Suicide Prevention

Luke Evans Excerpts

Thursday 11th September 2025 Commons Chamber

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

I thank the hon. Member for Doncaster East and the Isle of Axholme (Lee Pitcher). He honours John by securing the debate. All hon. Members who have spoken have honoured respectively the people they held so dear, in the most powerful way possible by turning personal grief into public purpose. I therefore thank them all for giving their time to speak.

There was a TikTok video that went viral. It opens with a young woman energetically and innocently asking:

“Be honest: who do you call whenever you’re at your lowest? Who’s that one person?”

The stitched video replies come in, with men answering. The replies are harrowing and insightful:

“Nobody. I’m a man. No one cares.”

“Not a single soul.”

“Nobody.”

“No one, cause I am all alone.”

“I think I speak for a lot of people when I say I don’t call anyone.”

“Nobody. I’m a guy—no one gives a s***”

“Speaking for the guys, literally no one.”

“You all call someone?”

“There’s no one. Nobody who cares.”

“No one. I’m a man. No one cares.”

“Not a single person. I wouldn’t turn to a single person on this earth as they will use it against me.”

“I wouldn’t call anyone.”

“What—we can call somebody?”

That small insight from a seemingly jokey platform hits on what we—the House and wider society—must look at to try to understand why men feel they are not valued. Why do they feel they cannot call someone? Why do they fear doing so will be used against them? Why do they fear asking for help? Many hide in plain sight, struggling and battling until it is too late. After all, we know from the Samaritans that about two thirds of suicide victims are not known to mental health services.

Hon. Members may wonder why I am choosing to focus my comments on men when the latest data from the Office for National Statistics shows that suicide rates are at their highest level since 1999. As we have heard, men account for three quarters of all suicides in the UK. The latest paper by the Centre for Policy Research on Men and Boys puts that in stark light. It showed that more men under 50 die in the UK due to suicide than for any other reason; 14 men every day die by suicide in the UK; 74% of all suicides are male; three times as many men die by suicide every year than die in a vehicle accident; and by 2023, over 90,000 men in England and Wales had died by suicide this century. That is enough to fill Wembley stadium.

There is so much to do in this area. I want to highlight the focus and progress of the previous Government. Through the NHS long-term plan, an additional £57 million was provided by the former Conservative Government between 2019-20 and 2023-24 to fund suicide prevention and bereavement services in every local authority. My former colleague Sajid Javid, who was touched tragically by the experience of losing his own brother to suicide, was instrumental in starting the development of the suicide prevention strategy, which was published in 2023. Key initiatives included the development of a new nationwide, near real-time suspected suicide surveillance system that aimed to provide early detection and timely action to address changes in suicide rates. The strategy in its entirety set out over 100 actions to make progress across Government Departments, the NHS, the voluntary sector and national partners.

In 2021, the previous Government also announced £150 million of funding for crisis mental health facilities and patient safety in mental health units. In January 2023, it was announced that £7 million of funding would be allocated to new mental health ambulances, with £143 million going towards 150 new projects, including schemes providing alternatives to A&E. That is welcome, but the stats show that, even with all that focus, the trend is worsening.

Despite all that work and prioritisation of funding, we have yet to hear anything substantial from this Government about what they are doing on suicide prevention. As we know from one example, training can make a difference. Samaritans reports from its rail team that, for every one life lost, it is estimated that six lives are saved by interventions made thanks to the training given to National Rail and rail operating staff. That is proof that things can be done.

Just yesterday it was World Suicide Prevention Day and the Prime Minister was asked twice about the topic. In response he said, first:

“May I also thank those dealing with suicide prevention? Probably everybody in this House knows someone who has taken their life. It touches all of us and we must do everything we can, together, to prevent suicide.”—[Official Report, 10 September 2025; Vol. 772, c. 862.]

Secondly, he said:

“I think that suicide prevention matters to everybody in this House. I will reaffirm our commitment and I will work across the House with all Members to deal with suicide prevention.”—[Official Report, 10 September 2025; Vol. 772, c. 868.]

Those are positive, warm words from the Prime Minister, which we are all pleased to hear. However, I think that we, across this House and among the public, would be interested in hearing the tangible actions taken by this Government after one year in office. Will the Minister provide an update on what direct, practical steps this Government are taking on suicide prevention, including the implementation of the recommendations in the strategy? What points—for example, disparities in the difference across ethnicities and races in the UK—are being addressed?

I know that the Government have been consulting on a wide range of issues, particularly when it comes to men’s health and the men’s health strategy. I have been shining a light on those issues since I was elected in 2019, so I thank the Government for taking that important step forward. I understand that the Government are due to publish the mental health strategy and I commend them for that. Indeed, I note than in an Adjournment debate earlier this year, the Minister for Care stated:

“In November, my right hon. Friend the Secretary of State for Health and Social Care brought together leading campaigners, experts and the Premier League to gather ideas and inform our strategy and our 10-year health plan. We take suicide prevention extremely seriously, because every suicide is a tragedy that has a devastating and enduring impact on families, friends and communities.”—[Official Report, 24 March 2025; Vol. 764, c. 757.]

His Majesty’s Opposition welcome that step forward, but in looking at the 10-year plan, I note that suicide is mentioned only three times. I think that everyone here hopes to see it feature heavily in the upcoming men’s health strategy. Will the Minister provide an update on timescales for the strategy and how it will consider suicide prevention?

Will the Government look at the prospect of a Minister for men and boys if the evidence points in that direction? We have a Minister for Women, as we believe that women have different problems across society. By that very logic, men and boys have different needs too. If we are to go down the route of segregating policies on sex, there appears to be a compelling argument to have a men’s Minister to work across Departments. That cannot be starker if we consider that for every woman who dies by suicide in the UK three men die.

Another achievement by the previous Government was the launch of the suicide prevention grant fund, as we have heard, providing £10 million to 79 organisations between August 2023 and March 2025. In my constituency, the charity First Step Leicester, Leicestershire and Rutland received £76,845 and the grant was used to improve specialist counselling work in prisons and to build on pilot projects. It is therefore a regret that the suicide prevention grant came to an end in March 2025 and has yet to be renewed or replaced. In response to a written question in April, the Minister for Care stated:

“There are currently no plans to run another grant fund.”

Will the Minister explain the basis behind the decision earlier this year not to renew or replace the suicide prevention grant fund, and what alternative provision, if any, is being provided?

[Liz Twist]

I thank the shadow Minister for his comments. There is no question but that we all want to work together to achieve the best outcome. May I remind him, however, that the £10 million voluntary services grant was a one-off grant and that the last Government failed to renew the funding—the £57.1 million that was mentioned—for local authorities’ prevention work?

[Dr Evans]

I thank the hon. Lady for all the work she does with the APPG. I am looking holistically at the different parts of what we are trying to do in this space. I have already outlined all the funding that the previous Government put in, and I will come on to some of the other problems, such as the national insurance rise, because she will know that they will have a devastating impact.

At the time, the Minister also stated:

“We will be evaluating the impact of the fund, and the services that have been provided by the grant-funded organisations. Learning from this evaluation will help to inform…the Government’s mission to reduce the lives lost to suicide.”

Could the Minister provide further details about that evaluation, such as when it will be completed and whether the Government would reconsider their decision to end the grant funding if the results show that it has had a positive impact in supporting suicide prevention?

Charities were not exempted from the increase in employer national insurance contributions in the Budget. That has significantly hampered their financial situation. We just have to listen to what the Samaritans said in response to the spending review last year:

“The reality is that funding for suicide prevention has dwindled down to next to nothing. To deliver our life-saving work, charities are reliant on donations—on the generosity of the public. And this is even more precarious at a time when many people across the country are facing economic hardship.”

I point that out not to score political points, but to draw attention to the fact that the Labour Government need to set a direction and plan to deal with the leading killer of men and women under the age of 30.

In closing, I want to recognise that yesterday was World Suicide Prevention Day. Every year, 720,000 people across the world take their own lives. The theme this year was, “Changing the Narrative on Suicide”. It calls on us all to challenge harmful myths, reduce stigma and foster open, compassionate conversations about suicide. That leads me to where I started: if men do not know their value, if they do not know they have someone to confide in and if they do not truly believe that we care, we will not break the cycle, we will not make a difference and, ultimately, we will not save lives. That is the challenge laid before society, this House and, ultimately, this Government.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I believe we have a new Minister, Dr Zubir Ahmed—congratulations on the promotion and welcome to the Dispatch Box. Just in case you need to know, we have been touched by young male suicide in my constituency of Sussex Weald, so I will be listening closely to your response.

Eating Disorders: Prevention of Deaths

Luke Evans Excerpts

Tuesday 2nd September 2025 Westminster Hall

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

The hon. Member for Isle of Wight West (Mr Quigley) said that he wants to push for change, and he is a tremendous advocate for doing exactly that. We are six months on from a very similar debate on eating disorders. The fact that so many Members across the parties are here to support the debate shows the strength of feeling.

In the short time that I have, I will not repeat everything that I said last time. Following the debate in April, I wrote to the Government to find out more and ask some questions. I received a letter from Baroness Merron on 12 June. The first question I had asked was whether the Government had a plan for eating disorders. The reply stated:

“The Department has no current plans to create an eating disorder strategy”.

It went on to say:

“NHS England is currently refreshing guidance on children and young people's eating disorders. The refreshed guidance will highlight the importance of awareness and early recognition of eating disorders within schools, colleges, primary care, and broader children and young people’s mental health services.”

I hope that the Minister can provide us with an update on when that updated guidance will be brought forward.

Back in April, I also posed the question whether the Government would be open to having a cross-party meeting or roundtable with experts in APPGs. I have not yet had a response to that question, either in a debate or in the letter that I received, but I think it would go a long way towards helping to explore this issue in a way that would make a difference.

In the previous debate, the hon. Member for Bath (Wera Hobhouse) raised an issue around the recording of death. She said:

“Accurate recording will raise awareness and ultimately save lives.”—[Official Report, 1 April 2025; Vol. 765, c. 30WH.]

The Minister responded:

“I share the concern of the hon. Member for Bath about accurate recording of deaths to understand the extent to which eating disorders and other factors have caused or contributed to deaths. This matter is being explored with the national medical examiner for England and Wales, the Office for National Statistics and the Coroners’ Society of England and Wales.”

Can he provide an update on where that has got to and what the outcome is?

Back in April, the Minister also gave us great expectations about the 10-year health plan:

“Through the 10-year health plan, this Government will overhaul the NHS and ensure that those with mental health needs, including those living with eating disorders, are given the support that they need.”—[Official Report, 1 April 2025; Vol. 765, c. 49WH.]

He also said:

“Raising awareness of eating disorders and improving treatment services is a key priority for the Government, and a vital part of our work to improve mental health services.”—[Official Report, 1 April 2025; Vol. 765, c. 47WH.]

I will be grateful if the Minister can respond to the Beat CEO, who has said:

“We’re very disappointed to see that mental health hasn’t been consistently highlighted as a priority throughout the Government’s 10 Year Health Plan, and that there are no specific commitments on eating disorders.”

That is a concern—not as a party political point, but because people who are suffering can now see it written that there is no strategy, and it is not mentioned in the 10-year health plan. I will be grateful if the Minister can alleviate the concerns about whether this issue is truly a priority.

Finally, one of the big plays that the Government have made is changing integrated care boards. In the last debate, the Minister said:

“The Government’s view is that ICBs are best placed to make decisions as close as possible to the communities that they serve and to target and, if necessary, reallocate funding accordingly.”—[Official Report, 1 April 2025; Vol. 765, c. 47WH.]

The changes brought forward by this Government have seen a reduction in staffing of 50% in many ICBs. Are the Government concerned? Has any analysis been done of whether there will be an impact on commissioning in respect of eating disorders, given the severity that has been highlighted across the Chamber?

It is often said that treatment is about progress, not perfection. I guess that much the same could be said about formulating policy as we deal with the rising number of people with eating disorders. To that end, I hope that the Government will take these questions as part of the process, helping to highlight this area in which we all want to see progress as the Minister brings his policies to bear on this country.

--- Later in debate ---

[Stephen Kinnock]

I will come on to talk about the guidance that is being produced. There is a risk that we can end up with a proliferation of documents, strategies and plans. Our view is that the more streamlined we are and the clearer the lines of accountability, the better the performance becomes. We are committed to the guidance, and I will talk a bit about that, but we are not convinced that having strategies alongside guidance, plans and other documents will help the process.

Members here will be well aware of the increase in the prevalence of mental health conditions, including eating disorders, since the pandemic. The increase in demand has placed significant pressure on services, but the extra funding is making a difference. The latest quarterly figures from NHS mental health services monthly statistics show that, between April and June 2025, 3,138 children successfully entered treatment in community eating disorder services. That is the highest figure on record since NHS England began collecting this data in 2021.

At the same time, waiting lists to begin routine eating disorder treatment have shortened by 20% from the year before. NHS England has also commissioned the Royal College of Psychiatrists to carry out a national audit of eating disorders. That audit is collecting data on eating disorders across community and in-patient settings to drive improvements in the identification and treatment of eating disorders. The audit will monitor how services are performing against standards, and highlight any inequalities in access to care. That will help services to provide safe, effective, patient-centred, timely, efficient and equitable care.

In addition to improved services for the treatment of eating disorders, we are also working to tackle their underlying causes. In particular, we are deeply concerned about harmful online content that promotes negative body image, harmful eating behaviours, suicide or self-harm to those who are most vulnerable. The Online Safety Act 2023 has now come into force and delivers on our commitment to make the United Kingdom the safest place to be online. By now, all sites with a significant user base in this country are required to have conducted children’s access and risk assessments, and to follow the new children’s safety codes to prevent them from accessing harmful content, such as promotion of eating disorders. Ofcom now has the ability to investigate or carry out enforcement action against any site that will not abide by those codes.

Hon. Members today have raised the need for early intervention to lower the numbers of hospital admissions from eating disorders. We know that the earlier the treatment is provided, the better the chance of recovery, and we are committed to ensuring that everyone with an eating disorder can access specialist help. As part of our mission to build an NHS that is fit for the future, there is a critical need to shift the treatment of eating disorders from hospital to community, including children’s community eating disorder services, crisis care services and intensive day-hospital or home-treatment services. Improved care in the community will give young people early access to evidence-based treatment involving families and carers, thereby improving outcomes and preventing relapse. By preventing eating disorders from progressing into adulthood, we will build on our aim of raising the healthiest generation of children.

We have also committed to expanding mental health support teams to reach full coverage in England. To date, we have expanded MHSTs to 52% of pupils; they are working hard in schools to support staff and students alike in meeting the mental health needs of children.

[Dr Luke Evans]

I thank the Minister for giving way. I am pleased that his Government have continued the roll-out, because we share the aim of trying to deal with this early. On that point, there was mention of the updated guidance, and clearly these hubs are going to need that guidance if it is updated. Will he set out when that guidance will be brought forward?

[Stephen Kinnock]

I absolutely will; that is just coming up in my comments. I am not sure that the shadow Minister will be satisfied with the answer, but I will refer precisely to the question that he is asking.

The MHSTs will continue to provide assistance to school staff in raising staff understanding, recognition and awareness of eating disorders, ensuring that they can provide crucial early intervention for children at risk.

Early intervention is also a priority for adults with eating disorders, as set out in the NHS’s adult community mental health framework. NHS England has established 15 provider collaboratives focusing on adult eating disorders. Those collaboratives are working to redesign care pathways and focus resources on community services. By providing treatment earlier and closer to home, we will see better outcomes for adults with eating disorders and their families.

Turning to the guidance, which a number of hon. Members, including the shadow Minister, have raised, we are producing updated guidance to help services to implement those transformations. NHS England first published guidance in 2019 for adult eating disorder services to ensure that they are integrated with day-patient services or in-patient care. A new service specification for adult eating disorder in-patient provision has been through a public consultation and will progress to publication this year. So I can guarantee that it will be published before 1 January, but I cannot give the shadow Minister a precise date.

[Dr Evans]

Forgive me if I misheard, but the Minister said that that was for adults. Can he comment on children and schools?

[Stephen Kinnock]

Can I come back to the hon. Gentleman on that? I will double-check. My understanding was that this was for both. My notes do say “for adult eating disorder services”, but my understanding was that this was a holistic process that would include children and schools. I will come back to him to confirm that point, so apologies if that is not entirely clear. Actually, I am sorry—it is next in my comments. NHS England is also producing updated national guidance for eating disorders in children and young people. That will reflect the full range of eating disorders in children and young people, and the treatment options available to CYP and their families to address them. It will focus on early identification and intervention, community treatment and support, and it will highlight the importance of integrating schools, colleges and primary care to improve support. Before the hon. Gentleman intervenes, he will have noted, as I have, that there is no specific date for that, so I will come back to him on that. The adult one will be before 1 January.

I would like to address the very serious concerns that have been raised about reports of people with eating disorders being offered end-of-life care. Let me be absolutely clear: these reports are deeply troubling, and I acknowledge the distress that they will have caused to families and all those affected by eating disorders. The Royal College of Psychiatrists has been crystal clear that eating disorders are not terminal illnesses. It has updated its guidance to re-emphasise that important point, so that no person, nor their loved ones, should ever feel that treatment has reached a point of no return.

NHS England is clear that all those with severe, complex or long-standing eating disorders should have access to eating disorder services, including hospital care when needed. A personal recovery model, with a focus on harm minimisation, symptom management and quality of life, is well established in providing hope and opportunities for recovery for many people with eating disorders. English law provides a robust framework for safeguarding a patient’s best interests.

I assure hon. Members that we take these concerns very seriously. We will continue to work with clinicians, NHS England and families to ensure that the highest standards of care are upheld, and that every person is given hope and support in their recovery.

