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Mental Health Advocacy

Volume 486: debated on Monday 12 January 2009

Motion made, and Question proposed, That this House do now adjourn.—(Chris Mole.)

It is a great privilege and honour to move the first Adjournment debate after the Christmas recess. I welcome the Minister to his place. I had the great pleasure of working with him when I served on the Public Administration Committee and he was the Minister for the third sector. He took a great deal of interest in the work of our Committee and he always listened and was always helpful. I hope he will be equally helpful this evening.

I had the great honour and privilege of serving on the Mental Health Bill in 2007. The Bill has now become an Act and its measures came into force on 3 November 2008. Many parts of the Act were welcomed in all parts of the House. However, some parts of the Act caused many Members on all sides of the House great concern. The Act contained significant powers to detain and treat people against their will. Many of us in this place were concerned about that. The Act also incorporated safeguards in the form of independent mental health advocacy that would ensure that people who were being detained against their will or faced being detained against their will for mental health problems could receive the support of an independent advocate. That is crucial.

When someone has a mental illness and has an episode that requires or may require their detention, their liberty is removed and their freedom of movement is restricted. Some people are committed to secure hospitals. Others are subject to community treatment orders which restrict their liberties and freedom of movement in the community. The role of the advocate is to support those people in their dealings with health care professionals. Someone having a mental episode may be extremely bewildered, upset and frightened. They get a great deal of information, some of which they do not agree with and much of which they may be hostile towards. They can feel very alone and isolated.

The role of advocates is to stand and sit by that person and to ensure that they understand as far as possible their rights under the Mental Health Act 2007—their right to say no and to question the treatments and recommendations proposed by health care professionals and clinicians. That is a hugely important part of the Act.

Let us turn for a moment to our criminal justice system. When defendants before the courts face losing their liberty, we have a robust legal system which ensures that they get proper representation, that their interests and concerns are given a proper hearing, and that their side of the story is put. It is just as important that people who face being incarcerated and having their liberty removed as a result of a mental health episode have the same level of professional representation—people who go in to bat on their behalf.

As I said, the Act came into force on 3 November 2008. However, the part of the Act dealing with mental health advocacy is not due to come into force until 1 April 2009. That creates problems, which I should like to explore with the Minister for a few moments. We are about 10 and a half weeks away from the go-live date, but the commissioning of these services by primary care trusts has only just got under way.

On 16 December, just before the House rose for the Christmas recess, the Minister made a helpful statement about how the tendering process would commence. However, today is 12 January and we have just over 10 weeks to get the services in place. Tendering and commissioning is a complex process that requires thought and time. Organisations such as the NHS Confederation, Mind and Rethink are concerned that the tendering could be rushed and that solutions that do not best fit the needs of mental health patients will be put in place. We need to be alive to those concerns.

One of the fears is that because of the short space of time for putting out a tender and commissioning the services, the process may favour large, national providers. As the Minister will know from his time as Minister with responsibility for the third sector, I had a concern about such providers squeezing out good, locally based advocacy providers. Large, national providers have large infrastructures and experts within their tendering teams who can quickly put together and present a complex tender. They may be good advocacy providers; I do not doubt for a minute their ability to deliver the service. However, we must ensure whenever possible that established local groups get the chance—or perhaps are prioritised—to deliver the services. Such organisations are rooted in communities and have a track record of success. I hope that the Minister will give PCTs further guidance on how to ensure the outcome within 10 and a half weeks from the go-live date.

I have listened carefully to my hon. Friend and I can endorse his knowledge of and input into this subject, as I was leading for the Conservatives on the Mental Health Bill.

My hon. Friend is absolutely right. My concern is that the Mental Health Act 2007, which represents a reform of mental health legislation for the first time in about 25 years, contains a lot of innovative, controversial and technical legislation. To have advocates in place by April, late though that is, is demanding. To have well trained and well qualified advocates in place capable of offering the service to many vulnerable people in complicated conditions is a great challenge. My fear is that those people might not be available.

My hon. Friend has pre-empted the next part of my speech; if he will bear with me for a few moments, I shall answer his intervention.

