Mental Health Bill [ Lords ] (Sixth sitting)

Jen Craft Excerpts

Committee stage
Tuesday 17th June 2025 Public Bill Committees

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

It is a pleasure to serve under your chairmanship, Mrs Harris. I rise to speak in support of clauses 24 to 28, schedule 2, and the vital amendments 54 and 55 in the name of my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer). Together, those provisions form a crucial pillar of the Bill, which must modernise our framework for the 21st century while not forgetting one of the oldest truths in our social contract: that parents, not the state, bear the first and deepest duty to protect their children.

The Bill will reform an Act that has stood in various forms since 1983, and which was itself built on a much older legacy of how this country balances individual liberty with the need, in rare cases, to deprive someone of that liberty for the sake of that person’s safety, or the safety of others. For decades, that balancing act has been shaped by the so-called “nearest relative” rule. However well intentioned that rule was, it has often failed to serve the people it is meant to protect. Patients have found themselves legally represented by estranged parents, distant cousins or an ex-spouse with whom they have had no contact for years. In the worst cases, that has compounded trauma and undermined recovery. Clause 24 will address that problem by giving patients the power to appoint a “nominated person” of their choosing: someone whom they trust, who understands their needs, and who can speak up when they themselves cannot. That is, quite simply, the right approach for modern mental health care. It is grounded in autonomy, and respect for the individual’s right to shape their own care and safeguard their own dignity.

Good principles must be matched by good machinery. That is why schedule 2 is not a mere administrative detail, but the backbone of this reform. It sets out, step by step, how a nomination is made, who may be nominated, how conflicts are avoided, and how mistakes are corrected. Under part 1 of schedule 2, a patient must make the appointment in writing. It must be signed and witnessed by

“a health or care professional or independent mental health advocate”.

That is a safeguard against casual or coerced choices. The nominated person must themselves consent: they are not a passive bystander but an active participant. If the relationship breaks down, the patient may revoke the nomination, or the nominated person may resign. Crucially, the county court may step in to remove or bar a nominated person if that person acts unreasonably, abuses their power, or is clearly unsuitable.

Part 2 of proposed new schedule A1 to the Mental Health Act 1983, inserted by schedule 2 to the Bill, addresses an issue that we must take seriously: capacity. Not every patient will have the capacity to make the appointment at the moment it matters most. The proposed new schedule therefore provides a fall-back system. A court may appoint a nominated person on the patient’s behalf, or a default can be determined under criteria set by regulation. The court again retains ultimate oversight to resolve disputes or replace a default, if the circumstances require it. It is thoughtful, practical and rights-based lawmaking, and I commend the drafters for getting the balance broadly right.

Clauses 25 to 28 will give the nominated person real power. They are not a figurehead. Clause 25 demands that professionals consult the nominated person before applying for detention or guardianship. If the nominated person objects, the professional must provide a report showing why detention is none the less necessary, with a clear risk-based justification. The nominated person can then challenge that decision. Clause 26 shortens the duration of the bar on discharge requests from six months to three. If a nominated person believes that the person no longer needs to be detained, they can press for release sooner and more effectively than before.

[Jen Craft (Thurrock) (Lab)]

Without wanting to sound abrupt, we all have the explanatory notes and are reading them, so in the interests of brevity might the hon. Member consider getting to the point about what he would add to or take away from the Bill? We all know what the clauses aim to do; the Minister has already set that out.

[Gregory Stafford]

I thank the hon. Lady for her point, but I shall continue in the same vein unless I am told to do otherwise.

Clause 27 will ensure that when community treatment orders are considered, with all the restrictions they bring, the nominated person’s voice must be heard and an objection must be properly countered with evidence. Clause 28 addresses hospital transfers, recognising that being moved to another hospital can uproot fragile support networks and compound distress. By embedding a consultation duty here, too, the Bill will make it harder for patients to be moved arbitrarily or without explanation.

In summary, the clauses and the schedule empower patients, embed transparency and build trust, but they do so through a lens rightly focused on adults—capable, consenting adults who make choices freely. That brings me to my fundamental point: we must be absolutely certain that this approach will not inadvertently erode a bedrock of child protection: that a parent is the default legal protector for their child. For an adult, autonomy means freedom of choice, but for a child, especially one under 16, autonomy must never mean being left alone to navigate a labyrinth of legal forms and healthcare powers without the protection of a parent. That is why I strongly support amendments 54 and 55, which would ensure that for under-16s, parents remain the lawful decision makers and the first safeguard for their child’s welfare.

Let us imagine for a moment a vulnerable 14-year-old who, in the confusion and fear of a psychiatric admission, is persuaded by a well-meaning adult—or, worse, someone with a hidden agenda—to appoint them as the nominated person. That child may be separated from their parents—the very people who know the child best and have a legal duty to care for them—while an outsider gains rights to object to treatment or discharge decisions. Once that nomination is made and witnessed, it carries weight in law and could marginalise the very people who brought that child into the world and have a moral and legal duty to protect them.

This is not just theoretical. We know from real cases in family courts that unscrupulous individuals can exploit vulnerable young people. The risk that the new system could unintentionally open the door to manipulation must be taken seriously. Let us not be naive about how exploitation works: groomers, traffickers and abusers thrive in grey areas of the law; they will find loopholes and drive a coach and horses through them. If we do not make it crystal clear that no child under 16 can override parental responsibility without a court’s explicit order, we risk creating an invitation for abuse.

Can the Minister assure the Committee that no child under 16 will be permitted to override parental responsibility simply by nominating someone else without a full and proper process? Schedule 2 does include fall-back arrangements and eligibility checks, and those are welcome, but unless the law is explicit that only a court can displace a parent’s right to act for their child, those safeguards are not watertight.

Amendment 54 addresses a related area, the notification of incidents. It would require the Secretary of State to review whether the law should be strengthened so that all admissions of children and young people for mental health treatment trigger mandatory incident reporting, and whether the timeframes for that reporting are still appropriate. It would require the Secretary of State to review whether incident reporting requirements are robust enough for all under-18s in mental health settings. Are all incidents of restraint, seclusion, injury or absconding being reported promptly and comprehensively? If not, what must change?

We have seen far too many tragic cases in which harm or abuse in children’s mental health units came to light only after a scandal broke, because the system did not catch it in time. Proper oversight is not an optional extra; it is essential for the trust of families. In my view, a review alone is not enough, so I urge to the Minister to confirm that, if the review finds gaps, the Government will legislate swiftly to close them. In the meantime, what interim steps will be taken to ensure that no child is left unprotected?

Amendment 55 is the final safeguard in this suite of amendments. It would allow the Secretary of State to make consequential amendments to other laws to implement the Bill cleanly. That is good housekeeping, but it must not become a blank cheque. When it comes to parental rights or child safeguarding, no technical tweak should be done behind closed doors by negative procedure; Parliament must approve it in full daylight, on the record. Will the Minister confirm without ambiguity that any consequential amendment that touches on parental powers or child protections will come before both Houses under the affirmative procedure?

To illustrate things in the starkest terms, let me paint one more scenario for this Committee. A 15-year-old girl, already vulnerable, is detained following a self-harm incident. Her parents, distressed but committed, wish to be involved in her care plan and discharge, but in her fragile mental state the child is persuaded by an older friend—perhaps well-meaning, perhaps not—to nominate them instead. That friend, now a legally recognised nominated person, blocks discharge, disagrees with treatment and excludes the parents from updates. The clinicians are caught in a legal tangle. The child is caught in the middle, and the parents must fight in court to reclaim their rightful role. As I said before, that is not a theory; it is the sort of real-life pitfall that sloppy drafting can enable. If we see it coming and fail to stop it, we will have failed as legislators.

I wish to be clear that I support clauses 24 to 28 and schedule 2 because they modernise mental health law for adults in a way that is respectful and empowering. I support amendment 54, because it would strengthen transparency and accountability where children’s lives and safety are at stake. I support amendment 55, because it would keep our statute book coherent, but it must never be misused to erode rights by stealth. Above all, I support the amendments because they ensure that the new nominated person system does not inadvertently weaken the oldest and strongest protection we have, which is the legal responsibility of parents to care for their own child.

I urge this Committee to adopt the clauses, the schedule and amendments 54 and 55 as essential guardrails to ensure that what we pass here is not just legally sound, but morally right. Let us modernise this law and strengthen patient voice, but let us never allow a child to lose their parents’ protection by accident or bureaucratic slip. Let us be in no doubt: when the state removes or limits parental rights, it must do so under the strictest scrutiny of a court of law, with evidence tested and the child’s welfare paramount. A signed piece of paper at a bedside should never be enough. That is the dividing line between a humane, modern health system and one that risks creating new injustices in the name of progress.

I ask the Minister again: will the Government enshrine in this Bill or elsewhere that parents are the legal representatives for under-16s unless a court directs otherwise? Will he guarantee rigorous checks to prevent the manipulation of young minds at their most vulnerable? Will he commit that any necessary changes found by the incident review under amendment 54 would be acted on without delay? I commend this package of reforms to the Committee, and I trust that the Government will listen carefully to these warnings and act to make the legislation watertight.

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[Stephen Kinnock]

Yes, but the issue may have a bearing on a potential Division. The challenge that I am facing is that my notes said,

“This amendment seeks to overturn”,

but we are talking about a clause that is seeking to overturn a previous amendment. Are we speaking in favour of a clause that will overturn an amendment? [Interruption.] Confusion reigns.

[Jen Craft]

I am equally confused; I did not think we were talking about an amendment. I thought we were talking about a clause. Apologies.

[The Chair]

Clause 35 was added by a Lords amendment; maybe that is where the confusion has come from. The Government tabled an amendment to leave out clause 35.

