Mental Health Bill [ Lords ] (Sixth sitting)

Sojan Joseph Excerpts

Committee stage
Tuesday 17th June 2025 Public Bill Committees

These clauses will help to move mental health care towards greater openness and patient empowerment and therefore, hopefully with some positive answers from the Minister on those three questions, I commend them to the Committee.

[Sojan Joseph (Ashford) (Lab)]

I welcome the strengthening of section 132 of the Mental Health Act in respect of information about complaints, as proposed in clauses 42 to 44.

Clause 42 deals with information about complaints for detained patients. Currently, through the code of practice, there is a requirement that hospital managers will pass on that information. They should do so both orally and in writing, ensuring that the information is accessible, including in easy-read format for people with learning disabilities. Hospital managers should also ensure that the information has been understood. The clause would amend section 132 of the Act by placing that statutory duty on hospital managers, supplying detained patients and the nominated person with the necessary information about complaints, and taking practicable steps to ensure that the information has been understood.

Proposed new subsection (2A) deals with the types of complaints covered by that duty. They include complaints about carrying out of functions under the Act and about medical treatment. Proposed new subsection (2A)(c) ensures that the statutory duty covers information about the patient’s right to complain to the Parliamentary and Health Service Ombudsman about the maladministration of such complaints. Proposed new subsection (2B) sets out that the duty is triggered

“as soon as practicable after the commencement of the patient’s detention”.

That means that the duty will be triggered each time the section under which the patient is detained changes, and when the authority to detain under that section is renewed.

In respect of part III of the 1983 Act, which concerns restricted patients to whom automatic renewals do not apply, the duty will be triggered every 12 months from the start date of detention. As I mentioned earlier, much of that process is already expected to take place, but ensuring it takes place in future by making it a statutory duty is a sensible and welcome strengthening of that safeguard.

That is also the case for clause 43, which relates to information about complaints for community patients and seeks to amend section 132A of the 1983 Act. As a result of the clause’s changes, there will be a statutory duty on hospital managers to supply information about the complaints procedure, as set out in clause 42, to community patients and the nominated person. That will mean that the patient must be provided with complaints information as soon as practicable after they are placed under a community treatment order, and each time that community treatment order is renewed.

Clause 44 deals with information about complaints for conditionally discharged patients and inserts proposed new section 132B, which requires hospital managers to give complaints information to conditionally discharged restricted patients. The proposed new section states that such information must be provided before the patient leaves hospital, or as soon as possible when the patient is conditionally discharged. Patients must receive the information when they are first detained in the hospital, and again whenever they are conditionally discharged. As with clause 42, the hospital manager must ensure that the patient has received such information both orally and in writing, and that practical steps have been taken to ensure that the patient understands the information. A copy of the information must also be given to the nominated person within a reasonable timeframe, unless the patient has requested otherwise. I support the clauses, as the changes made by it will strengthen the Act.

[Aphra Brandreth]

I rise to make a few brief remarks about clauses 42 to 44, which would amend the 1983 Act to place statutory duties on hospital managers to supply complaints information to both the patient and the nominated person in respect of detailed patients, patients subject to a CTO and conditionally discharged patients.

These are important clauses. The people concerned are potentially vulnerable individuals. They need to know that they have a voice in this process and feel empowered to speak out and complain, should they wish. There is a duty on hospital managers to ensure that detained patients understand how to make complaints. However, I ask the Minister how that duty will be checked and evaluated. We all agree that the ability to speak out to make a complaint is important, but we need to ensure that proper safeguards and parameters are in place on how that will happen.

I also welcome the provision requiring that the information must be provided as soon as is practicable. That is important to give patients confidence. The timing requirements will potentially make a huge difference. The journey of a patient may change rapidly over the course of their treatment, so not leaving it too long will potentially make a substantial difference to their ability to recover swiftly, and ensure that they have been able to speak out if they are concerned not just about their detainment but about the way that their treatment is being carried out, and the potential implications of that.

Like many of the measures that we have discussed, these clauses might have administrative implications. We need to ensure that we have fully considered and are able to put in place the necessary support for hospital managers to deal with complaints appropriately. It is important that if someone comes forward with a complaint, it can be dealt with swiftly.

As mentioned on some other matters, we need to ensure consistency for patients, so that they understand the information that they are being provided and that, whatever region they might live in or hospital they might be at, consistent information is provided. I would like the Minister’s reassurance on that point.

Overall, however, the clause improves patients’ awareness of their rights and how they can seek redress. I think we all agree that that is extremely important. It will promote accountability in mental health services by encouraging feedback and complaints. I would like reassurance of some oversight to ensure feedback on any complaints that come forward so that we identify where consistent issues come up, to provide better services not just to the individual but to future individuals. Overall, the clauses support better outcomes by addressing potential grievances and ensuring that they are addressed early and constructively, so I am supportive of them.

[Dr Shastri-Hurst]

You will be delighted to know that I will be mercifully brief, Mrs Harris, because I am broadly supportive of all three clauses. Having worked as a doctor in clinical practice, and as a barrister, I am cognisant of the importance of transparency, patient autonomy and procedural fairness, in particular with vulnerable patients who are often seen in a mental health care setting.

I welcome this trio of clauses, but I have some gentle challenges to put to the Minister for when he gets to his feet. First, how will data be captured on the information that is to be provided to patients and their families? What feedback mechanisms will be in place, not just for patients but for those who support them—their carers and families—and for clinicians, on the practicalities of how the system is working?

[Sojan Joseph]

I was a clinician and I practised on wards; patient records are electronic for staff. When staff complete the explanation of section 132 rights, they record that on the electronic patient records. Does the hon. Member agree that that would be a good place to get the data?

Mental Health Bill [ Lords ] (Fifth sitting)

Sojan Joseph Excerpts

Committee stage
Tuesday 17th June 2025 Public Bill Committees

[Dr Evans]

Brevity is an important skill that you have exemplified in this House for many years, Sir Desmond, so I will not subject the Committee again to matters that I have already covered.

I ask again the question that I posed just before the suspension: how will clinicians be guided in applying the new “necessary” test? Will the code of practice be updated with examples and scenarios? Crucially, what measures will be taken to ensure that patients are clearly informed that a breach of CTO conditions is not, in itself, an automatic ground for recall? That concern has come across in evidence and is a long-standing source of misunderstanding and mistrust, as has been highlighted in cases and in the Wessely report.

Clause 23(2) will insert new subsection (3B) into section 72 of the Mental Health Act, giving mental health tribunals the power to recommend that the responsible clinician reconsider whether a CTO condition is necessary, even when they do not discharge the patient. That is a welcome enhancement of patient rights. Currently, if a tribunal decides not to discharge a patient, it has no power to challenge potentially excessive conditions. The clause strikes a useful middle ground, offering oversight without overturning clinical decisions. Having said that, will there be any requirement for the responsible clinician to formally respond to the tribunal’s recommendations? Without such a duty, there is a risk that recommendations may be quietly disregarded and the benefit of the provision may be undermined.

Clause 23 is a positive and proportionate reform, but to strengthen its practical impact I suggest that the Government consider updating the code of practice to clarify what constitutes a “necessary” condition under section 17B of the Mental Health Act; introducing a duty to respond to tribunal recommendations under proposed new section 72(3B), with a short time limit and a written explanation if the recommendation is rejected; and providing clear information to patients.

New clause 4, tabled by the Liberal Democrats, seeks to place a general duty on ICBs to ensure that sufficient resources are available for community-based mental health services, particularly in the context of implementing provisions under the Mental Health Act. It speaks to a concern that many Committee members will have heard time and again from patients, practitioners and families alike: that the success of any reform to the Mental Health Act will ultimately rest on the capacity of community services to deliver. We know the reality: patients can be discharged to under-resourced settings or subject to CTOs that depend on clinicians who may be overstretched or unavailable. Clause 22 will rightly expand the role of community clinicians in CTO decisions, but that works only if they exist, are available and have the time and tools to engage meaningfully.

I acknowledge that new clause 4 identifies a genuine structural risk in the way in which we approach reform, and I commend colleagues for raising it, but should it sit in primary legislation? I am not so sure. I have some questions for the hon. Member for Winchester not about the intention of the new clause, but about the appropriateness and practicality of placing such a duty in primary legislation. Primary legislation is best used where duties are clear, enforceable and universal. The duty proposed in the new clause, although admirable, is qualified by the words

“insofar as is reasonably practical”,

which reflects the reality that integrated care boards do not control all the levers of workforce, capital investment or even, in many cases, service design.

With that in mind, I ask the hon. Member the following questions. What mechanism would be used to enforce the duty? If an ICB fails to meet the duty, what would the consequences be? Would the duty not create legal ambiguity or even the potential for judicial review where service users feel that resources are inadequate, or even where the ICB has acted reasonably in difficult circumstances? Furthermore, how would the duty interact with the existing statutory duties on ICBs under the Health and Care Act 2022, including the duties around health inequalities and integration?

A stronger element of the new clause, which merits closer consideration, is the assessment and publication of findings on local community mental health capacity. This kind of transparent, data-led accountability could be an effective tool not only for Parliament and regulators, but for local patients and advocacy groups. Perhaps that element could be taken forward in secondary legislation as part of the updated NHS England commissioning guidance. The Minister will forgive me, but I am not sure whether such a tool already exists, so perhaps he will address that point.

Does the Department plan to require ICBs to assess and report on community mental health capacity in the light of the new duties being created by the Bill? Could there be scope for a reporting duty to be included in regulations or guidance, even if a general resourcing duty is not placed in primary legislation? The Bill refers to commissioning, and under earlier clauses we have talked about dynamic registers. Will the Minister set out whether the issue is covered here or in another way?

We cannot ignore the resource dimension, so I am grateful to colleagues for pressing the Committee to address it. However, we must be careful about the tools we use, what we write into law, and what we deliver through planning, commissioning and political will. I look forward to hearing from the hon. Member for Winchester and the Minister in response to my questions.

[Sojan Joseph (Ashford) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Desmond. I welcome the changes proposed in clauses 22 and 23. Clause 22 seeks to amend the Mental Health Act to require the community clinician responsible for overseeing the patient’s care as a community patient to be involved in decisions regarding the use and operation of community treatment orders.

