GP Funding: South-west England
Stephen Kinnock Excerpts(2 days, 17 hours ago)
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The Minister for Care (Stephen Kinnock)
It is a real pleasure to serve under your chairship, Dame Siobhain. I thank the hon. Member for Newton Abbot (Martin Wrigley) for securing this debate and raising this important issue. I pay tribute to every hon. Member who has taken part in the debate for their insightful contributions.
The health and wellbeing of constituents across the south-west remains a top priority for us all; I welcome the opportunity to address the concerns that have been raised today. The issue strikes at the very heart of the NHS and its ability to serve our communities effectively. General practitioners are the cornerstone of the NHS. They provide the first point of contact for millions of patients, enabling access to specialist services, managing long-term and chronic conditions, and delivering preventive care.
The south-west is a unique part of our country with a population that faces distinct challenges, from its rural geography and dispersed communities to an ageing demographic and areas of health inequality. The dedication of GPs and primary care teams, often working under difficult conditions, is a testament to the NHS’s commitment to accessible healthcare. I thank those professionals for their invaluable service.
I was pleased to see the fantastic interest and engagement that we had from the south-west in our 10-year health plan consultation. The hon. Member for Newton Abbot and his colleagues from the area will be pleased to note that the south-west had a higher than average response rate compared with the rest of the country on our change.nhs.uk platform. We also saw that 126 community-led events were run in the south-west using our “workshop in a box” toolkit, which demonstrates just how important reforming the NHS is to people in the region.
The Government recognise that GP practices in rural and remote areas face specific pressures, including recruitment difficulties and population fluctuations due to tourism. We also acknowledge the demographic reality. The south-west has a higher proportion of older residents, which increases the demand on primary care for managing complex, long-term conditions. These challenges require tailored and effective responses.
Since taking office, the Government have made primary care a central pillar of NHS reform. We have committed to strengthening GP services nationwide through a series of measures designed to increase funding, support workforce growth and improve patient access. These measures support progress towards a neighbourhood health service, with more care delivered locally to create healthier communities, spot problems earlier, and support people to stay healthier and maintain their independence for longer.
Edward Morello (West Dorset) (LD)
The Minister mentions the ageing demographic of the south-west. I do not know if it is actually a fact, but one of my favourite things that I have ever been told about the population of West Dorset is that if we were a country, we would have an older population than Japan—we would be the oldest country in the world. The only things older than our population are some of our GP buildings; about one in five predates the NHS itself. Can the Minister outline how the Government intend to help GP surgeries to upgrade their facilities?
Stephen Kinnock
I thank the hon. Gentleman for his intervention and for that fun fact. I will come on to it a bit later in my speech, but the £102 million primary care utilisation fund will make a major contribution to upgrading the creaking primary care estate. He is right to identify that as a major challenge. It is also major drain on productivity. We must ensure that our GPs have the tools at their disposal to do the work they need to do.
Adam Dance
Will the Minister visit Ariel Healthcare in Chard in Somerset, where the building is really not fit for purpose, and meet the GPs to talk about their concerns?
Stephen Kinnock
I am impressed by the way the hon. Gentleman did that and I congratulate him on it. If he would care to write to me to set that out, I will have a look at it and get back to him.
I want to take this opportunity to briefly outline what we have done since July 2024, and what we intend to do, to ensure that GP funding and services in the south-west are fit for purpose and capable of meeting the needs of the local population. In February, we concluded the annual consultation between the Department of Health and Social Care, NHS England and the general practitioners committee of the British Medical Association. For the first time in four years, GPC England voted in favour of the GP contract package, which illustrates the progress we are making to rebuild our relationship with the profession.
The 2025-26 contract is already improving services for patients and making progress towards the Government’s health mission. It supports the three key shifts the Government want to achieve: from analogue to digital; from sickness to prevention; and from hospital to community care. Patients across the country can expect online GP services to be available throughout the day, and better continuity of care for those who would benefit most. Patients can also expect a stronger focus on prevention, in particular to tackle the biggest killers, such as cardiovascular disease.
In 2025-26, we are investing an additional £889 million into the core GP contract to fix the front door of the NHS. Despite the difficult financial situation this nation faces, we are backing our health workers with above-inflation pay rises for the second year running. We are accepting the Doctors and Dentists Review Body’s recommendation of a 4% uplift to the pay element of the GP contract on a consolidated basis.
Dr Luke Evans
The Minister talks about contracts, which is an appropriate point to question him again on his Government’s position on the GP partnership model. It is not clear what that looks like from any of the documentation, so I would be grateful to understand that or, if the Secretary of State is considering new models, what they are and when we can see them.
Stephen Kinnock
We recognise that the partnership model has many strengths. It is a very important part of the system, and it helps to drive efficiency, innovation and a kind of go-getting approach to general practice. That is what we want to see—innovative approaches.
We are committed to substantive GP contract reform. We see the partnership model as a really important part of that, but we also recognise that fewer GPs are interested in going into partnership. The partnership model is not the only model delivering general practice; GP practices can and do choose to organise themselves in different ways. Many practices cite evidence of good outcomes on staff engagement and patient experience through the partnership model. I do not think it is right to say that there are any specific plans to change the partnership model, but we recognise that there are a number of other ways, and we will always keep the way in which the contract is delivered under review.
Vikki Slade
For some leasehold properties, there is a requirement that practices have partners. How is the Minister ensuring that such practices can be taken on, either by the ICB or the DHSC? Somebody has to take responsibility for those practices, and if we are moving to a model of having more salaried people, who will do that?
Stephen Kinnock
In debates about how we deliver health and care in our country, the question often comes up about the balance between the role of the DHSC at the centre, the role of ICBs and the role of those who are at the coalface delivering services. I do not think there is a single answer to that question. What is important is that we commit to devolution and to empowering those who are closest to their communities, because they are in the best position to make the decisions that work for their communities.
It is vital that we at the centre agree on and set desired outcomes for health, access and quality that the entire system is expected to meet. We have to set a framework, and it is then up to those at the coalface to decide how best to deliver it. It would not be right for me to say, on specific leasehold cases for example, that case A should go this way and case B should go that way; to try to dictate that from the centre would be a recipe for disaster. We do need to hold the system to account, however, and the system needs to hold us to account. That is the way to deliver true political and strategic leadership.
Jess Brown-Fuller
It is interesting that the Minister mentioned devolution, because the effect of the cuts to ICBs has meant that Sussex ICB is now having conversations with Surrey ICB about a merger. The cuts are therefore achieving the exact opposite of devolution, because such a merger would move power further away from communities. Does he have any thoughts on that?
Stephen Kinnock
Integrated care boards in the south-west have received almost £1.3 billion in their primary medical care allocation for ’25-26, which is an increase of nearly 13% compared with ’24-25, so I am not quite sure where the hon. Lady is getting her figures. For me, a 13% increase is not a cut.
That growth in local resources includes the south-west’s share of the additional £889 million agreed for the GP contract, as well as the transfer of some additional roles reimbursement scheme funding that had previously been held centrally by NHS England. Those funding allocations will be further uplifted to fund in full the pay recommendations of the DDRB and the NHS Pay Review Body.
Rachel Gilmour (Tiverton and Minehead) (LD)
I appreciate that recruitment, including of GPs, is extraordinarily difficult in the south-west. In Minehead, there is one GP practice and just one doctor. He is outstanding, and everybody knows him—to that extent, he fits the named GP pledge—but he serves 11,000 people. Rural premium or not, would the Minister agree that that is simply unacceptable and unsustainable, irrespective of where in the country one might be?
Stephen Kinnock
That is an extraordinary statistic. There are clearly major imbalances in the way the system works and general practice is funded in our country. A little later I will come to the Carr-Hill formula; I am sure hon. Members will have seen announcements trailed in the media today about what my right hon. Friend the Health Secretary will say shortly in a speech in Blackpool. The issue raised by the hon. Member for Tiverton and Minehead (Rachel Gilmour) is directly pertinent to the work we are doing around the formula for funding GPs, to ensure that it is needs based, unlike the current, deeply anachronistic and dysfunctional funding system.
On funding, general practices are funded through a range of streams, the majority from core payments known as global sum payments. The rest is made up of incentive schemes, premises payments and enhanced and additional services. The Carr-Hill formula is applied as a weighting of 50% to 60% of GP funding allocated through the core contract, and is a workload-based formula designed to reimburse practices for their expected workloads.
The formula takes into consideration patient demographics, such as age and gender, and factors such as morbidity, mortality, patient turnover and geographical location. I am truly proud that today my right hon. Friend the Health Secretary is in Blackpool to announce that we are reviewing the Carr-Hill formula, which is outdated and not fit for purpose. Currently, GP surgeries that serve working-class areas receive on average 10% less funding per patient than practices in more affluent areas, and that needs to change.
Politics is about choices. For 14 years, the Conservatives —propped up for five years by the Liberal Democrats, I am afraid to say—chose to favour the richest. Who can forget the right hon. Member for Richmond and Northallerton (Rishi Sunak) boasting about how he had deliberately redirected funding from deprived urban areas to leafy suburbs? This Labour Government are reversing that ethos. Our decision to reform the Carr-Hill formula is a clear example of how we are putting our Labour values into practice.
We recognise the importance of ensuring funding for core services is distributed equitably between practices across the country. In our upcoming 10-year health plan, that is what we will do, through our review and reform of the Carr-Hill formula. Alongside that work, the Advisory Committee on Resource Allocation—ACRA—will be asked to advise on how the setting of ICB allocations can better support the reduction of health inequalities, to ensure that resources are targeted where they are most needed.
On workforce and recruitment, we recognise the difficult situation whereby patients have been unable to get GP appointments and recently qualified doctors have been unable to find jobs. That is why, in August last year, we announced £82 million in ringfenced funding, allowing primary care networks to recruit newly qualified GPs through the additional roles reimbursement scheme. More than 1,700 GPs have now been recruited through that scheme.
As part of the 2025-26 GP contract package, we made the additional roles reimbursement scheme more flexible, to allow PCNs to accommodate local workforce needs better. That includes removing restrictions on the number or type of staff covered, including GPs and practice nurses. When I took up my ministerial responsibilities in July, I was astonished to find that it was not possible to recruit GPs through the ARRS. We have bulldozed that red tape, which has resulted in a dramatic increase in the number of GPs on the frontline.
Dr Luke Evans
On that point, what would the Minister say to junior doctors, now coming to be registrars, who will be looking for a job? Should they look to the ARRS as the way forward when they qualify? What will he say to them if they do not get a job? Should that be the route they look to? Is it an expansion he is asking for? What are the alternatives for those graduating in August?
Stephen Kinnock
We have been really pleased with the take-up under the ARRS. It is a rapid and clear way of recruiting, particularly because it has the ringfence and the reimbursement system underpinning it. We absolutely encourage newly graduating GPs to take up opportunities through the ARRS; it is an important tool for bringing more GPs on to the frontline. The challenge is not so much the number of qualifying and graduating GPs in the pipeline, but getting them to the parts of the country that need them most. That variation in provision is the No. 1 priority. The review of the Carr-Hill formula will also have important synergy with the issue of recruitment and workforce.
Dr Luke Evans
It seems pertinent to ask this question now: the Australian scheme I mentioned is one way that another country has dealt with the issue. Would the Government consider placing overseas doctors in the areas of most need? Is that something under consideration?
Stephen Kinnock
The hon. Member raises an interesting point. We are thinking strategically about the whole way that recruitment and workforce function. Similarly, on another part of my portfolio, we have several thousand international dentists who are waiting to do the overseas registration exam. We need to get that sorted out, because we have issues with capacity and there are ways of addressing them. We are absolutely committed to prioritising the training and appointment of our home-grown talent, but we also need to look at other options and solutions. We are going into this with eyes open, and I thank the hon. Member for that suggestion; it is definitely something we are looking at.
In addition, the newly launched £102 million primary care utilisation and modernisation fund will help create much-needed additional clinical space in more than 1,000 GP practices across England. The investment responds directly to findings from Lord Darzi’s independent review of the NHS, which highlighted how outdated, inefficient premises can hinder the delivery of high-quality patient care and negatively impact staff productivity and morale. This is the first dedicated national capital funding stream for primary care since 2020, and a clear demonstration of the Government’s commitment to strengthening primary and community care infrastructure.
Once again, I thank the hon. Member for Newton Abbot for securing this debate and thank all Members who have spoken for their passionate and insightful contributions. The Government remain fully committed to ensuring that GP funding in the south-west reflects the region’s particular challenges and needs. Through investment in the workforce and infrastructure, we aim to deliver a sustainable, high-quality primary care service for all. We also remain committed to delivering a neighbourhood health service that will improve people’s experience of health and social care and will increase their agency in managing their own care, health and wellbeing.
As we get our NHS back on its feet, and as we build an NHS fit for the future, we need more care closer to people’s homes and in people’s homes. For too long, NHS resources have been tilted towards hospitals and away from communities. The result is poorer services for patients who would benefit from care closer to home and in their communities. Moving care from hospitals into the community will be at the heart of the 10-year health plan, which will set out how we will continue to transform the NHS into a neighbourhood health service. The full vision will be set out in the plan, which we will publish very shortly.
We recognise the pressures on GPs and the impact on patients, and I assure hon. Members that addressing those challenges is a top priority for the Government. The NHS is evolving, but its founding principle remains: healthcare free at the point of use, accessible to everyone, everywhere.
Martin Wrigley
I am not quite sure what to say now that the Minister has actually said that my prime ask will be delivered. That is fantastic, and shows the emphasis of these debates.
I thank colleagues from across the House for their contributions. We all agree on the importance of GPs and the need to fix their funding. It is vital to recognise the many good things that GPs and GP practices have been doing in what have been difficult circumstances for a good number of years.
It has been delightful to hear that MPs have been interacting with their local GP practices to understand the problems with the funding formula. Delighted as I am to hear the Minister announce changes to the Carr-Hill formula, GP funding is still complex. I tried to show how complex it is by focusing on just on two of its elements, but we have heard from other hon. Members that the extra funds are even more complex. The fact that the 7% increase is eaten up by the 6% increase in wages, NICs and so on shows that it is not simple.
I thank the Minister for being here—
Martin Wrigley
I have never been interrupted by a Minister before—I would be delighted.
Stephen Kinnock
I do not even know whether an intervention is allowed here, Dame Siobhain—this is a revolutionary step—but the hon. Gentleman raised some concerns about the quality and outcomes framework, and I wanted to say that we have retired 32 out of the 76 quality and outcomes framework indicators, reflecting the fact that we agree with him: it was way too complex and there were too many indicators. By retiring those, we freed up £298 million, £100 million of which will go into the global sum, maximising the flexibility for practices to do what is right for their patients. The remaining £198 million will be repurposed to target cardiovascular disease prevention.
Mental Health Bill [ Lords ] (Ninth sitting)
Stephen Kinnock ExcerptsTuesday 24th June 2025
(3 days, 17 hours ago)
Public Bill CommitteesRead Full debate Mental Health Bill [HL] 2024-26 View all Mental Health Bill [HL] 2024-26 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 24 June 2025 - (24 Jun 2025)
David Burton-Sampson (Southend West and Leigh) (Lab)
It is a pleasure to serve under your chairship, Mr Vickers. Sadly, there are clear racial inequalities within the mental health system, as in other areas of health, and this must change. People from ethnic minority communities are more likely to experience a mental health problem, are less likely to receive support, and have poorer outcomes from services. It is very concerning that black and ethnic minority people are over-represented in detentions in our mental health system, and there are well-documented worries over disparities in the quality of care that they receive.
Decades of evidence and lived experience testimony point to systemic injustice. Black British people suffer a 6% higher rate of common mental health problems than white British people, and black adults are twice as likely to show symptoms of post-traumatic stress disorder—at 8%, compared with 4% of the white British population. Black men are over 10 times more likely to be placed under community treatment orders, and black women are more likely than any other group of women to experience common mental health problems. Studies have shown that experiences of racism link to depression, psychosis and post-traumatic stress. When people are assaulted—not just physically, but emotionally and psychologically—by the structures around them, it leaves a lasting impact.
I have witnessed at first hand the racial disparities at a visit to my local in-patient mental health care at Rochford community hospital, where I could see a visibly disproportionate number of black men on the ward, compared with the percentage of black men I know live in my community. People from ethnic minority communities are more likely to come into contact with mental health services through crisis pathways, the police, accident and emergency, and detention. They are more likely to be restrained, isolated and subjected to coercive treatment. We must listen to what these communities are telling us.
Research by Mind identified nine key barriers to accessing care, from stigma and discrimination to Eurocentric models of treatment, language and cultural barriers. People feel othered by a system that was not built with them in mind. We need to rebuild trust and recognise that mental health cannot be separated from the broader social and political context. Austerity, Brexit, the Windrush scandal and covid-19 have all disproportionately affected the black, Asian and minority ethnic community. That has led to a decrease in trust towards the establishment, and that bleeds into general distrust of organisations and officials working in healthcare settings and mental health.
People from BAME communities have shared many examples of direct and indirect discrimination they have experienced within mental health services. Those negative lived experiences further erode trust in the system and often deter people from seeking help. Racial disparities in mental health are a pressing issue that requires immediate and sustained action.
New clauses 1 and 3, tabled by the hon. Member for Winchester and outlined by the hon. Member for Guildford, have good intentions, but we need to reflect on whether they fit in the Bill. I would suggest not. The drivers of disparity here are much deeper than the scope of the Bill, and it would be wrong to attempt to wrap up the solution to this issue within it. That does not mean that action should not be taken.
I am hopeful that this Government are doing wider work to drive down racial inequalities, including with the challenge we can see here with mental health. Perhaps the Minister will outline more about the Government’s work, and therefore why the new clauses are not needed. I support the intent of the hon. Member for Winchester, but I cannot support the new clauses as an addition to the Bill. I would be happy to meet the Minister and others to discuss further ongoing overall inequalities for the BAME community.
The Minister for Care (Stephen Kinnock)
It is a pleasure to serve under your chairship this morning, Mr Vickers.
New clause 1, tabled by the hon. Member for Winchester, would require the Secretary of State to undertake a review of racial disparities in the use of community treatment orders. It is our view that the evidence base is already strong, and further reviews are not necessary. There are significant racial disparities in the use of community treatment orders. In 2023-24, black or black British people were issued with CTOs at seven times the rate of white or white British people. The use of community treatment orders as a proportion of overall detention numbers is higher for all minority ethnic groups compared with the white British population.
We are committed to reducing these disparities through our reforms and through the patient and carer race equality framework, which was a recommendation of the independent review. This includes a greater focus on prevention and early intervention, in part by promoting the use of advance choice documents, rather than an approach that simply makes it harder to impose CTOs. We are developing and monitoring an evaluation strategy, and we will continue to monitor and report on ethnic disparities via the published Mental Health Act statistics and our annual implementation report to Parliament.
New clause 3 would create the new “responsible person” role. They would have a duty to report on racial disparities and other inequalities in the use of the Mental Health Act. However, as drafted, the remit is significantly broader than that, to the extent that it would not be practical to combine all the stated functions into one role. We agree that there is a need to strengthen organisational leadership, improve data collection and change cultures across the mental health system. We also agree that it is important to have more targeted responsibilities to monitor and address racial disparities at board level in trusts, and that is already an explicit requirement of the PCREF.
The PCREF is a contractual requirement of mental health providers under the NHS standard contract. It builds on the statutory duties that apply already under the Equality Act 2010. These existing requirements cover the key responsibilities needed to monitor and address racial disparities. The PCREF can be updated more regularly than primary legislation, allowing us to take an iterative approach throughout implementation to ensure that we are capturing reporting and acting on the right data from frontline services. Ultimately, we feel that the PCREF will be more effective at reducing racial inequalities than the very broad remit outlined in this new clause, and that the addition of a responsible person in legislation is duplicative and unnecessary.
My hon. Friend the Member for Southend West and Leigh asked about implementation. The PCREF is the key instrument that we will use, but we are seeking to improve and strengthen decision making in three important ways: first, by requiring that an individual must be at risk of serious harm to be made subject to a CTO; secondly, by requiring the community clinician to be involved in all community treatment order decisions; and thirdly, by increasing the frequency of automatic reviews of patient cases by the tribunal, so that CTOs can be removed as soon as it is safe and appropriate to do so. I hope that that gives my hon. Friend some reassurance around the work that we are doing, but of course I would be happy to discuss these matters with him.
For those reasons, I ask the hon. Member for Guildford to withdraw new clause 1, on behalf of the hon. Member for Winchester.
Zöe Franklin
I thank the Minister for outlining the PCREF and the focus that it will have in addressing these issues. I was particularly interested in the explanation of the iterative approach that it will allow. I also thank the hon. Member for Southend West and Leigh for his insights into the issue. I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
New Clause 2
Mental Health Crisis Breathing Space
“(1) Any person detained under sections 3, 37, 41 or 47 of the Mental Health Act 1983 must be offered support from the mental health crisis breathing space debt respite scheme.”—(Dr Chambers.)
This new clause ensures that MHCBS, a debt respite scheme, is offered and available to patients detained under sections 3, 37, 41 and 47 of the Mental Health Act 1983.
Brought up, and read the First time.
Dr Danny Chambers (Winchester) (LD)
I beg to move, That the clause be read a Second time.
The new clause relates to the mental health crisis breathing space debt respite scheme, and would allow it to be
“offered and available to patients detained under sections 3, 37, 41 and 47 of the Mental Health Act 1983.”
The mental health crisis breathing space mechanism is another vital tool that can protect people in a mental health crisis from the impacts of problem debt, by pausing enforcement action, contacting creditors and freezing interest and charges on any debts.
However, the number of people benefitting from an MHCBS are significantly below its potential, largely because both patients and healthcare professionals do not know about it. Ensuring that everyone detained under the longer provisions of the Act would automatically be offered access to the scheme would ensure that many more people could benefit from it. We have discussed in previous sittings the impact of debt on mental health, and the work of Winchester Citizens Advice. I am really pleased to say that this week, I presented them with a huge award for best social enterprise at the Hampshire business awards, so my congratulations go to them.
Stephen Kinnock
I am grateful to the hon. Member for Winchester for bringing this issue before the Committee. The Government’s breathing space programme plays an important role in protecting people experiencing problem debt. We recognise that that can be particularly critical for people whose mental illness is worsened or even triggered by financial problems.
Let me reassure the hon. Gentleman that people under the sections identified by his new clause are already eligible for breathing space. In fact, eligibility covers all individuals detained in hospital for assessment or treatment under the Mental Health Act, as well as those receiving crisis treatment in a community setting from a specialist mental health service. Furthermore, NHS England guidance already sets out that financial support, including referral to breathing space, should be offered to patients receiving acute in-patient mental health care, whether detained or voluntary patients. We will make explicit the need for staff to offer proactively that support in the Mental Health Act code of practice. For those reasons, I ask the hon. Member for Winchester to withdraw his new clause.
Dr Chambers
I thank the Minister for his comments. I am concerned about the lack of knowledge among patients and healthcare professionals. We cannot see any downside to making this an automatic right, so we will press new clause 2 to a vote.
Question put, That the clause be read a Second time.
Stephen Kinnock
I am grateful to the hon. Member for Winchester for tabling the new clause. Like him, we are committed to preventing mental ill health and promoting good mental health. Achieving our vision for mental health requires a spectrum of interventions across the whole of society and across the life course, from prevention and early intervention through to treatment and specialised care for those with a severe mental illness in community and in-patient settings. We are committed to the shifts from treatment to prevention, hospital to community and analogue to digital, and our forthcoming NHS 10-year health plan will affirm those commitments.
With our commitment to neighbourhood health, we are encouraging stronger partnership working between local government, mental health services and the voluntary and community sector. As part of our shift to community, we have already launched six pilot neighbourhood mental health centres to deliver a 24/7 service, with open access to anyone who requires mental health support. Through the shift to prevention, we are putting more emphasis on early intervention and recovery to support people to live well and thrive, ensuring that we improve the conditions for creating good mental health.
Alongside that, I remind the Committee of the existing prevention concordat for better mental health: a voluntary agreement signed by local authorities and integrated care boards. Signing the concordat involves a commitment to take evidence-based, preventive and promotional action to support the mental health and wellbeing of their populations. The new clause would be duplicative of that existing programme, and could introduce an unnecessary resource burden on local authorities and commissioning bodies.
We are committed to moving to a meaningful partnership between central and local government, and to letting local leaders lead within their communities. For those reasons, I hope that the hon. Member for Guildford feels able to withdraw the motion.
Zöe Franklin
I thank the Minister for his comments. In particular, I was interested to hear about the mental health centre pilot schemes. I look forward to their further roll-out. They will be crucial in addressing the issues that we sought to address in the new clause. I was also very pleased to hear about the focus on a meaningful partnership between local government, national Government and mental health providers. On that basis, I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
New Clause 7
Funding and reporting
“(1) For each financial year until all sections of this Act have come into force, of the total health service expenditure by the bodies (taken together) in subsection (2), the proportion which relates to mental health spending—
(a) under the Mental Health Act 1983, and
(b) under this Act or which, in future, would be made under provision inserted into the Mental Health Act 1983 by this Act, (taken together) must not decrease.
(2) The bodies are the Department of Health and Social Care, NHS England and integrated care boards.”—(Dr Chambers.)
This new clause would require that mental health spending as a proportion of health service expenditure must not decrease in the implementation period of the Act.
Brought up, and read the First time.
Stephen Kinnock
I thank the hon. Member for Winchester for his new clause. This was raised in the other place and there are several issues with it that have not yet been fully addressed.
First, the new clause would apply only to spend under the Mental Health Act. The mental health system, and its accounting, is not structured based on the legal framework that patients are subject to. A single ward may contain a mix of patients under the Mental Health Act and informal patients who would not usually be considered to be under the Act. Community services will support some patients on community treatment orders, who are therefore subject to the Mental Health Act, but also many who are not and have never been subject to the Act. It would not be feasible or desirable to try to restructure accounting and reporting based on which patients are subject to the Act and which are not.
Secondly, the Government believe in prevention. We want to see better mental health outcomes, with more people cared for in the community so that the need for use of the Act is reduced. Over time, we want to see a shift in spend into preventive community services, which should in turn lead to a fall in the need for the use of the Mental Health Act. Few would disagree with that general aim, but the new clause would prevent that. By requiring share of spend under the Act to increase or remain the same, we are necessarily limiting the share of spend that could instead go towards preventing people from needing to use the Act in the first place.
We will need to invest to deliver these reforms, as the impact assessment makes clear; however, the new clause is flawed and not the right mechanism to achieve the necessary investment. Parliament already has the power to scrutinise departmental spend via the estimates process. We are required to report on the share of spend on mental health under the National Health Service Act 2006. This is sufficient to hold the Government to account. I therefore hope that the hon. Member for Winchester feels able to withdraw the motion.
Dr Chambers
I thank the Minister for his comments. If there is a duty to report the spend on mental health as a share of the whole budget, then I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
New Clause 8
Mental Health Commissioner
“After section 142B of the Mental Health Act 1983, insert—
‘Mental Health Commissioner
142C Independent Mental Health Commissioner: establishment
(1) There is to be an office known as the Office of the Mental Health Commissioner.
(2) The Office in subsection (1) must be established by the Secretary of State three months after the day on which the Mental Health Act 2025 is passed.
(3) The Office of the Mental Health Commissioner will be led by an individual appointed by the Secretary of State titled the “Independent Mental Health Commissioner”.
(4) The role in subsection (3) is referred to as the “Mental Health Commissioner”.
(5) The Mental Health Commissioner may appoint staff to the Office of the Mental Health Commissioner they consider necessary for assisting in the exercise of their functions in section 142D.
142D Functions of the Commissioner
(1) The Mental Health Commissioner is responsible for overseeing the implementation and operability of functions discharged by relevant bodies and persons under the provisions of this Act, the Mental Health Act 1983, and the Mental Capacity Act 2025 particularly regarding the provision of treatment, care, and detention of people with a mental disorder.
(2) The Mental Health Commissioner must publish an annual report on the use of functions discharged under this Act, which must assess—
(a) the quality of mental health care treatment provided by relevant services;
(b) the accessibility of mental health care treatment services;
(c) the relationship between mental health and the criminal justice system;
(d) inequalities of mental health care provision regarding protected characteristics under the Equality Act 2010;
(e) the use and effectiveness of detention measures under this Act, including but not limited to Community Treatment Orders, for the purposes of therapeutic benefit outlined in section 1(2B);
(f) challenges surrounding stigma of mental health conditions;
(g) the accessibility of advice and support to mental health service users, their families and carers on their legal rights;
(h) other issues deemed appropriate by the Mental Health Commissioner.
(3) In fulfilling their duties under subsection (1), the Mental Health Commissioner may review, and monitor the operation of, arrangements falling within subsection (1), (2) and (3) for the purpose of ascertaining whether, and to what extent, the arrangements are effective in promoting the principles in section 118(2B) of this Act.
(4) Subject to any directions from the Secretary of State, the Commissioner may take action necessary or expedient in connection for the purposes of their functions.
(5) This may include—
(a) collaborating with health services, public authorities, charitable organisations, and other relevant entities, including NHS bodies, the Care Quality Commission, and the Parliamentary and Health Service Ombudsman;
(b) ensuring enforcement authorities and public bodies under the Mental Health Act 1983 have the necessary capacity and resources to adequately discharge duties under the Mental Health Act 1983 and this Act.
142E Appointment, Tenure, and Remuneration of the Mental Health Commissioner
(1) The Secretary of State may by regulation make provision for the appointment, tenure, removal, and general terms of appointment of the Mental Health Commissioner.
(2) The Secretary of State may also by regulation determine the Commissioner’s remuneration, allowances, and pension entitlements.
142F Examination of cases
(1) The Secretary of State may, by regulations, make provision for the examination by the Mental Health Commissioner of the cases of those who are detained under this Act receiving treatment by authorised mental health care providers.
(2) The Secretary of State may, by regulations, provide for the Office of the Mental Health Commissioner to access and examine relevant data on mental health treatment provision held by NHS England and any other authorities the Secretary of State considers appropriate.
142G Regulations
A statutory instrument containing regulations under sections 142E and 142F may not be made unless a draft of the instrument has been laid before and approved by a resolution of each House of Parliament.’”—(Dr Chambers.)
This new clause establishes the office of the Mental Health Commissioner and makes provisions for relevant duties and responsibilities.
Brought up, and read the First time.
Dr Chambers
I beg to move, That the clause be read a Second time.
New clause 8 would establish the office of a mental health commissioner and makes provision for relevant duties and responsibilities. The commissioner would have a strategic, cross-government focus, working to promote mental health and tackle inequalities, and would be a powerful advocate for the rights and wellbeing of those living with mental health problems, who would finally have a voice at the top table. The commissioner would also play a vital role in the public sphere, tackling stigma and discrimination, and championing policies that support good mental health across society. The commissioner would have an independence to comment on the implementation of the reform of the Mental Health Act and any subsequent changes or issues that arise. International evidence highlights the impact that such a role can have in improving communities.
I keep coming back to a conversation I had in my office in Winchester with a psychiatrist whose wife also worked in the medical profession. He said that they were struggling to navigate the mental health system to get the healthcare that their child desperately needed. He made a really good point: if they, with their knowledge, expertise and experience, could not navigate the mental health system, what hope does anyone else have? That is why it is important to have someone with an overview who can advocate for patients, and the patient journey in general, to ensure that the process is streamlined and that people have the information they need to access the care they are entitled to.
Stephen Kinnock
I am grateful to the hon. Member for Winchester for bringing this issue, which was also debated extensively in the other place, before the Committee. Our view has not changed: the functions of the proposed commissioner clearly duplicate existing responsibilities of other organisations, most notably the Care Quality Commission. The Children’s Commissioner has expressed concerns that introducing a new mental health commissioner risks interfering with her own role in relation to children and young people’s mental health.
We recognise that the patient quality and oversight landscape is not working effectively, but I strongly doubt that inserting another body whose role overlaps with those already in place would help to address that issue. The landscape is already cluttered and fragmented. That is why last year we asked Dr Penny Dash to assess whether the current range and combination of organisations deliver effective leadership, listening and regulation for the health and care systems in relation to patient and user safety, or whether a new delivery model is needed. We will shortly see the results of her much-anticipated review.
We appreciate that our argument that the proposed mental health commissioner’s role would be duplicative of the CQC has previously been met with concerns about the effectiveness of that organisation. I reiterate that two major independent reviews into the wider role of the Care Quality Commission have reported under this Government, the recommendations from which the CQC has accepted in full. While we are confident in the progress that the CQC is making, we recognise that those reviews did not closely inspect the CQC’s statutory role and responsibilities in relation to monitoring the use of the Mental Health Act.
Therefore, in response to an amendment tabled in the other House, we committed to report on the CQC’s monitoring functions under the Act in the first of the Government’s annual reports on the implementation of the Bill. That will include reflections from the new chief inspector of mental health, Dr Arun Chopra, on the CQC’s statutory functions and its role as a key partner in delivering the reforms. I am looking forward to meeting Dr Arun Chopra very shortly in his new role.
Lastly, creating a mental health commissioner with a supporting office would require significant resources that we simply cannot justify. The original Mental Health Act commission was brought within the CQC to reduce Government spending and realise the benefits of aligning the CQC’s functions under the Mental Health Act with its functions under the Health and Social Care Act 2012, and to give it new powers to monitor via potential enforcement. Bearing in mind the radical reforms that we are making to the national health system to rid it of duplication, inefficiency and waste, we believe that now is not the time to reverse course on these matters.
Anna Dixon
I commend the work that the Minister and Penny Dash are doing to look at patient safety and the changes going on at the CQC. Could he reassure us that, within scope, he is also looking at the role of the Parliamentary and Health Service Ombudsman? There seems to be some confusion about whether complaints under the Act fall to the CQC or the PHSO.
Stephen Kinnock
The Dash review is looking at the landscape regarding all the different institutions and organisations, including the PHSO and the CQC, to map out how they interact with each other. Our view is that there is a lot of confusion and a lack of clarity, but we await the outcome of the review. I can confirm, however, that Penny Dash is looking at those matters. For those reasons, I ask the hon. Member for Winchester to withdraw the motion.
Dr Chambers
I thank the Minister for his reassurances. The issue is that the ability of the CQC to oversee implementation is limited, and it does not have a policy advisory function, which is something that a commissioner could do. Although we understand the Minister’s concerns about the office of a commissioner, the issue is important enough that we put it in our manifesto. We stood on a manifesto commitment to improve mental health access and streamline services via a commissioner. For that reason, we will press new clause 8 to a vote.