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[Stephen Kinnock]

Right. Advocates have told us that implementing what is set out in the clause would raise logistical and resourcing problems, as it would require a significant shift from their current role. They have also raised concerns that if they acted in effect on behalf of the hospital to collect feedback, their independence and impartiality in the eyes of the patient might be undermined. We would prefer to direct resources to increasing access to advocacy services among in-patients, as proposed by the Bill. Advocates play a crucial role in promoting and protecting the rights of patients. We do not wish to detract from that or to dilute their role. I do not commend the clause to the Committee.

[Jen Craft]

Like many Committee members, I was deeply confused about how we were proceeding.

On the face of it, the clause broadly seems as if it should be part of any Act about mental health care, including post discharge. I have spoken about my own experience of interacting with the Mental Health Act as it stands. I might have found the clause fairly helpful post discharge and others might have found it useful as well. However, I have just heard the Minister’s description of the limitations of the clause, and the speech that I was about to make has been thrown into complete disarray by the confusion just now. But I implore the Minister to consider the fact that, when it comes to encouraging participation, understanding, and co-designing and co-producing services, capturing the experience of those recently detained under the Mental Health Act can be extraordinarily useful. Clause 35, which was added by an amendment from the Lords, seems a fairly useful way to do that.

[Gregory Stafford]

Like the hon. Lady, I see many benefits from the clause. Like many Committee members, I am surprised that the Government intend to vote against it.

As has been mentioned, the clause was inserted in the House of Lords by my noble Friends Earl Howe and Lord Kamall. I think it introduces a very valuable and forward-looking provision—namely, a mandatory debrief session within 30 days of discharge. It introduces a formal mechanism for learning from patient experiences following detention under the Mental Health Act. Although patient feedback mechanisms exist in some services, they are not consistently applied or mandated. The clause ensures that every detained patient has the opportunity to reflect on their care with an independent advocate, and that their feedback contributes to service improvement. It reflects a broader shift in mental health law towards transparency, accountability and the patient voice, and aligns with the recommendations from the 2018 independent review of the Mental Health Act, which the Government have used as an argument in favour of many of the other clauses.

Clause 35 is more than just a procedural addition. It represents a shift in culture towards embedding the patient voice and accountability in the mental health care system. It recognises the importance of empowering individuals after detention, supporting their recovery, and learning from their lived experience to improve future services. Mental health charities and third sector organisations have strongly endorsed the clause, seeing it as a meaningful step towards a more rights-based, transparent approach to care.

Clearly, the clause empowers patients, because it gives them a structured opportunity to share their experiences and influence service provision. It promotes transparency by requiring hospitals to report publicly on what they have learned and how they have responded. It supports quality improvement by encouraging services to reflect on and address systemic issues in the delivery of care. Furthermore, it has independent oversight through the involvement of IMHAs, which helps to ensure that feedback is gathered impartially and respectfully.

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

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[Stephen Kinnock]

The CQC visits and interviews thousands of detained patients each year under its statutory duty to monitor the use of the Mental Health Act. Those visits can lead to the CQC requesting improvements from service providers. The CQC publishes annual reports highlighting key findings and themes from those visits.

Trust boards are responsible for collecting and acting on service user feedback to improve services. Under the NHS contract, the patient and carer race equality framework requires trusts to have clear and visible systems in place for gathering and responding to feedback from patients and carers. What is more, Healthwatch England and its local branches also play a key role in representing the views of health and social care users. I do not really know what more the system could do. The clause simply over-embroiders and over-complicates; when that happens, we usually end up with vast numbers of unintended consequences.

We appreciate that concerns have been raised around the CQC’s role in collecting in-patients’ views. As I said, we would prefer to work with stakeholders to understand those concerns and improve the feedback mechanisms that we have, rather than reinvent the wheel and create something new. We recognise that, although there are multiple aims to the clause, the primary one is to provide a space for people to heal from their experiences of being detained. We are strongly of the view that inviting the individual to share their experiences as part of their advance choice document or care plan—

[Jen Craft]

I am glad that the Minister is explaining how capturing feedback and experience is being allowed for in other parts of the Bill. To clarify, in my own head I feel that the clause aims to capture the experience immediately after it has happened, just as hospitals offer women who have just given birth the opportunity to talk through their experience. It is healing for the patient to understand what happened to them, and it provides immediate feedback to the hospital. Is that kind of level captured in other parts of the Bill?

[Stephen Kinnock]

I understand and recognise my hon. Friend’s concerns, but we can rattle through all the different forums where feedback can be captured: the CQC, the trust boards, the patient and carer race equality framework, Healthwatch England and all the other informal channels in the mental health ecosystem. Our view is that adding another layer into all that would in the end be counterproductive. That is the Government’s position.

Mental Health Bill [ Lords ] (Third sitting)

Jen Craft Excerpts

Committee stage
Thursday 12th June 2025 Public Bill Committees

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

It is a pleasure to serve under your chairship, Ms Furniss.

Government amendments 26 to 29 risk undoing some of the good work done in the other place, where careful improvements were made to strengthen the Bill and ensure a more compassionate and effective response to mental health crises. I am concerned that by removing the words

“by a constable or other authorised person”

and deleting clause 5(7), which provides a clear definition of who the authorised persons are, we will open up ambiguity about who is permitted to detain someone under the Mental Health Act. This is not just a technical or drafting issue; it has very real consequences for the people involved.

I understand and support the principle of enabling more flexible and clinically led responses to mental health incidents. We all recognise that the police should not be the default option in every case. The amendments made in the Lords acknowledged that and broadened the group of people who could respond to mental health crises beyond police officers to trained and equipped professionals: mental health nurses, approved mental health professionals, paramedics and, crucially, someone trained and equipped to carry out detentions under the Act and who would not be put at unnecessary risk by doing so. “Trained and equipped”—that is the key point.

The definition of “authorised person” in the Bill as it stands makes it clear that those given such a serious responsibility must have the appropriate training and experience and must not be “put at unnecessary risk” when carrying out that role. That wording is important. As the shadow Minister, my hon. Friend the Member for Hinckley and Bosworth, said, it provides a framework of accountability, not a free-for-all. By removing that structure, the Government’s amendments will leave a legal vacuum. The law will say that someone must be detained, but not by whom. That uncertainty will create a risk that services will simply revert to defaulting to the police.

I stress again that that is not fair on the police, who are already under immense pressure. Yes, they are used to seeing people at their most vulnerable, but dealing with someone in a mental health crisis is a very particular challenge, and one that they might not be fully trained to manage. The College of Policing’s 2019 mental health snapshot found that almost 95% of police call-outs flagged as involving mental health did not actually require a police response, yet police officers continue to be sent out because the system lacks clarity and capacity elsewhere.

Baroness May, speaking from real experience as a former Home Secretary, made that very point in the other place. She said that police officers were being sent to mental health incidents for which they had no training or clinical expertise, and were being asked to make judgments that they simply were not equipped to make. She went on to say that

“the very essence of a police presence—somebody in the uniform coming to deal with them—could actually exacerbate their mental health situation”.—[Official Report, House of Lords, 20 January 2025; Vol. 842, c. 1525.]

I would add that, for the individual experiencing a mental health crisis, being approached by the police may feel criminalising rather than supportive. It reinforces a justice-led response rather than a health-led one. That is not the direction in which we should be going.

Although I welcome the Government’s intention to offer more flexibility in emergency and clinical settings, we have to be careful about how we achieve that. Removing the wording inserted into the Bill will not create clarity; it will create confusion. In a system already under pressure, confusion tends to mean delay, risk aversion and inappropriate responses. Removing the specification will not free professionals; it will expose them, and it will expose patients to the possibility of being handled by someone without the right qualifications, which may worsen their condition or create a longer-term distrust of mental health services.

I hope that the Minister can offer some reassurances, both about who will be expected to carry out these detentions and about how we can ensure that they have the proper training, resourcing and protection. Without a clear definition of “authorised person”, we cannot be confident that those involved will have the right expertise to support extremely vulnerable individuals at times of acute need.

I want to touch briefly on the importance of early intervention and de-escalation. Situations involving mental health crises can often be tense, and support in the early moments can be critical. De-escalation is a vital skill; the presence of a calm, trained mental health nurse, for example, in those early moments can change the outcome of a person’s crisis. Having the right professional present—someone who can act without waiting for the police to attend—can be the difference between escalation and calm. The identity of the responder matters.

This is not just about outcomes, but about the experience of the individual. Removing the criminal justice framing from the outset is essential to delivering dignity and the right kind of care.

[Jen Craft (Thurrock) (Lab)]

There seems to be some circular talk about the level of risk that clinicians and medical professionals can be expected to shoulder. I notice that clause 5(7), inserted in the other place, specifies that they would

“not be put at unnecessary risk”.

Is there not an inherent risk involved in detaining people who need to be detained under the Mental Health Act? Those people are not in a position to give consent and quite often do not wish to be detained. By stipulating that the police will not be involved in situations or by making medical professionals the first responders, is there not a risk of putting them in harm’s way?

[Aphra Brandreth]

It is extremely important that people are not put at risk, and that is exactly the point I have been making. People need to be properly trained, and we need to set out who those individuals can be, rather than leaving ambiguity in the wording. The Government amendment will undo exactly the protection that the hon. Lady rightly points out.

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[Jen Craft]

On clause 5(4), the amendment in the other place inserted the phrase

“by a constable or other authorised person”

which relates specifically to the phrase

“unless the patient is immediately restrained from leaving the hospital”.

What the hon. Gentleman describes as a level of ambiguity in the subsection allows that to be done by people who are not necessarily listed as an authorised person, such as a medical practitioner. I think we would all agree that we would not expect to see a nurse, doctor or other clinician immediately and physically restraining a patient, and that when a police constable is not available, other people, such as hospital security staff, can carry out the task. The clause says, “immediately restrained”. The specification in the list of words proposed in the other place can leave people at risk of harm, particularly clinicians.