Hon. Members have raised how those with eating disorders are disproportionately at risk of self-harm or suicide. The national suicide prevention strategy has highlighted the increased risk, and is committed to working with policy, clinical and personal experience experts to explore bespoke suicide prevention activity when needed. Specialists in eating disorders must ensure that they take a holistic approach to eating disorder treatment, and ensure that they are not likely to inadvertently increase the risk of suicide.

Several hon. Members, as well as the APPG report published in January this year, have raised the creation of a national register for eating disorder deaths, and the holding of a confidential inquiry into all eating disorder deaths. I reassure colleagues that the Department of Health and Social Care is wholeheartedly committed to learning from deaths, in order to prevent future tragedies and to improve quality of care.

The Department receives and responds to prevention of future deaths—PFD—notices relating to eating disorders, and it uses that work to inform practice going forward. For example, the medical emergencies in eating disorders—MEED—guidance was created following a coroner’s report and has since been rolled out nationwide. This Government are determined to focus funding directly to frontline services, in order to best support those currently struggling with this deadly illness.

Similarly, we share the concerns that have been raised about eating disorder deaths not being accurately recorded. It is vital that the extent to which eating disorders have caused or contributed to deaths is properly known. That matter is currently being explored with the national medical examiner for England and Wales, the Office for National Statistics and the Coroners’ Society of England and Wales.

To draw my remarks to a close, I would like to thank all the hon. Members here today. The fact that the debate was so well attended reflects how important the issue is to all of us and our constituents. The service that we provide can often be a matter of life and death. We are all very conscious of the gravity of the responsibility that we hold in that context. I thank all those in attendance for advocating for their constituents and all those across the country who have been affected by an eating disorder.

NHS Pensions: Frontline Patient Care

Luke Evans Excerpts

Thursday 17th July 2025 Commons Chamber

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

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on NHS pensions and the impact of administrative delays on frontline patient care.

[The Minister for Secondary Care (Karin Smyth)]

As the House knows, the NHS pension scheme is administered by the NHS Business Services Authority, which is facing challenges, as are all public sector pension schemes, as a result of the coalition Government’s public sector pension reforms in 2015, which in 2018 were found to have been discriminatory—known as the McCloud remedy. The work to remedy that is complex, and much of that I have already detailed in a written ministerial statement on 31 March and a subsequent urgent question. It is complex, technical work, and as the NHSBSA began to produce individual statements, it became clear that its initial estimate of the time needed for each one was too low. My written statement of 1 July updated the House that the NHSBSA did not meet its deadline to deliver statements to certain classes of member by that date and set out the actions that I was taking.

Let me be clear that this Government remain absolutely committed to providing affected members with their statements at the earliest opportunity, and that is what we are doing. The authority is developing a revised plan, and I will hold it to account against the new deadlines. I met the chief executive of the authority and was very clear about my disappointment in the progress, my expectation for the authority to remedy the situation for members, and the need to have a more robust assessment of the delivery plan. I also ensured that the independent chair of the NHS pension board is ready to set up an independent review of the delivery plans. I met her yesterday and was clear that I expect a thorough review of the process and a realistic assessment of delivery, and to hear her initial assessment. She will give her full report after the summer recess.

I will set new deadlines, including for members who are expecting statements this month. I will update the House as soon as possible, of course, both on the progress with the assessment and on the revised deadlines. Let me be clear that members will not face further financial detriment as a consequence of remediable service statement delays, interest on related pension arrears will be paid at 8%, and my Department and the authority have already put in place compensation arrangements for direct financial losses that members may have incurred.

People who have served in our NHS deserve their dues, and we will prioritise members based on need. Let me end by reassuring the House that there will be no direct impact on frontline care. I will continue to update the House.

[Dr Evans]

I declare an interest, for myself and on behalf of the shadow Front-Bench team, as we all have NHS pensions.

In April, Mr Speaker granted us an urgent question because the Government have no real plan for NHS pension statements. Today we return because the Government have now admitted in writing that a new plan is failing— deadlines were missed, then pushed back, and now we have no idea what they are. Just 1,359 statements have been issued out of a required total of 381,920—just 0.35%. Further still, there is no comment on the remediable pension savings statements. Has the Government’s own delayed deadline of July been met or discussed?

This matters. Hundreds of thousands of frontline doctors are not getting their pension statements. The British Medical Association is clear that senior doctors are stepping back from extra work for fear of unexpected tax liabilities. In short, taking on extra work risks an extra tax bill of thousands of pounds. When I raised this in April, the Minister retorted that I could have asked about the impact on services of cancelling the strikes. Well, I will do so now, as the strikes are back on. It will be the senior doctors who have to pick up the slack—the very doctors who are avoiding extra shifts for fear of the tax. If they will not take on the extra work for fear of the heavy tax burden, we have a huge problem.

This should be a priority for the Government, especially as we plan for winter pressures. What will the Minister do to remedy the situation with RSS? What will she do regarding RPSS? Ministers cannot just announce new deadlines and then miss them, so would she be kind enough to publish a delivery plan? Finally, she said that the Government have faith in the NHS Business Services Authority. Is that still the case? Will she demand that the Pensions Regulator steps up and expedites its investigation, given that the referral was made in December 2024? In the end, doctors are counting on her, and so are their patients.

[Karin Smyth]

As I outlined in my initial response and further to the written ministerial statement, we have asked for an independent review of the process and will report back as soon as possible with a realistic deadline for that. With regard to the strikes, we will continue to be open to discussing the avoidance of those strikes, and I hope that the Opposition will support us in that.

Rare Cancers Bill

Luke Evans Excerpts

Report stage
Friday 11th July 2025 Commons Chamber

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the shadow Minister.

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

I rise to speak on behalf of His Majesty’s official Opposition in support of the Rare Cancers Bill, and to welcome its thoughtful and necessary intervention on behalf of a group of patients who have been under-researched, under-represented, and under-acknowledged for too long. I commend the hon. Member for Edinburgh South West (Dr Arthur) on bringing this Bill forward, and on his ongoing dedication to the issue.

The case for the Bill is clear: rare cancers—defined, in line with the UK rare diseases framework, as conditions affecting fewer than one in 2,000 people—are individually uncommon but collectively account for more than 20% of all cancer diagnoses. However, as we know, patients with rare cancers routinely face delayed diagnosis, limited treatment options and far fewer opportunities to participate in clinical research.

The Bill does not claim to be a silver bullet, but it does mark a significant step forward in how we think about and legislate for research, regulation and data access in rare cancer care. It is focused, proportionate and strategically aligned with the existing NHS and National Institute for Health and Care Research frameworks.

Clause 1 places a duty on the Secretary of State to carry out a review of the law relating to marketing authorisations for orphan medicinal products that are for the diagnosis, prevention or treatment of cancer. It also rightly requires that the review includes comparisons with regulatory approaches in other countries. This is vital. The explanatory notes rightly observe that research into rare cancers is often commercially unattractive because of small patient populations and high developmental costs. If our regulatory environment creates further barriers to entry, patients suffer—not because the science does not exist but because the system does not support it.

The UK’s current approach to orphan designation lacks the pre-authorisation incentives found in systems such as the European Medicines Agency and the US Food and Drug Administration. The review required under the Bill is the opportunity to ask whether we are doing enough to attract the research and development that rare cancer patients deserve.

[Sir Christopher Chope]

I am not quite sure whether my hon. Friend is responding to the amendments or making a Third Reading speech. I hope he will address the amendments I have tabled, including those that relate to clause 1, about which he has just spoken.

[Dr Evans]

If my hon. Friend bears with me, I will turn directly to his amendments. It is important to first set out the context, because we must understand the clauses if we are to debate the amendments to them.

Clause 2 makes crucial changes to the Secretary of State’s duty under the National Health Service Act 2006 by stating explicitly that it must include research into cancers that, in the opinion of the Secretary of State, are rare. Although this matters, the research agenda is often driven by numbers and funding scales. By mandating that rare cancers be part of the agenda, the Bill begins to shift the culture towards inclusion, equity and long-term thinking.

I particularly welcome the creation of the national specialty lead for rare cancers, modelling the NIHR’s existing structure of research delivery leaders. This individual will be tasked with promoting and facilitating research, advising on trial design and convening collaboration. The success of this role will depend on it not just being symbolically supported but having a clear remit, adequate funding and a strategic alignment with the wider NIHR research delivery network.

Clause 3 amends section 261 of the Health and Social Care Act 2012 to allow NHS England to disclose information from cancer registries for the purpose of identifying and contacting potential clinical trial participants. This is a significant and necessary step. The Bill distinguishes between a disease registry, like the National Disease Registration Service, and a contact registry, such as Be Part of Research. Making sure that these systems can speak to each other will be of significant benefit when it comes to matching patients with opportunities. Importantly, the clause reaffirms that any such data sharing must remain compliant with the Data Protection Act 2018. As proposed new subsection 6A to the 2012 Act makes clear,

“A power conferred by this section to process information does not authorise the processing of information which would contravene the data protection legislation”.

This is a safeguard that we must preserve, not weaken, if we are to maintain public trust in the system.

At this point I turn to the amendments tabled by my hon. Friend the Member for Christchurch (Sir Christopher Chope). He approaches private Members’ Bills in the way that a jeweller examines diamonds—with a magnifying glass, a steady hand and absolutely no tolerance for flaws. We may grumble as the clock ticks on, but deep down we all sleep better knowing that he is reading the footnotes. This Bill is no different; he has approached it with rigour, and I thank him for his commitment to precision and improving clarity and accountability. As he pointed out, the Bill is not trivial. Therefore, it is not only right, but indeed the duty of this House, to scrutinise closely legislation and amendments laid before us.

To that end, several of the amendments aim to tighten the Bill’s drafting or introduce firmer deadlines. For example, amendment 4 would reduce the timeframe for the review under clause 1 from three years to two. Amendment 2 would require the Secretary of State to

“set out a timetable for implementing any changes in the law recommended by the review.”

I understand the concern that reviews can drift, but the three-year period reflects the complexity of the subject: a UK-wide review of the Human Medicines Regulations 2012, including benchmarking against other jurisdictions and engaging multiple agencies. Compressing the timeline might jeopardise the depth or quality of the analysis. Likewise, a statutory timetable for implementation could constrain the Government prematurely, before the review’s conclusions are even known.

[Sir Christopher Chope]

I am very grateful to my hon. Friend for his unprompted comments. He will know that the funding is sufficient to staff the review only for one year. If there is only funding for one year, why does it take three?

[Dr Luke Evans]

My hon. Friend knows, far better than I, not to look at legislation in isolation. The Government will at some point bring forward the cancer plan, which will have a direct crossover with the Bill, so it is right to give the Government the freedom and space to implement the legislation. If we rush it, we could get it wrong, which would be even more detrimental for those who suffer with rare cancers.

Other amendments address definitions and discretion. For example, amendment 5 would remove

“in the opinion of the Secretary of State”

from the definition of rare cancer, and amendment 8 would remove similar wording in relation to NHS England’s discretion. At first glance, the amendments may seem like matters of tidy drafting, but retaining discretion is important, especially as regards rare cancers. Prevalence data can be uncertain or lagging, and flexibility allows for expert judgments about edge cases in which rigid definitions may unintentionally exclude patients from trials or research that could benefit them.

On top of that, there are concerns even about simple definitions. We are still exploring the difference between, for example, pre-cancerous and cancerous cells. If someone goes for a smear, that is what they are told. This is a new area. Who knows what will come up in the future? Simply defining rare cancers on the basis of lagging prevalence data is a risk, and it is therefore right that the Government and the Secretary at State have discretion to direct in one way or another.

However, I would grateful if the Government would answer the question, which has been rightly posed, of who or what will fill the role when NHS England is abolished. It is not clear exactly what that will look like. I have asked the Minister this question several times, in relation to the Mental Health Bill and other areas, and it is a question that this House should rightly ask. Who will be responsible for what, when and why?

That said, amendment 7, which would ensure that the proposed national specialty lead is appointed within six months of Royal Assent, deserves serious consideration. Patients have waited long enough. If the Government are confident that the post can be established promptly and resourced effectively, I would welcome that ambition being stated at the Dispatch Box today.

Finally, I must express my concern about amendment 9, which proposes to remove the data protection safeguard in clause 3(4). Although the provision may be declaratory, in that it reaffirms existing legal obligations, it none the less offers clarity and reassurance. In an area as sensitive as health data, such clarity matters, and the subsection’s removal could cause unnecessary concern, even if the underlying law remains unchanged.

In conclusion, this Bill is not about grandstanding. It is modest in financial cost, careful in its drafting and realistic in its scope, but its impact could be significant. For patients living with rare cancers, and clinicians and researchers striving to support them, the Bill offers real hope—hope for faster access to innovation, hope for more inclusive research and hope for a regulatory system that works for the many, not just the minority. Every patient matters, whether they are one in two or one in 2,000. As we stated on Second Reading and in Committee, we support the Bill, and I thank the House for giving me the chance to explain why.

--- Later in debate ---

[Dr Luke Evans]

I again thank the hon. Member for Edinburgh South West (Dr Arthur) for his tireless work on this important Bill. It has united the House, and rightfully so, because it speaks to something fundamental: the need for people with rare cancers to be seen, heard and addressed.

The Opposition have supported the Bill from the outset, and as the shadow Secretary of State, my right hon. Friend the Member for Melton and Syston (Edward Argar), and my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson) have said, we will continue to do so today. We would like to thank the charities and campaigners who have worked tirelessly to bring this issue forward: Pancreatic Cancer UK, the Brain Tumour Charity, Cancer52 and many more. Their work has helped to put rare cancers firmly on the agenda, and this Bill is part of their legacy.

I have been on the other side of this, delivering the news, particularly when I worked on an upper gastrointestinal hospital ward as a junior doctor. Delivering the news that someone has pancreatic cancer is one of the toughest things I have ever had to do, and it is worse still for the relatives who have to receive that news. I long for a day when no doctor has to deliver a death sentence to a patient, and this Bill brings that a step closer.

My hon. Friend the Member for Sleaford and North Hykeham spoke in Committee about the repurposing of drugs, and I want to highlight its importance. Treatments that were developed for other conditions may be lifesaving for people with rare cancers. It is vital that the Bill’s scope allows for innovation to thrive. Conservative Members urge the Government to embed the provisions of the Bill in the forthcoming national cancer plan. I hope the Minister will confirm that that will happen, and hopefully he will tell us when it will be published.

Finally, as the expert jeweller, my hon. Friend the Member for Christchurch (Sir Christopher Chope) said on Report—his keen eye for a flaw is important—there is the glaring problem of the pending abolition of NHS England, which poses practical questions about data sharing and, of course, oversight. Conservative Members will do all we can to ensure that the legislation remains workable under the new structures, and I hope the Government will do that too.

The Bill will not solve everything overnight, but it is a serious step forward and a statement that even the rarest conditions deserve our fullest attention. As Maya Angelou said,

“when you know better, do better.”

The House knows better, thanks to the tireless work of the hon. Member for Edinburgh South West, and the Bill will help ensure that we do better too.

Glaucoma Awareness

Luke Evans Excerpts

Wednesday 9th July 2025 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Pritchard. I, too, thank the hon. Member for Leicester South (Shockat Adam), who is a colleague both in my region and in primary care. His powerful testimonies about patients and what they suffer are exactly why he is an asset to this House. He presents information that we all need to hear when we debate health issues.

The hon. Member for Alloa and Grangemouth (Brian Leishman) spoke about the fantastic Perth royal infirmary. It is lovely to hear a success story. We do not hear enough success stories about the NHS, because the good news, despite what we hear in this place, is that the NHS broadly does a fantastic job for many patients, and we should never forget that. The experience he described is what we want to see across the country when it comes to dealing with glaucoma.

The hon. Member for Strangford (Jim Shannon) is nothing if not tenacious and consistent because, when I checked the records, I saw that in April 2024 he introduced a similar debate to raise this cause and to make sure people hear about it. He is a credit to his party and the people he represents when it comes to raising health issues.

The hon. Member for North Ayrshire and Arran (Irene Campbell) talked about NHS working groups. I have worked in places that have had PEARS—primary eye care acute referral schemes. Patients love them, GPs love them and I think the opticians and those who work in the services love them too, because they allow better joined-up care, which is what we all want.

Glaucoma is actually a spectrum of conditions. Ocular hypertension affects 3% to 5% of people in the UK aged over 40. Primary open angle glaucoma affects about 2% of people in the UK older than 40, but when we break that down, it affects 1% of people aged 40, 3% of people aged 60 and about 8% of people aged 80. With a growing elderly population, we can see why this is a problem. Primary angle closure glaucoma affects about 0.4%. There are also some rarer ones, but the point is that glaucoma affects about 700,000 people, who could potentially go blind.

Are the Government considering the call of the Association of Optometrists, and it is a simple one, to commission a national glaucoma pathway? I ask the Minister to think about that.

The National Institute for Health and Care Excellence guidance on glaucoma is very clear:

“If any of the following risk factors for glaucoma are present, consider advising people to have their eyes examined by an optometrist…Older age. People 60 years of age or older should be examined every 2 years until they are 70 years of age, when they should be examined annually—free examination is available through the NHS…Family history of glaucoma. People older than 40 years of age who have a first-degree relative (parent, sibling, or child) with open angle glaucoma should be examined annually—free examination is available through the NHS…Ethnicity. People older than 40 years of age who are of black African family origin should be examined…Certain people are entitled to…NHS-funded eye examinations by optometrists…These include people …With a family history…as described above…Aged 60 years or older…In receipt of certain benefits”

or

“Who have been advised by an ophthalmologist”

to have a follow-up. This is really important, as we have heard today, when we are talking about awareness. People should get their eyes checked, check their availability and, if they are 60 or over, make sure they understand that they can get their eyes checked through the NHS.

