Mental Health Act 1983: Detention of People with Autism and other Lifelong Conditions

As time is short, I want to speak briefly about the Transforming Care agenda. We know that, when all agencies work together at the same pace, it is excellent, but the trouble is that we still have agencies dragging their heels or causing problems that mean people are spending longer in detention than they need to. The readmission of patients who are being discharged is another depressing example of our failure to break the vicious cycle in many cases.

We know what “good” looks like; we have the NHS England “Building the Right Support” service model and National Institute for Health and Care Excellence guidance. We know that there are pockets of good practice that the Government are actively promoting and supporting, but more needs to be done to join that up. If we are to see these figures starting to come down, consistent with the Government’s own priorities, the time for action is now.

There are, therefore, two things that the Government can do. They can not only bring forward the legislation, but fulfil their pledge to add more substance to the strategies they have outlined. The £74 million, pledged in the 2020 Budget to help with what are known as the double running costs when people with a learning disability or autism are discharged into the community, is extremely welcome. I know there are funding commitments in the NHS long-term plan to help the development of community support. However, as the recent Health and Social Care Committee inquiry noted, we still are not in the place we need to be. We still do not have that level of support that will make the discharge of patients a much more seamless and successful process. I know that ending those perverse incentives and this artificial division between the NHS and local government is part of the integration agenda, and I look forward to the White Paper that my hon. Friend will be publishing very soon, but I want everything to be joined up, in a way I was acutely conscious of when I was Justice Secretary.

I will end on this note: I was acutely conscious of the need for greater speed when it came, for example, to the approval of the recommendation of clinicians, which was the responsibility of my Department. Prior to the onset of covid, I collaborated directly with the then Health Secretary to jointly pursue the Mental Health Act reform agenda. My abiding regret is that I was not able to do more, and I want to say that I am sorry that I was not able to do more, but here I am in my place asking my friends to carry on the work, to pick up the ball and to take it further for all the people we represent and their families. By calling this debate and by making that direct request to Government to act, I hope that together we can make the necessary changes and save lives.

To keep people safe now, all autistic people and people with a learning disability must receive high-quality, safe care. That is our first priority. We know that some people may require support in a mental health hospital; when that is necessary, it should have a clear therapeutic benefit, be the least restrictive support possible, be close to home and be for the shortest possible time. We will not tolerate instances of abuse or poor-quality care.

To ensure that people are safe, all autistic people and people with a learning disability in an in-patient setting now receive a safe and wellbeing review. These reviews, which are led by NHS England, are a priority and the majority will be completed by the end of January. We also fully support the more robust approach that the CQC is taking in increasing the amount of shorter, unannounced inspections and closing hospitals that do not provide a high-quality standard of care.

My right hon. and learned Friend mentioned people who are in long-term segregation. There are about 100 of them and a couple of cases were mentioned in the debate. Every single one of them will receive independently chaired reviews of their care and treatment. The reviews will consider how to move towards a less restrictive or, ideally, community-based setting.

As part of a wider £31 million package to support discharge and develop community support, we have provided funding for a senior intervenors pilot. These independent experts will work to resolve blockages in the path to discharge, where there can be multidiscipline teams who basically do not agree or manage to find a solution among themselves. The senior intervenors will help to unblock things for those people in a long-term situation, and move them towards a less restrictive setting and back into the community, which is where we want people wherever possible.

My hon. Friend the Member for Broxtowe (Darren Henry) mentioned the need to build and make sure we have the right support in the community. The Government want to make sure that, wherever possible, autistic people and people with a learning disability are able to lead full lives in the community, close to their families, with the right support in place to prevent crisis.

In the NHS long-term plan we committed to reduce the number of autistic people and people with a learning disability who are in-patients in mental health hospitals by 50% by the end of March 2024. Since 2015, we have achieved a 29% reduction, which is equivalent to a reduction of around 800 in-patient beds—800 people—and means we need to close around 600 more to meet the target. I am firmly committed to achieving that.

The building the right support programme is our national policy to ensure that autistic people and people with a learning disability are supported in the community, and more than £90 million of additional funding for community services and support for discharges has been provided for 2021-22 to help to achieve that. Joint action across organisations and systems is essential to drive progress, so we are developing an action plan to outline the steps that we and all our partners will take to deliver that action with urgency, and we will publish it as soon as possible. We also know that early diagnosis is key, as the hon. Member for Strangford (Jim Shannon) mentioned, and that prevention and intervention at an early stage are vital, so we are investing £2.5 million to test and implement the most effective ways to reduce autism diagnosis waiting times for children and young people in England. Additionally, we are investing £600,000 in significantly expanding an autism early identification pilot to at least 100 schools over the next three years. Those actions and others set out in our all-age autism strategy, which was published in July, should make a big difference.

I want to touch on the subject of “do not attempt CPR” decisions, which hon. Members have mentioned. My right hon. and learned Friend the Member for South Swindon mentioned the culture; we are working to ensure that there is a culture of compassionate care for autistic people and people with a learning disability that is also of the highest quality. The Department has remained crystal clear that it is unacceptable for DNACPR decisions to be applied in a blanket fashion to any group of people.

We have also developed and trialled the Oliver McGowan mandatory training in learning disability and autism for all health and social care staff, working with Health Education England and Skills for Care. The programme is backed by a £1.4 million investment, and I think it will go a long way towards changing the culture.

We want to end inappropriate detentions for autistic people and people with a learning disability, and we are introducing once-in-a-generation reforms to the Mental Health Act that will be critical to achieving that. Under our proposed reforms, we will limit the scope to detain autistic people or people with a learning disability under section 3 of the Act. We want to prevent the detention under section 3 of people who do not have a co-occurring mental health condition; they simply have a learning disability.

We want to ensure that the right services are in place, allowing individuals to receive the best possible care in the community. Our proposed reforms will create new duties for commissioners to ensure an adequate supply of community services and ensure that every local area understands and monitors the risk of crisis at an individual level. This will transform our capability to provide those services in the community and to keep people safe in their community.

I thank all hon. Members for their contributions and thank my right hon. and learned Friend again for securing this vital debate. It is important that we continue to listen to people with lived experience and to their families, most importantly, in shaping and delivering high-quality care, both in in-patient settings, where they still exist, and in the community. Having heard some truly shocking experiences as Minister for Care and Mental Health, I am grateful that the debate has given us an opportunity to set out my personal commitment and to give a voice to those people who, for too long, have not had one.

In addition to the work that the Government are undertaking now and in the longer term, we must make sure that all autistic individuals and people with other lifelong conditions are treated with dignity and respect and are able to lead fulfilling lives in their community. I am absolutely determined to see that happen, and I look forward to working with my right hon. and learned Friend; I know that he is determined, too. There should never be an instance of people with a learning disability and autistic people being treated as anything less than equal in our society. He has my commitment that I will work with him to achieve that.