Mental Health Bill [HL]

Lord Crisp Excerpts

Tuesday 14th January 2025 Lords Chamber

[Lord Scriven (LD)]

My Lords, I will speak to Amendments 22, 24, 25, 26, 29, 30 and 31 in my name in this group. I support Amendment 28, which was just spoken to very ably by the noble Baroness, Lady Browning, and Amendments 36 and 37, in the name of the noble Baroness, Lady Hollins. I want to put on record my condolences to her at what must be a very sad and difficult time.

Quite a number of amendments that I have put down in this group, particularly Amendment 22, are about prevention. It is about getting upstream and trying to use the dynamic support registers—the risk registers—in a better way, and, by so doing, having the correct information that is available to a place, rather than just to an organisation, such as the NHS or the ICB, within that place.

Amendment 22 would ensure that local authorities have an active role in assisting ICBs in identifying people for inclusion in the risk registers. NHS England’s policy and guidance on dynamic support registers states:

“Early identification of people at risk of admission to a mental health hospital and their access to person-centred planning and support are essential for the prevention of avoidable admissions”.


Many people with risk factors will first come into contact with a local authority, particularly people with learning disabilities and autism. It is important that the local authority has a clear responsibility to assist ICBs in identifying people for inclusion on the register, to ensure that people get the right support at the right time. I hope that the Minister will take this amendment in the spirit that it is given. This is an important issue which is not strong enough in the Bill and which really needs to be taken account of.

There have been difficulties for some people getting enrolled on the DSR, and this is particularly true for autistic people without a learning disability. Additionally, NHS England data shows that 52% of autistic people and people with a learning disability detained in a mental health hospital are not on a risk register prior to admission. Therefore, there is a gap, and the Bill gives us a chance to help plug it. Hopefully, placing this duty on local authorities will facilitate greater uptake and enrolment on the register for all, therefore helping to reduce admissions, improving support in the community and being a good preventive measure.

Coupled with this, Amendments 36 and 37 in the name of the noble Baroness, Lady Hollins, would help with that prevention role by making sure that proper provision was available. Taken together, Amendments 22, 36 and 37 would be a really good group of steps forward to help with preventive measures to make sure that all people who can be identified who come into contact with a local authority but are not known to the ICB go on the register, and that provision is made.

Amendments 24 and 29 would change the current language in the Bill. After listening to debate on previous amendments, I will not labour the point because I have a good idea what the Minister might say, but again I think the provision needs to be strengthened so that ICBs and local authorities have a duty to consider the risk register when exercising commissioning and marketing functions.

In Amendments 25 and 30 there is the same approach by strengthening the words in the Bill to ensure that ICBs and local authorities have a duty to ensure that the needs of autistic people and people with a learning disability are met in the community wherever possible. The current language in the Bill states only that ICBs and local authorities must “seek to ensure” that the needs of autistic people and people with a learning disability are met. This wording is vague and does not compel a strong enough duty to meet the needs of people in the community. Again, the amendments in the name of the noble Baroness, Lady Hollins, would strengthen my amendments even further.

These amendments are important. I hope that the Minister has listened very carefully, will make efforts to implement some of these steps and reports back on Report.

[Lord Crisp (CB)]

My Lords, I will speak to my noble friend Lady Hollins’s Amendments 36 and 37. I add myself to the comments by the noble Baroness, Lady Watkins, about the remarkable commitment that my noble friend is showing at this awful time and express my personal condolences. What I am going to say is based on comments that she has passed to me. I should perhaps say at the beginning that I too am an honorary fellow of the Royal College of Psychiatrists—“(unqualified)”, as others have made that disclaimer.

The purpose of these amendments is very clear. Amendment 36 states that ICBs

“must ensure the availability of integrated comprehensive, accessible, and responsive community services for autistic people and people with learning disabilities … to reduce hospital admissions … and … reliance on restrictive interventions”.

As the previous two noble Lords said, it is very much about prevention and creating appropriate services.

I note that the Explanatory Notes to the Bill say that Clause 4

“is designed to help ensure that ICBs can monitor individuals at risk of detention and put in place the necessary preventative measures to help keep people out of hospitals”.

Putting it simply, this amendment takes that rather weak wording in the explanation and toughens it up. The issue here is not about good intentions and ensuring that it is possible for something to happen. I am sure that all noble Lords share the intention and the hope that these things will be in place, but this is about making sure that something happens. It is about implementation and seeing that a change happens.

This is vital because it is clear that there are major problems in service coverage right now. For example, only a quarter of integrated care systems are meeting their target of having only 30 people per million admitted. Of course, that number would ideally be much lower than it is, but only a quarter of these systems are even meeting that. Amendment 36 spells out what these services should include. I will not read them out in detail but noble Lords can see that they cover all the relevant areas that one would expect: evidence-based treatments, crisis prevention and intervention services, non-restrictive walk-in services, and the provision of “suitable housing”.

I will comment on two of those items in a moment. All of them are important but what I think the noble Baroness, Lady Hollins, had in mind was not just discussing these items but seeing her amendment as an opportunity to discuss which services are the right ones—the ones that should be there—and which areas ICBs and local authorities should address. The key point at this stage is not so much about the detail but the need for some clear legislative requirements on what services must be provided. Good intentions are simply not good enough; implementation is what is needed.

I will mention two of those items that relate to points made earlier by other noble Lords in our debates on this group and others. One is the reference to “non-drug-based interventions” and “social prescribing”; their importance in community services applies in all kinds of ways. The second is the point about housing, which, as has been discussed, is vital. Ten years ago, I did a review for the Royal College of Psychiatrists on discharges from acute adult hospitals. A third of the people in those hospitals were there because they did not have adequate accommodation anywhere else. That third included people who had nowhere to be discharged to, in terms of adequate housing. It is a really serious issue. I make those points because both of these issues go beyond this amendment: in some ways, they are not about healthcare as much as they are about enabling people to have a decent life and creating the conditions for people to be healthy and live in the best way possible.

Amendment 37 is about issuing guidance on standards and monitoring and reviewing progress. Again, without that, we cannot be sure that this legislation will make a difference to the people who matter.

I will make three final points. I recognise that there are perverse issues of finance here because, of course, the NHS pays when people are in hospital and the local authority pays for the services in the community. Of course, that reminds us all of the need to get the social care policy right and the importance, wherever the boundaries fall between public bodies, of using public money wisely across organisations.

In that context, I stress that what the noble Baroness, Lady Hollins, has set out in this amendment is not an unachievable wish list. Even in today’s circumstances, some people are making real progress. Mencap pointed me towards the Black Country’s emergency response team, which noble Lords may know about and which meets many of these criteria for services. In 2022-23, it supported 51 people who were presumably being paid for by the local authority and who might otherwise have been admitted for the equivalent cost of a single assessment and treatment bed, presumably paid for by the NHS. Preventive and good-quality services so often make good financial sense, as well as being better for the people concerned. I do not know whether the Minister is familiar with that project but I would certainly encourage her to have a look at it if she has not already done so.

The second point I want to make is that, although I have not actually checked the reference, I believe that the Minister said something at Second Reading about delaying the implementation of some parts of this Bill until the services are in place. I would be grateful if she could say what was meant by that, but also why it is necessary when people can make progress quite quickly.

The Black Country example—and I suspect that there are others—shows that people are making progress and that, in many ways, it is better to have a stretching target that people are moving towards rather than saying, “If you don’t have the services, we won’t implement the legislation”. We need to keep moving forward and show faith both in what this Bill is designed to achieve and in the Government’s agenda on prevention and on moving towards the community. No doubt the digital transformation is also extremely relevant here.