Mental Health Bill [Lords]

Gregory Stafford Excerpts

Report stage
Tuesday 14th October 2025 Commons Chamber

However, there will always be instances in which people do need to be detained in an in-patient setting, so investment in those facilities is vital. I am delighted that Lynfield Mount hospital in my constituency has recently secured funding to implement a fantastic plan to upgrade its in-patient facilities, which will help to ensure that people are treated closer to home, get support to recover, maintain relationships with family, friends and colleagues, and restart their lives after detention. I commend the amendments to the Minister.

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

As a member of the Bill Committee, I had the opportunity to closely examine the development and scrutiny of this Bill alongside my Opposition colleagues. We sought to strengthen the legislation, particularly in relation to safeguarding children and ensuring robust protections for those admitted under the Mental Health Act framework.

Given the shortness of time, I will speak only about amendments 41 and 42. They make the vital clarification that the nominated person for any patient under the age of 16 must have parental or guardian responsibility unless there are clear and established safeguarding concerns. In essence, that would ensure that the parents remain the lawful decision-makers and the first and most natural safeguards for their child’s welfare.

Let us consider, for a moment, what is at stake. Imagine a vulnerable 14-year-old girl, frightened and confused during a psychiatric admission. In that moment of distress, a well-meaning adult—or, worse, someone with a hidden agenda—could persuade the child to nominate them as their representative. That individual would then gain legal powers to object to treatment or discharge decisions, while the parents—the very people who know the child best and have both a moral and legal duty to protect them—could be sidelined.

Once such a nomination is witnessed, it carries legal force. The rights and responsibilities of parents could, in effect, be overridden. Although that may sound hypothetical, it is not. Family courts have seen precisely how manipulative individuals exploit vulnerable young people. Groomers, traffickers and abusers thrive in the legal grey zones. If we are not crystal clear that only a court may displace parental responsibility, we risk leaving the door ajar for such exploitation. I ask the Minister to assure the House in winding up that no child under 16 will be permitted to override parental authority simply by nominating someone else, without a full and proper judicial process.

The Bill does have fallback provisions, which are of course welcome, but they are not watertight unless the law explicitly confirms that only a court can transfer or restrict parental rights.

[Dr Luke Evans]

My hon. Friend makes an excellent point. The only protections that I can see in schedule 2 are an age requirement, a stipulation not to be disqualified by a previous court order, and the presence of a witness. There is therefore no pre-emptive way of protecting people, which is why amendment 41 is so important.

[Gregory Stafford]

My hon. Friend is absolutely right. Both he and I made those points in Committee. I am surprised that the Minister does not see the risks here. The safeguard that my hon. Friend talks about must be beyond any doubt. The amendment in his name provides exactly that clarity. It would prevent unrelated or loosely connected individuals from stepping into a role that rightfully belongs to those with both a legal duty and an emotional bond—the parents or guardians—and it would preserve the fundamental principle that parents should not find their role diminished by accident or administrative oversight.

As I was saying, this is not an abstract risk; it is a very real and foreseeable consequence of the unclear drafting. These amendments do not weaken the rights of patients. They strengthen the protections around them. They ensure that in modernising this law, quite rightly, we do not inadvertently undermine the oldest and most important protection of all: a parent’s duty to safeguard their child. We must ensure that the state can only curtail that right under the strictest judicial scrutiny, with evidence tested and the child’s welfare paramount. In doing so, we will make this legislation not only legally sound but, in my view, morally right.

New clause 31, tabled by my hon. Friend the Member for Hinckley and Bosworth (Dr Evans), would require local authorities and ICBs to supply a fully costed plan to ensure they are able to provide adequate community services for people with learning disabilities and autistic people. I support that entirely. As vice-chairman of the all-party parliamentary group for special educational needs and disabilities, and from speaking to groups in my constituency such as Last Wednesday and Growing Hope, I know that the process around SEND is complicated and not fit for purpose. Fortunately, we have a chance to help it slightly with this Bill, so I ask the Minister to support new clause 31.

[Sojan Joseph]

I would like to speak in support of new clause 37, tabled by my hon. Friend the Member for Thurrock (Jen Craft). On Second Reading, I warmly welcomed the changes that this legislation will introduce regarding autistic people or those who have a learning disability. As a result, it will no longer be possible for someone to be detained in a mental health hospital indefinitely simply because they have autism or a learning disability. In the current system, autistic people and those with a learning disability have experienced inappropriate care, over-medication and extended periods of detention because of a lack of facilities in the NHS and social care, so this change is welcome and long overdue.

The Government have confirmed that the changes will be implemented once the necessary community provision is in place. Establishing strong support in the community is essential for not only enabling safe discharge from hospital settings but preventing unnecessary admissions in the first place. I recognise that the Government are working on setting out what strong community services look like and what resources they require to implement them. From serving with the Minister in Committee, I have no doubt about his commitment to ensuring that this community provision is introduced in a timely manner, but I support the proposal of my hon. Friend the Member for Thurrock that there should be a road map in the legislation that will provide a clear framework outlining how those services will be introduced. After all, ending inappropriate detention requires robust community-based alternatives to ensure that people with autism or a learning disability who would have previously been detained do not fall through gaps in the system.

Having a road map developed in conjunction with autistic people, people with learning disabilities, their carers and healthcare professionals will help to identify and address any gaps in service provision and workforce capacity. I also believe that it will help to reduce the risk of people with autism or a learning disability needing police intervention or emergency hospital care because the support is inadequate. By putting in place a road map, new clause 37 would help to ensure that we end all the sooner the injustice of people with autism or a learning disability being detained.

Draft Human Medicines (Authorisation by Pharmacists and Supervision by Pharmacy Technicians) Order 2025

Gregory Stafford Excerpts

Monday 13th October 2025 General Committees

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

It is a pleasure to serve under your chairmanship this evening, Ms McVey.

As we have heard, the order before us will, broadly speaking, enable pharmacists to authorise pharmacy technicians to take primary responsibility for the preparation, assembly and supply of medicines in pharmacies and hospital aseptic facilities. Like the Minister, I thank the thousands of pharmacists across the country for the way they serve our communities, both in the community and in hospital settings.

The Conservatives will not be opposing this legislation. The current model of medical dispensing centralises responsibility upon the shoulders of the pharmacist, taking their clinical skills away from treating patients and underutilising qualified pharmacy technicians. It is clearly sensible, therefore, for both pharmacists and technicians to work at the top of their remit. That will be more rewarding for them and more efficient for the NHS.

That is why the Conservative Government launched a consultation in 2023 on retaining the need for each pharmacy to have a responsible pharmacist but enabling them to delegate more straightforward tasks to technicians. The risk of doing so is low, and it is further lowered by the fact that, in Great Britain, pharmacy technician is a regulated profession. I am therefore pleased to see that this Government have picked up the baton from the previous Conservative Government, and we welcome the new legislation in principle. However, I do have a few questions for the Minister.

First, embedded within these provisions is a total reliance on “supervision” and “authorisation”, yet clarity of definition is missing on how those will operate in practice for a pharmacist authorising a pharmacy technician to dispense medicines. I note that 76% of pharmacists in the consultation shared that anxiety. The Government assure us that there will be a transition period to enable the General Pharmaceutical Council to update its 2005 guidance on pharmacist supervision, but the length of that transition period remains uncertain.

Will the Minister confirm the length of that transition period to ensure that regulators can put the correct safeguards in place to preserve accountability when it comes to the rather loose terms of “supervision” and “authorisation”? What guidance has he provided to the regulator on those guidelines? This is a particularly important clarification, given the Government’s preference for oral authorisation, which, although flexible, leaves pharmacists without specific written record-keeping.

As the Minister knows, not all pharmacies have a pharmacy technician. In fact, NHS England’s 2023 community pharmacy workforce survey found that there were 17,666 full-time employed pharmacists and 4,324 pharmacy technicians. The impact assessment notes that smaller pharmacies are less likely to have a technician, so larger pharmacies will be able to dispense more cheaply and develop a broader service. With that in mind, what assessment has the Minister made of the effect on rural, remote or small family pharmacies? What plans does he have to monitor the effect of the consolidation on travel distances and patient choice?

With the time freed up by delegation of tasks, pharmacists will be able to provide contraception services, blood-pressure checks and vaccinations. They will also be able to expand Pharmacy First provision—another great service introduced by the previous Government, I note. However, as a new service, Pharmacy First was introduced within a fixed funding envelope, so what plans does the Minister have to expand that service?

Finally, what discussions has the Minister had with his counterparts in Northern Ireland regarding the establishment of a regulated profession of pharmacy technicians there?

As Conservatives, we welcome improving efficiency and giving patients faster access to appointments and prescriptions. For those reasons, the changes are to be welcomed. I conclude by paying tribute to officials in the Department, and organisations outside this House, who have worked hard to get these updated provisions before us today.

Baby Loss

Gregory Stafford Excerpts

Monday 13th October 2025 Commons Chamber

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

Let me first draw Members’ attention to my entry in the Register of Members’ Financial Interests.

I congratulate my right hon. Friend the Member for Godalming and Ash (Sir Jeremy Hunt) and the hon. Members for Rossendale and Darwen (Andy MacNae) and for Sherwood Forest (Michelle Welsh) on securing the debate, and on their eloquent and thoughtful speeches. Behind the statistics that I will put before Members, as others have done today, are the broken families with a gaping hole in their lives and a pain that will never go away. There are so many unanswered questions. What would their first word have been? When would they have taken their first steps? Who would they have grown up to become? For families who have lost a baby, these questions, painfully, tragically, will never be answered.

I have been honoured to meet representatives of charities all of which are doing excellent work to support families who have been affected by baby loss, and campaigning for improved maternity services. I pay tribute to those charities—including Bliss, Sands and Tommy’s—and to the royal colleges, and I thank the families in the Maternity Safety Alliance for sharing their very personal and moving stories with me when the shadow Secretary of State and I met them recently.

The last Government worked hard to improve maternity services. A decade ago, my right hon. Friend the Member for Godalming and Ash, then Secretary of State for Health and Social Care, announced an ambition to halve the rates of stillbirths, neonatal and maternal deaths in England by 2030, and he made encouraging progress. The stillbirth rate fell by about 20%, as did the neonatal death rate, and the maternal death rate fell by about a third.

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

Does my hon. Friend agree that the introduction of baby loss certificates following the pregnancy loss review under the last Government was a vital step in recognising bereaved parents’ grief and offering support on their terms?

[Dr Johnson]

My hon. Friend is, of course, right. Those certificates have proved to be of great comfort to many. The hon. Member for Washington and Gateshead South (Mrs Hodgson) talked about her work in that regard, and I thank her for it. I am also grateful for the work of my former colleague Tim Loughton.

One of the reasons I went into politics is the fact that one can make more of a difference as a politician than as a single doctor alone. The changes made by my right hon. Friend the Member for Godalming and Ash mean that, by quite some margin, he has saved more babies’ lives than I have as a consultant paediatrician. I assure the Secretary of State that it is not flattery when I say that he has more capacity than any NHS doctor when it comes to saving babies’ lives. I am pleased to see him here at almost midnight; I know that he cares, and I know that, like all of us, he wants to stop the tragedies about which we have heard so much today. However, I ask him to consider, every day, whether he is really doing all that he can to maximise the opportunity that he has, and, in the spirit of constructive opposition, I have a few questions for him. He said he came in with a plan, but in fact he took a year to create the 10-year plan, which creates a maternity and neonatal taskforce that is tasked with creating another plan. I sincerely hope that it is a good plan, after all this waiting, but I do worry that it has lost time, so can he confirm when it will be published?