I am very concerned that small local providers of advocacy services may be squeezed out as a result of the tendering process. The 2007 Act also set aside £8 million in the regulatory impact assessment to fund the provision of additional advocacy services for people suffering from mental illness who face having their liberty removed and restrictions being placed on their freedom of movement. I believe that the £8 million is still in place and will go to primary care trusts and it is very important that it should. That is additional expenditure.

One of Mind’s concerns is that the money may not materialise and that we will have to rob Peter to pay Paul—that the PCT funding for advocacy services working for other groups of patients will be reduced, so that PCTs meet their statutory obligation under the 2007 Act. I am sure that the Minister will answer those very real concerns as he winds up this evening. We do not want to see again the viability of small local groups being put into question because they have suddenly lost significant parts of their funding because PCTs are meeting their obligations by bringing in larger, national providers of advocacy services. I hope that the £8 million will come.

I appreciate that we live in straitened financial times and that Members asking for money in the House tend to get pretty short shrift. However, the NHS Confederation is extremely concerned that, given the short time available to get the services in place, the £8 million will not be enough. In a sense, I am the mouthpiece of the NHS Confederation on that point; I am bringing its concerns to the Minister. I hope that he will be able to respond. Whatever he says, I am sure that it will go some way towards putting the minds of those at the NHS Confederation at rest.

My hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) mentioned training and qualifications. As we debate independent mental health advocacy this evening, there is no recognised qualification in place for these advocates to take. There are plans afoot and wheels in motion to produce that qualification, but as of yet it has not materialised. I hope that in the next six months something will appear. As my hon. Friend said, the legislation is extremely technical, and we need people representing the mentally ill who have an implicit and intrinsic understanding of it and of their client’s rights under it. In the criminal justice system, one would expect to be represented by a lawyer or, at the minimum, a paralegal of some training who understands what is going on. We should not in any way sell the mentally ill short on the quality of the representation that we give them.

There is a delayed training requirement. By that, I mean that people providing advocacy from 1 April will not be required to demonstrate proficiency in the Act for a year after they have started providing that advocacy. I do not know—perhaps the Minister can tell me—whether that is only in the first year from 1 April 2009 to 31 March 2010, while the Act beds in. However, I hope that as soon as possible we can ensure that people providing this service in very stressed conditions where the stakes are very high—we are talking about removing people’s liberty for six months or more—have the level of expertise to get it right and to ensure that the clients whom they represent are confident in their abilities. I know that it is dangerous territory to talk about measuring the effectiveness of representation, because we have too much measuring, but in the early stages we need to ensure that the advocacy being provided, even by people with training, is up to the mark. People with mental illness deserve the very best, and we as a society should give them the very best.

I have received representations from organisations and clinicians who represent and deal with ethnic minority groups, and they are very concerned about the delay in the implementation of advocacy services. A black Afro-Caribbean male exhibiting the same symptoms as someone who is white is twice as likely as a white person to be detained under mental health legislation. That is fairly horrifying, and it needs to be addressed. We need to ensure that people providing advocacy services have cultural relevance. I have nothing against people in the home counties providing advocacy services to a broad range of clients, but in inner-city environments it is absolutely vital that people providing those services understand the cultural issues and pressures and the sense of anger and fear that resides in many ethnic minority communities about their chances of being penalised and discriminated against under the Act. We need to ensure, as a priority, that minority groups get representation that meets their needs and in which they have total confidence.

My hon. Friend continues to make a strong case. There are subsections within black and minority ethnic communities, particularly young Afro-Caribbean men, for whom the figures are far worse than just twice the likelihood of being picked up. Not only are there problems with encouraging members of BME communities experiencing mental health problems to access services—they are often less likely to come forward—but once they are in the care of those services it is vital that they have trust in somebody who is going to advocate for them. I have noticed that there is a campaign trying specifically to recruit advocates who reflect the people whom they are going to represent in court.

The last thing we want is communities suffering in silence, or fearing an engagement with the health service that is there to serve them because they fear a result that affects their liberty or freedom of movement. My hon. Friend is absolutely right, and I know that the Government will be concerned about the issue. I know that they were concerned about it during the passage of the 2007 Act. All of us have a duty to get it right, for everyone, but we must not forget the difficult groups that feel excluded. We need to get it right for them as well if our mental health system is to carry the credibility it deserves.

