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.

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.

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 ] (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 ] (Fifth sitting)

Gregory Stafford Excerpts

Committee stage
Tuesday 17th June 2025 Public Bill Committees

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

It is a pleasure to serve under your leadership, Sir Desmond, especially on such a warm day. I hope that there is not too much hot air in the Committee to keep us even warmer.

Clause 22 will introduce a series of important amendments to the operation of community treatment orders under the Mental Health Act 1983. The clause has the stated aim of strengthening clinical safeguards and ensuring continuity of care between hospital and community settings. The Opposition support these goals in principle.

Let me set out the current legal position. At present, decisions to place a person on a CTO require two professional inputs: the patient’s responsible clinician and an approved mental health professional. The responsible clinician can vary, suspend, recall or revoke the order, often with no statutory obligation to consult the clinician who will be managing the patient’s care in the community. 

Clause 22 will change that. It introduces the new role of the community clinician—defined as the approved clinician who will oversee the patient’s care in the community—and requires their involvement at key decision points in the life of a CTO. Specifically, it requires a written statement from the community clinician that the CTO criteria are met, where they are not the responsible clinician. It obliges the responsible clinician to consult the community clinician before varying conditions, recalling or revoking a CTO, unless such consultation would cause unreasonable delay. It also includes the community clinician in the process of renewing a CTO, again via a written statement. 

These are not insignificant changes. They mark a shift towards multidisciplinary accountability and a greater emphasis on the continuity of care between in-patient and community settings. The Opposition strongly support both principles. However, there are several points that I would like to probe constructively, and I hope the Minister will respond in the spirit of improving what is clearly a well-intentioned clause. 

First, the term “unreasonable delay” appears multiple times in the clause as an exception to the duty to consult the community clinician, but I cannot see it defined in the Bill or in the explanatory notes. Could the Minister clarify what constitutes “unreasonable delay” in practice? Will guidance be issued to ensure consistency across trusts and clinicians? We must ensure that this exception does not swallow the rule or become a loophole in time-sensitive situations.

Secondly, what happens when clinicians disagree? The clause requires the agreement of the community clinician in writing before a CTO can be made, but it is silent on what happens when there is disagreement between the responsible clinician and the community clinician. This is not a hypothetical concern; differing clinical views are common and can be a healthy part of multidisciplinary practice. Could the Minister confirm whether there is a proposed resolution mechanism where clinicians differ? Would the decision default to a tribunal or a second opinion, or is the CTO simply not made?

Thirdly, as the Minister has mentioned, on the operational readiness to implement this clause, the new duties on community clinicians are not trivial. They are being asked to produce written statements, engage in formal consultations and be available to advise on time-sensitive decisions such as recalls and condition changes. Can the Minister reassure the Committee that a workforce impact assessment has been or will be conducted? Will there be investment in community mental health staffing and digital infrastructure to ensure that this duty is workable?

Fourthly, I want to raise the issue of handover and role clarity. The clause will introduce a new statutory role—the community clinician—but patients often transition rapidly between settings. There may be uncertainty about who holds that responsibility at a given time. Will guidance ensure that community clinicians are formally designated and that responsibilities are clearly recorded at the point of discharge?

I want to end on a constructive note. Clause 22 is a step in the right direction. It reflects many of the recommendations of the independent review of the Mental Health Act, including the emphasis on least restriction and on therapeutic benefit. I encourage the Government to consider defining or clarifying unreasonable delay in regulations or guidance, introducing a clear process for resolving professional disagreement, and committing to publish a plan detailing workforce support, guidance and digital infrastructure to ensure that this takes place.

Clause 23, which is linked to clause 22, will introduce two important amendments to the operation of community treatment orders under the Mental Health Act 1983. As things stand, section 17B(2) allows a responsible clinician to attach conditions to a CTO if they are necessary or appropriate, to ensure the patient receives treatment, to prevent risk to health or safety or to ensure engagement with services. Such conditions can include where the person lives, their attendance at appointments and even lifestyle restrictions such as abstaining from alcohol or drugs. However, we know that these conditions can be seen as coercive. Patients often feel that breaching them means automatic recall to hospital. In practice, some CTO conditions may drift toward overreach rather than clinical necessity.

