Mental Health Bill [ Lords ] (Third sitting)

Zöe Franklin Excerpts

Committee stage
Thursday 12th June 2025 Public Bill Committees

Grounds for community treatment orders

[Zöe Franklin (Guildford) (LD)]

I beg to move amendment 11, in clause 6, page 13, line 6, at end insert—

“(c) after subsection (6) insert—

‘(6A) Any person subject to a community treatment order must be informed orally and in writing at the time of the making of the order of their right to an independent mental health advocate under section 130A of this Act.’”

The amendment would ensure that people who are to be subject to a community treatment order would receive information about their right to advocacy.

[The Chair]

With this it will be convenient to discuss the following:

Government amendment 30.

Clause stand part.

[Zöe Franklin]

It is a pleasure to serve under your chairmanship, Ms Furniss. Our amendment would ensure that people who are subject to community treatment orders receive information about their right to advocacy. People under CTOs should not miss out on advocacy because they were not aware. CTOs can have a significant impact on how people are able to live their lives, and ensuring that those who are subject to them are effectively represented is crucial. I am delighted that advocacy is a crucial part of the Bill, but this seems something of an oversight.

Not being aware of mental health advocacy could lead to a damaging lack of autonomy and voice for an individual. This simple change would ensure that people receive the support to which they are entitled. People in this situation are in acute mental distress, so the idea that they must actively seek out information on advocacy seems an unfair burden that will make the welcome provisions around mental health advocates far less effective.

We also need to be aware that CTOs have consistently been shown to be a point of disparity in care for black and minority ethnic groups. Clearly pointing towards an advocate may help to alleviate that and ensure that the patient is adequately supported on leaving the hospital.

Is the Minister satisfied that people subject to CTOs will have adequate access to advocacy under the Bill? Is he satisfied that information on rights to mental health advocates will be clear enough? My Liberal Democrat colleagues and I are concerned that the answer to those questions is no, which is why we tabled the amendment.

[Dr Evans]

I rise to speak to clause 6 and Government amendment 30. Clause 6 will make important amendments to conditions for community treatment orders under the Mental Health Act. CTOs are a tool that allows certain detained patients to receive ongoing treatment in the community rather than in hospital, providing continuity of care and supporting recovery outside institutional settings. Since their introduction in 2007, they have offered a mechanism to maintain contact with mental health services and prevent relapse while balancing the patient’s right to live more freely.

However, CTOs have not been without controversy. There is concern about their overuse and their disproportionate effect on black and ethnic minority patients. There are also a number of questions about the evidence for their effectiveness in reducing relapse or readmission. Moreover, concerns about coercion and the infringement of patient autonomy have been raised repeatedly. The 2018 independent review recommended tightening their use. Some also argue for going further by abolishing them completely.

Clause 6 seeks to address many of those concerns. It will introduce stronger safeguards, clear risk-based criteria and a maximum 12-month duration to prevent indefinite or inappropriate use. It will mandate patient involvement through consultation and regular review, promoting shared decision making. Accountability is enhanced by aligning CTOs with a code of practice and introducing external oversight. Crucially, CTOs will now be used only when there is a clear and necessary risk, focusing on clinical need and safety.

Challenges remain. The new requirements bring complex administration and an increasing workload for clinicians. Despite reforms, CTOs remain a form of compulsory treatment, raising concerns about ongoing coercion. Their success depends heavily on the availability of community services, which are not always adequately resourced. Finally, terms such as “serious harm” may be open to interpretation, risking inconsistency. To unpack all that, we must take a closer look.

Clause 6 rightly seeks to update and clarify the legal framework governing CTOs to ensure that their use is proportionate, justified and consistent with evolving standards of care and risk management. It does so primarily by aligning the grounds for making and renewing a CTO with the new, more precise risk criteria for detention. It specifies that a CTO should be made only if there is real risk that

“serious harm may be caused to the health or safety”

of a patient or others without treatment, and if that treatment is necessary given

“the nature, degree and likelihood of the harm”.

Again, there is an argument about the definition of “serious harm”, and the same discussion as the one we had under clause 5 about escalation of behaviour or cumulative concerns applies here.

In the light of that discussion, it might be helpful if the Minister clarified the interface between CTOs and grounds for detention. Is there scope for the code of conduct to cover the management of risk, both to the public and to patients themselves, across both? Given the emphasis placed on real risk of serious harm, clause 6 aligns CTOs more clearly with the threshold for detention, with the aim of reducing the inappropriate use or overuse of CTOs, which is much more welcome. It will help to safeguard and protect patients from unnecessary restrictions on their liberty, while maintaining the ability of a responsible clinician to act decisively when there is genuine risk.