This issue was raised in a debate at the end of April 2024, just a few weeks before the election. It is worth looking at what was said by the then shadow Minister, the hon. Member for Gorton and Denton (Andrew Gwynne), who went on to be a Health Minister:

“I have a degree of frustration with the Government’s approach to the issue. Given the statistics, I would like to see the Minister commit today to turbocharge access to ophthalmology services and make eye tests more commonplace for people who do not routinely test their eyes, but also to get people access to eye care services once conditions have been diagnosed.”—[Official Report, 30 April 2024; Vol. 749, c. 51WH.]

And he finished his remarks by saying:

“We will support the Government in the remaining weeks or months that they have to get this policy right, but mark my words: the next Labour Government see this as a priority and we will act.”—[Official Report, 30 April 2024; Vol. 749, c. 53WH.]

Now that we are one year into this Government, it is worth checking the record to see whether that priority has been given.

Forgive me for being a bit of a pedant, but I checked Hansard to see how many times glaucoma has been mentioned. There have been four mentions since the election, only two of which were in the context of health. One mention was made by the hon. Member for Leicester South last month, and the other was made by the hon. Member for Strangford in a debate on rare retinal disease. That does not seem like it is a priority.

I am being a bit of a pedant, but I also looked through the 10-year plan again, and there were two mentions of eye care, one of which was “ophthalmology” and the other was “optometrists”. The Minister will argue that it is a strategy document, but it raises the question: what is the plan for glaucoma?

The last Government concentrated on several areas. These included early detection and greater use of community optometry, with an emphasis on the importance of routine tests. There was £500 million a year for sight tests and optical vouchers, supporting more than 12.5 million NHS sight tests provided free of charge. The budget was demand-led rather than limited by volume, and the public were encouraged through campaigns and social media advertising to get tested. Integrated care boards expanded local services for minor and urgent eye care, pre- and post-cataract checks and glaucoma referral filtering. The post-covid backlog recovery programme also received £8 billion.

I am getting death stares from you, Mr Pritchard, so I will move on to my main points and my questions for the Minister.

[Mark Pritchard (in the Chair)]

The shadow Minister needs to be brief. He has had five minutes, and I gave six minutes to the Liberal Democrat spokesperson. I will give the shadow Minister another 30 seconds.

[Dr Evans]

Is there a plan or a strategy for considering a glaucoma pathway? Will the Government also commit to the workforce? The Health Service Journal has noted that the plan, as it stands, has no delivery chapter. Where is the delivery chapter for the 10-year health plan?

[Mark Pritchard (in the Chair)]

To be clear, it is important that the Chair is both neutral and fair in the distribution of time.

[The Minister for Care (Stephen Kinnock)]

Thank you, Mr Pritchard. It is a pleasure to serve under your chairship.

I thank the hon. Member for Leicester South (Shockat Adam) for securing this important debate to raise awareness of glaucoma. I enjoyed our meeting some time ago, when we discussed this and other related issues at length. I am keen to ensure that we keep that dialogue going, and not just in this Chamber. This is a timely debate as it follows Glaucoma Awareness Week, which ran from 30 June to 6 July.

Losing one’s eyesight can be devastating, and I pay tribute to the charities that do so much to help people live with glaucoma or to research a cure, such as Glaucoma UK, the Glaucoma Foundation and the Royal National Institute of Blind People, to name just a few.

Last week, the Prime Minister set out our plan to get the NHS back on its feet and fit for the future. Underpinning our plan are three big shifts: from hospital to community, from analogue to digital and from sickness to prevention. The plan was developed through extensive engagement with the public, patients and staff, including the eye care sector. All three shifts are relevant to preventing and managing conditions such as glaucoma in all parts of the country. More tests and scans delivered in the community, and better joint working between services, will support the management of conditions, including glaucoma, closer to home.

I turn to glaucoma detection. This Government take glaucoma very seriously, as it is one of the main causes of sight loss. It is a time-sensitive condition, and early detection and treatment can help to slow down or prevent vision loss. I acknowledge the vital role played by community optometry in protecting people’s eye health across the country. That includes the hon. Member for Leicester South, who of course is an optometrist and has significant expertise in this sector. I also pay tribute to all the hon. Members who have contributed to this debate with such passion and conviction.

Sight tests play a vital role in the early detection of glaucoma. Most glaucoma patients are identified through routine sight tests. It is not possible to “feel” glaucoma; it does not cause any symptoms and the eye pressure does not always cause pain. That is why regular sight tests are so essential, so that conditions such as glaucoma can be diagnosed and treated as early as possible.

It is recommended that everyone should have a sight test every two years, and more often if it is considered clinically necessary. The NHS invests over £600 million annually in the provision of sight tests and optical vouchers, and high street opticians deliver more than 13 million NHS sight tests annually, which are free of charge for eligible patients. NHS sight tests are widely available across the country for millions of people and those who are entitled to receive them include children, individuals over the age of 60, individuals on income-related benefits and individuals diagnosed with glaucoma or considered to be at risk of glaucoma.

We understand that some people might not prioritise sight tests, compared with other healthcare, or they might not know that sight tests are recommended every two years. That is why we always look for opportunities to remind the public through social media. I was pleased that the Department supported Glaucoma Awareness Week and highlighted the importance of regular sight tests through our social media platform last week. I will also take this opportunity to urge anyone who might be watching or reading this debate, “Visit your optician if you have not had a sight test in the last two years. Please check on the NHS website to see whether you are eligible for any help in paying for a test.” NHS sight test providers in the high street also display information about NHS sight test eligibility.

Some high street optical practices are also being commissioned by integrated care boards to provide glaucoma referral refinement services. Moving more care into the community is one of the key priorities in our 10-year plan; we want to see care happening as locally as possible for patients. Where a patient has been identified as having raised eye pressure, local glaucoma referral refinement schemes provide additional tests to confirm whether a referral into secondary care is absolutely necessary. These schemes can save patients time and worry, and reduce unnecessary referrals, while freeing up space for others who need specialist attention in hospital. More than 70% of ICBs currently have some coverage of referral refinement in place.

For those patients who do need to be seen in secondary care, it is vital that they have access to timely diagnosis and any clinically necessary treatment. We have wasted no time in getting to work on cutting NHS waiting lists and ensuring that people have the best possible experience during their care. We promised change and we have delivered early, with a reduction in the list of over 230,000 pathways, including ophthalmology. The waiting list has been reduced by over 24,000 patients since July 2024; it has fallen from 606,819 to 582,385 as of February 2025. In addition, we have exceeded our pledge to deliver an additional 2 million operations, scans and appointments, having now delivered over 4 million additional appointments.

[Dr Luke Evans]

The Minister will probably be aware of the Full Fact and Sky News report that examined the speed at which appointments are being delivered. The Government have indeed delivered 4 million appointments, but under the last Conservative Government there were 5 million appointments within a similar time period, so we are actually seeing a slowdown in appointments. How will that affect people with eye conditions or other health conditions?

[Stephen Kinnock]

I thank the hon. Gentleman for that intervention. In our manifesto, we of course set a target of 2 million additional appointments within the first year of a Labour Government, and we have delivered 4 million. The key thing is to ensure that we get people off the waiting list. Regarding the figure of 5 million that he referred to, I do not know whether there was more activity, but somehow it was not helping to reduce the waiting lists, because we saw the waiting lists rise consistently. The key metric is, of course, the waiting list being reduced, and I am very pleased to say that, when it comes to eyecare, a reduction of 24,000 patients has been delivered since July 2024.

That marks a vital first step to delivering on the commitment that 92% of patients will wait no longer than 18 weeks from referral to consultant-led treatment, in line with the NHS constitutional standard, by March 2029.

In addition to making progress on reducing waiting lists, we recognise the challenges facing ophthalmology services as one of the largest out-patient specialities in the NHS, and demand is set only to increase due to the ageing population. NHS England has worked with 11 ICBs to test a new way of delivering eyecare that aims to reduce pressure on hospital eye services.

The new model is emblematic of our shift from analogue to digital, as it uses IT connectivity between primary and secondary care services to improve the referral and triage of patients, with patient data and images being assessed by clinicians to determine whether patients need a secondary care appointment. It is called the single point of access approach. The SPOA approach reduces unnecessary hospital appointments, reduces the time from referral to treatment and allows more patients to be managed in the community. The ICBs testing the SPOA model have consistently demonstrated a reduction in unnecessary secondary care appointments and a significant reduction in wait times, both in time to treatment and to follow-up care. NHS England is continuing to share the learning from the accelerator sites for the SPOA with ICBs.

I want to see more ICBs adopting that approach for the benefit of patients, including those with suspected or diagnosed glaucoma. I believe that the SPOA has tremendous unharnessed potential and is a great example of how, by harnessing technology, we can improve the way the overall system works and facilitate the interface between primary and secondary care that we know is at the heart of so many of the challenges that we face across our health and care system.

Looking at the shift from sickness to prevention, although glaucoma cannot be cured, if it is caught early, treatment can prevent sight loss. The National Institute for Health and Care Excellence plays a crucial role in evaluating new medicines, medical devices and other technologies to determine their clinical and cost-effectiveness before recommending them for NHS use. NICE has published guidelines on the diagnosis and management of glaucoma. It has also published guidance on interventional procedures that provide recommendations on whether glaucoma-related procedures are safe and effective enough for wider use in the NHS.

A number of treatments are available for glaucoma, including eye drops, laser treatment or surgery, aiming to lower eye pressure and prevent or slow down optic nerve damage to reduce the risk of sight loss. Although there are treatments for glaucoma, it is a lifelong condition that requires regular monitoring. Historically, that has taken place in hospital but, in line with our aim to move more care from hospital to the community, there is no reason why, when clinically appropriate, that activity could not be undertaken outside of hospital. We know that some ICBs are already commissioning glaucoma monitoring in the community.

We must also recognise that, if diagnosed late, glaucoma can sadly lead to irreversible sight loss. The hon. Member for Leicester South spoke passionately from clinical experience about the significant impact that sight loss can have on an individual. Emotional support is therefore vital. There are various resources that aim to improve the support, including mental health support, available to patients through their sight loss journey. That includes NHS England’s patient support toolkit for commissioners and providers and the RNIB’s 2023 patient support pathway. Those sit alongside talking therapies and psychological therapies, which are widely available and to which patients can refer themselves directly. We are also taking steps to update the form for certificates of visual impairment to improve the signposting of patients to local support services.

Finally, I recognise the potential for research and innovation to help us to understand sight loss and to develop new treatments, including for glaucoma. The Department for Health and Social Care funds eyecare research through the National Institute for Health and Care Research. NIHR infrastructure funding provides investment in research expertise, specialist facilities, a research workforce and services that help to support and deliver research studies through a range of clinical areas, including eyecare research. That includes the NIHR Moorfields Biomedical Research Centre, which received funding of almost £22 million for five years from 1 December 2022, and is solely dedicated to eyecare research. The Moorfields BRC has been key in advancing research through a range of studies and clinical innovations in the glaucoma field. One of its flagship projects is a large-scale trial investigating the use of vitamin B3 to slow the progression of glaucoma. Recruitment for that study is ongoing at multiple sites across England.

As I have set out, the Government take glaucoma extremely seriously. Community optometry continues to play a vital role in preventing glaucoma. We are committed to improving eyecare services and patient outcomes, to reducing avoidable sight loss and, in particular, to harnessing the power of technology to drive those improvements forward. I also hope that this debate has further helped to raise awareness and may prompt a few more sight tests as a result. Once again, I congratulate the hon. Member for Leicester South on securing this important debate.

GP Funding: South-west England

Luke Evans Excerpts

Wednesday 25th June 2025 Westminster Hall

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

It is a pleasure to serve under your leadership, Dame Siobhain, and to be here. I pay tribute to the hon. Member for Newton Abbot (Martin Wrigley) for securing this debate on a topic that I am all too familiar with, having spent time as a GP. This place may not be so familiar with the inner workings of GP practices, so it is fantastic to have the chance to discuss it. I declare an interest: many of my immediate and wider family are GPs, and it is important to put that on the record.

This debate has allowed us to discuss a huge variety of things, including the Carr-Hill formula and the QOF. We did not touch on DES and LES—directed enhanced services and local enhanced services. Rural dispensing practices are a really important funding stream. We have talked about the partnership model, retention, joining up services, ICBs and their toolkits, the interaction with the planning department and rurality, which has a particular impact on services in my area.

I want to pick up on the comments made by the hon. Member for Mid Dorset and North Poole (Vikki Slade). Fair play to her for going out and shadowing a GP to see what their life is all about. At the heart of what she said was the good care that goes on. If we were to believe the Daily Mail, every GP is on the golf course and only cares about the money. The money is important, but GPs care far more about the patients and the quality of care they give. That is what drives them and gets them out of bed each day. We in this house must not forget that when we discuss healthcare, because it is important. We will get far better healthcare than ever before in the last few decades, and we must not lose sight of that.

I am grateful to the hon. Member for Newton Abbot for giving me my first chance as a shadow Health Minister to debate general practice and ask the Minister some questions. Without further ado, I will turn to those questions. First, what is the Government’s current position on primary care and its models? In an interview in The Times in January 2023, the current Secretary of State for Health and Social Care said:

“I’m minded to phase out the whole system of GP partners altogether and look at salaried GPs working in modern practices alongside a range of other professionals.”

He went on to speak at events held by the King’s Fund and the Institute for Public Policy Research, where he acknowledged that he has

“observed a GP partnership model in decline where very soon we’re going to have more salaried GPs than partner GPs”

and that the

“status quo is not an option”.

Then 18 months ago, just six months before the election, the Secretary of State stated,

“What we were minded to do is to sort of phase it out over time. I’m still not sure whether or not the GP partnership can survive in the longer term. But I haven’t reached a sort of firm conclusion that says that it shouldn’t.”

In the light of that, and given the importance of the partnership model, could the Government clarify their position with regard to the partnership model and any other models that are being considered?

[Vikki Slade]

I thank the hon. Member for his comments about my visit to the GP, because it was an absolutely wonderful experience. If the proposal is to phase out the partnership model and move to a salaried model, how would that work, given the severe cuts that ICBs are facing? With 50% cuts to most of the ICB funding, somebody will have to pick up the costs of running these organisations, rather than the clinical side of it.

[Dr Evans]

The hon. Lady is spot on. I posed my question to the Government because we know that primary care is one of the most efficient parts of the NHS. Why? Because the people running those businesses—they are businesses, and we have to be open and honest about that—pay attention to where the money comes in and goes out. They take full pride in it, first, because they care, and secondly, because their salaries are paid from the profit that comes out of that. Again, “profit” is a dirty word that people do not like to use, but it is the reality of what we are dealing with when it comes to how we break down the funding.

The Government have proposed to get rid of NHS England, and it is still unclear not only how much that will cost, but how much it will save and where the administrative burden will fall. On top of that, we do not know what will replace the partnership model if we lose it, and this is the question to be asked. Given that it was only six months before the election that the Secretary of State stated his intent, I too am keen to find out the answer.

I have a second question to pose to the Government. There are concerning reports this month in the Health Service Journal, which has had sight of a leaked version of the Government’s 10-year plan to improve the NHS. It says that the plan will push back the Government’s ambition to increase the share of NHS spending on primary and community care to 2035, rather than 2029 as originally promised. Can the Minister confirm or deny those reports?

When it comes to funding, the Government raised taxes directly on GPs as part of the national insurance increase. Has the Department made any assessment of how much of the £886 million uplift that has been allocated to GP practices will be needed to meet the increase in employer’s national insurance contributions?

I turn to the figures for the ARR scheme. The Government announced in April that they thought they had reached 1,500 new GPs, but as the RCGP pointed out at the time, although having

“more GPs employed in the workforce is encouraging, when considering full time equivalent GPs—which gives the most accurate picture of the GP workforce and the care and services GPs are able to deliver for patients—the numbers published today are lower, at 851 GPs”.

The increase is encouraging, but when we dig into the data, it appears that we are simply seeing more locum doctors coming back into the scheme. I would be grateful to understand exactly how the numbers are made up, and where the inference of 1,500 GPs comes from.

More importantly, where is the scheme going in the future? Is it time-limited? Will it continue? Will it be expanded and, if so, what does that look like? Although it is an important part of addressing provision, we also need to understand exactly what is going on. Initial reviews of the data suggest that appointments have not kept up with the pace of the introduction of GPs, so I am interested to understand from the Minister why, despite the supposedly new GPs coming in, the number of appointments has not increased proportionately. I would be grateful for any comment on that.

Finally, I turn to recruitment. Training new GPs has understandably been seen as the priority when it comes to solving the long-term workforce problems in England. As Pulse magazine puts it:

“This is probably one of the areas of workforce planning that could be considered a success. Health Education England, which has been incorporated into NHS England, has been able to meet its target of over 4,000 new GP trainees a year.”

The NHS workforce report, launched under the previous Government in 2023, made commitments to increase that. It set goals to increase the number of GP specialist training places to 6,000 by 2031, ensure that all foundation-year doctors do a rotation in general practice, and require GP registrars to spend the full three years in general practice.

There has been progress, but along with progress come new problems. The British Medical Association has warned that up to 1,000 GP registrars could face difficulty when qualifying in summer 2025 without funding for GP practices to recruit newly qualified, unemployed or underemployed GPs. What active steps are the Government taking to avoid that, and what support will they be offering newly qualified GPs?

[Dr Simon Opher (Stroud) (Lab)]

The ARR scheme in my practice at May Lane surgery in Dursley is employing newly qualified GPs who provide a lot of extra appointments for the surgery, so the scheme is working quite well for newly qualified GPs.

[Dr Evans]

I am pleased to hear that the scheme is working well, but the question is—as the hon. Member would know if he had been here for the start of the debate and all the way through it—what does it look like going forward?

In other places, are locums simply being stepped into the ARR scheme because there has been a shift in the way that GPs commission their work and PCNs are looking to deal with that? That is the question at the heart of it. We seem to be training more GPs than ever, yet at the same time, we have a disproportionate number of people at the top end who are not able to find work.

