“Learning from Lives and Deaths” Report: Learning Disabilities and Autism

Stephen Kinnock Excerpts

Tuesday 2nd September 2025 Written Statements

[The Minister for Care (Stephen Kinnock)]

Today I would like to acknowledge the publication of the eighth annual report “Learning from lives and deaths—People with a learning disability and autistic people” (LeDeR) produced by Kings College London. A copy will be deposited in the Libraries of both Houses. We know that families and stakeholders have been waiting for this report and it has been significantly delayed due to the need to resolve practical data issues.

It has been just over a year since I was appointed as the Minister of State for Care. I have felt privileged to fulfil this role and to hear from people with a learning disability, autistic people, their families and carers, and staff about their experiences, both good and bad. It is critical we continue to learn about what we need to do to address the clear health inequalities that continue to exist in our health and social care system. We must reduce these inequalities, and highlight the action needed to prevent avoidable deaths and understand how services can improve. To do this, it is crucial that we review the deaths of people with a learning disability and autistic people.

The latest report shows that on average, people with a learning disability die 19.5 years younger than the general population and are almost twice as likely to die from an avoidable cause of death. This is unacceptable.

In 2022, LeDeR began reporting on the deaths of autistic people without a learning disability. The number of deaths reviewed this year remains small, although the findings are very concerning. It is crucial we improve our understanding of the deaths of autistic people. We expect that with increased awareness of the ability to report these deaths, we can then take specific action to address the issues raised.

It is promising to see from the latest report that, since 2021, LeDeR reviews that identified good practice in care of people with a learning disability have increased by over 10%. While such improvements are encouraging, the findings about health outcomes and how care can be improved to prevent premature mortality highlight that there is much work for us to do. We are committed to maintaining LeDeR going forward as we integrate NHS England and the Department and we are taking action to drive tangible improvements to our health and care services.

In July, we launched the 10-year health plan which will drive a shift to care in the community, rather than in hospitals, to preventing sickness, rather than just treating it, and to harnessing digital opportunities. Neighbourhood health services will work in partnership with other local services to provide more holistic, ongoing support including for people with a learning disability and autistic people.



To support this, we have been rolling out the Oliver McGowan mandatory training programme to ensure health and care staff have the right knowledge and skills to provide effective care.

We set out in our manifesto a commitment to modernise mental health legislation. Our Mental Health Bill, currently before Parliament, will limit the scope to detain people with a learning disability and autistic people and introduce a package of measures to improve community support. We want to see this legislation implemented as soon as possible so that people with a learning disability and autistic people get the support they need in the community, improving care and keeping people out of hospitals.

Alongside the legislation, action is being taken now to reduce reliance on in-patient care. NHS operational planning guidance for 2025-26 sets an objective to deliver a minimum 10% reduction in the use of mental health in-patient care for people with a learning disability and autistic people.

Patients and their families, carers and advocates have a critical part to play in their care and can be uniquely placed to identify acute illness or deterioration in their or their loved ones’ condition, including where that may indicate a need to change their treatment or care. Martha’s rule is a major patient safety initiative in hospitals encouraging patients, families and carers to speak to the care team if they notice changes in someone’s condition and providing them with a way to seek an urgent review if their or their loved one’s condition deteriorates, and they are concerned this is not being responded to. Martha’s rule is being rolled out in 143 acute in-patient pilot sites, as announced in February 2024. In addition, NHS England is working toward roll-out in further acute hospital sites that were not part of the original 143 sites.

NHS England has published its action from learning report 2023-24, highlighting actions across the country to improve care and reduce avoidable and preventable deaths of autistic people and people with a learning disability.

People with a learning disability aged over 14 who are on a GP learning disability register are eligible for a learning disability annual health check. At March 2025, 80% of eligible people had received a learning disability annual health check and 79% had a health action plan. NHS England has also developed an autism-specific health check, currently being tested in primary care.

Further work is under way to ensure people with a learning disability and autistic people access the right support at the right time in the right place. NHS England is working with people with lived experience, clinical professionals and commissioners to produce a quality framework for the learning disability annual health check. This will set out expectations for the annual health check and the accompanying health action plan. Both should make it easier for GPs to add people to their learning disability register so that more people can access appropriate care and support more easily. NHS England is also working to co-develop standards of practice for appropriate interventions for adults and children in a range of settings.

Roll-out of the reasonable adjustment digital flag is progressing, which enables health and publicly funded care professionals to record, share and view details of the reasonable adjustments that individuals need to support their care and treatment. NHS England has also recently published guidance for frontline staff in acute hospitals about how to implement the Mental Capacity Act 2005 for people with a learning disability, helping to ensure that people’s human rights are upheld.

Together with NHS England and partners, we are committed to driving further improvements, implementing our 10-year health plan and working towards healthcare that is equitable and provides the quality of care that people with a learning disability and autistic people should rightly expect.

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Eating Disorders: Prevention of Deaths

Stephen Kinnock Excerpts

Tuesday 2nd September 2025 Westminster Hall

[The Minister for Care (Stephen Kinnock)]

It is a pleasure to serve under your chairship, Sir Desmond. I begin by congratulating my hon. Friend the Member for Isle of Wight West (Mr Quigley) on securing today’s debate and speaking so bravely and movingly about his family. I pay tribute to his work in the all-party parliamentary group on eating disorders, and I know that he and many other hon. Members present have worked tirelessly to advocate for those with eating disorders.

