Mental Health Bill [ Lords ] (Second sitting)
Gregory Stafford ExcerptsTuesday 10th June 2025
(1 year, 5 months ago)
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Dr Danny Chambers (Winchester) (LD)
It is an honour to serve under your chairpersonship, Ms Furniss. I know that the hon. Member for Farnham and Bordon will have spent his lunch time anticipating the responses to his long series of questions. The tension is palpable— I hope he is excited to hear our replies.
Dr Chambers
Unfortunately, I was busy meeting Brian May and talking about farming, so I have not had a chance to work up a really good response.
The point of the Liberal Democrat amendments is to recognise that mental ill health requires holistic care and that many non-clinical factors directly influence mental health. Although the Bill’s scope is understandably narrow, very much focusing on people once they are admitted to hospital for treatment, we need to recognise that, if someone is discharged back into the situation from which they were admitted, they are very likely to have a relapse and to need treatment again. Some of those factors are non-clinical. For example, people living in poverty—those in the lowest 20% of income—are more than twice as likely to suffer mental health issues than those on an average income.
We strongly support the Bill, but we need to recognise that, on its own, it will not improve mental health or do anything to prevent people from developing mental health issues. If our amendments are not within scope or are not appropriate for the Bill, we urge the Minister to work with other Departments, such as the Ministry of Housing, Communities and Local Government, to ensure that this good piece of legislation, which we support, can be successful.
The hon. Member for Farnham and Bordon made a point this morning about local authorities. He is right that local authority reorganisation is a challenge, especially when it comes to providing accommodation for young people and for people being discharged from mental health care centres. It is also an opportunity, because the current situation is not fit for purpose. Hampshire county council is struggling to provide the care these people need. Housing, which often affects young people’s mental health, is probably the single biggest issue that comes up in my inbox and when I knock on doors.
I thank the hon. Member for Hinckley and Bosworth. As a clinician, his point about the evidence base, especially when it comes to reviews, is really important. We are discussing a Mental Health Bill that may not be changed significantly for another 40 years, so it is important that we use the best evidence. As a long-time trustee of an evidence-based medicine charity, I am passionate about this.
I thank the hon. Member for Thurrock for pointing out that clinical guidelines suggest six-month reviews. Yearly reviews are used for many medical conditions, and I would argue that a year is also an arbitrary period, rather than one based in evidence. Why six months and not a year, or why a year and not six months?
Dr Chambers
I will not argue with an esteemed Member who has the hon. Gentleman’s background in mental health. I take his point as it stands.
Gregory Stafford
I have been listening carefully to the hon. Member’s argument. I do not disagree with anything in it; I just fail to see how the amendment fits with the clause that we are discussing, which I think may be the point that the hon. Member for Ashford is making.
As far as I can tell, clause 4 is about producing a register of people who have a learning disability or autism, who are at risk of being detained for a mental health episode and for whom those risk factors are active, for example because they have been sectioned before or have presented at A&E. Those are specific incidences. What the hon. Member for Winchester is talking about is more wide-ranging; it is not about touchpoints in the same sense. I can see how he could potentially say, “Well, domestic abuse has led to a mental health episode and therefore to a presentation at A&E or in the system.” However, if we put in societal factors, for want of a better phrase, we could end up putting most people on the list, because most people will have experienced a bereavement. I get what the hon. Member is trying to do, but I fail to see how the amendment matches the overall purpose of clause 4.
Dr Chambers
I thank the hon. Member for his intervention. In my maiden speech, I focused primarily on mental health and on the fact that there are so many demographics of people who we know are at significantly higher risk of suicide and mental ill health than the general population. Whether the issue is more appropriately addressed in the Bill or outside it, but using the Bill as a mechanism to highlight it and to cause the proactive engagement of other relevant Departments and other pieces of legislation, I am determined that we are not going to discuss the biggest piece of mental health legislation in 40 years and not even have a discussion about how we proactively engage with groups of people who we know are at very high risk of mental health issues.
Dr Chambers
I will carry on, if that is okay.
Our social and health services need to see the whole person, including their social needs and the factors in their environment that threaten their wellbeing. Trying to treat a mental disorder but failing to account for that person’s lack of housing, which drove their anxiety and depression in the first place, is doomed to fail. A lack of support for a child who has lost their parents at a young age could lead to significant harmful consequences further down the line.
There are a huge range of areas that require change, but for now we would like to press the Minister on three specific issues. We understand that some of them may turn out not to be within the scope of this Bill, but it is still important that they be addressed in some capacity.
Will the Government finally implement a register of all bereaved children to ensure that they get the support they need? Will the Government ensure that all women who go through miscarriage, stillbirth or traumatic birth access mental health support quickly and effectively? Will the Government establish a veterans register to ensure that those who have served in the armed forces and who face particular challenges as a result get the tailored mental health support that they need and do not reach the point of requiring detention?
Dr Evans
I entirely agree with the hon. Lady’s end point and with the thrust of what she says. Causality is not causation, and we need to be very careful. When we get to the later clauses of the Bill, that will be at the forefront of our discussion.
We cannot deny the reason we are having this legislative debate in the first place: the observation that black men in particular are subject to community treatment orders far more than any other group in the country. However, we must not make a lazy causal analysis and say, “Well, just because that is the case.” For example, black men have a higher risk of prostate cancer, and white people a higher chance of coeliac disease, because of the genetic basis. Is there something in that? Is there systemic bias by clinicians, as she hinted? That all needs to be explored.
The hon. Member for Shipley beat me to the punch when it comes to my closing statement. We owe it to our children and young people not to legislate in haste, so I welcome the spirit of the amendments, and I welcome the debate, but we must be careful to ensure that we are truly legislating for and defining exactly what we know. Otherwise, we risk creating other inequalities and unintended consequences or, worse still, a system that becomes even more flabby and difficult to manoeuvre through. That is the last thing we want for our patients, clinicians and the public.
Gregory Stafford
It is a pleasure to serve under your chairmanship, Ms Furniss. I have some criticisms of the specifics of the amendments tabled by the hon. Member for Winchester, but I entirely support him and congratulate him on the passion with which he spoke about them. As I remember, his maiden speech touched on a number of these issues. Whether they are within the scope of the Bill is for the Clerks and the Committee to decide, but he made several extraordinarily good points that I hope the Government will take away. If the Bill is not the appropriate place for them, there should be another avenue.
The lead amendment is about the ICB register. It would insert a new subsection to extend the duty on integrated care boards to establish and maintain a register for those at risk of detention to cover all children and young people who meet certain risk criteria. As drafted, the duty to maintain a register under clause 4 may not explicitly include all under-18s. Therefore, the amendment would ensure that children and young people are proactively identified and supported before reaching a crisis point that might lead to detention.
Clearly, there are positives. As the hon. Member stated, early intervention might help to prevent unnecessary detention by identifying risk earlier, which is especially important for children. Likewise, there is a strong argument about equity and care to ensure that young people receive the same proactive planning as adults. That would clearly lead to improved safeguarding through better tracking of vulnerable minors in the mental health system. A corollary to that would be better data collection on youth mental health needs, which I think we would all support. We would be able to use that information to support more informed policymaking and resource decisions.
As my hon. Friend the Member for Hinckley and Bosworth highlighted, however, and as I highlighted in the debates on other clauses, there would clearly be a resource demand, especially on ICBs, from expanding registers and services. Likewise, there is the complexity of implementation, because defining who qualifies as being “at risk” may be subjective. I therefore ask the hon. Member for Winchester, when he sums up on the amendments, to give us some indication of how “at risk” would be defined, or whether that would simply be down to the mental health professional or some other medical professional. There are also, of course, privacy and consent concerns related to maintaining a register for minors. Again, the hon. Member may have thought about some practical things that could assuage my concerns about that.
There may also be a risk of stigmatisation. We have to be very careful, especially with children and young people, because being labelled or treated differently due to being on the register would not help their mental health. We would have to have some really strict privacy and data-sharing controls to ensure that they were protected within the proposed system.
As I said in my intervention, I entirely support the aims of amendment 47 because it would specify the risk factors for detention for those on the register of people at risk of detention under clause 4. The criteria for identifying such individuals are left to be defined in regulations as the Bill stands. The amendment would mandate in law specific evidence-based risk factors—which I agree are risk factors for the issues that the hon. Member is talking about, particularly those linked to trauma and social disadvantage—rather than leaving them to discretion.
At a general level, the amendment recognises the role of trauma and social determinants in mental health crises—I congratulate the hon. Member on clearly explaining some of the factors. Going back to our debate on the previous group of amendments, that would improve the early identification of individuals at risk, promote preventive care, strengthen equity and provide clarity and consistency. However, like my hon. Friend the Member for Hinckley and Bosworth, I am concerned about prescribing a relatively small list and therefore limiting the clause’s flexibility—there may be risk factors that are not listed in the amendment or ones that we have not even thought of.
Jen Craft
Does the hon. Gentleman agree that the Bill makes allowances for the Secretary of State to introduce appropriate risk factors via regulation, and that it is more appropriate to list the risk factors that ICBs should take into account in secondary legislation issued by the Secretary of State than in primary legislation, as amendment 47 seeks to do?
Gregory Stafford
I agree with the hon. Lady; that is my understanding, but perhaps the Minister can confirm that when he sums up. The flexibility in the clause is one of its strengths.
Dr Evans
Does my hon. Friend share my opinion that it makes sense to agree with the Government? The impact of social media and the evidence coming out about using mobile phones and about the impact of certain sites have been debated in this House for the last five years—since I have been here—and there have been advances. Legislation has been brought forward, but there is a growing consensus on both sides of the House that it never quite keeps up. Allowing the Secretary of State to add risk factors as they come up, even in policy guidance, might be a shrewder way to future-proof the Bill against those difficulties. In 1983, we were not discussing or even thinking about the likes of Facebook, yet here we are. With the advent of artificial intelligence, who knows where we will be in another 40 years?
Gregory Stafford
I entirely agree with my hon. Friend. To touch on his point about social media, it is a very useful tool, but is deeply pervasive and can cause the bullying, harassment and mental health issues that he describes. As far as I can tell, the risk factors in amendment 47 would not cover something like that unless it was part of something else—for example, part of domestic abuse, armed conflict and so on.
Anna Dixon
This discussion of the list of risk factors throws up a concern for me: one of the risk factors that has been facing families and other constituents of mine in Shipley for some years is the inability to get appropriate support for their children from children’s social care, for example, because there are very long waiting times for child and adolescent mental health services. Even when people have EHCPs, they are often not fulfilled. Does the hon. Gentleman recognise that we need to address special educational needs and disabilities and children’s social care and put those things in place, as the Government are doing? Children with autism and learning disabilities will remain at high risk of much more complex mental health needs if they do not get the support they need at an early stage.
Gregory Stafford
Once again, the hon. Lady tempts me to make a party political point, but I shall resist. On her general point, there are factors, such as the ones she described, that would not necessarily fall within the list in amendment 47. [Interruption.]
Gregory Stafford
Thank you, Ms Furniss. I was coming to my closing remarks on amendment 47. Suffice it to say that some of the concerns that I raised on amendment 8 about the administrative burdens, the data sharing, and the potential safeguarding and privacy concerns transfer through. Again, perhaps the hon. Member for Winchester could give some reassurance on that when summing up.
Amendment 9, as far as I can tell, would extend the duty on integrated care boards and local authorities to exercise their marketing functions in a way that seeks to ensure that children and young people’s needs can be met without detaining them.
Dr Neil Shastri-Hurst (Solihull West and Shirley) (Con)
Does my hon. Friend agree that, although the intention behind the amendment may be worthy, there is a lack of clarity in the drafting? In particular, it is unclear what “seek to ensure” means and how that would be legally defined.
Gregory Stafford
My hon. Friend is right; although a number of the Liberal Democrats are entirely worthy, there are some concerns about the drafting, which could give rise to ambiguity, legal loopholes and definitional issues. In that example, I do not think that “seek to ensure” is helpful. When the hon. Member for Winchester is summing up, perhaps he might explain how “seek to ensure” can be robustly defined within the law, or if it cannot be, suggest a different form of wording that he may wish to use in a future amendment if this amendment fails to be agreed.
Part II of the Mental Health Act 1983 covers the powers to detain individuals for assessment and treatment. Detention can clearly be traumatic, especially for children and young people. Amendment 9 reflects a growing consensus that detention should be the last resort— I think hon. Members on both sides of the House agree with that—and that community-based preventive and therapeutic alternatives should be prioritised. Again, I think it would be very hard to disagree with that ambition.
On the positive side, community-based care is clearly better than detention in most cases, and, if we can get to a point where people are assessed earlier, as is the intention of some of the other amendments, clearly—hopefully—that would lead to community-based care and not detention. The amendment would also protect children’s rights and support the trauma-informed approaches to mental health that were raised previously regarding amendment 47.
The amendment could also reduce the long-term harm associated with institutionalisation and potentially coercive treatment. As we have heard from Members on both sides, that would align with best practice in child and adolescent mental health services and it would promote and encourage a system of accountability by making ICBs and local authorities responsible for proactive care planning. All of that is extraordinarily laudable.
On the potential downsides, there is an ambiguity about the enforcement of the amendment, as my hon. Friend the Member for Solihull West and Shirley said, because of the lack of legal force or clarity in some of the phraseology. There would be also resource implications and, if there are resource limitations at the ICB or local authority level, that might hinder their ability to provide adequate, community-based alternatives.
I do not say that as an excuse for not supporting the amendment, but the hon. Member for Winchester has to understand the reality of the world we live in. Although I want local authorities and ICBs in every area to be entirely fully funded and resourced—and frankly, I do not think the Government’s cut of 50%, or indeed more in some ICBs, will do anything to help community-based care—there would be resource challenges. There would also be implementation challenges in areas where mental health services are already underfunded or overstretched that could lead to delays in care.
This is the key question that I ask the hon. Member to respond to in his summing up. Members on both sides of the House want to ensure that all people of all ages get the best, most appropriate mental health care as early as possible. But in an imperfect world, if there are potential delays in care because community services are struggling to find alternatives to detention, the unintended consequence could be that someone may not be treated at all because of the onus on defined community-based care rather than detention. Will the hon. Member explain how that would work?
I draw my remarks to a close by saying I, certainly, and the Opposition, entirely agree with the ambitions of the amendments. However, some practical and legal issues would need to be ironed out before I could wholeheartedly support them.
Stephen Kinnock
Again, I thank the hon. Member for Winchester for his amendments. I understand the intent behind amendments 8 and 9, but the clauses on registers and the associated duties on integrated care boards and local authorities are specifically aimed at people with a learning disability and autistic people, because of the detrimental outcomes that these groups of people may suffer when detained.
We recognise the concern around the treatment of children and young people, which is why we have several provisions in the Bill aimed at improving their care. However, dynamic support registers are particularly tailored to the needs of people with a learning disability and autistic people, and have been established in NHS England’s policy for some time. We do not have evidence that they would be an appropriate mechanism for wider cohorts.
We do recognise that bereavement, miscarriage, the experience of trauma and difficult life transitions can all have a bearing on mental health. However, access to mental health support is based on clinical need, not on the circumstances that might give rise to that need.
Dr Chambers
I know how much the hon. Member for Farnham and Bordon enjoys speaking in Bill Committees—we were on the Tobacco and Vapes Bill Committee together a few months ago—and I am really pleased that our amendments have given so much material for discussion. I really appreciate the input from Members on both sides of the Committee; it has been really insightful, useful and constructive.
It has been rightly pointed out that the current state of local authorities—their funding and their capacity—means that they might not be able to deliver the more holistic care we are pushing for in the amendments, but I do not think that the Mental Health Bill should be limited by the current state of local services and funding. If that is the underlying problem, that is what should be addressed, not the measures in the Bill.
Gregory Stafford
I accept that we should aim for the pinnacle and the best. What I was trying to say was that because the amendments restrict us, rather than giving us the space to, hopefully, reach the pinnacle, or to explore other options if we cannot, they could have unintended consequences if we cannot reach that pinnacle.
Gregory Stafford
My hon. Friend is making an excellent case for new clause 11, which could potentially solve funding issues I have raised. He mentioned the NHS 10-year plan. Will he suggest that the Minister looks at ensuring that, if new clause 11 is not passed today, the details in it are fed through into the plan? When it is published, which the Minister has indicated will be relatively soon, the information and outcomes my hon. Friend is trying to achieve through the new clause could be in it.
Dr Evans
Far be it from me to tell the Minister what to do, but if I were a wise Minister, I might look at where my predecessors had benefitted from further information and where they may have stumbled. The Bill has been looked at for a number of years by many people from outside and inside the House. Many have been involved throughout its progress, including a former Prime Minister, who tabled amendments in the other place. There is definitely the ability to learn from what the last Government found and to use that information in the kinds of plans that we need.
Sojan Joseph
I rise briefly to speak about training in our health settings. There is, in fact, too much mandatory training in NHS and care settings; the issue is that we are not complying with it. We also heavily rely on agency staff, whose training often nobody monitors. It is not that we are short of training. As my hon. Friend the Member for Thurrock mentioned, the Oliver McGowan training was rolled out across the NHS.
Gregory Stafford
I want to be clear about what the hon. Gentleman is saying. My understanding of the amendment, for which I have a lot of sympathy, is that the mandatory training will be around appropriate care in the settings listed. I think he is talking about manual handling or data protection stuff. As someone who worked in the NHS for seven years, I entirely agree that there is a lot of “mandatory training” that could be scrapped to make the NHS much more efficient. The amendment is specifically about ensuring that there is appropriate training for those who are working in the settings listed. I hope that he is not saying that he does not think that there should be training for mental health professionals. I am sure he is not saying that, but that is how it is coming across.
Gregory Stafford
Given that we have discussed the proposed new sections in depth, I do not intend to dilate upon this clause for long. Suffice it to say that the Opposition, notwithstanding the questions asked by the shadow Minister, support the clause, which is essential to ensure the safeguards and progress that we are trying to achieve through the Bill.
