Mental Health Bill [ Lords ] (Sixth sitting)

Jen Craft Excerpts

Committee stage
Tuesday 17th June 2025 Public Bill Committees

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

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

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

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

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

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

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

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

[Jen Craft (Thurrock) (Lab)]

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

[Gregory Stafford]

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

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

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

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

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

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

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

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

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

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

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

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

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

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[Stephen Kinnock]

Yes, but the issue may have a bearing on a potential Division. The challenge that I am facing is that my notes said,

“This amendment seeks to overturn”,

but we are talking about a clause that is seeking to overturn a previous amendment. Are we speaking in favour of a clause that will overturn an amendment? [Interruption.] Confusion reigns.

[Jen Craft]

I am equally confused; I did not think we were talking about an amendment. I thought we were talking about a clause. Apologies.

[The Chair]

Clause 35 was added by a Lords amendment; maybe that is where the confusion has come from. The Government tabled an amendment to leave out clause 35.

--- Later in debate ---

[Stephen Kinnock]

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

[Jen Craft]

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

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

[Gregory Stafford]

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

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

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

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

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

--- Later in debate ---

[Stephen Kinnock]

The CQC visits and interviews thousands of detained patients each year under its statutory duty to monitor the use of the Mental Health Act. Those visits can lead to the CQC requesting improvements from service providers. The CQC publishes annual reports highlighting key findings and themes from those visits.

Trust boards are responsible for collecting and acting on service user feedback to improve services. Under the NHS contract, the patient and carer race equality framework requires trusts to have clear and visible systems in place for gathering and responding to feedback from patients and carers. What is more, Healthwatch England and its local branches also play a key role in representing the views of health and social care users. I do not really know what more the system could do. The clause simply over-embroiders and over-complicates; when that happens, we usually end up with vast numbers of unintended consequences.

We appreciate that concerns have been raised around the CQC’s role in collecting in-patients’ views. As I said, we would prefer to work with stakeholders to understand those concerns and improve the feedback mechanisms that we have, rather than reinvent the wheel and create something new. We recognise that, although there are multiple aims to the clause, the primary one is to provide a space for people to heal from their experiences of being detained. We are strongly of the view that inviting the individual to share their experiences as part of their advance choice document or care plan—

[Jen Craft]

I am glad that the Minister is explaining how capturing feedback and experience is being allowed for in other parts of the Bill. To clarify, in my own head I feel that the clause aims to capture the experience immediately after it has happened, just as hospitals offer women who have just given birth the opportunity to talk through their experience. It is healing for the patient to understand what happened to them, and it provides immediate feedback to the hospital. Is that kind of level captured in other parts of the Bill?

[Stephen Kinnock]

I understand and recognise my hon. Friend’s concerns, but we can rattle through all the different forums where feedback can be captured: the CQC, the trust boards, the patient and carer race equality framework, Healthwatch England and all the other informal channels in the mental health ecosystem. Our view is that adding another layer into all that would in the end be counterproductive. That is the Government’s position.