Mental Health Bill [ Lords ] (Second sitting)

Stephen Kinnock Excerpts

Committee stage
Tuesday 10th June 2025 Public Bill Committees

[The Chair]

I remind the Committee that with this we are discussing the following:

Amendment 51, in clause 4, page 4, line 41, at end insert—

“(iv) accommodation and relocation, and”.

This amendment ensures that the impact of accommodation and relocation is considered in care and treatment reviews for patients with autism or learning disabilities.

Amendment 2, in clause 4, page 5, line 23, at end insert—

“(v) the patient,

(vi) the patient’s nominated person, and

(vii) the patient’s independent mental health advocate.”

This amendment would ensure that nominated persons and independent mental health advocates receive copy of a care, education, and treatment review meeting report for children and young people with autism or a learning disability.

Amendment 3, in clause 4, page 5, line 31, for “12” substitute “six”.

This amendment would shorten the length between care and treatment reviews from 12 months to six months.

Amendment 4, in clause 4, page 7, line 6, at end insert—

“(iii) housing, and”.

This amendment ensures that housing needs are considered as part of care and treatment review meetings.

Amendment 5, in clause 4, page 7, line 32, at end insert—

“(v) the patient,

(vi) the patient’s nominated person, and

(vii) the patient’s independent mental health advocate.”

This amendment ensures that nominated persons and independent mental health advocates receive a copy of a care and treatment review meeting report.

Amendment 6, in clause 4, page 7, line 40, for “12” substitute “six”.

This amendment would shorten the length between care and treatment reviews from 12 months to six months.

Amendment 7, in clause 4, page 8, line 12, leave out “must have regard to” and insert

“have a duty to carry out”.

This amendment ensures that integrated care boards and local authorities responsible for a patient's treatment and care have a duty to implement recommendations arising from a care and treatment review.

[The Minister for Care (Stephen Kinnock)]

It is a pleasure to serve under your chairship, Ms Furniss.

I thank the hon. Members for Winchester and for Guildford for tabling this group of amendments. I will address each in turn, beginning with amendments 1, 4 and 51. We recognise that a lack of appropriate housing can be a barrier to discharge for some patients. That is why we have put the important reviews on a statutory footing. I am pleased to provide an assurance that the Bill already makes provision for any relevant recommendation about a patient’s discharge, including meeting their housing needs.

Statutory guidance will assist the responsible commissioner to determine who to involve in review meetings. That will include guidance on when the involvement of partners such as housing departments and organisations may be appropriate. Placing a specific requirement to consider the housing needs of every patient would mean that housing would have to be considered in every case, even if it is not a relevant issue. Potentially, that could divert focus from factors more relevant to the patient’s care and treatment.

On amendments 2 and 5, the Bill makes it clear that a copy of the review report must be provided to those who have a legal duty to have regard to the review recommendations, so that any recommendations are implemented as appropriate. The patient should receive the report, in line with good practice. However, we are concerned that requiring a longer list of people to receive the report in every case might increase the chance of patients withdrawing their consent for a review to be held, especially if they do not wish for those people to see the report. We recognise that it is often appropriate for the report to be provided to other people, such as those listed in the amendments, but the Bill was amended in the other place to make it clear that a copy of the report may be provided to other persons not listed in the legislation, with the patient’s consent.

Amendments 3 and 6 are unnecessary. The current drafting provides that review meetings take place at least once every 12 months. That is in addition to the requirement that arrangements must be made for an initial review meeting to take place within 14 days of admission for children and for some people aged 18 and over, and within 28 days for other adults. We also know that more frequent reviews may not be appropriate for all patients. For example, for a patient who is unable to be discharged for a long time, reviews that focus on discharge may be rather distressing.

Commissioners should use their judgment to determine whether the individual needs of a patient might mean that a more frequent review is appropriate. NHS England policy makes it clear that patients, their families and advocates can request a review meeting at any point. Statutory guidance will provide commissioners with further information on factors to consider when determining whether more frequent reviews should take place. For example, current practice, in line with NHS England policy, is that children under 18 should have a review meeting at least every three months—that will be made clear in the guidance. We consider it preferable to set out that information in statutory guidance, which can provide detailed case studies and be readily updated in line with emerging best practice, including on frequency and considering particular circumstances.

[Dr Luke Evans (Hinckley and Bosworth) (Con)]

The Minister makes a fair point about best practice. However, did the Government consider any mechanism for how best to share best practice across areas? Especially as the Bill also covers Wales, as heard this morning, it might be useful—across the integrated care boards—to understand the Government’s thinking on how to ensure that best practice in exemplar places, where care is really good, can be shared to help places where care might not be so good.

[Stephen Kinnock]

The shadow Minister is right, and one of the overarching objectives of this Government is to take the best of the NHS to the rest of the NHS. We are very keen to ensure that we identify best practice right across the board in all the services that we provide, and that it is then replicated and scaled up. We also recognise, though, that every community and area of the country is different, so it is not about exporting and importing best practice. It is more about looking at those exemplars and asking, “How could we use some of this, without reinventing the wheel?” That is absolutely the culture of how we want our health service to run—I think it is a cultural point.

[Dr Evans]

The Minister makes a good point about the differences in the country, one of which is how the Care Quality Commission looks at the standards. Especially as the CQC is under new leadership, will it be taking a role in looking at how best practice is implemented while ensuring standards?

[Stephen Kinnock]

The CQC has a key inspection role, which is an important check and balance in the system. I would rather see the incremental building of a culture of excellence across the board, including within upstream institutions, ICBs, local authorities, healthcare professionals, mental health professionals and social workers. We need to create a collaborative approach across the board so that best practice is developed within a culture of excellence. One would hope that the CQC, when it does its inspections, is then finding positive results. Of course, it also plays an important role in identifying, investigating and holding to account when things are not going as they should.

Finally, I will address amendment 7. The Bill requires named persons and bodies to have regard to the review recommendations. This is a well-established duty that clinicians, integrated care boards and other public bodies are used to applying and already exists within the Act. Where effective care and treatment is the central aim, we expect careful consideration of all recommendations. Where these bodies decide not to accept a relevant recommendation, we expect them to have a very good reason.

It is inappropriate to place an absolute duty on a body to follow recommendations in every case, as flexibility is required to depart from a recommendation where appropriate, for example if a recommendation is outside the body’s purview or not in the patient’s best interests. As currently drafted, the Bill already requires that certain named persons or bodies carefully consider the recommendations and give them appropriate weight. Where a body does not consider a recommendation appropriately, that may be subject to review by the courts. In the light of all this, I therefore thank the Liberal Democrats—

[Dr Evans]

The Minister is right about the absolute nature of the Liberal Democrat amendment, but we talked about the duty to respond requiring a body to set out why it has decided to take action or not. The Minister seemed to allude to that, but he then jumped to talking about being challenged in court. Is there a hybrid version within that duty to respond so that it could stipulate the setting out of why the body is accepting the recommendations or not, because that may well help transparency?

[Stephen Kinnock]

I see where the shadow Minister and the amendments are coming from, but there is a risk of over-embroidering the Bill if we try to load additional duties on to something that we believe is already happening. It is a very well-established duty that clinicians, integrated care boards and other public bodies are used to applying, and this already exists within the Act. I think there is an element here of “If it ain’t broke, don’t fix it.”

If there is compelling evidence that it is not working, clearly we need to intervene as a system, which is about real leadership at the ICB level. As things stand, we feel that this amendment is surplus to requirements for the reasons I have set out. I thank the hon. Members for Winchester and for Guildford for this exchange of views, and I hope that they are content to withdraw amendment 1.

[Dr Danny Chambers (Winchester) (LD)]

It is an honour to serve under your chairpersonship, Ms Furniss. I know that the hon. Member for Farnham and Bordon will have spent his lunch time anticipating the responses to his long series of questions. The tension is palpable— I hope he is excited to hear our replies.

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[Gregory Stafford]

My hon. Friend is right; although a number of the Liberal Democrats are entirely worthy, there are some concerns about the drafting, which could give rise to ambiguity, legal loopholes and definitional issues. In that example, I do not think that “seek to ensure” is helpful. When the hon. Member for Winchester is summing up, perhaps he might explain how “seek to ensure” can be robustly defined within the law, or if it cannot be, suggest a different form of wording that he may wish to use in a future amendment if this amendment fails to be agreed.

Part II of the Mental Health Act 1983 covers the powers to detain individuals for assessment and treatment. Detention can clearly be traumatic, especially for children and young people. Amendment 9 reflects a growing consensus that detention should be the last resort— I think hon. Members on both sides of the House agree with that—and that community-based preventive and therapeutic alternatives should be prioritised. Again, I think it would be very hard to disagree with that ambition.

On the positive side, community-based care is clearly better than detention in most cases, and, if we can get to a point where people are assessed earlier, as is the intention of some of the other amendments, clearly—hopefully—that would lead to community-based care and not detention. The amendment would also protect children’s rights and support the trauma-informed approaches to mental health that were raised previously regarding amendment 47.

The amendment could also reduce the long-term harm associated with institutionalisation and potentially coercive treatment. As we have heard from Members on both sides, that would align with best practice in child and adolescent mental health services and it would promote and encourage a system of accountability by making ICBs and local authorities responsible for proactive care planning. All of that is extraordinarily laudable.

On the potential downsides, there is an ambiguity about the enforcement of the amendment, as my hon. Friend the Member for Solihull West and Shirley said, because of the lack of legal force or clarity in some of the phraseology. There would be also resource implications and, if there are resource limitations at the ICB or local authority level, that might hinder their ability to provide adequate, community-based alternatives.

I do not say that as an excuse for not supporting the amendment, but the hon. Member for Winchester has to understand the reality of the world we live in. Although I want local authorities and ICBs in every area to be entirely fully funded and resourced—and frankly, I do not think the Government’s cut of 50%, or indeed more in some ICBs, will do anything to help community-based care—there would be resource challenges. There would also be implementation challenges in areas where mental health services are already underfunded or overstretched that could lead to delays in care.

This is the key question that I ask the hon. Member to respond to in his summing up. Members on both sides of the House want to ensure that all people of all ages get the best, most appropriate mental health care as early as possible. But in an imperfect world, if there are potential delays in care because community services are struggling to find alternatives to detention, the unintended consequence could be that someone may not be treated at all because of the onus on defined community-based care rather than detention. Will the hon. Member explain how that would work?

I draw my remarks to a close by saying I, certainly, and the Opposition, entirely agree with the ambitions of the amendments. However, some practical and legal issues would need to be ironed out before I could wholeheartedly support them.

[Stephen Kinnock]

Again, I thank the hon. Member for Winchester for his amendments. I understand the intent behind amendments 8 and 9, but the clauses on registers and the associated duties on integrated care boards and local authorities are specifically aimed at people with a learning disability and autistic people, because of the detrimental outcomes that these groups of people may suffer when detained.

We recognise the concern around the treatment of children and young people, which is why we have several provisions in the Bill aimed at improving their care. However, dynamic support registers are particularly tailored to the needs of people with a learning disability and autistic people, and have been established in NHS England’s policy for some time. We do not have evidence that they would be an appropriate mechanism for wider cohorts.

We do recognise that bereavement, miscarriage, the experience of trauma and difficult life transitions can all have a bearing on mental health. However, access to mental health support is based on clinical need, not on the circumstances that might give rise to that need.

[Dr Evans]

The Minister is right about the registers, but I did notice that the Children’s Wellbeing and Schools Bill introduced the unique identifier number. That came about after the Lord Laming report into Victoria Climbié, who was “lost in the system.” It also builds on the work of the Children’s Commissioner, which found that around 10,000 children are not in school. Is there a role for getting some of the identifiers that we are looking at here in place along with that unique identifier number?

Equally, how does that unique identifier input into the Bill’s provisions on risk registers, now that that piece of legislation has passed Third Reading? There will be an interaction, but the unique identifier is much broader and the dynamic support register is held slightly differently. What work have the Government done to ensure that there is bridging and understanding about what that would look like, not only in the short term but in the long term?

[Stephen Kinnock]

The dynamic support register is specifically focused on people, both children and adults, who have learning disabilities and people who are autistic. I think it is quite a separate thing. I am not familiar with the detail of that education legislation but, as the hon. Gentleman says, it is a very broad identifier not based at all on the clinical conditions of the persons, as I understand it, whereas this is very focused and specific for people with the conditions that we are debating. I do not think that there would be a connection between the two.

[Dr Evans]

Let me take the example of a young person with deteriorating or fluctuating problems. They may be in school or out of school. We know that people with autism and learning disabilities are at greater risk of abuse and of being taken advantage of. If the Minister is not aware of it, would he look at how this duality could work, because clearly there is scope?

One benefit that the Government argued for in having this unique number was that it could be shared across these registers. It sounds as if there is work that could be done. The Minister is absolutely right, and I am not suggesting merging the two, but on the risk register, there could be a nice piece of crossover work to pull that all together, so that the information moves across agencies. What we know from people with severe learning disabilities, autism and mental health issues is that they are often in contact with multiple agencies at multiple times—from social services to, potentially, the police, the NHS, dentistry and, of course, educational settings, which might be multiplicitous. Is that a consideration that the Minister will take forward?

[Stephen Kinnock]

The hon. Member makes an interesting point. I am certainly happy to discuss that with officials, just as long as everybody is clear that there are two very different things going on here, with different types of risk and therefore different agencies. But I am all in favour of joined-up government wherever we can deliver it.

I turn now to amendment 47. It is important that robust measures are in place to support people with a learning disability and autistic people who are at risk of admission. That is why the Bill will, for the first time, put dynamic support registers on a statutory footing and, via regulations, set out the factors that the Secretary of State considers increase the probability of someone being detained. That is the most appropriate approach in order to provide sufficient flexibility for updates in line with emerging best practice, evidence and clinical and commissioner understanding.

As the factors are likely to be updated regularly, returning them to Parliament at every such instance would be disproportionate and unmanageable. Additionally, although putting them in primary legislation would not prevent the Secretary of State from providing and updating a longer list in regulations, having some factors but not others in the Bill could be perceived to give them primacy—for example, having a history of in-patient admissions or presenting in A&E in crisis. That could have unintended consequences and divert support from those most at risk.

We will of course engage with expert stakeholders, who are best placed to advise on what the list of risk factors for detention should be, taking into account the existing NHS England policy on dynamic support registers. I am pleased to provide assurance to the Committee that current NHS England policy provides examples of factors such as those in the amendment—for example, having no fixed address, having drug and alcohol addiction and having had significant life events such as bereavement and abuse. For those reasons, I hope the hon. Member for Winchester will not press his amendments.

[Dr Chambers]

I know how much the hon. Member for Farnham and Bordon enjoys speaking in Bill Committees—we were on the Tobacco and Vapes Bill Committee together a few months ago—and I am really pleased that our amendments have given so much material for discussion. I really appreciate the input from Members on both sides of the Committee; it has been really insightful, useful and constructive.

It has been rightly pointed out that the current state of local authorities—their funding and their capacity—means that they might not be able to deliver the more holistic care we are pushing for in the amendments, but I do not think that the Mental Health Bill should be limited by the current state of local services and funding. If that is the underlying problem, that is what should be addressed, not the measures in the Bill.

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[Aphra Brandreth]

I rise to make a few remarks on new clause 11, which would require 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 II of the 1983 Act.

We need to ensure that there is a fully cost-effective plan with accountability to support those with learning disabilities. For instance, Cheshire West and Chester council, one of the local authorities in my constituency of Chester South and Eddisbury, has let down parents, families and those with learning difficulties because of its poor management. It has come at the cost of adequate provision, particularly in school places, and therefore puts more people at risk of mental health problems because they are not getting the support they need in the community.

With the measures outlined in new clause 11, we could go a long way to ensuring accountability. I am sure the Minister will agree that we need to ensure that commitments are backed by funding for the good of those who need SEND support. I urge all those on the Committee to reflect on the value of the new clause. Crucially, it would also require the costed plan to be informed by a consultation with a range of stakeholders. That is incredibly important, because we need to listen to the lived experience of those who are often extremely vulnerable to ensure that they receive the right support. In my intervention, I referred to some of the important groups in my constituency. Down Syndrome Cheshire and the Cheshire West and Chester SEND Accountability group are just two examples, but there are so many more. They are clear that they value being listened to, so that they can inform the process.

The new clause would ensure a costed plan, where commitments are not just words, but backed by funding. Crucially, it would mandate a formal consultation process to inform the plan, incorporating the view of a broad range of stakeholders, including those with lived experience such as those I mentioned in my constituency. There are individuals, carers, healthcare providers and advocacy groups whose voices all matter. We need a plan that is costed so it can be delivered, and that, crucially, reflects the needs and rights of those most affected. I fully support the new clause.