Zöe Franklin
I see them as absolutely sympathetic to each other and working in concert. We want to ensure that veterans have specific, tailored mental health care, as is outlined in the Bill. That is why the new clause would ensure that veterans’ unique needs are not just recognised but actively addressed. It is a practical and overdue step to improve care, safeguard rights and deliver the joined-up service that veterans deserve. After all, they give so much to our nation through their service.
I hope that the Minister will support the new clause, but if he does not, I hope that he will outline for the Committee how the Government will ensure that the aims of the new clause will be addressed through the Bill and its accompanying documents as they stand.
Stephen Kinnock
I am grateful to the hon. Member for Guildford for bringing the issue before the Committee. While most veterans lead healthy and successful lives following their service in the armed forces, we know that some may need mental health support. This Government are proud of the courage and dedication of our armed forces, and we are committed to ensuring that those who serve and served in the armed forces receive the best possible care.
All service personnel have access to mental health support throughout their career. The Defence Medical Services provide a responsive, flexible, accessible and comprehensive treatment service and, for leavers from the armed forces, NHS mental health services are available that are specially designed to support the unique needs of veterans. That includes veterans in mental health in-patient settings under the Mental Health Act and those within the criminal justice system. In England, these services are Op Courage and Op Nova, and in Wales there is Veterans NHS Wales. These bespoke services link with wider NHS mental health services to advocate for and support veterans to receive care tailored to their needs.
We are committed to giving veterans and armed forces personnel fair access to mental health care services and special consideration where appropriate. That is reflected in the core principles of the armed forces covenant, to which public bodies such as the NHS are legally bound to give regard. It is our firm view that a wealth of measures are already in place that respond to the unique needs and experiences of those who serve and have served in our armed forces. For that reason, I ask the hon. Member for Guildford to withdraw new clause 9.
Zöe Franklin
I thank the Minister for his comments—particularly about Op Courage, Op Nova and the armed forces covenant—and for his commitment to the veterans who have served this country and their courage, even when they face challenges with their mental health. The Liberal Democrats are willing to withdraw the amendment, but we will observe the passage of the Bill closely to ensure that it serves our veterans well across the UK. I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
New Clause 11
Costed plan to ensure community provision for individuals with learning disabilities and autism who are at risk of detention
“(1) Within 18 months of the day on which this Act is passed, the Secretary of State must publish a fully costed plan for how Integrated Care Boards and local authorities will ensure provision of adequate community services for individuals with learning disabilities and autistic people who are at risk of detention under Part 2 of the Mental Health Act 1983.
(2) As part of the development of that plan, a formal consultation process must take place to determine how the decision to enact the relevant parts of this Act will be made.
(3) The consultation must include input from relevant stakeholders, including—
(a) individuals with learning disabilities and autistic people;
(b) carers for people with learning disabilities and autistic people;
(c) healthcare professionals; and
(d) advocacy groups.”—(Dr Evans.)
This new clause requires a costed plan to ensure that ICBs and local authorities are able to provide adequate community services for individuals with learning disabilities and autistic people at risk of detention under Part 2 of the 1983 Act, informed by a consultation with a range of stakeholders.
Brought up, and read the First time.
Question put, That the clause be read a Second time.
Aphra Brandreth
My hon. Friend is absolutely right. We have seen examples where regulators have not intervened quickly or robustly enough, and where systemic issues went unnoticed or unaddressed for far too long. We need to strengthen the remit and ensure that the CQC is properly equipped and held to the high standards that we expect of it.
I am an economist by background, so evaluation is something I think about a great deal. Reform, however well intentioned, must be followed by evidence, scrutiny and a willingness to learn and improve. The new clause ensures that we do not just set change in motion, but that we stop to ask whether it is working, whether the right things are being done, and if not, how we can improve.
The review required by the new clause would look not only backwards at whether the regulator has effectively carried out its existing duties under the Act, but, crucially, forwards, assessing whether it is ready to meet the responsibilities placed on it by the new reforms. I particularly welcome the requirement for the review to be published and laid before Parliament. Transparency is essential. It would allow Parliament to scrutinise but also gives patients, families, professionals and the public confidence that those questions are being asked seriously and answered publicly.
Ultimately, the new clause is about improving outcomes. When regulation works well it safeguards dignity, prevents harm, identifies and spreads good practice, develops trust and helps us build a system where the principles of this Bill—choice, autonomy, less restriction and greater therapeutic benefit—are not just written in statute, but visible in practice. That is especially important in mental health care, where so often the people subject to the Act are among the most vulnerable. Those in in-patient settings, particularly those who are detained, are often not in a position to advocate for themselves. They rely on a system that is vigilant, takes its safeguarding responsibilities seriously and puts patients’ rights first.
I hope that all members of this Committee will support the new clause. It is collaborative in its intent, constructive in its purpose and essential to delivering the meaningful reform that we all want to see. It reinforces the importance of accountability, transparency and listening to those most affected by this legislation. We owe it to those individuals and their families to make sure that we not only change the law, but also the culture and oversight that surrounds it. This review would help us do exactly that.
Stephen Kinnock
I am grateful to the Opposition spokesman, the hon. Member for Hinckley and Bosworth, for bringing this issue forward.
Two major independent reviews into the Care Quality Commission have reported under this Government: one by Dr Penny Dash, on the CQC’s operational effectiveness as a regulator of all health and social care providers including those in mental health, the other by Professor Sir Mike Richards on its single assessment framework. The CQC has accepted those recommendations in full, and although we are confident in the progress that the CQC is making, we recognise that the reviews did not closely inspect its statutory role in relation to monitoring the use of the Mental Health Act.
Those powers and duties are entirely distinct from those that the CQC uses to regulate the health and social care sector under the Health and Social Care Act 2008. In recognition of that gap, as the Opposition spokesman pointed out, we committed in the other place to report on that specific aspect of the CQC’s role in the first of the Government’s annual reports on the implementation of the Bill, which will be laid before Parliament one year after Royal Assent.
Dr Evans
The Minister mentioned the Government’s annual reports, but at other times he has said that they will issue written ministerial statements. Will he clarify which it will be? There is a big difference between a couple of paragraphs in a written ministerial statement laid before the House, and a full report. When debating the other clauses, new clauses and amendments, the Government’s answer has been that they will report back to Parliament in a year’s time. I am grateful for that, but clarity would be helpful, because a full and comprehensive report would give more weight to the Opposition in terms of understanding and transparency.
Stephen Kinnock
I can confirm that the information will be in a section of the written ministerial statement that will be tabled within 12 months of Royal Assent. We think that requirement makes the Bill more robust and effective, because it is an integral part of the entire ecosystem that we are looking at in terms of implementing this legislation and making sure we have the institutional capacity and capability. We think it helps to have the information as an integral part of the written ministerial statement, but the hon. Gentleman is right to point out that we should be clear in the definitions and language we use.
The written ministerial statement will be an overall implementation report. It will contain a number of sections, one of which will be on the role of the CQC and the inspection function. It will include reflections from the new chief inspector of mental health, Dr Arun Chopra, on the CQC’s statutory functions under the Mental Health Act, as well as its role as a key partner in the delivery of the reforms. The written ministerial statement—the report—will be laid before both Houses of Parliament within 12 months of Royal Assent. I hope the hon. Member for Hinckley and Bosworth therefore feels able to withdraw his new clause.
Question put, That the clause be read a Second time.
Stephen Kinnock
I am grateful to the hon. Member for Winchester for bringing this issue before us. We are committed to closely monitoring the quality of in-patient care and driving continuous improvement in services. Indeed, we are already in the process of doing that, and a further review is not necessary to drive the changes forward.
The CQC’s role is to monitor the quality of in-patient services. Its annual “Monitoring the Mental Health Act” report specifically discusses the in-patient environment, and considers the quality of accommodation under the 1983 Act. The independent review in particular made a recommendation to replace dormitory provision with private rooms. To date, the NHS has invested £575 million in doing that, and we are committed to completing our programme of investment.
Anna Dixon
I draw attention to Lynfield Mount hospital in my constituency, which provides mental health in-patient care. It has a fantastic plan for upgrading its facilities, but at the moment it has secured only a proportion of the capital funding. Will the Minister meet me and local NHS leaders to see whether we can close the gap in the capital funding for that facility?
Stephen Kinnock
I congratulate Lynfield Mount on the important work it is doing—and I congratulate my hon. Friend on that extremely strategic intervention. Yes, I would of course be more than happy to meet her, and we will make sure to get that in the diary.
The Government have allocated £750 million for estates safety in 2025-26, to address high-priority estate issues across the NHS systems, including in the mental health estate. The CQC will continue to monitor the impact of the reforms through its existing monitoring and reporting duties. A further statutory review is therefore not required, so I ask the hon. Member for Winchester to withdraw his new clause.
Dr Chambers
I thank the Minister for his reassurances, especially on the ongoing reviews. I will withdraw the new clause, but I make the obvious point that this is about not only the health and safety of the staff and patients, but the public perception of mental health, and the stigma surrounding it if we are treating people in Victorian-era asylums. I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
New Clause 15
Review of impact of this Act on detention
“(1) The Secretary of State must, within a period of 12 months following the day on which this Act is passed, commission an independent review into the impact of relevant provisions on reducing the number of people detained under Part 2 of the Mental Health Act 1983.
(2) In subsection (1), ‘relevant provisions’ include—
(a) sections 4, 5 and 6,
(b) section 8,
(c) section 21, and
(d) sections 46 and 47.
(3) The Secretary of State must, within 12 months of the publication of the review in subsection (1), publish a strategy to implement the recommendations of that review.”—(Zöe Franklin.)
This new clause would require the Secretary of State to commission a review into the impact of relevant provisions in the Act in reducing the number of people detained, in particular the provisions relating to people with autism or a learning disability, on grounds for detention and for community treatment orders, medical treatment, care and treatment plans, and on after-care, and to implement any recommendations within 12 months of the publication of the review.
Brought up, and read the First time.
Zöe Franklin
New clause 15 calls for an independent review of whether the legislation achieves one of its core aims: reducing unnecessary detention under the Mental Health Act. People with learning disabilities and autistic people are still far too often detained in hospital settings, sometimes for months or years, despite clear evidence that community-based support would be more effective and humane. The Bill’s provisions—including those on grounds for detention, care and treatment planning and aftercare—are supposed to address that, but if we do not review their impact, there is a risk that they remain warm words without real change.
The new clause would ensure that the Government must review how well the new law is working, in particular for those most vulnerable to inappropriate detention, and then act on that evidence within a year. If we are serious about reform, which I believe the Government are given the content of the Bill, then the new clause would ensure serious scrutiny and accountability.
I turn to new clause 18. Eating disorders are complex, often misunderstood and frequently mismanaged in the mental health system. Too many patients face delayed interventions, inappropriate detention or a lack of tailored care, particularly when their condition does not fit into a narrow clinical threshold. The Bill introduces reforms to detention criteria, treatment decisions and care planning, but we must ensure that the changes actually work for people with eating disorders.
The new clause would require the Secretary of State to publish a report within 12 months that assesses the Bill’s impact on patients with eating disorders, including whether it is has improved access to appropriate treatment, safeguarded against unnecessary detention and strengthened aftercare. This is a matter not just of policy but of real people’s lives. We owe it to this vulnerable group to ensure that the reforms deliver real change, and that they are not left behind in a system that is still too often shaped by other conditions.
Finally, on new clause 23, children and young people in temporary foster care are some of the most vulnerable in our system. They often face multiple disruptions in care, placement and support, all of which can significantly impact their mental health. The new clause asks for a focused impact assessment on how the changes in the legislation will affect them. In particular, the new clause looks at whether the ordinary residence rules delay or block access to mental health treatment, whether placement changes disrupt continuity of care, and whether the provisions in section 125G of the Mental Health Act unintentionally harm this group.
Foster children should not fall through the cracks of bureaucracy. If we are serious about improving mental health services for all, we must understand and address the unique risks that face those who are moved frequently, often with little warning or support. An impact assessment is a necessary first step to ensure that their needs are not overlooked.
I commend all the new clauses to the Committee and look forward to hearing from the Minister.
Stephen Kinnock
On new clause 15, we want more people cared for in the community and fewer people reaching a point of crisis and detention, but we do not think it is right to use the legislation to drive down the numbers in an arbitrary way that could interfere with clinical decision making and create a risk that people do not receive the help that they need. An evaluation of the relevant clauses should therefore focus not purely on the reduction in detentions, but on the overall improvement of experience and outcomes. Such improvement is predicated on the independent review principles of choice and control, therapeutic benefit, and the person as an individual, as well as the principle of least restriction.
The timescales suggested in new clause 15 are not feasible. Following Royal Assent, our priority will be to update the code and for staff to be trained on the new legislation and code, before commencing the first phase of the reforms. The first phase of significant reforms cannot take effect until the work on the code and the training of staff are completed. Few, if any, of the sections mentioned in new clause 15 could therefore be commenced within 12 months, and it would be premature to commission a review of their effect on detention rates within that time period.
We plan to commission an independent evaluation of the reforms, subject to funding and fundable research applications. This will be a long-term, staged exercise, given the long period over which different reforms are expected to be sequentially commenced following the initial primary legislation. We will monitor the impact of the reforms on the number of detentions and disparities in detention rates, all of which are already published under the monthly Mental Health Act statistics. We have also committed to providing Parliament with an annual update on the implementation of the reforms. As we already plan to commission an independent evaluation of the Bill, and as the timescale set out in new clause 15 would not be feasible, I ask the hon. Member for Guildford to withdraw the new clause.
On new clauses 18 and 23, we have already published an impact assessment alongside the Bill, which was scrutinised by the Regulatory Policy Committee and rated fit for purpose. We have also committed to laying an annual report on the Bill’s implementation, through the written ministerial statement. We are committed to monitoring and evaluating the reforms to understand their impact on different groups affected by the legislation.
On new clause 18, we recognise the devastating impact that an eating disorder can have on someone’s life. The earlier treatment is provided, the greater the chance of recovery. The implementation and evaluation of the reforms will be a long-term, staged exercise. It would not be possible to assess the impact of the reforms on people with eating disorders within 12 months, as not all reforms will have been implemented. We will continue to work closely with NHS England to improve access to appropriate and timely care and treatment for people with an eating disorder.
On new clause 23, we recognise that there are inequalities in mental health prevalence and outcomes for children and young people in care. We are committed to ensuring that all children are able to access the care and treatment they need. We plan to develop bespoke guidance in the revised code on the care and treatment of children and young people, to account for the specific needs of that cohort. I hope that hon. Members will not press their new clauses.
Zöe Franklin
I thank the Minister for his comments; it was really helpful to hear about how he sees the timings in our new clause fitting with the ongoing work to implement the Mental Health Act and the commissioning of the independent review. I am concerned about his comment that the work will be dependent on funding. I hope that the funding for the important independent review will be ensured. However, on the basis of the Minister’s comments, I am happy not to press any of the new clauses. I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
New Clause 16
Transfer of patients: out of area placements
“(1) The Mental Health Act 1983 is amended as follows.
(2) After section 19 (transfer of patients), insert—
‘19A Transfer of patients: out of area placements
(1) The Secretary of State must reduce to zero, within five years of the passage of the Mental Health Act 2025, the number of patients transferred to a hospital outside of the area in which the patient is ordinarily resident.
(2) The Secretary of State must publish, within six months of the passage of the Mental Health Act 2025, a report to outline how the duty under this section will be met, including how provision for treatment under this Act will be increased.’”—(Dr Chambers.)
This new clause would require the transfer of patients to hospitals outside of their area to be reduced to zero within 5 years, and for the Secretary of State to produce a report on how this will be achieved.
Brought up, and read the First time.
Dr Chambers
I welcome the hon. Gentleman’s comments. That is a sensible and insightful point, and I will take on board the Minister’s response too.
Stephen Kinnock
We believe that everyone should receive treatment for mental illness as close to home as possible, but there are circumstances in which placement on a ward outside the area where a person usually resides is clinically necessary. Some specialised services—for example, treatment for an eating disorder—may require a person to be transferred to a placement away from home, and we wish to retain that option.
However, we know that too many patients are placed outside their local area, which is why we have set aside £75 million in capital funding for local systems to invest in reducing such placements for all patients. We are also trialling new models of care, including six pilots of 24/7 neighbourhood mental health centres, with the aim of treating more people in their local communities. Similar international models have achieved significant reductions in hospitalisation.
NHS England is developing a new model for specialised children’s and young people’s mental health services that aims to ensure that children and young people are treated in the least restrictive environment close to their family and home. I hope that that satisfies the hon. Gentleman and that he will withdraw the new clause.
Dr Chambers
I thank the Minister for his comments. He recognises the issue and is taking steps to address it, so I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
New Clause 19
Report and Guidance: Improving Outcomes for LGBT Patients
“(1) The Secretary of State must, within 12 months of the day on which this Act is passed, prepare and lay before Parliament a report on the mental health outcomes of patients who are treated under the Mental Health Act 1983 and who identify as lesbian, gay, bisexual, or transgender (LGBT).
(2) The report under subsection (1) must include an assessment of—
(a) any differences between non-LGBT patients and LGBT patients in—
(i) the extent of the use of detention measures under the Mental Health Act 1983; and
(ii) treatment outcomes following detention, and
(b) the availability and accessibility of ‘culturally competent’ mental health treatment under the 1983 Act for LGBT patients.
(3) Following publication of the report under subsection (1), the Secretary of State must publish guidance for responsible bodies and individuals working with patients under the Mental Health Act 1983, including but not limited to those working in—
(a) mental health hospitals;
(b) places of safety;
(c) crisis accommodation; and
(d) relevant community mental health services.
(4) The guidance under subsection (3) must include—
(a) provisions about updated training standards for staff regarding the specific mental health needs and experiences of LGBT individuals, including training on non-discriminatory practice and inclusive communication approaches;
(b) steps to improve safety for LGBT patients in relevant mental health settings, with particular regard to addressing discrimination and harassment; and
(c) a definition of ‘cultural competent mental health treatment’ for the purposes of subsection (2).
(5) Responsible bodies and individuals working with patients under the Mental Health Act 1983 must have regard to guidance published under subsection (3).
(6) In preparing the report under subsection (1) and the guidance under subsection (3), the Secretary of State must consult—
(a) patients with a mental disorder who identify as LGBT;
(b) the families or carers of patients with a mental disorder who identify as LGBT;
(c) relevant professional bodies;
(d) integrated care boards;
(e) local authorities;
(f) providers of mental health treatment; and
(g) such other persons as the Secretary of State considers appropriate.
(7) The Secretary of State must update the guidance under subsection (3) at regular intervals, and no less frequently than every three years.”—(Zöe Franklin.)
This new clause would require the Secretary of State to report on mental health outcomes and disparities for LGBT patients in treatment under the Mental Health Act 1983 and publish guidance covering training and safety for this specific group.
Brought up, and read the First time.
Stephen Kinnock
I am grateful to the hon. Member for bringing this issue before the Committee. This Government are committed to tackling health inequalities. The NHS continues to pursue its advancing mental health equalities strategy, which sets out plans to address inequalities in access, experience and outcomes in mental health care, including for LGBTQ+ people. However, we do not think that a review within 12 months of the passage of this Bill is the right approach. First, there are known data quality issues with the recording of sexual orientation in the mental health services dataset, which, combined with small numbers, limits our ability to monitor outcomes accurately and reliably.
Secondly, we do not need a review before acting to improve patient experience under the Act. We will update the code of practice following the passage of this Bill, including the statutory guidance to the Mental Health Act, and will work with patient groups to consider what further guidance is needed to reduce disparities in use of the Act. That consideration will cover issues based on sexuality, gender, race and other protected characteristics. We are also committed to monitoring and evaluating the reforms, which will include an assessment of whether new safeguards and support mechanisms are being equitably accessed through different groups. For those reasons, I ask the hon. Member to withdraw the new clause.
Zöe Franklin
I thank the Minister for his comments, for the recognition that individuals in the LGBT community clearly have concerns about the way that mental health care is provided, and for the commitment to addressing those. I hope that at some point he will be able to advise on the timeline for looking to resolve the issue of the unreliability of data; it is crucial that we have accurate data in order to ensure good outcomes and improvements in mental health care. However, in the light of the Minister’s comments and commitment on the issue, we will not press the new clause, although I look forward to observing closely, as this Bill continues through the House, how it will address the current inequalities for the LGBT+ community. I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
New Clause 22
National strategy on mental health units
“(1) The Mental Health Act 1983 is amended as follows.
(2) In Part VIII (Miscellaneous Functions of Local Authorities and the Secretary of State), after section 118, insert—
‘118A National strategy on mental health units
(1) The Secretary of State must, within 12 months of the passing of the Mental Health Act 2025, publish a national strategy to set out how the Government will ensure that all relevant mental health units meet or exceed ‘good’ safety standards as assessed by the Care Quality Commission (CQC).
(2) A strategy issued under this section must address the following matters—
(a) recruitment, retention and training of mental health staff,
(b) patient-to-staff ratios, and
(c) safe staffing levels during crises and night shifts.
(3) Following publication of the strategy, a report on implementation progress must be laid before Parliament annually.
(4) For the purposes of this section, a ‘relevant mental health unit’ is a facility used for treatment under this Act.”—(Dr Chambers.)
This new clause would require the Secretary of State to publish a strategy, followed by an annual progress report, on how the Government will ensure that all mental health units used for treatment under the Mental Health Act 1983 are rated “good” or above by the CQC.
Brought up, and read the First time.
Dr Chambers
I beg to move, That the clause be read a Second time.
New clause 22 is quite similar to new clause 14, on the state of in-patient facilities. It would require the Secretary of State to publish a national strategy to ensure that all mental health units meet or exceed a good rating for safety, as assessed by the Care Quality Commission. It would also mandate annual progress reports to Parliament. We all know that far too many mental health settings fall below acceptable standards. The CQC has repeatedly flagged serious failings in in-patient mental health services, including unsafe staffing levels, poor physical conditions and risks of harm to patients. These are not isolated issues but persistent and systemic problems.
The new clause calls for a proper, co-ordinated response. It would require the Government to set out how they will address staffing shortages, improve recruitment and retention, and ensure safe staffing levels, particularly at night and during crisis periods, when the risk is often highest. It is not enough to rely on reactive inspections or piecemeal initiatives; we need a national strategy backed by data, accountability and regular reporting to the House. Too many vulnerable people are currently treated in mental health units that are overstretched, understaffed and, in some cases, unsafe. The new clause would begin to change that by setting clear expectations on monitoring progress and holding the Government to account. I commend the new clause to the Committee.
Stephen Kinnock
We all agree that patient safety is paramount. Anyone who receives treatment in an in-patient mental health facility deserves safe and high-quality care. There have been too many incidents of poor-quality and unsafe care resulting in trauma and sometimes tragedy.
Although we agree with the principle of the new clause, the overriding objective duplicates NHS England’s in-patient quality transformation programme, a national initiative aimed at improving the quality and safety of care in in-patient mental health, learning disability and autism services. The programme has been developed with service users, families and staff, and sets out a long-term vision for improving in-patient services.
The new clause focuses specifically on staffing arrangements. Although we of course agree that the workforce is an important consideration in ensuring safe in-patient care, it is not the only factor. By comparison, NHS England’s in-patient quality transformation programme takes a more comprehensive view of the factors that contribute to safe and effective in-patient care. For example, it includes support for the cultural changes required to create and sustain an in-patient environment in which patients and staff can flourish. The programme’s progress will be measured using a range of data and evidence, for example on patient and staff experience.
We know that more needs to be done to support the providers of mental health care to improve the quality of their services in a sustainable way, which is why we are putting in place a robust package of reforms to help to improve performance. There will be no more rewards for failing; instead, ICBs and providers that do well will be rewarded with greater freedoms, while the most challenged will receive focused intervention. For those reasons, I ask the hon. Gentleman to withdraw the new clause.
Dr Chambers
I thank the Minister for his comments and reassurances. I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
New Clause 24
Application in respect of patient already on hospital grounds
“(1) The Mental Health Act 1983 is amended as follows.
(2) In section 5(1) (Application in respect of a patient already in hospital), after ‘or,’ insert ‘that the patient has attended a hospital or been brought to a hospital to seek help or admission as a patient or,’”.—(Dr Shastri-Hurst.)
This new clause would allow people who have attended or been brought to a hospital to seek help or admission as a patient to pursue an application for admission under the Mental Health Act.
Brought up, and read the First time.
Question put, That the clause be read a Second time.
Natasha Irons
My hon. Friend is absolutely right. This is about transparency and providing answers for the families of patients when the very worst happens.
Independence has allowed investigations into deaths in places of custody to improve significantly. As outlined by the independent advisory panel on deaths in custody, patients detained under the Mental Health Act now have the highest mortality rate across all places of custody. Indeed, the rate is three times higher than in prisons, when taking into account estimates of time in custody and the number of people in each setting. Behind each of these tragedies are families who have unanswered questions and who have had to fight to find out what happened to their loved ones, and vulnerable people who should have received better care.
In my constituency, there is the story of Catherine Horton, who died in 2017 while in the care of the South London and Maudsley NHS trust. The inquest into her death found that the risk assessment was not properly updated, with no formal risk assessment conducted, and no care plan on her arrival or while at the facility. There is also the story of Tia Wilson, who died in 2021 in the care of the same trust. The inquest into her death found that there were multiple failures in managing her risk, which contributed to her death. Then there is the story of the brother of one of my constituents, who absconded from his care, went missing, and was later found dead in a wooded area a stone’s throw from her home.
For each of those cases, we know that internal reviews will have taken place and assurances of improvements will have been made, and yet issues with risk assessments remain and families are left pushing for answers. This is not unique to south London; the internal review process is failing to deliver the necessary improvements across the country. Without embedding independence into the process, we risk undoing a lot of the good work that the Bill seeks to achieve. Adding independence into the investigation of these incidents where the very worst things happen gives trusts a genuine space to learn the lessons. It would improve patient safety and provide families with the transparency they need.
Although we must all acknowledge the incredible work that trusts do across our country to provide care for people at their most vulnerable, we must also provide a proper framework for challenge and improvement. The new clause is an opportunity to treat the deaths of people detained under the Mental Health Act with the same seriousness and care as deaths in other custody settings, to embed transparency, and to make the meaningful improvements that all patients deserve.
Stephen Kinnock
I am very grateful to my hon. Friend for bringing this issue to the Committee. I thank her for her powerful speech, which drew on specific experiences of people who have been through very terrible and tragic processes. I have discussed some work on the broader issue of quality of care, but this is a vital issue, and I reiterate how grateful I am to her for enabling us to discuss it on the public record. We recognise that there have been too many incidents of poor-quality and unsafe care, which sometimes result in tragedy. I hope my hon. Friend is reassured by the measures we are taking to support providers of mental health care to improve the quality of their services. We have carefully considered her new clause, and I am afraid that we do not think this needs to be addressed through the Bill.
Natasha Irons
I thank the Minister for his comments. The cluttered and chaotic way in which we investigate these things is part of the problem, so I am glad to hear that there is a wider review of how we streamline the process better for patients, because we are seeing mistakes repeated over and over again. I am content to withdraw the new clause, but I would be grateful if the Minister would meet me to discuss the wider plans in this area and how I can support that work and take it forward.
Stephen Kinnock
I would be more than happy to meet my hon. Friend. It is also worth mentioning the independent advisory panel on deaths in custody report, which she mentioned. We are considering that carefully, so we should include it in our discussions.
Natasha Irons
I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
New Clause 26
Use of restraint and restrictive intervention
“(1) The Mental Health Act 1983 is amended as follows.
(2) In Part II (Compulsory Admission to Hospital and Guardianship), after section 7, insert—
‘7A Use of force in connection with admission for assessment or treatment
(1) A relevant organisation that operates a hospital must appoint a responsible person for the purposes of this section.
(2) The responsible person must—
(a) be employed by the relevant health organisation, and
(b) be of an appropriate level of seniority.
(3) The responsible person must keep a record of any use of force by staff who work in that hospital against a person (“P”) who—
(a) has been admitted for assessment or treatment under sections 2 to 5 of this Act; or
(b) is on the hospital premises and is at risk of detention under this Act.
(4) The Secretary of State must by regulations provide for the risk factors to be considered under subsection (3)(b).
(5) A record kept under this section must include—
(a) the reason for the use of force
(b) the place, date and duration of the use of force
(c) whether the type or types of force used on the patient formed part of the patient's care plan;
(d) the name of the patient on whom force was used;
(e) a description of how force was used;
(f) the patient's consistent identifier;
(g) the name and job title of any member of staff who used force on the patient;
(h) the reason any person who was not a member of staff in the hospital was involved in the use of force on the patient;
(i) the patient's mental disorder (if known);
(j) the relevant characteristics of the patient (if known);
(k) whether the patient has a learning disability or autistic spectrum disorders;
(l) a description of the outcome of the use of force;
(m) whether the patient died or suffered any serious injury as a result of the use of force;
(n) any efforts made to avoid the need to use force on the patient; and
(o) whether a notification regarding the use of force was sent to the person or persons (if any) to be notified under the patient's care plan.
(6) The responsible person must keep the record for three years from the date on which it was made.
(7) The Secretary of State must ensure that, at the end of each year, statistics are published regarding the use of force by staff who work in hospitals under the conditions set out in this section.’”—(Jen Craft.)
This new clause would require hospitals to record information on all incidents in which force is used against patients with mental disorders, in line with the reporting currently required in mental health units, including force against those at risk of detention for assessment or treatment. It would also require the Government to publish annual figures on the same topic.
Brought up, and read the First time.
Stephen Kinnock
I thank my hon. Friend the Member for Sheffield Hallam for tabling this important new clause, and I thank my hon. Friend the Member for Thurrock for moving it on her behalf.
The new clause seeks to recreate some of the duties from the Mental Health Units (Use of Force) Act 2018, but apply them to patients detained under sections 2, 3, 4 or 5 of the Mental Health Act or those at risk of detention under that Act. This would cover patients receiving mental health treatment who are not in specialist mental health beds, such as young people with eating disorders who are detained in general paediatric wards.
There are practical reasons why we do not support the new clause as it is drafted. For the vast majority of mental health patients, this duty would duplicate duties that already exist under the 2018 Act. Although the new clause would go further in requiring the recording of use of force outside mental health units, it does not require any further use of that data to develop policies or train staff, which is a key element of the 2018 Act. As drafted, the new clause would introduce new duties to record and report data, without there being any clear further use of that data.
I accept, however, that we need to do more to reduce the use of restraint for all patients detained or at risk of detention under the Mental Health Act. NHS England has an ongoing programme of work, overseen by the reducing restrictive practice oversight group, to address this issue for people experiencing acute distress and mental health difficulties. My officials have also written to the CQC to commission it to develop a viable and proportionate mechanism for reporting use of restraint to the CQC, drawing on the views of NHS Providers and NHS England. Any potential changes can be made in regulations and would not require primary legislation, so we can continue this work in parallel with the passage of the Bill, delivering on our commitment to reduce the use of force for mental health patients. For those reasons, I hope that my hon. Friend the Member for Thurrock will withdraw the new clause.
Jen Craft
I thank the Minister for his comments. I am reassured, as I am sure my hon. Friend the Member for Sheffield Hallam will be, to hear that he accepts the need to do more about the use of restraint, regardless of the setting in which it occurs. I am also pleased to hear about the measures by which he is seeking to do so in parallel with the passage of the Bill. I am content with what the Minister said, and I imagine my hon. Friend the Member for Sheffield Hallam will be, too. I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
Clause 55
Power of Secretary of State to make consequential provision
Question proposed, That the clause stand part of the Bill.
The Chair
With this it will be convenient to consider the following:
Clauses 56 to 58 stand part.
Government amendment 39.
Clause 59 stand part.
I should say to Members that we have 10 minutes left. If they want to conclude the Committee’s business this morning, they should bear that in mind.
Stephen Kinnock
Clauses 55 to 59 are the general provisions of the Bill. They include the powers to make provision that is consequential on the Bill by regulations. The clauses also set out the territorial extent of the measures, and the commencement and short title of the Bill.
Clause 55 will allow the Secretary of State to make regulations that make provisions that are consequential on the Bill. The power may be used to
“amend, repeal or revoke provision made by or under primary legislation passed—
(a) before this Act, or
(b) later in the same session of Parliament as this Act.”
Clause 56 will provide an equivalent power for Welsh Ministers to make consequential provision in areas of their devolved legislative competence. Regulations that make consequential provision will be subject to the affirmative scrutiny procedure where they amend or repeal primary legislation, and to the negative procedure where they amend or revoke secondary legislation.
Clause 57 sets out the extent of the Bill. The majority of the Bill will extend to England and Wales, but the general provisions in clauses 55 to 59 will apply UK-wide. We have tabled two amendments, Government amendments 37 and 38, that will modify section 6(3)(b) of the Human Rights Act 1998, extending its protection to cover private care providers when providing certain services arranged or paid for by public authorities. That change, if accepted, will extend UK-wide; we tabled the amendments to clause 57 to reflect that position.
Dr Evans
I will be brief. On this clause, I will be grateful if the Government can ensure good co-operation between the devolved powers, and if the Minister can set out how he will engage with the Welsh Government before exercising the power.
On clause 57, what consideration has been given to cross-border issues to ensure that there are no unintended consequences between the likes of England and Wales or Scotland and England? Clause 58 covers commencement; will there be a clear published timetable for that over the next 10 years? Will Government allow Parliament sight of the transitional provisions? We have talked about the annual written ministerial statement, which we have clarified, but will there be further tracking reports that we can look at?
Clause 59 states that the Bill will not impose new public spending or taxation, and yet the impact assessment lists £1.9 billion for the NHS in England, £396 million for local authorities, £2.5 billion for supporting housing and social care, and £287 million for legal costs and tribunals. Clearly, costs are associated with the Bill’s implementation over the next 10 years, so a money resolution is rightly required. When I raised those issues on our first and second days in Committee, the Minister rightly could not answer, because we had not had the Government’s settlement. We have now had that settlement, so I will be grateful to understand how the funding is to be applied to mental health on the community side and with regards to the Bill. Finally, given that we are dealing with Scotland, Wales and Northern Ireland, what are the Barnett consequentials of the Bill in ensuring the support implied in the clauses?
I am grateful to the Committee, the Clerks, the Chairs, everyone here and everyone who has helped me prepare. Committee stage has been a joy, but also a long trial to get through. I am glad to be present as the Bill proceeds, because it is the right thing for the country.