While I was practising as a mental health professional, I was personally involved in many community treatment orders and in recalling patients to hospital. Although I acknowledge the concerns raised by various charities and members of the Committee about the overuse of community treatment orders and restrictions on patients, such orders have many benefits. As the Minister has highlighted, they help to release the pressure on in-patient settings. They also help patients to live in a home environment: without such provision, some patients would have to stay in hospitals for longer, which can be more restrictive than being in the community.

The Committee needs to understand the kinds of patient who are often considered for community treatment orders. These patients are already well known to mental health services. They may have a long-term serious mental illness and may have to take medication continuously. More often, they are on regular injections of what is called depot medication; mental health professionals administer such medication either once a month or once every three months. Community treatment orders enable clinicians to make sure that patients receive the medication they need, so that they do not relapse and so they can have a good quality of life.

By introducing an additional professional check on whether the patient really needs the support of a community treatment order, and by requiring more evidence that the patient needs the support of the community treatment order to get better, clause 22 will adopt two of the four principles of treatment proposed in Sir Simon Wessely’s independent review, namely the principle of least restriction and the principle of therapeutic benefit.

[Dr Evans]

The Committee is very lucky to have the experience and expertise of someone who has used community treatment orders in the field. Will the hon. Member address my point about clinical conflict? We are introducing two new people: a community clinician and a responsible clinician. Has he seen any difficulties in practice with a difference of opinion between clinicians? How were they resolved? Does he see any way in which the clause could create or resolve a problem? My worry is that there is no clear resolution that would deal with discrepancies. I would love to know what is happening at the moment, as the law stands, in the hon. Member’s clinical experience.

[Sojan Joseph]

I thank the hon. Member for that important intervention. Healthy conflicts between professionals can be useful and can be used as a reassurance to people who are concerned about the overuse of CTOs. However, capacity can sometimes be an issue, especially in community settings, an issue that new clause 4 addresses.

It is also important to understand that mental health services have changed over the years. The consultant who treats the patient in hospital may not know much about them or how they are in the community. In the past, all those patients were followed by a care co-ordinator—not necessarily a mental health psychiatrist, but a mental health nurse or social worker who followed the patient throughout their journey and kept an eye on them. We do not have enough capacity these days, so nobody is following the patient. A community treatment order helps them to have at least minimum contact when they have to go and see a patient to administer medication. I support that conflict—sometimes it can be very healthy—but I also acknowledge that we need more capacity in the community.

Clause 22 makes a new distinction between a patient’s responsible clinician with overall responsibility for them, including in hospital, and a community clinician with the responsibility for the patient in the community. It will impose specific duties on the community clinician where they are not the responsible clinician. For example, subsection (2) will amend section 17A(4) of the Mental Health Act to require that where the responsible clinician is not the clinician who will have care for the patient in the community after their discharge, that community clinician must also agree in writing that the community treatment order criteria are met. That will ensure continuity of care of the patient from the hospital into the community, and it will have the added benefit of additional professional oversight in respect of the need for a community treatment order. That is to be warmly welcomed.

I also highlight subsection (4), on the power to recall a community patient to hospital. That will mean that if the community clinician is not the responsible clinician, the community clinician will still need to be consulted before a patient can be recalled under the community treatment order, unless such a consultation would lead to an unreasonable delay. That seems an entirely welcome and sensible reform. In some cases, an unreasonable delay may not be helpful, because some patients need to have their medication at regular intervals. For example, a patient on clozapine who misses their medication for three or four days in a row may have to restart their whole treatment regime, which will mean an even longer in-patient admission process.

Subsection (6) will require a community clinician to make a statement in writing, if they are not the responsible clinician, in support of the renewal of a patient’s community treatment order, if that is the conclusion of the responsible clinician. Getting written confirmation from the community clinician who is intimately involved in the patient’s care that a renewal of the community treatment order is both necessary and appropriate and is the correct thing to do. Once again, it is about ensuring that a further professional opinion is considered; it is also about checking whether the patient still needs the support of a community treatment order.

Clause 23 will make changes in relation to the conditions that a person subject to a community treatment order may be required to follow. It will amend section 17B of the Mental Health Act so that conditions can be imposed only if they are “necessary”. This is a simple and welcome update from the current wording, “necessary or appropriate”.

Clause 23’s second modernisation is to give the tribunal a new power to

“recommend that the responsible clinician reconsider whether a condition…in the community treatment order is necessary”.

This would apply when the tribunal has decided not to discharge a patient completely from a community treatment order, but has come to the conclusion that not all its conditions are required. Once again, this is a welcome reform and is in line with the principle of therapeutic benefit. Some conditions put on patients can be seen as restrictive: for example, if a condition states that patient cannot use alcohol or illicit drugs, the clinicians will be looking at whether the patient’s use of alcohol or illicit drugs has an impact on their mental state or on their non-compliance with treatment. That is very important. I welcome the changes in clause 23.

--- Later in debate ---

[Dr Chambers]

Amendment 49 extends the support offered by mental health advocates to cover social and financial stresses and to family carers and other members of the household when the patient is discharged.

Other hon. Members have today discussed how social and financial struggles can play a major role in someone’s mental ill health and in blocking their recovery, and how those are often the areas where someone can most benefit from advocacy and advice. As we are all aware, patients should not be viewed as a collection of symptoms, but within their whole context, including the situation they are living in. Addressing someone’s housing insecurity, debt or family breakdown should not be viewed as a separate consideration, but as a core part of supporting them to live happily, healthily and independently. Furthermore, family carers and the wider household are absolutely critical for people’s wellbeing and recovery, and should be properly equipped to prepare for their loved one returning from hospital. They, too, may need advocacy and may be missing out on support that they can and should receive.

A good example comes from Winchester, where Winchester Citizens Advice has a member of staff—a former mental health nurse—based at Melbury Lodge in-patient mental health unit. Often, someone may be admitted for two, three or four months, and when they are discharged, they go home to all their life admin—there will be final demands for credit cards or requirements to repay personal independence payments and that type of thing. It is very overwhelming, particularly for those who already have fragile mental health, to have to sort out a whole backload of administration—especially financial and complicated administration. For two days a week, that staff member supports in-patients in sorting out all their administration from anything that needs to be done.

What is interesting is that when these patients are discharged from Melbury Lodge in Winchester, if they have had that help, they end up being hospitalised and on medication for a shorter time. They are also more likely to engage with various support and community services once they have been discharged and are much less likely to be readmitted to hospital. For every £1 spent on that initiative, £14.08 is saved in cost avoidance. That initiative run by Melbury Lodge and Winchester Citizens Advice was up for an NHS award last year. It is a proven concept and something that should be done across the entire country. It has been running for two years and has proved how much money can be saved. Unfortunately, it was a pilot project and is struggling to secure money to continue indefinitely. I urge the Government to look at how that type of initiative could be rolled out around the whole country.

[Sojan Joseph]

The hon. Member is making a very valid point that all patients need help with their finance and accommodation to keep them in the community and make discharge more appropriate. However, those provisions are already in place as part of the patient’s care plan. Different hospitals have different settings, such as a discharge or enablement team, or even the nurses on the ward itself can help and look into those provisions. Does the hon. Member think that that is the role for independent mental health advocates, who prioritise detention and the Mental Health Act, rather than the finance and accommodation issues, which need to be resolved by a different team?

[Dr Chambers]

I accept that point. It is a very sensible point. There has been a huge amount of discussion about what is in scope. Given that this is focused primarily on both current in-patients and preventing readmittance to an in-patient unit, I think it is within scope. I am aware that a lot of staff support patients, but it is not a core part of their role. It is something they squeeze in among all their other duties. When we have the expertise of someone at citizens advice, who knows how to navigate the huge complexity of various organisations and businesses that have to be dealt with, it is a lot more efficient. The figures speak for themselves.

Mental Health Bill [ Lords ] (Third sitting)

Sojan Joseph Excerpts

Committee stage
Thursday 12th June 2025 Public Bill Committees

[Dr Evans]

The hon. Lady points to the fact that the police are named, as they should be. Imagine if we took out the police completely—whowould then have the power to restrain, restrict and detain people under the Mental Health Act? That is the whole point of having the provision. What we are trying to do is refine and constrict the definition to make it clear for everyone in this country exactly who is entitled to do what. Emergency incidents could happen outside this House—would the police and mental health responder be there? That will come down to the clinical judgment of the 999 responder, the call handler and the clinician there, so I do not want to make it too restrictive. At the same time, we have to consider the evidence that is right under our nose, which is that 95% of the time the police are being called out inappropriately for mental health conditions. I guess that is the rub of what we are trying to sort out.

Our responsibility in this House is not only to write good law, but to enable better systems of care. That means ensuring that the law empowers the right professionals to act at the right time, and centring the needs of the individuals in crisis, not just managing risk from the top down. I therefore ask the Minister to reconsider the amendments. Instead of deleting the definition of “authorised person”, let us work to try to strengthen and clarify it to support a wider, safer and compassionate response to mental health crises. Let us seize this opportunity to reset the balance between policing and care, which the police themselves are asking for and our continents desperately need.

Much was made of the amendment in the other place, and I am grateful to the Lords Minister, Baroness Merron, for writing to Baroness May with an explanation of her concerns about the changes. The letter is dated 3 June and a copy was kindly laid before this House and the Committee. It is worth working our way through some of the issues raised. I fully recognise the Government’s concerns within it, and I agree with the need for extreme care when legislating on the deprivation of liberty, but I express reservations about the Government’s decision to overturn the amendment.

According to the letter, the Government’s central concern seems to be the unintended extension of police powers. The Government argue in the letter:

“Your amendments to clause 5 would give the police additional powers under the Mental Health Act. We do not support extending police powers in this way, and we understand that the police do not support this extension either.”

That is also what the Minister has said in Committee. Respectfully, that is a mischaracterisation of the amendments. The original Lords amendments do not extend the powers of the police; they reflect current practice where the police are often involved in detaining individuals in mental health crises.

[Sojan Joseph (Ashford) (Lab)]

Does the hon. Member agree that, since detentions under sections 2, 3 and 5(4) of the Act often happen in clinical settings, are completed by consultants, psychiatrists and social workers, and do not involve police, we do not actually need police presence on these occasions?

--- Later in debate ---

[Dr Evans]

My hon. Friend is absolutely right. Under the last Government, the “right care, right person” initiative was launched with the Humberside police force to try to ensure appropriate care, but that is an example in isolation.

