Mental Health Bill [ Lords ] (Ninth sitting)

Danny Chambers Excerpts

Committee stage
Tuesday 24th June 2025 Public Bill Committees

[Zöe Franklin]

I thank the Minister for outlining the PCREF and the focus that it will have in addressing these issues. I was particularly interested in the explanation of the iterative approach that it will allow. I also thank the hon. Member for Southend West and Leigh for his insights into the issue. I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 2

Mental Health Crisis Breathing Space

“(1) Any person detained under sections 3, 37, 41 or 47 of the Mental Health Act 1983 must be offered support from the mental health crisis breathing space debt respite scheme.”—(Dr Chambers.)

This new clause ensures that MHCBS, a debt respite scheme, is offered and available to patients detained under sections 3, 37, 41 and 47 of the Mental Health Act 1983.

Brought up, and read the First time.

[Dr Danny Chambers (Winchester) (LD)]

I beg to move, That the clause be read a Second time.

The new clause relates to the mental health crisis breathing space debt respite scheme, and would allow it to be

“offered and available to patients detained under sections 3, 37, 41 and 47 of the Mental Health Act 1983.”

The mental health crisis breathing space mechanism is another vital tool that can protect people in a mental health crisis from the impacts of problem debt, by pausing enforcement action, contacting creditors and freezing interest and charges on any debts.

However, the number of people benefitting from an MHCBS are significantly below its potential, largely because both patients and healthcare professionals do not know about it. Ensuring that everyone detained under the longer provisions of the Act would automatically be offered access to the scheme would ensure that many more people could benefit from it. We have discussed in previous sittings the impact of debt on mental health, and the work of Winchester Citizens Advice. I am really pleased to say that this week, I presented them with a huge award for best social enterprise at the Hampshire business awards, so my congratulations go to them.

[Stephen Kinnock]

I am grateful to the hon. Member for Winchester for bringing this issue before the Committee. The Government’s breathing space programme plays an important role in protecting people experiencing problem debt. We recognise that that can be particularly critical for people whose mental illness is worsened or even triggered by financial problems.

Let me reassure the hon. Gentleman that people under the sections identified by his new clause are already eligible for breathing space. In fact, eligibility covers all individuals detained in hospital for assessment or treatment under the Mental Health Act, as well as those receiving crisis treatment in a community setting from a specialist mental health service. Furthermore, NHS England guidance already sets out that financial support, including referral to breathing space, should be offered to patients receiving acute in-patient mental health care, whether detained or voluntary patients. We will make explicit the need for staff to offer proactively that support in the Mental Health Act code of practice. For those reasons, I ask the hon. Member for Winchester to withdraw his new clause.

[Dr Chambers]

I thank the Minister for his comments. I am concerned about the lack of knowledge among patients and healthcare professionals. We cannot see any downside to making this an automatic right, so we will press new clause 2 to a vote.

Question put, That the clause be read a Second time.

--- Later in debate ---

[Zöe Franklin]

I thank the Minister for his comments. In particular, I was interested to hear about the mental health centre pilot schemes. I look forward to their further roll-out. They will be crucial in addressing the issues that we sought to address in the new clause. I was also very pleased to hear about the focus on a meaningful partnership between local government, national Government and mental health providers. On that basis, I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 7

Funding and reporting

“(1) For each financial year until all sections of this Act have come into force, of the total health service expenditure by the bodies (taken together) in subsection (2), the proportion which relates to mental health spending—

(a) under the Mental Health Act 1983, and

(b) under this Act or which, in future, would be made under provision inserted into the Mental Health Act 1983 by this Act, (taken together) must not decrease.

(2) The bodies are the Department of Health and Social Care, NHS England and integrated care boards.”—(Dr Chambers.)

This new clause would require that mental health spending as a proportion of health service expenditure must not decrease in the implementation period of the Act.

Brought up, and read the First time.

[Dr Chambers]

I beg to move, That the clause be read a Second time.

We are aware from the Darzi report that mental health cases account for about 20% of the NHS burden, and currently receive about 10% of the funding. Our mental health services urgently need investment. Children at risk of self-harm, anorexia and suicide often wait months to be seen. I keep thinking about a few people I spoke to in Winchester who have teenage daughters with anorexia. They have been told that their daughters have to reach a lower BMI before they hit the threshold for treatment. That is horrific for the individuals, and we know that their anorexia will be more difficult to treat, will require more intensive, longer treatment, and will cost the NHS more in resources and finances.

Many people cannot access the care in the community that they need. In a context in which suicide and mental ill health is on the rise, it is therefore disappointing to us that the Government have removed key NHS targets on mental health, such as physical health checks for those with mental disorders. Supporting those with mental health conditions is a fundamental pillar of the Government’s welfare reforms and economic agenda, but we know there were about 1 million people waiting in 2024 for mental health services. That is why we need to ensure that the spend on mental health care does not decrease and that, if anything, it increases.

[Anna Dixon (Shipley) (Lab)]

As a member of the Public Accounts Committee, I carefully scrutinise the annual accounts of the Department of Health and Social Care. We have been urging that exactly how the breakdown of expenditure relates to issues is made more transparent within those accounts, such as how much is spent on mental health. Does the hon. Gentleman agree that there are other ways in which we can scrutinise and hold the Department to account for its spend on mental health?

[Dr Chambers]

That sounds very sensible.

[Stephen Kinnock]

I thank the hon. Member for Winchester for his new clause. This was raised in the other place and there are several issues with it that have not yet been fully addressed.

First, the new clause would apply only to spend under the Mental Health Act. The mental health system, and its accounting, is not structured based on the legal framework that patients are subject to. A single ward may contain a mix of patients under the Mental Health Act and informal patients who would not usually be considered to be under the Act. Community services will support some patients on community treatment orders, who are therefore subject to the Mental Health Act, but also many who are not and have never been subject to the Act. It would not be feasible or desirable to try to restructure accounting and reporting based on which patients are subject to the Act and which are not.

Secondly, the Government believe in prevention. We want to see better mental health outcomes, with more people cared for in the community so that the need for use of the Act is reduced. Over time, we want to see a shift in spend into preventive community services, which should in turn lead to a fall in the need for the use of the Mental Health Act. Few would disagree with that general aim, but the new clause would prevent that. By requiring share of spend under the Act to increase or remain the same, we are necessarily limiting the share of spend that could instead go towards preventing people from needing to use the Act in the first place.

We will need to invest to deliver these reforms, as the impact assessment makes clear; however, the new clause is flawed and not the right mechanism to achieve the necessary investment. Parliament already has the power to scrutinise departmental spend via the estimates process. We are required to report on the share of spend on mental health under the National Health Service Act 2006. This is sufficient to hold the Government to account. I therefore hope that the hon. Member for Winchester feels able to withdraw the motion.

[Dr Chambers]

I thank the Minister for his comments. If there is a duty to report the spend on mental health as a share of the whole budget, then I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 8

Mental Health Commissioner

“After section 142B of the Mental Health Act 1983, insert—

‘Mental Health Commissioner

142C Independent Mental Health Commissioner: establishment

(1) There is to be an office known as the Office of the Mental Health Commissioner.

(2) The Office in subsection (1) must be established by the Secretary of State three months after the day on which the Mental Health Act 2025 is passed.

(3) The Office of the Mental Health Commissioner will be led by an individual appointed by the Secretary of State titled the “Independent Mental Health Commissioner”.

(4) The role in subsection (3) is referred to as the “Mental Health Commissioner”.

(5) The Mental Health Commissioner may appoint staff to the Office of the Mental Health Commissioner they consider necessary for assisting in the exercise of their functions in section 142D.

142D Functions of the Commissioner

(1) The Mental Health Commissioner is responsible for overseeing the implementation and operability of functions discharged by relevant bodies and persons under the provisions of this Act, the Mental Health Act 1983, and the Mental Capacity Act 2025 particularly regarding the provision of treatment, care, and detention of people with a mental disorder.

(2) The Mental Health Commissioner must publish an annual report on the use of functions discharged under this Act, which must assess—

(a) the quality of mental health care treatment provided by relevant services;

(b) the accessibility of mental health care treatment services;

(c) the relationship between mental health and the criminal justice system;

(d) inequalities of mental health care provision regarding protected characteristics under the Equality Act 2010;

(e) the use and effectiveness of detention measures under this Act, including but not limited to Community Treatment Orders, for the purposes of therapeutic benefit outlined in section 1(2B);

(f) challenges surrounding stigma of mental health conditions;

(g) the accessibility of advice and support to mental health service users, their families and carers on their legal rights;

(h) other issues deemed appropriate by the Mental Health Commissioner.

(3) In fulfilling their duties under subsection (1), the Mental Health Commissioner may review, and monitor the operation of, arrangements falling within subsection (1), (2) and (3) for the purpose of ascertaining whether, and to what extent, the arrangements are effective in promoting the principles in section 118(2B) of this Act.

(4) Subject to any directions from the Secretary of State, the Commissioner may take action necessary or expedient in connection for the purposes of their functions.

(5) This may include—

(a) collaborating with health services, public authorities, charitable organisations, and other relevant entities, including NHS bodies, the Care Quality Commission, and the Parliamentary and Health Service Ombudsman;

(b) ensuring enforcement authorities and public bodies under the Mental Health Act 1983 have the necessary capacity and resources to adequately discharge duties under the Mental Health Act 1983 and this Act.

142E Appointment, Tenure, and Remuneration of the Mental Health Commissioner

(1) The Secretary of State may by regulation make provision for the appointment, tenure, removal, and general terms of appointment of the Mental Health Commissioner.

(2) The Secretary of State may also by regulation determine the Commissioner’s remuneration, allowances, and pension entitlements.

142F Examination of cases

(1) The Secretary of State may, by regulations, make provision for the examination by the Mental Health Commissioner of the cases of those who are detained under this Act receiving treatment by authorised mental health care providers.

(2) The Secretary of State may, by regulations, provide for the Office of the Mental Health Commissioner to access and examine relevant data on mental health treatment provision held by NHS England and any other authorities the Secretary of State considers appropriate.

142G Regulations

A statutory instrument containing regulations under sections 142E and 142F may not be made unless a draft of the instrument has been laid before and approved by a resolution of each House of Parliament.’”—(Dr Chambers.)

This new clause establishes the office of the Mental Health Commissioner and makes provisions for relevant duties and responsibilities.

Brought up, and read the First time.

[Dr Chambers]

I beg to move, That the clause be read a Second time.

New clause 8 would establish the office of a mental health commissioner and makes provision for relevant duties and responsibilities. The commissioner would have a strategic, cross-government focus, working to promote mental health and tackle inequalities, and would be a powerful advocate for the rights and wellbeing of those living with mental health problems, who would finally have a voice at the top table. The commissioner would also play a vital role in the public sphere, tackling stigma and discrimination, and championing policies that support good mental health across society. The commissioner would have an independence to comment on the implementation of the reform of the Mental Health Act and any subsequent changes or issues that arise. International evidence highlights the impact that such a role can have in improving communities.

I keep coming back to a conversation I had in my office in Winchester with a psychiatrist whose wife also worked in the medical profession. He said that they were struggling to navigate the mental health system to get the healthcare that their child desperately needed. He made a really good point: if they, with their knowledge, expertise and experience, could not navigate the mental health system, what hope does anyone else have? That is why it is important to have someone with an overview who can advocate for patients, and the patient journey in general, to ensure that the process is streamlined and that people have the information they need to access the care they are entitled to.

[Stephen Kinnock]

I am grateful to the hon. Member for Winchester for bringing this issue, which was also debated extensively in the other place, before the Committee. Our view has not changed: the functions of the proposed commissioner clearly duplicate existing responsibilities of other organisations, most notably the Care Quality Commission. The Children’s Commissioner has expressed concerns that introducing a new mental health commissioner risks interfering with her own role in relation to children and young people’s mental health.