Stephen Kinnock
I thank the shadow Minister for his question about devolved powers. We have worked closely with the Welsh Government on the Bill. The Senedd has yet to vote, but the Welsh Government in their legislative consent memorandum recommended that it grants consent to the Bill. We also seek a legislative consent motion from the Northern Ireland Executive for extending—in Government amendments 37 and 38—the remit of the Human Rights Act 1998 to cover private care providers when providing certain services arranged for or paid by local by public authorities. I will look into the cross-border issues and, if something is there, I will certainly write to update the shadow Minister.
On the published timetable, the written ministerial statement will absolutely be a report on progress over the 12 months and will have a forward plan in it. I cannot say at this moment whether it will be a forward plan all the way through the proposed 10-year commencement period, because some of that will go beyond the spending review period, for example, but I assure the hon. Member that a timetable will at least cover the period of the initial spending review. I do not know whether there will be tracking reports—I will check that point with officials—but my sense is that the written ministerial statement will be the main hook to hang this on.
The shadow Minister asked about the money resolution. We have the overall financial envelope for the DHSC. There is now—how should I describe this?—intense dialogue going on between departments within the DHSC and across portfolios, so I think it will take a couple of weeks before we get the carve-up of the envelope across the different portfolios.
I note the shadow Minister’s point about the Barnett consequentials. I will look into it and come back to him.
It remains for me to thank you, Mr Vickers; everyone in Committee, for their very hard work; and all the staff and officials, to whom we are hugely grateful. I commend the Bill to the Committee.
Question put and agreed to.
Clause 55 accordingly ordered to stand part of the Bill.
Clause 56 ordered to stand part of the Bill.
Clause 57
Extent
Amendments made: 37, in clause 57, page 68, line 3, at end insert “subject to subsection (2).”
This is consequential on amendment 38.
Amendment 38, in clause 57, page 68, line 4, leave out “This section, section 55” and insert—
“Section (Human Rights Act 1998: extension to certain private care providers), section 55, this section”.—(Stephen Kinnock.)
This ensures that NC10 extends to England and Wales, Scotland and Northern Ireland.
Clause 57, as amended, ordered to stand part of the Bill.
Clause 58 ordered to stand part of the Bill.
Clause 59
Short title
Amendment made: 39, in clause 59, page 68, line 25, leave out subsection (2).—(Stephen Kinnock.)
This removes the privilege amendment inserted in the Lords.
Clause 59, as amended, ordered to stand part of the Bill.
Bill, as amended, to be reported.
Access to GPs
Stephen Kinnock Excerpts(4 days, 17 hours ago)
Commons ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
The Minister for Care (Stephen Kinnock)
I thank the hon. Member for North Down (Alex Easton) for raising GP access, which is a vital matter for so many of our constituents. I congratulate him on securing his first Westminster Hall debate—well done on that. [Interruption.] His first Adjournment debate—sorry. We are not in Westminster Hall right now. It has been a long day; I thank hon. Members for their forbearance.
When we ask people what their top priority for the NHS is, the chances are that they will say it is to fix general practice, because GPs are the front door to our national health service. They are the first port of call for millions of people, and they perform a vital service by delivering care in communities right across our country. Of course, health is a devolved matter in Northern Ireland, and decisions about GP services there rightly sit with the Northern Ireland Executive and at Stormont. Nevertheless, this Government are committed to being an active partner in helping to deliver better public service outcomes across the UK while respecting the devolution settlement. I am delighted that the Under-Secretary of State for Northern Ireland, my hon. Friend the Member for Putney (Fleur Anderson), is here with me on the Front Bench this evening, showing how important the teamwork between the UK Government and the Northern Ireland Executive is.
Ultimately, the underlying challenges are the same. Whether it is access, capacity or workforce pressures, we recognise those issues across the UK. Our manifesto pledged to reset our relationship with the devolved Administrations, to put country before party, and to work with them on issues from trade and tackling child poverty to a whole range of issues around the economy and growth that affect all of us. I welcome this chance to hear the perspective of the hon. Member for North Down and to exchange ideas across the Floor of the Chamber. Access to timely GP appointments is at the heart of a strong and responsive healthcare system.
Mr Tom Morrison (Cheadle) (LD)
On that point, I will raise the issue of a resident who lives in my constituency. She needs to give blood every three months for a long-term condition she has, but she can never get an appointment in Bramhall, where she lives; instead, she has to travel 3 miles to Shaw Heath. That happens every three months. Does the Minister agree that that should not be happening in our country and that access to GPs should be not only easier, but available to all our residents?
Stephen Kinnock
I agree absolutely with the points that the hon. Gentleman makes. We will very shortly publish our 10-year plan for the NHS. As I will say a little later in my speech, a big part of that is about the shift to a neighbourhood health service and shifting from hospital to community so that the front door of the NHS is fixed, and access is a vital part of that.
Chris Coghlan
The big issue in my constituency is that I have constituents who are on the point of qualifying as GPs, but they do not have jobs as GPs to go into. What do the Government plan to do as part of their 10-year plan to fix the issue that we have people qualifying as GPs who do not have GP jobs to go into?
Stephen Kinnock
I am sure the hon. Gentleman will welcome the fact that we secured a record £889 million increase in the GP contract. That is a first step in digging us out of the very deep hole that the previous Government left for us. When I look across my portfolio, whether it is GPs, mental health, dentistry or pharmacy—you name it—it is a car crash right across the piece. I was frankly shocked by what I saw when I first went into the Department back in July. We are, I hope, beginning to get things back on an even keel. The hon. Gentleman is right, though: we do not have a shortage of people coming through GP training, but supply and demand are not matching up. That has to change.
I am sure that the hon. Member for North Down will welcome the fact that we secured £82 million of additional funding through the additional roles reimbursement scheme, leading to the recruitment of an additional 1,700 GPs. The challenge is more about getting GPs in the places where they are most needed, which is something we need to work on—other colleagues have talked about the geographical imbalance. We need to look at the formula for the way that funding is allocated across the country, as it is an important part of the access issue that the hon. Gentleman raised.
Tom Gordon (Harrogate and Knaresborough) (LD)
I have been working with Lib Dem councillor Hannah Gostlow to tackle some of the issues that local health services and GP surgeries in Knaresborough are facing. I recently visited a surgery and was told that it had the staff that it wanted to get in place, but did not have the consulting rooms. The problem that surgery faces is that the money from the community infrastructure levy and other sources of funding will not come until further down the line, so it cannot take on those staff because the consulting rooms cannot be built. Does the Minister agree that we need to get funding into those GP services, so that we can provide the services that local people deserve and need?
Stephen Kinnock
The hon. Gentleman is right; one challenge we face is that, where we are developing new centres of housing, we are not getting the social infrastructure wrapping around them. We need to use things such as section 106 agreements and the CIL, as he mentioned. That process is not always working—the developers are not always coming forward with real, concrete commitments—so the integrated care boards do not commission because they are not sure that the infrastructure will be there, and we end up in a chicken-and-egg situation. We are working closely with colleagues in the Ministry of Housing, Communities and Local Government to break through some of that and attach stronger strings to the deals being done with developers. We also have the £102 million capital infrastructure scheme for primary care, which will go some way towards addressing the issue, but this is fundamentally about getting much clearer and stronger commitments from developers.
Jim Shannon
I thank the Minister for his responses, which have been incredibly helpful. When I think of GP access, I think of two things; the first is Strangford and the villages along the Ards peninsula, where I have lived for most of my life and where I represent. There, the best way of contacting a GP is by phone—that is the nature of the situation there—but one of the things that helps in Newtownards, which is the biggest nucleus of people in the area, is for people to go down to the surgery at 8 o’clock or half-past 8, join the queue and get their appointment there and then. That is another way of trying to access the GP; there is nothing as frustrating as being on the phone from 8 o’clock to half-past 8 or 9 o’clock and not being able to get an appointment. At least when people can see their doctor, they can definitely get one.
Stephen Kinnock
We have to have a mixture of access channels. The telephone is very important, as is being able to turn up in person, but we also need to shift more to online booking. I am really pleased that the new contract that we have with GPs is based on an £889 million investment that came with a lot of strings attached around reform. One of those strings is that every GP surgery—in England, at least—must have online booking facilities by 1 October. I hope that will improve access, and will make more space in the reception process for people who cannot use the internet.
We have to ensure that we get the balance right. That is why, as I mentioned, we took decisive action in October 2024. We invested £82 million in the additional roles reimbursement scheme, which was a targeted move to strengthen our frontline services and ease the pressure on practices across the country. That funding has directly supported the recruitment of over 1,700 GPs across England. Those GPs are now in place, helping to increase appointment availability and—most importantly—improving care for thousands of patients who have been struggling to get the help they need when they need it. We have also seen a rise in the number of GPs employed directly by practices over the past 12 months, which is a positive sign that general practice is stabilising and beginning to rebuild capacity on the ground. Together, these developments are making it easier for patients to access care and for practices to deliver it.
Robin Swann
As the hon. Member for North Down (Alex Easton) mentioned, there are contracts that have been handed back to the Department. We have people coming forward who want to be GPs, but it is getting harder to find those partners who want to run and manage practices. Does the Minister agree that in any training scheme and any course that comes forward, that side of general practice—how to run a business and how to run a practice—needs to be reinforced in training? There are people who want to be GPs and medics, but we need that skills mix, too.
Stephen Kinnock
The hon. Member speaks with great knowledge and expertise in this area, so I am pleased that he is here for this debate. He is right that it is about the skills mix. Many GPs really enjoy the management, administration and leadership role at partnership level. He raises an interesting and important point about the training for that. My impression is that many go into managing a practice having just learned on the job and gone through the process in an ad hoc way. Perhaps training is a matter for further discussion with the Royal College of General Practitioners. It is also about learning to run a business. Could we look at that in respect of universities and MBAs or whatever it might be, given that business administration is an important part of the equation?
I also wanted to say a word about bureaucracy. Too much red tape is holding GPs back. On 4 October, the Secretary of State launched the red tape challenge, with a clear goal to identify and eliminate unnecessary administrative burdens, freeing up GPs to see more patients and focus on delivering high-quality care. Improving access is not just about cutting bureaucracy; it is also about transforming how care is delivered. That is why we have committed to moving towards a neighbourhood health service. That model of care will bring a range of services together, breaking down barriers and silos between services and streamlining support for patients. That integrated approach will mean that patients are seen sooner by the right person in the right setting.
We will require all practices to ensure that patients can go online to request an appointment at any point during core opening hours. That is about not just adding a digital option, but transforming how general practice works for the modern world. By making online access standard, we are giving patients more control and greater flexibility over how they engage with their GP. It will mean no longer having to call at 8 am sharp or waiting in a phone queue. That is especially important for those juggling work, childcare or other responsibilities. This change also helps those who prefer to call or go to the surgery in person; by enabling more people to use online routes, we reduce pressure on phone lines and reception desks, meaning shorter waits and faster service for everyone.
We are also taking action to improve access for those who need it most by incentivising better continuity of care, particularly for patients with chronic or complex conditions. They benefit significantly from seeing the same practitioner over time. Continuity does not just improve the patient experience; it improves outcomes. When patients see a familiar clinician, issues are identified earlier, care is more personalised and time is not lost repeating history or re-explaining symptoms. Our manifesto pledge is to bring back the family doctor, and that is what we will do.
Physical infrastructure has also been mentioned by hon. Members. Our new £102 million primary care utilisation and modernisation fund will create additional clinical space in more than 1,000 GP practices across England. This investment will deliver more appointments and improve patient care.
Ben Maguire (North Cornwall) (LD)
Stratton surgery in my constituency has long been trying to get access to two rooms on the third floor of the surgery that could be used for clinical space, but the ICB seems to be dragging its feet. The rooms were previously used by Cornwall’s ICB for maternity services. They are no longer in use, so can the Minister please help in working with the ICB to help Stratton surgery to get access to those much-needed clinical spaces?
Stephen Kinnock
If the hon. Member could write to me on that issue, I would be more than happy to look into it. I am always keen to help hon. Members to get their ICBs to move in the right direction.
We have directly provided £61 million to assist the expansion of the multidisciplinary team approach across Northern Ireland, which will help to stabilise primary care, focus on the prevention and management of conditions away from hospital settings, and better utilise the skills of the community and voluntary sector. We will provide additional funding by 2028-29 to bring back the family doctor by supporting the training of thousands more GPs and delivering millions more appointments over the spending review period, and will build further on the 1,700 additional GPs who have already been recruited. Through these improvements, we are making a difference to patient satisfaction: the latest health insight survey shows a sustained improvement in satisfaction, with 72.5% of patients who contacted their general practices in the past 28 days reporting a good overall experience—up from 67.4% in July 2024.
This Government are delivering concrete results, because we believe that everyone deserves access to high-quality care closer to home. I am delighted that general practitioners committee England voted in favour of this year’s GP contract in March. This is the first time the contract has been accepted in four years. The agreement resets our relationship and marks a turning point—a shared commitment to work together on behalf of patients and practitioners alike. The changes in the contract will streamline targets for GPs, incentivise improved continuity of care, make progress towards our health mission and, crucially, require practices to make it possible for patients to go online to request an appointment throughout the duration of core opening hours. Those changes are backed by an extra £889 million, representing cash growth of more than 7% in overall contract investment.
The NHS belongs to the people. Those are not just my words; they are in the NHS constitution. Everything that this Government have done since the election has been geared towards saving the NHS, giving it back to the people and getting it back on its feet. We are putting power back into the hands of patients, where it rightly belongs, because this is their health service and it must work for them. Ensuring that every patient has access to the care that they need is not just a priority, but a promise.
Tom Gordon
I thank the Minister for indulging me again. Will he join me in congratulating the many fantastic GPs in my constituency and throughout the country? It is not an easy job; we hear of the flak that they get from patients day in, day out when they are working to tight timeframes. One such GP in my area is Dr Viv Poskitt, who has been elected as a Liberal Democrat town councillor. Will the Minister share my thanks to Viv and to all the GPs across our country?
Stephen Kinnock
I will certainly congratulate Dr Viv Poskitt—I think I have got the name right—on being a GP, although I will probably not congratulate her on being a Liberal Democrat town councillor. The hon. Gentleman is right: GPs are the backbone, or the beating heart, of our NHS. They represent the front door, and we must fix that front door, which is currently creaking on its hinges. This Government are absolutely committed to fixing it, and to moving on from there to fix our NHS, get it back on its feet and make it fit for the future.
Question put and agreed to.
Statutory Learning Disability and Autism Training
Stephen Kinnock Excerpts(1 week, 1 day ago)
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The Minister for Care (Stephen Kinnock)
Today I am pleased to lay in Parliament the Oliver McGowan draft code of practice on statutory learning disability and autism training. The launch of this code represents a significant moment in the journey towards improving the care and treatment of people with a learning disability and autistic people. With its clear focus on ensuring that people receive tailored and compassionate support, it is especially fitting to be launching this code after recently celebrating World Autism Awareness Day in April and during Learning Disability Week, which this year is focusing on ensuring that people are seen, heard and valued. An easy-read version of the code is also available.
The purpose of the code is to ensure that service providers registered with the Care Quality Commission have the necessary guidance to meet the legal requirement introduced in the Health and Care Act 2022. The effect of the requirement is that, from 1 July 2022, CQC-registered providers are required to ensure that their staff receive training on learning disability and autism, appropriate to their role. To aid those who need to comply with the training requirement, the Secretary of State is obliged by the 2022 Act to issue a code of practice. Therefore, this code sets out the standards that training needs to meet to comply with the legislation and guidance on what providers need to do to meet those standards.
As set out in the code, the Oliver McGowan mandatory training on learning disability and autism is the Government’s preferred and recommended training package to support CQC-registered providers to meet the new requirement. The training is named after Oliver McGowan, a young autistic teenager with a mild learning disability, who very sadly died after having a severe reaction to medication given to him against his and his family’s strong wishes. Oliver’s parents, Paula and Tom McGowan, have tirelessly campaigned for better training for health and care staff to improve understanding of the needs of people with a learning disability or autistic people. The training has been trialled with over 8,000 participants and independently evaluated to ensure that the final package is robust and high quality. A long-term, independent evaluation on its delivery and impact is also now under way.
People with a learning disability and autistic people experience disparities in the quality of care they receive. Research indicates that a lack of understanding and knowledge of learning disability and autism likely contributes to this. This government have set out three big shifts needed to make our health service fit for the future, including shifting from treatment to prevention and from hospitals to communities. Ensuring that health and care staff have the right knowledge and skills to provide informed care for people with a learning disability and autistic people will help to meet these goals and improve health outcomes.
The legislative requirement and the code must be the catalyst for positive cultural change. With them we can help to deliver care and support that is tailored to the person, making sure that staff have the right attitudes, skills and behaviours to support people with a learning disability and autistic people safely, confidently and respectfully.
[HCWS715]
Mental Health Bill [ Lords ] (Seventh sitting)
Stephen Kinnock ExcerptsThursday 19th June 2025
(1 week, 1 day ago)
Public Bill CommitteesRead Full debate Mental Health Bill [HL] 2024-26 View all Mental Health Bill [HL] 2024-26 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 19 June 2025 - (19 Jun 2025)
Dr Luke Evans (Hinckley and Bosworth) (Con)
I know that the Committee has been waiting in earnest for me to deliver this speech on clauses 42 to 44. As the temperature gets to almost 30° today, I will try to maintain the same gumption that President Trump had when introducing his flagpoles, because this is an exciting topic and I am keen to treat it with verve.
Clauses 42 to 44 will introduce new duties on hospital managers to provide information about complaints procedures to patients under different legal regimes within the Mental Health Act 1983. The clauses move important safeguards from the code of practice into primary legislation, thereby giving them statutory force, which is a welcome step. I acknowledge the Government’s intentions to strengthen patients’ rights and accountabilities within the mental health system.
Clause 42 concerns information for detained patients. Under the current law, section 132 of the Mental Health Act 1983 requires hospital managers to give patients information about their rights under the Act, including their rights to apply to the mental health tribunal and to access independent mental health advocates. Although complaint procedures are mentioned in the code of practice, however, they are not explicitly covered in statute. Clause 42 will amend section 132 to impose a new statutory duty to provide information on how to make complaints about: the carrying out of functions under the Act, any medical treatment received while detained, and the outcome of any such complaint, including routes for escalation such as through the Parliamentary and Health Service Ombudsman.
Importantly, the information must be provided both orally and in writing, and steps must be taken to ensure that the patient actually understands it. Those duties must be carried out on initial detention and then repeated either annually for restricted patients or on the submission of renewed report under section 20 of the Act. The Opposition welcome that positive and necessary step. We know from independent reviews, including the Wessely review, that many patients do not know how to complain or fear that doing so will affect their care. By placing these requirements in primary legislation, we provide more robust legal protection.
I would be grateful if the Minister clarified some points. How will “understanding” be assessed or evidenced in practice? For example, what guidance will be issued to ensure that the needs of patients with a learning disability, cognitive impairment or limited English are met? Will independent mental health advocate services play a formal role in supporting patients to understand the Act with regard to this information about complaints? Is that part of their expanded role? Will complaints about poor complaint handling, not just about the original matter, be clearly included in the framework, as implied in the explanatory notes? To whom would such complaints be reported: NHS England, the Department, the integrated care board or a regulator such as the Care Quality Commission?
As we are talking about complaints, I notice that paragraph 327 of the explanatory notes states:
“New subsection (2A)(c) ensures the duty covers information about the patient’s right to complain to the Parliamentary and Health Services Ombudsman about the maladministration of complaints about medical treatment.”
That is very welcome, but it brings up an entirely new set of questions about the role of the Parliamentary and Health Service Ombudsman in this guise—an institution that embodies the public’s right to accountability, redress and justice when our health and public services fall short. In essence, it is the final arbiter; at best, it is the final safety net for those who feel they have nowhere else to turn. In particular, I want to focus on its critical yet often underappreciated work in relation to mental health complaints and how it intersects with the new Bill.
The ombudsman investigates unresolved complaints about NHS services in England, including those related to mental health care, alongside complaints against Government Departments and other bodies. For many families affected by failings in mental health provision, be that in crisis care, discharge planning or secure settings, the ombudsman provides a route to independent evidence-based resolution. We must therefore ask whether it is functioning with the efficiency, compassion and authority that patients deserve.
To pick just some of the data, in 2022-23 the PHSO received more than 35,000 complaints, which was an increase of 20% on pre-pandemic levels. If we look at timelines, performance remains under pressure: only 32% of investigations were completed within 13 weeks, 50% within 26 weeks and 81% within 52 weeks—that comes from the annual report. In the mental health sphere, such delays can exacerbate trauma and deepen distrust in public systems, in particular if the complainant is already experiencing severe distress.
The PHSO has reported a rise in callers exhibiting suicidal ideation, a tragic indicator of the depth of need and the urgency of timely reform. Over the past few years, to its credit, the ombudsman has introduced reforms for a new case severity assessment framework to triage cases more effectively; investment in digital case management; training for frontline staff to deal more sensitively with mental health complaints; and a proactive push for transparency, including publishing more case outcomes and data.
That is important work, but there is still some way to go. What assurances can the Government provide that PHSO’s funding is sufficient to cope with increased volumes of complex mental health cases, especially as it has a somewhat unique structure? The PHSO reports to the Public Accounts Committee. It does not have a departmental home. It is appointed by the King on the advice of the Prime Minister, after scrutiny by the PAC, but it is funded through the House of Commons Commission. That makes the PHSO rightly independent, but we need to ensure that it has the ability to deal with the top level of complaints about severe cases of mental health issues.
Under this legislation, we will be creating more automatic referrals to tribunals; we are rightly empowering more patients to complain; and we are putting more reports in for accountability. We need to ensure that when there are complaints—as there could well be—they will still be dealt with. Therefore, has an impact assessment been carried out, or will one be carried out, about PHSO funding, capacity and ability to deal with more mental health complaints?
As we debate a new Bill, we must ensure that accountability mechanisms fully integrate with any legislative reform. The Bill will, rightly, enhance patient rights and restrict inappropriate detention, but the ombudsman must be equipped to robustly investigate breaches of those rights. We should also ensure a clear reporting pathway for detained individuals when their families go to the ombudsman. My overarching question for the Minister, which I hope he will address is: how will the Bill, empowered in this way, interface with the PHSO? Will it strengthen the ombudsman’s ability to investigate complaints relating to involuntary treatment or detention?
Clause 43, on information about complaints for community patients, will make an equivalent amendment to section 132A of the Mental Health Act, which governs patients subject to a community treatment order. Again, patients are currently told about their rights to tribunal and IMHA support, but not necessarily about how to raise concerns or complaints about their care in the community. The clause will therefore require hospital managers to provide information about how to make complaints about functions carried out under the Act, about medical treatments for mental disorder while on a CTO, and about the outcome of any such complaint.
Clause 43 will also add a new requirement to repeat the information as soon as practicably possible after the CTO renewal. Again, that seems sensible and overdue, because clear repeat information can help to balance the power dynamics and support the patient voice. However, what steps will be taken to ensure that community patients who do not have regular contact with hospital staff are still given the information promptly and meaningfully? Will that be the duty of the new community clinician, for example? What is the role of community mental health teams or primary care staff, such as GPs or community psychiatric nurses, in delivering or enforcing the duties? Will the Minister confirm whether patient carers or families beyond the nominated person will be supported in understanding how someone can make a complaint?
Finally, clause 44, on information for conditionally discharged patients, will introduce proposed new section 132B of the Mental Health Act, extending the same principles to patients who are conditionally discharged, including restricted patients under section 42, 73 or 74. Such individuals often remain subject to significant restrictions in the community, such as curfews, reporting conditions or residence in supervised accommodation, and they can be recalled to hospital at any time, yet under the current law they have no statutory right to be informed of how to complain about or challenge decisions that affect them.
Clause 44 will require hospital managers to inform those patients about which section they are discharged under, how the Mental Health Act continues to apply, their rights to apply to a tribunal, and—crucially—how to make complaints about the carrying out of MHA functions, medical treatments and complaints outcomes. That requirement must be met as soon as practicable, in both oral and written form. A copy must also be given to the nominated person.
The explanatory notes state that the duty applies to
“patients subject to transfer directions”
from prison, and that the information should be given before discharge if possible. That is welcome, but it raises a question why, unlike clause 42, clause 44 does not impose a duty to repeat that information periodically. Given that conditionally discharged patients may remain under conditions for many years, have the Government considered adding a requirement to re-provide the information, say, annually? What support or advocacy will be available to conditionally discharged patients, particularly those in forensic or community forensic services, to help them to make complaints or understand their rights? Finally, will the Minister clarify how the provisions will work for patients who lack capacity, or who have no nominated person? Will there be a fall-back or safeguard in those cases?
In clauses 42 to 44, the Government are rightly seeking to embed the right to complain, and to understand that right, into the framework of the Mental Health Act. These are technical but powerful reforms. As ever, however, the challenge lies in not what is required but how it is delivered, especially for the patients who are most marginalised, restricted or isolated. I hope that the Minister can provide some reassurances about monitoring for compliance, clear statutory guidance, and the support of the advocacy structure, particularly at the very top, for dealing with complaints.
The Minister for Care (Stephen Kinnock)
It is a pleasure to serve under your chairmanship, Sir Desmond. I will respond to the questions that have been asked.
The hon. Member for Farnham and Bordon asked what training would be provided to staff on communicating the information clearly and compassionately. We will seek to clarify the complaints process and, when we come to revise the code of practice, we will consult on the guidance for how information on complaints should be provided. The Department will work with the NHS, Social Work England and other partners to develop appropriate training for staff on the reforms. Once the code of practice has been updated, professionals working under the Act will be required to undergo training to maintain their competence and awareness of the Act.
The hon. Member also asked how to ensure that information is genuinely accessible. It is important that the complaints process is accessible to all patients. Hospital managers must take practicable steps to ensure that patients have understood complaints procedures, and information about complaints must be provided both verbally and in writing. We expect all healthcare organisations to meet people’s communication needs to support equitable access, experience and outcomes, including when someone is in hospital for their mental health.
NHS England sets out guidance for providers on how to support individuals with their communication needs. That support may involve providing access to interpreters, providing information in a range of formats—such as in translation, large print, braille and easy read format—or the use of augmentative and alternative communication, video clips and visual diagrams to aid understanding. The accessible information standard requires all applicable organisations to identify, record, flag, share and meet the information and communication support needs of patients, service users, carers and parents with a disability, impairment or sensory loss.
On the question of whether there will be an audit of whether patients feel genuinely informed and empowered to complain, we know that some service users are not aware of the avenues by which they can make a complaint. The changes in clauses 42 to 44 seek to address that problem, and to increase awareness of the complaints system. To ensure that patients are supported and empowered to exercise their rights, we are expanding the right to an independent mental health advocate to all mental health in-patients. Complaints information must be provided to both the patient and the nominated person. Family and carers also have a right to complain about care and treatment given under the Mental Health Act.
The hon. Member for Solihull West and Shirley asked for reassurance on oversight, and that feedback from complaints will identify issues. I think that the hon. Member for Chester South and Eddisbury also asked about that, as well as asking what mechanisms will be in place to give feedback on how the system is working. Complaints data enables CQC Mental Health Act reviewers and mental health inspectors to understand trends and focus on areas of concern in their respective monitoring and inspection activities. Focused activity— for example, a focused Mental Health Act visit or inspection activity—can also be scheduled in response to concerns raised in MHA complaints. When looking at trust and provider-level MHA inspection activity, complaints information informs the CQC’s questioning of trusts or independent providers about their complaints processes.
Gregory Stafford (Farnham and Bordon) (Con)
It is a pleasure to serve under your chairmanship, Sir Desmond. You and the Committee will be pleased to know that my hon. Friends have made most of the points I wanted to flag.
In poll after poll and survey after survey, patients feel they do not get information in a timely and constructive way. Our amendment 46 would give patients a stronger say in their future care if they lose capacity. It clarifies that patients must be given clear, proactive support to understand, prepare and use the documents. It is about ensuring that advance choice documents are not just theoretical paperwork, but living, respected statements of a patient’s wishes.
I therefore support the clause and the amendment, and I ask the Minister three questions. How will NHS England and local integrated care boards ensure that commissioners are trained to respect and use ACDs in practice, especially in emergencies? Secondly, what oversight will ensure that ACDs are not simply ignored at the bedside, when a patient is most vulnerable? Will the Government consider a review mechanism so that we can assess how well ACDs are working in a few years’ time, after the Bill is passed?
I turn briefly to Liberal Democrat amendment 18. Like other hon. Members, I feel that the inclusion of financial information in an ACD is not appropriate, both from a practical and a personal security, safety and information point of view. I do, however, completely support the hon. Member for Winchester’s overall view that there is a significant problem with how financial stress can affect a person’s mental health. Like him, I call on the Minister to think about how we as a country, whether in this Bill or somewhere else, can address the impact of financial stress on mental health.
Stephen Kinnock
I will speak first to amendment 46. We agree with the principle of the amendment, but do not think it necessary. Under the Bill, if an individual who is likely to benefit from making an advance choice document approaches services to create one, they should be offered information and appropriate support to do so. The approach that we have taken in the Bill is therefore functionally equivalent to a right to request an advance choice document.
Dr Evans
If I am correct, the Minister said “if” a patient “approaches”. That is the fundamental point: that the onus is on the patient to know what their right is to approach the authorities. We are trying to do it the other way, by saying that their right is to be told about what is going on. Will the Minister clarify what he meant, because this is essentially what we are concerned about?
Stephen Kinnock
What I meant is what I said. I will read it again: if an individual who is likely to benefit from making an ACD approaches services to create one, they should be offered information and appropriate support to do so. The approach that we have taken in the Bill is therefore functionally equivalent to a right to request an advance choice document.
We are also concerned about prescribing that commissioners inform and support some of the groups of individuals identified by the amendment. For example, it may be practically challenging and not always appropriate to contact people who were detained or admitted informally many years ago about making an ACD. We agree, however, that that there is a good rationale for encouraging past voluntary and involuntary patients, especially those discharged in the past 12 months, to create an ACD. That is reflected in the Government amendments to strengthen the duties on health commissioners, which I will come to shortly.
The approach is based on research findings that suggest that the optimal time to write an advance choice document is shortly after discharge from hospital. That also recognises that many of the individuals are likely still to be under the care of mental health services and therefore well positioned to receive support and advice from services to make their ACD. Ultimately, the amendment was debated in the other place and not considered workable. In recognition of concerns expressed by Earl Howe and Lord Kamall, however, my noble Friend Baroness Merron made a commitment to strengthen duties on health commissioners in relation to the advance choice documents.
Government amendments 32 to 35, which we tabled in response to the amendment, will strengthen the duties in three ways. First, they will require that health commissioners proactively make arrangements to bring information on and help with making an advance choice document to the attention of the appropriate people. That is to prevent the risk of commissioners taking a minimal approach to discharging the duties.
Secondly, the Government amendments will require that information and help is provided through discussion with a suitably qualified person, such as a health or care professional, advocate, support worker or peer support worker. That is to ensure that people can rely on the guidance and support of a professional, where they wish to receive it.
Lastly, the Government amendments will encourage commissioners to have regard to the benefits of a person making an advance choice document within 12 months of discharge from a mental health hospital. That builds on research findings that suggest the optimal time to write an advance choice document is shortly after detention.
Government amendments 32 to 35 will help to further secure the success of advance choice documents by ensuring that people who are at risk of contact with the Act are given the opportunity to make an ACD, as well as being offered the dedicated support that they may need to do so.
On amendment 18, we agree that there is value in encouraging people to include details of any relevant financial matters within their ACD. Financial matters, such as problem debt, can worsen or even trigger a person’s mental illness. We expect that doing so will help to ensure that people receive the care and support that they need if they later experience a mental health crisis. We feel that it is important for individuals to have autonomy over what they include in their ACD, however, rather than prescribing the contents in legislation. We therefore think that the intention behind the amendment is better achieved by other means.
We plan to develop guidance and a template ACD to support service users in making their document. Those will include prompts to consider any relevant financial matters. Furthermore, the guidance that we plan to include in the code of practice for mental health professionals will cover the need to support the person to consider any relevant financial matters that may be important to their mental health recovery.
Finally, I turn to the clause in its entirety. Advance choice documents provide a place for people to set out their wishes, feelings, decisions, values and beliefs, while they are well, regarding their care and treatment. That is in preparation for the scenario in which they are too unwell and lack capacity to express such things at the time. At that point, the contents of their ACD should be considered by mental health professionals to inform their decision making regarding the person’s admission to hospital, detention under the Act, and care and treatment.
Research shows that ACDs can have a range of benefits, including reducing the risk of hospital admissions. To help to unlock those benefits and ensure the uptake of ACDs among service users, the clause will place duties on health commissioners to make appropriate arrangements so that relevant individuals are informed and supported to make an ACD. The duty aims to ensure that individuals who are likely to benefit most from making an ACD are proactively given the opportunity to make one while they are well.
Other clauses create the framework to ensure that the contents of a person’s ACD have a real impact on care and treatment decisions, for example the clinical checklist, the compelling reason test and the new framework for creating a nominated person. I therefore ask the hon. Member for Hinckley and Bosworth to withdraw amendment 46, and I ask Liberal Democrat Members not to press amendment 18. I commend Government amendments 32 to 35 and clause 45 to the Committee.
The Chair
With this it will be convenient to discuss the following:
Clause 47 stand part.
New clause 21—Duty to provide advice and support to families and carers—
“(1) The Mental Health Act 1983 is amended as follows.
(2) After section 117B, insert—
‘117C After-care: provision of support and advice to families and carers
(1) The responsible integrated care board must ensure that, as part of the provision of after-care services under section 117 of this Act, advice and support is offered to the family or carers of the person discharged.
(2) This support must include—
(a) information about the person’s condition and recovery;
(b) guidance on how to support their recovery at home and avoid relapse;
(c) access to financial, housing, and social care advice services relevant to the situation of the person’s family; and
(d) procedures for family members or nominated persons to notify the integrated care board of concerns that the person is at future risk of detention under Part 2 of this Act.
(3) Where a concern is raised under subsection (2)(d), the integrated care board must—
(a) consider whether the individual meets criteria to be included on the register of persons at risk under section 125D of this Act; and
(b) take reasonable steps to involve the family or nominated person in planning of subsequent support, subject to—
(i) the person’s consent; or
(ii) if they lack capacity, the person’s best interests.
(4) The Secretary of State must publish guidance under section 125B of this Act on the format and provision of support under subsection (3)(b).’”
This new clause would require the integrated care board, as part of the aftercare services offered under the Mental Health Act 1982, to offer support and advice to the family or carers of the person being discharged from treatment.
