Mental Health Bill [ Lords ] (First sitting)

Sojan Joseph Excerpts

Committee stage
Tuesday 10th June 2025 Public Bill Committees

[Stephen Kinnock]

I can give the hon. Gentleman that assurance. We are moving to a nuanced position that is about defining where there are co-occurring conditions and where there are not. I think everybody recognises that that is, by definition, a complex process, so the training and the code of practice that go around it will be vital.

[Sojan Joseph (Ashford) (Lab)]

In the past, many people with mental health disorders have been detained in hospitals for months or even years because of a lack of proper social care provision in the community. Will the Minister also ensure that local communities, which will be providing social care for patients who are discharged from hospital, are part of that discussion?

[Stephen Kinnock]

It is absolutely a team effort. Sadly, when people have severe and acute mental health disorders, a multi-agency effort is often required to support them and to help them to get the treatment they need. The process should not be about trying to isolate people. We are keen to ensure that people stay in mainstream society and remain as integrated as possible, because that is often an important part of supporting their mental health condition.

All of that means that local authorities, mental health professionals, social workers, and often children’s social care professionals or adult social care professionals are important in the process—it requires a team effort. That integrated approach will be really important as we build the community services that we want to see.

Mental Health Bill [ Lords ] (Second sitting)

Sojan Joseph Excerpts

Committee stage
Tuesday 10th June 2025 Public Bill Committees

[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.

[Sojan Joseph (Ashford) (Lab)]

The purpose of this part of the legislation is for ICBs to keep a register of anyone who is diagnosed with autism or a learning disability. Patients who are already under a clinical team already have a risk assessment, which covers all the areas that the hon. Gentleman is specifying. As a result of the amendment, would we not be duplicating information about risks that already exists for most patients with their clinical teams?

[Dr Chambers]

The point of having an at-risk list is that ideally there is proactive contact with people—perhaps in quite a soft way, and perhaps through community hubs, as we have discussed—before they demonstrate a severe mental health crisis. I assume that the people the hon. Gentleman is talking about have already been admitted to hospital and have received treatment, and that they are being followed up after they have been discharged. That is not a proactive list; it is a reactive register. Am I correct? I apologise if I have misunderstood his question.

[Sojan Joseph]

Anyone who is under the care of a clinical team for their mental health has a risk assessment. That is basic paperwork, which is completed by the clinicians. That risk assessment covers everything that is specified in the amendment. The purpose of this part of the legislation is for ICBs to have a register. However, ICBs will not be providing direct care; that will be provided by the clinicians. Those patients who are under any clinical team have a risk assessment that covers all the points in the amendment. My point is that the amendment would duplicate some of that paperwork.

[Dr Chambers]

I will not argue with an esteemed Member who has the hon. Gentleman’s background in mental health. I take his point as it stands.

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[Sojan Joseph]

I will briefly trot through the proposed amendments and new clause. We all know that the closure of learning disability hospitals was a gradual process. The reason was the institutionalisation of some of those patients, as seen in the Winterbourne View scandal. The aim was to create new community-based housing to look after people with learning disabilities and autism. Amendment 20 seeks to create appropriate fully staffed crisis accommodation. Will the Lib Dems clarify whether they are looking to create more in-patient settings? Are we going back to where we were years ago, or should we work with the new plan to create more community-based accommodation?

Not all patients with a learning disability or autism need detention or community-based accommodation. Many of them are looked after by their family members, so we also need to look into the support we are providing to carers, so that we can keep those people at home with their family member’s support.

I will keep this brief: as a member of the all-party parliamentary group on adult social care, I recently met with many people who have lived experience of this. They want their views to be heard. They are not asking for more hospital settings; they are asking for more support, including for carers. I was pleased to see that the Minister for Care was there to engage with those people.

In the new NHS 10-year plan, the focus is on moving care from the hospitals to the community. Can the Minister clarify how we can make that happen? We have talked about that for many years, but we have never seen it happening. In my own experience practising in a mental health ward, many patients with a learning disability and autism were detained and, as the hon. Member said, kept in hospitals because we could not find a suitable place for them to be discharged to—it was not that they needed the hospital.

I think we are all talking about the same thing, but we need to find a solution. That is why the new NHS 10-year plan and its focus on moving care from the hospitals to the community is important. Again, can the Minister clarify how we will do that? The Government have already started the work, and the new commission, led by Baroness Casey, should also be looking into where we will find the social care support for carers and the community provision for people with learning disability, rather than just creating more crisis accommodations.

[Dr Evans]

The hon. Member mentioned Baroness Casey, for whom I have the utmost respect, but herein lies the problem: she is still currently undertaking a review for the Home Office that has now been delayed and has not concluded. This is at the same time that she is supposed to be looking at social care. The whole idea of an amendment that asks for a statutory plan is to stop these kind of slippages. Given his point about wanting to see progress, is that something that he would consider if he were voting on this new clause?

[Sojan Joseph]

I hope that Baroness Casey completes her commission work and gives us her report. It was promised in the Chamber that the initial report would be available within a year. Regardless of whether she is taking up another role, I hope there will not be any delay and that we get that report and a detailed report within three years. I am looking for a solid plan to fix this problem forever. I am not looking for sticking plasters or an immediate fix, but we need a plan, perhaps including a national care service. These are the people who are looking for a long-term solution to these problems.

The hon. Member asked about how I will vote; unfortunately, I will not be supporting new clause 11. The Government have already started some work, which is why I am specifically talking about the NHS 10-year plan to move care from hospitals to the community, along with the social care commission, which is looking into how we can get good progress on that. This is the answer; we need to get a long-term solution to this problem.

[Dr Shastri-Hurst]

It is a pleasure to serve under your chairmanship, Ms Furniss. I rise to speak to Liberal Democrat amendments 20, 10, 22, 24 and 21, and set out why, although I think they are honourable in their intent, I am unable to support them today.

I will start with amendment 20. The purpose of the amendment is to require ICBs to ensure the availability of specialist crisis accommodation for people with autism and learning disabilities. The aim is to provide a safe and therapeutic alternative to detention, which I think we would all agree is a sensible course of action. Section 136 of the Mental Health Act 1983 allows police to remove an individual who is experiencing a mental health crisis from a public place to a place of safety. That can, on unfortunate occasions, lead to detention in inappropriate settings, which may include police cells. That can obviously be deeply harmful, particularly to those with conditions such as autistic spectrum disorder or other learning difficulties.

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[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.

[Gregory Stafford]

I want to be clear about what the hon. Gentleman is saying. My understanding of the amendment, for which I have a lot of sympathy, is that the mandatory training will be around appropriate care in the settings listed. I think he is talking about manual handling or data protection stuff. As someone who worked in the NHS for seven years, I entirely agree that there is a lot of “mandatory training” that could be scrapped to make the NHS much more efficient. The amendment is specifically about ensuring that there is appropriate training for those who are working in the settings listed. I hope that he is not saying that he does not think that there should be training for mental health professionals. I am sure he is not saying that, but that is how it is coming across.