I have spoken for 15 minutes, which is the normal allotted time for such debates, but I understand that I have a little longer tonight. I will detain the House only for about another five minutes. Connected to the issue of mental health advocacy services is the idea of care in the community. While I have the Minister’s attention, I would like to bring to his attention something exciting and innovative that I recently came across. We all accept that the idea behind care in the community was good, but that it lacked something in the execution. A lot of people felt very isolated when they were returned to the community because it remains fearful of people with mental illness—I shall return to that point at the end of my short speech.

Something called adult fostering is being pioneered in America, which a few local authorities are now adopting. Adult fostering involves not taking people out of a mental health hospital and putting them straight into the community, but placing them with families who understand and have compassion for people with mental illness and who can meet their needs and support them back into the community. I think that idea is revolutionary. It is a truly exciting development, which really is care in the community, and reflects that aspiration. I know that the idea is slightly off the terms of tonight’s debate, but I hope that the Minister will consider it. It works both ways: it helps people coming out of hospital back into the community, but it can prevent people from going into hospital by providing them with support to ensure that they can recover their equilibrium and do not need to spend time in hospital. I do not have the details of the scheme, but I would like to learn more about it. If successful, it might be implemented throughout this country, where we could be very proud of it.

I conclude by noting that our tabloid press are having great sport with discriminatory remarks made by a member of the royal family. The reporting of the tabloid press on people with mental illness is atrocious and appalling, and it is discrimination of the worst kind. Many people are fearful of coming forward with mental health problems because they fear that they know how their community will react to them. There is still hostility in our communities to people with mental illness and I firmly believe that a lot of that hostility is whipped up by hysteria in the tabloid press. It is the worst kind of discrimination; it is vile discrimination. I hope that our tabloid press gets their house in order before we have to get it in order for them.

Thank you for hearing me out, Mr. Deputy Speaker. I shall now allow others to take part.

I am delighted to take part in this debate and I congratulate the hon. Member for Broxbourne (Mr. Walker) on securing it. I shall not detain the House long. I declare an interest in that my son works in the field of mental health, at Broadmoor hospital. He has some knowledge of aspects of mental health but in a slightly different context.

I begin by congratulating the Government. I recently asked a parliamentary question about this issue, and the Minister’s response was better than I expected—apart from the delay, we have done the right thing. We have realised the importance of advocacy, and I have long believed that we needed to do that. In a sense, the Government are going to get blamed whatever they do. If they had rushed ahead and implemented the advocacy strategy without sufficient numbers of people and without the strategy being grounded in real expertise, there would have been obvious problems. On the other hand, as the hon. Gentleman rightly said, it has been delayed beyond the implementation of the other aspects of the Act, which leaves some of us rather nervous.

My concern throughout has been for the poor souls who are in the process of being sectioned. Those of us who know a little bit about it, perhaps not through direct experience but through talking to people who have been sectioned and those who undertake the sectioning, have found it somewhat bizarre that the advocate of the person being sectioned has, until the present change, been the very person undertaking the sectioning. That may be because those people are skilled experts who know how to cope with the various pressures that they will meet in the most difficult circumstances, but one has to be somewhat naive to believe that there will not be occasions when the person being sectioned genuinely feels that it is wrong, and that they cannot get the advice that they want, whether from a community psychiatric nurse whom they know or an approved social worker. The people giving them advice are essentially those who are taking their liberty away. Even if not immediately upon sectioning, we need to recognise that the independence of the advocate’s role in giving advice to someone who has faced the most trying circumstances is right and proper.

I am grateful to the hon. Gentleman for giving way, because intervening saves me having to ask to make a speech. Is it not the case that a number of people who need to be sectioned for mental illness are sectioned at the instigation of family members who are acting in their interests but with whom they have fallen out? They do not feel that they can rely on family and friends to advocate for them informally, as they might in the case of other illnesses or in legal proceedings, because not trusting them is part of their illness. That is why the role of an independent advocate who can only have their interests at heart is essential, and why we really must get on with it.