Clearly, the clause is prevention-focused and helps avoid unnecessary and traumatic hospital admissions. It leads to better planning because it supports tracked admission of services tailored to individual needs. It also has an element of legal accountability, given that it makes it a legal duty for ICBs to monitor and support at-risk individuals. It is also data driven because it encourages the use of real-time data to inform care decisions.
That being said, a number of the concerns that we raised during debate on the amendments apply to the clause itself. In the Minister’s summing up, can he touch once again on the privacy concerns, as well as the resource demands and the risk of stigma? By that, I mean that being placed on a register could be seen as labelling or pathologising. How do we ensure that the register does what it is supposed to without that risk? Can he also touch on some of the vague criteria and definitional phrases, such as “at risk”, and how they might potentially lead to inconsistent application?
Stephen Kinnock
I am conscious that we will be voting imminently, so I will try to rattle through. Going back to my phrase “the red thread”, the thread running through all the shadow Minister’s questions is delivery. The proof of the pudding in all legislation is whether we convert it into action in a way that best delivers for the interests of the British people, and in a way that absorbs the risks, builds resilience in the system and ensures that we are constantly monitoring, evaluating, reviewing and learning from what is happening on the ground and, through a constant process, improving delivery.
The shadow Minister asks some very good questions, but the problem is that so many will relate to the work that we need to do at pace as soon as the Bill receives Royal Assent. This is a sequential process; we first need the legislation and the comprehensive spending review, so that we know our funding package. We then need to start work consulting on the code of practice, getting that feedback and shaping a plan that defines what good community services look like, because we all know that we are a million miles from having good community services at the current time. We are in a state of crisis and the system is on its knees; we are very conscious of all those facts. There is an immense urgency with all this.
The shadow Minister asked about evaluating and updating pathways and CETRs, duty to respond, the information collected, managing the risks, preventing paternalism and ensuring that people do not get labelled. All those things will have to be set out and explained in the project plan. That is something we will all be working very hard on as soon as the Bill gets Royal Assent.
One of the shadow Minister’s factual questions was on how many CETRs have been issued. I cannot give him that number, but I can tell him that, as set out in the impact assessment, 86% of in-patients received a CETR in the last year. If my answer that this is about delivery does not satisfy him and he thinks there are issues that relate directly to the Bill rather than to the implementation plan, I am happy to write to him on that.
The Lord Commissioner of His Majesty’s Treasury (Taiwo Owatemi)
I am the only one who can move the Adjournment.
Gregory Stafford
That is not true. Any member of the Committee can move the Adjournment.
Gregory Stafford
On a point of order, Ms Furniss. I called for a Division on the Adjournment before several members of the Committee who are now in the room came back. What is your ruling on whether members who were not here when the Division was called will be allowed to vote?
Chris Bloore
With the greatest of respect to the hon. Member for Farnham and Bordon, I clearly asked my question before the Question was put. We therefore have not divided yet.
Taiwo Owatemi
Members have 15 minutes to get back when a Division is called in the House. The 15 minutes had not elapsed when the Adjournment was moved. How can the vote be allowed to stand when the rules say that members of the Committee have 15 minutes to get back?
Gregory Stafford
Ms Furniss, your ruling, as I am sure Hansard will show, is that we were required to come back at 20 minutes to 6. Opposition members of the Committee were back at 20 minutes to 6, and few others were here. You did not suspend the Committee again when the House divided on Third Reading because you were not here, and therefore the 15-minute rule cannot apply.
Taiwo Owatemi
When the previous vote was called, I made it very clear to the Committee that we had three votes plus a vote on Third Reading.
Gregory Stafford
The Chair said that we must be back here at 20 minutes to 6, and that the Committee would be suspended until that point. We have not been suspended since then.
The Chair
Arguing about whether we were here or not is not moving us on, is it? We need to know what we are going to do now, so let us stop there. I think the Government Whip will agree that if we adjourn the debate now, the business will resume on Thursday. The Committee has another eight sittings after that, so you should have time to catch up. That is what it would mean.
Question put, That the debate be now adjourned.
Dr Evans
Amendment 52 would amend clause 5 to introduce an important distinction in the grounds for detention under section 2 of the Mental Health Act, namely on whether a person has the mental capacity or competence to consent to admission. This amendment, tabled by my hon. Friend the Member for Runnymede and Weybridge, raises questions that go to the heart of how we balance liberty and protection, autonomy and risk in our mental health system.
Under the current Mental Health Act, and indeed under the Bill as drafted, an individual can be detained for assessment if they are experiencing a mental disorder and if serious harm could be caused to themselves or others unless they are detained. There is no distinction based on whether they have the capacity to consent to care. In other words, a person who has full understanding and decision-making ability may still be detained against their will to protect them from themselves.
The amendment proposes a change to that approach, so that if someone lacks the capacity to make a decision about admission and treatment, the current protection should apply—they can be detained if they are at risk of harming themselves or others. But if someone has capacity, understands what is happening and what the risks are, and still refuses care, they should be detained only if they pose a risk to others and not just to themselves.
I will give a brief example to try to bring that to life. Imagine a young adult, aged 22 and living with long-standing depression. They have attempted suicide in the past, but they now clearly and repeatedly say that they do not want to be admitted. They understand the risks, are coherent, consistent and judged by clinicians to have capacity. Under the Bill as it stands, that person could still technically be detained, but under this amendment they could not unless they pose a risk to someone else.
Why does this amendment have merit? There is much in it that is compelling. It puts autonomy at the centre of the mental health framework, which the Committee discussed and agreed on earlier. It aligns more closely with the Mental Capacity Act 2005, which already allows people to make unwise decisions so long as they understand what they are doing. It also echoes the principles in the UN convention on the rights of persons with disabilities, which calls for supported decision making over substitute decision making. It could reduce unnecessary or overly paternalistic detentions, especially of people from marginalised groups who are already disproportionally affected by coercive care.
Gregory Stafford
I am interested in the points that my hon. Friend is raising. Could he give any examples of the situations he is talking about? It would help the Committee, and certainly help me, to understand the practical realities of what he is talking about.
Dr Evans
I will try to elucidate a little further. We know that some people have fluid capacity, such as those with dementia or depression. How do we ensure that people have safeguards for themselves and the wider community, while respecting their capacity and allowing them to be masters of their own destiny? The Bill literally says that we want to see individual autonomy, and by definition, there is always a balance to be struck. The Bill shifts more to the paternalistic side, which brings some challenges because it could create gaps in protections, as I will explain.
There are clinical situations in which a person in mental health crisis—for example, in the early stages of a manic episode or a severe personality disorder crisis—may present with superficial capacity but be at grave risk of harm. Are we confident that clinicians can assess capacity accurately in real time, in often pressured and emergency contexts? Might we inadvertently tie the hands of practitioners trying to prevent suicide or serious self-injury? If capacity becomes the gateway to protection, what support and guidance will be provided to ensure that it applies fairly, consistently and safely?
That is important when we talk about detention, because detaining people is one thing; the next thing is how we get them out. To understand that, it is worth focusing on the crucial interaction between the Bill and liberty protection safeguards. It is worth my briefly explaining to the Committee what LPS are, how they evolved and why they matter. Liberty protection safeguards are the new legal framework that replaces the old deprivation of liberty safeguards, or DoLS. DoLS were designed to protect people who lack capacity, but had become widely criticised as complex, slow and limited mainly to hospitals and care homes.
In response, the Conservative Government introduced LPS through the Mental Capacity (Amendment) Act 2019, to simplify the process and extend protections to community settings such as supported living and people’s own homes. Given that we are talking about Darzi’s shift, that is important. With that context, I turn to the key concerns before us today: how the Bill interacts with LPS, especially when individuals move from hospital detention to community care.
To illustrate why this matters, let us consider the case of Mrs A. She is a 55-year-old woman with bipolar disorder and mild dementia. She was detained under the Mental Health Act after a severe manic episode put her at risk. While in hospital, the Act governed her detention and treatment. After several months, Mrs A stabilises enough to be discharged, but because of her dementia, she lacks the capacity to consent to her care arrangements in the community. She requires supported living, with 24/7 care, which means that she will continue to be deprived of her liberty, but now in the community. Because she is no longer detained under the Mental Health Act upon discharge, the liberty protection safeguards must authorise the deprivation of liberty in the community.
This requires careful consideration. An LPS assessment and best intention decisions are required, and formal authorisation must be in place before she leaves hospital. This transition point is critical, because without clear protocols, Mrs A could find herself deprived of liberty without lawful authorisation—a breach of her human rights. Information sharing between hospital staff, community providers and local authorities may be delayed or incomplete. There may be confusion among professionals about who is responsible for co-ordinating the handover. Training gaps might lead to the inconsistent application of safeguards.
The Bill reforms detention in hospitals, but there is some opacity regarding how the handover to LPS in the community will be managed. Will the Bill ensure a seamless transition, with no gaps in safeguards? If it does not, then how will this be provided? Will there be statutory duties to mandate information sharing and co-ordinate reassessments? How will professionals across health and social care be trained to navigate both systems effectively?
The Bill rightly aims to reduce inappropriate detentions and enhance patient autonomy in hospital, but protections under LPS in the community must be equally robust to maintain dignity and rights post discharge. How will the Government guarantee parity of safeguards across settings? The Bill also seeks to address disproportionate detention rates among ethnic minorities. We must be equally vigilant that the reforms and the wider LPS regime do not perpetuate inequalities once individuals leave hospital. We therefore need to ask the questions: what monitoring is done and what safeguards will be in place?
On detention, I gently ask the Minister to clarify the Government’s plan to manage the vital interface between the Mental Health Act and LPS, even as the Bill stands, to embed clear statutory duties, guidance and accountability to protect all individuals like Mrs A throughout her care journey.
What is the Government’s view on distinguishing between those with and without capacity in the context of detention for self-harm risk? Has the Department assessed the clinical and operational implications of requiring real-time capacity judgments before detaining someone at risk to themselves? Will the Government consider a limited override provision in extreme cases where the risk is immediate, catastrophic and the capacity assessment is finely balanced? We will see more of these kinds of cases as we go forward, with more and more people living with the likes of dementia or acquired brain injuries.
If the Government do not support the amendment as drafted, might they consider refining the code of practice to provide clear guidance on how capacity, autonomy and right to self are waived? The amendment presents a thoughtful and principled intervention. It is not perfect in my eyes, but it challenges us, rightly, to consider whether our mental health laws strike the right balance between protection and personal freedom.
Amendment 53, like its partner on section 2, reflects a growing consensus that the law should better respect the autonomy of people with mental health conditions, especially when they have the capacity to make informed decisions. In introducing a necessary distinction, if someone can truly understand the consequences of refusing treatment and they pose no risk to others, should the state override their decision on their own behalf? The amendment would add a capacity-based distinction into section 3, mirroring the earlier amendment on section 2. Specifically, if a patient lacks capacity to consent to a medical treatment, they may be detained if there is risk of serious harm to themselves or others. If a person has capacity, they may be detained only if there is risk to others. In short, if a person is mentally unwell but understands the consequences of refusing treatment in this case and only poses a risk to themselves, they would not be eligible for detention under this amendment.
Imagine a woman with anorexia nervosa who is dangerously underweight, has a good understanding of her condition and the risk, and refuses in-patient treatment. Under the Bill as it stands she can be detained, but under the amendment if she is judged to have capacity and only poses a risk to herself, she could not be detained under section 3. Therefore, there are huge and far-reaching consequences to the amendment. The wider science is moving towards capacity, but it needs to answer some of these questions. Some are even being grappled with now—take the Terminally Ill Adults (End of Life) Bill. This truly cuts to the heart of humanity and I am sure there are varying views not only across the Committee, but across society. Similar questions will arise when it comes to capacity.
To that end, the question posed is not simple. In some cases, such as severe anorexia or chronic suicidal tendencies, capacity may be technically present but clinically contested. The stakes could not be higher. The amendment challenges us, and therefore the Government—and rightly so—to ask: are we doing enough to balance liberty and care? Do we have the right clinical tools, legal thresholds and ethical safeguards in place?
New clause 24 is on a different but related subject. This Back-Bench amendment relates to the application for admission in respect of patients who are already on hospital grounds but have not yet been formally admitted. This is really important, because it comes down to the ability. As my hon. Friend the Member for Solihull West and Shirley said, when it comes to the mechanism this is the day-to-day reality. Someone, just because they turn up in A&E, is not under the care of A&E per se until they are admitted. That is when the clinicians will take control. If they just give their name, at what point do we have that grey area? That is the matter of contention in day-to-day working.
Currently, under section 5(1) of the Mental Health Act, applications for detention or admission can be made only in relation to patients who are already admitted to hospital—that is the key part. This leaves a grey area for people who come to hospital voluntarily, perhaps by walking into A&E and seeking help or being brought by an ambulance or the police, but have not yet been formally admitted. The amendment would explicitly allow applications for admission to be made as soon as someone attends or is brought into hospital to seek help, even before formal admission.
Gregory Stafford
I rise to speak to amendments 52 and 53, tabled by my hon. Friend the Member for Runnymede and Weybridge and moved by my hon. Friend the Member for Solihull West and Shirley. Clearly, both my hon. Friends have significant clinical experience, and I bow in many ways to their expertise. However, the amendments cause me some concerns.
Amendments 52 and 53
“would add to the grounds for admission to hospital for assessment or treatment that the patient must lack the capacity to consent to that admission, if they would not be detained due to being a risk to others.”
Clearly, both amendments would introduce a capacity-based distinction in the grounds for detaining a person for medical treatment under the Mental Health Act, as my hon. Friend the Member for Hinckley and Bosworth mentioned. That would ensure that, for patients who lack capacity or competence, detention is justified if serious harm may be caused to themselves or others unless they receive that treatment. For patients who have capacity or competence, detention is justified only if serious harm may be caused to others unless they received that treatment.
The amendments build on the principle of autonomous individuals, which we have talked about and which, as my hon. Friend said, is in the Bill. People should not be detained solely for their own protection if they are capable of making informed decisions about their care. As my hon. Friend said, that aligns with the Mental Capacity Act and broader human rights principles, aiming to ensure that detention is used proportionately and, most importantly, ethically.
Where the two amendments improve the current legislation is around the strengthening of patient autonomy by limiting the detention of capable individuals to cases where others are at risk. The amendments align the Bill with the human rights principles and the Mental Capacity Act, and clarify a number of legal thresholds for detention, reducing ambiguity in clinical decision making. That will help clinicians to make more sensible and consistent judgments when it comes to who should or should not be detained. Obviously, the amendments promote a proportionality element in the use of coercive powers, and support the person-centred care that we want.
However, I am concerned that the amendments may increase complexity when assessing capacity in applying the correct legal tests. It will absolutely require training and guidance. Government Members have been concerned about mandatory training, and I make no apologies for hoping there would be significant training on this for clinicians when acting in this role, to ensure consistent application of these services. While I accept that the provisions clarify the legal thresholds, I think there is a potential for legal challenges if the distinction is misapplied or misunderstood, hence the need to return to my point about having the correct training. I hope the Minister is able to address some of those concerns, rather than just dismissing the amendments outright.
New clause 24 was tabled by my hon. Friend the Member for Runnymede and Weybridge and moved by my hon. Friend the Member for Solihull and West Shirley—
Gregory Stafford
I am doing my best—I will get it right by week three, I promise.
New clause 24 would allow people who have attended or been brought to hospital to seek help or admission as a patient to pursue an application for admission under the Mental Health Act. As other Members have mentioned, section 5(1) of the Mental Health Act allows for the detention of individuals who are already in-patients. However, there has been ambiguity about whether that applies to individuals who are on hospital grounds but not yet formally admitted; for example, those who arrive voluntarily or are being brought in during a crisis. New clause 24 seeks to close that gap by explicitly allowing applications for detention to be made in such circumstances, ensuring that a timely intervention can occur when necessary for safety or treatment, according to my hon. Friends the Members for Solihull West and Shirley and for Runnymede and Weybridge.
I listened carefully to my hon. Friends on the benefits of the new clause, and I accept some of them. However, I have some concerns about deterring people from turning up to a hospital setting, either for some other treatment or to visit friends or relations. I am worried that people would be concerned that they would be forcibly sectioned or detained without their consent by just turning up. There is a real risk of overreach in new clause 24. If we go back to the point about autonomy, people need to have assurance about when and where they will potentially be detained when they seek voluntary help.
The line between voluntary attendance and involuntary detention is the nub of the new clause. While I accept the arguments that have been made by my two hon. Friends, I am not thus far convinced that the balance in the clause is correct, but I am hopeful that the Minister can give some clarity.
Anna Dixon
I have a great deal of respect for the hon. Member for Runnymede and Weybridge. I have worked with him on some aspects of the Terminally Ill Adults (End of Life) Bill; he brings great expertise as a psychiatrist, and an understanding of the Mental Capacity Act that is perhaps greater than mine and that of some Members of the Opposition. However, even though I respect the hon. Member for Runnymede and Weybridge, does the hon. Member for Farnham and Bordon recognise that we need to ensure compatibility between the Mental Capacity Act and the Bill before us? I hope the Minister will be able to assure us that the legal checks have been done and that the proposals before us are compatible. Given that pre-legislative scrutiny was carried out under the previous Government, I am sure that process fully got to the bottom of these issues, and I therefore hope that we can move on.
Gregory Stafford
Just in case my hon. Friend the Member for Runnymede and Weybridge is not following this Bill in Hansard, I will pass on the hon. Lady’s compliments to him. Like her, I have great respect for him; I am not trying to denigrate his great work on the amendments and the new clause. All I am suggesting is that, from a layperson’s perspective, there are some elements that need tightening up, if not changing altogether. I take the hon. Lady’s point about pre-legislative scrutiny, but obviously these amendments and the new clause were not part of that because they have only just been tabled. I therefore think it is entirely appropriate to be debating them now.