Staffing levels have been mentioned in many tragic incidents, and the Secretary of State has promised that he will train thousands of additional midwives. Looking at the figures, an average of 10 fewer students have been accepted on to midwifery degrees in England across his two years in office compared with 2023. Can the Secretary of State confirm when he expects to train the 1,000 additional midwives he promised in his manifesto?

The previous Government increased the number of medical school places and built five new medical schools. As those students begin to qualify, the specialist training places need to be expanded and British graduates need to be prioritised. The Secretary of State seemed to understand that at Easter, but what has he done about it? The applicant-to-place ratio has risen dramatically, and now strikes are threatened, which would threaten the care of women and babies across the country.

We know that reducing baby loss starts before a baby is conceived and that factors such as teenage pregnancy, smoking, obesity and sub-optimally managed chronic conditions increase the risk of stillbirth. We must systemically improve on factors that increase the risk of baby death. I welcome the fact that the Secretary of State has brought through legislation, introduced by the previous Government, to fortify bread flour with folic acid by the end of 2026. That will prevent 200 cases of neural tube defects a year and improve the health of pregnant women. I am also pleased to see that the Tobacco and Vapes Bill is gradually making its way through Parliament. However, given that the Bill completed its Second Reading in the House of Lords on 23 April and is not due to appear in Committee until 27 October—more than six months later—there just does not seem to be enough urgency in the Government’s actions. Can the Secretary of State tell us what he is doing to improve pre-conception advice and optimise the management of chronic conditions in women to reduce the risk of baby loss?

As an NHS doctor, I pay tribute to my colleagues, who welcome almost 600,000 tiny miracles into the world each year. However, as we have heard this evening, care does not always meet the highest standards and too often avoidable deaths occur. Can the Secretary of State assure us that the findings of the ongoing Ockenden review into maternity services will be swiftly acted on? Donna Ockenden’s 2020 review into maternity care at the Shrewsbury and Telford trust found that at least 201 babies and nine mothers could have survived had they had better care. From her report came a £95 million ringfenced fund to improve the care available for expectant mothers, but as we have heard already this evening, the Government have slashed that fund from £95 million to just £2 million, with the rest of the money siphoned off to England’s 42 integrated care boards.

The Government have also reduced ICB budgets and are forcing them to restructure. I am worried that this un-ringfencing of the budget, and the distracting reorganisation, will have a negative impact on efforts to improve maternity services. What is the Secretary of State doing to prevent negative consequences?

Neonatal care can be lifesaving. One in seven babies in the UK requires neonatal care, but unfortunately their fight for life is not always won, and 1,933 babies died in neonatal care in 2023. With that in mind, will the Secretary of State clarify the extent to which neonatal services will be included in the maternity and neonatal investigation due by the end of the year? How will the quality of neonatal care be assessed? The recent NHS estates review of maternity and neonatal care did not appear to include parental accommodation, yet many parents find that their babies are transferred miles away for specialist care. May I urge the Secretary of State to recognise the value of this accommodation and make sure it is widely available?

As many Members have mentioned, black and ethnic minority women are more likely to suffer baby loss or maternal death. Can the Secretary of State update us on what progress he has made on his Government’s manifesto promise to close the maternal mortality gap for black and Asian women?

In the decade since the previous Government launched ambitions to improve maternity safety in the UK, the number of stillbirths and neonatal deaths has reduced by almost a quarter, and the number of maternal deaths has reduced by around a third. These are encouraging signs, and they show good progress. We must build on these achievements, but there is so much more work to be done. Today we have heard many stories of loss and of care failures. Only action will turn the page on baby loss. We all wish for improved maternity and neonatal care, but the Secretary of State is the man with the levers to make that happen—the levers to save hundreds of lives. I urge him to use them urgently.

Rare Cancers Bill

Gregory Stafford Excerpts

Report stage
Friday 11th July 2025 Commons Chamber

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

To your delight, I am sure, Madam Deputy Speaker, and to the delight of the whole House—especially that of the Government Whips—I am not going to speak for very long on Report, although I am not promising not to speak for some time on Third Reading. I wish to briefly speak to amendments 5 and 8 tabled by my hon. Friend the Member for Christchurch (Sir Christopher Chope). Before that, though, I congratulate the hon. Member for Edinburgh South West (Dr Arthur) on the Bill. I am generally supportive of it and think it is entirely necessary.

Turning to the amendments, my hon. Friend the Member for Christchurch is right. It does concern me that the words

“the opinion of the Secretary of State”

are included proposed new subsection (2) of section 1E of the National Health Service Act 2006. As my hon. Friend has pointed out, proposed new subsection (4) of section 1E and proposed new subsection (5A) of section 261 of the Health and Social Care Act 2012 set out the definition of a rare cancer, and if the Bill passes, that definition will become law. I therefore think there is a contradiction within this piece of legislation: it contains an absolute definition of a rare cancer, but adds some ambiguity by referring to the “opinion” of the Secretary of State. I ask the Minister to explain how both those things can be true. If the Secretary of State decides that there is some other definition of a rare cancer, how can that possibly be in line with the definition that is written into the law?

As the hon. Member for Edinburgh South West has said, the definition that has been included in the Bill—that a rare cancer is

“a cancer that affects not more than 1 in 2000 people in the United Kingdom”—

aligns it with the UK rare diseases framework, which was published by Lord Bethell in the other place in 2021. It seems to me that that is an effective and suitable definition, so again, I ask the Minister whether he expects there to be some other definition. If he does not expect that, why is it necessary to include the words

“the opinion of the Secretary of State”?

The Bill is not even consistent. Proposed new subsection (2) of section 1E of the National Health Service Act 2006 refers to the opinion of the Secretary of State, but proposed new subsection (5A) of section 261 of the Health and Social Care Act 2012 talks about

“the opinion of NHS England”.

As my hon. Friend the Member for Christchurch has pointed out, NHS England is fortunately going to be abolished very soon. When that happens, will we have to pass either primary legislation or secondary legislation to delete those words from the Bill? Would it not be better if we deleted the words “the opinion of NHS England” now? Why will the Minister not consider removing them? If there is some reason why he thinks the Secretary of State might have to change the definition, why are those two clauses of the Bill not consistent?

I hope hon. Members will see that what the hon. Member for Christchurch and I are trying to achieve—certainly through amendments 5 and 8—is to establish a clear definition of a rare cancer. We are aiming to ensure that there is no ambiguity in that definition, and if there is to be ambiguity, we want to at least ensure that the body or authority that is going to make any changes is consistent in the legislation.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the shadow Minister.

--- Later in debate ---

[Gregory Stafford]

Once again, I congratulate the hon. Member for Edinburgh South West (Dr Arthur) on bringing this essential Bill before us and thank him for the hard work he has done to make sure we get to this place. As I have said many times in this House, early detection saves lives, but without meaningful progress in research we will fall behind other countries making major advances in cancer care.

We call these rare cancers, and they are rare in their individual components, but I have been amazed by how many constituents across Farnham, Bordon, Haslemere, Liphook and the surrounding villages have contacted me in support of the Bill and to share their experiences. Despite rare and less common cancers receiving more than half of UK cancer research funding in recent years, a staggering 82% of patients surveyed by Cancer52 said that they were never offered the chance to participate in a clinical trial. That is not because there is no public support or because the science is not there, but because persistent structural barriers are in the way. The Bill addresses those barriers directly.

If enacted, the Rare Cancers Bill will appoint a national specialty lead for rare cancers within Government, creating accountability, facilitating research and collaboration, and embedding co-ordination across NHS England—while it still exists—the National Institute for Health and Care Research and cancer alliances. Secondly, it will mandate a review of the UK’s orphan drug regulations, aligning incentives such as marketing exclusivity and reduced regulatory fees with international best practice. Thirdly, it will adapt the NIHR’s Be Part of Research platform to create a dedicated, proactive registry that directly links patients with relevant clinical trials.

Let us be clear: this Bill aims to deploy smarter systems, harness the power of artificial intelligence, expand fair access to treatment, end the postcode lottery and ensure that every patient, no matter the type of cancer, has the opportunity to benefit from research and high-quality personalised care. Let us also be clear about the need. Rare and less common cancers account for 47% of all UK cancer diagnoses, yet they are responsible for 55% of all cancer deaths. That means that more than half of those who die of cancer in this country do so from conditions that receive disproportionately less investment, less attention and less hope.

The disparity in survival is stark. For some rare cancers, five-year survival rates languish in the single digits. Only 16% of people diagnosed with cancers of the pancreas, brain, oesophagus, liver or stomach survive beyond five years. By contrast, the five-year survival rate across more common cancers is more than 55%. This is not a marginal issue; this is mainstream cancer care, but it is neglected.

Our international peers are taking action. In countries such as France, Germany and the USA, regulatory frameworks are actively incentivising clinical trials for rare cancers. The UK, meanwhile, has fallen from second to 10th in Europe for access to orphan medicines. We must reverse that decline. We must unlock the potential of our research base, and this Bill gives us the legislative structure to do so.

The NHS 10-year plan, launched with the ambition to modernise our health service, is a wide-ranging document. It rightly champions early diagnosis, innovation and personalised care, and there is no doubt that many of its pillars, particularly those on genomics, digital access and therapeutic innovation, can benefit people with rare cancers, but “can” is not the same as “will”, and “should” is not the same as “must”. The plan sets out a national goal to diagnose 75% of all cancers at stages 1 or 2 by 2028. That target explicitly includes rare and less common cancers. That is an important and necessary ambition but, as campaigners have rightly pointed out, without specific structural action on rare cancers, we will not hit that target; even worse, we will leave some of the most vulnerable patients behind.

As I have said, these are not fringe diseases: these are mainstream conditions that are under-researched and under-resourced. The 10-year plan includes a number of relevant commitments, such as the whole genome sequencing of newborns, supported by £650 million of investment, which could revolutionise early detection of genetic cancer syndromes. Of course, there are some safeguarding issues around that sequencing—I do not want to pre-empt my column in PoliticsHome on Monday, but please read it for more about my concerns over those safeguards.

Likewise, the plan includes the expansion of genomic and pharmacogenomic services in the NHS, giving us the potential to offer targeted therapies for rare cancers. It has a pipeline for advanced therapy medicinal products, including CAR T-cell treatments, which are already being rolled out for certain rare blood cancers. It also streamlines the regulatory pathways through a proposed innovator passport to bring treatments to patients faster.

Those are steps in the right direction, but let me be frank: the plan does not go far enough for people with rare cancers. There is no dedicated rare cancer taskforce, despite repeated calls from Cancer52, Sarcoma UK and the Brain Tumour Charity. There is no specific ringfenced funding for rare cancer services, despite the complex multidisciplinary care that these conditions require. There are no rare cancer-specific training pathways or fellowships, despite clear evidence from clinicians that a lack of expertise is hampering outcomes. The England rare diseases action plan, published alongside the NHS strategy, takes some welcome steps on collaborative networks and data integration, but rare cancers are again folded into a general framework, rather than given the targeted attention they so desperately need.

[Uma Kumaran (Stratford and Bow) (Lab)]

I am here today on behalf of my young constituent, Imogen, and all young people facing tongue cancer. It is a rare cancer, with frightening and disabling treatment options. I am also here on behalf of my constituent Ros, who lost her mother to pancreatic cancer just 24 hours after diagnosis. Does the hon. Member agree that this House should be united in its support for practical, targeted reforms to advance rare cancer research, which are supported by more than 30 expert charity partners and which so many of our constituents desperately want to see passed into law?

[Gregory Stafford]

I thank the hon. Member for her intervention. She is absolutely right—I hope this matter has cross-party support in the House. As she points out, a significant number of charities across the country hope that the Bill will pass today, as do I.

