Rare Cancers Bill

Stephen Kinnock Excerpts

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.

--- Later in debate ---

[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.

Access to GPs

Stephen Kinnock Excerpts

Monday 23rd June 2025 Commons Chamber

[The Minister for Care (Stephen Kinnock)]

I thank the hon. Member for North Down (Alex Easton) for raising GP access, which is a vital matter for so many of our constituents. I congratulate him on securing his first Westminster Hall debate—well done on that. [Interruption.] His first Adjournment debate—sorry. We are not in Westminster Hall right now. It has been a long day; I thank hon. Members for their forbearance.

When we ask people what their top priority for the NHS is, the chances are that they will say it is to fix general practice, because GPs are the front door to our national health service. They are the first port of call for millions of people, and they perform a vital service by delivering care in communities right across our country. Of course, health is a devolved matter in Northern Ireland, and decisions about GP services there rightly sit with the Northern Ireland Executive and at Stormont. Nevertheless, this Government are committed to being an active partner in helping to deliver better public service outcomes across the UK while respecting the devolution settlement. I am delighted that the Under-Secretary of State for Northern Ireland, my hon. Friend the Member for Putney (Fleur Anderson), is here with me on the Front Bench this evening, showing how important the teamwork between the UK Government and the Northern Ireland Executive is.

Ultimately, the underlying challenges are the same. Whether it is access, capacity or workforce pressures, we recognise those issues across the UK. Our manifesto pledged to reset our relationship with the devolved Administrations, to put country before party, and to work with them on issues from trade and tackling child poverty to a whole range of issues around the economy and growth that affect all of us. I welcome this chance to hear the perspective of the hon. Member for North Down and to exchange ideas across the Floor of the Chamber. Access to timely GP appointments is at the heart of a strong and responsive healthcare system.

[Mr Tom Morrison (Cheadle) (LD)]

On that point, I will raise the issue of a resident who lives in my constituency. She needs to give blood every three months for a long-term condition she has, but she can never get an appointment in Bramhall, where she lives; instead, she has to travel 3 miles to Shaw Heath. That happens every three months. Does the Minister agree that that should not be happening in our country and that access to GPs should be not only easier, but available to all our residents?

--- Later in debate ---

[Stephen Kinnock]

I agree absolutely with the points that the hon. Gentleman makes. We will very shortly publish our 10-year plan for the NHS. As I will say a little later in my speech, a big part of that is about the shift to a neighbourhood health service and shifting from hospital to community so that the front door of the NHS is fixed, and access is a vital part of that.

[Chris Coghlan]

The big issue in my constituency is that I have constituents who are on the point of qualifying as GPs, but they do not have jobs as GPs to go into. What do the Government plan to do as part of their 10-year plan to fix the issue that we have people qualifying as GPs who do not have GP jobs to go into?

[Stephen Kinnock]

I am sure the hon. Gentleman will welcome the fact that we secured a record £889 million increase in the GP contract. That is a first step in digging us out of the very deep hole that the previous Government left for us. When I look across my portfolio, whether it is GPs, mental health, dentistry or pharmacy—you name it—it is a car crash right across the piece. I was frankly shocked by what I saw when I first went into the Department back in July. We are, I hope, beginning to get things back on an even keel. The hon. Gentleman is right, though: we do not have a shortage of people coming through GP training, but supply and demand are not matching up. That has to change.

I am sure that the hon. Member for North Down will welcome the fact that we secured £82 million of additional funding through the additional roles reimbursement scheme, leading to the recruitment of an additional 1,700 GPs. The challenge is more about getting GPs in the places where they are most needed, which is something we need to work on—other colleagues have talked about the geographical imbalance. We need to look at the formula for the way that funding is allocated across the country, as it is an important part of the access issue that the hon. Gentleman raised.

[Tom Gordon (Harrogate and Knaresborough) (LD)]

I have been working with Lib Dem councillor Hannah Gostlow to tackle some of the issues that local health services and GP surgeries in Knaresborough are facing. I recently visited a surgery and was told that it had the staff that it wanted to get in place, but did not have the consulting rooms. The problem that surgery faces is that the money from the community infrastructure levy and other sources of funding will not come until further down the line, so it cannot take on those staff because the consulting rooms cannot be built. Does the Minister agree that we need to get funding into those GP services, so that we can provide the services that local people deserve and need?

[Stephen Kinnock]

The hon. Gentleman is right; one challenge we face is that, where we are developing new centres of housing, we are not getting the social infrastructure wrapping around them. We need to use things such as section 106 agreements and the CIL, as he mentioned. That process is not always working—the developers are not always coming forward with real, concrete commitments—so the integrated care boards do not commission because they are not sure that the infrastructure will be there, and we end up in a chicken-and-egg situation. We are working closely with colleagues in the Ministry of Housing, Communities and Local Government to break through some of that and attach stronger strings to the deals being done with developers. We also have the £102 million capital infrastructure scheme for primary care, which will go some way towards addressing the issue, but this is fundamentally about getting much clearer and stronger commitments from developers.

[Jim Shannon]

I thank the Minister for his responses, which have been incredibly helpful. When I think of GP access, I think of two things; the first is Strangford and the villages along the Ards peninsula, where I have lived for most of my life and where I represent. There, the best way of contacting a GP is by phone—that is the nature of the situation there—but one of the things that helps in Newtownards, which is the biggest nucleus of people in the area, is for people to go down to the surgery at 8 o’clock or half-past 8, join the queue and get their appointment there and then. That is another way of trying to access the GP; there is nothing as frustrating as being on the phone from 8 o’clock to half-past 8 or 9 o’clock and not being able to get an appointment. At least when people can see their doctor, they can definitely get one.

[Stephen Kinnock]

We have to have a mixture of access channels. The telephone is very important, as is being able to turn up in person, but we also need to shift more to online booking. I am really pleased that the new contract that we have with GPs is based on an £889 million investment that came with a lot of strings attached around reform. One of those strings is that every GP surgery—in England, at least—must have online booking facilities by 1 October. I hope that will improve access, and will make more space in the reception process for people who cannot use the internet.