Dr Evans
I have spoken to my hon. Friend the Member for Runnymede and Weybridge and looked into this issue a bit further. Psychiatry is already looking towards future capacity and trying to bring the two pieces of legislation together. I believe that Scotland has already moved in that direction. We are therefore into the cycle of chasing legislation for something behind us. I appreciate the concerns, but that is why the Government need to be alive to these situations. At the end of the day, the nub of the issue is patients getting caught up between capacity and safety under the Mental Health Act. Does my hon. Friend agree?
Gregory Stafford
I thank my hon. Friend for his extraordinarily helpful intervention. I was not aware of the changes, and I certainly had not heard of fusion before, or about what is going on in Scotland. Of course, if the new clause had already been enacted in another part of the United Kingdom in some form, I would be much more comfortable with it. But, as I said in relation amendments 52 and 53, if the new clause is to pass in its current form in this Bill or in some future form in another Bill, there has to be a focus on proper training and guidance. Because there is potentially such a legal quagmire, we must ensure that people understand the legal framework within which they can do this.
Stephen Kinnock
Once again, I am grateful to the hon. Member for Solihull West and Shirley for moving the amendments and the new clause on behalf of the hon. Member for Runnymede and Weybridge.
I will first speak to amendments 52 and 53. The new detention criteria explicitly require decision makers to consider the risk of serious harm and the likelihood of harms occurring in order to justify detention. It is right that clinicians have the power to intervene when a patient is at risk of seriously harming themselves, both when they do and when do not have mental capacity.
If we were to accept the amendments and the new clause, we think that patients would be left without the protections that the Mental Health Act provides. For example, let us consider a patient with a serious eating disorder who is assessed as having capacity but is refusing treatment. If there were no longer an option to detain that patient under the Mental Health Act, that could leave clinicians and families without a route for treatment, potentially leading to tragic results.
The pre-legislative scrutiny Committee highlighted concerns about cases where the concept of capacity had been used to justify denying individuals care that they had sought voluntarily, particularly in relation to very ill and potentially suicidal patients. That goes against the spirit of the Mental Health Act and could fall short of professional standards.
Patient choice is, of course, critical, and the changes that we are making recognise that when patients have a say in their treatment, they are more likely to engage. We also think that it is right that when those decisions put people at risk of serious harm, including risk to their own life, there is a duty to intervene.
We recognise that detaining and treating patients with capacity without their consent is a very serious step to take. However, we think that it is right that we intervene when someone is a risk to themselves, not just to other people. That is in line with the Government’s commitment to delivering a cross-sector suicide prevention strategy for England. We should deprive somebody of their liberty and detain them only as a last resort. The threshold of serious harm in the new criteria reflects the gravity of that decision.
Mental Health Bill [ Lords ] (First sitting)
Gregory Stafford Excerpts(1 year, 5 months ago)
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Stephen Kinnock
There were a number of technical and drafting issues. The Public Bill Office ruled that the amendment, as drafted, was out of scope. One of the key concerns was about the unintended consequences of the relationship between physical disability and mental disorder. The drafting of the amendment could have caused confusion, because it could have started to bring physical disability into the scope of the Bill, which is clearly not what it is about. There were a number of technical and drafting issues, but I do not think that they are insurmountable. We can get to where we need to be, just not through a legislative vehicle.
Gregory Stafford (Farnham and Bordon) (Con)
I support the comments of the Minister and the hon. Member for Winchester on the issue. On a cross-party basis, I know that my right hon. Friend the Member for Godalming and Ash (Sir Jeremy Hunt) has taken a close interest. Could he also be included in those discussions?
Stephen Kinnock
Yes, absolutely. We had a very constructive meeting with the right hon. Member for Godalming and Ash, along with the hon. Member for Dorking and Horley, and we are certainly open to working with that team of people, who are clearly focused on getting the results that we all want to see.
Clause 1 will make it a statutory requirement for the Secretary of State to include, in the statement of principles in the Mental Health Act code of practice, the wording of the four principles identified by the independent review. Those principles are choice and autonomy, least restriction, therapeutic benefit and the person as an individual. This will ensure that the review’s principles underpin the implementation of the Mental Health Act 1983 and are considered when making decisions related to care, support or the treatment provided to patients under the Act.
Embedding the principles in day-to-day practice will help to drive the culture change envisaged by the independent review. We are including the principles in the Act so that they govern the content of the code of practice and can changed only by Parliament. The Government are firmly supportive of the four principles, which were co-designed with service users during the independent review. They have informed every decision made in developing the Bill. We have embedded the principles in measures throughout the Bill, such as via the inclusion of therapeutic benefit in the detention criteria and several measures to improve patient choice and autonomy, including new treatment safeguards, introducing advance choice documents and the right to choose a nominated person.
I turn to clause 2. The code of practice for Wales already includes a statement of principles, although it is not a statutory requirement under section 118 of the Mental Health Act 1983 for Welsh Ministers to do so. Clause 2 will amend section 118 to extend subsection (2A) to Wales, along with the new subsection (2B) inserted by clause 1. To do so, clause 2 will also make amendments elsewhere in section 118 to clarify the application of each subsection, which will be to the Secretary of State in relation to England, to Welsh Ministers in relation to Wales, by virtue of the transfer of devolved functions, or to both.
The extent of the Mental Health Act is England and Wales, and there are separate codes of practice for England and Wales. Both codes of practice currently include a statement of principles, although the principles themselves vary slightly. Clause 2 will place a statutory requirement on Welsh Ministers to include the wording of the four principles identified by the independent review in the statement of principles when preparing the Mental Health Act code of practice for Wales.
As in clause 1, we are putting these principles explicitly in the Act so that they govern the content of the code of practice and so that they cannot be changed except by Parliament, or by the Senedd in respect of Wales. The Welsh code is already required to undergo scrutiny by Senedd Cymru, but clause 2 will also update the position in relation to the Senedd Cymru scrutiny procedure for the Welsh code. I commend clauses 1 and 2 to the Committee.
Stephen Kinnock
It is absolutely a team effort. Sadly, when people have severe and acute mental health disorders, a multi-agency effort is often required to support them and to help them to get the treatment they need. The process should not be about trying to isolate people. We are keen to ensure that people stay in mainstream society and remain as integrated as possible, because that is often an important part of supporting their mental health condition.
All of that means that local authorities, mental health professionals, social workers, and often children’s social care professionals or adult social care professionals are important in the process—it requires a team effort. That integrated approach will be really important as we build the community services that we want to see.
Gregory Stafford
On the point made by the hon. Member for Ashford about local authorities, given that the Government are devolving and reorganising local government structures across parts of the country, how will the Minister ensure that the standards around this issue—and other health and social care issues—are maintained? That restructuring means that we will have a whole load of new local authorities that do not necessarily have experience of dealing with this area.
Stephen Kinnock
The devolution Bill and the process of reorganising and restructuring are based on two really strong principles: that it is up to us through legislation to create the outcomes that we need to see delivered across the country and that there are clear standards and targets that we need to see met. But the implementation work needs to be done to deliver those desired outcomes and targets. Local authorities are empowered to do that, which is why we are seeing, for example, a lot of breaking down of ringfencing. The Government are keen to massively reduce the amount of ringfencing, because that has become a straitjacket for local authorities, integrated care boards and others in how they can best manage their portfolio of activities and deliver that devolved power and responsibility.
The answer to the hon. Gentleman’s question is that we want to devolve. We are absolutely committed to decentralising and we believe that is an important part of modern governance. Of course, that has to be done within a framework of set targets and the development of community services that the Bill commits to. All of that will come together to enable those at the coalface, who are best placed to understand them, how to deliver those services to their communities.
Zöe Franklin (Guildford) (LD)
I rise to speak to amendments 2 and 5, which, in summary, would ensure that patients, named persons and independent mental health advocates would receive a copy of a care, education and treatment review meeting report for children and young people with autism or a learning disability.
Patients, along with all those tasked with helping to represent their wishes, should be able to see transparently what has been judged to be safe and appropriate care for them. Being given the opportunity to understand why their care or treatment is changing or remaining the same should be a basic right for patients, yet as it stands they are often frozen out of seeing that final report. Similarly, the nominated person, whether that is a friend, a mother, a sibling, or another parent, often has care of the patient; they know the whole person better than any NHS institution, and will often have a far fuller understanding of the patient’s history.
Gregory Stafford
I have a lot of sympathy with what the hon. Lady is trying to achieve with these amendments. My question is about how she would ensure, within the context of the provisions, that the patient’s confidentiality would be maintained where it needed to be.
Zöe Franklin
The hon. Member raises an interesting and pertinent point. There will always need to be balance when addressing the issues around patient confidentiality. I have seen from my own casework that when families who have been through mental health crises with their loved ones have not been involved in that process, unfortunately the crisis has lasted much longer and been more significant because those around them have been unable to support the individual. I do not have the answer, but we need to work collectively to find a way to strike that balance in order to address the needs of the patient.
Gregory Stafford
Moving on from the confidentiality point, if there is going to be sharing—again, I have a lot of sympathy with the amendments—how would the hon. Lady ensure that disagreements between family members and the patient are safeguarded against?
Zöe Franklin
That presents challenges, but again, I would refer back to my own casework, and I am sure there are Members on the Committee who will have had the same experience. There are examples across the UK where health boards and providers find ways to appropriately share information with families and other carers to get the best outcomes for patients. I simply ask that, when the Minister and colleagues in this space have those examples, they share them. I know that there are some areas where this is already done effectively, particularly in Scotland, and I seek to reference those examples.
My final point on amendments 2 and 5 is that we need to ensure that those around a patient are given the opportunity to raise concern or the alarm when part of the report does not meet the patient’s needs. We need to address the patient’s full needs, and to ensure that they are both reflected in the reports and met.
Dr Evans
I rise to speak to Liberal Democrat amendments 1 to 7 and 51 to clause 4. I welcome the intention behind the amendments, which aim to enhance the care and treatment review process for people with autism and learning disabilities, particularly by addressing housing and accommodation needs and ensuring that key advocates receive reports.
There are positive elements of the amendments that are worth highlighting. I understand the good intent of including housing and accommodation considerations explicitly in reviews, as it recognises that a person’s living situation is often central to their wellbeing and recovery. Additionally, ensuring that nominated persons and independent mental health advocates receive reports promptly promotes transparency and patient advocacy. Shortening the review intervals from 12 to six months could lead to more responsive care planning.
However, I have some significant reservations about the statutory implications of blurring housing, for example, so directly with the care and treatment review process. Housing is traditionally managed under separate statutory frameworks from health and social care, so to embed housing as a statutory element within these reviews risks creating confusion about which agency holds responsibility and may expose health bodies or commissioners to legal obligations that they are neither funded nor structured for.
I have a few questions for the Liberal Democrats. In their eyes, how would the Government ensure clarity over the statutory duties applied to housing recommendations arising from the reviews? Would that not risk delaying or complicating discharges if housing issues became a statutory sticking point within health-led care reviews? Moreover, housing provision often depends on local authorities and housing departments that have their own complex eligibility criteria and resourcing constraints. Are we confident that ICBs and responsible commissioners would be able to co-ordinate effectively across these boundaries, especially given the patchwork of funding and powers in play?
Gregory Stafford
To take that point slightly further, given that pretty much every local authority has a different set of criteria by which to determine people’s housing needs, how would, for example, an ICB that potentially crosses multiple local authorities with differing housing needs be able to understand the complexities within the current structure, and ensure that the patient is served best?
Gregory Stafford
It is a pleasure to serve under your chairmanship, Mr Vickers. As I have indicated, I have a lot of sympathy with the amendments, but some practical constraints need to be teased out.
Amendment 1 seeks to ensure that housing needs are explicitly considered during a care, education and treatment review meeting. I can see the pros of that. Clearly, a holistic approach recognises that stable housing is fundamental to mental health and recovery, especially for vulnerable individuals. Addressing housing barriers may reduce unnecessary hospital admissions. Likewise, it could lead to improved discharge planning, ensuring that patients are not delayed in hospital due to a lack of suitable accommodation. All Governments, of every colour and political party, want to see collaboration between health, social care and housing services, and the amendment brings those things together.
As I said in an intervention, however, local authorities and NHS bodies such as ICBs may face challenges to co-ordinating housing assessments within the CETRs. As my hon. Friend the Member for Hinckley and Bosworth mentioned, his constituency crosses a number of local authority boundaries, while my seat of Farnham and Bordon, with two thirds of it in Surrey and one third in Hampshire, has that same issue. The county councils are wonderful and Conservative run, but Waverley is run by Liberal Democrats.
The hon. Member for Winchester, who moved the amendment, recognised the issue of implementation capacity, but there are also likely to be resource constraints. These days, local authorities spend most of their money on social care, education and the bits of health that sit within their remit, so there may be insufficient housing stock or funding to meet the identified needs that the amendment would bring forward. There are therefore practical implications.
Dr Evans
Thinking that through, how does my hon. Friend feel that existing statutory requirements to provide accommodation will balance out if we provide another statutory requirement on accommodation in these plans? Does he worry, as I do, about creating a risk, for example, of pitting someone with severe learning disabilities against a homeless person if there is resource rationing thanks to the practicalities of how many houses we have? Members throughout the House agree that we need to build more houses, but until that happens, such local authorities have the resources issue.
Gregory Stafford
I agree. Even if the Government build the number of houses that they propose—I have some scepticism—there will always be the potential conflict or disagreement on prioritisation in the housing register and list. As my hon. Friend says, that might well lead to local authorities having to change their criteria, which are not necessarily consistent across local authorities, and, as in his example, potentially pitting a homeless person against someone with mental health needs.
The amendment would also have the potential for scope creep. I have a lot of sympathy with what it is trying to achieve, but expanding CETRs to include housing might dilute their focus and overburden the process. I am interested to hear from the mover and supporters of the amendment how they would ensure that the CETR continues to have that core focus on the health and wellbeing of the individual, rather than potentially be bogged down in the mire of housing issues.
Moving on, amendment 51 would ensure that the care and treatment of individuals with autism or learning disabilities explicitly considered the impact of accommodation and relocation in the planning and decision-making process. Again, I have a lot of sympathy with that. It would promote holistic care planning, reduce trauma and disruption, support continuity of care and, I think, align with the person-centred principles throughout the Bill, which all of us support. Again, however, amendment 51 might complicate discharge planning, if suitable accommodation were limited.
Dr Shastri-Hurst
Does my hon. Friend share my concerns that not resolving housing and accommodation at the point of discharge could lead to a delay in transition? Patients would remain in hospital for longer than might be beneficial to them.
Gregory Stafford
I agree entirely. That could be the unintended consequence of amendment 51: in essence, if the housing provision is not there, discharge will be delayed. From my understanding of the amendments in the group, those who tabled them are trying to speed up and improve discharge. My hon. Friend is absolutely right that we need to think about the practical implications of the Bill.
The amendment would require co-ordination among health, social care and housing services, which may be challenging in under-resourced areas. Frankly, because parts of those organisations are not used to working in the ways that the amendment would require, it might fall over without suitable training, the necessary lead-in time and a practical understanding of how it will work.
Amendment 4 would ensure that housing needs are formally considered during the care and treatment review meetings for adults with autism or a learning disability, without an EHCP. I understand that the aim is to support more effective discharge planning and reduce the risk of unnecessary or prolonged hospital stays. That is entirely in keeping with what we should be trying to do in the Bill. Holistic care planning reduces delays in discharge, improves cross-sector collaboration and supports community-based care, which we all support.
Once again, however, there is potential for complexity in the implementation. New processes may be required to involve the housing authorities. Resources and local housing shortages could limit the amendments’ practical impact. Another layer of complex review processes could add to that administrative burden. If there is inconsistent local capacity, the effectiveness of the amendment will almost certainly vary depending on the local housing infrastructure, which could lead to a postcode lottery, for want of a better phrase, in who receives the adequate care and housing.
Amendment 2 would ensure that children and young people with autism or learning disability, as well as their nominated persons and independent mental health advocates, receive a copy of the care, education and treatment review meeting report. I have a lot of sympathy with that. It potentially increases empowerment and transparency, ensuring that patients and their advocates are fully informed, which could enable better participation in care decisions. It has a legal and ethical alignment with the principles of the Mental Capacity Act 2005 and the UN convention on the rights of persons with disabilities, both of which emphasise supported decision making. It might also improve advocacy, as independent mental health advocates can more effectively represent a patient’s interest when they have access to the full report.
Aphra Brandreth
My hon. Friend is making valuable points about the benefits of the amendment. For vulnerable individuals, family involvement is often extremely important, but does he agree that that must be balanced with ensuring that potential disagreements do not put at risk what is best for the individual?
Gregory Stafford
My hon. Friend makes a key point that I was about to address. Clearly, where there is a supportive family structure with the best interests of the individual at heart, the amendment will work extraordinarily well. However, we have to be realistic about the practical implications.
Not every patient has a strong family structure around them. Unfortunately, some patients may even have family members who, for financial or other reasons, actively do not have their best interests at heart. There is a potential concern around confidentiality. I ask the hon. Members for Winchester and for Guildford how they would balance that conflict in practical terms, especially when the CETR includes sensitive clinical information that could be used in a way that is not beneficial to the patient by someone who does not have their best interests at heart. As my hon. Friend the Member for Chester South and Eddisbury points out, disputes can happen if patients or families disagree with professional assessments or recommendations.
Finally, although this is probably not the strongest point, we should think about the administrative burden. Given the increased workload that we are putting on all our health and care workers and services, there will clearly be an administrative burden in sharing these reports.
Gregory Stafford
I knew it began with S and was somewhere that is not Surrey or Hampshire—because where else would you want to be, Mr Vickers? The amendment would potentially increase the workload, because more frequent reviews place additional pressure on professionals and services.
