Mental Health Bill [ Lords ] (Second sitting)

Zöe Franklin Excerpts

Committee stage
Tuesday 10th June 2025 Public Bill Committees

Division 1

Ayes: 2

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Liberal Democrat: 2

Noes: 9

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Labour: 9

[Zöe Franklin (Guildford) (LD)]

I beg to move amendment 20, in clause 4, page 9, line 38, at end insert—

“125ZF Registers: duty to maintain crisis accommodation

(1) In exercising its functions under section 125E, an integrated care board must seek to ensure that there is appropriate crisis accommodation for people with autism or a learning disability within its area.

(2) For the purposes of this section, ‘appropriate crisis accommodation’ means accommodation which—

(a) is designed to meet the specific needs of people with autism or learning disability during periods of acute mental health crisis;

(b) is staffed by persons with specialist training in supporting people with autism or a learning disability;

(c) maintains appropriate staffing ratios determined by guidance issued by the Secretary of State; and

(d) provides a safe alternative to detention under section 136 of this Act.

(3) The Secretary of State must issue guidance about the exercise of functions under this section, and integrated care boards must have regard to this guidance.”

This amendment would require integrated care boards to establish and maintain appropriate crisis accommodation specifically designed for people with autism or learning disability as one of its duties in relation to registers of people at risk of detention.

[The Chair]

With this it will be convenient to discuss the following:

Amendment 10, in clause 4, page 10, line 5, at end insert—

“125FA Report: sufficient commissioning services for people with autism or learning disability

(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.”

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.

Amendment 22, in clause 4, page 10, line 5, at end insert—

“125FA Assessment: provision of services for people with autism or learning disability

(1) Each financial year, an integrated care board must—

(a) conduct an assessment of the availability and adequacy of services within its area for people with autism or a learning disability who have specified risk factors for detention under Part 2 of this Act;

(b) publish the results of the assessment; and

(c) publish an action plan to address any gaps in provision identified.

(2) The assessment under subsection (1) must include consideration of—

(a) the availability of appropriate crisis accommodation;

(b) the availability of appropriate community support services;

(c) the adequacy of training for responsible bodies and individuals to carry out support, diagnostic and treatment plans; and

(d) the experiences of people with autism or a learning disability who have specified risk factors for detention under Part 2 of this Act and their families or carers.

(3) The integrated care board must consult the following in conducting the assessment—

(a) persons with autism or a learning disability who have specified risk factors for detention under Part 2 of this Act and their families or carers;

(b) the relevant local authority or authorities;

(c) providers of relevant services; and

(d) such other persons as the integrated care board considers appropriate.

(4) The Secretary of State must issue guidance about the conduct of assessments under this section, and integrated care boards must have regard to this guidance.”

This amendment would require integrated care boards to conduct and publish annual assessments of the provision available for people with autism or learning disability at risk of detention and to prepare action plans to address any identified gaps.

Amendment 24, in clause 4, page 10, line 5, at end insert—

“125FA Report: services for people with autism or learning disability

(1) The Secretary of State must, within 12 months of this section coming into force and annually thereafter, prepare and lay before Parliament a report on—

(a) the availability of appropriate accommodation for people with autism or learning disability detained under this Act;

(b) the number of instances where appropriate accommodation could not be found within statutory timeframes;

(c) the progress towards implementation of sections 3 and 4 of the Mental Health Act 2025 and the impact of any delays to implementation on people with autism or a learning disability; and

(d) progress made towards meeting the needs of people with autism or a learning disability without detaining them under Part 2 of this Act.

(2) In preparing the report, the Secretary of State must consult—

(a) people with autism or a learning disability who have specified risk factors for detention under Part 2 of this Act and their families or carers;

(b) integrated care boards;

(c) local authorities; and

(d) such other persons as the Secretary of State considers appropriate.”

This amendment would require the Secretary of State to report annually to Parliament on the availability of appropriate placements for people with autism or learning disabilities and on progress implementing the relevant provisions of the Act.

Amendment 21, in clause 58, page 68, line 15, at end insert—

“(5A) The Secretary of State must by regulations make provision for sections 3, 4 and 21 to come into force in full no later than two years after the day on which this Act is passed.”

This amendment would establish an accelerated implementation timeline for provisions related to autism and learning disabilities, requiring them to be fully implemented within 2 years.