Every death from an eating disorder is a tragedy. We have heard from hon. Members about the devastating effect of these conditions, both for patients and their loved ones. But we must be clear that eating disorders are not terminal illnesses. With the right treatment and support, recovery is possible. Many across the Chamber have made that point, and I pay tribute to everyone who has contributed so powerfully. I also congratulate Arek and Claudia, who I know made outstanding contributions to drafting the speech made by my hon. Friend the Member for Beckenham and Penge (Liam Conlon).

Through the 10-year health plan, the Government will ensure that those living with eating disorders are given the support they need. We will cut waiting times and ensure that people can access treatment and support earlier. Improving eating disorder services is a priority for the Government, and a fundamental part of our work to transform mental health services. Last financial year, we provided £106 million in funding for children’s eating disorder services, an increase of £10 million since 2023-24. That increase in funding is helping our clinicians to support more people, and to change and save lives.

[Tom Gordon]

One of the great organisations that does a lot of work on the accountability of services, including eating disorder services, is Healthwatch. We know that these organisations are going to be scrapped. They have done loads of valuable work at local and regional levels. What levels of accountability will the new systems put in place for eating disorder services?

[Stephen Kinnock]

I agree that Healthwatch did some important work, but what we are doing is changing the culture of how our NHS works. As the hon. Gentleman will have seen, we are abolishing NHS England. That is of a piece with our belief that proper leadership, proper accountability and proper management of a complex system such as our NHS, and particularly its interaction with ICBs and trusts, is about having a clear line of accountability from the Secretary of State through Ministers into the system and those operating at the coalface. We believe that if more layers are put between, and cut across, those lines of accountability, that does not actually drive better outcomes—it drives poorer performance. That is the approach we are taking to the entire system.

[Wera Hobhouse]

As I said, I have been the chair of the APPG for six years, and nothing has changed and got better. I really trust that this Government will make a difference—I hope they will. This is about culture change, but eating disorders are a very complex illness. The APPG has therefore called repeatedly for a dedicated strategy on eating disorders. Will the Minister please look at that?

[Stephen Kinnock]

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

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

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

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

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

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

[Dr Luke Evans]

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

[Stephen Kinnock]

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

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

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

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

[Dr Evans]

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

[Stephen Kinnock]

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

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

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

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

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

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

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

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

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

NRS Healthcare: Insolvency

Stephen Kinnock Excerpts

Monday 1st September 2025 Written Statements

[The Minister for Care (Stephen Kinnock)]

I would like to inform the House about an important issue concerning NRS Healthcare—also known as Nottingham Rehab Ltd —a supplier of integrated community equipment services, which became insolvent on 1st August 2025.

NRS Healthcare provided essential services and equipment such as wheelchairs, hoists, and technology that supported disabled and older people to live independently at home. This helped avoid admissions to hospitals or care homes and assisted people in returning home after leaving hospital.

Local authorities have statutory duties under the Care Act 2014 and the Children and Families Act 2014 to arrange for the provision of disability aids and community equipment to meet the assessed needs of individuals in their area. While some local authorities provide these services themselves, many have contracts with external suppliers, such as NRS Healthcare. Customers of these services also include the NHS, private customers, pharmacies, and other adult social care and healthcare settings.

Before their insolvency, 44 local authorities had contracts with NRS Healthcare and relied on their services. NRS Healthcare supplied around 50% of hospitals with equipment used in adult social care across England, Wales, Scotland and Northern Ireland.

Since the company filed for insolvency, the court has appointed an official receiver as the liquidator, supported by special managers, who are overseeing the wind-down of operations, managing the company's assets, and ensuring that statutory duties and obligations to creditors and people who draw on these services are met. The official receiver is an independent officer of the court required by law to carry out these duties.

As part of the liquidation process, the Government have made available short-term funding to the official receiver to cover the essential operating costs of NRS Healthcare and its affiliated companies. This funding has ensured that trading was able to continue for a limited time, to minimise disruption by providing crucial time for local authorities to put alternative supply in place. The use of this funding, should it be necessary, will be subject to robust scrutiny and governance by the Government and the insolvency office holders. The final cost to HM Government will be known when the insolvency process is complete. Costs will be reported in the DHSC annual report and accounts.

The Government have also provided the official receiver with a legal indemnity to protect them against financial loss or legal claims incurred while carrying out their duties. This indemnity is unlimited and will remain in place until the official receiver’s services are no longer required. The indemnity is a standard mechanism in high-risk or complex insolvencies where appointees are expected to act in the national interest without undue risk to the appointees. Crystallisation is expected to be limited.

Without the Government providing the above support, there was a risk that the official receiver would have had no choice but to close services immediately following their appointment, in line with their statutory duties. This could have had an immediate and significant impact on hospital flow and the safety of people in the community who relied on NRS Healthcare’s services.

These measures were therefore essential to enable the official receiver to discharge their duties for the benefits of creditors and protect public spending by avoiding additional hospital admissions or preventing discharge to care settings, while minimising risk to vulnerable people who previously relied on NRS Healthcare’s services. If the liability is called, provision for any payment will be sought through the normal supply procedure. The Treasury has approved this arrangement.

My officials in the Department of Health and Social Care are continuing to monitor the situation closely and will continue to do so until its conclusion.