I agree entirely, but of course the corollary to that is that occasionally, someone who has been sectioned has every right to distrust their family. There might be a family dispute going on. Too often, people come to us to ask us to intervene, saying that someone is mentally unwell, when nothing of the sort is true. There might be a wider dispute, and the family has sadly taken the ultimate step of saying that the person in question is not of sound mind. They want to get the authorities to intervene so that a course of action takes place that will help them to argue their case.

I have read the Mind briefing on the matter, which is very useful. It asks when the change will occur and whether it will genuinely happen this April. It asks how the change will be funded, who will be trained to do it and which organisations will have the means to undertake advocacy, which are all genuine questions. I support completely what the hon. Member for Broxbourne said, and I hope that as the Minister has a little longer than usual available to him, he can go into some depth in answering those questions.

I wish to dwell on two matters that concern me. First, I would like to think that some of the advocacy could be undertaken by people who have themselves suffered from mental health problems. I never cease to be amazed by the way in which those who have recovered from such problems are the best at knowing about the service, its strengths and weaknesses and, if you like, where the bodies are buried. For all sorts of reasons, the matter has to be handled incredibly sensitively, but I hope that when we hand out the commission for the work that is to be undertaken, there is a genuine effort to use people who have had mental health problems and are prepared to use their expertise to advocate on behalf of those who are currently going through such problems. That can be incredibly powerful. It has to be done carefully, but I would like to think that it will be considered closely.

Secondly, we have to be careful because we can get into something of a minefield. There are those who not only have mental health problems but are dependent on drugs and alcohol. We therefore need to recognise that the advocate’s role involves a range of skills. We must take account, too, of those who also have learning disabilities. The role of the advocate may be not only to undertake advocacy in language that professionals understand, but to work backwards from the professionals to the person who has been taken under mental health supervision. Perhaps that person has no language capability and finds the process alien to their whole being. In my constituency, many caring people are trying to work with those who do not have language understanding but who may not have mental health problems.

We know that there is an association between extreme learning difficulties and mental health problems, especially in later life. Those with severe learning difficulties can develop mental health problems, and it is vital to have advocates who can genuinely interpret and translate for and work with the sometimes difficult cases of people who do not understand what is happening to them, and why what is happening is anything other than cruel. I appreciate that it is difficult to talk about such matters and that I am considering an extreme, but unless we raise these issues and recognise the problem, there is a danger that advocates will not come forward. The job is skilled and will be difficult, and I hope that we find enough of the right people to do it. The last thing we want is for those people to be overused and drop out quickly because of the pressure. I hope that the Minister has some good things to say about that. I appreciate being able to make a short contribution.

I congratulate the hon. Member for Broxbourne (Mr. Walker) on securing the debate and thank him for raising an important issue. I am delighted that my hon. Friend the Member for Stroud (Mr. Drew) and the hon. Member for East Worthing and Shoreham (Tim Loughton) took advantage of our slightly extended time as a result of the main business finishing early to share their commitment, concerns and passion about getting the matter right. Hon. Members clearly have knowledge and experience—they served on the Committee that considered the Mental Health Act 2007, and some can bring family experience to bring to bear, too.

The remarks of the hon. Member for Broxbourne reflect a key concern, not only in mental health, on which I shall focus, but throughout the health service: how we ensure that everybody, regardless of background or circumstances, gets the best possible treatment and care. My hon. Friend the Member for Stroud mentioned diversity—I shall say more about the impact on black and minority ethnic groups shortly. It is important to convey a strong message, as we did with Lord Darzi’s next stage review, that we put the patient and patients’ needs at the heart of the health service. That is the key to improving the quality of care.

The hon. Member for Broxbourne is right that, for the most vulnerable members of our community—patients suffering from mental health problems—advocacy is one way of helping to ensure that the patient and patients’ needs are at the heart of the health service and to drive forward quality of care.

Giving patients a voice through advocacy or in other ways is about more than simply improving services, although it will have that effect. As my hon. Friend the Member for Stroud hinted, advocacy is about helping preserve a person’s dignity and self-respect, as well as protecting their legal and human rights, and that was considered when the Mental Health Bill was debated in Parliament.

