Learning Disabilities and Autism: Solitary Confinement in Hospital

Lord Allan of Hallam Excerpts

Thursday 23rd November 2023 Lords Chamber

[Lord Allan of Hallam (LD)]

My Lords, on a good day we learn in and through debates in this place, as we bring a mix of different experiences. I was struck by the suggestion of the noble Baroness, Lady Hollins, that there should be Secretary of State approval for certain forms of solitary confinement. That made me think of debates that we have had in a different context around warrants for the interception of communications, where critics will say, “What is the point of the Secretary of State warrant? They will just approve it, rubber-stamp it”. Of course, it is true that the Secretary of State is not sitting there thinking, “Does this particular drug dealer deserve to have their phone tapped?”

However, crucially, the instrumental part of it, the key functionality, is that the approval process then requires a group of officials to dig into the case, look at all the details and understand whether the warrant is justified. They do not want to send up to the Minister for approval something that is deficient. It made me think that if an official is willing to send to the Secretary of State a request to approve a confinement for 450 days in a windowless room on a mattress on the floor, then good luck to them, but if nobody is willing to put that forward, it should not be happening. This is a process that is well worth considering. Who ultimately signs off and takes ownership of this? Also, the process by which it is approved is critical. It should not be left to the decision of, as the noble Baroness said, a private provider somewhere who just has a problem to resolve and feels empowered, with no further external approval, to make such a fundamental decision that will have such an impact on an individual. That was interesting. I hope that the Minister will respond on it.

The other part of the report that I found helpful was the four-stage failure that is described in annexe B, which appeals to my analytical brain. There is a notion that the first failure is the community-based failure that leads to someone going into hospital, then the failure of the treatment in hospital, which then leads to solitary confinement being considered, the failure of the solitary confinement, then the failure properly to assign responsibility and ownership, which is wrapped around all this. This was really helpful from an analytical point of view.

I hope that the Minister can confirm that there will be published data on all those stages. There are certainly recommendations for there to be reporting on the use of the solitary confinement mechanism, but it is really important to understand how many people are being treated in the community and how many failures there are of that treatment which then lead to hospital treatment and how many failures there then are in the hospital, so that at each stage we understand the number and types of failures that are occurring. That will inform our ability to hold the right bodies to account and resolve that fourth failure, that of accountability. It is only through that relentless scrutiny that we can address the issue of accountability—and that relentless scrutiny depends on the data.

I want to ask the Minister about the federated data platform in this context, although today is not the day to talk about this. For noble Lords who are not following this closely, this is the new all-singing, all-dancing thing that will pull together all NHS data. It seems to me that is very much acute focused—which is a good thing—as it is very much about ensuring that we get the flow-through in in hospitals, but it seems to me that the same kinds of tools and disciplines are needed for what we are talking about here, for understanding where people are in the system including, crucially, across different providers. However, it is not clear whether the hundreds of millions of pounds that are being spent and all that effort will yield any benefits in this area where, as the noble Baroness, Lady Watkins, pointed out, you are dealing with multiple providers of services and multiple commissioners, and it seems that a lot of them have very un-joined-up systems. It may be that the federated data platform is not the answer, but the tools, practices and data models that are developed could potentially all read across very effectively to the world that we are describing today, in which we face similar challenges about understanding where people are, how they are moving through and, critically, whether those failures occurred at any point when they moved from setting A to setting B either between or within institutions.

I ask the Minister specifically: is there a group somewhere in NHS England that is working on this, looking at the data flows in mental health care, so that we can understand and benefit from all the investment that is going in, rather than potentially facing a scenario where acute medical healthcare gets the investment and mental health care is the also-ran, poor service which will only benefit at a later stage?

I am extraordinarily grateful to the noble Baroness, Lady Hollins, for the report and for analysing the problem so well and so effectively. It is a short report, which is great: there is no excuse for anybody not to understand the problem with a report that size. I am also grateful to her for providing this very clear set of recommendations, and I look forward to the Minister explaining how he will be accepting all of them without reservation.