Mental Health Bill [ Lords ] (First sitting)

Zöe Franklin Excerpts

Committee stage
Tuesday 10th June 2025 Public Bill Committees

[Dr Chambers]

It is an honour to serve under your chairmanship, Mr Vickers. I will speak to amendments 1, 51 and 4 together, as they all relate to housing. Amendment 1 ensures that housing needs are considered as part of care, education and treatment reviews. Amendment 51 ensures that the impact of accommodation and relocation is considered in care and treatment reviews for patients with autism or learning disabilities. Amendment 4 ensures that housing needs are considered as part of care and treatment reviews.

Appropriate housing is critical for people’s wellbeing and cannot be viewed as separate from effective and safe care. Ensuring that housing or any temporary or crisis accommodation supports the safety and independence of people with a learning disability should be a key part of care, education and treatment reviews. We believe that it is essential for fulfilling the duties of the Bill.

Without that provision, it will be far harder for patients to leave detention and for care to be facilitated in the community. If people with learning disabilities who are detained risk being discharged into insecure or inappropriate housing, their recovery from mental ill health could be jeopardised. Patients should be viewed in their whole context, not just as a collection of conditions or symptoms. Housing is among the most fundamental social needs that should be considered.

[Zöe Franklin (Guildford) (LD)]

I rise to speak to amendments 2 and 5, which, in summary, would ensure that patients, named persons and independent mental health advocates would receive a copy of a care, education and treatment review meeting report for children and young people with autism or a learning disability.

Patients, along with all those tasked with helping to represent their wishes, should be able to see transparently what has been judged to be safe and appropriate care for them. Being given the opportunity to understand why their care or treatment is changing or remaining the same should be a basic right for patients, yet as it stands they are often frozen out of seeing that final report. Similarly, the nominated person, whether that is a friend, a mother, a sibling, or another parent, often has care of the patient; they know the whole person better than any NHS institution, and will often have a far fuller understanding of the patient’s history.

[Gregory Stafford]

I have a lot of sympathy with what the hon. Lady is trying to achieve with these amendments. My question is about how she would ensure, within the context of the provisions, that the patient’s confidentiality would be maintained where it needed to be.

[Zöe Franklin]

The hon. Member raises an interesting and pertinent point. There will always need to be balance when addressing the issues around patient confidentiality. I have seen from my own casework that when families who have been through mental health crises with their loved ones have not been involved in that process, unfortunately the crisis has lasted much longer and been more significant because those around them have been unable to support the individual. I do not have the answer, but we need to work collectively to find a way to strike that balance in order to address the needs of the patient.

[Gregory Stafford]

Moving on from the confidentiality point, if there is going to be sharing—again, I have a lot of sympathy with the amendments—how would the hon. Lady ensure that disagreements between family members and the patient are safeguarded against?

[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.

[Dr Shastri-Hurst]

I have a certain degree of sympathy for the amendments, but I am sure the hon. Lady will recognise that patients and their families often find the review process overwhelming in and of itself. Bringing it forward to six months, when such reviews would often not be required, can cause a huge amount of stress and place pressure on those family units and patients. Of course, reviews can be brought forward when clinical need requires it. To stipulate that within the legislation puts an enormous burden upon those families and, most importantly, the patients.

[Zöe Franklin]

I return to my point that a review can be short when clinicians and those involved in a patient’s treatment deem it appropriate. Again, where the system is working for a patient, it is good and proper that we do a short review, and they can then carry on with their treatment. When it is not working, why should the patient struggle on for 12 months alongside their families, who will also be struggling?

[Dr Shastri-Hurst]

Will the hon. Lady give way?

[Zöe Franklin]

No, I will move on to amendment 7, which I also want to cover. This amendment is very important, as it would ensure that the integrated care boards and local authorities responsible for a patient’s treatment and care would have a duty to implement the recommendations arising from a care and treatment review. The legislation states “must have regard to”, but we believe that that is too weak and could see crucial parts of care and treatment reviews left unimplemented.

As it stands, this part of the Bill could be considered to be implemented even if no adequate resourcing was required, with the care and treatment review left as an empty exercise. One of the key parts of this legislation is to ensure that resources are there to implement treatment for patients. Will the Minister reassure us that adequate resources will be provided to ensure that patients’ treatment needs are met, that training for clinicians and others supporting an individual is made available through resourcing, and that we do not again find ourselves in a situation like the current one, in which patients too often struggle because there are not the resources to meet their care needs?

[Dr Evans]

I rise to speak to Liberal Democrat amendments 1 to 7 and 51 to clause 4. I welcome the intention behind the amendments, which aim to enhance the care and treatment review process for people with autism and learning disabilities, particularly by addressing housing and accommodation needs and ensuring that key advocates receive reports.