Dr Shastri-Hurst
Does my hon. Friend agree that there is a risk that the amendment would not only increase the workload of practitioners, but divert attention from patient care?
Gregory Stafford
My hon. Friend is entirely correct. We operate in a resource-confined area. It does not matter what the resource envelope is; it will always be confined. If we use resource to service the very laudable aims of the amendment, it will take resource and money away from another area.
Dr Evans
Would my hon. Friend speculate on a question that I hope will be answered by the hon. Member for Winchester? It is about the evidence base behind choosing six months instead of 12. GPs would do learning disability reviews every year, for example, and it is an annual thing with asthma and in similar areas. Is the hon. Member for Winchester aware of an evidence base for why it should be six months? There may not be one—often these can be arbitrary, in terms of just giving a clinical judgment—but I wonder whether there is a specific reason for choosing to reduce the period between reviews to six months.
Gregory Stafford
My hon. Friend attributes to me a level of clairvoyance that I do not possess, but I am sure that the hon. Member for Winchester or the hon. Member for Guildford will pick up that point.
The resource implications are not just about the funding. They are about increased workload and the pressure put on the professions and services. As my hon. Friend the Member for Solihull West and Shirley said, the amendment would divert attention away from delivering care, if it is not balanced properly. My hon. Friend the Member for Hinckley and Bosworth is right to ask, “Why six months?” Why not nine months, eight months or any other period? Is there a clinical basis for six months?
Jen Craft
On a small point of clarification, the six-month criteria are based on the current NHS guidance around CETRs. It is loose guidance; it is not statutory. The reason that it is six months as opposed to 12 months is that that would bring us closer in line with the guidance.
Gregory Stafford
I thank the hon. Member for her helpful intervention. If that is correct, I will draw my comments on that point to a close.
Amendment 6 concerns CETR frequency. It seeks to change the timetabling of these reviews. The same issues, both positive and negative, run through it as in amendment 3.
Amendment 7 would strengthen the legal obligation on integrated care boards and local authorities by requiring them to implement recommendations from the care, education and treatment reviews rather than merely considering them. That would ensure that review outcomes lead to concrete action and improved care. I do not think that anyone in the Committee could possibly disagree with that point. It would lead to greater accountability and would ensure that CETR recommendations are not ignored or delayed. That would clearly improve outcomes, because it would increase the likelihood that patients receive timely and appropriate care.
The amendment would also introduce stronger legal clarity. By removing “must have regard to” and replacing it with
“have a duty to carry out”,
it would remove ambiguity around the responsibilities of the ICBs and local authorities, supporting the rights-based care and the principles of transparency and enforceability in service provision that we all support.
I hope that the hon. Members for Winchester and for Guildford will be able to clarify the problem of resource pressures, which applies to all these amendments. Local authorities and ICBs may struggle to implement all the recommendations due to funding or capacity constraints. What would be the legal sanction for ICBs and local authorities if, through no “fault” of their own—although one might argue that they should have the necessary resources in place—they genuinely do not have the resources to implement all the recommendations? I would hope that such a sanction did not put them into further financial difficulty.
The reduction in flexibility concerns me. It may limit professional discretion in cases in which recommendations are impractical or outdated. It may require new systems for monitoring and enforcement, and if recommendations are not implemented it could increase the likelihood of legal challenges.
Anna Dixon
The hon. Member is going into some detail on these amendments. There is a duty where EHCPs are in place. Local authorities have had their funding cut over many years, so they have found it difficult to meet their EHCP obligations for the many children with SEND needs. Is there not a similar risk that the amendments will put duties on local authorities that they will not be able to meet unless they have sufficient resources? There must be some flexibility as well as duty on local authorities and the NHS to balance their duties and responsibilities with resources.
Gregory Stafford
I will do my best, Mr Vickers. The hon. Lady raises some good points. She made a slightly party political point, but I will forgive her because I made one earlier. Maybe that is our party politicking done for the day.
As the vice-chair of the all-party parliamentary group for SEND, I recognise the issues that the hon. Lady has raised. I would be surprised if there were any hon. Member on this Committee who did not recognise her point. Across the piece, there is a significant problem with the process and the funding of EHCPs. I look to the Minister; I know it is not his responsibility, but I understand that the Government are introducing something around EHCPs.
I will draw my comments to a close, but I ask the hon. Members for Winchester and for Guildford to address those concerns.
Mental Health Bill [ Lords ] (First sitting)
Gregory Stafford ExcerptsTuesday 10th June 2025
(1 year, 5 months ago)
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Stephen Kinnock
There were a number of technical and drafting issues. The Public Bill Office ruled that the amendment, as drafted, was out of scope. One of the key concerns was about the unintended consequences of the relationship between physical disability and mental disorder. The drafting of the amendment could have caused confusion, because it could have started to bring physical disability into the scope of the Bill, which is clearly not what it is about. There were a number of technical and drafting issues, but I do not think that they are insurmountable. We can get to where we need to be, just not through a legislative vehicle.
Gregory Stafford (Farnham and Bordon) (Con)
I support the comments of the Minister and the hon. Member for Winchester on the issue. On a cross-party basis, I know that my right hon. Friend the Member for Godalming and Ash (Sir Jeremy Hunt) has taken a close interest. Could he also be included in those discussions?
Stephen Kinnock
Yes, absolutely. We had a very constructive meeting with the right hon. Member for Godalming and Ash, along with the hon. Member for Dorking and Horley, and we are certainly open to working with that team of people, who are clearly focused on getting the results that we all want to see.
Clause 1 will make it a statutory requirement for the Secretary of State to include, in the statement of principles in the Mental Health Act code of practice, the wording of the four principles identified by the independent review. Those principles are choice and autonomy, least restriction, therapeutic benefit and the person as an individual. This will ensure that the review’s principles underpin the implementation of the Mental Health Act 1983 and are considered when making decisions related to care, support or the treatment provided to patients under the Act.
Embedding the principles in day-to-day practice will help to drive the culture change envisaged by the independent review. We are including the principles in the Act so that they govern the content of the code of practice and can changed only by Parliament. The Government are firmly supportive of the four principles, which were co-designed with service users during the independent review. They have informed every decision made in developing the Bill. We have embedded the principles in measures throughout the Bill, such as via the inclusion of therapeutic benefit in the detention criteria and several measures to improve patient choice and autonomy, including new treatment safeguards, introducing advance choice documents and the right to choose a nominated person.
I turn to clause 2. The code of practice for Wales already includes a statement of principles, although it is not a statutory requirement under section 118 of the Mental Health Act 1983 for Welsh Ministers to do so. Clause 2 will amend section 118 to extend subsection (2A) to Wales, along with the new subsection (2B) inserted by clause 1. To do so, clause 2 will also make amendments elsewhere in section 118 to clarify the application of each subsection, which will be to the Secretary of State in relation to England, to Welsh Ministers in relation to Wales, by virtue of the transfer of devolved functions, or to both.
The extent of the Mental Health Act is England and Wales, and there are separate codes of practice for England and Wales. Both codes of practice currently include a statement of principles, although the principles themselves vary slightly. Clause 2 will place a statutory requirement on Welsh Ministers to include the wording of the four principles identified by the independent review in the statement of principles when preparing the Mental Health Act code of practice for Wales.
As in clause 1, we are putting these principles explicitly in the Act so that they govern the content of the code of practice and so that they cannot be changed except by Parliament, or by the Senedd in respect of Wales. The Welsh code is already required to undergo scrutiny by Senedd Cymru, but clause 2 will also update the position in relation to the Senedd Cymru scrutiny procedure for the Welsh code. I commend clauses 1 and 2 to the Committee.
Stephen Kinnock
It is absolutely a team effort. Sadly, when people have severe and acute mental health disorders, a multi-agency effort is often required to support them and to help them to get the treatment they need. The process should not be about trying to isolate people. We are keen to ensure that people stay in mainstream society and remain as integrated as possible, because that is often an important part of supporting their mental health condition.
All of that means that local authorities, mental health professionals, social workers, and often children’s social care professionals or adult social care professionals are important in the process—it requires a team effort. That integrated approach will be really important as we build the community services that we want to see.
Gregory Stafford
On the point made by the hon. Member for Ashford about local authorities, given that the Government are devolving and reorganising local government structures across parts of the country, how will the Minister ensure that the standards around this issue—and other health and social care issues—are maintained? That restructuring means that we will have a whole load of new local authorities that do not necessarily have experience of dealing with this area.
Stephen Kinnock
The devolution Bill and the process of reorganising and restructuring are based on two really strong principles: that it is up to us through legislation to create the outcomes that we need to see delivered across the country and that there are clear standards and targets that we need to see met. But the implementation work needs to be done to deliver those desired outcomes and targets. Local authorities are empowered to do that, which is why we are seeing, for example, a lot of breaking down of ringfencing. The Government are keen to massively reduce the amount of ringfencing, because that has become a straitjacket for local authorities, integrated care boards and others in how they can best manage their portfolio of activities and deliver that devolved power and responsibility.
The answer to the hon. Gentleman’s question is that we want to devolve. We are absolutely committed to decentralising and we believe that is an important part of modern governance. Of course, that has to be done within a framework of set targets and the development of community services that the Bill commits to. All of that will come together to enable those at the coalface, who are best placed to understand them, how to deliver those services to their communities.
Zöe Franklin (Guildford) (LD)
I rise to speak to amendments 2 and 5, which, in summary, would ensure that patients, named persons and independent mental health advocates would receive a copy of a care, education and treatment review meeting report for children and young people with autism or a learning disability.
Patients, along with all those tasked with helping to represent their wishes, should be able to see transparently what has been judged to be safe and appropriate care for them. Being given the opportunity to understand why their care or treatment is changing or remaining the same should be a basic right for patients, yet as it stands they are often frozen out of seeing that final report. Similarly, the nominated person, whether that is a friend, a mother, a sibling, or another parent, often has care of the patient; they know the whole person better than any NHS institution, and will often have a far fuller understanding of the patient’s history.
Gregory Stafford
I have a lot of sympathy with what the hon. Lady is trying to achieve with these amendments. My question is about how she would ensure, within the context of the provisions, that the patient’s confidentiality would be maintained where it needed to be.
Zöe Franklin
The hon. Member raises an interesting and pertinent point. There will always need to be balance when addressing the issues around patient confidentiality. I have seen from my own casework that when families who have been through mental health crises with their loved ones have not been involved in that process, unfortunately the crisis has lasted much longer and been more significant because those around them have been unable to support the individual. I do not have the answer, but we need to work collectively to find a way to strike that balance in order to address the needs of the patient.
Gregory Stafford
Moving on from the confidentiality point, if there is going to be sharing—again, I have a lot of sympathy with the amendments—how would the hon. Lady ensure that disagreements between family members and the patient are safeguarded against?
Zöe Franklin
That presents challenges, but again, I would refer back to my own casework, and I am sure there are Members on the Committee who will have had the same experience. There are examples across the UK where health boards and providers find ways to appropriately share information with families and other carers to get the best outcomes for patients. I simply ask that, when the Minister and colleagues in this space have those examples, they share them. I know that there are some areas where this is already done effectively, particularly in Scotland, and I seek to reference those examples.
My final point on amendments 2 and 5 is that we need to ensure that those around a patient are given the opportunity to raise concern or the alarm when part of the report does not meet the patient’s needs. We need to address the patient’s full needs, and to ensure that they are both reflected in the reports and met.
Dr Evans
I rise to speak to Liberal Democrat amendments 1 to 7 and 51 to clause 4. I welcome the intention behind the amendments, which aim to enhance the care and treatment review process for people with autism and learning disabilities, particularly by addressing housing and accommodation needs and ensuring that key advocates receive reports.
There are positive elements of the amendments that are worth highlighting. I understand the good intent of including housing and accommodation considerations explicitly in reviews, as it recognises that a person’s living situation is often central to their wellbeing and recovery. Additionally, ensuring that nominated persons and independent mental health advocates receive reports promptly promotes transparency and patient advocacy. Shortening the review intervals from 12 to six months could lead to more responsive care planning.
However, I have some significant reservations about the statutory implications of blurring housing, for example, so directly with the care and treatment review process. Housing is traditionally managed under separate statutory frameworks from health and social care, so to embed housing as a statutory element within these reviews risks creating confusion about which agency holds responsibility and may expose health bodies or commissioners to legal obligations that they are neither funded nor structured for.
I have a few questions for the Liberal Democrats. In their eyes, how would the Government ensure clarity over the statutory duties applied to housing recommendations arising from the reviews? Would that not risk delaying or complicating discharges if housing issues became a statutory sticking point within health-led care reviews? Moreover, housing provision often depends on local authorities and housing departments that have their own complex eligibility criteria and resourcing constraints. Are we confident that ICBs and responsible commissioners would be able to co-ordinate effectively across these boundaries, especially given the patchwork of funding and powers in play?
Gregory Stafford
To take that point slightly further, given that pretty much every local authority has a different set of criteria by which to determine people’s housing needs, how would, for example, an ICB that potentially crosses multiple local authorities with differing housing needs be able to understand the complexities within the current structure, and ensure that the patient is served best?
Gregory Stafford
It is a pleasure to serve under your chairmanship, Mr Vickers. As I have indicated, I have a lot of sympathy with the amendments, but some practical constraints need to be teased out.
Amendment 1 seeks to ensure that housing needs are explicitly considered during a care, education and treatment review meeting. I can see the pros of that. Clearly, a holistic approach recognises that stable housing is fundamental to mental health and recovery, especially for vulnerable individuals. Addressing housing barriers may reduce unnecessary hospital admissions. Likewise, it could lead to improved discharge planning, ensuring that patients are not delayed in hospital due to a lack of suitable accommodation. All Governments, of every colour and political party, want to see collaboration between health, social care and housing services, and the amendment brings those things together.
As I said in an intervention, however, local authorities and NHS bodies such as ICBs may face challenges to co-ordinating housing assessments within the CETRs. As my hon. Friend the Member for Hinckley and Bosworth mentioned, his constituency crosses a number of local authority boundaries, while my seat of Farnham and Bordon, with two thirds of it in Surrey and one third in Hampshire, has that same issue. The county councils are wonderful and Conservative run, but Waverley is run by Liberal Democrats.
The hon. Member for Winchester, who moved the amendment, recognised the issue of implementation capacity, but there are also likely to be resource constraints. These days, local authorities spend most of their money on social care, education and the bits of health that sit within their remit, so there may be insufficient housing stock or funding to meet the identified needs that the amendment would bring forward. There are therefore practical implications.
Dr Evans
Thinking that through, how does my hon. Friend feel that existing statutory requirements to provide accommodation will balance out if we provide another statutory requirement on accommodation in these plans? Does he worry, as I do, about creating a risk, for example, of pitting someone with severe learning disabilities against a homeless person if there is resource rationing thanks to the practicalities of how many houses we have? Members throughout the House agree that we need to build more houses, but until that happens, such local authorities have the resources issue.
Gregory Stafford
I agree. Even if the Government build the number of houses that they propose—I have some scepticism—there will always be the potential conflict or disagreement on prioritisation in the housing register and list. As my hon. Friend says, that might well lead to local authorities having to change their criteria, which are not necessarily consistent across local authorities, and, as in his example, potentially pitting a homeless person against someone with mental health needs.
The amendment would also have the potential for scope creep. I have a lot of sympathy with what it is trying to achieve, but expanding CETRs to include housing might dilute their focus and overburden the process. I am interested to hear from the mover and supporters of the amendment how they would ensure that the CETR continues to have that core focus on the health and wellbeing of the individual, rather than potentially be bogged down in the mire of housing issues.
Moving on, amendment 51 would ensure that the care and treatment of individuals with autism or learning disabilities explicitly considered the impact of accommodation and relocation in the planning and decision-making process. Again, I have a lot of sympathy with that. It would promote holistic care planning, reduce trauma and disruption, support continuity of care and, I think, align with the person-centred principles throughout the Bill, which all of us support. Again, however, amendment 51 might complicate discharge planning, if suitable accommodation were limited.
Dr Shastri-Hurst
Does my hon. Friend share my concerns that not resolving housing and accommodation at the point of discharge could lead to a delay in transition? Patients would remain in hospital for longer than might be beneficial to them.
Gregory Stafford
I agree entirely. That could be the unintended consequence of amendment 51: in essence, if the housing provision is not there, discharge will be delayed. From my understanding of the amendments in the group, those who tabled them are trying to speed up and improve discharge. My hon. Friend is absolutely right that we need to think about the practical implications of the Bill.
The amendment would require co-ordination among health, social care and housing services, which may be challenging in under-resourced areas. Frankly, because parts of those organisations are not used to working in the ways that the amendment would require, it might fall over without suitable training, the necessary lead-in time and a practical understanding of how it will work.
Amendment 4 would ensure that housing needs are formally considered during the care and treatment review meetings for adults with autism or a learning disability, without an EHCP. I understand that the aim is to support more effective discharge planning and reduce the risk of unnecessary or prolonged hospital stays. That is entirely in keeping with what we should be trying to do in the Bill. Holistic care planning reduces delays in discharge, improves cross-sector collaboration and supports community-based care, which we all support.
Once again, however, there is potential for complexity in the implementation. New processes may be required to involve the housing authorities. Resources and local housing shortages could limit the amendments’ practical impact. Another layer of complex review processes could add to that administrative burden. If there is inconsistent local capacity, the effectiveness of the amendment will almost certainly vary depending on the local housing infrastructure, which could lead to a postcode lottery, for want of a better phrase, in who receives the adequate care and housing.