That brings me nicely on to what Jane Lyons, the former chief executive of Cancer52, has said:

“Rare and less common cancers make up a massive part of the cancer burden in this country. They need proper structural attention—not just well-meaning inclusion in generic plans.”

She is right. We need dedicated leadership and a single accountable individual or office for rare cancer research and care. We need smarter data platforms, such as the adapted Be Part of Research system proposed in the Bill, and we need a clear strategy for delivering orphan drug access, so that the UK becomes a destination for innovation, not a detour.

When the NHS 10-year plan speaks of transformation, we must ensure that that transformation is inclusive. When we talk about prevention, early detection and innovation, we must be honest about who gets access and who does not. If we are serious about improving outcomes for all cancer patients, rare cancers must not be treated as an afterthought. They must be recognised for what they are: a major public health challenge hiding in plain sight.

The 10-year plan gives us the tools, but it is now up to this House and to Ministers to ensure that those tools are used equitably, strategically and with urgency. That is why I was incredibly saddened to hear that Dr Susan Michaelis, the founder of the lobular moonshot project, died a couple of days ago. Susan’s life and legacy exemplify why this Bill matters. Lobular breast cancer affects 22 women every single day in the UK and more than 1,000 globally. It is not rare in the strict legal sense—more than six per 100,000 are diagnosed annually—but due to the severe lack of research, awareness and tailored treatment, it deserves to be treated as such by our systems.

Susan was due to meet the Secretary of State on 14 July—this coming Monday—to discuss how to accelerate the vital five-year research project she helped to initiate. Thankfully, that meeting will still go ahead. The campaign will not stop. The lobular moonshot project will continue—for Susan, and for every woman still facing this disease without the research-backed options that she deserved.

Susan is far from alone. A constituent recently wrote to me about their mother, who died in 2011, just three years after her diagnosis with glioblastoma multiforme, an aggressive and incurable brain tumour. The average glioblastoma survival time is 12 to 18 months; only 25% of patients survive more than a year, and just 5% live beyond five. Another campaigner spoke movingly about the delays she faced before being diagnosed with a rare kidney cancer—initially misdiagnosed, postponed by covid, and ultimately caught too late.

There are so many rare cancers, and the stories repeat. Rare cancers are not rare to those living with them; they are rare only to the system. According to Jane Lyons, the former CEO of Cancer52,

“Something like 47% of all cancer diagnoses are for rare and less common cancers, but they account for 55% of all cancer deaths…That’s a massive number of challenges—and a huge opportunity for impact.”

Sarcoma UK’s recent report found that one in three sarcoma patients waits more than six months to be diagnosed. Referral pathways are frequently misapplied, and this delay is not a minor inconvenience; in cancer care, it can be fatal.

The Brain Tumour Charity has called the Bill

“essential for any real hope of progress in finding a cure.”

The Less Survivable Cancers Taskforce has declared that this legislation is

“crucial for early diagnosis and equity of access.”

The Urostomy Association, in its rare cancers manifesto, calls for urgent structural change to improve data, screening and outcomes, and Lynch Syndrome UK has spoken powerfully about the opportunities to accelerate genetic-led, AI-informed cancer prevention if rare cancer research is properly funded.

I believe that the Rare Cancers Bill will help to achieve that. It has three core provisions: first, a named lead for rare cancer research so that this agenda has a home in Government and a voice at the top table; secondly, a review of the orphan drug regulations to create better commercial incentives for new treatments and trials; and thirdly, a patient-focused data system built into the Be Part of Research platform so that people are no longer left in the dark about trials that could change their lives. This is not just about saving lives; it is about improving them. It is about ensuring that families are not left with grief and regret when better systems might have given them hope.

Today, as we consider the Rare Cancers Bill, let us remember people like Susan Michaelis and the countless families who have campaigned for change they may not live to see. Let us recognise that rare cancers are not someone else’s problem, but a public health injustice hiding in plain sight. Let us pass the Bill—not just for the scientists and clinicians, but for every patient, and for every parent and partner who has watched a loved one suffer from a cancer few people can even pronounce. This is our chance to correct the imbalance, drive innovation and deliver real, lasting change. If we seize this moment, we can ensure that every patient—no matter how rare their cancer—can access trials, treatment and the possibility of life.

Let us not waste this opportunity. Let us be clear-eyed about the gaps and build an NHS that genuinely serves every patient, with every type of cancer, in every part of this country. Together, let us leave a legacy worthy of those we have lost, and transform care for those still fighting.

Mental Health Bill [ Lords ] (Ninth sitting)

Gregory Stafford Excerpts

Committee stage
Tuesday 24th June 2025 Public Bill Committees

[Zöe Franklin]

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

The new clause would introduce a dedicated veterans’ mental health oversight officer, recognising that those who serve or have served in the UK or Commonwealth armed forces face distinct mental health challenges that are not always adequately met by the current system. Far too many veterans experience post-traumatic stress disorder, depression, anxiety or substance misuse that, sadly, is linked to their service. Yet they are often treated within a system that does not fully take account of those experiences, and they are sometimes detained under the Mental Health Act without the benefit of trauma-informed, veteran-specific pathways of care.

New clause 9 seeks to change that. It would create an independent officer, tasked with monitoring the use of the Mental Health Act in relation to veterans, advocating for tailored assessment and care linked to veterans’ service history, promoting alternatives to detention where appropriate, particularly through veteran-specific services, and reporting annually to Parliament on outcomes including rates of detention, recidivism and systemic barriers. It is not just about oversight; it is about respect and responsibility.

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

I am very sympathetic to the hon. Member’s concerns, but how does she see the new clause fitting in with the already established armed forces covenant, which protects and promotes healthcare for veterans across the country?

[Zöe Franklin]

I see them as absolutely sympathetic to each other and working in concert. We want to ensure that veterans have specific, tailored mental health care, as is outlined in the Bill. That is why the new clause would ensure that veterans’ unique needs are not just recognised but actively addressed. It is a practical and overdue step to improve care, safeguard rights and deliver the joined-up service that veterans deserve. After all, they give so much to our nation through their service.

I hope that the Minister will support the new clause, but if he does not, I hope that he will outline for the Committee how the Government will ensure that the aims of the new clause will be addressed through the Bill and its accompanying documents as they stand.

--- Later in debate ---

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

It is a pleasure to serve under your chairmanship, Mr Vickers. I rise to speak in strong support of new clause 13, tabled by the shadow Minister. The new clause would place a duty on the Secretary of State to review the functions and effectiveness of the regulatory authority, which is currently the Care Quality Commission, within one year of the passage of the Bill. The new clause is a timely, necessary and constructive addition to the Bill.

As colleagues will know, the Care Quality Commission plays a dual role in relation to the Mental Health Act. First, as the regulator of services, it ensures that providers meet fundamental standards of care and safety. Secondly, through its specific responsibilities in visiting and speaking to those detained under the Act, it ensures that people’s rights are protected and that the law is used appropriately and humanely. That is no small task. It is a balance that requires the CQC to be not only reactive but proactive, and not only independent but responsive to the lived experiences of patients—especially to the voices of the most vulnerable. That is why the new clause matters. As we bring forward significant reforms to the Mental Health Act through the Bill, and rightly modernise and improve safeguards and place greater emphasis on autonomy, dignity and therapeutic benefit, we must also ensure that our system of oversight and regulation is fit for purpose.

I welcome the direction that the Bill sets. Its four core principles are rightly placed at the heart of the legislation: choice and autonomy, least restriction, therapeutic benefit, and seeing the person as an individual. Those principles must shape the way that care is delivered on the ground. That means they must also shape the way that care is monitored, inspected and held to account. A review of the regulator’s role is not about criticism for its own sake; it is about ensuring that the regulatory framework supports and reinforces the ambitions of the Bill and that it can respond to emerging challenges, shine a light where services are falling short and, crucially, act to protect patient rights.

[Gregory Stafford]

My hon. Friend is being slightly charitable to the CQC. Given Penny Dash’s review, we all know that the CQC has significant problems, otherwise we would not be reviewing it. Does my hon. Friend agree that the new clause is absolutely vital because of the failures of the CQC up to this point, and our lack of faith in it being able to meet the challenges that this legislation will bring to the mental health sector? Does she also share our concern about the CQC’s ability to regulate and scrutinise properly?

[Aphra Brandreth]

My hon. Friend is absolutely right. We have seen examples where regulators have not intervened quickly or robustly enough, and where systemic issues went unnoticed or unaddressed for far too long. We need to strengthen the remit and ensure that the CQC is properly equipped and held to the high standards that we expect of it.

I am an economist by background, so evaluation is something I think about a great deal. Reform, however well intentioned, must be followed by evidence, scrutiny and a willingness to learn and improve. The new clause ensures that we do not just set change in motion, but that we stop to ask whether it is working, whether the right things are being done, and if not, how we can improve.

The review required by the new clause would look not only backwards at whether the regulator has effectively carried out its existing duties under the Act, but, crucially, forwards, assessing whether it is ready to meet the responsibilities placed on it by the new reforms. I particularly welcome the requirement for the review to be published and laid before Parliament. Transparency is essential. It would allow Parliament to scrutinise but also gives patients, families, professionals and the public confidence that those questions are being asked seriously and answered publicly.

Ultimately, the new clause is about improving outcomes. When regulation works well it safeguards dignity, prevents harm, identifies and spreads good practice, develops trust and helps us build a system where the principles of this Bill—choice, autonomy, less restriction and greater therapeutic benefit—are not just written in statute, but visible in practice. That is especially important in mental health care, where so often the people subject to the Act are among the most vulnerable. Those in in-patient settings, particularly those who are detained, are often not in a position to advocate for themselves. They rely on a system that is vigilant, takes its safeguarding responsibilities seriously and puts patients’ rights first.

I hope that all members of this Committee will support the new clause. It is collaborative in its intent, constructive in its purpose and essential to delivering the meaningful reform that we all want to see. It reinforces the importance of accountability, transparency and listening to those most affected by this legislation. We owe it to those individuals and their families to make sure that we not only change the law, but also the culture and oversight that surrounds it. This review would help us do exactly that.

Department of Health and Social Care

Gregory Stafford Excerpts

Tuesday 24th June 2025 Commons Chamber

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

I congratulate the hon. Member for Birmingham Erdington (Paulette Hamilton) on securing the debate.

We have learned this week that rather than the Government ensuring that funding reaches the frontline, spending on staff at the Department of Health and Social Care and seven other arm’s length bodies has increased by more than 10% since Labour came to power, while GPs, social care providers and hospices are forced to do more with less.

The situation is further compounded by rising financial pressures. Despite repeated promises that additional funding would improve patient care, the chief financial officer of NHS England has confirmed to the Select Committee that all the extra money allocated to the NHS will be swallowed up by national insurance increases, inflation and pay settlements, which means that none of it will go towards real improvements in frontline care.

The rise in national insurance contributions was supposed to bolster the NHS and social care. In reality, it has landed like an extra tax on providers themselves. GP surgeries, care homes, hospices and community services are all grappling with the additional payroll costs, just as they struggle with surging demand and chronic workforce shortages. The Institute of General Practice Management estimates that the average GP practice now pays an extra £20,000 a year in national insurance alone. Across the nearly 6,500 practices, that adds up to around £125 million a year—money that could otherwise pay for more than 2 million GP appointments, at a time when patients are struggling to be seen.