New clause 11—Costed plan to ensure community provision for individuals with learning disabilities and autism who are at risk of detention—

“(1) Within 18 months of the day on which this Act is passed, the Secretary of State must publish a fully costed plan for how Integrated Care Boards and local authorities will ensure provision of adequate community services for individuals with learning disabilities and autistic people who are at risk of detention under Part 2 of the Mental Health Act 1983.

(2) As part of the development of that plan, a formal consultation process must take place to determine how the decision to enact the relevant parts of this Act will be made.

(3) The consultation must include input from relevant stakeholders, including—

(a) individuals with learning disabilities and autistic people;

(b) carers for people with learning disabilities and autistic people;

(c) healthcare professionals; and

(d) advocacy groups.”

This new clause requires a costed plan to ensure that ICBs and local authorities are able to provide adequate community services for individuals with learning disabilities and autistic people at risk of detention under Part 2 of the 1983 Act, informed by a consultation with a range of stakeholders.

[Zöe Franklin]

It is a pleasure to serve under your chairmanship, Ms Furniss. I am grateful to my hon. Friend the Member for St Neots and Mid Cambridgeshire (Ian Sollom), and I am sure many in this room will remember his passionate speech about his constituent Declan Morrison, who has inspired many of these amendments. I am grateful to my hon. Friend for his help with my notes.

Amendment 20 would require integrated care boards to establish and maintain appropriate crisis accommodation specifically designed for people with autism and learning disability, as one its duties in relation to registers of people at risk of detention. Currently, just over 2,000 people with autism or learning disabilities are detained in mental health hospitals for an average of five years. Over half of delayed discharges are due to a lack of suitable housing or accommodation.

The crisis provision created in Cambridgeshire after my hon. Friend’s constituent Declan passed away was operating at 90% capacity before funding was withdrawn. When we hear Declan’s story, we realise the severe implications behind the amendment and why it is being put forward. We must also recognise that there has been a significant increase in section 136 use over the past 10 years. Many of the suites being used are outdated, unable to keep up with demand and unfit for purpose.

The amendment would therefore make appropriate crisis accommodation a statutory duty, and I hope all Members would agree that there is a desperate need for such accommodation, specifically for autistic people and those with learning disabilities. It would also require there to be specialist training for staff. We have already referenced today how important training is when it comes to protecting those who are in crisis and who need support. Finally, it would provide for safe, alternative detention under section 136, preventing situations such as that experienced by the hon. Friend’s constituent, where a vulnerable person is held in inappropriate emergency settings for extended periods.

Amendments 10 and 22 are both designed to ensure that there are sufficient resources for people with autism or learning disabilities. On amendment 10, it is crucial that community services are properly resourced to meet the needs of people with autism and learning disabilities. Too many of us will have seen how inadequate community services make detention and in-patient care much more likely, which is worse for the person detained, far more costly and unsustainable in the long term. Our amendments place duties on the integrated care board at the local level, and the Secretary of State at the national level, to be transparent about gaps in provision and to take steps to eliminate them.

Amendment 22 would require an integrated care board to conduct an assessment of the availability and adequacy of the relevant services within its area for people with autism or learning disabilities who have specified risk factors for detention, and to set out a plan to respond to those findings. There is currently an absence of suitable placements, with over 100 places that were contacted having no single bed available. We cannot continue with such a situation, given the significant implications when things go wrong.

Through those amendments, we are asking for an assessment, because there is currently no systematic assessment of whether services match demand, which is crucial to ensuring that the Bill is workable in the long term. It is also acknowledged that it may take 10 years to fully implement the Bill and to ensure that additional clinical and judicial staff are trained.

Amendment 21 was also tabled by my hon. Friend the Member for St Neots and Mid Cambridgeshire. It would establish an accelerated implementation timeline for provisions related to autism and learning disabilities, requiring those provisions to be fully implemented within two years. Currently, just over 2,000 autistic people and people with learning disabilities are detained in mental health hospitals who are being let down by the system.

The Government have sadly already missed the targets, and we cannot afford to wait another decade—people’s lives are too important. In fact, the UN Human Rights Committee has called on the UK to end the detention of people with disabilities based solely on their disability. Every day that we wait means more people at risk of tragic outcomes. As I said, the amendment would establish a two-year deadline, and it recognises that these are some of the most urgent reforms in the Bill. I ask the Government to consider them as a priority.