The clause responds to these concerns in two ways. Subsection (1) will remove the words “or appropriate” from section 17B(2), meaning that CTO conditions must now be strictly necessary, not just advisable or convenient. The Opposition support this narrowing of the threshold. It sends a clear message that CTO conditions must be clinically justified, proportionate and tailored to the individual’s needs. However, I ask the Minister how clinicians will be guided in applying the new “necessary” test. Will the code of practice be updated with examples and scenarios? Crucially, what measures will be taken to ensure that patients are clearly informed that a breach of a CTO condition, in itself, is not automatic grounds for recall?

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

It is a pleasure to serve under your chairmanship, Sir Desmond. Taking a step back to my hon. Friend’s point about “necessary”, is he concerned, as I am, that it is not clear to those responsible what “necessary” means? We could open ourselves up to potential legal challenges and disputes, which would give lawyers lots of money but would have no benefit for the patients.

[Dr Evans]

My hon. Friend makes an incredibly important point. Some later clauses try to address a problem where a patient was consenting to a community order, but the restrictions were so tight that it worked out as deprivation of liberty. My hon. Friend is absolutely right that knowing what is necessary is important to provide a clearly defined structure for the patient. Patients worry that if they breach that protocol, they will be automatically recalled. That might prevent them from breaching the conditions in the first place, but on the other hand it is a sword of Damocles above them. In no way does that create a beneficial therapeutic environment for them.

--- Later in debate ---

[Dr Chambers]

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

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

[Gregory Stafford]

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

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

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

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

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

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

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

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

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

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

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

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

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

[Stephen Kinnock]

The term “unreasonable delay” is subject to review by the courts, and further guidance will be given in the code of practice. On what happens if the responsible clinician and the community clinician disagree, the addition of a third decision maker is not about overruling the responsible clinician, who continues to have overall responsibility for the patient on the community treatment order. Including the community clinician at the point of putting someone on a community treatment order helps to ensure continuity of care for the patient. Involving the community clinician in other decisions around the community treatment order, particularly recall, revocation, renewal and discharge, means they can provide an additional insight into the patient’s status while in the community.

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Amendments 54 and 55 would alter the balance by stipulating that in all cases involving patients under 16, the nominated person must have responsibility. That would, in effect, significantly narrow the pool of eligible nominees. I understand the rationale for that: by legal definition, children under 16 are minors. Their capacity to make decisions about their healthcare is rightly subject to additional safeguards. The nominated person who has access to personal information can object to the treatment or detention and can challenge decisions. They wield serious influence.

[Gregory Stafford]

I thank my hon. Friend for his comprehensive analysis of the provisions under discussion. Does he understand amendments 54 and 55 to mean that, although there would be a narrowing of who can be chosen as the nominated person, there would still be some flexibility for the child to choose? Does he have any concerns about a situation in which a minor—someone under the age of 16—may, for whatever reason, choose somebody who the health professionals believe is not the most appropriate person, and does he have any sympathy with the idea that, given a parent has responsibility for the child in every other aspect of their life, the parent should have that same responsibility in this context?

[Dr Evans]

My hon. Friend has identified the nub of the issue, and his intervention leads me on to an example that demonstrates the problems that we are talking about. I have chosen to debate these provisions in the order shown on the selection list because I wish to understand whether the Minister believes that Government amendments 40 and 41 will deal some of the issues that I am about to raise. There clearly has to be flexibility in dealing with these situations, but it is worth exploring what could go wrong. The nub of the issue is that they may well go wrong. Let us take an example.

