Mental Health Bill [ Lords ] (First sitting)

Aphra Brandreth Excerpts

Committee stage
Tuesday 10th June 2025 Public Bill Committees

[Stephen Kinnock]

I see. I am sorry; I had misunderstood the shadow Minister’s point. I thought it was about sharing data on particular patients, especially those who are crossing borders. The point about waiting lists is a more difficult issue. The Welsh Government have taken a view on how best to define them. For example, I know that ambulance waiting times have been quite controversial because there is a different definition in Wales to England. Many feel that the definition adopted by the Welsh Government sets the bar at a higher standard, which can then sometimes framed, in the hurly-burly of politics, as failing more than they would be if they had used a different metric, but they have chosen to use that metric.

In the context of devolution, it is up to the Welsh Government to decide how best to evaluate the Welsh health service and its performance. I take the shadow Minister’s point on having the best alignment that we can, but when it comes to this UK Government, we will determine how performance is evaluated for England, and the Welsh Government will determine how best to evaluate performance for Wales. I think that the Welsh media, the UK media, this Parliament and the Welsh Parliament will then decide who is failing and who is succeeding.

[Aphra Brandreth (Chester South and Eddisbury) (Con)]

I represent an English constituency on the border with Wales; on some streets, one side is considered Welsh and the other English. Does the Minister recognise that it matters to people in England and Wales that there is consistency across both parts of our fantastic country, and that it is not sufficient to say that what happens in Wales will affect only Welsh people, or what happens in England will affect only English people?

[Stephen Kinnock]

I absolutely accept the point that there are deeply integrated communities on that border. A huge number of people live in England and work in Wales, or live in Wales and work in England. However, the fact of the matter is that health is a devolved policy area. It is, therefore, up to the devolved Administrations to determine how they want to measure the performance of their respective systems. It would be a violation of the principles of devolution if one Government in our United Kingdom were to dictate to another how they should evaluate their devolved policy areas—whether that is health, education or any other devolved area. I hope that I have responded to the best of my ability.

Question put and agreed to.

Clause 1 accordingly ordered to stand part of the Bill.

Clause 2 ordered to stand part of the Bill.

Clause 3

Application of the Mental Health Act 1983: autism and learning disability

--- Later in debate ---

[Zöe Franklin]

That presents challenges, but again, I would refer back to my own casework, and I am sure there are Members on the Committee who will have had the same experience. There are examples across the UK where health boards and providers find ways to appropriately share information with families and other carers to get the best outcomes for patients. I simply ask that, when the Minister and colleagues in this space have those examples, they share them. I know that there are some areas where this is already done effectively, particularly in Scotland, and I seek to reference those examples.

My final point on amendments 2 and 5 is that we need to ensure that those around a patient are given the opportunity to raise concern or the alarm when part of the report does not meet the patient’s needs. We need to address the patient’s full needs, and to ensure that they are both reflected in the reports and met.

[Aphra Brandreth]

Like my hon. Friend the Member for Farnham and Bordon, I have a lot of sympathy with some of the things that the hon. Lady is trying to achieve through the amendments. If there is to be an additional requirement for six-monthly rather than annual checks, how will the balance be struck to ensure that there is a focus on care rather than on the administrative burden that might be required?

[Zöe Franklin]

Helpfully, I was about to move on to a point about amendments 3 and 6, which would shorten the length between care and treatment plan reviews from 12 to six months.

We need to reflect on the fact that sometimes we do not get it right when we support an individual. In such circumstances, it is particularly important that we are able to have reviews every six months, rather than 12. It does not have to be a detailed, full-scale review. If all involved in the patient’s care come to the conclusion that the care needs are being met, that review could be incredibly short. If someone’s care is inadequate or inappropriate, it is not right that they should have to suffer unnecessarily for a year without the changes that are needed. Halving the time between the care and treatment reviews ensures that patients are not left languishing and instead have care that truly reflects their individual needs. I would reiterate that a six-month review can be incredibly short, and it also benefits patients by making them aware of where their care is not working for them, so that it can be reviewed.

--- Later in debate ---

[Gregory Stafford]

I agree entirely. That could be the unintended consequence of amendment 51: in essence, if the housing provision is not there, discharge will be delayed. From my understanding of the amendments in the group, those who tabled them are trying to speed up and improve discharge. My hon. Friend is absolutely right that we need to think about the practical implications of the Bill.

The amendment would require co-ordination among health, social care and housing services, which may be challenging in under-resourced areas. Frankly, because parts of those organisations are not used to working in the ways that the amendment would require, it might fall over without suitable training, the necessary lead-in time and a practical understanding of how it will work.

Amendment 4 would ensure that housing needs are formally considered during the care and treatment review meetings for adults with autism or a learning disability, without an EHCP. I understand that the aim is to support more effective discharge planning and reduce the risk of unnecessary or prolonged hospital stays. That is entirely in keeping with what we should be trying to do in the Bill. Holistic care planning reduces delays in discharge, improves cross-sector collaboration and supports community-based care, which we all support.

Once again, however, there is potential for complexity in the implementation. New processes may be required to involve the housing authorities. Resources and local housing shortages could limit the amendments’ practical impact. Another layer of complex review processes could add to that administrative burden. If there is inconsistent local capacity, the effectiveness of the amendment will almost certainly vary depending on the local housing infrastructure, which could lead to a postcode lottery, for want of a better phrase, in who receives the adequate care and housing.

Amendment 2 would ensure that children and young people with autism or learning disability, as well as their nominated persons and independent mental health advocates, receive a copy of the care, education and treatment review meeting report. I have a lot of sympathy with that. It potentially increases empowerment and transparency, ensuring that patients and their advocates are fully informed, which could enable better participation in care decisions. It has a legal and ethical alignment with the principles of the Mental Capacity Act 2005 and the UN convention on the rights of persons with disabilities, both of which emphasise supported decision making. It might also improve advocacy, as independent mental health advocates can more effectively represent a patient’s interest when they have access to the full report.

[Aphra Brandreth]

My hon. Friend is making valuable points about the benefits of the amendment. For vulnerable individuals, family involvement is often extremely important, but does he agree that that must be balanced with ensuring that potential disagreements do not put at risk what is best for the individual?

[Gregory Stafford]

My hon. Friend makes a key point that I was about to address. Clearly, where there is a supportive family structure with the best interests of the individual at heart, the amendment will work extraordinarily well. However, we have to be realistic about the practical implications.

Not every patient has a strong family structure around them. Unfortunately, some patients may even have family members who, for financial or other reasons, actively do not have their best interests at heart. There is a potential concern around confidentiality. I ask the hon. Members for Winchester and for Guildford how they would balance that conflict in practical terms, especially when the CETR includes sensitive clinical information that could be used in a way that is not beneficial to the patient by someone who does not have their best interests at heart. As my hon. Friend the Member for Chester South and Eddisbury points out, disputes can happen if patients or families disagree with professional assessments or recommendations.

Finally, although this is probably not the strongest point, we should think about the administrative burden. Given the increased workload that we are putting on all our health and care workers and services, there will clearly be an administrative burden in sharing these reports.