We would like to acknowledge and thank all colleagues, particularly those in HMT, UKGI, MHCLG, NHS England, and Partners in Care and Health—a sector support programme funded by DHSC—for their efforts throughout this challenging period. Their support leading up to, and following the insolvency in brokering discussions, sharing vital information, and helping local authorities prepare and respond has been invaluable in minimising disruption and protecting those who rely on these essential services.

[HCWS896]

Oral Answers to Questions

Stephen Kinnock Excerpts

Tuesday 22nd July 2025 Commons Chamber

[Greg Smith (Mid Buckinghamshire) (Con)]

4. If he will make an assessment of the potential merits of siting a neighbourhood health centre in Long Crendon, Buckinghamshire, as part of the 10-year health plan for England.

[The Minister for Care (Stephen Kinnock)]

This Government aim to establish a neighbourhood health centre in every community by 2035. We are starting in areas of greatest need where healthy life expectancy is lowest, including rural towns and communities with higher deprivation levels. Planning work has already begun. The hon. Gentleman will know that I updated colleagues yesterday in a “dear colleague” letter around integrated care boards and local authorities being invited to apply to participate in the national neighbourhood health implementation programme.

[Greg Smith]

I am grateful to the Minister for that answer. He will have heard me put the case for Long Crendon many times over many years, and given the proposals for neighbourhood health centres in the 10-year plan, Long Crendon offers a very quick win. The community has the land, the planning permission and a GP practice willing to serve there; it just does not have the funds for the bricks and mortar to build it. Can I ask the Minister to meet me and the members of Long Crendon parish council who are leading on this, so that the Government can get a quick win on neighbourhood health centres?

[Stephen Kinnock]

The hon. Member is clearly a doughty campaigner—I am sure that will mean something good will happen for him in the reshuffle that we are all watching with bated breath. I am happy to have that discussion with him. As I said, the neighbourhood health process will be driven primarily by identifying areas where healthy life expectancy is lowest and deprivation is highest. Clearly, he makes a case for his area, and I would be happy to have that discussion with him.

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[Mr Richard Quigley (Isle of Wight West) (Lab)]

5. What recent estimate his Department has made of the proportion of mental health research funding allocated to eating disorders.

[The Minister for Care (Stephen Kinnock)]

Through the National Institute for Health and Care Research, the Department is committed to finding new ways of tackling eating disorders through research. We are supporting research projects, including the eating disorders genetics initiative—one of the largest studies of its kind—and have a £4.25 million collaboration with other UK research funders to build new partnerships in eating disorder research. We are also strengthening support for people with eating disorders by recruiting more mental health workers, expanding mental health support in schools and embedding it in young futures hubs.

[Mr Quigley]

Eating disorders cost the UK an estimated £9 billion each year, yet research into these serious conditions receives just 1% of all mental health research funding. That is despite eating disorders affecting around 9% of people with mental health conditions, the consequences of which are delayed diagnosis and treatment and often lengthy hospital admissions. Will the Minister agree to meet me and the eating disorder charity Beat to discuss how the Government can break this cycle and ensure that eating disorder research receives the attention and investment that it urgently needs?

[Stephen Kinnock]

I know that this subject is close to my hon. Friend’s heart, and I pay tribute to him for his work on it. We recognise the devastating impact that an eating disorder can have, and the earlier the treatment is provided, the greater the chance of recovery. The Department continues to work closely with NHS England, which is now refreshing guidance on children and young people’s eating disorders. I commend the work of Beat, and I would be happy to discuss this further with my hon. Friend.

[Mr Gregory Campbell (East Londonderry) (DUP)]

The eating disorder issue is escalating, as the Minister rightly points out. Will he agree to hold discussions and consultations with the devolved structures in Northern Ireland, Scotland and Wales, so this issue goes to the top of the list of issues that have not really been dealt with in the past but need dealing with now?

[Stephen Kinnock]

We remain in close contact with all our colleagues in all the devolved Administrations. I will certainly be following up with officials as we develop the research programmes that we are working on, and as we integrate eating disorders into the broader work we are doing around mental health. Getting 8,500 more mental health workers and creating Young Futures hubs and mental health crisis centres is just some of the work that this Government are doing on this important issue.

[Graham Stuart (Beverley and Holderness) (Con)]

6. What assessment his Department has made of the adequacy of urgent eyecare in east Yorkshire.

[The Minister for Care (Stephen Kinnock)]

The right hon. Member’s constituents can access urgent eyecare services from Hull University teaching hospitals NHS trust 24 hours a day, seven days a week and from a range of high-street optical practices locally. Integrated care boards are responsible for commissioning primary and secondary eyecare services to meet local need. As part of our 10-year plan, we are keen to explore how we can make best use of our primary eyecare workforce as we consider shifting more healthcare into the community.

[Graham Stuart]

Would it was so. My constituent Scott Young, a 34-year-old father-to-be from Beverley, was left permanently blind in one eye after NHS failures, including a two-month delay to urgent surgery following a diabetic haemorrhage, which the trust now blames on admin mistakes. When the same issue threatened his remaining sight, identical delays occurred until I intervened. Yet the Hull University teaching hospitals NHS trust response contained factual errors, including claiming that a heart condition delayed surgery even though it had not been diagnosed when the delay occurred. Does the Minister agree that such failings demand accountability, and what steps can he take to improve the administrative processes within our hospitals?

