Mental Health Bill [HL]

Debate between Lord Bradley and Baroness Whitaker

Tuesday 14th January 2025 Lords Chamber

[Baroness Whitaker (Lab)]

My Lords, I first apologise for not having been able to speak at Second Reading; I would have welcomed the Bill. In speaking to Amendments 2, 49, 52, 60, 112, 114, 118, 119 and 126 in my name, I declare my interests as honorary vice president of the Royal College of Speech and Language Therapists, as a former member of the Tavistock and Portman NHS Foundation Trust board, as a patron of the British Stammering Association, and as a stammerer myself. I thank the Royal College for its briefing and my noble friend Lord Bradley and the noble Lord, Lord Patel, for their support. I also warmly support Amendment 1 in the name of the noble Baroness, Lady Tyler. I shall add amendments consistent with it in a later group.

My amendments, which are supported by 49 professional, charitable and training organisations, are all based on the premise that speech and communication difficulties are an insufficiently recognised component of a very great number of mental ill-health symptoms and that professional speech and language therapy could—and should—enable more successful treatment. One study found that 80% of people accessing mental health services had a difficulty with language and 60% with communication or discourse. Especially in the case of children and young people, those with a mental health disorder report having five times more speech or language problems than those without. One study found that 81% of children with social, emotional and mental health needs had significant unidentified language deficits.

One of the problems with the lack of specialised staff to help such children is the demoralisation or challenging behaviour that comes from frustration with unmet communication needs, quite apart from the impediments to treatment. I could quote many examples of this, as well as some success stories—for instance, where speech and language therapy effected a sizeable reduction in the use of restraint in a secure children’s home, or enabled psychological treatment to work and give the inestimable benefit of the ability to cope. I must emphasise that most of us take the ability to communicate for granted, perhaps without realising how essential it is to our lives. It is when it is lacking that you notice what it means. I am therefore sure that it must underpin the principles of this excellent Bill.

Amendment 2 does that. Without a rider of that kind to the principles, we will not have effective treatment in very many cases of acute distress and challenging behaviour. Amendment 49 puts the speech and language therapist squarely in the frame of responsible clinician, so that where communication difficulties are the key problem, that can be tackled. Amendment 52 does the same for treatment decisions and Amendment 60 for care and treatment plans.

Amendment 112 provides the same safeguard for detained patients who need to complain and Amendment 114 is to make sure that patients can understand their information on discharge, which is surely essential. Amendments 118, 119 and 126 have a similar function: to make sure that advance choice documents are properly understood and properly made.

[Lord Bradley (Lab)]

My Lords, I rise to speak in support of Amendment 2, to which I have added my name, but first I declare my interests as listed in the register, especially as honorary vice-president of the Royal College of Speech and Language Therapists and as an honorary fellow of the same organisation. I am able to speak briefly as a result of the excellent explanation of these amendments by my noble friend Lady Whitaker, which I am pleased to support.

As we have heard, the lead amendment would place a requirement in the statement of principles to specify in the table the communication needs of the individual and recognise the disability, difficulty or difference to ensure they will be identified and supported. This requirement then flows throughout the Bill—as evidenced by the number of amendments to which I have also added my name—ensuring a thread of consistency for this vital area of support. These include, as we have heard, Amendments 49, 60, 112, 118 and 126, but I will not speak specifically to each of those and test the patience of the Committee.

The importance of Amendment 2 is clearly laid out in the excellent briefing, as we have heard, prepared by the Royal College of Speech and Language Therapists and endorsed by at least 46 related organisations representing this crucial area of work and service.

As we know, communication is fundamental and foundational to human life. It is central to how we express ourselves, how we understand others and how we interact. It is also fundamental and foundational to the aims of this Bill. It underpins the principles to inform decisions and is key to the matters to be addressed. Crucially, it ensures the individual is properly involved in the decisions taken as a consequence of this legislation. As we know, many people accessing mental health services have some form of communication disability, difficulty or difference. This can affect whether they are able to make themselves understood, understand what is being said to them, and how they interact with people. Left unidentified and unsupported, it can subject people to a range of negative outcomes, including inaccessible referrals, assessments, treatment and care and, potentially, unnecessary detentions and detentions longer than necessary.

I first recognised this issue when I undertook my independent report for the then Government, published way back in 2009, about people with mental health problems or learning disabilities in the criminal justice system. At that time, I identified appropriate adults as a key group to support people with communication issues and recommended that they should receive specific training to ensure the most effective support. They still play an invaluable part in such communication. I also recommended the establishment of liaison and diversion services, and I am pleased that in the subsequent years they have been rolled out across the country and we now have 100% coverage for that service.

These liaison diversion teams, placed in police stations and the courts, identify, assess and support people with complex needs, including mental health problems, to try to divert them away from the criminal justice system and support them along the criminal justice pathway. I recognised during this rollout that certain key additional services should be connected to the teams, including speech and language therapists, to enhance the support required for these people with communication difficulties in a variety of settings and circumstances. As the speech and language therapists who I have met over the years themselves identified, these many situations and settings include significant unmet communication needs among individuals on mental health wards, challenging behaviour relating to communication needs, lack of staff knowledge and skills in relation to communication needs in people with mental health conditions, and many more.