Say that A is 16, and she is struggling with anxiety and behavioural issues. She has had serious suicidal episodes and previous drug use. She lives at home with her loving, supportive parents, who have always acted in her best interests and want to engage constructively with her care, but A is under pressure from a 19-year-old boyfriend. He is controlling, and discourages her from speaking to her parents or professionals. When asked to nominate a trusted adult, A names him. Under the Bill as drafted, the nominated person could be accepted, provided A is deemed to be competent. That would give her boyfriend access to her care decisions and significant legal standing. Under amendments 54 and 55, that would not be possible because he does not have parental responsibility, and therefore could not be appointed.

That example illustrates why the amendments matter. Children, especially those in crisis, may be vulnerable to coercion, grooming, or misplaced trust. Loving parents, who have legal obligations to protect and care for their children in every other walk of life—as my hon. Friend the Member for Farnham and Bordon pointed out—could find themselves legally sidelined.

Are there risks in amendments 54 and 55? We must consider the edge cases. Not all children under 16 live with those who are trusted and have parental responsibility. There are estranged families, kinship carers, informal fostering arrangements and situations of abuse. A strict parental responsibility requirement could exclude the very people relied on by a child. I ask the Minister whether there is flexibility in the amendments for exceptional cases in which someone without PR may be appropriate, with oversight. Do Government amendments 40 and 41 already address that point? Forgive me if I have misinterpreted, but they seem to be bridging amendments. Would guidance or a statutory code of practice provide a better mechanism to balance protection and flexibility? What assessment has been made of children in care or informal arrangements, where parental responsibility might technically lie with a local authority or estranged parent, especially under the changes proposed by Government amendments 40 and 41?

There are potential routes forward. One option might be to require PR by default but allow exceptions if the child expresses a clear competence preference, the AMHP agrees that a person is suitable and poses no safeguard risks, and a senior commissioner or legal oversight has sign-off. That is a possible way of keeping amendments 54 and 55 alive, and it would keep within the spirit of the amendments by protecting children from harmful influence without removing their voice in complex or marginal cases. We could also explore adding an explicit safeguard power to override a child’s nomination where there is concern of coercion or abuse, regardless of parental responsibility status. Again, I think that may be what Government amendments 40 and 41 are trying to do, but I would be grateful to see whether that is the case.

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[David Burton-Sampson]

It is a pleasure to serve under your chairship, Sir Desmond. I rise to speak to clauses 24 to 28, and I will start by sharing the story of two of my constituents: Carol and her husband John.

John had been an active member of the local community before he was sadly diagnosed with dementia. As his dementia progressed, John was settled into a good care home and Carol was happy with the care that he was receiving. Due to a change in his medication, Carol was told that John had become more agitated and aggressive than usual. She was asked whether she would agree to John being assessed. Although she did not really understand what that meant, she did not see any reason to refuse.

From that point on, Carol says that she felt like she had lost control over her husband’s care. John was assessed by four strangers, and Carol was told that she could not be present. Following the assessment, Carol was told that John would need to be detained under the Mental Health Act within the next two weeks. Carol was very concerned to hear that John would be detained, but despite having power of attorney, she was not able to overrule that decision. She hoped that he would be able to get help with his medication and that he would be discharged.

In the end, Carol had only half an hour’s notice that John was going to be detained. She rushed to the care home to see her husband, who had been sat in the garden having a cup of tea with some friends, being abruptly put into a van by two men and taken away. She was not allowed to come with him, and for the first time in her life, Carol had a panic attack. She could not imagine how traumatic it was for John, who was disorientated and confused because of his dementia, to be taken by people he did not know to a strange place.

John was taken to a secure mental health ward that was very different from the familiar environment of his care home. Carol was told that she could not visit him, but she was insistent and turned up anyway. She was then allowed to meet his doctors on his first day and was reassured to hear that he would be detained for only two weeks while his medication was reviewed.