[Stephen Kinnock]

I am very sorry to hear of Scott’s experience. What the right hon. Gentleman has outlined is clearly unacceptable. I will absolutely follow up on that issue with officials and report back to him. We cannot allow that sort of poor performance to exist, and those responsible must be held to account.

[Gareth Snell (Stoke-on-Trent Central) (Lab/Co-op)]

7. What steps his Department is taking to improve electronic patient record systems in the NHS.

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[Josh Dean (Hertford and Stortford) (Lab)]

T4. My ADHD—attention deficit hyperactivity disorder—diagnosis in May this year helped to answer questions about my life and to put support in place to improve it, but we know that over 300,000 children are waiting for an assessment and that untreated ADHD affects educational attainment, employment prospects and health outcomes. Will the Secretary of State set out the Department’s plans to improve access to assessments and treatment for ADHD? Will he work across Government to develop a long-term, joined-up approach to ADHD care?

[The Minister for Care (Stephen Kinnock)]

I commend my hon. Friend for bringing his personal experience to bear on this important matter. NHS England’s independent ADHD taskforce is looking at how to provide support for people with ADHD and how to improve it. We are considering the taskforce’s interim report and look forward to the final report later this year. The taskforce is joined up with expert groups established across Government to provide advice on meeting the needs of neurodivergent children and young people in education, and on boosting neurodiversity inclusion at work.

[Jim Shannon (Strangford) (DUP)]

T7.   Will the Minister confirm what steps the Department will take to build neighbourhood health services in partnership with charities, such as Macmillan, that have a proven track record of designing and delivering community-based services for people with long-term conditions? How can we ensure that this is a UK-wide service, and not a postcode lottery for cancer services?

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[Mr Richard Quigley (Isle of Wight West) (Lab)]

T8. Thank you, Mr Speaker. I am so delighted to have two questions on health this week that I am not even going to mention ferries!As my hon. Friend will know, the process for securing an education, health and care plan is complex and can lead to delays in accessing vital support. That can have a serious impact on the health and wellbeing of young people and children. What steps is the Minister taking to improve the health element of EHCPs for families navigating the process, including those in my constituency?

[Stephen Kinnock]

We have inherited a system that is utterly failing to meet the needs of children with special educational needs. This Government are reforming the SEND system, ensuring that there is joined-up support across education and healthcare. We are also supporting inclusive environments and earlier intervention for children through the early language support for every child programme, or ELSEC, and the partnership for inclusion of neurodiversity in schools programme, or PINS.

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

Eight years ago, Weybridge community hospital burned down. After a long journey, the replacement finally received planning consent last week; all it needs now is for the Secretary of State to sign the cheque on the dotted line. Will he do so as soon as possible?

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[Mr Speaker]

Order. I call the Minister.

[Stephen Kinnock]

Our 10-year plan will boost support for family carers via digital tools such as My Carer and include them in care planning and shared decision-making processes. We have raised the carer’s allowance earnings limit to £196 a week—the biggest increase since 1976—and we have launched the independent commission into adult social care, which will look at unpaid carers’ needs. The hon. Member raises an important point about respite care; I am chairing a cross-ministerial group on our carers strategy, and I would be happy to update him outside the Chamber.

[John Whitby (Derbyshire Dales) (Lab)]

Last autumn, there was not a single NHS dental practice in Derbyshire Dales accepting new adult patients other than those referred for specialist care. The lack of NHS dentistry has led many of my constituents to experience severe economic hardship, with one telling me he had to spend £100 to have a single tooth fixed and another spending £2,000 on dentures. Will the Government provide increased funding for NHS dentistry to ensure that more people in rural areas like Derbyshire Dales can access NHS dentists?

[Stephen Kinnock]

The mess we inherited from the previous Government beggars belief, with 14 million adults with an unmet dental need, while for children between five and nine years old, the most common reason for hospital admission was to have their rotten teeth removed. This Government are determined to get NHS dentistry back on its feet. We are targeting the areas most in need, including rural areas, by delivering 700,000 additional urgent dental appointments, and reforming the dental contract. Our consultation is under way, and I encourage my hon. Friend to participate.

[Wera Hobhouse (Bath) (LD)]

I was really disappointed that there was not one mention of eating disorders in the NHS 10-year plan, which is particularly troubling given that some of the proposed measures to reduce obesity may inadvertently harm those affected by eating disorders. When will the Government finally commit to an eating disorder strategy, as recommended by the eating disorders all-party parliamentary group?

[Stephen Kinnock]

This Government are investing an extra £688 million this year to improve access to mental health services. We are transforming our mental health services with 24/7 neighbourhood health centres; I was very pleased last week to visit the centre we are launching in Bethnal Green. I would gently say to the hon. Lady that she is part of the political party that propped up the Tories in government—this lot opposite—which led to some of the desperate situations we see across mental health today.

[Nick Smith (Blaenau Gwent and Rhymney) (Lab)]

Parkrun is a global public health phenomenon. Will the Minister meet me and the new Parkrun chief executive to talk about future collaboration?

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[Adrian Ramsay (Waveney Valley) (Green)]

Data published last week shows that despite the Government’s initial action, the proportion of dentists working in the NHS in Norfolk and Waveney continues to drop. I am pleased to hear about the Government’s work on the dental contract, but the Public Accounts Committee is clear that this will work only if it is backed by sustainable funding. I will give the Minister another chance to answer the question: will the Government ensure that the extra funding that has been put into the Department is actually reflected in extra funding for NHS dentistry?