We have to ensure that we get the balance right. That is why, as I mentioned, we took decisive action in October 2024. We invested £82 million in the additional roles reimbursement scheme, which was a targeted move to strengthen our frontline services and ease the pressure on practices across the country. That funding has directly supported the recruitment of over 1,700 GPs across England. Those GPs are now in place, helping to increase appointment availability and—most importantly—improving care for thousands of patients who have been struggling to get the help they need when they need it. We have also seen a rise in the number of GPs employed directly by practices over the past 12 months, which is a positive sign that general practice is stabilising and beginning to rebuild capacity on the ground. Together, these developments are making it easier for patients to access care and for practices to deliver it.

[Robin Swann]

As the hon. Member for North Down (Alex Easton) mentioned, there are contracts that have been handed back to the Department. We have people coming forward who want to be GPs, but it is getting harder to find those partners who want to run and manage practices. Does the Minister agree that in any training scheme and any course that comes forward, that side of general practice—how to run a business and how to run a practice—needs to be reinforced in training? There are people who want to be GPs and medics, but we need that skills mix, too.

[Stephen Kinnock]

The hon. Member speaks with great knowledge and expertise in this area, so I am pleased that he is here for this debate. He is right that it is about the skills mix. Many GPs really enjoy the management, administration and leadership role at partnership level. He raises an interesting and important point about the training for that. My impression is that many go into managing a practice having just learned on the job and gone through the process in an ad hoc way. Perhaps training is a matter for further discussion with the Royal College of General Practitioners. It is also about learning to run a business. Could we look at that in respect of universities and MBAs or whatever it might be, given that business administration is an important part of the equation?

I also wanted to say a word about bureaucracy. Too much red tape is holding GPs back. On 4 October, the Secretary of State launched the red tape challenge, with a clear goal to identify and eliminate unnecessary administrative burdens, freeing up GPs to see more patients and focus on delivering high-quality care. Improving access is not just about cutting bureaucracy; it is also about transforming how care is delivered. That is why we have committed to moving towards a neighbourhood health service. That model of care will bring a range of services together, breaking down barriers and silos between services and streamlining support for patients. That integrated approach will mean that patients are seen sooner by the right person in the right setting.

We will require all practices to ensure that patients can go online to request an appointment at any point during core opening hours. That is about not just adding a digital option, but transforming how general practice works for the modern world. By making online access standard, we are giving patients more control and greater flexibility over how they engage with their GP. It will mean no longer having to call at 8 am sharp or waiting in a phone queue. That is especially important for those juggling work, childcare or other responsibilities. This change also helps those who prefer to call or go to the surgery in person; by enabling more people to use online routes, we reduce pressure on phone lines and reception desks, meaning shorter waits and faster service for everyone.

We are also taking action to improve access for those who need it most by incentivising better continuity of care, particularly for patients with chronic or complex conditions. They benefit significantly from seeing the same practitioner over time. Continuity does not just improve the patient experience; it improves outcomes. When patients see a familiar clinician, issues are identified earlier, care is more personalised and time is not lost repeating history or re-explaining symptoms. Our manifesto pledge is to bring back the family doctor, and that is what we will do.

Physical infrastructure has also been mentioned by hon. Members. Our new £102 million primary care utilisation and modernisation fund will create additional clinical space in more than 1,000 GP practices across England. This investment will deliver more appointments and improve patient care.

[Ben Maguire (North Cornwall) (LD)]

Stratton surgery in my constituency has long been trying to get access to two rooms on the third floor of the surgery that could be used for clinical space, but the ICB seems to be dragging its feet. The rooms were previously used by Cornwall’s ICB for maternity services. They are no longer in use, so can the Minister please help in working with the ICB to help Stratton surgery to get access to those much-needed clinical spaces?

--- Later in debate ---

[Stephen Kinnock]

If the hon. Member could write to me on that issue, I would be more than happy to look into it. I am always keen to help hon. Members to get their ICBs to move in the right direction.

We have directly provided £61 million to assist the expansion of the multidisciplinary team approach across Northern Ireland, which will help to stabilise primary care, focus on the prevention and management of conditions away from hospital settings, and better utilise the skills of the community and voluntary sector. We will provide additional funding by 2028-29 to bring back the family doctor by supporting the training of thousands more GPs and delivering millions more appointments over the spending review period, and will build further on the 1,700 additional GPs who have already been recruited. Through these improvements, we are making a difference to patient satisfaction: the latest health insight survey shows a sustained improvement in satisfaction, with 72.5% of patients who contacted their general practices in the past 28 days reporting a good overall experience—up from 67.4% in July 2024.

This Government are delivering concrete results, because we believe that everyone deserves access to high-quality care closer to home. I am delighted that general practitioners committee England voted in favour of this year’s GP contract in March. This is the first time the contract has been accepted in four years. The agreement resets our relationship and marks a turning point—a shared commitment to work together on behalf of patients and practitioners alike. The changes in the contract will streamline targets for GPs, incentivise improved continuity of care, make progress towards our health mission and, crucially, require practices to make it possible for patients to go online to request an appointment throughout the duration of core opening hours. Those changes are backed by an extra £889 million, representing cash growth of more than 7% in overall contract investment.

The NHS belongs to the people. Those are not just my words; they are in the NHS constitution. Everything that this Government have done since the election has been geared towards saving the NHS, giving it back to the people and getting it back on its feet. We are putting power back into the hands of patients, where it rightly belongs, because this is their health service and it must work for them. Ensuring that every patient has access to the care that they need is not just a priority, but a promise.

[Tom Gordon]

I thank the Minister for indulging me again. Will he join me in congratulating the many fantastic GPs in my constituency and throughout the country? It is not an easy job; we hear of the flak that they get from patients day in, day out when they are working to tight timeframes. One such GP in my area is Dr Viv Poskitt, who has been elected as a Liberal Democrat town councillor. Will the Minister share my thanks to Viv and to all the GPs across our country?

[Stephen Kinnock]

I will certainly congratulate Dr Viv Poskitt—I think I have got the name right—on being a GP, although I will probably not congratulate her on being a Liberal Democrat town councillor. The hon. Gentleman is right: GPs are the backbone, or the beating heart, of our NHS. They represent the front door, and we must fix that front door, which is currently creaking on its hinges. This Government are absolutely committed to fixing it, and to moving on from there to fix our NHS, get it back on its feet and make it fit for the future.

Question put and agreed to.

Mental Health Bill [ Lords ] (Eighth sitting)

Stephen Kinnock Excerpts

Committee stage
Thursday 19th June 2025 Public Bill Committees

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

It is a pleasure to serve under your chairmanship, Mrs Harris. Having taken your clear instructions, I will be very brief in speaking to clauses 46 and 47.