The debate is a great opportunity to spell out what the Government are doing about improving advocacy services. I hope that I will respond to all the concerns that have been raised. Before I go into detail, it might be useful to put the matter in context and describe how far mental health services have travelled in recent years. That shows why it is so crucial to get advocacy right.

I hope that hon. Members of all parties recognise that mental health services have improved significantly in the past decade. The national service framework—supported, I am pleased to say, by some sustained increases in investment—has transformed the scale and scope of mental health services in this country. There are now 740 new mental health teams in the community, offering people reassurance and effective treatment at home. There are also some very good early intervention programmes for those experiencing a first episode of psychosis, ensuring that people receive the help that they need.

I was intrigued to hear about the example from the United States that the hon. Member for Broxbourne mentioned. We should look not just to these shores for examples of good practice to spread, but throughout the world, where we see good practice, particularly in preventing people from entering forms of care that might be restrictive. The more that we can do that, the better.

My hon. Friend the Member for Stroud mentioned people with drug or alcohol issues. There is a need not only for outreach services that reach out assertively to people in the community who have other problems, but to see how we can make that connection with mental health services as well.

I am pleased to say that the work that we have done to date—clearly we want to do more—won international acknowledgement in the World Health Organisation’s recent mental health report, which rated services in this country as among the best in Europe. That is quite a turnaround from where we were in the 1980s, with a patchy, Swiss cheese model of mental health services, if I can put it that way, with inadequate and underfunded provision hiding under the cloak of care in the community, which the hon. Member for Broxbourne mentioned earlier. Now, we see an increasingly confident, assertive and innovative sector.

If the last decade has been about putting mental health on the road to recovery, by rebuilding capacity and encouraging diversity, we must respond in the next decade to new challenges. The biggest challenge of all is to ensure that some of the most vulnerable people in our community receive the care and dignity that they deserve. As I have already said, advocacy is key to that.

The hon. Gentleman will know this, but I want to remind the House that mental health advocates have supported patients in many mental health services for a number of years, helping to involve them in decisions about their care and treatment. That may include explaining why people have been detained under the Mental Health Act 2007 and what that means, helping them to communicate their views to medical staff or giving them support as they prepare for tribunals, for example.

Clearly, that is an important part of our duty of care and of upholding patient well-being. That is why we want to ensure that more mental health patients can benefit from mental health advocates. The Mental Health Act therefore seeks to improve and standardise existing arrangements, by introducing new independent mental health advocates, or IMHAs as they are known in the jargon. Such advocates must be available for all qualifying patients.

Let me pick up the point that my hon. Friend the Member for Stroud made about the independence of advocates, which is a central part of the design of the service. Hon. Members who scrutinised the 2007 Act will know that that independence is an important part of the role of advocates. Advocates will help individuals to understand and exercise their legal rights and will represent their views and interests in decisions about their medical care and treatment.

Independent advocates will be available to help most detained patients, as well as patients on supervised community treatment or in guardianship. Other patients whose treatment is subject to the special safeguards provided by the 2007 Act, which the hon. Member for East Worthing and Shoreham mentioned, will also be eligible. We estimate that just over 40,000 patients a year will be able to benefit from support from advocates.

Hon. Members have expressed concern about the delay in implementing the measures. The statutory provision for independent advocates comes into force in England from 1 April, as the hon. Member for Broxbourne rightly said. He asked why it had taken so long. My hon. Friend the Member for Stroud summed up the dilemma quite nicely. We want to get on with it and make things happen, but also ensure that we get it right. They say, “Marry in haste, repent at leisure,” and I am afraid the same is true of the more prosaic act of our implementing legislation.

We wanted to ensure that the introduction of the new advocacy service went smoothly, which has meant developing appropriate local commissioning processes and putting training arrangements in place, about which I shall say a bit more in a moment. I want to assure hon. Members that I am as anxious as they are for the measures to be enacted, but we want to get them right, too.