[Stephen Kinnock]

One thing that I made clear to officials when I came into this post was that every penny that is allocated to NHS dentistry must be spent on NHS dentistry. We are in a crazy situation where demand for NHS dentistry is going through the roof, yet we have had underspends. That needs to stop. We will focus the spending on where it is most needed, including areas that are under-served, such as the hon. Gentleman’s constituency.

[Sarah Owen (Luton North) (Lab)]

My constituents Marie Brewis and Denise Coates are bravely using their own experience of breast cancer treatment to campaign for a dedicated cancer support centre in Luton. Does the Minister agree that Luton could benefit from the wraparound care of a cancer support centre locally, and will she meet me to discuss this?

Rare Cancers Bill

Stephen Kinnock Excerpts

Report stage
Friday 11th July 2025 Commons Chamber

[The Minister for Care (Stephen Kinnock)]

I am grateful to my hon. Friend the Member for Edinburgh South West (Dr Arthur) for bringing this Bill before the House, and I congratulate him on getting it to Report. Amendment 1 allows amendment 2 to be inserted into the Bill. Amendment 2 would require the Secretary of State, having carried out the review described in clause 1, to set out a timetable for implementing changes to the law recommended by the review. However, it would not be appropriate to presume the outcome of the review of orphan drug regulations that is outlined in clause 1. Amendment 2 presupposes that the review will recommend changing the law, and that there are changes the Secretary of State would be willing to support, following a legal consultation. That is not considered appropriate at this stage.

Amendment 3 is unnecessarily restrictive, introducing wording that confines the review unnecessarily. We want to ensure that a thorough review is conducted, and my hon. Friend the Minister for Secondary Care will be working with her officials to ensure that that happens. For amendment 4, the three-year timeframe to prepare and publish the review and the necessary resourcing requirements have been discussed with officials in my Department and at the Medicines and Healthcare products Regulatory Agency. I remind Members that the text in the Bill reflects the statutory deadline, but we will endeavour to publish a report ahead of the three-year timeframe, which has been put forward to be consistent with the MHRA’s overall workplan.

On amendment 5, there are different definitions of a rare cancer, and we worked with my hon. Friend the Member for Edinburgh South West to agree the definition in the Bill as a cancer that affects not more than one in 2,000 people in the UK. However, a level of discretion for the Secretary of State is required over what falls within that definition, since the facts underlying and the data on diagnoses are constantly changing. The amendment would make it difficult to implement the clause in practical and operational terms.

Amendment 6 would remove the ability of the Secretary of State to exercise discretion as to how their duty would be discharged. This is not considered appropriate, since it makes the operation of clause 2 less workable in practice, and would lack the Government’s assessment of what in all the circumstances would be the most appropriate manner of implementation. Amendment 7 would introduce a specific timeframe—just six months—to allow the appointment of the specialty lead. Although I agree that we will need to appoint the specialty lead promptly, introducing a statutory timeframe is not considered workable for practical reasons. There could be unforeseen delays; for example, recruitment processes might delay the appointment beyond six months.

On amendment 8, as mentioned previously there are different definitions for a rare cancer. That is because the data on cancer diagnoses is constantly changing, and decisions on whether the criteria for a rare cancer are met will inevitably involve an element of judgment. The amendment would make it difficult to implement the clause in practical and operational terms.

I turn finally to amendment 9. It is essential that information relating to people’s health and care is shared appropriately, lawfully, and in line with their reasonable expectations. Amendment 9 would remove the provision confirming that any sharing of information pursuant to the powers created by the Bill, and under NHS England’s existing powers, must be in accordance with data protection legislation. That includes compliance with key principles such as lawfulness and fairness. That layer of assurance is essential for the protection of patients, and clause 3 is a standard provision that makes that explicit.

For those reasons, I ask the hon. Member for Christchurch (Sir Christopher Chope) to withdraw all nine of his amendments.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Sir Christopher, is it your pleasure that amendment 1 be withdrawn?

--- Later in debate ---

[Stephen Kinnock]

I again congratulate my hon. Friend the Member for Edinburgh South West (Dr Arthur). It is a huge achievement for a colleague who has only served in this place for just over a year to have got a Bill this far. I thank hon. Members across the House who have spoken in the debate so powerfully and movingly, as well as all those who sat on the Bill Committee. We welcome effective scrutiny from Committees, and we value the vital role that Parliament plays in holding us to account. I pay tribute to the charities that are backing the Bill, many of which we are engaging with on the development of our national cancer plan.

The Government want to go further for everyone diagnosed with a rare cancer, and the Bill will act to incentivise the recruitment to, oversight of and accessibility of rare cancer research, so that NHS patients are at the front of the queue for cutting-edge treatments. We know the benefits of embedding clinical research across the NHS and beyond. It leads to better care for patients and more opportunities for our workforce, and it provides a huge economic benefit for our health and care system.

On 3 July, we published our 10-year health plan, which sets out the vision to distribute power to patients and revitalise our NHS, making it fit for the future. The plan will deliver three shifts in care to ensure that the health service can tackle the problems of today and tomorrow, all of which will be key to tackling cancer. Through the 10-year health plan we will ensure that patients receive the most cutting-edge treatment, and that everyone can search for research studies through the Be Part of Research service on the NHS app.