[Stephen Kinnock]

I thank hon. Members for this set of amendments, which draw attention to the important matter of implementation and community support for people with a learning disability and autistic people. I heard this issue raised many times on Second Reading.

I will begin with amendment 20. I am grateful that this important issue has been raised. Although he has not been appointed to the Committee, I know that the hon. Member for St Neots and Mid Cambridgeshire has spoken powerfully and movingly about the tragic circumstances surrounding the death of Declan Morrison, his constituent, and the need to ensure effective and timely community-based support.

Proposed new section 125E of the Mental Health Act, provided within the Bill, already requires integrated care boards and local authorities to seek to ensure that the needs of autistic people and people with a learning disability can be met without detaining them. That should be driven by the specific needs of the local population, informed by the dynamic support register. That requirement already covers any relevant needs for crisis accommodation. We expect, and will set out in statutory guidance on dynamic support registers, that they will cover any relevant needs for crisis accommodation.

In contrast, the amendment seeks to place a prescriptive legal requirement to ensure provision of a specific service in all circumstances, irrespective of what people in the area actually need. That would have the unintended effect of restricting integrated care boards in designing provision and allocating resources in the most effective way to meet people’s needs.

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[Anna Dixon]

I thank the Minister for setting out so clearly the importance of the annual ministerial statement. Does he envisage that the statement will also give an update on the extent of community provision available and the execution of the transition of people with learning disabilities and autism from institutional settings to community settings closer to home? Is that within scope of the statement?

[Stephen Kinnock]

I think the short answer to my hon. Friend’s question is yes. The written ministerial statement will be an update on the work done over the preceding 12 months, but it absolutely will also be a forward plan, so it will set out the next actions that the Government will take, what the broader, long-term change delivery process will be, the institutions that will need to change and how they will change.

A number of colleagues have also asked the question, “What does good look like?” In many ways, it is absolutely right that we, as a Government, are being held to account on the content of the Bill, but there will be a really important accountability moment 12 months after it gets Royal Assent, which will be that written ministerial statement. I fully expect every colleague in this room to read that in great detail and hold the Government to account, both on what has been achieved over the preceding 12 months and, importantly, on what the forward plan looks like.

I think that covers most of what I wanted to say, although one additional point I would make is that the amendments could have the unintended consequence of requiring Government and local areas to set out unfunded or speculative plans ahead of any funding settlements, which would affect their credibility. It is more effective to set out plans when they are ready, when we have a clear line of sight on funding and deliverability.

We also need time to engage with expert stakeholders to inform implementation planning. We know that sufficient community services cannot be achieved without wider system reforms beyond health, and details contained in any plan must also consider the context of the 10-year health plan and the independent commission into adult social care, chaired by Baroness Casey. For that reason, I thank hon. Members for their contributions and invite them to withdraw amendment 20 and not to press amendments 24, 10, 22, 21 and new clause 11.

[Dr Chambers]

I thank everyone for all their insights into our amendments; they were very useful and constructive. I will address a couple of them briefly.

First, I thank the hon. Member for Ashford; we totally agree that we want to be moving mental health care—any care, actually, but mental health care specifically—back into the community and have more community care. We are not advocating for more hospital care. There is a specific point to amendment 20: my hon. Friend the Member for St Neots and Mid Cambridgeshire, who is in the Public Gallery, had a tragic case of a constituent, which resulted from there not being enough available safe places for someone in crisis to be cared for.

A lot of our amendments have rightly been criticised for possibly being outside the scope of the Bill, because this Bill is for when people are in a mental health crisis, and a lot of our amendments are about how we can improve community care. To me, amendment 20 appears to be very in scope, because it addresses a failure of someone who was admitted for mental health care.

I thought that the insightful comments on most of our amendments from the hon. Member for Solihull West and Shirley, given his legal and medical background, were very useful, and we will take those on board. The only one that I would disagree with, and I think he might feel the same, is on amendment 20 specifically. His main criticisms of that were that it might result in variability across the nation, that there are currently staff shortages and that there could be implementation delays. I do not see any of those three reasons to be strong enough to not want to maintain crisis accommodation.

I thank the Minister for his comments and his serious consideration of all our amendments. We will press amendment 20 to a vote, but will not press any of our other amendments.

Question put, That the amendment be made.

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[Sojan Joseph]

Not at all. I am not claiming that there should not be training for people who work in any settings; I am saying that more and more training has been added every time we learn something and yet compliance with the training requirement is not being monitored. That is the point I am making—not that we do not need the training.

I support training, because appropriate training is necessary, but we also need to ensure that the people who work in those settings are compliant with the training. That is the larger point I am making. This is not about the amount of training we might want to add to this legislation; we need to ensure that existing training is completed by the staff working in those areas.

[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.

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[Gregory Stafford]

Given that we have discussed the proposed new sections in depth, I do not intend to dilate upon this clause for long. Suffice it to say that the Opposition, notwithstanding the questions asked by the shadow Minister, support the clause, which is essential to ensure the safeguards and progress that we are trying to achieve through the Bill.

Clearly, the clause is prevention-focused and helps avoid unnecessary and traumatic hospital admissions. It leads to better planning because it supports tracked admission of services tailored to individual needs. It also has an element of legal accountability, given that it makes it a legal duty for ICBs to monitor and support at-risk individuals. It is also data driven because it encourages the use of real-time data to inform care decisions.

That being said, a number of the concerns that we raised during debate on the amendments apply to the clause itself. In the Minister’s summing up, can he touch once again on the privacy concerns, as well as the resource demands and the risk of stigma? By that, I mean that being placed on a register could be seen as labelling or pathologising. How do we ensure that the register does what it is supposed to without that risk? Can he also touch on some of the vague criteria and definitional phrases, such as “at risk”, and how they might potentially lead to inconsistent application?

[Stephen Kinnock]

I am conscious that we will be voting imminently, so I will try to rattle through. Going back to my phrase “the red thread”, the thread running through all the shadow Minister’s questions is delivery. The proof of the pudding in all legislation is whether we convert it into action in a way that best delivers for the interests of the British people, and in a way that absorbs the risks, builds resilience in the system and ensures that we are constantly monitoring, evaluating, reviewing and learning from what is happening on the ground and, through a constant process, improving delivery.

The shadow Minister asks some very good questions, but the problem is that so many will relate to the work that we need to do at pace as soon as the Bill receives Royal Assent. This is a sequential process; we first need the legislation and the comprehensive spending review, so that we know our funding package. We then need to start work consulting on the code of practice, getting that feedback and shaping a plan that defines what good community services look like, because we all know that we are a million miles from having good community services at the current time. We are in a state of crisis and the system is on its knees; we are very conscious of all those facts. There is an immense urgency with all this.

The shadow Minister asked about evaluating and updating pathways and CETRs, duty to respond, the information collected, managing the risks, preventing paternalism and ensuring that people do not get labelled. All those things will have to be set out and explained in the project plan. That is something we will all be working very hard on as soon as the Bill gets Royal Assent.

One of the shadow Minister’s factual questions was on how many CETRs have been issued. I cannot give him that number, but I can tell him that, as set out in the impact assessment, 86% of in-patients received a CETR in the last year. If my answer that this is about delivery does not satisfy him and he thinks there are issues that relate directly to the Bill rather than to the implementation plan, I am happy to write to him on that.

[Dr Evans]

I appreciate what the Minister is saying. The blue threat, or blue and yellow thread, running through the debate is the question of how much needs to be in the primary legislation. The argument from the Conservative side has been that, while some of the Lib Dem amendments are too restrictive, the danger is that the freedom and flexibility at the Government’s end is too loose. I trust the Minister implicitly—but, having seen Ministers on our side come and go, there could be a change within Government or a change of colour of Government, and no Government are bound by the one that went before.

I am trying to get the balance right by asking questions around procedure to assess whether some of these things should be in the legislation. I agree that there has to be a balance. That is why the Opposition chose to say 18 months, as opposed to four months; it was to have accountability and safeguards in place and to urge good delivery, but not to curtail the ICBs or clinicians—the people delivering stuff—and make them simply check boxes.

I appreciate the Minister’s offer to write to me. I would be grateful for that data, because where we find it will be important in future debates and in his future written or oral statements. I hope he understands that these probes are to make sure that we get the balance right between primary legislation, what is going in the code of practice and what is well intentioned, but could be left to blow in the wind.

[Stephen Kinnock]

That is a valid question, and one that has probably been asked in pretty much every Bill Committee that has ever taken place. It is always a challenge to get the balance right, having the right level of steer to the system in primary legislation without tying the hands of the system. Everything is constantly evolving, particularly in the age of technology in which we live, so it would be foolish to tie our hands too tightly given the changing nature of the landscape we are working in.

My answer to the question—I say this personally and from the point of view of the Government—is that we are satisfied that we have the balance more or less right. That is in the eye of the beholder, and not everybody will agree, but we feel that clause 4 gets that balance right, and sends clear signals to the system through primary legislation. The proof of the pudding will then be in the eating, and that is for the code of practice, the regulations and the programme planning. On that basis, I commend the clause to the Committee.

Question put and agreed to.

Clause 4 accordingly ordered to stand part of the Bill.

Clause 5

Grounds for detention

[Dr Shastri-Hurst]

I beg to move amendment 52, in clause 5, page 11, leave out lines 20 to 22 and insert—

“(b) in the case of a patient who lacks capacity or competence to consent to admission for assessment (or for assessment followed by medical treatment), serious harm may be caused to the health or safety of the patient or of another person unless the patient is so detained by a constable or other authorised person, or in the case of a patient who does not lack capacity or competence to consent to admission for assessment (or for assessment followed by medical treatment) serious harm may be caused to the health or safety of another person unless the patient is so detained by a constable or other authorised person; and”

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[Stephen Kinnock]

My understanding was that we would all come back after the final vote, which was on Third Reading.

[The Lord Commissioner of His Majesty’s Treasury (Taiwo Owatemi)]

I am the only one who can move the Adjournment.

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[Gregory Stafford]

I thank my hon. Friend for his extraordinarily helpful intervention. I was not aware of the changes, and I certainly had not heard of fusion before, or about what is going on in Scotland. Of course, if the new clause had already been enacted in another part of the United Kingdom in some form, I would be much more comfortable with it. But, as I said in relation amendments 52 and 53, if the new clause is to pass in its current form in this Bill or in some future form in another Bill, there has to be a focus on proper training and guidance. Because there is potentially such a legal quagmire, we must ensure that people understand the legal framework within which they can do this.

[Stephen Kinnock]

Once again, I am grateful to the hon. Member for Solihull West and Shirley for moving the amendments and the new clause on behalf of the hon. Member for Runnymede and Weybridge.

I will first speak to amendments 52 and 53. The new detention criteria explicitly require decision makers to consider the risk of serious harm and the likelihood of harms occurring in order to justify detention. It is right that clinicians have the power to intervene when a patient is at risk of seriously harming themselves, both when they do and when do not have mental capacity.

If we were to accept the amendments and the new clause, we think that patients would be left without the protections that the Mental Health Act provides. For example, let us consider a patient with a serious eating disorder who is assessed as having capacity but is refusing treatment. If there were no longer an option to detain that patient under the Mental Health Act, that could leave clinicians and families without a route for treatment, potentially leading to tragic results.

The pre-legislative scrutiny Committee highlighted concerns about cases where the concept of capacity had been used to justify denying individuals care that they had sought voluntarily, particularly in relation to very ill and potentially suicidal patients. That goes against the spirit of the Mental Health Act and could fall short of professional standards.

Patient choice is, of course, critical, and the changes that we are making recognise that when patients have a say in their treatment, they are more likely to engage. We also think that it is right that when those decisions put people at risk of serious harm, including risk to their own life, there is a duty to intervene.

We recognise that detaining and treating patients with capacity without their consent is a very serious step to take. However, we think that it is right that we intervene when someone is a risk to themselves, not just to other people. That is in line with the Government’s commitment to delivering a cross-sector suicide prevention strategy for England. We should deprive somebody of their liberty and detain them only as a last resort. The threshold of serious harm in the new criteria reflects the gravity of that decision.

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[Dr Evans]

I am grateful to the Minister for how seriously he is taking this issue, and I agree that there is not necessarily a consensus even within the Opposition. Having the debate is therefore really important. It may be useful to collect data on the number of incidents and where these handovers are. Would the Government commit to that? We would be better able to have this debate, and to decide how much of a problem this is and to work out what the solutions are. Again, I struggle to find data that indicates where this is an issue, but I have spoken to clinicians who I know and colleagues who I have worked with when I have seen it. It happens enough that I was aware of it as a bog-standard GP who has worked in A&E, but it is clearly not rampant and we are not seeing it every single day. Would the Government commit to collecting data on it? If so, in what format would it come?

[Stephen Kinnock]

I ask the hon. Gentleman to clarify his question about data collection. Is he looking for clarity on the number of people who are judged to have mental capacity but who trigger the deprivation of liberty condition because they are seen to be either of severe risk of harm to themselves or to society?

[Dr Evans]

That would be a very useful piece of data, but I was in fact talking about new clause 24 and the grey area of hospital detentions. That data is probably easier to collect. I specifically ask the Minister to keep in mind the collection of data on those who turn up to A&E but end up having to be taken out of the hospital to be sectioned, for example. That is the nub of the issue and the practicality of what is going on. In a number of incidents, although the law is set in a way that is supposed to be helpful, the interface unfortunately becomes very difficult.

The Minister has rightly pointed out that there are different ways to deal with this. The new clause is one such potentially heavy-handed way of dealing with it. At the same time, it comes from the good place of trying to address what clinicians deal with in A&E day in, day out. However, we need some data and some teeth behind that to understand and appreciate how much of a problem it is and to then come up with a solution. I hope that clarifies my question.

[Stephen Kinnock]

That does clarify it. I will absolutely discuss that with officials. It is clear that we need a complete picture of the prevalence of people reporting to emergency departments and then having to be extracted from them and put into other facilities. That is an important point. We clearly need to think more about this issue and consult further. Obviously, understanding the data is a very important part of that. I cannot give the hon. Gentleman a nailed-on commitment to do that, but I give him a nailed-on commitment to discuss it with officials. It is possible that the data is already out there. We need to find that out.

We have heard concerns that there is a lack of clarity about what legal powers are available to health professionals to hold someone in emergency departments until they can be assessed. However, it is a complex issue that requires extreme care and caution. We have committed to continue to explore the issue. We will engage with stakeholders to understand how the current legal framework is applied, and identify solutions to the problems raised. We will provide further guidance on the existing legal framework, including the handover process from police to health, in the next revision of the code of practice. We are also taking steps to address current operational pressures. NHS operational and planning guidance for this year tasks local health systems to improve patient flow through mental health crisis pathways and to reduce waits of more than 12 hours in emergency departments.

[Anna Dixon]

Will the setting up of more health settings—places of healthcare and of safety—help to address the issue?

[Stephen Kinnock]

Yes, I think that is right. We have a commitment to creating—either building or repurposing—facilities for more acute mental health settings. We have also created the 111 mental health line. We have a commitment to 8,500 more mental health specialists. We are committed to having a mental health-trained person in every school in the country.

I hope that all those wraparound measures will help in the overall role that we play in the community, and identify people with challenges in a way that will help to support them and, one hopes, avoid them getting to the acute stage. My hon. Friend is absolutely right to point to some of the wraparound measures that the Government are pushing forward.

For the reasons that I have outlined, I ask the hon. Member for Solihull West and Shirley not to press amendments 52 and 53 and new clause 24 to a vote.

[Dr Shastri-Hurst]

I have listened carefully to the Minister, who has addressed the issue with his usual thoughtfulness. I ask that he looks into sharing that data, particularly around new clause 24, but on the basis of the reassurances that he has provided, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Ordered, That further consideration be now adjourned.—(Taiwo Owatemi.)

Mental Health Bill [ Lords ] (First sitting)

Stephen Kinnock Excerpts

Tuesday 10th June 2025 Public Bill Committees

[The Chair]

With this it will be convenient to discuss clause 2 stand part.

[The Minister for Care (Stephen Kinnock)]

It is a pleasure to serve under your chairship, Mr Vickers.

