Mental Health Bill [ Lords ] (Fourth sitting)

Gregory Stafford Excerpts

Committee stage
Thursday 12th June 2025 Public Bill Committees

[Anna Dixon]

There is a big difference, because when we address clinical variation we usually do so through clinical guidelines, clinical best practice, training and many other non-statutory levers, which are much more effective at driving out unwarranted variation. They also include feeding back data; the hon. Gentleman talked about data and encouraging NHS trusts and organisations to ensure transparency about which psychiatrists are overusing CTOs. That feeding back of data can be much more effective at driving out unwarranted variation, although that is not to say that we accept that there are people who are potentially on long CTOs that go through renewal.

The other point is that there are other mechanisms, as the hon. Gentleman acknowledged, such as the tribunals. Those review points need to be as effective as possible at ensuring that people are not unnecessarily being kept under community supervision when that is no longer necessary.

I will be seeking assurances from the Minister about what will be in the code of practice to ensure that any statutory time limit is really just a backstop that maximises the ability of clinicians to have some discretion, while using these other methods to ensure good practice, consistency in decision making and reductions, certainly in racial disparities, and as an urgent matter, but also in some of the intra-professional variation that is not necessarily connected with racial discrimination. In that sense, I will support Government amendment 30 as long as the Minister gives a reassurance that we do not accept either the racial disparities in use or some of the lengthy uses, and that he is confident that the provisions in the code of practice will start moving us away from the current situation with the use of CTOs.

The hon. Member for Hinckley and Bosworth made some interesting points about research and evaluation. Having been the chief analyst in the Department of Health and Social Care, I am well versed in this. Obviously we have a generous settlement for all the research and innovation. The National Institute for Health and Care Research is world-renowned for the research that it commissions. There is clearly quite a disparity in the views that this Committee has heard, with the likes of Mind perhaps at one end in saying that the only solution is to get rid of CTOs. I think the majority of us here see a role for them, but only if used in the right way.

In addition to the ongoing data collection and feedback to clinicians, which it was suggested the Minister might want to take away and consider with the NHS, the Department and NHS England—while perhaps also talking to NIHR about the research and evaluation in this area, as well as the research gaps that could inform future implementation of CTOs and help to underpin best practice—we might consider looking into such matters as what is driving the racial inequalities and interprofessional variation, so that we can ensure that future policymakers and legislators like ourselves are better informed and can make more evidence-based policy decisions.

I am close to concluding, but I would like to touch briefly on Liberal Democrat amendment 11. Mental health advocacy is clearly critical, particularly for those who lack capacity as well as those who are compulsorily detained in an in-patient setting. I hope and expect that with the use of CTOs as a method of discharge, the relationship with advocacy they may have accessed in the in-patient setting would continue in the community. I acknowledge the spirit behind the amendment and hope to hear the Minister respond on how we will ensure that all those with complex mental health issues—particularly those who lack capacity and are detained in an in-patient setting—will have access to appropriate advocacy.

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

I rise briefly to dilate on clause 6, on Liberal Democrat amendment 11 and on Government amendment 30. Those of us on the Health and Social Care Committee recently had a fascinating panel about the disparities for black and minority ethnic groups in maternity, and it does not end there, as we can see from the evidence raised by my hon. Friend the Member for Hinckley and Bosworth and by the hon. Member for Shipley.

When CTOs were introduced—for good reasons—the elements of controversy that hon. Members have raised were not predicted. The overuse of CTOs, especially among black and minority ethnic patients, should give us all concern, although I have to say that there is some limited evidence of effectiveness in reducing relapse or readmission. Will the Minister give us the Government’s view on that and how they might seek improvement going forward?

What we are trying to achieve in the clause is to bring legislation in line with the 2018 independent review of the Mental Health Act, which recommended tightening the use of CTOs, or indeed abolishing them altogether for some groups. I support the clause because it brings in stronger safeguards, a clearer commitment and time limits to reduce the risk of indefinite or inappropriate use. It also improves patient involvement, because it requires a consultation and review, promoting shared decision-making, and increases accountability because it aligns with the code of practice and introduces external oversight. It focuses on the reality, ensuring that CTOs are used only where truly needed.