Clause 46 is a positive step in principle, but there are concerns that the recommendations remain non-binary and may therefore lack the practical effect—or the teeth —without enforcement or review mechanisms. I have three questions that I hope the Minister will address. First, will he clarify whether there are any plans to give legal weight to tribunal recommendations, perhaps by requiring a written response or justification where those recommendations are not followed? Secondly, how will the Government ensure that resource-constrained local authorities can implement recommended aftercare plans promptly and fully? Thirdly, could he please provide data on the expected impact of this provision on readmission rates?

Clause 47 clearly sets out and improves on the legal clarity, which is welcome, but I have a couple of questions. What steps will be taken to ensure that frontline practitioners understand and consistently apply the revised ordinary residence test? Has the Department conducted an assessment of the administrative burdens or delays that may result from the implementation of the clause? Apart from those questions, I welcome the provision.

[The Minister for Care (Stephen Kinnock)]

It is a pleasure to serve under your chairship this afternoon, Mrs Harris. I will go through the questions that have been asked.

The shadow Minister, the hon. Member for Hinckley and Bosworth, asked whether there will be any duty on ICBs or local authorities to respond to recommendations. The tribunal will have the power to recommend that plans are put in place for a patient’s aftercare. To assist in ensuring that these recommendations are followed, the tribunal can reconvene if its recommendations are not acted on, ensuring accountability from aftercare bodies.

The shadow Minister asked what mechanisms are in place to resolve disputes between authorities. There is already a process in place under the Care Act 2014 for resolving disputes and an opportunity to escalate decisions to the Secretary of State and Welsh Ministers, if required. He also asked what the notice must contain. We will absolutely look at the guidance in the code on the process for ending aftercare and notifying the person.

The hon. Member for Solihull West and Shirley asked about plans for legal weight, resourcing and data. I will write to him on his questions about plans for legal weight and data. I think that resourcing will be a constant theme. Obviously, we have to assess all the resourcing implications once the Bill receives Royal Assent, and we will develop an implementation plan on that basis. The first annual written ministerial statement will be the hon. Gentleman’s opportunity to hold the Government to account on that.

Question put and agreed to.

Clause 46 accordingly ordered to stand part of the Bill.

Clause 47 ordered to stand part of the Bill.

Clause 48

Tribunal powers in guardianship cases: burden of proof

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

[Stephen Kinnock]

Currently, where an application is made to the appropriate tribunal by or in respect of a patient who is subject to guardianship, the patient can be discharged only if they can prove to the tribunal that they do not continue to meet the guardianship criteria. The burden of proof is on the patient. The clause will amend the Mental Health Act so that it will now be for the local authority responsible for the guardianship to prove to the tribunal that the patient continues to meet the guardianship criteria. As the independent review pointed out, the current burden of proof is “out of line” with all other applications to the tribunal. The Government consider that this should be remedied.

[Dr Shastri-Hurst]

I fear that I may test your patience a little further on this occasion, Mrs Harris, but I rise to address clause 48. Although much of the Bill aims to modernise and humanise our mental health framework, and in many ways it does so commendably, clause 47 presents not only an opportunity, but a challenge: to ensure that we get the balance right between liberty and protection.

The clause will make an amendment to section 72(4) of the Mental Health Act 1983. As the Minister said, it will shift the burden of proof in tribunal proceedings concerning patients who are subject to a guardianship order. Under the current legal framework, it is the patient who must demonstrate that the criteria for guardianship are no longer met, by showing either that they are no longer suffering from a mental disorder or that continued guardianship is no longer necessary for their welfare or the protection of others.

Clause 48 would reverse that burden. It would place the onus instead upon the local authority to demonstrate, in the mental health tribunal, that the individual still meets the statutory test. The tribunal would be required to direct a discharge unless the authority can prove otherwise.

Let me be clear: I am not opposed to the principle of this reform. On the contrary, I believe that there is a strong case for rebalancing the legal dynamics in favour of the individual, particularly when we reach situations in which their liberty and autonomy are at stake. The principle of least restriction is not, or should not be, merely aspirational; it should be foundational to any mental health regime in a liberal democracy.

I say with equal conviction that the practical operation of such a change requires careful thought and adequate resourcing. It must be done under clear legal parameters. Precisely on those fronts, I seek clarification from the Minister and, if I may be so bold, I seek some improvements to this aspect of the Bill.

First, we must consider the legal principle at play. A reversal of the burden of proof in this context is not technical or incidental; it marks a constitutional shift in the relationship between the citizen and the state. Traditionally, as the Minister well knows, the burden of proof lies on the party making an assertion that departs from the status quo. In this case, that would ordinarily be the patient applying for discharge from the guardianship. However, when the state exercises more coercive powers—particularly powers that have an impact on an individual’s liberty and private life—it is appropriate that the state be required to justify those powers afresh, especially when challenged. That is the logic that clause 48 seeks to embrace. In broad terms, as I say, I support it.

The approaches are reinforced by our obligations under article 5 of the European convention on human rights, which protects the right to liberty and security of the person. It is clear that any deprivation of liberty must be justified not just initially, but on an ongoing basis. Jurisprudence from Strasbourg has repeatedly emphasised that periodic review mechanisms must be substantive and not merely procedural in nature. The state must show continuing justification and must not rely on past assessments or presumptions in its favour.

Clause 48 helps us to move closer to compliance with those principles, but the legislation, as drafted, does leave some important questions unanswered. What, precisely, is the standard of proof that local authorities must meet? Is it the civil standard on the balance of probabilities, or is it something higher, given the gravity of what is at stake? If we are to take this shift seriously, we must also give tribunals clear statutory guidance on how to interpret the new burden. Otherwise, we will fall into the trap of risking inconsistency in decision making, confusion among professionals and a potential increase in appeals and legal challenges.

Secondly, and crucially, I would like to press the Minister on the question of practical implementation. Changing the legal burden is not merely a matter of legislative drafting; it requires a systematic adjustment in how evidence is gathered, how professionals prepare for tribunal hearings, and how decisions are reviewed internally within local authorities. As hon. Members will know, local authorities are already operating under intense financial and operational pressures. Mental health social workers are often working with caseloads that stretch the limits of what may be considered reasonable. Legal teams within councils are often overstretched and under-resourced; if we now place them under a legal obligation to present a comprehensive, evidentially sound case for continued guardianship—perhaps at multiple intervals across an individual’s care pathway—we must ensure that they are adequately supported to do so.