There are positive elements of the amendments that are worth highlighting. I understand the good intent of including housing and accommodation considerations explicitly in reviews, as it recognises that a person’s living situation is often central to their wellbeing and recovery. Additionally, ensuring that nominated persons and independent mental health advocates receive reports promptly promotes transparency and patient advocacy. Shortening the review intervals from 12 to six months could lead to more responsive care planning.

However, I have some significant reservations about the statutory implications of blurring housing, for example, so directly with the care and treatment review process. Housing is traditionally managed under separate statutory frameworks from health and social care, so to embed housing as a statutory element within these reviews risks creating confusion about which agency holds responsibility and may expose health bodies or commissioners to legal obligations that they are neither funded nor structured for.

I have a few questions for the Liberal Democrats. In their eyes, how would the Government ensure clarity over the statutory duties applied to housing recommendations arising from the reviews? Would that not risk delaying or complicating discharges if housing issues became a statutory sticking point within health-led care reviews? Moreover, housing provision often depends on local authorities and housing departments that have their own complex eligibility criteria and resourcing constraints. Are we confident that ICBs and responsible commissioners would be able to co-ordinate effectively across these boundaries, especially given the patchwork of funding and powers in play?

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.

--- Later in debate ---

[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.

Mental Health Bill [Lords]

Zöe Franklin Excerpts

2nd reading
Monday 19th May 2025 Commons Chamber

[Zöe Franklin (Guildford) (LD)]

I welcome the direction of the Mental Health Bill. It marks a long-overdue shift in how we treat some of the most vulnerable in our society, recognising that people deserve more than crisis care—they deserve dignity, choice and autonomy. It has been a real privilege to be in the Chamber for this important debate, and to hear the very moving speech by my hon. Friend the Member for St Neots and Mid Cambridgeshire (Ian Sollom), and by so many others across the Chamber who shared their constituents’ stories, and their own.

The Bill rightly puts patients at its centre. It gives them more say in their treatment, improves the complaints process and introduces personalised care plans. Replacing the outdated “nearest relative” with a nominated person reflects a broader move toward a more respectful, person-centred system that listens, empowers and supports recovery. But here is the uncomfortable truth: however well-intentioned, the Bill will achieve little unless we confront the funding crisis already engulfing our mental health services. The Bill asks overstretched and underpaid staff to deliver changes that demand time and care when many are already at breaking point. My constituents across Guildford see that every single day. Jennifer came to me in despair over the care that her daughter Leah is receiving at a local mental health unit. Chronic understaffing and a lack of support mean that concerns go unanswered. Underfunding has created a cycle of inadequate care—treatment refused, early discharges to free up beds, and inevitable readmissions when Leah’s needs are left unmet. I have heard from Samantha, whose son suffered a psychotic episode that ended in tragedy—a stark reminder of what happens when crises go unsupported. I also want to mention the story of a young woman whom I will not name, but who made a series of attempts on her life until she tragically succeeded, after gaining access to a poison from overseas. I know this is not a unique story, and that multiple coroners have written to the Secretary of State for Health and his predecessors on this issue. Will the Minister agree to meet me to discuss the case and whether it may be possible to use the Mental Health Bill to prevent further similar deaths?

There is also the fact that across the country people are waiting months and sometimes years for mental health care. Children and young people are falling through the cracks, as CAMHS is overwhelmed and referrals are delayed; patients are sent miles from home due to local bed shortages; and police are left to respond to mental health emergencies because there is no one else to call. Our system is not just stretched; it is at breaking point. Yet the proportion of NHS funding going to mental health care is falling—despite soaring demand, despite mental illness making up a fifth of the NHS’s burden, and despite the Government’s promises. These are not just gaps in the system; they are failures of political will.

[Iqbal Mohamed]

As well as NHS funding for direct mental health services, does the hon. Lady agree that we should invest in preventive steps to help children to avoid the mental health anguish that they are suffering today?

[Zöe Franklin]

Absolutely. I know from my own caseload of too many stories of where if young people had received preventive care and support, they would not be facing the tragic situations they and their families are now living through.

This Government have scrapped key mental health targets, including goals for early intervention, therapy access and physical health checks for people with mental illnesses. I am sorry, but this signals a retreat at the very moment we need to advance.

I support the vision outlined in the Bill, but its success depends entirely on the foundation on which it stands. Without adequate investment, even the very best intentions will struggle to take root. Ensuring that people can exercise their rights and that staff can support them demands more than legislation; it demands real resources and sustained commitment from this Government.