I am slightly concerned about Government amendment 30, which will remove the detailed provision that would have introduced new statutory limits and review procedures for community treatment orders, specifically under subsection (3), and inserted new subsections (8) to (11) into section 17B of the Mental Health Act. The implication of removing subsection (3) is that essentially we will maintain the current legal framework, which does not impose a fixed maximum duration or the same level of structured review currently written into the clause. I am afraid that that would not bring in the safeguards and oversight mechanisms that would, at least to some degree, start to tackle the problems that hon. Members on both sides of the Committee have been talking about. It may be seen as taking a step back from what campaigners and professionals who are advocating for stronger patient rights and accountability on the use of CTOs would like to see.

I ask the Minister for the same reassurances that the hon. Member for Shipley asked for in this area. If the Government are to move Government amendment 30 successfully, we will need to see how they intend to deal with these issues going forward.

Liberal Democrat amendment 11 would ensure that people subject to a CTO receive information about their right to advocacy. That is an entirely laudable aim, but I ask Liberal Democrat Members to answer a few questions. First, how do they see the administrative burden on clinicians to ensure that both oral and written communications are documented? Secondly, what additional training do they think those professionals might need to ensure that the information is both consistent and correct? Thirdly, might there be delays in issuing a CTO if, for some reason, advocacy information is not immediately available?

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[The Chair]

The Ayes were 10 and the Noes were five, so the Ayes have it.

[Gregory Stafford]

On a point of order, Mr Vickers. Just to be clear, I counted six Noes, and I think you announced five. Can we just check on that?

[The Chair]

You are right—my apologies. The record will be amended.

[Gregory Stafford]

Further to that point of order, Mr Vickers. I should say it was the Liberal Democrats who pointed it out to me; I do not want to take the credit from them.

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[Dr Evans]

I will speak to clause 8 first, then work my way through the other provisions in the group. The clause will introduce a statutory requirement that medical treatment under the Act must have a reasonable prospect of therapeutic benefit for the individual. This is a significant and, I believe, welcome development, bringing the law into closer alignment with modern principles of person-centred care and clinical justification. Again, the intention is clear: to ensure that no one is detained or treated under compulsion unless there is a realistic chance that they will benefit from the treatment. That is another laudable aim, and as a doctor myself, I fully support it.

Significant concerns have been raised that individuals, especially those with complex or treatment-resistant conditions, have been subject to interventions where the purpose was therapeutic but the likelihood of benefit was minimal or uncertain. By introducing a consistent legal definition of appropriate medical treatment early in the Mental Health Act, and ensuring its application across both civil and forensic pathways, the clause marks a step forward in rights protection and clinical accountability. I welcome the shift away from vague references to appropriateness towards a test that is both objective and patient specific; however, several important questions remain, and I hope the Minister will address them.

The first is on defining a reasonable prospect in practice. While the term “reasonable prospect” is a flexible one, that flexibility cuts both ways. The explanatory notes clarify that clinicians do not need to conclude that the benefit is more likely than not, only that it is reasonably possible, but what guidance will clinicians receive to ensure that this threshold is applied consistently and fairly across the country? Will the updated codes of practice provide clear examples or scenarios, and will the guidance be subject to consultation with patients, carers and professionals?

When it comes to forensic patients, and equity and safeguards, I welcome the fact that the clause applies equally to part III patients, who are involved in the criminal justice system. Historically, this group has sometimes been subject to more coercive and less scrutinised care pathways. Will the Minister confirm that the same therapeutic benefit test will apply at every decision point—initial detention, transfer, conditional discharge and recall—so that forensic patients are not denied the safeguards enjoyed by civil patients?

When it comes to legal remedies and review, what mechanisms will be available to patients who believe that the reasonable prospect test has not been met? Will this be a justifiable cause in tribunals or courts? Will mental health tribunals be empowered to scrutinise the clinical judgments behind this test, and if so, what training will be provided to tribunal members?

While I welcome the statutory clarity that clause 8 brings, we must be mindful that legislative change is only the first step: implementation will be critical. I would hope the Government will publish a clear timetable for updating the codes of practice, as well as plans for training, auditing and evaluation. Without that, there is a risk that the reasonable prospect test becomes, again, a box-ticking exercise rather than a meaningful safeguard.

