Mental Health Bill [ Lords ] (Fourth sitting)

Stephen Kinnock Excerpts

Committee stage
Thursday 12th June 2025 Public Bill Committees

[The Minister for Care (Stephen Kinnock)]

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

I turn to amendment 11, tabled by the hon. Member for Winchester. Under the Bill, English qualifying patients subject to the Mental Health Act 1983, including those on a community treatment order, will be covered by a new opt-out approach to advocacy. That means that the relevant hospital manager must provide the advocacy provider with information about the patient so that they can arrange for an advocate to interview them to determine whether they wish to use advocacy services. Requiring oral and written information about their right to an advocate would therefore be unnecessary. I hope that that is satisfactory, and I encourage the hon. Member for Guildford to withdraw the amendment.

Government amendment 30 would remove clause 6(3) from the Bill on the basis that it is unnecessary. The requirement in section 118(2D) of the Mental Health Act for decision makers to have regard to the code of practice already ensures that they must take it into account when making decisions in relation to community treatment orders. Imposing a maximum duration of 12 months on community treatment orders, with the option to renew them after a review every six months, is also unnecessary. That is because the Bill already requires community treatment orders to be reviewed before renewal after the initial six months, again after the next six months and then yearly. The responsible clinician can renew the CTO only if there is a risk of serious harm without it and a reasonable prospect of it having therapeutic benefit for the patient.

The Bill increases professional oversight by requiring the community clinician to be involved in all decision making relating to CTOs. That aligns with Lord Scriven’s amendment, but, rather than that person being a General Medical Council-registered psychiatrist, it is more appropriate that they be an approved clinician, meaning that they have specific training regarding the Mental Health Act and approval to make decisions under the Act.

We have also increased the frequency of tribunal reviews so that they will happen automatically at renewal periods following the initial six-month period, after a further six months and after any subsequent 12-month periods. We are already providing a new power for the tribunal to recommend that the responsible clinician reconsider whether a CTO condition is necessary. Clause 6(3) would duplicate that.

[Anna Dixon]

I am grateful to the Minister for outlining so clearly what safeguards will be in place to ensure that there are no unnecessary extensions to CTOs beyond the period during which the patient is benefiting therapeutically or meets the detention criteria, which are being updated by the Bill. The answers that the Minister has given assure me that there will be significant review points. Does he, like me, think that these provisions will, in time, reduce some of the unwarranted variation and some of the excessive lengths? As the Bill is implemented in practice, we will see changes in the pattern of use of CTOs.

[Stephen Kinnock]

I pay tribute to my hon. Friend for her expertise and am pleased to hear that she feels reassured by my remarks. It is absolutely the Government’s ambition to bring more consistency and clarity to this area. A number of hon. Members have raised issues around racial disparities; I plan to come on to that. That is a specific focus, I know, for her and other colleagues. More broadly, this is about ensuring that the CTO system is proportionate, well regulated and managed on the basis of a patient-centric system.

We therefore wish to remove clause 6(3), as we do not think that it is necessary. It duplicates some provisions in the Bill or, in the case of the review periods, conflicts with existing renewal periods, and under the current drafting it is not clear how the two would interact. Where there are differences, the current provisions are more appropriate, for example in requiring a community clinician to be involved in all decision making.

Let me move on to clause 6 in its entirety. CTOs allow individuals detained under the Mental Health Act to be discharged into the community, under specific conditions, to ensure continued treatment. CTOs aim to maintain contact with mental health services to provide support and prevent relapse. Patients on CTOs can be recalled to hospital under that Act in certain circumstances. The main purpose of introducing CTOs was to improve care for higher-risk patients and to enhance public safety. We believe that community treatment orders remain necessary in a small number of cases to ensure continued treatment and to protect both patients and the public.

However, the independent review rightly noted that considerably more people than expected were being put on a community treatment order—about 5,500 people a year—and that there were racial disparities in the use of CTOs. Clause 6 therefore amends the community treatment order risk criteria in line with the new detention criteria set out in clause 5. It is now the case that, to be put on a community treatment order, the patient must be at risk of serious harm and there must be a reasonable prospect of therapeutic benefit for the patient.