I hope that the Minister will forgive me if I do not quite recognise the rosy picture that he paints of mental health services, not least because of the reduced funding, proportionately, that mental health services get as part of the NHS. I want to bring him to the subject of community treatment orders. He will know how contentious CTOs were during the passage of the Bill. From the initial draft Bill, through the further draft Bill and the pre-legislative scrutiny Committee, CTOs were always contentious. They have now come into force. One of the reasons that their opponents were prepared to accept the watered-down version of CTOs—objectionable though they were, in many respects—was the safeguard that would be provided by the advocacy service, for which many of us petitioned for many years. The CTOs and the advocacy service were supposed to start at the same time. Why has that not happened? Why have CTOs gone ahead without that safeguard? The Minister cannot say that he has not had any warning about this, because the Mental Health Bill was many years in the making, and advocacy was always something that many people wanted.

I had better not get drawn into a debate about which party has given more funding to the NHS to support services of this kind. I think that the hon. Gentleman will probably find that he has voted against supporting more funding for the NHS. But let us not sour the debate by talking about which party has trebled the funding for the NHS from £30 billion to £100 billion a year over the past 10 years.

I had reached the point about why we had delayed implementation. In fact, the Act says that advocacy will not be available in law until 1 April, so we are working within the time scale of that legislation. These matters were debated by the House. As I said earlier, we wanted to ensure that we got this right. We wanted to get the commissioning framework right, as well as the recruitment—about which I shall say a bit more in a moment—and the training. Making these decisions and getting these things right was central, and hon. Members who have contributed to the debate might, like me, not be happy with the delay, but they will none the less recognise that getting these things right is more important than implementing the measures in haste and getting them wrong.

Getting the commissioning framework right was important. We wanted to develop a commissioning process that offered maximum flexibility so that local needs could be met. That maximum flexibility addresses some of the concerns that the hon. Member for Broxbourne raised about the ability of local and small organisations, as well as larger ones, to bid for contracts. In my former role as Minister with responsibility for the third sector, I ensured that the commissioning process across a whole range of aspects of Government policy provided such local organisations with a level playing field when bidding for contracts.

A challenge for all organisations bidding to provide these services will be ensuring that they deliver a consistent, high-quality service, so that people can have confidence in the standard of advocacy wherever they live and whatever organisation is providing the service. During 2007, we consulted widely, including with third sector organisations, on the best commissioning arrangements for delivering the new duty. Last month, I reached the conclusion that primary care trusts were best placed to commission those independent advocacy services. That will have a number of advantages. PCTs can commission jointly with other PCTs, or they can delegate commissioning responsibilities to them. That will provide a powerful degree of flexibility, which will be particularly important when patients are moving between treatment providers in different areas.

The system might also include advocacy services in partnership arrangements with local authorities, which would be useful, given local authorities’ experience in commissioning other types of advocacy. PCTs already commission other specialist mental health services. Many have already commissioned non-statutory advocacy services for patients, for example. Given that the main users of independent advocates will be those receiving in-patient care, PCTs will be best placed to know what services are needed in their areas.

I should like to draw attention to the guidance for commissioners that we published on independent mental health advocacy, as it addresses a number of the concerns that the hon. Member for Broxbourne raised. It also contains details on diversity, which I shall return to in a moment. First, however, I want to turn to funding—without getting into the territory that I mentioned earlier. We have taken into account the new statutory duty when setting PCT allocations for the next two years, so I can tell the hon. Gentleman that there is money in the system to support these measures, and we will expect PCTs to fulfil the duty effectively. Of course, different areas have different needs, and it will be for PCTs and their local partners to decide how best to use their resources to meet their statutory duty, but we want to give them plenty of support to help them exercise it.

At the end of last year, the National Institute for Mental Health in England published comprehensive guidance for PCTs. It discusses good practice and sets out recommended processes for commissioning. I have also asked the institute to work with commissioners and with mental health services and advocacy providers to provide ad hoc support and information for those engaged in introducing the new service.