Adult social care providers face an equally stark reality. The Nuffield Trust projects that employers will shoulder nearly £940 million in extra national insurance costs in this financial year, on top of the £1.85 billion required to cover the rise in the national living wage. Local councils already face a £665 million shortfall in delivering their legal social care duties. The Government have promised a 3% real-terms rise in NHS revenue spending each year to 2028-29, reaching £232 billion by the end of that financial year, yet despite the headline increases, capital investment is being held flat in real terms. NHS leaders have made it clear that it will not be enough to rebuild or modernise our hospitals, or to fund the facilities required to support more care in the community.

The Health and Social Care Committee’s recent inquiry, “Adult Social Care: the Cost of Inaction”, has drawn attention to the enormous human and economic toll of the Government’s failure to reform the care sector. From the burden of unpaid carers to the economic impact of people leaving the workforce due to unmet care needs, the system is under severe and unsustainable strain, but rather than tackling this issue, the Government have once again kicked social care into the long grass and are waiting for a report from Baroness Casey that will probably not emerge until the very end of the Session. The cross-party talks that this Government promised have been scrapped again.

Although the spending review includes £4 billion in additional adult social care funding and an increase in the NHS minimum contribution to the better care fund, there remains little clarity on how the Government will fund their commitment to deliver a fair pay agreement for care workers. It is also far from clear that the better care fund is currently structured to meet the real needs of the care sector, rather than simply alleviating pressures in primary care. These estimates are not abstract figures; they translate directly into longer waits for elderly patients, overstretched family carers and staff driven to exhaustion.

Can the Minister confirm exactly how much funding the Government will allocate next year to tackle the social care workforce emergency, reduce waiting lists for assessments and services, and ensure that councils can meet their statutory obligations? What concrete recruitment and retention measures will be put in place to attract and retain carers, nurses and support workers in this vital sector, and how much new capital investment will be committed to help providers to modernise facilities and expand capacity to meet the needs of our growing and ageing population? When will the cross-party talks that the Government promised on social care happen? They must happen; otherwise, all the good effort—from Members on both sides of the House—on this issue will be lost. Finally, with social care vacancies entrenched and NHS productivity still trailing pre-pandemic levels, will the Minister set out what credible workforce and capital investment plans will be included in the forthcoming NHS 10-year plan to address these challenges once and for all?

I pay tribute to all the health and social care workers—employed or voluntary—across this country. This Government, with their massive majority, have a real opportunity to make real changes. They must start doing so now, and quickly.

Incontinence

Gregory Stafford Excerpts

Thursday 19th June 2025 Commons Chamber

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

Thank you very much, Mr Deputy Speaker. I welcome you to your place today.

It is an honour to speak in this debate on behalf of His Majesty’s Opposition, and I pay tribute to the hon. Member for Dudley (Sonia Kumar) for securing it. Her speech included the wealth of experience that she brings to the topic, and I especially congratulate her on putting this issue so clearly on the agenda today in the House. It was a powerful and wide-ranging speech that demonstrated the wide range of issues and conditions that can lead to incontinence.

As the hon. Member for Nuneaton (Jodie Gosling) told us earlier, incontinence is a condition that affects around 14 million people across the UK, yet too often it remains misunderstood, under-discussed and—worse still—dismissed. One in three women experience urinary incontinence, and half a million adults live with bowel incontinence. Incontinence does not discriminate; whether bladder or bowel, temporary or chronic, or mild or severe, it touches people of all ages, backgrounds and walks of life. It affects new mothers, people recovering from surgery, those with neurological conditions, the elderly, and even children. However, too many suffer in silence, held back by stigma, isolation, or the belief that nothing can be done.

Like other Members, I received some heartbreaking stories from my constituents in Farnham, Bordon, Haslemere, Liphook and the surrounding villages. Incontinence is a medical issue, not a personal failing. It is not something to be ashamed of; it is something to be addressed through compassion, awareness and proper care. The impact of incontinence can be profound. It affects people’s confidence, their work, their relationships and their mental health. That is why Continence Week, which we are currently marking, matters. We cannot expect people to reach out for help unless we first create a culture where they feel safe and supported in doing so. We also need to ensure that services are in place to respond when they do seek help. That means better access to continence nurses, urologists, and physiotherapists, such as the hon. Member for Dudley. It means investing in community support, and in research and innovation, and recognising that continence care is a core part of our health system, not an afterthought.

I therefore welcome the Government’s stated ambition to tackle inequalities in women’s health and to address conditions such as incontinence more seriously, but warm words and long-term ambitions are not enough when so many continue to struggle. For example, the “Excellence in Continence Care” guidance, first published in 2018, was a groundbreaking piece of work, but we now need clear next steps, funding and measurable outcomes. We must not allow this to drift for another seven years while millions suffer in silence.

Under the previous Conservative Government, we delivered real and lasting progress in this area. In 2022, we published England’s first ever women’s health strategy, a genuine turning point shaped by listening to more than 100,000 women’s voices. That strategy committed to trauma-informed care, expanded research and, crucially, improved the quality and accessibility of information on the NHS website so that women could make informed choices about their own health.

Under our leadership, women’s health hubs were launched with a clear mandate to exist in every integrated care system, bringing services closer to communities and breaking down barriers to care. We also ensured the creation of specialist mesh centres across England, delivering multidisciplinary, regionally-based care for women facing the severe consequences of surgical complications. At a recent roundtable I attended with lecturers from Bath University on mesh, Primodos and valproate, it was clear that there is still more work to do to support these women and to learn from the past. I thank the hon. Members for Wolverhampton West (Warinder Juss) and for Harlow (Chris Vince) for raising the mesh scandal so passionately earlier.

On incontinence, the Conservative Government backed National Institute for Health and Care Research funding for vital research into patient-reported outcome measures, empowering patients, improving clinical care and ensuring that the lived experience is properly reflected in decision making. As my hon. Friend the Member for Dumfries and Galloway (John Cooper) so powerfully elucidated earlier, men are often forgotten in this area. On the Opposition Benches, we support any culture and any steps that will help men with incontinence. As the hon. Member for Strangford (Jim Shannon) mentioned, we men are pretty poor at going for diagnosis and treatment, and that needs to change.

The scale of the issue remains significant. Nearly half of women experience incontinence after childbirth and one in 10 experience faecal incontinence, yet only 17% seek help. That is often because they are told subtly or directly that it is simply part of ageing or the price of motherhood. That attitude was unacceptable then and must not be tolerated now. When a third of women suffer pelvic floor disorders after giving birth and still face barriers to care, when men living with incontinence are afraid to leave their homes, and when people are forced to depend on charities for access to basic hygiene products, it is clear that we have a public health problem that transcends mere inconvenience.

Will the Department commit to publishing an updated “Excellence in Continence Care” strategy this year, with clear timelines and accountability? Will we see dedicated funding to expand women’s health hubs further, so that continence care is a core service, not a bolt-on? Will the Minister also bring forward a plan for better health services for male incontinence? Will NHS England guarantee national consistency of access to continence services and products, ending the unacceptable postcode lottery? Will the Government protect and grow funding for continence research to improve treatments for men and women?

Finally, I pay tribute to the organisations, including Bladder and Bowel UK, Prostate Cancer UK and the Urology Foundation, that are breaking taboos and supporting patients so tirelessly, but it is not their responsibility alone; the Government must lead. We Conservatives made a start, and we now need the current Government to have the same urgency, ambition and delivery to ensure that these hard-won improvements are built upon so that no one is left to struggle in silence.

Mental Health Bill [ Lords ] (Seventh sitting)

Gregory Stafford Excerpts

Committee stage
Thursday 19th June 2025 Public Bill Committees

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

It is a pleasure to serve under your chairmanship, Sir Desmond. You and the Committee will be pleased to know that my hon. Friends have made most of the points I wanted to flag.

In poll after poll and survey after survey, patients feel they do not get information in a timely and constructive way. Our amendment 46 would give patients a stronger say in their future care if they lose capacity. It clarifies that patients must be given clear, proactive support to understand, prepare and use the documents. It is about ensuring that advance choice documents are not just theoretical paperwork, but living, respected statements of a patient’s wishes.

I therefore support the clause and the amendment, and I ask the Minister three questions. How will NHS England and local integrated care boards ensure that commissioners are trained to respect and use ACDs in practice, especially in emergencies? Secondly, what oversight will ensure that ACDs are not simply ignored at the bedside, when a patient is most vulnerable? Will the Government consider a review mechanism so that we can assess how well ACDs are working in a few years’ time, after the Bill is passed?

I turn briefly to Liberal Democrat amendment 18. Like other hon. Members, I feel that the inclusion of financial information in an ACD is not appropriate, both from a practical and a personal security, safety and information point of view. I do, however, completely support the hon. Member for Winchester’s overall view that there is a significant problem with how financial stress can affect a person’s mental health. Like him, I call on the Minister to think about how we as a country, whether in this Bill or somewhere else, can address the impact of financial stress on mental health.

[Stephen Kinnock]

I will speak first to amendment 46. We agree with the principle of the amendment, but do not think it necessary. Under the Bill, if an individual who is likely to benefit from making an advance choice document approaches services to create one, they should be offered information and appropriate support to do so. The approach that we have taken in the Bill is therefore functionally equivalent to a right to request an advance choice document.

Mental Health Bill [ Lords ] (Eighth sitting)

Gregory Stafford Excerpts

Committee stage
Thursday 19th June 2025 Public Bill Committees

[Josh Dean (Hertford and Stortford) (Lab)]

It is a pleasure to serve under your chairship once again, Mrs Harris. The Minister has set out in detail the function of clause 54, so I will not cover that in detail for reasons of time. I welcome the clause, which represents a step forward in regulating the placement of children and young people in adult treatment settings, and in ensuring their safeguarding. I welcome the fact that it recognises the need to review the existing safeguards available to young people.

The independent review of the Mental Health Act made recommendations in this area, including that when an under-18 is placed on an adult ward, the CQC should be notified within 24 hours, and that the reasons for and the proposed length of the placement should be recorded. I would be grateful if the Minister would set out what consideration the Government have given to those recommendations, and whether they will form part of the review.

I turn to the important matter of children and young people who are under 18 placed in adult treatment settings. I think we all recognise the extremely difficult context in which these detentions take place. We know that there is a serious shortage of specialist in-patient beds for children and young people, which means that places are often full or may not be available at a time of urgent crisis.

When someone under 18 is placed in an adult treatment setting, they are more likely to witness or even experience high levels of restraint, be denied support from their peers, and lack access to educational opportunities. These placements can actually cause further harm to children and young people’s mental health, and therefore be detrimental to their recovery. I will be grateful if the Minister can assure me of the actions that the Government will take to further safeguard those children and young people who hit crisis point and find themselves in adult treatment settings because of the shortage of beds. How will we ensure that they are protected from being placed in inappropriate treatment settings?

I do not wish to test your patience, Mrs Harris, but before I conclude I want to examine the point about children and young people a little further, given the interaction of clause 54 and associated new clauses with their treatment. I welcome the Government’s consistent restatement of the importance of getting the Bill right for children and young people. I know that the Minister takes such matters incredibly seriously, and I have listened carefully to what he has said this afternoon and throughout the Committee.

The Minister has stated that a number of the reforms relating to children and young people will be addressed in the code of practice, but that contrasts with the approach of many of the welcome safeguards set out for over-18s in the Bill. Will the Minister clarify why these issues are being addressed differently when it comes to children and young people, compared to adults? Children and young people are a uniquely vulnerable group.

On the point about the code of practice, I note that any deviation from that would need to be justified, but my understanding is that the code cannot impose duties on practitioners or require them to exercise their functions under the Act. I am concerned that putting safeguards for under-18s on a different footing from those for adults could make it harder for young people to access those safeguards. I welcome much of the work being done by the Bill, and I want to make sure that children and young people can also access its safeguards. I will be grateful if the Minister can address those points in his response.