It is important to build up multidisciplinary teams that take account of the pharmacists, nurses and mental health workers around GPs, and I welcome the fact that the ARR scheme allows that. It has been widened to get more funding but, as the hon. Member will know, there is a discrepancy in how much doctors are funded for and there are limitations on how long they can work in the scheme. If I were to return to practice, I would not qualify under the scheme. The Government need to pose these questions; although the scheme is welcome, does it solve the whole problem? I do not think so, and my final set of questions relates to that.

We have seen a trend in international medical graduates coming to work in the UK, with the number of international medical graduates overtaking domestically trained medics for the first time in 2023. Have the Government considered something similar to the Australian scheme? Australia classifies locations using the modified Monash model or the Australian statistical geography standard to rank areas from major cities to remote regions, and then prioritises overseas doctors into the areas of most need. That could help to deal with the disparities across different parts of the UK. Will the Government consider that model in attempting to address those disparities? Whether it is right for the UK is for the Government to decide.

Hospitals might save your life, but your GP has been quietly guarding it for decades. That fact is often lost in our debates, so it has been a privilege to remind the Government, the House and the public of that fact today. I look forward to the Government’s response.

--- Later in debate ---

[Stephen Kinnock]

I am impressed by the way the hon. Gentleman did that and I congratulate him on it. If he would care to write to me to set that out, I will have a look at it and get back to him.

I want to take this opportunity to briefly outline what we have done since July 2024, and what we intend to do, to ensure that GP funding and services in the south-west are fit for purpose and capable of meeting the needs of the local population. In February, we concluded the annual consultation between the Department of Health and Social Care, NHS England and the general practitioners committee of the British Medical Association. For the first time in four years, GPC England voted in favour of the GP contract package, which illustrates the progress we are making to rebuild our relationship with the profession.

The 2025-26 contract is already improving services for patients and making progress towards the Government’s health mission. It supports the three key shifts the Government want to achieve: from analogue to digital; from sickness to prevention; and from hospital to community care. Patients across the country can expect online GP services to be available throughout the day, and better continuity of care for those who would benefit most. Patients can also expect a stronger focus on prevention, in particular to tackle the biggest killers, such as cardiovascular disease.

In 2025-26, we are investing an additional £889 million into the core GP contract to fix the front door of the NHS. Despite the difficult financial situation this nation faces, we are backing our health workers with above-inflation pay rises for the second year running. We are accepting the Doctors and Dentists Review Body’s recommendation of a 4% uplift to the pay element of the GP contract on a consolidated basis.

[Dr Luke Evans]

The Minister talks about contracts, which is an appropriate point to question him again on his Government’s position on the GP partnership model. It is not clear what that looks like from any of the documentation, so I would be grateful to understand that or, if the Secretary of State is considering new models, what they are and when we can see them.

[Stephen Kinnock]

We recognise that the partnership model has many strengths. It is a very important part of the system, and it helps to drive efficiency, innovation and a kind of go-getting approach to general practice. That is what we want to see—innovative approaches.

We are committed to substantive GP contract reform. We see the partnership model as a really important part of that, but we also recognise that fewer GPs are interested in going into partnership. The partnership model is not the only model delivering general practice; GP practices can and do choose to organise themselves in different ways. Many practices cite evidence of good outcomes on staff engagement and patient experience through the partnership model. I do not think it is right to say that there are any specific plans to change the partnership model, but we recognise that there are a number of other ways, and we will always keep the way in which the contract is delivered under review.

--- Later in debate ---

[Stephen Kinnock]

That is an extraordinary statistic. There are clearly major imbalances in the way the system works and general practice is funded in our country. A little later I will come to the Carr-Hill formula; I am sure hon. Members will have seen announcements trailed in the media today about what my right hon. Friend the Health Secretary will say shortly in a speech in Blackpool. The issue raised by the hon. Member for Tiverton and Minehead (Rachel Gilmour) is directly pertinent to the work we are doing around the formula for funding GPs, to ensure that it is needs based, unlike the current, deeply anachronistic and dysfunctional funding system.

On funding, general practices are funded through a range of streams, the majority from core payments known as global sum payments. The rest is made up of incentive schemes, premises payments and enhanced and additional services. The Carr-Hill formula is applied as a weighting of 50% to 60% of GP funding allocated through the core contract, and is a workload-based formula designed to reimburse practices for their expected workloads.

The formula takes into consideration patient demographics, such as age and gender, and factors such as morbidity, mortality, patient turnover and geographical location. I am truly proud that today my right hon. Friend the Health Secretary is in Blackpool to announce that we are reviewing the Carr-Hill formula, which is outdated and not fit for purpose. Currently, GP surgeries that serve working-class areas receive on average 10% less funding per patient than practices in more affluent areas, and that needs to change.

Politics is about choices. For 14 years, the Conservatives —propped up for five years by the Liberal Democrats, I am afraid to say—chose to favour the richest. Who can forget the right hon. Member for Richmond and Northallerton (Rishi Sunak) boasting about how he had deliberately redirected funding from deprived urban areas to leafy suburbs? This Labour Government are reversing that ethos. Our decision to reform the Carr-Hill formula is a clear example of how we are putting our Labour values into practice.

We recognise the importance of ensuring funding for core services is distributed equitably between practices across the country. In our upcoming 10-year health plan, that is what we will do, through our review and reform of the Carr-Hill formula. Alongside that work, the Advisory Committee on Resource Allocation—ACRA—will be asked to advise on how the setting of ICB allocations can better support the reduction of health inequalities, to ensure that resources are targeted where they are most needed.

On workforce and recruitment, we recognise the difficult situation whereby patients have been unable to get GP appointments and recently qualified doctors have been unable to find jobs. That is why, in August last year, we announced £82 million in ringfenced funding, allowing primary care networks to recruit newly qualified GPs through the additional roles reimbursement scheme. More than 1,700 GPs have now been recruited through that scheme.

As part of the 2025-26 GP contract package, we made the additional roles reimbursement scheme more flexible, to allow PCNs to accommodate local workforce needs better. That includes removing restrictions on the number or type of staff covered, including GPs and practice nurses. When I took up my ministerial responsibilities in July, I was astonished to find that it was not possible to recruit GPs through the ARRS. We have bulldozed that red tape, which has resulted in a dramatic increase in the number of GPs on the frontline.

[Dr Luke Evans]

On that point, what would the Minister say to junior doctors, now coming to be registrars, who will be looking for a job? Should they look to the ARRS as the way forward when they qualify? What will he say to them if they do not get a job? Should that be the route they look to? Is it an expansion he is asking for? What are the alternatives for those graduating in August?

[Stephen Kinnock]

We have been really pleased with the take-up under the ARRS. It is a rapid and clear way of recruiting, particularly because it has the ringfence and the reimbursement system underpinning it. We absolutely encourage newly graduating GPs to take up opportunities through the ARRS; it is an important tool for bringing more GPs on to the frontline. The challenge is not so much the number of qualifying and graduating GPs in the pipeline, but getting them to the parts of the country that need them most. That variation in provision is the No. 1 priority. The review of the Carr-Hill formula will also have important synergy with the issue of recruitment and workforce.

[Dr Luke Evans]

It seems pertinent to ask this question now: the Australian scheme I mentioned is one way that another country has dealt with the issue. Would the Government consider placing overseas doctors in the areas of most need? Is that something under consideration?

Mental Health Bill [ Lords ] (Ninth sitting)

Luke Evans Excerpts

Committee stage
Tuesday 24th June 2025 Public Bill Committees

[Zöe Franklin]

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

The new clause would require local authorities and commissioning bodies to promote and report annually on mental health wellbeing in regard to any guidance published by the Secretary of State.

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

I thank the hon. Lady for giving way so early in her speech. I mentioned my concern about this provision on Second Reading: a rough road is not the same as a broken bridge. We are dealing here with the most severe mental health issues. The new clause talks about wellbeing, which affects everyone. Trying to report that and fit it into this criteria risks diluting the very aim of the Bill in trying to deal with the most severe mental health issues. I would be grateful for clarification on the difference between mental wellbeing, which affects everyone, and mental health issues, which not everyone has.

[Zöe Franklin]

When it comes to enabling the Mental Health Act to function, having an understanding on the ground of the picture across our communities regarding mental health wellbeing is very important. That is why we tabled the new clause, which would allow us to get community care right. That would then feed into the crisis care that we are discussing in this Committee.

--- Later in debate ---

Brought up, and read the First time.

[Dr Evans]

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

I rise to speak in support of the new clause, which was tabled by the Conservative party. It would place a duty on the Secretary of State to review the effectiveness of the regulatory authority’s role under the Mental Health Act 1983 within one year of the Act’s passage.

Allow me to provide the current legal and regulatory context. Under the framework in the Mental Health Act 1983, the Care Quality Commission, which is the regulatory authority in England, is tasked with monitoring and regulating providers of mental health services. We have debated some of this, and there are issues still to be addressed.

The CQC inspects hospitals, community mental health teams, and other relevant services to ensure compliance with statutory safeguards and standards. It publishes reports on providers and issues recommendations where it identifies failings. Additionally, there is an existing reporting framework under the Act whereby the Secretary of State is expected to oversee and ensure the Act’s proper implementation, with periodic ministerial reports to Parliament and CQC inspection outcomes made publicly available. However, there is currently no statutory requirement to review the CQC’s own role and effectiveness in carrying out these specific mental health functions. The gap means that although providers are scrutinised, the regulator itself escapes similar structured accountability and review.

This question was debated in the other place and I welcome the comments from the Minister in the Lords, Baroness Merron, who, in a letter, rightly highlights existing transparency measures. She states that,

“findings from CQC’s monitoring activity are reported annually in their Monitoring the Mental Health Act report, which is laid before Parliament and published publicly.”

That is true. She also notes the annual quality account reports produced by NHS healthcare providers under the Health Act 2009, which cover patient safety, treatment effectiveness, and patient feedback. True. Those are indeed important components of the current oversight framework, and we support the continuation and strengthening of those transparency mechanisms.

[Dr Neil Shastri-Hurst (Solihull West and Shirley) (Con)]

My hon. Friend makes a powerful point about transparency, but it is not just about that. Does he agree that it is also about having an evidence base that allows reform and improvement of the regulator?

[Dr Evans]

I do, and to expand the point, this is about understanding the performance of CQC as well. We know from the Dash report and from Mike Richards that there are, and have been, concerns about CQC performance. That is at the heart of this new clause—to try to make sure we actually look at the performance and regulation of the regulator. Those reports focus on the performance of mental health services and providers, but they do not amount to a dedicated statutory review of the regulator itself—specifically, the CQC’s role, effectiveness, and capacity under the Mental Health Act.

Annual reports primarily reflect the CQC’s monitoring outcomes rather than a comprehensive, independent evaluation of whether its regulatory functions are being discharged optimally, or whether it is adequately equipped to meet the new challenges posed by the legislation. In other words, reporting on what the regulator monitors is not the same as reviewing how well the regulator performs its duties.

The new clause would address that distinct gap by mandating a focused review with a parliamentary report and a Government response, thereby strengthening accountability at the regulatory level. The new clause aims to establish an additional layer of scrutiny, not duplicative reporting. It would require the Government, within 12 months of the Bill becoming law, to conduct a formal review of the CQC’s effectiveness, specifically in regulating mental health services under the 1983 Act. It mandates an assessment of whether the CQC is adequately fulfilling its duties, including monitoring, inspection, and enforcement responsibilities, as well as whether it will be capable of carrying out its duties under the new legislation. Given the well-documented problems in mental health, it seems entirely appropriate to address the key point: is the regulator regulating effectively?

[Dr Shastri-Hurst]

My hon. Friend makes a strong point about having a review to ensure that the regulator is operating effectively. Does he share some of my concerns that a one-off review may not demonstrate ongoing oversight and scrutiny of the performance of the regulator?

[Dr Evans]

We do not want to introduce too much bureaucracy, but ensuring an accountable statutory mechanism to ensure adequate oversight is incredibly important. Much of the debate about the Bill has been about whether we put things in primary legislation or in policy, or whether we allow policy and legislation to be done at a secondary level—or even leave them for the organisation to deal with. My concern with the CQC is that we have not seen the organisation step up in the way that it should do. That does not mean that it is not making progress, but we need to see further progress.

--- Later in debate ---

[Stephen Kinnock]

I am grateful to the Opposition spokesman, the hon. Member for Hinckley and Bosworth, for bringing this issue forward.

Two major independent reviews into the Care Quality Commission have reported under this Government: one by Dr Penny Dash, on the CQC’s operational effectiveness as a regulator of all health and social care providers including those in mental health, the other by Professor Sir Mike Richards on its single assessment framework. The CQC has accepted those recommendations in full, and although we are confident in the progress that the CQC is making, we recognise that the reviews did not closely inspect its statutory role in relation to monitoring the use of the Mental Health Act.

Those powers and duties are entirely distinct from those that the CQC uses to regulate the health and social care sector under the Health and Social Care Act 2008. In recognition of that gap, as the Opposition spokesman pointed out, we committed in the other place to report on that specific aspect of the CQC’s role in the first of the Government’s annual reports on the implementation of the Bill, which will be laid before Parliament one year after Royal Assent.

[Dr Evans]

The Minister mentioned the Government’s annual reports, but at other times he has said that they will issue written ministerial statements. Will he clarify which it will be? There is a big difference between a couple of paragraphs in a written ministerial statement laid before the House, and a full report. When debating the other clauses, new clauses and amendments, the Government’s answer has been that they will report back to Parliament in a year’s time. I am grateful for that, but clarity would be helpful, because a full and comprehensive report would give more weight to the Opposition in terms of understanding and transparency.

[Stephen Kinnock]

I can confirm that the information will be in a section of the written ministerial statement that will be tabled within 12 months of Royal Assent. We think that requirement makes the Bill more robust and effective, because it is an integral part of the entire ecosystem that we are looking at in terms of implementing this legislation and making sure we have the institutional capacity and capability. We think it helps to have the information as an integral part of the written ministerial statement, but the hon. Gentleman is right to point out that we should be clear in the definitions and language we use.

The written ministerial statement will be an overall implementation report. It will contain a number of sections, one of which will be on the role of the CQC and the inspection function. It will include reflections from the new chief inspector of mental health, Dr Arun Chopra, on the CQC’s statutory functions under the Mental Health Act, as well as its role as a key partner in the delivery of the reforms. The written ministerial statement—the report—will be laid before both Houses of Parliament within 12 months of Royal Assent. I hope the hon. Member for Hinckley and Bosworth therefore feels able to withdraw his new clause.

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

--- Later in debate ---

Finally, clause 59 states that the Bill’s short title will be the Mental Health Act 2025, once it becomes an Act of Parliament. I therefore commend clauses 55 to 59 and Government amendment 39 to the Committee.

[Dr Evans]

I will be brief. On this clause, I will be grateful if the Government can ensure good co-operation between the devolved powers, and if the Minister can set out how he will engage with the Welsh Government before exercising the power.

On clause 57, what consideration has been given to cross-border issues to ensure that there are no unintended consequences between the likes of England and Wales or Scotland and England? Clause 58 covers commencement; will there be a clear published timetable for that over the next 10 years? Will Government allow Parliament sight of the transitional provisions? We have talked about the annual written ministerial statement, which we have clarified, but will there be further tracking reports that we can look at?

Clause 59 states that the Bill will not impose new public spending or taxation, and yet the impact assessment lists £1.9 billion for the NHS in England, £396 million for local authorities, £2.5 billion for supporting housing and social care, and £287 million for legal costs and tribunals. Clearly, costs are associated with the Bill’s implementation over the next 10 years, so a money resolution is rightly required. When I raised those issues on our first and second days in Committee, the Minister rightly could not answer, because we had not had the Government’s settlement. We have now had that settlement, so I will be grateful to understand how the funding is to be applied to mental health on the community side and with regards to the Bill. Finally, given that we are dealing with Scotland, Wales and Northern Ireland, what are the Barnett consequentials of the Bill in ensuring the support implied in the clauses?

I am grateful to the Committee, the Clerks, the Chairs, everyone here and everyone who has helped me prepare. Committee stage has been a joy, but also a long trial to get through. I am glad to be present as the Bill proceeds, because it is the right thing for the country.

[Stephen Kinnock]

I thank the shadow Minister for his question about devolved powers. We have worked closely with the Welsh Government on the Bill. The Senedd has yet to vote, but the Welsh Government in their legislative consent memorandum recommended that it grants consent to the Bill. We also seek a legislative consent motion from the Northern Ireland Executive for extending—in Government amendments 37 and 38—the remit of the Human Rights Act 1998 to cover private care providers when providing certain services arranged for or paid by local by public authorities. I will look into the cross-border issues and, if something is there, I will certainly write to update the shadow Minister.

On the published timetable, the written ministerial statement will absolutely be a report on progress over the 12 months and will have a forward plan in it. I cannot say at this moment whether it will be a forward plan all the way through the proposed 10-year commencement period, because some of that will go beyond the spending review period, for example, but I assure the hon. Member that a timetable will at least cover the period of the initial spending review. I do not know whether there will be tracking reports—I will check that point with officials—but my sense is that the written ministerial statement will be the main hook to hang this on.

The shadow Minister asked about the money resolution. We have the overall financial envelope for the DHSC. There is now—how should I describe this?—intense dialogue going on between departments within the DHSC and across portfolios, so I think it will take a couple of weeks before we get the carve-up of the envelope across the different portfolios.

I note the shadow Minister’s point about the Barnett consequentials. I will look into it and come back to him.

It remains for me to thank you, Mr Vickers; everyone in Committee, for their very hard work; and all the staff and officials, to whom we are hugely grateful. I commend the Bill to the Committee.

Question put and agreed to.