Stephen Kinnock
I will set out the details of two important clauses relating to aftercare. Clause 46 will provide the tribunal with an important new power to recommend that plans for aftercare arrangements are undertaken for patients who are not yet ready to be discharged from hospital. Under the Mental Health Act, the tribunal can make decisions about discharge, but it does not have a role in recommending aftercare while a patient remains detained. Giving the tribunal the power to make recommendations that aftercare planning should take place will encourage earlier planning for a patient’s eventual discharge from hospital.
Those recommendations are particularly important for complex cases in which patients may require intensive support following their discharge. Early aftercare planning ensures that the necessary health and social care services are co-ordinated and in place when the patient is ready to leave the hospital. This will help to reduce the likelihood of delayed discharges or failed transitions back into the community.
Although the tribunal’s recommendations are not legally binding, they are intended to carry significant weight with aftercare providers. If recommendations are not taken forward, the tribunal retains the power to review the patient’s case. That will ensure that there is both encouragement and accountability in the aftercare planning process, enhancing patient outcomes by making sure that care is appropriately planned and delivered.
The clause will strengthen the role of tribunals in overseeing the care and treatment of patients under the Mental Health Act, ensuring that a patient’s needs are addressed holistically and in a timely manner. By encouraging earlier and more co-ordinated aftercare planning, we will reduce the risk of patients being discharged without the necessary support in place, leading to better overall patient outcomes and smoother transitions from hospital to community care.
David Burton-Sampson (Southend West and Leigh) (Lab)
It is a pleasure to serve under your chairship, Sir Desmond. Again, I reflect on stories that I have heard from local constituents on the issues that are being addressed in the Lampard inquiry. Does the Minister agree that these provisions will help to avoid the too early discharges that have led people either to go back into care or to get into even more difficult situations? One of my constituents ended up taking his own life because he was discharged too early from care.
Stephen Kinnock
My hon. Friend is absolutely right. In many ways, the best way to look at the issue of discharge is to start thinking about it almost as soon as the patient is admitted. We need to be thinking holistically about what place they are in, what the aftercare plan might look like and how it might relate to the discharge plan. The earlier we do so, the better. In so many cases, upstream intervention is important to avoid having to scramble to deal with a crisis further down the line. My hon. Friend is absolutely right to raise that point.
I turn to clause 47. Section 117 of the Mental Health Act places a duty on the NHS and local social services authorities to provide aftercare to certain patients who have been detained under the Act once they leave hospital. Aftercare services seek to reduce the risk of readmission, and they must be provided until the NHS and local social services authorities are satisfied that the person is no longer in need of such services. However, there is currently no requirement to notify the person when that ends. Clause 47 requires that the provision of aftercare lasts until the NHS and local social services authorities jointly give notice to the person in writing that they are satisfied that the person is no longer in need of such services. This will clarify when aftercare services have ended.
Decisions on entitlement to and responsibility for aftercare services are heavily contested. Deeming rules are used to deem a person to be ordinarily resident in one area, even though they are living in a different area. They ensure continuity of financial responsibility when a person is placed in a local authority area and prevent the local authority from placing someone out of area to ease its financial burdens. Currently, section 117 does not contain any deeming rules.
Clause 47 will apply existing deeming rules under social care legislation to identify which local authority is responsible for arranging aftercare for an individual patient. This change will add clarity and consistency to an often litigious system and more closely align local authority social care and NHS rules for determining ordinary residents. This aims to support organisations to work together to provide and plan for aftercare services and reduce the number of disputes that have arisen in recent years.
Finally, I thank the hon. Member for Guildford for tabling new clause 21, which seeks to place a duty on the responsible integrated care board to ensure that advice and support is offered to the family or carers of the patient being discharged. The statutory guidance on discharge from mental health in-patient settings sets out how NHS organisations should exercise duties to co-operate under sections 72 and 82 of the National Health Service Act 2006 in the discharge process. This includes providing information or support on housing, social services provision and financial support. The Mental Health Act code of practice also provides statutory guidance on the information that should be provided to patients, families and carers.
We do not believe that it is necessary to place additional duties on integrated care boards to provide information and support, as existing duties are sufficient. We will consider whether to use the revised code to bring together guidance on discharge into one place and explore how to clarify best practice on information and support to carers. I hope that what I have set out satisfies the hon. Member for Guildford and that she will not press new clause 21. I commend clauses 46 and 47 to the Committee.
Dr Evans
I will speak to clauses 46 and 47 and then to new clause 21. Clauses 46 and 47 form a significant part of the Government’s effort to strengthen discharge planning in continuity of mental health aftercare. Clause 46 extends tribunal power. Under the current Mental Health Act, when a first-tier tribunal considers a patient detained under part II of the Act and decides not to discharge them, it may still make non-binding recommendations, for example that the patient be transferred to another hospital or given leave of absence.
Mental Health Bill [ Lords ] (Eighth sitting)
Stephen Kinnock ExcerptsThursday 19th June 2025
(1 week, 1 day ago)
Public Bill CommitteesRead Full debate Mental Health Bill [HL] 2024-26 View all Mental Health Bill [HL] 2024-26 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 19 June 2025 - (19 Jun 2025)
Dr Neil Shastri-Hurst (Solihull West and Shirley) (Con)
It is a pleasure to serve under your chairmanship, Mrs Harris. Having taken your clear instructions, I will be very brief in speaking to clauses 46 and 47.
Clause 46 is a positive step in principle, but there are concerns that the recommendations remain non-binary and may therefore lack the practical effect—or the teeth —without enforcement or review mechanisms. I have three questions that I hope the Minister will address. First, will he clarify whether there are any plans to give legal weight to tribunal recommendations, perhaps by requiring a written response or justification where those recommendations are not followed? Secondly, how will the Government ensure that resource-constrained local authorities can implement recommended aftercare plans promptly and fully? Thirdly, could he please provide data on the expected impact of this provision on readmission rates?
Clause 47 clearly sets out and improves on the legal clarity, which is welcome, but I have a couple of questions. What steps will be taken to ensure that frontline practitioners understand and consistently apply the revised ordinary residence test? Has the Department conducted an assessment of the administrative burdens or delays that may result from the implementation of the clause? Apart from those questions, I welcome the provision.
The Minister for Care (Stephen Kinnock)
It is a pleasure to serve under your chairship this afternoon, Mrs Harris. I will go through the questions that have been asked.
The shadow Minister, the hon. Member for Hinckley and Bosworth, asked whether there will be any duty on ICBs or local authorities to respond to recommendations. The tribunal will have the power to recommend that plans are put in place for a patient’s aftercare. To assist in ensuring that these recommendations are followed, the tribunal can reconvene if its recommendations are not acted on, ensuring accountability from aftercare bodies.
The shadow Minister asked what mechanisms are in place to resolve disputes between authorities. There is already a process in place under the Care Act 2014 for resolving disputes and an opportunity to escalate decisions to the Secretary of State and Welsh Ministers, if required. He also asked what the notice must contain. We will absolutely look at the guidance in the code on the process for ending aftercare and notifying the person.
The hon. Member for Solihull West and Shirley asked about plans for legal weight, resourcing and data. I will write to him on his questions about plans for legal weight and data. I think that resourcing will be a constant theme. Obviously, we have to assess all the resourcing implications once the Bill receives Royal Assent, and we will develop an implementation plan on that basis. The first annual written ministerial statement will be the hon. Gentleman’s opportunity to hold the Government to account on that.
Question put and agreed to.
Clause 46 accordingly ordered to stand part of the Bill.
Clause 47 ordered to stand part of the Bill.
Clause 48
Tribunal powers in guardianship cases: burden of proof
Question proposed, That the clause stand part of the Bill.
Stephen Kinnock
Currently, where an application is made to the appropriate tribunal by or in respect of a patient who is subject to guardianship, the patient can be discharged only if they can prove to the tribunal that they do not continue to meet the guardianship criteria. The burden of proof is on the patient. The clause will amend the Mental Health Act so that it will now be for the local authority responsible for the guardianship to prove to the tribunal that the patient continues to meet the guardianship criteria. As the independent review pointed out, the current burden of proof is “out of line” with all other applications to the tribunal. The Government consider that this should be remedied.
Dr Shastri-Hurst
I fear that I may test your patience a little further on this occasion, Mrs Harris, but I rise to address clause 48. Although much of the Bill aims to modernise and humanise our mental health framework, and in many ways it does so commendably, clause 47 presents not only an opportunity, but a challenge: to ensure that we get the balance right between liberty and protection.
The clause will make an amendment to section 72(4) of the Mental Health Act 1983. As the Minister said, it will shift the burden of proof in tribunal proceedings concerning patients who are subject to a guardianship order. Under the current legal framework, it is the patient who must demonstrate that the criteria for guardianship are no longer met, by showing either that they are no longer suffering from a mental disorder or that continued guardianship is no longer necessary for their welfare or the protection of others.
Clause 48 would reverse that burden. It would place the onus instead upon the local authority to demonstrate, in the mental health tribunal, that the individual still meets the statutory test. The tribunal would be required to direct a discharge unless the authority can prove otherwise.
Let me be clear: I am not opposed to the principle of this reform. On the contrary, I believe that there is a strong case for rebalancing the legal dynamics in favour of the individual, particularly when we reach situations in which their liberty and autonomy are at stake. The principle of least restriction is not, or should not be, merely aspirational; it should be foundational to any mental health regime in a liberal democracy.
I say with equal conviction that the practical operation of such a change requires careful thought and adequate resourcing. It must be done under clear legal parameters. Precisely on those fronts, I seek clarification from the Minister and, if I may be so bold, I seek some improvements to this aspect of the Bill.
First, we must consider the legal principle at play. A reversal of the burden of proof in this context is not technical or incidental; it marks a constitutional shift in the relationship between the citizen and the state. Traditionally, as the Minister well knows, the burden of proof lies on the party making an assertion that departs from the status quo. In this case, that would ordinarily be the patient applying for discharge from the guardianship. However, when the state exercises more coercive powers—particularly powers that have an impact on an individual’s liberty and private life—it is appropriate that the state be required to justify those powers afresh, especially when challenged. That is the logic that clause 48 seeks to embrace. In broad terms, as I say, I support it.
The approaches are reinforced by our obligations under article 5 of the European convention on human rights, which protects the right to liberty and security of the person. It is clear that any deprivation of liberty must be justified not just initially, but on an ongoing basis. Jurisprudence from Strasbourg has repeatedly emphasised that periodic review mechanisms must be substantive and not merely procedural in nature. The state must show continuing justification and must not rely on past assessments or presumptions in its favour.
Clause 48 helps us to move closer to compliance with those principles, but the legislation, as drafted, does leave some important questions unanswered. What, precisely, is the standard of proof that local authorities must meet? Is it the civil standard on the balance of probabilities, or is it something higher, given the gravity of what is at stake? If we are to take this shift seriously, we must also give tribunals clear statutory guidance on how to interpret the new burden. Otherwise, we will fall into the trap of risking inconsistency in decision making, confusion among professionals and a potential increase in appeals and legal challenges.
Secondly, and crucially, I would like to press the Minister on the question of practical implementation. Changing the legal burden is not merely a matter of legislative drafting; it requires a systematic adjustment in how evidence is gathered, how professionals prepare for tribunal hearings, and how decisions are reviewed internally within local authorities. As hon. Members will know, local authorities are already operating under intense financial and operational pressures. Mental health social workers are often working with caseloads that stretch the limits of what may be considered reasonable. Legal teams within councils are often overstretched and under-resourced; if we now place them under a legal obligation to present a comprehensive, evidentially sound case for continued guardianship—perhaps at multiple intervals across an individual’s care pathway—we must ensure that they are adequately supported to do so.
What assessment have the Government made of the financial and operational impact of clause 48? Will local authorities receive new funding to enable them to meet that duty? Will social care professionals receive specific training on the evidential requirements now expected of them? Without such support, we risk not only undermining the intent of the clause, but creating a perverse outcome in which discharges may occur not because the patient no longer meets the criteria, but because the local authority lacks the capacity to make the evidential case in time.
I also caution against the risk of overcorrection. Although I fully support the principle that individuals should not bear an unfair evidential burden, we must not move so far in the other direction that we weaken the legitimate protective mechanisms that should be in place. Guardianship is not detention; it is a community-based measure designed to provide oversight and structure for individuals who may struggle to live independently due to serious mental illness. It is used infrequently and only where strictly necessary.
Dr Luke Evans (Hinckley and Bosworth) (Con)
It is a pleasure to follow my hon. Friend the Member for Solihull West and Shirley. I would expect nothing less from him than a fantastic canter through this important clause. I will not repeat a lot of what he said, but I will try to emphasise it.
Although clause 48 is short, it speaks to the much larger principle of the balance between public protection and individual liberty. I will not go through all the details, as the Minister laid out the changes, but the burden of proof is currently on the patient to convince the tribunal that they no longer meet the criteria for guardianship. The clause will change that. Instead, the burden will fall on the local authority or relevant public body to prove that guardianship remains justified. The Government’s explanatory notes put it plainly:
“the patient should be discharged by the Tribunal unless the local authority can prove that the patient continues to meet the guardianship criteria.”
The clause is not just a technical amendment; it is a fundamental realignment of legal principle. It reinforces the presumption of liberty. It aligns guardianship cases with the principle that when the state restricts an individual freedom, it is for the state to justify that restriction, not the individual to justify their freedom. It echoes the evolution of mental health law towards a less restrictive approach, a principle we put in place on the first day of our deliberations on the Bill. Although clause 48 amends only a few words, it reflects a big change in principle: liberty is the default, and restriction must be justified and not presumed.
There are some important questions that I want to echo and emphasise, again leading on from my hon. Friend the Member for Solihull West and Shirley. Are local authorities prepared for the reversal of burden? Have they been consulted? Do they have the legal resources, documentation, standards and evidential processes to meet the burden before the tribunal? On top of that, we have already agreed that there will be automatic referrals. We would therefore expect more referrals to the tribunal as well as a change in how they operate. This is a huge undertaking. If they fail through a lack of capacity organisation, we risk a situation in which patients are discharged not because they no longer meet the criteria, but because the case was poorly presented. How will the Government ensure that that does not happen?
Secondly, will the Government issue statutory guidance or regulations to ensure that consistency in how the burden is discharged? We do not want a postcode lottery in the quality of guardianship applications or tribunal evidence. Thirdly, we must always consider public protection. The guardianship regime is not designed for high-risk individuals, but it can still apply in cases where behaviour poses a serious risk to self or others—for example, individuals with profound learning difficulties who might place themselves in danger if not properly supported.
We also talked about cumulative or escalating behaviour in one of our first debates. The reason for doing so is that we are at the fringe of significant cases. What safeguards are in place to ensure that public safety considerations are given due weight in cases where the evidence might be incomplete or borderline? Finally, do the Government intend to monitor the impact of the clause? Will data be published on whether tribunal discharge rates increase following this reform, and whether that leads to any unintended consequences?
I want to be clear that His Majesty’s Opposition support the principle behind the clause. We support a mental health system that is rights-based, person-centred and built on the presumption of liberty. But that principle must be matched by a system capable of meeting the duties it imposes. Rights on paper are meaningful only if public authorities are resourced and able to support them and uphold them in practice. I look forward to the Minister addressing those points.
Stephen Kinnock
On the assessment of impact, it might be useful for the Committee to know, for context, that the use of guardianships under the Act is small: the number of new cases has declined from 470 in 2004-05 to just 40 in 2024-25. The number of open cases has also fallen in recent years. I think pretty much all the questions from the hon. Member for Solihull West and Shirley and the shadow Minister are addressed by that point. We are talking here about small numbers, so the cost would be relatively minor.
Dr Evans
That is a staggering drop in numbers. Is there a reason behind it? Is it that the burden of proof was always put on the patient, so they did not feel that they were in a position to do something? If we are inverting that, does the Minister expect the numbers to go back up?
Stephen Kinnock
I do not have any data to suggest that the numbers will go back up. That relates to the question that the hon. Member for Solihull West and Shirley asked about having a statutory review. We will be vigilant. As with all the changes in the Bill, we will closely monitor implementation and impact. That goes right across the board and, hopefully, addresses the Member’s questions.
Question put and agreed to.
Clause 48 accordingly ordered to stand part of the Bill.
Clause 49
Removal of police stations and prisons as places of safety
Question proposed, That the clause stand part of the Bill.
Stephen Kinnock
Police stations are not appropriate places to hold people in need of mental health treatment. The Mental Health Act 1983 (Places of Safety) Regulations 2017 amended the 1983 Act to set a high threshold for using police stations as places of safety. Uses have reduced from over 8,000 in 2012-13 to just 322 in 2023-24 across England and Wales. While that number is mercifully low, the Bill will, under the principles of therapeutic benefit, end the use of police cells as places of safety. Instead, when police exercise powers to remove a person from a public space or private premises for the purpose of a mental health assessment, they will take them to a suitable place of safety, such as a hospital.
Anna Dixon (Shipley) (Lab)
I declare an interest: my sister practises as a psychiatrist within the NHS, as the Minister knows. She has seen the important shift away from the use of police stations as places of safety and towards making sure that all patients have access to a place of safety in a healthcare setting. I know from my local police that, while they do their best to support people in distress in a police station, it is not the right place. This is the right thing to do, and I support the Government’s move.
Stephen Kinnock
I ask my hon. Friend to pass on our thanks to her sister for the vital work that she does in what I know can often be a challenging environment—we appreciate it. My hon. Friend is absolutely right that this is an important principle. There has been a remarkable drop in the use of police cells, which is to be warmly welcomed. We think that now is the time to make it clear, on the face of the Bill, that a police cell is not an appropriate place for these purposes.
The clause’s amendment to sections 135 and 136 of the Mental Health Act will not change the police’s ability to intervene when someone is in a mental health crisis, nor their ability to detain someone in a cell when exercising their powers in relation to criminal, or suspected criminal, activity. The clause will prevent courts from temporarily detaining people with severe mental illness in prison as a place of safety while they are waiting to access a bed for treatment or assessment under the Mental Health Act. Under the reforms, a defendant or convicted person who meets the criteria for detention under the Mental Health Act for treatment or assessment must be transferred directly to hospital, or, in the case of children, to a hospital, surgery, community home or other place that the court considers suitable, ensuring that they receive swifter access to the care they need. I commend the clause to the Committee.
Dr Shastri-Hurst
You will be pleased to know that I will be briefer this time, Mrs Harris; I want to leave room for my Opposition colleagues. The intent of the clause is entirely sound: to treat mental health as a health issue, not a criminal one. However, the capacity of NHS services to provide timely and suitable alternatives remains in question.
With that in mind, I have three questions that I hope the Minister will be able to address. First, will the Government commit to publishing the implementation plan for ensuring adequate numbers of health-based places of safety across regions before the clause comes into force? Secondly, what contingency measures are currently in place or foreseen if no place of safety is available and police powers have been limited? Thirdly, can the Minister commit to an annual publication of data on hospital-based places of safety, their capacity and their use?
Dr Evans
As we have heard, the proposals set out to remove police stations and prisons as places of safety. It does this in both relation to people detained under civil powers—sections 135 and 136—and in respect of certain part III patients involved in the criminal justice system, who may currently be held in such settings when a hospital bed is not available. The Government’s explanatory notes describe the rationale clearly:
“This is in response to evidence that suggests these settings are not suitable environments for individuals with a severe mental health, in crisis, awaiting assessment and treatment.”
As we have discussed in some of the earlier clauses, it is not just treatment, but the environment that plays a part in helping harbour a holistic care approach, so this is very much welcome. To that end, the Opposition can agree on this position in principle. A police station or prison cell is no place for someone with acute mental distress. They are not therapeutic environments; they can be frightening, disorientating and, in some cases, re-traumatising, particularly for children and young people. The clause aims to remove that contradiction in the law.
As the law stands, when police officers encounter someone in a public place who appears to be suffering from a mental disorder and is in immediate need of care or control, they can detain them under section 136 and take them to a place of safety. Under section 135, a magistrate can issue a warrant to remove a person from their home or another place to a place of safety. Currently, that place of safety includes a police station, although section 136A limits that to exceptional circumstances—for example, when the individual poses an imminent risk of serious injury to themselves. Similarly, under part III of the Act, a person appearing before a criminal court can be held in a place of safety, which can currently include a police station or prison, pending hospital admission.
Clause 49 will remove that. It amends section 55 to redefine “place of safety” and exclude police stations and prisons. It alters section 35, repeals section 136A, which has previously allowed police stations to be used in limited situations, and retains transitional protections for individuals already detained under early directions before the clause comes into place. That is a bold and principled legislative step, and I acknowledge that it builds on progress under the last Government. The 2017 Conservative Government, following public outcry and recommendations from the Care Quality Commission and the Wessely review, pledged to eliminate police cells as a place of safety for children. Since then, the numbers of such detentions have significantly decreased. Data from NHS Digital shows a downward trend in the use of police stations under section 136, which is evidence that change is possible with the right investment and inter-agency collaboration. That work deserves credit, so I thank the Minister for that.
Clause 49 must not only move the law forward, but ensure that the practice can be followed. I therefore want to raise a number of questions, which I hope the Minister will take in good faith. The classic one is “Where would people go instead?” The explanatory notes are right to say that hospitals and healthcare-based settings are more appropriate, but do those settings exist in sufficient numbers, with trained staff, beds and security protocols to receive safely all those who would otherwise have been taken to police stations? If they do not, we risk creating a gap between the law and the real world—a dangerous vacuum, whereby someone in crisis may end up in an ambulance bay, in a police car or in a general A&E without specialist support. It could have wider impact on the safety of not only the individual patient suffering, but other patients in healthcare settings such as A&E, interacting with an acutely ill mental patient. Without proper capacity, we risk many more police officers having to be at health settings to keep the mental unwell patients safe from themselves and others.
I appreciate that the Government have said that it will take 10 years to implement the Bill fully, but this clause will come into force immediately. What assurances can the Government give that there will be not only capacity, but capacity in the right places, so that, for example, people are not transferred to other areas of the country to ensure that the legal requirement is met? Although it is welcome not to be in a police station, being miles from family and support circles would be just as detrimental.
What provisions are being made for children and young people? The clause rightly states that for minors, the place of safety must now comply with the Children and Young Persons Act 1933, but excluding police stations. Are there sufficient CAMHS—child and adolescent mental health services—crisis beds and child-friendly places of safety in each region? What guarantees are there that children will not end up in adult settings, or worse, in informal or unlawful detention?
I turn to the transitional support given to the police. Officers may no longer be able to use their custody suites, but what training, resources and alternative pathways are being made? What happens in the middle of the night in a rural police force, where there is no mental health professional on call and the nearest hospital bed is 80 miles away? How would the Government monitor performance? Will the Government commit to publishing annual data on delays in finding a place of safety, the use of inappropriate settings post reform, and outcomes for those detained under sections 135 and 136? Will the CQC or another body be tasked with auditing local compliance?
Clause 49 reflects a consensus that mental healthcare belongs in health settings, not custodial ones. I urge the Minister to answer the questions in the good faith in which they were asked, because we all want to see this become a reality.
Stephen Kinnock
I think it is probably right to say that the questions asked by the hon. Members for Solihull West and Shirley and for Chester South and Eddisbury and the shadow Minister basically all relate to building capacity to ensure that we are ready to absorb this change. We have committed to lay an annual report on implementation, which will set out progress made and future plans for implementation. We are working closely with the Home Office, the police and NHS England to better understand the implementation requirement for switching on this change. There is considerable variation across the country in the way in which police stations are being used, so there is a need to target support.
I would add that the number and shape of dedicated health-based places of safety that are needed in a local authority will depend on the mental health needs of that population and the wider mental health crisis pathway provision. We are taking steps to ensure that people in crisis receive support and treatment sooner, so that fewer people need to be taken to a place of safety. It is worth noting that the Government have hit the ground running on this issue since we came into office last July. We are committing £26 million in capital investment to open new mental health crisis centres, which will aim to provide accessible and responsive care for individuals in mental health crisis.
Evidence from systems with established crisis centres indicates that they can help to streamline urgent mental health care pathways and reduce unnecessary conveyance to A&E by ambulance, health-based transport or the police. We have also selected six areas to trial a new approach to mental health support by providing 24-hour neighbourhood mental health centres, seven days a week, bringing together all aspects of community mental health services.
Dr Evans
The Minister has partially answered my question. He talked about the £26 million investment being targeted at certain areas of the country, but will that be based on the areas of highest priority? The danger is that if the highest priorities are all in the north, the south will be left out.
Stephen Kinnock
We have selected six areas, but off the cuff I cannot tell the shadow Minister exactly what they are or whether they have been announced yet. If they have not been announced, I will not be able to tell him, but if they have been, of course I can share that information. I suspect that the areas will primarily be based on assessed need, but they are trial pilots, so there is no reason to suspect that they will be limited to six. Let us see how much traction they get.
Question put and agreed to.
Clause 49 accordingly ordered to stand part of the Bill
Clause 50
Removal of patients by authorised persons
Question proposed, That the clause stand part of the Bill.
Stephen Kinnock
We have previously discussed Government amendments 26 to 29, which seek to overturn amendments tabled in the other place by Lord Kamall, Earl Howe and Baroness May, which added police and other authorised persons to sections 2, 3 and 5 of the Mental Health Act. As I said in the earlier debate, the police currently have no powers under those sections, and the decision makers on whether to use those sections are health and social care professionals. We do not support extending police powers to health and social care professionals in this way, and the police do not support such an extension either. We are therefore seeking to remove clause 50 from the Bill.
The clause extends legal powers currently held by the police under sections 135 and 136 to other professionals. That would enable other professionals to enter premises by force, if necessary, to remove a person believed to be suffering from a mental health disorder under section 135. Under section 136, other professionals would have the power to remove a person from a public space to a place of safety. Both those changes would represent a major shift in roles and responsibilities for health and care professionals.
Indeed, the co-chair of the approved mental health professional leads network has said that extending police powers in this way to health and care professionals would have
“disastrous unintended consequences for both individuals in crisis and those responding to mental health emergencies.”
Nine organisations, including the Royal College of Psychiatrists, the Royal College of Nursing, the Royal College of Emergency Medicine and the Association of Ambulance Chief Executives, have made a joint statement of concern about extending police powers to health and care professionals in this way.
Anna Dixon
It is clear from what the Minister is saying that there are widespread concerns among health professionals about the change that was proposed in the other place, which would effectively give police powers to health and care professionals. Can he reassure psychiatrists such as my sister, and others working in mental health services, that they will always be able to rely on and work closely with their police colleagues to have that back-up when they are entering somebody’s home to potentially detain them?
Stephen Kinnock
I absolutely can give my hon. Friend that assurance. There has to be a team-based approach to this work. In any successful team, it is about ensuring that everybody knows their role and that everybody’s role within that team is appropriate. There has to be good collaboration and co-ordination.
That is why I must say that I am quite taken aback by the attempts in the other place to insert these clauses; I do not think that is a safe way to make legislation. That is why it is so important that we remove the clause from the Bill.
The statement that I referred to earlier, by all those eminent organisations, called it a
“radical proposal with a number of serious and potentially dangerous consequences”.
It also says:
“Delegating police powers to professionals without consulting them, or patients would be a very damaging way to make policy.”
It is important to restate what I said in an earlier sitting, namely that the majority of assessments under the Mental Health Act happen without police involvement, and that action is already under way to further reduce the amount of police involvement. However, we of course recognise the pressures that the police are facing and that police involvement can be stigmatising for people who are detained. Almost all police forces in England and Wales are implementing the “right care, right person” approach, a police-led initiative to reduce inappropriate police involvement in cases where people have health or social care needs. There has already been a 10% decrease in section 136 detentions in the year ending March 2024.
There remain certain circumstances in which the police play a vital role in keeping particular people and the wider public safe. A blanket approach of extending powers in sections 135 and 136 to other professionals may not necessarily address the issues being faced by police officers and could create other unintended challenges. For example, while the current Act deliberately sets out who has what powers in what situations, a blanket extension of the police’s powers under sections 135 and 136 to other professionals—giving multiple agencies the same powers—risks confusion over who should respond in an emergency situation and could lead to delays in action as services try to decide who should act. That would be counter to our shared aim of ensuring that people in a mental health crisis get the right support as rapidly as possible.
We are also concerned that giving health and social care staff statutory powers that increase the number of situations in which they may have to use reasonable force could have unintended risks for the safety of staff, patients and the public.
Dr Shastri-Hurst
I rise to speak briefly to clause 50, which expands the authority to remove individuals under Mental Health Act powers by allowing trained and authorised non-police personnel to carry out removals that previously could be carried out only by police constables. A couple of key changes arise from the clause.
First, the clause provides for the inclusion of authorised persons by amending sections 135 and 136 of the 1983 Act. That will allow individuals other than police officers, if they are authorised—“authorised” is the important word—to remove and transport people under Mental Health Act powers. That provides wider operational flexibility, and includes removals under warrant, by virtue of section 135, and without a warrant in public places. It is predicated on the fact that those authorised persons are appropriately trained and designated. Prior to the clause being inserted into the Bill, only police officers could carry out removals.
Stephen Kinnock
Extending the police powers in section 135 and 136 to other authorised persons would represent a major shift in the roles and responsibilities of health and social care professionals. Our key health and social care stakeholders have warned us that extending the powers could have dangerous consequences, and that making changes to them without proper consultation is not the right way to go about making policy. I again extend my thanks to those stakeholders for their efforts to share their views on the role of police in mental health-related incidents.
We of course recognise the pressures that police face. However, I must emphasise that the majority of assessment under the Mental Health Act already happen without police involvement. Action under the “right care, right person” approach is already reducing that further: there was a 10% decrease in section 136 detentions in the year ending March 2024.
Simply taking the blanket approach of extending the powers may not actually address the issues the police face and could have unintended negative consequences, such as risks for staff, patients and the public, and delays in response. The Government are profoundly concerned about making such a change without proper engagement with the groups that would be impacted. I therefore do not commend clause 50 to the Committee.
Question put, That the clause stand part of the Bill.
Stephen Kinnock
Clause 51 will reform the Bail Act 1976 to prevent courts from remanding a defendant for their own protection where the only concern relates to their mental health.In response to the independent review, a commitment was made to end the use of prison as a place of safety. Those reforms were welcomed, but concerns were raised about the use of a similar power under the Bail Act 1976 to remand a defendant to prison for their “own protection”. That power can sometimes be used when the court is concerned that the defendant’s mental health presents a risk to their own safety.
Nobody should be sent to prison because they are struggling with their mental health, so the clause will amend the Bail Act to prevent the remand of a defendant for their own protection solely on mental health grounds. Instead, courts will be directed to bail the defendant and work with local health services to put in place appropriate support and care to address risks to their safety.
The clause does not amend the court’s power to refuse bail in respect of a child or young person for their own welfare, because it is already the case that youths cannot be subject to a custodial remand solely for mental health reasons. However, in exceptional circumstances it may still be necessary for a court to remand a child to local authority accommodation for their mental wellbeing, and for that reason the power is preserved.
On clause 52, patients from the Crown dependencies—the Channel Islands and the Isle of Man—currently cannot be transferred to England and Wales under sections 35, 36 and 38 of the Mental Health Act. The clause will introduce new powers to enable the Crown dependencies’ courts to send patients who are subject to their equivalent of remand under sections 35 or 36, or an interim hospital order under section 38, to suitably secure hospitals in England and Wales for treatment and assessment. The changes will ensure that that vulnerable cohort of patients can receive appropriate and secure treatment in England and Wales, while enabling the Crown dependencies’ courts to maintain control of the criminal proceedings, so that justice can be done swiftly and efficiently.
Finally, clause 53 will ensure that where provisions in the Mental Health Act provide for the processing of personal data, any such processing, including the sharing of data, is subject to data protection legislation, including the Data Protection Act 2018 and the UK general data protection regulation principles. For example, personal data—including special category data such as health data—is likely to be contained in a report produced under clause 4, which inserts clauses specific to people with a learning disability and autistic people, so that their care, treatment and differing support needs are identified, and recommendations are made to ensure that those needs can be met. That report will be shared with the bodies set out in the clause, including the patient’s responsible clinician, the relevant integrated care board and the local authority.
Clause 53 will ensure that such processing of personal data must comply with the controls and safeguards in the legal framework that governs the use of personal data. That includes compliance with key principles such as lawfulness and fairness, and adherence to high standards of information security, privacy and transparency.
In essence, the provision means that where there is a duty or power under the Mental Health Act to process personal data, the processing—including the sharing—of the information must be done in a way that will not contravene data protection legislation, including the UK GDPR and the Data Protection Act 2018. In turn, among other things, that requires personal data to be processed lawfully, fairly and transparently, and confers certain rights on data subjects to access that data and have any errors rectified. That gives vital reassurance to patients about the processing of their personal data under the Mental Health Act. For those reasons, I commend clauses 51 to 53 to the Committee.
Dr Shastri-Hurst
I ask for a series of clarifications from the Minister about all three clauses. On clause 51, how will the courts be supported in identifying community-based alternatives to remand? What training or guidance will be provided to judges in applying the provisions effectively? What assurances can the Minister give that support pathways will be available before and after the changes have taken effect?
I accept that clause 52 is a technical a change to the legislation, but it is an important clarification none the less. It will require some robust co-ordination between jurisdictions and clearer procedural safeguards. How will the Government monitor the implementation of proposed new schedule A2 to ensure that patients’ rights are preserved during transfers? Will guidance be issued to courts and practitioners in the UK and the Crown dependencies about the new procedures, particularly their cross-jurisdictional nature? What consultation has taken place, and will continue to take place, with authorities in Jersey, Guernsey and the Isle of Man before the measures are implemented in law?
Finally, I recognise that clause 53 is arguably a sensible safeguard. The challenge will be to ensure compliance on the frontline, especially where legal duties to share information and duties to protect confidentiality can butt against some degree of tension. With that in mind, what support or training will be given to health and care professionals to navigate overlapping legal duties? Will the Minister publish sector-specific guidance on data sharing as a consequence of the Bill? How will the Government assess whether the legal framework strikes the right balance between patient safety and privacy?
Stephen Kinnock
The hon. Member for Solihull West and Shirley asked how the courts would be supported in training for judges and so on. To safely enact that reform, it is vital that the appropriate pathways are in place from first contact with the criminal justice system into the right care and support, whether that is community mental health services or receiving treatment in hospital under the Mental Health Act, where appropriate. We will work with courts, health service commissioners and clinicians to ensure that sentencers have the confidence to bail vulnerable defendants into the community, with the appropriate package of support and smooth pathways into treatment in a healthcare setting for those who need it. We will confirm the timelines for commencement in due course.