[Gregory Stafford]

I confess that I do not entirely follow the hon. Lady’s argument. My understanding is that the people she has listed—for example, hospital security staff—are not covered at the moment, so I do not think that that is the case. As I said in response to my hon. Friend the Member for Hinckley and Bosworth, there are situations, in a number of settings, in which mental health professionals act in the capacity of restraining. With the correct and appropriate training, which is what I think all Opposition Members want, I do not think that the issue that the hon. Member for Thurrock is raising would necessarily arise. Having said that, if she really feels that the wording needs to be tweaked, I look forward to seeing and potentially supporting her amendment to the subsection, and I hope she tables it.

The second key problem is the risk of returning the burden to police officers. We have heard from Members on both sides of the House in the debate, and from police forces up and down the country for years, that the police do not have the expertise, training or capacity to be the first responders to mental health emergencies. Clause 5 finally reflects that reality, helping to move the response from law enforcement to healthcare. The Government amendments would muddy that distinction. They would result in the police once again becoming the default responders—not because it is right but because it is unclear who else is meant to act.

Thirdly, the amendments introduce legal and safe-guarding risks. Without a clear definition of who can detain, one risks inconsistency, poor practice and potentially unlawful deprivation of liberty. The amendments offer no alternative safeguards—just the deletion of the existing ones. That is not reform; it is abdication of responsibility. Finally, they undermine the spirit of the Bill. The Bill aims to modernise mental health legislation by making it more humane and effective, and more rooted in health than enforcement. The amendments point in the opposite direction. They strip away clarity, increase reliance on the police and risk compounding trauma for those already in crisis.

It is not just about legislative precision; it is about protecting people. When someone is in acute mental health crisis, they are at their most vulnerable. Turning up with police officers, sirens and handcuffs does not calm the situation; it escalates it. It creates trauma, damages trust and can lead to long-term disengagement from mental health services. Clause 5 offers us a path out of that pattern. It allows approved professionals—such as paramedics, mental health nurses and crisis practitioners —to intervene early, with care and dignity. It does not exclude the police, where there is a genuine risk to safety, but it rightly repositions them as the last resort, not the first response. The Government amendments may be well intentioned, but they threaten to unravel that balance. We cannot allow vague flexibility to become a smokescreen for inadequate planning or under-resourced services.

If the Minister pushes his amendments to a vote, and, as the parliamentary maths suggests they will, those amendments pass, what will he do to sort out the problem that we, on both sides of the House, have talked about today? He is currently planning to keep the status quo, which we all seem to agree is not appropriate. At least we and our noble Friends in the other place have attempted to improve the situation. What will he and his Department do?

The clause is part of a broader rethinking of how we response to mental health need. It supports community-based care. It pushes for better training. It honours patient autonomy and it places the right people—clinicians, not constables—at the centre of care delivery. We all want a system where people in distress are met with compassion, not criminalisation. Clause 5 helps us to get there. The Government’s amendments drag us backwards. Clause 5 is one of the most thoughtful and necessary parts of the Bill. It raises standards, reduces harm and finally begins to close the gap between what the Mental Health Act allows and what good mental health care demands.

Mental Health Bill [ Lords ] (First sitting)

Jen Craft Excerpts

Committee stage
Tuesday 10th June 2025 Public Bill Committees

[Stephen Kinnock]

The red thread that goes through all those questions, from both my hon. Friend and the Opposition spokesman, is very much about how we are going to build a clear and strong understanding of what good community support looks like, and then build towards it so that we achieve the aims that we set out for ourselves. In many ways, that is a difficult question to answer in this Committee, because an important part of the answer will come from the consultation on the code of practice that will be launched as soon as the Bill gets Royal Assent.

The Government believe passionately in making policy on the basis of evidence, so we need that consultation and input for the code of practice. We need a clear definition based on engagement with those who are at the cutting edge of delivering these services, so that we can define the new reality that we want to work towards, and then implement it step by step.

I apologise to Committee members for the fact that in some ways that is a step beyond what we are doing here in scrutinising the Bill. We will, I hope, pass the Bill, and then it will get Royal Assent. From that day, we will be straining every sinew to get community services to where they need to be.

[Jen Craft (Thurrock) (Lab)]

I do not want to speak outside the scope of the clause, but I would very much welcome a commitment from the Minister on ensuring that people with learning disabilities and/or autism are part of the process of the consultation to produce guidance on what good community services look like, and that they are engaged with from the start in a very real and meaningful way.

[Stephen Kinnock]

Absolutely, and I pay tribute to my hon. Friend for her outstanding work in the all-party parliamentary group; I am looking forward to meeting with the APPG as soon as diary time can be organised.

There is absolutely no point in the Government making policy in an ivory tower in Westminster or Whitehall. Policy must be evidence-based and based on the real, lived experience of patients—we are very committed to building a patient-centric national health service—and practitioners. If we try to make policy without involving the voices of those people, the policy will fail; we know that from bitter experience.

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[Gregory Stafford]

My hon. Friend attributes to me a level of clairvoyance that I do not possess, but I am sure that the hon. Member for Winchester or the hon. Member for Guildford will pick up that point.

The resource implications are not just about the funding. They are about increased workload and the pressure put on the professions and services. As my hon. Friend the Member for Solihull West and Shirley said, the amendment would divert attention away from delivering care, if it is not balanced properly. My hon. Friend the Member for Hinckley and Bosworth is right to ask, “Why six months?” Why not nine months, eight months or any other period? Is there a clinical basis for six months?

[Jen Craft]

On a small point of clarification, the six-month criteria are based on the current NHS guidance around CETRs. It is loose guidance; it is not statutory. The reason that it is six months as opposed to 12 months is that that would bring us closer in line with the guidance.

Mental Health Bill [ Lords ] (Second sitting)

Jen Craft Excerpts

Committee stage
Tuesday 10th June 2025 Public Bill Committees

[Dr Chambers]

I do not know the best place for it to be held. That is an important point. For a lot of the issues that Members are bringing up, we are not expecting there to be answers today. However, we want to ensure that they are all being considered, given that the subject might not return to Parliament for another 40 years.

[Jen Craft (Thurrock) (Lab)]

I have a question about the list of risk factors that has been provided. Is there not a concern that it might be too prescriptive or restrictive, and that putting it in primary legislation prevents local authorities or ICBs from widening it, from having registers and risk factors that might be appropriate to their areas, and from focusing on what the appropriate level of care is that they are best placed to meet?

[Dr Chambers]

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

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[Gregory Stafford]

It is a pleasure to serve under your chairmanship, Ms Furniss. I have some criticisms of the specifics of the amendments tabled by the hon. Member for Winchester, but I entirely support him and congratulate him on the passion with which he spoke about them. As I remember, his maiden speech touched on a number of these issues. Whether they are within the scope of the Bill is for the Clerks and the Committee to decide, but he made several extraordinarily good points that I hope the Government will take away. If the Bill is not the appropriate place for them, there should be another avenue.

The lead amendment is about the ICB register. It would insert a new subsection to extend the duty on integrated care boards to establish and maintain a register for those at risk of detention to cover all children and young people who meet certain risk criteria. As drafted, the duty to maintain a register under clause 4 may not explicitly include all under-18s. Therefore, the amendment would ensure that children and young people are proactively identified and supported before reaching a crisis point that might lead to detention.

Clearly, there are positives. As the hon. Member stated, early intervention might help to prevent unnecessary detention by identifying risk earlier, which is especially important for children. Likewise, there is a strong argument about equity and care to ensure that young people receive the same proactive planning as adults. That would clearly lead to improved safeguarding through better tracking of vulnerable minors in the mental health system. A corollary to that would be better data collection on youth mental health needs, which I think we would all support. We would be able to use that information to support more informed policymaking and resource decisions.

As my hon. Friend the Member for Hinckley and Bosworth highlighted, however, and as I highlighted in the debates on other clauses, there would clearly be a resource demand, especially on ICBs, from expanding registers and services. Likewise, there is the complexity of implementation, because defining who qualifies as being “at risk” may be subjective. I therefore ask the hon. Member for Winchester, when he sums up on the amendments, to give us some indication of how “at risk” would be defined, or whether that would simply be down to the mental health professional or some other medical professional. There are also, of course, privacy and consent concerns related to maintaining a register for minors. Again, the hon. Member may have thought about some practical things that could assuage my concerns about that.

There may also be a risk of stigmatisation. We have to be very careful, especially with children and young people, because being labelled or treated differently due to being on the register would not help their mental health. We would have to have some really strict privacy and data-sharing controls to ensure that they were protected within the proposed system.

As I said in my intervention, I entirely support the aims of amendment 47 because it would specify the risk factors for detention for those on the register of people at risk of detention under clause 4. The criteria for identifying such individuals are left to be defined in regulations as the Bill stands. The amendment would mandate in law specific evidence-based risk factors—which I agree are risk factors for the issues that the hon. Member is talking about, particularly those linked to trauma and social disadvantage—rather than leaving them to discretion.

At a general level, the amendment recognises the role of trauma and social determinants in mental health crises—I congratulate the hon. Member on clearly explaining some of the factors. Going back to our debate on the previous group of amendments, that would improve the early identification of individuals at risk, promote preventive care, strengthen equity and provide clarity and consistency. However, like my hon. Friend the Member for Hinckley and Bosworth, I am concerned about prescribing a relatively small list and therefore limiting the clause’s flexibility—there may be risk factors that are not listed in the amendment or ones that we have not even thought of.