Finally, I want to focus particularly on how the measure will apply to people who have long-term, complex or non-degenerative mental conditions where there may be limited, if any, prospect of clinical improvement through medical intervention. These include, but are not limited to, some forms of autism, learning disabilities and personality disorders, particularly those for which trauma-informed approaches may be more appropriate than medical ones. What about acquired brain injuries, or individuals with treatment-resistant psychosis or chronic conditions for which medication has been ineffective? Under the Mental Health Act, such individuals can be and are detained for prolonged periods, sometimes years, even when no clear therapeutic progress is being made.

Families, advocates and patients themselves frequently describe a sense of clinical limbo—being held under compulsion with little hope of change, because the system has no better option. Of course, that is one of the big reasons for the Bill in the first place, and it brings with it an entirely new set of problematic scenarios that need careful consideration. In short, the prize of clause 8 is that that limbo should no longer happen: detention and compulsory treatment should occur only when there is a reasonable prospect of actual benefit.

How will clinicians be expected to assess the prospect of benefit in cases in which a condition is not considered medically treatable in the conventional sense? For example, if a person with autism is detained during a crisis, but their underlying condition is not one that responds to medication, will the presence of social support or behavioural interventions be considered sufficient to meet the threshold of therapeutic benefit?

Will the Government clarify that detention is not justified when the primary issue is risk management, rather than therapeutic progress? There is a long-standing concern that individuals are being detained primarily because of perceived risk, even when there is no viable treatment plan likely to improve their condition. Clause 8 provides an opportunity to set a clear boundary: that risk alone is not enough; there needs to be a reasonable prospect of improving the person’s mental health through treatment.

How will the new test interact with decisions around discharge and the renewal of detention? If a person has been detained and the anticipated benefit of treatment has not materialised, will the failure to have achieved a benefit trigger a presumption of discharge, or at least a fresh review of the justification for ongoing detention? Will there be specific guidance in the revised code that addresses how the new tests apply to conditions such as brain injuries? After a recent question, I know that the Government are continuing with the brain injury strategy, but has there been any work on how that can be incorporated?

Those are not mere technical questions; they speak to the ethical foundations of the Mental Health Act, which confers extraordinary powers to detain and treat without consent and to deprive someone of their liberty.

[Gregory Stafford]

We are trying to future-proof the Bill as much as possible. Does my hon. Friend think that the clause has enough future-proofing to deal with mental health issues that we are currently unaware of, or issues whose nature or treatment we do not fully understand?

[Dr Evans]

My hon. Friend is a shrewd surveyor of legislation, and even foresees the amendments that I have tabled, which may well expose and shine a little light on something that might make a difference. In essence, he is right: trying to future-proof the Bill, while ensuring that it is robust and applicable, was at the heart of the first day’s debate and seems to be at the heart of today’s debate.

As I said, the Mental Health Act confers extraordinary powers to detain and treat without consent and to deprive someone of their liberty, but in exchange there needs to be a clear, evidence-based justification for doing so. The clause goes some way to strengthening that justification, but only if the principle of therapeutic benefit is applied rigorously and not just diluted.

Let me turn to amendments 44 and 45, tabled in my name on behalf of His Majesty’s Opposition, which speak to what my hon. Friend the Member for Farnham and Bordon just said. They seek to embed trauma- informed principles into the definition of “appropriate medical treatment” under the Mental Health Act. These amendments aim to ensure that medical treatment for mental disorder not only addresses symptoms but actively minimises patient distress, promotes psychological wellbeing and supports recovery from childhood trauma.

There is robust and compelling evidence demonstrating that childhood trauma is a causal factor in the development of a wide range of mental health conditions. The “Adverse Childhood Experiences Study”, by Felitti et al. in 1988, demonstrated a strong dose response relationship between the number of traumatic experiences in childhood and the likelihood of developing of mental health disorders later in life, including depression, anxiety, psychosis and substance misuse.

Neuroscientific studies such as Teicher et al. in 2016 have revealed how early maltreatment alters brain structures and functions critical to emotional regulation and stress response. A review of trauma and psychosis by Read et al. in 2005 identified childhood trauma as a significant risk factor for several mental illnesses, including psychiatric disorders. Furthermore, clinical guidance such as NICE’s 2018 recommendations emphasises the importance of assessing trauma history and incorporating trauma-focused interventions into care. These findings are reflected in UK health policy, with the Department of Health recognising trauma-informed care as essential for effective mental health services.

