Dame Diana Johnson

I congratulate my hon. Friend the Member for Hornsey and Friern Barnet (Catherine West) on securing this important debate. I have spoken to the Minister for Social Care, who is happy to meet my hon. Friend to discuss her concerns, including her concerns around standards of care in particular. We can arrange for that to happen. This debate is important because when we talk about social care and mental health services, it can be easy to talk in terms of systems, services, assessments and waiting lists, but behind every one of those words is a real person—someone who may be struggling to get through the day without the right support. It could be a family member who has reached breaking point in trying to care for someone that they love. Those are the people we must keep at the heart of the changes that we are making to our NHS and social care system. My hon. Friend has taken a sustained interest in these issues in Hornsey and Friern Barnet, particularly the pressures facing adult social care and mental health services, the importance of community provision and the importance of ensuring that people can access the right support at the right time. Let me be clear: it is unacceptable that anyone is left without the mental health care that they need, particularly when they are in crisis. Let me turn to the local picture in my hon. Friend’s constituency. There is clearly a variation in mental health need across north London. The prevalence of severe mental health illness is particularly high in Haringey, where an estimated 1.44% of residents are living with a severe mental illness—compared with 1.16% nationally—making it among the highest rates in England. Residents of Hornsey and Friern Barnet draw on mental health and social care services at some of the most difficult points in their lives. As my hon. Friend knows, the constituency is served by both Barnet and Haringey councils. There is a different picture in each area. Barnet was assessed by the Care Quality Commission as “good” in January ’25. Haringey was rated as “requires improvement” in February ’25, with the CQC highlighting concerns surrounding mental health discharge processes, communication and timeliness around hospital discharge, partnership working, and a shortage of move-on accommodation for people with mental health needs. I appreciate how important these issues are for people who are already facing considerable challenges, and how frustrating it is when services do not work together effectively. The Department has therefore supported Haringey through its improvement offer, and I am pleased that the council has engaged constructively with that process. In May, Haringey requested to be de-escalated from the Department’s formal reporting process, which was accepted. The council provided a voluntary update on its progress in August, and expressed confidence in its improvement trajectory. While that is encouraging, I want to be clear that de-escalation does not change the CQC rating, which remains at “requires improvement” until the CQC completes a further assessment. The CQC issued a notice of assessment on 3 August and we will now await the outcome. I hope that will provide a clear picture of the progress being made and, most importantly, help to ensure that people receive the safe, timely and joined-up support that they deserve. I want to say a few words about the national picture for mental health. I think we all acknowledge that the challenge is significant, but our ambition is significant too. The 10-year health plan sets out our ambition to reform the NHS, and we are already taking important steps to improve mental health services, including reforming the Mental Health Act 1983 to support better and more personalised care, and recruiting thousands more mental health staff. We are also making £473 million of capital funding available over the next four years, including community-based mental health centres and mental health emergency departments. That includes £343 million to establish 100 community-based mental health centres and 59 mental health emergency departments across England, building on the six centres already operating in Birmingham, York, Copeland, Tower Hamlets, Lewisham and Sheffield. One community-based mental health centre will be established in most places in England. That typically coincides with a borough in London. Mental health emergency departments will cover approximately 50% of type-1 A&E departments by ’29-30, and I am pleased to report that there is already a unit at Highgate mental health centre on Dartmouth Park Hill, which has been operational since 2024, but of course we recognise that we must go further. That is why we are developing a new mental health strategy for England, which will set out how we can transform mental health care so that people receive support earlier, face shorter waits, and are helped to stay active and participate in education, work, family and community life. On delayed discharge and in-patient capacity, my hon. Friend described how discharge delays can leave people with no choice but to remain in mental health in-patient settings for longer than is appropriate. The Government recognise the importance of ensuring that people can leave hospital as soon as they are ready, with the appropriate support in place, such as rehabilitation services. That provision requires effective joint working across health and social care services, which is why the better care fund has committed over £9 billion in ’26-27 to integrated care boards and local authorities. That pooled funding is intended to support services that help people to retain or recover their independence, and