In conclusion, I welcome the step forward that clause 54 represents, because it addresses an important issue that we need to get to grips with. I look forward to the Minister’s response.

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

It is a pleasure to serve under your chairmanship, Mrs Harris. I rise to speak in support of clause 54, but with the caveat that it would be much more effective if new clause 12, in the name of my hon. Friend the Member for Hinckley and Bosworth, were added to the Bill.

Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 requires healthcare providers to notify the Care Quality Commission of certain serious incidents. However, it may not comprehensively cover all mental health-related admissions of minors. Clause 54 responds to concerns about transparency and safeguarding in child and adolescent mental health services, and aims to ensure that all relevant incidents are properly monitored and reported.

Like other hon. Members who have spoken, we welcome the Government’s shift to improve these standards; there is support for that across the Committee. The clauses about children and young people are some of the most vital parts of the Bill. They are vital not only to get the Bill right but, more importantly, to ensure that children are protected. That is why new clause 12, in the name of my hon. Friend the Member for Hinckley and Bosworth, is so essential to strengthen the Bill.

The new clause would amend section 131A of the Mental Health Act 1983, which governs the accommodation of children in mental health settings. It responds to ongoing concerns about the inappropriate placement of children on adult wards, which can be distressing and unsafe, and which is clearly contrary to best clinical practice. The new clause would introduce a requirement that hospital managers must justify such placements in writing, including an explanation of why no alternative was available, and the steps being taken to ensure the child’s safety and transfer to more suitable accommodation. The new clause would also introduce mandatory reporting to regulatory authorities when a child was placed on an adult ward for more than 24 hours, and to local authorities when the placement exceeds 28 days, or involves an out-of-area admission.

The new clause would ensure that children are placed on adult wards only when absolutely necessary. It requires the written justification and formal notification of placements. It involves local authorities and regulators in monitoring prolonged or out-of-area placements, and strengthens and clarifies existing provisions of the Mental Health Act. Most importantly, it aligns with clinical guidance on age-appropriate mental health care.

I turn to new clauses 17 and 20, tabled by the Liberal Democrats. I think that their purpose is in some ways similar to that of our new clause 12. However, they put the cart before the horse, or the horse before the cart —it depends on which way round we are. We are trying to fix the system by ensuring that nobody enters an inappropriate place unless there are exceptional circumstances; new clauses 17 and 20 try to exclude those circumstances, but without necessarily fixing the problem in the first place. Although I understand, as ever, the motivations and sentiments of the new clauses tabled by the Liberal Democrats, I do not think they will have the intended consequences; at least, I do not think they will be effective.

I have two questions for the Minister about clause 54. First, will the Department publish regular summaries of the notifications mentioned in the clause showing trends and disparities across the services or regions? Secondly, will the Care Quality Commission be resourced and empowered to act swiftly where patterns of overuse or misuse emerge?

Mental Health Bill [ Lords ] (Sixth sitting)

Gregory Stafford Excerpts

Committee stage
Tuesday 17th June 2025 Public Bill Committees

[The Chair]

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

Amendment 54, in schedule 2, page 77, line 21, at end insert—

“(3) Where the patient has not attained the age of 16 years, a nominated person must have parental responsibility for the patient.”

This amendment would stipulate that the nominated person for a patient under 16 must have parental responsibility for the patient.

Amendment 55, in schedule 2, page 80, line 13, after “2(2))” insert

“, has parental responsibility for the patient (see paragraph 2(3))”.

This amendment would stipulate that the nominated person for a patient under 16 must have parental responsibility for the patient.

Government amendments 40 and 41.

Schedule 2 stand part.

Clauses 25 to 28 stand part.

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

It is a pleasure to serve under your chairmanship, Mrs Harris. I rise to speak in support of clauses 24 to 28, schedule 2, and the vital amendments 54 and 55 in the name of my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer). Together, those provisions form a crucial pillar of the Bill, which must modernise our framework for the 21st century while not forgetting one of the oldest truths in our social contract: that parents, not the state, bear the first and deepest duty to protect their children.

The Bill will reform an Act that has stood in various forms since 1983, and which was itself built on a much older legacy of how this country balances individual liberty with the need, in rare cases, to deprive someone of that liberty for the sake of that person’s safety, or the safety of others. For decades, that balancing act has been shaped by the so-called “nearest relative” rule. However well intentioned that rule was, it has often failed to serve the people it is meant to protect. Patients have found themselves legally represented by estranged parents, distant cousins or an ex-spouse with whom they have had no contact for years. In the worst cases, that has compounded trauma and undermined recovery. Clause 24 will address that problem by giving patients the power to appoint a “nominated person” of their choosing: someone whom they trust, who understands their needs, and who can speak up when they themselves cannot. That is, quite simply, the right approach for modern mental health care. It is grounded in autonomy, and respect for the individual’s right to shape their own care and safeguard their own dignity.

Good principles must be matched by good machinery. That is why schedule 2 is not a mere administrative detail, but the backbone of this reform. It sets out, step by step, how a nomination is made, who may be nominated, how conflicts are avoided, and how mistakes are corrected. Under part 1 of schedule 2, a patient must make the appointment in writing. It must be signed and witnessed by

“a health or care professional or independent mental health advocate”.

That is a safeguard against casual or coerced choices. The nominated person must themselves consent: they are not a passive bystander but an active participant. If the relationship breaks down, the patient may revoke the nomination, or the nominated person may resign. Crucially, the county court may step in to remove or bar a nominated person if that person acts unreasonably, abuses their power, or is clearly unsuitable.

Part 2 of proposed new schedule A1 to the Mental Health Act 1983, inserted by schedule 2 to the Bill, addresses an issue that we must take seriously: capacity. Not every patient will have the capacity to make the appointment at the moment it matters most. The proposed new schedule therefore provides a fall-back system. A court may appoint a nominated person on the patient’s behalf, or a default can be determined under criteria set by regulation. The court again retains ultimate oversight to resolve disputes or replace a default, if the circumstances require it. It is thoughtful, practical and rights-based lawmaking, and I commend the drafters for getting the balance broadly right.

Clauses 25 to 28 will give the nominated person real power. They are not a figurehead. Clause 25 demands that professionals consult the nominated person before applying for detention or guardianship. If the nominated person objects, the professional must provide a report showing why detention is none the less necessary, with a clear risk-based justification. The nominated person can then challenge that decision. Clause 26 shortens the duration of the bar on discharge requests from six months to three. If a nominated person believes that the person no longer needs to be detained, they can press for release sooner and more effectively than before.

[Jen Craft (Thurrock) (Lab)]

Without wanting to sound abrupt, we all have the explanatory notes and are reading them, so in the interests of brevity might the hon. Member consider getting to the point about what he would add to or take away from the Bill? We all know what the clauses aim to do; the Minister has already set that out.

[Gregory Stafford]

I thank the hon. Lady for her point, but I shall continue in the same vein unless I am told to do otherwise.

Clause 27 will ensure that when community treatment orders are considered, with all the restrictions they bring, the nominated person’s voice must be heard and an objection must be properly countered with evidence. Clause 28 addresses hospital transfers, recognising that being moved to another hospital can uproot fragile support networks and compound distress. By embedding a consultation duty here, too, the Bill will make it harder for patients to be moved arbitrarily or without explanation.

In summary, the clauses and the schedule empower patients, embed transparency and build trust, but they do so through a lens rightly focused on adults—capable, consenting adults who make choices freely. That brings me to my fundamental point: we must be absolutely certain that this approach will not inadvertently erode a bedrock of child protection: that a parent is the default legal protector for their child. For an adult, autonomy means freedom of choice, but for a child, especially one under 16, autonomy must never mean being left alone to navigate a labyrinth of legal forms and healthcare powers without the protection of a parent. That is why I strongly support amendments 54 and 55, which would ensure that for under-16s, parents remain the lawful decision makers and the first safeguard for their child’s welfare.

Let us imagine for a moment a vulnerable 14-year-old who, in the confusion and fear of a psychiatric admission, is persuaded by a well-meaning adult—or, worse, someone with a hidden agenda—to appoint them as the nominated person. That child may be separated from their parents—the very people who know the child best and have a legal duty to care for them—while an outsider gains rights to object to treatment or discharge decisions. Once that nomination is made and witnessed, it carries weight in law and could marginalise the very people who brought that child into the world and have a moral and legal duty to protect them.

This is not just theoretical. We know from real cases in family courts that unscrupulous individuals can exploit vulnerable young people. The risk that the new system could unintentionally open the door to manipulation must be taken seriously. Let us not be naive about how exploitation works: groomers, traffickers and abusers thrive in grey areas of the law; they will find loopholes and drive a coach and horses through them. If we do not make it crystal clear that no child under 16 can override parental responsibility without a court’s explicit order, we risk creating an invitation for abuse.

Can the Minister assure the Committee that no child under 16 will be permitted to override parental responsibility simply by nominating someone else without a full and proper process? Schedule 2 does include fall-back arrangements and eligibility checks, and those are welcome, but unless the law is explicit that only a court can displace a parent’s right to act for their child, those safeguards are not watertight.

Amendment 54 addresses a related area, the notification of incidents. It would require the Secretary of State to review whether the law should be strengthened so that all admissions of children and young people for mental health treatment trigger mandatory incident reporting, and whether the timeframes for that reporting are still appropriate. It would require the Secretary of State to review whether incident reporting requirements are robust enough for all under-18s in mental health settings. Are all incidents of restraint, seclusion, injury or absconding being reported promptly and comprehensively? If not, what must change?

We have seen far too many tragic cases in which harm or abuse in children’s mental health units came to light only after a scandal broke, because the system did not catch it in time. Proper oversight is not an optional extra; it is essential for the trust of families. In my view, a review alone is not enough, so I urge to the Minister to confirm that, if the review finds gaps, the Government will legislate swiftly to close them. In the meantime, what interim steps will be taken to ensure that no child is left unprotected?

Amendment 55 is the final safeguard in this suite of amendments. It would allow the Secretary of State to make consequential amendments to other laws to implement the Bill cleanly. That is good housekeeping, but it must not become a blank cheque. When it comes to parental rights or child safeguarding, no technical tweak should be done behind closed doors by negative procedure; Parliament must approve it in full daylight, on the record. Will the Minister confirm without ambiguity that any consequential amendment that touches on parental powers or child protections will come before both Houses under the affirmative procedure?

To illustrate things in the starkest terms, let me paint one more scenario for this Committee. A 15-year-old girl, already vulnerable, is detained following a self-harm incident. Her parents, distressed but committed, wish to be involved in her care plan and discharge, but in her fragile mental state the child is persuaded by an older friend—perhaps well-meaning, perhaps not—to nominate them instead. That friend, now a legally recognised nominated person, blocks discharge, disagrees with treatment and excludes the parents from updates. The clinicians are caught in a legal tangle. The child is caught in the middle, and the parents must fight in court to reclaim their rightful role. As I said before, that is not a theory; it is the sort of real-life pitfall that sloppy drafting can enable. If we see it coming and fail to stop it, we will have failed as legislators.

I wish to be clear that I support clauses 24 to 28 and schedule 2 because they modernise mental health law for adults in a way that is respectful and empowering. I support amendment 54, because it would strengthen transparency and accountability where children’s lives and safety are at stake. I support amendment 55, because it would keep our statute book coherent, but it must never be misused to erode rights by stealth. Above all, I support the amendments because they ensure that the new nominated person system does not inadvertently weaken the oldest and strongest protection we have, which is the legal responsibility of parents to care for their own child.