We also know from clinical studies that trauma history influences treatment outcomes, with trauma-uninformed care risking re-traumatisation and poor recovery. It is vital to stress that recognising trauma as a causal factor is not about excusing behaviour but about understanding behaviour. Such understanding enables clinicians and services to respond more compassionately and effectively, supporting genuine recovery and healing, rather than merely managing symptoms or controlling behaviour. Embedding trauma-informed care in law is a progressive step that aligns with modern mental health best practice and respects the lived experience of many retained under the Act, the majority of whom have experienced significant trauma in their lives.

If the Government do not accept these amendments, can the Minister clarify what steps they will take to ensure that trauma-informed approaches are embedded in mental health services? Will there be guidance, training or oversight in the mechanisms to ensure that patient distress is minimised and psychological wellbeing promoted?

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In conclusion, I very much welcome the idea of putting therapeutic care front and centre. I would welcome the Minister’s thoughts on how this idea applies to those with very serious and complex personality disorders, and those with learning disability and autism. However, this is a really important step change, not only in how we treat people with a severe mental illness in a locked setting but in how patients are viewed, and in the importance and value of their experience. I would like to express my own gratitude for it, reflecting the views of people with lived experience. It plays into the idea that if someone is in a secure mental unit, they are not just there because they are at risk to themselves or to other people; they are there because they are a person deserving of care, deserving of treatment, and deserving of improvement and recovery.

[Gregory Stafford]

I will keep my remarks relatively brief. As my hon. Friend the Member for Hinckley and Bosworth has pointed out, Members on this side of the House entirely support clause 8, mainly because of the change towards a therapeutic focus, which ensures that all compulsory treatment must have a clear clinical benefit. The clause is much more patient-centred; it gives legal clarity and stronger safeguards than currently exist in the law.

I will also touch briefly on amendments 44 and 45, which my hon. Friend the shadow Minister tabled. The key point about amendment 44 is the promotion of the therapeutic environment, which is absolutely key to this. It aligns with the best practice in mental health care and supports recovery-orientated approaches.

The key point about amendment 45 is the reinforcement of the compassionate, person-centred care that we are all trying to achieve. It ensures that responses to symptoms or behaviours are not punitive but supportive, and complements amendment 44 by applying the same principle to clinical interpretation of patient behaviours, which ultimately will encourage understanding of trauma-related behaviours, reduce risks of re-traumatisation and promote the psychological safety in treatment settings.

I entirely support the view expressed by the hon. Member for Thurrock, my colleague on the Health Committee, that a requirement to consider other trauma factors could be added to the Bill, either now or at a future point. I would be interested to hear the Minister’s thoughts on that subject.

I will also touch briefly on amendment 12, which was tabled by the Liberal Democrats, on treatment centres. Like my hon. Friend the shadow Minister, I support the overall context of what the amendment tries to achieve, but I have some concerns about how clinical decisions might be complicated if disagreements arise over the suitability of a treatment environment; and again, additional resources might be required to ensure that appropriate settings are available and accessible. When the hon. Member for Winchester winds up for the Liberal Democrats on that amendment, I will be interested to see whether he can assuage my concerns in that regard.

Finally, we support clause 9. It brings the consistency that we want. The alignment, between the treatment standard for prisoners that would be used for non-prisoner patients, adds clarity. Again, it is rights-based, and I think it will reduce the possibility of misuse, thereby helping to prevent inappropriate or unnecessary hospital transfers.

[Aphra Brandreth (Chester South and Eddisbury) (Con)]

It is a pleasure to serve under your chairmanship, Mr Vickers.

I rise to speak in support of amendments 44 and 45, which have been tabled by my hon. Friend the shadow Minister. These amendments seek to put patients at the centre of the Bill by promoting a safe therapeutic environment and recovery from any childhood trauma.

Clause 8 provides for a new definition of “appropriate medical treatment”, which requires that treatment to have

“a reasonable prospect of alleviating, or preventing the worsening of…a patient’s mental disorder.”

Amendment 44 would introduce an additional criterion to the definition of “appropriate medical treatment” by establishing that an appropriate medical treatment should not only address the individual’s immediate health needs, but be designed with the intent to reduce psychological distress and actively support an individual’s recovery from the effects of childhood trauma. This recognises the long-term impact that early, adverse experience can have on mental and emotional wellbeing and ensures that treatment approaches are trauma-informed, compassionate and conducive to long-term improvement.