Finally, amendment 24, which was also tabled by my hon. Friend the Member for St Neots and Mid Cambridgeshire, would establish an accelerated implementation timeline of services related to autism and learning disabilities, by again requiring them to be implemented within two years. I reiterate what we heard in the Chamber, which I am sure we will all hear in our inboxes and in conversations with our residents: it is crucial that we implement these changes at pace; otherwise, we risk failing individuals with autism and learning disabilities further.

[Dr Evans]

I will direct my remarks at new clause 11 and the amendments spoken to by the hon. Member for Guildford. New clause 11 seeks a clear, costed and consultative plan to help ensure that integrated care boards and local authorities are properly equipped to deliver the community-based services that individuals with learning disabilities and autism need and, of course, deserve, so that they are not unnecessarily detained under part 2 of the Mental Health Act.

Let me begin by recognising the good intentions across the House when it comes to reducing inappropriate and prolonged detentions in mental health settings. There is broad consensus that detention should be the last resort. However, good intentions must be matched by a concrete, deliverable plan because, as the evidence has shown, too many people are being held in hospitals or other facilities, not because of clinical need, but because the right community support simply is not there.

--- Later in debate ---

Division 2

Ayes: 2

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Liberal Democrat: 2

Noes: 9

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Labour: 9

[Zöe Franklin]

I beg to move amendment 25, in clause 4, page 10, line 5, at end insert—

“125FA Training standards

(1) The Secretary of State must by regulations make provision about training standards for responsible bodies and individuals working with people with autism or a learning disability in—

(a) mental health hospitals;

(b) places of safety designated under sections 135 or 136 of this Act;

(c) crisis accommodation; and

(d) such other settings as the Secretary of State considers appropriate.

(2) Regulations under subsection (1) must—

(a) specify minimum training requirements;

(b) require training to be co-produced with people with autism or learning disability and their families or carers;

(c) require regular refresher training; and

(d) include training on de-escalation techniques and alternatives to restraint.

(3) The Secretary of State must publish guidance about the standards set out in regulations under subsection (1).

(4) A statutory instrument containing regulations under this section is subject to annulment in pursuance of a resolution of either House of Parliament.”

This amendment would require the Secretary of State to produce guidance on minimum training standards for staff working with people with autism or learning disabilities in mental health settings and require that training be co-produced with people with lived experience and their families.

Amendment 25 was, again, tabled by my esteemed colleague, my hon. Friend the Member for St Neots and Mid Cambridgeshire. It would require the Secretary of State to produce guidance on minimum training standards for staff working with people with autism or learning disabilities in mental health settings, and would require that the training be co-produced with people with lived experience and their families.

I suggest to all colleagues on the Committee, particularly those who heard my hon. Friend’s passionate speech on Second Reading, that we need to reflect and learn from the tragic story of his constituent Declan, in which insufficient training sadly contributed to Declan’s death. Autistic people in hospitals risk being subject to unnecessary restraint, over-medication and solitary confinement. That raises real concerns about whether there is sufficient training available to staff working with them. I acknowledge that enormous numbers of incredible professionals work with individuals who are in crisis, but when such tragedies happen, we need to reflect on whether training is sufficient.

Across mental health hospitals, places of safety and crisis accommodation, training is crucial to ensuring good outcomes for those in crisis. Some 92% of people with learning disabilities or autism in hospitals are detained under the Mental Health Act, yet many staff lack specialist understanding. Research shows that training is most effective when it is developed with people with lived experience.

The amendment would ensure that all staff working with autistic people and people with learning disabilities receive specialist training. It would require co-production with families and people with lived experience, with which Conservative colleagues have already said that they agree. That would include mandatory training in de-escalation techniques and alternatives to restraint; create consistent national standards, rather than the unfortunate postcode lottery; and address fundamental staff knowledge gaps that contribute to inappropriate treatment. I ask the Minister to accept the amendment, which would enable us to ensure that those providing crucial mental health support to those in crisis have the appropriate training to prevent tragedies like the loss of Declan.

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[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.

[Zöe Franklin]

Having had a conversation with my hon. Friend the Member for Winchester, I can say that we will withdraw the amendment. However, we hope that the Minister will ensure that the provisions addressing the need for training in such situations will come soon, and with a timeline, so that all members of the Committee understand when we will see the statutory guidance. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Question proposed, That the clause stand part of the Bill.

[Dr Evans]

It is a shame that the hon. Member for Shipley is not in her place to hear me speak to the rest of the clause 4, having considered the amendments to it first—[Interruption.] Oh, she is here just in time. I am grateful to the Government and the Chair, as the clause stand part debate allows things to be more structured.