We recognise that the patient quality and oversight landscape is not working effectively, but I strongly doubt that inserting another body whose role overlaps with those already in place would help to address that issue. The landscape is already cluttered and fragmented. That is why last year we asked Dr Penny Dash to assess whether the current range and combination of organisations deliver effective leadership, listening and regulation for the health and care systems in relation to patient and user safety, or whether a new delivery model is needed. We will shortly see the results of her much-anticipated review.

We appreciate that our argument that the proposed mental health commissioner’s role would be duplicative of the CQC has previously been met with concerns about the effectiveness of that organisation. I reiterate that two major independent reviews into the wider role of the Care Quality Commission have reported under this Government, the recommendations from which the CQC has accepted in full. While we are confident in the progress that the CQC is making, we recognise that those reviews did not closely inspect the CQC’s statutory role and responsibilities in relation to monitoring the use of the Mental Health Act.

Therefore, in response to an amendment tabled in the other House, we committed to report on the CQC’s monitoring functions under the Act in the first of the Government’s annual reports on the implementation of the Bill. That will include reflections from the new chief inspector of mental health, Dr Arun Chopra, on the CQC’s statutory functions and its role as a key partner in delivering the reforms. I am looking forward to meeting Dr Arun Chopra very shortly in his new role.

Lastly, creating a mental health commissioner with a supporting office would require significant resources that we simply cannot justify. The original Mental Health Act commission was brought within the CQC to reduce Government spending and realise the benefits of aligning the CQC’s functions under the Mental Health Act with its functions under the Health and Social Care Act 2012, and to give it new powers to monitor via potential enforcement. Bearing in mind the radical reforms that we are making to the national health system to rid it of duplication, inefficiency and waste, we believe that now is not the time to reverse course on these matters.

[Stephen Kinnock]

The Dash review is looking at the landscape regarding all the different institutions and organisations, including the PHSO and the CQC, to map out how they interact with each other. Our view is that there is a lot of confusion and a lack of clarity, but we await the outcome of the review. I can confirm, however, that Penny Dash is looking at those matters. For those reasons, I ask the hon. Member for Winchester to withdraw the motion.

[Dr Chambers]

I thank the Minister for his reassurances. The issue is that the ability of the CQC to oversee implementation is limited, and it does not have a policy advisory function, which is something that a commissioner could do. Although we understand the Minister’s concerns about the office of a commissioner, the issue is important enough that we put it in our manifesto. We stood on a manifesto commitment to improve mental health access and streamline services via a commissioner. For that reason, we will press new clause 8 to a vote.

--- Later in debate ---

Brought up, and read the First time.

[Dr Chambers]

I beg to move, That the clause be read a Second time.

The new clause would require a review of the quality of accommodation for people detained or admitted to hospital under the Mental Health Act, and require the Secretary of State to publish a strategy to implement the recommendations of that review.

Lord Darzi found that many people are being treated in Victorian-era asylums. Many mental health hospitals are crumbling and the wards are not fit for purpose. Both the Care Quality Commission and the independent review of the Mental Health Act confirmed that many mental health wards are unsafe for staff and patients, and provide poor-quality care in unsuitable buildings. One CQC inspection report found that the seclusion rooms had low ceilings that contained electrical wires overhead, creating a safety hazard, and that staff could not see people clearly through the window panels because they were cloudy.

Is the Minister confident that the mental health estate is adequate to fulfil the Bill’s objectives? In particular, is the Minister satisfied that the mental health estate is sufficiently safe, in structural terms, and designed appropriately for those using it? For example, is it free of ligature points, and does it have sufficient in-patient capacity for children and young people?

--- Later in debate ---

[Stephen Kinnock]

I congratulate Lynfield Mount on the important work it is doing—and I congratulate my hon. Friend on that extremely strategic intervention. Yes, I would of course be more than happy to meet her, and we will make sure to get that in the diary.

The Government have allocated £750 million for estates safety in 2025-26, to address high-priority estate issues across the NHS systems, including in the mental health estate. The CQC will continue to monitor the impact of the reforms through its existing monitoring and reporting duties. A further statutory review is therefore not required, so I ask the hon. Member for Winchester to withdraw his new clause.

[Dr Chambers]

I thank the Minister for his reassurances, especially on the ongoing reviews. I will withdraw the new clause, but I make the obvious point that this is about not only the health and safety of the staff and patients, but the public perception of mental health, and the stigma surrounding it if we are treating people in Victorian-era asylums. I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 15

Review of impact of this Act on detention

“(1) The Secretary of State must, within a period of 12 months following the day on which this Act is passed, commission an independent review into the impact of relevant provisions on reducing the number of people detained under Part 2 of the Mental Health Act 1983.

(2) In subsection (1), ‘relevant provisions’ include—

(a) sections 4, 5 and 6,

(b) section 8,

(c) section 21, and

(d) sections 46 and 47.

(3) The Secretary of State must, within 12 months of the publication of the review in subsection (1), publish a strategy to implement the recommendations of that review.”—(Zöe Franklin.)

This new clause would require the Secretary of State to commission a review into the impact of relevant provisions in the Act in reducing the number of people detained, in particular the provisions relating to people with autism or a learning disability, on grounds for detention and for community treatment orders, medical treatment, care and treatment plans, and on after-care, and to implement any recommendations within 12 months of the publication of the review.

Brought up, and read the First time.

[Zöe Franklin]

I beg to move, That the clause be read a Second time.

--- Later in debate ---

[Zöe Franklin]

I thank the Minister for his comments; it was really helpful to hear about how he sees the timings in our new clause fitting with the ongoing work to implement the Mental Health Act and the commissioning of the independent review. I am concerned about his comment that the work will be dependent on funding. I hope that the funding for the important independent review will be ensured. However, on the basis of the Minister’s comments, I am happy not to press any of the new clauses. I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 16

Transfer of patients: out of area placements

“(1) The Mental Health Act 1983 is amended as follows.

(2) After section 19 (transfer of patients), insert—

‘19A Transfer of patients: out of area placements

(1) The Secretary of State must reduce to zero, within five years of the passage of the Mental Health Act 2025, the number of patients transferred to a hospital outside of the area in which the patient is ordinarily resident.

(2) The Secretary of State must publish, within six months of the passage of the Mental Health Act 2025, a report to outline how the duty under this section will be met, including how provision for treatment under this Act will be increased.’”—(Dr Chambers.)

This new clause would require the transfer of patients to hospitals outside of their area to be reduced to zero within 5 years, and for the Secretary of State to produce a report on how this will be achieved.

Brought up, and read the First time.

[Dr Chambers]

I beg to move, That the clause be read a Second time.

The new clause would require the number of patients transferred to hospitals outside their area to be reduced to zero within five years, and the Secretary of State would have to produce a report on how this would be achieved. We should not underestimate the harm and distress caused to patients and their families when they are allocated an out-of-area mental health placement. At the end of March 2024, there were 900 active out-of-area placements in England, of which 89% were deemed inappropriate.

Patients must be treated in a centre close to their home and family, and that can be achieved by increasing capacity and co-ordination between services. The new clause calls on the Secretary of State to publish guidance within six months of the Bill’s passage, setting out what processes and funding will be available for that purpose. Vulnerable people deserve to be treated near to their families and home, and the new clause would ensure that happens.

[Dr Shastri-Hurst]

The new clause is underpinned by noble intentions, but does the hon. Gentleman believe that patients would be better served if such a process were in guidelines rather than in the Bill? That would ensure that it is deliverable.

[Dr Chambers]

I welcome the hon. Gentleman’s comments. That is a sensible and insightful point, and I will take on board the Minister’s response too.

[Stephen Kinnock]

We believe that everyone should receive treatment for mental illness as close to home as possible, but there are circumstances in which placement on a ward outside the area where a person usually resides is clinically necessary. Some specialised services—for example, treatment for an eating disorder—may require a person to be transferred to a placement away from home, and we wish to retain that option.

However, we know that too many patients are placed outside their local area, which is why we have set aside £75 million in capital funding for local systems to invest in reducing such placements for all patients. We are also trialling new models of care, including six pilots of 24/7 neighbourhood mental health centres, with the aim of treating more people in their local communities. Similar international models have achieved significant reductions in hospitalisation.

NHS England is developing a new model for specialised children’s and young people’s mental health services that aims to ensure that children and young people are treated in the least restrictive environment close to their family and home. I hope that that satisfies the hon. Gentleman and that he will withdraw the new clause.

[Dr Chambers]

I thank the Minister for his comments. He recognises the issue and is taking steps to address it, so I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 19

Report and Guidance: Improving Outcomes for LGBT Patients

“(1) The Secretary of State must, within 12 months of the day on which this Act is passed, prepare and lay before Parliament a report on the mental health outcomes of patients who are treated under the Mental Health Act 1983 and who identify as lesbian, gay, bisexual, or transgender (LGBT).

(2) The report under subsection (1) must include an assessment of—

(a) any differences between non-LGBT patients and LGBT patients in—

(i) the extent of the use of detention measures under the Mental Health Act 1983; and

(ii) treatment outcomes following detention, and

(b) the availability and accessibility of ‘culturally competent’ mental health treatment under the 1983 Act for LGBT patients.

(3) Following publication of the report under subsection (1), the Secretary of State must publish guidance for responsible bodies and individuals working with patients under the Mental Health Act 1983, including but not limited to those working in—

(a) mental health hospitals;

(b) places of safety;

(c) crisis accommodation; and

(d) relevant community mental health services.

(4) The guidance under subsection (3) must include—

(a) provisions about updated training standards for staff regarding the specific mental health needs and experiences of LGBT individuals, including training on non-discriminatory practice and inclusive communication approaches;

(b) steps to improve safety for LGBT patients in relevant mental health settings, with particular regard to addressing discrimination and harassment; and

(c) a definition of ‘cultural competent mental health treatment’ for the purposes of subsection (2).

(5) Responsible bodies and individuals working with patients under the Mental Health Act 1983 must have regard to guidance published under subsection (3).

(6) In preparing the report under subsection (1) and the guidance under subsection (3), the Secretary of State must consult—

(a) patients with a mental disorder who identify as LGBT;

(b) the families or carers of patients with a mental disorder who identify as LGBT;

(c) relevant professional bodies;

(d) integrated care boards;

(e) local authorities;

(f) providers of mental health treatment; and

(g) such other persons as the Secretary of State considers appropriate.

(7) The Secretary of State must update the guidance under subsection (3) at regular intervals, and no less frequently than every three years.”—(Zöe Franklin.)

This new clause would require the Secretary of State to report on mental health outcomes and disparities for LGBT patients in treatment under the Mental Health Act 1983 and publish guidance covering training and safety for this specific group.

Brought up, and read the First time.

[Zöe Franklin]

I beg to move, That the clause be read a Second time.

New clause 19 would require the Secretary of State to report on mental health outcomes for LGBT patients detained or treated under the Mental Health Act 1983, and to publish clear guidance to improve staff training, patient safety and inclusive care for that group. We all deserve appropriate support when experiencing poor mental health, and that support must be fair and respectful, no matter whether the patient identifies as lesbian, gay, bisexual or transgender. Members of the LGBT community should have confidence that they will be treated with dignity and should not face unequal or inappropriate treatment because of who they are. Unfortunately, we know that that is not always the reality.

Stonewall’s “LGBT in Britain—Health” report revealed deeply concerning findings: almost one in four LGBT individuals had heard discriminatory or negative remarks about them from healthcare staff, one in eight had experienced unequal treatment, one in 10 had been outed without their consent in healthcare settings, and one in seven had avoided treatment altogether for fear of discrimination. That is unacceptable anywhere in our health system, but it is especially alarming in mental health settings, where patients are already in distress and often detained, and may not be in a position to advocate for themselves.

--- Later in debate ---

[Zöe Franklin]

I thank the Minister for his comments, for the recognition that individuals in the LGBT community clearly have concerns about the way that mental health care is provided, and for the commitment to addressing those. I hope that at some point he will be able to advise on the timeline for looking to resolve the issue of the unreliability of data; it is crucial that we have accurate data in order to ensure good outcomes and improvements in mental health care. However, in the light of the Minister’s comments and commitment on the issue, we will not press the new clause, although I look forward to observing closely, as this Bill continues through the House, how it will address the current inequalities for the LGBT+ community. I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 22

National strategy on mental health units

“(1) The Mental Health Act 1983 is amended as follows.