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

We have touched already on the stark racial disparities in the use of CTOs and the Mental Health Act more generally, so I welcome these reforms. I appreciate that we will come to this point later in the Committee, but can the Minister set out what interaction the advance choice documents will have in reducing the number of CTOs, particularly for those groups that have seen them used disproport-ionately?

[Stephen Kinnock]

My hon. Friend raises a very valid point that, as he says, we will come on to in greater detail. Right across our health service, in every aspect, early intervention is always better than trying to pick up the pieces after a crisis. That is the same for both physical and mental health. We believe that the advance choice documents will be a helpful tool in building an earlier understanding of the challenges that a particular individual faces and, on the basis of that earlier understanding, enabling earlier intervention. Giving the opportunity to patients, while they are in a position to do so, to set out what their advance choices are will enhance their autonomy and enhance trust in the interaction between the patient and the system. That trust piece is so important to the entire picture.

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

It is a pleasure to serve under your chairship, Mr Vickers. I was interested to hear what the Minister has just said, but I think it goes much further. Can he give me assurances that we will take time to look at what is driving so many young black men in particular into these mental health crisis situations? We need to look much further back, at the start of the process, where something is pushing young black men into mental health crisis and they are ending up in a position where they have to be placed in a facility and go through a whole period of attempting to recover. Can the Minister give me his thoughts on what the Government are doing to prevent that from happening in the first place, particularly with this group of men?

[Stephen Kinnock]

My hon. Friend is absolutely right, and we could go into the question he has just raised in a profound way, because the social determinants of ill health are such an important part of the picture. Many people in our communities are dealing with all sorts of incredibly challenging and traumatic issues in their lives, often driven by a whole range of social determinants. We have to recognise that there is a need to build capacity in the system as well.

I am pleased that the Government reconfirmed in the spending review yesterday the 8,500 additional mental health specialists in the system, a mental health trained specialist in every school, 24/7 mental health hubs being opened around the country and £26 million being put into opening mental health crisis centres around the country. The fundamental drive of the Government is to move from sickness to prevention. We want to build a preventive state, and the mental health part of that is vital, for the reason my hon. Friend has just elucidated.

[Dr Evans]

The Minister makes an excellent point about the services that are required, but key to all this is the underlying research. Has research already been commissioned into this? If not, would he look at commissioning in the space of ethnic minorities, the impacts of CTOs and mental health? That might shine a light on what further services will be needed, the reasons, and preventive measures, which the Government rightly put at the front of the agenda.

[Stephen Kinnock]

We have piloted culturally appropriate advocacy models, which ran up to March 2025. An evaluation of the pilot will be published in the summer, and that will feed into the evidence base for the impact and deliverability of culturally appropriate advocacy at local level. We will use the learnings from our culturally appropriate advocacy pilots to inform our understanding of how to increase uptake of advocacy for community treatment order patients from black communities, who are disproportionately likely to be put on a CTO. A lot of that evaluation and investigation work is happening, and I am sure that hon. Members across this Committee will read the findings in the summer with great interest.

The change in the criteria for a CTO is intended to reduce the number of inappropriate community treatment orders being given, reducing restrictions on patients and helping to protect against the disproportionate use of coercion among racialised communities. Only those for whom there is a risk of serious harm and who will benefit therapeutically should be subject to a community treatment order, and it should be removed when it no longer provides benefit.

I want to touch on some of the questions that have been asked. The Opposition spokesman asked about the number of CTOs being overturned at tribunal. According to Care Quality Commission data from 2023-24, 129 discharges by tribunal took place following 4,438 applications against CTOs. I emphasise that people are often discharged without going to tribunal, so those numbers are not a full picture.

On evaluation, we are developing a monitoring and evaluation strategy for the Mental Health Act, as the Bill will become once—one hopes—it gets Royal Assent. It will be important to monitor new processes such as discharges and changes to CTOs to assess whether reforms are being delivered as intended and to monitor uptake among patients. There was also a question about racial equalities, but I think I have answered that. With those remarks, I hope that the Committee will support Government amendment 30 and that the hon. Member for Guildford will withdraw amendment 11.