Amendment 2 would ensure that children and young people with autism or learning disability, as well as their nominated persons and independent mental health advocates, receive a copy of the care, education and treatment review meeting report. I have a lot of sympathy with that. It potentially increases empowerment and transparency, ensuring that patients and their advocates are fully informed, which could enable better participation in care decisions. It has a legal and ethical alignment with the principles of the Mental Capacity Act 2005 and the UN convention on the rights of persons with disabilities, both of which emphasise supported decision making. It might also improve advocacy, as independent mental health advocates can more effectively represent a patient’s interest when they have access to the full report.
Aphra Brandreth
My hon. Friend is making valuable points about the benefits of the amendment. For vulnerable individuals, family involvement is often extremely important, but does he agree that that must be balanced with ensuring that potential disagreements do not put at risk what is best for the individual?
Gregory Stafford
My hon. Friend makes a key point that I was about to address. Clearly, where there is a supportive family structure with the best interests of the individual at heart, the amendment will work extraordinarily well. However, we have to be realistic about the practical implications.
Not every patient has a strong family structure around them. Unfortunately, some patients may even have family members who, for financial or other reasons, actively do not have their best interests at heart. There is a potential concern around confidentiality. I ask the hon. Members for Winchester and for Guildford how they would balance that conflict in practical terms, especially when the CETR includes sensitive clinical information that could be used in a way that is not beneficial to the patient by someone who does not have their best interests at heart. As my hon. Friend the Member for Chester South and Eddisbury points out, disputes can happen if patients or families disagree with professional assessments or recommendations.
Finally, although this is probably not the strongest point, we should think about the administrative burden. Given the increased workload that we are putting on all our health and care workers and services, there will clearly be an administrative burden in sharing these reports.
Gregory Stafford
I knew it began with S and was somewhere that is not Surrey or Hampshire—because where else would you want to be, Mr Vickers? The amendment would potentially increase the workload, because more frequent reviews place additional pressure on professionals and services.
Dr Shastri-Hurst
Does my hon. Friend agree that there is a risk that the amendment would not only increase the workload of practitioners, but divert attention from patient care?
Gregory Stafford
My hon. Friend is entirely correct. We operate in a resource-confined area. It does not matter what the resource envelope is; it will always be confined. If we use resource to service the very laudable aims of the amendment, it will take resource and money away from another area.
Dr Evans
Would my hon. Friend speculate on a question that I hope will be answered by the hon. Member for Winchester? It is about the evidence base behind choosing six months instead of 12. GPs would do learning disability reviews every year, for example, and it is an annual thing with asthma and in similar areas. Is the hon. Member for Winchester aware of an evidence base for why it should be six months? There may not be one—often these can be arbitrary, in terms of just giving a clinical judgment—but I wonder whether there is a specific reason for choosing to reduce the period between reviews to six months.
Gregory Stafford
My hon. Friend attributes to me a level of clairvoyance that I do not possess, but I am sure that the hon. Member for Winchester or the hon. Member for Guildford will pick up that point.
The resource implications are not just about the funding. They are about increased workload and the pressure put on the professions and services. As my hon. Friend the Member for Solihull West and Shirley said, the amendment would divert attention away from delivering care, if it is not balanced properly. My hon. Friend the Member for Hinckley and Bosworth is right to ask, “Why six months?” Why not nine months, eight months or any other period? Is there a clinical basis for six months?
Jen Craft
On a small point of clarification, the six-month criteria are based on the current NHS guidance around CETRs. It is loose guidance; it is not statutory. The reason that it is six months as opposed to 12 months is that that would bring us closer in line with the guidance.
Gregory Stafford
I thank the hon. Member for her helpful intervention. If that is correct, I will draw my comments on that point to a close.
Amendment 6 concerns CETR frequency. It seeks to change the timetabling of these reviews. The same issues, both positive and negative, run through it as in amendment 3.
Amendment 7 would strengthen the legal obligation on integrated care boards and local authorities by requiring them to implement recommendations from the care, education and treatment reviews rather than merely considering them. That would ensure that review outcomes lead to concrete action and improved care. I do not think that anyone in the Committee could possibly disagree with that point. It would lead to greater accountability and would ensure that CETR recommendations are not ignored or delayed. That would clearly improve outcomes, because it would increase the likelihood that patients receive timely and appropriate care.
The amendment would also introduce stronger legal clarity. By removing “must have regard to” and replacing it with
“have a duty to carry out”,
it would remove ambiguity around the responsibilities of the ICBs and local authorities, supporting the rights-based care and the principles of transparency and enforceability in service provision that we all support.
I hope that the hon. Members for Winchester and for Guildford will be able to clarify the problem of resource pressures, which applies to all these amendments. Local authorities and ICBs may struggle to implement all the recommendations due to funding or capacity constraints. What would be the legal sanction for ICBs and local authorities if, through no “fault” of their own—although one might argue that they should have the necessary resources in place—they genuinely do not have the resources to implement all the recommendations? I would hope that such a sanction did not put them into further financial difficulty.
The reduction in flexibility concerns me. It may limit professional discretion in cases in which recommendations are impractical or outdated. It may require new systems for monitoring and enforcement, and if recommendations are not implemented it could increase the likelihood of legal challenges.
Anna Dixon
The hon. Member is going into some detail on these amendments. There is a duty where EHCPs are in place. Local authorities have had their funding cut over many years, so they have found it difficult to meet their EHCP obligations for the many children with SEND needs. Is there not a similar risk that the amendments will put duties on local authorities that they will not be able to meet unless they have sufficient resources? There must be some flexibility as well as duty on local authorities and the NHS to balance their duties and responsibilities with resources.
Gregory Stafford
I will do my best, Mr Vickers. The hon. Lady raises some good points. She made a slightly party political point, but I will forgive her because I made one earlier. Maybe that is our party politicking done for the day.
As the vice-chair of the all-party parliamentary group for SEND, I recognise the issues that the hon. Lady has raised. I would be surprised if there were any hon. Member on this Committee who did not recognise her point. Across the piece, there is a significant problem with the process and the funding of EHCPs. I look to the Minister; I know it is not his responsibility, but I understand that the Government are introducing something around EHCPs.
I will draw my comments to a close, but I ask the hon. Members for Winchester and for Guildford to address those concerns.
Dementia Care
Gregory Stafford Excerpts(1 year, 5 months ago)
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Freddie van Mierlo (Henley and Thame) (LD)
I congratulate my hon. Friend the Member for South Devon (Caroline Voaden) on securing this very important debate. There is hardly a healthcare issue so big that we do not talk enough about as dementia. Perhaps that is because it is one of the most feared diseases, for understandable reasons.
For decade upon decade—unlike cancer, for example—there has been very little tangible scientific progress, until recently. As the chair of the all-party parliamentary group on access to medicines and medical devices, I will focus my remarks on those treatments. Breakthroughs are coming through thick and fast, with the UK’s Medicines and Healthcare products Regulatory Agency approving two disease-modifying therapies in 2024 for Alzheimer’s. Those medicines chart a path to a time when Alzheimer’s and other forms of dementia are a treatable condition that can be delayed to the point where it is, for all intents and purposes, cured. That is incredibly exciting for families such as mine with a history of Alzheimer’s, and more is on the way.
More than 100 medicines are being investigated, so it is a matter of not if, but when new medicines come forward, yet the UK is not ready. The alarm has been raised, but no one is listening. The last Government were asleep at the wheel, and I fear that this Government are too. Moving from a system focused entirely on care to prevention and treatment will require a monumental shift in thinking that breaks down departmental silos and redistributes budget to treatment. We know that reversing brain damage is nigh impossible, but preventing it is not. That is why early detection and diagnosis are so critical.
Dementia begins without symptoms as early as people’s 40s or 50s. We need to identify those people before the onset of decline, but that requires a system with sufficient diagnostic capacity. That means improved GP waiting times, increased capacity at memory clinics and a massive increase in magnetic resonance imaging, positron emission tomography and lumbar puncture test capacity. The lack of capital investment in our NHS has left us dangerously exposed, with the lowest number of MRI scanners per capita in the OECD. The UK has 6.1 systems per million people. In Germany, the rate is 30.5. Emerging diagnostics, including the blood biomarkers being investigated at the Warneford in Oxfordshire, need to be embraced alongside getting the basics right.
The Government must also look actively at how the National Institute for Health and Care Excellence assesses new medicines in dementia. Both lecanemab and donanemab were approved by the MHRA and then rejected by NICE on the same day. That means the MHRA believes these medicines are safe and effective, but NICE believes them too expensive for the NHS, because it fails to consider the economic and social benefits, including savings to informal care.
Do we want a system where those who can pay privately for medicines that delay dementia get treatment, and those who cannot, do not? Even when a new therapy is approved by the MHRA, given the green light by NICE and by some miracle we have diagnostic capacity, patients still may not get their hands on it. Depending on how a new medicine is delivered, we may not have enough infusion capacity. If it is a pill, we will be in luck, but we cannot bank on that. The truth is that the NHS cannot cope with the innovation we all want in dementia. My message to the Government is simple: get ready.
I hope the Minister for Care will take note of one final point: please stop punting problems down to the ICBs. My recent written parliamentary question, asking what steps the Government are taking to increase the number of Alzheimer’s disease specialists, was answered by him yesterday, and he said:
“The provision of dementia health care services is the responsibility of local integrated care boards”.
Gregory Stafford (Farnham and Bordon) (Con)
The hon. Member is making a powerful speech, especially with that last point. Is he, like me, concerned that ICBs will have their funding cut by 50%? Dementia will be one of the many conditions that will suffer because of that.
Freddie van Mierlo
Like the hon. Member, I am incredibly frustrated that whenever I put concerns to the Minister, I get pointed towards the ICBs, and when I talk to the ICBs, they tell me to talk to the Minister. There must be responsibility within our system. The Minister has been in politics for longer than me, but I hope he will allow me to offer him a little advice. It is not the ICBs that the people of this country are angry with when it comes to not getting the treatment they deserve; it is the Government. They expect the Government to take responsibility, not pass the buck.
Andrew Pakes
My hon. Friend has answered his own question, given the passion with which he has told that story; the role of young carers is a story to which the House must bear witness. I know that my hon. Friend the Minister for Care is passionate about ensuring that those who care for loved ones facing health conditions get the recognition and support they need, so I thank my hon. Friend the Member for Harlow (Chris Vince) for his question as well as the Minister, in recognition of the role he plays in this issue.
Gregory Stafford (Farnham and Bordon) (Con)
The hon. Gentleman’s story of his saving his local centre rings a bell with me. The Hunter Centre in Haslemere, which had been run by the Alzheimer’s Society, looked like it was going to close in 2017, but because of some great work by Anne Downing, it was saved and is now thriving—in fact, I am a patron—so I am sure that this can be done not just in the hon. Gentleman’s constituency and in mine, but across the country.
Andrew Pakes
I thank the hon. Gentleman for giving us such a wonderful practical example. I would correct him only by saying that it was not me that saved our centre; it was the campaigners and their families. I would like to ensure that the record represents that it was their work that saved it, rather than me as an individual MP, although I was glad to play my small role alongside their great efforts to hold me to account.
Fundamentally, care belongs in the community. It is our duty to promote and support such initiatives as I have talked about, and to ensure that the wonderful creation that is the NHS is centred on community-based care, not on top-down-based care. It is our duty to promote this and I sincerely hope that this type of provision, alongside the additional services that hon. Members have spoken so passionately about today, will be the hallmark of what comes next and will feature prominently in the 10-year plan and in the remarks that the Minister will shortly make.
Parkinson’s Disease
Gregory Stafford Excerpts(1 year, 5 months ago)
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Gregory Stafford (Farnham and Bordon) (Con)
It is a pleasure to serve under your chairmanship, Mr Stuart. I thank the hon. Member for Colne Valley (Paul Davies) for his role in securing this vital debate and all Members who contributed.
As we have heard today, Parkinson’s affects 153,000 people in the UK; more shockingly, every hour, two more people are diagnosed. For me, the issue is personal: a close family member was initially diagnosed and treated for Parkinson’s, but more recently that diagnosis was revised to progressive supranuclear palsy—a rarer and more aggressive condition. That journey from uncertainty to diagnosis and then to living with a progressive neurological condition has profoundly impacted me. I have witnessed first hand the critical importance of early diagnosis, emotional support, specialist care and—above all—hope.
Last month, ahead of World Parkinson’s Day, I met representatives of Parkinson’s UK and individuals affected by the condition. I heard powerful accounts from volunteers about the daily challenges that they face with mobility issues, speech difficulties and the emotional toll on themselves and their families. I will continue to commend Parkinson’s UK for its tireless work, both across my constituency of Farnham and Bordon, including Haslemere, Liphook and the surrounding villages, and across the country, providing advice, support and advocacy at every stage of the Parkinson’s journey.
However, I have been concerned that the Labour Government have yet to identify Parkinson’s as a strategic priority. Will the Minister confirm what level of funding is being allocated to Parkinson’s research this year? How does that compare with the past five years? During my tenure at the NHS Getting It Right First Time programme, I was involved in the publication of the neurology national specialty report. That analysis highlighted significant variation in neurological services across England, particularly in managing conditions such as Parkinson’s disease. The recommendations are essential for reducing disparities and improving outcomes, so will the Minister commit to addressing in detail the priorities in the report, beyond general references to cutting waiting lists?
The previous, Conservative Government invested more than £79 million into research into Parkinson’s between 2019 and 2024; in 2022-23, the National Institute for Health and Care Research enabled 114 studies related to Parkinson’s through its infrastructure. We also rolled out a new treatment for advanced Parkinson’s disease through the NHS, which started in February last year, offering an additional option for patients whose symptoms were no longer responding to oral medication. I would be grateful if the Minister could confirm that the Government plan to continue that momentum. What research funding will be maintained or increased and what new treatment options are being supported or explored? The new Government have committed to updating the last Conservative Government’s long-term workforce plan. When will they announce the detail and what specialist training there will be for Parkinson’s nurses and clinicians? Will they maintain the focus on specialist care?
Charities such as Parkinson’s UK do an amazing job, but as with many other sectors they are having to respond to higher taxes and squeezed funding. Will the Minister outline how he is talking to the charitable sector to ensure that the changes that the Government are making in the Budget are not damaging Parkinson’s care?
Finally, what guarantees can the Minister offer that the recent restructuring of NHS England will not worsen access to Parkinson’s services? With 50% cuts to integrated care boards, can the Minister reassure people that Parkinson’s sufferers and their families will not be disadvantaged?
Members from across the House are united in wanting to improve treatment, support and outcomes for people with Parkinson’s. In response to a debate I spoke in earlier this month, the Public Health Minister said that she would be happy to meet with stakeholder organisations to discuss the Parky charter and the progress of Parkinson’s Connect pilots. I would be grateful if the Minister could outline whether the Public Health Minister has arranged those meetings and, if she has not, when they might happen. A meeting would prove the Government’s action on workforce, waiting times, integration, support for carers, and access to research and innovation.
My colleagues in the Conservative party and I stand ready to work constructively with the Government, and with Members from all parties, to ensure that progress is not only protected but accelerated. Let us match awareness with action, for only with action will there be hope.
Mental Health Bill [Lords]
Gregory Stafford ExcerptsMonday 19th May 2025
(1 year, 5 months ago)
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Gregory Stafford (Farnham and Bordon) (Con)
Despite having worked in healthcare for most of my career and serving on the Health and Social Care Select Committee, having listened to the speeches thus far this evening, I feel in awe of the experience of hon. Members on both sides of the House, especially the hon. Member for Sittingbourne and Sheppey (Kevin McKenna) and my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer). I also commend the hon. Member for Dorking and Horley (Chris Coghlan), who I know is supported by my right hon. Friend the Member for Godalming and Ash (Sir Jeremy Hunt), for his extraordinarily powerful speech.
This Bill is essentially about the duty of care not only to those who have mental health issues, but to the public, including the family, friends, carers, public servants and everyone else who interacts with those individuals. The duty of care also exists to protect those individuals from themselves. As many Members have said, our hope and ambition should be that as few people as possible find themselves in a crisis situation. I therefore entirely endorse and support the comments about ensuring that we have proper and well-funded mental health services, both in the community and in the acute setting.
Iqbal Mohamed
The hon. Member mentions support for the person needing help—to help themselves, and also to help society. Does he agree that more and more people are getting into situations where they do not feel that they are being helped, and that they just feel incarcerated and restricted?
Gregory Stafford
I agree with the hon. Gentleman that more can be done to help people in crisis. What I would say, however—I think my hon. Friend the Member for Runnymede and Weybridge also made this point—is that there are people who are at such a point that, unfortunately, they need to be incarcerated in order to be able to help themselves. Hopefully, they spend their time incarcerated not just away from society but being treated effectively and appropriately.
That brings me to the point that this is a balancing act and a difficult situation. I think all of us of all parties are clear that the current Act is no longer fit for purpose, especially when we think about forensic mental health. As such, I am glad that the Government are taking forward this legislation, which was started under the previous Government. The cross-party consensus we have heard this evening reflects the fact that this piece of legislation has come from both of the major parties. I am likely to be on the Bill Committee after the Whitsun recess, so I will not test the patience of the House by going through every single bit of the Bill I have some interest in or concerns about, but I will briefly raise three important areas, which I am pleased were raised by Members in the other place. A number of Opposition amendments were tabled in the other place which would have strengthened the Bill, and I hope they will be made in Committee in this place.
The first area is reducing unnecessary police involvement. The noble Lord Kamall and Baroness May tabled some amendments that in my view represent a very significant and much-needed shift in how detentions and removals under the Mental Health Act can be managed. Under the current framework, the power to detain individuals and move them to a place of safety—particularly under sections 135 and 136—is largely restricted and falls under the responsibility of police officers. Although those provisions are designed to protect the public, they can often result in the criminalisation of people in acute mental health crisis, even when there is no threat of violence or risk to others.