That is why we welcome the Bill, which is aligned with our commitments. It raises the profile of rare cancer research, ensures our international regulatory competitiveness, and allows rare cancer patients to be contacted as quickly as possible about research opportunities. That innovation will be delivered through Be Part of Research, our flagship research registry delivered through the National Institute for Health and Care Research, which allows people from all walks of life to sign up and get involved in research across the UK. I urge everyone watching this debate, and Members in the Chamber who are interested, to sign up to Be Part of Research, and see what research opportunities are relevant to them.

The Government want to give all rare cancer patients access to clinical trials, and greater choice and control over their healthcare. That is why we are delighted to pledge Government support for the Bill. As we set out in our manifesto, the Government are committed to ensuring that the clinical research ecosystem is more efficient, competitive and accessible, and the provisions in the Bill align with that. We want the UK to lead the world in this space as the prime destination for clinical research.

The Government also want to give patients greater choice and control over their healthcare, and rare cancer patients should have access to vital research if they choose to. Once again, I thank my hon. Friend the Member for Edinburgh South West for presenting the Bill, and those Members who served on the Committee. I pay tribute to all the charities that are backing this important Bill. The Government support the Bill, and I look forward to working with Members across the House to improve outcomes for rare cancer patients across our country.

Glaucoma Awareness

Stephen Kinnock Excerpts

Wednesday 9th July 2025 Westminster Hall

[The Minister for Care (Stephen Kinnock)]

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

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

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

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

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

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

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

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

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

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

[Dr Luke Evans]

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

[Stephen Kinnock]

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

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

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

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

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

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

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

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

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

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

NHS Dental Contract Reforms: Consultation

Stephen Kinnock Excerpts

Tuesday 8th July 2025 Written Statements

[The Minister for Care (Stephen Kinnock)]

As set out in the 10-year health plan, the Government are launching a public consultation on a package of reforms to improve the current NHS dental contract, representing the next step towards delivering a dentistry service fit for the future.

Satisfaction with NHS dentistry has fallen to a record low, from 85% in 2019 to 69% in 2024 and the British Dental Association estimates that 13 million adults—over 1 in 4—are struggling to find NHS care. Poor oral health can have a devastating impact on individuals, yet is largely preventable. We inherited a broken NHS dental system, and we are committed to fixing it, so we can deliver more care to those who need it.

Our plan to stabilise NHS dentistry is already under way. From April 2025, integrated care boards started making available the 700,000 additional urgent dental appointments that we promised in our manifesto. As set out in the 10-year health plan, training a dentist costs the taxpayer up to £200,000 and we believe it is fair to expect graduate dentists to invest their skills and expertise in the NHS in return. Having consulted on the principle, we will now make it a requirement for all newly qualified dentists to practice in the NHS for a minimum period. We intend this minimum period to be at least three years. That will mean more NHS dentists, more NHS appointments and better oral health.

We are today launching a public consultation, running until 19 August 2025, on a package of reforms to improve the current NHS dental contract and improve the experience of NHS dentistry for patients. From 2026-27 the proposals are intended to:

Make it easier for those who need dental care and treatment to get it by requiring all practices to provide an agreed amount of urgent and unscheduled care which is accessible to all who need it, irrespective of whether they have been to the practice before.

Deliver improvements in the clinical care and treatment received by people with complex care needs. We will do this by introducing new care pathways which integrate prevention and treatment, with fairer payment arrangements for the professionals treating them, and without fear of excessive charges for patients.

Deliver improvements in preventive oral care for children, including through the promotion of fluoride varnish treatment.

Reduce the number of people in good oral health being recalled to the dentist too frequently and the costs to patients associated with that. Guidance from the National Institute for Health and Care Excellence states that people with healthy teeth and gums should be seen every 12 to 24 months. Making this a reality will enable practices to provide better care to those patients who are most in need.

Make dental staff feel valued members of the wider NHS and able to focus on quality of care. We will do this by developing minimum terms of engagement for dental associates, supporting performance evaluation through appraisals, and extending eligibility for discretionary support payments.

This consultation is an important step towards the fundamental reform to the dental contract that we committed to in our manifesto, for which the process will begin this year. We want a contract that matches resources to need, improves access, promotes prevention and rewards dentists fairly, while enabling the whole dental team to work to the top of their capability.

We will also deliver a step change in prevention, which is key to good oral health.

On 7 March 2025, we announced £11.4 million to implement the manifesto commitment for a national, targeted supervised toothbrushing scheme for three to five-year-olds. In addition to this investment, we have secured an innovative partnership with Colgate, which has generously committed to donate over 23 million toothbrushes and toothpastes over the next five years. Together we will reach up to 600,000 children, with the first donations being made before the school holidays.

Following public consultation, we also announced the expansion of community water fluoridation across the north-east of England, which will reach an additional 1.6 million people.

Taken together, these reforms represent vital steps in our plan to build an NHS dental service fit for the future.

[HCWS794]

Down’s Syndrome Regression Disorder

Stephen Kinnock Excerpts

Tuesday 8th July 2025 Westminster Hall

[The Minister for Care (Stephen Kinnock)]

It is a pleasure to serve under your chairship, Sir Jeremy. I thank and pay tribute to my hon. Friend the Member for Thurrock (Jen Craft) for securing this important debate. I commend her for the work she is doing to raise such an important issue, and for sharing her personal experiences in a moving and powerful way, as a parent of a child with Down’s syndrome. I also pay tribute to all the hon. Members who have spoken so powerfully and movingly in this debate.