I thank the many hon. Members who spoke on Second Reading. It is clear that in this place, as in the other place, the Bill will proceed in a collaborative and constructive spirit, with the single motivation of getting the reforms right. On Second Reading, we heard numerous powerful accounts from hon. Members arising from their personal experience of supporting family, friends or constituents with a serious mental illness, a learning disability or neurodiversity, or drawing on their own experiences to underscore the importance of the need for reform. I was heartened to hear from so many Members who set out the positive impact of the changes that the Bill will introduce, particularly the vital changes to ensure that patients’ voices are heard and that—as we would expect in any modern mental health service—the patient is at the heart of all decision making.

In our manifesto, we committed to modernising the Mental Health Act 1983 to give patients greater choice, autonomy, enhanced rights and support, and to ensure that everyone is treated with dignity and respect throughout their treatment. I am proud that we included this critical Bill in our first King’s Speech, and I look forward to constructive engagement with the Committee on this important legislation.

I will also take a moment to thank the Liberal Democrat Member, the name of whose constituency escapes me, and other MPs who have shone a light on the experiences of Fiona Laskaris and other families. No one should lose a child in that way. I thank Fiona for meeting me and I commend her tireless campaign efforts. The engagement that my officials and I have had with Fiona and the hon. Member has been incredibly valuable. Unfortunately, the Bill is not the appropriate vehicle to address those concerns, but I have committed to continuing engagement with Fiona and the hon. Member to further explore those issues and how we might tackle them.

[Dr Danny Chambers (Winchester) (LD)]

I know that my hon. Friend the Member for Dorking and Horley (Chris Coghlan) has been pushing forward on that very emotive and difficult issue of capacity; he brought it up in his maiden speech and has been campaigning tirelessly on it. My hon. Friend said that the Minister was very constructive in his engagement on the issue, which we very much appreciate. Even though we cannot include it in the Bill, we look forward to working on it.

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[Stephen Kinnock]

I thank the hon. Member for that intervention, not least because it gave me the opportunity to remember the constituency of the hon. Member for Dorking and Horley—please pass my apologies to him for forgetting that important point. He has been a tireless campaigner and I believe that we can find a way forward; this Bill is just not the correct vehicle for it.

[Dr Luke Evans (Hinckley and Bosworth) (Con)]

I also want to assess the amendment that could potentially have been tabled. The Opposition were struggling to see how it would fit in, and it looks as if there is a crossover with the Mental Capacity Act 2005. Can the Minister set out why he felt that it did not quite fit into this area and how it could be taken forward, so that with cross-party work outside this Committee we can see how we can make it happen?

[Stephen Kinnock]

There were a number of technical and drafting issues. The Public Bill Office ruled that the amendment, as drafted, was out of scope. One of the key concerns was about the unintended consequences of the relationship between physical disability and mental disorder. The drafting of the amendment could have caused confusion, because it could have started to bring physical disability into the scope of the Bill, which is clearly not what it is about. There were a number of technical and drafting issues, but I do not think that they are insurmountable. We can get to where we need to be, just not through a legislative vehicle.

[Gregory Stafford (Farnham and Bordon) (Con)]

I support the comments of the Minister and the hon. Member for Winchester on the issue. On a cross-party basis, I know that my right hon. Friend the Member for Godalming and Ash (Sir Jeremy Hunt) has taken a close interest. Could he also be included in those discussions?

[Stephen Kinnock]

Yes, absolutely. We had a very constructive meeting with the right hon. Member for Godalming and Ash, along with the hon. Member for Dorking and Horley, and we are certainly open to working with that team of people, who are clearly focused on getting the results that we all want to see.

Clause 1 will make it a statutory requirement for the Secretary of State to include, in the statement of principles in the Mental Health Act code of practice, the wording of the four principles identified by the independent review. Those principles are choice and autonomy, least restriction, therapeutic benefit and the person as an individual. This will ensure that the review’s principles underpin the implementation of the Mental Health Act 1983 and are considered when making decisions related to care, support or the treatment provided to patients under the Act.

Embedding the principles in day-to-day practice will help to drive the culture change envisaged by the independent review. We are including the principles in the Act so that they govern the content of the code of practice and can changed only by Parliament. The Government are firmly supportive of the four principles, which were co-designed with service users during the independent review. They have informed every decision made in developing the Bill. We have embedded the principles in measures throughout the Bill, such as via the inclusion of therapeutic benefit in the detention criteria and several measures to improve patient choice and autonomy, including new treatment safeguards, introducing advance choice documents and the right to choose a nominated person.

I turn to clause 2. The code of practice for Wales already includes a statement of principles, although it is not a statutory requirement under section 118 of the Mental Health Act 1983 for Welsh Ministers to do so. Clause 2 will amend section 118 to extend subsection (2A) to Wales, along with the new subsection (2B) inserted by clause 1. To do so, clause 2 will also make amendments elsewhere in section 118 to clarify the application of each subsection, which will be to the Secretary of State in relation to England, to Welsh Ministers in relation to Wales, by virtue of the transfer of devolved functions, or to both.

The extent of the Mental Health Act is England and Wales, and there are separate codes of practice for England and Wales. Both codes of practice currently include a statement of principles, although the principles themselves vary slightly. Clause 2 will place a statutory requirement on Welsh Ministers to include the wording of the four principles identified by the independent review in the statement of principles when preparing the Mental Health Act code of practice for Wales.

As in clause 1, we are putting these principles explicitly in the Act so that they govern the content of the code of practice and so that they cannot be changed except by Parliament, or by the Senedd in respect of Wales. The Welsh code is already required to undergo scrutiny by Senedd Cymru, but clause 2 will also update the position in relation to the Senedd Cymru scrutiny procedure for the Welsh code. I commend clauses 1 and 2 to the Committee.

[Dr Evans]

It is a pleasure to serve under your chairmanship, Mr Vickers. I thank the Minister for his collaborative tone on some of the difficult amendments that we have discussed.

I will open where the shadow Secretary of State, my right hon. Friend the Member for Melton and Syston (Edward Argar), left us on Second Reading. As he rightly emphasised, the importance of updating the Mental Health Act cannot be overstated. I fully share his view that it was right to take the necessary time to get this legislation right. The cross-party commitment to reform in this area, spanning both previous and current Governments, reflects a shared recognition of the urgent need to modernise our approach to mental health, particularly for those who are most vulnerable.

I welcome the Bill’s focus on enhancing patients’ voice and autonomy, including through the expansion of independent advocacy and the shift away from using police and prison cells as a place of safety. Those are positive and overdue steps. At the same time, as my right hon. Friend outlined, the Opposition’s role is to engage rigorously and constructively with the details of the Bill. Over the next few weeks, I look forward to working with colleagues on the Committee to ensure that, for example, the principle of patient choice is embedded not only in policy but in practice, such as through the use of advance choice documents.

We will continue to scrutinise the Bill in good faith, proposing improvements where needed, with the aim of delivering the strongest possible protections and outcomes for patients, their families and the community. How we begin a conversation often determines whether it becomes dialogue or dispute, so I hope that the Committee can take a constructive and productive look at what lies ahead of us.

I support clause 1, which will rightly update section 118(2B) of the Mental Health Act 1983 and embed a refreshed code of practice at the very heart of the mental health framework. This is not merely a procedural amendment; it is a statement of values, placing humanity, dignity and recovery at the centre of how we treat some of the most vulnerable people in our society, who are profoundly affected by mental health legislation. It is vital that the framework guiding professionals be clear, principled and rooted in respect for individuals.

Why do we need these changes? For too long, the Mental Health Act has been criticised as outdated and insufficiently centred on patient autonomy and dignity. Concerns raised by successive independent reviews, clinicians and, crucially, by people with lived experience have pointed to inconsistencies in how decisions are made, which can often result in over-restriction, lack of patient involvement and insufficient therapeutic focus.

The independent review of the Mental Health Act, which was published in 2018, made a landmark contribution by recommending the adoption of the four core principles in front of us today: choice and autonomy, least restriction, therapeutic benefit and recognition of the person as an individual. These principles are designed to shift the culture and practice towards one that respects autonomy while safeguarding wellbeing and public safety.

The historical context is that the Mental Health Act has undergone several amendments since its introduction—notably, in 2007, updates were made to some of the detention criteria and safeguards—but it was clear that the Act remained predominantly paternalistic. The 2018 independent review was a comprehensive, evidence-based re-examination of the entire Act, informed by extensive consultation, including with patients, families and clinicians. It concluded that embedding the principles formally into the law and code of practice was essential to modernise and humanise mental health law.

The four key principles—choice and autonomy, least restriction, therapeutic benefit and the person as an individual to be treated with dignity—are not abstract ideals. They are the foundations of compassionate, lawful and effective care. They echo the spirit of the UN convention on the rights of persons with disabilities and signal a move away from paternalism and towards genuine co-production of care plans. Involvement ensures that decisions are not made about patients without them. The principle of choice and autonomy reminds us that the mental illness must not be a justification for blanket restrictions. The principle of least restriction challenges us to find community-based alternatives before defaulting to detention. Therapeutic benefit ensures that care is not custodial, but meaningful healing. These principles are what most of us would hope to see for our own family.

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Finally, we hope that the new structure will not inadvertently lead to inequality. We already see that in the wider Welsh-English NHS approach. With something as sensitive as severe mental health issues, we need to do our best to guard against that. We welcome the locally tailored codes, but we must maintain shared standards of care, dignity and human rights across the UK.

[Stephen Kinnock]

I thank the shadow Minister for his questions. I will answer to the best of my ability, but I may need to write to him on one or two points.

On enforcement and accountability, the code of practice is underpinned by the Bill and is therefore legally binding. Any divergence from the code of practice would need an extremely strong justification. That could well end up being a matter for the courts. I think that we will see a fairly strong line of sight from this primary legislation through to the code of practice and its implementation. Enforcement and accountability will be provided on that basis.

On balancing conflict, we will consult on the code of practice. Consultation will launch as soon as the Bill becomes an Act. That will be an important part of getting to the nub of some of these nuanced issues. It is quite difficult to put all that down in a document—a lot is about the culture, as the shadow Minister said—so we need an approach that has sufficient flexibility, but with clear outcomes and accountability. The consultation process will help us to get that.

[Dr Evans]

I agree with the Minister. Does the Department have a rough idea of the timetable for putting in place the code of practice? How long will the consultation need to take? When will it be implemented? How many rounds go with it? How wide is it to be—will it consult across England and Wales, or just in England?

[Stephen Kinnock]

We expect the entire process to take about a year from Royal Assent. My colleague Baroness Merron made a strong commitment from the Dispatch Box in the other place that we will present a written ministerial statement to the House every year. That will be the opportunity for us to report on the progress of all the measures that need to be implemented. A pressing task is to build the community capability required in this shift from hospital to community, which is very much part of the Bill and of our broader strategy for mental health and, indeed, health across the board. We need to report every year on that, but the first year will also be a report on the consultation and its conclusion, including the conclusion of a draft code of practice. We expect that to take approximately 12 months.

That, in some ways, has also answered the shadow Minister’s question about training and resources. A big part of the reason for the 10-year implementation period is the time that it will take to do the training and the training needs analysis, to identify trainers to deliver the training, and to get the system up to speed. That will be a fairly large chunk of the 10-year process.

[Dr Evans]

The Opposition appreciate the timescale taken to skill-up in this area, but the workforce plan is soon to be announced by the hon. Member’s Government. Has any consideration been made of what the capacity might look like, and of the crossover between having this legislation not quite in place—although likely to happen, upon Royal Assent—and its impact on updating the workforce plan on mental health?

[Stephen Kinnock]

The shadow Minister is tempting me to reveal the details of the workforce plan. While I have a huge amount of respect for this Committee, I do not think that it is where we will launch it. Absolutely, however, that is built into our thinking about the plan. There is a huge mental health challenge in our country, and those with acute and severe disorders and conditions which the Bill is designed to address are absolutely a part of that. A skilled and compassionate workforce is required, and I pay tribute to the amazing staff, mental health professionals and others who work in this area, often in incredibly challenging circumstances. We recognise and value that. The Bill does need to hook up with the workforce plan, and we are focused on that.

On Wales and the risk of divergence, the shadow Minister makes an interesting point. I guess it is about ensuring that that there is devolution, but not divergence, in the sense that we have a framework here—much of the legal framework is reserved—but the delivery of mental health services is devolved. That balance has to be right, but it is something that the two Governments have been working on since devolution started in 1998. There is a fairly mature and sophisticated culture in the interface between the two Governments. The shadow Minister is right to flag that point, and I am more than happy to seek some assurances from officials and write to him. However, as things stand, I do not see any particular risks.

[Dr Evans]

The Minister is right that there is shared working. However, part of the problem between devolved nations, such as Scotland and Wales, is that the datasets and definitions of data are often changed. Actually, the comparison of data across the UK can be quite hard to manage. Given that we are talking specifically about mental health, including some of the most at-risk people with the most severe mental health illnesses, will the Government commit to pushing for shared data that is comparable between Scotland and Wales, which we are legislating on in this case, to ensure that there is data transparency, so no one country can hide behind a different comparison or by saying, “We are looking at apples and pears”?

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[Stephen Kinnock]

It is important that we do not see devolution as a wall between the two countries; in fact, we should be sharing information and best practice—nobody has a monopoly on good ideas. The Welsh Government have achieved some things, particularly in mental health, that England could learn from, and vice versa. There is no reason why the data cannot be shared from my own practicable and pragmatic point of view. There may be some issues with data protection, but data protection law really should be implemented in the same way right across the board because it is reserved.

[Dr Evans]

I entirely agree, and I hope that data is and will be shared. The question is about the definitions and standards, such as those used for waiting times. We often use the A&E waiting time of four hours. When it comes to the most vulnerable patients who will potentially be on waiting lists, or looking at specific data, if it is categorised differently in Wales, Scotland and England, that makes it very hard to see where best practice is so that it can be shared. That is the Opposition’s concern. I know that both sides of the House have shared that concern in my five years in Parliament. Is there a mechanism to address that issue either in the Bill or in the Minister’s wider portfolio?

[Stephen Kinnock]

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

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

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

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

[Stephen Kinnock]

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

Question put and agreed to.

Clause 1 accordingly ordered to stand part of the Bill.

Clause 2 ordered to stand part of the Bill.

Clause 3

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

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[Dr Evans]

The hon. Member is correct about the way in which the world looks at this issue. The problem is that we are sat here debating definitions in legislation that is 40 years old. Will we be here in 40 years debating definitions that have moved on? The amendment suggests that, somehow, we need to try to ensure that legislation is flexible and updated enough, and has the scrutiny and safeguards in place. That relates to not just health, but any part of government that we tend to look at in the House.

I wanted to speak to the amendment to probe the Government on how they will safeguard the legislation. I do not have all the answers, but this is important. I do not want to see my successors—the hon. Member for Hinckley and Bosworth from whatever party—sat here debating this issue in 40 years’ time because the definitions that we happen to set today have become outdated and have unintended consequences.

That is the balance that I am looking for. I do not see a body across the UK, given that this is UK legislation, that fulfils this role. It could be a transitory role or fully established. A psychiatrist could take it on, or it could come under NICE. With the abolition of NHS England, it could be a new role for the Department of Health to take on. All those are viable vehicles that could potentially look into the definitions. I want to ensure that what we pass in Parliament actually translates into the real world for clinicians, patients and the public.

The Opposition can see the argument both ways, as I mentioned. Perhaps it would be useful to have an expert panel, with representatives of clinicians, legal experts and service users to support regulatory updates. I put those questions to the Minister and I look forward to his answers.

[Stephen Kinnock]

I am grateful to the hon. Member for Solihull West and Shirley for moving the amendment on behalf of the hon. Member for Runnymede and Weybridge, and to the shadow Minister for speaking to it.

As this regulation-making power would amend primary legislation, it would signify a Henry VIII power that the Government consider to be unjustified. We have significant concern that it could change the way in which the Bill applies to people with certain conditions without appropriate consultation or parliamentary scrutiny. The serious matter of detention for compulsory treatment should be considered in primary legislation.

The hon. Member for Solihull West and Shirley spoke about the need to stay in touch with our evolving understanding of these terms and conditions. My view is that the Bill does that. We have modified the meaning of mental disorder by including new definitions of autism, learning disability and psychiatric disorder. That acknowledges the advancement in our understanding of learning disabilities and autism, and how the Bill should apply in respect of those conditions. Any future change to the definitions should be a matter for Parliament, informed by strong evidence and consultation with the public.

For those reasons, I ask the hon. Member for Solihull West and Shirley to withdraw the amendment.

[Dr Shastri-Hurst]

I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Question proposed, That the clause stand part of the Bill.

[The Chair]

With this it will be convenient to discuss schedule 1.