What assessment have the Government made of the financial and operational impact of clause 48? Will local authorities receive new funding to enable them to meet that duty? Will social care professionals receive specific training on the evidential requirements now expected of them? Without such support, we risk not only undermining the intent of the clause, but creating a perverse outcome in which discharges may occur not because the patient no longer meets the criteria, but because the local authority lacks the capacity to make the evidential case in time.

I also caution against the risk of overcorrection. Although I fully support the principle that individuals should not bear an unfair evidential burden, we must not move so far in the other direction that we weaken the legitimate protective mechanisms that should be in place. Guardianship is not detention; it is a community-based measure designed to provide oversight and structure for individuals who may struggle to live independently due to serious mental illness. It is used infrequently and only where strictly necessary.

--- Later in debate ---

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

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

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

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

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

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

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

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

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

[Stephen Kinnock]

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

[Dr Evans]

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

[Stephen Kinnock]

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

Question put and agreed to.

Clause 48 accordingly ordered to stand part of the Bill.

Clause 49

Removal of police stations and prisons as places of safety

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

[Stephen Kinnock]

Police stations are not appropriate places to hold people in need of mental health treatment. The Mental Health Act 1983 (Places of Safety) Regulations 2017 amended the 1983 Act to set a high threshold for using police stations as places of safety. Uses have reduced from over 8,000 in 2012-13 to just 322 in 2023-24 across England and Wales. While that number is mercifully low, the Bill will, under the principles of therapeutic benefit, end the use of police cells as places of safety. Instead, when police exercise powers to remove a person from a public space or private premises for the purpose of a mental health assessment, they will take them to a suitable place of safety, such as a hospital.

[Anna Dixon (Shipley) (Lab)]

I declare an interest: my sister practises as a psychiatrist within the NHS, as the Minister knows. She has seen the important shift away from the use of police stations as places of safety and towards making sure that all patients have access to a place of safety in a healthcare setting. I know from my local police that, while they do their best to support people in distress in a police station, it is not the right place. This is the right thing to do, and I support the Government’s move.

[Stephen Kinnock]

I ask my hon. Friend to pass on our thanks to her sister for the vital work that she does in what I know can often be a challenging environment—we appreciate it. My hon. Friend is absolutely right that this is an important principle. There has been a remarkable drop in the use of police cells, which is to be warmly welcomed. We think that now is the time to make it clear, on the face of the Bill, that a police cell is not an appropriate place for these purposes.

The clause’s amendment to sections 135 and 136 of the Mental Health Act will not change the police’s ability to intervene when someone is in a mental health crisis, nor their ability to detain someone in a cell when exercising their powers in relation to criminal, or suspected criminal, activity. The clause will prevent courts from temporarily detaining people with severe mental illness in prison as a place of safety while they are waiting to access a bed for treatment or assessment under the Mental Health Act. Under the reforms, a defendant or convicted person who meets the criteria for detention under the Mental Health Act for treatment or assessment must be transferred directly to hospital, or, in the case of children, to a hospital, surgery, community home or other place that the court considers suitable, ensuring that they receive swifter access to the care they need. I commend the clause to the Committee.

[Dr Shastri-Hurst]

You will be pleased to know that I will be briefer this time, Mrs Harris; I want to leave room for my Opposition colleagues. The intent of the clause is entirely sound: to treat mental health as a health issue, not a criminal one. However, the capacity of NHS services to provide timely and suitable alternatives remains in question.

With that in mind, I have three questions that I hope the Minister will be able to address. First, will the Government commit to publishing the implementation plan for ensuring adequate numbers of health-based places of safety across regions before the clause comes into force? Secondly, what contingency measures are currently in place or foreseen if no place of safety is available and police powers have been limited? Thirdly, can the Minister commit to an annual publication of data on hospital-based places of safety, their capacity and their use?

--- Later in debate ---

[Dr Evans]

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

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

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

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

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

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

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

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

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

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

[Stephen Kinnock]

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

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

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

[Dr Evans]

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

[Stephen Kinnock]

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

Question put and agreed to.

Clause 49 accordingly ordered to stand part of the Bill

Clause 50

Removal of patients by authorised persons

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

[Stephen Kinnock]

We have previously discussed Government amendments 26 to 29, which seek to overturn amendments tabled in the other place by Lord Kamall, Earl Howe and Baroness May, which added police and other authorised persons to sections 2, 3 and 5 of the Mental Health Act. As I said in the earlier debate, the police currently have no powers under those sections, and the decision makers on whether to use those sections are health and social care professionals. We do not support extending police powers to health and social care professionals in this way, and the police do not support such an extension either. We are therefore seeking to remove clause 50 from the Bill.

The clause extends legal powers currently held by the police under sections 135 and 136 to other professionals. That would enable other professionals to enter premises by force, if necessary, to remove a person believed to be suffering from a mental health disorder under section 135. Under section 136, other professionals would have the power to remove a person from a public space to a place of safety. Both those changes would represent a major shift in roles and responsibilities for health and care professionals.

Indeed, the co-chair of the approved mental health professional leads network has said that extending police powers in this way to health and care professionals would have

“disastrous unintended consequences for both individuals in crisis and those responding to mental health emergencies.”

Nine organisations, including the Royal College of Psychiatrists, the Royal College of Nursing, the Royal College of Emergency Medicine and the Association of Ambulance Chief Executives, have made a joint statement of concern about extending police powers to health and care professionals in this way.

[Anna Dixon]

It is clear from what the Minister is saying that there are widespread concerns among health professionals about the change that was proposed in the other place, which would effectively give police powers to health and care professionals. Can he reassure psychiatrists such as my sister, and others working in mental health services, that they will always be able to rely on and work closely with their police colleagues to have that back-up when they are entering somebody’s home to potentially detain them?

[Stephen Kinnock]

I absolutely can give my hon. Friend that assurance. There has to be a team-based approach to this work. In any successful team, it is about ensuring that everybody knows their role and that everybody’s role within that team is appropriate. There has to be good collaboration and co-ordination.

That is why I must say that I am quite taken aback by the attempts in the other place to insert these clauses; I do not think that is a safe way to make legislation. That is why it is so important that we remove the clause from the Bill.

The statement that I referred to earlier, by all those eminent organisations, called it a

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

It also says:

“Delegating police powers to professionals without consulting them, or patients would be a very damaging way to make policy.”