I want to discuss proposed new part 8A of the Mental Health Act 1983, which will introduce welcome changes to provisions specific to people in England with autism or learning disabilities who are subject to detention under the Act. At the outset, let me say that the Opposition welcome the Government’s recognition that people with autism or learning disabilities require a tailored and rights-based approach within our health system. We know—the evidence points clearly to the fact—that such individuals have been inappropriately detained in institutional settings, often for years, without the care and support that they truly need. The creation of a statutory care, education and treatment review in legislation was a step in the right direction. It therefore makes sense in this part of our proceedings to discuss such reviews.

The background is really important to understanding what the measure will do. Care, education and treatment reviews were introduced in 2015 as part of the Transforming Care programme, a joint initiative between NHS England and the Department of Health and Social Care under the last Government. The TCP was launched in response to the Winterbourne View scandal, which we have heard mentioned a few times, where serious abuses of people with learning disabilities and autism in private hospitals were exposed.

The purpose of CETRs in the Transforming Care programme was to ensure multi-agency oversight of care plans for people with learning disabilities and/or autism, particularly those with complex needs detained in in-patient or secure settings. They were there to promote person-centred care by involving patients, families and a broad range of professionals; to identify barriers to discharge and support safe, timely moves to community or less restrictive settings; and to improve care quality and reduce inappropriate long-term in-patient stays.

The implementation timetable started in 2015 with CETRs introduced as a mandatory part of the TCP, initially focusing on children and adults with learning disabilities and/or autism in in-patient settings. In 2017 to 2019, CETRs were expanded and refined, with NHS England producing guidance and a framework for conducting reviews consistently. Ongoing, CETRs are now embedded across the health and social care systems, extending beyond learning disabilities to other groups with complex mental health needs, including secure mental health services.

CETRs are multidisciplinary independent reviews designed to improve the care and treatment of people with complex mental health needs, particularly those detained in secure hospitals or secure settings, such as children and young people with learning disabilities, autism or complex mental health needs, or in other in-patient settings where there are concerns about the appropriateness of their care, treatment or placement. The purpose is to ensure that the care, education and treatment plans are appropriate, person-centred and holistic; to identify and address any barriers to overcoming recovery and discharge; to promote co-ordinated working between health, social care, education and other relevant services; and to support the least restrictive care principle, one that we have now enshrined in the Bill—helping people to move to less restrictive settings where possible.

There are, however, some complications. The number of CETRs has increased over recent years, especially with the growing recognition of the need for better oversight of complex needs. Several hundred CETRs take place annually across England and Wales, primarily within secure and specialist mental health services. Exact numbers are quite difficult to pin down and vary by service user populations, health trusts, NHS England monitoring and the reporting of the activity.

What is a CETR made up of? That is really important. A typical CETR involves a multidisciplinary panel including independent clinical reviewers such as a senior psychiatrist or clinician not involved in direct care; representatives from social care services; educational specialists, especially for children and young people; advocates or independent mental health advocates; the patient or service users themselves, where possible, to ensure their voice is central; family members or carers where appropriate and with consent; and commissioners and other relevant professionals involved in the person’s care pathway.

Under the review process, the panel examines the individual care, the treatment, the education and progress. It assesses whether the current placement and treatment plan are meeting the person’s needs and whether there is scope to support transition to less restrictive or more appropriate settings. Recommendations may be made on changes to care, treatment plans, discharge or support arrangements.

CETRs are a very valuable safeguard. They bring together the independent clinicians, the social care professionals, the educators, the advocates and, crucially, the patients and their families to review the care and treatment being provided. The aim is to ensure that the treatment is person-centred, appropriate and geared towards recovery, while also exploring opportunities to move people to less restrictive environments when safe to do so. That said, while CETRs are increasingly used, questions remain about their consistency, effectiveness and impacts on outcomes. On page 12 of the explanatory notes, paragraph 46 states that

“recommendations are not always being acted upon”,

which is contributing to

“the perpetuated detention of people with a learning disability and autistic people, often without therapeutic benefit.”

That is really significant. To that end, how many CETRs are conducted annually and what are the mechanics in place to ensure that the reviews lead to meaningful change in care, rather than becoming a procedural exercise? I must admit that I struggled to find that information. If I, as someone looking into it, am struggling, there is a concern about how wide that information and data is.