[Stephen Kinnock]

Currently, a person with a learning disability can be detained for treatment under section 3 of the Mental Health Act when their learning disability

“is associated with abnormally aggressive or seriously irresponsible conduct”.

A person can be detained under section 3 on the basis of being autistic, which is classed as a mental disorder under the Act. However, we know that people with a learning disability and autistic people may sometimes be detained because of needs that have arisen due to insufficient community support, rather than for treatment of a mental health condition, and compulsory treatment in hospital settings is rarely likely to be helpful, particularly for autistic people.

Clause 3 and schedule 1 will insert new definitions in the Act and make amendments using those definitions throughout the Act. Those amendments will remove, for the purposes of part 2 of the Act, learning disability and autism from the conditions for which a person can be detained for compulsory treatment. It will be possible to detain someone for treatment under part 2 only if they satisfy the conditions set out in section 3, as amended by the Bill. These include that they have a “psychiatric disorder”, which is a

“mental disorder other than autism or learning disability”.

The changes will not apply to section 2 of the Act, under which a person can be detained for a maximum of 28 days for assessment to understand whether they have a psychiatric disorder that warrants detention under section 3. The revised detention criteria will not apply to part 3, so people in the criminal justice system can continue to be diverted to hospital, where appropriate, to access the specialist support they may need.

We recognise the importance of implementation in ensuring these reforms have their intended effect. For this reason, the proposed changes will be commenced only when there are strong community services in place. I commend the clause and schedule to the Committee.

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[Stephen Kinnock]

The red thread that goes through all those questions, from both my hon. Friend and the Opposition spokesman, is very much about how we are going to build a clear and strong understanding of what good community support looks like, and then build towards it so that we achieve the aims that we set out for ourselves. In many ways, that is a difficult question to answer in this Committee, because an important part of the answer will come from the consultation on the code of practice that will be launched as soon as the Bill gets Royal Assent.

The Government believe passionately in making policy on the basis of evidence, so we need that consultation and input for the code of practice. We need a clear definition based on engagement with those who are at the cutting edge of delivering these services, so that we can define the new reality that we want to work towards, and then implement it step by step.

I apologise to Committee members for the fact that in some ways that is a step beyond what we are doing here in scrutinising the Bill. We will, I hope, pass the Bill, and then it will get Royal Assent. From that day, we will be straining every sinew to get community services to where they need to be.

[Jen Craft (Thurrock) (Lab)]

I do not want to speak outside the scope of the clause, but I would very much welcome a commitment from the Minister on ensuring that people with learning disabilities and/or autism are part of the process of the consultation to produce guidance on what good community services look like, and that they are engaged with from the start in a very real and meaningful way.

[Stephen Kinnock]

Absolutely, and I pay tribute to my hon. Friend for her outstanding work in the all-party parliamentary group; I am looking forward to meeting with the APPG as soon as diary time can be organised.

There is absolutely no point in the Government making policy in an ivory tower in Westminster or Whitehall. Policy must be evidence-based and based on the real, lived experience of patients—we are very committed to building a patient-centric national health service—and practitioners. If we try to make policy without involving the voices of those people, the policy will fail; we know that from bitter experience.

[David Burton-Sampson (Southend West and Leigh) (Lab)]

It is a pleasure to serve under your chairship, Mr Vickers. I, too, have received messages from organisations in my constituency that welcome clause 3 and clause 4, which I will speak to later. On the implementation, however, they have made it very clear that it is really important to hear the voices of the individuals who will be impacted and their families. As we work with the ICBs, local authorities and commissioners to implement these new regulations, I seek an assurance that the voices of the community will be heard.

[Stephen Kinnock]

My hon. Friend is absolutely right that those voices must be heard. One example is that we must produce a code of practice to ensure that approved mental health professionals are better supported in their decision making, including when assessing whether somebody with a learning disability or an autistic person has a co-occurring mental disorder. At the heart of the process are the assessment and the definition, and the pathway that flows from that. That code of practice can be developed only on the basis of dialogue and engagement with precisely the people he has talked about.

[Dr Shastri-Hurst]

Building on the Minister’s last point, can he reassure the Committee that any consultation will have a strong focus on ensuring that practitioners have the training and, most importantly, the resources that they need to achieve a seamless transition from one set of regulations to another?

[Stephen Kinnock]

I can give the hon. Gentleman that assurance. We are moving to a nuanced position that is about defining where there are co-occurring conditions and where there are not. I think everybody recognises that that is, by definition, a complex process, so the training and the code of practice that go around it will be vital.

[Sojan Joseph (Ashford) (Lab)]

In the past, many people with mental health disorders have been detained in hospitals for months or even years because of a lack of proper social care provision in the community. Will the Minister also ensure that local communities, which will be providing social care for patients who are discharged from hospital, are part of that discussion?

[Stephen Kinnock]

It is absolutely a team effort. Sadly, when people have severe and acute mental health disorders, a multi-agency effort is often required to support them and to help them to get the treatment they need. The process should not be about trying to isolate people. We are keen to ensure that people stay in mainstream society and remain as integrated as possible, because that is often an important part of supporting their mental health condition.

All of that means that local authorities, mental health professionals, social workers, and often children’s social care professionals or adult social care professionals are important in the process—it requires a team effort. That integrated approach will be really important as we build the community services that we want to see.

[Gregory Stafford]

On the point made by the hon. Member for Ashford about local authorities, given that the Government are devolving and reorganising local government structures across parts of the country, how will the Minister ensure that the standards around this issue—and other health and social care issues—are maintained? That restructuring means that we will have a whole load of new local authorities that do not necessarily have experience of dealing with this area.

[Stephen Kinnock]

The devolution Bill and the process of reorganising and restructuring are based on two really strong principles: that it is up to us through legislation to create the outcomes that we need to see delivered across the country and that there are clear standards and targets that we need to see met. But the implementation work needs to be done to deliver those desired outcomes and targets. Local authorities are empowered to do that, which is why we are seeing, for example, a lot of breaking down of ringfencing. The Government are keen to massively reduce the amount of ringfencing, because that has become a straitjacket for local authorities, integrated care boards and others in how they can best manage their portfolio of activities and deliver that devolved power and responsibility.

The answer to the hon. Gentleman’s question is that we want to devolve. We are absolutely committed to decentralising and we believe that is an important part of modern governance. Of course, that has to be done within a framework of set targets and the development of community services that the Bill commits to. All of that will come together to enable those at the coalface, who are best placed to understand them, how to deliver those services to their communities.

[Dr Evans]

Will the hon. Gentleman give way?

[Stephen Kinnock]

I just need to turn to the question asked by my hon. Friend the Member for Shipley. On strong duties, the code of practice flows from the primary legislation and therefore has a statutory power. There is no stronger power to ensure that people with learning disabilities and autism get the treatment, service and support that they require. The system will have a statutory duty to ensure that that happens within the framework of the legislation.

My hon. Friend is right that the transition from children’s to adult services is a major challenge. I am engaging with colleagues in the Department for Education about that to ensure that conversations about the transition happen upstream. We do not want a situation where an individual is looked after until they are 18 and then handed over without any prior conversations and engagement. We want the handover from one service to the other to be as seamless as possible. Our commitment to dynamic support registers will help in this context. They will be an important tool for understanding the needs of individuals who are at risk of admission and for getting that information into the system across the board prior to any detention.

My hon. Friend also asked about carers who so often pick up the baton in the gaps in community provision. She is absolutely right to flag that. We owe a huge debt of gratitude to the millions of unpaid carers across our country, many of them dealing with extremely challenging family situations. The system would simply collapse without them, so she is right to pay tribute to those people.

[Dr Evans]

I want to expand a little on the practicalities and respond to the question asked by my hon. Friend the Member for Farnham and Bordon about local authorities. I declare an interest because Leicestershire is one of the 21 county councils going through a devolution process. About 85% of its budget deals with special educational needs and social care. It is part of an ICB where the mental health team and primary and secondary care come together, but there is oversight from NHS England.

With so many moving parts, including the legislation we are putting in place, the budgetary constraints for ICBs, and the fact that we are getting rid of NHS England, there is a real worry among Opposition Members that things could drop through the gap, or more likely, that because we are moving all these things at the same time, we do not decide which is the fixed point that leads where others follow. If we are trying to cut costs in the ICBs, if NHS England is going over the next two years, and if devolution of responsibilities is also happening over the next couple of years with unitary councils forming, we will create a sticky situation for who is actually leading on this issue. At the heart of it are the clinicians and the patients who could fall through the gap.

What consideration has been given to the top-down strategy for how to incorporate all that? The Minister has talked about a red thread that runs through it all, but is there a running plan? Different Departments, agencies and areas of the country are involved. They are trying to come together to manage their budgets, legislation and policies. It is a complex situation to work through. The imperative part—the legislation—is almost the easier part to get in place; it is the delivery that is all-important. Can the Minister explain further how those three things tessellate?

[Stephen Kinnock]

I do not know whether I will be able to answer the hon. Gentleman’s question in its entirety, because quite a lot of that is being led by my colleagues in the Ministry of Housing, Communities and Local Government—in the English devolution Bill, for example. On the part of his question relating to the Department of Health and Social Care, we came to the view following the general election last year that NHS England was an unnecessary layer of bureaucracy. We think it is important that there is a clear line of accountability from the Secretary of State to Ministers, to ICBs, to trusts and to the system per se for delivery. That line of accountability was being blurred by NHS England, which is why we have removed it from the equation.

The hon. Gentleman is right that there are a lot of moving parts, but, by definition, a reform agenda creates change and some turbulence. We believe that is the only way we will get the system to where we need it to be so that we can deliver the three big shifts in our 10-year health plan: the shifts from hospital to community, from sickness to prevention and from analogue to digital. Many of the questions he is asking will be answered in the 10-year plan. He does not have long to wait for that to be published; it is coming very soon.

I reiterate that the principle underlying all of this is about empowering, devolving and giving agency to those closest to the communities they serve, because they are best placed to deliver. That all has to fit into the Bill, but the fundamental principle underpinning the Bill is the right one: it is about devolution, and about being patient-centric. The Bill deals with a cohort of people whose needs should drive the services that we design and deliver.

Question put and agreed to.

Clause 3 accordingly ordered to stand part of the Bill.

Schedule 1 agreed to.

Clause 4

People with autism or learning disability

[Dr Chambers]

I beg to move amendment 1, in clause 4, page 4, line 41, at end insert—

“(iv) housing.”

This amendment ensures that housing needs are considered as part of care, education and treatment review meetings.

Dementia Care

Stephen Kinnock Excerpts

Tuesday 3rd June 2025 Commons Chamber

[The Minister for Care (Stephen Kinnock)]

I thank the hon. Member for South Devon (Caroline Voaden) for securing this debate, and I commend her for her work as a member of the all-party parliamentary group on dementia. It has been a thoughtful and constructive debate, with a number of truly powerful and moving personal contributions from Members across the Chamber.

This is a cause that is close to my heart. I thank all Members for their kind words about my own family, but our history is far from unique. We know that one in two of us will be affected by dementia in our lifetime—by caring for someone with the condition, developing it ourselves, or both. It is predicted that just under 1.5 million people in England will be living with dementia by 2040. Each person, along with their loved ones and carers, has a unique journey and their own heartbreaking stories. On behalf of the Government, I thank everyone working to support people with dementia, as well as their friends, families and carers. This Government will back them every step of the way. We are also backing our scientists to deliver new treatments and ways to care for people living with dementia, and I recently had the pleasure of visiting the UK Dementia Research Institute’s centre for care and technology, where I saw some of its innovative smart-home tools.

A timely diagnosis is vital to ensure that everyone can access the advice, information and support that can help them to live well with dementia and remain independent for as long as possible. This Government remain committed to the national ambition for two thirds of people living with dementia to receive a formal diagnosis. We are funding evidence-based improvement projects to pilot the diagnosing advanced dementia mandate in 14 trusts. I am delighted that best practice is currently being shared and promoted with regional and local partners, following an impact assessment of the pilots.

Dementia can impact anyone, but there is varying and unequal access to health services. That is why the Office for Health Improvement and Disparities is working to make our country fairer by developing a tool that provides a clear assessment of population characteristics, such as rurality and socioeconomic deprivation.

[Joe Robertson]

I welcome the Minister’s confirmation of his commitment to the diagnosis target of two thirds. Will he put that in a key document—the equivalent of the planning guidance for NHS England? Will he ensure that that is well documented and set out in a strategic document, so that we can be absolutely clear and are not relying on his oral assertions in this Chamber?

[Stephen Kinnock]

We are absolutely on the record with the 66.7% target.

I want to take this opportunity to set out what appears to be a philosophical difference between this Government’s approach to our health and care system and that of many Opposition Members. We believe in devolution, we believe in decentralisation, and we believe in empowering those who are closest to the citizen to make the decisions that need to be made. If others have a more centralising and deeply anachronistic approach to managing our health and care system, which I heard from Liberal Democrat and Conservative Members, that is up to them, but we believe in modernising our system, not micromanaging or having shopping lists of targets. It is about providing support and agreeing on outcomes, but leaving those who are best placed at the coalface to decide how best to meet the unmet needs of their communities. That is a very clear dividing line between us.

On research, it is worth pointing out that we have done studies with UK Research and Innovation, the Alzheimer’s Society and the People’s Postcode Lottery. We have found that through our investment, ADAPT and READ-OUT are working to produce clinical and economic data that could bring blood tests to the NHS within five years to support the diagnosis of dementia. All of this means that the rate of diagnosis is improving. The latest data from April shows that the diagnosis rate has inched up to 65.5%, up 0.3% since July 2024, and it is worth noting that the 66.7% ambition has not been met since 2020.

The quality and availability of care services is variable, as Members have pointed out. We are empowering local leaders with the autonomy they need. We are supporting integrated care boards. I am pleased to say that we recently published the Dementia 100 pathway assessment tool, which brings together multiple resources into a single, consolidated training tool. That launched last month, and there has been huge interest and support from the sector, with 1,000 people registering to attend the launch webinar. We have the dementia care pathway full implementation guidance, and we are supporting the implementation of that guidance through a dashboard, to enable targeted support where it is needed.

All those who have dementia deserve to receive high-quality care. We must have a workforce that is equipped with the skills that are needed. We are incredibly proud of everyone who works in the care sector, and they deserve the training that many Members have mentioned. The care workforce pathway provides guidance for progression and development for professionals across adult social care with the knowledge, skills, values and behaviours that our carers need. It links learning outcomes to existing frameworks, including the dementia training standards framework.

Some of those learning outcomes can be achieved through the training and qualifications eligible for funding under the learning and development support scheme. That scheme, launched in September last year, supports adult social care employers to invest in their workforce through funded training opportunities, including a range of dementia-related qualifications. I am pleased to confirm that we have backed the scheme with a £12 million investment. Pay and conditions are also vital elements of our workforce strategy, so I am sure Members across the House will welcome our groundbreaking fair pay agreement legislation in the Employment Rights Bill for adult social care workers, which is hugely significant in this context.

On the question of our care workforce, a number of Members have highlighted the vital role that unpaid carers play. To support them, on 7 April the Government increased the carer’s allowance weekly earnings limit from £151 a week to £196 a week, which is the equivalent of 16 hours at the national living wage—the largest increase in the earnings limit since the carer’s allowance was introduced in 1976. We are very proud of that change.

I understand that every person with dementia, alongside their friends, families and carers, has their own unique and important story of living with dementia. I know that I am not alone in this fight. I want to pay tribute to the Alzheimer’s Society, Dementia UK and Alzheimer’s Research UK for all their vital work. Together, we will build a society where every person with dementia receives high-quality care from diagnosis through to the end of life. I once again thank the hon. Member for South Devon for raising this vital topic.

Draft Human Medicines (Amendments Relating to Hub and Spoke Dispensing etc.) Regulations 2025

Stephen Kinnock Excerpts

Monday 2nd June 2025 General Committees

[The Minister for Care (Stephen Kinnock)]

I beg to move,

That this Committee has considered the draft Human Medicines (Amendments Relating to Hub and Spoke Dispensing etc.) Regulations 2025.

It is a pleasure to serve under your chairship, Mr Stuart. These regulations amend the Medicines Act 1968 and the Human Medicines Regulations 2012 to enable hub and spoke dispensing for pharmacies and dispensing doctors that are not within the same legal entity.