In the end, John was detained for eight months. Carol continued to visit every day, spending as much time as possible with him. She had specially adapted her home to accommodate John’s needs, but she was not able to have him discharged to either his home or a care home. Precious time was taken up with the endless fight to get John into a more appropriate environment. Sadly, John’s health significantly declined while he was detained. He lost the ability to walk and speak, and Carol felt that, in his declining state, he could not pose any danger to himself or anyone else. However, it was only after he was admitted to hospital for a catheter fitting that Carol was able to get him discharged, thanks to a doctor telling her that she could use her power of attorney to take him home—something she was told she was unable to do in the mental health facility.

She took him to a care home, where, sadly, he died two weeks later. John’s cause of death was listed as Parkinson’s, but Carol feels strongly that the anxiety and fear of his final months contributed to his death. Carol understood that her husband was dying; all she wanted was to be included in making decisions about his care. She knew very clearly what she wanted for him. She told me:

“I wanted him to die in a bed with clean sheets, with a window open and with me by his side.”

Those wishes were not taken into account.

As John’s wife and carer, Carol spent every day with him, yet she felt excluded from the decision-making process for his care. She should have been able to focus on what was important: spending time with him. The changes in clauses 24 to 28 would have helped Carol to feel more involved in representing John during his time in care. Clearly, there were failures to allow Carol, as John’s nearest relative, the rights that she was entitled to in order to support him.

With the move from “nearest relative” to “nominated person”, the new rights afforded by the Bill would have given Carol even greater engagement. Given that she had power of attorney, it is likely that she would have been appointed the nominated person by the AMHP. However, moving forward, it is important that those rights are properly afforded to the nominated person, so that we do not have another situation like John and Carol’s.

Although I welcome and fully support the changes in clauses 24 to 28, I seek an assurance from the Minister that all efforts will be made to ensure that the rights of nominated persons are fully recognised and assigned, and that nominated persons will be made fully aware of their responsibilities and powers, allowing advocacy for the patient under care.

I turn briefly to amendments 54 and 55 and Government amendments 40 and 41. I agree with the Government’s view that if a child has capacity, they should be able to have the choice to appoint their own nominated person. I appreciate the intent of the amendments from the hon. Member for Runnymede and Weybridge, but I think that the Government’s approach is more appropriate.

[Gregory Stafford]

I appreciate that the hon. Gentleman sees the potential benefit in the amendments standing in the name of my hon. Friend the Member for Runnymede and Weybridge. However, my hon. Friend the Member for Hinckley and Bosworth gave an example, which I do not think is entirely distanced from reality or possibility, in which a person could well choose someone who is deeply inappropriate. In that situation, the person or people—that is, the parents—who had in every other part of life had responsibility for that child would now potentially not have responsibility for the child, in what is probably the most important part of that responsibility.

Does the hon. Member for Southend West and Leigh really not have any concerns about that? If he does, does he not support at least the intentions behind those two amendments, if not the exact wording or drafting? If he does accept those intentions, would he like to see the Government table similar amendments, drafted in a way that he would find more appropriate?

[David Burton-Sampson]

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

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

It is a pleasure to serve under your chairmanship, Sir Desmond. I rise to support amendments 54 and 55, tabled by my hon. Friend the Member for Runnymede and Weybridge, but I will first briefly speak to clause 24, which is an important and long-overdue step towards modernising the Mental Health Act 1983, crucially strengthening the rights, dignity and autonomy of individuals subject to it.

The reform of the existing nearest relative provisions, replacing them with a new system that allows for the appointment of a nominated person, is an important part of ensuring that individuals get the right support, and modernises an outdated system. The current model is based on a rigid and outdated hierarchy in which the role of the “nearest relative” is determined by law, not by the wishes of the patient. This one-size-fits-all approach fails to account for the complexities and nuances of individual relationships. It can result in someone unsuitable, or even actively harmful, being placed in a central role in a person’s care and treatment journey. Indeed, the limitations of the system have been acknowledged by practitioners, patients and policymakers alike. It is too often disempowering, and the patient can lose agency at a time when they need to be empowered to feel in control of the situation as much as possible.