(2) In Part VIII (Miscellaneous Functions of Local Authorities and the Secretary of State), after section 118, insert—

‘118A National strategy on mental health units

(1) The Secretary of State must, within 12 months of the passing of the Mental Health Act 2025, publish a national strategy to set out how the Government will ensure that all relevant mental health units meet or exceed ‘good’ safety standards as assessed by the Care Quality Commission (CQC).

(2) A strategy issued under this section must address the following matters—

(a) recruitment, retention and training of mental health staff,

(b) patient-to-staff ratios, and

(c) safe staffing levels during crises and night shifts.

(3) Following publication of the strategy, a report on implementation progress must be laid before Parliament annually.

(4) For the purposes of this section, a ‘relevant mental health unit’ is a facility used for treatment under this Act.”—(Dr Chambers.)

This new clause would require the Secretary of State to publish a strategy, followed by an annual progress report, on how the Government will ensure that all mental health units used for treatment under the Mental Health Act 1983 are rated “good” or above by the CQC.

Brought up, and read the First time.

[Dr Chambers]

I beg to move, That the clause be read a Second time.

New clause 22 is quite similar to new clause 14, on the state of in-patient facilities. It would require the Secretary of State to publish a national strategy to ensure that all mental health units meet or exceed a good rating for safety, as assessed by the Care Quality Commission. It would also mandate annual progress reports to Parliament. We all know that far too many mental health settings fall below acceptable standards. The CQC has repeatedly flagged serious failings in in-patient mental health services, including unsafe staffing levels, poor physical conditions and risks of harm to patients. These are not isolated issues but persistent and systemic problems.

The new clause calls for a proper, co-ordinated response. It would require the Government to set out how they will address staffing shortages, improve recruitment and retention, and ensure safe staffing levels, particularly at night and during crisis periods, when the risk is often highest. It is not enough to rely on reactive inspections or piecemeal initiatives; we need a national strategy backed by data, accountability and regular reporting to the House. Too many vulnerable people are currently treated in mental health units that are overstretched, understaffed and, in some cases, unsafe. The new clause would begin to change that by setting clear expectations on monitoring progress and holding the Government to account. I commend the new clause to the Committee.

[Stephen Kinnock]

We all agree that patient safety is paramount. Anyone who receives treatment in an in-patient mental health facility deserves safe and high-quality care. There have been too many incidents of poor-quality and unsafe care resulting in trauma and sometimes tragedy.

Although we agree with the principle of the new clause, the overriding objective duplicates NHS England’s in-patient quality transformation programme, a national initiative aimed at improving the quality and safety of care in in-patient mental health, learning disability and autism services. The programme has been developed with service users, families and staff, and sets out a long-term vision for improving in-patient services.

The new clause focuses specifically on staffing arrangements. Although we of course agree that the workforce is an important consideration in ensuring safe in-patient care, it is not the only factor. By comparison, NHS England’s in-patient quality transformation programme takes a more comprehensive view of the factors that contribute to safe and effective in-patient care. For example, it includes support for the cultural changes required to create and sustain an in-patient environment in which patients and staff can flourish. The programme’s progress will be measured using a range of data and evidence, for example on patient and staff experience.

We know that more needs to be done to support the providers of mental health care to improve the quality of their services in a sustainable way, which is why we are putting in place a robust package of reforms to help to improve performance. There will be no more rewards for failing; instead, ICBs and providers that do well will be rewarded with greater freedoms, while the most challenged will receive focused intervention. For those reasons, I ask the hon. Gentleman to withdraw the new clause.

[Dr Chambers]

I thank the Minister for his comments and reassurances. I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 24

Application in respect of patient already on hospital grounds

“(1) The Mental Health Act 1983 is amended as follows.

(2) In section 5(1) (Application in respect of a patient already in hospital), after ‘or,’ insert ‘that the patient has attended a hospital or been brought to a hospital to seek help or admission as a patient or,’”.—(Dr Shastri-Hurst.)

This new clause would allow people who have attended or been brought to a hospital to seek help or admission as a patient to pursue an application for admission under the Mental Health Act.

Brought up, and read the First time.

Question put, That the clause be read a Second time.

Mental Health Bill [ Lords ] (Seventh sitting)

Danny Chambers Excerpts

Committee stage
Thursday 19th June 2025 Public Bill Committees

[Jen Craft]

I agree on the notion of a right; where we vary is that I think that the Bill as written, and Government amendments 32 and 33, enshrine the notion of a right without it having to be spelled out as such. Local variation includes localised populations, such as those from marginalised communities. We might consider different translations of support that is available. That will not be the case across the board—it will vary from area to area. This does not remove people’s ability to make an advance choice document; it simply gives local commissioners the ability to determine what is most appropriate for their area, how that support should look and how it will be targeted.

Without getting ahead of the Minister, I hope that he will say what guidance on best practice for local commissioners and ICBs will be set out, particularly in relation to those with learning disabilities and autism. We have spoken about easy-read documents, for example, which should probably be made available, as should advice on how commissioners can best make sure that all those who might benefit from an advance choice document are meaningfully engaged and informed of their right and ability to do so.

The Minister has agreed previously to make sure that he works with disabled people’s organisations, including those run by and for people with learning disabilities and autism, on bringing forward a code of practice on the Mental Health Bill. Input on patient experience into how best to contact and meaningfully engage people who would benefit from an advance choice document would be particularly beneficial.

Very briefly, the aim of Liberal Democrat amendment 18 is to include consideration of financial circumstances in an advance choice document. I have looked into this—in my opinion, it is outside the scope of what an advance choice document does. An advance choice document sets out how an individual would wish to be treated if they became so unwell that they were unable to make those decisions for themselves. I am not fully sure how one’s financial circumstances fit into how one would be treated relative to detention or, potentially, in a community-based setting. I understand that financial circumstances have an impact on people’s mental health—we have talked about that in debates on other clauses—but they do not necessarily have a place in this specific part of the Bill.

I encourage the Committee to support clause 45 and to adopt Government amendments 32 and 33. This is, once again, a big step forward in ensuring that those with serious mental illnesses are able to input into their care and treatment in a real and meaningful way.

[Dr Danny Chambers (Winchester) (LD)]

It is a pleasure to serve under your chairship, Sir Desmond. In the previous sitting of the Committee, I spoke extensively about the close link between money worries and poor mental health. That link is why I have sought, through amendment 18, to ensure that advance choice documents include a specific section on money. This would give people greater choice and control over their finances when they are in crisis. Without that provision, financial worries could be an even greater hurdle to recovery.

We have talked a lot about financial problems being a major contributor to mental health crises, and they can make it much more difficult to recover from one. I will not go through all the details again, but the numbers show how significant the problem is. Last year, nearly 21,000 people in England alone were struggling with problem debt while in hospital for their mental health, so it is not a small cohort of patients for whom this is a specific issue. Ensuring that people’s finances are taken into consideration when they are in a mental health crisis will prevent future illness, reduce waiting lists and help people to return to daily life more smoothly, including to work. If we ignore it, that will end up costing the NHS more in time and resources.

Mental Health Bill [ Lords ] (Sixth sitting)

Danny Chambers Excerpts

Committee stage
Tuesday 17th June 2025 Public Bill Committees

This is consequential on amendment 40.

[Dr Danny Chambers (Winchester) (LD)]

I beg to move amendment 49, in schedule 2, page 87, line 13, at end insert—

“(18A) In section 130B (arrangements in relation to independent mental advocates: England), after subsection (3)(d), insert—

‘(e) support the patient’s carer and family members to prepare for the patient’s discharge from hospital treatment, and

(f) support the patient to access help with social and financial stressors that might otherwise increase their likelihood of future detention.’”

This amendment extends the support offered by Mental Health advocates to cover social and financial stressors and support for family carers and other members of the household when the patient is discharged.

It is an honour to serve under your chairmanship, Mrs Harris. I jumped the gun this morning, so I have already spoken in detail about the amazing initiative at Melbury Lodge with Winchester Citizens Advice. I will not bore the Committee with the details again, except to say that it is a brilliant example not only of delivering really good care for patients, but of a really good cost-effective intervention for the taxpayer. If it is not appropriate for it to be set out in secondary or primary legislation, will the Minister consider a meeting with me, Melbury Lodge and Winchester Citizens Advice to discuss how this type of initiative could be rolled out across the country?

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

It is a pleasure to serve under your chairmanship, Mrs Harris. I rise to make some brief comments on amendment 49.

I am sympathetic to aims of the hon. Member for Winchester in tabling the amendment. A patient who is being discharged from hospital may indeed require specific, targeted support. The overall success of their treatment and continued recovery can be greatly enhanced where the right structures are in place to support them in the community. The amendment rightly draws attention to social and financial stressors that may affect an individual at the point of discharge and in the weeks and months that follow. We all recognise that there is a pressing need for a more joined-up approach between in-patient services and community provision. Without that, we risk patients falling through the cracks and suffering unnecessary and distressing re-admissions. Better discharge planning must be at the heart of our efforts.

I have some concerns, however. Although I acknowledge the good intentions behind the amendment, it risks expanding the remit of independent mental health advocates beyond what might be appropriate. There is a delicate balance, but an important distinction, between advocacy and care co-ordination. Independent mental health advocates play a vital role, and it is essential that their independence and clarity of purpose be preserved. If we are not careful, we risk blurring that boundary. In doing so, we may undermine the very effectiveness of the independent mental health advocate in fulfilling their primary function.

The role of an IMHA is to support patients in understanding and exercising their rights under the Mental Health Act. They may already be involved in supporting an individual to prepare for discharge, including by contributing to plans for ongoing care and support. The amendment would significantly increase the breadth of that role and might shift the focus away from the core purpose of advocacy.

--- Later in debate ---

[Stephen Kinnock]

I am grateful to the hon. Member for Winchester for bringing this issue before the Committee. The intention of his amendment is to extend the support offered by independent mental health advocates

“to cover social and financial stressors and support for family carers and other members of the household when the patient is discharged.”

It would amend paragraph 18 of schedule 2, which deals with amendments relating to nominated persons. It should more properly be inserted into schedule 3, which deals with independent mental health advocates.

The Bill will already extend the support that advocates can provide to help patients to be involved in decisions about their care and treatment, to be able to make a complaint and to be provided with information about other available services. Those other services could include support following discharge from statutory or voluntary organisations, which may cover social and financial issues, and help to support carers. Those organisations would be better placed to support patients with these specific needs, rather than independent mental health advocates, whose skillset is specific to supporting patients to understand their rights under the Mental Health Act and participate in decisions about their care and treatment. We will consult on guidance in the code of practice to help independent mental health advocates to understand their extended role.

In addition to policy regarding independent mental health advocacy, advance choice documents give individuals the chance to give instructions about practical aspects of their life. Examples of such aspects include domestic, financial or caring responsibilities, such as children or pets. This provision allows the individual to be looked after when unwell and aims to ease additional anxieties. For those reasons, I ask the hon. Member for Winchester to withdraw his amendment.

[Dr Chambers]

I appreciate the valid points that hon. Members have made. The point about running a pilot was a sensible suggestion. We have had something that could be viewed as a pilot in Winchester for two years. We know that it works well, and every £1 spent on it saves £14.08. If I have suggested this amendment in the wrong part of the Bill through my naivety and inexperience, or if mental health advocates are not the right people to deliver a solution that we know works, may I ask the Minister whether there is a more appropriate part of the Bill in which to include it or another way to implement this proven system, such as by amending a different Bill, before I decide whether to press the amendment to a vote?

[Stephen Kinnock]

I thank the hon. Gentleman for that question. Fundamentally, our view is that the role that he is proposing is not the right one for an independent mental health advocate. The role of an independent mental health advocate is to work with the patient around their legal rights, rather than to deal with some of the more practical issues that he is talking about here. Our sense is that there are both statutory and voluntary organisations who are better placed to carry out that work. I do not think that a pilot would work with IMHAs, because by definition that is not the right role for IMHAs.