People who present with serious mental health concerns need to know that they are receiving support and care in the right environment. They are at their most vulnerable, and having the confidence in their environment can make a world of difference. That is particularly pertinent for those who have suffered childhood trauma. It is important that we deal with the consequences of mental ill health, and adequately address the root causes. Among these, childhood trauma is one of the most serious and persistent factors contributing to long-term psychological conditions. By supporting this amendment, we would create a more resilient system that is equipped to respond to the reality and prevalence of childhood trauma in our society.

I recently met with Alison, who heads up a fantastic organisation called WeMindTheGap. It is based in Wrexham, but it is now moving and expanding to cover parts of my constituency, Chester South and Eddisbury. It does a fantastic job supporting young people who have struggled in the conventional education system, are absent from school or have dropped out of the system. We discussed childhood trauma and the rise in the number of young people not currently in any kind of education. One of the points that Alison made that resonated with me is that absence from school is linked not just to deprivation, but many contributing factors, including difficult domestic situations, isolation and rural isolation.

Many of these challenges are the most severe ones linked to childhood trauma, and although there are many wonderful organisations stepping in to support young people at an early stage, for some the impacts of childhood trauma continue to affect psychological wellbeing into adulthood. Sadly, childhood trauma is a societal issue that we face, and it is more common that we might imagine. Therefore, a step to embed trauma-informed care into the legal framework, specifically for childhood trauma, is a step in the right direction.

Childhood trauma can lead to self-destructive behaviour in adults. There is, as my hon. Friend pointed out, evidence to show that it is a causal factor. We must recognise the long-term impact of adverse childhood experiences on mental health. This amendment, by adding a new criterion to the definition of “appropriate medical treatment” to require that treatment to aim to minimise distress and to support recovery from childhood trauma, would embed trauma-informed care into the legal framework.

Amendment 45, by inserting the words

“seeks to minimise the patient’s distress and promote their psychological wellbeing and recovery from any childhood trauma”,

would reduce the risk of re-traumatisation. Responses to symptoms or behaviours must be supported; it is about helping people to move towards genuine recovery.

Childhood trauma is unique, and it presents symptoms that are different from other mental health illnesses. Therefore, having a dedicated, compassionate and person-centred approach to care is incredibly important. Setting the right culture to support patients, recognising the trauma that they carry and ensuring that there is adequate support and provisions in the legislation and the legal framework, is the right approach. I am therefore pleased to support these amendments, which would strengthen clause 8.

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[David Burton-Sampson]

I rise to speak in support of clauses 13 and 14. I have talked briefly today about the ongoing Lampard inquiry. There are two examples that are now public. Patient A was detained under the Mental Health Act for more than five years without a clear therapeutic plan and was subjected to prolonged seclusion and chemical restraint. The inquiry found that, despite the family raising concerns, there was a lack of clinical oversight and a failure to review detention and treatment status regularly. Patient B, a young man detained for over two years, experienced frequent use of rapid tranquillisation and segregation. The patient’s condition deteriorated, and that was documented, but there was no change to his care approach and no treatment review at all.

I welcome the clauses, but I put to the Minister how vital it is that we ensure that these reviews happen. There is a three-month review process at the moment, but in those two cases it did not happen. I also welcome shortening the time to two months. It is vital that the three-pronged approach that is outlined in the Bill happens. We have heard that no one size fits all—individual care is so important. Establishing the capacity and competency of an individual is vital. Every patient is different and they should be treated appropriately.

It is important to have appropriate review mechanisms in mental health care. Shortening the review process to two months for patients ensures that the therapeutic and clinical treatment remains appropriate. Hopefully, it also helps to lead to the desired quicker recovery period for the patient, but if not, it helps to adapt the treatment if a stronger or different type of treatment is required. The key is looking at ways to get people out of care as quickly as possible. Reviewing care regularly is really important. I welcome clauses 13 and 14.

[Gregory Stafford]

I rise to talk briefly about clauses 13 and 14, which I generally and genuinely support. Clause 13 addresses a long-standing ethical and legal tension: how to balance the need for treatment with a patient’s right to refuse it, especially when they may have made advance decisions or have legal representatives.