[Jen Craft]

Does the hon. Gentleman agree that the Bill makes allowances for the Secretary of State to introduce appropriate risk factors via regulation, and that it is more appropriate to list the risk factors that ICBs should take into account in secondary legislation issued by the Secretary of State than in primary legislation, as amendment 47 seeks to do?

[Gregory Stafford]

I agree with the hon. Lady; that is my understanding, but perhaps the Minister can confirm that when he sums up. The flexibility in the clause is one of its strengths.

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[Dr Evans]

I shall be interested to know what the hon. Lady’s rose-tinted spectacles show when we consider Scotland or Wales. One of my biggest frustrations in debates about the NHS is that in each nation health is devolved, each is run by a different political party, and each has challenges. We in this place enjoy the political football, scoring points without seeing what is blindingly obvious: that across the board, across all the countries, health and mental health services are struggling to keep pace and keep our population healthy with the workforce and technology provided.

[Jen Craft]

Will the hon. Gentleman give way?

[Dr Evans]

Let me address these points, then I will be happy to give way. When we come to clause stand part, I will address the other amendments, but I specifically said that my comments would be on new clause 11. When scrutinising the Bill, it is important that we talk about how we will deliver, as the hon. Member for Shipley rightly pointed out. It is entirely right to try to put together a plan to ensure that the Government are held accountable. We are not saying how the plan should be formulated; we simply stipulate that a plan should be formulated and introduced. That is a very different argument.

My concern about previous Lib Dem amendments was that they were too specific. We have to get the balance right. New clause 11 simply provides that the Government have 18 months to introduce a fully costed plan, so that we can again have a debate in this House. Especially as a spending review will, I believe, be announced tomorrow, we need to consider how we will match budgets in the future. We accept that it is a 10-year project.

[Dr Evans]

I am still addressing the hon. Lady’s first point. The Conservatives understand that it will take a long time to put in place, but a credible plan is needed. There was a credible plan in place, as I have said, in the 2011 and 2016 strategies, with the funding to match. I use that as an illustration because it is provides an apt evidence base for the new clause. Otherwise, I might well be challenged by someone saying, “What is your evidence base of a delivery network and a delivery ability from a Government?” I hope that by talking through these points, I am giving the Government the chance to learn from the mistakes we made and from the way we took forward mental health. Regardless of political party, I hope hon. Members that the debate has moved on a long way from when we started in 2010 with the work done partly under the coalition Government. I will now take the intervention.

[Jen Craft]

I thank the hon. Gentleman for reflecting on the fact that mistakes were made by the previous Government—acknowledgment of that is often sorely lacking. I respect the fact that he says that the debate has moved on, but does he accept that while the debate may have moved on, policy to enact actual change for people who are detained under the Mental Health Act, particularly those with learning disabilities and autism, has not kept pace? The number of people in locked units, under detention, has remained solid, without much wavering, for the past 14 years. Despite the acknowledgement that this is a scandal, and we should all hang our head in shame that it continues to this day, not much has been done to get them out of those units.

While we look back on the history of the past 14 years, focusing specifically on the people who are detained under the Mental Health Act, let us remember that Lord Darzi pointed out in his report that some of the facilities are more redolent of the Victorian era than of a modern mental health care service. Perhaps those who were in government in those 14 years should reflect on why that is the case.

[Dr Evans]

There is quite a lot to unpack in the hon. Lady’s intervention. As I pointed out, reflecting on what the previous Government learned is also important—for example, when considering Wales. Objectively, the data shows that Wales is struggling more than England, and the same is true of Scotland. Wales and Scotland have been run by different parties from England for a long time, so my natural inclination is to attack back and say, “Well, actually, the Conservatives did better,” but my fundamental point is that we all need to do better because we have seen the problems rising. As I mentioned, over the last 10 years the number of people turning up in mental health facilities has increased by a quarter.

On the hon. Lady’s point about people with autism and learning disabilities, I sat on the Health and Social Care Committee that looked specifically at that issue. We looked at some of the best models in the world, including that of Trieste, where community care is in place. When we took evidence, we found that most people were supportive of that model, but fearful people did come forward to say that the community was not the best place for their daughter, son, husband or wife. Managing the nuance is really important. It takes time to get this right. In 2018, when the last Government looked to legislate on this issue, there was pre-legislative scrutiny, which does not always happen in this place. It was done because there was fundamental agreement that we must get the legislation right, because it applies to the most vulnerable people.

The hon. Lady is right that Lord Darzi identified three shifts that will be really important, but when he looked at this issue, he missed a fundamental point. His report starts from 2010, but when I was a junior doctor— I qualified in 2007—we had issues that affect the culture now: for example, how we managed MRSA and C. diff. That was not a brilliant time to be a patient. The medical training application service fiasco affected doctors applying for jobs so much that in 2004 the Government had to apologise and change the system, because so many people who wanted to get into specialist training could not go through that service.

We are still paying for IT infrastructure that the last Labour Government tried to introduce. The last report, in 2018, said that that cost the taxpayer almost £14 billion. We wonder why, when we try to make a shift to introduce more tech, as recommended by Darzi, people in the NHS are reticent, but they have been burnt by IT projects before. They have seen what happened under a Conservative Government, a coalition Government, and a Labour Government. All that has an immediate and impregnable effect on the legislation and the practicalities that we are dealing with today.

I am not trying to talk facetiously about the legislation; the point is to give some pragmatic direction and to actually say something tangible. On that basis, I look forward to the Minister hopefully supporting proposed new clause 11, which would give the Government the flexibility to have a plan that they choose, as is their democratic right, but also the safeguards to know that it will be delivered and we will not have more delay. There is a balance between making legislation in haste and making sure that we avoid inaction. Would the hon. Member for Shipley like to intervene?

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There is a dependency on data quality. If there is inconsistent or incomplete data, that can undermine the report’s usefulness. The impact could be limited if reports are not followed up by concrete action. There is a risk of politicisation of any report, especially if the findings are critical of the Government’s performance. Finally—I say this for completeness—there is an administrative burden. That should not be an anchor on us taking action, but it is something we must be cognisant of. To compile and publish these reports places an administrative burden on the Department of Health and Social Care when there are huge pressures upon the wheels of government already. For those reasons, I cannot support these amendments on this occasion.

[Jen Craft]

I will be reasonably brief, as Members have covered a lot of what I was going to talk about.

The intent behind amendments 10 and 24 and new clause 11 is to address the issue raised by a number of organisations, such as Mencap, the National Autistic Society and the NHS Confederation, around the delay in particular clauses being switched on for people with autism or with a learning disability due to insufficient community services. The concern is that there is not, as yet, an articulation of what sufficient community services look like or how we will know when we have reached that point, so that we can turn on parts of the Act. There is a sufficient community backing in place for that to happen. Therefore, I would welcome the Minister’s thoughts on how we will know that we have reached the point where we can address the issues that clause 3 looks to tackle.

As the Conservative Members mentioned, there are concerns about funding and access to fairly scarce resources, and a concern that rolling out this provision could put undue burdens on people who are unable to deliver certain parts of it.

However, it would definitely be welcome to have an understanding of where we are heading, what “good” looks like and how we are going to get there, and what the Minister might see as a road map for community services to reach the point where clause 3 can be switched on, so that autistic people and people with a learning disability do not need to be detained under the Mental Health Act purely because there is insufficient support for them in the community to enable alternative provision. I would welcome any thoughts from the Minister about how those concerns about the operability of the Bill can be addressed. If they will not be addressed via these amendments, how will they be taken forward?

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[Jen Craft]

I rise to share a few brief reflections. I appreciate that the intent behind amendment 25 is to make sure that the relevant training is in place. I assume that the hon. Member for Guildford has in mind something similar to the Oliver McGowan training provided across hospital trusts, which mandates that all healthcare providers spend a certain amount of time training with someone who has lived experience of autism and of learning disabilities, in order to make sure that the very different ways in which people with autism or learning disabilities might present do not overshadow what they are attending hospital to demonstrate. Particularly for mental health, we all know that diagnostic overshadowing can be fairly significant. In a locked setting, someone with a learning disability or autism may be unable to demonstrate behaviours that show they are improving or getting better, which can undermine the care they receive.

I would just question whether primary legislation is the best vehicle by which to provide for this. We have spoken at length about how the NHS workforce plan and the 10-year plan are coming forward. I wonder whether this would be better placed within that wider framework. Training could be taken forward either as part of continual professional development, or for medical professionals at the start of their career.

[Natasha Irons (Croydon East) (Lab)]

On the point about training in the round for NHS staff, or any staff dealing with someone in crisis, might it be about taking a more contextual safeguarding approach that relates to not just the one setting? I agree with the point about looking at the 10-year plan, and making sure that mental health training is provided for all staff, because we know that people can present in very different ways, in many different contexts across the health system.

[Jen Craft]

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

[Sojan Joseph]

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

Mental Health Bill [Lords]

Jen Craft Excerpts

2nd reading
Monday 19th May 2025 Commons Chamber

[Wes Streeting]

I am happy to reaffirm that we have a really strong working relationship with Minister Mike Nesbitt and the Northern Ireland Executive, and we are keen to share insight wherever we can.

The hon. Gentleman makes a very important point, which refers back to the remarks I made about the limitations of the legislation. Reform of the statute book is important in terms of how the law treats people. But as well as reforming the model of care, clinical pathways and looking at new treatments, innovations and technologies, we also need to focus on prevention, attacking the social determinants of ill health, including mental ill health, of which poverty is a key driver of stress, anxiety, depression and worse. That is why the Government will keep such a focus not just in our 10-year plan for health, but more broadly across public policy.

