Mental Health Bill [ Lords ] (Second sitting)

Sojan Joseph Excerpts

Committee stage
Tuesday 10th June 2025 Public Bill Committees

[Dr Chambers]

That is a very insightful point. The list could be longer and is not meant to be exclusive. I am not sure of the answer to the hon. Lady’s question but, taking a step back, we know that the single most common cause of death in women 12 months after giving birth is suicide, and there is no proactive automatic care. If a person is addicted to alcohol, they are admitted to hospital for treatment for their physical symptoms. When they are physically well enough to go home and they are discharged, there is no automatic enrolment or follow-up in mental health care. I would not want to bring in a system, as the hon. Lady says, that ends up being too prescriptive. However, at the moment, we have one that is not prescriptive enough. I could list a handful of demographics of people who desperately need that proactive care.

[Sojan Joseph (Ashford) (Lab)]

The purpose of this part of the legislation is for ICBs to keep a register of anyone who is diagnosed with autism or a learning disability. Patients who are already under a clinical team already have a risk assessment, which covers all the areas that the hon. Gentleman is specifying. As a result of the amendment, would we not be duplicating information about risks that already exists for most patients with their clinical teams?

[Dr Chambers]

The point of having an at-risk list is that ideally there is proactive contact with people—perhaps in quite a soft way, and perhaps through community hubs, as we have discussed—before they demonstrate a severe mental health crisis. I assume that the people the hon. Gentleman is talking about have already been admitted to hospital and have received treatment, and that they are being followed up after they have been discharged. That is not a proactive list; it is a reactive register. Am I correct? I apologise if I have misunderstood his question.

[Sojan Joseph]

Anyone who is under the care of a clinical team for their mental health has a risk assessment. That is basic paperwork, which is completed by the clinicians. That risk assessment covers everything that is specified in the amendment. The purpose of this part of the legislation is for ICBs to have a register. However, ICBs will not be providing direct care; that will be provided by the clinicians. Those patients who are under any clinical team have a risk assessment that covers all the points in the amendment. My point is that the amendment would duplicate some of that paperwork.

[Dr Chambers]

I will not argue with an esteemed Member who has the hon. Gentleman’s background in mental health. I take his point as it stands.

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[Sojan Joseph]

I will briefly trot through the proposed amendments and new clause. We all know that the closure of learning disability hospitals was a gradual process. The reason was the institutionalisation of some of those patients, as seen in the Winterbourne View scandal. The aim was to create new community-based housing to look after people with learning disabilities and autism. Amendment 20 seeks to create appropriate fully staffed crisis accommodation. Will the Lib Dems clarify whether they are looking to create more in-patient settings? Are we going back to where we were years ago, or should we work with the new plan to create more community-based accommodation?

Not all patients with a learning disability or autism need detention or community-based accommodation. Many of them are looked after by their family members, so we also need to look into the support we are providing to carers, so that we can keep those people at home with their family member’s support.

I will keep this brief: as a member of the all-party parliamentary group on adult social care, I recently met with many people who have lived experience of this. They want their views to be heard. They are not asking for more hospital settings; they are asking for more support, including for carers. I was pleased to see that the Minister for Care was there to engage with those people.

In the new NHS 10-year plan, the focus is on moving care from the hospitals to the community. Can the Minister clarify how we can make that happen? We have talked about that for many years, but we have never seen it happening. In my own experience practising in a mental health ward, many patients with a learning disability and autism were detained and, as the hon. Member said, kept in hospitals because we could not find a suitable place for them to be discharged to—it was not that they needed the hospital.

I think we are all talking about the same thing, but we need to find a solution. That is why the new NHS 10-year plan and its focus on moving care from the hospitals to the community is important. Again, can the Minister clarify how we will do that? The Government have already started the work, and the new commission, led by Baroness Casey, should also be looking into where we will find the social care support for carers and the community provision for people with learning disability, rather than just creating more crisis accommodations.

[Dr Evans]

The hon. Member mentioned Baroness Casey, for whom I have the utmost respect, but herein lies the problem: she is still currently undertaking a review for the Home Office that has now been delayed and has not concluded. This is at the same time that she is supposed to be looking at social care. The whole idea of an amendment that asks for a statutory plan is to stop these kind of slippages. Given his point about wanting to see progress, is that something that he would consider if he were voting on this new clause?

