Mental Health Bill [HL]

Lord Scriven Excerpts

Committee stage
Monday 20th January 2025 Lords Chamber

Moved by

[Lord Scriven]

33: Clause 4, page 9, line 40, at end insert—
“125FA Report: sufficient commissioning services for people with autism or learning disabilities(1) Within four months of the day on which the Mental Health Act 2025 is passed, the Secretary of State must lay before Parliament a plan to allocate sufficient resources for commissioning services regarding the treatment and detention of autistic people and people with learning disabilities to ensure operability of provisions in this Act.(2) The plan must include—(a) revised assumptions of the number of autistic people and people with learning disabilities who may require detention under this Act;(b) the actions that the Secretary of State will take to ensure community services are available to meet demand after the 28-day detention period;(c) plans for data collection to support commissioning sufficient services;(d) plans to allocate appropriate resource to ensure operability of services, including, but not limited to, financial resource;(e) plans to ensure that responsible bodies and individuals receive the necessary training to carry out support, diagnostic, and treatment plans.”Member's explanatory statement
This amendment requires the Secretary of State to present a plan within four months to ensure sufficient services, resources, data, and training are in place to support autistic people and those with learning disabilities under the Act.

[Lord Scriven (LD)]

This group of amendments has to do with learning disabilities and autism, and the implementation of the Government’s recommendations, particularly on the change in detention criteria. My Amendment 33 is probing; I shall come to its details shortly. The Committee needs to look into this subject, because many times before in government policy we have seen a good aim and good intentions of moving care into the community, but all too often the facilities have not been there, and people have ended up in crisis.

I tabled Amendment 33 to probe the Government’s staged approach to ensure that community facilities are in place before the change in detention happens, and to understand their timing. On page 72 of the impact assessment, the suggestion is that the change will not happen until the community facilities are in place. That is good, but that could be five, 10 or 15 years away, so the Committee needs to understand the Government’s approach to timing.

Amendment 34, tabled by my noble friend Lady Barker, and the amendment tabled by the noble Earl, Lord Howe, cover mandatory training for medical staff and others associated with looking after people with learning disabilities and autism, to detect the signs, so that people are not missed and put into detention.

My Amendment 33 would create an obligation for the Government to lay a costed plan for sufficient services before Parliament within four months of the passage of the Bill. The four-month period is important, because we really need to understand the Government’s intentions on timing. The change in detention criteria for autistic people and people with learning disabilities is a vital change in the Bill, to ensure that people are not inappropriately detained but are supported in the community instead.

As I have said, success depends on there being sufficient services in each area across the country to meet the needs of autistic people and people with learning disabilities. Based on the impact assessment, we know that the Government do not plan to enact those, so it is important that when the Minister replies, she lets the Committee know exactly what the timing is and what the Government’s assumed plans are.

In the equality impact assessment, there are dates for both funding and implementation, which seem to be at the same time. As a former NHS manager, I can say that people cannot start a service involving such a change and receive the funding in the same year. There has to be upfront funding to enable people to plan the services over time. Otherwise, the services are not there, and staff run round trying to get services when people are in distress. It is important to understand that.

Additionally, as the NHS long-term plan target to reduce the number of detentions of autistic people and people with learning disabilities has been missed, there are no active targets to get people out of hospitals. My amendment tries to put in targets to hold the Government and the services to account on ensuring that people are not inappropriately detained.

It is important to have a comprehensive action plan, which is what my amendment seeks to do, and to find out exactly how the Government intend to build and fund those community services moving forward. Additionally, this must include new targets to reduce the number of detentions of autistic people and people with learning disabilities. The timelines for building this support will also be crucial if the Government are to meet the expected 2026-27 commencement date for the new detention criteria for autistic people and people with learning disabilities.

I hope that the Minister will fully brief the Committee so we can make an informed decision about not just the thinking of the Government but the detailed implementation around community services with the change of criteria. I look forward to hearing noble Lords speak to their amendments on the provision of training and the appropriateness of medical practitioners’ expert knowledge of learning disabilities and autism. I beg to move.

[Baroness Barker (LD)]

My Lords, I shall speak to my Amendment 34. As I do so, I extend my condolences to the noble Baroness, Lady Hollins. We miss her very much today. She was extremely helpful to me only a few days ago when we were discussing the subject of this amendment, so I hope I do her a lot of justice with this.

We have heard time and time again that people with learning disabilities and autism find themselves on the wrong end of diagnoses made by practitioners with the best of intent, quite often when people are at points of severe distress, that are inappropriate because the people making them have not perhaps had the degree of experience and knowledge of working with people with learning disabilities and autism as they would otherwise have done.

We started to discuss last week that, while there are mental disorders for which detention in the sorts of facilities that we fund in acute hospitals in the NHS is right and appropriate, there are also some people for whom detention in those circumstances is absolutely not; it is an aggravating factor. Therefore, in my amendment I am seeking to address that issue: not just the competence of the people making decisions about detention and treatment but also the confidence with which they, as professionals, can approach the jobs that they are increasingly being required to do. Knowledge and understanding of learning disability and autism is expanding all the time. We now have a greater number of adults than ever before who, at stages in later life, are being diagnosed as being autistic, and I am quite sure that quite a number of those people have been subject to misdiagnosis.