What the hon. Member for Broxbourne said has given me a chance to make the point that independent mental health advocacy is not a replacement for anything, but a wholly new statutory service for a very specific purpose. It is there to provide extra assistance to people subject to compulsory measures under the Mental Health Act 2007. We have been very clear that independent advocates do not replace non-statutory mental health advocacy services. That is why we provided additional funding for PCTs. Advocacy provision is already available on a non-statutory basis, as we discussed earlier, from a number of agencies, and we expect those arrangements to continue.

It is important to get the right people acting as independent advocates, as my hon. Friend the Member for Stroud argued. They must be well trained, genuinely independent and suitably vetted. I remind the House that we have published new standards in regulations that make it clear what qualities we expect of independent health advocates. Training and recruitment are crucial to the success of the programme, as I am sure the hon. Member for Broxbourne would agree. We laid regulations that set minimum appointment requirements and set out who would be responsible for checking that independent advocates met the requirements.

Assuming that any individual—my hon. Friend the Member for Stroud made the particular suggestion that previous service users become advocates—meets the requirements, there should be no barrier to their appointment, but they really must meet the requirements set down in the legislation. Under the regulations, advocates must have appropriate experience or training for the role, and the Department website gives advice on what that involves. I hope that deals with the concern raised about a trainee carrying on when someone has been appointed; the people appointed must have appropriate experience or training for the role. We did not want to be too prescriptive, however; we wanted to be flexible about the experience and qualifications necessary, because we wanted to leave as much discretion as possible to those making the appointments.

My Department is also working with City & Guilds to develop a national advocacy qualification, which will include a specialist module for independent mental health advocates. I anticipate that this qualification and its training materials will be available before independent advocates take up their positions on 1 April, and I expect all of them to complete their training within a year of starting practice. Alongside that, the National Institute for Mental Health in England is producing an effective practice guide, including issues such as patient engagement and working with other mental health professionals.

In deciding whether a person has appropriate experience and training to overcome the concerns raised by the hon. Member for Broxbourne, the person or organisation appointing the advocate should particularly consider whether they have previous experience of working in advocacy, particularly mental health advocacy, or of working with people with mental health needs and whether they have successfully completed an advocacy qualification, such as the one I described a few moments ago.

The hon. Member for Broxbourne and others raised concerns about the diversity of the groups that will need to use independent advocacy. I certainly recognise, and the guidance clearly spells it out, that the design of local mental health advocacy services can impact on access to the service by those qualified to receive it who have very different needs. Accordingly, regulations require commissioners in making arrangements for these services to have regard to the diverse circumstances and needs, including—and, I have to say, not limited to—the ethnic, cultural and demographic needs of qualifying patients.

The commissioning guidance that I referred to earlier offers advice to PCTs on how their independent mental health advocacy services might best meet the diverse needs of patients. That specific question about diversity is also discussed in the training module. We will need to monitor the legislation carefully, and the hon. Gentleman is right to suggest that we need to monitor matters carefully. We know that in some circumstances, people from some black and minority ethnic groups have been more likely to be subject to compulsion in their care. The reasons for this are complex and, as he knows, not fully understood. That is why we have put in place and have been funding “Delivering Race Equality”, which is a comprehensive action plan to help tackle the problems that BME communities can experience in mental health services. I am pleased to say that it is generating an unprecedented amount of work and research on how services can be improved, but there clearly is more that we need to be doing.

To sum up—I have taken more time than I would normally take—mental health is at an important crossroads. As the national service framework draws to an end, we can look back on 10 years of rising investment, capacity and innovation, but we need to look forward to an even brighter future for mental health services. The “New Horizons” programme, led by my Department, will help us to chart a new way forward and a new vision for mental health, building on the old framework and incorporating good examples from other parts of the world. I am clear that that new way forward means putting patients first in everything that we do. Frankly, investment in mental health services will count for nothing unless it protects the patient and improves their experience of care.

That has to be our singular purpose, and advocacy can really help us to deliver on that promise. We need to unlock the full benefits of the progress that we have made in the past decade for patients, which is why implementing this new duty is a huge priority for me and the Department. It is why we have taken such pains to prepare the ground thoroughly, and why I am confident that the new measures will, from April, make a real and lasting difference to people’s lives—something that I know that I and other Members of the House desperately want to see.

Question put and agreed to.

House adjourned.