Clause 55 accordingly ordered to stand part of the Bill.

Clause 56 ordered to stand part of the Bill.

Clause 57

Extent

Amendments made: 37, in clause 57, page 68, line 3, at end insert “subject to subsection (2).”

This is consequential on amendment 38.

Amendment 38, in clause 57, page 68, line 4, leave out “This section, section 55” and insert—

“Section (Human Rights Act 1998: extension to certain private care providers), section 55, this section”.—(Stephen Kinnock.)

This ensures that NC10 extends to England and Wales, Scotland and Northern Ireland.

Clause 57, as amended, ordered to stand part of the Bill.

Clause 58 ordered to stand part of the Bill.

Clause 59

Short title

Amendment made: 39, in clause 59, page 68, line 25, leave out subsection (2).—(Stephen Kinnock.)

This removes the privilege amendment inserted in the Lords.

Clause 59, as amended, ordered to stand part of the Bill.

Bill, as amended, to be reported.

Mental Health Bill [ Lords ] (Seventh sitting)

Luke Evans Excerpts

Committee stage
Thursday 19th June 2025 Public Bill Committees

[The Chair]

I remind the Committee that with this we are considering clauses 43 and 44 stand part.

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

I know that the Committee has been waiting in earnest for me to deliver this speech on clauses 42 to 44. As the temperature gets to almost 30° today, I will try to maintain the same gumption that President Trump had when introducing his flagpoles, because this is an exciting topic and I am keen to treat it with verve.

Clauses 42 to 44 will introduce new duties on hospital managers to provide information about complaints procedures to patients under different legal regimes within the Mental Health Act 1983. The clauses move important safeguards from the code of practice into primary legislation, thereby giving them statutory force, which is a welcome step. I acknowledge the Government’s intentions to strengthen patients’ rights and accountabilities within the mental health system.

Clause 42 concerns information for detained patients. Under the current law, section 132 of the Mental Health Act 1983 requires hospital managers to give patients information about their rights under the Act, including their rights to apply to the mental health tribunal and to access independent mental health advocates. Although complaint procedures are mentioned in the code of practice, however, they are not explicitly covered in statute. Clause 42 will amend section 132 to impose a new statutory duty to provide information on how to make complaints about: the carrying out of functions under the Act, any medical treatment received while detained, and the outcome of any such complaint, including routes for escalation such as through the Parliamentary and Health Service Ombudsman.

Importantly, the information must be provided both orally and in writing, and steps must be taken to ensure that the patient actually understands it. Those duties must be carried out on initial detention and then repeated either annually for restricted patients or on the submission of renewed report under section 20 of the Act. The Opposition welcome that positive and necessary step. We know from independent reviews, including the Wessely review, that many patients do not know how to complain or fear that doing so will affect their care. By placing these requirements in primary legislation, we provide more robust legal protection.

I would be grateful if the Minister clarified some points. How will “understanding” be assessed or evidenced in practice? For example, what guidance will be issued to ensure that the needs of patients with a learning disability, cognitive impairment or limited English are met? Will independent mental health advocate services play a formal role in supporting patients to understand the Act with regard to this information about complaints? Is that part of their expanded role? Will complaints about poor complaint handling, not just about the original matter, be clearly included in the framework, as implied in the explanatory notes? To whom would such complaints be reported: NHS England, the Department, the integrated care board or a regulator such as the Care Quality Commission?

As we are talking about complaints, I notice that paragraph 327 of the explanatory notes states:

“New subsection (2A)(c) ensures the duty covers information about the patient’s right to complain to the Parliamentary and Health Services Ombudsman about the maladministration of complaints about medical treatment.”

That is very welcome, but it brings up an entirely new set of questions about the role of the Parliamentary and Health Service Ombudsman in this guise—an institution that embodies the public’s right to accountability, redress and justice when our health and public services fall short. In essence, it is the final arbiter; at best, it is the final safety net for those who feel they have nowhere else to turn. In particular, I want to focus on its critical yet often underappreciated work in relation to mental health complaints and how it intersects with the new Bill.

The ombudsman investigates unresolved complaints about NHS services in England, including those related to mental health care, alongside complaints against Government Departments and other bodies. For many families affected by failings in mental health provision, be that in crisis care, discharge planning or secure settings, the ombudsman provides a route to independent evidence-based resolution. We must therefore ask whether it is functioning with the efficiency, compassion and authority that patients deserve.

To pick just some of the data, in 2022-23 the PHSO received more than 35,000 complaints, which was an increase of 20% on pre-pandemic levels. If we look at timelines, performance remains under pressure: only 32% of investigations were completed within 13 weeks, 50% within 26 weeks and 81% within 52 weeks—that comes from the annual report. In the mental health sphere, such delays can exacerbate trauma and deepen distrust in public systems, in particular if the complainant is already experiencing severe distress.

The PHSO has reported a rise in callers exhibiting suicidal ideation, a tragic indicator of the depth of need and the urgency of timely reform. Over the past few years, to its credit, the ombudsman has introduced reforms for a new case severity assessment framework to triage cases more effectively; investment in digital case management; training for frontline staff to deal more sensitively with mental health complaints; and a proactive push for transparency, including publishing more case outcomes and data.

That is important work, but there is still some way to go. What assurances can the Government provide that PHSO’s funding is sufficient to cope with increased volumes of complex mental health cases, especially as it has a somewhat unique structure? The PHSO reports to the Public Accounts Committee. It does not have a departmental home. It is appointed by the King on the advice of the Prime Minister, after scrutiny by the PAC, but it is funded through the House of Commons Commission. That makes the PHSO rightly independent, but we need to ensure that it has the ability to deal with the top level of complaints about severe cases of mental health issues.

Under this legislation, we will be creating more automatic referrals to tribunals; we are rightly empowering more patients to complain; and we are putting more reports in for accountability. We need to ensure that when there are complaints—as there could well be—they will still be dealt with. Therefore, has an impact assessment been carried out, or will one be carried out, about PHSO funding, capacity and ability to deal with more mental health complaints?

As we debate a new Bill, we must ensure that accountability mechanisms fully integrate with any legislative reform. The Bill will, rightly, enhance patient rights and restrict inappropriate detention, but the ombudsman must be equipped to robustly investigate breaches of those rights. We should also ensure a clear reporting pathway for detained individuals when their families go to the ombudsman. My overarching question for the Minister, which I hope he will address is: how will the Bill, empowered in this way, interface with the PHSO? Will it strengthen the ombudsman’s ability to investigate complaints relating to involuntary treatment or detention?

Clause 43, on information about complaints for community patients, will make an equivalent amendment to section 132A of the Mental Health Act, which governs patients subject to a community treatment order. Again, patients are currently told about their rights to tribunal and IMHA support, but not necessarily about how to raise concerns or complaints about their care in the community. The clause will therefore require hospital managers to provide information about how to make complaints about functions carried out under the Act, about medical treatments for mental disorder while on a CTO, and about the outcome of any such complaint.

Clause 43 will also add a new requirement to repeat the information as soon as practicably possible after the CTO renewal. Again, that seems sensible and overdue, because clear repeat information can help to balance the power dynamics and support the patient voice. However, what steps will be taken to ensure that community patients who do not have regular contact with hospital staff are still given the information promptly and meaningfully? Will that be the duty of the new community clinician, for example? What is the role of community mental health teams or primary care staff, such as GPs or community psychiatric nurses, in delivering or enforcing the duties? Will the Minister confirm whether patient carers or families beyond the nominated person will be supported in understanding how someone can make a complaint?

Finally, clause 44, on information for conditionally discharged patients, will introduce proposed new section 132B of the Mental Health Act, extending the same principles to patients who are conditionally discharged, including restricted patients under section 42, 73 or 74. Such individuals often remain subject to significant restrictions in the community, such as curfews, reporting conditions or residence in supervised accommodation, and they can be recalled to hospital at any time, yet under the current law they have no statutory right to be informed of how to complain about or challenge decisions that affect them.

Clause 44 will require hospital managers to inform those patients about which section they are discharged under, how the Mental Health Act continues to apply, their rights to apply to a tribunal, and—crucially—how to make complaints about the carrying out of MHA functions, medical treatments and complaints outcomes. That requirement must be met as soon as practicable, in both oral and written form. A copy must also be given to the nominated person.

The explanatory notes state that the duty applies to

“patients subject to transfer directions”

from prison, and that the information should be given before discharge if possible. That is welcome, but it raises a question why, unlike clause 42, clause 44 does not impose a duty to repeat that information periodically. Given that conditionally discharged patients may remain under conditions for many years, have the Government considered adding a requirement to re-provide the information, say, annually? What support or advocacy will be available to conditionally discharged patients, particularly those in forensic or community forensic services, to help them to make complaints or understand their rights? Finally, will the Minister clarify how the provisions will work for patients who lack capacity, or who have no nominated person? Will there be a fall-back or safeguard in those cases?

In clauses 42 to 44, the Government are rightly seeking to embed the right to complain, and to understand that right, into the framework of the Mental Health Act. These are technical but powerful reforms. As ever, however, the challenge lies in not what is required but how it is delivered, especially for the patients who are most marginalised, restricted or isolated. I hope that the Minister can provide some reassurances about monitoring for compliance, clear statutory guidance, and the support of the advocacy structure, particularly at the very top, for dealing with complaints.

[The Minister for Care (Stephen Kinnock)]

It is a pleasure to serve under your chairmanship, Sir Desmond. I will respond to the questions that have been asked.

The hon. Member for Farnham and Bordon asked what training would be provided to staff on communicating the information clearly and compassionately. We will seek to clarify the complaints process and, when we come to revise the code of practice, we will consult on the guidance for how information on complaints should be provided. The Department will work with the NHS, Social Work England and other partners to develop appropriate training for staff on the reforms. Once the code of practice has been updated, professionals working under the Act will be required to undergo training to maintain their competence and awareness of the Act.

The hon. Member also asked how to ensure that information is genuinely accessible. It is important that the complaints process is accessible to all patients. Hospital managers must take practicable steps to ensure that patients have understood complaints procedures, and information about complaints must be provided both verbally and in writing. We expect all healthcare organisations to meet people’s communication needs to support equitable access, experience and outcomes, including when someone is in hospital for their mental health.

NHS England sets out guidance for providers on how to support individuals with their communication needs. That support may involve providing access to interpreters, providing information in a range of formats—such as in translation, large print, braille and easy read format—or the use of augmentative and alternative communication, video clips and visual diagrams to aid understanding. The accessible information standard requires all applicable organisations to identify, record, flag, share and meet the information and communication support needs of patients, service users, carers and parents with a disability, impairment or sensory loss.

On the question of whether there will be an audit of whether patients feel genuinely informed and empowered to complain, we know that some service users are not aware of the avenues by which they can make a complaint. The changes in clauses 42 to 44 seek to address that problem, and to increase awareness of the complaints system. To ensure that patients are supported and empowered to exercise their rights, we are expanding the right to an independent mental health advocate to all mental health in-patients. Complaints information must be provided to both the patient and the nominated person. Family and carers also have a right to complain about care and treatment given under the Mental Health Act.

The hon. Member for Solihull West and Shirley asked for reassurance on oversight, and that feedback from complaints will identify issues. I think that the hon. Member for Chester South and Eddisbury also asked about that, as well as asking what mechanisms will be in place to give feedback on how the system is working. Complaints data enables CQC Mental Health Act reviewers and mental health inspectors to understand trends and focus on areas of concern in their respective monitoring and inspection activities. Focused activity— for example, a focused Mental Health Act visit or inspection activity—can also be scheduled in response to concerns raised in MHA complaints. When looking at trust and provider-level MHA inspection activity, complaints information informs the CQC’s questioning of trusts or independent providers about their complaints processes.

--- Later in debate ---

Advance choice documents

[Dr Evans]

I beg to move amendment 46, in clause 45, page 57, leave out lines 5 to 11 and insert—

“(1) All eligible patients shall have a right to create an advance choice document.

(1A) For the purposes of this section, an ‘eligible patient’ is a patient who—

(a) has previously been detained under Part 2 or Part 3 of this Act,

(b) has been diagnosed with a mental disorder which may lead to the possibility they will be detained under this Act in the future, or

(c) is an English qualifying informal patient (see section 130CA).

(1B) NHS England and each integrated care board must make such arrangements as it considers appropriate for—

(a) ensuring that all eligible patients for whom it is responsible for the purposes of this section are informed of their right to create an advance choice document, and

(b) helping an eligible patient to create an advance choice document.”

This amendment gives all eligible patients the statutory right to create an advance choice document if they so wish.

[The Chair]

With this it will be convenient to discuss the following:

Government amendments 32 and 33.

Amendment 18, in clause 45, page 57, line 33, at end insert—

“(3A) An ‘advance choice document’ under subsection (3) should include consideration of the person’s financial circumstances.”

This amendment ensures that the advance choice document includes matters relating to the patient’s financial circumstances.

Government amendments 34 and 35.

Clause stand part.

[Dr Evans]

I am grateful for the opportunity to speak to clause 45 and amendment 46. I will also speak to the amendments from the Government and the Liberal Democrats.

The Bill introduces advance choice documents as a new tool to empower people with lived experience of mental health conditions. This is a significant development in mental health law and policy. Currently, people who are detained or treated under the 1983 Act often have limited ability to influence decisions about their care at times when they lack capacity. Although the Act includes some mechanisms such as advance statements, they have been criticised for their limited legal weight and inconsistent application.

Clause 45 will insert proposed new sections 130M and 130N into the Act, and place duties on NHS England, integrated care boards in England and local health boards in Wales to facilitate access to information about ACDs and to provide support to individuals who want to create such documents. As the Government’s explanatory notes state, ACDs are written statements

“made by an individual while they have capacity or competence …setting out their decisions, wishes and/or feelings about matters that may be relevant to their assessment for admission…and treatment”

should they lack capacity. That extends the scope of patients’ involvement in care planning and respects autonomy in a way that the current law does not fully achieve.

I commend the Government for recognising the importance of enabling people to set out their wishes in advance, especially when they have previously been detained or treated informally. That can help to reduce stress, improve trust between patients and professionals, and potentially prevent crisis escalation to detention. Nevertheless, I have some constructive questions that I hope the Committee will consider.

On the strength of duty on the NHS bodies, proposed new section 130M(1) will require NHS England and each ICB to

“make such arrangements as it considers appropriate”

to provide information about and support with ACDs, which leaves considerable discretion. Will that discretion lead to inconsistencies across regions and vulnerable populations? Should the Bill include clear minimum standards or benchmarks for what constitutes “appropriate” arrangements, for example by mandating proactive outreach to high-risk groups, such as those in secure children’s homes or immigration centres, where awareness of rights or access to support is often poor?

There is then the legal status and practical use of ACDs. The clause defines ACDs but does not specifically set out their legal weight in decisions about treatment or detention. How will clinicians balance these documents with their clinical judgment or clinical care needs? The explanatory notes mention that ACDs may include

“advance decisions under the Mental Capacity Act 2005.”

The Bill could clarify how conflicts will be resolved; this is a recurring theme in our discussions. It would be helpful to have explicit guidance on safeguards to ensure that ACDs are given full weight and respect while maintaining clinical safety.

I turn to the issues of training, resourcing and monitoring. This is a big change, and supporting people to make meaningful ACDs requires skilled staff and resources. Who is expected to provide that support? Is it the CPN, the community clinician, the IMHA or even the GP? Will there be training programmes for clinicians and care staff on how to discuss, record and use ACDs effectively? Furthermore, will there be monitoring and reporting requirements so that Parliament and public can hold the services to account? Who will those requirements sit with if NHS England is abolished? Will it be the CQC, the ICBs or even the Department of Health and Social Care?

We then have the issues of access and equity. We have already identified that people with learning difficulties and certain racial groups find themselves in contact with mental health services more than other groups. These groups can be less keen then to interact with services, either by choice or due to ability, so how do the Government intend to ensure that ACDs are accessible to people from diverse backgrounds, including those with communication difficulties, learning disabilities or limited English? What consultation will there be with charity and representative groups to ensure that documentation is accessible enough for all, yet thorough and robust enough to properly reflect wishes correctly?

Clause 45 is a welcome step towards enhancing patient autonomy and improving mental health care, but to ensure that the new powers deliver real benefits, the Government should consider how to strengthen the duties placed on various bodies. That leads me to amendment 46, tabled in my name. Embedding ACDs into mental health is long overdue, but the clause places duties on NHS England and integrated care boards only to “make such arrangements” as they consider “appropriate” for providing information and support for ACDs. The intention is good, and a marked step from where we were, but the language risks creating a postcode lottery in which patients’ access to this important right depends on where they live or how proactive their local systems happen to be.

That is why my amendment seeks to move from discretion to entitlement. It would replace the current discretionary wording of the clause with a clear legal right for eligible patients to create an advance choice document. The amendment defines “eligible patient” as a patient who has previously been detained under parts II or III of the Act, who has a diagnosis that may lead to future detention, or who qualifies as an informal patient under proposed new section 130CA. It would also require NHS England and ICBs to proactively inform eligible patients of their rights and offer them support in exercising them. This is a targeted and proportionate amendment. It would not mandate ACDs for all, nor would it impose burdensome new duties; it would simply create a right to be offered and supported to make an ACD.

The letter of 3 June from Baroness Merron to my colleague in the Lords appears, in part, to address the issue, so I will talk a little about what she wrote. I thank Baroness Merron for the letter and the tone of the letter, which reflects genuine engagement on the issue and acknowledges the importance of reflective care after detention. She notes:

“The impact assessment for the Bill accounts for multiple hours being spent with the individual by health and care professionals to inform and support them to make choice in advance of a potential future mental health crisis.”

That is welcome. She also stated that the Government had tabled an amendment that day that

“requires commissioners to make arrangements for bringing information and help available regarding ACDs, to the attention of people…especially those in the 12 months following their discharge from hospital.”