The particular thing that I want to focus on is training for people who are responsible for detention and high levels of treatment. Noble Lords will be aware of the tragic case of Oliver McGowan, a young man with learning disabilities who was inappropriately treated and died. There has been an amazing campaign by his mother to ensure that that does not happen to other people by making sure that anybody who is involved in the provision of mental health services has undergone appropriate training and understands learning disabilities and autism.

My understanding from Oliver’s mother is that there are three tiers of training. Tier 1 is a level of training which is required for all people who work generally with people with learning disabilities and autism. They need to have this general level of awareness. Tier 2 is for health and social care staff and others with responsibility for providing care and support for a person or people with learning disabilities or autistic people but who would seek support from others in a complex management and decision-making process. They would be part of a team referring up to others. Tier 3 is specialist training for professionals who have a high degree of autonomy and are able to provide care in very complex situations, which might include people with learning disabilities and autism.

The training appears to be sequential. You have to have completed tier 1 training in order to go on to tier 2 and then tier 3. Tier 1 is an e-training module which takes about half a day. As far as I understand it, about 1.5 million people have done that. That is a good thing: we are getting to a greater basic understanding of learning disability and autism by many people across the NHS going about doing their jobs. Tier 2 is a one-day intensive training programme, and that has not gone so well. There have been problems with its implementation, and it is not clear how many people have undergone that training. There are also some quite considerable questions about the quality and scope of that training.

Tier 3 is not part of the Oliver McGowan programme, although it is the most relevant to this Bill. As of December 2024, the Department of Health website makes absolutely no mention of tier 3 training at all. Can the Minister tell us where the development of that training is up to, and who is responsible for ensuring that the content of it is suitable? Is it sufficiently developed for people who are having to make very difficult decisions, particularly around detention of people who are quite often in a state of disturbance at the point at which that decision is taken? If we do not follow up on this tier 3 training, then we are going to carry on in the situation where we are now, where we know that people are being wrongly diagnosed by people who, perhaps, should not be expected entirely to understand them because their professional training up to this point has largely not included such people.

The noble Baroness, Lady Murphy, and I bow to her superior knowledge, very much made the case to us last week that we are talking about different types of mental disorders and very different specialisms across the mental health services. I am therefore asking that anybody who is in a position of making the decision to detain—and let us remember that people are making decisions to detain not just under the mental health legislation but also, at times, under the mental capacity legislation—should be appropriately trained. That is why I put down my amendment which, I admit, is not perfect, but I hope that the Minister might take some of my point and my intent and that we might take this forward together.

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[Baroness Merron (Lab)]

I would be pleased to write to the noble Baroness.

As I set out in response to other noble Lords, I hope the Committee has heard how much I agree that the adequacy of training is a key issue. We are aware that developments in best practice in caring for people with a learning disability and autistic people need to be reflected throughout. As I set out, the Health and Care Act 2022 requires that staff be given the training appropriate to their role, and we expect that this should be reviewed in line with the up-to-date situation. The CQC assesses staff training as part of its regulatory function. For these reasons, I ask the noble Lord to withdraw his amendment.

[Lord Scriven (LD)]

My Lords, I thank noble Lords who have taken part in this useful and informative debate, and I thank the Minister for a thorough explanation of what happens. However, there does seem to be a disjoint between what is happening on the ground and what people in an office in Whitehall seem to think is happening. That is why noble Lords have discussed issues to do with data, training, a costed plan, research and development, and the implementation of people who at least have training and an expertise in diagnosis. Something just does not feel right. The Minister has explained what is happening, but without a fully costed plan up front, with targets, accountability and data ongoing, what will happen is what happens now. Things will be diverted and diluted, and we will not be able to hold the plan to account. For that reason, while I thank the Minister for the explanation she has given, I feel that we will return to this issue at a later stage to dig down and get that deliverable framework. In the meantime, I beg leave to withdraw my amendment.

Amendment 33 withdrawn.

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[Lord Scriven (LD)]

I have listened very carefully to the debate on this set of amendments. Those in the name of the noble Baroness, Lady May, would create a specialism within the relevant professions which is not there at the moment, based on a change of law. The Minister’s response was focused on the skills of people now, based on their generic roles. My question is this: in responding to the noble Baroness, Lady May, did officials and the Minister look at the potential change that would happen to the skill set, and at the skills and professionals that would be specific for this purpose? In practice, if the law changed, that is exactly what would happen to those professions: a subset of skills would develop, which would allow the gap to which my noble friend alluded to be closed.

[Lord Davies of Brixton (Lab)]

With your Lordships’ permission, I want to respond to what the noble Lord has just said. On the front line in this are the paramedics; they are the ones who will have to deal with this issue, most of the time. They need recognition for the additional work that they are already doing. The noble Baroness referred to the gap—the gap is being filled, but in a very inefficient and unrecognised way. We need to recognise that this is something that needs to be dealt with properly, with the staff involved being given the appropriate powers to deliver.