Mental Health Act 1983: Detention of People with Autism and other Lifelong Conditions

Gillian Keegan Excerpts

Thursday 20th January 2022 Commons Chamber

[The Minister for Care and Mental Health (Gillian Keegan)]

I take this opportunity to genuinely thank my right hon. and learned Friend the Member for South Swindon (Sir Robert Buckland) for securing a debate on this vitally important topic. Improving the care and treatment of autistic people is something he has championed, particularly through his commitment to reform of the Mental Health Act. I thank him for his continued work on this matter, no matter where he is sat. I give him my commitment that I share his determination for change, and I will continue to work with him. There is absolutely no place for poor-quality care for autistic people or anybody with a learning disability in our society. The system needs change.

I recently visited Norfolk to meet the families of those affected by the tragedy that occurred at Cawston Park Hospital, which was the subject of a previous Adjournment debate. I met the parents of the young people who suffered and sadly died and heard at first hand about the experience of people with autism and people with Down’s syndrome in health and care settings, and it was shocking. Such experience has too often fallen unacceptably short of the standard of care that individuals and families—those people who are the most vulnerable and often voiceless—should rightly expect. It is truly awful to hear about such appalling experiences.

We are taking action for children, young people and adults, for people who have been in-patients for longer than they should, and to prevent people from being admitted, even for a short time, when they do not need to be. I welcome this opportunity to set out the immediate and longer-term actions we are taking. They include our planned Mental Health Act reforms, which will provide the opportunity to change the legal framework and to reinforce and underpin the changes we are making now. I cannot commit today to a timetable for that, but the planning is well under way and I will keep my right hon. and learned Friend informed.

To keep people safe now, all autistic people and people with a learning disability must receive high-quality, safe care. That is our first priority. We know that some people may require support in a mental health hospital; when that is necessary, it should have a clear therapeutic benefit, be the least restrictive support possible, be close to home and be for the shortest possible time. We will not tolerate instances of abuse or poor-quality care.

To ensure that people are safe, all autistic people and people with a learning disability in an in-patient setting now receive a safe and wellbeing review. These reviews, which are led by NHS England, are a priority and the majority will be completed by the end of January. We also fully support the more robust approach that the CQC is taking in increasing the amount of shorter, unannounced inspections and closing hospitals that do not provide a high-quality standard of care.

My right hon. and learned Friend mentioned people who are in long-term segregation. There are about 100 of them and a couple of cases were mentioned in the debate. Every single one of them will receive independently chaired reviews of their care and treatment. The reviews will consider how to move towards a less restrictive or, ideally, community-based setting.

As part of a wider £31 million package to support discharge and develop community support, we have provided funding for a senior intervenors pilot. These independent experts will work to resolve blockages in the path to discharge, where there can be multidiscipline teams who basically do not agree or manage to find a solution among themselves. The senior intervenors will help to unblock things for those people in a long-term situation, and move them towards a less restrictive setting and back into the community, which is where we want people wherever possible.

My hon. Friend the Member for Broxtowe (Darren Henry) mentioned the need to build and make sure we have the right support in the community. The Government want to make sure that, wherever possible, autistic people and people with a learning disability are able to lead full lives in the community, close to their families, with the right support in place to prevent crisis.

In the NHS long-term plan we committed to reduce the number of autistic people and people with a learning disability who are in-patients in mental health hospitals by 50% by the end of March 2024. Since 2015, we have achieved a 29% reduction, which is equivalent to a reduction of around 800 in-patient beds—800 people—and means we need to close around 600 more to meet the target. I am firmly committed to achieving that.

The building the right support programme is our national policy to ensure that autistic people and people with a learning disability are supported in the community, and more than £90 million of additional funding for community services and support for discharges has been provided for 2021-22 to help to achieve that. Joint action across organisations and systems is essential to drive progress, so we are developing an action plan to outline the steps that we and all our partners will take to deliver that action with urgency, and we will publish it as soon as possible. We also know that early diagnosis is key, as the hon. Member for Strangford (Jim Shannon) mentioned, and that prevention and intervention at an early stage are vital, so we are investing £2.5 million to test and implement the most effective ways to reduce autism diagnosis waiting times for children and young people in England. Additionally, we are investing £600,000 in significantly expanding an autism early identification pilot to at least 100 schools over the next three years. Those actions and others set out in our all-age autism strategy, which was published in July, should make a big difference.

I want to touch on the subject of “do not attempt CPR” decisions, which hon. Members have mentioned. My right hon. and learned Friend the Member for South Swindon mentioned the culture; we are working to ensure that there is a culture of compassionate care for autistic people and people with a learning disability that is also of the highest quality. The Department has remained crystal clear that it is unacceptable for DNACPR decisions to be applied in a blanket fashion to any group of people.

We have also developed and trialled the Oliver McGowan mandatory training in learning disability and autism for all health and social care staff, working with Health Education England and Skills for Care. The programme is backed by a £1.4 million investment, and I think it will go a long way towards changing the culture.

We want to end inappropriate detentions for autistic people and people with a learning disability, and we are introducing once-in-a-generation reforms to the Mental Health Act that will be critical to achieving that. Under our proposed reforms, we will limit the scope to detain autistic people or people with a learning disability under section 3 of the Act. We want to prevent the detention under section 3 of people who do not have a co-occurring mental health condition; they simply have a learning disability.

We want to ensure that the right services are in place, allowing individuals to receive the best possible care in the community. Our proposed reforms will create new duties for commissioners to ensure an adequate supply of community services and ensure that every local area understands and monitors the risk of crisis at an individual level. This will transform our capability to provide those services in the community and to keep people safe in their community.

I thank all hon. Members for their contributions and thank my right hon. and learned Friend again for securing this vital debate. It is important that we continue to listen to people with lived experience and to their families, most importantly, in shaping and delivering high-quality care, both in in-patient settings, where they still exist, and in the community. Having heard some truly shocking experiences as Minister for Care and Mental Health, I am grateful that the debate has given us an opportunity to set out my personal commitment and to give a voice to those people who, for too long, have not had one.

In addition to the work that the Government are undertaking now and in the longer term, we must make sure that all autistic individuals and people with other lifelong conditions are treated with dignity and respect and are able to lead fulfilling lives in their community. I am absolutely determined to see that happen, and I look forward to working with my right hon. and learned Friend; I know that he is determined, too. There should never be an instance of people with a learning disability and autistic people being treated as anything less than equal in our society. He has my commitment that I will work with him to achieve that.

[Madam Deputy Speaker (Dame Eleanor Laing)]

Before I put the Question, I am sure that the whole House will wish to join me in congratulating the right hon. and learned Member for South Swindon (Sir Robert Buckland) on his knighthood. [Hon. Members: “Hear, hear.”] Congratulations, Sir Robert—I see that we have quite a lot of Sir Roberts around.

Question put and agreed to.