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[Sojan Joseph]

Not at all. I am not claiming that there should not be training for people who work in any settings; I am saying that more and more training has been added every time we learn something and yet compliance with the training requirement is not being monitored. That is the point I am making—not that we do not need the training.

I support training, because appropriate training is necessary, but we also need to ensure that the people who work in those settings are compliant with the training. That is the larger point I am making. This is not about the amount of training we might want to add to this legislation; we need to ensure that existing training is completed by the staff working in those areas.

[Stephen Kinnock]

The Health and Social Care Act 2008, as amended by the Health and Care Act 2022, already requires that all CQC-registered health and adult social care providers ensure that their staff receive specific training, appropriate to their role, on learning disability and autism. The associated code of practice has been consulted on and is expected to be published and laid before Parliament soon.

The code sets out four standards that outline minimum training requirements, including expectations of training content at different levels; that training is co-produced and co-delivered alongside people with a learning disability and autistic people—that addresses the point made by my hon. Friend the Member for Thurrock about co-production and things not being done in an ivory tower; and that staff complete training at least every three years. To set out separate standards in secondary legislation, as the amendment asks, would cut across that existing legal requirement and the forthcoming code. Inadvertently, that could lead to confusion. I hope that that satisfies the hon. Member for Guildford enough to persuade her to withdraw the amendment.

Mental Health Bill [ Lords ] (First sitting)

Sojan Joseph Excerpts

Tuesday 10th June 2025 Public Bill Committees

[Stephen Kinnock]

I can give the hon. Gentleman that assurance. We are moving to a nuanced position that is about defining where there are co-occurring conditions and where there are not. I think everybody recognises that that is, by definition, a complex process, so the training and the code of practice that go around it will be vital.

[Sojan Joseph (Ashford) (Lab)]

In the past, many people with mental health disorders have been detained in hospitals for months or even years because of a lack of proper social care provision in the community. Will the Minister also ensure that local communities, which will be providing social care for patients who are discharged from hospital, are part of that discussion?

[Stephen Kinnock]

It is absolutely a team effort. Sadly, when people have severe and acute mental health disorders, a multi-agency effort is often required to support them and to help them to get the treatment they need. The process should not be about trying to isolate people. We are keen to ensure that people stay in mainstream society and remain as integrated as possible, because that is often an important part of supporting their mental health condition.

All of that means that local authorities, mental health professionals, social workers, and often children’s social care professionals or adult social care professionals are important in the process—it requires a team effort. That integrated approach will be really important as we build the community services that we want to see.

Mental Health Bill [Lords]

Sojan Joseph Excerpts

2nd reading
Monday 19th May 2025 Commons Chamber

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

I rise to speak in support of the Bill. To begin with, I need to make a couple of declarations. I have a family member who is a consultant psychiatrist. I am now a non-practising general adult psychiatrist with an endorsement and years in psychiatry, and I previously worked as a consultant psychiatrist. I took part in the 2018 Wessely review as a panel member on the tribunal working group, and I was on the pre-legislative scrutiny Committee in the last Parliament.

In a declaration of a more personal nature, this is an area that I feel passionately about. It is a great privilege to speak to this important piece of legislation and reforms going forward. The United Kingdom reforms its mental health legislation every 20 years or so. I did not want to correct the Secretary of State, but the first Mental Health Act was in 1959—I hope that was substantially before he was born, with reference to his earlier comments. The legislation has gone through various iterations from the original Lunacy Act and similar legislation in the 19th century. In the UK, we have always been at the forefront of reform to the law and to provisions and powers in this area.

It is important in this Second Reading debate to focus on what the Mental Health Act is and what it does. Members have talked more broadly about the challenges of delivering mental health care currently, but it is important to reflect that the Mental Health Act is very specific and precise. It is about the regulation of detention—sometimes for assessment, sometimes for treatment—of people with mental disorder, and has a range of powers on aftercare and guardianship. It is focused on detention and assessment, or treatment, of people with mental disorder. We need that because there are times when people with severe mental illness become so unwell that they are unable to recognise their illness. Their illness puts their health at risk—predominantly through self-neglect or non-treatment. It puts their safety at risk, again through self-neglect, as well as through suicide. And, less commonly but critically, it puts them at risk of causing harm to others.

The legal framework allows us to regulate compulsory treatment in that regard. It is absolutely critical that we have those powers so that, when people are so unwell that they do not recognise it and they lose agency, we can, as a compassionate society, take them into hospital and treat them, with a view to getting them back to themselves. I have used the 1983 Act countless times, applying it both to assessments and, as a section 12-approved doctor, to treatments, and I have used it as a responsible clinician. I suspect that I am one of the few Members of this House—certainly in this debate—who has had those roles and responsibilities.

In terms of framing, it is important to reflect that one of the key changes in the 1983 Act, which is such an important piece of legislation, was that it was about restricting powers and ensuring that there were strong procedures for reviewing detentions. As a former health professional in this area, I am certain that all professionals working in it are mindful of the scope of powers that the Act provides. When applying restrictions, people do not use these powers in anger or without a great degree of thought and contemplation. The most intrusive intervention available to us in the health service is to detain and treat people in hospital or in secure hospital settings. Those powers are not taken lightly.

A lot of concern was expressed at the start of the debate—and I am sure it will continue—about the way in which people have been treated in hospital. There have been some very high-profile scandals in which things have not worked well, to say the least, and care and treatment have been atrocious and abusive. However, people working in health and care in the UK are doing so because they want to see the best outcomes for their patients. Sometimes, they are limited in that because of the resources available. They do not use the Mental Health Act with a view to harming people, but with a view to helping them.

Being detained under the Mental Health Act is not a prime facie harm; it is a treatment and a good thing. If someone needs to be detained and treated in hospital, they need to be detained and treated in hospital. If I became so unwell that I needed to be detained under the Act, I would want to be detained. Thankfully, I am not in that position today—[Interruption.] At least I believe that I am not, although the shadow Minister, my hon. Friend the Member for Hinckley and Bosworth (Dr Evans), might have a different view on that. [Laughter.] Should I get to the point where I am so unwell that I cannot consider my own care, I would want the powers of the Mental Health Act to be used quickly, particularly if I were posing a risk to myself, my family and others, so that I can get better and back to living my life.

I pay tribute to Baroness May of Maidenhead, who kicked this off, and to Professor Sir Simon Wessely—a good friend—Stephen Gilbert, Sir Mark Hedley and Rabbi Baroness Neuberger for their work in the 2018 review. There is a lot of good work in the Bill, from the greater focus on advance care planning and the more frequent detention reviews, which I recognise may bring a workforce burden, to the provisions on nominated persons. I will not go into the detail in this Second Reading speech, but I will focus on a few general points on which I think a bit more work needs to be undertaken.