[Dr Chambers]

In that case, can we have a discussion outside the Committee about how to do this?

[The Chair]

Order. Does the hon. Gentleman wish to press the amendment?

[Dr Chambers]

indicated assent.

Amendment 49 negatived.

Schedule 2, as amended, agreed to.

Clauses 25 to 28 ordered to stand part of the Bill.

Clause 29

Detention periods

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

[Stephen Kinnock]

Currently, under the Mental Health Act, a person detained for treatment can be kept in hospital initially for six months before the responsible clinician must make an assessment to decide whether to continue their detention or to discharge them. The independent review raised concerns that six months is too long. It heard evidence that patients were sometimes detained longer than necessary and were only considered for discharge when a tribunal hearing was due. It found that in up to 17% of cases referred to the mental health tribunal, discharge happened in the 48 hours before the hearing. That suggests that some patients are being detained longer than is necessary.

The review recommended reducing from six months to three months the initial detention period for people admitted for treatment, so that a patient’s detention is reviewed sooner to ensure that patients are not detained when they are no longer benefiting from treatment and can be safely discharged.

Clause 29 will mean that patients detained for treatment have their detention reviewed three times—up from twice—in the first year: at three, six and twelve months from the date of detention. The new renewal periods will not apply to part III patients, except in very specific circumstances when an unrestricted patient changes status. I commend the clause to the Committee.

--- Later in debate ---

[Dr Chambers]

I do not know whether we could combine yoga with our proceedings, Mrs Harris.

The hon. Member for Hertford and Stortford spoke really well in a similar vein to what I am about to say. Our amendment 19 to clause 41 would extend the provision of opt-out advocacy services in England to informal patients under 18 years old. Young people and their families and carers often face a nightmare navigating the mental health system. We find this on every level. A psychiatrist who came into my office in Winchester said that he and his wife, who is also a medical professional, were struggling to navigate the system to get care for their own child. His words were quite profound: “If we can’t navigate the system, what hope has anyone else got?”

Even when young people have secured desperately needed in-patient care, often after many months of delay, they can face real challenges in understanding the care being implemented and its impact. Often, such young people are cared for far from home. Enabling them to benefit from mental health advocacy that ensures the pressures on the system do not lead to unfair or damaging decisions for mentally ill young people is crucial. It can help to ensure that the patient’s whole situation and entire history is always taken into account, and that treatment is always appropriate, rather than symptoms just being addressed in isolation. We should be looking to empower patients and their families and carers across the whole system, not just in relation to those who are sectioned.

[Gregory Stafford]

You will be delighted to know that there will be no yoga from me, Mrs Harris.

I rise to support clause 41 and schedule 3, which will expand access to independent mental health advocates to not only those detained under the Mental Health Act but informal voluntary patients. Like many Committee members, I am sure, a number of IMHAs in my constituency have approached me about this, and they welcome the expansion. I pay tribute to the amazing work that they do across Farnham, Bordon, Haslemere, Liphook and the surrounding villages. Previously, only patients detained under specific sections of the Mental Health Act or subject to certain treatments were entitled to IMHA support.

The clause reflects the recommendations of the 2018 independent review of the Mental Health Act and the 2021 White Paper, and aims to enhance patient rights and reduce disparities in access to advocacy. That clearly empowers more patients by giving informal patients access to advocacy support. It improves transparency and accountability in mental health care settings. It ensures proactive outreach so that patients are not left unaware of their rights or support options, and supports informed decision making and potentially reduces coercive practices.

Clearly, there may be some resource implications for advocacy services, which the Minister may wish to touch on. Likewise, there may be some implementation challenges, which other hon. Members have raised, especially around ensuring timely and consistent notification and engagement. There could be potential delays in care co-ordination if advocacy processes are not well integrated. I would welcome the Minister’s thoughts on that.

This shift is long overdue. Too many vulnerable people, admitted voluntarily but feeling powerless, have lacked a clear, independent voice. The clause corrects that injustice by embedding advocacy deeper into the system, moving from passive availability to proactive engagement.

Schedule 3 underpins clause 41 by putting clear duties on hospital managers and advocacy providers alike to ensure that patients are automatically offered support. It is opt out, not opt in. That clarity of responsibility will reduce coercion, increase transparency and ultimately lead to fairer treatment decisions.

Schedule 3 operationalises the principles set out in clause 41 by embedding them in the structure of the Mental Health Act 1983. Like clause 41, it reflects recommendations from the 2018 independent review and the 2021 White Paper, aiming to reduce disparities in access to advocacy and ensure that all patients, regardless of detention status, are supported in understanding and exercising their rights. Like clause 41, it strengthens patient voice, reduces inequalities, improves compliance and encourages the early intervention and resolution of concerns.

Let me turn to Liberal Democrat amendment 19, which was tabled in the name of the hon. Member for Winchester. Clearly, its purpose is to extend the opt-out advocacy services in England to include informal patients under the age of 18. This ensures that children and young people who are not formally detained under the Mental Health Act, but who are receiving in-patient care, still have automatic access to an IMHA.

Currently, opt-out advocacy provisions primarily apply to patients who are formally detained. However, informal patients aged under 18, who may be in hospital with parental consent, can still experience significant restrictions and may not fully understand or exercise their rights. This amendment seeks to close the gap by ensuring that young informal patients are automatically offered advocacy support, recognising their vulnerability and limited legal autonomy.

My view is that this does strengthen patient rights. It safeguards vulnerable patients and promotes equality by aligning the rights of informal patients aged under 18 with those of detained patients. It supports informed decision making and helps young people to understand their rights and treatment options. If the hon. Member is minded to press the amendment, I hope that the Government will at least give it tacit support, even if they do not vote for it. That being said, I would welcome the Minister’s comments on why he does not feel that the amendment, or an alternative draft of the wording, if he does not like the specifics of it, should be included in the Bill. I do believe that this is important.

Government amendments 42 and 43 to schedule 3 are relatively technical but important elements of the Bill that align provision in England and Wales. I have just a few questions for the Minister. Robust rights must come with realistic resources. How will the Government ensure that advocacy services are funded and resourced properly to meet the new wider demand? Although they are technical, the Government amendments will still have an impact. What steps will be taken to monitor consistency so that a patient in Farnham, Bordon, Haslemere, Liphook or one of the villages surrounding my constituency has the same access to an advocate as a patient in Coventry, Aberafan or Swansea. We want to make sure that there is consistency.

Finally, will there be clear standards for timely engagement, especially given the risk of treatment delays if advocacy is not well integrated? If the Minister can answer those questions, I think that this will be a good step forward for patient voice and fairness in mental health, and I would support the clause and schedule 3.

--- Later in debate ---

[The Chair]

Does the hon. Member for Winchester wish to press amendment 19?

[Dr Chambers]

I think the hon. Member for Farnham and Bordon has spent more time discussing our amendments than I have, so I would like to give him the opportunity to vote in favour of one of them.

Amendment proposed: 19, in schedule 3, page 91, line 13, after “patient” insert—

“or English qualifying informal patient under 18”— (Dr Chambers.)

This amendment extends the provision of opt-out advocacy services in England to informal inpatients under 18.

Question put, That the amendment be made.

Mental Health Bill [ Lords ] (Fifth sitting)

Danny Chambers Excerpts

Committee stage
Tuesday 17th June 2025 Public Bill Committees

[Dr Danny Chambers (Winchester) (LD)]

It is an honour to serve under your chairship, Sir Desmond. I thank the Minister and the hon. Member for Hinckley and Bosworth for their comments on Liberal Democrat new clause 4.

This is another good example of how, although we are aware that it has laudable aims, the Bill will fail without the supporting infrastructure. As everyone will be aware, community mental health services are among the issues that generate the most emails and correspondence—certainly in Winchester, where young people especially are struggling to access mental health care. In that context, we are alarmed that mental health spending has fallen as a share of overall health spending in the last financial year. That has been coupled with the decision to drop a number of mental health targets, including targets for the number of people receiving mental health interventions such as talking therapy, and the target to ensure that 75% of people with a severe mental health illness receive an annual physical check. Priority has not been given to the services necessary to deliver better mental health care.

For the Bill to make a meaningful difference, the Government must ensure that community mental health care services receive the investment that they need to fulfil their obligations under the Bill—I know that that is a bit of a circular argument—and reduce the overwhelming pressure on in-patient services.

There is also the impact on schools, police services and families. When I went out with the police in Winchester not long ago, they told me that between 40% and 50% of their time is spent dealing with people who have a mental health issue in some capacity. The lack of community mental health care is not just a resource burden on the health service; a lot of our other services are also affected.

[Dr Evans]

The hon. Member rightly talks about resources and about the cuts as a proportion—although small, it is a cut in NHS spending. The last Conservative Government brought in the mental health investment standard to try to ensure parity between physical health and mental health in investment so that, regardless of how big the pot was, mental health was prioritised. Does the hon. Member agree that there is a concern that that could be slipping under this Government? Does he agree that that needs to be addressed in the context of the community provision that we are discussing?

[Stephen Kinnock]

Where is the evidence for that?

[Dr Chambers]

Would the Minister like to intervene?

[Stephen Kinnock]

No, thank you. I am chuntering from a sedentary position.

--- Later in debate ---

[Dr Chambers]

I broadly agree. We were really heartened that in the King’s Speech, the Government said that mental health needs to be treated as seriously as physical health. There are many reasons to join a political party but, given my long history of working in mental health charities, one major reason for joining the Lib Dems was that they had been saying that for years. I was pleased to hear that in the King’s Speech too, but we have to ensure that the percentage of spend on mental health does not slip in proportion to other very important resources.

[Anna Dixon (Shipley) (Lab)]

I think we are all agreed that, in order to implement the changes to the Bill, we need investment in mental health services, particularly community mental health services, but does the hon. Gentleman recognise that the Labour Government have kept the mental health investment standard, ensuring that there is sufficient and increasing investment in mental health in this country?

[Dr Chambers]

I hope that that is the case. I know that is the aim, but I suppose we will see in four, five or six years’ time what the mental health resources are. No one aims to underfund these services, but the demand on them changes and they need to be resilient. Darzi said that in April 2024 there were 1 million people on mental health waiting lists, and we know that some children wait 15 months, so we must not just maintain the current investment standard, but try to catch up on the huge backlog, which will not change unless we reform the system or invest in more staff and resources.

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

The hon. Gentleman makes a good point—mental health services are in a very bad place—but does he agree that the Government have already announced investment in mental health specialists in all schools, and in mental health crisis centres? I have no doubt that once the 10-year plan for the NHS comes out, there will be an even clearer path for how we tackle mental health issues.

[Dr Chambers]

I am really looking forward to the 10-year plan and reading about how it will improve mental health. We shared Labour’s manifesto commitments to mental health practitioners in each school and mental health hubs, so we certainly support that.

The hon. Member for Hinckley and Bosworth made some very good points and said that this proposal should possibly not be in primary legislation. I accept that integrated care boards do not have control over how every part of the service is delivered, so I am happy not to press the new clause to a vote, but I think the second part, which says that integrated care boards should have a duty to assess and report on the resource needed to meet the demands on services every two years, is important.

[Gregory Stafford]

I rise to speak to clauses 22 and 23 and to Liberal Democrat new clause 4.

As my hon. Friend the Member for Hinckley and Bosworth said, the Opposition support clauses 22 and 23 generally. Clause 22 addresses the concern that community clinicians—essentially, those responsible for overseeing a patient’s care outside hospital—have historically had limited formal input into decisions about community treatment orders, even though they are central to the patient’s ongoing care. It ensures that community clinicians not only are consulted but, in some cases, must provide written agreement before key decisions are made. It aims to improve continuity of care, ensure decisions reflect the realities of community-based treatment, and reduce inappropriate and poorly co-ordinated use of CTOs.