One solution would be to include guidance in the codes of practice, but it would not have the statutory footing to allow that legal certainty, which is the concern. Another would be to include something in the annual statement that we will receive from the Government. We should work collaboratively to try to find a decent piece of work to look for the evidence base and build a delivery plan to help the police extract themselves from situations, when appropriate, and care givers to insert themselves. It is admirable to share a problem that is difficult not just in England but in Wales, Scotland and Northern Ireland.

I agree that the Government are right to proceed with caution, but caution is not the same as inaction, especially when lives are at stake and the law no longer reflects the reality of mental health care. The amendments are not about expanding police powers; they are about reducing the need for police involvement by giving others the lawful authority to act. Although maths may not be my strong point, I am not blind to the make-up of this Committee; I realise that the change will inevitably happen. I want to press the Minister on how he proposes to reduce the burden on the police to safeguard them from thousands of hours spent dealing with mental health crisis issues. In extreme cases, they are not appropriate responders.

This is the key issue to improve so many aspects of our society. We could improve the working life of the police, allowing them to do what they are paid to do, trained to do and passionate about: policing and protecting their communities. We could improve life for the public, because it would free up the police to tackle crime and keep them safe. Most importantly, we could provide the correct care to those patients at their biggest time of need. I hope the Minister will set out how the Government plan to achieve that.

[Sojan Joseph]

I rise to support the Government amendments, which will simply remove the words

“by a constable or other organised person”.

On Second Reading, I highlighted my concern about the amendments made to the Bill in the other place that sought to extend police powers of detention under sections 135 and 136 of the Mental Health Act to other organised persons, including medical practitioners, approved mental health professionals, mental health nurses or doctors and further healthcare and social care professionals.

I know that the noble Lords who introduced the amendments intended to remove the need for the police to be present at mental health incidents in the absence of any risk. However, they would grant the police greater powers; as an unintended consequence, they would also apply to detentions under sections 2, 3 and 5 of the Mental Health Act, where the police currently do not have power to intervene.

A section 2 application is completed by two doctors and a social worker, and the patient may already be in a clinical setting. Section 3 relates to somebody who is already receiving treatment or already has a known diagnosis in a clinical setting. Doctors’ powers extend to that section; the police currently do not have any role in completing a section 3 application. Section 5(4) provides nurses with a holding power for a patient who is already in the clinical setting, where the nurse believes that the patient is at immediate risk; again, the police have no role.

If we did not make the Government amendments, we would give more power to the police to get involved under those sections of the Mental Health Act and put more pressure on police services.

[Gregory Stafford]

I am interested in the hon. Member’s argument, but it seems to be entirely the opposite of the one he made when he intervened on me on Second Reading. He said then:

“Sections 135 and 136 of the current Mental Health Act give the police the power to break into someone’s property or detain somebody in a public place where there is the possibility of the involvement of weapons. Does the hon. Member think that health professionals would be able to manage those kinds of situations? Would the police not be the best people to deal with those situations?”—[Official Report, 19 May 2025; Vol. 767, c. 815.]

In that intervention, the hon. Member was pressing for police involvement; now, he seems to be arguing that he wants to take the police out of these settings. I am a little confused by his stance.

[Sojan Joseph]

What the hon. Member read is absolutely right. I was talking about sections 135 and 136. I am talking here about sections 2, 3 and 5. I absolutely stand by what I said about sections 135 and 136, and I am happy to come to that. As a former mental health nurse, I certainly would not support giving the police greater powers under sections 2, 3 and 5 of the Mental Health Act.

I am also opposed to the amendments passed in the other place because I believe that the extension of legal powers held by the police to other healthcare professionals would represent a major shift in the roles and responsibilities of healthcare and care professionals, placing significant additional pressure on the NHS and social care providers.

The Royal College of Psychiatrists, the Royal College of Nursing and the British Medical Association are among the health and social care organisations that have warned against such an extension, saying that it is

“a radical proposal with a number of serious and potentially dangerous consequences”.

Those organisations also point out that the proposed extension has not been properly tested with relevant health and social care professionals and has been given minimal serious consideration during the eight years in which reform of the Mental Health Act has been under discussion.

The majority of assessment under the Mental Health Act already happens without police involvement. However, where the police may be required to make a detention, I know from my experience working in mental health that the presence of officers can often ensure that an otherwise risky situation remains contained and everyone remains safe.

Entering someone’s home without permission is fraught with huge risk and currently is done only with the assistance of police intelligence. Under section 135, health professionals ask the court for an order to remove somebody forcefully from their residence and the police use that order to do so; sometimes, they have to break in. That is the power that the hon. Member for Hinckley and Bosworth spoke to earlier. Without it, health and social care professionals would be expected to enter homes without police help, and without crucial intelligence that could ensure their safety. As Dr Lade Smith, the president of the Royal College of Psychiatrists, said:

“It is well known that at times, people experiencing a mental health crisis cannot be safely reached and cared for without the assistance of the police. Delegating police powers without proper consultation or planning is likely to disproportionately affect those from minoritised backgrounds and would increase risk to patients and compromise the safety of others. It sets a dangerous precedent.”

I am also concerned that the amendments passed in the other place granting police powers to authorised persons risk damaging their therapeutic relationships with patients. They would have the effect of lessening clinicians’ ability to treat patients, and I fear that patients would be less likely to attend an appointment if they thought they might be forcibly detained by the clinician.

--- Later in debate ---

[Dr Evans]

I rise to speak to clause 6 and Government amendment 30. Clause 6 will make important amendments to conditions for community treatment orders under the Mental Health Act. CTOs are a tool that allows certain detained patients to receive ongoing treatment in the community rather than in hospital, providing continuity of care and supporting recovery outside institutional settings. Since their introduction in 2007, they have offered a mechanism to maintain contact with mental health services and prevent relapse while balancing the patient’s right to live more freely.

However, CTOs have not been without controversy. There is concern about their overuse and their disproportionate effect on black and ethnic minority patients. There are also a number of questions about the evidence for their effectiveness in reducing relapse or readmission. Moreover, concerns about coercion and the infringement of patient autonomy have been raised repeatedly. The 2018 independent review recommended tightening their use. Some also argue for going further by abolishing them completely.

Clause 6 seeks to address many of those concerns. It will introduce stronger safeguards, clear risk-based criteria and a maximum 12-month duration to prevent indefinite or inappropriate use. It will mandate patient involvement through consultation and regular review, promoting shared decision making. Accountability is enhanced by aligning CTOs with a code of practice and introducing external oversight. Crucially, CTOs will now be used only when there is a clear and necessary risk, focusing on clinical need and safety.

Challenges remain. The new requirements bring complex administration and an increasing workload for clinicians. Despite reforms, CTOs remain a form of compulsory treatment, raising concerns about ongoing coercion. Their success depends heavily on the availability of community services, which are not always adequately resourced. Finally, terms such as “serious harm” may be open to interpretation, risking inconsistency. To unpack all that, we must take a closer look.

Clause 6 rightly seeks to update and clarify the legal framework governing CTOs to ensure that their use is proportionate, justified and consistent with evolving standards of care and risk management. It does so primarily by aligning the grounds for making and renewing a CTO with the new, more precise risk criteria for detention. It specifies that a CTO should be made only if there is real risk that

“serious harm may be caused to the health or safety”

of a patient or others without treatment, and if that treatment is necessary given

“the nature, degree and likelihood of the harm”.

Again, there is an argument about the definition of “serious harm”, and the same discussion as the one we had under clause 5 about escalation of behaviour or cumulative concerns applies here.

In the light of that discussion, it might be helpful if the Minister clarified the interface between CTOs and grounds for detention. Is there scope for the code of conduct to cover the management of risk, both to the public and to patients themselves, across both? Given the emphasis placed on real risk of serious harm, clause 6 aligns CTOs more clearly with the threshold for detention, with the aim of reducing the inappropriate use or overuse of CTOs, which is much more welcome. It will help to safeguard and protect patients from unnecessary restrictions on their liberty, while maintaining the ability of a responsible clinician to act decisively when there is genuine risk.

[Sojan Joseph]

Does the hon. Gentleman agree that CTOs help to keep people out of hospital so that rather than having long-term admissions, they can live in the community and in their own house, and that clinicians can recall patients to hospital if they are not complying with the agreed treatment?

[Dr Evans]

Spot on. The hon. Gentleman will have used them far more than I ever have, and that was exactly the point of them when they were brought in in 2008. The reason they have been so contentious is their misuse, misapplication and ongoing use. That is what we are trying to highlight. With clause 6 the Government are trying to streamline their use.

That leads me neatly on to why the Lords introduced clause 6(3), which Government amendment 30 would remove. It is about how to ensure that there is adequate oversight so that people do not remain on CTOs in perpetuity or, more likely, have them applied inappropriately. Concerns have been raised about racial disparities in the use of CTOs—particularly for black men, but there is also work to be done on those from other communities who find themselves on CTOs. The hon. Gentleman is right: that is the ethos behind ensuring that we push people to community care. The problem is how to set that against the legislation on CTOs and how to provide the resources to enable an appropriate setting for that care.

[Sojan Joseph]

Does the hon. Gentleman agree that this is more an issue of practice than of the law itself?

[Dr Evans]

Yes. As the Minister pointed out on the Committee’s first day, legislation sets the culture. One the main reasons for the Wessely report was the racial disparities that had been found. We still have to look into the cause and effect of that, but one of the big markers was that CTOs were increasing indefinitely and seemed to hit certain communities disproportionately, without there being a full understanding of why. That was why in the House of Lords some argued that we should get rid of CTOs completely. The Opposition do not agree with that; we agree that clause 6 is important and that CTOs serve a purpose, for the reason that the hon. Gentleman explains so eloquently. The emphasis is on getting people into community treatment where we think it will be better for them, but ensuring that CTOs are not an undue burden on clinicians or patients and are not used inappropriately.

Clause 6(3), introduced in the Lords, sets out a maximum duration of 12 months for CTOs, after which an extension would require thorough review. That process would demand consultation with the patient, their nominated persons and relevant mental health professionals, and the written agreement of a qualified psychiatrist. That multi-layered review process is vital to ensure that any extension is based on clear therapeutic benefit and necessity rather than routine or bureaucratic inertia. Moreover, the requirement of regular reviews every six months to extend CTOs would further strengthen oversight and accountability. The involvement of tribunals, which may recommend variations or terminations, would add yet another layer of protection for patients’ rights, as the Government and Opposition both acknowledge.