It is important to restate what I said in an earlier sitting, namely that the majority of assessments under the Mental Health Act happen without police involvement, and that action is already under way to further reduce the amount of police involvement. However, we of course recognise the pressures that the police are facing and that police involvement can be stigmatising for people who are detained. Almost all police forces in England and Wales are implementing the “right care, right person” approach, a police-led initiative to reduce inappropriate police involvement in cases where people have health or social care needs. There has already been a 10% decrease in section 136 detentions in the year ending March 2024.

There remain certain circumstances in which the police play a vital role in keeping particular people and the wider public safe. A blanket approach of extending powers in sections 135 and 136 to other professionals may not necessarily address the issues being faced by police officers and could create other unintended challenges. For example, while the current Act deliberately sets out who has what powers in what situations, a blanket extension of the police’s powers under sections 135 and 136 to other professionals—giving multiple agencies the same powers—risks confusion over who should respond in an emergency situation and could lead to delays in action as services try to decide who should act. That would be counter to our shared aim of ensuring that people in a mental health crisis get the right support as rapidly as possible.

We are also concerned that giving health and social care staff statutory powers that increase the number of situations in which they may have to use reasonable force could have unintended risks for the safety of staff, patients and the public.

[Dr Shastri-Hurst]

I rise to speak briefly to clause 50, which expands the authority to remove individuals under Mental Health Act powers by allowing trained and authorised non-police personnel to carry out removals that previously could be carried out only by police constables. A couple of key changes arise from the clause.

First, the clause provides for the inclusion of authorised persons by amending sections 135 and 136 of the 1983 Act. That will allow individuals other than police officers, if they are authorised—“authorised” is the important word—to remove and transport people under Mental Health Act powers. That provides wider operational flexibility, and includes removals under warrant, by virtue of section 135, and without a warrant in public places. It is predicated on the fact that those authorised persons are appropriately trained and designated. Prior to the clause being inserted into the Bill, only police officers could carry out removals.

--- Later in debate ---

[Stephen Kinnock]

Extending the police powers in section 135 and 136 to other authorised persons would represent a major shift in the roles and responsibilities of health and social care professionals. Our key health and social care stakeholders have warned us that extending the powers could have dangerous consequences, and that making changes to them without proper consultation is not the right way to go about making policy. I again extend my thanks to those stakeholders for their efforts to share their views on the role of police in mental health-related incidents.

We of course recognise the pressures that police face. However, I must emphasise that the majority of assessment under the Mental Health Act already happen without police involvement. Action under the “right care, right person” approach is already reducing that further: there was a 10% decrease in section 136 detentions in the year ending March 2024.

Simply taking the blanket approach of extending the powers may not actually address the issues the police face and could have unintended negative consequences, such as risks for staff, patients and the public, and delays in response. The Government are profoundly concerned about making such a change without proper engagement with the groups that would be impacted. I therefore do not commend clause 50 to the Committee.

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

--- Later in debate ---

[The Chair]

With this it will be convenient to discuss clauses 52 and 53 stand part.

[Stephen Kinnock]

Clause 51 will reform the Bail Act 1976 to prevent courts from remanding a defendant for their own protection where the only concern relates to their mental health.In response to the independent review, a commitment was made to end the use of prison as a place of safety. Those reforms were welcomed, but concerns were raised about the use of a similar power under the Bail Act 1976 to remand a defendant to prison for their “own protection”. That power can sometimes be used when the court is concerned that the defendant’s mental health presents a risk to their own safety.

Nobody should be sent to prison because they are struggling with their mental health, so the clause will amend the Bail Act to prevent the remand of a defendant for their own protection solely on mental health grounds. Instead, courts will be directed to bail the defendant and work with local health services to put in place appropriate support and care to address risks to their safety.

The clause does not amend the court’s power to refuse bail in respect of a child or young person for their own welfare, because it is already the case that youths cannot be subject to a custodial remand solely for mental health reasons. However, in exceptional circumstances it may still be necessary for a court to remand a child to local authority accommodation for their mental wellbeing, and for that reason the power is preserved.

On clause 52, patients from the Crown dependencies—the Channel Islands and the Isle of Man—currently cannot be transferred to England and Wales under sections 35, 36 and 38 of the Mental Health Act. The clause will introduce new powers to enable the Crown dependencies’ courts to send patients who are subject to their equivalent of remand under sections 35 or 36, or an interim hospital order under section 38, to suitably secure hospitals in England and Wales for treatment and assessment. The changes will ensure that that vulnerable cohort of patients can receive appropriate and secure treatment in England and Wales, while enabling the Crown dependencies’ courts to maintain control of the criminal proceedings, so that justice can be done swiftly and efficiently.

Finally, clause 53 will ensure that where provisions in the Mental Health Act provide for the processing of personal data, any such processing, including the sharing of data, is subject to data protection legislation, including the Data Protection Act 2018 and the UK general data protection regulation principles. For example, personal data—including special category data such as health data—is likely to be contained in a report produced under clause 4, which inserts clauses specific to people with a learning disability and autistic people, so that their care, treatment and differing support needs are identified, and recommendations are made to ensure that those needs can be met. That report will be shared with the bodies set out in the clause, including the patient’s responsible clinician, the relevant integrated care board and the local authority.

Clause 53 will ensure that such processing of personal data must comply with the controls and safeguards in the legal framework that governs the use of personal data. That includes compliance with key principles such as lawfulness and fairness, and adherence to high standards of information security, privacy and transparency.

In essence, the provision means that where there is a duty or power under the Mental Health Act to process personal data, the processing—including the sharing—of the information must be done in a way that will not contravene data protection legislation, including the UK GDPR and the Data Protection Act 2018. In turn, among other things, that requires personal data to be processed lawfully, fairly and transparently, and confers certain rights on data subjects to access that data and have any errors rectified. That gives vital reassurance to patients about the processing of their personal data under the Mental Health Act. For those reasons, I commend clauses 51 to 53 to the Committee.

[Dr Shastri-Hurst]

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

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

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

--- Later in debate ---

Clause 52 is a sensible and overdue reform to an obscure but important part of the Mental Health Act. It will allow for humane, clinically appropriate and legally managed transfers of individuals caught between criminal justice and serious mental illness. However, it raises important operational and ethical questions about legal safeguards, court oversight and administrative accountability.