The benefits of the clause are obvious, but they are worth restating. Clearly, it improves the continuity of care and ensures that clinicians with direct knowledge of the patient’s community care are involved in those key decisions. It enhances safeguards, adding an additional layer of professional oversight before coercive measures are imposed or suggested. It promotes collaboration by encouraging joint decision making between the hospital-based and community-based clinicians, and it reduces the risk of inappropriate CTOs by ensuring they are used only when genuinely appropriate and supported by those delivering care.

However, I ask the Minister to touch on three points. First, requiring a written agreement or consultation could delay urgent decisions if not managed efficiently, so will he explain how, under the clause, any potential delay—a disagreement or just administrative inertia—can be removed to ensure treatment is not delayed?

That moves me on to the administrative burden. Clearly, the clause adds a level of complexity and requires more documentation and co-ordination. Although I understand that that is a necessary outcome, I would again be grateful for the Minister’s thoughts on how to ensure effective and speedy implementation.

As my hon. Friend the Member for Hinckley and Bosworth said, the ambiguity in the roles of the two clinicians may create confusion or disputes over responsibilities if they are not clearly defined or agreed. My reading of the clause is that there is no such clear definition; will the Minister look to provide one through other agencies, or will he put something into the clause in Committee or later in the Bill’s proceedings?

Clause 23, on the conditions of community treatment orders, addresses the concerns that the threshold for imposing conditions on community treatment orders has been too low, allowing conditions that may be clinically unnecessary or overly restrictive. By removing the “appropriate” test, the clause will tighten the legal standard to ensure that only necessary conditions are imposed.

Additionally, the clause will empower tribunals to play a more active role in scrutinising CTO conditions by allowing them to recommend that clinicians review specific conditions, even if the patient is not discharged. This reflects the Bill’s broader aim of enhancing patient rights and removing unnecessary restrictions.

The clause is a welcome addition. It will ensure that CTO conditions are imposed only when strictly necessary, meaning that there are stronger safeguards, and it will enhance the role of tribunals in protecting patient rights without requiring full discharge. It will reduce clinical overreach by preventing the use of overly broad or vague conditions that may not be clinically justified.

However, as with the previous clause, I have some questions. First, the tribunal power is limited in that it can only recommend, not require, the reconsideration of conditions. Is that the intention, or will the Minister strengthen the clause at some point to ensure that the tribunal can require a reconsideration of conditions? If he will not, what issues does he see arising from there not being a reconsideration?

Secondly, as I mentioned in my intervention on my hon. Friend the Member for Hinckley and Bosworth, I have a concern about the potential ambiguity in the shift from “appropriate” to “necessary” leading to uncertainty or dispute over interpretation. As we touched on in relation to other clauses, clinicians will need additional guidance or training to apply the revised standard consistently. Where will that revised training and guidance be located, and what is the timeframe for its implementation? We need to ensure that all clinicians are fully trained and ready to use this new power.

I will briefly touch on new clause 4, tabled by the Liberal Democrats, because although I understand that the hon. Member for Winchester may not press it, somebody else might. It would place a general duty on integrated care boards to ensure that services in the community have the necessary level of resource to meet demand such that the provisions of the Bill function as intended, and to assess and report on this every two years. As my hon. Friend the Member for Hinckley and Bosworth mentioned, the Opposition generally support the overall aims of the new clause, but as ever, there are some issues with the detail, so I have five questions for the hon. Member for Winchester if he responds, or for the Minister to answer in his summing up.

First, if we imposed a statutory duty on ICBs to ensure sufficient resources for the CTOs, what mechanisms would there be to monitor and enforce compliance? Secondly, what would be the consequences if an ICB failed to meet this duty? Would there be formal accountability or a sanction process? Thirdly, how would the duty interact with existing NHS budgetary constraints and competing priorities? Would it become a statutory obligation with no clear means of redress if unmet? Fourthly, could the duty set a precedent whereby Parliament mandates resource guarantees without providing additional central funding? Finally, what constitutes “sufficient” resources in the context of the CTOs? Who defines that standard, and it is defined locally or nationally?

--- Later in debate ---

[David Burton-Sampson]

I appreciate the hon. Member’s intervention. He makes the point that there may be situations in which the young person’s request might be inappropriate. However, on the flip side, there may be a situation in which it might be inappropriate for the person with parental responsibility to be the nominated person. They could have been involved in the situation that has led to that young person entering a mental health spiral—an abuse situation, for example, which has not been discovered by the authorities. That person would still have parental responsibility at that time. I think it is important that the young person can choose the person to support them in their ongoing care. I will be supporting clauses 24 to 28 and Government amendments 40 and 41.

[Dr Chambers]

Amendment 49 extends the support offered by mental health advocates to cover social and financial stresses and to family carers and other members of the household when the patient is discharged.

Other hon. Members have today discussed how social and financial struggles can play a major role in someone’s mental ill health and in blocking their recovery, and how those are often the areas where someone can most benefit from advocacy and advice. As we are all aware, patients should not be viewed as a collection of symptoms, but within their whole context, including the situation they are living in. Addressing someone’s housing insecurity, debt or family breakdown should not be viewed as a separate consideration, but as a core part of supporting them to live happily, healthily and independently. Furthermore, family carers and the wider household are absolutely critical for people’s wellbeing and recovery, and should be properly equipped to prepare for their loved one returning from hospital. They, too, may need advocacy and may be missing out on support that they can and should receive.

A good example comes from Winchester, where Winchester Citizens Advice has a member of staff—a former mental health nurse—based at Melbury Lodge in-patient mental health unit. Often, someone may be admitted for two, three or four months, and when they are discharged, they go home to all their life admin—there will be final demands for credit cards or requirements to repay personal independence payments and that type of thing. It is very overwhelming, particularly for those who already have fragile mental health, to have to sort out a whole backload of administration—especially financial and complicated administration. For two days a week, that staff member supports in-patients in sorting out all their administration from anything that needs to be done.

What is interesting is that when these patients are discharged from Melbury Lodge in Winchester, if they have had that help, they end up being hospitalised and on medication for a shorter time. They are also more likely to engage with various support and community services once they have been discharged and are much less likely to be readmitted to hospital. For every £1 spent on that initiative, £14.08 is saved in cost avoidance. That initiative run by Melbury Lodge and Winchester Citizens Advice was up for an NHS award last year. It is a proven concept and something that should be done across the entire country. It has been running for two years and has proved how much money can be saved. Unfortunately, it was a pilot project and is struggling to secure money to continue indefinitely. I urge the Government to look at how that type of initiative could be rolled out around the whole country.

[Sojan Joseph]

The hon. Member is making a very valid point that all patients need help with their finance and accommodation to keep them in the community and make discharge more appropriate. However, those provisions are already in place as part of the patient’s care plan. Different hospitals have different settings, such as a discharge or enablement team, or even the nurses on the ward itself can help and look into those provisions. Does the hon. Member think that that is the role for independent mental health advocates, who prioritise detention and the Mental Health Act, rather than the finance and accommodation issues, which need to be resolved by a different team?

[Dr Chambers]

I accept that point. It is a very sensible point. There has been a huge amount of discussion about what is in scope. Given that this is focused primarily on both current in-patients and preventing readmittance to an in-patient unit, I think it is within scope. I am aware that a lot of staff support patients, but it is not a core part of their role. It is something they squeeze in among all their other duties. When we have the expertise of someone at citizens advice, who knows how to navigate the huge complexity of various organisations and businesses that have to be dealt with, it is a lot more efficient. The figures speak for themselves.

--- Later in debate ---

[Dr Chambers]

My apologies, Sir Desmond. I thought amendment 49 was included in the debate on clause 24.

[Rosie Wrighting (Kettering) (Lab)]

I rise to speak to clauses 24 to 28 and the Government amendments to them. They cover an important and long overdue reform, which introduces a new statutory role: the nominated person, replacing the outdated concept of the nearest relative. I think, cross party, we all agree that this is about protecting some of the most vulnerable people in society and children.

The clauses and amendments make important changes to the current Act, which too often forces an individual to rely on someone they may not trust or even have contact with, just because of their family relationship. As the Minister said, the White Paper found that the vast majority would choose their parents, but we must have legislation that reflects the diversity of society and families. Growing up in a single parent family, it would have been inappropriate for my other parent—who is one of my nearest relatives, but who I did not live with, know or particularly trust—to be my representative or make decisions on my treatment and care. In my upbringing, the people who knew me best were not always my closest blood relatives.

The nominated person model gives individuals the right to decide who should speak for them when they are at their most vulnerable. That might seem like a small change, but it is a powerful one and aligns with the Bill’s overall goal of placing patient voices at the heart of mental healthcare. Having someone a person trusts—someone who knows them and can advocate for them—is vital. I was contacted by a constituent whose brother was sectioned and assessed at hospital as needing ongoing support in sheltered accommodation. His social worker challenged the decision and recommended private accommodation. That confusion, despite his sister continually challenging the recommendation, meant he was discharged, with nowhere to go, in the middle of the night.

It is crucial that safeguards will remain. Where an individual cannot nominate someone themselves, a person can still be appointed on their behalf, but with far clearer guidelines and recourse if concerns arise. It is not about removing protection; it is about modernising it to reflect the society we represent. Mental health legislation must reflect the value and diversity of the society it serves, and the clauses and amendments before us bring us a step closer to that.

Spending Review: Health and Social Care

Danny Chambers Excerpts

Thursday 12th June 2025 Commons Chamber

[Madam Deputy Speaker (Caroline Nokes)]

I call the Liberal Democrat spokesperson.

[Dr Danny Chambers (Winchester) (LD)]

To reiterate: after years of Conservative mismanagement, the NHS is in crisis, with patients left waiting hours for ambulances, women giving birth in unsafe maternity units, and children turning up at A&E with rotting teeth because an NHS dentist cannot be found. That is the Conservative legacy, and they must never be trusted with our health service ever again. So yes, we welcome this funding boost—we really do—and we agree that funding must come with reform, because unless this funding is targeted properly, it will not bring the change that patients urgently need.

When it comes to reform we need to talk about fixing social care, because putting more money into the NHS today will be like pouring money into a leaky bucket. Last year, the Secretary of State for Health and Social Care stated that £1.7 billion a year is wasted because patients who are medically fit for discharge cannot leave hospital, simply because no care is available to support them at home. The hospital in Winchester that supports both your constituency, Madam Deputy Speaker, and mine has up to 160 people waiting to be discharged at any given time, and they would be better cared for with social care packages.

We need urgent action and a higher minimum wage for care workers. We need proper respite and financial support for family carers, and a clear commitment to conclude the social care review, hold cross-party talks, and deliver the real reform that the Minister has been talking about. We also need to tackle the crisis in primary care, because that is where prevention happens and where pressure on hospitals is eased. Will the Minister confirm that the funding boost will deliver the extra 8,000 GPs that are needed to guarantee everyone an appointment within seven days, or within 24 hours for urgent cases? Can she also confirm that the funding will bring dentists back into the NHS, and bring an end to dental deserts? That will not happen without urgent reform of the NHS dental contract, which is outdated, unworkable and driving dentists out of the system.

Finally, we cannot ignore the shocking state of NHS buildings, including our hospital in Winchester. It is an outrage that overcrowded hospitals must close operating theatres due to unsafe ceilings and other health and safety issues. I urge the Minister to spend the money where it matters: on primary care, on social care, and on ensuring that our existing NHS buildings are fit for purpose.

[Karin Smyth]

I thank the hon. Gentleman for welcoming, on behalf of his party, the commitment that the Chancellor has made and the extra funding that she has identified, but I think his party still opposes the way in which we have raised the funding to do just that. It is good to have your cake and eat it, but we are clear that the funding does come with reform. As I said in my statement, we are committed to improving the front door—primary care—as well as social care and discharge. That is why the NHS contribution, as part of the settlement to the better care fund, increases. He will be aware that we previously revised the better care fund to make it better and more targeted on discharge, which is important.