The amendments tabled in the other place would have allowed authorised and qualified health professionals such as paramedics, approved mental health professionals or specialised nurses to carry out those detentions and to move individuals under sections 2, 3 and 5 of the Act. That would relieve police officers of responsibilities that fall outside their core expertise while reducing the stigma and trauma associated with police-led interventions. It would streamline the process, ensuring that individuals were supported by professionals trained specifically in mental health care and would maintain police involvement only where there was a clear and present risk to safety. That would significantly change and strengthen the system, placing mental health crises more firmly within the domain of health rather than law enforcement.
Sojan Joseph
Sections 135 and 136 of the current Mental Health Act give the police the power to break into someone’s property or detain somebody in a public place where there is the possibility of the involvement of weapons. Does the hon. Member think that health professionals would be able to manage those kinds of situations? Would the police not be the best people to deal with those situations?
Gregory Stafford
I am sorry if I was not clear for the hon. Gentleman. I thought I had made it very clear that I was talking about situations in which there was no risk to other professionals. Clearly, in the situations he describes, the police are entirely the right people to be involved.
The second area that I want to touch on is that of strengthening safeguards for vulnerable children. What I would like to see introduced is an essential safeguard for children and young people within the mental health care system. As my hon. Friend the Member for Runnymede and Weybridge mentioned, the current legislation allows for a nominated person to be appointed to represent the child’s interests. In my view, though, it does not provide adequate protection against the risk that that person could be coercive, abusive or in other ways inappropriate, particularly in cases involving looked-after children or those with complex family dynamics.
As such, I would like to see amendments made that address that gap by establishing clear criteria for who can be appointed as a child’s nominated person. For looked-after children, the local authority would automatically become the nominated individual, ensuring oversight by a public body accountable for the child’s welfare. For other children, only individuals with legal parental responsibility—such as a guardian or someone named in a court order—should be appointed. Such measures would ensure that no vulnerable child would be exposed to undue influence during what may be one of the most difficult or disorienting times in their life. They would align mental health law with broader child protection standards and reinforce the principle that safeguarding must be at the heart of any mental health intervention involving children.
Finally, I want to see amendments made that would introduce more patient voice and accountability. I accept that in its current form, the Bill makes steps in the right direction, but I would like to see an amendment made mirroring the one that was tabled in the other place by the noble Lords Howe and Kamall. Such an amendment would introduce the valuable and forward-looking provision of a mandatory debrief session within 30 days of discharge from detention under part 2 of the Mental Health Act. That session would be led by an independent mental health advocate, and would provide patients with the opportunity to reflect on their experience, raise any concerns about their treatment, and offer feedback in a safe, supportive and non-judgmental setting.
That would be more than just a procedural addition; it represents a shift in culture, which I think we would all agree with, towards embedding patient voice and accountability in the mental health care system. It recognises the importance of empowering individuals after detention, supporting their recovery and learning from their lived experience to improve future services. Mental health charities and third sector organisations have strongly endorsed the proposal, so I hope the Minister will give some indication in his wind-up that he would support a similar amendment.
Taken together, these reforms prioritise professional clinical opinion, safeguard children from inappropriate influence during periods of acute vulnerability and elevate the patient voice in the post-care process. In doing so, they align the Mental Health Act closer to modern standards of care, international best practice and evolving public expectations. These amendments are essential to strengthening the Bill, ensuring that our mental health system becomes not only more effective, but more compassionate, responsive and just.
Oral Answers to Questions
Gregory Stafford Excerpts(1 year, 6 months ago)
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Ashley Dalton
And he has just sold me on what a wonderful charity it is. I would be more than happy to make sure that the relevant Minister meets the hon. Member to discuss the matter.
Gregory Stafford (Farnham and Bordon) (Con)
The Secretary of State for Health and Social Care (Wes Streeting)
As the Prime Minister and I announced, NHS England will be brought back into the Department to put an end to the duplication, waste and inefficiency resulting from two organisations doing the same job. That is the final nail in the coffin of the disastrous 2012 reorganisation, which led to the longest waiting times, lowest patient satisfaction and most expensive NHS reorganisation in history. Since the announcement, we have set up a joint board, assessed resources and responsibilities across existing organisations, developed proposals about the role, functions and structure of the new centre, and started detailed operational and legislative planning.
Gregory Stafford
The Secretary of State claims to support change, yet delays to NHS reorganisation, including to the promised abolition of NHS England, suggest otherwise. Is it not the truth, as he outlined in his Guardian article, that he is bogging the system down in a slow, top-heavy restructuring, while resorting to tax rises, instead of delivering the decentralised, locally delivered, value-for-money healthcare that our constituents deserve?
Wes Streeting
A lot of words and not a lot of sense. We are reforming the NHS and, as a result of these changes, redirecting hundreds of millions of pounds to the frontline. What was the Conservative party’s response to the abolition? The shadow Chancellor of the Duchy of Lancaster, the hon. Member for Brentwood and Ongar (Alex Burghart), said it could be a “great thing”, but it
“could be a total disaster”.
Will they let us know when they have made their mind up?
Parkinson’s Awareness Month
Gregory Stafford Excerpts(1 year, 6 months ago)
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Gregory Stafford (Farnham and Bordon) (Con)
It is a pleasure to speak on behalf of His Majesty’s Opposition in this most important debate. I commend the hon. Member for Dunfermline and Dollar (Graeme Downie) for securing it and for his heartfelt and impassioned speech. I was particularly moved by the recitation of Bobbie’s poem and the highlighting of the amazing “Movers and Shakers” podcast.
I thank all hon. Members for their heartfelt contributions on behalf of their constituents and those across the country living with Parkinson’s. We heard inspiring stories such as that of Jagdeep, as raised by the hon. Member for Ilford South (Jas Athwal), and John and Anne of Something Old, Something New, as raised by the hon. Member for Stirling and Strathallan (Chris Kane).
I note that, as a result of other events in the country, our debate has had a relatively Scottish flavour, but Parkinson’s Awareness Month is UK-wide and a time to focus national attention on the condition that affects over 150,000 people here in the UK. That number that continues to rise. The disease impacts not just individuals but families, carers and communities. It challenges both body and spirit, demanding a comprehensive response from all sectors of society.
We often learn about Parkinson’s from friends, family and colleagues, as was highlighted so powerfully by the hon. Member for Glasgow West (Patricia Ferguson). For me, it is a deeply personal issue. A close family member was initially diagnosed and treated for Parkinson’s disease. More recently, that diagnosis was revised to progressive supranuclear palsy, or PSP, which is a rarer and unfortunately more aggressive condition. That journey from uncertainty to diagnosis and then living with a progressive neurological condition has profoundly impacted my family. I have witnessed at first hand the critical importance of early diagnosis, specialist care, emotional support and, above all, hope.
Since becoming a Member of Parliament, I have spoken to many constituents across Farnham, Bordon, Haslemere, Liphook and the surrounding villages affected by Parkinson’s. I have been inspired by their bravery and strength in responding to the cruel difficulties that life has thrown at them.
Parkinson’s has no cure, as hon. Members have said, and that is one of the many challenges that people and their loved ones face on diagnosis, but thanks to advances in research and medicine, there are ever improving treatments to help manage and relieve symptoms. As a result, many people with Parkinson’s can have a normal or near-normal life expectancy. Physiotherapy, occupational therapy and medication can help relieve symptoms and enable people to stay living independently at home for longer.
In my constituency, people with Parkinson’s have benefited from free membership of local leisure centres in Whitehill and Bordon and in Haslemere, helping them to keep active and manage their symptoms, but there is so much more to do, whether on research, diagnosis, treatment or—hopefully—a cure.
Last month, ahead of World Parkinson’s Day, like the hon. Members for Hertford and Stortford (Josh Dean) and for Strangford (Jim Shannon), I met Parkinson’s UK and individuals affected by the condition. I heard powerful accounts from volunteers about the daily challenges they face from mobility issues and speech difficulties and the emotional toll on themselves and their families. I commend Parkinson’s UK for its tireless work in providing advice, support and advocacy at every stage of the Parkinson’s journey. Help is available via its website and helpline. I encourage anyone who needs support to reach out. However, as the hon. Member for Bathgate and Linlithgow (Kirsteen Sullivan) mentioned, there are still many who do not know what support is out there; that must change.
I praise the local charities and volunteers across my constituency and across the country, as raised by my right hon. Friend the Member for Gainsborough (Sir Edward Leigh), and the work they do. Like the hon. Member for Aberdeenshire North and Moray East (Seamus Logan), I have experienced working in healthcare, and during my tenure with the NHS Getting it Right First Time programme I was involved in the publication of the neurology national speciality report. The analysis in that report highlighted significant variation in neurology services across England, particularly in managing conditions such as Parkinson’s disease. Key conclusions included the urgent need for timely access to specialist neurology services, the development of standardised care pathways for chronic neurological conditions, the expansion of the neurological workforce, including advanced practitioners, and much better data, as my hon. Friend the Member for Meriden and Solihull East (Saqib Bhatti) mentioned. Those recommendations are essential to reducing disparities and improving outcomes. Will the Minister commit to addressing those three priorities in more detail beyond general references to cutting waiting lists and updating the workforce plan?
Medical research in the UK is funded by both public and private sectors as well as charities and non-governmental organisations. In 2022, nearly £250 million was spent on neurological research including Parkinson’s and other neurodegenerative conditions across 1,873 individual projects. Parkinson’s UK and Cure Parkinson’s alone contributed £2.6 million.
Under the previous Conservative Government, we invested more than £79 million in research into Parkinson’s disease between 2019 and 2024. In 2022-23, the National Institute for Health and Care Research enabled 114 studies related to Parkinson’s through its infrastructure. We also rolled out a new treatment for advanced Parkinson’s disease through the NHS, starting in February 2024, offering an additional option for patients whose symptoms were no longer responding to oral medications. I would be grateful if the Minister would confirm the Government’s plans to continue with that momentum. What research funding will be maintained or increased? What new treatment options are being supported or explored? We also made progress in workforce planning, recruiting record numbers of doctors and nurses, and publishing the first ever NHS long-term workforce plan. That plan recognised the need for more specialist nurses and clinicians in areas such as neurology. The new Government have committed to updating that plan. Will they therefore retain that level of detail and maintain the focus on specialist roles needed for Parkinson’s care?
I want to raise constituents’ concerns regarding recent shortages of medications, such as amantadine and apomorphine. That has real, distressing consequences for people trying to manage their condition. The Government have rightly acknowledged those supply constraints, but what action is being taken to restore and secure access to those medications? We have also heard concerns about the potential impact of President Trump’s proposed pharmaceutical tariffs. What assessment has been made of the risks that could pose to access and affordability of Parkinson’s treatments?
Turning to the Labour Government’s record to date, I believe that Parkinson’s has yet to be identified as a strategic priority. Will the Minister confirm what level of funding is being allocated to Parkinson’s research this year and how that compares with recent years? There are also wider concerns about the implications of tax and benefit changes in the Budget, as the hon. Member for Strangford raised, including the national insurance rise. Many people with Parkinson’s rely on social care services, which are not exempt from the national insurance rises. Has any assessment been made of those extra costs for local authorities, charities and self-funders? Charities such as Parkinson’s UK do extraordinary work, but they too are affected by those rising costs. How are Ministers engaging with the charity sector to understand how higher taxes and squeezed funding may threaten support services or reduce research investment?
We know that neurology waiting times are already among the longest in the NHS. Will the Minister outline a targeted plan to specifically address that? Will the Government also publish a long-term strategy for neurological conditions, including Parkinson’s, with clear plans for service integration between the NHS and social care? A multidisciplinary, multi-agency approach is vital for people with Parkinson’s to live full, independent lives.
Finally, what guarantees can the Minister offer that recent restructuring in NHS England and the Department of Health and Social Care will not worsen access to Parkinson’s services, delay initiatives or harm continuity of care? With 50% cuts to integrated care boards, will the Minister reassure people with Parkinson’s and their families that they will not be disadvantaged?
The House is united in wanting to improve treatment, support and outcomes for people with Parkinson’s. We hope that the Government will listen carefully to today’s contributions and respond with clear commitments that include action on workforce, waiting times, integration, support for carers and access to research and innovation. Parkinson’s is a relentless condition that robs individuals of independence and dignity, but with research, investment, compassionate care and community support, we can fight back. The Conservative party stands ready to work constructively with the Government and with Members from all parties to ensure that progress is not only continued but accelerated. Let us match awareness with action, for only with action comes hope.
Department of Health and Social Care
Gregory Stafford Excerpts(1 year, 8 months ago)
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Gregory Stafford (Farnham and Bordon) (Con)
As a member of the Health and Social Care Committee, I know that there are serious challenges facing our health and social care system, particularly in the context of current and future funding. We all know that the NHS is under immense pressure. Our population is ageing, health needs are becoming more complex and the effects of the pandemic continue to be felt. If we want a system that works for everyone, we need to address these challenges with smart, strategic and effective solutions.
Before I became a Member of Parliament, I worked in healthcare, most recently as part of the NHS Getting it Right First Time programme. This programme focuses on improving patient care by studying what works best, comparing data and making practical changes. Through that work, I saw where the system was bogged down by excessive bureaucracy, poor organisation and feeble productivity improvements, leading to unacceptable and unwarranted variations in care. Those problems waste time and money instead of helping patients. We need to streamline processes, modernise services and focus on patient outcomes rather than bureaucracy.
When the last Government were in charge, we increased NHS funding to record levels. In 2023-24, the NHS’s day-to-day budget was nearly £180 billion, and there is even more being spent in the current budget. But the real question is: where is this extra money going? Despite this additional spending, NHS England’s chief financial officer admitted to the Health and Social Care Committee that almost all of this year’s £10.6 billion uplift will be consumed by pay settlements, increased national insurance contributions and rising costs of treatments and medicines, meaning that very little, or indeed none at all, will be left for improving patient care. The Government are pouring billions into the NHS, but without demanding productivity reforms the money is being absorbed by the system instead of reaching the frontline where it is needed the most.
In my constituency of Farnham and Bordon, which includes Haslemere, Liphook and the surrounding villages, we have challenges in ensuring fair access to services across our different areas. In Bordon, rapid housing developments continue, yet healthcare provision has failed to keep pace. The ICB is pushing ahead with proposals for a new health hub, but there are concerns that it will not meet the future demands of a growing population. Residents who rely on the Chase hospital need assurance that new facilities will provide long-term, sustainable care.
In Haslemere, the hospital has made great strides in expanding services, reducing pressure on nearby GP surgeries and major hospitals such as the Royal Surrey County hospital, but ongoing support is needed. Upgrading equipment, increasing staffing and ensuring continued investment will allow Haslemere hospital to remain a cornerstone of our local healthcare provision. Farnham, meanwhile, faces persistent issues with both healthcare and access to dental services. The shortage of NHS dentists is an escalating crisis, leaving many residents without the care they need. Too many people are forced to travel long distances or go without treatment entirely.
Indeed, across the constituency, transport links to places such as Frimley Park hospital remain a concern. As a regional hub, Frimley Park plays a vital role in serving Farnham and beyond. However, for many residents, particularly those in rural areas, accessing treatment there is a challenge. I have worked closely with the local authorities and Frimley Park to improve transport connections, including through the expansion of the Waverley Hoppa service. If the Government truly want to expand services, they need to look at this holistically: not just at the buildings but at how patients can access them.
Labour’s tax increases on GPs, pharmacies, care homes and social care providers are putting vital services at risk. The Royal College of General Practitioners has warned that these changes could force some surgeries to close or reduce their services. In my constituency, that was amply demonstrated to me when I visited Badgerswood GP surgery and pharmacy. I have also spoken to Dr Kabir from the Hampshire primary care network and Tim Corry from Guardian Angels. They told me that these changes are forcing small healthcare providers to cut staff hours, downsize operations and even lay off employees. Hospices are also struggling, with projected cost increases of £30 million. I am lucky that the Phyllis Tuckwell hospice in my constituency is currently going through a major rebuild, but others are not so lucky.
The Government need to focus on real reforms that improve productivity and modernise healthcare. If the Health Secretary is serious about making the NHS better, he must explain how he plans to integrate those innovations into his 10-year plan. The reality is that this Labour Government have failed to build the new hospital programme and to implement the Conservative Government’s cap on social care costs. Labour has no plans to fix the NHS. Instead of returning to the futile model of “Whitehall knows best”, the Government should be looking at actively devolving funding to local systems, with the provision of punishment if they fail. Ultimately, they must have an honest and open conversation with the public about how we deliver, provide and fund healthcare.
Jen Craft (Thurrock) (Lab)
Meeting my constituents in Thurrock serves as a constant reminder of the state of our NHS and the health of our nation. I regularly hear from residents who cannot access NHS services, who are stuck on a waiting list or who are unable to see their doctor. I see how the social determinants of health play out, putting people in parts of my constituency at a disadvantage from day one. Housing, unemployment and education drive health inequalities, and in our most deprived communities, people do not live to see their 80th birthday. That is representative of the immense task this Government have been set. The funding of the health service and the estimates we are discussing today are fundamental to turning the tide on these trends.
Fourteen years of neglect and failure, the highest waiting lists on record, an ageing population that is getting sicker and unmet need in communities across the country mean that the NHS is at a pivotal point in its history. It must fundamentally change how it operates in order to survive. The £22.6 billion of funding committed to revenue spending at the Budget was a welcome and much-needed cash injection, the impact of which is already being felt. The delivery of Labour’s manifesto commitment of 2 million more appointments a year is testament to that.
Gregory Stafford
I did mention this in my speech, but I think the hon. Lady was there in the Health and Social Care Committee when the chief financial officer of NHS England said that the extra £10.6 billion allocated for this year would be entirely eaten up by other costs, including national insurance rises, and that there would be almost no extra money for frontline patient care. Does she remember that?
Jen Craft
I was indeed at that Committee, and I also remember the reflection that NHS England was incredibly grateful for the amount of money that was being given. It was the highest amount of money given to any Department at the Budget, and it was much, much more than has been given in previous years.