The current legislation has left many people with a learning disability and many autistic people in mental health hospitals, when they could receive much better care elsewhere. Around four in 10 people with a learning disability or autism could be cared for in the community. The Bill aims to improve the care and treatment people receive when detained, while keeping patients and the public safe. Through the Bill, we are: strengthening and clarifying the criteria for detention and community treatment orders to better support clinicians in their decision-making; introducing increased scrutiny and oversight for compulsory detention and treatment; and providing patients with a clear road to recovery by introducing statutory care and treatment plans for all patients detained under the Act, except if under a very short-term section.

[Jen Craft (Thurrock) (Lab)]

Does the Secretary of State agree that a proper community treatment plan for those with learning disabilities and autism is not just reliant on the actions of his Department, but a cross-Government effort and an integrated care system at a local level?

[Wes Streeting]

My hon. Friend is absolutely right. I am very glad that my Department is working closely with other Departments across a range of issues, in particular with my right hon. Friend the Secretary of State for Work and Pensions on the link between employment, welfare and health, and with my right hon. Friend the Secretary of State for Education on the reform of special educational needs and disabilities, and the interface between health and education services—I could go on. The point is that a wide range of factors have an impact on people’s health and wellbeing. Indeed, people’s health and wellbeing can have an impact on a wide range of aspects of their lives, which is why we have to work in a mission-driven cross-Government way.

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[Dr Spencer]

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

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

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

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

[Jen Craft]

I am grateful to the hon. Gentleman, who has brought his wealth of experience to this place. Would he concede that the focus on learning disability and autism is perhaps because those disorders have very specific features? Being in an unfamiliar, over-sensory stimulating or noisy environment, with a break from routine, has an adverse effect on some people precisely because of the nature of their disability, and perhaps more so than for some of the other conditions he has mentioned. Indeed, it seemed something of a weird anomaly that learning disability and autism were classed as mental illness for the sake of the Mental Health Act. I am sure the hon. Gentleman will agree they very much are not.

[Dr Spencer]

I thank the hon. Lady for her intervention. Sensory over-stimulation can be a particular issue for those with autistic spectrum disorders. I have been concerned when I have looked after patients, and I have thought carefully about the challenges, particularly in general adult wards, of catering to the needs of people with autistic spectrum disorders or a learning disability. I would argue that that would apply broadly to anyone in a general adult hospital, irrespective of diagnosis—everyone has particular needs and sensitivities and we need to be mindful of that.

I suspect this is something that the hon. Lady and I will disagree on, but I would consider an autistic spectrum disorder and a learning disability to be a mental disorder. It certainly is under the ICD-10 classification of mental and behavioural disorders. One problem with how this issue is framed in the Bill is, for example, where Rett disorder, which is also a pervasive developmental disorder, would come into it. Does it come under the term “autistic”? Where does a not otherwise specified pervasive developmental disorder come into it? I am not sure whether how the terms in the Bill will operate in real life has been thought through. I do not understand why we are not pushing for such a provision for every disorder and condition that people have when they come into hospital. That is why we are not focused on something like a treatability test, or otherwise.

This has a specific real-life fall-out. If people need to be in hospital after 28 days and there is a deprivation of liberty, that is going to happen. It will not stop happening; with the best will in the world, and even with this Bill, it will keep on happening. People will either be detained under liberty protection safeguards, or they will end up being detained with anxiety related to their ASD or learning disability, which would place them within scope of the Mental Health Act.

A further challenge and disparity in the Bill is that it does not affect forensic provisions. People could be keener to pursue a criminal prosecution of people with ASD or an LD because that would enable a longer stay in detention than 28 days. That is why in the pre-legislative scrutiny we suggested that there should be an option to get a pre-authorisation for detention beyond 28 days by going to a tribunal, which we thought might deal with some of the concerns raised. Personally, I like the idea of pre-authorisation in general beyond 28 days, and it is something that Professor Richardson spoke about in her review back in the late ’90s. The Government recognise that there are challenges with this area, which is why these changes are in the schedules. There is a recognition that, frankly, this is not workable, and we will see as the Bill progresses that there are broader concerns about how it operates.

Another area of concern is nominated persons and parental responsibility. The Bill changes “nearest relative” to a “nominated person”, which means that people can choose who performs that important role under the 1983 Act. The nearest relative or nominated person can discharge someone from the powers of the Act, which would inevitably mean that they would be discharged from hospital—there are powers to bar people, but it is quite a high threshold. This measure is important because it will allow someone under the age of 18 to choose someone who is not their parent to have that important statutory power. We raised this issue in the pre-legislative scrutiny Committee. We could have a situation in which a 16-year-old with competence who is detained under the 1983 Act in hospital chooses their mate, or somebody else—not their parent or someone with parental responsibility—to have the power to discharge them from measures under the Act, which would inevitably mean them leaving hospital. The parent, who in such situations is often responsible in some way for the after care, would lose that power.

I am concerned, as were the Lords, about the impact of that measure on the Children Act 1989. I think there is a serious problem in changing this area of law—we do not have this in physical health—and introducing the ability to give a statutory power to a non-parent. I know the Minister will look into that in the Bill Committee, but I think the Government will have to row back on that. They could easily amend the Bill to say that if someone is under the age of 16, the nominated person must have parental responsibility unless there is a good reason for them not to have it. Sixteen and 17-year-olds are a bit different, especially when people start getting close to 18 and there are other children’s rights, but I cannot see why we should legislate to let someone under 16 choose someone who does not have parental responsibility to have that important power.

The third problem is that the Bill is silent on deprivations of liberty in A&E, which are ongoing. It has been a while since I worked in A&E, but there has always been the challenge of what to do with someone who turns up to A&E if the doctor thinks that they will probably need detaining under the Mental Health Act because they are suicidal or very unwell, and wants to keep them there while the assessment takes place. We can get through it using the Mental Capacity Act 2005, but it is messy. It would be a lot clearer for everybody if we said, for example, that section 5(2) of the 1983 Act, which allows for temporary detention, could apply to an A&E setting. There is a bunch of technical stuff about the interaction between deprivation of liberty and the Mental Capacity Act, but I suspect you will start giving me the evil eye, Madam Deputy Speaker, and telling me to move on if I start—[Interruption.] Madam Deputy Speaker says no, but I suspect that Members across the House might start doing that, so I will move on.

Let me flag two things in the Bill. It allows for a discharge from hospital under supervised conditional discharge to a deprivation of liberty. That is in response to the case of Secretary of State for Justice v. MM, which involves a problem with how the law currently operates. As far as I know, in mental health law we have never had a situation where deprivations of liberty in the community were authorised under the Mental Health Act—someone had to be in a registered hospital. That is a big Rubicon to cross. I see why the Government need to tidy up this area of law, but I am not convinced that we have realised what a big Rubicon this is to cross. The operation of the Mental Health Act has always meant that someone was detained in hospital, but when they are in the community they are in the community. Someone might have certain restrictions placed on them by a community treatment order, or otherwise, but they are not deprived of their liberty in their home or in some other community setting that is not a registered medical hospital. I think that measure needs a bit more reflection.

I believe that the majority of those who will undergo compulsory treatment under detention, certainly for a long period of time, under this legislation will be people with psychosis, such as schizophrenic forms of psychosis, schizophrenia and bipolar affective disorder, but lot of the debate and focus has been on non-psychotic illnesses. That is not to say that those illnesses are less important—they are certainly not less important, especially for those who experience them—but I am concerned that people with schizophrenia always get a raw deal. They are often marginalised by society and in terms of the amount of advocacy they have.

In fact, a lot of the evidence that we reviewed in the pre-legislative scrutiny Committee focused on non-psychotic disorders, perhaps because sadly people often turn their backs on people with psychotic illnesses. Sometimes those people find themselves in a situation where their illness is so debilitating that they cannot advocate for themselves, so there tends to be a bias towards disorders such as dementia, ASD and LD, where there is someone to advocate, such as CAMHS or families who might push a little bit more. I am not saying that any condition is more important—I really want to stress that—but as parliamentarians, we do not necessarily understand that the bulk of the conditions that the Bill focuses on concern psychosis.

Finally, I have spoken a lot about how psychosis can lead to people being detained in hospital and about the impact of that. Psychosis is a pretty terrible disease but it does not need to be: lots of people get better and it is one of the most treatable diseases. The Bill will help people to get better and we cannot lose sight of that.

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[Kevin McKenna]

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

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

[Jen Craft]

I very much support what my hon. Friend is saying about making sure that there is an active plan. One of my concerns is that implementation of this Bill will be delayed until community support is ready. Does he agree that it would be welcome if the Minister offered a reflection on what good looks like in this space, and what ready looks like, so that we know what we are aiming for?

[Kevin McKenna]

I absolutely agree. We should flip this around from a delay until we are absolutely ready to an active process of deciding what good looks like.

Two weeks ago in my constituency, I ran a mental health conference. That was largely because, as I was going around as a new MP talking to every different organisation I could, mental health was right at the top of nearly all their worry lists, whether it was the food bank, the schools, the police, the prisons, or organisations in my community that had set themselves up to support people with mental health. I have a MenTalk in Sittingbourne and a MenTalk in Sheppey; they work in different ways, but that shows the level of pressure that exists locally. All of those organisations brought out mental health as their biggest worry, even if it was not their primary purpose.

Just bringing people together and getting them to talk together—people who perhaps had not talked to each other until that point—really made a difference. You could see it in the room on that day. I am sure I am way behind the curve compared with a lot of other Members who have been doing this sort of stuff already, but for me, it really showed that we have got to be active in pushing this forwards. What we have learned from 2019 and the long-term plan for the NHS is that it is the implementation that matters. It is not the words in the strategy; it is getting an implementation plan really tight and fast on the ground. Given that the impact assessment talks about 2027 as a key point, I would like to see a commitment in the Bill to produce a workable plan by 2027 at the latest—one that can give us the road map we need for the future. That has been called for by organisations such as Mencap and the National Autistic Society, so I really commend it to the Minister.