Let me expand the point that my hon. Friend the Member for Hinckley and Bosworth made about the level of potential appeal around the compelling reasons test. If the patient he was talking about continued to have an episode where it was believed that they did not have the capacity to act and they did not have a legal representative or family members who could advocate on their behalf, has the Minister given any thought to there being an external or independent person who could advocate on behalf of that patient during that period of incapacity and who is not a medical professional? In the current drafting of the clause, that seems to be a potential loophole. When someone regains capacity, they could potentially instruct legal counsel, but that may be too late if the treatment they have received has had an adverse impact on their life. I would like to hear more on that element, if possible.

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[Josh Dean]

It is a pleasure to serve under your chairmanship, Mr Vickers. I start by recognising the extremely difficult circumstances that the provisions deal with. I will speak to clauses 15, 17 and 18 and the Liberal Democrat amendment.

I welcome the additional safeguards set out in these provisions by the Government, particularly clause 15 and the role it plays in ensuring that the approved clinician can decide whether a referral for a second opinion appointed doctor is required. I note that there is a slight contrast, as the Opposition spokesperson touched on, with 57A, but I believe that recognises the unique circumstances of ECT, and that is important.

Clause 17 is important because of the way in which it—like these clauses generally—respects patient choice, embedding the central principles of choice and autonomy into this form of treatment and building on the framework set out earlier. I also note that clause 18 inserts a particular safeguard on certification that is really key to ensure that ECT therapy is administered according to strict safeguards. That is key in the context of the type of therapy that we are talking about.

I commend the spirit of amendment 13 and the intention behind it, and I really welcome the positive cross-Bench engagement on this issue. It is one of the most challenging circumstances and types of therapy that a patient will experience, but I echo the Minister’s points that such provisions have been covered elsewhere, particularly the changes in some of these clauses.

To make a brief point about invasive treatment generally, I note that we are talking specifically about ECT, but I would be very grateful if the Minister could set out what consideration the Government have given to additional safeguards on nasogastric tube feeding, for example, which is another type of extremely invasive treatment. While I would not seek to draw an equivalence between the two, I would be grateful if the Minister could touch upon that in his response.

[Gregory Stafford]

I rise to speak to clauses 15, 17 and 18 and Liberal Democrat amendment 13 to clause 18. I note the hon. Member for Winchester is not here; I do not know whether he intends to push amendment 13 to a vote but, just in case he does, I shall speak to it.

As colleagues across the Committee have said, ECT is a very controversial treatment, particularly when administered without consent. Under current law, it can be given to patients who lack capacity, but concerns have been raised about insufficient safeguards, especially where the treatment may conflict with prior decisions or a legal representative’s view. Clause 15 responds to recommendations from the 2018 independent review of the Mental Health Act and aims to ensure that ECT is used only when absolutely necessary, with independent oversight and respect for patient autonomy—something that everyone in this House can agree with.

I have a couple of questions for the Minister on clause 15. Clearly, the Opposition support the intention of the clause, but I would like to ask him about the challenges in interpretation. For example, determining whether a decision conflicts with an advance directive may be complex, so has he or his Department given any thought to how we might deal with some of those potentially complex, conflicting points of view?

Likewise, clause 17 updates section 62 of the Mental Health Act, allowing for urgent treatment without consent in specific circumstances. Once again, I welcome this provision because it gives some new legal clarity, supports clinical judgment, safeguards capacity and, most importantly, protects life and health. However, without strict oversight, there is a risk that the urgent treatment exception could be overused. What discussions has the Minister had with both his Department and, more importantly, campaign groups and mental health professionals to ensure that the urgent treatment exemption is understood and put forward in a way that satisfies both those undertaking the treatment and those receiving it?

Clause 18 also changes section 62 of the Act, which I again support; I mention this clause only because I wish to talk briefly about Liberal Democrat amendment 13. Like other Members, I believe that this amendment is extraordinarily well intentioned, but I have some questions about its wording. Specifically, subsection (c) says “the treatment is reversible”, but I do not necessarily know what the legal or medical definition would be of a reversible treatment. I cannot think how ECT could in any way be reversible, so paragraph (c) of the amendment would potentially mean that nobody could receive ECT. I do not fully understand how it could ever possibly be reversible. I think I have made that point as strongly as I possibly can but, if the Liberal Democrats are going to move the amendment, I ask for some understanding of what definition—either legal or medical—is being used for paragraph (c).