I believe that that is a reference to one of the Government amendments to this clause. I hope I am right; if so, I will return to that amendment once I have set out the position on ours. As set out in the letter, the Government amendment is another step forward, and I acknowledge that the Government have appeared to move in response to concerns raised by my colleagues in the Lords and by many stakeholders, but I gently suggest that it falls short. It retains the same permissive language—duties to do what is a “appropriate”, decided locally by commissioners. That may allow for good practice in some areas, but it does not create enforceable rights for individuals. Without a clear entitlement, patients who need this the most may never even be told that it was an option.

Let me give a practical example to illustrate why statutory rights matter. A person with bipolar disorder may be detained under the 1983 Act during an acute episode, but once well, they may want to specify in writing that in future they do not want a particular medication or that they want to be admitted to a specific hospital near family. Those are reasonable, clinically relevant requests, but unless the person is informed of the right to make an ACD and offered support to do so, that opportunity could be lost, especially for those facing health inequalities or language barriers, or those who have a history of mistrust with services.

The Government have said that those conversations will happen anyway within the care planning or under the community mental health framework, but the reality is that the systems are patchy. People discharged from hospital often face month-long waits to be re-engaged by community teams. They may not have a named worker. They may receive support only from overstretched primary care. ACDs must not rely on assumptions about care pathways, which too often do not work as intended.

On trauma and mandating reflection, I want to take seriously a point that Baroness Merron raises in her letter: for some individuals, reflecting on past detention may be traumatic, and that support should be user-led. Absolutely—that is why my amendment would create a right, not an obligation. No one should be forced to make an ACD, but people should be informed that they can, and they should receive its support if they so choose. Choice is not trauma; it is autonomy.

Let us remember that, for many, reflecting on what went wrong in past care is not re-traumatising but restorative. It is how people regain control and how the services learn. I believe this is a thoughtful and sensible amendment. It would strengthen clause 45 by creating clear, predictable entitlements for those most at risk of future detention. It would respect clinical discretion while affirming patients’ rights. It would not undermine the Government’s intent but fulfil it. We all agree that ACDs could be transformative. Let us give them the best chance to succeed by ensuring those who need them the most are offered them, not just as a maybe.

I will touch quickly on amendment 18, tabled by the Liberal Democrats, and spend the rest of my speech addressing the Government amendments. I am grateful to the hon. Member for Winchester for highlighting an important part of dealing with mental health, but I simply wonder whether primary legislation is the correct place to do what he suggests. Could it be done in codes of practice? What if people are admitted, but when they produce plans do not want to disclose their financial arrangements? Might compulsions have to be created for them to do so? I wonder about the unintended consequences of amendment 18, and I look forward to the hon. Gentleman’s addressing them.

I think the Minister in the other place was referring to Government amendments 32 and 33, so I am grateful to be able to address what has come forward. Government amendment 32 appears to be a step in the right direction. It seeks to insert new paragraph (c) into proposed new section 130M(1), with the following wording:

“bringing the availability of that information and help to the attention of such people as it considers appropriate.”

That is welcome, as it moves beyond simply making information available, which could mean leaving a leaflet in a waiting room or uploading something to a website, and instead encourages proactive communication. However, the language still leaves a significant loophole: it is limited to

“such people as it considers appropriate”.

That allows NHS England or integrated care boards to withhold communication for individuals who may be eligible, based on subjective judgment or resource constraints. Although it improves the duty, it still falls short of a universal and consistent approach to ensure people with serious mental health needs know their rights.

Government amendment 33 will insert two further subsections, (1A) and (1B). Proposed new subsection (1A) states:

“The arrangements that must be made…include such arrangements…for people to be given information or help by having a conversation with someone who is suitably qualified”.

Proposed new subsection (1B) states:

“NHS England or an integrated care board must have regard to the particular benefits to a person of making an advance choice document within 12 months of their discharge”.

The amendment rightly recognises that a conversation, not just a form, is often essential for meaningful care. It also acknowledges that the post-discharge period is a crucial window in which individuals are stabilising and may be open to shaping a future care plan in a thoughtful way, but again the language is discretionary. There is no guarantee that the conversation will happen, even where a person is recently discharged from hospital and known to be at high risk of readmission. Who is “suitably qualified”? Is it the clinician, an independent advocate or a voluntary sector worker with lived experience? If the amendment is to be meaningful, the Government must provide clarity in the codes of practice or in regulations.

--- Later in debate ---

[Anna Dixon (Shipley) (Lab)]

The hon. Gentleman makes some very good points about the importance of patients being offered advance choice documents and being supported to make them, as the Bill describes. The evidence submitted from the General Medical Council makes it clear that it supports the duties as set out in the Bill, and it says that they are in line with the current good medical practice guidelines for professionals. Does the hon. Gentleman agree that the Bill, as it stands, fits very well with current medical practice?

[Dr Evans]

I am grateful for the hon. Lady’s point. It would be interesting to know if that advice came when the Bill was debated in the Lords, because these clauses were not in place, but were introduced through the Government’s amendments. This is an extension to that. Our amendment to give a right to a patient would be a further strengthening. I entirely agree that the Bill is a good step forward, but if we are not going to address this again in the next 40 years, the Opposition would like that right to be enshrined. To be offered the opportunity is the key bit here—no mandation. It is good practice to let people know their rights, and we are affirming that. The worry is that while there is good intention to allow it based on the system, what happens if times are stretched? The amendment would give someone a statutory chance to say they have that right, and that it is upheld in law. That is what the Opposition are pushing for.

In essence, we are both trying to solve the same problem, but taking different approaches. The key distinction between the approach of the Government and that of the Opposition is that the Government’s creates a duty on the system, but no individual entitlement, while the Opposition’s proposes a patient right matched by a clear responsibility to inform and support the individual. The Government’s clause says that NHS England and ICBs must make arrangements as they consider “appropriate”. We say all eligible patients should have an informed right to create one. I anticipate that the Government might turn around and say, “Well, this is too rigid,” or that it imposes unfunded burdens on the ICB. I argue that it is targeted; we are not extending the right to everyone with a mental health condition but only to those at the most risk of future detention.

[Sojan Joseph (Ashford) (Lab)]

As a clinician, I hope that the hon. Gentleman will understand what I am trying to say. There are many mental health patients who do not have any insight into their illness and often refuse to take medications. It is important that, as the clause says,

“‘qualifying person’ means a person who has capacity or competence to make the statement,”

so that people do not make inappropriate decisions in their advance choice documents. It is important to keep the clause as it is, whereby a qualifying person is someone who can make a competence decision.

[Dr Evans]

The hon. Gentleman is spot on. We do not want people making decisions about their care when they do not have capacity. The whole point of what we are trying to do—as is the Government’s intent—is to allow people to make advance care decisions when they have capacity, so that when they are not lucid in the future and come back into contact, their preferred decisions are already set out. The clause does allow for a handbrake mechanism for clinical safety, to overstep them. However, what I am worried about is finding ourselves in a situation where patients never even find out that they have the right to create one of these ACDs.

The hon. Gentleman will know, as I do from my time, that good clinical practice is to ensure that patients have a plan. We do that for asthma: we expect patients to have an emergency plan for what happens, who they contact, where they go, what they take and what it looks like, personalised to them. Why should mental health be any different? My amendment actually gives ACDs legal footing, rather than simply saying that the system should offer it to them.

The amendment is cost-effective. Evidence suggests that ACDs can reduce the use of coercive powers, prevent relapse and improve continuity of care. That reduces costs, not adds to them. It is already good clinical practice; many mental health trusts already encourage care planning conversations. Our amendment would simply raise the standard across the country.

The Opposition understand that the Government have the numbers on this Committee. Will the Government clarify the role of the code of conduct? Do the Government intend to issue national guidance or benchmarks to ensure that ICBs do not apply widely different criteria for who is appropriate to be informed or held? Could the Government explain further, in response to the letter and in this Committee, why they do not accept ACDs as a basic right, narrowly defined, for only the most vulnerable individuals to be offered this opportunity? What mechanism will be used to monitor compliance with these new duties? How will patients know whether they are being fulfilled?

To my eyes, Government amendments 34 and 35 will do the same as amendments 32 and 33, but covering the Welsh system and local health boards, so I will not rehearse the arguments that we have just had. However, I would be interested to know whether this creates an issue for data collection on compliance across the two countries. We touched on this in relation to clause 2, but if different health authorities take different approaches to monitoring data, does that not risk making it even more opaque when we try to see both good and bad performance? Could the Minister address that point?

[Jen Craft (Thurrock) (Lab)]

I rise to speak briefly to clause 45, Government amendments 32 and 33, Lib Dem amendment 18 and Opposition amendment 46. I am very supportive of clause 45. The ability to make an advance choice document is incredibly important to people who may come under the scope of the 1983 Act and be subject to detention under mental health legislation.

We have spoken at length about the importance of patients’ input into their care and the improvements in outcomes when they feel that they have been involved and their wishes and feelings are taken into account. An advance choice document allows someone at risk of being detained under the Act to set out their choices, thoughts and opinions before becoming so unwell that they may need to be admitted to hospital. Other hon. Members have spoken about how an advance choice document can help prevent detention in a mental health unit, as it can stop issues escalating to the point where there is no option but detention, to ensure patient safety or the safety of others. I am broadly supportive of clause 45, and I urge the Committee to be.

I turn briefly to Opposition amendment 46. I have heard the thoughts of the hon. Member for Hinckley and Bosworth. My understanding is that clause 45, along with Government amendments 32 and 33, will effectively create the rights for those who should have an advance choice document to be able to take advantage of them. Government amendments 32 and 33 will go further in ensuring that people who may benefit most from an advance choice document are informed of their ability to do so.

I note that Government amendment 32 will put a duty on an integrated care board to bring information to such people as it deems appropriate. I welcome the duty being on an integrated care board or commissioner locally, particularly because there are such nuances in localised care and localised populations. There are areas of the country in which the prevalence of things like learning disability and autism is higher than in others. The amendment will allow an ICB or local commissioner to consider what may be appropriate for the population in their area.

[Dr Evans]

I appreciate what the hon. Lady is saying. There are differences—rightly so—and regional variation. By definition, different regions will take different approaches to dealing with this issue. My argument is simply that someone with a learning disability should have the right to decide to make an ACD, as should someone with bipolar disorder or anorexia. There should be no regional variance in that; it should be a right given to the individual there and then. Regional discrepancy should not come into the system to deal with this. I appreciate that there will be regional discrepancy, but, fundamentally, we want to engage the right, not just the responsibility for the ICB to decide who it thinks is appropriate. I am interested in the hon. Lady’s take—I think this goes to the heart of what we are trying to do.

[Jen Craft]

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

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

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

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

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

--- Later in debate ---

[Stephen Kinnock]

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

[Dr Evans]

If I am correct, the Minister said “if” a patient “approaches”. That is the fundamental point: that the onus is on the patient to know what their right is to approach the authorities. We are trying to do it the other way, by saying that their right is to be told about what is going on. Will the Minister clarify what he meant, because this is essentially what we are concerned about?

[Stephen Kinnock]

What I meant is what I said. I will read it again: if an individual who is likely to benefit from making an ACD approaches services to create one, they should be offered information and appropriate support to do so. The approach that we have taken in the Bill is therefore functionally equivalent to a right to request an advance choice document.

We are also concerned about prescribing that commissioners inform and support some of the groups of individuals identified by the amendment. For example, it may be practically challenging and not always appropriate to contact people who were detained or admitted informally many years ago about making an ACD. We agree, however, that that there is a good rationale for encouraging past voluntary and involuntary patients, especially those discharged in the past 12 months, to create an ACD. That is reflected in the Government amendments to strengthen the duties on health commissioners, which I will come to shortly.

The approach is based on research findings that suggest that the optimal time to write an advance choice document is shortly after discharge from hospital. That also recognises that many of the individuals are likely still to be under the care of mental health services and therefore well positioned to receive support and advice from services to make their ACD. Ultimately, the amendment was debated in the other place and not considered workable. In recognition of concerns expressed by Earl Howe and Lord Kamall, however, my noble Friend Baroness Merron made a commitment to strengthen duties on health commissioners in relation to the advance choice documents.

Government amendments 32 to 35, which we tabled in response to the amendment, will strengthen the duties in three ways. First, they will require that health commissioners proactively make arrangements to bring information on and help with making an advance choice document to the attention of the appropriate people. That is to prevent the risk of commissioners taking a minimal approach to discharging the duties.

Secondly, the Government amendments will require that information and help is provided through discussion with a suitably qualified person, such as a health or care professional, advocate, support worker or peer support worker. That is to ensure that people can rely on the guidance and support of a professional, where they wish to receive it.

Lastly, the Government amendments will encourage commissioners to have regard to the benefits of a person making an advance choice document within 12 months of discharge from a mental health hospital. That builds on research findings that suggest the optimal time to write an advance choice document is shortly after detention.

Government amendments 32 to 35 will help to further secure the success of advance choice documents by ensuring that people who are at risk of contact with the Act are given the opportunity to make an ACD, as well as being offered the dedicated support that they may need to do so.

On amendment 18, we agree that there is value in encouraging people to include details of any relevant financial matters within their ACD. Financial matters, such as problem debt, can worsen or even trigger a person’s mental illness. We expect that doing so will help to ensure that people receive the care and support that they need if they later experience a mental health crisis. We feel that it is important for individuals to have autonomy over what they include in their ACD, however, rather than prescribing the contents in legislation. We therefore think that the intention behind the amendment is better achieved by other means.

We plan to develop guidance and a template ACD to support service users in making their document. Those will include prompts to consider any relevant financial matters. Furthermore, the guidance that we plan to include in the code of practice for mental health professionals will cover the need to support the person to consider any relevant financial matters that may be important to their mental health recovery.

Finally, I turn to the clause in its entirety. Advance choice documents provide a place for people to set out their wishes, feelings, decisions, values and beliefs, while they are well, regarding their care and treatment. That is in preparation for the scenario in which they are too unwell and lack capacity to express such things at the time. At that point, the contents of their ACD should be considered by mental health professionals to inform their decision making regarding the person’s admission to hospital, detention under the Act, and care and treatment.

Research shows that ACDs can have a range of benefits, including reducing the risk of hospital admissions. To help to unlock those benefits and ensure the uptake of ACDs among service users, the clause will place duties on health commissioners to make appropriate arrangements so that relevant individuals are informed and supported to make an ACD. The duty aims to ensure that individuals who are likely to benefit most from making an ACD are proactively given the opportunity to make one while they are well.

Other clauses create the framework to ensure that the contents of a person’s ACD have a real impact on care and treatment decisions, for example the clinical checklist, the compelling reason test and the new framework for creating a nominated person. I therefore ask the hon. Member for Hinckley and Bosworth to withdraw amendment 46, and I ask Liberal Democrat Members not to press amendment 18. I commend Government amendments 32 to 35 and clause 45 to the Committee.

[Dr Evans]

I would like to press amendment 46.

Question put, That the amendment be made.

--- Later in debate ---

[Stephen Kinnock]

My hon. Friend is absolutely right. In many ways, the best way to look at the issue of discharge is to start thinking about it almost as soon as the patient is admitted. We need to be thinking holistically about what place they are in, what the aftercare plan might look like and how it might relate to the discharge plan. The earlier we do so, the better. In so many cases, upstream intervention is important to avoid having to scramble to deal with a crisis further down the line. My hon. Friend is absolutely right to raise that point.

I turn to clause 47. Section 117 of the Mental Health Act places a duty on the NHS and local social services authorities to provide aftercare to certain patients who have been detained under the Act once they leave hospital. Aftercare services seek to reduce the risk of readmission, and they must be provided until the NHS and local social services authorities are satisfied that the person is no longer in need of such services. However, there is currently no requirement to notify the person when that ends. Clause 47 requires that the provision of aftercare lasts until the NHS and local social services authorities jointly give notice to the person in writing that they are satisfied that the person is no longer in need of such services. This will clarify when aftercare services have ended.

Decisions on entitlement to and responsibility for aftercare services are heavily contested. Deeming rules are used to deem a person to be ordinarily resident in one area, even though they are living in a different area. They ensure continuity of financial responsibility when a person is placed in a local authority area and prevent the local authority from placing someone out of area to ease its financial burdens. Currently, section 117 does not contain any deeming rules.

Clause 47 will apply existing deeming rules under social care legislation to identify which local authority is responsible for arranging aftercare for an individual patient. This change will add clarity and consistency to an often litigious system and more closely align local authority social care and NHS rules for determining ordinary residents. This aims to support organisations to work together to provide and plan for aftercare services and reduce the number of disputes that have arisen in recent years.

Finally, I thank the hon. Member for Guildford for tabling new clause 21, which seeks to place a duty on the responsible integrated care board to ensure that advice and support is offered to the family or carers of the patient being discharged. The statutory guidance on discharge from mental health in-patient settings sets out how NHS organisations should exercise duties to co-operate under sections 72 and 82 of the National Health Service Act 2006 in the discharge process. This includes providing information or support on housing, social services provision and financial support. The Mental Health Act code of practice also provides statutory guidance on the information that should be provided to patients, families and carers.

We do not believe that it is necessary to place additional duties on integrated care boards to provide information and support, as existing duties are sufficient. We will consider whether to use the revised code to bring together guidance on discharge into one place and explore how to clarify best practice on information and support to carers. I hope that what I have set out satisfies the hon. Member for Guildford and that she will not press new clause 21. I commend clauses 46 and 47 to the Committee.

[Dr Evans]

I will speak to clauses 46 and 47 and then to new clause 21. Clauses 46 and 47 form a significant part of the Government’s effort to strengthen discharge planning in continuity of mental health aftercare. Clause 46 extends tribunal power. Under the current Mental Health Act, when a first-tier tribunal considers a patient detained under part II of the Act and decides not to discharge them, it may still make non-binding recommendations, for example that the patient be transferred to another hospital or given leave of absence.

