Queen’s Speech: What’s on the government’s agenda?

Mental Health Act reform welcomed

We welcome the government’s commitment to bring forward a new draft bill to modernise the Mental Health Act. 

The Act needs substantial reform to give people more choice and control over their care and treatment when they are admitted to hospital for a mental illness and more opportunities to challenge their detention if they are objecting to it. 

To support people having more say, independent mental health advocacy needs to be enhanced and extended. In the new Bill, the government must legislate and then swiftly implement: 

• extending the right to an advocate to people who are in hospital voluntarily 
• an ​‘opt-out’ model of advocacy provision (where people automatically get referred for support from an advocate, rather than having to ask for one, but can still choose to ​‘opt-out’)
• a wider roll out of the current pilots of culturally-appropriate advocacy 

The Mental Health Act reforms must also contribute to quickly reducing the number of people with a learning disability and autistic people in mental health in-patient services. New powers for the Mental Health Tribunal (an independent judicial body that hears appeals against detention) to direct public bodies to provide services in the community are important and must have ​‘teeth’. The government should also explore how these powers could apply to people who have been transferred to hospital from the criminal justice system. 

Human rights protections at risk

As much as we welcome reform of the Mental Health Act, in equal measure we have concerns about the government’s proposal to water down the Human Rights Act with a new Bill of Rights. 

As an organisation that puts people’s rights at the core of our work and seeks to make sure people are heard when it matters most, especially when trying to access support or when decisions might be being made about how they live their lives, the Human Rights Act and the case law that has come from several key judgements over many years have been crucial to upholding people’s rights. 

Weakening the role of the courts in holding the government and public bodies to account and providing that vital check and balance that a vibrant democracy needs ultimately puts those in the most vulnerable circumstances at greatest risk of harm and abuse of their rights. 

The Queen’s Speech doesn’t include everything that parliament or government will do though. There are also lots of committees, debates and the development of new policy that are not in the Queen’s Speech. 

Here are some issues we’re working on with government and parliamentarians to make sure people have their voice heard when it matters most. 

Liberty Protection Safeguards

The government published a suite of documents to launch their consultation on the Mental Capacity Act Code of Practice, regulations, and workforce and training strategies in light of changes to how people will be supported and protected when they are deemed to lack capacity and are deprived of their liberty. The Liberty Protection Safeguards (LPS) will replace the Deprivation of Liberty Safeguards (DoLS) and will mean more people should get advocacy support when they are in these situations. 

We are working on our response to the consultation at the moment together with other advocacy organisations. We are also a member of the DHSC’s LPS National Steering Group and are supporting consultation engagement events. 

The consultation is significant but there are a few areas of the consultation which are the highest priority for us: 

• The definition of a deprivation of liberty and whether the definition accurately reflects our understanding of the case law and how we would apply it to our work 
• How an Independent Mental Capacity Advocate (IMCA will work and the processes that an IMCA will need to follow to support a person, especially when challenging decisions 
• The role of the Appropriate Person and how to make sure more people get advocacy support for this important role 
• The duties of Responsible Bodies and making sure the processes and requirements in place are person-centred and support people’s rights 

Outside of the consultation response, we are also making it clear that the right funding must be in place to support the implementation of LPS and the increased demand that is expected under the new system, in order to make sure this is a meaningful system change and people’s rights are upheld and voices are heard. 

Building the Right Support

Building the Right Support is a programme that was established by government to address the thousands of people with learning disabilities and autistic people who are held long-term in mental health in-patient services and who often experience segregation, seclusion and restraint. Many of these are not of therapeutic benefit to them and in frequent cases cause them harm. 

Earlier this year, we published a short paper that sets out the case for a nationally commissioned, specialist advocacy service for people with a learning disability and autistic people in mental health in-patient services. We shared evidence that, whilst advocacy services can and should be an important resource, the quality of support is too variable and sometimes advocacy is absent altogether. A national commissioning model would enable a higher quality advocacy service that worked more closely with family members to achieve better outcomes for people with a learning disability and autistic people in mental health in-patient services. 

We expect the Building the Right Support Action Plan to be published soon and we are working together with others to push for the Action Plan to have the robust ambition it needs and to be implemented as an urgent priority. 

To make sure more people get high quality advocacy support, when they are in these circumstances, we are calling for the Department of Health and Social Care (DHSC) to nationally commission a specialist advocacy service to provide more effective and consistent support for people with a learning disability and autistic people in mental health in-patient services. 

Social care

There is broad consensus on the positive vision set out in the white paper, People at the Heart of Care. It proposes an approach to social care that offers people choice and control, promotes independence, enables people to live well as members of a community, and where people are supported when needed by staff who are valued and respected. However, while the vision may be strong, the methods and resources set out in the white paper to achieve such a transformation are limited and the wholescale reform of social care will take more than that which is articulated in the government’s current proposals. 

One of the easiest things the government could do, is to put in place policies and funding to make sure the Care Act is implemented in the full spirit of the law. That people are front-and-centre and making sure that ​“promoting an individual’s well-being” as defined in the act is a driving factor in decisions about care and support. 

The latest updates from government on their plans for social care and integration risk further embedding silos and the continued deprioritisation of social care funding, when the NHS is under increased pressure. This shouldn’t be an either/​or choice – both our NHS and our social care system must be properly funded and supported to ensure that health and care have parity of esteem. 

If the integration government is proposing is to be successful, it must look at the systems whole scale – how they talk to each other, how people access support, how people move between the health and social care support throughout their lives, especially not forgetting that social care is not just about older people selling their houses to pay for care but also about tens of thousands of working age adults who want and deserve to live full and vibrant lives in their communities.