Mental Health Bill [ Lords ] (First sitting)

Neil Shastri-Hurst Excerpts

Committee stage
Tuesday 10th June 2025 Public Bill Committees

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

I beg to move amendment 56, in clause 3, page 3, line 19, at end insert—

“(4) The Secretary of State may by regulations update the definitions in subsection (2) in response to scientific advancements.

(5) A statutory instrument containing regulations under this section may not be made unless a draft of the instrument has been laid before and approved by a resolution of each House of Parliament.”

This amendment would allow the definitions for mental disorder, autism, learning disability and psychiatric disorder to be updated by secondary legislation as science evolves.

It is a pleasure to serve under your chairmanship, Mr Vickers. I rise to speak to amendment 56, which is in the name of my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer), who has extensive clinical experience. The amendment provides for a narrowly drawn but important power, namely, to update, via regulations and subject to affirmative procedure, the statutory definitions in clause 3, in response to developments in scientific and clinical understanding.

I recognise that any clause that confers powers on the Executive to amend the statutory definitions must be treated with due caution. There could be concerns that changes could be made without broad clinical consensus. However, on this occasion, I believe that my hon. Friend, who brings to the debate the weight of his clinical expertise, has struck the right balance. The proposed power is tightly scoped. It is triggered only by new scientific knowledge. It cannot be exercised on ministerial whim. Crucially, it is subject to the full rigour of parliamentary approval under the affirmative resolution procedure. It is not a case of Executive overreach; it is a recognition that the pace of medical and neuroscientific research is such that legislation risks obsolescence unless we allow for responsible adaptation.

One need only look at the evolution of our understanding of conditions such as autism spectrum disorder and complex post-traumatic stress disorder to appreciate how quickly definitions can move on. Clearly, any change must reflect best practice and take place under broad consultation. However, I argue that we are not opening the back door to arbitrary change; we are safeguarding the front door against stagnation. For that reason, I support the amendment.

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[Stephen Kinnock]

I am grateful to the hon. Member for Solihull West and Shirley for moving the amendment on behalf of the hon. Member for Runnymede and Weybridge, and to the shadow Minister for speaking to it.

As this regulation-making power would amend primary legislation, it would signify a Henry VIII power that the Government consider to be unjustified. We have significant concern that it could change the way in which the Bill applies to people with certain conditions without appropriate consultation or parliamentary scrutiny. The serious matter of detention for compulsory treatment should be considered in primary legislation.

The hon. Member for Solihull West and Shirley spoke about the need to stay in touch with our evolving understanding of these terms and conditions. My view is that the Bill does that. We have modified the meaning of mental disorder by including new definitions of autism, learning disability and psychiatric disorder. That acknowledges the advancement in our understanding of learning disabilities and autism, and how the Bill should apply in respect of those conditions. Any future change to the definitions should be a matter for Parliament, informed by strong evidence and consultation with the public.

For those reasons, I ask the hon. Member for Solihull West and Shirley to withdraw the amendment.

[Dr Shastri-Hurst]

I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

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

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[Stephen Kinnock]

My hon. Friend is absolutely right that those voices must be heard. One example is that we must produce a code of practice to ensure that approved mental health professionals are better supported in their decision making, including when assessing whether somebody with a learning disability or an autistic person has a co-occurring mental disorder. At the heart of the process are the assessment and the definition, and the pathway that flows from that. That code of practice can be developed only on the basis of dialogue and engagement with precisely the people he has talked about.

[Dr Shastri-Hurst]

Building on the Minister’s last point, can he reassure the Committee that any consultation will have a strong focus on ensuring that practitioners have the training and, most importantly, the resources that they need to achieve a seamless transition from one set of regulations to another?

[Stephen Kinnock]

I can give the hon. Gentleman that assurance. We are moving to a nuanced position that is about defining where there are co-occurring conditions and where there are not. I think everybody recognises that that is, by definition, a complex process, so the training and the code of practice that go around it will be vital.

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[Zöe Franklin]

Helpfully, I was about to move on to a point about amendments 3 and 6, which would shorten the length between care and treatment plan reviews from 12 to six months.

We need to reflect on the fact that sometimes we do not get it right when we support an individual. In such circumstances, it is particularly important that we are able to have reviews every six months, rather than 12. It does not have to be a detailed, full-scale review. If all involved in the patient’s care come to the conclusion that the care needs are being met, that review could be incredibly short. If someone’s care is inadequate or inappropriate, it is not right that they should have to suffer unnecessarily for a year without the changes that are needed. Halving the time between the care and treatment reviews ensures that patients are not left languishing and instead have care that truly reflects their individual needs. I would reiterate that a six-month review can be incredibly short, and it also benefits patients by making them aware of where their care is not working for them, so that it can be reviewed.

[Dr Shastri-Hurst]

I have a certain degree of sympathy for the amendments, but I am sure the hon. Lady will recognise that patients and their families often find the review process overwhelming in and of itself. Bringing it forward to six months, when such reviews would often not be required, can cause a huge amount of stress and place pressure on those family units and patients. Of course, reviews can be brought forward when clinical need requires it. To stipulate that within the legislation puts an enormous burden upon those families and, most importantly, the patients.