Pharmacies play a vital role in our healthcare system, ensuring that patients have access to medicines and acting as an easily accessible front door to our NHS. This Government recognise the importance of community pharmacies and are committed to supporting the sector. That is why we have increased the core contract for community pharmacy funding to £3.073 billion, with the deal representing the largest uplift in funding for any part of the NHS in 2025-26—over 19% across 2024-25 and 2025-26.

Community pharmacies work hard for the NHS and the patients they serve. In England alone they dispense around 1.1 billion NHS medicines every year, and that number grows year on year. Dispensing of a medicine is not just handing out a package, but covers a number of processes: the receipt of a prescription; clinical and accuracy checks to ensure the prescribed medicine regime is suitable and safe for the patient; sourcing and buying the medicines on behalf of the NHS; the preparation, assembly and supply of medicines; and advising patients to ensure they know how and when to take the medicine. It is complex and important work.

As the number of prescriptions rises, we need to support our pharmacists to focus on the provision of advice and support to patients in order to optimise their use of the medicines on which the NHS spends nearly £10 billion in primary care each and every year. That is why the Government have introduced these regulations to allow all pharmacies, should they choose, to make use of hub and spoke dispensing.

In hub and spoke dispensing, the routine elements of dispensing—such as sourcing products, the preparation and assembly of medicines, and labelling—take place on a large scale in a hub pharmacy, separate from the pharmacy at which the prescription was handed in, which is the spoke. There are typically many spokes to one hub. Existing hubs often make use of automated processes to realise economies of scale and increased efficiencies. Not all pharmacy businesses are able to invest in their own hub, and businesses are currently not able to engage a hub that they do not own. The Government propose changes that would level the playing field in community pharmacy by enabling all pharmacies and dispensing doctors to use hub and spoke dispensing, if they choose.

Hub and spoke arrangements already exist in the UK, but the 1968 Act restricts their use to community pharmacies that are part of the same legal entity. That has limited the use of hub and spoke arrangements to the larger pharmacy chains. The proposed changes to the 1968 Act and the 2012 regulations will remove that legal restriction and allow all pharmacies, including small independents and dispensing doctors, to utilise the arrangement as and when best suits them, levelling the playing field and cutting red tape.

We propose to amend the 2012 regulations and the 1968 Act using the powers in the Medicines and Medical Devices Act 2021. The amendments go beyond simply removing the barrier that currently limits hub and spoke dispensing to pharmacies within the same legal entity, and they include additional elements to ensure the policy’s safe and effective implementation by putting in place provisions to ensure accountability, governance and transparency for patients.

We propose to amend the 1968 Act to remove the restriction that prevents a medicine from being sold or supplied from a different pharmacy from the one at which it was dispensed, unless those pharmacies belong to the same legal entity, and to remove section 131 of the Act, which covers the definitions of wholesale dealing, retail sale and related expressions. The definitions of those terms will now be those found in the 2012 regulations to ensure clarity across the legislation.

The proposed changes to the 2012 regulations create a new model of hub and spoke dispensing. They establish a framework for the sharing of patient information between the hub and the spokes and set the following criteria for the newly permitted arrangements. Both a hub and a spoke must be pharmacies registered with the pharmacy regulator. There must be written arrangements between any hub and spoke that must include a comprehensive statement about their responsibilities to ensure that each party is clear about the process and activities for which they are responsible. The medicine label must include the name and address only of the spoke so that patients know where to address any questions about their medicines. The spoke must conspicuously display a notice on its premises and its online presence about hub and spoke dispensing arrangements, where they are in use.

The changes also establish an information gateway that includes conditions for lawful sharing of relevant patient data between the different legal entities that operate hub and spoke arrangements. There is potential for this model to increase patient safety. Evidence shows that, where businesses have implemented hub and spoke systems with tracking technology, automated systems in the hub have had a dispensing error rate six times lower than manual processes.

During the consultation on the proposals in 2022, respondents shared evidence suggesting that the working environment in both the hub and the spoke can be calmer and more focused, reducing some of the stresses on our valued pharmacy workforce. Providing space and time at the spoke gives staff more time to deal with complex issues and carry out patient-facing work, including explaining to patients how to get the best outcomes from their prescribed medicines.

All the amendments will come into force in October 2025. They will apply across the UK, and the timescale allows time for secondary legislation to be amended, as appropriate, across the four nations. It also gives the pharmacy sector time to explore the relevance of the new hub and spoke arrangement.

I hope I have explained the rationale behind amending the 2012 regulations and the 1968 Act to enable hub and spoke dispensing arrangements across different legal entities. I commend the regulations to the Committee, and I hope hon. Members will join me in supporting them.

--- Later in debate ---

[Stephen Kinnock]

I will endeavour to answer all the questions that have been asked, but there may well be some that I am not able to. I will be more than happy to write to hon. Members accordingly.

Let me say a word on the rationale for choosing model 1. The main driver was the view that the most important aspect is the interface between the pharmacist and the patient. We felt that the spoke-to-hub-to-spoke-to-patient model best ensured the connection, at high street level, between the pharmacist and the patient, whereas the spoke-to-hub-to-hub-to-patient model would somewhat cut the high street pharmacist out of the loop. That was a balanced judgment—it was not a slam dunk.

That leads on to one of the questions asked by the hon. Member for Hinckley and Bosworth, which was about whether the Government are still open to looking at model 2. We certainly keep things under review, and we want to see how model 1 goes. If there is a feeling that it needs to be reviewed, we would be happy to do so. However, as things stand, we do not have any plans to do anything other than go with model 1, for the reason that I set out.

The hon. Member also asked about further funding. We have set out a pretty substantial uplift— £3.073 billion—for the pharmacy sector. We are hopeful that that will go some way to easing the tremendous pressures that the sector is facing. We also feel that the hub and spoke model will drive productivity, which we hope will enable pharmacies to do more with less. That will be a good way to address some of the funding challenges.

On recording data and where the data will be held, I will write to the hon. Member. I do not have that technical information to hand.

On the incentives, we are clear that this is a flexible business arrangement. All we have said is that we need to see set out in writing how the relationship between the hub and the spoke will work. That is in the draft regulations. Letting that business relationship work with the greatest possible flexibility—rather than trying to micromanage it too much with incentives set from the centre—is the best way for it to work. As I say, however, every time we will want the assurance of a clear written relationship between the two.

I thank my hon. Friend the Member for North Somerset for his kind words. I have absolutely welcomed his relentless lobbying during various Divisions over the past few months—I promise him that is the truth and nothing but the truth. On VAT status, however, I will dodge the question, because of course decisions on VAT are the responsibility of His Majesty’s Treasury. I strongly encourage him to ask his question of my ministerial colleagues in the Treasury.

Finally, I thank the hon. Member for South Antrim for his engagement. We have had excellent engagement with his colleagues in the Northern Irish Government. He has my absolute, 100% assurance that we will continue that engagement and, given the time available, which I set out in my speech, we will ensure that all nations are able to take this legislation on board and make the necessary changes in a way that works for devolution and for the entire system across the UK.

Question put and agreed to.

Parkinson’s Disease

Stephen Kinnock Excerpts

Wednesday 21st May 2025 Westminster Hall

[The Minister for Care (Stephen Kinnock)]

It is a great pleasure to serve under your chairship, Mr Stuart.

I pay tribute to my hon. Friend the Member for Colne Valley (Paul Davies) for securing this important debate. He spoke with real passion and conviction, as did hon. Members from across the Chamber. I do not know whether we have a full house from Dorset, but we have the hon. Member for West Dorset (Edward Morello), my hon. Friend the Member for South Dorset (Lloyd Hatton) and the hon. Member for Mid Dorset and North Poole (Vikki Slade); it was great to hear their thoughts. We also heard from the hon. Member for Strangford (Jim Shannon), who spoke, as always, with great passion and conviction. This debate follows closely on the heels of the Backbench Business debate on Parkinson’s Awareness Month, which was led by my hon. Friend the Member for Dunfermline and Dollar (Graeme Downie). I thank the Members who have spoken in both debates.

I pay tribute to the invaluable work of NHS clinicians, charities and care workers who spend every single day improving the lives of people with Parkinson’s disease. I am particularly encouraged by the Parky charter, which is raising public and professional awareness about the needs of the Parkinson’s community and the importance of timely diagnosis, comprehensive care and dignity for all people with Parkinson’s. Organisations that fight for patients, such as Parkinson’s UK, are at the heart of our policies for the NHS, which is broken but not beaten. We look forward to working with them to fix the foundations of the NHS and to make it work for people with Parkinson’s in Colne Valley, throughout Yorkshire and across the country.

Parkinson’s disease can severely impact every aspect of a person’s daily life, as well as the lives of their family and unpaid carers. It can put people under immense strain, and they deserve additional support to help them live with the condition. Around 153,000 people live with Parkinson’s in the UK, and it is the fastest growing neurological condition in the world. About 16.5 million people in the UK, or one in six of the population, have a neurological condition, and 600,000 people are diagnosed with one each year. Together, neurological conditions cause around 140,000 deaths every year in the UK—one fifth of all deaths—and they are the leading cause of disability.

In 2019, the NHS spent just under £4.5 billion on neurological conditions and they cost the UK economy £96 billion, so tackling them presents a real opportunity not just for the Government’s health mission but for our growth mission. We must face the fact that patients are facing significant challenges, including not enough people in the places we need them, and delays to treatment and care, with long waiting times. We also listen to patients who tell us that they have experienced a lack of information and support.

We are acting to address those challenges, starting with our workforce. Parkinson’s nurses and neurologists are worth their weight in gold, and they are key to meeting patient demand. This summer, we will publish a refreshed long-term workforce plan, as a first step towards rebuilding our workforce over the next decade and treating patients on time again. We will ensure that the NHS has the right people, in the right places, with the right skills, to deliver the care that patients need when they need it. We will set out in black and white the numbers of doctors, nurses and other professionals who will be needed in five, 10 and 15 years’ time.

Turning to waiting lists, the NHS constitution sets out that patients should start consultant-led treatment within a maximum of 18 weeks from referral for non-urgent conditions. At the start of the year, my right hon. and learned Friend the Prime Minister announced our elective reform plan, which sets out our approach to hitting that target by the end of this Parliament. We have already surpassed our manifesto pledge to deliver an extra 2 million elective appointments, seven months ahead of the deadline; we are now on 3 million appointments and counting. Many of those were appointments for treating Parkinson’s.

I know that there may be some people with Parkinson’s watching the debate at home and shouting at their telly, “Well, I am still waiting for treatment.” Although waiting lists are coming down, and recently fell for six months in a row, they are still high. I completely understand why people who are still waiting feel frustrated. I say to them: we are throwing the proverbial kitchen sink at waiting lists, and we will not stop until you see and feel the results.

The NHS has begun some important initiatives to improve its neurology services, including the neuroscience transformation programme, the Getting it Right First Time initiative, a strengthened clinical reference group and the appointment of a national clinical director for neurology. The NHS is focusing on improving patient experiences, addressing the disparities in care and ensuring that patients are given their medicines on time. The neuroscience transformation programme is focusing on faster diagnoses, better co-ordinated care and improved access to specialist services.

At the at the recent Backbench Business debate—and, of course, in this debate—a number of hon. Members spoke about personal independence payment as an important way of helping people to cope with the extra living costs of a disability or health condition. I am sure all Members would agree that those who can work should work. However, I am happy to reassure colleagues that our “Pathways to Work” Green Paper will make sure that people with the most severe lifelong health conditions who cannot work will see their incomes protected. We are consulting on the Green Paper to hear how best we can support those impacted by our reforms.

We continue to encourage research, which is advancing our understanding of Parkinson’s at breakneck speed, through targeted funding, infrastructure support and collaboration. For example, the UK Dementia Research Institute, sponsored by this Government, is partnering with Parkinson’s UK to establish a new £10 million research centre. The NIHR is supporting research that has discovered that eye scans can detect Parkinson’s disease up to seven years before symptoms appear, which helps people to receive treatment earlier and prepare themselves as best they can.

Research also underpins the entire drug discovery and development process. Produodopa is a groundbreaking new treatment for Parkinson’s disease, particularly for patients with advanced disease and severe motor fluctuations. It is revolutionary because it provides a continuous 24-hour infusion of medication via a small pump, allowing more consistent symptom control. The NHS rolled it out in February last year. It has been shown to improve motor function and has proved its worth by significantly improving the quality of life for people with advanced Parkinson’s.

At the debate on 1 May, many Members emphasised the importance of staying active. Indeed, there is strong scientific evidence that being physically active can help people to lead a healthier and happier life. For example, exercise can reduce the risk of major illnesses and lowers the risk of early death by up to a third. Our social prescribing programme is a key component of the NHS’s universal personalised care and a way for GPs or local agencies to refer people to a social prescribing link worker. Those workers give people time, focusing on what matters to them and taking a holistic approach to people’s health and wellbeing. They connect people to community groups and statutory services for practical and emotional support.

Looking forward, we have committed to publishing a 10-year plan for health to shift the focus of our NHS from hospital to community, from analogue to digital and from treatment to prevention. In the meantime, we have taken steps towards those shifts through the home-based care pathway, which is providing comprehensive support and care for people with Parkinson’s in their own home, and through the NIHR project to test a non-invasive vibrational cueing system, helping people with Parkinson’s to maintain their walking as they go about their everyday lives.

[Chris Bloore (Redditch) (Lab)]

I congratulate my hon. Friend the Member for Colne Valley (Paul Davies) on securing the debate. I declare an interest as a member of the APPG on Parkinson’s, as the son of a sufferer of Parkinson’s, and as the grandson of someone who died suffering of Parkinson’s. We all agree that, while there are real challenges, we must secure a cure for Parkinson’s. Does the Minister agree that we owe a great debt of gratitude to the partners, spouses and community groups that do so much to support people suffering from Parkinson’s as they go through not only horrific mobility loss but the associated deep psychiatric problems?

[Stephen Kinnock]

My hon. Friend is absolutely right; our system could not survive without the amazing and heroic work of our unpaid carers. One of our Government’s actions that I am most proud of is the change to the carer’s allowance. We increased the number of hours for which a carer can work and still keep their carer’s allowance by raising the threshold from £151 to £196. I hope that is giving carers the flexibility that they need. Many carers want to work but it is immensely stressful for them to balance their working and caring responsibilities. I was very pleased that we could announce that change back in January, but my hon. Friend is absolutely right that there is a lot more that we can do. I am working with colleagues in DWP and the Department for Business and Trade to look at how we can do more as a Government for unpaid carers. My hon. Friend is absolutely right to pay tribute to them; they are the lifeblood of our care system.

The consultation on our 10-year plan received over 190,000 responses, giving people with Parkinson’s and other conditions a voice in the future of healthcare. I want to conclude this debate by quoting just one of those voices—that of Winston, a former St John Ambulance worker from Lewisham. He said:

“People don’t always see what’s happening to me, or what Parkinson’s looks like on me. They don’t see me early in the morning. They see me looking nice and managing the condition as best I can. But I have to deal with my own bubble sometimes, and it gets burst, and things go all over the place.”

I am pleased that Winston is doing fantastically well and now sharing tips with people on how to improve their public speaking abilities. His words will resonate with anyone who has a long-term condition. Stories like his should remind us why we need a health service that sees the whole person, not just the condition, to give patients the dignity, care and respect that they deserve.

I thank my hon. Friend the Member for Colne Valley again for securing this important debate, and I pay tribute to all Members for making it constructive and powerful. I look forward to working with Members on this matter.

Mental Health Bill [Lords]

Stephen Kinnock Excerpts

2nd reading
Monday 19th May 2025 Commons Chamber

[The Minister for Care (Stephen Kinnock)]

It was truly a privilege to be in the Chamber this evening to hear so many moving, powerful and thoughtful contributions. It really was Parliament at its best, and it is an honour for me to close the debate.

The Bill has been a long time coming. Patients, practitioners, campaigners and charities have all long awaited the introduction of this legislation and have played a hugely important role in getting the Bill to this point. I would like to put on record my thanks on behalf of the Government and pay testament to their commitment to change. I thank Members in both this House and the other place, including our brilliant and esteemed colleague Baroness Merron, for all their work.

As the Bill started in the other place, it has already been through extensive detailed scrutiny under the eyes of peers, many of whom were there when the Act was last revisited in 2007—I am sure they will enjoy me reminding them of that. It is testament to the cross-party consensus that has so far underpinned the Bill that the debates were constructive and largely led to the betterment of the Bill. I trust that this collegiate spirit will now continue in this House, and I thank the Opposition and the Liberal Democrats for the constructive spirit in their approach to this debate.