[Stephen Kinnock]

The hon. Member for Solihull West and Shirley asked how the courts would be supported in training for judges and so on. To safely enact that reform, it is vital that the appropriate pathways are in place from first contact with the criminal justice system into the right care and support, whether that is community mental health services or receiving treatment in hospital under the Mental Health Act, where appropriate. We will work with courts, health service commissioners and clinicians to ensure that sentencers have the confidence to bail vulnerable defendants into the community, with the appropriate package of support and smooth pathways into treatment in a healthcare setting for those who need it. We will confirm the timelines for commencement in due course.

The shadow Minister, the hon. Member for Hinckley and Bosworth, asked about people who are under 18. Custody should be a last resort for children, and the legislative threshold for remanding a child to custody is already very high. Under-18s are not included in this provision, as the Legal Aid, Sentencing and Punishment of Offenders Act 2012 already precludes the remand of children to custody solely for mental health reasons. When the court’s concerns relate only to the child’s welfare, the preferred option would usually be bail. In exceptional circumstances, a court might remand a child to local authority accommodation, such as a children’s home or foster care, for their own mental wellbeing. Including children in this provision would remove that important safeguard.

On the question of legal limbo, courts in England and Wales will not be able to exercise any criminal jurisdictional powers in relation to these patients. Their powers are restricted to renewal of the remand or interim order, ancillary powers and recommendations for the patient’s return, as well as obligations to inform the Secretary of State. We have included additional provisions in the Bill to allow courts in England and Wales to order a section 36 for treatment for a patient who has previously been transferred from the Crown dependencies on the equivalent of a section 35 for assessment. That is aimed at enabling access to treatment for the patient and preventing the need for the patient to be required to travel back and forth between jurisdictions.

Question put and agreed to. 

Clause 51 accordingly ordered to stand part of the Bill. 

Clauses 52 and 53 ordered to stand part of the Bill. 

Clause 54

Review of duty to notify incidents

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

[The Chair]

With this it will be convenient to discuss the following:

New clause 12—Age-appropriate treatment for children—

“(1) Section 131A of the Mental Health Act 1983 is amended as follows.

(2) After subsection (1), insert—

‘(1A) A patient to whom this section applies must not be detained in, or admitted to, an adult ward unless the managers of the hospital consider that—

(a) there are exceptional circumstances which justify the patient’s detention in, or admission to, an adult ward; and

(b) the decision is in accordance with the best interests of the child.’

(3) After subsection (3) insert—

‘(3A) Where a patient has been detained in, or admitted to, an adult ward, the managers of the hospital must record in writing the reasons for the admission, including—

(a) the reason, or reasons, why other options for accommodation were not available or suitable for the patient;

(b) details of the measures to be taken by the hospital to ensure that, while the patient is detained or otherwise accommodated in the adult ward, the patient is provided with care in a safe environment; and

(c) unless it has been determined that an adult ward is the most appropriate environment for the patient in accordance with subsection (1A), the steps being taken by the hospital to transfer the patient to more appropriate accommodation.

(3B) Where a patient to whom this section applies is—

(a) detained in, or admitted to, an adult ward or placed out of area; and

(b) the detention or admission is of more than 24 consecutive hours’ duration,

the managers of the hospital must notify the regulatory authority immediately, setting out why they consider that the requirements under subsection (1A) above are met and providing the information set out in subsection (3A).

(3C) Subsection (3D) applies when—

(a) the managers of a hospital accommodate a patient to whom this section applies in an adult ward for a consecutive period of at least 28 days; or

(b) detain or admit a patient to whom this section applies who—

(i) was ordinarily resident immediately before being detained or admitted in the area of a local authority other than the local authority within whose area the hospital is situated, or

(ii) was not ordinarily resident within the area of any local authority.

(3D) Where this subsection applies, the managers of the hospital must immediately inform the appropriate officer of the responsible local authority—

(a) of the patient's detention or admission, and

(b) when the patient's detention or admission ceases.’

(4) Leave out subsection (4) and insert—

‘(4) In this section—

(a) “adult ward” means a ward in a hospital to which persons aged 18 or over are detained in or admitted to;

(b) “the appropriate officer” means—

(i) in relation to a local authority in England, their director of children's services, and

(ii) in relation to a local authority in Wales, their director of social services;

(c) “hospital” includes a registered establishment; and

(d) “the responsible authority” means—

(i) the local authority appearing to the managers of the hospital to be the authority within whose area the child was ordinarily resident immediately before being detained or admitted, or

(ii) where it appears to the managers of the hospital that the patient was not ordinarily resident within the area of any local authority, the local authority within whose area the hospital is situated.’”

This new clause seeks to ensure that children are only placed on adult wards where there are exceptional circumstances, and it is in their best interests. It includes procedural safeguards for determining the reasons behind (and suitability of) admitting a child to a hospital environment in which adults are simultaneously accommodated or in an out of area placement.

New clause 17—Children detained on adult wards—

“(1) The Mental Health Act 1983 is amended as follows.

(2) After section 131A (Accommodation, etc. for children), insert—

‘131B Children detained on adult wards

(1) The Secretary of State must reduce to zero, within five years of the passage of the Mental Health Act 2025, the number of children detained on adult wards.

(2) The Secretary of State must publish, within six months of the passage of the Mental Health Act 2025, a report to outline how the duty under this section will be met, including how provision for treatment under this Act will be increased.’”

This new clause would require the number of children detained on adult wards to be reduced to zero within 5 years, and for the Secretary of State to produce a report on how this will be achieved.

New clause 20—Report and Guidance: Transition to Adult Mental Health Treatment—

“(1) The Secretary of State must, within 18 months of passing of this Act, prepare and lay before Parliament a report on improving provision for patients transitioning from treatment in a hospital environment for children and young people to one for adults when they attain the age of 18.

(2) The report under subsection (1) must include an assessment of—

(a) the current pathways and outcomes for young people transitioning between hospital environments for children and for adults;

(b) any gaps in care or support experienced by patients during this transition;

(c) best practices for ensuring safe and effective transitions.

(3) Following the report under subsection (1), the Secretary of State must publish guidance for integrated care boards, local authorities, and providers of mental health treatment on improving outcomes and ensuring continuity of care for patients transitioning to a hospital environment for adults.