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[Jen Craft (Thurrock) (Lab)]

The Mental Health Bill is a long overdue update to the Mental Health Act 1983, and I hope it will be the start of a much wider overhaul of a mental health system that is often not fit for purpose and has historically been treated as secondary to the physical health system. It is a system where too often patient voices are ignored, injustices are common and the use of detention is relied upon in the place of person-centred community care. Too frequently, those in acute mental health crisis cannot access the right support. They are refused help in the community, forced to rely on accident and emergency, and detained against their will as their mental health deteriorates. Incidence of detention is three times higher in the most deprived areas. Black British people are detained at 3.5 times the rate of white people, and those with learning disabilities and/or autism are at a unique and increased risk from detention and the impact that it can have on their lives. I will initially focus on that latter group. I declare an interest as the chair of the all-party parliamentary group on learning disability.

Under the 1983 Act, as we have heard, learning disability or autism in themselves can be a reason for detention. The hon. Member for Runnymede and Weybridge (Dr Spencer) said that we will disagree on this, and I am afraid that we will, because I do not think that learning disability or autism are necessarily conditions of the mind. A number of these conditions are genetic and also affect the physical health of a person.

[Dr Ben Spencer]

rose—

[Jen Craft]

I am sure the hon. Member will want to come in on this.

[Dr Ben Spencer]

I appreciate the hon. Member giving way. There is a logical inconsistency, which is that people with autism and learning disability are looked after under mental health services for autism and learning disability. If the argument is, “Well, those conditions should not be within the scope of Mental Health Act”, one could make an argument that they should not be within scope of mental health services full stop.

[Jen Craft]

I thank the hon. Member for his intervention. I would welcome the opportunity to discuss this issue in more detail with him, although we will probably continue to disagree. People with learning disabilities and autism can suffer from mental health conditions as much as the rest of the population, but they have a unique set of challenges. I point out as a note to policymakers in general that they should not conflate learning disability and autism as one and the same thing. That is vital.

At the end of January 2025, 2,065 in-patients in locked mental health facilities were autistic or living with a learning disability. As one of my hon. Friends said earlier, the average length of stay for these patients is nearly five years. For those with a learning disability or autism, a locked mental health ward can be a living hell. For someone with sensory issues, a reliance on routine, a need for a specialist diet or equipment or myriad other needs, being in a busy, over-stimulating environment—often with strip lighting and minimal privacy—often means they are set up to fail from the very beginning.

[Chris Vince (Harlow) (Lab/Co-op)]

My hon. Friend is making an important speech, and I know that her experience in this issue is almost second to none. She is making a point about how those with learning disabilities being confined in the way she suggests could add to their mental health issues. Supporting them in the community would alleviate a lot of those mental health issues. In the long term, that is better for them and for the community.

[Jen Craft]

I will come to that point a little later, but that confinement is detrimental to their mental health. It can sometimes be hard to pick apart a co-existing or co-occurring mental health condition from the behaviour exhibited within that environment. This is part of the reason that it is all but impossible for some detained individuals, in the circumstances they are in, to demonstrate the behaviour change they need to prove they have become sufficiently well to be released.

My attention was drawn last year to the case of a young woman called Bethany, who was detained for the best part of half a decade under the Mental Health Act. She is an autistic young woman whose parents believed that her entering a secure unit was the best choice. However, she ended up being locked up for days, weeks and then months on end in a room with only a mattress on the floor. She was unable to see her family or her support network, and her parents were absolutely devastated at being unable to get her out of that environment and seeing her continually deteriorate. It is hard to imagine the anguish of people seeing someone that they love go through this. When this happens to someone or their family, how on earth can they ever again trust the system that put them there? Learning disabled people and autistic people who have been through that have their confidence in accessing support taken away. In turn, that can create a vicious cycle.

I strongly welcome the moves that this Bill makes towards removing learning disability and autism as a reason alone for detention. However, similar to my hon. Friend the Member for Sittingbourne and Sheppey (Kevin McKenna), I note that the Government have said that these changes to detention criteria will only be switched on when systems can demonstrate a sufficient level of community support. That is a source of real concern. As the NHS Confederation has warned, the

“success of the reforms will be dependent on the wider infrastructure to support”

the Bill. As others have said, there is no clarity on what a sufficient level of support means in practice. We do not know where we are heading or when we will have got there.

The most successful support for learning disabled and autistic people to live independently in their communities is integrated care that encompasses health, housing, occupation and much more besides. I would welcome the Minister’s assurances on how that will be delivered in the timescales set out and how we get from where we are now to where good is. The continual detention of people in this way should shame us all, and an end to that cannot come fast enough.

I sound a note of caution—I think this is fairly similar to that of the hon. Member for Runnymede and Weybridge—that the legislation continues to allow for the co-occurrence of mental health conditions to be a reason to detain someone with a learning disability and autism. That in and of itself could lead to this continual cycle where people are detained for longer than is necessary for their treatment while in an environment that is entirely counterproductive to them becoming well. We also need those with a specialism in learning disability and autism to be present in assessing whether an individual also has a co-occurring mental health condition.

Finally, I put a plea in to the Minister that there is a real need for those who live with a learning disability or autism to be properly consulted. A number of disabled people’s charities that are run by people with a learning disability, such as the “Bring People Home from Hospital” campaign, which is operating under the auspices of Inclusion London, do not feel that they have had sufficient opportunity to input. A very minor point is that some relevant documents related to this legislation have not been printed in easy read. If they have, it has taken a while for them to arrive. People who have a lived experience of these conditions are unable to contribute in a meaningful way.

More broadly, I welcome the legislation’s attempt to make progress in putting patient voice at the heart of care, particularly through advance choice documents, but there is scope to go further. The Royal College of Psychiatrists is advocating for a statutory right to an advance choice document, which the pre-legislative scrutiny Committee also recommended. That would ensure that all patients who would benefit from one would get one, with the aim of reducing detentions and involuntary treatment. While I recognise the importance of this step and this legislation alongside the Government’s investment in mental health crisis centres, a pledge to recruit 8,500 mental health staff and the Secretary of State’s commitment to the mental health investment standard, there is a desperate need to transform community mental health services to put patient voice and experience at its heart and avoid the need for detention orders in the first place.

As a member of the Health and Social Care Committee, I have had the privilege of hearing from some extraordinarily courageous individuals who shared their experience of living with a serious mental illness. It is in that same spirit that I will share my own experience now. I hope that it offers an insight into the limitations of our current system.

I was diagnosed with obsessive compulsive disorder as a teenager, and with bipolar disorder in my 20s. In two and half decades with these conditions I have received good care, but sadly that is the exception and not the rule. I have never been asked what it is that I want from treatment, what it is that I want for my life, and how I can be helped to get there. I have received care that is patronising, reductive, inconsistent and non-existent. During mental health crises I have had to tread a fine line between proving that I am ill, and sometimes extremely ill, and proving that I am not so ill that I need to lose my liberty, because I know that more often than not, treatment is based not on therapeutic care but on risk management. Like thousands of others, I have had to create my own care package and my own route to treatment, because I made the decision that I deserved to live, and I deserved to live well—and also that my children deserved their mum. However, I am very aware that my ability to do this is based on a number of privileges, in no small part a very supportive family, which so many do not have.

While I welcome the Bill for its advances in reducing the amount of detention and increasing the agency of those who are detained, I must call for a significant overhaul of community mental health services to prevent crises from occurring in the first place. We know that we can and must do better. I ask all Members to note that when we discuss people’s serious mental illnesses, we often talk as though they were “others”, which they are not. Let me say this: “There is someone standing here among you, a Member of Parliament, who has a serious mental illness. It does not prevent me from doing my job or from living my life; in some ways, it makes me better at it.” While the Bill continues its passage through Parliament, can we please bear in mind that we are talking about individuals, and individuals who will be affected by it, and that what we seek to do—and what I hope we will accomplish—is give people who live with serious mental illnesses the ability and the right to live the best lives that they possibly can, with all the support that we can make available?

[Madam Deputy Speaker (Ms Nusrat Ghani)]

The hon. Lady’s family must be very proud.

--- Later in debate ---

[Josh MacAlister]

Absolutely. We need to support young carers and young people in care. One of the common challenges facing both of those populations is that services sometimes fail to look at what support can be provided to the whole family unit, so I take my hon. Friend’s point.

Finally, I will say a few words about a sensitive issue that is a growing trend. Most weeks, I visit a school in my constituency, and there is a growing theme: teachers, and now parents, are raising concerns about the potential over-diagnosis or misdiagnosis of ADHD and mild autism. I raise this point for two reasons: first, because the risk is that the scale of the increase in diagnosis is so great that it may take away much-needed mental health services from those with acute and genuine need; and secondly, because we have yet to grasp the potential negative impacts of treating what may be social challenges as medical disorders.

Some 400,000 children are currently awaiting an ADHD assessment, and rates of diagnosis have risen sharply in recent years. Diagnosis varies dramatically depending on where someone lives, who does the assessment and, worryingly, the socioeconomic background of the individual.

[Jen Craft]

Is my hon. Friend able to name an intervention for a diagnosis of mild autism that could be considered a medical intervention, not something to address one of the social issues he has identified, that could harm the individual?

[Josh MacAlister]

Yes, in a number of schools we have seen a growing number of ADHD and mild autism diagnoses that do not come with any form of treatment. That is in a system where there is an expectation that education, health and care plans will be filled and met by multiple agencies, and the families are often left battling the system, having to fight for a diagnosis to get that label and then finding that the help is not there. My argument is that those families—not all, but some of them—are battling a system that already has finite resources and now spends a huge proportion of its resources gatekeeping, when actually we should step back and look at what support the young person and their family need.