The urgent and emergency care plan that we published a couple of weeks ago also confirms our recognition that flow through the hospital system is important for patients and staff; we must ensure that we do not face that continued crisis of corridor care over many years. We are committed to the fair pay agreement, and our colleagues in the Ministry of Housing, Communities and Local Government will make more statements in the coming weeks about how that will work.

Mental Health Bill [ Lords ] (Second sitting)

Danny Chambers Excerpts

Committee stage
Tuesday 10th June 2025 Public Bill Committees

[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.

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

Thrilled.

[Dr Chambers]

Unfortunately, I was busy meeting Brian May and talking about farming, so I have not had a chance to work up a really good response.

The point of the Liberal Democrat amendments is to recognise that mental ill health requires holistic care and that many non-clinical factors directly influence mental health. Although the Bill’s scope is understandably narrow, very much focusing on people once they are admitted to hospital for treatment, we need to recognise that, if someone is discharged back into the situation from which they were admitted, they are very likely to have a relapse and to need treatment again. Some of those factors are non-clinical. For example, people living in poverty—those in the lowest 20% of income—are more than twice as likely to suffer mental health issues than those on an average income.

We strongly support the Bill, but we need to recognise that, on its own, it will not improve mental health or do anything to prevent people from developing mental health issues. If our amendments are not within scope or are not appropriate for the Bill, we urge the Minister to work with other Departments, such as the Ministry of Housing, Communities and Local Government, to ensure that this good piece of legislation, which we support, can be successful.

The hon. Member for Farnham and Bordon made a point this morning about local authorities. He is right that local authority reorganisation is a challenge, especially when it comes to providing accommodation for young people and for people being discharged from mental health care centres. It is also an opportunity, because the current situation is not fit for purpose. Hampshire county council is struggling to provide the care these people need. Housing, which often affects young people’s mental health, is probably the single biggest issue that comes up in my inbox and when I knock on doors.

I thank the hon. Member for Hinckley and Bosworth. As a clinician, his point about the evidence base, especially when it comes to reviews, is really important. We are discussing a Mental Health Bill that may not be changed significantly for another 40 years, so it is important that we use the best evidence. As a long-time trustee of an evidence-based medicine charity, I am passionate about this.

I thank the hon. Member for Thurrock for pointing out that clinical guidelines suggest six-month reviews. Yearly reviews are used for many medical conditions, and I would argue that a year is also an arbitrary period, rather than one based in evidence. Why six months and not a year, or why a year and not six months?

[Dr Evans]

The hon. Member is correct to establish the evidence base and the guidance. Broadly, we need to balance that with the logistics and the impact on the clinician, the patient and the resources. Move too far one way and it becomes a tick-box exercise or more resource-heavy; move too far the other way and the safeguards that we are trying to implement are lost or watered down.

When I look at the amendments, that is the balance I am trying to understand; if the guidelines are written with that in mind, that makes sense. The job of this House is to scrutinise the numbers and decide whether we agree that they are right, or whether we should push a bit harder—whether we should tighten the safeguards or relax them a little to allow clinicians more freedom of choice.

I guess that is the purpose of the Bill—getting the right boundary between the safety of the individual patient, support for the wider public, and making sure that clinicians have the freedom to make their judgment so that we are not stepping on expert opinion or, worse, creating bureaucratic processes. I hope the hon. Member understands that is why we are probing further on the rationale.

[Dr Chambers]

I completely agree with everything the hon. Member just said. Atul Gawande did a fantastic piece of work on checklists that emphasised the need for them not to become tick boxes. They are meant to involve active thinking and decision making.

I thank the Minister for reassuring us about housing. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Dr Chambers]

I beg to move amendment 8, in clause 4, page 8, line 27, at end insert—

“(ba) the person is under 18 years old and satisfies the conditions in (b)(ii).”

This amendment inserts a new subsection that extends the duty on integrated care boards to establish and maintain a register for those at risk of detention to all children and young people under the age of 18.

[The Chair]

With this it will be convenient to discuss the following:

Amendment 47, in clause 4, page 9, line 20, at end insert—

“(6) The risk factors specified in regulations under subsection (5) must include—

(a) homelessness;

(b) addiction;

(c) domestic abuse;

(d) miscarriage and traumatic birth;

(e) experience of armed conflict; and

(f) bereavement.”

This amendment would specify risk factors for detention for people on the register of people at risk of detention under Clause 4.

Amendment 9, in clause 4, page 9, line 29, at end insert—

“(c) seek to ensure that the needs of children and young people can be met without detaining them under Part 2 of this Act.”

This amendment extends the duty on integrated care boards and local authorities to exercise their marketing functions in a way that seeks to ensure that children and young people’s needs can be met without detaining them.

[Dr Chambers]

Amendments 8 and 9 would insert a new subsection to extend to all children and young people under the age of 18 the duty on integrated care boards to establish and maintain a register of those at risk of detention. Amendment 9 would extend the duty on integrated care boards and local authorities to exercise their marketing functions in a way that seeks to ensure that children and young people’s needs can be met without detaining them.

Far too many children are unable to access the mental health care they need, leaving them more vulnerable to experiencing a mental health crisis that then requires detention, which all too often ends in tragedy. Child and adolescent mental health services are in a state of near collapse, with many children unable to access the care and treatment they need until their mental ill health has reached the point of crisis. Waiting 15 months in great mental distress is far too long, especially for children. It is a huge disruption not only to their personal development but to their education. Waiting up to two years for treatment is a huge proportion of a 12-year- old’s life.

We are pleased that the Bill, as it currently stands, includes specific provisions to prevent people with learning disabilities from requiring detention under the Act. The Government should take that approach for more people, especially our young people. Early intervention, delivered through regular check-ups and cutting waiting times for treatment by community services, is critical. We should not pretend that acute mental health services and in-patient care exist in a vacuum. The pressures they face are directly impacted by the quality of community services. We need stronger steps to ensure that fewer people require detention in the first place, especially children.

We are pleased that the Government are taking steps towards having mental health support in every school, for which we have long campaigned. We would like them to go further by ensuring a dedicated professional in every school. We are alarmed that the targets for mental health are being dropped, so I press the Government for assurances that the upcoming 10-year plan will ensure that children who are referred can expect swift and efficient support and treatment, with binding duties on health bodies to deliver that.

Alongside this Bill, what requirements and resources will ICBs have for preventing mental health crises? As part of that, will the Department make specific changes to CAMHS?

[Dr Evans]

The hon. Gentleman makes a pertinent point about the pressure on CAMHS. In Leicestershire, about 45% of CAMHS referrals are for things like autism and ADHD, and the problem is that it takes a lot of services away from those who have eating disorders or depression, or who self-harm. Does he believe there is scope to reorganise services to make sure they are appropriate where there needs to be treatment? A child suffering with severe anxiety and self-harming tendencies should not be on a pathway with someone who has autism, for example. Has he given any thought to how this Bill might be a way of opening that door?

[Dr Chambers]

On the surface, what the shadow Minister says seems logical and makes sense. I am not a mental health clinician, so I want to be really careful about pushing in one direction. Whether someone has an eating disorder or is waiting for a diagnosis of something like ADHD, the waiting times are too long. We must better structure a system that ensures that everyone gets healthcare when they need it, rather than prioritising what we perceive as most important.

One of the most heartbreaking things that I hear from parents in Winchester, who are worried sick, is that young teenagers with an eating disorder have been told that they have to hit a lower BMI to reach the threshold to qualify for treatment. That is essentially saying that someone has to be sicker for longer. No one would ever say, “We’ll wait until your cancer reaches stage 4 before we start treatment,” but that is happening with eating disorders. The treatment will end up being longer, more complicated, more costly for the taxpayer and maybe less successful.

A question often comes up—the hon. Member for Farnham and Bordon alluded to this—about the pressures on local authorities to deliver mental health care. Actually, the question is “How we can afford not to deliver it?” People with mental health disorders are ending up in A&E or prison and costing police time. It costs £52,000 a year to keep someone in prison, yet apparently we cannot afford to give them the community interventions that might stop them going there in the first place.

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

The Labour Government are working on a range of early interventions for young people in the area of mental health and to stop them spiralling into crime, such as the Young Futures hubs and introducing mental health support in every single school. The hon. Gentleman makes a valid point, but it sits outside the Bill, and there is plenty that the Government are doing. Regrettably, there will always be a need, at certain times, for a young person to be under a section 2 notice and to be brought into care for a period of time, for their own safety. That is unavoidable and will be the right thing for that individual, but there is so much work being done outside this Bill to help young people and others with their mental health.

[Dr Chambers]

We support all efforts to keep young people happy and healthy in their communities. I visited Winchester Youth Counselling recently, where pupils can self-refer to talk through their issues. That does not involve any clinical personnel. It is hugely impactful and cost-effective and is part of the community. We support those community hubs.

Amendment 47 would specify risk factors for detention for people on the register of people at risk of detention under clause 4, including homelessness, addiction, domestic abuse, miscarriage and traumatic birth, experience of armed conflict, and bereavement. For anyone, including people with learning disabilities, life events can have a profound impact on mental ill health and can drive mental disorders. Well over a third of women with mental health problems have been a victim of domestic violence, and 50% of rough sleepers have mental health problems. The disastrous impact that bereavement can have on anxiety and depression, which are key factors in suicide, has been well documented.

It seems obvious, frustratingly, that public services do not currently reflect that key fact. There are no registers of bereaved children to ensure that they get the right support in the community and in school. There are no registers of veterans, despite their far higher risk of mental ill health and suicide. Women who have suffered a miscarriage do not receive an automatic referral, including to mental health services. The Government need to ensure that people can get mental health assessment and support at key points in their life, including the most traumatic moments.

[Dr Evans]

We have certain registers of carers, for example in primary care. There is a stipulation about moving towards veterans being included. Who does the hon. Gentleman think might hold the register, in the light of his amendment?

[Dr Chambers]

I do not know the best place for it to be held. That is an important point. For a lot of the issues that Members are bringing up, we are not expecting there to be answers today. However, we want to ensure that they are all being considered, given that the subject might not return to Parliament for another 40 years.

[Jen Craft (Thurrock) (Lab)]

I have a question about the list of risk factors that has been provided. Is there not a concern that it might be too prescriptive or restrictive, and that putting it in primary legislation prevents local authorities or ICBs from widening it, from having registers and risk factors that might be appropriate to their areas, and from focusing on what the appropriate level of care is that they are best placed to meet?

[Dr Chambers]

That is a very insightful point. The list could be longer and is not meant to be exclusive. I am not sure of the answer to the hon. Lady’s question but, taking a step back, we know that the single most common cause of death in women 12 months after giving birth is suicide, and there is no proactive automatic care. If a person is addicted to alcohol, they are admitted to hospital for treatment for their physical symptoms. When they are physically well enough to go home and they are discharged, there is no automatic enrolment or follow-up in mental health care. I would not want to bring in a system, as the hon. Lady says, that ends up being too prescriptive. However, at the moment, we have one that is not prescriptive enough. I could list a handful of demographics of people who desperately need that proactive care.

[Sojan Joseph (Ashford) (Lab)]

The purpose of this part of the legislation is for ICBs to keep a register of anyone who is diagnosed with autism or a learning disability. Patients who are already under a clinical team already have a risk assessment, which covers all the areas that the hon. Gentleman is specifying. As a result of the amendment, would we not be duplicating information about risks that already exists for most patients with their clinical teams?

[Dr Chambers]

The point of having an at-risk list is that ideally there is proactive contact with people—perhaps in quite a soft way, and perhaps through community hubs, as we have discussed—before they demonstrate a severe mental health crisis. I assume that the people the hon. Gentleman is talking about have already been admitted to hospital and have received treatment, and that they are being followed up after they have been discharged. That is not a proactive list; it is a reactive register. Am I correct? I apologise if I have misunderstood his question.

[Sojan Joseph]

Anyone who is under the care of a clinical team for their mental health has a risk assessment. That is basic paperwork, which is completed by the clinicians. That risk assessment covers everything that is specified in the amendment. The purpose of this part of the legislation is for ICBs to have a register. However, ICBs will not be providing direct care; that will be provided by the clinicians. Those patients who are under any clinical team have a risk assessment that covers all the points in the amendment. My point is that the amendment would duplicate some of that paperwork.