--- Later in debate ---

[Zöe Franklin]

The hon. Member makes a really good point. There is definitely a place for ensuring that we work on this further to make sure that it covers that. I will come on to that later, if she will allow me.

We know that early intervention is key. We know that families, carers and those around an individual are often the first to spot the warning signs, and that they need to feel empowered, not sidelined. I hear time and again, as I am sure hon. Members across this Committee Room have heard, from people who have been left out of the discharge planning for their loved ones. They say that they have received no clear information and that they feel unsupported and unable to fully support their loved one when they return home.

Importantly, the new clause sets out a process whereby, if a family member wants to raise a concern, the team must consider whether that individual should be added to the register of persons at risk of detention under part II of the Mental Health Act. We believe that this is a sensible, joined-up approach to prevention, spotting risks early and acting before a crisis point is reached. Finally, the new clause would require the Secretary of State to publish national guidance and ensure consistency and clarity across the system.

We often speak of carers as the invisible workforce of our NHS. The new clause would make their contribution visible by recognising their role and giving them the information and support they need to fulfil it well.

[Dr Evans]

Forgive me if I missed it, but I did not hear any discussion of this point. I am slightly concerned about the way the new clause is written, as it could be a duplication of the support, protections and duties put in place through the Care Act 2014. Could the hon. Member set out how the new clause would run in parallel with the Care Act? Is it complementary, or does it work against it?

[Zöe Franklin]

In my final comments, I was going to say to the Minister that, having considered the points he set out in his opening statement in relation to this clause, I am prepared not to press the new clause. I appreciate that some of the information already exists in the Bill and in the existing documentation to which the shadow Minister referred. I also acknowledge the point made by the hon. Member for Thurrock, that some aspects around consent must be dug into.

However, I ask the Minister to work with me, my hon. Friend the Member for Winchester and other hon. Members with an interest in the issue, so that he can hear our constituents’ experiences of where the current guidance is clearly not working, and ensure that appropriate additions are made to the supporting documents for the Bill to address the concerns that we have raised in the new clause.

Ordered, That the debate be now adjourned.—(Taiwo Owatemi.)

Mental Health Bill [ Lords ] (Eighth sitting)

Luke Evans Excerpts

Committee stage
Thursday 19th June 2025 Public Bill Committees

I urge the Government to provide guidance, oversight and support, to engage not only with the legal professionals but with those who live under guardianship regimes, and to use the noble principle of least restriction not as a slogan but as a functional safeguard. If the Government can do that, and if they can meet the high standards to which the clause aspires, that will represent meaningful reform. If not, I fear that we risk crafting a well-meaning provision with good intentions that will be undermined by poor execution. I urge the Government to get this right for those living with mental health illnesses, for the professionals who support them and, crucially, for the integrity of our legal system as a whole.

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

It is a pleasure to follow my hon. Friend the Member for Solihull West and Shirley. I would expect nothing less from him than a fantastic canter through this important clause. I will not repeat a lot of what he said, but I will try to emphasise it.

Although clause 48 is short, it speaks to the much larger principle of the balance between public protection and individual liberty. I will not go through all the details, as the Minister laid out the changes, but the burden of proof is currently on the patient to convince the tribunal that they no longer meet the criteria for guardianship. The clause will change that. Instead, the burden will fall on the local authority or relevant public body to prove that guardianship remains justified. The Government’s explanatory notes put it plainly:

“the patient should be discharged by the Tribunal unless the local authority can prove that the patient continues to meet the guardianship criteria.”

The clause is not just a technical amendment; it is a fundamental realignment of legal principle. It reinforces the presumption of liberty. It aligns guardianship cases with the principle that when the state restricts an individual freedom, it is for the state to justify that restriction, not the individual to justify their freedom. It echoes the evolution of mental health law towards a less restrictive approach, a principle we put in place on the first day of our deliberations on the Bill. Although clause 48 amends only a few words, it reflects a big change in principle: liberty is the default, and restriction must be justified and not presumed.

There are some important questions that I want to echo and emphasise, again leading on from my hon. Friend the Member for Solihull West and Shirley. Are local authorities prepared for the reversal of burden? Have they been consulted? Do they have the legal resources, documentation, standards and evidential processes to meet the burden before the tribunal? On top of that, we have already agreed that there will be automatic referrals. We would therefore expect more referrals to the tribunal as well as a change in how they operate. This is a huge undertaking. If they fail through a lack of capacity organisation, we risk a situation in which patients are discharged not because they no longer meet the criteria, but because the case was poorly presented. How will the Government ensure that that does not happen?

Secondly, will the Government issue statutory guidance or regulations to ensure that consistency in how the burden is discharged? We do not want a postcode lottery in the quality of guardianship applications or tribunal evidence. Thirdly, we must always consider public protection. The guardianship regime is not designed for high-risk individuals, but it can still apply in cases where behaviour poses a serious risk to self or others—for example, individuals with profound learning difficulties who might place themselves in danger if not properly supported.

We also talked about cumulative or escalating behaviour in one of our first debates. The reason for doing so is that we are at the fringe of significant cases. What safeguards are in place to ensure that public safety considerations are given due weight in cases where the evidence might be incomplete or borderline? Finally, do the Government intend to monitor the impact of the clause? Will data be published on whether tribunal discharge rates increase following this reform, and whether that leads to any unintended consequences?

I want to be clear that His Majesty’s Opposition support the principle behind the clause. We support a mental health system that is rights-based, person-centred and built on the presumption of liberty. But that principle must be matched by a system capable of meeting the duties it imposes. Rights on paper are meaningful only if public authorities are resourced and able to support them and uphold them in practice. I look forward to the Minister addressing those points.

[Stephen Kinnock]

On the assessment of impact, it might be useful for the Committee to know, for context, that the use of guardianships under the Act is small: the number of new cases has declined from 470 in 2004-05 to just 40 in 2024-25. The number of open cases has also fallen in recent years. I think pretty much all the questions from the hon. Member for Solihull West and Shirley and the shadow Minister are addressed by that point. We are talking here about small numbers, so the cost would be relatively minor.

[Dr Evans]

That is a staggering drop in numbers. Is there a reason behind it? Is it that the burden of proof was always put on the patient, so they did not feel that they were in a position to do something? If we are inverting that, does the Minister expect the numbers to go back up?

[Stephen Kinnock]

I do not have any data to suggest that the numbers will go back up. That relates to the question that the hon. Member for Solihull West and Shirley asked about having a statutory review. We will be vigilant. As with all the changes in the Bill, we will closely monitor implementation and impact. That goes right across the board and, hopefully, addresses the Member’s questions.

Question put and agreed to.

Clause 48 accordingly ordered to stand part of the Bill.

Clause 49

Removal of police stations and prisons as places of safety

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

--- Later in debate ---

Removing police stations is patient-focused and police-focused. My concern about this—perhaps, again, the Minister can clarify and reassure me—is ensuring that there is sufficient support in place for the police and ambulance services to deal with the transition. Again, at the heart of my support for the clause is that I think it will deliver a more therapeutic, suitable and effective process for the patient, while also, I hope, allowing our public services to do the job they are intended to do with the right support and resources.

[Dr Evans]

As we have heard, the proposals set out to remove police stations and prisons as places of safety. It does this in both relation to people detained under civil powers—sections 135 and 136—and in respect of certain part III patients involved in the criminal justice system, who may currently be held in such settings when a hospital bed is not available. The Government’s explanatory notes describe the rationale clearly:

“This is in response to evidence that suggests these settings are not suitable environments for individuals with a severe mental health, in crisis, awaiting assessment and treatment.”

As we have discussed in some of the earlier clauses, it is not just treatment, but the environment that plays a part in helping harbour a holistic care approach, so this is very much welcome. To that end, the Opposition can agree on this position in principle. A police station or prison cell is no place for someone with acute mental distress. They are not therapeutic environments; they can be frightening, disorientating and, in some cases, re-traumatising, particularly for children and young people. The clause aims to remove that contradiction in the law.

As the law stands, when police officers encounter someone in a public place who appears to be suffering from a mental disorder and is in immediate need of care or control, they can detain them under section 136 and take them to a place of safety. Under section 135, a magistrate can issue a warrant to remove a person from their home or another place to a place of safety. Currently, that place of safety includes a police station, although section 136A limits that to exceptional circumstances—for example, when the individual poses an imminent risk of serious injury to themselves. Similarly, under part III of the Act, a person appearing before a criminal court can be held in a place of safety, which can currently include a police station or prison, pending hospital admission.

Clause 49 will remove that. It amends section 55 to redefine “place of safety” and exclude police stations and prisons. It alters section 35, repeals section 136A, which has previously allowed police stations to be used in limited situations, and retains transitional protections for individuals already detained under early directions before the clause comes into place. That is a bold and principled legislative step, and I acknowledge that it builds on progress under the last Government. The 2017 Conservative Government, following public outcry and recommendations from the Care Quality Commission and the Wessely review, pledged to eliminate police cells as a place of safety for children. Since then, the numbers of such detentions have significantly decreased. Data from NHS Digital shows a downward trend in the use of police stations under section 136, which is evidence that change is possible with the right investment and inter-agency collaboration. That work deserves credit, so I thank the Minister for that.

Clause 49 must not only move the law forward, but ensure that the practice can be followed. I therefore want to raise a number of questions, which I hope the Minister will take in good faith. The classic one is “Where would people go instead?” The explanatory notes are right to say that hospitals and healthcare-based settings are more appropriate, but do those settings exist in sufficient numbers, with trained staff, beds and security protocols to receive safely all those who would otherwise have been taken to police stations? If they do not, we risk creating a gap between the law and the real world—a dangerous vacuum, whereby someone in crisis may end up in an ambulance bay, in a police car or in a general A&E without specialist support. It could have wider impact on the safety of not only the individual patient suffering, but other patients in healthcare settings such as A&E, interacting with an acutely ill mental patient. Without proper capacity, we risk many more police officers having to be at health settings to keep the mental unwell patients safe from themselves and others.

I appreciate that the Government have said that it will take 10 years to implement the Bill fully, but this clause will come into force immediately. What assurances can the Government give that there will be not only capacity, but capacity in the right places, so that, for example, people are not transferred to other areas of the country to ensure that the legal requirement is met? Although it is welcome not to be in a police station, being miles from family and support circles would be just as detrimental.

What provisions are being made for children and young people? The clause rightly states that for minors, the place of safety must now comply with the Children and Young Persons Act 1933, but excluding police stations. Are there sufficient CAMHS—child and adolescent mental health services—crisis beds and child-friendly places of safety in each region? What guarantees are there that children will not end up in adult settings, or worse, in informal or unlawful detention?

I turn to the transitional support given to the police. Officers may no longer be able to use their custody suites, but what training, resources and alternative pathways are being made? What happens in the middle of the night in a rural police force, where there is no mental health professional on call and the nearest hospital bed is 80 miles away? How would the Government monitor performance? Will the Government commit to publishing annual data on delays in finding a place of safety, the use of inappropriate settings post reform, and outcomes for those detained under sections 135 and 136? Will the CQC or another body be tasked with auditing local compliance?

Clause 49 reflects a consensus that mental healthcare belongs in health settings, not custodial ones. I urge the Minister to answer the questions in the good faith in which they were asked, because we all want to see this become a reality.

[Stephen Kinnock]

I think it is probably right to say that the questions asked by the hon. Members for Solihull West and Shirley and for Chester South and Eddisbury and the shadow Minister basically all relate to building capacity to ensure that we are ready to absorb this change. We have committed to lay an annual report on implementation, which will set out progress made and future plans for implementation. We are working closely with the Home Office, the police and NHS England to better understand the implementation requirement for switching on this change. There is considerable variation across the country in the way in which police stations are being used, so there is a need to target support.

I would add that the number and shape of dedicated health-based places of safety that are needed in a local authority will depend on the mental health needs of that population and the wider mental health crisis pathway provision. We are taking steps to ensure that people in crisis receive support and treatment sooner, so that fewer people need to be taken to a place of safety. It is worth noting that the Government have hit the ground running on this issue since we came into office last July. We are committing £26 million in capital investment to open new mental health crisis centres, which will aim to provide accessible and responsive care for individuals in mental health crisis.

Evidence from systems with established crisis centres indicates that they can help to streamline urgent mental health care pathways and reduce unnecessary conveyance to A&E by ambulance, health-based transport or the police. We have also selected six areas to trial a new approach to mental health support by providing 24-hour neighbourhood mental health centres, seven days a week, bringing together all aspects of community mental health services.

[Dr Evans]

The Minister has partially answered my question. He talked about the £26 million investment being targeted at certain areas of the country, but will that be based on the areas of highest priority? The danger is that if the highest priorities are all in the north, the south will be left out.

[Stephen Kinnock]

We have selected six areas, but off the cuff I cannot tell the shadow Minister exactly what they are or whether they have been announced yet. If they have not been announced, I will not be able to tell him, but if they have been, of course I can share that information. I suspect that the areas will primarily be based on assessed need, but they are trial pilots, so there is no reason to suspect that they will be limited to six. Let us see how much traction they get.

Question put and agreed to.

Clause 49 accordingly ordered to stand part of the Bill

Clause 50

Removal of patients by authorised persons

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

--- Later in debate ---

[Dr Shastri-Hurst]

The hon. Gentleman speaks with a huge amount of experience and knowledge in this area. Of course, what he describes would be the default setting, but there may be scenarios in which a qualified healthcare worker is in the vicinity and can provide the support that that individual needs before the police can get there. The clause seeks to provide that flexibility. I acknowledge the split in the Committee on this, but the clause has some significant advantages: reducing police involvement in mental health crises, where that is most appropriate; improving response times, as I have just touched on; and supporting de-escalation.

I accept that there are operational and legal questions to be addressed, but we are here to look at all the potential scenarios. The Minister has clearly set out the consequences of removing the clause from the Bill, but it is perfectly possible that a Government Member on the Committee will choose to support it, and I therefore seek some clarification from the Minister on the operational and legal challenges around training, oversight and the uniformity of authorised roles were the clause to remain part of the Bill. How would training standards be mandated for authorised persons and who would accredit them? How would consistency in practice be ensured across NHS trusts and ambulance services? Will the Minister also clarify the liability position in a case in which an authorised person used force or restraint during a removal?

[Dr Evans]

I am pleased that the Minister has clarified that the Government intend to take out clause 50, because that allows me to take out some of my speech. It would not be appropriate for me to retread the entirety of the argument—we have been through it, and I am aware of the numbers on the Committee—but I will address a few points, because the clause is important.

The clause would keep the role of authorised persons for the purposes of sections 135 and 136. Hon. Members will know that this is not a new issue, as we debated the removal of the definition of authorised person in relation to clause 5. On that occasion, I expressed my concerns about the risk of doing so, which were shared by Baroness May, who rightly argued that we must stop treating mental health as a policing issue and start enabling care to be delivered by the right person in the right way at the right time. This clause gives us a chance to make that principle real.

Clause 50 allows certain non-police professionals, defined as authorised persons, to use existing powers under section 135 to enter premises under a warrant and remove a person in a mental health crisis to a place of safety or assessment of care. It also allows those professionals to use powers under section 136, which is even more sensitive, permitting the removal and detention of a person from a public place without a warrant if they appear to be suffering from a mental health disorder.

The clause is not about weakening safeguards. It is about strengthening the frontline and moving away from a model where the police are the default responders to every mental health crisis, which is often not because they are best placed, but because no one else has the authority. As modelling has shown, 95% of mental health-related police calls do not require a criminal justice response. Officers are spending hours, even days, sitting in A&E with patients in distress, because no one else is trained and empowered to act.

Clause 50 helps to break that cycle. It creates a legal basis for trained health professionals—mental health nurses, paramedics and approved mental health practitioners —to intervene in crisis situations, rather than relying solely on the police.

The hon. Member for Ashford asked how we decide, but we already triage people when they ring 999 or 111. How do we decide who gets an ambulance for what sounds like a heart attack or stroke? That decision is made by clinicians. We have the ability to make those triaging decisions, and I think it is completely appropriate to try to empower the health services to find a better way of dealing with these people.

[Anna Dixon]

Does the hon. Gentleman recognise that health professionals do not wear stab vests or cameras? They are not equipped to go into dangerous situations. It is essential to protect healthcare workers and not put them at risk. We should maintain the current situation, whereby they work in tandem with the police, but the police are present for the detention.

[Dr Evans]

The hon. Lady is absolutely right. A paramedic never knows what they are going to when they are called out. It could be a terrorist incident; it could just be a person in distress who is hysterical. A paramedic never knows, but that is part of the point—when they get there, they would be able to make that assessment rather than having to call the police out. At the moment, they do not have those powers, so that is a reason to give them the option. I am not saying that that is always the right option, but it gives them the option. The clause allows us to think of new, innovative ways to deal with the complex, changing world of mental health in the modern age.

The Government have argued elsewhere that the definition of who detains could be too rigid or unnecessary, but I would say the opposite. Professionals on the ground need clarity—a lawful mandate to act in the best interests of a person in crisis, with clear boundaries of competence and training. The Lords were right to include a definition of “authorised person” that sets out the conditions of suitability. Clause 50 builds on that framework.

Having these powers in the Bill gives NHS trusts the chance and confidence to design alternative crisis responses. The clause is by no means a blanket approach—it actually drives innovation. Health professionals have the clarity to act and police forces have the breathing space to return to their core purpose: preventing and investigating crime.

Of course, the power must come with safeguards; it is not a blank cheque. The use of coercive powers by the police or anyone else must always be subject to training, regulation and oversight. Entering someone’s home or detaining them in public is a profound interference with their liberty and dignity, so the power must be exercised with care and caution.