In the case of ADHD, the National Institute for Health and Care Excellence guidelines set out very clearly that, before an assessment is made, it should be established whether parenting support could be put in place to help. My guess is that, in many cases at the moment, that offer of parenting support is not in place before an ADHD diagnosis is made.

Diagnoses of autism have doubled in the last five years. I am not saying that that is incorrect, but I think the question needs to be asked, as part of the wider debate, whether that growing trend is a reflection of previously undiagnosed autism or, because of recent changes in the ICD-11 manual—the 11th edition of the “International Classification of Diseases”—people are being brought into that diagnosis who would previously have been supported in other ways.

I close by urging the Government to consider the implications of the reform of mental health services for those in rural and remote communities. They need to acknowledge the benefits that will come from these measures for those with a care experience, but also to think deeply about the need for residential care that can meet their need for a secure setting. They should also consider ways in which we as a country can have a full and rich conversation about the growing diagnosis of ADHD and mild autism, so that we can establish the best routes of support for the children crying out for support and the parents often battling against the system, who may be building up a future need for the crisis mental health services we have been speaking about this evening.

Oral Answers to Questions

Jen Craft Excerpts

Tuesday 6th May 2025 Commons Chamber

[Karin Smyth]

The hon. Gentleman is not correct: maternity funding is not ringfenced at the same level—I think that is what he is referring to. It has, however, absolutely been committed to as far as ICB allocations are concerned. Local leaders will decide how best to allocate that money. We will continue to work with Donna Ockenden and the families who have been affected by previous incidents and ensure that the recommendations of her report and the maternity review are fully implemented.

[Jen Craft (Thurrock) (Lab)]

As colleagues will be aware, there is a consistent failure in maternity units to listen to women and put their experiences—and quite often their pain during childbirth—at the heart of driving improvements. What assurances can the Minister give us that women’s experiences and voices will be at the heart of any maternity improvement strategy that the Government focus on?

[Karin Smyth]

My hon. Friend is absolutely right to highlight that point, which has been found in all the reviews that have been undertaken. It is completely unacceptable. That is why the Secretary of State has continued to meet families and hear their experiences to ensure that we learn from them, continue to support the implementation of those recommendations and, crucially, ensure that women’s voices are taken forward as part of our 10-year plan.

Down’s Syndrome

Jen Craft Excerpts

Wednesday 19th March 2025 Westminster Hall

[Jen Craft (Thurrock) (Lab)]

It is an honour to serve under your chairship, Mr Turner. I congratulate the right hon. Member for Beverley and Holderness (Graham Stuart) on securing this important debate.

Down’s syndrome regression disorder is an aspect of Down’s syndrome that has been, until now, largely overlooked. It affects roughly 1% to 2% of people with Down’s syndrome and usually presents between the ages of 10 and 30. It is a truly horrific condition. People with Down’s syndrome regression disorder change, almost overnight. I met a mum whose son developed Down’s syndrome regression disorder. Overnight, he became non-responsive, uncommunicative and catatonic. She said it was like everything that was him had left.

Young people who previously held down jobs or voluntary positions, and had many interests, hobbies and a love of life, lose the ability to speak, lose continence and retreat into themselves. The change is not gradual; it is stark, unexpected and profound. There is a fundamental lack of awareness of the condition. It is often wrongly diagnosed as early-onset dementia or late-diagnosed autism, even though it does not fit the profile of either of those conditions. There is currently no pathway for diagnosis, and progress is often fraught. Finding a clinician who recognises the symptoms and will treat is, by and large, impossible. However, there is hope: 80% of people who receive the right treatment in a timely manner achieve some prospect of recovery.

I want to be clear: if a typical child who does not have Down’s syndrome stopped eating and taking any interest in jobs overnight, and if they suddenly became catatonic and completely unresponsive, it would be treated as a medical emergency. People whose children have Down’s syndrome, and who have finally managed to speak to the right clinician, have been told, “You need to take your child to A&E.” If it was a typical child, that would be happening, but because that child has Down’s syndrome, it is overlooked. Will the Minister meet with me and individuals affected by this disorder to discuss how we can best create awareness, and what their thoughts are on how we can create a pathway to diagnose and treat it?

I would also like to touch briefly on my reflections as a parent of a child with Down’s syndrome, and what I think would be generally helpful in the space. Many of us feel that some kind of pathway for parents whose child is born with Down’s syndrome would be extraordinarily useful. When their child is born, or when they receive an antenatal diagnosis, they very often think, “What lies ahead? What can I expect? What does my future look like?” Down’s syndrome is the most common chromosomal condition, and we know that 50% of children born with Down’s syndrome will have a heart condition, and there is a higher prevalence of conditions such as leukaemia. By and large, those with Down’s syndrome do not have a very strong immune system—as I know every flippin’ winter, when my child gets cold after cold.

I have had lovely responses and gained a level of knowledge about what to expect from various parts of my child’s condition. We have cobbled that together from speaking to other parents, through WhatsApp groups and Facebook groups, and sometimes from speaking to professionals and support groups. It would be helpful to have that set out officially, so that parents know what lies ahead, what to expect and what to look for.

This is a very small thing, but when people with Down’s syndrome have a fever, their temperature sometimes goes down rather than up. It is really unusual, but it is normal for the condition, and it is quite useful to know as a parent. It is also useful to know how to diagnose things, because people with Down’s syndrome do not present conditions typically, including conditions that can be really awful. Parents have lost children to sepsis because it does not present as it would with a typical child, so knowing how to diagnose it is really useful.

As people transition into adulthood and make those steps into the adult world, it is important to have an idea of how people with learning disabilities and Down’s syndrome can expect to be treated. What kind of things help them to live full and happy lives? As their parents and caregivers, what kind of things should we be encouraging them to take part in? That is extraordinarily helpful to know.

I will keep my speech brief, as I know other Members want to speak, but I will just end by reflecting that Friday is World Down Syndrome Day. In our community, we typically see it is a day of celebration, as well as an opportunity to present a challenge to policy makers. This year, we are asking them to ensure that we have the right support.

People will see this debate who have just received a diagnosis of Down’s syndrome. They might be receiving it today; they might be receiving it antenatally or postnatally. When I received that diagnosis seven years ago, it was a shock. I felt like the carpet had been pulled from under my feet, and I was devastated. I look back at that moment with shame at the thought that I was so devastated at the news of this person who became the beating heart of our family. She is joyous, although she is not always happy. That is a misconception—she is not—and if people say that, I will say, “Oh, did I get a wrong one?” Of course, I did not. She is stubborn—I like calling girls stubborn—she is determined, and she is feisty.

She is also a fantastic dancer. At a community event we went to, I was there as an MP, but she had me up dancing in the middle of the floor. I was not in the background; I was right there, and she dragged me into the heart of it. She is really funny, and she is so kind, especially with her sister. There is a really brilliant statistic that 95% of people who have a sibling with Down’s syndrome think that they have enhanced their life. She has made me a better person, and she has made my husband a better person. When she loves, she loves deeply, and she loves hard. People who meet her share that and feel that love with her.

The brilliant thing is that, if a parent has a child with Down’s syndrome, they join this wonderful community. I have met some of my best friends through that community and we are there to support each other. There are some brilliant groups; I will give a shoutout to Faye and Claire from our local Down’s syndrome group, who welcomed us with open arms and showed us what our life is. We are taking what we call the scenic route, not the quick path. It is a lot better than the casual straight line. Who wants normal? It is boring, and they showed us that joy.

Upwards with Downs in Harlow is a fantastic group that organises so many wonderful events, including a holiday we have been on with people who get it. There is also Downright Excellent in Hackney, and I say to my wonderful friends Charlotte and Kirsty: what a brilliant and fantastic community we have. Happy World Down Syndrome Day—I love all of you. If anyone is ever worried about what the future looks like, come and talk to me, or to any of us, because we can tell you that it is not just going to be okay; it is going to be brilliant.

[Several hon. Members rose—]

NHS England Update

Jen Craft Excerpts

Thursday 13th March 2025 Commons Chamber

[Wes Streeting]

First, I give the Chair of the Select Committee my assurance that I would be delighted to appear in front of her Committee at the earliest opportunity —that means soon. I appreciate that it will want to scrutinise these changes in more detail, and I would welcome the constructive challenge that it offers. I also reassure her that the direction that we are giving to frontline leaders is to deliver the three big shifts in our 10-year plan, and to ensure that as we take immediate steps to bring the finances under control, we do so in a way that lays the firm foundations for the future of the NHS that we need to build.

My cautionary note to Members across the House is that when we ask frontline leaders to reform and to change ways of working, sometimes that requires not just changes to the bureaucracy as it were—the easier and lower hanging fruit—but service reconfiguration in the interests of patient outcomes and better use of taxpayers’ money. Sometimes, they get those changes wrong. I have successfully campaigned against closures of services such as the King George accident and emergency department, which should not have closed and where we won the case on clinical grounds.

Sometimes, let us be honest, the public can get anxious, and Members of Parliament feel duty bound to act as megaphones and amplifiers for public concerns. It is important that we support and engage with local NHS leaders. By all means, we should scrutinise, challenge and ask questions, but we must give local leaders the support to do the task that we are asking of them on behalf of patients and taxpayers. The powers that I have to intervene in those frontline service reconfigurations are ones that I will use only in the most exceptional and necessary cases, and that is why I have not used them once in the past eight months.

[Jen Craft (Thurrock) (Lab)]

The crisis in our NHS goes deep. I am sure that the Secretary of State agrees that it is an existential crisis that poses a threat to the future of the NHS if fundamental change does not happen. While I strongly welcome today’s statement, what assurances can he give me and the House that the right people will be in the right place in leadership positions to drive the fundamental change that is necessary?

