Mental Health Bill [HL]

Debate between Lord Scriven and Baroness Browning

Tuesday 14th January 2025 Lords Chamber

[Baroness Browning (Con)]

My Lords, this group includes Amendment 22, tabled by the noble Lord, Lord Scriven, to which I have added my name—to which I will not speak because I think it will be fully discussed—and two amendments in the name of the noble Baroness, Lady Hollins. She is a dear colleague and friend of many years, and this is my first opportunity in the debate to express my personal sympathy for her loss this week.

I will speak to Amendment 28 in this group, which is in my name. In addition to local authorities’ market-shaping function—I have to say I find the choice of words there a little difficult; I had to read it a few times just to make quite clear that I know what that is—the Bill includes reference to the “commissioning functions” of local authorities when having regard to information from risk registers and ensuring that the needs of people with a learning disability and autistic people are met.

Under the Bill, new Section 125G makes it clear that integrated care boards’ commissioning functions are related only to health services. New Section 125E(3) makes clear that

“‘market function’, in relation to a local authority, means its function”

to

“promoting diversity and quality in provision of services”

under the Care Act 2014. This amendment would add local authority commissioning explicitly, by which is meant the local authority’s commissioning duties in relation to providing care and support under the Care Act 2014. The proposed duty in relation to local authority market shaping does not adequately cover local authority commissioning. The issue of poor commissioning in relation to this group has been frequently cited in reports. This is an opportunity to redress that and to be clear about their function.

[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.