In some ways—I will have to message Sir Simon after this to ask his forgiveness—the Bill is a missed opportunity in that we have are not moving towards fusion law. For the benefit of those who are not all over the detail, at the moment the UK has two pieces of legislation regulating how to treat people in the absence of consent. The Mental Capacity Act 2005 came about from case law in the ’80s and ’90s and was codified in 2005. That Act broadly regulates physical health treatments for people who lack the capacity to consent—we have focused quite a lot on capacity in the recent debates on the Terminally Ill Adults (End of Life) Bill. The principles of the 2005 Act are autonomy and the functional capacity and best interests tests for people who lack capacity, meaning that we test someone’s capacity, and only if they lack capacity can we intervene in their best interests, sometimes by using deprivations of liberty.

The Mental Health Act arose from a very different pathway. In its first days, it was more about the regulation of asylums. The Act is about status and risk. The gatekeeper conditions for the current Mental Health Act are that a patient has a mental disorder of a nature and a degree that requires assessment in hospital because of the risk to their health and to the safety of others. Capacity does not feature whatsoever.

We have two pieces of legislation. One applies to the most severe mental disorders and deals with status and risk, and the other deals with autonomy and best interests. I strongly believe that the two need to be merged. We should use capacity and best interest frameworks to regulate treatment of mental disorder in the absence of consent—there are ways of doing that. I like the fact that we are starting to incorporate a bit more in the Bill.

[Sojan Joseph (Ashford) (Lab)]

Does the hon. Member not think that the deprivation of liberty safeguards, which, unlike the Mental Health Act, help to hold those who lack capacity in an environment that is not secure or locked, such as a hospital, are useful, and that bringing the two provisions together is unnecessary?

[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.

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[Sojan Joseph]

My hon. Friend is absolutely right to say that patients with challenging behaviours should not be detained in a mental health ward for many, many years. They should be in a different setting. Does he agree that we do not have enough support or accommodation for patients? We need to invest more in community settings for some of these patients with challenging behaviours.

[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.

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[Gregory Stafford]

I agree with the hon. Gentleman that more can be done to help people in crisis. What I would say, however—I think my hon. Friend the Member for Runnymede and Weybridge also made this point—is that there are people who are at such a point that, unfortunately, they need to be incarcerated in order to be able to help themselves. Hopefully, they spend their time incarcerated not just away from society but being treated effectively and appropriately.

That brings me to the point that this is a balancing act and a difficult situation. I think all of us of all parties are clear that the current Act is no longer fit for purpose, especially when we think about forensic mental health. As such, I am glad that the Government are taking forward this legislation, which was started under the previous Government. The cross-party consensus we have heard this evening reflects the fact that this piece of legislation has come from both of the major parties. I am likely to be on the Bill Committee after the Whitsun recess, so I will not test the patience of the House by going through every single bit of the Bill I have some interest in or concerns about, but I will briefly raise three important areas, which I am pleased were raised by Members in the other place. A number of Opposition amendments were tabled in the other place which would have strengthened the Bill, and I hope they will be made in Committee in this place.

The first area is reducing unnecessary police involvement. The noble Lord Kamall and Baroness May tabled some amendments that in my view represent a very significant and much-needed shift in how detentions and removals under the Mental Health Act can be managed. Under the current framework, the power to detain individuals and move them to a place of safety—particularly under sections 135 and 136—is largely restricted and falls under the responsibility of police officers. Although those provisions are designed to protect the public, they can often result in the criminalisation of people in acute mental health crisis, even when there is no threat of violence or risk to others.

The amendments tabled in the other place would have allowed authorised and qualified health professionals such as paramedics, approved mental health professionals or specialised nurses to carry out those detentions and to move individuals under sections 2, 3 and 5 of the Act. That would relieve police officers of responsibilities that fall outside their core expertise while reducing the stigma and trauma associated with police-led interventions. It would streamline the process, ensuring that individuals were supported by professionals trained specifically in mental health care and would maintain police involvement only where there was a clear and present risk to safety. That would significantly change and strengthen the system, placing mental health crises more firmly within the domain of health rather than law enforcement.

[Sojan Joseph]

Sections 135 and 136 of the current Mental Health Act give the police the power to break into someone’s property or detain somebody in a public place where there is the possibility of the involvement of weapons. Does the hon. Member think that health professionals would be able to manage those kinds of situations? Would the police not be the best people to deal with those situations?

[Gregory Stafford]

I am sorry if I was not clear for the hon. Gentleman. I thought I had made it very clear that I was talking about situations in which there was no risk to other professionals. Clearly, in the situations he describes, the police are entirely the right people to be involved.

The second area that I want to touch on is that of strengthening safeguards for vulnerable children. What I would like to see introduced is an essential safeguard for children and young people within the mental health care system. As my hon. Friend the Member for Runnymede and Weybridge mentioned, the current legislation allows for a nominated person to be appointed to represent the child’s interests. In my view, though, it does not provide adequate protection against the risk that that person could be coercive, abusive or in other ways inappropriate, particularly in cases involving looked-after children or those with complex family dynamics.

As such, I would like to see amendments made that address that gap by establishing clear criteria for who can be appointed as a child’s nominated person. For looked-after children, the local authority would automatically become the nominated individual, ensuring oversight by a public body accountable for the child’s welfare. For other children, only individuals with legal parental responsibility—such as a guardian or someone named in a court order—should be appointed. Such measures would ensure that no vulnerable child would be exposed to undue influence during what may be one of the most difficult or disorienting times in their life. They would align mental health law with broader child protection standards and reinforce the principle that safeguarding must be at the heart of any mental health intervention involving children.

Finally, I want to see amendments made that would introduce more patient voice and accountability. I accept that in its current form, the Bill makes steps in the right direction, but I would like to see an amendment made mirroring the one that was tabled in the other place by the noble Lords Howe and Kamall. Such an amendment would introduce the valuable and forward-looking provision of a mandatory debrief session within 30 days of discharge from detention under part 2 of the Mental Health Act. That session would be led by an independent mental health advocate, and would provide patients with the opportunity to reflect on their experience, raise any concerns about their treatment, and offer feedback in a safe, supportive and non-judgmental setting.

That would be more than just a procedural addition; it represents a shift in culture, which I think we would all agree with, towards embedding 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 proposal, so I hope the Minister will give some indication in his wind-up that he would support a similar amendment.

Taken together, these 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 closer to modern standards of care, international best practice and evolving public expectations. These amendments are essential to strengthening the Bill, ensuring that our mental health system becomes not only more effective, but more compassionate, responsive and just.

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[Sojan Joseph (Ashford) (Lab)]

It is a pleasure to be called to speak in this Second Reading debate. Prior to being elected to this House, I worked for 22 years in NHS mental health services, and I am the chair of the all-party parliamentary group on mental health. This is an issue I care about deeply.

It has been widely accepted that the Mental Health Act is outdated, and the need to modernise it has been talked about for some time. I pay tribute to Baroness May who, when she was Prime Minister, commissioned Professor Sir Simon Wessely to undertake an independent review of the Act, and I commend this Labour Government for introducing the Bill without delay.

As Members will be aware, last week was Mental Health Awareness Week. The discussions I took part in showed how far we have come in removing much of the stigma around mental ill health, but I fear that a lot of stigma remains when it comes to discussing severe mental ill health, such as cases of schizophrenia. I therefore welcome the importance that the Government have attached to the Bill, and to updating the law so that it is fit for the 21st century. I hope that, through our deliberations, we can play our part in ensuring that severe mental ill health is treated with the respect and understanding it deserves.