to prevent avoidable admissions. Funding recipients are expected to agree local goals for preventing avoidable admissions and reducing delayed discharge, and to work together to develop effective services. Let me address the point about social care, housing and community support at discharge that my hon. Friend made so eloquently. For some people, particularly those with more complex needs, being clinically fit to leave hospital is not the only condition required for a safe and successful discharge; the right social care, housing and community support must also be available to enable them to live well in the place they call home. In particular, autistic people and people with a learning disability can lack suitable supported housing options in their community, which can contribute to people remaining in mental health hospitals past the point of need. The Government are taking action to increase the availability of appropriate housing and support, including through the £39 billion social and affordable homes programme that my hon. Friend referred to, through which we want new supported housing supply across a diverse range of housing types, including for people with learning disabilities and autistic people. NHS England is also investing £13 million in 2026-27 through its housing capital programme, to support areas to develop housing for autistic people and people with learning disabilities outside mental health hospital settings, alongside additional funding to support the development of crisis accommodation. Supporting timely discharge incudes ensuring that suitable arrangements are in place. It is essential that people leave mental health in-patient settings safely, with appropriate support in the community and with their needs properly considered. Revised statutory guidance on discharge from mental health in-patient settings was published in 2024 under the National Health Service Act 2006. The guidance sets out how health and care systems can work effectively together to support discharge from hospital and ensure that the right support is in place in the community. It also includes best practice on involving patients and carers in discharge planning, as well as providing clarity on how health and care partners should work together effectively, including in relation to shared responsibilities and arrangements for funding section 117 aftercare. Section 117 of the Mental Health Act 1983 places a duty on the NHS and local authorities to provide aftercare once they have left hospital to certain patients who have been detained under the Act. That aftercare should provide people with the support they need to live successfully and safely in the community, while reducing the risk of deterioration in their mental health and the need for further hospital admissions. Depending on an individual’s needs, aftercare can include accommodation, day services and other health and social care support. We know, however, that there can be a lack of clarity over which organisation is responsible for providing and funding aftercare and in which locality, which can lead to further delays in providing support to vulnerable people. The Government’s recent reforms to the Mental Health Act clarify which local authority is responsible for arranging an individual’s aftercare, by applying the existing social care rules on ordinary residents to people receiving aftercare under the Act. That should provide greater clarity and consistency for local authorities and ICBs, supporting more effective joint planning and better aligned aftercare services. I now turn to longer term adult social care reform and the Casey commission, which my hon. Friend referred to. We need to think ambitiously about the future of social care. At its best, social care is transformational. It can give people the support they need to live independently, maintain relationships, contribute to their communities and live the lives that they want. That is at the heart of the Government’s vision for a national care service: a system that is more person-centred, integrated with health services and preventive. The Prime Minister has been clear that he wants rapid progress towards that vision, working in partnership with the adult care sector. The Independent Commission on Adult Social Care, led by Baroness Casey, remains central to the Government’s ambitions to reform the sector. Baroness Casey’s Big Conversation on Care, launched on 29 July, gives people across England the opportunity to tell us what they want and expect from a future care service. This conversation will feed into the commission’s recommendations for the funding of adult social care, which will now be made in the summer of ’27. In the meantime, we will continue to put in place the building blocks of the national care service through improving support for the workforce and unpaid carers, and providing more than £4.6 billion of additional funding for adult social care in 2028-29, compared with 2025-26. I thank my hon. Friend again for raising these important issues and for shining a light on the experience of people who rely on mental health and social care services in her constituency. They are encouraging signs of progress locally, particularly Haringey’s engagement with the improvement process, but clearly there is more to do. The Government are determined to support local partners to make these improvements, while addressing the long-term challenges facing social care. Ultimately, this is about making sure that no one is left waiting unnecessarily for care and giving every person confidence that the services around them will work together when they need them most. Question put and agreed to.