(4) The guidance under subsection (3) must include—

(a) specific steps to guarantee continuity of care for patients transitioning between treatment in a hospital environment for children and young people and one for adults;

(b) measures to identify young people requiring transition support at an appropriate stage;

(c) provisions for joint working and information sharing between providers of treatment for children and young people and for adults;

(d) requirements for the review and updating of care and treatment plans to reflect the needs of patients transitioning to a hospital environment for adults.

(5) Integrated care boards, local authorities, and providers of mental health treatment must have regard to guidance published under subsection (3).

(6) In preparing the report under subsection (1) and the guidance under subsection (3), the Secretary of State must consult—

(a) young people with experience of transitioning between children and young people’s and adult mental health services, and their carers and guardians;

(b) relevant professional bodies;

(c) integrated care boards;

(d) local authorities;

(e) providers of mental health treatment;

(f) such other persons as the Secretary of State considers appropriate.

(7) The Secretary of State must update the guidance under subsection (3) at regular intervals, and no less frequently than every three years.”

This new clause would require the Secretary of State to review and report on the transition of patients from children's to adult mental health settings for treatment at age 18 and publish guidance for relevant bodies on improving provision and ensuring continuity of care during this transition.

[Stephen Kinnock]

I rise to speak to clause 54 and to a number of new clauses relating to the treatment of children and young people.

I turn first to clause 54. The Care Quality Commission (Registration) Regulations 2009 require the CQC to be notified of specified events, one of which is where a child is placed in an adult psychiatric unit and the placement has lasted more than 48 hours. When the CQC is notified, the circumstances are reviewed and the risk is assessed. These notifications can trigger further assessments and inspections, and require the trust to provide regular updates and give assurance that the children concerned are being safeguarded.

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[Dr Shastri-Hurst]

You will be disappointed to know, Mrs Harris, that the notable contributions from my hon. Friends the Members for Chester South and Eddisbury and for Farnham and Bordon mean that my contribution will be even briefer than usual. [Interruption.] Rapturous support across the Committee—exactly the consensus-building that we are seeking to achieve.

I rise to speak in support of new clause 12. It necessarily addresses the inappropriate placement of children on adult wards, which is not just distressing but deeply damaging to those involved. The issue is about having child-centred safeguards. It is essential that we ensure that children under 18 are placed on adult wards only when it is absolutely necessary and there is no alternative. The new clause would not only support best practice—it aligns with clinical guidelines on age-appropriate care—but provide welcome legal clarity. It would strengthen and clarify the existing provisions within the Mental Health Act. For those reasons, I encourage all hon. Members to support it.

On clause 54, the Minister would be disappointed if I did not put a couple of questions to him.

[Stephen Kinnock]

Yes, I would.

[Dr Shastri-Hurst]

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

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

--- Later in debate ---

Publishing another report in six months’ time and setting a five-year goal will be of little comfort to a 17-year-old who, this week, might find herself placed on an adult ward for lack of a suitable alternative, or indeed a 15-year-old, detained miles from home, isolated and at risk. Those children do not need a long-term goal; I gently say that they need protection now. That is why our new clause does three critical things—which I will not state again. While I welcome the ambition of new clause 17, I believe that it must be complementary and enforced by duties today, not tomorrow. On that point, I will wait for the Lib Dems to wind up.

[Stephen Kinnock]

The hon. Member for Guildford asked about timelines. There is the timeline for the review on the face of the Bill, and then there is the broader question about implementation and how all the moving parts fit together. We have now had the spending review, which will provide a financial envelope for mental health more broadly, and for implementation of the Bill. We will be ready to move forward with implementation on that basis, which will include the code of practice.

My hon. Friend the Member for Hertford and Stortford asked about a time limit for notification. It is already a legislative requirement for the CQC to be notified when a child or young person is placed on an adult ward for a continuous period of longer than 48 hours. In addition, the previous Government assessed that the current requirement of 48 hours was sufficient. As part of the review that is mentioned on the face of the Bill, we will consider whether that remains the case for receiving notifications, and whether it remains appropriate.

My hon. Friend also asked about further safeguards for children and young people, including those in inappropriate settings. Obviously, the placement of a child or young person on an adult mental health ward only happens following a thorough clinical assessment. Trusts are required to have robust local safeguarding protocols in place, including mandatory staff training on safeguarding and incident-reporting mechanisms, to ensure accountability and oversight. Staff are appropriately trained in child and adolescent mental health care, and they must meet level 3 competency in safeguarding children.

The hon. Member for Farnham and Bordon asked about data. The CQC already publishes “Monitoring the Mental Health Act”, a statutory annual report that must be laid before Parliament, in which it reports on the number of people under 18 who are admitted to adult wards. Additionally, it reports qualitative information on placements for children and young people, such as placements on children’s general wards. I hope that I have addressed that point.

--- Later in debate ---

Brought up, and read the First time.

[Stephen Kinnock]

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

[The Chair]

With this it will be convenient to discuss Government amendments 37 and 38.

[Stephen Kinnock]

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

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

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

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

[Dr Evans]

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

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

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

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

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

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

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

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

[Stephen Kinnock]

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

Question put and agreed to.

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

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

Statutory Learning Disability and Autism Training

Stephen Kinnock Excerpts

Thursday 19th June 2025 Written Statements

[The Minister for Care (Stephen Kinnock)]

Today I am pleased to lay in Parliament the Oliver McGowan draft code of practice on statutory learning disability and autism training. The launch of this code represents a significant moment in the journey towards improving the care and treatment of people with a learning disability and autistic people. With its clear focus on ensuring that people receive tailored and compassionate support, it is especially fitting to be launching this code after recently celebrating World Autism Awareness Day in April and during Learning Disability Week, which this year is focusing on ensuring that people are seen, heard and valued. An easy-read version of the code is also available.

The purpose of the code is to ensure that service providers registered with the Care Quality Commission have the necessary guidance to meet the legal requirement introduced in the Health and Care Act 2022. The effect of the requirement is that, from 1 July 2022, CQC-registered providers are required to ensure that their staff receive training on learning disability and autism, appropriate to their role. To aid those who need to comply with the training requirement, the Secretary of State is obliged by the 2022 Act to issue a code of practice. Therefore, this code sets out the standards that training needs to meet to comply with the legislation and guidance on what providers need to do to meet those standards.