The Mental Health Act provides the legal framework for the detention of people when their mental ill health means that they are at risk to themselves or others, so that they can receive appropriate treatment. The Bill looks to modernise that legal framework. I welcome clause 1, which adopts the four principles of treatment proposed in Sir Simon Wessely’s independent review. By adopting those principles, the legislation will give patients greater choice, enhanced rights and support, and ensure that being treated with dignity and respect is an integral part of their treatment.

This reform is long overdue. We talk a great deal about wanting to deliver personalised care in our health service. That should be the guiding principle in every part of the service, especially for the most vulnerable. Adopting the principles is about redressing the balance of power away from the system, so that the patient has more autonomy, and more say over their treatment. That will help to ensure that those in society with the most severe mental health conditions get better, more personalised care. I also welcome the statutory role that clauses 24 to 28 will give a nominated person, who will have a greater say over the patient’s treatment and care. Replacing the old hierarchical list of relatives with a person who has been selected by the patient, albeit that there will be certain safeguards in place, is an update to the legislation to reflect today’s world.

Clause 3 deals with the application of the Mental Health Act to autistic people and those who have a learning disability. The clause modifies the definition of mental disorder by introducing new definitions of autism, learning disability and psychiatric disorder. As a result, people with a learning disability or those who are autistic can no longer be detained or made subject to a community treatment order unless they have a co-occurring psychiatric disorder. This is a welcome and long overdue change. Under the Mental Health Act, autistic people and those with a learning disability have experienced inappropriate care, over-medication and extended periods of detention. As we look to modernise the Act, it is wholly appropriate to ensure that they cannot be detained unless they have a co-occurring psychiatric disorder.

However, concern has been expressed in parts of the learning disability and autism sectors that the change may have unintended consequences. For example, it may lead to an increase in alternative routes to detention. In particular, concern has been raised that people with high-risk behaviours who require treatment in appropriate and safe hospital environments may end up having to be dealt with by the criminal justice system if they cannot be detained under the Mental Health Act. These concerns were debated when the Bill was considered in the other place, but I would be grateful if the Minister could say whether the Government have given any further consideration to those points. I would also be grateful if he could give an assurance that he and his officials will engage with the learning disability and autism sectors as the Bill continues through this House.

In the other place, the Conservatives were successful in amending the Bill to allow the extension of police powers of detention under sections 135 and 136 to other specified healthcare professionals. The amendment provoked serious concern from representatives of healthcare professionals, and I understand it is not supported by the police either. The “right care, right person” model, put in place in 2023, has already reduced the time the police have to deal with mental health patients. Will the Government look into overturning that amendment? I would also be grateful if he said how the Government will build on the Bill to ensure wider reform of, and investment in, mental health, and how we can ensure that the aims of the Bill are accompanied by high-quality mental health services, especially community services for people experiencing poor mental health.

In preparation for today’s debate, on Thursday, as chair of the APPG on mental health, I was pleased to organise for a small group of Members a visit to the mental health centre at the St Charles hospital in Kensington. During our visit, we were able to spend time in the mental health crisis assessment service. This excellent facility is open 24 hours a day, seven days a week, for anyone in the area who is experiencing a mental health crisis. I recommend that such facilities be instituted across the country, especially in my constituency. In Ashford, there are no mental health emergency facilities. Over 2,600 people whose primary issue was recorded as mental ill health presented themselves at the A&E department at the William Harvey hospital in 2024. Such facilities would help to prevent that. I press for more support to be put in place, alongside the Bill.

Oral Answers to Questions

Sojan Joseph Excerpts

Tuesday 25th March 2025 Commons Chamber

[Karin Smyth]

I am absolutely clear that we need to make sure that the job evaluation scheme looks at staff across the piece and that people are rewarded appropriately for the work they are asked to do. We will do that as part of our discussions with the NHS Staff Council, and we will be working consistently with staff as part of the 10-year plan to ensure that people are rewarded. We depend on these staff, and we want to encourage them to be part of the NHS workforce. That is the approach we intend to take.

[Sojan Joseph (Ashford) (Lab)]

7. What steps his Department is taking to reduce the number of people waiting for NHS treatment.

[The Secretary of State for Health and Social Care (Wes Streeting)]

The 18-week standard for elective care has not been met for almost a decade. That is the legacy of the Conservative party. Our plan for change commits us to cutting waiting lists from 18 months to 18 weeks by the end of this Parliament through a combination of investment and reform. Since we took office, the waiting list has reduced by over 190,000. We achieved our manifesto pledge of 2 million extra appointments seven months early, and waiting lists have fallen five months in a row. A lot done, but a lot more to do. Change has begun, and the best is still to come.

[Sojan Joseph]

I welcome that NHS waiting lists for physical health have fallen for the last five months in a row and that NHS waiting lists are down by almost 200,000 since Labour was elected, but with people who have mental health conditions eight times as likely to have to wait 18 months for treatment, what steps are the Government taking to ensure that we see the same progress in waiting times for both mental and physical health treatments? Can they deliver a parity of esteem that the Opposition failed to achieve in their 14 years in power?

[Wes Streeting]

I am grateful to my hon. Friend for his question and for his long-standing commitment to improving mental health services. Lord Darzi highlighted that those waiting over a year for mental healthcare outnumbered the entire population of Leicester. We are committed to tackling this. We will fix the broken system by recruiting an extra 8,500 mental health workers, introducing access to a specialist in every school and rolling out community Young Futures hubs in England. We will shortly be publishing before Parliament our mental health investment standard report, which will show that when it comes to mental health this Government are putting their money where their mouth is.

Terminally Ill Adults (End of Life) Bill (Twenty-fifth sitting)

Sojan Joseph Excerpts

Tuesday 18th March 2025 Public Bill Committees

[The Minister for Care (Stephen Kinnock)]

It is a pleasure to serve under your chairship, Sir Roger. Before I speak to amendments 497 and 498, on which the Government have worked with my hon. Friend the Member for Spen Valley, let me address amendments 462 and 463.

Amendment 462 would amend clause 18 to require the co-ordinating doctor to explain to the person that they do not have to proceed and self-administer the approved substance, and that they may still cancel their declaration. Although it is not specified, it is presumed that the amendment refers to the second declaration that the person will have made. The Committee may wish to note that there is already a requirement in clause 18(4)(b) that,

“at the time the approved substance is provided”,

the co-ordinating doctor must be satisfied that the person

“has a clear, settled and informed wish to end their own life”.

The purpose of amendment 463 is to limit what the co-ordinating doctor is permitted to do in relation to providing the person with an approved substance under clause 18. As the clause stands, subsection (6) sets out the activities that the co-ordinating doctor is permitted to carry out in respect of an approved substance provided to the person under subsection (2). It states that the co-ordinating doctor may

“(a) prepare that substance for self-administration by that person,

(b) prepare a medical device which will enable that person to self-administer the substance, and

(c) assist that person to ingest or otherwise self-administer the substance.”