Waiting lists have fallen for the fourth month in a row—I hope the hon. Gentleman and his colleagues will welcome that—with 160,000 fewer people waiting for treatment than when Labour took office. That includes a member of my own family, so I am very grateful to see that happening. Extending the opening hours of community diagnostic centres, such as the one set to open in my constituency this summer, will be key in catching conditions earlier.
While I welcome those measures, I would like to make the key point that funding alone is not enough to change and save how our NHS operates, and we must turbocharge the left shift to community and neighbourhood healthcare. In my constituency, it is often the front door to the NHS that lets local people down, which drives admissions to A&E when there is no available alternative. We have some of the most acute GP shortages in the country, with an average of 3,431 patients per GP. The neighbourhood health hubs promised by the previous Government have yet to be delivered. People in Tilbury, one of my most economically deprived areas, are still waiting for a long-promised facility, which currently looks like a hole in the ground, and I would welcome a discussion with the Minister about how we can work to deliver it.
The record funding uplift for general practice, with £889 million of investment, is again welcome news, but it highlights the fundamental tension between tackling the crisis in acute care and driving the vital left shift to community care that will be fundamental in turning the tide on the NHS. We must not lose sight of the goal of creating a healthier population in order to reduce pressure on acute services in this country, creating better, healthier lives and delivering the right care at the right time that puts the focus on the individual.
Thurrock community hospital in my constituency delivers excellent integrated community care that brings together social workers from the local authority and NHS staff to meet people where they are, intervening early and reducing pressures on acute care. That is partly thanks to a real partnership between the local authority and the integrated care board, and it has removed the need to focus on which public body benefits and which public body pays. I have to point out that our local authority has one of the lowest spends on adult social care, partly due to measures such as this.
The real focus is on how to deliver for individual patients—what do patients need and how do they get to that place? I welcome the bold move in the recent planning guidance to drastically reduce the strict targets placed on integrated care boards, allowing more of this work to take place by giving ICBs independence to make decisions that are relevant to their local population. However, I have heard from ICBs, including mine, that there is a risk that a focus on the elective care target may draw attention away from prevention.
I would like to point out the removal from the planning guidance of the targets for annual health checks for people with learning disabilities. That community historically has been under-represented and has not had its health needs fully met. This population dies younger and does not access preventive care at the point at which it would be most beneficial for them. Blanket prevention measures do not cover such populations. People in this community need specific intervention that allows them to access the healthcare that they need, when they need it. While a blanket annual health check is not necessarily the right way forward, it is absolutely critical that historically overlooked groups who are not served as well as others by our healthcare system are not overlooked when we shift to community and prevention work.
I very much welcome the strong investment that the Government are making in our NHS; it is vital in order to turn the NHS around and ensure that it is there for generations to come. I would welcome the Minister’s thoughts on how we can incentivise prevention as well as providing acute care.
Layla Moran (Oxford West and Abingdon) (LD)
We are proving that estimates are not dull, although they have a terrible reputation for being so. Everything comes from the money, and if we do not follow the money, we do our constituents a disservice. The Government have announced an incredibly welcome £22.6 billion increase in day-to-day spend on health and social care, in addition to the further £3 billion in capital expenditure. It sounds like, and is, a huge amount of money. The only thing bigger than the uplift will be the disappointment of our constituents if the money is not spent wisely and does not lead to the change that they desperately want and need.
I will start with an example. My constituent was referred to her GP for an NHS-funded assessment for autism spectrum disorder. She took tests, and exceeded the threshold in all of them, and was told that she would be put on a waiting list, with an expected wait of 16 years to 18 years—yes, years. She is 34 with young children, and will be waiting for an appointment until she is 51. That is clearly ridiculous.
We welcome the three shifts, the 10-year plan and the long-term thinking, which hopefully will end stories like the one that I just told; I know Members from across the House will have similar stories. I was interested to hear the Secretary of State choose technology as his top pick when I pressed him to pick a favourite priority at our Committee hearing on 18 December. In recent correspondence with the Committee, which is now online, the Department credited technology with a 0.7% productivity contribution this year alone. I am concerned, though, that we do not have much detail about how exactly technology will achieve that, and we will press the Department on that figure.
Prevention is also incredibly important, and it is always in danger of being overlooked. I assure the Minister—I know she is responsible for prevention—that if the Government do not pursue it, we will press them to, as will the electorate, I am sure, because is a no-brainer.
Gregory Stafford
If we want prevention, we have to invest in social care, but the Government are putting almost all the investment that the hon. Member talks about into the NHS, rather than social care. Surely there needs to be a rebalancing.
Neil Duncan-Jordan (Poole) (Lab)
I acknowledge the £25 billion of additional funding allocated to health and social care in the autumn Budget. We are already beginning to see improvements in waiting times, the number of dental appointments and access to treatment. That is absolutely what my Poole constituents wanted and needed to see from a Labour Government.
Neil Duncan-Jordan
I am afraid I will not.
Funding is more challenging in social care, and that is what I will focus my comments on. There is widespread acceptance that our social care system is neither sustainable nor fit for purpose. For far too long, it has been the Cinderella service of the welfare state, overlooked and underfunded, and it has suffered from a number of problems that started to emerge decades ago but have become critical as a result of severe cuts to funding and increasing demand.
Most people who have looked at the system recognise the huge cost to the NHS of keeping people in hospital when they could be discharged into the community. However, too often there are not the care packages in place to enable that discharge. That will be resolved only when we have a better understanding of the dynamics of social care and a more effective way of managing it. Addressing the crisis in the system requires us to reconsider the meaning of the term “social care,” and to abandon the false divisions between medical, nursing, personal and social care, and instead regard all those activities as part of a single care service.
A new national care service should seek to go further than the existing model of provision. As well as providing free domiciliary and residential care to all users who are self-funding, it should also have to: take account of the 2 million older people who have needs that are not being met by the system; improve terms and conditions for care staff; strengthen regulation and monitoring of services; and provide greater support for the country’s 5 million unpaid carers. There needs to be an immediate national debate about how a new national care service can be publicly funded and delivered, what it should include and who should be responsible for its delivery. The new Casey commission will only delay that debate further, in my view.
We have known about the problems for a long time. Over the last two decades, we have had at least 20 commissions, inquiries and reports analysing what is wrong with the system and what might be done to address the problems. However, successive Governments have all found the issue too difficult to tackle, and have instead favoured short-term answers that have largely left the system untouched. The issue that all politicians have avoided is the false division between health and social care, and the question of how such care should be funded.
No one should face personal costs simply because they are unlucky enough to suffer from conditions such as dementia. That undermines the very principle of our NHS. Society must share the burden, and those most able to contribute must pay their fair share. Our universalist principles must lead us to talk about correcting those inequalities and ensuring that wealth, resources and budgets are used to build a fairer and healthier society for all.
Joe Robertson
I agree with all those things, and I am happy that the hon. Lady and I agree with each other. I hope that she acknowledges that £10 billion does not cover the basic requirements of the NHS. It delivers nothing more; in fact, it delivers less. The NHS will be able to continue to grow only if it delivers productivity gains, and it should.
Gregory Stafford
Does my hon. Friend remember, as I do, that when the Secretary of State was in opposition, he was very clear that there would be no pay increases unless there were productivity gains and reforms to the way the NHS operates? Now that Labour is in government, that seems to have completely evaporated.
Joe Robertson
I remember that clearly. I would like the Minister to spell out how she will deliver those productivity gains through reform. We want to hear more detail so that we can be confident that the NHS is secure.
Let me turn to one area that the Minister might like to reflect on: the use of technology. Penny Dash, the candidate to take over as chair of NHS England, told the Health and Care Committee clearly that she would like technology to deliver and that she sees lots of opportunities. She herself remarked that basic technology in the NHS is not working. I recall that she used the example of nurses taking half an hour to turn on a computer system and having to use five passwords to access it. I said to her that it is hardly sensible to try delivering technology gains around artificial intelligence and all the opportunities that it might bring if we cannot deal with very basic, low-tech problems throughout the NHS. She agreed and accepted that is a challenge. I would like to see how the Secretary of State will, through the Minister, support NHS England in delivering that.
I would also like to see the dementia diagnosis target brought back into the planning guidance document for NHS England. It was taken out this year, in consultation with the Secretary of State—so he allowed that. Diagnosing dementia is the most important thing we can do for people living with dementia and their families. Taking that diagnosis rate target out is inexcusable. I accept the wider point that if everything is a target and a priority, then nothing is a priority, but I think we can all agree that dementia—the biggest killer in this country—must be a priority for the NHS. That target for diagnosis rates must come back into the planning guidance next year. Indeed, the word “dementia” does not even feature in the guidance, which is shameful, frankly.
Let me finish by talking about where the money is spent. We can have disagreements about how much is needed, but Lord Darzi was very clear that it is not being spent in the right places. Too much money in the NHS is being spent on hospitals, and not enough is being spent in the community. The Secretary of State will have to take some tough decisions, which he accepts, and one of them will have to be to reduce the proportion of money spent on hospitals. That is politically difficult, but across the House we are prepared to back him, if it is part of a plan to deliver meaningful change and to move more people out of hospitals and into communities, which is where they most want to be treated. Nobody wants to be in hospital if they have no medical reason to be there.
Finally, the Chancellor must understand that every decision she takes must be coherent and consistent with delivering the three shifts. When she came to the Dispatch Box to deliver the Budget in October, she recognised that national insurance increases were going to be crippling for healthcare. That is why she exempted the NHS from those increases. However, she failed to exempt other key providers of healthcare, particularly in primary care, such as GPs, so it is no good now saying that the GP pay deal is a record deal, because the money that they must pay in national insurance contributions represents more than 50% of the money that the Government have given them. The Chancellor must back up the left shift with the fiscal decisions she announced at the Dispatch Box.
Nesil Caliskan
I am very pleased to have accepted my hon. Friend’s intervention and I entirely agree with her. If we want to see an improvement in the estate of the NHS, we need to have money allocated to it.
When the NHS was at breaking point, my constituents had to feel the pain of not being able to get appointments for their sicknesses. The population I represent already has some of the worst health inequalities in the country, exacerbated by the lack of primary healthcare provision. Some wards in my constituency have no GPs at all, so I welcome the remarks made by Members from all parties about the importance of primary healthcare provision.
Without reform, the NHS is simply not financially sustainable, but alongside reform there must be a culture of change in NHS England. The Public Accounts Committee report highlights that last year NHS England failed to approve ICB financial plans until months after the financial year had begun. Working with local NHS bodies, we have seen examples of ICBs, as other hon. Members have said, talking a good talk on prevention and public health, but we see a lack of action from many areas on commissioning in a way that has a positive impact on prevention.
Gregory Stafford
I entirely agree with the point the hon. Lady makes, but does the impetus not have to come from the top? Unless the Government are making strides to shift moneys from healthcare to social care, why on earth should any of the ICBs follow suit?
Nesil Caliskan
I do not disagree with that, which is why the Government commitment around reform will be so critical. I sit on the Public Accounts Committee that produced the report that highlighted some of those gaps. As a Committee, we will be looking closely at the reforms that have come forward from the Government, and I would welcome further reassurance from the Minister.
The Government are right to invest in the NHS to help to deal with the current critical waiting lists, but only alongside reform will the additional investment in the NHS be value for money. Only through reform can the NHS improve productivity to make it sustainable. I endorse comments made by Members from all parties about productivity because, without reform, the NHS cannot even meet its own productivity targets. That is why the estimates under discussion are so important. The 4.9% increase in investment is welcome because it will help to cover the pay review body’s recommended pay increase for NHS staff, stop the strikes, improve staff retention and keep more doctors and nurses at work. That is crucial if we want a properly functioning NHS.
The Secretary of State for Health and Ministers in his team have said time and again that the NHS is beaten but not broken. These estimates are important because they set the foundation and springboard for what is required to fix our NHS.
Sarah Bool (South Northamptonshire) (Con)
The Government came into office making all the right noises about tackling waiting lists and delivering a better healthcare service, which all our constituents want to see. However, since their election, I am concerned that Ministers are giving out more money—about £22.6 billion —for the day-to-day running of the NHS, without plans about how that may be spent to reform our health service, make it more efficient and support priority areas, such as dentistry, general practice or hospice care.
The Government are seemingly giving with one hand but taking with the other. No one should overestimate the impact of the increase of the employer national insurance contribution on our GP surgeries. Both Towcester and Brackley medical centres in my constituency have said that that increase will cost at least £40,000 to £50,000 and may result in redundancies, stopping the growth of their practices. Our surgeries are not here to make profit, but to deliver care, and attacks like this make care unsustainable.
The Darzi report said:
“The NHS budget is not being spent where it should be—too great a share is being spent in hospitals, too little in the community, and productivity is too low.”
Gregory Stafford
I agree entirely with what my hon. Friend says, but has she seen anything from this Government that suggests that there will be a significant shift from acute care in hospitals to community care, despite the rhetoric that we have heard from the Government Benches?
Sarah Bool
I concur that I have not seen anything, which is why today’s debate is so important. My GPs tell me that more attention needs to be given to GP practices: they are the praetorian guard who can ultimately protect the NHS. Access to timely appointments is crucial, as is rebuilding the key relationship and contact between a GP and their patient.
The Parliamentary Under-Secretary of State for Health and Social Care (Ashley Dalton)
Let me begin by thanking the Chair of the Public Accounts Committee, the hon. Member for North Cotswolds (Sir Geoffrey Clifton-Brown), for opening the debate. As a Public Accounts Committee alumna, it is my pleasure to have my first outing at the Dispatch Box for this debate.
I also thank all other colleagues for taking part. The number of right hon. and hon. Members who have contributed today speaks to the significant interest in our health and social care services not only in this House but in the country. The wide range of issues raised shows how broad and overarching our NHS and social care services are. I will try to cover as many of those issues as I can, and if I miss anything, I will happily pick it up with hon. Members afterwards. I will also attempt to respond to all hon. Members who have spoken, but if I miss anyone, I hope they will forgive me, because we have had so many contributions.
The Chair of the Public Accounts Committee, as well as the hon. Member for St Ives (Andrew George), my hon. Friends the Member for Poole (Neil Duncan-Jordan) and for Sheffield South East (Mr Betts) and many other Members, talked about social care. Productivity was a key point mentioned by the Chair of the Public Accounts Committee, as well as by the right hon. Member for Salisbury (John Glen), the hon. Member for Farnham and Bordon (Gregory Stafford) and my hon. Friend the Member for Barking (Nesil Caliskan). Prevention in public health was raised by many Members—as the Minister responsible for those areas, I am delighted to discuss that.
My hon. Friend the Member for Uxbridge and South Ruislip (Danny Beales) talked about dentistry, and shifts were mentioned by many hon. Members. My hon. Friend the Member for Barking talked about the work not only of public health but of local government, and the role of ICBs. It was great to hear my hon. Friend the Member for Gloucester (Alex McIntyre) talk about his pride in the NHS. This Government will always stand by our NHS and will always keep it free at the point of use.
In her autumn Budget, the Chancellor took the necessary decisions to put our NHS on the road to recovery, with an increase of more than £22.5 billion in day-to-day health spending and over £3 billion more in the capital budget over this year and the next. Thanks to her, we are taking the first steps towards fixing the foundations of our NHS and making it fit for the future. I say to the shadow Minister that yes, this will make a difference, because it is not just about the money but about making the right choices.
Gregory Stafford
I thank the Minister, and welcome her to her place. This, I think, is the fundamental point that Conservatives are making. We all accept that we want to see a shift from acute hospital provision to social care, but when the Chancellor’s Budget does not reflect that and when the national insurance rises hit the social care end of the spectrum, how can the public have faith that what the Minister says is anything more than rhetoric?
Ashley Dalton
I am coming to all of that.
Since coming into office, the Government have made choices. We have ended the resident doctors strike. We have published our elective reform plan, which will cut maximum waiting times from 18 months today to 18 weeks by the end of this Parliament. We have introduced investment and reform in general practice to fix the front door to the NHS and bring back the family doctor. We have started to get waiting lists falling, and we have kept the promise in our manifesto to deliver an extra 2 million appointments in our first year, a target that we have actually smashed in the first seven months. Anyone who thinks the Chancellor was wrong to make the necessary decisions and trade-offs must explain what they would cut from that list. Anyone who thinks they could have achieved everything we have done in less than a year without the autumn Budget is living in cloud cuckoo land.
Today we are setting out our supplementary estimates to the House. Funding will help the NHS to deliver 40,000 extra elective appointments a week, and to make progress on reducing the number of patients who wait longer than 18 weeks between referral and consultant-led treatment. We will publish our departmental budgets for the next financial year in the spring through phase 2 of the spending review.
Tobacco and Vapes Bill (Fourteenth sitting)
Gregory Stafford ExcerptsTuesday 28th January 2025
(1 year, 9 months ago)
Public Bill CommitteesRead Full debate Tobacco and Vapes Act 2026 View all Tobacco and Vapes Act 2026 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 28 January 2025 - (28 Jan 2025)
Dr Johnson
I thank the Minister for setting out what the clauses do, which is, essentially, to provide for smoke-free places in England.
Clause 136 introduces changes to the Health Act 2006, and specifically updates provisions regarding smoke-free places in England to allow for the addition of smoke-free areas beyond those already designated under existing law. It empowers the Secretary of State to extend smoke-free regulations to more places—and, I would argue, to essentially any place—with the aim of reducing exposure to second-hand smoke and promoting public health.
Although it clearly is the Government’s intention to use these powers to improve public health, they are very wide-ranging. As far as I can see, the clauses give the Secretary of State carte blanche to extend the smoke-free legislation to any place without needing a reason, because the Government did not accept our amendment that it should only apply to places that have a significant risk of actually having any smoke. I understand that the measures allow for greater flexibility, but I would be interested in the Minister’s reasons for the wide-ranging scope.