[Dr Chambers]

I will not argue with an esteemed Member who has the hon. Gentleman’s background in mental health. I take his point as it stands.

[Gregory Stafford]

I have been listening carefully to the hon. Member’s argument. I do not disagree with anything in it; I just fail to see how the amendment fits with the clause that we are discussing, which I think may be the point that the hon. Member for Ashford is making.

As far as I can tell, clause 4 is about producing a register of people who have a learning disability or autism, who are at risk of being detained for a mental health episode and for whom those risk factors are active, for example because they have been sectioned before or have presented at A&E. Those are specific incidences. What the hon. Member for Winchester is talking about is more wide-ranging; it is not about touchpoints in the same sense. I can see how he could potentially say, “Well, domestic abuse has led to a mental health episode and therefore to a presentation at A&E or in the system.” However, if we put in societal factors, for want of a better phrase, we could end up putting most people on the list, because most people will have experienced a bereavement. I get what the hon. Member is trying to do, but I fail to see how the amendment matches the overall purpose of clause 4.

[Dr Chambers]

I thank the hon. Member for his intervention. In my maiden speech, I focused primarily on mental health and on the fact that there are so many demographics of people who we know are at significantly higher risk of suicide and mental ill health than the general population. Whether the issue is more appropriately addressed in the Bill or outside it, but using the Bill as a mechanism to highlight it and to cause the proactive engagement of other relevant Departments and other pieces of legislation, I am determined that we are not going to discuss the biggest piece of mental health legislation in 40 years and not even have a discussion about how we proactively engage with groups of people who we know are at very high risk of mental health issues.

[Gregory Stafford]

Will the hon. Member give way?

[Dr Chambers]

I will carry on, if that is okay.

Our social and health services need to see the whole person, including their social needs and the factors in their environment that threaten their wellbeing. Trying to treat a mental disorder but failing to account for that person’s lack of housing, which drove their anxiety and depression in the first place, is doomed to fail. A lack of support for a child who has lost their parents at a young age could lead to significant harmful consequences further down the line.

There are a huge range of areas that require change, but for now we would like to press the Minister on three specific issues. We understand that some of them may turn out not to be within the scope of this Bill, but it is still important that they be addressed in some capacity.

Will the Government finally implement a register of all bereaved children to ensure that they get the support they need? Will the Government ensure that all women who go through miscarriage, stillbirth or traumatic birth access mental health support quickly and effectively? Will the Government establish a veterans register to ensure that those who have served in the armed forces and who face particular challenges as a result get the tailored mental health support that they need and do not reach the point of requiring detention?

[The Chair]

I need to remind the hon. Member that issues that are not within the scope of the Bill are not within the scope of the debate—but we have let you get away with it this time.

--- Later in debate ---

[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.

[Gregory Stafford]

I accept that we should aim for the pinnacle and the best. What I was trying to say was that because the amendments restrict us, rather than giving us the space to, hopefully, reach the pinnacle, or to explore other options if we cannot, they could have unintended consequences if we cannot reach that pinnacle.

[Anna Dixon]

rose—

[Dr Chambers]

I give way to the hon. Lady.

[Anna Dixon]

The hon. Gentleman may want to take these points together. We drew attention to proposed new section 125. Subsection (1) relates to integrated care boards, while subsection (2) relates to local authorities. They do exactly what he wants: strengthen the requirements on ICBs and local authorities to better meet the needs of people with autism or learning disabilities in order to avoid detention. The very essence of the Bill therefore provides the duties that the Minister reassured us on in response to my earlier point. The expectation is that commissioners will meet needs as identified in these dynamic registers.

[Dr Chambers]

I thank both hon. Members for their input and their valid points. We appreciate the Minister addressing these concerns. We will not press amendment 9 or 47, but we would like to vote on amendment 8.

Question put, That the amendment be made.

--- Later in debate ---

[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.

Mental Health Bill [ Lords ] (First sitting)

Danny Chambers Excerpts

Committee stage
Tuesday 10th June 2025 Public Bill Committees

[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.

--- Later in debate ---

[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.

[The Chair]

With this it will be convenient to discuss 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.

[Dr Chambers]

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

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

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

[Zöe Franklin (Guildford) (LD)]

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

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

Dementia Care

Danny Chambers Excerpts

Tuesday 3rd June 2025 Commons Chamber

[Dr Danny Chambers (Winchester) (LD)]

I thank my hon. Friend the Member for South Devon (Caroline Voaden) for securing this important debate. Listening to the stories from Members on all sides of the House, it is clear that this is not simply a political debate; it is deeply personal to pretty much everyone here.

My father had dementia. He was a typical Irish farmer; he was very strong-willed, physically tough and fiercely independent, and he was used to working all hours of the day. Watching that man slip away, becoming increasingly confused, anxious and very often unreasonably angry, was one of the most heartbreaking experiences of my life. I know I am not alone in experiencing that, as we have heard very similar stories.

Many Members have said that with dementia we lose the person we love twice—first slowly, piece by piece, and then again at the end. The final loss can feel like a relief, because it is a prolonged bereavement; the grief starts sometimes years before. Dementia is a brutal disease, not just for those who are experiencing it but for those who are caring. For spouses, children and families, it is relentless emotional toil, sleepless nights and endless juggling of tasks.

[Sarah Dyke]

My hon. Friend shares his experience of losing his father. I lost my father in the same way, and he too was a proud farming man. I want to raise an issue from a constituent who contacted me about her father James. He is currently alone in a room in a hospital, and he is scared to mix with other violent dementia patients. He wants to be at home, and the family want him to be at home, but there are barriers in social care in Somerset at the moment. Does my hon. Friend agree that dementia patients should be able to live independently at home, with dignity, and receive the care—

[Madam Deputy Speaker]

Order.

[Dr Chambers]

Yes, I agree that empowering people to live as independently as possible is hugely important.

For me, there was guilt—for many years actually. I felt guilty about the moments of resentment at how my job and career were affected, and for losing patience when faced with the anger of someone you are trying to care for. I remember that my dad did not really understand that all we were trying to do was help. I want to mention the very insightful piece of advice from the right hon. Member for Wetherby and Easingwold (Sir Alec Shelbrooke) not to argue with people who have dementia. I wish I had understood when we were caring for my father that there was no need to correct his current understanding of the world. My grandfather was born in 1870, and my father kept asking where he was. We tried to explain that he would have been aged 130 if he had still been alive, but I wonder why we had those discussions. That was a hugely important and emotive piece of advice.

[James Naish (Rushcliffe) (Lab)]

When I led a district council, one thing we tried to do was take initiatives to make us more dementia-friendly. There is some excellent training run by the Alzheimer’s Society. Does the hon. Member agree that all MPs’ offices should be seeking to take such initiatives so that we can be compassionate in the way that he describes?

[Dr Chambers]

I completely agree with what the hon. Member has just suggested. There is no way that we can approach dementia without a huge amount of compassion and empathy.

[Joe Robertson (Isle of Wight East) (Con)]

I thank the hon. Member for drawing attention to the issue of not seeking to correct those with dementia on where they think they are. In that respect, dementia care and understanding have come a long way, and in fact it is now standard not to try to do that. I thank the hon. Member, along with my right hon. Friend the Member for Wetherby and Easingwold (Sir Alec Shelbrooke), for raising that issue in the Chamber.

[Dr Chambers]

I remember trying to explain to my father about the sheepdog, which he loved to train but which he did not recognise as his own any more. That is unusual for a farmer. There was no need to have that discussion; it was heartbreaking. The dog loved my dad and dad not recognising him any more was very upsetting. This all still feels very raw, but as we have heard today, my story is not in any way unique. There are so many families in Winchester and around the country who are experiencing that similar, heartbreaking journey.

Caring for my father is one of the hardest things that my family has ever done. I pay tribute to my mother, who bore the brunt of caring for my father for many years; to my sister Irene, who helped hugely for years and years; to my cousin Patrick; and to our neighbours James and Deborah Hodgson—we could not have managed without them. However, especially nearer the end, we could not have done without the extraordinary support of the care workers who came to help on a regular basis. Their compassion, skill and dedication helped get us through some of the darkest days.

That dedication was extraordinary. Dad loved singing and one of our care workers had printed out some of the songs that he knew—some old Methodist hymns, “The Old Rugged Cross” and “Danny Boy”, which was his favourite song and the song that I am named after. He might not have remembered our dog, but he could remember every word of “Danny Boy” when he was singing it. The dedication of the care workers, to find out someone’s favourite song and then sing it with them, was quite extraordinary.

Care workers, who are vital and skilled, are often underpaid, undervalued and stretched beyond endurance. We just cannot allow that to continue. That is why the Liberal Democrats call for urgent and meaningful reform of social care—reform that starts with recognising and properly rewarding and supporting the workforce who underpin it. We have been calling for a national social care workforce plan—not for the can to be kicked further down the road, but a real plan to address recruitment, retention and training, with practical steps to fix the staffing crisis. We want to establish a royal college of care workers to give care professionals the recognition and career development that they deserve. I pay tribute to Liz Blacklock from Winchester, who runs Lapis Care based in Bishop’s Waltham, where I went on some visits a few weeks ago. Liz has long been calling for a formal register of care workers, which would be one of the functions of any new royal college of care workers.

Liberal Democrats also call for a national carers register, so that all unpaid family carers can be better supported, for example with statutory respite care. We also call for a higher carer’s minimum wage, because paying poverty wages for such emotionally and physically demanding work is not only unjust but short-sighted and drives burnout, turnover and, ultimately, worse care.

Let us be clear: dementia is not going away. One in three people born today will develop dementia. The hon. Member for Worthing West (Dr Cooper), with her public health experience, was insightful in her advice on how we can help to prevent it from developing.

The financial pressures on local authorities, driven in large part by adult social care, are among the most urgent political challenges of this decade. In Winchester, the Chesil Lodge day centre provides essential care for older adults, including those with dementia, and importantly provides respite care for family members. Hampshire county council is threatening to withdraw funding. That could overwhelm unpaid carers, forcing loved ones into residential care, which in the end will cost the council and taxpayers more.

With the political will, proper investment and genuine commitment to value and care work, we can build a system that supports people with dementia with dignity and gives their families the help and hope they so desperately need.

[Madam Deputy Speaker (Judith Cummins)]

I call the shadow Minister.

Access to NHS Dentistry

Danny Chambers Excerpts

Thursday 22nd May 2025 Commons Chamber

[Dr Danny Chambers (Winchester) (LD)]

I thank the hon. Member for Great Grimsby and Cleethorpes (Melanie Onn) for securing this really important debate. Before I was elected, I drove around Winchester, the Meon valley and the beautiful New Forest treating horses as a veterinary surgeon, and a key part of that role is providing regular dental treatment. Horses do not like going to the dentist any more than humans do, but they need to have their teeth brushed every six months—at least every year—or they get ulcers in their mouths and they can get infected tooth roots. When we have to remove a tooth with a root that is three inches long—especially on a hot day like today—we work up a sweat and it takes a long time, but it is really painful for the horse, even though we use painkillers and nerve blocks. Often, all of that would have been avoidable had they had regular dental treatment, and it costs the owner a lot more money. It is exactly the same with human medicine.

There is cross-party agreement, with no one disputing that prevention is better than cure, and when it comes to dental care in the NHS we are failing at even the most basic level of public health. I am not going to go through all the stats that hon. Members have repeated about the numbers of children needing general anaesthetics for dental care.

[Alex McIntyre]

Will the hon. Gentleman welcome the Government’s partnership with Colgate on tooth- brushing in schools so that we can tackle prevention with children and make sure they are not going into hospital with tooth decay because they are learning how to brush their teeth and doing so properly?

[Dr Chambers]

I absolutely welcome that fantastic initiative.