Every speech we heard sought to improve processes and outcomes for patients and their loved ones, and there is broad cross-party support for the overall ambitions of the Bill. However, some specific issues and queries were raised in the course of the debate that need addressing. Many hon. Members asked about our implementation plans, rightly stating that legislation is only as good as its application. Indeed, we know that community service provision is very far from where it needs to be—an issue that we intend to address alongside the implementation of the Bill.

Our first priority after Royal Assent will therefore be to draft and consult on the code of practice. It is essential that we listen both to practitioners and to those with experience of the Act when we draw up the statutory guidance.

[Helen Hayes (Dulwich and West Norwood) (Lab)]

The review of the Mental Health Act 1983 is very welcome. It started its life close to my constituency with the work of Professor Sir Simon Wessely, who drew on the experience of many residents in south-east London, particularly with regard to his work on racial inequalities. As the Minister is talking about the implementation of the Bill, I wonder whether he can reassure my constituents, who want to know that this Bill will do the job of eliminating racial inequality from mental health services, by committing to putting the patient and carer race equality framework on the face of the Bill.

--- Later in debate ---

[Stephen Kinnock]

We are already working to reduce inequalities under the Mental Health Act. The patient and carer race equality framework is now a contractual requirement for all providers of NHS-commissioned care. It will support trusts to improve their interaction with racialised and culturally diverse communities and improve governance, accountability and leadership on improving experience of care for those communities and drive concrete actions to reduce racial inequalities within mental health services.

Given that our first priority after Royal Assent will be to draft and consult on the code of practice, it is essential that we listen both to practitioners and to those with experience of the Act when drawing up the statutory guidance that supports the Act’s application. We will therefore engage with people with lived experience, their families and carers, staff and professional groups, commissioners, providers and others to do this. The code will be laid before Parliament before final publication.

Alongside the code, we will develop secondary legislation that will be laid before Parliament, subject to the parliamentary process as set out in the legislation. We have already published policy papers that set out more information on some of the delegated powers in the Bill and provide an early indication of what we intend to set out in regulations. We recognise the appetite to deliver after years of delay and the importance of parliamentary scrutiny and accountability in this crucial work. We have therefore committed to laying an annual written ministerial statement on progress, so that hon. Members will have ample opportunity to hold us to account for progress made and milestones achieved.

We have covered a wide range of topics and questions this evening, and I will not be able to cover all of them in the time allocated to me. I will therefore limit my comments to two areas that have come up repeatedly, namely the implementation plan and the treatment of people with autism and learning disabilities.

[Melanie Ward]

I thank the Minister for giving way. He is talking, rightly, about the importance of the implementation of legislation. He will be aware that new measures came into force two months ago under the Online Safety Act 2023, which introduced legal powers to remove online content that promotes suicide. Ahead of this, I wrote to Ofcom about a platform that is actively promoting suicide and suicidal ideation, and has been linked to the deaths of almost 100 young people and adults. The Ofcom chief executive replied to say that Ofcom was opening an investigation. Does the Minister agree that it needs to get on and remove this kind of content across the UK?

[Stephen Kinnock]

Of course, we have the Online Safety Act, and there are measures within that legislation that address this issue. However, my hon. Friend is absolutely right that it is time to crack on and deal with this deeply troubling issue. I pay tribute to her excellent work, and I hope she will continue to press Ofcom to do the right thing, and to do it rapidly.

We know that implementation will take time, as the pre-legislative scrutiny Committee recognised. We estimate that it will take around 10 years to fully implement all Bill’s measures, due largely to the time needed to train specialised workforce groups, including second opinion appointed doctors and tribunal judges, and the need to ensure that the right community support is available for people with a learning disability and autistic people. This timeframe necessarily spans multiple spending reviews and multiple Parliaments, so I am limited in the detail I can give today about future spend and timelines.

However, we have set out in the impact assessment what we think is required in both time and funding. We expect the process of drafting and consulting on the code of practice to take at least a year. Alongside the code, we will develop secondary legislation, which will be laid before Parliament. We have already published policy papers, which contain more information on some of the delegated powers in the Bill and provide an early indication of what will be set out in regulations.

We will then need time to train the existing workforce on the new Act, regulations and code, which will likely be in 2026 and 2027. Although we will commence some clauses, such as on supervised discharge, two months after Royal Assent, the first major reforms, including clauses concerning grounds for detention—excluding the changes to part 2 for people with learning disability and autistic people—and nominated persons, are expected to follow the training in mid-2027. The timelines for later phases are inevitably less defined, but we will expand the workforce and improve community support with the aim of implementing the reforms increasing the frequency of mental health tribunals from 2030-31. These timelines are indicative, and we will iterate the plans as we get more certainty on future funding and wider workforce plans.

The other issue that came up a lot is the treatment of people with autism and learning disabilities. Again, implementation should be well planned to ensure that the proposed legislative changes have the intended effect. The proposed changes to the detention criteria will be commenced only when strong community services are in place so that the alternatives to hospital care are robust. Members will understand that robust implementation plans are dependent on the final legislation that is passed and on future funding, which is subject to future spending reviews.

However, local systems do not need to wait for legislative changes to come into force to begin putting in place the necessary community services for people with a learning disability and autistic people. There is renewed funding in 2025-26 within ICB baselines to continue improving community support provision for people with a learning disability and autistic people.

We should recognise that the Bill is the result of the independent review commissioned by the now Baroness May of Maidenhead during her premiership. Many important contributions have also come from those with lived experience of the Act and their loved ones. It takes real courage to speak openly about those experiences and to channel pain into change.

As my right hon. Friend the Health Secretary said in his opening speech, the Government have demonstrated their commitment to funding mental health properly, and that commitment has been translated into real, tangible delivery: the £150 million multi-year capital investment to improve mental health urgent and emergency care pathways; 600 new or expanded crisis alternative services nationally, including crisis cafés, safe havens and crisis houses, providing an alternative to A&E or psychiatric admission; £26 million in capital investment to open new mental health crisis assessment centres, which aim to provide accessible and responsive care for individuals in mental health crisis; and 8,500 more mental health workers.

We are also committed to improving early intervention and shifting care to the community to support people to live well and thrive. We have committed to improve support for young people, with Young Futures hubs, making support workers more accessible to children. We are piloting in England the 24/7 neighbourhood mental health centre model, which builds on learning from international exemplars.

It is a privilege to be leading this transformational legislation through the House. I know that, because it matters so much, many people will have views on what is needed to get it right, and I look forward to further debates in that constructive and improving spirit. I commend the Bill to the House.

Question put and agreed to.

Bill accordingly read a Second time.

Mental Health Bill [Lords] (Programme)

Motion made, and Question put forthwith (Standing Order No. 83A(7)),

That the following provisions shall apply to the Mental Health Bill [Lords]:

Committal

(1) The Bill shall be committed to a Public Bill Committee.

Proceedings in Public Bill Committee

(2) Proceedings in the Public Bill Committee shall (so far as not previously concluded) be brought to a conclusion on Thursday 26 June 2025.

(3)The Public Bill Committee shall have leave to sit twice on the first day on which it meets.

Consideration and Third Reading

(4) Proceedings on Consideration shall (so far as not previously concluded) be brought to a conclusion one hour before the moment of interruption on the day on which those proceedings are commenced.

(5) Proceedings on Third Reading shall (so far as not previously concluded) be brought to a conclusion at the moment of interruption on that day.

(6) Standing Order No. 83B (Programming committees) shall not apply to proceedings on Consideration and Third Reading.

Other proceedings

(7) Any other proceedings on the Bill may be programmed.—(Anna Turley.)

Question agreed to.

Mental Health Bill [Lords] (Money)

King’s recommendation signified.

Motion made, and Question put forthwith (Standing Order No. 52(1)(a)),

That, for the purposes of any Act resulting from the Mental Health Bill [Lords], it is expedient to authorise the payment out of money provided by Parliament of any increase attributable to the Act in the sums payable under or by virtue of any other Act out of money so provided.—(Anna Turley.)

Question agreed to.

Oral Answers to Questions

Stephen Kinnock Excerpts

Tuesday 6th May 2025 Commons Chamber

[The Minister for Care (Stephen Kinnock)]

I am pleased to tell my hon. Friend that we have recruited over 1,500 additional GPs since October through an investment of £82 million, helping to fix the front door to the NHS. Today we have announced £100 million to unlock new capacity and more appointments in GP surgeries. We have also launched a red tape challenge and scrapped unnecessary targets in our new GP contract to cut down on bureaucracy and free up time to spend with patients.

[Alex Ballinger]

My constituents in Halesowen have written to me time and again complaining that they are calling their GP surgeries at 8 am, as instructed, but are still unable to get a same-day appointment. Can the Minister set out how the £100 million investment in GP surgeries, consulting rooms and other facilities will finally put an end to the frustrating 8 am scramble?

[Stephen Kinnock]

I absolutely share the frustrations of my hon. Friend and his constituents. The investment made today was in response to GPs telling us that they needed more space; the investment will lead to more capacity and better access and outcomes for his constituents. Today’s announcement was only possible thanks to the decisions made in the October Budget, which were opposed by every party opposite. The choice is clear: investment in our NHS with Labour, or cuts with the Tories and Reform.

[Rebecca Smith (South West Devon) (Con)]

My constituent Dr Toby Nelson, an NHS consultant dermatologist, has started a business that seeks to address the heavy demand on primary care for skin health screening. His business Map My Mole sends an image capture kit to patients to attach to their smartphones. The patients then send a high-resolution image remotely to be reviewed by a specialist consultant, bypassing the need for a GP appointment and freeing up time and resources for both doctor and patient. It has already resulted in a significant drop in skin cancer referrals in pilot GP surgeries. Will the Minister agree to meet Dr Nelson and me to discuss this revolutionary proposal?

[Stephen Kinnock]

The hon. Lady raises what sounds like an extremely interesting scheme. She will know that we have a strong commitment in our 10-year plan to shift from hospital to community, and indeed from analogue to digital. The digital aspects of that scheme sound very interesting, so I would be more than happy to take further representations from her.

[Marsha De Cordova (Battersea) (Lab)]

4. What steps he is taking to improve eye healthcare through the 10-year health plan.

[The Minister for Care (Stephen Kinnock)]

My hon. Friend is an outstanding campaigner on this issue, as I am sure everybody across the House is aware. She will know that the NHS England accelerator pilots have shown how improved IT connectivity and a single point of access can speed up eye care referrals and allow more patients to be managed in the community. That is a great example of the shift we want to make from analogue to digital. We are developing the 10-year health plan with input from the public, our partners and health staff, and that of course includes the eye care sector.

[Marsha De Cordova]

I thank the Minister for his response, and I welcome all the work that he and the Secretary of State are doing in rebuilding our NHS. However, we know that there is a capacity crisis within eye healthcare. NHS ophthalmology continues to be the busiest and largest outpatient service. That is essentially what is leading to many people not getting seen soon enough, which is resulting in many of them losing their sight unnecessarily. What we need is a joined-up healthcare plan. Will the Minister ensure that eye healthcare will be part of the Government’s wider 10-year health plan?

[Stephen Kinnock]

My hon. Friend is right that early intervention is crucial, and the interface between the high street and secondary care is a vital part of that. That means having a joined-up eye health strategy. The 10-year plan will have that joined-up strategy at its heart. She will be pleased to know that, since July, ophthalmology waiting lists have dropped by 24,000, so change has begun. There is still a long way to go to dig us out of the mess left by the Conservative party, but it is thanks to the decisions that the Government have made, opposed by Opposition parties, that we are beginning to see that change gaining traction.

[Sir James Cleverly (Braintree) (Con)]

Another part of the 10-year health plan is the use of digital technology. Auto-contouring with artificial intelligence reduces waiting times and frees up capacity for radiotherapists, which is why £15.5 million was allocated to it under the Conservative Government; money that has been cut under the Minister’s Government. Why?

[Stephen Kinnock]

I think that the right hon. Gentleman is referring to the single point of access digital technology, which is game changing in terms of improving the interface between high street and secondary care. It is probably worth reminding him that the question is about eye care. We are absolutely committed to single point of access technology, which we believe can be game-changing technology and is a vital part of our shift from analogue to digital.

[Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)]

The president of the Royal College of Ophthalmologists has stated that the widespread outsourcing of NHS cataract surgery to private, for-profit providers risks the integrity of hospital eye surgery departments meaning that there will be few services to treat patients with preventable blindness. How can we reassure the public that such services will be maintained?

[Stephen Kinnock]

Although the independent sector clearly has an important role to play in tackling waiting lists and backlogs, we will not tolerate any overpriced or sub-par care, and we will not tolerate any distortion of patient choice. The recently published partnership agreement between NHS England and the Independent Healthcare Provider Network commits to ending incentives that can lead to that, and to supporting equal access and genuine choice for all patients. We are working together to deliver on that.

[Jess Brown-Fuller (Chichester) (LD)]

NHS Sussex ICB is one of only five in England not to commission a minor eye conditions service—known as MECS—in community optometry settings. That means that patients in Chichester with urgent or minor eye issues have to either join the 8 am queue for a GP appointment or go to their hospital rather than being seen quickly on the high street. Given that 99.9% of MECS patients elsewhere in England are seen within 24 hours, will the Minister set out what action he is taking to ensure that those services are commissioned consistently across all ICBs within the 10-year health plan?

[Stephen Kinnock]

ICBs are responsible for the commissioning of these services, which are clearly extremely important, and the early intervention side of eye care is particularly important. I would be more than happy to look into that issue with the hon. Lady’s ICB if she wrote to me and made further representations.

[Blake Stephenson (Mid Bedfordshire) (Con)]

5. Whether he has had discussions with the Secretary of State for Housing, Communities and Local Government on the interaction between mayors and integrated care boards, in the context of the English devolution White Paper.

--- Later in debate ---

[Manuela Perteghella (Stratford-on-Avon) (LD)]

7. What recent assessment he has made of the adequacy of access to emergency dentistry.

[The Minister for Care (Stephen Kinnock)]

We are already rolling out our manifesto commitment of 700,000 extra urgent dental appointments per year. These appointments are available across the country for those experiencing painful dental issues such as infections, abscesses or cracked or broken teeth. We are committed to reforming the dental contract and making NHS dentistry fit for the future.

[Manuela Perteghella]

The dental contract imposed in 2006 is widely recognised as a key factor driving dentists out of the NHS. In my constituency of Stratford-on-Avon, there are no NHS dentists currently taking on new patients, and existing NHS patients are being actively pressured to go private or seek care out of county. Will the Minister commit to urgent reform of NHS dentistry, and set out a timeline for negotiations, so that I can reassure my constituents?

[Stephen Kinnock]

The hon. Member is right to say that the dental contract is fundamentally flawed and needs reform. I met representatives of the British Dental Association on 8 April, and had a productive discussion with them about dental contract reform. Officials from the Department of Health and Social Care are working hard with the BDA and other stakeholders to develop a dental contract that works for patients, for dental professionals and for the public purse. I will of course keep her and the House updated. I know this issue is of huge importance to the country, and to every Member of this House.

[Chris Webb (Blackpool South) (Lab)]

It is a year today since I was sworn into this House, and every single week, someone has raised with me the issue of getting access to an NHS dentist in Blackpool. Nowhere is taking on adults, and nowhere is looking after pregnant women. This has to change, so can the Minister outline to my constituents when they will be able to get access to an NHS dentist under this Labour Government?

[Stephen Kinnock]

There is no perfect payment system. We have to look at the issue around units of dental activity, and at options around capitation and sessional payments, and come to a conclusion about what works and about how to ensure that everything that we commit to NHS dentistry is spent on NHS dentistry. We are in a mad situation in which, although demand for NHS dentistry is going through the roof, we have an underspend every year on the contract. We have to fix that. It will take some time to work that out with the British Dental Association and other key stakeholders. What is tragic about this situation is that the Conservatives had 14 years to fix the situation and left it in a terrible mess.

[Laura Kyrke-Smith (Aylesbury) (Lab)]

8. What steps he is taking to improve perinatal mental health provision.

--- Later in debate ---

[Josh MacAlister (Whitehaven and Workington) (Lab)]

T6.   West Cumbria, like many parts of the UK, is a dental desert. In some communities, urgent dental access centres have proved to be a real success at building up dental services, so will the Minister support my campaign to introduce an urgent dental access centre in west Cumbria?

[The Minister for Care (Stephen Kinnock)]

The Government have launched a scheme to provide 700,000 urgent dental appointments. There are 57,500 allocated to my hon. Friend’s integrated care board. He will know that ICBs are responsible for commissioning primary care services based on the needs of the population, but I know that he is a strong campaigner for his constituents. I understand that his dialogue with his ICB on this matter has been positive and constructive, and I am sure that he will continue to fly the flag.