The shadow Minister, the hon. Member for Hinckley and Bosworth, asked about people who are under 18. Custody should be a last resort for children, and the legislative threshold for remanding a child to custody is already very high. Under-18s are not included in this provision, as the Legal Aid, Sentencing and Punishment of Offenders Act 2012 already precludes the remand of children to custody solely for mental health reasons. When the court’s concerns relate only to the child’s welfare, the preferred option would usually be bail. In exceptional circumstances, a court might remand a child to local authority accommodation, such as a children’s home or foster care, for their own mental wellbeing. Including children in this provision would remove that important safeguard.
On the question of legal limbo, courts in England and Wales will not be able to exercise any criminal jurisdictional powers in relation to these patients. Their powers are restricted to renewal of the remand or interim order, ancillary powers and recommendations for the patient’s return, as well as obligations to inform the Secretary of State. We have included additional provisions in the Bill to allow courts in England and Wales to order a section 36 for treatment for a patient who has previously been transferred from the Crown dependencies on the equivalent of a section 35 for assessment. That is aimed at enabling access to treatment for the patient and preventing the need for the patient to be required to travel back and forth between jurisdictions.
Question put and agreed to.
Clause 51 accordingly ordered to stand part of the Bill.
Clauses 52 and 53 ordered to stand part of the Bill.
Clause 54
Review of duty to notify incidents
Question proposed, That the clause stand part of the Bill.
The Chair
With this it will be convenient to discuss the following:
New clause 12—Age-appropriate treatment for children—
“(1) Section 131A of the Mental Health Act 1983 is amended as follows.
(2) After subsection (1), insert—
‘(1A) A patient to whom this section applies must not be detained in, or admitted to, an adult ward unless the managers of the hospital consider that—
(a) there are exceptional circumstances which justify the patient’s detention in, or admission to, an adult ward; and
(b) the decision is in accordance with the best interests of the child.’
(3) After subsection (3) insert—
‘(3A) Where a patient has been detained in, or admitted to, an adult ward, the managers of the hospital must record in writing the reasons for the admission, including—
(a) the reason, or reasons, why other options for accommodation were not available or suitable for the patient;
(b) details of the measures to be taken by the hospital to ensure that, while the patient is detained or otherwise accommodated in the adult ward, the patient is provided with care in a safe environment; and
(c) unless it has been determined that an adult ward is the most appropriate environment for the patient in accordance with subsection (1A), the steps being taken by the hospital to transfer the patient to more appropriate accommodation.
(3B) Where a patient to whom this section applies is—
(a) detained in, or admitted to, an adult ward or placed out of area; and
(b) the detention or admission is of more than 24 consecutive hours’ duration,
the managers of the hospital must notify the regulatory authority immediately, setting out why they consider that the requirements under subsection (1A) above are met and providing the information set out in subsection (3A).
(3C) Subsection (3D) applies when—
(a) the managers of a hospital accommodate a patient to whom this section applies in an adult ward for a consecutive period of at least 28 days; or
(b) detain or admit a patient to whom this section applies who—
(i) was ordinarily resident immediately before being detained or admitted in the area of a local authority other than the local authority within whose area the hospital is situated, or
(ii) was not ordinarily resident within the area of any local authority.
(3D) Where this subsection applies, the managers of the hospital must immediately inform the appropriate officer of the responsible local authority—
(a) of the patient's detention or admission, and
(b) when the patient's detention or admission ceases.’
(4) Leave out subsection (4) and insert—
‘(4) In this section—
(a) “adult ward” means a ward in a hospital to which persons aged 18 or over are detained in or admitted to;
(b) “the appropriate officer” means—
(i) in relation to a local authority in England, their director of children's services, and
(ii) in relation to a local authority in Wales, their director of social services;
(c) “hospital” includes a registered establishment; and
(d) “the responsible authority” means—
(i) the local authority appearing to the managers of the hospital to be the authority within whose area the child was ordinarily resident immediately before being detained or admitted, or
(ii) where it appears to the managers of the hospital that the patient was not ordinarily resident within the area of any local authority, the local authority within whose area the hospital is situated.’”
This new clause seeks to ensure that children are only placed on adult wards where there are exceptional circumstances, and it is in their best interests. It includes procedural safeguards for determining the reasons behind (and suitability of) admitting a child to a hospital environment in which adults are simultaneously accommodated or in an out of area placement.
New clause 17—Children detained on adult wards—
“(1) The Mental Health Act 1983 is amended as follows.
(2) After section 131A (Accommodation, etc. for children), insert—
‘131B Children detained on adult wards
(1) The Secretary of State must reduce to zero, within five years of the passage of the Mental Health Act 2025, the number of children detained on adult wards.
(2) The Secretary of State must publish, within six months of the passage of the Mental Health Act 2025, a report to outline how the duty under this section will be met, including how provision for treatment under this Act will be increased.’”
This new clause would require the number of children detained on adult wards to be reduced to zero within 5 years, and for the Secretary of State to produce a report on how this will be achieved.
New clause 20—Report and Guidance: Transition to Adult Mental Health Treatment—
“(1) The Secretary of State must, within 18 months of passing of this Act, prepare and lay before Parliament a report on improving provision for patients transitioning from treatment in a hospital environment for children and young people to one for adults when they attain the age of 18.
(2) The report under subsection (1) must include an assessment of—
(a) the current pathways and outcomes for young people transitioning between hospital environments for children and for adults;
(b) any gaps in care or support experienced by patients during this transition;
(c) best practices for ensuring safe and effective transitions.
(3) Following the report under subsection (1), the Secretary of State must publish guidance for integrated care boards, local authorities, and providers of mental health treatment on improving outcomes and ensuring continuity of care for patients transitioning to a hospital environment for adults.
(4) The guidance under subsection (3) must include—
(a) specific steps to guarantee continuity of care for patients transitioning between treatment in a hospital environment for children and young people and one for adults;
(b) measures to identify young people requiring transition support at an appropriate stage;
(c) provisions for joint working and information sharing between providers of treatment for children and young people and for adults;
(d) requirements for the review and updating of care and treatment plans to reflect the needs of patients transitioning to a hospital environment for adults.
(5) Integrated care boards, local authorities, and providers of mental health treatment must have regard to guidance published under subsection (3).
(6) In preparing the report under subsection (1) and the guidance under subsection (3), the Secretary of State must consult—
(a) young people with experience of transitioning between children and young people’s and adult mental health services, and their carers and guardians;
(b) relevant professional bodies;
(c) integrated care boards;
(d) local authorities;
(e) providers of mental health treatment;
(f) such other persons as the Secretary of State considers appropriate.
(7) The Secretary of State must update the guidance under subsection (3) at regular intervals, and no less frequently than every three years.”
This new clause would require the Secretary of State to review and report on the transition of patients from children's to adult mental health settings for treatment at age 18 and publish guidance for relevant bodies on improving provision and ensuring continuity of care during this transition.
Stephen Kinnock
I rise to speak to clause 54 and to a number of new clauses relating to the treatment of children and young people.
I turn first to clause 54. The Care Quality Commission (Registration) Regulations 2009 require the CQC to be notified of specified events, one of which is where a child is placed in an adult psychiatric unit and the placement has lasted more than 48 hours. When the CQC is notified, the circumstances are reviewed and the risk is assessed. These notifications can trigger further assessments and inspections, and require the trust to provide regular updates and give assurance that the children concerned are being safeguarded.
Dr Shastri-Hurst
You will be disappointed to know, Mrs Harris, that the notable contributions from my hon. Friends the Members for Chester South and Eddisbury and for Farnham and Bordon mean that my contribution will be even briefer than usual. [Interruption.] Rapturous support across the Committee—exactly the consensus-building that we are seeking to achieve.
I rise to speak in support of new clause 12. It necessarily addresses the inappropriate placement of children on adult wards, which is not just distressing but deeply damaging to those involved. The issue is about having child-centred safeguards. It is essential that we ensure that children under 18 are placed on adult wards only when it is absolutely necessary and there is no alternative. The new clause would not only support best practice—it aligns with clinical guidelines on age-appropriate care—but provide welcome legal clarity. It would strengthen and clarify the existing provisions within the Mental Health Act. For those reasons, I encourage all hon. Members to support it.
On clause 54, the Minister would be disappointed if I did not put a couple of questions to him.
Dr Shastri-Hurst
That is an invitation that I will remember as we go on in this Committee. On this occasion, I have just two questions. First, will any interim guidance be issued while the review is ongoing? Secondly, can the Minister commit that the consultation will be undertaken on a wide basis, and include patient advocates, child psychologists and safeguarding boards?
Because I cannot count, I will add a third question: did the Government consider an alternative to a two-year review period, either through an immediate extension of regulation 18 or perhaps a shorter period, so that these important changes can be put in place without delay?
Stephen Kinnock
The hon. Member for Guildford asked about timelines. There is the timeline for the review on the face of the Bill, and then there is the broader question about implementation and how all the moving parts fit together. We have now had the spending review, which will provide a financial envelope for mental health more broadly, and for implementation of the Bill. We will be ready to move forward with implementation on that basis, which will include the code of practice.
My hon. Friend the Member for Hertford and Stortford asked about a time limit for notification. It is already a legislative requirement for the CQC to be notified when a child or young person is placed on an adult ward for a continuous period of longer than 48 hours. In addition, the previous Government assessed that the current requirement of 48 hours was sufficient. As part of the review that is mentioned on the face of the Bill, we will consider whether that remains the case for receiving notifications, and whether it remains appropriate.
My hon. Friend also asked about further safeguards for children and young people, including those in inappropriate settings. Obviously, the placement of a child or young person on an adult mental health ward only happens following a thorough clinical assessment. Trusts are required to have robust local safeguarding protocols in place, including mandatory staff training on safeguarding and incident-reporting mechanisms, to ensure accountability and oversight. Staff are appropriately trained in child and adolescent mental health care, and they must meet level 3 competency in safeguarding children.
The hon. Member for Farnham and Bordon asked about data. The CQC already publishes “Monitoring the Mental Health Act”, a statutory annual report that must be laid before Parliament, in which it reports on the number of people under 18 who are admitted to adult wards. Additionally, it reports qualitative information on placements for children and young people, such as placements on children’s general wards. I hope that I have addressed that point.
Stephen Kinnock
The new clause takes forward a commitment made in the Lords by Baroness Merron to address issues relating to the unequal application of the Human Rights Act 1998 for some mental health patients. Sadly, this issue was highlighted following the death of Paul Sammut. I extend my deepest condolences to his family.
We now wish to take action to ensure a more equal application of the Human Rights Act, with the aim of extending its protection to certain mental health patients. Under this amendment, private providers will be taken to be exercising a function of a public nature for the purposes of section 6(3)(b) of the Human Rights Act when they are carrying out certain services and when those services are arranged and/or paid for by either local authorities or the NHS. Those functions are section 117 aftercare; services provided in pursuance of arrangements made by a local authority in Scotland, discharging its duty under section 25 of the Mental Health (Care and Treatment) (Scotland) Act 2003; and in-patient treatment and assessment for mental disorder, whether or not a patient is detained under the Mental Health Act.
When carrying out those services, private providers will be required to act compatibly with the convention rights set out in the Human Rights Act. Many patients in private facilities already have those protections. Private providers are already taken to be exercising a function of a public nature for the purposes of section 6(3)(b) of the Human Rights Act when caring for patients detained under the Mental Health Act or providing care for patients due to the effect of section 73 of the Care Act 2014. The new clause seeks to extend those protections to other mental health patients in private provision, where care is arranged and/or paid for by the NHS or a local authority. As the new clause is a modification of the Human Rights Act, this is a reserved matter and the amendment will therefore apply in all four nations.
Government amendments 37 and 38 are minor technical amendments to the Bill’s extent provision in clause 57 to ensure that our amendment—new clause 10—relating to the Human Rights Act extends UK-wide. The Human Rights Act, which the new clause 10 seeks to modify, extends UK-wide. The amendments are therefore necessary to ensure that the same Human Rights Act protections extend to all four nations. I hope that hon. Members feel able to support the amendments.
Dr Evans
I welcome the opportunity to speak on these important provisions, which apply the Human Rights Act 1998 to certain private care providers delivering mental health services. At present, the Human Rights Act applies directly to public authorities and to those exercising functions of a public nature. However, an increasing proportion of mental health care and aftercare services are delivered by private providers, under arrangement with NHS bodies and local authorities. The current legislation leaves some ambiguity about whether private providers are legally bound to comply with the Human Rights Act when delivering such services. That creates a potential accountability gap that risks undermining the protections that we want to guarantee to vulnerable patients.
The Government’s proposal to explicitly extend the application of the Human Rights Act to registered private care providers when they deliver specific services commissioned or paid for by public authorities is a welcome step towards closing the gap. By doing so, it will ensure that these providers are treated as performing public functions under section 6 of the Act. That means that they will be directly accountable for upholding the rights enshrined in the Human Rights Act, including the rights to liberty, dignity, privacy and freedom from inhuman or degrading treatment.
This approach is not without precedent. For example, in the case of prison outsourcing, courts have established that private companies running prisons are subject to the Human Rights Act because they perform public functions. Similarly, private care providers delivering publicly funded mental health services should be held to the same standard as NHS bodies or local authorities.
It is worth noting that although this explicit statutory extension of the Human Rights Act to private providers is a new provision in the Mental Health Act 1983 for England and Wales, similar principles already apply in Scotland through case law and existing legislation. Under the Mental Health (Care and Treatment) (Scotland) Act 2003, local authorities have a statutory duty to provide aftercare services, which may be delivered by private providers. Scottish courts recognise that when private providers perform public functions, such as delivering those statutory services, they are subject to the Human Rights Act, following key judgments such as YL v. Birmingham City Council.
This Government proposal provides much-needed clarity and an explicit statutory footing across all four nations of the UK. It also ensures consistency across the four nations, referencing equivalent legislation in Scotland, Wales and Northern Ireland. This helps to remove ambiguity and ensure consistency. However, we must also consider the practical impact. Although these changes strengthen rights and protections, they also increase the regulatory burden on private providers. Providers may face new compliance costs, legal challenges and the need for enhanced training and oversight. That could have a knock-on effect on service availability, particularly in a market already facing staffing pressures and financial constraints.
The Government should therefore consider how to support providers to meet the new obligations without destabilising service provision. There is also a need to ensure that commissioners and regulators have the necessary resources and powers to monitor and enforce compliance effectively. In that spirit, I will pose some questions to the Minister for clarification and look for reassurance.
How will the Government monitor compliance with the Human Rights Act among private providers, and what enforcement mechanisms will be used? Has there been any consultation with private care providers about the potential operational and financial impacts of this extension, and will the extension apply only to services arranged or paid for by NHS bodies? What protections exist for patients receiving private mental health care outside these arrangements? How do the Government plan to ensure consistency in application across all four nations? Do the Government foresee private provision of mental health-related services expanding? If so, by how much?
I agree that the final two amendments look like two small consequential amendments that clarify and ensure that the human rights extension applies equally across England and Wales, Scotland and Northern Ireland. The insertion of “subject to subsection (2)” appears to be technical. I would just welcome confirmation from the Minister that it will not inadvertently limit the scope of the new protections. Otherwise, Opposition Members will support them.
Stephen Kinnock
I thank the shadow Minister for those questions. I will have to get back to him in writing, because the questions that he asks obviously have an important legal dimension, and it was physically impossible to get the information in the time between his sitting down and my standing up to speak. I am not a human rights lawyer either, so it is best if I write to him on those points.
Question put and agreed to.
New clause 10 accordingly read a Second time, and added to the Bill.
Ordered, That further consideration be now adjourned. —(Taiwo Owatemi.)
Mental Health Bill [ Lords ] (Sixth sitting)
Stephen Kinnock ExcerptsTuesday 17th June 2025
(1 week, 3 days ago)
Public Bill CommitteesRead Full debate Mental Health Bill [HL] 2024-26 View all Mental Health Bill [HL] 2024-26 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 17 June 2025 - (17 Jun 2025)
Gregory Stafford
I thank the hon. Lady for her point, but I shall continue in the same vein unless I am told to do otherwise.
Clause 27 will ensure that when community treatment orders are considered, with all the restrictions they bring, the nominated person’s voice must be heard and an objection must be properly countered with evidence. Clause 28 addresses hospital transfers, recognising that being moved to another hospital can uproot fragile support networks and compound distress. By embedding a consultation duty here, too, the Bill will make it harder for patients to be moved arbitrarily or without explanation.
In summary, the clauses and the schedule empower patients, embed transparency and build trust, but they do so through a lens rightly focused on adults—capable, consenting adults who make choices freely. That brings me to my fundamental point: we must be absolutely certain that this approach will not inadvertently erode a bedrock of child protection: that a parent is the default legal protector for their child. For an adult, autonomy means freedom of choice, but for a child, especially one under 16, autonomy must never mean being left alone to navigate a labyrinth of legal forms and healthcare powers without the protection of a parent. That is why I strongly support amendments 54 and 55, which would ensure that for under-16s, parents remain the lawful decision makers and the first safeguard for their child’s welfare.
Let us imagine for a moment a vulnerable 14-year-old who, in the confusion and fear of a psychiatric admission, is persuaded by a well-meaning adult—or, worse, someone with a hidden agenda—to appoint them as the nominated person. That child may be separated from their parents—the very people who know the child best and have a legal duty to care for them—while an outsider gains rights to object to treatment or discharge decisions. Once that nomination is made and witnessed, it carries weight in law and could marginalise the very people who brought that child into the world and have a moral and legal duty to protect them.
This is not just theoretical. We know from real cases in family courts that unscrupulous individuals can exploit vulnerable young people. The risk that the new system could unintentionally open the door to manipulation must be taken seriously. Let us not be naive about how exploitation works: groomers, traffickers and abusers thrive in grey areas of the law; they will find loopholes and drive a coach and horses through them. If we do not make it crystal clear that no child under 16 can override parental responsibility without a court’s explicit order, we risk creating an invitation for abuse.
Can the Minister assure the Committee that no child under 16 will be permitted to override parental responsibility simply by nominating someone else without a full and proper process? Schedule 2 does include fall-back arrangements and eligibility checks, and those are welcome, but unless the law is explicit that only a court can displace a parent’s right to act for their child, those safeguards are not watertight.
Amendment 54 addresses a related area, the notification of incidents. It would require the Secretary of State to review whether the law should be strengthened so that all admissions of children and young people for mental health treatment trigger mandatory incident reporting, and whether the timeframes for that reporting are still appropriate. It would require the Secretary of State to review whether incident reporting requirements are robust enough for all under-18s in mental health settings. Are all incidents of restraint, seclusion, injury or absconding being reported promptly and comprehensively? If not, what must change?
We have seen far too many tragic cases in which harm or abuse in children’s mental health units came to light only after a scandal broke, because the system did not catch it in time. Proper oversight is not an optional extra; it is essential for the trust of families. In my view, a review alone is not enough, so I urge to the Minister to confirm that, if the review finds gaps, the Government will legislate swiftly to close them. In the meantime, what interim steps will be taken to ensure that no child is left unprotected?
Amendment 55 is the final safeguard in this suite of amendments. It would allow the Secretary of State to make consequential amendments to other laws to implement the Bill cleanly. That is good housekeeping, but it must not become a blank cheque. When it comes to parental rights or child safeguarding, no technical tweak should be done behind closed doors by negative procedure; Parliament must approve it in full daylight, on the record. Will the Minister confirm without ambiguity that any consequential amendment that touches on parental powers or child protections will come before both Houses under the affirmative procedure?
To illustrate things in the starkest terms, let me paint one more scenario for this Committee. A 15-year-old girl, already vulnerable, is detained following a self-harm incident. Her parents, distressed but committed, wish to be involved in her care plan and discharge, but in her fragile mental state the child is persuaded by an older friend—perhaps well-meaning, perhaps not—to nominate them instead. That friend, now a legally recognised nominated person, blocks discharge, disagrees with treatment and excludes the parents from updates. The clinicians are caught in a legal tangle. The child is caught in the middle, and the parents must fight in court to reclaim their rightful role. As I said before, that is not a theory; it is the sort of real-life pitfall that sloppy drafting can enable. If we see it coming and fail to stop it, we will have failed as legislators.
I wish to be clear that I support clauses 24 to 28 and schedule 2 because they modernise mental health law for adults in a way that is respectful and empowering. I support amendment 54, because it would strengthen transparency and accountability where children’s lives and safety are at stake. I support amendment 55, because it would keep our statute book coherent, but it must never be misused to erode rights by stealth. Above all, I support the amendments because they ensure that the new nominated person system does not inadvertently weaken the oldest and strongest protection we have, which is the legal responsibility of parents to care for their own child.
I urge this Committee to adopt the clauses, the schedule and amendments 54 and 55 as essential guardrails to ensure that what we pass here is not just legally sound, but morally right. Let us modernise this law and strengthen patient voice, but let us never allow a child to lose their parents’ protection by accident or bureaucratic slip. Let us be in no doubt: when the state removes or limits parental rights, it must do so under the strictest scrutiny of a court of law, with evidence tested and the child’s welfare paramount. A signed piece of paper at a bedside should never be enough. That is the dividing line between a humane, modern health system and one that risks creating new injustices in the name of progress.
I ask the Minister again: will the Government enshrine in this Bill or elsewhere that parents are the legal representatives for under-16s unless a court directs otherwise? Will he guarantee rigorous checks to prevent the manipulation of young minds at their most vulnerable? Will he commit that any necessary changes found by the incident review under amendment 54 would be acted on without delay? I commend this package of reforms to the Committee, and I trust that the Government will listen carefully to these warnings and act to make the legislation watertight.
The Minister for Care (Stephen Kinnock)
It is a pleasure to serve under your chairship, Mrs Harris, not least because I understand you have just returned from New Zealand, where you had duties as the Government’s trade envoy. I thought perhaps we should do a haka in your honour to mark it, but you might rule against that.
Stephen Kinnock
I have no comment on that, and we are not going to divide on it either.
Let me address the questions raised in this morning’s debate. First, I was asked how disputes will be resolved when the nominated person and clinicians disagree. Where a specific nominated person, power or right is being used, the nominated person’s decision applies, because these are statutory powers and rights under the Mental Health Act. However, clinicians will have discretion and can overrule a nominated person’s decision, if there is a danger to the patient or others. That will be clarified in the code.
Secondly, I was asked how we will ensure that nominated persons are aware of their powers. In addition to the broader training and familiarisation required alongside the reforms for clinicians, the statutory forms used to appoint a nominated person will set out that the witness should explain the role of the nominated person and make sure that the nominated person and patient understand the powers and requirements of the role. I think my hon. Friend the Member for Southend West and Leigh raised that point, too.
Thirdly, I was asked whether there is a mechanism to appoint an interim nominated person, and yes, there is. The interim nominated person is the nominated person appointed by an approved mental health professional when a person lacks the competence or capacity to appoint their own nominated person. While the legislation does not refer to the term “interim nominated person”, that in practice is what they are.
A lot of the discussion today has focused on how the provision will apply to children and young people. I understand the concerns raised and the importance of getting this right. In summary, we object to amendments 54 and 55, which would require nominated persons for patients under 16 to have parental responsibility for the child, whether chosen by the child or appointed for them, on the basis that children with the relevant competence should have the ability to choose their own nominated person. That is in line with the recommendations of the independent review, and in keeping with the principles of choice and autonomy and treating the person as an individual. We have put safeguards in place to ensure that their selection is appropriate and to remove anyone who does not exercise those powers in the best interests of the child.
Stephen Kinnock
I can assure my hon. Friend on that. We have safeguards in place both to ensure that the selection is appropriate in the first place and that, if there are behaviours that indicate that the person is not right for the task, they will be removed and their powers taken away.
Dr Luke Evans (Hinckley and Bosworth) (Con)
Can the Minister clarify where these powers are and what they look like? For example, if a 15-year-old decides to appoint someone who is 23—maybe a boyfriend, maybe not—the problem is that once they make that nomination, we are waiting for something to happen. The idea behind the clauses we have been debating, and the use of exceptional circumstances to try to solve this problem, is to ensure that we prevent any problem from happening in the first place. That is the bit I am not clear on. I thought that Government amendments 40 and 41 were possibly intended to address that point, but my worry is that once the person is chosen, we do not know how they will behave. The whole idea is to give parental responsibility first. Could the Minister address where this is in the Bill, or what it looks like in the code? This is the critical bit to get right for children.
Stephen Kinnock
With all due respect to the hon. Gentleman, I am not going to spend time shuffling my papers around. If he cares to look at schedule 2, I think he will find it there.
Government amendments 40 and 41 have been tabled because we believe that it is not necessary to specify in legislation which person the parental responsibility the approved mental health professional must appoint as nominated person for an under-16-year-old. We have committed to clarify this in the code of practice. We have committed to establishing an expert taskforce to support the development of a statutory code of practice to provide clear guidance for professionals involved in the nominated person appointment process.
The fourth question was whether we need parental responsibility by default. The current nearest relative provision assigns an automatic relative according to a hierarchical list, which does not reflect modern family structures. For instance, step-parents and parents who live abroad are not included. That can mean that children and young people may have a nearest relative who can make decisions about their care but who may not know the child well or engage with the role, or who could even be a risk to them. Without formal care proceedings, the child would be left to be represented by a relative who will not act in their best interests.
Fifthly, questions were raised about how to ensure that young patients are not isolated from family support if needed. Engagement with children and young people suggests that they are most likely to appoint their parent as a nominated person. If they appoint someone who is not their parent, then parents could still be involved in their care and treatment where appropriate. Safeguards are in place to allow for the overruling and displacement of the nominated person if they are behaving in a way that is not in the child or young person’s best interests.
Similarly, where a child is under a care order and parental responsibility sits primarily with the local authority, the local authority will retain its parental responsibility for the child even if the child chooses a nominated person who is not the local authority. The code of practice will provide guidance on how practitioners should include those with parental responsibility and care in key processes and decisions.
Sixthly, in cases where there are safeguarding concerns, what safeguards exist to ensure that the nominated person acts in the best interests of the child? The witness will determine whether the child’s nomination is suitable. Clinicians will also have the power to overrule decisions made by a nominated person if they think there is a danger to the patient or to others. The patient, an approved mental health professional, parents and anyone with an interest in the child’s welfare can apply to the court to displace the nominated person if they think they are behaving in a way that is not in the child’s best interests.
Finally, there was a question about how we will ensure that there is no coercion, including in the example involving an older partner. We will provide guidance to the witness on how to check that no coercion has taken place, as well as wider suitability criteria. A nominated person cannot be appointed if coercion or undue pressure has taken place. We intend to state in the code, subject to consultation, that an advocate should be involved early on to provide support to the child or young person throughout the nomination process. Advocates could work with witnesses to ensure that they have the relevant information about the child to make an informed appointment.
I hope that hon. Members are satisfied with those answers and will not press their amendments. I commend Government amendments 40 and 41, clauses 24 to 28 and schedule 2 to the Committee.
Question put and agreed to.
Clause 24 accordingly ordered to stand part of the Bill.
Schedule 2
Nominated persons
Amendment proposed: 54, in schedule 2, page 77, line 21, at end insert—
“(3) Where the patient has not attained the age of 16 years, a nominated person must have parental responsibility for the patient.”—(Dr Evans.)
This amendment would stipulate that the nominated person for a patient under 16 must have parental responsibility for the patient.
Dr Evans
This morning, we touched on amendment 49, so I will not repeat my remarks. I will simply ask a pithy question of the hon. Member for Winchester. He rightly talked about the incredible work that his local citizens advice bureau carries out. How will the amendment blur the lines between social workers, caseworkers and the independent advocates who are already doing this work? How does he perceive that working? I worry about the complexity that it would create. I would be grateful if the hon. Member addressed that point.
Stephen Kinnock
I am grateful to the hon. Member for Winchester for bringing this issue before the Committee. The intention of his amendment is to extend the support offered by independent mental health advocates
“to cover social and financial stressors and support for family carers and other members of the household when the patient is discharged.”
It would amend paragraph 18 of schedule 2, which deals with amendments relating to nominated persons. It should more properly be inserted into schedule 3, which deals with independent mental health advocates.
The Bill will already extend the support that advocates can provide to help patients to be involved in decisions about their care and treatment, to be able to make a complaint and to be provided with information about other available services. Those other services could include support following discharge from statutory or voluntary organisations, which may cover social and financial issues, and help to support carers. Those organisations would be better placed to support patients with these specific needs, rather than independent mental health advocates, whose skillset is specific to supporting patients to understand their rights under the Mental Health Act and participate in decisions about their care and treatment. We will consult on guidance in the code of practice to help independent mental health advocates to understand their extended role.
In addition to policy regarding independent mental health advocacy, advance choice documents give individuals the chance to give instructions about practical aspects of their life. Examples of such aspects include domestic, financial or caring responsibilities, such as children or pets. This provision allows the individual to be looked after when unwell and aims to ease additional anxieties. For those reasons, I ask the hon. Member for Winchester to withdraw his amendment.
Dr Chambers
I appreciate the valid points that hon. Members have made. The point about running a pilot was a sensible suggestion. We have had something that could be viewed as a pilot in Winchester for two years. We know that it works well, and every £1 spent on it saves £14.08. If I have suggested this amendment in the wrong part of the Bill through my naivety and inexperience, or if mental health advocates are not the right people to deliver a solution that we know works, may I ask the Minister whether there is a more appropriate part of the Bill in which to include it or another way to implement this proven system, such as by amending a different Bill, before I decide whether to press the amendment to a vote?
Stephen Kinnock
I thank the hon. Gentleman for that question. Fundamentally, our view is that the role that he is proposing is not the right one for an independent mental health advocate. The role of an independent mental health advocate is to work with the patient around their legal rights, rather than to deal with some of the more practical issues that he is talking about here. Our sense is that there are both statutory and voluntary organisations who are better placed to carry out that work. I do not think that a pilot would work with IMHAs, because by definition that is not the right role for IMHAs.
Dr Chambers
In that case, can we have a discussion outside the Committee about how to do this?
Dr Chambers
indicated assent.
Amendment 49 negatived.
Schedule 2, as amended, agreed to.
Clauses 25 to 28 ordered to stand part of the Bill.
Clause 29
Detention periods
Question proposed, That the clause stand part of the Bill.
Stephen Kinnock
Currently, under the Mental Health Act, a person detained for treatment can be kept in hospital initially for six months before the responsible clinician must make an assessment to decide whether to continue their detention or to discharge them. The independent review raised concerns that six months is too long. It heard evidence that patients were sometimes detained longer than necessary and were only considered for discharge when a tribunal hearing was due. It found that in up to 17% of cases referred to the mental health tribunal, discharge happened in the 48 hours before the hearing. That suggests that some patients are being detained longer than is necessary.
The review recommended reducing from six months to three months the initial detention period for people admitted for treatment, so that a patient’s detention is reviewed sooner to ensure that patients are not detained when they are no longer benefiting from treatment and can be safely discharged.
Clause 29 will mean that patients detained for treatment have their detention reviewed three times—up from twice—in the first year: at three, six and twelve months from the date of detention. The new renewal periods will not apply to part III patients, except in very specific circumstances when an unrestricted patient changes status. I commend the clause to the Committee.
Gregory Stafford
I have some brief questions for the Minister about this important clause, which has serious implications for patient liberty and for public protection. We must ensure that decisions are clinically and legally sound. First, how will the proposed changes to initial and renewal detention periods help conditions and services and manage public risk more effectively, particularly in forensic or high-risk cases? Secondly, do longer detention periods after revocation of a community treatment order reflect a higher perceived risk, and if so, is there clear clinical evidence supporting that extension to six months? Thirdly, are we confident that the new timelines strike the right balance between protecting the public and ensuring patients are not detained longer than necessary? Finally, and as an adjunct to that, what other considerations are there in the clause or the Bill to keep the public safe and to make sure that decisions are correct in the context of clause 29?
Stephen Kinnock
The aim of the clause is to ensure that a patient’s detention is reviewed sooner. The planned reforms will not change the fundamental power and purpose of the Act, which is to detain and treat people when they are so unwell that they become a risk to themselves or others. Where a patient continues to meet the criteria, their detention will be renewed.
Opposition Members have asked about extra paperwork and workload in general for both clinicians and tribunals. In the impact assessment that we published alongside the Bill, we set out the estimated costs and benefits of the reforms and the expected workforce requirements that are critical to our implementation planning. That includes consideration of the impact on clinicians of additional detention reviews, which we have calculated is estimated to be around four hours of additional workload by the clinician for each patient who is detained beyond three months.
On the clinical evidence for shortening the detention period, in the independent review we found that in 17% of cases referred to the mental health tribunal, discharge happened in the 48 hours before the hearing, which strongly suggests that some patients are being detained for longer than is necessary.
Stephen Kinnock
I did not catch the question to which the hon. Gentleman is referring. Could he repeat it, please?
Dr Evans
The issue is about resetting. As the legislation is written, it would suggest that because people are moving from one place to another, the clock resets. Clinically, that could make sense, but part of the problem is that every time the clock resets, so does the person’s detention. That is a key part. Fundamentally, in this clause we are trying to stop people being detained when they do not need to be. In fact, the Minister has just said that 17% of people were discharged before the tribunal could happen. The question is around specifying, when it comes to admission and transfer, that the clock resets. What safeguards do we have to make sure that we are counting the number of times it is reset, that it is clinically appropriate and, most importantly, that we are not substituting one way of dealing with this with a back-door way of creating a reset motion?
Stephen Kinnock
I am struggling a little to understand what the hon. Gentleman is driving at. I pointed out in my opening remarks that the review clearly recommended reducing the initial detention period for people admitted for treatment from six months to three months, so that a patient’s detention is reviewed sooner to ensure patients are not detained when they are no longer benefiting from treatment and can be safely discharged. The clause means that patients detained for treatment will have their detention reviewed three times in the first year: at three, six and 12 months from the date of detention—up from two, as it was previously. I do not think that there is any implication that it is resetting the detention; it is just a rolling set of reviews.
Question put and agreed to.
Clause 29 accordingly ordered to stand part of the Bill.
The Chair
I will not tolerate any further speaking outside the structure. It is the second time that it has happened this afternoon, and I will not tolerate it any further.
Clause 30
Periods for tribunal applications
Stephen Kinnock
Clause 30 will introduce important reforms to the tribunal process by adjusting the timeframes for when patients can apply to the tribunal regarding their detention. Section 2 patients will now have 21 days rather than the current 14 to apply. This reform addresses concerns that patients in crisis often need more time to fully understand their rights, access legal advice and make an application.