[Zöe Franklin]

I return to my point that a review can be short when clinicians and those involved in a patient’s treatment deem it appropriate. Again, where the system is working for a patient, it is good and proper that we do a short review, and they can then carry on with their treatment. When it is not working, why should the patient struggle on for 12 months alongside their families, who will also be struggling?

[Dr Shastri-Hurst]

Will the hon. Lady give way?

[Zöe Franklin]

No, I will move on to amendment 7, which I also want to cover. This amendment is very important, as it would ensure that the integrated care boards and local authorities responsible for a patient’s treatment and care would have a duty to implement the recommendations arising from a care and treatment review. The legislation states “must have regard to”, but we believe that that is too weak and could see crucial parts of care and treatment reviews left unimplemented.

As it stands, this part of the Bill could be considered to be implemented even if no adequate resourcing was required, with the care and treatment review left as an empty exercise. One of the key parts of this legislation is to ensure that resources are there to implement treatment for patients. Will the Minister reassure us that adequate resources will be provided to ensure that patients’ treatment needs are met, that training for clinicians and others supporting an individual is made available through resourcing, and that we do not again find ourselves in a situation like the current one, in which patients too often struggle because there are not the resources to meet their care needs?

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[Gregory Stafford]

I agree. Even if the Government build the number of houses that they propose—I have some scepticism—there will always be the potential conflict or disagreement on prioritisation in the housing register and list. As my hon. Friend says, that might well lead to local authorities having to change their criteria, which are not necessarily consistent across local authorities, and, as in his example, potentially pitting a homeless person against someone with mental health needs.

The amendment would also have the potential for scope creep. I have a lot of sympathy with what it is trying to achieve, but expanding CETRs to include housing might dilute their focus and overburden the process. I am interested to hear from the mover and supporters of the amendment how they would ensure that the CETR continues to have that core focus on the health and wellbeing of the individual, rather than potentially be bogged down in the mire of housing issues.

Moving on, amendment 51 would ensure that the care and treatment of individuals with autism or learning disabilities explicitly considered the impact of accommodation and relocation in the planning and decision-making process. Again, I have a lot of sympathy with that. It would promote holistic care planning, reduce trauma and disruption, support continuity of care and, I think, align with the person-centred principles throughout the Bill, which all of us support. Again, however, amendment 51 might complicate discharge planning, if suitable accommodation were limited.

[Dr Shastri-Hurst]

Does my hon. Friend share my concerns that not resolving housing and accommodation at the point of discharge could lead to a delay in transition? Patients would remain in hospital for longer than might be beneficial to them.

[Gregory Stafford]

I agree entirely. That could be the unintended consequence of amendment 51: in essence, if the housing provision is not there, discharge will be delayed. From my understanding of the amendments in the group, those who tabled them are trying to speed up and improve discharge. My hon. Friend is absolutely right that we need to think about the practical implications of the Bill.

The amendment would require co-ordination among health, social care and housing services, which may be challenging in under-resourced areas. Frankly, because parts of those organisations are not used to working in the ways that the amendment would require, it might fall over without suitable training, the necessary lead-in time and a practical understanding of how it will work.

Amendment 4 would ensure that housing needs are formally considered during the care and treatment review meetings for adults with autism or a learning disability, without an EHCP. I understand that the aim is to support more effective discharge planning and reduce the risk of unnecessary or prolonged hospital stays. That is entirely in keeping with what we should be trying to do in the Bill. Holistic care planning reduces delays in discharge, improves cross-sector collaboration and supports community-based care, which we all support.

Once again, however, there is potential for complexity in the implementation. New processes may be required to involve the housing authorities. Resources and local housing shortages could limit the amendments’ practical impact. Another layer of complex review processes could add to that administrative burden. If there is inconsistent local capacity, the effectiveness of the amendment will almost certainly vary depending on the local housing infrastructure, which could lead to a postcode lottery, for want of a better phrase, in who receives the adequate care and housing.

Amendment 2 would ensure that children and young people with autism or learning disability, as well as their nominated persons and independent mental health advocates, receive a copy of the care, education and treatment review meeting report. I have a lot of sympathy with that. It potentially increases empowerment and transparency, ensuring that patients and their advocates are fully informed, which could enable better participation in care decisions. It has a legal and ethical alignment with the principles of the Mental Capacity Act 2005 and the UN convention on the rights of persons with disabilities, both of which emphasise supported decision making. It might also improve advocacy, as independent mental health advocates can more effectively represent a patient’s interest when they have access to the full report.

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I return to the practical parts, which were raised by my hon. Friend from Shropshire—

[Dr Shastri-Hurst]

Not quite: Solihull.

[Gregory Stafford]

I knew it began with S and was somewhere that is not Surrey or Hampshire—because where else would you want to be, Mr Vickers? The amendment would potentially increase the workload, because more frequent reviews place additional pressure on professionals and services.

[Dr Shastri-Hurst]

Does my hon. Friend agree that there is a risk that the amendment would not only increase the workload of practitioners, but divert attention from patient care?

[Gregory Stafford]

My hon. Friend is entirely correct. We operate in a resource-confined area. It does not matter what the resource envelope is; it will always be confined. If we use resource to service the very laudable aims of the amendment, it will take resource and money away from another area.