Additionally, subsection (7) provides that

“the decision to self-administer the approved substance and the final act of doing so must be taken by the person to whom the substance has been provided.”

Amendment 463 would remove subsection (6)(c), which would result in the co-ordinating doctor being unable to assist the person

“to ingest or otherwise self-administer”

the approved substance. The co-ordinating doctor would still be permitted to prepare that substance for self-administration and to prepare a medical device to enable the person to self-administer the substance. This could mean that a co-ordinating doctor may not be able to provide assistance such as helping the person to sit up to help with swallowing, or explaining how the medical device for self-administering the substance works. This could result in practical difficulties in self-administration of the substance and/or place the co-ordinating doctor in a difficult position.

[Sojan Joseph (Ashford) (Lab)]

Does the Minister think that it is confusing for health professionals when we say that they can assist the patient to sit up or hold a cup of water or put the medication into their mouth? Is it not confusing for medical professionals that we are giving contradictory statements?

[Stephen Kinnock]

One of the fundamental principles of the Bill, which my hon. Friend the Member for Spen Valley has prioritised, is self-administration. It is not for me as a Minister to opine on that; it is simply there in the Bill. Once that fundamental principle is established, it is about defining what “assistance” means, compared with what “self-administration” means. As I was setting out, I think “assistance” can mean things like helping the patient to sit up; it does not mean actually administering the substance to the patient. It is about the dividing line between assistance and self-administration—hence the term “assisted dying”, I suppose, which is very different from the doctor actually administering the substance.

--- Later in debate ---

[Stephen Kinnock]

I thank my hon. Friend, who speaks with considerable clinical expertise. It is about exactly that difference between self-administration and administration. If we cleave to those two principles, that is the basis on which we will achieve the stated aim of my hon. Friend the Member for Spen Valley.

[Sojan Joseph]

Does the Minister agree that assisting a person to ingest is different from assisting a person to self-administer?

[Stephen Kinnock]

In order to ingest, there has to be self-administration. The self-administration is the precondition for ingesting the substance. That is my reading. I hope that that satisfies my hon. Friend.

--- Later in debate ---

[Danny Kruger]

I am grateful to the hon. Lady. Let me let me look that up later. I am happy to exchange data, because this is clearly something we should be trying to get right.

Nevertheless, I want to try to explain why I am suggesting that we have a problem with the drugs that are used in assisted dying and that it has been suggested we use here. Let me continue the quote from Dr Zivot:

“When one watches an execution, it’s not clear that this is happening”—

meaning that it looks like a peaceful, painless death. He continues:

“There is not much to see. Executions, like, I imagine, medical assistance in dying, are a rather bloodless event; not much can be seen outwardly. But the autopsies revealed a very disturbing and surprising finding.”

He makes the point that that is particularly disturbing, given that assisted dying often uses a paralysing drug, which induces the impression of peace and calm in the patient, when in fact something else might be going on below the surface.

To conclude my quote from Dr Zivot, he says:

“To claim that this is a death that is peaceful, well, it can be nothing else because now a person is unable to move in any way, but whether or not they have any conscious experience of what is happening is unknown…it should be clear to the Canadian public that the kind of death that they will experience…will be something other than the way it is represented. It could be exceedingly painful and more akin to drowning.”

I cannot judge whether Dr Zivot is right, but we should be very wary of any claims that there is a simple answer to the question surrounding lethal drugs. To the point made by the hon. Lady, and I think by the hon. Member for Stroud, there is no evidence in the many reports from Dignitas, which has a regime very similar to the one we are imagining here—I will certainly look at the evidence mentioned made by the hon. Lady—that contradicts the concerns raised by Dr Zivot.

[Sojan Joseph]

Does this not show that clinical documentation is very important? We debated the issue in Committee earlier, when we talked about professionals being required to complete all relevant documentation. Maybe we are missing certain data because these things are not clearly documented in other places. Should we not take from that the learning that if we go ahead with this proposal, we should have proper documentation and make it clear to the clinician what they should and should not document?

[Danny Kruger]

I entirely agree that there is great concern about the lack of evidence in countries on which we are constantly relying for evidence of why this proposal is safe. I have suggested that, from the quite limited evidence we have, that it may not be safe. The hon. Gentleman is absolutely right that if we are to proceed, we need to be extremely strict about data collection.

To the hon. Gentleman’s point about making it clear to clinicians what drugs they are permitted to use, we also need to have a proper regime of clearing and approving those drugs. In earlier clauses, we debated the imperative on the NHS, the Medicines and Healthcare products Regulatory Agency and the Department of Health to properly authorise the specifics of what drugs will be used. It is not clear at the moment what those would be, and I very much agree that we need to be clearer on that.

I finish with a reference to an earlier debate, in which it was suggested, on the basis of the Australian example, that there is no evidence of complications. The hon. Member for Stroud talked about horrible stories from the United States and Canada. He also referred to Australia, where there is apparently no evidence of problems. In fact, I understand that of the six states, only Western Australia records complications, and it does so in relation only to practitioner administration—when the doctor administers the drug—which we do not propose to do here. It does not record complications in relation to self-administration, which is what the Bill proposes. In Western Australia, complications have been reported in 4.3% of cases involving practitioner administration. Again, we are dealing with the great mystery and enigma of how death happens with assisted suicide, and it is certainly unclear what we should do about it.

--- Later in debate ---

[Sojan Joseph]

We repeatedly talk about doctors, but nurses, healthcare assistants and other professionals will definitely be involved in a hospital environment. The Bill does not talk about other professionals. Furthermore, within a hospital environment, NHS wards may be bays without individual bedrooms. Does the hon. Lady think we need to be clearer on the procedures that will happen in those areas?

[Sarah Olney]

I am grateful for the hon. Gentleman’s professional experience, which is extremely helpful. He is absolutely right. Following the point made by the hon. Member for Banbury, we cannot define the circumstances in which a patient will find themselves when this is taking place. That is why it is incumbent on us to make sure we provide very clear guidance on precisely what Parliament intends.

As Dr Rebecca Jones told us in written evidence:

“As the death may take many hours, I’m uncertain of the practicalities of”

doctors remaining with the patient

“for many doctors…have competing demands on their time.”

In written evidence, Dr Chris Ainsworth asked how this will work in cases where death takes several days, as has happened in Oregon, while Dr Trevor Stammers wrote:

“If the doctor is required to be present until the patient’s death, this may require hours of practitioners’ time to fulfil and is unlikely to be adhered to in many cases if the dying process is protracted.”

Dr Rachel Fisher said in her written evidence that for Australian doctors, who are not required to be present at the final act, each assisted death requires around 60 hours of professional time. For British doctors, we will need to add the time it takes for the self-administration to result in death. Dr Fisher also raised the real impact on doctors, writing,

“imagine the practicalities of those who must deliver it. The GP, motivated by a deep desire to preserve life and relieve suffering arrives at the home of the patient with a cocktail of powerful drugs. What if the patient has symptoms? Who will collect their child from nursery or school if the patient takes a long time to die? How will they know when to decide the death was unsuccessful? Will there be counselling for GPs observing and feeling complicit in a potentially drawn out and symptomatic death?”