While the reforms are, on the whole, positive, we must remain vigilant. The consideration of risks must be applied carefully and consistently to avoid unintended consequences such as deterring clinicians from using CTOs when they are genuinely needed.

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

Mental Health Bill [ Lords ] (Second sitting)

Sojan Joseph Excerpts

Committee stage
Tuesday 10th June 2025 Public Bill Committees

[Dr Chambers]

That is a very insightful point. The list could be longer and is not meant to be exclusive. I am not sure of the answer to the hon. Lady’s question but, taking a step back, we know that the single most common cause of death in women 12 months after giving birth is suicide, and there is no proactive automatic care. If a person is addicted to alcohol, they are admitted to hospital for treatment for their physical symptoms. When they are physically well enough to go home and they are discharged, there is no automatic enrolment or follow-up in mental health care. I would not want to bring in a system, as the hon. Lady says, that ends up being too prescriptive. However, at the moment, we have one that is not prescriptive enough. I could list a handful of demographics of people who desperately need that proactive care.

[Sojan Joseph (Ashford) (Lab)]

The purpose of this part of the legislation is for ICBs to keep a register of anyone who is diagnosed with autism or a learning disability. Patients who are already under a clinical team already have a risk assessment, which covers all the areas that the hon. Gentleman is specifying. As a result of the amendment, would we not be duplicating information about risks that already exists for most patients with their clinical teams?

[Dr Chambers]

The point of having an at-risk list is that ideally there is proactive contact with people—perhaps in quite a soft way, and perhaps through community hubs, as we have discussed—before they demonstrate a severe mental health crisis. I assume that the people the hon. Gentleman is talking about have already been admitted to hospital and have received treatment, and that they are being followed up after they have been discharged. That is not a proactive list; it is a reactive register. Am I correct? I apologise if I have misunderstood his question.

[Sojan Joseph]

Anyone who is under the care of a clinical team for their mental health has a risk assessment. That is basic paperwork, which is completed by the clinicians. That risk assessment covers everything that is specified in the amendment. The purpose of this part of the legislation is for ICBs to have a register. However, ICBs will not be providing direct care; that will be provided by the clinicians. Those patients who are under any clinical team have a risk assessment that covers all the points in the amendment. My point is that the amendment would duplicate some of that paperwork.

[Dr Chambers]

I will not argue with an esteemed Member who has the hon. Gentleman’s background in mental health. I take his point as it stands.

--- Later in debate ---

[Sojan Joseph]

I will briefly trot through the proposed amendments and new clause. We all know that the closure of learning disability hospitals was a gradual process. The reason was the institutionalisation of some of those patients, as seen in the Winterbourne View scandal. The aim was to create new community-based housing to look after people with learning disabilities and autism. Amendment 20 seeks to create appropriate fully staffed crisis accommodation. Will the Lib Dems clarify whether they are looking to create more in-patient settings? Are we going back to where we were years ago, or should we work with the new plan to create more community-based accommodation?

Not all patients with a learning disability or autism need detention or community-based accommodation. Many of them are looked after by their family members, so we also need to look into the support we are providing to carers, so that we can keep those people at home with their family member’s support.

I will keep this brief: as a member of the all-party parliamentary group on adult social care, I recently met with many people who have lived experience of this. They want their views to be heard. They are not asking for more hospital settings; they are asking for more support, including for carers. I was pleased to see that the Minister for Care was there to engage with those people.

In the new NHS 10-year plan, the focus is on moving care from the hospitals to the community. Can the Minister clarify how we can make that happen? We have talked about that for many years, but we have never seen it happening. In my own experience practising in a mental health ward, many patients with a learning disability and autism were detained and, as the hon. Member said, kept in hospitals because we could not find a suitable place for them to be discharged to—it was not that they needed the hospital.

I think we are all talking about the same thing, but we need to find a solution. That is why the new NHS 10-year plan and its focus on moving care from the hospitals to the community is important. Again, can the Minister clarify how we will do that? The Government have already started the work, and the new commission, led by Baroness Casey, should also be looking into where we will find the social care support for carers and the community provision for people with learning disability, rather than just creating more crisis accommodations.

[Dr Evans]

The hon. Member mentioned Baroness Casey, for whom I have the utmost respect, but herein lies the problem: she is still currently undertaking a review for the Home Office that has now been delayed and has not concluded. This is at the same time that she is supposed to be looking at social care. The whole idea of an amendment that asks for a statutory plan is to stop these kind of slippages. Given his point about wanting to see progress, is that something that he would consider if he were voting on this new clause?

[Sojan Joseph]

I hope that Baroness Casey completes her commission work and gives us her report. It was promised in the Chamber that the initial report would be available within a year. Regardless of whether she is taking up another role, I hope there will not be any delay and that we get that report and a detailed report within three years. I am looking for a solid plan to fix this problem forever. I am not looking for sticking plasters or an immediate fix, but we need a plan, perhaps including a national care service. These are the people who are looking for a long-term solution to these problems.

The hon. Member asked about how I will vote; unfortunately, I will not be supporting new clause 11. The Government have already started some work, which is why I am specifically talking about the NHS 10-year plan to move care from hospitals to the community, along with the social care commission, which is looking into how we can get good progress on that. This is the answer; we need to get a long-term solution to this problem.

[Dr Shastri-Hurst]

It is a pleasure to serve under your chairmanship, Ms Furniss. I rise to speak to Liberal Democrat amendments 20, 10, 22, 24 and 21, and set out why, although I think they are honourable in their intent, I am unable to support them today.

I will start with amendment 20. The purpose of the amendment is to require ICBs to ensure the availability of specialist crisis accommodation for people with autism and learning disabilities. The aim is to provide a safe and therapeutic alternative to detention, which I think we would all agree is a sensible course of action. Section 136 of the Mental Health Act 1983 allows police to remove an individual who is experiencing a mental health crisis from a public place to a place of safety. That can, on unfortunate occasions, lead to detention in inappropriate settings, which may include police cells. That can obviously be deeply harmful, particularly to those with conditions such as autistic spectrum disorder or other learning difficulties.

--- Later in debate ---

[Jen Craft]

I think there is a concern about having a prescriptive mandate in primary legislation, rather than using a vehicle that could implement real change. Again, I would welcome the Minister’s thoughts on how to ensure that those working in a mental health environment have sufficient training on learning disabilities and autism. We need to make sure that those with a specialism in learning disabilities and/or autism are present and people have access to them, so that things like diagnostic overshadowing do not continue to occur.

[Sojan Joseph]

I rise briefly to speak about training in our health settings. There is, in fact, too much mandatory training in NHS and care settings; the issue is that we are not complying with it. We also heavily rely on agency staff, whose training often nobody monitors. It is not that we are short of training. As my hon. Friend the Member for Thurrock mentioned, the Oliver McGowan training was rolled out across the NHS.

[Gregory Stafford]

I want to be clear about what the hon. Gentleman is saying. My understanding of the amendment, for which I have a lot of sympathy, is that the mandatory training will be around appropriate care in the settings listed. I think he is talking about manual handling or data protection stuff. As someone who worked in the NHS for seven years, I entirely agree that there is a lot of “mandatory training” that could be scrapped to make the NHS much more efficient. The amendment is specifically about ensuring that there is appropriate training for those who are working in the settings listed. I hope that he is not saying that he does not think that there should be training for mental health professionals. I am sure he is not saying that, but that is how it is coming across.

--- Later in debate ---

[Sojan Joseph]

Not at all. I am not claiming that there should not be training for people who work in any settings; I am saying that more and more training has been added every time we learn something and yet compliance with the training requirement is not being monitored. That is the point I am making—not that we do not need the training.

I support training, because appropriate training is necessary, but we also need to ensure that the people who work in those settings are compliant with the training. That is the larger point I am making. This is not about the amount of training we might want to add to this legislation; we need to ensure that existing training is completed by the staff working in those areas.

[Stephen Kinnock]

The Health and Social Care Act 2008, as amended by the Health and Care Act 2022, already requires that all CQC-registered health and adult social care providers ensure that their staff receive specific training, appropriate to their role, on learning disability and autism. The associated code of practice has been consulted on and is expected to be published and laid before Parliament soon.

The code sets out four standards that outline minimum training requirements, including expectations of training content at different levels; that training is co-produced and co-delivered alongside people with a learning disability and autistic people—that addresses the point made by my hon. Friend the Member for Thurrock about co-production and things not being done in an ivory tower; and that staff complete training at least every three years. To set out separate standards in secondary legislation, as the amendment asks, would cut across that existing legal requirement and the forthcoming code. Inadvertently, that could lead to confusion. I hope that that satisfies the hon. Member for Guildford enough to persuade her to withdraw the amendment.

Mental Health Bill [ Lords ] (First sitting)

Sojan Joseph Excerpts

Committee stage
Tuesday 10th June 2025 Public Bill Committees

[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.

[Sojan Joseph (Ashford) (Lab)]

In the past, many people with mental health disorders have been detained in hospitals for months or even years because of a lack of proper social care provision in the community. Will the Minister also ensure that local communities, which will be providing social care for patients who are discharged from hospital, are part of that discussion?

[Stephen Kinnock]

It is absolutely a team effort. Sadly, when people have severe and acute mental health disorders, a multi-agency effort is often required to support them and to help them to get the treatment they need. The process should not be about trying to isolate people. We are keen to ensure that people stay in mainstream society and remain as integrated as possible, because that is often an important part of supporting their mental health condition.

All of that means that local authorities, mental health professionals, social workers, and often children’s social care professionals or adult social care professionals are important in the process—it requires a team effort. That integrated approach will be really important as we build the community services that we want to see.

Mental Health Bill [Lords]

Sojan Joseph Excerpts

2nd reading
Monday 19th May 2025 Commons Chamber

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

I rise to speak in support of the Bill. To begin with, I need to make a couple of declarations. I have a family member who is a consultant psychiatrist. I am now a non-practising general adult psychiatrist with an endorsement and years in psychiatry, and I previously worked as a consultant psychiatrist. I took part in the 2018 Wessely review as a panel member on the tribunal working group, and I was on the pre-legislative scrutiny Committee in the last Parliament.