[Wes Streeting]

That is an excellent question. We are building an outstanding transformational team with Sir Jim Mackey, which will be announced very shortly. It will bring together some of the best leaders across the country, and expertise from outside the NHS, to drive the scale and pace of transformation that is necessary. My hon. Friend is right to say that it is existential, because we cannot allow the curve of cost and demand to continue to rise to the extent that it is. The NHS’s long-term workforce plan has one in nine people in our country working for the NHS. On the current trajectory, in 50 years’ time, 100% of the public would be working for the NHS. That is clearly not a sustainable position.

I tell people who resist this reform out of love for the NHS not to kill it with kindness. We have to bend the curve of cost and demand to ensure that our health services are sustainable for the long term on the equitable foundations of a public service, free at the point of use, that we will always defend. I also say to my hon. Friends on the Government Back Benches that if we do not get this right, goodness knows what will come next. The Leader of the Opposition says that she wants a debate on the funding model for the NHS. The leader of the Reform party—I am not sure whether he is the Leader of the Opposition yet—says that he is up for anything. I am sure he is. That should worry us.

To those who want to debate the funding model of our NHS and the equitable principle of it being a public service, free at the point of use, I say that we are happy to have that debate but the Government are unequivocal: under Labour, the NHS is not for sale. It will always be a public service, free at the point of use, so that when people fall ill, they never have to worry about the bill.

Department of Health and Social Care

Jen Craft Excerpts

Wednesday 5th March 2025 Commons Chamber

[Jen Craft (Thurrock) (Lab)]

Meeting my constituents in Thurrock serves as a constant reminder of the state of our NHS and the health of our nation. I regularly hear from residents who cannot access NHS services, who are stuck on a waiting list or who are unable to see their doctor. I see how the social determinants of health play out, putting people in parts of my constituency at a disadvantage from day one. Housing, unemployment and education drive health inequalities, and in our most deprived communities, people do not live to see their 80th birthday. That is representative of the immense task this Government have been set. The funding of the health service and the estimates we are discussing today are fundamental to turning the tide on these trends.

Fourteen years of neglect and failure, the highest waiting lists on record, an ageing population that is getting sicker and unmet need in communities across the country mean that the NHS is at a pivotal point in its history. It must fundamentally change how it operates in order to survive. The £22.6 billion of funding committed to revenue spending at the Budget was a welcome and much-needed cash injection, the impact of which is already being felt. The delivery of Labour’s manifesto commitment of 2 million more appointments a year is testament to that.

[Gregory Stafford]

I did mention this in my speech, but I think the hon. Lady was there in the Health and Social Care Committee when the chief financial officer of NHS England said that the extra £10.6 billion allocated for this year would be entirely eaten up by other costs, including national insurance rises, and that there would be almost no extra money for frontline patient care. Does she remember that?

[Jen Craft]

I was indeed at that Committee, and I also remember the reflection that NHS England was incredibly grateful for the amount of money that was being given. It was the highest amount of money given to any Department at the Budget, and it was much, much more than has been given in previous years.

Waiting lists have fallen for the fourth month in a row—I hope the hon. Gentleman and his colleagues will welcome that—with 160,000 fewer people waiting for treatment than when Labour took office. That includes a member of my own family, so I am very grateful to see that happening. Extending the opening hours of community diagnostic centres, such as the one set to open in my constituency this summer, will be key in catching conditions earlier.

While I welcome those measures, I would like to make the key point that funding alone is not enough to change and save how our NHS operates, and we must turbocharge the left shift to community and neighbourhood healthcare. In my constituency, it is often the front door to the NHS that lets local people down, which drives admissions to A&E when there is no available alternative. We have some of the most acute GP shortages in the country, with an average of 3,431 patients per GP. The neighbourhood health hubs promised by the previous Government have yet to be delivered. People in Tilbury, one of my most economically deprived areas, are still waiting for a long-promised facility, which currently looks like a hole in the ground, and I would welcome a discussion with the Minister about how we can work to deliver it.

The record funding uplift for general practice, with £889 million of investment, is again welcome news, but it highlights the fundamental tension between tackling the crisis in acute care and driving the vital left shift to community care that will be fundamental in turning the tide on the NHS. We must not lose sight of the goal of creating a healthier population in order to reduce pressure on acute services in this country, creating better, healthier lives and delivering the right care at the right time that puts the focus on the individual.

Thurrock community hospital in my constituency delivers excellent integrated community care that brings together social workers from the local authority and NHS staff to meet people where they are, intervening early and reducing pressures on acute care. That is partly thanks to a real partnership between the local authority and the integrated care board, and it has removed the need to focus on which public body benefits and which public body pays. I have to point out that our local authority has one of the lowest spends on adult social care, partly due to measures such as this.

The real focus is on how to deliver for individual patients—what do patients need and how do they get to that place? I welcome the bold move in the recent planning guidance to drastically reduce the strict targets placed on integrated care boards, allowing more of this work to take place by giving ICBs independence to make decisions that are relevant to their local population. However, I have heard from ICBs, including mine, that there is a risk that a focus on the elective care target may draw attention away from prevention.

I would like to point out the removal from the planning guidance of the targets for annual health checks for people with learning disabilities. That community historically has been under-represented and has not had its health needs fully met. This population dies younger and does not access preventive care at the point at which it would be most beneficial for them. Blanket prevention measures do not cover such populations. People in this community need specific intervention that allows them to access the healthcare that they need, when they need it. While a blanket annual health check is not necessarily the right way forward, it is absolutely critical that historically overlooked groups who are not served as well as others by our healthcare system are not overlooked when we shift to community and prevention work.

I very much welcome the strong investment that the Government are making in our NHS; it is vital in order to turn the NHS around and ensure that it is there for generations to come. I would welcome the Minister’s thoughts on how we can incentivise prevention as well as providing acute care.

[Madam Deputy Speaker (Judith Cummins)]

I call the Chair of the Select Committee.

--- Later in debate ---

[Layla Moran]

We should be celebrating examples of where this works well, not shutting them down.

In Oxford, the Hospital at Home programme, run by Oxford University hospital ambulatory team, does incredible work. I visited 91-years-young Mavis the other day, who was receiving top-notch ultrasounds in her home—ultrasounds of better quality than those that she would have got in the hospital. That saves hundreds of pounds for the NHS and means no long trip for her and her family. That is definitely something that we should do more of.

Let me turn to the estimates, because they are why we are here. The supplementary estimates have been published. I will not hit anyone over the head with them—they are incredibly heavy. They are worth a read. They talk about a £198.5 billion day-to-day spending budget. At face value, that is an increase of £10.9 billion on the estimate from July, but £9.2 billion is for staff pay increases. Let us be clear: staff deserve that pay rise. It is long overdue. Retention and mental health are important, and we must invest in our workforce, but that does leave just £1.7 billion.

[Jen Craft]

Will the hon. Member give way?

--- Later in debate ---

[Joe Robertson (Isle of Wight East) (Con)]

I commend my hon. Friend the Member for North Cotswolds (Sir Geoffrey Clifton-Brown) for his introduction to the debate. I agree with the majority of what I have heard so far.

We must understand the context of the large figures announced by the Government. In particular, the £10 billion for the NHS next year sounds like a big figure, but as my colleague and Chair of the Health and Social Care Committee, the hon. Member for Oxford West and Abingdon (Layla Moran), was right to inform us, the vast majority of that money—around £8 billion to £9 billion—will be taken up by union pay deals, the national insurance increases brought about by the Chancellor, and inflation. When all the essential costs that the NHS must meet are taken into account, the £10 billion represents a shortfall. The NHS will be able to deliver only if it produces productivity gains. We must understand that £10 billion will not even meet the required costs of the NHS.

[Jen Craft]

Does the hon. Member not consider the workforce a vital part of the NHS? Properly funding the workforce, through a pay deal that appropriately recognises the effort they put in, is part of the work of turning around the outlook for our NHS.

[Joe Robertson]

I agree with all those things, and I am happy that the hon. Lady and I agree with each other. I hope that she acknowledges that £10 billion does not cover the basic requirements of the NHS. It delivers nothing more; in fact, it delivers less. The NHS will be able to continue to grow only if it delivers productivity gains, and it should.

Oral Answers to Questions

Jen Craft Excerpts

Tuesday 11th February 2025 Commons Chamber

[Stephen Kinnock]

The hon. Lady will know that the Government’s position on the Terminally Ill Adults (End of Life) Bill is one of neutrality. I am on the Bill Committee simply to speak about the Government’s position on the workability and operationalisation of the Bill. We look forward to seeing the amendment that will be brought forward by my hon. Friend the Member for Spen Valley (Kim Leadbeater). Any comment we make or position we take will be based on the operationalisation of that amendment, should it become part of the Bill and, ultimately, should the Bill gain Royal Assent.

[Jen Craft (Thurrock) (Lab)]

Thurrock community hospital does fantastic work on integrated care, particularly on integrated mental health care. On a visit, representatives said that what makes the hospital successful is a commitment to working across integrated care boards, the local authority and other relevant partners in the community, as well as a commitment to meeting people where they are, finding out what is important for them and working from there. Does the Minister see that model as integral to the reform of mental health care in this country? Will he join me on a visit to Thurrock community hospital to see what it does and what can be learned from how that work is undertaken?

[Stephen Kinnock]

My hon. Friend is a doughty campaigner on this issue in her constituency. She is right that the integration of services is crucial to ensuring that we get the best possible outcomes for people who are struggling with their mental health. I would be very happy to discuss with her the possibility of me visiting her constituency.