[Stephen Kinnock]

On the point about situations in which just the approved clinician provides certification, because of potential delays in appointment of the SOAD, such certification by the approved clinician can only occur in a very narrow set of circumstances, when the regulator has determined

“that there will be a delay in appointing a second opinion doctor,”

and the treating clinician considers urgent and compulsory electroconvulsive therapy to be life-sustaining. Our intention is that certification will be documented in a statutory form, to be set out in regulations, to ensure that there is an administrative record of the decision. Each time ECT is administered under an approved clinician’s certificate, it must be reported to the regulator so that such instances can be closely monitored and reported on publicly. While an approved clinician can approve treatment in those limited circumstances, there is still a duty on the regulator to appoint a second opinion doctor. Once that occurs, the approved clinician certificate ceases to apply. My hon. Friend the Member for Hertford and Stortford made an important point about how these provisions highlight choice and autonomy, and I thank him for putting that front and centre.

On additional safeguards, with particular reference to nasogastric interventions, there are already regulation-making powers in the Mental Health Act to subject treatments such as the one he mentions to new safeguards. We have always intended to engage with stakeholders to determine which treatments should be subject to which safeguards. That is an ongoing and important piece of work.

The hon. Member for Farnham and Bordon asked what happens when a decision conflicts with advance choice. There will be an important process of arbitration around that. The advance choice, as articulated by the patient, is vital and should in principle take primacy, but there are certain circumstances in which a compulsory treatment is necessary. Nothing in the Bill removes the ability to carry out those compulsory treatments, albeit subject to the safeguards that we have debated. Ensuring that the urgent treatment exemption is understood by everyone will be an important part of drafting the code of practice, as will ensuring that the code of practice addresses that important point about maximising and universalising awareness and understanding of the urgent treatment exemption.

Question put and agreed to.

Clause 15 accordingly ordered to stand part of the Bill.

Clause 16

Review of treatment

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

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[Gregory Stafford]

I want to pick up on a few points made by my gallant and learned hon. Friend the Member for Solihull West and Shirley. He talked about people who, like many of us, have seen the benefits of assessments online. There could well be benefits from clause 19 for that. He also talked about how some people did not find that an appropriate way to have their assessment. My understanding is that if someone has a physical ailment, they might be pushed strongly down a route to have an online assessment for whatever reason, whether that be at a primary care setting or at a secondary care or acute setting, but that if they wanted to see a doctor—for example, a GP—physically to talk about their ailment, although it might take them a little bit of time, they had the right to do so.

My concern about the clause is the suggestion that in certain circumstances, some patients would not have the right to a face-to-face assessment. The Minister talked about where things will be taken into account, where it is appropriate and where “it would be discouraged”. “Discouraged” is not the same as “it will not happen”. We need clarification, either within the Bill or very strongly in the code of conduct, so that a patient has the right to a face-to-face consultation. I would be very keen to hear the Minister’s thoughts on that.

[Stephen Kinnock]

We are very much on the same page in looking to harness the power of technology wherever we possibly can to shift from analogue to digital, but recognising the importance of putting the patient’s needs and disposition first. Telemental health is welcomed by many service users and has become an established part of delivering mental health care in a range of settings and scenarios. We expect the use of a hybrid approach involving both in-person and remote interview and examination to improve the efficiency of the second opinion appointed doctor service, and therefore to be of benefit to all patients.

We understand that remote interview or examination may not always be appropriate compared with in-person options. That is why the clause permits the use of remote only where it is considered appropriate by the second opinion appointed doctor. We will provide specific guidance on the circumstances under which remote may be appropriate, and where we discourage its use. All of that will be in the Mental Health Act code of practice. Many of the answers to the questions asked by the shadow Minister and by the hon. Members for Solihull West and Shirley and for Farnham and Bordon asked are contained in that. We are going to develop detailed guidance in the Mental Health Act code of practice, which will clarify and specify very clearly where this should be implemented and where we would discourage it.

Question put and agreed to.

Clause 19 accordingly ordered to stand part of the Bill.

Clause 20

Capacity to consent to treatment 

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

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When it comes to mental health professionals identifying children of parents with a mental illness, we are way behind countries such as the Netherlands and Norway, both of which have introduced statutory requirements for mental health professionals to consider whether adults with mental health problems have children. I will conclude my remarks there, but—

[Gregory Stafford]

Hear, hear!

[Zöe Franklin]

I thank the hon. Gentleman for that interjection, and I thank the Committee for considering these amendments. I hope the Government will either consider agreeing to them or give me an overview of how they will already be addressed in the detail of the Bill.