In a declaration of a more personal nature, this is an area that I feel passionately about. It is a great privilege to speak to this important piece of legislation and reforms going forward. The United Kingdom reforms its mental health legislation every 20 years or so. I did not want to correct the Secretary of State, but the first Mental Health Act was in 1959—I hope that was substantially before he was born, with reference to his earlier comments. The legislation has gone through various iterations from the original Lunacy Act and similar legislation in the 19th century. In the UK, we have always been at the forefront of reform to the law and to provisions and powers in this area.

It is important in this Second Reading debate to focus on what the Mental Health Act is and what it does. Members have talked more broadly about the challenges of delivering mental health care currently, but it is important to reflect that the Mental Health Act is very specific and precise. It is about the regulation of detention—sometimes for assessment, sometimes for treatment—of people with mental disorder, and has a range of powers on aftercare and guardianship. It is focused on detention and assessment, or treatment, of people with mental disorder. We need that because there are times when people with severe mental illness become so unwell that they are unable to recognise their illness. Their illness puts their health at risk—predominantly through self-neglect or non-treatment. It puts their safety at risk, again through self-neglect, as well as through suicide. And, less commonly but critically, it puts them at risk of causing harm to others.

The legal framework allows us to regulate compulsory treatment in that regard. It is absolutely critical that we have those powers so that, when people are so unwell that they do not recognise it and they lose agency, we can, as a compassionate society, take them into hospital and treat them, with a view to getting them back to themselves. I have used the 1983 Act countless times, applying it both to assessments and, as a section 12-approved doctor, to treatments, and I have used it as a responsible clinician. I suspect that I am one of the few Members of this House—certainly in this debate—who has had those roles and responsibilities.

In terms of framing, it is important to reflect that one of the key changes in the 1983 Act, which is such an important piece of legislation, was that it was about restricting powers and ensuring that there were strong procedures for reviewing detentions. As a former health professional in this area, I am certain that all professionals working in it are mindful of the scope of powers that the Act provides. When applying restrictions, people do not use these powers in anger or without a great degree of thought and contemplation. The most intrusive intervention available to us in the health service is to detain and treat people in hospital or in secure hospital settings. Those powers are not taken lightly.

A lot of concern was expressed at the start of the debate—and I am sure it will continue—about the way in which people have been treated in hospital. There have been some very high-profile scandals in which things have not worked well, to say the least, and care and treatment have been atrocious and abusive. However, people working in health and care in the UK are doing so because they want to see the best outcomes for their patients. Sometimes, they are limited in that because of the resources available. They do not use the Mental Health Act with a view to harming people, but with a view to helping them.

Being detained under the Mental Health Act is not a prime facie harm; it is a treatment and a good thing. If someone needs to be detained and treated in hospital, they need to be detained and treated in hospital. If I became so unwell that I needed to be detained under the Act, I would want to be detained. Thankfully, I am not in that position today—[Interruption.] At least I believe that I am not, although the shadow Minister, my hon. Friend the Member for Hinckley and Bosworth (Dr Evans), might have a different view on that. [Laughter.] Should I get to the point where I am so unwell that I cannot consider my own care, I would want the powers of the Mental Health Act to be used quickly, particularly if I were posing a risk to myself, my family and others, so that I can get better and back to living my life.

I pay tribute to Baroness May of Maidenhead, who kicked this off, and to Professor Sir Simon Wessely—a good friend—Stephen Gilbert, Sir Mark Hedley and Rabbi Baroness Neuberger for their work in the 2018 review. There is a lot of good work in the Bill, from the greater focus on advance care planning and the more frequent detention reviews, which I recognise may bring a workforce burden, to the provisions on nominated persons. I will not go into the detail in this Second Reading speech, but I will focus on a few general points on which I think a bit more work needs to be undertaken.

In some ways—I will have to message Sir Simon after this to ask his forgiveness—the Bill is a missed opportunity in that we have are not moving towards fusion law. For the benefit of those who are not all over the detail, at the moment the UK has two pieces of legislation regulating how to treat people in the absence of consent. The Mental Capacity Act 2005 came about from case law in the ’80s and ’90s and was codified in 2005. That Act broadly regulates physical health treatments for people who lack the capacity to consent—we have focused quite a lot on capacity in the recent debates on the Terminally Ill Adults (End of Life) Bill. The principles of the 2005 Act are autonomy and the functional capacity and best interests tests for people who lack capacity, meaning that we test someone’s capacity, and only if they lack capacity can we intervene in their best interests, sometimes by using deprivations of liberty.

The Mental Health Act arose from a very different pathway. In its first days, it was more about the regulation of asylums. The Act is about status and risk. The gatekeeper conditions for the current Mental Health Act are that a patient has a mental disorder of a nature and a degree that requires assessment in hospital because of the risk to their health and to the safety of others. Capacity does not feature whatsoever.

We have two pieces of legislation. One applies to the most severe mental disorders and deals with status and risk, and the other deals with autonomy and best interests. I strongly believe that the two need to be merged. We should use capacity and best interest frameworks to regulate treatment of mental disorder in the absence of consent—there are ways of doing that. I like the fact that we are starting to incorporate a bit more in the Bill.

[Sojan Joseph (Ashford) (Lab)]

Does the hon. Member not think that the deprivation of liberty safeguards, which, unlike the Mental Health Act, help to hold those who lack capacity in an environment that is not secure or locked, such as a hospital, are useful, and that bringing the two provisions together is unnecessary?

[Dr Spencer]

The hon. Member is of course very knowledgeable given his background as a mental health nurse. I would like to see in the Bill a provision setting out that, in order to detain someone for the purposes of health or safety, they must lack decision-making capacity for the detention to be authorised. For the prevention of harm to others, there are reasons to overcome autonomy in decision-making capacity, but I would like to see an additional component specifying that if the detention for assessment and treatment in hospital is purely based on health and safety and not on risk of harm to others, the patient must also lack capacity. Otherwise, people who have full and intact decision-making capacity can nevertheless come into the scope of the powers.

The liberty protection safeguards are a bit of a mess, quite frankly, and the DoLS were clearly a substantial mess. It is interesting that the legislative scrutiny of the Bill points out that it is a missed opportunity not to tidy up some of the interface between the Mental Health Act and the Mental Capacity Act—a point that I will come to a little later in my speech. In terms of parity of esteem, bringing forward fusion law and gelling the Acts closer together needs to be the direction of travel. I hope that we do not have to waste another 20 years until we get the opportunity something like that.

There is something else that we need to reflect on. It comes to my other points about the focus in the Bill, but I will reiterate it. The core focus of the Bill is on reducing detentions of people from black and minority ethnic groups, who are over-represented in detention. One of the key focuses in fixing that must be on socioeconomic deprivation—where we see socioeconomic deprivation, we see severe mental disorder following—but I worry that the Bill is a missed opportunity and will not do what is required to deal with those disparities.

There are three problems with the Bill, and two things that I wish to flag. I am sensitive to the concerns that have been raised about people with autistic spectrum disorders and learning disabilities, and the advocacy regarding such people being in hospital. Being in a general adult ward is a challenging environment as it is, and it is particularly challenging for someone with an ASD or a learning disability. People can get stuck in hospital not really going anywhere. That concern applies to most disorders—I do not think it is unique, given the lack of community support services. I disagree, however, with the focus on ASD and LD above all other conditions. If we want to talk about non-progressive conditions, I do not understand why a brain injury, or Korsakoff’s dementia for example, are not within the scope of this measure. I do not understand why, rather than using the Bill to take people out of section 3 of the Mental Health Act, something like a bolstered treatability test is not used, which is what was in the Act before it was modified in 2007.

--- Later in debate ---

[Sojan Joseph]

My hon. Friend is absolutely right to say that patients with challenging behaviours should not be detained in a mental health ward for many, many years. They should be in a different setting. Does he agree that we do not have enough support or accommodation for patients? We need to invest more in community settings for some of these patients with challenging behaviours.

[Kevin McKenna]

My hon. Friend has jumped ahead of me on that—not surprisingly, given his background as a mental health nurse. That is absolutely true. We do need to invest more, but we need to think beyond the NHS. Although this is the Mental Health Bill and it has “health” in its name, this issue is much bigger than the services that the NHS can provide.

There is a weakness in this Bill. The concern I have, which several other Members have mentioned, is that it does not tie us down to a tight timeline for this transformation. The Bill provides a get-out. That is done to ensure that services in the community are properly set up, but I worry that that the timeline will slip and slip. The time to move is now. People have been languishing for too long in settings that do not offer them a therapeutic way forward, and in places that are frankly inhumane and breach what we would all consider to be our human rights. The Minister is here and listening, and I recommend that he thinks about how we can get an active plan, so that we do not let this issue slip, but actively ensure support for services in the community, invest in them where needed, and foster them.

--- Later in debate ---

[Gregory Stafford]

I agree with the hon. Gentleman that more can be done to help people in crisis. What I would say, however—I think my hon. Friend the Member for Runnymede and Weybridge also made this point—is that there are people who are at such a point that, unfortunately, they need to be incarcerated in order to be able to help themselves. Hopefully, they spend their time incarcerated not just away from society but being treated effectively and appropriately.

That brings me to the point that this is a balancing act and a difficult situation. I think all of us of all parties are clear that the current Act is no longer fit for purpose, especially when we think about forensic mental health. As such, I am glad that the Government are taking forward this legislation, which was started under the previous Government. The cross-party consensus we have heard this evening reflects the fact that this piece of legislation has come from both of the major parties. I am likely to be on the Bill Committee after the Whitsun recess, so I will not test the patience of the House by going through every single bit of the Bill I have some interest in or concerns about, but I will briefly raise three important areas, which I am pleased were raised by Members in the other place. A number of Opposition amendments were tabled in the other place which would have strengthened the Bill, and I hope they will be made in Committee in this place.

The first area is reducing unnecessary police involvement. The noble Lord Kamall and Baroness May tabled some amendments that in my view represent a very significant and much-needed shift in how detentions and removals under the Mental Health Act can be managed. Under the current framework, the power to detain individuals and move them to a place of safety—particularly under sections 135 and 136—is largely restricted and falls under the responsibility of police officers. Although those provisions are designed to protect the public, they can often result in the criminalisation of people in acute mental health crisis, even when there is no threat of violence or risk to others.