Finally, Dr Paul Shaw asked in his written evidence:

“How will this service be funded? What support will be required from the NHS when things go wrong or death takes longer than expected? Will this be a 0900-1700hrs service? What will be the out of hours arrangements?”

A lot of the written evidence touches on the practicalities of a doctor being required to remain with the patient until they die. Amendment 429, in the name of the hon. Member for Bexleyheath and Crayford, seeks to clarify whether “being with the patient” requires the doctor to be physically present in the room.

--- Later in debate ---

[Sojan Joseph]

Does my hon. Friend think that 10% is a high number? Does he also think that if we informed patients about the side-effects of those medications from the beginning, the number of patients opting out would probably be higher?

--- Later in debate ---

[Dr Opher]

I almost agreed with the hon. Gentleman earlier, when he asked at one point, should we not just leave this to doctors?

One of the key things the hon. Gentleman said is that the doctor administers the drug. This is self-administered, first of all, so that is a very clear line. However, also, in a case of terminal care—this is what I am trying to get across to the Committee—we know the patient is dying, and therefore if they are becoming worse we simply do things to make them comfortable, and we do not try to revive them, because they are dying. It is important that we realise that this is a very different medical situation from normal care, and that it actually needs very different skills as a doctor. Here, a doctor is not trying to prolong life, but trying to make a death as comfortable as possible.

That is why I support the Bill—because I think it will enhance a comfortable death. I wanted to make it clear that that is normal practice now in terminal care: we do not revive a patient with a terminal diagnosis who is in terminal care, but we make them comfortable.

[Sojan Joseph]

This is a very good discussion, and with a clinician as well—maybe my hon. Friend can help here. Are we leaving the Bill to professionals to administer, who might be confused and not clear about what they should be doing? In normal current practice, when somebody has a poor prognosis and is very fragile; we use “do not resuscitate” or “do not attempt CPR” decisions. Why do we not build that into the Bill—that everyone who is going through this process should have a DNR or DNACPR in place?

[Dr Opher]

I thank my hon. Friend for his experience in a clinical setting. I would remind everybody that in the Bill we are trying to help people die in a comfortable way, and I do not feel it is the Bill’s job to define exactly how we treat nausea or abdominal obstruction and so on. What we would like to do here is ensure that a patient has a pain-free death, and a death that they are in control of.

--- Later in debate ---

[Sojan Joseph]

We had some discussion earlier about how we will potentially be assisting dying in people’s own homes—that was not previously known to us; we thought it would be always in clinical settings—so medication will be transported from where it is stored as a controlled drug, in a hospital setting, to the patient’s home. Does the hon. Gentleman think that it is important that we have clear guidance as to how we store this medication?

[Danny Kruger]

I entirely agree. The regulations need to specify not only what drugs may be approved, but, as the hon. Gentleman suggests, how they should be stored and transported. I would expect that to be part of the package of regulations under the Bill.

As I have stated, I do not accept that we are talking about healthcare here; nevertheless, we are using products that are comparable to health products. The MHRA would need to significantly adapt its work in order to identify the most effective drug to cause what we currently perceive as harm—namely, the death of a patient. I recognise that that would be a significant change of remit and work for the MHRA, but we need to do it. One of the reasons that we need regulation of approved substances is to help ensure that falsified versions of the drug—drugs that do not have a licence for use in assisted dying—cannot enter the market. Such drugs may not be effective and could cause distress to those ending their lives and their families. I would be grateful if the Minister could clarify whether, in his view, clause 20 is sufficient to establish the necessary regulatory regime, or whether further legislation will be needed.

We had evidence from Greg Lawton, and other pharmacists, who wrote to the Committee to suggest that the approved substances would not legally come within the definition of a “medicinal product”, so medicines law, the protections associated with medicines and the MHRA licensing process might not apply. If that is the case, what do we do about it? We need a new licensing regime to ensure that the MHRA is able to properly regulate the substances, or, potentially, another regulatory agency would need to be established to do the job.

The Committee needs to make sure that there is a process that applies to approved substances used for assisted dying. It is not necessarily the case that a product licensed for treating a medical condition could not be used to bring about death—it is not the case that we cannot use any drug that is currently used for genuine health treatment—but it would not be being used as a medicine, so medicines law may not apply to its use for that purpose. There is an ambiguity, and I would be grateful for clarity on it.

The amendments that I am supporting would ensure that the MHRA had approved the drug for the specific purpose of ending someone’s life, and that there was scientific consensus that the drug would be effective for that purpose. The MHRA, in the marketing authorisation for the approved substance, would define the dosage of the drug required to bring about death. It would also ensure that specific considerations and warnings were placed in the product licence.

For example, some patients have allergies to certain drugs. If they decide to end their own life, that should be brought about as a result of the effect of the drug, not an unintended allergic reaction to it. Some patients would not be able to take drugs orally and might need to have the drug administered through a tube into the stomach, so different formulations would need to be available. Some drugs may need to be administered by injection. Patients may be unable to do the injection themselves, as we have discussed. Even if the patient is physically capable, injection techniques require proper training, and that needs to be considered when licensing drugs for assisted dying if the patient is responsible for self-administration.

There will be further considerations when deciding what drugs can be used. Patients will have a right to know what to expect. If they take the drug orally, how long will they have to wait before they die? Will they lose consciousness first? If so, how long will that take? Could there be some side effects or reactions after taking the drug, such as seizures or choking, that the family or carers will have to deal with? Can the drug be taken at home—that relates to the point that the hon. Member for Ashford made—or must it be used in a clinical setting? We have suggested that it could be used at home, so questions about transportation arise. Is a combination of drugs required? If so, in what order should they be taken? What happens if the patient passes out before taking the entire concoction of drugs? Has the drug formulation been optimised for the purpose of assisted dying, so that it reaches maximum blood levels as quickly as possible?

All these sorts of questions are appropriate for medical regulators. The MHRA could ensure that the patient information leaflet, and the warnings associated with it, given with the drug when it is prescribed prompt doctors to think about what drugs are most suitable for the patient and to provide information to the patient about what to expect.

Parliament must have oversight. It must bear responsibility for the kinds of deaths that it approves. Both Houses of Parliament should approve the statutory instrument. To inform that decision, the Secretary of State should provide all relevant information on the likely time to death, and on complications and side effects. When the state is creating a regime that will end lives, there must be maximum transparency and accountability, yet the Bill provides that this will be done by a negative statutory instrument. In other words, Parliament will get a say on the regulations only if the Leader of the Opposition prays against them—that is the process for a negative SI. That is the only circumstance under which the Government would make time for a debate and a vote on a negative SI. Given that this is an issue of conscience, I find it inconceivable that the Leader of the Opposition would want to take a position on it and so pray against it to trigger a proper debate. I think it is highly likely that Parliament would never get a say on this crucial issue because of the use of the negative procedure.

