemented, whichever is sooner.
Stephen Kinnock
Yes, I was just coming on to that, because the hon. Gentleman raised it in his speech. We are protecting the mental health investment standard in real terms, as it will rise in line with inflation. Our position is quite straightforward. We feel that for far too long the NHS has been run by a series of input-based targets which micromanage frontline leaders, while failing to ensure improvements in patient experience and care. We are bringing the era of command and control to an end, setting frontline leaders free to innovate and run their services as they know best.
I also remind the Opposition spokesman that we are investing £473 million in capital funding in mental health nationally over 2026-27 to 2029-30. That funding will: support the establishment of a 24/7 neighbourhood mental health service; deliver mental health emergency departments, known as crisis assessment centres; expand neighbourhood mental health services; eliminate inappropriate out-of-area placements; and increase crisis accommodation for people with learning disabilities and autism. I gently say to the hon. Gentleman that when we see a rising tide lifting all the boats, we are connecting our mental health spend to that rising tide. We are then seeing a rise in real terms on what this Government are spending on mental health across the board.
I am very happy to again meet the hon. Member for Winchester (Dr Chambers), the Liberal Democrat spokesman, and look at that particular issue. He raised it in Committee. I hope that some of the things I have just set out will help very much on the tragedy of suicide in our country. We are very conscious of how much we need to do to combat that.
I put on record my thanks to all Members and noble peers who have paid such a close interest in the development of the proposals, along with the officials and parliamentary staffers who have supported us to do so. The officials involved in the Bill are too many to mention, but I would like to pay tribute to colleagues in my private office, Emily Cowhig and Penny Sherlock, who have done such sterling work on the Bill, supporting me and the entire team throughout.
Transforming mental health care for the most vulnerable patients with serious mental illness requires the Bill to pass into statute. I am therefore grateful to hon. Members for their support in enabling us to do so.
Lords amendments 19B and 19C agreed to.