Last week, we launched our 10-year health plan for the NHS, which creates a new model of care, fit for the future. The neighbourhood health service will help to improve life outcomes for disabled people, including people with Down’s syndrome, by providing access to holistic, ongoing support that is closer to home. Through local commissioning, we will ensure that neighbourhood health services work in partnership with family hubs, schools, nurseries and colleges to offer timely support to children, young people and their families, including those with special educational needs and disabilities.

We have heard powerful testimonies about the challenges associated with Down’s syndrome regression disorder, both for people with Down’s syndrome and for their families and carers. As we have heard, regression describes the loss of previously acquired cognitive and developmental skills in an individual. Down’s syndrome regression disorder is a specific, rare type of regression, which usually presents in adolescence or early adulthood.

People with Down’s syndrome can live full lives pursuing their personal interests, taking up employment, and living independently. However, regression can have a devastating impact for people with Down’s syndrome; the loss of developmental skills can affect daily living, language, motor abilities or social interaction. We know that symptoms can often be overlooked, or misdiagnosed as dementia. We have heard that further awareness and understanding of the disorder is needed. Like with other support for people with Down’s syndrome, it is important that care for regression disorder is personalised and takes into account the specific needs of the individual.

As my hon. Friend the Member for Thurrock so clearly explained, there is currently limited understanding of Down’s syndrome regression disorder. We know that experts in the field have looked into regression and developed a position statement on regression in adolescence and early adulthood experienced by people who have Down’s syndrome. This includes recommended healthcare actions for people with Down’s syndrome who show signs of loss of skills or cognitive decline.

There has been some academic research into regression, but there is still much to learn about this disorder and why it happens to some people. We understand that many factors may come into play in causing regression, but the specific underlying cause of Down’s syndrome regression disorder is still unclear. Through its research delivery arm, the National Institute for Health and Care Research, the Department of Health and Social Care welcomes high-quality funding applications from researchers seeking to better understand this condition, and to inform enhanced management and care.

More broadly, patients will receive the most cutting-edge treatment years earlier than planned under the Government’s 10-year health plan, which will speed up clinical trials so that the UK becomes a hotbed of innovation. Millions of people will now be able to search for and sign up to life-changing clinical trials via the NIHR Be Part of Research service on the NHS app, allowing patients to browse and find the trials best suited to their interests and needs.

The Government are committed to improving life outcomes for people with Down’s syndrome, including those who have regression disorder. In order to achieve this, it is vital that we raise awareness of the needs of people with Down’s syndrome. We know that despite many positive developments, such as increased life expectancy, people with Down’s syndrome do not always receive the care and support they need to lead the lives they want to lead in their communities.

[Ayoub Khan]

First, I apologise to the hon. Member for Thurrock for using clumsy language—I meant no discourtesy. We have been discussing PIP and how it could impact many people who require care. Regression can happen very suddenly for people with Down’s syndrome, which is concerning because we are still looking at research and the methods for getting a final determination. Will the Government incorporate something, such as financial care packages and so forth, to deal with the additional care required by those individuals?

[Stephen Kinnock]

As the Government have made clear throughout the debate on reforming the welfare system, those who need to be supported and protected will be supported and protected, so I can reassure the hon. Gentleman on that point. There is clearly a lot of work to do through the review that will be led by the Minister for Social Security and Disability, my right hon. Friend the Member for East Ham (Sir Stephen Timms). This will be an important part of his work.

Through the implementation of the Down Syndrome Act 2022, we will improve awareness and understanding of the needs of people with Down’s syndrome and how to meet them. The Act requires the Secretary of State for Health and Social Care to give guidance to relevant authorities, including local authorities, education and housing services, on the appropriate steps they should be taking to meet the needs of people with Down’s syndrome in exercising their relevant functions.

Work to develop the statutory guidance under the Act is being taken forward as a priority, with a view to issuing it for consultation in the autumn. The shadow Minister, the right hon. Member for Melton and Syston (Edward Argar), asked about that. We looked at publishing it over the summer, but we received feedback from stakeholder groups that parents in particular are often busy with their kids over the summer, so it is better to wait until the autumn. That is what we are doing, and we will be publishing it as soon as the school holidays are over.

Officials have considered a range of evidence and engaged extensively with sector partners to inform the development of the guidance. This includes a national call for evidence, which received more than 1,500 responses. A summary report of its findings will be published ahead of, or alongside, issuing the draft guidance for consultation. Based on what we were told during the call for evidence and our subsequent engagement with sector partners and experts, a needs profile has been developed setting out the different needs of people with Down’s syndrome, including people with Down’s syndrome regression disorder. We intend to publish the needs profile paper alongside the draft guidance this autumn to ensure full transparency.

The guidance itself will raise awareness of the specific needs of people with Down’s syndrome, including health needs such as unexplained regression. The guidance will also set out practical steps that relevant authorities should take to meet the needs of people with Down’s syndrome.

We have made significant progress in developing the guidance. We are working closely with relevant Government Departments and sector partners to ensure that it is helpful, accurate and fully reflective of the latest developments in Government policy. Crucially, that engagement has involved people with lived experience of Down’s syndrome, as well as organisations that support people with Down’s syndrome, other conditions and/or a learning disability.