As set out in the code, the Oliver McGowan mandatory training on learning disability and autism is the Government’s preferred and recommended training package to support CQC-registered providers to meet the new requirement. The training is named after Oliver McGowan, a young autistic teenager with a mild learning disability, who very sadly died after having a severe reaction to medication given to him against his and his family’s strong wishes. Oliver’s parents, Paula and Tom McGowan, have tirelessly campaigned for better training for health and care staff to improve understanding of the needs of people with a learning disability or autistic people. The training has been trialled with over 8,000 participants and independently evaluated to ensure that the final package is robust and high quality. A long-term, independent evaluation on its delivery and impact is also now under way.

People with a learning disability and autistic people experience disparities in the quality of care they receive. Research indicates that a lack of understanding and knowledge of learning disability and autism likely contributes to this. This government have set out three big shifts needed to make our health service fit for the future, including shifting from treatment to prevention and from hospitals to communities. Ensuring that health and care staff have the right knowledge and skills to provide informed care for people with a learning disability and autistic people will help to meet these goals and improve health outcomes.

The legislative requirement and the code must be the catalyst for positive cultural change. With them we can help to deliver care and support that is tailored to the person, making sure that staff have the right attitudes, skills and behaviours to support people with a learning disability and autistic people safely, confidently and respectfully.

[HCWS715]

Mental Health Bill [ Lords ] (Seventh sitting)

Stephen Kinnock Excerpts

Committee stage
Thursday 19th June 2025 Public Bill Committees

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The explanatory notes state that the duty applies to

“patients subject to transfer directions”

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

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

[The Minister for Care (Stephen Kinnock)]

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

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

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

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

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

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

--- Later in debate ---

[Gregory Stafford (Farnham and Bordon) (Con)]

It is a pleasure to serve under your chairmanship, Sir Desmond. You and the Committee will be pleased to know that my hon. Friends have made most of the points I wanted to flag.

In poll after poll and survey after survey, patients feel they do not get information in a timely and constructive way. Our amendment 46 would give patients a stronger say in their future care if they lose capacity. It clarifies that patients must be given clear, proactive support to understand, prepare and use the documents. It is about ensuring that advance choice documents are not just theoretical paperwork, but living, respected statements of a patient’s wishes.

I therefore support the clause and the amendment, and I ask the Minister three questions. How will NHS England and local integrated care boards ensure that commissioners are trained to respect and use ACDs in practice, especially in emergencies? Secondly, what oversight will ensure that ACDs are not simply ignored at the bedside, when a patient is most vulnerable? Will the Government consider a review mechanism so that we can assess how well ACDs are working in a few years’ time, after the Bill is passed?

I turn briefly to Liberal Democrat amendment 18. Like other hon. Members, I feel that the inclusion of financial information in an ACD is not appropriate, both from a practical and a personal security, safety and information point of view. I do, however, completely support the hon. Member for Winchester’s overall view that there is a significant problem with how financial stress can affect a person’s mental health. Like him, I call on the Minister to think about how we as a country, whether in this Bill or somewhere else, can address the impact of financial stress on mental health.

[Stephen Kinnock]

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

[Dr Evans]

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

[Stephen Kinnock]

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

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

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

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

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

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

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

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

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

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

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

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

[Dr Evans]

I would like to press amendment 46.

Question put, That the amendment be made.

--- Later in debate ---

[The Chair]

With this it will be convenient to discuss the following:

Clause 47 stand part.

New clause 21—Duty to provide advice and support to families and carers—

“(1) The Mental Health Act 1983 is amended as follows.

(2) After section 117B, insert—

‘117C After-care: provision of support and advice to families and carers

(1) The responsible integrated care board must ensure that, as part of the provision of after-care services under section 117 of this Act, advice and support is offered to the family or carers of the person discharged.

(2) This support must include—

(a) information about the person’s condition and recovery;

(b) guidance on how to support their recovery at home and avoid relapse;

(c) access to financial, housing, and social care advice services relevant to the situation of the person’s family; and

(d) procedures for family members or nominated persons to notify the integrated care board of concerns that the person is at future risk of detention under Part 2 of this Act.

(3) Where a concern is raised under subsection (2)(d), the integrated care board must—

(a) consider whether the individual meets criteria to be included on the register of persons at risk under section 125D of this Act; and

(b) take reasonable steps to involve the family or nominated person in planning of subsequent support, subject to—

(i) the person’s consent; or

(ii) if they lack capacity, the person’s best interests.

(4) The Secretary of State must publish guidance under section 125B of this Act on the format and provision of support under subsection (3)(b).’”

This new clause would require the integrated care board, as part of the aftercare services offered under the Mental Health Act 1982, to offer support and advice to the family or carers of the person being discharged from treatment.

[Stephen Kinnock]

I will set out the details of two important clauses relating to aftercare. Clause 46 will provide the tribunal with an important new power to recommend that plans for aftercare arrangements are undertaken for patients who are not yet ready to be discharged from hospital. Under the Mental Health Act, the tribunal can make decisions about discharge, but it does not have a role in recommending aftercare while a patient remains detained. Giving the tribunal the power to make recommendations that aftercare planning should take place will encourage earlier planning for a patient’s eventual discharge from hospital.

Those recommendations are particularly important for complex cases in which patients may require intensive support following their discharge. Early aftercare planning ensures that the necessary health and social care services are co-ordinated and in place when the patient is ready to leave the hospital. This will help to reduce the likelihood of delayed discharges or failed transitions back into the community.

Although the tribunal’s recommendations are not legally binding, they are intended to carry significant weight with aftercare providers. If recommendations are not taken forward, the tribunal retains the power to review the patient’s case. That will ensure that there is both encouragement and accountability in the aftercare planning process, enhancing patient outcomes by making sure that care is appropriately planned and delivered.

The clause will strengthen the role of tribunals in overseeing the care and treatment of patients under the Mental Health Act, ensuring that a patient’s needs are addressed holistically and in a timely manner. By encouraging earlier and more co-ordinated aftercare planning, we will reduce the risk of patients being discharged without the necessary support in place, leading to better overall patient outcomes and smoother transitions from hospital to community care.

[David Burton-Sampson (Southend West and Leigh) (Lab)]

It is a pleasure to serve under your chairship, Sir Desmond. Again, I reflect on stories that I have heard from local constituents on the issues that are being addressed in the Lampard inquiry. Does the Minister agree that these provisions will help to avoid the too early discharges that have led people either to go back into care or to get into even more difficult situations? One of my constituents ended up taking his own life because he was discharged too early from care.

[Stephen Kinnock]

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

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

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

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

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

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

[Dr Evans]

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