That situation has been recognised repeatedly as being unacceptable. When Lord Falconer introduced his Assisted Dying Bill to the House of Lords in 2014, it too provided for a negative SI power on this matter. The highly respected House of Lords Delegated Powers and Regulatory Reform Committee—we do not have an equivalent Committee in the Commons, but it sits over Parliament—said that it did not consider either the power or the procedure in the Falconer Bill to be appropriate, yet that is the procedure that we are being presented with here.

In 2021, when Baroness Meacher introduced her Assisted Dying Bill to the House of Lords, the Delegated Powers and Regulatory Reform Committee again issued a report, in which it said:

“In the interests of clarity and transparency on such important issues of public policy, the matters that are in due course to be dealt with under clause 4(7) by negative regulations should in our view be spelled out in detail on the face of the Bill from the outset. Accordingly, the Bill should contain a definitive list of medicines, and details of the manner and conditions under which such medicines are to be dispensed, stored, transported, used and destroyed. The power to amend such matters should be a matter for regulations subject to the affirmative procedure.”

We then come to Lord Falconer’s 2024 Assisted Dying for Terminally Ill Adults Bill, which he withdrew following the introduction of this Bill by the hon. Member for Spen Valley. That Bill in part took on that feedback from the Lords Committee. Although it did not provide a list of medicines, it did at least provide that the power to specify the drugs would be through the affirmative procedure.

The Hansard Society, which is non-partisan and neutral on assisted dying, has issued a critical report on this power. It says:

“MPs may wish to enquire why Kim Leadbeater has chosen not to adopt the scrutiny procedure set out in the 2024 bill, but has preferred that proposed in the 2014 and 2021 incarnations of the bill, despite the advice to the contrary of the Delegated Powers Committee.”

I would be grateful to learn from the hon. Lady why she has chosen this procedure.

It might be objected that the list that I am requesting might need to be modified quickly and that the affirmative procedure—having a parliamentary vote—would be an obstacle to doing that. The Hansard Society anticipated that objection. It said that

“this could be addressed by making provision for the use of the ‘made affirmative’ procedure in urgent cases where the Secretary of State wishes to remove a substance from the approved list and is of the opinion that it is necessary to do so immediately in order to prevent adverse medical events or failed assisted deaths. This would mean Ministers could act expeditiously but Parliament would have to debate and approve – albeit retrospectively – the change in the list. Whilst not perfect it would provide more opportunity for oversight than that offered by the negative scrutiny procedure.”

It seems to me that there is no justification for this vital matter to be regulated under the negative procedure. Too much power and responsibility is being given to Ministers subsequent to the passage of the Bill— if that is what happens. My amendment 467 would ensure that Parliament has a meaningful say, through the affirmative procedure, and that a report is published as part of that process setting out the expected efficacy of the drugs that will be used. I hope that the Committee will support it.

Terminally Ill Adults (End of Life) Bill (Twenty-fourth sitting)

Sojan Joseph Excerpts

Committee stage
Tuesday 18th March 2025 Public Bill Committees

[Sojan Joseph (Ashford) (Lab)]

Record keeping is a huge issue in our healthcare system. A huge number of coroners’ reviews have identified that record keeping has been an issue. By specifying only that clinicians need record a “recordable event”, we are leaving it as the responsibility of individual clinicians to decide what a recordable event is.

It is important that a good record be available to prevent future incidents and learn good practice. Leaving it open to a clinician to decide whether something is a recordable event could lead to most issues not getting recorded. For example, if a clinician has identified that there was coercion, it will be for the clinician to decide how much documentation to do. In my view, if they have identified a coercion, that should be recorded as an incident and further investigation should be done, but the Bill leaves it up to the clinician to decide. There is no standard for record keeping across the healthcare system, so a care home’s may be different from an NHS ward’s. I think it is for the Committee to look into what “recordable event” actually means.

[Stephen Kinnock]

The purpose of amendments 474 to 478 is to improve the drafting of the Bill by creating a new definition of “recordable event”. Recordable events are the events set out in clause 16(1) related to the recording of declarations and statements.

The amendments would also make consequential changes to clause 16, which refer to the occurrence of the recordable event, as per the new definition, and include reference to a report in addition to a statement or declaration. The reference to a report is consequential on the amendments already agreed by the Committee to clauses 7 and 8.

--- Later in debate ---

That is all very helpful. That is what we thought the Bill said anyway. It is not clear to me what the purpose of subsections (7) and (8) is, except that there is inherent danger in subsection (6). I am afraid that subsections (7) and (8) do not cancel that danger, because of the inherent lack of clarity—the blurring—that exists in the concept of assisting the person to ingest or otherwise self-administer.

[Sojan Joseph]

Will the hon. Gentleman clarify something? He is making a valid point, and I have been thinking about it. As a nurse who has worked in many areas, I know that a disabled person may not be able to take medication by themselves, and sometimes a nurse has to administer it with a spoon. There may be occasions on which a person’s medication comes back out and they have to do it a few times. Is that something the hon. Gentleman is concerned about—actually pushing the medication into the person?

NHS England Update

Sojan Joseph Excerpts

Thursday 13th March 2025 Commons Chamber

[Wes Streeting]

This Government committed in our manifesto to doubling the number of diagnostic scanners, and we will deliver that over the course of this Parliament. NHS charities have a valuable role to play. Philanthropy has a valuable role to play as an additional source of support to the NHS. When public funding is as tight as it is, we need to look at how we can maximise the benefits and the impact of bringing together sources of public investment, private investment, voluntary sector and philanthropic investment to deliver the most bang for the buck. Without knowing the details of the specific case the hon. Lady mentions, I would not want to comment too strongly, except to say that we are committed to doubling diagnostic scanners through public funds, but I am not sure I necessarily share the view that NHS charities do not have a role to play.

[Sojan Joseph (Ashford) (Lab)]

I know from my experience of working on the NHS frontline how hard it has become over the years to get basic things done. Nurses and matrons spend hours and hours getting basic changes made to their workplace on the frontline. I therefore welcome my right hon. Friend’s announcement. Will he ensure that by cutting bureaucracy, we can get more resources to where direct patient care takes place, which will help with the retention of nurses and healthcare assistants and see more patients being treated quicker and getting the care they need?

[Wes Streeting]

My hon. Friend is absolutely right. Some of the best innovation and improvements for patients I have seen has been led by frontline clinical teams that have had great executive leaders behind them, giving them the freedom and the tools to do the job. I hope that, as a result of these reforms, not only will we see the results for patients in the data, but staff and patients will feel the outcome and the difference in their experience of working in or being treated by the NHS.

Terminally Ill Adults (End of Life) Bill (Twentieth sitting)

Sojan Joseph Excerpts

Committee stage
Tuesday 11th March 2025 Public Bill Committees

[Sojan Joseph (Ashford) (Lab)]

I support amendments 422, 468 and 423, which I think would strengthen and safeguard the Bill. However, as someone who worked in mental health for many years, I have grave concerns about amendment 201, which would restrict access to medical records. Health professionals work in environments with great confidentiality of records; I have no concern about health professionals or doctors having access to health records. Some Committee members have talked about doctors not needing to know whether a person had tonsillitis, but most medical records or GP summaries will note whether someone has had tonsillitis, along with details about vaccinations and infections. I do not think that those records will necessarily be relevant or that a doctor would look in detail at what medication they have had in that respect.