On 4 June, I met the all-party parliamentary group on Down syndrome and provided an update on the latest progress on the guidance. We discussed how we can ensure that the guidance is as effective and impactful as possible. The latest version of the draft guidance, which has had input from all relevant Government Departments, was also shared with sector partners in June for their feedback.

Officials are reviewing that feedback ahead of issuing the guidance for consultation this autumn, which will provide a further opportunity for individuals and organisations to share their views. We remain committed to delivering high-quality guidance that supports improved outcomes for people with Down’s syndrome, while bringing wider benefit where possible. To support implementation of the guidance, NHS England published statutory guidance on 9 May 2023 requiring that every integrated care board must have a named leader for Down’s syndrome.

The 10-year health plan will ensure a better health service for everyone, regardless of condition or service area. We want disabled people’s access to and experience of healthcare services to be equitable, effective and responsive to their needs. Significant engagement took place as part of the 10-year health plan’s development, and informed the final plan. That engagement included a roundtable on learning disability, at which we heard directly from people with Down’s syndrome about their experience of the NHS. We also received contributions from organisations that support and advocate for Down’s syndrome across the health and social care sector.

The 10-year health plan sets the vision for what good, joined-up care looks like for people with a combination of health and care needs, including people with Down’s syndrome regression disorder or other disabilities. The neighbourhood health service will support disabled people to be more active in the delivery and management of their own care. That includes increasing uptake of personal health budgets, which provide individuals with greater choice and flexibility on how their assessed wellbeing needs are met. We know that there are many disabled people, including people with Down’s syndrome, who want to work. The 10-year plan will break down barriers to opportunity by delivering the holistic support that people need to access and thrive in employment.

A number of hon. Members raised questions about training. The guidance will raise awareness of the specific needs of people with Down’s syndrome, including people with regression disorder. We understand that training is an important part of that picture. Under the Health and Social Care Act 2008 and the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, providers registered with the Care Quality Commission must ensure that staff receive appropriate professional development necessary for them to carry out their duties. Specific training on learning disability and autism, appropriate to the staff member’s role, is also mandated under the Health and Care Act 2022. We expect that providers should consider whether specific training on Down’s syndrome is required for their staff.

Members also raised questions about funding research into regression disorder. The Department funds health and social care research through the NIHR. The NIHR welcomes funding applications for research into any aspect of human health and care, including Down’s syndrome regression disorder. Such applications are subject to peer review and are judged in open competition, with awards made on the basis of the importance of the topic to patients and to health and care services, value for money, and scientific quality. That enables maximum flexibility, both in the amount of research funding that can be awarded to a particular area, and in the type of research that can be funded.

The NIHR works closely with other Government funders—including UK Research and Innovation, which is funded by the Department for Science, Innovation and Technology and includes the Medical Research Council—to fund research to improve care and prevent poor health outcomes for people with Down’s syndrome.

The shadow Minister asked a couple of specific questions. I think he mentioned Down’s Syndrome Association-supported research by Cambridge University, and the trials in the United States of America. If it is okay, I will write to him on those points. I am not in a position to address them today.

I hope I have addressed the points raised by hon. Members in this debate. I end by thanking all those who have committed so much time and effort to supporting the development of the guidance under the Down Syndrome Act. We are grateful for the invaluable input that individuals and organisations continue to provide on the draft guidance. Their feedback has been, and is, instrumental in helping us to ensure that the final guidance has maximum benefit. Officials will continue to work with sector partners to ensure that the communities they represent are aware of the forthcoming consultation and can share their views.

I once again thank my hon. Friend the Member for Thurrock for securing this important debate, and for all the incredibly important work that she is doing in this area. I also thank all hon. Members for their contributions.

GP Funding: South-west England

Stephen Kinnock Excerpts

Wednesday 25th June 2025 Westminster Hall

[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?

--- Later in debate ---

[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—

[Stephen Kinnock]

Will the hon. Gentleman give way?

[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 Excerpts

Committee stage
Tuesday 24th June 2025 Public Bill Committees

[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.

--- Later in debate ---

It is simply not enough to provide care to those with the most acute mental health problems; we must look at preventive measures to ensure that people are supported through difficult times in their lives. The new clause would require a report from local authorities so that we could ensure that they are providing tailored support to those in need. We Liberal Democrats strongly believe that early intervention and preventive services are key to tackling mental health issues, and the new clause would urge mental health service providers to look beyond putting out fires, and move towards a place where we understand our local communities and the situation in relation to mental health and wellbeing, so that we do not reach crisis point in the future.

[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.

--- Later in debate ---

[Dr Chambers]

That sounds very sensible.

[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.

--- Later in debate ---

[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.

--- Later in debate ---

[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.

--- Later in debate ---

[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?

--- Later in debate ---

[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.

--- Later in debate ---

[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.

--- Later in debate ---

[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.

--- Later in debate ---

New clause 19 would begin to address the injustice. It would require an assessment of outcomes and experiences for LGBT patients and ensure that services take practical steps to improve, including through staff training on inclusive practice, reducing harassment and discrimination, and setting out what culturally competent mental health care looks like in this context. If we are serious about modernising mental health care and making it equitable, we must collect the right data, confront the disparities and embed inclusive practice across the board. That is why we have tabled the new clause. I hope that the Minister will address our concerns.

[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.

--- Later in debate ---

[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.

--- Later in debate ---

[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.

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[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.

--- Later in debate ---

[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.