For section 3 patients and transferred guardianship patients, clause 30 will reduce the initial application period from six months to three months. This aligns the application period with the new, shorter initial detention period of three months, reduced from six months, for these patients. This change maintains the current rights for these patients to make an application once during each successive period of detention.
For conditionally discharged restricted patients, clause 30 provides different application periods. These vary depending on whether the patient has been conditionally discharged with or without conditions that amount to a deprivation of liberty. Conditionally discharged restricted patients who are subject to deprivation of liberty conditions—also known as patients on a supervised discharge—can make an application to the tribunal sooner, between six months and 12 months from the date that they become subject to said conditions, and thereafter every two years. In contrast, conditionally discharged restricted patients who are not subject to deprivation of liberty conditions will have application periods between 12 months and two years, and thereafter every two years.
The different application periods reflect the need to consider a patient’s detention more frequently and earlier where more restrictive deprivation of liberty conditions are present. These changes improve access to the tribunal, ensuring greater protection for some of society’s most vulnerable individuals.
Clause 31 will strengthen the system of automatic referrals to the tribunal for patients detained under the Mental Health Act. It ensures that patients who may not be able to make an application to the tribunal themselves are still afforded regular judicial oversight. For patients detained under section 2, this clause reduces the automatic referral period from six months to three months. This improves the current safeguard by bringing the trigger for the automatic referral sooner. This will apply when a section 2 patient’s detention has been extended beyond 28 days and no application or referral has been made to the tribunal for review of the patient’s detention.
The clause will also improve the automatic referrals for patients detained under section 3. It does this by triggering referrals on the expiry of three months and 12 months and annually thereafter, where the tribunal has not considered the patient’s case. Additionally, this clause removes the automatic referral trigger on revocation of a community treatment order. It was found in practice that the automatic referral was an ineffective safeguard, as often the patient either was back in the community and subject to a new CTO or had reverted to being a section 3 patient before the tribunal reviewed their case. Now, where a patient’s CTO is revoked, they will be automatically referred at three months and 12 months after revocation, and then every subsequent 12 months. This allows the automatic referral periods to apply afresh from the date on which the CTO is revoked.
The clause will ensure that patients detained under the Mental Health Act are subject to regular and timely tribunal reviews, particularly when they are unable to advocate for themselves.
Clause 32 will deliver important tribunal oversight for the small cohort of restricted patients discharged into the community under conditions that amount to a deprivation of liberty, who are also known as supervised discharge patients. The clause will require patients subject to supervised discharge to be referred initially at 12 months after deprivation of liberty conditions are imposed, followed by a further referral every two years, where the patient’s case has not been heard by the tribunal in this period. The clause will also provide a safeguard for patients who may fluctuate between conditional and supervised discharge, to ensure that no supervised discharge patient will go more than four years without their case being considered by the tribunal. Automatic referrals to the tribunal ensure that patients under some of the most restrictive conditions have routine oversight of their detention where independent review would otherwise be absent.
The clause will also clarify the powers of the tribunal when considering the application or reference of a conditionally discharged patient, which include the power for the tribunal to impose conditions amounting to a deprivation of liberty. Deprivation of liberty conditions may be imposed or retained only where the tribunal is satisfied that they are necessary to protect another person from serious harm and are no less beneficial to the patient than a recall to hospital. This test preserves public protection, while enhancing the safeguards in place for conditionally discharged patients, ensuring that their care and liberty are subject to regular independent scrutiny.
Together, these changes will promote a more robust system of oversight for patients subject to long-term detention and restrictive conditions, ensuring that their rights are respected and their detention is regularly reviewed.
Clause 33 will extend the same principles of regular, proportionate scrutiny to restricted patients who are not conditionally discharged subject to deprivation of liberty conditions. For restricted patients detained in hospital, section 71 will be amended to reduce the automatic referral period from three years to one year. That amendment aligns with the amendments to increase the frequency of automatic referrals introduced in the Bill for part II patients. Through annual tribunal reviews, it is intended that those individuals are safeguarded against inappropriate detention. That aligns with the broader principles of fairness and accountability, ensuring that individuals in long-term detention are subject to appropriate judicial oversight.
Dr Evans
That is a difficult balance to get right. I appreciate that the Government have said that the Bill will take 10 years to implement, but if these measures come into force from day one, we will start to see automatic referrals come through. There will be a lag as the transition happens, but my hon. Friend is absolutely right: we can foresee scenarios where patients who want to be referred into the tribunal are waiting in inappropriate care places, which may be to the detriment of their personal care and may actually make their recovery worse. He is right to highlight that question, which is why having a broad understanding of how many extra referrals are coming would be useful.
Clause 32 focuses on conditionally discharged restricted patients who are subject to deprivation of liberty conditions. It rightly ensures that those patients are brought within scope of automatic referral, first after 12 months and then every two years. Again, that is a positive step, ensuring that even those not detained in hospital will still have access to a review of their conditions. Crucially, the clause also gives the tribunals the power to vary or remove those DoL conditions.
Can the Minister say more about how that important power will be used? What criteria will the tribunals apply to assess whether a condition is genuinely necessary and proportionate? Will patients be legally represented in those hearings by default? Will another advocate be there, or will it be someone else in their place? Here, too, I would welcome some clarification from the Minister. I hope he will forgive my legal naivety, but my mother always said, “It’s better to ask a dumb question than stay dumb forever.”
The explanatory notes talk about DoL conditions. The current legal framework for authorising the deprivation of liberty for individuals who lack capacity is complex and in transition. Under the Mental Capacity Act 2005, deprivation of liberty safeguards have been the established mechanism since 2009 to ensure lawful deprivation of liberty in care settings. However, the Mental Capacity (Amendment) Act 2019 introduced liberty protection safeguards as modernising replacements, designed to simplify and broaden protections.
LPS are widely seen as an improvement to DoLS, because they extend safeguards to a wider range of settings, including hospitals and people’s own homes where deprivation of liberty might occur. They also streamline the assessment process, reducing bureaucratic delays and better reflecting person-centred decision making. The Law Commission and various stakeholder groups have supported LPS as a way to address the significant practical and legal challenges posed by DoLS, including the so-called DoLS backlog, where assessments have been delayed for many vulnerable individuals.
Despite that, I do not believe that LPS have yet been implemented, leaving DoLS still in force. I wonder if we are therefore creating ambiguity as we update the Mental Health Act through the Bill’s clauses, such as those addressing conditional discharge and deprivation of liberty, without clarity on how those will intersect with the forthcoming LPS framework that will be introduced under separate legislation. That raises important questions about the sequencing and co-ordination of legislation reform. How will the Government ensure coherence and avoid conflicting provisions when different statutes address overlapping issues at different times?
Given that context, have the Government abandoned the planned implementation of LPS, or do they remain committed to bringing them into force? If the implementation is still planned, will the Government provide a clear timeline for when LPS will replace DoLS? How do the Government intend to ensure that the provisions we are debating will align with or adapt to the introduction of LPS? What steps are being taken to ensure that vulnerable individuals and professionals who navigate this complex legal landscape will have clear, consistent safeguards and guidance through the transition? Clarification on those points is essential to avoid legal uncertainty and to ensure that the reforms provide coherent protection for those deprived of their liberties.
Clause 33 deals with patients who are not under DoLS conditions. It will ensure that even those who are under DoLS conditions, such as detained restricted patients or conditionally discharged patients with lesser restrictions, receive automatic tribunals. It will reduce the current three-year referral intervention for detained restricted patients to 12 months and introduce automatic referrals for non-DoL conditionality discharge patients after two years and then every four years. Again, that is a step forward, but four years feels like a long gap between reviews for those discharged with conditions that still significantly affect their daily lives. Will the Minister explain the thought behind the chosen timeframe? If a person’s condition changes, is there a mechanism to trigger an early referral outside the normal cycle?
The clauses show progress. They reflect a clear intention to strengthen patients’ rights, increase oversight and address historical injustices, particularly for those living under deprivation of liberty conditions in the community. But with complexity comes risk, and we need to ensure that patients understand their rights and the legal support available. The tribunal system must be properly resourced to uphold the safeguards that we place in the legislation.
Stephen Kinnock
I will try to answer some of the questions. On tribunal capacity, people who are conditionally discharged and those with restrictions that amount to a deprivation of liberty represent only a small fraction of tribunal business—well under 1% of all mental health tribunal cases. The modest increase in hearings is therefore expected to be absorbed within existing capacity, while delivering significant rights benefits to the individuals concerned. It is worth noting, too, that the mental health tribunal continues to perform strongly. Amazingly, it is one of the very few areas of our public services not to be left with a massive backlog by the previous Government. The open caseload has remained stable at approximately 3,700 cases for a decade, despite 31,226 appeals in 2024-25.
I was asked about LPS and replacing DoLS. The previous Government paused the implementation of the liberty protection safeguards; they decided to focus on other priorities. In the absence of LPS, the deprivation of liberty safeguards system will continue to apply. The Department has made it clear that all bodies with legal duties under the DoLS must continue to operate these important safeguards to ensure that the rights of people without the relevant mental capacity are protected.
Stephen Kinnock
We have made it clear that we are going to continue with DoLS. Basically, we have to look at whether replacing them with LPS will achieve the stated objectives of the exercise, and I am not entirely convinced about that. It is under review.
On supporting patients, the independent mental health advocate will ensure that patients are aware of their rights. Throughout the Bill we are ensuring that patients have support by moving to an opt-out model. Additionally, if a patient does not bring a case, they will be referred automatically to the tribunal if a specified period has passed. Patients will be supported in getting tribunal oversight, as the referrals are made by a hospital manager.
Question put and agreed to.
Clause 30 accordingly ordered to stand part of the Bill.
Clauses 31 to 33 ordered to stand part of the Bill.
Clause 34
Discharge: process
Question proposed, That the clause stand part of the Bill.
Stephen Kinnock
The clause seeks to strengthen the protocol on discharging individuals under the Act by introducing a statutory requirement on the person who makes the discharge decision to consult with another. Currently, a patient’s responsible clinician can, in law, unilaterally decide to discharge a hospital in-patient from certain powers of the Act. Under our amendments, they will be required to consult someone else who is professionally concerned with the patient’s treatment, whether that be in the hospital or in the community. Where the responsible clinician is a consultant psychiatrist, the consultee may be a nurse, psychologist or occupational therapist. That is to ensure a more rounded perspective on the patient’s readiness for discharge from the Act.
The clause will introduce a similar protocol for the discharge of people under guardianship, guardianship orders and community treatment orders. For guardianship and guardianship orders, the person who makes the decision to discharge from the powers under the Act may need to consult either the responsible local social services authority or a person’s designated social worker. For patients under a community treatment order, the responsible clinician is required to consult the community clinician, in recognition of the fact that they will likely have a much clearer understanding of the patient’s progress in the community and whether they are ready for discharge under the Act.
Although multidisciplinary-based decisions represent best practice, we know that they are not always taken. The clause seeks to change that by helping to make sure that the decision to discharge is carefully considered and receives greater professional oversight.
Aphra Brandreth
I rise to speak to the implications of clause 34 for clinical decision making, patient safety and the operation of the Mental Health Act more broadly. The clause introduces a new requirement for the responsible clinician to consult another professional, from a different professional discipline, who is involved in the patient’s care before they make a decision to discharge a patient from detention or from a community treatment order under section 23 of the Mental Health Act 1983. If the patient is on a community treatment order, the clinician must consult the relevant community clinician.
At its heart, the clause seeks to ensure that decisions about discharge are not taken in isolation. It reflects a wider shift in mental health care towards collaborative, multidisciplinary approaches. We should welcome that in principle. These are often complex decisions that involve vulnerable individuals, and a single viewpoint may not always capture the full clinical picture. By requiring consultation with someone from another discipline, be that a nurse, an occupational therapist or a psychologist, we can help to ensure that decisions are more thoroughly considered and less likely to overlook risks.
The clause provides an important safeguard against premature or inappropriate discharge, particularly in cases where a patient may continue to pose a risk to themselves or others. It builds in a degree of professional scrutiny that supports safer and more consistent practice and, in doing so, should improve confidence among patients, families and practitioners.
I would be grateful if the Minister provided further clarity on a few practical points about how the clause will operate. First, it requires consultation but does not appear to specify whether the consulted clinician must agree with the responsible clinician’s decision in order for discharge to proceed. In cases where there is disagreement between clinicians of different professional backgrounds, what is the expected course of action? Is the responsible clinician ultimately free to proceed, or will there be an escalation mechanism? It would be helpful to understand how differing professional opinions are to be balanced and how potential deadlock is to be managed.
Secondly, although I welcome the intention to improve the rigour of decision making, will the Minister reassure the Committee that the additional consultation requirement will not introduce unnecessary delays into the discharge process? It is, of course, essential to get these decisions right, but it is also important that we do not create new barriers to discharge when a patient is clinically ready to move on. Delays in discharge can have a negative impact on patient outcomes, as well as increasing pressure on services. Although the consultation must be meaningful, it should also be proportionate, timely and clearly understood by all involved.
Will the Minister comment on how the requirement will be implemented in practice? For example, will guidance be issued to support clinicians in understanding their duties under the clause and to ensure consistency across services?
Overall, the clause represents a thoughtful and measured reform. It strengthens patient safety, promotes professional collaboration and introduces a safeguard that is both reasonable and necessary. Notwithstanding the clarifications I have raised, I hope that it will help to ensure that discharge decisions are made with greater confidence and care without becoming unduly bureaucratic.
Dr Evans
I rise to speak to clause 34, which inserts new consultation requirements into section 23 of the Mental Health Act 1983. The requirements relate to the discharge of individuals detained under parts II and III of the Act, as well as those subject to community treatment orders or guardianship.
Currently, under the Act, the responsible clinician has the power to discharge patients detained under sections 2 and 3, as well as unrestricted patients subject to a hospital order under part III, without any formal requirement to consult other professionals. This is already considered outdated practice in most clinical settings, where decisions are typically made within the multi-disciplinary team. However, that is not required by law. By contrast, discharge decisions for restricted patients remain with the Secretary of State for Justice or the mental health tribunal and are not affected by the clause.
Clause 34 seeks to change the current situation. It will insert proposed new subsections (2A) to (2C) into section 23 of the 1983 Act, placing a statutory consultation duty on responsible clinicians, local authorities and, in some cases, the patient’s nominated person. The aim, as outlined in the Government’s explanatory notes and by the Minister, is to formalise best practice and ensure that no discharge decision is made unilaterally without appropriate professional oversight. The Opposition welcome the intention behind the clause—strengthening safeguards, encouraging multidisciplinary collaboration and protecting patients from unsafe or premature discharges are all necessary and overdue steps—but we have a few questions about it that I hope the Minister will address.
First, proposed new subsection (2A) requires the responsible clinician to
“consult a person—
(i) who has been professionally concerned with the patient’s care or treatment, and
(ii) who belongs to a profession other than that to which the responsible clinician belongs”.
That is a sound principle, but there is an ambiguity in the phrase “has been professionally concerned”. Who do the Government have in mind? The Minister set out that it could be a nurse or a counsellor, but would it stretch as far as a GP or a practice nurse? Will there be a codifying list, either in statute or in the code of practice, so that we know who is expected to speak to that person? Does it require current involvement in the patient’s care? For example, could a professional who saw the patient only briefly many months ago qualify? If so, is that adequate to meet the clause’s intention? We would welcome clarification from the Minister on whether a definition of who and what an appropriate consultee looks like will be covered in guidance or regulations.
Secondly, I fully understand the good intent behind proposed new subsection (2B)(c), but as a good Opposition we should point out a possible unforeseen problem. It states that when the nominated person—that is, the person chosen by the patient to act in their interests—is making a discharge decision under guardianship, they
“must consult the responsible local social services authority.”
That raises both legal and practical questions. Is it appropriate to place a statutory duty on a layperson, who may be a relative, a friend or a carer with no formal training or professional support? What is the consequence if they fail to consult? Would their decision be invalid, or could it be legally challenged?
I know that the Government are trying to ensure that relatives and advocates are consulted, which is commendable. I am sure there will be no issue in the vast majority of cases, but there is a risk that the duty may unintentionally create legal uncertainty and administrative burdens for families. Has the Minister thought about whether it might be better framed as a duty on the local authority to advise or support the nominated person, rather than vice versa? I am sure we both agree on the motive and principle of shared decision making; it is simply a question of where to place the burden.
Thirdly, under proposed new subsection (2C), if someone is on a community treatment order, the responsible clinician and hospital managers must consult the community clinician before they discharge the person from that order. Again, that seems sensible, but what happens if there is no identified or available community clinician? As we have discussed, they are legally named, so could that requirement create a bottleneck to discharge? Will there be provision for proceeding with discharge if consultation is not practicable within a reasonable time? Without such a safeguard, there is a risk that patients remain subject to detention, such as conditions under a CTO, even when all parties agree that discharge is clinically appropriate.
Furthermore, the clause does not appear to require the consultation outcome to be documented, nor any disagreement to be recorded. If the responsible clinician consults someone and then disregards their view—as we heard earlier, according to the Minister they have precedence—that may be entirely justified, but surely transparency demands the recording of the reasons. Will the Government consider adding a requirement to document consultation, perhaps in the code of practice, to ensure that reasons are given when discharge proceedings are taken against clinical advice?
The clause represents an important step towards improving safety, accountability and multidisciplinary care in discharge planning, but the Opposition believe that to realise its full potential and avoid creating uncertainty or delay, the Government should look again at the clarity of key terms, such as “professionally concerned”; the appropriateness of placing duties on laypeople, such as the nominated person; the practical challenges around consultations when key professionals are not available; and the need for clear documentation requirements to uphold transparency and safeguarding in decision making. I look forward to hearing the Minister address those points.
Stephen Kinnock
The hon. Member for Chester South and Eddisbury asked about differences of opinion. The second professional does not have to agree. The ultimate decision in such cases sits with the responsible clinician, to ensure the clear accountability of decision making.
The hon. Lady also asked about delays. We see consultation with another professional as important to making a more informed decision on whether the patient is ready for discharge under the Act. It is especially important that the second professional involved in discharge decisions is from a discipline different from that of the responsible clinician. That will ensure a broader perspective, particularly when the second professional, such as a nurse, may have had more frequent contact with the patient.
Aphra Brandreth
On the discipline of the second clinician consulted, is there any guidance as to who might be appropriate? I mean not just the list of potential professions but whether there is guidance on who would be appropriate in different situations. We welcome the multidisciplinary approach, but I would like some clarification. Given your earlier response, saying that they need to agree, it is not really clear how this would add to the process. It would help if there were clarity on the professions.
Stephen Kinnock
We will absolutely provide guidance on that in the code, but the consultee in the case of a detained person is someone who is professionally concerned with the patient’s treatment, whether that be in the hospital or in the community, and who is from a discipline different from that of the responsible clinician. Those criteria will be applied throughout the process.
Finally, on the question from the Opposition spokesman, the hon. Member for Hinckley and Bosworth, yes, reasons will have to be given whenever there is a difference of opinion. All the relevant documentation and how that should work will be set out in the code of practice.
Question put and agreed to.
Clause 34 accordingly ordered to stand part of the Bill.
Clause 35
Ascertaining and learning from patients’ experiences of hospital treatment
Question proposed, That the clause stand part of the Bill.
Stephen Kinnock
This amendment seeks to overturn the previous amendment tabled—sorry, I should have said “the clause”. The clause seeks to overturn the previous amendment, tabled by Earl Howe and Lord Kamall. Although we support the intention of the amendment, our view continues to be that it would be duplicative.
There are already many ways in which service user feedback is used to inform policy and practice. For instance, every year the Care Quality Commission conducts thousands of interviews and visits with people detained under the Mental Health Act 1983. That may result in the CQC investigating a complaint or requiring an action statement from providers about service improvements. Although there may be room to enhance existing feedback mechanisms, we would prefer to improve what we have rather than create something new that would risk confusion.
If the objective is to provide time and space for the person to reflect on their past experiences post-discharge, I reassure the Committee that that should already form a part of co-producing a person’s care in the community plan. We also intend to create space for individuals to reflect on past experiences when making their advance choice document, with facilitation from a suitably qualified person.
Josh Dean (Hertford and Stortford) (Lab)
Young people who have been through detention often report challenging circumstances following that detention. Rather than supporting them, that sometimes increases their trauma. Can the Minister assure me that, as part of the changes he just set out, we will still ensure that young people have the opportunity to feed their experiences back? What specific work will the Government undertake to gather those views from young people?
Stephen Kinnock
My hon. Friend makes an important point. We are absolutely committed to ensuring that we create a space for young people to provide feedback. Some of that will be around past experiences when making their advance choice documents, but much broader opportunities for feedback will absolutely be built into the system. We want this to be a learning process. It is important that the code of practice is not just a document that sits on the shelf gathering dust; it should be a live document. That is why the feedback is so important.
It should be noted that although reflecting on past experiences may be therapeutic for some individuals, for others it can be traumatic, so the measure should be entirely service-user led. We also continue to be concerned about the burden that the amendment would place on independent mental health advocacy services, which are already under strain.
Gregory Stafford
I apologise—this may be due to the terminology of “amendment” versus “clause”—but is the Minister saying that the Government are likely to vote against clause 35 as it currently stands? He is talking about amendments and clauses, and that is slightly confusing me. [Interruption.] His officials are nodding.
Stephen Kinnock
Yes, but the issue may have a bearing on a potential Division. The challenge that I am facing is that my notes said,
“This amendment seeks to overturn”,
but we are talking about a clause that is seeking to overturn a previous amendment. Are we speaking in favour of a clause that will overturn an amendment? [Interruption.] Confusion reigns.
The Chair
Clause 35 was added by a Lords amendment; maybe that is where the confusion has come from. The Government tabled an amendment to leave out clause 35.
Stephen Kinnock
We will figure it out as we go along. I have now lost my place. [Interruption.] My answer to the hon. Member for Farnham and Bordon is that the Government are voting against clause 35 stand part.
Stephen Kinnock
Right. Advocates have told us that implementing what is set out in the clause would raise logistical and resourcing problems, as it would require a significant shift from their current role. They have also raised concerns that if they acted in effect on behalf of the hospital to collect feedback, their independence and impartiality in the eyes of the patient might be undermined. We would prefer to direct resources to increasing access to advocacy services among in-patients, as proposed by the Bill. Advocates play a crucial role in promoting and protecting the rights of patients. We do not wish to detract from that or to dilute their role. I do not commend the clause to the Committee.
Jen Craft
Like many Committee members, I was deeply confused about how we were proceeding.
On the face of it, the clause broadly seems as if it should be part of any Act about mental health care, including post discharge. I have spoken about my own experience of interacting with the Mental Health Act as it stands. I might have found the clause fairly helpful post discharge and others might have found it useful as well. However, I have just heard the Minister’s description of the limitations of the clause, and the speech that I was about to make has been thrown into complete disarray by the confusion just now. But I implore the Minister to consider the fact that, when it comes to encouraging participation, understanding, and co-designing and co-producing services, capturing the experience of those recently detained under the Mental Health Act can be extraordinarily useful. Clause 35, which was added by an amendment from the Lords, seems a fairly useful way to do that.
Stephen Kinnock
Fundamentally, we do not support the clause because it is overkill. It simply puts too much burden on to a system that is already carrying out the tasks that the clause seeks to impose on the system, particularly through the CQC. Given that advocates currently have no role in relation to discharged patients, it is clear that the clause would present a new burden; that has been confirmed through my officials’ engagement with advocates and other stakeholders. One hospital manager said that within their small trust alone, the clause would result in contacting and interviewing more than 1,000 individuals discharged from the Act each year.
Dr Evans
The Minister says that advocates had no role in discharge, but they do when advising patients about their rights—that is fundamentally what they do. At the point of discharge, they enable patients to know what their rights are. I take his point about capacity issues. If the Government want to take the clause away, how will they hardwire patients’ feedback into the heart of the Bill?
Stephen Kinnock
The CQC visits and interviews thousands of detained patients each year under its statutory duty to monitor the use of the Mental Health Act. Those visits can lead to the CQC requesting improvements from service providers. The CQC publishes annual reports highlighting key findings and themes from those visits.
Trust boards are responsible for collecting and acting on service user feedback to improve services. Under the NHS contract, the patient and carer race equality framework requires trusts to have clear and visible systems in place for gathering and responding to feedback from patients and carers. What is more, Healthwatch England and its local branches also play a key role in representing the views of health and social care users. I do not really know what more the system could do. The clause simply over-embroiders and over-complicates; when that happens, we usually end up with vast numbers of unintended consequences.
We appreciate that concerns have been raised around the CQC’s role in collecting in-patients’ views. As I said, we would prefer to work with stakeholders to understand those concerns and improve the feedback mechanisms that we have, rather than reinvent the wheel and create something new. We recognise that, although there are multiple aims to the clause, the primary one is to provide a space for people to heal from their experiences of being detained. We are strongly of the view that inviting the individual to share their experiences as part of their advance choice document or care plan—
Jen Craft
I am glad that the Minister is explaining how capturing feedback and experience is being allowed for in other parts of the Bill. To clarify, in my own head I feel that the clause aims to capture the experience immediately after it has happened, just as hospitals offer women who have just given birth the opportunity to talk through their experience. It is healing for the patient to understand what happened to them, and it provides immediate feedback to the hospital. Is that kind of level captured in other parts of the Bill?
Stephen Kinnock
I understand and recognise my hon. Friend’s concerns, but we can rattle through all the different forums where feedback can be captured: the CQC, the trust boards, the patient and carer race equality framework, Healthwatch England and all the other informal channels in the mental health ecosystem. Our view is that adding another layer into all that would in the end be counterproductive. That is the Government’s position.
Natasha Irons
The Minister mentioned the complex network of ways in which patients can give their feedback; perhaps the aim of the clause is to try to simplify that and, as my hon. Friend the Member for Thurrock mentioned, make it a bit more direct and immediate after treatment. Are there any plans to simplify the process in another way? The complex cobweb that the Minister described is perhaps the reason why the patient voice is not always captured and utilised in a way that we would want if the services that people rely on are to be improved.
Stephen Kinnock
My hon. Friend raises an important point. I do worry about the list of different organisations and agencies throughout the system, and not just in mental health—so many parts of the system have had layer upon layer of bureaucracy added in. That is one of the reasons why we are abolishing NHS England: we want to try to find greater simplicity and clearer channels of communication.
Through the development of the code of practice and the consultation process, simplifying and clarifying the system will be a key objective. Adding another layer would have the opposite effect. But my hon. Friend makes an important point, which will definitely be a part of the process of consultation and development of the guidelines and code of practice. On the basis of those answers, I recommend that we do not adopt the clause.
The Chair
Order. I am expecting four Divisions imminently, so I will suspend the Committee.
Stephen Kinnock
Clause 36 will introduce a subset of the current conditional discharge power where deprivation of liberty conditions are expressly allowed, otherwise known as supervised discharge. The aim of the clause is to prevent a small group of criminal justice patients with specialised support needs from remaining in hospital unnecessarily, while ensuring the risk they pose in the community is robustly managed. The reform responds to a Supreme Court decision, which found that there was no power under the current Act to impose discharge conditions that amount to a deprivation of liberty. Prior to the judgment, such conditions were used in a small number of cases in which patients with specialist needs required stringent arrangements to protect themselves and the public from harm.
Careful consideration has been given to the ethical and legal balance of the arrangements. We are clear that the threshold for use of the power is very high, and it will be accompanied by appropriate safeguards. A stringent test will be applied. The conditions will only be applied if the tribunal or Justice Secretary views the conditions as necessary to protect others from serious harm and, for the tribunal, if it considers the conditions would be no less beneficial than if the patient remained in hospital. We are also introducing additional safeguards, which ensure that supervised discharge patients are automatically referred to the tribunal after 12 months and every two years thereafter. That is more frequent than patients subject to conditional discharge, given the restrictive nature of the conditions being placed upon them.
I turn to clause 37. Prisoners and other detainees who become acutely mentally unwell in prison or another place of detention, such as an immigration removal centre or youth detention accommodation, can be transferred to hospital for treatment under sections 47 and 48 of the Act. Clause 37 will make two minor changes to those provisions.
Currently, the criteria for detention under the Act provides that appropriate treatment must be “available” for the patient or other detainee. The Court of Appeal, however, ruled that due to the specialised provision and security requirements relating to this cohort of patients, treatment must be available in practice for the detention criteria to be met, meaning that a hospital place must be identified. That diverges from how “available” treatment is interpreted across the rest of the Act, and it risks creating an additional barrier for this cohort of patients in accessing the care they need.
We are therefore clarifying the detention criteria to ensure that they can still be met, based on the patient’s clinical need, even when no hospital place has yet been identified. The change is also necessary for the effective implementation of the statutory time limit in clause 38, so that the Secretary of State is not delayed in issuing a transfer warrant when a specific bed space has not yet been identified. Clause 37 will also update the list of immigration legislation provided in section 48 to expand the scope of immigration detainees who can be transferred under that section.
Stephen Kinnock
On safeguards, supervised discharge will only be used when necessary, given its restrictive nature and significant resource demands. A stringent test will apply. It must be deemed necessary by the tribunal or Justice Secretary to protect others from serious harm, and the tribunal must deem it to be no less beneficial than hospital care. Additional safeguards include automatic tribunal referrals after 12 months and every two years thereafter, if not previously reviewed.
On capacity, our expectation is that this will not have a significant impact on other restricted patients. The small cohort who are likely to be subject to supervised discharge will free beds, and that could positively impact any patient who needs a bed, but the numbers remain small and are unlikely to lead to widespread bed availability.
On demand for secure beds, clause 37 will correct a discrepancy in detention criteria caused by a Court of Appeal decision. Rather than creating further disparity, it aligns the criteria for sections 47 and 48 of the Mental Health Act with the consistent interpretation of available treatment used throughout the rest of the Act. Clause 37 does not alter the approach to clinical prioritisation of in-patient care, or the fact that a person will only be transferred once an appropriate bed has been found, in terms of both therapeutic care and level of security. That also addresses the question on implementation from the hon. Member for Farnham and Bordon.
I turn to the questions asked by my hon. Friend the Member for Shipley. She asked about the 28-day limit. Any change to the time limit would require an enhanced level of parliamentary scrutiny. Therefore, the power shall be subject to the draft affirmative procedure to ensure that both Houses are given the opportunity to debate any decision.
On dual tests, the Secretary of State for Justice applies a slightly different test from that of the tribunal in order to preserve their discretion in the interests of public protection, but conditions for patients must still be appropriate and proportionate. We will publish operational guidance to make it clear that the Secretary of State for Justice should have regard to the principle of therapeutic benefit and only use this type of discharge when the evidence indicates that it is in the best interests of the patient.
Under section 120 of the Mental Health Act, the Care Quality Commission and Health Inspectorate Wales have a duty to monitor the use of the Act. Patients subject to supervised discharge will be captured by section 120 for the purpose of regulatory oversight as a subset of conditionally discharged patients who are liable to be detained under the Mental Health Act.
I turn to the questions asked by the shadow Minister, the hon. Member for Hinckley and Bosworth. The Ministry of Justice considers that these measures are compatible with article 5 of the European convention on human rights. In 2018, the Supreme Court case of Secretary of State for Justice v. MM established that there was no lawful basis under the Act to impose conditions that amounted to a deprivation of liberty. The new provisions will provide a statutory basis for the Justice Secretary and the tribunal to impose such conditions.
The Chair
With this it will be convenient to discuss the following:
Amendment 19, in schedule 3, page 91, line 13, after “patient” insert
“or English qualifying informal patient under 18”.
This amendment extends the provision of opt-out advocacy services in England to informal inpatients under 18.
Government amendments 42 and 43.
Schedule 3.
Stephen Kinnock
I will first discuss clause 41 and schedule 3. Independent mental health advocates are specially trained advocates who can support patients detained under the Mental Health Act to understand their rights and participate in decisions about their care and treatment, but not everyone who would benefit from an independent mental health advocate currently has access to one. In view of the benefits that advocacy can bring, we are expanding the right to an independent mental health advocate to all mental health patients, including informal or voluntary patients who are not detained under the Act.
We know that some informal patients are not told about their rights and legal status. Informal patients in Wales already have the protection, and we want to extend it to patients in England. It will help ensure that the voices of individuals are heard and their rights respected, and that potentially vulnerable groups, including children and young people, do not go without important advocacy protections.
Moreover, the Bill provides an additional enhanced mechanism for ensuring that the most vulnerable mental health patients, those compulsorily detained under the Mental Health Act, are able to benefit from advocacy. We are introducing an opt-out system for that particular cohort, to put the onus on hospital managers rather than patients themselves to request independent mental health advocacy services. Hospital managers must notify providers of advocacy services about the patients who are eligible for IMH advocacy. Advocacy providers must then arrange for independent mental health advocates to interview those patients to find out whether they want to use their services.
The right to an independent mental health advocate will also be expanded to include part III patients who are subject to the new supervised discharge, which allows for part III patients to be conditionally discharged into the community and still deprived of their liberty. The Bill also enables independent mental health advocates to provide extra help to patients to have a greater say in their treatment or to make a complaint. Together, these changes increase the access that patients have to advocacy, which contributes to improved patient rights.
I will next address amendment 19. We appreciate that people under 18 are a vulnerable group who would benefit from advocacy representation. For this reason, the Bill extends the right to an independent mental health advocate to informal patients, including under-18s, who are often admitted on a voluntary basis. We are introducing a duty on hospital managers to inform them of this right. That means that hospital managers will be expected to proactively approach all children and young people, and others, such as their parents or carers, to make sure they know that they are entitled to an advocate and help them to appoint one.
We will make it clear in the code of practice how independent mental health advocates should support children and young people with their particular needs. However, we think it is right that detained patients, including under-18s—rather than informal patients—receive advocacy on an opt-out basis. This is because they are subject to greater restrictions, meaning that it is even more important that they are supported to exercise their rights.
Finally, I will address Government amendments 42 and 43. Schedule 3 introduces the concept of “English qualifying informal patients”, who, for the first time in England, will be eligible for independent mental health advocacy services. We are amending this measure to change the definition of both English and Welsh qualifying informal patients. Amendments 42 and 43 are minor amendments to address a technical issue with the legislation. There is case law saying that the term “informal patient” would cover anyone there on a voluntary basis and not subject to any compulsory legislative framework. However, as currently drafted, the Bill’s definition is wider, defining an informal patient in England or Wales as an in-patient in hospital who is receiving assessment or treatment for a mental disorder at the hospital but not subject to the Mental Health Act. A person deprived of their liberty under any other legislation such as the Mental Capacity Act 2005 or under a court order would therefore be classed as an “informal patient”, which would be incorrect, as people who are detained cannot, under case law, be informal patients.