As the shadow Minister says, clause 24 is the cornerstone of the reforms. It is an important change to the current legislation to reaffirm the commitment to patient-centred care, to dignity and to the principle that those receiving treatment under the Mental Health Act should have a voice in decisions about their support network. The aim of the clause—to put the patient first—is important. It acknowledges that the person best placed to advocate for the patient may not be their closest relative. In some cases, family dynamics are fraught. In others, the designated relative may hold views about treatment that conflict with the patient’s wishes or medical advice. We have seen real-world examples in which the imposition of the “nearest relative” role has led to tension, distress and, ultimately, a breakdown in trust. That is not the kind of environment in which recovery is fostered.

Amendments 54 and 55 would address the specific issue of nominated persons and those with parental responsibility for children under the age of 16. It is important that we consider situations in which a young person may be in a vulnerable position and their decision on who their nominated person should be may not be in their best interests. We have a particular duty to ensure that children are safeguarded. Clause 24 as it stands will allow under-16s to choose someone who is not the parent to have significant power, including the ability to discharge the child from hospital.

We must listen to and actively try to support any young person who needs that kind of intervention—it is not that their views should not be considered. However, there is a very real risk that a vulnerable child or teenager might be coerced by or under the control of an older partner, for example, as my hon. Friend the Member for Hinckley and Bosworth pointed out. Perhaps they might choose an older friend. We need to consider that a decision made by the nominated person, such as an older friend, may have implications for those with parental responsibility. For example, that older friend may decide to discharge a child from hospital and into the care of the parents, who would not provide advocacy or be part of that decision making.

The Minister said that safeguards will be put in place, but can he expand on that? There are some real concerns here. Let us consider a situation in which there has been a decision by a court to determine which parent has responsibility for the child. If complex family issues have already been considered by the family court, it is right that the decision be followed. I respectfully ask the Minister to reconsider this point. We must respect the fact that parents of those under 16 are best placed to advocate for, support and act for their children. This is about capacity, consent and, ultimately, safeguarding.

[Gregory Stafford]

My hon. Friend makes a powerful point. I remember the comments made by the hon. Member for Southend West and Leigh, who is chuntering from a sedentary position—I think he disagrees with my hon. Friend’s point. In his reply to my intervention, he made the point that there are situations in which things are the other way round, where those who have parental responsibility are not necessarily the appropriate persons.

Does my hon. Friend agree that, on first principles, the parent should have parental responsibility in all areas of life, including the ones that she is talking about, unless there are specific reasons, such as the court decision to which she referred, that suggest that the parent is not the correct person to have responsibility? Surely, in the balance of danger or risk, there is a far greater risk if the nominated person is not a parent than if the nominated person is a parent.

[Aphra Brandreth]

My hon. Friend makes an important point. If parents are not acting in the best interests of their children, there is a wider safeguarding issue that needs to be considered. One would question why such parents had been left in a situation in which they have responsibility for their children and are potentially harming them.

That leads me nicely to another point, which is that introducing the additional wording would bring mental health in line with physical health. For someone under the age of 16, it is their parents who have the responsibility to act in the best interests of their physical health; it seems to me that one would expect the same for mental health. I therefore urge the Committee to support amendments 54 and 55.

Let me return briefly to the overarching aims of clause 24. I underscore the point that the wider principle at stake—patient autonomy—is one that I support. The ability to make informed choices about one’s care should be a central component of our care system. In mental health, where individuals can feel particularly vulnerable, that becomes even more essential. Granting patients the power to nominate someone who will advocate for them, advise them and represent their wishes is a powerful act of empowerment. Moreover, this change enhances safeguards for patients. It ensures that the person acting on their behalf is someone they have chosen and trust. It reduces the potential for conflict and opens the door to a more collaborative and compassionate model of care.

If the Committee agrees to the amendments, which would provide the necessary safeguards for children, who I believe should be considered separately to adults, my overall view is that clause 24 represents a pragmatic, compassionate and patient-focused update to the Mental Health Act. It aligns with our modern understanding of mental healthcare and puts trust, respect and dignity at the heart of our legislative framework.