I urge this Committee to adopt the clauses, the schedule and amendments 54 and 55 as essential guardrails to ensure that what we pass here is not just legally sound, but morally right. Let us modernise this law and strengthen patient voice, but let us never allow a child to lose their parents’ protection by accident or bureaucratic slip. Let us be in no doubt: when the state removes or limits parental rights, it must do so under the strictest scrutiny of a court of law, with evidence tested and the child’s welfare paramount. A signed piece of paper at a bedside should never be enough. That is the dividing line between a humane, modern health system and one that risks creating new injustices in the name of progress.

I ask the Minister again: will the Government enshrine in this Bill or elsewhere that parents are the legal representatives for under-16s unless a court directs otherwise? Will he guarantee rigorous checks to prevent the manipulation of young minds at their most vulnerable? Will he commit that any necessary changes found by the incident review under amendment 54 would be acted on without delay? I commend this package of reforms to the Committee, and I trust that the Government will listen carefully to these warnings and act to make the legislation watertight.

[The Minister for Care (Stephen Kinnock)]

It is a pleasure to serve under your chairship, Mrs Harris, not least because I understand you have just returned from New Zealand, where you had duties as the Government’s trade envoy. I thought perhaps we should do a haka in your honour to mark it, but you might rule against that.

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[Aphra Brandreth]

My hon. Friend makes an important point. This is not a simple or straightforward addition; it would require potentially substantial training. We would not want somebody in a role that they were not adequately prepared for. With any amendment, we would need to ensure that training, and the time and expense of it, had been factored in.

Even with the best intentions, the success of any extended support role, such as that envisaged in the amendment, will ultimately rely on the availability and integration of local services. Where appropriate services are in place and are working well together, advocates can play a valuable role in signposting and supporting access. Rather than placing additional responsibilities on the IMHA, our focus should be on working with community providers to ensure that the necessary support, particularly for social and financial needs, is consistently available and is effectively joined up across the system.

Having said that, I recognise and welcome the emphasis placed by the hon. Member for Winchester on the role of carers and family members. Too often, they are overlooked in discharge planning, yet their involvement can make a critical difference to a patient’s successful transition from hospital to home. When carers feel informed, supported and prepared, it gives patients the reassurance and stability that they need to continue their recovery with confidence. The primary responsibility of the independent mental health advocate, however, must remain their responsibility to the patient. I am concerned that the drafting of the amendment could create ambiguity about who the IMHA is principally there to support.

Financial stress is undoubtedly a real and urgent concern. Mental ill health can severely affect an individual’s capacity to work, to manage their finances or even to engage with systems of support. Equally, financial instability can exacerbate mental health difficulties. Those are serious challenges that must be addressed, but I would question whether the IMHA is the right professional to take on that role directly. Instead, we should ensure that they are well placed to refer individuals to appropriate services without assuming responsibility for co-ordinating that support themselves.

[Gregory Stafford]

I do not know whether the hon. Member for Winchester will press his amendment to a vote, but if he does, would my hon. Friend support the idea of having a pilot roll-out of the system before we go the whole hog, because of all the potential problems that she has highlighted?

[Aphra Brandreth]

That is an important point. These are quite substantial changes, and we do not know the full impact that they would have on the system. We have talked about issues such as whether there is sufficient training for advocates and a joined-up approach with what is happening in the community. A pilot would provide the opportunity to see where it is working and where there might be things that need to be changed or considered. It would certainly be a sensible approach. We all want to ensure that we are supporting individuals to be discharged in a safe way that minimises the likelihood of their being readmitted, but we need to do so without overcomplicating the roles and the system that are currently in place.

I commend the hon. Member for Winchester for bringing these important issues to the attention of the Committee. His amendment raises legitimate and timely concerns around the support offered to individuals leaving hospital, as well as the wider context in which recovery takes place. I hope that I have been able to offer some reflections that will assist hon. Members in considering the matter further.

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[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.

[Gregory Stafford]

I have some brief questions for the Minister about this important clause, which has serious implications for patient liberty and for public protection. We must ensure that decisions are clinically and legally sound. First, how will the proposed changes to initial and renewal detention periods help conditions and services and manage public risk more effectively, particularly in forensic or high-risk cases? Secondly, do longer detention periods after revocation of a community treatment order reflect a higher perceived risk, and if so, is there clear clinical evidence supporting that extension to six months? Thirdly, are we confident that the new timelines strike the right balance between protecting the public and ensuring patients are not detained longer than necessary? Finally, and as an adjunct to that, what other considerations are there in the clause or the Bill to keep the public safe and to make sure that decisions are correct in the context of clause 29?

[Dr Evans]

Clause 29 addresses the length and renewal of detention periods under the Mental Health Act. I begin by acknowledging the important step that this clause represents in shifting towards a more rights-based, patient-centred model, as enshrined in the Bill.

Clause 29 would shorten the initial period of detention for treatment under section 3 of the Mental Health Act from six months to three months. Subsequent renewal periods are, likewise, reduced from six months to three months and then from one year to six months. This is clearly informed by the principle of least restriction, as is rightly highlighted in the explanatory notes in paragraph 212.

On that basis, we welcome the direction of travel, but, while we agree with the principle of moving towards shorter, more proportionate detention periods, we have questions and concerns about implementation, consistency and safeguards, which I hope the Minister will address.

First, will shorter periods lead to better outcomes, or just more paperwork? The goal here is to ensure that detention is not allowed to drift and that patients are not held in hospital for longer than is necessary without rigorous justification. However, the clause still allows for indefinite renewal in increments, once those shorter initial periods expire. Can the Minister assure us that these changes will result in more meaningful reviews and not just more frequent rubber-stamping of detention? It would be helpful to understand whether the Government have assessed the clinical capacity, particularly among responsible clinicians and approved mental health professionals, to conduct these reviews with real rigour. If not resourced properly, we risk replacing one form of inertia with another.

Secondly, what safeguards exist against the resetting of detention periods on transfer? I am by no means a legal expert, so forgive me if I have completely misinterpreted this, and I bow to the legal expertise of the Minister, the Government and, most importantly, to able staff in the Box. However, clause 29(2) introduces into section 19 of the Mental Health Act new subsection (2A), which provides that if a guardianship patient is transferred to hospital, they will be treated as if they had been admitted on the day of transfer. In practical terms, does that not reset the detention clock?

To my eyes, this concept of resetting the detention clock appears most clearly in subsections (2) and 29(5)(d) of clause 29, where a patient who is transferred from guardianship to hospital, or who has their community treatment order revoked, is treated as if they had been newly admitted to hospital on that day. This effectively resets the start date of the detention period. Clause 29(2), which will insert proposed new section 19(2A) into the Mental Health Act, states:

“But, in the case of a patient falling within subsection (2)(d), section 20 has effect as if the patient has been admitted to hospital in pursuance of an application for admission for treatment on the day on which the patient is transferred.”

New paragraph 5B of schedule 1 to the Mental Health Act states that the modifications

“apply in relation to a patient transferred from guardianship to a hospital in pursuance of regulations made under section 19…In section 20(1)(a)…for “admitted”…there is to be substituted “transferred”.

In new paragraphs 5C and 5D of that schedule, the same resetting principle applies to patients whose CTOs are revoked, with renewal detention starting from the date of revocation, not from their original hospital admission or order.

In practice, this could mean that if a patient is placed under guardianship on 1 January and transferred to hospital on 1 April under section 19(2)(d) of the Mental Health Act, then under proposed new section 19(2A), they would be treated as if they had been newly admitted on 1 April. Therefore, even though they have been under compulsion since 1 January, the new three-month detention clock begins on 1 April. Likewise, a patient under a community treatment order that was issued on 1 February and revoked on 1 August will, under paragraph 5D, start a new in-patient detention period on 1 August, not 1 February.

On one hand, that makes sense. We do not want people whose state is fluctuating to be released, or simply to time out. On the other hand, if we are looking purely from the patient’s perspective, as the legislation asks us to do, with regard to the principles in clause 1, that could be a problem. Will the Minister clarify how many times such a reset could occur for a single individual? Is there any form of oversight, review or reporting requirement where this happens? That mechanism might be necessary in some clinical contexts, but without safeguards it could become a back door to prolonging detention, which is something that the clause seeks to reduce. Is there some kind of register or mandatory recording of these incidents to spot repeat patterns?

Thirdly, another issue that needs addressing is the creation of possible complexity. Paragraphs 218 and 219 of the explanatory notes set out a separate but equally important issue. Clause 29’s welcome shortening of detention periods—from three months to start with, then three months, then six months, then annual reviews—is not applied evenly to patient groups. Who gets the shorter periods? Most civil patients detained under part II and some patients on revoked community treatment orders. Who does not get them? Patients detained by a hospital order from a court, if their CTO is revoked within six months of the order, as in paragraph 218. And, of course, restricted patients—typically those involved in more serious offences.

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[Dr Shastri-Hurst]

It is a pleasure to serve under your chairmanship this afternoon, Mrs Harris. I rise to speak on clauses 30 to 33, which go to the core of the rights architecture that surrounds mental health law in this country—namely, the oversight and challenge mechanisms available to individuals subject to detention, supervision or conditional discharge. I think we are all aware that the 1983 Act, although fit for its time, has failed to keep pace with the evolving understanding of mental health illness and modern expectations of legal accountability or procedural fairness. The clauses, although technical in nature, seek to rectify a number of the long-standing shortcomings in the operation of the mental health tribunal system.

Clause 30 will extend and clarify the time period within which patients may apply to tribunals. Essentially, it will do two things. First, it will extend the application window for section 2 patients—those detained for assessment—from 14 to 21 days. Secondly, it will reduce the initial waiting period for section 3 patients and those under guardianship from six months to three months. Those are sensible and overdue changes, because 14 days is a narrow window for any legal action, let alone one initiated by an individual who may be experiencing acute psychological distress.

Extending the application window to 21 days provides a fairer opportunity to seek representation and prepare a meaningful application. Equally, the reduction of the initial period for section 3 and guardianship patients to three months offers an important safeguard against prolonged detention without scrutiny. It restores a measure of clarity between the gravity of the detention order and the speed with which it may be challenged.

The clause will also clarify the rights of conditionally discharged restricted patients who are subject to deprivation of liberty conditions—that is, those who are discharged from hospital but required to comply with supervisional residence requirements that are so restrictive that they cross the legal threshold for a deprivation of liberty. At present, those individuals occupy a legal grey zone: they are not formally detained, yet the liberty they enjoy is so curtailed that it raises significant questions as to their article 5 rights. Clause 30 will properly address that anomaly by creating a defined, regular route of appeal, initially between six and 12 months from the imposition of the deprivation of liberty conditions, and biannually thereafter. Those are measured and proportionate changes that enhance access to justice, improve compliance with human rights obligations and restore clarity to a field that has suffered, at times, from legal opacity.

The reforms are not without consequences. A wider cohort of eligible applicants and more frequent review periods will inevitably increase the burden on the tribunal service, on legal aid provision and on clinical teams who must prepare documents and attend hearings. That challenge is not to be dismissed lightly.

[Gregory Stafford]

Does my gallant and learned hon. Friend have any information on the current waiting times for tribunals? What does he expect the effect of the changes proposed in these clauses to be on waiting times?

[Dr Shastri-Hurst]

My hon. Friend makes a pertinent point. We all know, from our casework or personal experiences outside of this place, about the pressures on the Courts and Tribunals Service. Mental health tribunals are not exempt from that pressure. Changing the timeframe on which tribunals operate, and the frequency with which reviews take place, will inevitably increase the burden on the service. Therefore, although these changes are broadly welcome, it is important that we are cognisant of their impact on the resources that will be required, the number of judges and wing members that will be needed, and of course the hard standing of the court and tribunal infrastructure that will need to be made available. Other issues, such as those around the digitalisation of the service, will also need to be addressed.