That would lead to complications in practice. A patient subject to the deprivation of liberty safeguards would be eligible for independent mental health advocacy as well as independent mental capacity advocacy. However, an independent mental health advocate cannot provide any help or support in relation to the Mental Capacity Act. The amendments address that issue by changing the definitions of “English qualifying informal patient” and “Welsh qualifying informal patient”, to be an in-patient receiving assessment or treatment for a mental disorder who is not detained under any other legislation or court order.
For those reasons, I hope that the hon. Member for Winchester is satisfied not to press his amendment, and I commend Government amendments 42 and 43, clause 41 and schedule 3 to the Committee.
Aphra Brandreth
I rise to speak to clause 41, which brings into sharper focus two pillars of a fair and rights-based mental health system: the provision of clear information to patients and the strengthening of independent mental health advocacy. It rightly recognises that, when a person is detained under the Mental Health Act 1983, often during a period of acute crisis and difficulty in their life, they need to feel that their clinical needs are being met, but in a way that respects them as individuals, with the same entitlements to dignity and agency as any other member of our society.
The clause provides for informal patients to be eligible for an independent mental health advocate. I welcome the extension to enable more individuals to access this vital advocacy. It empowers patients to know that independent advocacy is available, but we must ensure that there are sufficient resources so that those who choose this help are given sufficient support when they are in a potentially vulnerable position. As someone representing a constituency that is in England but borders Wales, I also welcome that these changes bring care into line so that advocacy help is offered to informal patients, regardless of which side of the border they are accessing treatment.
The clause places a renewed duty on services to ensure that information is given to patients clearly, promptly and in a form that they can understand. It introduces an obligation for advocacy providers to determine, through an interview, whether a qualifying patient wishes to use the service. This support is important; no person should be expected to navigate the complexities of mental health legislation, or their rights under it, without proper guidance. However, where there is a duty
“on hospital managers and others to notify providers of advocacy services about qualifying patients”,
can the Minister clarify who is meant by “others”? Will there be a list of people and roles who are given this responsibility?
The role of an independent mental health advocate is vital. These individuals can be a lifeline. They can help people to understand their rights and any medical treatment, and crucially, can support an individual to have their say about any treatment. Clause 41 rightly reinforces the importance of independent mental health advocates, and it is important that we match that ambition with the legal and practical steps to support them.
It is entirely right that we welcome the recognition of the role of independent mental health advocates, who serve a vital function in ensuring that patients’ voices are heard and their views represented, especially when navigating what can be an incredibly complex legal and clinical environment. Their independence is fundamental to not only their effectiveness but the confidence that patients and families can place in the system, which brings me back to my point. It is therefore important that we support independent mental health advocates with the resources that they need to do their job effectively.
If we are to rely further on advocates, we need to ensure that they are in a position to deal with that, so that we do not create statutory entitlements that are difficult to act upon. Actions, as well as words, are needed. At present, many areas already struggle with advocacy coverage. If we now place additional expectations on the service, and I believe that we will through this provision, we must ensure that there are sufficient numbers of trained, experienced independent mental health advocates across the country to meet rising demand. Can the Minister reassure the Committee that the necessary people with the skills and training are available to fulfil this expanded role?
We must also consider the patients’ experience, as has been the focus of so many of the remarks made in the Committee today. Again, I emphasise the vulnerability of patients at times of crisis. If we are to tell patients that support in the form of an advocate is there for them, we need to ensure that it is accessible and easy to reach and understand. Clause 41 moves us in the right direction, but implementation is everything. It must be backed by local accountability, adequate funding and clear operational guidance. This includes ensuring that all patients, regardless of background, language or capacity, are given support that is appropriate and effective.
It is vital to consider the wider implications of this clause. The reinforcement of the independent mental health advocate’s involvement should be mirrored by greater investment in advocacy services, stronger integration with care planning and more regular engagement with patients themselves on how these services work in practice. In our earlier discussions, my hon. Friend the Member for Farnham and Bordon suggested that we use trials, which could also be considered here to ensure that, as changes are brought in, they are matched by appropriate service levels.
I am largely supportive of clause 41, which I think moves us in the right direction towards a transparent mental health system that is there for patients, ensuring that they have a voice and are not an afterthought. As long as it is deliverable in practice, and does not give false hope to patients, the clause strengthens the Bill.
Dr Evans
The hon. Gentleman identifies exactly what the point of an IMHA is. The way the Bill is written, the IMHA determines whether a patient has capacity or competence to make a decision. That determining means that they are making the choice, which is quasi-clinical. According to the definition that the hon. Gentleman has just given, that would fall out of the IMHA’s scope, because that would involve the ability to make decisions about capacity.
My concern is whether we have scope creep here. If so, we should be explicit about it—perhaps it is something we want to consider—but the way it is written, IMHAs will make capacity-based decisions about whether a person has the capacity to decide whether they need help. I would argue that that should be done by someone who is qualified as a doctor, a psychiatrist or community psychiatric nurse, as currently happens. That is the clarification that I am looking for from the Government. If I have the wrong end of the stick, I will happily back down, but this area of the Bill needs clarifying.
To that end, and if the Bill is written as I fear, I would welcome it if the Minister can tell us how IMHA providers will be supported to make best interest decisions appropriately, especially in cases involving fluctuating capacity or complex presentations. Will there be clinical oversight or statutory guidance to avoid inconsistency or overreach in these assessments? Although I support the principle of proactively offering advocacy, we must ensure that the decisions made on a person’s behalf are done with the appropriate checks and accountability, and by the right people.
My third point is about the exclusion of emergency section patients. The welcome change in the clause and the schedule expands the pool of support, but we should also pay attention to those who are, by definition, excluded. Paragraph 317 of the explanatory notes make it clear that individuals detained under sections 4, 5, 135 and 136 will not benefit from IMHA support. Those are often people detained in crisis situations, sometimes in police custody, or brought in under emergency powers.
For completeness, will the Minister clarify why that group is being left out, given their heightened vulnerability and the likelihood of distress or disorientation? Are the Government satisfied that patients under these emergency powers are receiving adequate information and support at the most critical moments of intervention? Is there a mechanism to support the nominated person if the patient does not have capacity, so that the nominated person receives the information they need to make a fully informed decision? If the answer is that the duration of detention is too short to justify IMHA involvement, I ask the Minister: how short is too short when a person’s liberty and medical autonomy are in question?
It may be that Government amendments 42 and 43 address some of those points, so I will return to this in a second before moving on to my fourth point. In terms of information sharing and patient autonomy, I welcome the retention of the duty to inform patients, especially informal patients, of their right to advocacy, and for that provision to be given both orally and in writing. However, I note that the responsible person must also—except where the patient requests otherwise—be provided with written information to the nominated person. What safeguards are in place to ensure that that does not inadvertently breach the patient’s privacy, such as in situations involving estranged family members, controlling relationships or very personal health issues, which could be disclosed but are not relevant to mental health? It is essential that the nominated person framework enhances advocacy and support and does not undermine the person’s right to control who knows about their care.
Finally, I would welcome clarity from the Minister about how the uptake and impact of expanding the IMHA system will be monitored. Will there be reporting requirements on providers? If so, will that be through the integrated care boards, or is that part of the CQC? Will patients have the opportunity to feed back on the effectiveness of the support they receive?
Before I turn to the amendments, I reiterate that the Opposition support the principle of strengthening advocacy in mental health services. Clause 41 is an important step towards a more rights-based and person-centred system, but the detail of the implementation is key.
I note that proposed Government amendments 42 and 43 to schedule 3 specifically change the definition of “English qualifying informal patient” and “Welsh qualifying informal patient” to exclude patients detained under any
“legislation or by virtue of a court order”,
rather than limiting exclusion to those detained solely under the Mental Health Act. That important clarification partly improves on one of the problems I mentioned when discussing clause 41.
In simple terms, those amendments try to address the issue of clarity and coverage for patients detained under other laws, and I believe that this is how they do that. Originally, the Bill excluded only patients detained under the Mental Health Act from being classified as informal patients eligible for IMHA services, but some patients might be detained under other laws or court orders, such as criminal justice laws, which the original wording did not cover. The amendments change the definition to exclude anyone detained under any legislation or by a court, not just the Mental Health Act. In practice, this means that patients detained under other laws will not mistakenly be considered informal patients eligible for IMHA services under this part of the Bill.
The proposals close a gap so that the right groups get advocacy services, and there is less confusion for hospitals and advocates about who qualifies. In essence, by broadening and bettering the definition and defining the exclusion, this will ensure that patients detained under other legislation, such as the Criminal Justice Act, or other court-mandated detention powers, are not mistakenly classified as informal patients eligible for IMHA services under those provisions. That reflects a more comprehensive and legally coherent approach to defining eligibility.
This clarity is welcome, as it reduces potential ambiguity in respect of providers. That said, will the Minister comment further on how these changes will interact with existing IMHA provisions or advocacy entitlements for those detained under other legislation? Are there parallel safeguards or advocacy rights for those groups? What guidance will be provided to practitioners and IMHA providers to navigate the complexities of overlapping detention regimes, especially when a patient’s status might shift rapidly between voluntary Mental Health Act detention and court orders? Will this amendment necessitate any further changes in regulations or operational policies to ensure smooth implementation and clarity for patients, families and service providers? Ensuring that no patient falls through the cracks due to definitional nuances is crucial for integrity in our mental health advocacy services.
Finally, Lib Dem amendment 19 would insert after “patient”, in schedule 3, page 91, line 13,
“or English qualifying informal patient under 18”.
As the hon. Member for Hertford and Stortford and Opposition Members rightly pointed out, it is quite hard to see why the Government would not want to put that in place. The explanatory statement says that it aims to extend
“the provision of opt-out advocacy services in England to informal inpatients under 18.”
It seems clear in what it does and is a well-defined amendment to that end. I am keen to understand why the Government do not want to support it. Do they believe that this is currently balanced elsewhere in the system? Are there already provisions elsewhere? If not, why—if it is good for adults and we are strengthening their opportunities—should it not be the same for our children?
I will finish on that point. I would be grateful for answers on the clause, the schedule, the Government amendments and the Lib Dem amendment.
Stephen Kinnock
The hon. Member for Chester South and Eddisbury asked who can make referrals in addition to hospital managers. The list of responsible persons is in proposed new section 130CC, in paragraph 6 of schedule 3. In addition to hospital managers, the responsible local social services authority is also required to notify providers of advocacy services about qualifying patients; whether it is a matter for the hospital or the local authority depends on the patient.
I was asked whether there are enough people to fulfil the tasks of the IMHA. The impact assessment gives our current best estimate of likely workforce and funding requirements and sets out the expected expansion required for each workforce group. We will recruit approximately 330 additional IMHAs.
Aphra Brandreth
Does the Minister have any more detail on that? Is there a timeframe for recruiting these advocates and putting the training in place? That would help reassure the Committee that there is provision to ensure that the timing will fit with the introduction of the changes in the Bill.
Stephen Kinnock
As has been discussed, as soon as the Bill gets Royal Assent we will launch an extensive consultation around the code of practice. The code of practice will cover everything from training to recruitment to capacity building, and the plan will be set out in the first annual written ministerial statement, which will take place one year after the Bill receives Royal Assent.
My hon. Friend the Member for Hertford and Stortford asked about children admitted informally. We are introducing a duty on hospital managers to inform informal patients of their right to a mental health advocate. We will set out the importance of independent mental health advocate representation for children and young people in the code of practice. That could include the importance of a proactive approach for hospital managers.
We will also describe in the code the new role for independent mental health advocates in relation to informal patients, including vulnerable in-patient groups, such as children and young people, people from ethnic minority backgrounds and people with a learning disability or autism.
The hon. Member for Farnham and Bordon asked whether we have the money for it. The funding requirements will, I think, be related to our best estimate of likely workforce and funding requirements. If we are going for 330 additional IMHAs, the funding requirements will be defined by that number.
The shadow Minister, the hon. Member for Hinckley and Bosworth, asked whether it will be local authority funding. We are obliged to fund new burdens on local authorities to resource this expansion of the independent mental health advocates. He then asked a blizzard of additional questions; I got lost in the thread of them all. We will go through Hansard and write to him.
Stephen Kinnock
No, I have finished.
Question put and agreed to.
Clause 41 accordingly ordered to stand part of the Bill.
Schedule 3
Independent mental health advocates
Stephen Kinnock
The clauses will amend section 132 of the Mental Health Act in relation to detained patients, and section 132A in relation to community patients, and insert a new provision in relation to conditionally discharged patients. They place a statutory duty on hospital managers to supply complaints information to detained patients, community patients and conditionally discharged respectively, as well as to their nominated person.
Patients, their family and carers have a right to complain about the treatment they receive, including care and treatment under the Mental Health Act. The patient’s rights to complain are enshrined in the NHS constitution. Although the code of practice currently sets out that information about complaints should be provided to patients when they are detained, there is no statutory duty to do so. Under the clauses, hospital managers will be required to provide information on how to make a complaint about: first, functions under the Bill; secondly, any medical treatment for mental disorder received during their detention; and thirdly, the outcome of any complaint about medical treatment. That includes providing information about how to make a complaint to the Parliamentary and Health Service Ombudsman about the mismanagement of complaints about medical treatment, where the person believes their complaint to another body—for instance the hospital or CQC—was not appropriately investigated.
Hospital managers must take practicable steps to ensure that patients have understood complaints procedures, and information about complaints must be provided both verbally and in writing. The duty requires that information must be provided as soon as practicable after the patient is first detained, when the section that they are detained under changes, when the detention is renewed, or every 12 months for restricted patients under part III of the 1983 Act. For community patients, a duty is triggered as soon as it is practical after being placed on a community treatment order and as soon as practical each time the community treatment order is renewed. For conditionally discharged patients, it is triggered as soon as practicable after being conditionally discharged. I commend clauses 42 to 44 to the Committee.
Gregory Stafford
I rise to speak in favour of clauses 42, 43 and 44, which together strengthen the duty to inform patients—whether detained in the community or conditionally discharged—about how to make a complaint about their treatment and the outcome of that complaint. The Mental Health Act has long included duties to tell patients their rights, but too often that information has been patchy, hard to understand or buried in paperwork. The clauses tackle that by requiring clear, repeated information about not just detention, but treatment and the complaints process.
Clause 42 relates to information about complaints for detained patients. Section 132 of the Mental Health Act 1983 originally required hospitals to inform detained patients of their rights, but that was often inconsistently applied. This clause responds to long-standing concerns about transparency and patient empowerment, aligning with the broader goals of the Bill to enhance autonomy and dignity in mental health care. Specifically, there is an expanded duty of information. Hospital managers must now ensure that detained patients understand how to make complaints, not only about their detention, but about their treatment, along with the outcomes of any complaints.
There are some timing requirements, i.e. that the information must be provided as soon as practicable after detention begins and be repeated annually for restricted patients, or after each section 20 report for others. That will improve patient’s awareness of their rights and how to seek redress. It will promote accountability and mental health services by encouraging feedback and complaints, and support better outcomes by addressing grievances early and constructively.
Mental Health Bill [ Lords ] (Fifth sitting)
Stephen Kinnock ExcerptsTuesday 17th June 2025
(1 week, 3 days ago)
Public Bill CommitteesRead Full debate Mental Health Bill [HL] 2024-26 View all Mental Health Bill [HL] 2024-26 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 17 June 2025 - (17 Jun 2025)
The Chair
With this it will be convenient to discuss the following:
Clause 23 stand part.
New clause 4—General duty to secure sufficient resources for services in the community—
“(1) It is the general duty of integrated care boards to ensure, insofar as is reasonably practical, that services in the community responsible for delivering care, treatment, or detention provisions under the Mental Health Act 1983 and this Act have the necessary resources, including financial support, to meet service demands.
(2) Additional forms of resource may be determined by integrated care boards in consultation with relevant local authorities or health care service providers and may include—
(a) sufficient numbers of trained medical professionals;
(b) purpose-built facilities for patient care;
(c) community services responsible for out-patient care.
(3) Each Integrated Care Board must conduct an assessment of its resources every two years to evaluate its ability to deliver services in the community effectively.
(4) Each Integrated Care Board must publish a report outlining its findings upon completing the assessment in subsection (3). The first reports must be published within one year of the passage of this Act.”
This new clause places a general duty on integrated care boards to ensure that services in the community have the necessary level of resource to meet demand on services to ensure that the provisions of the Bill function as intended and to assess and report on this every 2 years.
The Minister for Care (Stephen Kinnock)
It is a pleasure to serve under your chairmanship, Sir Desmond. I will discuss a number of issues concerning community treatment orders and ensuring sufficient resources for community-based care.
Clause 22 will add the community clinician as a third key decision maker for community treatment orders, alongside the responsible clinician and approved mental health professional, ensuring additional professional oversight. Involving the community clinician in the initial request for a community treatment order will improve the planning and implementation of community treatment orders by ensuring good communication between ward and community doctors, aiding continuity of care. It should also help to prevent the inappropriate use of community treatment orders, for instance to free up beds where there are pressures on acute wards.
Making sure that only those who need to be on a community treatment order will be put on one supports the principles behind the reform of the Mental Health Act 1983, including the principles of least restriction, of therapeutic benefit and of treating the person as an individual. It should also positively impact the racial disparities that have been seen in the use of community treatment orders. The community clinician’s opinion is important when a patient is under a CTO, because the clinician may have a better understanding of the patient’s progress, including how well the patient is engaging with their treatment while in the community. Their insights are valuable in deciding whether the patient should be discharged to a community treatment order or recalled to the hospital if their symptoms worsen. Those who are supporting the patient in the community should be a part of the decision of whether the restrictions of the CTO are still required.
I turn to clause 23. In addition to reducing the number of people placed on CTOs, as has been referred to in relation to clauses 6 and 22, we aim to provide greater protection to those subject to them. CTOs extend the coercive powers of the Mental Health Act into people’s lives beyond hospital. CTOs should be used only when necessary, with conditions tailored to the individual rather than applying blanket restrictions. Currently, some CTO conditions display an overreach of power, such as requiring abstinence from alcohol even if this is unrelated to the person’s mental health condition. The clause will remove the ability of the responsible clinician to apply conditions to a person’s community treatment order which are appropriate but not necessary, giving a higher threshold for conditions to be set.
The clause will allow the mental health tribunal to recommend that the responsible clinician reconsider the necessity of conditions specified in a CTO if the tribunal determines that the patient is not yet suitable for discharge. For example, while not set out in the Bill, the tribunal may use this power if it finds the conditions imposed in a CTO to be possibly disproportionate, overly restrictive, lacking clinical benefit or not treating the person as an individual.
New clause 4 would place a general duty on integrated care boards in England to ensure that community services have the necessary resources to meet demand, and to report on this every two years. This duty to commission local services based on local need is already placed upon integrated care boards by the National Health Service Act 2006, as amended by the Health and Care Act 2022. An integrated care board must arrange for the provision of services as it considers necessary to meet the reasonable requirements of the people for whom it is responsible. Integrated care boards and their mental health trusts are required to prepare a joint forward plan that describes how the ICB will arrange for NHS services to meet their population’s physical and mental health needs. For that reason, we do not think the new clause is necessary, and it could place a disproportionate burden on ICBs and mental health providers. I therefore hope that the hon. Member for Winchester will be satisfied not to press it. I commend clauses 22 and 23 to the Committee.
Dr Evans
The hon. Member rightly talks about resources and about the cuts as a proportion—although small, it is a cut in NHS spending. The last Conservative Government brought in the mental health investment standard to try to ensure parity between physical health and mental health in investment so that, regardless of how big the pot was, mental health was prioritised. Does the hon. Member agree that there is a concern that that could be slipping under this Government? Does he agree that that needs to be addressed in the context of the community provision that we are discussing?
Gregory Stafford
I rise to speak to clauses 22 and 23 and to Liberal Democrat new clause 4.
As my hon. Friend the Member for Hinckley and Bosworth said, the Opposition support clauses 22 and 23 generally. Clause 22 addresses the concern that community clinicians—essentially, those responsible for overseeing a patient’s care outside hospital—have historically had limited formal input into decisions about community treatment orders, even though they are central to the patient’s ongoing care. It ensures that community clinicians not only are consulted but, in some cases, must provide written agreement before key decisions are made. It aims to improve continuity of care, ensure decisions reflect the realities of community-based treatment, and reduce inappropriate and poorly co-ordinated use of CTOs.
The benefits of the clause are obvious, but they are worth restating. Clearly, it improves the continuity of care and ensures that clinicians with direct knowledge of the patient’s community care are involved in those key decisions. It enhances safeguards, adding an additional layer of professional oversight before coercive measures are imposed or suggested. It promotes collaboration by encouraging joint decision making between the hospital-based and community-based clinicians, and it reduces the risk of inappropriate CTOs by ensuring they are used only when genuinely appropriate and supported by those delivering care.
However, I ask the Minister to touch on three points. First, requiring a written agreement or consultation could delay urgent decisions if not managed efficiently, so will he explain how, under the clause, any potential delay—a disagreement or just administrative inertia—can be removed to ensure treatment is not delayed?
That moves me on to the administrative burden. Clearly, the clause adds a level of complexity and requires more documentation and co-ordination. Although I understand that that is a necessary outcome, I would again be grateful for the Minister’s thoughts on how to ensure effective and speedy implementation.
As my hon. Friend the Member for Hinckley and Bosworth said, the ambiguity in the roles of the two clinicians may create confusion or disputes over responsibilities if they are not clearly defined or agreed. My reading of the clause is that there is no such clear definition; will the Minister look to provide one through other agencies, or will he put something into the clause in Committee or later in the Bill’s proceedings?
Clause 23, on the conditions of community treatment orders, addresses the concerns that the threshold for imposing conditions on community treatment orders has been too low, allowing conditions that may be clinically unnecessary or overly restrictive. By removing the “appropriate” test, the clause will tighten the legal standard to ensure that only necessary conditions are imposed.
Additionally, the clause will empower tribunals to play a more active role in scrutinising CTO conditions by allowing them to recommend that clinicians review specific conditions, even if the patient is not discharged. This reflects the Bill’s broader aim of enhancing patient rights and removing unnecessary restrictions.
The clause is a welcome addition. It will ensure that CTO conditions are imposed only when strictly necessary, meaning that there are stronger safeguards, and it will enhance the role of tribunals in protecting patient rights without requiring full discharge. It will reduce clinical overreach by preventing the use of overly broad or vague conditions that may not be clinically justified.
However, as with the previous clause, I have some questions. First, the tribunal power is limited in that it can only recommend, not require, the reconsideration of conditions. Is that the intention, or will the Minister strengthen the clause at some point to ensure that the tribunal can require a reconsideration of conditions? If he will not, what issues does he see arising from there not being a reconsideration?
Secondly, as I mentioned in my intervention on my hon. Friend the Member for Hinckley and Bosworth, I have a concern about the potential ambiguity in the shift from “appropriate” to “necessary” leading to uncertainty or dispute over interpretation. As we touched on in relation to other clauses, clinicians will need additional guidance or training to apply the revised standard consistently. Where will that revised training and guidance be located, and what is the timeframe for its implementation? We need to ensure that all clinicians are fully trained and ready to use this new power.
I will briefly touch on new clause 4, tabled by the Liberal Democrats, because although I understand that the hon. Member for Winchester may not press it, somebody else might. It would place a general duty on integrated care boards to ensure that services in the community have the necessary level of resource to meet demand such that the provisions of the Bill function as intended, and to assess and report on this every two years. As my hon. Friend the Member for Hinckley and Bosworth mentioned, the Opposition generally support the overall aims of the new clause, but as ever, there are some issues with the detail, so I have five questions for the hon. Member for Winchester if he responds, or for the Minister to answer in his summing up.
First, if we imposed a statutory duty on ICBs to ensure sufficient resources for the CTOs, what mechanisms would there be to monitor and enforce compliance? Secondly, what would be the consequences if an ICB failed to meet this duty? Would there be formal accountability or a sanction process? Thirdly, how would the duty interact with existing NHS budgetary constraints and competing priorities? Would it become a statutory obligation with no clear means of redress if unmet? Fourthly, could the duty set a precedent whereby Parliament mandates resource guarantees without providing additional central funding? Finally, what constitutes “sufficient” resources in the context of the CTOs? Who defines that standard, and it is defined locally or nationally?
Stephen Kinnock
The term “unreasonable delay” is subject to review by the courts, and further guidance will be given in the code of practice. On what happens if the responsible clinician and the community clinician disagree, the addition of a third decision maker is not about overruling the responsible clinician, who continues to have overall responsibility for the patient on the community treatment order. Including the community clinician at the point of putting someone on a community treatment order helps to ensure continuity of care for the patient. Involving the community clinician in other decisions around the community treatment order, particularly recall, revocation, renewal and discharge, means they can provide an additional insight into the patient’s status while in the community.
Dr Evans
I am grateful for the clarification. Does it mean that, in essence, there will be a hierarchy, so the responsible clinician is above the community clinician and trumps them? If a community treatment order cannot be signed off, it does not exist. I want to explore that angle; is that what the Minister is suggesting?
Stephen Kinnock
Yes, the responsible clinician has primacy.
On the workforce impact, our impact assessment, which was published alongside the Bill, sets out the additional hours of required clinician activity. We will invest in implementing these reforms.
On the meaning of the word “necessary”, we will provide further guidance in the code of practice to provide for a range of scenarios to help to clarify necessary conditions, as well as to clarify that failure to meet those conditions should not always result in recall to hospital.
On the requirement for a responsible clinician to respond to recommendations, we considered giving the tribunal the power to change or remove conditions on a person’s community treatment order. However, the outcome of our stakeholder engagement was that tribunal colleagues did not consider that it was appropriate for them to make clinical judgments, for example whether a condition is of clinical benefit. Providing the power to recommend that the responsible clinician reconsiders the conditions allows the tribunal to provide additional scrutiny but also allows for clinical discretion in decision making.
The hon. Member for Farnham and Bordon asked about training. The training plan will be in the first written ministerial statement.
On where the terms are defined, clause 10 defines responsible clinician and clause 22 defines community clinician. We will define the distinction between the roles in the code of practice.
Question put and agreed to.
Clause 22 accordingly ordered to stand part of the Bill.
Clause 23 ordered to stand part of the Bill.
Clause 24
Nominated person
Question proposed, That the clause stand part of the Bill.
The Chair
With this it will be convenient to discuss the following:
Amendment 54 to schedule 2, page 77, line 21, at end insert—
“(3) Where the patient has not attained the age of 16 years, a nominated person must have parental responsibility for the patient.”
This amendment would stipulate that the nominated person for a patient under 16 must have parental responsibility for the patient.
Amendment 55 to schedule 2, page 80, line 13, after “2(2))” insert
“, has parental responsibility for the patient (see paragraph 2(3))”.
This amendment would stipulate that the nominated person for a patient under 16 must have parental responsibility for the patient.
Government amendments 40 and 41.
Schedule 2.
Clauses 25 to 28 stand part.
Stephen Kinnock
I will discuss a number of issues concerning the topic of the nominated person, one of the Bill’s key reforms. I will first address clause 24 and schedule 2, which seek to replace the current nearest relative provisions with the nominated person, chosen by the patient, who can protect their rights when they are detained. The independent review found the nearest relative provision to be outdated and inappropriate. It allocates someone based on a hierarchical list, which does not reflect modern families and could result in someone unfamiliar or potentially risky to the patient being given the role.
We have ensured that appropriate safeguards are in place to protect patients as well as to enable choice. A health or social care professional or an advocate must witness the nomination and confirm in writing that the nominee meets the criteria and that no undue pressure has been put on the patient. Children and young people with the relevant capacity or competence can choose their own nominated person. We expect this will be their parent or guardian, but sometimes a step-parent or other relative over 18, without parental responsibility, may be more suitable to protect a patient’s rights. Safeguards will be put in place to support children in making this choice.
If a patient of any age lacks capacity or competence to make a nomination, an approved mental health professional will appoint a nominated person on their behalf. For children under 16, this will be someone with parental responsibility, including the local authority if the child is subject to a care order. This appointment is temporary until the patient has capacity or competence to make their own appointment.
For all patients, the responsible clinician or approved mental health professional can temporarily overrule the use of a particular nominated person’s power, for example to discharge the patient, if the patient is likely to act in a manner that is dangerous to themselves or others. A nominated person can be removed by the county court if deemed unsuitable—for example, if they misuse their powers or neglect the patient’s welfare or the public interest. Anyone with an interest in the patient’s welfare, such as their parents, can apply to the court. The Bill extends the nominated person safeguard to some restricted part III patients, but their nominated person’s powers will be limited, as appropriate, in the interests of public safety and criminal justice.
Amendments 54 and 55 would require nominated persons for patients under 16 to have parental responsibility for the child, whether chosen by the child or appointed for them. The Bill currently requires this if the child lacks competence to appoint their own nominated person. However, where a child has competence to decide, we think it is right that they can choose the person to represent their interests. That view was supported by the majority of respondents to the White Paper consultation on reform of the Mental Health Act, and it is in keeping with the principles of choice, autonomy and treating the person as an individual.
Like the current “nearest relative” provision, which the nominated person will replace, the amendments do not take into account the greater diversity of modern family structures—for example, where a step-parent may play a vital role in a young person’s life but does not have formal parental responsibility. Our engagement with children and young people during the development of the Bill suggests that the vast majority will appoint a parent as their nominated person. However, we think having choice is important to prevent children from having to have a nominated person who may not engage with the role or act in accordance with their best interests, just because they have formal parental responsibility.
Where children have competence to choose their own nominated person, a health or social care professional, or advocate, will be required to witness the nomination and confirm in writing that the nominated person is over 18 and suitable to take up the position. Regardless of nominated person status, parents should be involved in a child’s care and treatment, and they will retain their legal rights under parental responsibility. Safeguards are in place to allow for the overruling and displacement of the nominated person if they are behaving in a way that is not in the child or young person’s best interests.
Government amendments 40 and 41 will remove paragraph 11(3) to 11(5) of schedule 2 from the Bill, as it is unnecessary to specify in legislation which person with parental responsibility the approved mental health professional must appoint as nominated person for an under 16-year-old. A prescriptive list of who an approved mental health professional must appoint for a child under 16 may prevent a more suitable adult from being chosen as the nominated person. The Bill states that for under-16-year-olds lacking competence, an approved mental health professional must appoint a parent, or whoever has parental responsibility, to be the child’s nominated person. This would include consideration of special guardians and child arrangement orders.
The Government do not agree that a person with residual parental responsibility should always be blocked from being a nominated person, as the child arrangement order or special guardianship may be in place for reasons other than the parent being a risk to the child. For example, the parent might struggle with their own health issues, but that does not necessarily mean that they would not be an effective nominated person. The situation is different in the case of a care order because the local authority is being given lead parental responsibility. We have engaged with the Children’s Commissioner on that point.
If there is no suitable person with parental responsibility willing to act, the approved mental health professional must take into account the patient’s past and present wishes and feelings, so far as reasonably ascertainable, when deciding who to appoint. We will establish an expert taskforce to support the development of the statutory code of practice to provide clear guidance for professionals involved in the nominated person appointment process for children and young people.
Clause 25 will require the approved mental health professional to consult the nominated person before they make an application for admission for treatment or guardianship. This is an existing right for the nearest relative. However, currently if the nearest relative exercises one of their powers, such as the ability to block admission, but the professional believes their objection is unreasonable, the only means of overruling them is to remove or displace them as the nearest relative. This can leave patients without someone to represent their interests during detention.
Clause 25 will allow the approved mental health professional to make use of the existing barring order to temporarily overrule the nominated person, if the patient would be likely to act in a manner dangerous to other persons or themselves if their admission was blocked. This is a well-established process. Although the nominated person can continue to represent the patient in other ways, they can still be displaced by the court from the role entirely if their actions indicate they are unsuitable for the role—for example, if they are repeatedly objecting to admission without considering the welfare of the patient or the interests of the public. Approved mental health professionals can continue to use that process.
Clause 26 will transfer the nearest relative provisions relating to the power to order discharge of a patient to the new nominated person role. The power can be temporarily overruled by a responsible clinician if they think that the patient’s discharge would result in danger to themselves or others. It is a well-established process that allows for clinical discretion, but means that the nominated person can continue to represent the patient’s rights in other ways. Clause 26 also reduces from six months to three months the time period during which the nominated person cannot make another order for discharge. That reflects the changes in detention periods under clause 29.
Clause 27 will give the nominated person a new power to object to the use of a community treatment order. We also recognise, however, the importance of protecting patients and the public, so if the responsible clinician is concerned that without a community treatment order, there would be a risk of danger to the patient or others, they can overrule the nominated person’s objection. Those changes will help both to reduce the number of inappropriate community treatment orders and to ensure that safeguards are in place for patient safety and public protection.
Finally, clause 28 provides that before deciding to transfer a patient, the person responsible for taking that decision must consult the patient’s nominated person, unless consultation is not reasonably practicable or would involve unreasonable delay. The nominated person will not be able to object to a transfer, because there may be good reasons for transferring a patient—for example, if a different trust can provide better care, such as a specialist eating disorder unit. Consulting the nominated person, however, means that they are aware of the reasons for transfer and how it will benefit the patient. That will help the nominated person to remain actively involved in protecting patients’ rights and kept informed about a patient’s care and treatment.
Dr Evans
I welcome the chance to contribute to the debate on clauses 24 to 28. I will then turn to Government amendments 40 and 41 and to amendments 54 and 55, tabled by my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer).
Clauses 24 to 28 represent a significant reform to the Mental Health Act 1983. They seek a shift from the traditional concept of a nearest relative to giving patients more control by allowing them to nominate a person to act on their behalf. Clause 24 is the cornerstone of the reform, establishing the role of a nominated person as the patient’s chosen individual to take over certain rights and responsibilities previously held by the nearest relative. It represents a fundamental change from a fixed family-based system to one centred on patient choice and autonomy.
Currently, the nearest relative, often by blood relation, holds a range of statutory powers under the Mental Health Act, regardless of the quality of their relationship with the patient. The clause will enable patients, especially adults, to nominate a trusted person—a family member, friend or advocate—who can act in their best interests. That is a progressive and patient-focused change relating to modern social realities, where family ties are complex and a biological relative is not always the best supporter.