The amendments tabled in the other place would have allowed authorised and qualified health professionals such as paramedics, approved mental health professionals or specialised nurses to carry out those detentions and to move individuals under sections 2, 3 and 5 of the Act. That would relieve police officers of responsibilities that fall outside their core expertise while reducing the stigma and trauma associated with police-led interventions. It would streamline the process, ensuring that individuals were supported by professionals trained specifically in mental health care and would maintain police involvement only where there was a clear and present risk to safety. That would significantly change and strengthen the system, placing mental health crises more firmly within the domain of health rather than law enforcement.

[Sojan Joseph]

Sections 135 and 136 of the current Mental Health Act give the police the power to break into someone’s property or detain somebody in a public place where there is the possibility of the involvement of weapons. Does the hon. Member think that health professionals would be able to manage those kinds of situations? Would the police not be the best people to deal with those situations?

[Gregory Stafford]

I am sorry if I was not clear for the hon. Gentleman. I thought I had made it very clear that I was talking about situations in which there was no risk to other professionals. Clearly, in the situations he describes, the police are entirely the right people to be involved.

The second area that I want to touch on is that of strengthening safeguards for vulnerable children. What I would like to see introduced is an essential safeguard for children and young people within the mental health care system. As my hon. Friend the Member for Runnymede and Weybridge mentioned, the current legislation allows for a nominated person to be appointed to represent the child’s interests. In my view, though, it does not provide adequate protection against the risk that that person could be coercive, abusive or in other ways inappropriate, particularly in cases involving looked-after children or those with complex family dynamics.

As such, I would like to see amendments made that address that gap by establishing clear criteria for who can be appointed as a child’s nominated person. For looked-after children, the local authority would automatically become the nominated individual, ensuring oversight by a public body accountable for the child’s welfare. For other children, only individuals with legal parental responsibility—such as a guardian or someone named in a court order—should be appointed. Such measures would ensure that no vulnerable child would be exposed to undue influence during what may be one of the most difficult or disorienting times in their life. They would align mental health law with broader child protection standards and reinforce the principle that safeguarding must be at the heart of any mental health intervention involving children.

Finally, I want to see amendments made that would introduce more patient voice and accountability. I accept that in its current form, the Bill makes steps in the right direction, but I would like to see an amendment made mirroring the one that was tabled in the other place by the noble Lords Howe and Kamall. Such an amendment would introduce the valuable and forward-looking provision of a mandatory debrief session within 30 days of discharge from detention under part 2 of the Mental Health Act. That session would be led by an independent mental health advocate, and would provide patients with the opportunity to reflect on their experience, raise any concerns about their treatment, and offer feedback in a safe, supportive and non-judgmental setting.

That would be more than just a procedural addition; it represents a shift in culture, which I think we would all agree with, towards embedding patient voice and accountability in the mental health care system. It recognises the importance of empowering individuals after detention, supporting their recovery and learning from their lived experience to improve future services. Mental health charities and third sector organisations have strongly endorsed the proposal, so I hope the Minister will give some indication in his wind-up that he would support a similar amendment.

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

--- Later in debate ---

[Sojan Joseph (Ashford) (Lab)]

It is a pleasure to be called to speak in this Second Reading debate. Prior to being elected to this House, I worked for 22 years in NHS mental health services, and I am the chair of the all-party parliamentary group on mental health. This is an issue I care about deeply.

It has been widely accepted that the Mental Health Act is outdated, and the need to modernise it has been talked about for some time. I pay tribute to Baroness May who, when she was Prime Minister, commissioned Professor Sir Simon Wessely to undertake an independent review of the Act, and I commend this Labour Government for introducing the Bill without delay.

As Members will be aware, last week was Mental Health Awareness Week. The discussions I took part in showed how far we have come in removing much of the stigma around mental ill health, but I fear that a lot of stigma remains when it comes to discussing severe mental ill health, such as cases of schizophrenia. I therefore welcome the importance that the Government have attached to the Bill, and to updating the law so that it is fit for the 21st century. I hope that, through our deliberations, we can play our part in ensuring that severe mental ill health is treated with the respect and understanding it deserves.

The Mental Health Act provides the legal framework for the detention of people when their mental ill health means that they are at risk to themselves or others, so that they can receive appropriate treatment. The Bill looks to modernise that legal framework. I welcome clause 1, which adopts the four principles of treatment proposed in Sir Simon Wessely’s independent review. By adopting those principles, the legislation will give patients greater choice, enhanced rights and support, and ensure that being treated with dignity and respect is an integral part of their treatment.

This reform is long overdue. We talk a great deal about wanting to deliver personalised care in our health service. That should be the guiding principle in every part of the service, especially for the most vulnerable. Adopting the principles is about redressing the balance of power away from the system, so that the patient has more autonomy, and more say over their treatment. That will help to ensure that those in society with the most severe mental health conditions get better, more personalised care. I also welcome the statutory role that clauses 24 to 28 will give a nominated person, who will have a greater say over the patient’s treatment and care. Replacing the old hierarchical list of relatives with a person who has been selected by the patient, albeit that there will be certain safeguards in place, is an update to the legislation to reflect today’s world.

Clause 3 deals with the application of the Mental Health Act to autistic people and those who have a learning disability. The clause modifies the definition of mental disorder by introducing new definitions of autism, learning disability and psychiatric disorder. As a result, people with a learning disability or those who are autistic can no longer be detained or made subject to a community treatment order unless they have a co-occurring psychiatric disorder. This is a welcome and long overdue change. Under the Mental Health Act, autistic people and those with a learning disability have experienced inappropriate care, over-medication and extended periods of detention. As we look to modernise the Act, it is wholly appropriate to ensure that they cannot be detained unless they have a co-occurring psychiatric disorder.

However, concern has been expressed in parts of the learning disability and autism sectors that the change may have unintended consequences. For example, it may lead to an increase in alternative routes to detention. In particular, concern has been raised that people with high-risk behaviours who require treatment in appropriate and safe hospital environments may end up having to be dealt with by the criminal justice system if they cannot be detained under the Mental Health Act. These concerns were debated when the Bill was considered in the other place, but I would be grateful if the Minister could say whether the Government have given any further consideration to those points. I would also be grateful if he could give an assurance that he and his officials will engage with the learning disability and autism sectors as the Bill continues through this House.

In the other place, the Conservatives were successful in amending the Bill to allow the extension of police powers of detention under sections 135 and 136 to other specified healthcare professionals. The amendment provoked serious concern from representatives of healthcare professionals, and I understand it is not supported by the police either. The “right care, right person” model, put in place in 2023, has already reduced the time the police have to deal with mental health patients. Will the Government look into overturning that amendment? I would also be grateful if he said how the Government will build on the Bill to ensure wider reform of, and investment in, mental health, and how we can ensure that the aims of the Bill are accompanied by high-quality mental health services, especially community services for people experiencing poor mental health.

In preparation for today’s debate, on Thursday, as chair of the APPG on mental health, I was pleased to organise for a small group of Members a visit to the mental health centre at the St Charles hospital in Kensington. During our visit, we were able to spend time in the mental health crisis assessment service. This excellent facility is open 24 hours a day, seven days a week, for anyone in the area who is experiencing a mental health crisis. I recommend that such facilities be instituted across the country, especially in my constituency. In Ashford, there are no mental health emergency facilities. Over 2,600 people whose primary issue was recorded as mental ill health presented themselves at the A&E department at the William Harvey hospital in 2024. Such facilities would help to prevent that. I press for more support to be put in place, alongside the Bill.

Oral Answers to Questions

Sojan Joseph Excerpts

Tuesday 25th March 2025 Commons Chamber

[Karin Smyth]

I am absolutely clear that we need to make sure that the job evaluation scheme looks at staff across the piece and that people are rewarded appropriately for the work they are asked to do. We will do that as part of our discussions with the NHS Staff Council, and we will be working consistently with staff as part of the 10-year plan to ensure that people are rewarded. We depend on these staff, and we want to encourage them to be part of the NHS workforce. That is the approach we intend to take.

[Sojan Joseph (Ashford) (Lab)]

7. What steps his Department is taking to reduce the number of people waiting for NHS treatment.

[The Secretary of State for Health and Social Care (Wes Streeting)]

The 18-week standard for elective care has not been met for almost a decade. That is the legacy of the Conservative party. Our plan for change commits us to cutting waiting lists from 18 months to 18 weeks by the end of this Parliament through a combination of investment and reform. Since we took office, the waiting list has reduced by over 190,000. We achieved our manifesto pledge of 2 million extra appointments seven months early, and waiting lists have fallen five months in a row. A lot done, but a lot more to do. Change has begun, and the best is still to come.

[Sojan Joseph]

I welcome that NHS waiting lists for physical health have fallen for the last five months in a row and that NHS waiting lists are down by almost 200,000 since Labour was elected, but with people who have mental health conditions eight times as likely to have to wait 18 months for treatment, what steps are the Government taking to ensure that we see the same progress in waiting times for both mental and physical health treatments? Can they deliver a parity of esteem that the Opposition failed to achieve in their 14 years in power?

[Wes Streeting]

I am grateful to my hon. Friend for his question and for his long-standing commitment to improving mental health services. Lord Darzi highlighted that those waiting over a year for mental healthcare outnumbered the entire population of Leicester. We are committed to tackling this. We will fix the broken system by recruiting an extra 8,500 mental health workers, introducing access to a specialist in every school and rolling out community Young Futures hubs in England. We will shortly be publishing before Parliament our mental health investment standard report, which will show that when it comes to mental health this Government are putting their money where their mouth is.

Terminally Ill Adults (End of Life) Bill (Twenty-fifth sitting)

Sojan Joseph Excerpts

Committee stage
Tuesday 18th March 2025 Public Bill Committees

[The Minister for Care (Stephen Kinnock)]

It is a pleasure to serve under your chairship, Sir Roger. Before I speak to amendments 497 and 498, on which the Government have worked with my hon. Friend the Member for Spen Valley, let me address amendments 462 and 463.

Amendment 462 would amend clause 18 to require the co-ordinating doctor to explain to the person that they do not have to proceed and self-administer the approved substance, and that they may still cancel their declaration. Although it is not specified, it is presumed that the amendment refers to the second declaration that the person will have made. The Committee may wish to note that there is already a requirement in clause 18(4)(b) that,

“at the time the approved substance is provided”,

the co-ordinating doctor must be satisfied that the person

“has a clear, settled and informed wish to end their own life”.