The Minister has said that he wants to focus on three areas: hospitals, children’s playgrounds and educational settings, and I believe that that is his intention. Unfortunately, over time, that may not be the intention of the rest of his Government, which is a risk for the Committee in allowing these measures to stand.
The Welsh have banned smoking on hospital sites. We heard in our evidence that compliance regarding playgrounds has been very good but that compliance around hospitals has been relatively poor. Does the Minister have any figures to add to that evidence about compliance in Wales? That could be the number of people who have been prosecuted or convicted of such an offence, or surveys from hospital trust leaders on the prevalence in their site, accepting that not all people will necessarily be caught or prosecuted. If we are to be successful, it is not simply enough to write laws in Westminster; there has to be a practical application in the real world. Has the Minister had any conversations with his Welsh counterparts on the perceived reasons why the law on hospitals in Wales has been followed less well than it has been in other areas, so that we can understand why?
The Bill states in proposed new section 4(2) of the Health Act 2006—this is interesting terminology—that if
“the place is used as a place of work or open to the public only some of the time the regulations must provide for it to be smoke-free only when so used.”
That means that if a place is used for the public only some of the time, it can only be a smoke-free place during the time that it is in use. That could lead to a whole queue of people standing outside a hospital. If it were, say, a community diagnostic centre, so it is not open around the clock, or a GP practice, we could have people smoking outside just as people arrive for work in the morning and as the first patients arrive, which would be somewhat counterproductive to the aims of the Bill.
I wonder whether the word “must” would be better off as “should” or “could”, or perhaps we could allow leeway either side for hospitals or schools that are open from a set time. If a school opens at 8.45 am for the children to arrive, when is it officially open and when can people be expected to stop smoking outside it? It seems to me that the risk for children is that people are smoking as they arrive at school, and some children may arrive just before it opens. I remember standing outside the school with my son, waiting for the doors to open before I went to work. This particular question is important. It is sensible that if somewhere is closed and private most of the time, it would not have to be smoke-free except when it is open. However, some thought needs to be given to the detail of that and how it would apply in practice to places that are insufficiently open.
The regulations can also be tailored to different situations. The Bill states that the smoke-free designations can be applied to certain “places or vehicles”, in specific circumstances at particular times or if certain conditions are met. That flexibility ensures that the regulations can address a variety of scenarios and settings, including potentially temporary or conditional restrictions based on factors such as the type of location or event. The regulations also have the option to include exceptions, such as allowing areas within designated smoke-free places to be designated as non-smoke-free, based on the discretion of the person responsible for the area. That would potentially undermine the principle of the Bill, so I would be interested to hear more about that.
Before implementing any new regulations to designate additional smoke-free places, the Secretary of State “must consult” relevant individuals or groups, which again seems sensible. I would appreciate clarification from the Minister on the definition outlined in proposed new section (4)(1), which allows the Secretary of State to designate “any place in England” as smoke-free if it meets the criteria of being “a workplace” or “open to the public”. But “any place” is very broad and could be interpreted to include beaches or open-air public festivals. Does the Minister intend to include other places open to the public within the remit of this legislation, such as public woodlands or national parks? Has he spoken to his counterparts in Scotland about the areas that are subject to the right to roam, and therefore open to the public to some extent? That includes, for example, public footpaths and rights of way through farmland. Could the very remotest piece of land in the United Kingdom be designated smoke-free and subject to legal repercussions thereof, if it were also open to the public?
I want to ask whether the enforcement of such broad measures would be feasible. If every public space, regardless of size, location or usage, was subject to a smoking ban, would it be realistic for local authorities or enforcement officers to monitor compliance across such vast and varied spaces?
In the modern day and with the change in working practices since covid, what counts as a workplace? In the age of working from home, can private homes count as workplaces? If a man sits down with his computer to work on a park bench, as is sometimes done, is that a workplace? If someone is working in an open area on the beach—we have heard that some people apparently do—does that make it a workplace? Does that place alternate between being smoke-free and non-smoke-free, depending on whether the man is typing away on his computer, or whether he is having a little break for a cup of tea?
Our hypothetical al fresco worker could be hashing out his latest policy report, but he could also be having a little break to play solitaire or chess. Would that count as working or slacking? Would that then be a workplace or not? Would the police officer attending the scene have to check that the man is working before issuing a fine to nearby smokers? I suppose playing computer chess could count as work if the man were a professional chess player—perhaps he is. How would the offending smoker or the police officer know what the person near them is doing?
These are somewhat colourful hypotheticals, but I hope I have demonstrated that the clause does throw up a great deal of colourful hypotheticals. For the sake of the Bill’s integrity, I would appreciate clarity from the Minister on the terms used in the clause.
Furthermore, I would appreciate clarification on how we designate the physical borders of a smoke-free area. With three children, I have been to a fair number of playgrounds. Some playgrounds have physical barriers around them, often some sort of knee-high fencing, making it easy to say where the physical borders of the playground are. But some do not—some are play areas within a park where there is no clear boundary between where the play equipment is and the rest of the park. Does that make the rest of the park a playground or not, and where would the edges be?
Given the seriousness of the offence and the significance of the penalties, the Government should ensure that reasonable steps are taken so that people know when they are violating the law. In this case, will physical markers need to be built around every smoke-free area to ensure that smokers know exactly when they enter one? I can think of many village playgrounds local to me where there is no such marking. Has the Minister considered the cost of providing barriers or markings to ensure that people know where the boundary is?
The nature of second-hand smoke throws up another issue. The Minister well knows that the smoker need not be physically present in the smoke-free area for the effects of second-hand smoke to be felt in one. How does the clause propose to seek to address that scenario? If a park is designated smoke-free, and is or is not barriered, but someone is sat there smoking, watching her children play—she wants to be reasonably close to them so she can keep an eye on them, protect them and keep them safe—would she be violating the smoke-free area if her cigarette smoke wafts beyond the bounds of the park? What if the wind blows the other way? Would that then be legal? Are the mother’s actions based entirely on which way the wind happens to blow?
The principle behind the clause is very sensible: smoking is dangerous, passive smoking is a danger to others, and people—particularly children—should not be forced to breathe in other people’s smoke. But the enforcement of this clause requires it to be made very clear what people should and should not do, and where they should and should not do it. I am not entirely sure that the clause is clear enough on that.
Gregory Stafford (Farnham and Bordon) (Con)
Like the shadow Minister, I agree with the essential thrust of clause 136, notwithstanding the amendments that I voted for earlier, but there is a clear problem with second-hand smoke. We have seen in studies from Public Health England and the World Health Organisation that even brief exposure to second-hand smoke can increase the risk of respiratory diseases, heart disease, and lung cancer—particularly among vulnerable populations such as children and the elderly, as the Minister outlined.
However, we have to understand that there are clearly differences in how much smoke could be inhaled, depending on the setting. Where air circulation dissipates smoke, such as outside, the risks are probably not as pronounced as they are indoors. Although I do not dispute—I do not think anyone does—the dangers of second-hand smoke in enclosed spaces, the question remains whether outdoor areas such as parks and public squares should be subject to the same restrictions.
Andrew Gwynne
People sitting in a beer garden where smoking is prevalent are breathing in second-hand smoke, but as the chief medical officers reminded the Committee, there is a balance here, and the United Kingdom Government of which I am a member have decided that that balance is appropriate in order to protect the hospitality business. That is why Ministers—myself, the Secretary of State and the Prime Minister—have made it very clear that outdoor hospitality will not fall within the scope of the consultation that we intend to bring forward like the clappers. That is our view and it is what we will do. That is not to say that there is a risk that is mitigated for somebody sitting outside. There is a risk, and we cannot mitigate that risk, but it is the balance that the Government have come to. There have to be trade-offs and, given the precarious nature of the hospitality business, we have decided that we will not consult to extend the outdoor smoking provisions to hospitality. I know that that disappoints the shadow Minister—it probably delights other Members on the Opposition Benches—but that is where this Government are.
The powers in the Bill allow for a change at some stage in the future, when it may well be that the balance has shifted and people no longer desire there to be smoking outdoors in hospitality settings. The hospitality trade may say, “This is such a minority pursuit that it is putting off good people from coming to my restaurant.”
Gregory Stafford
Forgive me if I am incorrect, but the Minister is saying that businesses may make the decision that they do not want people to smoke on their premises. They already have that power now, so I am not sure what point he is making.
Andrew Gwynne
The point I am making is that industry collectively may come to Ministers and say, “You know what? This carve-out that we’ve been given is no longer needed.” Ministers may well then come to the conclusion that, given that most of these hospitality businesses at some stage in the future are already imposing outdoor smoking bans because that is where their customer base is, we should bring the law into line with that and make it illegal. The provisions are written in the way that they are so that at some stage in the future, when things change, we can change the law, but right now, as I have said on umpteen occasions, we will consult on outside hospitals, outside schools and public children’s play areas, and that is it.
Andrew Gwynne
That is why it will be down to the consultation as to what precise details we will bring forward. It is not our intention to include hospitality settings, but the hon. Member has rightly raised that some pubs and restaurants have children’s playgrounds. As part of the consultation exercise, we will have to work out how a children’s play area is defined for the purposes of these measures, so that there is absolute clarity on what constitutes a children’s playground. These are not matters for now; they are matters for when Ministers seek to bring forward proposals. We will have that debate then.
Gregory Stafford
I know the Minister is a man of his word. I ask him to be really clear on this, because he has talked about “some point in the future”. Some people’s “some point in the future” may be a very long way off, while others’ may not be such a long way off. Will he give a commitment that, while he is a Minister in the Department of Health and Social Care, he and his colleagues will not bring a consultation to include the hospitality industry?
Andrew Gwynne
Well, I hope that I will be a Minister for a very long time, both at the Department of Health and Social Care and with this public health brief, which I absolutely love. I will follow the evidence as and when it appears, but it is not my intention to bring forward changes any time soon. The reason that we are discussing changes now is that the last time that places were designated for a smoking ban was in 2006, and a lot of things have changed since that law came into force in 2007.
It may well be that, in a similar length of time into the future, things have changed sufficiently that the arguments we are having today on hospitality have become obsolete, and that the law needs to be brought into line with the facts on the ground. I hope that I can reassure the hon. Member for Farnham and Bordon—I am a man of my word—that it is not my intention, nor the intention of this Government to include the hospitality industry, but at some stage in the future, if things change, it may well be that Ministers do come back to the House on this. I cannot judge how long or short that time period may be, but I politely remind him and other Members of the length of time between 2006-07—when these issues were last being debated—and now, and hope that that gives him some reassurance.
The hon. Gentleman said that I have not been emphatic enough on beaches, woodlands, public parks, rights of way and public squares; these are all scenarios that are subject to consultation at some stage in the distant future. It is not our intention to cover these areas in England. I have been very clear about the three areas that we seek to extend smoke-free places to.
Jack Rankin
It is nice to have a fellow freedom fighter on the Committee—[Interruption.] I am trying to get the Minister to intervene.
My third point is one to which I think the Minister alluded earlier, but I ask him to repeat it in summing up. This part of the Bill will allow the Secretary of State to make decisions without really having the full approval of Parliament. The Minister has said that the Government will consult on the expansion of smoke-free areas, but as I understand it from the drafting, it is not necessary for the Government to consult on expanding vape-free and heated tobacco-free spaces in the same way. I think he might have touched on that point in his remarks, but I would welcome his confirmation.
My fourth point relates to the intervention of my hon. Friend the Member for Sleaford and North Hykeham on second-hand smoke. My understanding is that the rationale for smoke-free places, as initially envisaged, was that the smoker is affected as a result of them having made an informed decision, but people nearby are affected who have not. That is the point of the smoke-free place. Cancer Research UK, however, states that there is
“no good evidence that second-hand e-cigarette vapour is harmful”.
Public Health England has also found:
“Compared with cigarette smoke, heated tobacco products are likely to expose users and bystanders to lower levels of particulate matter and harmful and potentially harmful compounds.”
In my view, therefore, the point about second-hand smoke does not make anywhere near the same kind of sense for heated tobacco products as it does with cigarettes.
Even the Bill’s impact assessment states:
“There are currently no legal restrictions in the UK on where a person may vape. However, many businesses, venues, educational institutions, health service providers and public transport providers have voluntarily introduced their own rules preventing vape usage in these locations.”
We all recognise that that is the case. Given that the impact assessment also notes that
“There is currently limited evidence of health harm from ‘passive vaping’.”
should it not continue to be for the proprietors of such venues to make their own decisions, based on the needs and desires of their customers? That is my position.
Gregory Stafford
My hon. Friend always tempts me with his libertarian arguments. I am not quite with him on this Bill, but almost. Proposed new section 8B(2) of the Health Act 2006 says:
“Only smoke-free places may be designated as vape-free.”
I understand that to mean that there will potentially be places that are smoke-free but not necessarily vape-free, and I wonder whether that gives him any solace. I am specifically interested in our discussion about introducing vapes in vending machines in mental health trusts. Does he think there is a case—perhaps the Minister will comment on this in his remarks—for vapes to be used as a smoking cessation tool in certain places where we cannot smoke a cigarette or use other tobacco-based products?
Jack Rankin
My hon. Friend gets to the nub of the point that I am making. Vapes can be a tool to help the Government in their desire to create a smoke-free generation, and this legislation could be counterproductive to that, by their own measures of success. Members—certainly those on the Opposition Benches—have to engage with not necessarily the law that is written but how it will be implemented in reality. Businesses are likely to respond to this legislation by just putting up a sticker on the smoking shelter that says it is the designated vaping place as well. That is the risk.
Gregory Stafford
I want to confine my remarks to proposed new section 8D—“Offence of failing to prevent vaping”. I assume that the provisions under section 8D are similar, if not exactly the same, as the ones that would apply to cigarettes and other tobacco-based products. However, there is an issue: it is much easier to spot somebody smoking a tobacco-based product than a vape-based product. Tobacco has a distinctive smell. To be frank, the available products look like cigarettes, cigars and pipes, and we know what they look like, whereas the industry has got better at disguising vapes. Vapes do not have the distinctive smell of tobacco, although they have many flavours as we have discussed, and they do not necessarily look like a cigarette or a similar product.
I am interested in the Minister’s views on whether there will be a different defence threshold for failing to prevent vaping under proposed new section 8D. Subsection (4) says that a defence for a person charged with such an offence is
“that they took reasonable steps to cause the person in question to stop using the vape”.
The question is: will there be a different threshold for those who are sanctioned under the Bill for a tobacco-related offence versus a vape-related offence? That brings us back to burdens on the hospitality industry, retailers and so on. If there is not a differential, again, we will be putting undue pressure on retailers or nightclub owners that we would not expect for tobacco offences. It would be helpful to get some clarity on that.
Andrew Gwynne
We have had a good discussion on the clause. I sincerely thank the shadow Minister for the leadership that she has shown over a good number of years on this issue. I am not just saying that because her boss, the shadow Secretary of State, the right hon. Member for Melton and Syston (Edward Argar), is in the Public Gallery, gazing his beady eye over the Conservative Benches to see what is happening—I am sure that is precisely what he is doing.
In all fairness to the shadow Minister, she has taken a consistent view on vaping, which in some regards goes beyond the scope of the Bill. I know that it frustrates her, and indeed perhaps one or two Members on my own Benches, that the scope of the Bill does not go as far as creating a nicotine-free generation as well as a smoke-free one. I put on record my thanks and appreciation to her for championing this issue over a good number of years. I know that is why she supports the clause, as she said, and perhaps secretly supports a number of the other clauses that she has abstained on in Divisions—probably to further wind up the hon. Member for Windsor.
On the clause, there is evidence that second-hand exposure to vaping may worsen asthma in children and teenagers. There are also wider concerns about young people taking up vaping and becoming addicted to nicotine. To protect children and vulnerable groups, we are therefore taking powers to consider whether certain places, such as public transport, should be vape-free as well as smoke-free.
It is important that we consider exemptions for certain settings, particularly those with the intention of helping adult smokers to quit. I hope that that reassures the hon. Member for Farnham. That is an important aspect for us to consider, and it will be explored through consultation.
Gregory Stafford
Just for those listening, I should say that I am the Member of Parliament for Farnham and Bordon. The people of Bordon will be very upset if they are not mentioned.
Jack Rankin
I would not describe myself as libertarian; I would say I was arguing straightforward centre-right classical liberal opinions, rather than libertarian ones, but we might differ on that. An arbitrary line must obviously be drawn. The same argument could be made about someone idling in a car and people on the street. There is obviously a difference between that and smoking, where we have drawn a line. I acknowledge that I know less about heated tobacco products but, from what I have read, the spill-over effect from nearby users does not reach a threshold to merit state intervention—though I agree that that judgment is qualitative. That is the argument I am advancing. I again make the point to the Minister that heated tobacco, while a recent innovation, has been reported to be positively associated with success in quitting. We should therefore be careful and not treat it the same way as cigarettes in an effort to advance the aim of the Bill, which is to get more adult smokers to use this product and move away from smoking.
Gregory Stafford
Like my hon. Friend, I am no expert in heated tobacco products, but is he suggesting that they can also be used as a smoking cessation tool? If that is the case, his argument bears some weight. Does he have any understanding of where in the spectrum of harms—from cigarettes and cigars at one end to not smoking at all at the other, with vapes placed at some point on that continuum—where heated tobacco would sit? Is it closer to traditional tobacco-based products or to vape products? Is it an intermediary step, whereby someone who is trying to quit might move from smoking a cigarette or a cigar to heated tobacco, to vaping, and then eventually to quitting? Is that how he would see it?
Jack Rankin
That is effectively the argument I am advancing. In terms of the quantum of harm as a percentage of a cigarette, I do not know. As I understand it, even though we do not fully know yet the dangers of heated tobacco, it is similar to vaping in that we do not want anybody to take it up, but if someone smokes we would prefer them to use it as a cessation device. I understand that that is the way they are marketed.