Clause 31 will recast the regime for automatic tribunal referrals, replacing the prior six-month structure with the concept of “a relevant period”. For detained patients, referrals will now occur at three months, then 12 months, and annually thereafter. For community patients, they will occur at six months, then 12 months, then annually. Most significantly, hospital managers will be under a new duty to refer a case when no review has occurred in 12 months, regardless of whether an application has been made. That is a sound reform.

The clause will introduce coherence to a previously fragmented system, and establishes a minimum standard of legal oversight. The inclusion of a backstop provision—that no individual should go more than 12 months without review—is essential. In a system in which patients may not always have the means or capacity to apply for a review themselves, it offers a critical safety net. Clause 31 will also repeal section 68A of the 1983 Act, which has become unwieldy and duplicative. By streamlining the referral process, the Bill enhances legal clarity and administrative efficiency, but I would caution that the increased complexity of the new timeframes may require significant training of those responsible for their implementation.

Clause 32 will provide for restricted patients who are subject to deprivation of liberty conditions. It goes further than clause 30 by imposing mandatory referral duties on the Secretary of State. Under the clause, a tribunal must be convened after 12 months, every two years thereafter, and at four years if no review has occurred. Crucially, the clause also codifies the tribunal’s powers. It may now vary or impose conditions, including those that constitute a deprivation of liberty, provided that they are necessary to protect the public from serious harm and are no more restrictive than hospital detention. That clause introduces a principled, proportionate framework for balancing public protection with patient liberty, and avoids vague or discretionary use of such powers.

Finally, clause 33 will apply the same principles to restricted patients not subject to deprivation of liberty orders. Such individuals, although under fewer constraints, are none the less subject to significant legal orders. The new requirement for a tribunal review at two years, and every four years thereafter, ensures that oversight is regular and non-discriminatory.

All four clauses are united by a clear objective to rationalise tribunal access, enhance procedural safeguards and bring the Mental Health Act into alignment with modern standards of fairness and proportionality. However, I will close with a caveat: rights without resourcing are hollow. If we are to place greater demand on the tribunals service, and to rely on it as the guardian of liberty for thousands of individuals, it must be adequately funded, staffed and supported. Legal representation must be accessible. Tribunal members must be properly trained. Hospital managers must be equipped to meet their new responsibilities.

With those reservations, I broadly welcome clauses 30 to 33 as a necessary recalibration of our mental health law. They reflect the dignity of the individual, the demands of public safety, and the enduring principle that no one should be deprived of liberty without fair or timely review.

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[Gregory Stafford]

Does my hon. Friend think that if there is a backlog, that could undermine patient rights or clinical progress in some way? How will the tribunal system be able to cope with that increased workload and meet its legal obligations to provide timely tribunals so that patients get the best care?

[Dr Evans]

That is a difficult balance to get right. I appreciate that the Government have said that the Bill will take 10 years to implement, but if these measures come into force from day one, we will start to see automatic referrals come through. There will be a lag as the transition happens, but my hon. Friend is absolutely right: we can foresee scenarios where patients who want to be referred into the tribunal are waiting in inappropriate care places, which may be to the detriment of their personal care and may actually make their recovery worse. He is right to highlight that question, which is why having a broad understanding of how many extra referrals are coming would be useful.

Clause 32 focuses on conditionally discharged restricted patients who are subject to deprivation of liberty conditions. It rightly ensures that those patients are brought within scope of automatic referral, first after 12 months and then every two years. Again, that is a positive step, ensuring that even those not detained in hospital will still have access to a review of their conditions. Crucially, the clause also gives the tribunals the power to vary or remove those DoL conditions.

Can the Minister say more about how that important power will be used? What criteria will the tribunals apply to assess whether a condition is genuinely necessary and proportionate? Will patients be legally represented in those hearings by default? Will another advocate be there, or will it be someone else in their place? Here, too, I would welcome some clarification from the Minister. I hope he will forgive my legal naivety, but my mother always said, “It’s better to ask a dumb question than stay dumb forever.”

The explanatory notes talk about DoL conditions. The current legal framework for authorising the deprivation of liberty for individuals who lack capacity is complex and in transition. Under the Mental Capacity Act 2005, deprivation of liberty safeguards have been the established mechanism since 2009 to ensure lawful deprivation of liberty in care settings. However, the Mental Capacity (Amendment) Act 2019 introduced liberty protection safeguards as modernising replacements, designed to simplify and broaden protections.

LPS are widely seen as an improvement to DoLS, because they extend safeguards to a wider range of settings, including hospitals and people’s own homes where deprivation of liberty might occur. They also streamline the assessment process, reducing bureaucratic delays and better reflecting person-centred decision making. The Law Commission and various stakeholder groups have supported LPS as a way to address the significant practical and legal challenges posed by DoLS, including the so-called DoLS backlog, where assessments have been delayed for many vulnerable individuals.

Despite that, I do not believe that LPS have yet been implemented, leaving DoLS still in force. I wonder if we are therefore creating ambiguity as we update the Mental Health Act through the Bill’s clauses, such as those addressing conditional discharge and deprivation of liberty, without clarity on how those will intersect with the forthcoming LPS framework that will be introduced under separate legislation. That raises important questions about the sequencing and co-ordination of legislation reform. How will the Government ensure coherence and avoid conflicting provisions when different statutes address overlapping issues at different times?

Given that context, have the Government abandoned the planned implementation of LPS, or do they remain committed to bringing them into force? If the implementation is still planned, will the Government provide a clear timeline for when LPS will replace DoLS? How do the Government intend to ensure that the provisions we are debating will align with or adapt to the introduction of LPS? What steps are being taken to ensure that vulnerable individuals and professionals who navigate this complex legal landscape will have clear, consistent safeguards and guidance through the transition? Clarification on those points is essential to avoid legal uncertainty and to ensure that the reforms provide coherent protection for those deprived of their liberties.

Clause 33 deals with patients who are not under DoLS conditions. It will ensure that even those who are under DoLS conditions, such as detained restricted patients or conditionally discharged patients with lesser restrictions, receive automatic tribunals. It will reduce the current three-year referral intervention for detained restricted patients to 12 months and introduce automatic referrals for non-DoL conditionality discharge patients after two years and then every four years. Again, that is a step forward, but four years feels like a long gap between reviews for those discharged with conditions that still significantly affect their daily lives. Will the Minister explain the thought behind the chosen timeframe? If a person’s condition changes, is there a mechanism to trigger an early referral outside the normal cycle?

The clauses show progress. They reflect a clear intention to strengthen patients’ rights, increase oversight and address historical injustices, particularly for those living under deprivation of liberty conditions in the community. But with complexity comes risk, and we need to ensure that patients understand their rights and the legal support available. The tribunal system must be properly resourced to uphold the safeguards that we place in the legislation.

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[Stephen Kinnock]

My hon. Friend makes an important point. We are absolutely committed to ensuring that we create a space for young people to provide feedback. Some of that will be around past experiences when making their advance choice documents, but much broader opportunities for feedback will absolutely be built into the system. We want this to be a learning process. It is important that the code of practice is not just a document that sits on the shelf gathering dust; it should be a live document. That is why the feedback is so important.

It should be noted that although reflecting on past experiences may be therapeutic for some individuals, for others it can be traumatic, so the measure should be entirely service-user led. We also continue to be concerned about the burden that the amendment would place on independent mental health advocacy services, which are already under strain.

[Gregory Stafford]

I apologise—this may be due to the terminology of “amendment” versus “clause”—but is the Minister saying that the Government are likely to vote against clause 35 as it currently stands? He is talking about amendments and clauses, and that is slightly confusing me. [Interruption.] His officials are nodding.

[Stephen Kinnock]

I don’t know what that nod means.

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[Stephen Kinnock]

We will figure it out as we go along. I have now lost my place. [Interruption.] My answer to the hon. Member for Farnham and Bordon is that the Government are voting against clause 35 stand part.

[Gregory Stafford]

Thank you, Minister.

[Stephen Kinnock]

Right. Advocates have told us that implementing what is set out in the clause would raise logistical and resourcing problems, as it would require a significant shift from their current role. They have also raised concerns that if they acted in effect on behalf of the hospital to collect feedback, their independence and impartiality in the eyes of the patient might be undermined. We would prefer to direct resources to increasing access to advocacy services among in-patients, as proposed by the Bill. Advocates play a crucial role in promoting and protecting the rights of patients. We do not wish to detract from that or to dilute their role. I do not commend the clause to the Committee.

[Jen Craft]

Like many Committee members, I was deeply confused about how we were proceeding.

On the face of it, the clause broadly seems as if it should be part of any Act about mental health care, including post discharge. I have spoken about my own experience of interacting with the Mental Health Act as it stands. I might have found the clause fairly helpful post discharge and others might have found it useful as well. However, I have just heard the Minister’s description of the limitations of the clause, and the speech that I was about to make has been thrown into complete disarray by the confusion just now. But I implore the Minister to consider the fact that, when it comes to encouraging participation, understanding, and co-designing and co-producing services, capturing the experience of those recently detained under the Mental Health Act can be extraordinarily useful. Clause 35, which was added by an amendment from the Lords, seems a fairly useful way to do that.

[Gregory Stafford]

Like the hon. Lady, I see many benefits from the clause. Like many Committee members, I am surprised that the Government intend to vote against it.

As has been mentioned, the clause was inserted in the House of Lords by my noble Friends Earl Howe and Lord Kamall. I think it introduces a very valuable and forward-looking provision—namely, a mandatory debrief session within 30 days of discharge. It introduces a formal mechanism for learning from patient experiences following detention under the Mental Health Act. Although patient feedback mechanisms exist in some services, they are not consistently applied or mandated. The clause ensures that every detained patient has the opportunity to reflect on their care with an independent advocate, and that their feedback contributes to service improvement. It reflects a broader shift in mental health law towards transparency, accountability and the patient voice, and aligns with the recommendations from the 2018 independent review of the Mental Health Act, which the Government have used as an argument in favour of many of the other clauses.

Clause 35 is more than just a procedural addition. It represents a shift in culture towards embedding the patient voice and accountability in the mental health care system. It recognises the importance of empowering individuals after detention, supporting their recovery, and learning from their lived experience to improve future services. Mental health charities and third sector organisations have strongly endorsed the clause, seeing it as a meaningful step towards a more rights-based, transparent approach to care.

Clearly, the clause empowers patients, because it gives them a structured opportunity to share their experiences and influence service provision. It promotes transparency by requiring hospitals to report publicly on what they have learned and how they have responded. It supports quality improvement by encouraging services to reflect on and address systemic issues in the delivery of care. Furthermore, it has independent oversight through the involvement of IMHAs, which helps to ensure that feedback is gathered impartially and respectfully.

The reforms prioritise professional clinical opinion, safeguard children from inappropriate influence during periods of acute vulnerability, and elevate the patient voice in the post-care process. In doing so, they align the Mental Health Act much more closely to modern standards of care, international best practice and evolving public expectations. I believe that the clause is essential to strengthening the Bill and ensuring that our mental health system becomes not only more effective but more compassionate, responsive and just.

[Dr Evans]

I rise to speak to clause 35, which would insert new section 23A into the Mental Health Act 1983. It was introduced and passed in the Lords, and rightly so. As the hon. Member for Thurrock said, it seems surprising that anyone might want to take it out.