Empowering patients to select their nominated person can enhance trust, improve communication and ultimately lead to better care outcomes. It does, however, raise pressing questions. For children and young people, particularly those aged 16 and 17, who gain legal capacity to nominate, what safeguards ensure that parental concerns and children’s welfare remain adequately considered? How will disputes between nominated persons and relatives, or between the nominated person and clinicians, be resolved? Part of that might be addressed in Government amendments 40 and 41, but I am keen to understand a little more. What training and oversight will ensure that nominated persons understand their duties and, importantly, their boundaries? Finally, for a patient who does not or cannot nominate someone, will the nearest relative still have a role, and how will that be managed?
Clause 25, on applications for admission or guardianship, builds on clause 24. It will require the approved mental health professional to consult the nominated person before making applications for admission or guardianship, except where consultation is not reasonably practicable or would cause unreasonable delay. It will also allow the nominated person to object to such applications, requiring a barring report from the approved mental health professional if an objection is made.
The clause will formalise the nominated person’s involvement at a critically early stage of the intervention, ensuring that their voice can influence decisions that deeply affect the patient. The power to object introduces an important check, though it is balanced by the professional’s ability to override objections on the grounds of safety. The Opposition agree with that, but there are still some questions. How will professionals navigate conflicts between their clinical judgment and objections by the nominated person? Will there be clear guidance to avoid delays that could jeopardise patients or public safety?
Oral Answers to Questions
Stephen Kinnock Excerpts(1 week, 3 days ago)
Commons ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Charlotte Cane (Ely and East Cambridgeshire) (LD)
The Minister for Care (Stephen Kinnock)
After years of underfunding, the Government agreed a record uplift of £3.1 billion for ’25-26 for the pharmacy sector. The pharmacy access scheme provides £19 million to support pharmacies in areas with fewer pharmacies, including in rural areas, but funding must always come with reform. Our hub and spoke legislation, if it is passed in the other place today, will allow pharmacies to streamline their dispensing processes, and it is a major step in the right direction in marrying reform with investment.
Caroline Voaden
I recently visited Modbury pharmacy, where owner Phil Dawes highlighted the challenges facing small rural pharmacies. He explained how the current funding model does not take into account the lower footfall and limited referral rates that are common in rural areas. We know that if a pharmacy in a small market town closes, it can cause extreme difficulties for people to access advice and medicines, particularly where there is little or no public transport and they have to go a long way. Will the Government consider introducing rural exceptions or adjusted funding thresholds so that we can keep community pharmacies open?
Stephen Kinnock
The pharmacy sector is facing huge challenges after massive cuts over the past 14 years. We are beginning to rebuild, but the hon. Lady is right that there are particular challenges for rural pharmacies. We are looking at comprehensive reform in the pharmacy sector involving the better use of technology, hub and spoke dispensing, and a range of other options that would enable better remote dispensing for rural pharmacies.
Charlotte Cane
I have visited pharmacies across my constituency. They are all struggling to provide a service, but are all very keen to take on the new services that the NHS is suggesting. Will the Minister commit to ensuring that rural and community pharmacies are properly staffed and equipped to deliver those community services, such as diabetes testing and weight management treatments, so that patients are not left behind just because of where they live?
Stephen Kinnock
The hon. Lady is right that pharmacies will play a central role in the shift from hospital to community that we will be putting at the heart of our 10-year plan. An important part of that, of course, is Pharmacy First. The take-up of Pharmacy First is not what we would like it to be, so we are looking at options to increase awareness of Pharmacy First and to free up pharmacists to be able to operate at the top of their licence. Part of that is about streamlining the dispensing side of what they do, and the hub and spoke legislation that I mentioned earlier will be really important in that context.
Steve Yemm (Mansfield) (Lab)
The Minister has spoken many times about the importance of shifting from hospital to the community. I have visited many local pharmacies and met the chair of Community Pharmacy Nottinghamshire, seeing at first hand the important work they do to support communities in Mansfield. Does the Minister agree that community pharmacies have a key role to play in that shift and could help to take pressure off GP surgeries?
Stephen Kinnock
My hon. Friend is absolutely right, and I commend him for the work he is doing in his constituency, including with pharmacies. In many ways, what we want to see is a culture change, because the interface between general practice and community pharmacy is not where it should be. We believe that pharmacists have a huge amount more to offer, but that requires a better digital interface and better information sharing—a single patient record. That sort of vehicle will be really important for delivering some of those reforms.
Dr Luke Evans (Hinckley and Bosworth) (Con)
I am pleased to hear the Minister speak about Pharmacy First, which was brought forward by the previous Government and welcomed by communities, the public and the pharmacists. Although I am pleased to see the Government continue it, why have they decided to cap the number of consultations that a pharmacist may do?
Stephen Kinnock
Part of that is about the financial arrangements for Pharmacy First, which need to be set at a level that incentivises pharmacists. Sadly, given the way in which the scheme was set up under the previous Government, those incentives were not working, which is one reason why the take-up of Pharmacy First has not been what it needs to be. It is a question not of capping but much more one of getting the right level of financial compensation for Pharmacy First so that it works and incentivises the system.
Dr Evans
I am grateful to the Minister for his answer, but part of the problem is that once pharmacists hit that cap, they are no longer paid the £17 per consultation. In turn, that means that either patients will be turned away, or the pharmacist must take the hit and pay for it themselves. That disjoins the system and could create extra costs, because patients who are turned away will turn up in other areas of primary care, such as their GP surgery. How does that fit with Darzi’s push towards community-based services?
Stephen Kinnock
The hon. Gentleman will have seen—and I am sure will welcome—the record uplift of £3.1 billion that we are putting into the pharmacy sector after years of underfunding, incompetence and neglect from the Conservative party. A big part of this is ensuring that the shift from hospital to community takes place, and we want pharmacists to be taking pressure off primary care. We have to make Pharmacy First work effectively, which means getting the allocation of funding right. That is what we are working on in terms of reforms. Now that we have the spending review and the package, that is what we will be delivering.
Sadik Al-Hassan (North Somerset) (Lab)
Tim Farron (Westmorland and Lonsdale) (LD)
The Minister for Care (Stephen Kinnock)
I know this is an important issue for the hon. Member from the meeting we had about it last year. This Government are supporting local providers by recruiting an additional 8,500 mental health workers by the end of this Parliament. We are also expanding NHS talking therapies and piloting six new 24/7 neighbourhood mental health centres, including Hope Haven serving Whitehaven and rural Copeland.
Tim Farron
I thank the Minister for his reply, but this month the Care Quality Commission found high levels of staff vacancies in the already understaffed psychiatric intensive care units and acute mental health wards in South Cumbria, concluding that this is putting patient safety “at risk”. Yet, worryingly, the ICB in South Cumbria is making additional cuts of £142 million this year, with North Cumbria also making cuts. In the light of that, what is his plan to intervene to ensure that mental health staffing in Cumbria is increased to safe levels?
Stephen Kinnock
I thank the hon. Member for that. There is no doubt that the NHS, universities and others need to do more to get students, trainees and qualified doctors and mental health specialists in places where the NHS and patients need them. We will publish a refreshed workforce plan later this year to ensure that the NHS has the right people in the right places to care for patients when they need it.
Chris Kane (Stirling and Strathallan) (Lab)
The SNP has cut mental health services across Scotland, while failing to recruit the necessary workforce in rural communities such as those in Stirling and Strathallan. What assessment has the Department made of how devolved mismanagement of mental health services is affecting outcomes for patients in rural Scotland?
Stephen Kinnock
If we were to make an assessment of the way in which the SNP has mismanaged its responsibilities in Scotland we would be here for a very long time. I am not sure I can answer my hon. Friend’s question in the round, but I am sure that colleagues from the SNP will be welcoming the record investment that the UK Government have made in Scotland. I am certainly looking forward to the improved outcomes that they will be delivering as a result.
Andrew Rosindell (Romford) (Con)
The Minister for Care (Stephen Kinnock)
The spending review announced increases in NHS spending alongside more money for adult social care. By investing in DEXA scanners, we can more rapidly treat conditions such as osteoporosis, which particularly affect elderly women. Our urgent and emergency care plan promotes falls prevention technology for longer independent living and fewer hospital admissions. GPs are now incentivised to improve continuity of care, benefiting patients with long-term conditions.
Andrew Rosindell
I thank the Minister for his reply, but as the Secretary of State knows only too well, my borough of Havering contains one of the highest numbers of elderly people in the entire London region, yet Queen’s hospital in Romford remains chronically underfunded, overstretched and struggling to meet the growing healthcare needs of an ageing community. Will the Minister commit today to the serious investment that Queen’s hospital so desperately requires to ensure better health outcomes for older people across Romford?
Stephen Kinnock
I carefully note the fact that the Secretary of State for Health and Social Care, who is sitting next to me, has an interest in this issue, so I will tread very carefully with my answer. I understand that the hon. Gentleman has discussed this matter with the Minister for Secondary Care. The North East London health and care partnership integrated care board is responsible for delivery, implementation and funding decisions for local services, but the hon. Gentleman’s representations have been carefully noted today, not least by the Secretary of State for Health.
Mr Toby Perkins (Chesterfield) (Lab)
One of the most important things we can do to support the health of the elderly is to ensure that they can get to see their local doctor. It is great to hear the Health Secretary talk about the improved access to appointments—we are seeing that in Chesterfield—but he is also right to say that it is the first step back up the mountain. The Government inherited a real crisis in GP access and the situation is particularly difficult in more deprived areas. Will my hon. Friend tell me what more we will do to ensure that people are able to see a GP, and in particular that practices that serve the most deprived communities can get access to the extra GPs they need?
Stephen Kinnock
My hon. Friend will know that when we came into Government we inherited the absurd situation where the additional roles reimbursement scheme was weighed down by red tape and it was not actually possible to recruit GPs. We changed that. We invested an extra £82 million and as a result we have well over 1,000 more GPs on the frontline, but that is just the beginning. We have contract reform and £889 million of additional investment in general practice, and we are moving forward with an online booking system, which will be obligatory by 1 October. We have much more work to do—for example, around the interface with pharmacy; we are working hard on that. There is a lot more to do, but my hon. Friend is right that the first step up the mountain has been taken.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
Last health questions, I asked about delays to crucial medications in A&E and the Secretary of State said he was interested to hear more, but his office said he would delegate it to a Minister and we still have not been offered a date, so could I encourage him to look into that, please? The U-turn on winter fuel will help the elderly to stay warm and healthy this winter, but another way to help elderly people would be to protect them from the respiratory syncytial virus. Will the Government extend the vaccination to the over-80s?
Stephen Kinnock
I thank the hon. Lady for that question, but I did not quite catch the word she used. The virus was called? [Interruption.] Oh—RSV, yes. We are certainly looking at increasing the coverage of the RSV vaccination. I do not have the statistics to hand at the moment, but I would be happy to write to her on that point.
Dr Johnson
Many of those on waiting lists are elderly and have chronic conditions; rather than seeing consultants at regular intervals, which may coincide with them being relatively well, they are often kept on open appointments so that they can call when they are ill. This is efficient and responsive care. Is the Minister aware that this provision is being stopped in some areas in order to improve figures? I will quote from a letter about an elderly patient:
“I regret cannot keep him on my waiting list under the open appointment”
for treatment, and,
“I have explained the politics of everything and where we are at.”
Being re-referred to a GP each time is expensive and a waste of time. Can the Minister explain why doctors are being asked to make decisions for political reasons, instead of clinical ones?
Stephen Kinnock
I do not think any decisions are being made for political reasons—our medical and health staff are very much focused on doing the right thing from a clinical point of view. The hon. Lady raises an important point about continuity of care, with people constantly having to be re-referred into the system. Part of the reason for that is the utter incompetence with which the previous Government managed our primary care system, which has resulted in people being passed from pillar to post, the additional roles reimbursement scheme not actually being about having GPs on the frontline, but about having other staff, which creates more friction in the system, and poorer continuity of care. This Government are going to bring back the family doctor—that is the way to get our general practice back on its feet.
Mark Ferguson (Gateshead Central and Whickham) (Lab)
Laura Kyrke-Smith (Aylesbury) (Lab)
The Minister for Care (Stephen Kinnock)
We are getting the NHS back on its feet and making it fit for the future by shifting care to the community with £889 million more for GPs, 1,700 additional frontline GPs, 700,000 extra urgent dental appointments annually and a 19% uplift to the community pharmacy contract. Looking to the future, our commitment to building a neighbourhood health service is right at the heart of our 10-year plan.
Laura Kyrke-Smith
I am delighted by the Government’s commitment to moving healthcare closer to the community, including through the establishment of neighbourhood health centres. That is exactly what we need in Aylesbury, and I am pleased that all our key healthcare providers, including the NHS trust and several GP practices, are already working together to better integrate their care, which is an important step in the right direction. Will the Minister update me on his progress towards the model of neighbourhood-based healthcare? Can he advise what more Aylesbury’s healthcare providers can do to ensure that my residents benefit from the Government’s work in this area?
Stephen Kinnock
It is really good to hear about the fantastic work going on in my hon. Friend’s constituency. We are working with systems to move to a neighbourhood health model by building on existing good practice, particularly around the development of multidisciplinary teams. Aylesbury is an outstanding example of that. Ahead of the 10-year health plan’s publication, local communities can continue to make progress by utilising the neighbourhood health guidelines that were published back in January.
Graham Stuart (Beverley and Holderness) (Con)
Dental patients with untreated need end up in hospitals. In places like Hedon in my constituency, we have seen more and more dental practices moving away from the NHS. I have a constituent who found it took her three years to get her child their first check-up, and that dental practice has now ceased to look after NHS patients. She also cannot get the NHS treatment she deserves herself, even though she had a child in February. What in the 10-year plan will change that and ensure that everyone can get access to NHS dentistry?
Stephen Kinnock
The right hon. Member is right to point to children’s dental health. After we won the election in July, I looked across my portfolio and it was pretty much a car crash in every aspect, thanks to the incompetence of previous Governments. Perhaps the most shocking statistic of all is that the biggest reason five to nine-year-old children are admitted to hospital is to have their rotten teeth removed. That is a Dickensian state of affairs. We are working with the British Dental Association on contract reform. We have got to incentivise NHS dentistry, do away with the false economy set up under the last Government and get dentistry back to where it needs to be.
Michelle Welsh (Sherwood Forest) (Lab)
The saying goes that it takes a village to raise a baby, meaning that those in our community provide families with vital support. Does the Minister agree that we need to invest in more community midwives to ensure that families are properly supported through the whole of pregnancy and after birth?
Stephen Kinnock
I thank my hon. Friend for that important question. The role that midwives play, alongside other community health services such as district nurses, has been chronically underfunded and neglected over the past 14 years. She will be pleased to know that the role of community healthcare is front and centre in our 10-year plan, and I think she will be interested in and pleased with what she sees when that plan is published.
Ellie Chowns (North Herefordshire) (Green)
The Darzi report pointed out that 13% of hospital beds are occupied by people who are fit for discharge but who cannot get out because social care is broken. Lord Darzi said that we cannot fix the NHS until we fix social care. It is nearly six months since the Secretary of State promised cross-party talks and a commission, but the talks were cancelled and never rescheduled and the commission is delayed. Please, when will the Government stop going slow on social care? Please, when can we all get around the table to talk about fixing social care so that everyone gets the care they deserve?
Stephen Kinnock
I have to correct the hon. Lady: the commission is up and running, Baroness Casey has started meetings and she had a roundtable just a few weeks ago with people who have lived experience. The hon. Lady is therefore not correct on that point and I am sure that she will want to correct the record.
On the point about delayed discharge, the hon. Lady is absolutely right. We are reforming the better care fund to get much better interface between hospitals, care and local authorities. That system and those relationships can and should work much better, but there are pressing, long-term challenges. We are conscious of that and are working at pace with Baroness Casey to ensure that those reforms are delivered.
Helen Morgan (North Shropshire) (LD)
As we have just heard, it is widely acknowledged that the crisis in social care is a cause of dangerously high occupancy rates in hospitals that lead to the horrors of corridor care, the dreadful ambulance waiting times that we have seen and a knock-on effect on the community. When I was contacted by the family of a terminally ill man in Wem in my constituency last month, I was reminded that not only is care often provided in the wrong place, but it is often not available at all. Will the Government bring forward the timeline for the horribly delayed Casey review to report back, get it done this year and heed Liberal Democrat calls for cross-party talks so that we can agree on a long-term solution for the crisis?
Stephen Kinnock
May I just tackle the idea that we are not working at pace on these issues? We have had the unpaid carer’s uplift from £151 to £196, which is the biggest uplift in carer’s allowance since the 1970s when the policy was brought in; hundreds of millions of pounds’ uplift in the disabled facilities grant; and groundbreaking legislation for a fair pay agreement for care workers. Those are just some of the immediate steps that we have taken. The first phase of the Casey review will report next year and we continue to work closely with Baroness Casey to deliver the reforms that are so desperately needed after 14 years of neglect, including a number of years when the Liberal Democrats were in government.
Charlie Dewhirst (Bridlington and The Wolds) (Con)
The Minister for Care (Stephen Kinnock)
I am sorry to hear about the issues that my hon. Friend’s constituents are experiencing. I understand that he has raised the issue with the North East and North Cumbria ICB, which is investigating his concerns. I would be happy to be kept informed, and if he is not happy with the outcome of that investigation, he should certainly come back to me. This Government are committed to supporting community pharmacies after a decade of underfunding and neglect. We recently agreed a record uplift to £3.1 billion for 2025-26.
Bob Blackman (Harrow East) (Con)
The Secretary of State may well be aware of the greater awareness among young people of nicotine pouches. That seems to be a gap in the Tobacco and Vapes Bill currently going through Parliament. Will he commit to look at this issue to ensure that it is covered and that we bar this alongside other forms of tobacco and nicotine?
Stephen Kinnock
We have provided hospices in England with a record £100 million in capital funding, as my hon. Friend will know. ICBs are responsible for commissioning palliative and end-of-life care services, including hospices, to meet the needs of their local populations. NHS England has published statutory guidance to support that. I would of course be more than happy to meet my hon. Friend to discuss that further.
Adrian Ramsay (Waveney Valley) (Green)
The British Dental Association recently published analysis showing that the proportion of NHS funding spent on dentistry more than halved under the Conservatives, who failed to account for inflation and demand to the cost of £1 billion. It is no wonder that we have dental deserts across much of the country. Will the Secretary of State ensure that dentistry receives its fair share of funding from the new NHS funding allocated in the spending review?
Stephen Kinnock
The hon. Gentleman is absolutely right to point to the neglect and incompetence of the past 14 years. We are fighting to get NHS dentistry back to where it needs to be. An important first step, of course, is the 700,000 additional urgent appointments and supervised tooth-brushing programme, but long-term contract reform is what is needed, alongside the investment that will come through the spending review.
Ben Coleman (Chelsea and Fulham) (Lab)
According to the Trussell Trust, the impact of hunger and hardship on people’s health is driving an extra £6.3 billion in Government healthcare spending. What part is the Department playing in reducing hunger and hardship—and thus the related healthcare cost—in my constituency and across the country?
Stephen Kinnock
My hon. Friend is right to raise that important point. It is truly shameful that 4.5 million children in the UK now live in poverty. We are developing an ambitious strategy that tackles root causes, and we are already taking action. Alongside cross-Government work on free school meals, breakfast clubs and funded childcare, the Department is investing £56 million in Start for Life services and supporting healthy diets for 358,000 people through Healthy Start.
Mr Gagan Mohindra (South West Hertfordshire) (Con)
Opticians are important medical professionals for our community. Unfortunately, when I spoke to the Hertfordshire and West Essex integrated care board, I was told that it will not allow opticians to perform vital services such as treating minor eye injuries, as doing so is deemed too expensive, despite that being the norm in the areas surrounding my constituency. Will the Minister meet me to discuss how we can ensure a fair system across the country, rather than a postcode lottery?
Stephen Kinnock
The hon. Gentleman is right to point to the anomalies in the eyecare system. There are concerns about the role that some aspects of the independent sector are playing, particularly in the light of the lucrative nature of cataract operations. If he writes to me, I will be happy to set out the issues, and I guarantee that he will get the response in due course.
James Wild (North West Norfolk) (Con)
In March, the Minister for Care told me that no decision could be taken on a new dental school at the University of East Anglia until the spending review settlement was known. Now that we know it, will he instruct the Office for Students to allocate new training places at the UEA from 2026?
Stephen Kinnock
The spending review has just been published. The key now is to secure the allocations within the overall financial envelope. That will take a matter of weeks, and I will be happy to report back to the hon. Member once we have that clarity.
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
Between 2001 and 2011, the 15% health inequalities weighting in NHS allocations made a positive, measurable difference to the health of deprived people. Unfortunately, it was cut to 10% in 2015. With the spending review’s increase in funding to the NHS, when will the health inequalities weighting reach 15%?
Claire Hazelgrove (Filton and Bradley Stoke) (Lab)
The challenge of finding and keeping an NHS dentist is raised with me time and again across the Filton and Bradley Stoke constituency, and I welcome the early action that this Labour Government have taken to introduce more than 19,000 urgent care appointments across our integrated care board area. What will be the next steps to help ensure that NHS dentistry is opened up again to everybody?
Stephen Kinnock
I thank my hon. Friend for that question and her relentless campaigning on this issue. She is right that the 700,000 urgent dental appointments are a first step, and we are looking to embed that so that it goes forward every year of this Parliament. The broader issue is around contract reform. There is no perfect contract system—the current one clearly is not working—and we are looking at options around sessional payments, capitation, and getting a contract that works and brings dentists back into the NHS.
Blake Stephenson (Mid Bedfordshire) (Con)
The Secretary of State will know that my local ICB in Bedfordshire, Luton and Milton Keynes is set to merge with Hertfordshire, Cambridgeshire and Peterborough. The new ICB will cover a population of about 3 million people. Given the difficulties we have had securing a GP surgery in Wixams, will the Secretary of State set out how supersizing that quango will help rural mid-Beds to get the local healthcare it needs?
Terminally Ill Adults (End of Life) Bill
Stephen Kinnock ExcerptsFriday 13th June 2025
(2 weeks ago)
Commons ChamberRead Full debate Terminally Ill Adults (End of Life) Bill 2024-26 View all Terminally Ill Adults (End of Life) Bill 2024-26 Debates Read Hansard Text Watch Debate Read Debate Ministerial Extracts Amendment Paper: Consideration of Bill Amendments as at 13 June 2025 - large print - (13 Jun 2025)
Dr Kieran Mullan (Bexhill and Battle) (Con)
May I start by offering the condolences of His Majesty’s Opposition to all those affected by the Air India plane crash, including the families of the very many British citizens who, very sadly, lost their lives. Our thoughts are with all of them.
As is well understood now, the Opposition remain neutral on the principle of whether assisted dying should be introduced. That will depend on the Bill’s progress through its remaining stages in this and the other place. However, I wish to raise two important matters. First, on the matter of time, all of us understand the considerable challenges that Mr Speaker faces in having to balance the desire of colleagues to speak on this matter with the limited time available for private Members’ Bills—I know that he is doing his best to strike that balance. A number of Members have pointed out that the time being given to this Bill is significant and more than that normally allocated to even quite substantial Government Bills. None the less, it is right to acknowledge that this is far from an ordinary Bill.
It is hard to think of a more deeply consequential and highly contentious piece of legislation for our society. The reality is that, both today and in previous sittings, a number of Members have been unable to speak. There has been an informal time limit on speeches, and interventions have necessarily been limited as a result. Debate in this House is important not just because it decides how we vote, but because it is used by the courts to help interpret legislation. A more limited debate limits the scope for that.
Ordinarily, a Minister would have significant time at the end of Report to deal with amendments, provide clarification and explain intention, in a way that the promoter of the Bill will not. Again, a majority of Members may be satisfied with that, but very many are not. Although what we decide on the business of the House is ultimately determined by majority vote, how we reach a decision and how we allow alternative views to be explored matters. We should all consider whether we want a debate of such importance to be curtailed in the manner that it has been.
I ask the Government to consider assisting Mr Speaker by making more time available for us to ensure that, on Third Reading, we have the fullest debate possible, with every Member having a reasonable opportunity to speak and take interventions in the way that they would like.
Secondly, Members will be aware that the Bill, although extensive, is not the full picture. As others have highlighted, significant elements of how assisted dying will operate are due to be determined by future delegated legislation. The Government’s delegated powers memo notes that the Bill contains 38 delegated powers, including Henry VIII powers, and more powers are contained in the promoter’s amendments that are scheduled for decision today. They include matters such as the content, form and thoroughness of doctors’ reports, regulations for replacing a co-ordinating doctor who is unable or unwilling to continue, and decisions on who will be notified of the panel’s decision, which has been raised as an important potential safeguard. Those are not trivial matters. These pieces of legislation cannot be amended and MPs can vote only yes or no. In some cases, they are unlikely to be debated, and they almost certainly will not be on the Floor of the House. It is important for Members to fully understand that. MPs often have to weigh up the consequences of rejecting such legislation when they disagree with it, because it could leave a void.
Members are well within their rights to be content to proceed regardless. Certainly, a majority of the Committee have presented a Bill to the House with the composition as described. That is, of course, a legitimate choice for Members to make. We have heard in the debate today about amendments to curtail these powers, and Members will need to decide their views on that. I urge the Government, in the interests of helping Members to have the clearest possible idea of how a scheme they are being asked to vote on will operate, to provide as much detail as possible on what these future regulations might consist of. Although we will not be able to have all the answers, I think most Members would agree that it is better that we vote with more detail, rather than less, even if they are satisfied to support assisted dying in principle. This is something that only the Government can do. I ask that the Minister reflects on that challenge in his closing remarks, alongside giving the Government’s response to those asking for more Government time to allow wider debate with more Members able to speak.
I emphasise again that the Opposition remain neutral on whether we should introduce assisted dying, but it is incumbent on us to at least draw attention to matters of procedure that can be addressed only by the Government. I look forward to the Minister addressing the concerns of Members along the lines reflected in my remarks today.
The Minister for Care (Stephen Kinnock)
I associate the Government with the words of the Opposition spokesman regarding the tragic incident in India.
As Members will know, the Government remain neutral on the passage of the Bill and on the principle of assisted dying. We have always been clear that this is a decision for Parliament. However, the Government are responsible for ensuring that the Bill, if passed, is effective, legally robust and workable.
Let me start with a brief observation about the process and, in particular, the time made available to Parliament to scrutinise the Bill. The Bill has received over 90 hours of parliamentary time, which is more than most Bills receive. More than 500 amendments were tabled and considered in Committee. I thank Members on all sides of the debate for their contributions during the extensive consideration and scrutiny that the Bill has received.
Given the time, I will confine my remarks on the amendments to those about which the Government have significant legal or operational concerns, and those tabled by my hon. Friend the Member for Spen Valley (Kim Leadbeater) to address significant workability concerns. Before I get into the detail, I remind the House that a full list of amendments tabled by my hon. Friend that the Government deem essential or highly likely to contribute to the workability of the Bill can be found in the letter sent to all Members by me and the Minister of State at the Ministry of Justice, my hon. and learned Friend the Member for Finchley and Golders Green (Sarah Sackman), on 15 May.
Let me start with amendments tabled by my hon. Friend the Member for Spen Valley. New clause 13 and amendments 69, 53 and 72 would allow the Government to create or change legislation to set out the end-to-end process in relation to approved substances to be used for assisted dying. They would allow for monitoring and for a regulatory regime to be designed that will offer robust oversight of approved substances and the devices used to administer them, specifically in the context of assisted dying.
Amendment 54 and new clause 15 would replace clause 35, which is currently unworkable in the wider legal context. They would align the scrutiny and certification of assisted deaths with the existing process for deaths that are not deemed unnatural. That means that assisted deaths would be scrutinised by a medical examiner rather by a coroner unless reported to the coroner by anyone who has concerns about the death.
Amendments 92 to 94 would ensure that the Secretary of State and Welsh Ministers have powers to make necessary regulations to approve assisted dying services in Wales. Amendment 95 would bring the Welsh commencement powers in line with the devolution settlement and remove the requirement in clause 54 for Welsh Ministers to lay commencement regulations before the Senedd for approval, to align with usual procedure.
I now turn to amendments tabled by other Members that the Government assess as creating potentially significant workability challenges. Amendment 97 would require the MHRA to license the approved substances to be used in assisted dying. That may present workability challenges, as licensing is not possible if the approved substances do not meet the definition of “medicinal product” under the current relevant legislation. Furthermore, licensing is reliant on the manufacturer applying to the MHRA for a marketing authorisation for that indication and providing the necessary evidence of safety and efficacy in support. Should the Bill pass, the Government would work to put in place an appropriate regulatory regime for the approval of substances. It may be helpful to note that my hon. Friend the Member for Spen Valley has tabled new clause 13, which recognises the need for a robust regulatory framework and would provide the powers needed to introduce such a framework.
Amendments 105 to 107, amendment (a) to new clause 13 and amendment (a) to new clause 14 would restrict the scope of Henry VIII powers available to the UK and Welsh Governments to make provision about assisted dying services. They would further restrict the use of powers in relation to the regulatory framework for approved substances and the devices used to administer them, and to the prohibition on advertising. I point Members towards the delegated powers memorandum published by the Government, which sets out our consideration of the Henry VIII powers in the Bill. As with legislation more broadly, the Government recognise the need, in appropriate cases, for amendment by Henry VIII powers. Members will be aware that the Delegated Powers and Regulatory Reform Committee will issue its own consideration of the Bill, which will of course be made available to all parliamentarians.
Amendment 3 seeks to shorten the commencement period to three years. Should the Bill pass, an entirely new service with robust safeguards and protections will need to be carefully developed and tested, with input from a range of delivery partners. The Government’s view is that the Bill, as amended in Committee, with a four-year backstop for commencement would be more likely to provide for safe and effective implementation.
Tom Gordon
One of the key things that the Bill’s sponsor, the hon. Member for Spen Valley (Kim Leadbeater), has said throughout is that four years, in the Bill as it currently is, would be a backstop. Can that be the case if the Minister is talking about a requirement of four years and that it could not have been delivered sooner?
Stephen Kinnock
I can confirm that it is absolutely the policy intent of the sponsor for that to be a backstop. The Government are working on that basis to ensure that it is a backstop and not a target.
Amendment 42 seeks to remove the four-year backstop. Although that is a matter for Members to decide, we note that if both that amendment and amendment 94, tabled by my hon. Friend the Member for Spen Valley, were accepted, nobody would have the power to commence reserve provisions in Wales. That would create major workability concerns for the service in Wales.
Dr Johnson
The advocates of the Bill talk about the point of choice and autonomy in the decision about when and where a person will die. Can the Minister confirm whether we have enough doctors to provide a service for people to die at home at the time of their choosing?
Stephen Kinnock
I refer the hon. Lady to the impact assessment, which is of course not a forecast but a set of scenarios. In it, detail is given on expected numbers and the capacity of the system to deal with the service.
Amendments 13 and 82 to 85 relate to the appointment of the voluntary assisted dying commissioner and panel members. The amendments would put the process for the appointments out of kilter with standard practice for public or non-judicial appointments and could significantly limit the pool of individuals available. Amendment 86 would give the panel the same powers, privileges and authority as the High Court, which are significant in scope and are set out across different court rules and legislation. It is unclear how those would apply to panels in practice. They may be unworkable given that the panel is not designed to be a court.
New clause 4 and amendment 28 would put various responsibilities on the chief medical officers for England and Wales. Imposing duties in primary legislation on an individual civil servant may cause difficulties in the future if the role does not exist or if the title changes. It is usual practice for duties in primary legislation to be conferred on the Secretary of State, who may decide to delegate to the chief medical officer.
I would like to briefly respond to a number of questions directly asked of the Government. The hon. Member for South Antrim (Robin Swann) asked about medicines regulation in Northern Ireland. The amendments will not affect the application of EU law; they will instead ensure coherence between the different legislative frameworks. The sponsor will lead engagement with the devolved Governments, supported by officials.
The hon. Member for Richmond Park (Sarah Olney) asked about the equality impact assessment. The EQIA considers the nine protected characteristics alongside socioeconomic background, geography and mental health. The hon. Member for West Worcestershire (Dame Harriett Baldwin) asked about the Suicide Act and advertising. I can confirm that encouraging or facilitating suicide will remain a crime under the Suicide Act. On advertising, new clause 14, if passed, would oblige the Secretary of State to make regulations prohibiting certain forms of advertising that promote voluntary assisted dying services. The exemptions to that, which may be provided under subsection (2), will not cut across the criminal offences elsewhere in the Bill or in the Suicide Act.
I hope that those observations were helpful to Members in their consideration of the technical workability of the amendments that we have debated today.
Kit Malthouse (North West Hampshire) (Con)
claimed to move the closure (Standing Order No. 36).
Question put forthwith, That the Question be now put.
Question put and agreed to.
New clause 13 accordingly read a Second time, and added to the Bill.
New Clause 14
Prohibition on Advertising
“(1) The Secretary of State must by regulations make provision prohibiting—
(a) the publication, printing, distribution or designing (anywhere) of advertisements whose purpose or effect is to promote a voluntary assisted dying service;
(b) causing the publication, printing, distribution or designing of such advertisements.
(2) The regulations may contain exceptions (for example, for the provision of certain information to users or providers of services).
(3) Regulations under this section may make any provision that could be made by an Act of Parliament.
(4) But regulations under this section—
(a) may not amend this Act, and
(b) must provide that any offence created by the regulations is punishable with a fine.
(5) In this section “voluntary assisted dying service” means—
(a) any service for or in connection with the provision of assistance to a person to end their own life in accordance with this Act, or
(b) any other service provided for the purposes of any of sections 5 to 27.”—(Kim Leadbeater.)
This clause imposes a duty to make regulations prohibiting advertisements to promote services relating to voluntary assisted dying under the Bill.
Brought up, and read the First and Second time.
Amendment proposed to new clause 14: (b), in subsection (2), leave out from “exceptions” to the end of subsection (3) and insert—
“( ) for the following—
communication made in reply to a particular request by an individual for information about a voluntary assisted dying service;
(b) communication which is—
(i) intended for health professionals or providers of voluntary assisted dying services, and
(ii) made in a manner and form unlikely to be seen by potential service users.
(3) Regulations under this section may make provision that could be made by an Act of Parliament, but may not amend this Act or the Suicide Act 1961.”—(Paul Waugh.)
This amendment would limit the exceptions that can be created to the advertising ban set out in NC14 and also provides that regulations cannot amend the Suicide Act 1961, which includes the offence of assisting and encouraging suicide.
Question put, That the amendment be made.