The purpose of amendment 463 is to limit what the co-ordinating doctor is permitted to do in relation to providing the person with an approved substance under clause 18. As the clause stands, subsection (6) sets out the activities that the co-ordinating doctor is permitted to carry out in respect of an approved substance provided to the person under subsection (2). It states that the co-ordinating doctor may

“(a) prepare that substance for self-administration by that person,

(b) prepare a medical device which will enable that person to self-administer the substance, and

(c) assist that person to ingest or otherwise self-administer the substance.”

Additionally, subsection (7) provides that

“the decision to self-administer the approved substance and the final act of doing so must be taken by the person to whom the substance has been provided.”

Amendment 463 would remove subsection (6)(c), which would result in the co-ordinating doctor being unable to assist the person

“to ingest or otherwise self-administer”

the approved substance. The co-ordinating doctor would still be permitted to prepare that substance for self-administration and to prepare a medical device to enable the person to self-administer the substance. This could mean that a co-ordinating doctor may not be able to provide assistance such as helping the person to sit up to help with swallowing, or explaining how the medical device for self-administering the substance works. This could result in practical difficulties in self-administration of the substance and/or place the co-ordinating doctor in a difficult position.

[Sojan Joseph (Ashford) (Lab)]

Does the Minister think that it is confusing for health professionals when we say that they can assist the patient to sit up or hold a cup of water or put the medication into their mouth? Is it not confusing for medical professionals that we are giving contradictory statements?

[Stephen Kinnock]

One of the fundamental principles of the Bill, which my hon. Friend the Member for Spen Valley has prioritised, is self-administration. It is not for me as a Minister to opine on that; it is simply there in the Bill. Once that fundamental principle is established, it is about defining what “assistance” means, compared with what “self-administration” means. As I was setting out, I think “assistance” can mean things like helping the patient to sit up; it does not mean actually administering the substance to the patient. It is about the dividing line between assistance and self-administration—hence the term “assisted dying”, I suppose, which is very different from the doctor actually administering the substance.

--- Later in debate ---

[Stephen Kinnock]

I thank my hon. Friend, who speaks with considerable clinical expertise. It is about exactly that difference between self-administration and administration. If we cleave to those two principles, that is the basis on which we will achieve the stated aim of my hon. Friend the Member for Spen Valley.

[Sojan Joseph]

Does the Minister agree that assisting a person to ingest is different from assisting a person to self-administer?

[Stephen Kinnock]

In order to ingest, there has to be self-administration. The self-administration is the precondition for ingesting the substance. That is my reading. I hope that that satisfies my hon. Friend.

--- Later in debate ---

[Danny Kruger]

I am grateful to the hon. Lady. Let me let me look that up later. I am happy to exchange data, because this is clearly something we should be trying to get right.

Nevertheless, I want to try to explain why I am suggesting that we have a problem with the drugs that are used in assisted dying and that it has been suggested we use here. Let me continue the quote from Dr Zivot:

“When one watches an execution, it’s not clear that this is happening”—

meaning that it looks like a peaceful, painless death. He continues:

“There is not much to see. Executions, like, I imagine, medical assistance in dying, are a rather bloodless event; not much can be seen outwardly. But the autopsies revealed a very disturbing and surprising finding.”

He makes the point that that is particularly disturbing, given that assisted dying often uses a paralysing drug, which induces the impression of peace and calm in the patient, when in fact something else might be going on below the surface.

To conclude my quote from Dr Zivot, he says:

“To claim that this is a death that is peaceful, well, it can be nothing else because now a person is unable to move in any way, but whether or not they have any conscious experience of what is happening is unknown…it should be clear to the Canadian public that the kind of death that they will experience…will be something other than the way it is represented. It could be exceedingly painful and more akin to drowning.”

I cannot judge whether Dr Zivot is right, but we should be very wary of any claims that there is a simple answer to the question surrounding lethal drugs. To the point made by the hon. Lady, and I think by the hon. Member for Stroud, there is no evidence in the many reports from Dignitas, which has a regime very similar to the one we are imagining here—I will certainly look at the evidence mentioned made by the hon. Lady—that contradicts the concerns raised by Dr Zivot.

[Sojan Joseph]

Does this not show that clinical documentation is very important? We debated the issue in Committee earlier, when we talked about professionals being required to complete all relevant documentation. Maybe we are missing certain data because these things are not clearly documented in other places. Should we not take from that the learning that if we go ahead with this proposal, we should have proper documentation and make it clear to the clinician what they should and should not document?

[Danny Kruger]

I entirely agree that there is great concern about the lack of evidence in countries on which we are constantly relying for evidence of why this proposal is safe. I have suggested that, from the quite limited evidence we have, that it may not be safe. The hon. Gentleman is absolutely right that if we are to proceed, we need to be extremely strict about data collection.

To the hon. Gentleman’s point about making it clear to clinicians what drugs they are permitted to use, we also need to have a proper regime of clearing and approving those drugs. In earlier clauses, we debated the imperative on the NHS, the Medicines and Healthcare products Regulatory Agency and the Department of Health to properly authorise the specifics of what drugs will be used. It is not clear at the moment what those would be, and I very much agree that we need to be clearer on that.

I finish with a reference to an earlier debate, in which it was suggested, on the basis of the Australian example, that there is no evidence of complications. The hon. Member for Stroud talked about horrible stories from the United States and Canada. He also referred to Australia, where there is apparently no evidence of problems. In fact, I understand that of the six states, only Western Australia records complications, and it does so in relation only to practitioner administration—when the doctor administers the drug—which we do not propose to do here. It does not record complications in relation to self-administration, which is what the Bill proposes. In Western Australia, complications have been reported in 4.3% of cases involving practitioner administration. Again, we are dealing with the great mystery and enigma of how death happens with assisted suicide, and it is certainly unclear what we should do about it.

--- Later in debate ---

[Sojan Joseph]

We repeatedly talk about doctors, but nurses, healthcare assistants and other professionals will definitely be involved in a hospital environment. The Bill does not talk about other professionals. Furthermore, within a hospital environment, NHS wards may be bays without individual bedrooms. Does the hon. Lady think we need to be clearer on the procedures that will happen in those areas?

[Sarah Olney]

I am grateful for the hon. Gentleman’s professional experience, which is extremely helpful. He is absolutely right. Following the point made by the hon. Member for Banbury, we cannot define the circumstances in which a patient will find themselves when this is taking place. That is why it is incumbent on us to make sure we provide very clear guidance on precisely what Parliament intends.

As Dr Rebecca Jones told us in written evidence:

“As the death may take many hours, I’m uncertain of the practicalities of”

doctors remaining with the patient

“for many doctors…have competing demands on their time.”

In written evidence, Dr Chris Ainsworth asked how this will work in cases where death takes several days, as has happened in Oregon, while Dr Trevor Stammers wrote:

“If the doctor is required to be present until the patient’s death, this may require hours of practitioners’ time to fulfil and is unlikely to be adhered to in many cases if the dying process is protracted.”

Dr Rachel Fisher said in her written evidence that for Australian doctors, who are not required to be present at the final act, each assisted death requires around 60 hours of professional time. For British doctors, we will need to add the time it takes for the self-administration to result in death. Dr Fisher also raised the real impact on doctors, writing,

“imagine the practicalities of those who must deliver it. The GP, motivated by a deep desire to preserve life and relieve suffering arrives at the home of the patient with a cocktail of powerful drugs. What if the patient has symptoms? Who will collect their child from nursery or school if the patient takes a long time to die? How will they know when to decide the death was unsuccessful? Will there be counselling for GPs observing and feeling complicit in a potentially drawn out and symptomatic death?”

Finally, Dr Paul Shaw asked in his written evidence:

“How will this service be funded? What support will be required from the NHS when things go wrong or death takes longer than expected? Will this be a 0900-1700hrs service? What will be the out of hours arrangements?”

A lot of the written evidence touches on the practicalities of a doctor being required to remain with the patient until they die. Amendment 429, in the name of the hon. Member for Bexleyheath and Crayford, seeks to clarify whether “being with the patient” requires the doctor to be physically present in the room.

--- Later in debate ---

[Sojan Joseph]

Does my hon. Friend think that 10% is a high number? Does he also think that if we informed patients about the side-effects of those medications from the beginning, the number of patients opting out would probably be higher?

--- Later in debate ---

[Dr Opher]

I almost agreed with the hon. Gentleman earlier, when he asked at one point, should we not just leave this to doctors?

One of the key things the hon. Gentleman said is that the doctor administers the drug. This is self-administered, first of all, so that is a very clear line. However, also, in a case of terminal care—this is what I am trying to get across to the Committee—we know the patient is dying, and therefore if they are becoming worse we simply do things to make them comfortable, and we do not try to revive them, because they are dying. It is important that we realise that this is a very different medical situation from normal care, and that it actually needs very different skills as a doctor. Here, a doctor is not trying to prolong life, but trying to make a death as comfortable as possible.

That is why I support the Bill—because I think it will enhance a comfortable death. I wanted to make it clear that that is normal practice now in terminal care: we do not revive a patient with a terminal diagnosis who is in terminal care, but we make them comfortable.

[Sojan Joseph]

This is a very good discussion, and with a clinician as well—maybe my hon. Friend can help here. Are we leaving the Bill to professionals to administer, who might be confused and not clear about what they should be doing? In normal current practice, when somebody has a poor prognosis and is very fragile; we use “do not resuscitate” or “do not attempt CPR” decisions. Why do we not build that into the Bill—that everyone who is going through this process should have a DNR or DNACPR in place?

[Dr Opher]

I thank my hon. Friend for his experience in a clinical setting. I would remind everybody that in the Bill we are trying to help people die in a comfortable way, and I do not feel it is the Bill’s job to define exactly how we treat nausea or abdominal obstruction and so on. What we would like to do here is ensure that a patient has a pain-free death, and a death that they are in control of.

--- Later in debate ---

[Sojan Joseph]

We had some discussion earlier about how we will potentially be assisting dying in people’s own homes—that was not previously known to us; we thought it would be always in clinical settings—so medication will be transported from where it is stored as a controlled drug, in a hospital setting, to the patient’s home. Does the hon. Gentleman think that it is important that we have clear guidance as to how we store this medication?

[Danny Kruger]

I entirely agree. The regulations need to specify not only what drugs may be approved, but, as the hon. Gentleman suggests, how they should be stored and transported. I would expect that to be part of the package of regulations under the Bill.