Although it is welcome that the Bill’s Explanatory Notes highlight that a care and treatment plan

“may also contain other information, for example, how the patient’s communication needs will be met”,

clearly this is not sufficient. The Bill must therefore be strengthened to make it explicit both that communication is central to the Bill’s aims and that

“communication disability, difficulty, or difference”

must be identified and supported. This would help to ensure that people receive the best possible treatment and care to support their recovery, including through the necessary reasonable adjustments that should be made. It would also help to reduce the risk to them, including of their being unnecessarily detained, and to assure the wider public. These issues must also be fully covered in the code of practice. I hope therefore that the Government will recognise the importance of such communication being in the Bill and look forward to the Minister’s response on these points.

Health and Care Bill

Debate between Lord Bradley and Baroness Whitaker

Lords Hansard - Part 2 & Committee stage
Monday 24th January 2022 Lords Chamber

[Lord Bradley (Lab)]

My Lords, I shall speak on this group of amendments, and I declare my health and higher education interests, as in the register—and, specifically, my honorary fellowship of the Royal College of Speech and Language Therapists. We have had some excellent speeches, and some forensic analysis, of these amendments, which are so important to ensuring that the workforce is at the centre of the reform programme under the Bill. I cannot match those contributions, so I do not intend to.

However, I would still like to support Amendments 172 and 214, in the name of the noble Baroness, Lady Finlay of Llandaff, to which I have added my name. The noble Baroness spoke eloquently to those amendments, recognising, among other things, the crucial role that allied health professionals play in the delivery of healthcare. It is worth emphasising that allied health professionals are the third largest section of the health workforce, supporting people of all ages with a range of diagnostic and therapeutic interventions both within and beyond health and social care settings. Their contribution can often be overlooked in a narrative that frequently focuses only on the role of doctors and nurses—however important those clearly are.

As we have heard, Amendments 172 and 214 are designed to address those issues. I shall comment particularly on the role of the speech and language therapy workforce; I am grateful to the Royal College of Speech and Language Therapists for its briefing on this matter. There are around 19,500 speech and language therapists in the UK, many of whom have a portfolio career and work part-time. It is estimated that about two-thirds spend at least some of their working time in the National Health Service. Those not working in, or employed by, the NHS may work for local authorities, in schools, in the justice sector—in which I have a particular interest—with speech and language therapists becoming a key part of criminal justice liaison and diversion teams, in the third sector and in independent practice.

However, as already noted, these settings are not represented in current workforce planning. This risks not enough speech and language therapists being trained to meet current and future demand. In turn, this risks people of all ages with communication and swallowing needs not being able to access the speech and language therapy they and their families desperately require. Crucially, there is already a significant backlog identified, comprising unmet need and increased demand—that increased demand exacerbated by the pandemic.

From initial discussions with speech and language therapy services, it is estimated that a minimum increase of 15% is required in this skilled workforce, whereas in recent years the profession has grown by only 1.7% net per year. Amendment 172 would mean that the duty to report by the Secretary of State would include the whole health and care workforce, not only those directly employed by the NHS in England, and Amendment 214 would ensure that workforce planning takes into account the experience and expertise of the whole social care workforce by establishing a workforce board in every ICB area.

For speech and language therapists, establishing an advisory workforce mechanism would help to address current weaknesses of workforce planning in the country. In turn, this would support better service planning and delivery, ensuring that there are sufficient speech and language therapists to meet current and future patient need. I strongly support these amendments, which recognise the value of allied health professionals across many services, who will play a crucial role in the integration of care, which is the purpose of this Bill.

Since the debate has picked up Amendment 285 on the proposal to establish an office of health and care sustainability, I add my voice in support. I was a member of the ad hoc Select Committee on the Long-term Sustainability of the NHS, so ably chaired by the noble Lord, Lord Patel. It was one of that report’s recommendations, and our key recommendation, and we will pick up that debate on another group. In the light of the comments already made on that issue, I recommend our recommendation to this Committee as we develop our thoughts on this Bill.

I hope that the Minister will give a very positive response to ensuring that the role of our allied health professionals is embedded in the plans that will come forward, crucially, on the workforce in our health and care system.

[Baroness Whitaker (Lab)]

I add my support for Amendments 172 and 214, speaking as a vice-chair of the All-Party Parliamentary Group on Speech and Language Difficulties and a patron of the British Stammering Association. These amendments, which again have the support of the Royal College of Speech and Language Therapists, would do much to safeguard the position of that now rare commodity— speech and language therapists. As has been said by both noble Lords who tabled the amendment, they do not all work in the NHS.

The view of the Department of Health and Social Care is that speech and language therapists should be added to the shortage occupation list, because the profession is facing a range of pressures, including increasing demand in mental health in particular. The NHS long-term plan identified speech and language therapy as a profession in short supply. The need for those therapists must be taken account of in workforce planning.

Similarly, Amendment 214 provides an incentive to ensure that there are enough speech and language therapists to meet current and future demand, which is just not the case at present. I remind noble Lords that meeting communication needs, as well as ensuring the ability to swallow safely—both at risk from a wide range of conditions—are an essential component of well-being, and often safety itself. I hope that the Government will look favourably on these amendments.