[Sir Jeremy Hunt (Godalming and Ash) (Con)]

T2. The chief executive of the Royal College of Midwives has said that the axing of the maternity safety ringfenced pot would be a “wrecking ball” to the efforts being made to improve maternity safety. Just a single or a small group of babies being spared lifelong disability would pay for the cost of that ringfenced pot many times over. I know that the Secretary of State cares about this matter deeply, so will he reconsider?

--- Later in debate ---

[Stephen Kinnock]

My hon. Friend will know that we have hired 1,500 more GPs, which will help with access. We have also renegotiated the contract, so there will be online booking systems in every practice in the country, and we have changed the contract to incentivise continuity of care in order to bring back the family doctor. There is a suite of reforms coupled with investment, which I hope will deliver for my hon. Friend’s constituents.

[Bob Blackman (Harrow East) (Con)]

T4. One of the great frustrations for medical professionals and patients alike is when patients have appointments but do not turn up. What action will the Secretary of State take to ensure that the system penalises people who miss appointments, so that patients can get the treatment they need when they need it?

--- Later in debate ---

[Tessa Munt (Wells and Mendip Hills) (LD)]

T8. I have a constituent who has broken and rotting teeth. His GP referred him to the local dental hospital, but he has been refused treatment because the hospital said that the surgeon would take a referral only from a dentist, which my constituent and many others in Somerset just do not have. What does the Minister suggest my constituent should do to stop the pain?

[Stephen Kinnock]

As the hon. Lady knows, we now have a commitment to providing 700,000 more urgent dental appointments. Those who do not have an NHS dentist can call 111 and will be prioritised. We are very clear that every integrated care board has a target within those 700,000 appointments, and if they are not hitting that target, we will want to know why.

[Olivia Blake (Sheffield Hallam) (Lab)]

As someone with ADHD, it is disappointing to hear from many of my constituents about difficulties in accessing diagnosis, medication and other therapeutic inputs for ADHD, and the impact on their lives and livelihoods as a result. Whether for children or adults, waits of two, five or seven years are becoming the norm. What steps are the Government taking to make sure that individuals can exercise their right to choose?

[Stephen Kinnock]

I pay tribute to my hon. Friend for improving support for ADHD and recognise the valuable perspective that she brings through her lived experience. This Government inherited a broken NHS, with too many people facing long waits for an assessment. NHS England’s ADHD taskforce is looking at how support for people with ADHD can be improved. I look forward to reading its report, and I recently had a very productive meeting with the director of that taskforce.

[Mr Peter Bedford (Mid Leicestershire) (Con)]

T10. The Government have committed to providing 700,000 extra emergency dental appointments, but in the midlands the units of dental activity rate is just 83% and there is no additional funding for the integrated care boards. Will the Minister therefore give assurance to my constituents that he will fully deliver on that promise?

[Stephen Kinnock]

I give the hon. Member that assurance. We have been clear that every ICB has a target, and that was transparently published, and we will be monitoring it. I am holding regular meetings with officials to check that every single ICB is on track to hit those targets. If ICBs are not on track to hit those targets, we will want to know why.

[Markus Campbell-Savours (Penrith and Solway) (Lab)]

Earlier this year, I met the Cockermouth and Maryport primary care network, which told me about the increasing challenge of supporting my constituents with their mental health. Has the Secretary of State considered relaxing the additional roles reimbursement scheme funding rules to allow mental health nurses to be employed wholly by a PCN, and not need to be under the employment of a local mental health trust? That flexibility could help GP practices to intervene earlier and reduce referrals to secondary care quickly.

[Stephen Kinnock]

We have, in fact, relaxed the rules on ARRS so that a mental health worker can be employed by the PCN. My hon. Friend is absolutely right that that is an important part of stepping from hospital to community, but there is more we can do on that. We continue to do whatever we can to ensure that mental health and GP surgeries are actively integrating.

[Robin Swann (South Antrim) (UUP)]

Getting It Right First Time is a clinician-led programme that leads on improvement and transformation. Can the Secretary State give reassurance that in any restructuring of NHS England, that programme will not just be continued, but expanded and still available to the devolved Administrations?

--- Later in debate ---

[Catherine Atkinson (Derby North) (Lab)]

Last week, this Labour Government announced the freezing of prescription charges, putting pounds back in the pockets of people in Derby. I have visited pharmacies, including the Littleover pharmacy, which provide essential care and support for their communities. The Conservatives underfunded pharmacies and more than 750 closed across England between 2021 and 2024. What is the Minister doing to support community pharmacies so that we do not lose these vital local services?

[Stephen Kinnock]

After years of neglect, this Government have agreed with the sector a record uplift to £3.1 billion for 2025-26 for this vitally important front door to our NHS. We are also supporting pharmacies to operate more efficiently, including enabling hub and spoke dispensing between all pharmacies later this year. I am pleased to say that the legislation for that has been laid. What a contrast that is with the previous 14 years. I am also pleased to see that the National Pharmacy Association has withdrawn its view on taking collective action. We are moving in the right direction, but there is still a lot more to do.

[Calum Miller (Bicester and Woodstock) (LD)]

I welcome today’s announcement of new money for GPs’ surgeries, but GPs in my constituency tell me that they cannot get capital out of the integrated care board and that the Valuation Office Agency consistently undervalues the cost of rents, making future building impossible. Will the Secretary of State agree to meet me, and GPs from my constituency, in order to understand the problem better?

--- Later in debate ---

[Stephen Kinnock]

I pay tribute to my hon. Friend, who is a qualified physiotherapist, and who is right to refer to the value of community care. I would be happy to meet her to discuss the important issue that she has raised.

[Jim Shannon (Strangford) (DUP)]

What steps will be taken to support more community pharmacies that can offer a broad range of services to people in rural areas, to ensure that those who are most isolated from busy towns still have access to those important services?

[Stephen Kinnock]

As I said earlier, we are giving pharmacies a record 19% uplift to £3.1 billion, and I am pleased to confirm that of all the sectors in the NHS they received the best uplift in the 2025-26 settlement. We have also maintained the pharmacy access scheme, which provides £19 million to support pharmacies in areas where there are fewer of them, including the rural areas that the hon. Gentleman mentioned.

[Jon Trickett (Normanton and Hemsworth) (Lab)]

Pharmacies play a key role in communities in rural areas such as mine, but it is deeply frustrating when the supply chain breaks down and a pharmacy cannot deliver its medicine. Can the Minister tell me where we are now with the supply chain? Will she also thank all the heroic workers up and down the country who are doing their very best to deliver medicines, and will she thank in particular the 400 Superdrug workers in my constituency who are trying to make the supply chain work?

Community Health: Manchester Rusholme

Stephen Kinnock Excerpts

Monday 28th April 2025 Commons Chamber

[The Minister for Care (Stephen Kinnock)]

I congratulate my hon. Friend the Member for Manchester Rusholme (Afzal Khan) on securing this important debate. Before I begin my remarks, I would like to pay tribute to some of the stellar charities that are working to reduce health inequalities: the Health Foundation, which is leading the way with its Health Equals mission; the People’s Health Trust, which is providing funding and support to left-behind communities; and the BHA for Equality, which was founded in 1990 to address the lack of quality information and services for black communities in Manchester.

I am responding on behalf of the Minister for Public Health—the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for West Lancashire (Ashley Dalton)—but I am more than happy to take this debate because I recognise many of the issues that my hon. Friend the Member for Manchester Rusholme mentioned from my own constituency. I am responding not just on behalf of the Government, but as an MP from a constituency with some of the highest levels of deprivation in the United Kingdom.

I agree with my hon. Friend that the levels of inequality between the better-off and worse-off in our country are a national scandal. Fourteen years of austerity measures and stagnant wages have disproportionately affected lower-income households, exacerbating both income and regional disparities. Places such as Manchester and Port Talbot have borne the brunt. The life expectancy for Mancunian men and women is significantly worse compared with their compatriots in the rest of England. A baby boy born in the Manchester royal infirmary can expect to live for just over 75 years, which is four years less than the English average. A baby girl born in Manchester can expect to live to the age of about 79 and a half, which is also four years less than in England as a whole.

My hon. Friend raises some issues that are not within my Department’s remit, including housing, knife crime and fly-tipping, but I completely understand why he has done so, because the determinants of ill health are wide and it is much more than a single factor that predicts healthy life expectancy. The Government know that we cannot address the challenges we face in the north-west with each Department in Whitehall siloed one from another, so we are taking a whole-of-Government approach to tackling inequalities through our health mission. That is chaired by the Prime Minister, who is lending his weight and authority from the centre of Government.

We have a laser focus on addressing the social determinants of health in a truly strategic way, and addressing the wider determinants of health to improve healthy life expectancy for all, while halving the gap in healthy life expectancy between different regions of England. We are prioritising prevention, shifting more care into the community and intervening earlier in life to raise the healthiest generation of children in our history. Addressing healthcare inequity is a core focus of our 10-year health plan to ensure that the NHS is there for anyone who needs it whenever they need it. We have established 11 working groups to take forward policy development that will feed into the plan. That includes working groups focused on how care should be designed and delivered to improve healthcare equity, alongside ensuring that access to healthcare services is effective and responsive. We look forward to updating the House once the plan is published in June.

Proximity to fast food outlets is strongly associated with obesity. Kids living in the most deprived communities are in proximity to twice the number of fast food outlets compared with wealthier areas. Nearly 3,500 schools across the country now have a major food outlet within 400 metres; that is 1,000 more schools than 10 years ago.

We have an outstanding mayor in Andy Burnham. Devolution gives him and other leaders in Greater Manchester the freedom and flexibility to set priorities locally. In December, the Government published the revised national planning policy framework for local authorities, which gave them stronger, clearer powers to block new fast food outlets near schools and where young people gather. This will stop the relentless targeting of children and young people by the fast food industry.

I am delighted that just last week, the Tobacco and Vapes Bill passed its Second Reading in the other place. Smoking is a scourge on deprived communities and contributes to poverty, ill health and a lower life expectancy. Britain is leading the world through landmark legislation to break the cycle of addiction and disadvantage by gradually ending the sale of tobacco products across the country. The Bill contains powers to extend the ban on smoking indoors to certain outdoor settings to reduce the harms of second-hand smoking, particularly around children and vulnerable people.

Over the past 14 years, a two-tier health system has emerged in our country. People who can afford it are increasingly going private to skip the queue, while those who cannot are left behind. We are determined to end two-tier healthcare in this country, so whether someone is the richest or the poorest person in Manchester, they get timely, quality treatment that is free at the point of use. Our elective reform plan will see more NHS patients able to choose to be treated in a private hospital, where there is capacity, paid for by the state. More capacity will be available for people in working-class areas of the country and for women stuck on waiting lists for gynaecological care. Where we can treat working people faster, we will, and we will make no apology for doing so—working-class patients in this country deserve the same choice, control and convenience as the wealthy expect—and I am delighted that waiting lists have been falling now for six months in a row.

The previous Labour Government did so much to reduce inequality: lifting millions of children out of poverty through Sure Start; giving a lifeline to working families through child tax credits; creating the minimum wage; and fixing the NHS after almost two decades of under-investment. It is a matter of profound regret that so much of that legacy has been undone over the past 14 years, but the people of Manchester don’t just want us to look back in anger; they want us to get on with the job of building homes, fixing the NHS and putting more money in people’s pockets. My right hon. and learned Friend the Prime Minister has spoken about the “class ceiling” that prevents children from getting ahead. I look forward to working with my hon. Friend the Member for Manchester Rusholme to shatter the class ceiling that hangs above his constituency and mine.

Question put and agreed to.

Hospitals

Stephen Kinnock Excerpts

Wednesday 23rd April 2025 Commons Chamber

[The Minister for Care (Stephen Kinnock)]

I am glad you recognised me from the Chair, Mr Speaker. I have lost some hair since we last spoke.

I beg to move an amendment, to leave out from “it” to end and insert:

“also notes that the Chancellor has announced new fiscal rules to ensure capital budgets can no longer be cannibalised, with transfers from capital to resource budgets not permitted; recognises that the previous Government left a New Hospital Programme which was unfunded, unrealistic and undeliverable; welcomes that the Government has taken action to review that Programme and has published the New Hospital Programme Plan for Implementation, to put the Programme on a sustainable footing; supports the Government’s investment in the Plan, which will increase to up to £15 billion over each consecutive five-year wave, averaging around £3 billion a year from 2030; and further supports the work being done to bring forward construction of the reinforced autoclaved aerated concrete replacement schemes wherever possible, to ensure that patient and staff safety is prioritised.”

The amendment on the Order Paper is in the name of my right hon. and learned Friend the Prime Minister. I thank the Liberal Democrats for using their Opposition day to address a matter of vital importance for so many Members, including many colleagues right across the Chamber and their constituents. I sincerely hope that the Liberal Democrats will work with us on solutions, not on soundbites, because we need to be realistic about the problems we face and serious about how we tackle them.

The new hospital programme was announced by the last Government to much fanfare in October 2020, with a promise to deliver 40 new hospitals by 2030. We were told that there was a plan and a timetable, and we were glibly assured that it was fully funded, but from the outset it was clear that there were not 40 new schemes—some were just refurbishments or extensions. To put it simply, there were not 40 projects, they were not all new and many of them were not even hospitals.

The spin around the programme was widely questioned and challenged before the general election, but nevertheless we were truly shocked by what we found on entering the Department of Health and Social Care. The programme was hugely delayed, by several years more than had already been revealed by the National Audit Office. There was no credible plan to deliver the building projects, let alone to deliver them all in the next five years, and there was not even enough construction capacity in the UK to build all the hospitals in the new hospital programme by 2030. That is why when the hospitals with reinforced autoclaved aerated concrete were brought into the NHP in 2023, even the last Government had the sense to admit that nine schemes would have to be delivered past 2030 in order to prioritise the RAAC hospitals.

Perhaps most shocking of all, the funding for the programme was due to run out a month ago, with no provision whatsoever for future years: the money simply was not there. The programme was built on nothing more than false hope, dodgy claims and disingenuous press releases.

[Anna Dixon (Shipley) (Lab)]

Does the Minister share my constituents’ anger at the failure of the Tories to back up any of their promises about new hospitals? Will he reassure me that my constituents who are served by Airedale general hospital will finally get a new hospital to deal with the RAAC in an affordable, deliverable timetable, unlike the false promises of the Conservatives?

[Stephen Kinnock]

My hon. Friend is a doughty champion for her constituents, and she is absolutely right. The point she makes raises the even bigger issue of trust in politics and the trust that her constituents have in this place. That trust was fundamentally undermined by the disingenuous nature of what went on with the previous hospital programme. The British people are grown up enough for us to be able to level with them, be straight with them and say, “This plan is credible and affordable. It’s based on facts, not fantasy.”

[Daisy Cooper]

On the point of trust, the Conservatives completely blew trust with the constituents of West Hertfordshire. They promised a new hospital—they even said in 2023 that it would be fully funded, and it clearly was not. At the most recent general election, the Labour party promised that Watford general hospital would be a priority. Will the Minister make a new promise to keep that trust by coming to visit that hospital this year?

[Stephen Kinnock]

I am sure the hon. Lady will appreciate the fact that we have now come forward with a programme built not on sand or smoke and mirrors, but on reality, and the hospital she mentioned will be a part of that. She is very welcome to write to me with any further representations.

The situation I have described is the dog’s breakfast that we inherited from the Conservatives. This is genuinely not a partisan point, because when the previous Government did the right thing—for example, on the Tobacco and Vapes Bill—we were more than happy to support them, but where they failed, fibbed, and fobbed off Members of this House, we will not pretend that they were acting in good faith. It now falls to us to level with the British people about why their hospitals will not be fixed on time.

Our constituents are understandably furious, because our national health service is quite literally crumbling. As Lord Darzi found in his investigation, over the past 14 years our NHS has been starved of capital, with a staggering £37 billion under-investment over the course of the 2010s. I know that we will hear today from hon. Members about many examples of hospital roofs failing or falling, leaky pipes that freeze over in the winter and buckets for catching rainwater in corridors, and I know that capital spending is needed now more than ever.

Although we are deeply shocked by the neglect and incompetence of the Conservatives, it has not prevented us from rolling up our sleeves and clearing up the mess that they left behind. That is why we immediately commissioned a review, which had two core objectives. The first was to put the programme on a firm footing with sustainable funding, so that all the projects can be delivered to a realistic and affordable timetable. The second was to give patients a realistic, deliverable timetable based on facts rather than fantasy.