As I have stated, I do not accept that we are talking about healthcare here; nevertheless, we are using products that are comparable to health products. The MHRA would need to significantly adapt its work in order to identify the most effective drug to cause what we currently perceive as harm—namely, the death of a patient. I recognise that that would be a significant change of remit and work for the MHRA, but we need to do it. One of the reasons that we need regulation of approved substances is to help ensure that falsified versions of the drug—drugs that do not have a licence for use in assisted dying—cannot enter the market. Such drugs may not be effective and could cause distress to those ending their lives and their families. I would be grateful if the Minister could clarify whether, in his view, clause 20 is sufficient to establish the necessary regulatory regime, or whether further legislation will be needed.

We had evidence from Greg Lawton, and other pharmacists, who wrote to the Committee to suggest that the approved substances would not legally come within the definition of a “medicinal product”, so medicines law, the protections associated with medicines and the MHRA licensing process might not apply. If that is the case, what do we do about it? We need a new licensing regime to ensure that the MHRA is able to properly regulate the substances, or, potentially, another regulatory agency would need to be established to do the job.

The Committee needs to make sure that there is a process that applies to approved substances used for assisted dying. It is not necessarily the case that a product licensed for treating a medical condition could not be used to bring about death—it is not the case that we cannot use any drug that is currently used for genuine health treatment—but it would not be being used as a medicine, so medicines law may not apply to its use for that purpose. There is an ambiguity, and I would be grateful for clarity on it.

The amendments that I am supporting would ensure that the MHRA had approved the drug for the specific purpose of ending someone’s life, and that there was scientific consensus that the drug would be effective for that purpose. The MHRA, in the marketing authorisation for the approved substance, would define the dosage of the drug required to bring about death. It would also ensure that specific considerations and warnings were placed in the product licence.

For example, some patients have allergies to certain drugs. If they decide to end their own life, that should be brought about as a result of the effect of the drug, not an unintended allergic reaction to it. Some patients would not be able to take drugs orally and might need to have the drug administered through a tube into the stomach, so different formulations would need to be available. Some drugs may need to be administered by injection. Patients may be unable to do the injection themselves, as we have discussed. Even if the patient is physically capable, injection techniques require proper training, and that needs to be considered when licensing drugs for assisted dying if the patient is responsible for self-administration.

There will be further considerations when deciding what drugs can be used. Patients will have a right to know what to expect. If they take the drug orally, how long will they have to wait before they die? Will they lose consciousness first? If so, how long will that take? Could there be some side effects or reactions after taking the drug, such as seizures or choking, that the family or carers will have to deal with? Can the drug be taken at home—that relates to the point that the hon. Member for Ashford made—or must it be used in a clinical setting? We have suggested that it could be used at home, so questions about transportation arise. Is a combination of drugs required? If so, in what order should they be taken? What happens if the patient passes out before taking the entire concoction of drugs? Has the drug formulation been optimised for the purpose of assisted dying, so that it reaches maximum blood levels as quickly as possible?

All these sorts of questions are appropriate for medical regulators. The MHRA could ensure that the patient information leaflet, and the warnings associated with it, given with the drug when it is prescribed prompt doctors to think about what drugs are most suitable for the patient and to provide information to the patient about what to expect.

Parliament must have oversight. It must bear responsibility for the kinds of deaths that it approves. Both Houses of Parliament should approve the statutory instrument. To inform that decision, the Secretary of State should provide all relevant information on the likely time to death, and on complications and side effects. When the state is creating a regime that will end lives, there must be maximum transparency and accountability, yet the Bill provides that this will be done by a negative statutory instrument. In other words, Parliament will get a say on the regulations only if the Leader of the Opposition prays against them—that is the process for a negative SI. That is the only circumstance under which the Government would make time for a debate and a vote on a negative SI. Given that this is an issue of conscience, I find it inconceivable that the Leader of the Opposition would want to take a position on it and so pray against it to trigger a proper debate. I think it is highly likely that Parliament would never get a say on this crucial issue because of the use of the negative procedure.

That situation has been recognised repeatedly as being unacceptable. When Lord Falconer introduced his Assisted Dying Bill to the House of Lords in 2014, it too provided for a negative SI power on this matter. The highly respected House of Lords Delegated Powers and Regulatory Reform Committee—we do not have an equivalent Committee in the Commons, but it sits over Parliament—said that it did not consider either the power or the procedure in the Falconer Bill to be appropriate, yet that is the procedure that we are being presented with here.

In 2021, when Baroness Meacher introduced her Assisted Dying Bill to the House of Lords, the Delegated Powers and Regulatory Reform Committee again issued a report, in which it said:

“In the interests of clarity and transparency on such important issues of public policy, the matters that are in due course to be dealt with under clause 4(7) by negative regulations should in our view be spelled out in detail on the face of the Bill from the outset. Accordingly, the Bill should contain a definitive list of medicines, and details of the manner and conditions under which such medicines are to be dispensed, stored, transported, used and destroyed. The power to amend such matters should be a matter for regulations subject to the affirmative procedure.”

We then come to Lord Falconer’s 2024 Assisted Dying for Terminally Ill Adults Bill, which he withdrew following the introduction of this Bill by the hon. Member for Spen Valley. That Bill in part took on that feedback from the Lords Committee. Although it did not provide a list of medicines, it did at least provide that the power to specify the drugs would be through the affirmative procedure.

The Hansard Society, which is non-partisan and neutral on assisted dying, has issued a critical report on this power. It says:

“MPs may wish to enquire why Kim Leadbeater has chosen not to adopt the scrutiny procedure set out in the 2024 bill, but has preferred that proposed in the 2014 and 2021 incarnations of the bill, despite the advice to the contrary of the Delegated Powers Committee.”

I would be grateful to learn from the hon. Lady why she has chosen this procedure.

It might be objected that the list that I am requesting might need to be modified quickly and that the affirmative procedure—having a parliamentary vote—would be an obstacle to doing that. The Hansard Society anticipated that objection. It said that

“this could be addressed by making provision for the use of the ‘made affirmative’ procedure in urgent cases where the Secretary of State wishes to remove a substance from the approved list and is of the opinion that it is necessary to do so immediately in order to prevent adverse medical events or failed assisted deaths. This would mean Ministers could act expeditiously but Parliament would have to debate and approve – albeit retrospectively – the change in the list. Whilst not perfect it would provide more opportunity for oversight than that offered by the negative scrutiny procedure.”

It seems to me that there is no justification for this vital matter to be regulated under the negative procedure. Too much power and responsibility is being given to Ministers subsequent to the passage of the Bill— if that is what happens. My amendment 467 would ensure that Parliament has a meaningful say, through the affirmative procedure, and that a report is published as part of that process setting out the expected efficacy of the drugs that will be used. I hope that the Committee will support it.

Terminally Ill Adults (End of Life) Bill (Twenty-fourth sitting)

Sojan Joseph Excerpts

Committee stage
Tuesday 18th March 2025 Public Bill Committees

[Sojan Joseph (Ashford) (Lab)]

Record keeping is a huge issue in our healthcare system. A huge number of coroners’ reviews have identified that record keeping has been an issue. By specifying only that clinicians need record a “recordable event”, we are leaving it as the responsibility of individual clinicians to decide what a recordable event is.

It is important that a good record be available to prevent future incidents and learn good practice. Leaving it open to a clinician to decide whether something is a recordable event could lead to most issues not getting recorded. For example, if a clinician has identified that there was coercion, it will be for the clinician to decide how much documentation to do. In my view, if they have identified a coercion, that should be recorded as an incident and further investigation should be done, but the Bill leaves it up to the clinician to decide. There is no standard for record keeping across the healthcare system, so a care home’s may be different from an NHS ward’s. I think it is for the Committee to look into what “recordable event” actually means.

[Stephen Kinnock]

The purpose of amendments 474 to 478 is to improve the drafting of the Bill by creating a new definition of “recordable event”. Recordable events are the events set out in clause 16(1) related to the recording of declarations and statements.

The amendments would also make consequential changes to clause 16, which refer to the occurrence of the recordable event, as per the new definition, and include reference to a report in addition to a statement or declaration. The reference to a report is consequential on the amendments already agreed by the Committee to clauses 7 and 8.

--- Later in debate ---

That is all very helpful. That is what we thought the Bill said anyway. It is not clear to me what the purpose of subsections (7) and (8) is, except that there is inherent danger in subsection (6). I am afraid that subsections (7) and (8) do not cancel that danger, because of the inherent lack of clarity—the blurring—that exists in the concept of assisting the person to ingest or otherwise self-administer.

[Sojan Joseph]

Will the hon. Gentleman clarify something? He is making a valid point, and I have been thinking about it. As a nurse who has worked in many areas, I know that a disabled person may not be able to take medication by themselves, and sometimes a nurse has to administer it with a spoon. There may be occasions on which a person’s medication comes back out and they have to do it a few times. Is that something the hon. Gentleman is concerned about—actually pushing the medication into the person?

NHS England Update

Sojan Joseph Excerpts

Thursday 13th March 2025 Commons Chamber

[Wes Streeting]

This Government committed in our manifesto to doubling the number of diagnostic scanners, and we will deliver that over the course of this Parliament. NHS charities have a valuable role to play. Philanthropy has a valuable role to play as an additional source of support to the NHS. When public funding is as tight as it is, we need to look at how we can maximise the benefits and the impact of bringing together sources of public investment, private investment, voluntary sector and philanthropic investment to deliver the most bang for the buck. Without knowing the details of the specific case the hon. Lady mentions, I would not want to comment too strongly, except to say that we are committed to doubling diagnostic scanners through public funds, but I am not sure I necessarily share the view that NHS charities do not have a role to play.

[Sojan Joseph (Ashford) (Lab)]

I know from my experience of working on the NHS frontline how hard it has become over the years to get basic things done. Nurses and matrons spend hours and hours getting basic changes made to their workplace on the frontline. I therefore welcome my right hon. Friend’s announcement. Will he ensure that by cutting bureaucracy, we can get more resources to where direct patient care takes place, which will help with the retention of nurses and healthcare assistants and see more patients being treated quicker and getting the care they need?

[Wes Streeting]

My hon. Friend is absolutely right. Some of the best innovation and improvements for patients I have seen has been led by frontline clinical teams that have had great executive leaders behind them, giving them the freedom and the tools to do the job. I hope that, as a result of these reforms, not only will we see the results for patients in the data, but staff and patients will feel the outcome and the difference in their experience of working in or being treated by the NHS.