I visited two dental practices in Winchester, and both told me exactly the same thing: they want to do more NHS work, and they want to be there for their communities, but because of the current NHS dental contract they simply cannot make it financially viable. They are effectively subsidising their NHS patients with income from private work. The British Dental Association estimates that private dentistry in England cross-subsidises NHS care to the tune of £332 million a year, which is due to rise to £425 million if NHS practices are not offered any help with the tens of thousands in additional staff costs brought in by the increase in national insurance. With the NHS work they do perform, they do not have time for the education—the proactive, holistic healthcare— that they want to do. Instead, they have to get people through in a quick turnaround. I say this clearly: dentists are not the problem. They are doing their best within a contract that is outdated and damaging.

I also want to speak to something that is often overlooked in this conversation: oral health is not just about teeth. I know that my dentist colleagues, as in veterinary practice, routinely identify serious conditions such as oral cancers and squamous cell carcinomas during routine dental checks. Those cancers are often aggressive but spotted early, they can be treated. We also know that infections in the mouth can lead to things such as endocarditis, which is not a trivial condition, and there is good evidence that periodontitis can contribute to the onset of dementia. How many cancers are we missing? How many heart problems are we not avoiding by not having routine dental checks?

I will sum up now as I know that we are pushed for time. The Liberal Democrats will continue to fight tooth and nail for an NHS that includes dentistry. I managed to avoid making any jokes about equine dentistry, and Members will be glad to hear that straight from the horse’s mouth. We do not want NHS dentistry to be an afterthought; it has to be a core part of a truly universal, holistic health service. Everyone deserves access to routine dental care. Many Members have said that they live in areas that are dental deserts, where NHS dentists are rarer than hen’s teeth. It is clear that we have cross-party consensus. Let us get the dental contract reformed and let us make this Parliament the last one during which anyone has to extract their own teeth.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the shadow Minister.

Mental Health Bill [Lords]

Danny Chambers Excerpts

2nd reading
Monday 19th May 2025 Commons Chamber

[Dr Danny Chambers (Winchester) (LD)]

I thank the Secretary of State for introducing this really important Bill, and the Minister for his proactive engagement with us earlier this week. Before I entered Parliament, I was a trustee of the veterinary mental health charity Vetlife, which cares for the mental health of the veterinary profession—I have had to clarify before that it is not a mental health charity for animals with mental health issues. I became a trustee of the charity because my really close friend Sarah, at the age of just 31, when she had her whole life and career ahead of her, took her own life; I took her place as a trustee. Getting the news that I had lost her was one of the most painful experiences of my life. Many hon. Members in the Chamber will have suffered similar experiences with their friends and loved ones.

I speak about Sarah because while we are in this place, we rightly often discuss mental health issues using statistics—we talk about waiting times, workforce shortages and the economic impact—but we must never forget that there are individual lives behind the numbers, and nearly every person in the country is affected in some way. That might be through their own struggles or those of a loved one, or through grief after someone they care about has lost their battle with depression.

To return briefly to statistics, veterinary medicine—the profession I come from—has a suicide rate four times the national average. It is a small profession where everyone knows everyone, and everyone has lost a friend or a colleague to suicide. I share that not just for awareness, but because it reminds us that certain groups are at much higher risk—they are more vulnerable than others—and we should do much more to identify and support them.

[Sarah Dyke (Glastonbury and Somerton) (LD)]

My hon. Friend, as a veterinarian, will know that farmers also suffer with significant mental health issues. My constituents are under immense pressure following the family farm tax and the sudden closure of the sustainable farming incentive. Alongside that, they work extremely long hours, and the unpredictability of farm work means that it is more difficult for them to access mental health support and doctors’ appointments. Does he agree that we should introduce regular mental health MOT checks at key points in people’s lives—when they are most vulnerable to mental ill health—particularly for those in rural areas where there are barriers to accessing support?

[Dr Chambers]

My hon. Friend will not be surprised that I agree with her; she may as well have read the next bit of my speech. She is completely right. Farmers, those working in agriculture, military veterans and their families, mothers in the first year after childbirth, people living in poverty and the LGBTQ+ community are just a few of the groups that we know are at heightened risk.

We already take a proactive approach when it comes to physical health; we have targeted cancer screenings for at-risk demographics. We should take the same approach to mental health. That is why the Liberal Democrats have long called for properly resourced community mental health hubs, which could reach people before they reached crisis point. We are also calling, as my hon. Friend just did, for regular mental health check-ups at key life stages—for example, when someone has just given birth or just been discharged from the Army.

[Freddie van Mierlo (Henley and Thame) (LD)]

My hon. Friend is outlining the treatment options for patients. New medicines are also incredibly important, and groundbreaking research is happening at the Warneford hospital in Oxfordshire, a mental health hospital that is in desperate need of investment. Treatment options and new medicines go hand in hand, so does he agree that the Government should get behind the Warneford and invest in it?

[Dr Chambers]

I agree with my hon. Friend and thank him for his intervention.

Mental health MOTs could help to catch at-risk people early, so that we can start treating them before the problems develop further. I am sure that for all Members present mental health issues are among the top areas in our email inboxes and our correspondence. We receive emails from desperate parents of young people who are left on waiting lists for years throughout their schooling, and from adults falling between the cracks of an overstretched system. We should probably acknowledge that these are not anomalies. They are the symptoms of a system that is under immense strain. This long-awaited Mental Health Bill is a very welcome step, but it cannot be the only step, because at the heart of our approach must be the simple principle that prevention is better than cure.

[Victoria Collins (Harpenden and Berkhamsted) (LD)]

I absolutely support the idea that we need to invest in prevention—I am 100% behind that—but I have also spoken to many constituents who have issues with emergency health care. One of my constituents, Ed, sadly took his own life. He went into A&E undergoing a psychotic episode and was left simply with a phone number and no assessment. Hours later, he was lost. We need to ensure that those who need emergency treatment get it on the spot, as well as investing in prevention. Does my hon. Friend agree with that principle?

[Dr Chambers]

I totally agree, and I will come on to the care of people once they have been discharged after an acute mental health episode, because it is a hugely emotive and problematic situation.

We need a comprehensive mental health strategy that sees mental health not just as a clinical issue but, as the Secretary of State said, something that needs to run through housing, education, employment and justice. Good clinical services are vital, but we cannot medicate or refer our way out of a mental health crisis. Many mental health issues are often rooted in deeper challenges including poverty, housing, insecurity, loneliness, debt and trauma. These are not medical problems, but they put people at huge risk of developing mental health issues, and if we are serious about prevention we must tackle these root causes head-on.

The Bill focuses very much on the rights and treatment of people once they are admitted to mental health units, which is essential, but what is just as important—as my hon. Friend the Member for Harpenden and Berkhamsted (Victoria Collins) has just highlighted—is what happens when they are discharged and what support they get in the community to prevent a relapse. In Winchester, we have seen a brilliant initiative between local NHS mental health teams and Citizens Advice. Teams from Citizens Advice are in a mental health unit called Melbury Lodge, and they help mental health patients with all their life admin—the bills, the correspondence—so that they are not discharged back into the community only to come home to a load of outstanding credit card bills and demands to repay their personal independence payments, for example.

What is remarkable is that every pound spent on that initiative saves £14.08 in cost avoidance for the NHS through shorter in-patient stays, fewer readmissions, better engagement of services once they are discharged and a reduction in medication use. This is a win-win for staff, patients and the taxpayer, but it is a pilot project and there is no funding secured for it to continue, despite the proven cost-saving benefits. We urge the Government to look seriously at rolling out such initiatives nationwide.

My hon. Friend the Member for Dorking and Horley (Chris Coghlan) has been passionately campaigning since entering this House to ensure that families have a greater input into medical decisions when there are questions over the mental capacity of vulnerable patients, and I invite him to make an intervention now.

[Chris Coghlan (Dorking and Horley) (LD)]

I thank my hon. Friend. As he knows, in my maiden speech eight months ago I pledged that Fiona Laskaris would succeed in changing the law that had prevented her from saving her autistic son, Christopher, from murder. Fiona is here today. Despite pleading for years, she was never able to obtain a mental capacity assessment for her son. As we heard from the Secretary of State, the Government are now seriously looking at an amendment that would both honour Christopher’s legacy and save lives. Does my hon. Friend support that amendment?

[Dr Chambers]

I thank my hon. Friend for that moving intervention and offer my condolences to those in the Gallery. We appreciate that the Secretary of State is seriously considering an amendment that might help save lives.

Early intervention cannot just be a slogan; it has to be the foundation of a functional system. Last week, I sat around a campfire with the amazing team at the Winchester youth counselling services. That charity has a nature therapy programme in which 11 to 16-year-olds can go camping, have walk-and-talk therapies and do bushcraft and outdoor cooking. While we were toasting our marshmallows, the team were talking about the free, confidential mental health support that they offer, providing services such as one-to-one counselling and a weekly wellbeing walk-in session. By immersing young people in nature, this programme helps to reduce stress and anxiety and fosters emotional wellbeing and resilience. Crucially, the services are accessible without the need for a doctor’s referral or diagnosis. Young people can self-refer, ensuring that support is available promptly when it is needed most. This is why Liberal Democrats have been calling for mental health hubs for young people in every community. We support the Government’s campaign for a mental health professional in every primary and secondary school—not just an occasional visit or a pilot scheme, but a permanent funded presence.

[Edward Morello (West Dorset) (LD)]

Just to follow up on my hon. Friend’s point about the importance of mental health hubs, in West Dorset the only child and adolescent mental health services centre is in Dorchester, and for many people in my constituency, especially young people, that means at least a 30-mile round trip to access services. In rural Britain, we are lucky if transport links exist, and those that do are often limited. That makes accessing services nearly impossible, which is what makes hubs so important.

[Dr Chambers]

I totally recognise the importance of that intervention.

We also need a system that is much easier to navigate. A psychiatrist came to see me in my office in Winchester and told me that his son had been referred to CAMHS. He said that despite the fact that he and his wife worked in the medical profession, they had really struggled to access the help that they needed. He said:

“If we can’t navigate the system, what chance does anyone else have?”

That is one reason that Liberal Democrats are calling for a mental health commissioner: someone to champion families, cut through bureaucracy and help people to get the support they need before things get worse. The system needs to be simplified, both for the parents and families who are trying to access the service and to allow the system itself to function.

For years, Liberal Democrats have campaigned for mental health to be treated equally with physical health, and we welcome the commitment to parity in the King’s Speech, but it must be backed by action. The Darzi report showed that mental health accounts for around 20% of the NHS case burden—as the Secretary of State acknowledged—yet it receives just under 10% of the funding. For this reason, we want to ensure that the mental health investment standard is maintained and strengthened, and not quietly scrapped or watered down. The Secretary of State also highlighted the scale of this challenge. Around 1 million people are on waiting lists for mental health services, but importantly, 340,000 children are on mental health waiting lists and some of them are waiting an average of 15 months for care, which is a huge chunk of their educational time and personal development. This is not a crisis that is waiting to happen; it is a crisis that is already here.

In this economic crisis, some people ask how can we afford to invest in mental health, but the real question is how can we afford not to do so, because we already pay the price in lost productivity, emergency call-outs, A&E admissions and—most tragically of all—lives cut short. We must spend to save.

The hon. Member for Bermondsey and Old Southwark (Neil Coyle) spoke about spending time with police. I have done the same thing—a fascinating and informative exercise. I encourage everyone to go on patrol with their police. In Winchester, the police say they spend up to 40% of their time responding to mental health-related incidents. We know that patients turn up to A&E in mental health crisis, many already on a mental health waiting list. I heard that the average amount of time someone spends in a mental health crisis in Winchester’s A&E, often needing individual supervision, is 18 hours. That is not sustainable, because we are using the most expensive part of our health system to do the work that should be happening earlier, which would be more cost effective for the taxpayer and provide better outcomes for patients.

Finally, I pay tribute to all those on the frontline: the nurses, counsellors, psychiatrists, doctors, therapists, support staff and charities who prop up a system that should be supporting them. We very much look forward to working constructively with the Government to improve the Bill, and we support it. We will keep pushing until we live in a country where mental health gets the same attention and care as physical health.