[Chris Vince (Harlow) (Lab/Co-op)]

My hon. Friend talks about realistic timelines, which are really important. My constituents in Harlow were promised a new hospital when there was clearly no money, no business plan and not even a site made available for it. Does he agree that this work is so important for the trust that we want to have from our constituents? Certainly in Harlow, we have a realistic timeframe and plan that we can actually meet.

[Stephen Kinnock]

My hon. Friend is also a doughty champion for his constituents. With each brick we build in the new hospital programme, I hope that we will start to rebuild some trust between his constituents and this place. He is absolutely right to point out that it is much better to have a realistic programme, rather than one built on smoke and mirrors.

Officials reported on the review in the autumn and set out a range of options for a more realistic timetable for delivery. In January, my right hon. Friend the Secretary of State for Health and Social Care announced five-year waves of investment, backed by up to £15 billion of investment over consecutive five-year waves, averaging £3 billion a year from 2030. Our programme is a balanced portfolio of hospital schemes at different development stages, being delivered now and into the future. It is the most efficient and cost-effective way of giving our NHS the buildings it needs, while also giving the construction sector the certainty that it needs to deliver.

[Calum Miller (Bicester and Woodstock) (LD)]

The Minister referred to the capital needs of the NHS as a whole. As my hon. Friend the Member for North Shropshire (Helen Morgan) mentioned, that applies to many GP surgeries too. In my constituency, we have rapid growth in population. The populations of Woodstock, Heyford Park and Bicester are struggling, because GPs want to expand, but they cannot access the money to do so. Will the Minister look urgently at releasing more funds through integrated care boards so that future revenue can be provided to allow for the capital investment that would give my constituents an expansion in GP surgeries and take some pressure off our much-pressurised hospitals?

[Stephen Kinnock]

I was very pleased to see the £102 million capital investment in GP primary care. I encourage the hon. Gentleman’s ICB to look very carefully at that fund and to explore the potential that it offers. We are in conversation with colleagues in the Ministry of Housing, Communities and Local Government about ensuring that section 106 processes are working properly, so that when there are new developments, there is proper wraparound in the social infrastructure required to make them sustainable. In the space of just nine short months, we have gone from a charade based on smoke and mirrors to a programme based on serious, systematic delivery.

[Jim Dickson (Dartford) (Lab)]

The Minister is setting out very articulately what this Government are doing to clear up the mess around the hospital provision that this country needs. Does he agree that the announcement by Dartford and Gravesham NHS Trust last week that it will build a new and expanded intensive care unit at Darent Valley hospital is a big step forward for Dartford residents? It badly needs new facilities to cope with waiting lists and get them down and to cope with the rising population of the area.

[Stephen Kinnock]

My hon. Friend is a strong campaigner for his constituents. He is right that that development will be a game changer. It will be important that we keep people’s feet to the fire to deliver on what has been promised. I guarantee that he will have my full support and that of the entire ministerial team.

With your permission, Madam Deputy Speaker, I will now address the Liberal Democrat motion, beginning with its point about the cannibalising of NHS capital budgets to keep day-to-day services running. I am delighted to confirm from this Dispatch Box that this Government have drawn a line under that appalling practice, to which the Conservative party was utterly addicted. The Treasury now has new fiscal rules to prevent that from happening again; capital spending is safe in our hands.

Secondly, on reversing the so-called programme that we inherited on 4 July, I hope I have made it clear that that whole sorry mess was a work of fiction. It is not a question of reversing anything, as the Liberal Democrats say in their motion, because there was nothing to reverse. Instead, we have gone back to the drawing board, and systematically designed and built a completely new programme and a completely new approach.

[Ms Stella Creasy (Walthamstow) (Lab/Co-op)]

As somebody who had to put up with what I think was seven photo opportunities by previous Conservative Ministers—including one who is sat on the Opposition Front Benches now—proclaiming that they were rebuilding Whipps Cross hospital with money that did not exist, it is clear that what needs reversing is the Conservatives’ chutzpah in saying that somehow they are the ones championing change on reforming PFI. Some of us spent years trying to persuade Ministers that we could reform the disgraceful spending on PFI—particularly private finance 2—schemes brought in by the previous Conservative Administration. Under those schemes, some trusts were spending £2 billion a year on repayments—more than they were spending on drugs. That is one way in which we could get some money for the new hospitals, so does my hon. Friend agree that it is this Government, rather than the Opposition, who understand good public finances?

--- Later in debate ---

[Stephen Kinnock]

My hon. Friend, who is a relentless campaigner for her constituents, is right: it was simply government by press release, with so many aspects of policy based on making announcements and unfunded spending commitments. When we came into government, we discovered a £22 billion black hole in the public finances, largely based on promises that had no funding whatsoever attached to them. That is the sort of behaviour that undermines trust in politics.

On the Liberal Democrat proposal to create a taskforce, we have excellent teams working on the programme, and they are getting on with the job. We do not have a second to waste. Setting up a new taskforce would simply mean further delay and distraction through process, rather than a laser focus on delivery.

I know that Members across the House share my outrage at the almost £14 billion backlog maintenance bill facing NHS trusts after years of historic under-investment. I understand that many in the Chamber are concerned about the condition of the health facilities that serve their constituents, and I reassure them that my right hon. Friend the Chancellor has given us the funding to begin immediately reversing the trend of decline that started under the last Government. This financial year, we are backing NHS systems through over £4 billion in operational capital; a lifesaving cash injection of £750 million of targeted estate safety funding, as a vital first step towards fixing our crumbling estate; and £440 million to tackle crumbling RAAC, keeping staff, patients and their families safe. We are empowering systems to manage their capital allocations locally and assign funding to local priorities, ensuring that money is spent as effectively as possible, as soon as possible.

[Andy Slaughter]

My local hospitals were evicted from the new hospital programme when the RAAC schemes came along. There was nothing to delay—there was no money there at all. Does the Minister recognise that some very innovative schemes are now going on locally? We in the Imperial College healthcare trust are partnering with Paddington Life Sciences, Imperial College in South Kensington and White City, and the Hammersmith and Fulham industrial strategy to maximise the available resources so that we can rebuild three world-class hospitals.

[Stephen Kinnock]

My hon. Friend is making some very strong points on behalf of his constituents. We would certainly be very happy to work more with him on some of those innovations. So often, hospitals are anchor institutions—alongside universities—for driving forward innovation, harnessing the power of technology and contributing to the Government’s growth mission. There are huge opportunities there, and I would be happy to explore them further with my hon. Friend.

[Manuela Perteghella (Stratford-on-Avon) (LD)]

Despite overwhelming support, the Coventry and Warwickshire integrated care board has decided to cut all beds at the Ellen Badger hospital in Shipston-on-Stour, an anchor building and community hospital that is at the heart of our town. Does the Minister agree that cutting such vital services is unacceptable, and that community hospitals play an important role in rural areas by providing equality of access to our health services?

[Stephen Kinnock]

The hon. Lady is absolutely right that community hospitals play a vital role, and I share her disappointment with the decisions that are being made. The fact of the matter is that we are in a hole, and we have to dig ourselves out of that hole. It is going to take some time to do that. We are getting the public finances back on an even keel, we are getting our public services back to where they need to be, and we are getting the economy back on a sounder footing. As we make those achievements, I hope that we will be able to reverse some of the decisions that are being made—decisions that are, of course, damaging to the hon. Lady’s community—but we are in a very difficult position, and it will take some time for us to get over that.

[Several hon. Members rose—]

[Stephen Kinnock]

If hon. Members will bear with me, I will make a little bit more progress and then come back to them.

Many Liberal Democrat colleagues have made the argument that with hospitals in the state they are in, it is more important than ever to have a robust social care system in place. As the Minister for Care, I agree with them wholeheartedly, but it is simply not true to portray the Government as sitting on their hands while Baroness Casey gets cracking on her vital work. In fact, we have hit the ground running through a plethora of measures. We have legislated for the first ever fair pay agreement for social care in order to tackle the 130,000 vacancies we see today. We have delivered an extra 7,800 home adaptations through the disabled facilities grant to change the lives of thousands more disabled people for the better. In the Budget, the Chancellor provided the biggest increase in carer’s allowance since the 1970s, worth £2,000 a year to family carers and with an extra £3.7 billion for local authorities.

We are not hanging around on more structural reforms, either. We are introducing new standards to help people who use care, their families and providers to choose the most effective new technology as it comes on the market. We are joining up care and medical records, so that NHS and care staff have the full picture they need to provide the best possible care, and we are training more care workers to perform more health interventions, helping people to stay well and at home. Just two weeks ago, we announced a new qualification for social care staff, training them in artificial intelligence to automate routine tasks and motion sensors to detect falls. We are seizing the opportunities of care tech and harnessing it for the benefit of thousands who draw on care across our country.

[Layla Moran (Oxford West and Abingdon) (LD)]

We are desperate to help the Minister in this endeavour, and look forward to receiving our invitations to the cross-party talks, which have yet to be issued. However, the Health and Social Care Committee heard today from an organisation called Think Ahead, which is the only organisation in the country that trains mental health social care workers. I have just heard that the Department of Health and Social Care is not refunding that organisation. Can the Minister explain why?

[Stephen Kinnock]

I thank the hon. Lady for that intervention. Baroness Casey is working at pace to get the commission up and running, and that will be launched this month. On her point about Think Ahead, the fundamental challenge we had with that programme was its relatively high unit costs. We are aiming to ensure that we deliver value for money for the taxpayer—I am sure that the hon. Lady shares that objective. We have to ensure that we deliver a programme for mental health social care work that delivers not only the best possible outcomes for our communities, but the best possible value for taxpayer money.

A lot has been done in the nine months since the election, but there is a huge amount more to do, and this Government are getting on with the job. Alongside the work I have described, the Government are putting record levels of investment into healthcare, with capital spending rising to £13.6 billion over this year and the next. That includes £1.5 billion for new surgical hubs, diagnostic scanners and beds across the NHS estate, as well as new radiotherapy machines to improve cancer treatment; over £1 billion to tackle RAAC and make inroads into the backlog of critical maintenance, repairs and upgrades across the NHS estate; and over £2 billion to be invested in NHS technology and digital. We are also taking the pressure off our hospitals through care in the community, and I am sure the whole House will welcome the fact that we have recruited 1,500 extra GPs on to the frontline.

[Martin Wrigley (Newton Abbot) (LD)]

Coming back to community hospitals, I came to this House to try to save Teignmouth community hospital, which has been under threat of closure because Torbay, its parent hospital, has such a massive maintenance backlog that it cannot afford to maintain both itself and Teignmouth hospital, so it is shutting down community hospitals. In Devon, we have just three principal hospitals: North Devon, which we understand is under pressure, Torbay, which is under pressure, and Exeter. We need the community hospitals. Will the Minister stop Teignmouth hospital from being shut, so that we can maintain it until it can be rebuilt?

[Stephen Kinnock]

These decisions are the responsibility of ICBs, and the ICB is having to balance a range of pressures, as the hon. Member points out, created largely by the neglect and incompetence of the previous Government. It is now a question of ICBs having to cut their cloth to make the finances work with the limited resources they have. I am afraid that is symptomatic of the mess we found when we took over on 4 July.

[Chris Ward (Brighton Kemptown and Peacehaven) (Lab)]

The Royal Sussex in my constituency is in desperate need of a new cancer centre, and I am delighted that the centre is being added to wave one. I would be even happier if the Minister also added a new accident and emergency department, but we will come back to that another day. Is the reality not that we all want to build these new hospitals, but we all have to be honest with the public about how we will pay for them? The Liberal Democrats never are, and the motion is not. Bringing forward construction dates is a multibillion-pound commitment, but all the motion talks about is creating a taskforce. Is that not fundamentally unserious? This is an incredibly serious issue, and we should put forward proper proposals.

--- Later in debate ---

[Stephen Kinnock]

My hon. Friend is an outstanding champion for his constituents. I noted the point he made about A&E; that was nicely done. He is right in what he says about the motion. The broader point to make is that thanks to the necessary decisions that my right hon. Friend the Chancellor of the Exchequer made in the autumn Budget, we have generated the revenue that we will need to rebuild public services, and in particular our NHS, which was brought to its knees by the previous Government. I cannot claim to be a careful student of the Liberal Democrat manifesto for the last election, but I did notice that the revenue that would be generated by their measures was, I think, about £8.4 billion. Last time I checked, that was significantly lower than the £23 billion raised by the Chancellor’s Budget. The Liberal Democrats should probably get their calculators out and figure out exactly how they will generate this revenue, rather than criticising us constantly for the decisions we have taken.

[Several hon. Members rose—]

[Stephen Kinnock]

I will just make a little more progress, if I may. We are committed to rebuilding our NHS and rebuilding trust in Government. We will never play fast and loose with the public finances, and we will never try to pull the wool over the public’s eyes. Everyone in this House remembers, or should remember, that the last Labour Government cut waiting lists to their lowest level in history, raised patient satisfaction to the highest level in its history, and brought in historic health interventions, such as the smoking ban. What is less remembered is that they also delivered the largest hospital building programme in NHS history. All that meant that when the coalition took over in 2010, it was presented with a strong national health service that was firing on all cylinders. Tragically, that coalition Government and their successor Governments set about weakening and undermining every aspect of our precious NHS, to the extent that by the time this Government took over in July, the NHS was well and truly on its knees. Today, it once again falls to a Labour Government to take the necessary and right decisions for the future.

We have now put the new hospital programme on a sustainable footing. It has a timeline that can be met, and a budget consistent with our fiscal rules. That is how we have turned the programme from empty rhetoric into reality, and in doing so, we have provided the construction industry and its supply chains with vital certainty, while also restoring confidence in public sector procurement. We are on the side of the builders, not the blockers. Our plan is credible, achievable and fully funded. It is a programme grounded in fact, not fiction. I was born in Tredegar, the very same town as Aneurin Bevan, so it is the privilege of a lifetime to be part of a Government who are carrying his torch into the 21st century, building a generation of hospitals that would do Nye proud.

[Madam Deputy Speaker (Judith Cummins)]

I call the shadow Minister.

General Practitioner Recruitment

Stephen Kinnock Excerpts

Tuesday 8th April 2025 Written Statements

[The Minister for Care (Stephen Kinnock)]

General practice sits at the heart of our NHS and is its front door, but it has been neglected for far too long.

We are committed to getting primary care back on its feet and have already taken decisive action to get more GPs onto the frontline. This Government inherited a ludicrous situation where patients could not get a GP appointment, while GPs leaving training could not get a job.

Within weeks of coming into office, we committed to recruiting over 1,000 recently qualified GPs through an £82 million boost to the additional roles reimbursement scheme over 2024-25, as part of an initiative to address GP unemployment and secure the future pipeline of GPs. I am delighted to announce the Government have exceeded this target.

By cutting red tape and investing more in our NHS, we have put an extra 1,503 GPs into general practice to deliver more appointments. See: GPs recruited through the Additional Roles Reimbursement Scheme (ARRS) - NHS England Digital. https://digital.nhs.uk/supplementary-information/2025/arrs-claims-for-gps---to-31-march-2025

The recruitment boost, part of the Government’s plan for change, will help to end the scandal of patients struggling to see a doctor—easing pressure on GPs and cutting waiting times. Alongside changes to the GP contract for 2025-26, these additional GPs will help end the 8 am scramble for appointments, which so many patients currently endure every day.

Previously, primary care networks were limited in how they could use their funding. We have changed that. Now they can hire recently qualified doctors through the additional roles reimbursement scheme—a practical solution that is boosting GP numbers across the country. For 2025-26 we have gone further, delivering more flexibilities to the scheme to allow local systems to respond better to local workforce needs. GPs will be central to our 10-year health plan and shifting healthcare from hospitals to the community.

In February we reached agreement with the British Medical Association on a new GP contract for the first time in four years. We are investing an additional £889 million in general practice to fix the front door of the NHS. That comes alongside reforms to improve access, incentivise greater continuity of care and streamline targets to focus on preventing the biggest killers. And at the autumn Budget, the Chancellor announced £100 million of capital for GP estate upgrades over the next financial year, the biggest central GP capital investment since 2019-20.

Thanks to these decisions, the Government have already delivered over 2 million additional elective appointments since July, meeting their target seven months early, and brought the referral to treatment waiting list down by 193,000. But we are not complacent, and we know the job is not done. We are determined to go further and faster to deliver more appointments, faster treatment, and an NHS that the British public deserve as part of our plan for change.

[HCWS586]