[Sojan Joseph]

I hope that Baroness Casey completes her commission work and gives us her report. It was promised in the Chamber that the initial report would be available within a year. Regardless of whether she is taking up another role, I hope there will not be any delay and that we get that report and a detailed report within three years. I am looking for a solid plan to fix this problem forever. I am not looking for sticking plasters or an immediate fix, but we need a plan, perhaps including a national care service. These are the people who are looking for a long-term solution to these problems.

The hon. Member asked about how I will vote; unfortunately, I will not be supporting new clause 11. The Government have already started some work, which is why I am specifically talking about the NHS 10-year plan to move care from hospitals to the community, along with the social care commission, which is looking into how we can get good progress on that. This is the answer; we need to get a long-term solution to this problem.

[Dr Shastri-Hurst]

It is a pleasure to serve under your chairmanship, Ms Furniss. I rise to speak to Liberal Democrat amendments 20, 10, 22, 24 and 21, and set out why, although I think they are honourable in their intent, I am unable to support them today.

I will start with amendment 20. The purpose of the amendment is to require ICBs to ensure the availability of specialist crisis accommodation for people with autism and learning disabilities. The aim is to provide a safe and therapeutic alternative to detention, which I think we would all agree is a sensible course of action. Section 136 of the Mental Health Act 1983 allows police to remove an individual who is experiencing a mental health crisis from a public place to a place of safety. That can, on unfortunate occasions, lead to detention in inappropriate settings, which may include police cells. That can obviously be deeply harmful, particularly to those with conditions such as autistic spectrum disorder or other learning difficulties.

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[Jen Craft]

I think there is a concern about having a prescriptive mandate in primary legislation, rather than using a vehicle that could implement real change. Again, I would welcome the Minister’s thoughts on how to ensure that those working in a mental health environment have sufficient training on learning disabilities and autism. We need to make sure that those with a specialism in learning disabilities and/or autism are present and people have access to them, so that things like diagnostic overshadowing do not continue to occur.

[Sojan Joseph]

I rise briefly to speak about training in our health settings. There is, in fact, too much mandatory training in NHS and care settings; the issue is that we are not complying with it. We also heavily rely on agency staff, whose training often nobody monitors. It is not that we are short of training. As my hon. Friend the Member for Thurrock mentioned, the Oliver McGowan training was rolled out across the NHS.

[Gregory Stafford]

I want to be clear about what the hon. Gentleman is saying. My understanding of the amendment, for which I have a lot of sympathy, is that the mandatory training will be around appropriate care in the settings listed. I think he is talking about manual handling or data protection stuff. As someone who worked in the NHS for seven years, I entirely agree that there is a lot of “mandatory training” that could be scrapped to make the NHS much more efficient. The amendment is specifically about ensuring that there is appropriate training for those who are working in the settings listed. I hope that he is not saying that he does not think that there should be training for mental health professionals. I am sure he is not saying that, but that is how it is coming across.

--- Later in debate ---

[Sojan Joseph]

Not at all. I am not claiming that there should not be training for people who work in any settings; I am saying that more and more training has been added every time we learn something and yet compliance with the training requirement is not being monitored. That is the point I am making—not that we do not need the training.

I support training, because appropriate training is necessary, but we also need to ensure that the people who work in those settings are compliant with the training. That is the larger point I am making. This is not about the amount of training we might want to add to this legislation; we need to ensure that existing training is completed by the staff working in those areas.

[Stephen Kinnock]

The Health and Social Care Act 2008, as amended by the Health and Care Act 2022, already requires that all CQC-registered health and adult social care providers ensure that their staff receive specific training, appropriate to their role, on learning disability and autism. The associated code of practice has been consulted on and is expected to be published and laid before Parliament soon.

The code sets out four standards that outline minimum training requirements, including expectations of training content at different levels; that training is co-produced and co-delivered alongside people with a learning disability and autistic people—that addresses the point made by my hon. Friend the Member for Thurrock about co-production and things not being done in an ivory tower; and that staff complete training at least every three years. To set out separate standards in secondary legislation, as the amendment asks, would cut across that existing legal requirement and the forthcoming code. Inadvertently, that could lead to confusion. I hope that that satisfies the hon. Member for Guildford enough to persuade her to withdraw the amendment.