We need a national effort to rebuild mental health care from the ground up, with early intervention for young people, trained professionals in schools and communities, continuity of care and a culture shift that treats mental health with the same urgency and seriousness as physical health. Failure is not an option—not for the thousands still waiting, not for the staff stretched to their limits, and not for the communities left to pick up the pieces. We can and must do better.

NHS Backlog

Zöe Franklin Excerpts

Monday 6th January 2025 Commons Chamber

[Zöe Franklin (Guildford) (LD)]

Before Christmas, I shared in this Chamber the issues impacting my Guildford constituents who are struggling to access support for special educational needs and disabilities. Today, I want to highlight an aspect of the NHS that is directly linked to the SEND issues that I raised: child and adolescent mental health services, better known to most of us in the Chamber as CAMHS.

Unlike many SEND-related issues, CAMHS sits not within the remit of education but in health, as it requires significant input from NHS specialists. The first step to getting help from CAMHS is usually a referral for an assessment. However, the waiting list for some people is up to three years. That is why I am raising the matter today. A long wait for an assessment leaves young people without support or a diagnosis and has wide implications. A young person’s mental health can deteriorate during that wait, which can lead to self-harm, lashing out and harming family members, and even suicide. Imagine going through that as a parent—watching, often helpless to support your child, while the system designed to help does not. Even if they eventually get a CAMHS assessment, there are well-documented shortages in medication and problems accessing therapies.

The son of one of my constituents was diagnosed with attention deficit hyperactivity disorder and autism spectrum disorder in April 2020, but received no follow-up appointments. While his family said it was manageable initially, his school performance began to decline towards the end of 2021-22, leading his family to seek a review with CAMHS in February 2023. Twenty months on, the review has not taken place. His parents sought support to prepare him for his GCSEs, even if the medication had to be delayed, but they were met with a system unable to provide even basic support. They now face an indefinite wait with no resolution in sight.

Another constituent has been fighting for support for her 13-year-old daughter, who has been waiting more than two years for an ADHD and pathological demand avoidance assessment, despite the mother pleading for help for seven years. This single-parent family has endured systemic failure, leaving them suffering to an extent that I will not detail today. The prolonged wait for an assessment has taken a devastating toll on both their lives.

It is clear that action is desperately needed to ensure that the resources are there to support young people and their families through the CAMHS system and to ensure that medication shortages are addressed. How will this Labour Government work to recruit and train more professionals to clear the CAMHS backlog and ensure that the service can respond in good time—not years—to requests for assessments and support? Too many young people and their families are being failed by the current system, and it is time that that came to an end.

Children’s Hospices: Funding

Zöe Franklin Excerpts

Wednesday 30th October 2024 Westminster Hall

[Zöe Franklin (Guildford) (LD)]

It is a pleasure to serve under your chairmanship, Mr Twigg. I start by thanking the hon. Member for Liverpool West Derby (Ian Byrne) for organising this very important debate on the funding of children’s hospices. I have had the sobering privilege of visiting Christopher’s children’s hospice, which is run by Shooting Star Children’s Hospice Association of the South East, just beyond the border of my constituency of Guildford, on two occasions in the past year. Each of those visits has left me with a lasting impression, as I witnessed the incredible work that the dedicated staff team do to support not only the children with life-threatening conditions in my constituency, and well beyond, but their families.

My reason for speaking today, just as so many others have done, is to highlight how challenging the financial situation that hospices are experiencing has become. We have heard that only a third of the funding required by hospices comes from the NHS and central Government, and the rest is sourced from charitable donations. We are really fortunate to live in a society where fundraising for children’s hospitals can keep them funded, but is that really how we should be providing the majority of the funding for crucial services for children with life-limiting and life-threatening conditions? The £25 million allocated by NHS England is intended to support children’s hospices, but the distribution through ICBs has led to significant delays in accessing that funding for the upcoming 2024-25 financial year, and there is a really troubling uncertainty whether it will continue into 2025-26 and beyond. That only exacerbates the already daunting task of financial planning for hospices.

Given those circumstances, it is perhaps not surprising that, in a recent survey of children’s hospices, Together for Short Lives found that hospices would prefer NHS England funding to be distributed centrally, according to an overwhelming 83% of respondents. That would provide the certainty and stability that is crucial to them. I am sure that everyone here can agree that children’s hospices play a vital role in our communities, and I want to put on the record today a really big, heartfelt thanks for the care that hospices and their honestly incredible staff provide to children and their families. I particularly thank Christopher’s in Shalford for the care it provides for my own local residents, as well as those across Surrey and beyond. Those families and their children are going through some of the toughest challenges imaginable. However, our gratitude is not enough. I really urge the Minister today to commit to a fair, long-term deal on funding for children’s hospices and to ensure that the NHS funding returns to being a centrally managed grant.