The clause was introduced as a new duty to offer all patients detained under the Act a consultation with an IMHA within 30 days of discharge. The purpose is to review their experience of hospital and learn from that experience through a report shared with hospital managers. Currently, the Mental Health Act makes provisions for access to IMHAs primarily during detention, particularly around decisions concerning treatment and care planning. However, once a patient is discharged, formal advocacy tends to fall away, unless pursued through broader NHS complaints mechanisms. There is no statutory duty to engage with patients post discharge, to understand how they have experienced their care or to systematically learn from those experiences.

In that context, the clause represents a welcome and important step forward. We know from successive reviews from the Care Quality Commission, NHS England and, of course, the independent review of the Mental Health Act, led by Sir Simon Wessely, that patients often feel disempowered during their detention. Many describe experiences of coercion, poor communication or even trauma. Yet those experiences frequently go unheard: lost in the silence that can follow discharge. Clause 35 seeks to change that, creating a pathway for those voices to be heard, and, more importantly, for services to learn from them. I strongly support that principle.

We need to clarify one thing first: the clause says a patient must “be offered” a consultation within 30 days —it is no more formalised than that. It is not a statutory requirement to take part, but purely to offer. That is important when it comes to making sure that reports are made in partnership with the patient. That is positive language, which would help to support the decision making and feedback loop.

In their rebuttals, I appreciate that the Government may ask whether the clause would mean hospital managers marking their own feedback. They might also ask how we would deal with CQC capacity. Those are reasonable questions, but at the heart of the clause, as agreed by the Lords, is the fact that all too often patients’ thoughts after discharge are not fully taken into account.

[Gregory Stafford]

Surely the fundamental part of the Bill is self-assessment and self-reflection. That does happen in some cases, and certainly in other parts of the healthcare system, but in this area generally does not; when it does happen, it is done in an inconsistent manner. The clause seeks to formalise things and to ensure that there is a benchmark by which service users and patients can feed back to the service they have just come from, to improve services. Does my hon. Friend share my confusion about why the Government would want to take that out?

[Dr Evans]

My hon. Friend makes a strong point. In clinical practice, we know that reflective learning is important, but that is not mandated. As we have seen from the reports, part of the reason why we do not see improvements is that we do not know about them. The clause gives patients the chance to empower themselves in a statutory, regulated way, which then allows us further transparency on how those issues arise.

Let us not forget that patients with good experiences would also have the chance to feed those back, further helping to support the services and hopefully leading to beacons of best practice up and down the nation so that we could then learn from those. That is the idea behind the clause: making sure that the likes of the regulator would be able to share lessons about not only those who have struggled but those who have done well. Clause 35 really offers a rare opportunity to hardwire the patient voice into the feedback loop of mental health services. That is a principle that I and my Opposition colleagues strongly support.

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[The Chair]

I remind Members that if they want to take their jackets off, they may. It is very warm.

[Gregory Stafford]

I rise to support clauses 36 to 40. Clause 36 addresses a legal gap identified in case law, which held that the Mental Health Act 1983 did not permit the imposition of conditions amounting to a deprivation of liberty for conditionally discharged patients. The clause provides a clear statutory basis for such conditions, but only under strict safeguards. It aims to balance public protection with patient rights, ensuring that DoL conditions are used only when absolutely necessary and proportionate. This is a positive step, because it clarifies the legal authority, resolving any uncertainty, following court rulings, about the legality of DoL conditions in conditional discharges. It protects public safety by ensuring that high-risk patients can be managed safely in the community, under appropriate restrictions. It includes safeguards that require DoL conditions to be justified and proportionate, with a focus on patient welfare, and it aligns with notable human rights law, especially the definitions and principles from the Mental Capacity Act and the relevant case law.

However, I have a couple of questions for the Minister. My view is that there is potential for overuse. Without robust oversight, there is a risk that DoL conditions could be used too readily. What safeguards is the Minister putting in place to ensure that that does not happen? There is clearly an impact on patient liberty, and we need to get the balance right. Even with the safeguards, these conditions significantly restrict individual freedom and therefore must be carefully monitored. How is the Minister ensuring that that will happen? In relation to the legal thresholds, determining whether conditions meet the legal test may require detailed clinical and legal assessment. We have talked about the practical implications of this Act on numerous occasions. I again ask the Minister whether he is certain that we have the relevant clinical and legal assessors out there to ensure that we can push that forward.

Clause 37, entitled “Transfers of prisoners and others to hospital: conditions”, will update the legal framework for transferring individuals from prison or immigration detention to hospital under the Mental Health Act. The previous wording of the Act required that treatment be “available”, but did not specify that it must be appropriate for the individual’s condition. This clause will align the criteria with more modern clinical standards and broader reforms in the Bill, which emphasise person-centred care and treatment suitability. It will also ensure that immigration detainees are clearly included in the scope of these provisions. Again, it is positive, because it updates and consolidates the list of immigration-related detention powers covered by the Act. It supports human rights compliance, because it aligns with principles of lawful and proportionate deprivation of liberty under article 5 of the European convention on human rights; it brings the Act in line with the current clinical and legal terminology; and, most importantly, it ensures that transfers are made only when appropriate treatment—not just any treatment—is available.

I have just a couple of questions for the Minister on this clause. I see potential for disputes. Determining what constitutes appropriate treatment may lead to disagreements between clinicians and authorities. What are the Minister’s thoughts on those potential disagreements? There are also some resource implications. It may increase demand for secure hospital beds if more transfers are approved under the revised criteria. I would welcome any thoughts from the Minister on how to ensure that we have the right number of secure hospital beds, not just as a totality, but in the specific regions and areas where people may be being detained.

Clause 38 is also about the transfer of prisoners and others to hospital, but specifically about time limits. It responds to a long-standing concern about delays in transferring prisoners and immigration detainees to hospital for mental health treatment. Under the current system, there is no statutory time limit, and individuals can wait weeks or months in prison, despite being assessed as needing urgent psychiatric care. That has been criticised by mental health professionals, legal advocates and human rights bodies. The clause will introduce a legal framework for setting and enforcing time limits, aligning with the Bill’s broader goals, which I think we all agree with, of improving patient rights and dignity and timely access to care. Again, I support the clause, because it will reduce delays. It will help to ensure that mentally unwell detainees are transferred to appropriate care settings without unnecessary delay, and will introduce clear expectations and accountability for decision making. It enables some flexibility, I think, because it allows for tailored regulations, to accommodate different case types and operational realities.

Again, however, I have some questions. I think there will be some implementation challenges. Services may struggle to meet the deadlines without sufficient resources —an issue that I mentioned in relation to the previous clause. Also, time limits may be difficult to apply in complex or borderline cases without clear guidance. Does the Minister see a need for explicit guidance in the code of conduct, or in some other form, to ensure that the risk of a rigid application does not make things more complicated or, more especially, mean that a potential patient is sent to the wrong care simply because we are focusing on the time rather than the appropriateness of the care? Of course, I would welcome his thoughts on how any new tracking systems and co-ordination between prisons, hospitals and the Ministry of Justice might work in this case.

Finally, I will briefly touch on clause 39. This is a technical update regarding the term “remand centre”, because that is no longer used in law or in practice; instead, young people are remanded to youth detention accommodation. Given that the clause is purely technical, I support it.

[Anna Dixon]

It is a pleasure to serve under your chairship, Mrs Harris. I will briefly speak in support of clauses 36 to 40. These clauses reflect the principle of least restriction, albeit for people who are subject to part III, and who are therefore subject to the deprivation of liberty conditions. It is really important that there are frameworks around conditional discharge, and these clauses will do a lot to bring it in line with best practice, and to put the limit set out in the best practice guidelines on a statutory footing to ensure that there is a 28-day transfer. To be successful, that will require multidisciplinary working between the health and justice systems. With that in mind, will the Minister give an assurance that he is confident that the 28-day limit can be met? If there is already data on how many transfers are made within that time limit, in line with best practice guidelines, that would give some assurance that the new statutory time limit is likely to be met.

I am pleased to see that the time limit should be breached only in exceptional circumstances, and that the Bill specifies that a shortage of hospital beds or staff does not constitute exceptional circumstances. It is really important that that is not used as a reason not to transfer or discharge people later than the 28-day limit. Some of the discharge test rests not only on whether there is a risk of harm to another person, but on a public test. Can the Minister clarify how those two tests will work in tandem? Is that already being done in practice?

Finally, I note that the evidence that we have received from the Care Quality Commission says that it welcomes closing the legal gap following the High Court ruling, as set out in the explanatory notes. However, the CQC believes that supervised discharge should be used only “when strictly necessary”, and I know that there are ongoing discussions between the Department’s officials and the Care Quality Commission. Can the Minister give an update on those discussions and clarify what role, if any, the CQC will play in the oversight of these measures?

As the hon. Member for Farnham and Bordon said, clauses 67 to 70 bring the Bill in line with youth justice practices and terminology, and with immigration policy. It is important that we take the opportunity to make sure that the Bill is fully up to date and in line with other pieces of legislation, so I support the clauses.

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[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.

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[Stephen Kinnock]

The clauses will amend section 132 of the Mental Health Act in relation to detained patients, and section 132A in relation to community patients, and insert a new provision in relation to conditionally discharged patients. They place a statutory duty on hospital managers to supply complaints information to detained patients, community patients and conditionally discharged respectively, as well as to their nominated person.

Patients, their family and carers have a right to complain about the treatment they receive, including care and treatment under the Mental Health Act. The patient’s rights to complain are enshrined in the NHS constitution. Although the code of practice currently sets out that information about complaints should be provided to patients when they are detained, there is no statutory duty to do so. Under the clauses, hospital managers will be required to provide information on how to make a complaint about: first, functions under the Bill; secondly, any medical treatment for mental disorder received during their detention; and thirdly, the outcome of any complaint about medical treatment. That includes providing information about how to make a complaint to the Parliamentary and Health Service Ombudsman about the mismanagement of complaints about medical treatment, where the person believes their complaint to another body—for instance the hospital or CQC—was not appropriately investigated.

Hospital managers must take practicable steps to ensure that patients have understood complaints procedures, and information about complaints must be provided both verbally and in writing. The duty requires that information must be provided as soon as practicable after the patient is first detained, when the section that they are detained under changes, when the detention is renewed, or every 12 months for restricted patients under part III of the 1983 Act. For community patients, a duty is triggered as soon as it is practical after being placed on a community treatment order and as soon as practical each time the community treatment order is renewed. For conditionally discharged patients, it is triggered as soon as practicable after being conditionally discharged. I commend clauses 42 to 44 to the Committee.

[Gregory Stafford]

I rise to speak in favour of clauses 42, 43 and 44, which together strengthen the duty to inform patients—whether detained in the community or conditionally discharged—about how to make a complaint about their treatment and the outcome of that complaint. The Mental Health Act has long included duties to tell patients their rights, but too often that information has been patchy, hard to understand or buried in paperwork. The clauses tackle that by requiring clear, repeated information about not just detention, but treatment and the complaints process.

Clause 42 relates to information about complaints for detained patients. Section 132 of the Mental Health Act 1983 originally required hospitals to inform detained patients of their rights, but that was often inconsistently applied. This clause responds to long-standing concerns about transparency and patient empowerment, aligning with the broader goals of the Bill to enhance autonomy and dignity in mental health care. Specifically, there is an expanded duty of information. Hospital managers must now ensure that detained patients understand how to make complaints, not only about their detention, but about their treatment, along with the outcomes of any complaints.

There are some timing requirements, i.e. that the information must be provided as soon as practicable after detention begins and be repeated annually for restricted patients, or after each section 20 report for others. That will improve patient’s awareness of their rights and how to seek redress. It will promote accountability and mental health services by encouraging feedback and complaints, and support better outcomes by addressing grievances early and constructively.