What is relevant, however, are records for people who have a mental health disorder or are vulnerable. For example, people with serious mental illnesses such as chronic treatment-resistant schizophrenia may be on treatments such as clozapine that, if stopped, will have an impact on their mental health. The treatment that they may undergo during terminal illness may have an interaction, and medication that they have been using for many years to treat their mental health condition may have to be stopped. Doctors need to know why the person wanted to choose that route, and whether it will have an impact on their mental health.

Restricting access to important medical records by the doctor who makes the decision will have an impact on very vulnerable people. As we have discussed before, people may be homeless or may not have any family members, and it will all have an impact on why they decide to seek the assisted dying route. People may feel that they are a burden to society and the system. If there is any documentation from six months or a year ago, it will be relevant for the doctor. Removing access to medical records for doctors will have an impact on people with mental disorders, intellectual disabilities and neurodevelopmental conditions, so I oppose amendment 201, although I support the other amendments.

[Naz Shah]

I will try to keep my remarks brief. I first speak to amendment 468, tabled by the hon. Member for Reigate, on the asking of the question why someone wants to have an assisted death. When I originally came to this debate, Dermot, a humanist who was also my election agent—a lovely guy—came to me and said, “Now that this Bill is going through Parliament, will you support it”? I said, “Explain it to me.” He never once mentioned the word “autonomy”. If I remember correctly, what he talked about was suffering, pain and horrible deaths, which many hon. Members have referred to. We have heard lots of examples during this Bill Committee.

My hon. Friend the Member for Luton South and South Bedfordshire said that the decision was none of a doctor’s business and that the issue was about autonomy. However, if a woman was being coerced into an assisted death, the idea that it was none of the doctor’s business would not quite wash with me. We talk about autonomy, but if someone does not have autonomy in their lives—if they are in an abusive relationship, are a victim of coercion or have a vulnerability—they might not have the choice.

When we ask a question, it is often about something else. I have experienced this myself. I am very passionate; when I am talking about things, somebody might just stop me and say, “Naz—what’s this actually about?” That is all it takes to make me stop, take a step back and a breather, and think for a deeper minute about whether the issue could actually be about something else. We do not always stop to think.

Terminally Ill Adults (End of Life) Bill (Twenty First sitting)

Sojan Joseph Excerpts

Committee stage
Tuesday 11th March 2025 Public Bill Committees

[Sojan Joseph (Ashford) (Lab)]

Currently, when we start a patient on any medication, we usually give out information on indications and contraindications. If patients ask for one, we will give them a leaflet with information about the medication. Can the hon. Member clarify whether the amendment would help in that situation? Does he agree that a leaflet should be given to the patient?

[Dr Shastri-Hurst]

The hon. Member makes an important point. In practice, one would of course discuss the side-effect profile of any medication or substance to be administered. I do not feel that specifying that in the Bill, as amendment 305 is drafted, would achieve its purpose. The amendment refers to “any other effects”, but it does not specifically mention side effects. In any event, it must flow from the interaction between clause 9(2)(b)(iv) and clause 9(2)(c) that the conversation about complications as a result of the administration of a substance will encompass a conversation about side effects.

It is worth noting that all substances have a side-effect profile; what the side effects are will be specific to the substance in question. I do not think it a helpful improvement to the Bill to presuppose what the side effects may be. Amendment 305, although imperfect, is therefore preferable in my view to amendment 362, which would require that specific side effects be set out and which presupposes a scenario involving a particular set of medication.

Nevertheless, I remain concerned about the wording of amendment 305. I would be grateful if the hon. Member for Spen Valley provided some reassurances as to the steps she has taken to honour the intention of the amendment tabled by the hon. Member for York Central and achieve a tighter piece of legislative drafting.

I turn to amendment 142, tabled by the hon. Member for Broxtowe. It seeks to ensure that the discussion with the assessing doctor includes a discussion of how the substance will be administered. Although it may not be strictly necessary, because that should be a conversation that takes place when someone is going through an informed consent process, I do not consider that its inclusion would undermine the operability of the Bill. I am therefore minded to support the amendment. I do not consider that it will be restrictive should the circumstances change, because there may be a broad conversation about the variety of substances that can be administered, depending on the circumstances. As the drafting of the Bill does not preclude or prohibit such a wider discussion, it would be eminently sensible to include the route of administration.

Amendment 306, in the name of the hon. Member for York Central, would require the assessing doctor to include the escalation of medical intervention in their discussion should complications arise. In many ways, that issue is covered by clause 9(2)(c), so the amendment would not aid the operability or interpretation of the Bill. It would be much better dealt with under the code of conduct, to avoid the Bill becoming overly prescriptive and to allow flexibility as scientific and medical knowledge adjusts and adapts over time.

--- Later in debate ---

[Sarah Green]

I rise to speak to two aspects of this group of amendments. The first is the inclusion of social workers. When we first started receiving written evidence, I found the submissions from social workers the most compelling. I agreed with them that their profession has a key role to play in the process. I am pleased that they will feature on the panel: I believe that that will strengthen the safeguards in the Bill.

My second point relates to amendment (a) to new schedule 2, in the name of the right hon. Member for Dwyfor Meirionnydd. I was fortunate to grow up in a Welsh-speaking part of rural north Wales. I am a Welsh speaker, and Welsh is the first language of some of my friends, my neighbours and my family members. It is the language that they dream in, the language they count in and the language that they are most comfortable using, so when it comes to end-of-life conversations it is important that they can use the language in which they are most proficient and fluent.

Should an individual choose to access an assisted death through the medium of Welsh, they should be able to do so without the use of an interpreter. Crucially for the panel, that means that where an individual has chosen that route, the panel will need Welsh proficiency. Welsh speakers have had the right to ask for services in Welsh for years now, so assisted dying should be no different. That is why services in Welsh need to be on the face of the Bill. I wholeheartedly support the amendment and will vote for it if the right hon. Member chooses to press it.

[Sojan Joseph]

I will not talk for long, because most of my points have already been raised. I welcome the provisions in new schedule 2 on membership of the panel. I was concerned about all patients having access to a psychiatrist and a social worker, so the measures proposed are welcome and reassuring. My reservation, which other hon. Members have raised, is that it would be even better for people to have earlier access to the panel. I am also concerned about whether the panel would have the power to overturn the decisions taken by the two doctors and whether it might be influenced by them.

In addition, will the Health Minister clarify his response to amendment 1? He said that specifying one category of doctor, a registered psychiatrist, would create capacity issues. I hope that that will not be an issue when we have a psychiatrist on the panel. Otherwise, I welcome the proposals.

[Rebecca Paul]

First, I apologise: I have quite a lot to talk about.