We believe that clause 50 takes us in the right direction towards a health-led approach to mental health crisis, rather than a security-led one, as my hon. Friend the Member for Solihull West and Shirley said. It supports the police by lightening a burden from which they have long asked to be freed. It supports patients by increasing the chance that they will be met by someone who understands their needs. It supports the wider public by allowing police officers to return to doing what they are trained to do and passionate about doing: keeping communities safe. We should be building on this type of reform, not rowing back from it. I urge the Government to reconsider.

[The Chair]

Before I call the Minister, I remind Members that interventions are meant to be short and to the point, and that responses are meant to be short and to the point.

--- Later in debate ---

[Dr Shastri-Hurst]

I ask for a series of clarifications from the Minister about all three clauses. On clause 51, how will the courts be supported in identifying community-based alternatives to remand? What training or guidance will be provided to judges in applying the provisions effectively? What assurances can the Minister give that support pathways will be available before and after the changes have taken effect?

I accept that clause 52 is a technical a change to the legislation, but it is an important clarification none the less. It will require some robust co-ordination between jurisdictions and clearer procedural safeguards. How will the Government monitor the implementation of proposed new schedule A2 to ensure that patients’ rights are preserved during transfers? Will guidance be issued to courts and practitioners in the UK and the Crown dependencies about the new procedures, particularly their cross-jurisdictional nature? What consultation has taken place, and will continue to take place, with authorities in Jersey, Guernsey and the Isle of Man before the measures are implemented in law?

Finally, I recognise that clause 53 is arguably a sensible safeguard. The challenge will be to ensure compliance on the frontline, especially where legal duties to share information and duties to protect confidentiality can butt against some degree of tension. With that in mind, what support or training will be given to health and care professionals to navigate overlapping legal duties? Will the Minister publish sector-specific guidance on data sharing as a consequence of the Bill? How will the Government assess whether the legal framework strikes the right balance between patient safety and privacy?

[Dr Evans]

Clause 51 amends the Bail Act 1976 to restrict the court’s ability to remand individuals in custody for their own protection or, in the case of children, for their welfare, where the sole concern is mental health. Under existing law, the court may refuse bail to a defendant if it is satisfied that the individual should be kept in custody for their own protection. For those under 18, the relevant test is whether custody is required for their own welfare. Those provisions are found in schedule 1 to the Bail Act.

There is currently nothing in statute that precludes the court from remanding someone entirely on the basis of their mental health conditions—for example, if the defendant appears to pose a danger to themselves but no suitable mental health provision is immediately available. Clause 51 aims to change that. It amends all three parts of schedule 1 to the Bail Act—those dealing with imprisonment and non-imprisonment offences—so that the adult defendant, aged 18 or over, may not be remanded in custody for their own protection if the only concern is mental health.

Paragraph 360 of the Government’s explanatory notes states:

“Evidence suggests that in some cases this power is being used by the courts to remand defendants into custody where they would otherwise have been bailed were it not for the court’s concern for their mental health.”

The intent here is good: to end the inappropriate use of custody—especially in prison, as we have been discussing—as a place of safety for people with acute mental health needs. The clause is consistent with the wider direction of the Bill, which seeks to ensure that people in crisis are met with healthcare and not handcuffs. Although I support the clause, I have a few questions and concerns about how it will operate in practice, and invite the Minister to consider further safeguards.

Where is the alternative provision? That is a question we will keep asking, not in the form of an attack, but as something helpful for our consideration. We are told that instead of custody, courts may impose bail conditions under section 3(6) of the Bail Act, such as requirements to engage with mental health services or, where the statutory criteria are met, remand the person to hospital under the Mental Health Act. That sounds reasonable, but the reality on the ground is often different. We know from NHS data, and from countless reports by inspectors and charities, that community mental health services are stretched, beds are scarce and out-of-hours support can be lacking.

What assessment has been made of local mental health capacity to absorb those individuals who, under clause 51, will no longer be eligible for a custodial remand? Do the Government know, for example, how many are currently in that position? If the law changes overnight, how much extra provision will be needed for these specific patients? How will the Government, specifically on remand patients, ensure that there are places? What are the requirements, if any, on NHS integrated care boards to ensure that a place of safety or support is available in every local area? Without that, there is a real risk that the courts will be left with no safe options, particularly when a person presents in crisis late at night, in distress and with nowhere else to go.

Are the bail and hospital powers workable substitutes? The explanatory note refers to courts using the power to remand for mental health reports or treatment, but the orders depend on medical evidence, the availability of beds and local agreement. They are not always available at the moment when bail is being considered. Meanwhile, bail conditions, however well-meaning, cannot guarantee care or prevent harm if services are not responsive. Has the Department considered issuing new statutory guidance to accompany the clause, outlining what courts should do when no hospital or community support is available, but the defendant is clearly at risk? Further to that, will there be a formal route for courts to escalate concerns to NHS bodies where no safe custodial options exist?

We also need to consider children and young people. As I read it, the clause applies only to adults. The Government are arguing that section 98 of the Legal Aid, Sentencing and Punishment of Offenders Act 2012 already prevents the remand of children solely for mental health reasons. Does that not potentially leave a loophole? I am no lawyer, but the Bail Act still allows for remand for the child’s own welfare, and the revised wording in clause 51(2) and (4) does nothing to prevent that being interpreted in practice as the mental health concern that we have been discussing. Why have the Government not taken the opportunity to clarify in statute the status of children? They must not be remanded to custody solely on the basis of mental health-related welfare concerns.

Finally, how will we track the effects of the changes? I suggest that there must be ongoing scrutiny of how the clause operates. To that end, will the Minister commit to releasing annual statistics on the number of people refused bail under the provisions, to reporting on incidences where a safe, non-custodial alternative was not available, and to monitoring outcomes for those affected by the changes? Does the data fall under NHS or Ministry of Justice datasets? It is important that we understand who is responsible.

--- Later in debate ---

[Dr Shastri-Hurst]

That is an invitation that I will remember as we go on in this Committee. On this occasion, I have just two questions. First, will any interim guidance be issued while the review is ongoing? Secondly, can the Minister commit that the consultation will be undertaken on a wide basis, and include patient advocates, child psychologists and safeguarding boards?

Because I cannot count, I will add a third question: did the Government consider an alternative to a two-year review period, either through an immediate extension of regulation 18 or perhaps a shorter period, so that these important changes can be put in place without delay?

[Dr Evans]

I will first speak to clause 54, to give context to my comments about new clause 12, which is in my name, and new clauses 17 and 20, tabled by the Liberal Democrats.

Currently, under regulation 18 of the Care Quality Commission (Registration) Regulations 2009, registered providers must notify the CQC if a child under 18 is placed in an adult psychiatric unit for longer than 48 continuous hours. The notification duty enables the CQC to monitor such placements and take appropriate action to protect young people.

The clause places a statutory duty on the Secretary of State to review whether the duty to notify should be extended to other cases when a child is admitted to a hospital or registered establishment for treatment or assessment of a mental disorder—that bit is really important. It also requires a review of whether the current 48-hour notification timeframe remains appropriate. As the explanatory notes make clear, the purpose of the review is

“to ensure that where a child is admitted...notifications are made to the CQC in appropriate circumstances”,

so that the regulator can respond effectively. That is a welcome and sensible provision. It recognises that safe-guarding in mental health settings must be comprehensive and responsive in changing circumstances. For example, children placed in settings other than adult psychiatric units, such as specialist units or community hospitals, may also face risks that warrant timely CQC oversight.

However, I have a few questions for the Minister. Given the potential risks to children placed even briefly in adult psychiatric units or other settings, is the 48-hour threshold for notification too long? Would early notification—perhaps on admission—provide better protection for young people? Are there known gaps in the current notification system? For instance, how often do incidents involving children in mental health treatment go unreported under the existing framework?

The review is to be completed within two years of Royal Assent. Given the urgency of safeguarding children’s mental health and wellbeing, would it be possible to provide interim updates to Parliament to maintain transparency? Will that be part of the written statement, or stand alone? Will the review consider notifications from private and third sector providers, as well as NHS trusts, to ensure that no setting is overlooked?

We must look at the role of the CQC. In another letter from Baroness Merron, the Minister in the House of Lords, she addressed some of the issues raised and laid out the rationale for her confidence in the CQC as it stands. The letter emphasises the CQC’s “multiple roles” under the Mental Health Act as an independent regulator of services, an investigator of complaints and part of the national preventive mechanism to safeguard human rights. It points out that in 2022-23, the CQC carried out 860 monitoring visits and spoke to over 4,500 patients and 1,200 carers. Those impressive figures speak to a considerable degree of activity and reach.

However, as we have debated, the Bill puts significantly more requirements on the CQC, and clause 54 is a further one. The letter also stresses the CQC’s evolving role and notes that the creation of a new chief inspector of mental health is under way—a recommendation from Professor Sir Mike Richards. The aim, we are told, is to

“put mental health on an equal footing with physical health in CQC”

and to ensure “better information sharing” and

“stronger focus on Mental Health Act compliance.”

All that is welcome, but we also need to scrutinise what is not said. While the letter asserts that

“we will have a regulator that all of us can trust”,

it concedes that that

“will take time to achieve.”

That is a fair admission, but it weakens the case for relying on the status quo while reforms are still being bedded in. If the CQC’s systems are currently being rebuilt or recalibrated, can we be confident that they are robust enough right now to identify and respond to safeguarding concerns, especially when they are about children?

Then, there is the 48-hour threshold for notification when children are placed in adult units, which clause 54 seeks to address. Do we really believe that a child being in an inappropriate or unsafe environment for 47 hours is acceptable? Should the default not be real-time notification on admission, with durations used only to prioritise the level of scrutiny? We should aim for real-time notification in the 21st century—after all, we can track a bus on our phones anywhere in the world. Should we not aim for real-time data to spring services into action? Forty-eight hours is a long time in a young person’s life.

The clause rightly instructs the Secretary of State to review those questions, but I urge the Government to approach the review with openness—not just to minor procedural tweaks, but to the possibility that more fundamental changes might be necessary. On that point, does the Minister envisage the review as a desktop-type data review, or will it engage with children and families who have experienced these placements? Will it examine how well the notifications currently translate into timely action by the CQC? Seeing the data is important, but acting on it is more so. How will Parliament be kept informed before the two-year deadline for reporting? Will that be part of the written statement?

All that leads me to our new clause 12, which aims to address a lot of the background I have set out. At present, the Mental Health Act provides for the detention of patients who require treatment for mental health disorders, including children. Section 131A of that Act governs the accommodation of patients in hospital wards, but lacks explicit safeguards preventing children from being placed in adult wards, except in limited circumstances. That has led to troubling examples across the country, where children have been admitted to adult wards because of a lack of appropriate CAMHS beds.

--- Later in debate ---

[Stephen Kinnock]

The new clause takes forward a commitment made in the Lords by Baroness Merron to address issues relating to the unequal application of the Human Rights Act 1998 for some mental health patients. Sadly, this issue was highlighted following the death of Paul Sammut. I extend my deepest condolences to his family.

We now wish to take action to ensure a more equal application of the Human Rights Act, with the aim of extending its protection to certain mental health patients. Under this amendment, private providers will be taken to be exercising a function of a public nature for the purposes of section 6(3)(b) of the Human Rights Act when they are carrying out certain services and when those services are arranged and/or paid for by either local authorities or the NHS. Those functions are section 117 aftercare; services provided in pursuance of arrangements made by a local authority in Scotland, discharging its duty under section 25 of the Mental Health (Care and Treatment) (Scotland) Act 2003; and in-patient treatment and assessment for mental disorder, whether or not a patient is detained under the Mental Health Act.

When carrying out those services, private providers will be required to act compatibly with the convention rights set out in the Human Rights Act. Many patients in private facilities already have those protections. Private providers are already taken to be exercising a function of a public nature for the purposes of section 6(3)(b) of the Human Rights Act when caring for patients detained under the Mental Health Act or providing care for patients due to the effect of section 73 of the Care Act 2014. The new clause seeks to extend those protections to other mental health patients in private provision, where care is arranged and/or paid for by the NHS or a local authority. As the new clause is a modification of the Human Rights Act, this is a reserved matter and the amendment will therefore apply in all four nations.

Government amendments 37 and 38 are minor technical amendments to the Bill’s extent provision in clause 57 to ensure that our amendment—new clause 10—relating to the Human Rights Act extends UK-wide. The Human Rights Act, which the new clause 10 seeks to modify, extends UK-wide. The amendments are therefore necessary to ensure that the same Human Rights Act protections extend to all four nations. I hope that hon. Members feel able to support the amendments.

[Dr Evans]

I welcome the opportunity to speak on these important provisions, which apply the Human Rights Act 1998 to certain private care providers delivering mental health services. At present, the Human Rights Act applies directly to public authorities and to those exercising functions of a public nature. However, an increasing proportion of mental health care and aftercare services are delivered by private providers, under arrangement with NHS bodies and local authorities. The current legislation leaves some ambiguity about whether private providers are legally bound to comply with the Human Rights Act when delivering such services. That creates a potential accountability gap that risks undermining the protections that we want to guarantee to vulnerable patients.

The Government’s proposal to explicitly extend the application of the Human Rights Act to registered private care providers when they deliver specific services commissioned or paid for by public authorities is a welcome step towards closing the gap. By doing so, it will ensure that these providers are treated as performing public functions under section 6 of the Act. That means that they will be directly accountable for upholding the rights enshrined in the Human Rights Act, including the rights to liberty, dignity, privacy and freedom from inhuman or degrading treatment.

This approach is not without precedent. For example, in the case of prison outsourcing, courts have established that private companies running prisons are subject to the Human Rights Act because they perform public functions. Similarly, private care providers delivering publicly funded mental health services should be held to the same standard as NHS bodies or local authorities.

It is worth noting that although this explicit statutory extension of the Human Rights Act to private providers is a new provision in the Mental Health Act 1983 for England and Wales, similar principles already apply in Scotland through case law and existing legislation. Under the Mental Health (Care and Treatment) (Scotland) Act 2003, local authorities have a statutory duty to provide aftercare services, which may be delivered by private providers. Scottish courts recognise that when private providers perform public functions, such as delivering those statutory services, they are subject to the Human Rights Act, following key judgments such as YL v. Birmingham City Council.

This Government proposal provides much-needed clarity and an explicit statutory footing across all four nations of the UK. It also ensures consistency across the four nations, referencing equivalent legislation in Scotland, Wales and Northern Ireland. This helps to remove ambiguity and ensure consistency. However, we must also consider the practical impact. Although these changes strengthen rights and protections, they also increase the regulatory burden on private providers. Providers may face new compliance costs, legal challenges and the need for enhanced training and oversight. That could have a knock-on effect on service availability, particularly in a market already facing staffing pressures and financial constraints.

The Government should therefore consider how to support providers to meet the new obligations without destabilising service provision. There is also a need to ensure that commissioners and regulators have the necessary resources and powers to monitor and enforce compliance effectively. In that spirit, I will pose some questions to the Minister for clarification and look for reassurance.

How will the Government monitor compliance with the Human Rights Act among private providers, and what enforcement mechanisms will be used? Has there been any consultation with private care providers about the potential operational and financial impacts of this extension, and will the extension apply only to services arranged or paid for by NHS bodies? What protections exist for patients receiving private mental health care outside these arrangements? How do the Government plan to ensure consistency in application across all four nations? Do the Government foresee private provision of mental health-related services expanding? If so, by how much?

I agree that the final two amendments look like two small consequential amendments that clarify and ensure that the human rights extension applies equally across England and Wales, Scotland and Northern Ireland. The insertion of “subject to subsection (2)” appears to be technical. I would just welcome confirmation from the Minister that it will not inadvertently limit the scope of the new protections. Otherwise, Opposition Members will support them.

[Stephen Kinnock]

I thank the shadow Minister for those questions. I will have to get back to him in writing, because the questions that he asks obviously have an important legal dimension, and it was physically impossible to get the information in the time between his sitting down and my standing up to speak. I am not a human rights lawyer either, so it is best if I write to him on those points.

Question put and agreed to.

New clause 10 accordingly read a Second time, and added to the Bill.

Ordered, That further consideration be now adjourned. —(Taiwo Owatemi.)

Oral Answers to Questions

Luke Evans Excerpts

Tuesday 17th June 2025 Commons Chamber

[Mr Speaker]

I call the shadow Minister.

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

I am pleased to hear the Minister speak about Pharmacy First, which was brought forward by the previous Government and welcomed by communities, the public and the pharmacists. Although I am pleased to see the Government continue it, why have they decided to cap the number of consultations that a pharmacist may do?

[Stephen Kinnock]

Part of that is about the financial arrangements for Pharmacy First, which need to be set at a level that incentivises pharmacists. Sadly, given the way in which the scheme was set up under the previous Government, those incentives were not working, which is one reason why the take-up of Pharmacy First has not been what it needs to be. It is a question not of capping but much more one of getting the right level of financial compensation for Pharmacy First so that it works and incentivises the system.

[Dr Evans]

I am grateful to the Minister for his answer, but part of the problem is that once pharmacists hit that cap, they are no longer paid the £17 per consultation. In turn, that means that either patients will be turned away, or the pharmacist must take the hit and pay for it themselves. That disjoins the system and could create extra costs, because patients who are turned away will turn up in other areas of primary care, such as their GP surgery. How does that fit with Darzi’s push towards community-based services?

[Stephen Kinnock]

The hon. Gentleman will have seen—and I am sure will welcome—the record uplift of £3.1 billion that we are putting into the pharmacy sector after years of underfunding, incompetence and neglect from the Conservative party. A big part of this is ensuring that the shift from hospital to community takes place, and we want pharmacists to be taking pressure off primary care. We have to make Pharmacy First work effectively, which means getting the allocation of funding right. That is what we are working on in terms of reforms. Now that we have the spending review and the package, that is what we will be delivering.