[Zöe Franklin (Guildford) (LD)]

I thank the Minister for his comments on our amendment 11 and the clarification regarding the fact that the Bill covers a lot of the issues we raised in that amendment. I am therefore willing to withdraw our amendment.

On Government amendment 30, I am grateful to the hon. Members for Hinckley and Bosworth and for Farnham and Bordon for their comments on the Government’s request to remove subsection (3). It is good to have consensus on these Benches on the important issues included in it. While I do appreciate the comments from the Minister about how he believes that the Bill covers these issues, I do feel that the subsection needs to remain and I would therefore like to vote on the Government amendment. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

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

[Stephen Kinnock]

Clause 7 will amend the grounds for discharge by the tribunal to align with the revised grounds for detention set out in clause 5. The tribunal must consider whether the patient continues to meet the criteria when deciding whether to discharge a patient.

These changes will provide decision-makers with a clear and consistent set of considerations when assessing whether a patient continues to meet the detention criteria, and therefore whether detention or a community treatment order continues to be justified. The tribunal must consider all elements of the detention criteria, including whether there is a reasonable prospect that the patient is receiving therapeutic benefit from treatment and whether there is a risk of serious harm. The detention criteria ensure public and patient protection, while also protecting patients from lengthy and unnecessary detentions when they no longer pose a risk to themselves or others. I therefore commend clause 7 to the Committee.

[Dr Luke Evans]

I rise to speak on an essential aspect of our mental health system: the role of mental health tribunals, and the proposed changes to the grounds upon which they can discharge individuals detained under the Mental Health Act 1983. Each year in England and Wales, about 20,000 people come before a mental health tribunal. These individuals are not criminals, but patients—often vulnerable, often voiceless—detained in hospital or living under community treatment orders, sometimes against their will.

The function of the tribunals is clear: to act as an independent safeguard, to scrutinise the legality of detention, to test whether the continued deprivation of liberty is justified, and to ensure that care is being given within the bounds of both clinical necessity and human rights. Each tribunal consists of a legal judge, a psychiatrist, and a specialist lay member. Together, they form a check on the powers granted by the state to detain and treat people on mental health grounds. Therefore, tribunals are independent bodies that review whether a person should remain detained under the Mental Health Act.

Historically, while an imperative, there have been concerns that modernisation is needed. The criteria they used were broad and inconsistent with modern principles of least restriction and patient rights. The 2018 independent review of the Act recommended aligning tribunal powers with clear risk-based criteria to ensure the detention is only maintained when absolutely necessary.

The clause seeks to change the criteria that these tribunals apply when making decisions about discharge. Specifically, it would align the discharge tests used by tribunals with the statutory conditions for detentions—those found in section 2(2) in the 1983 Act for assessment, section 20(4) for treatment and section 17A(5) for community treatment. On one level, this is pragmatic reform. It simplifies the legal framework and avoids confusion caused by duplicative or overlapping tests. It creates consistency between the reasons someone can be detained and the reasons their tribunal must use to determine whether they should remain so.

I would, however, caution the Committee not to treat simplification as neutral. While the administrative clarity is welcome, legal clarity can also narrow discretion. In tightening the grounds for discharge to mirror the detention criteria exactly, the clause may reduce the tribunal’s ability to consider the broader context, including, for example, the patient’s progress, their lived experience or the factors not strictly enumerated in statute. There is a risk that tribunals become passive reviewers of statutory boxes, rather than active assessors of individual liberty and clinical justification. Tribunals may ask whether the criteria are still met, rather than whether continued detention is truly necessary or proportionate.

Moreover, I believe—although the Minister may have to correct me—that the clause applies retrospectively, including to individuals detained under forensic sections or already living under CTOs. We must ask whether it is right to shift the legal test midway through someone’s treatment or tribunal process, potentially raising the bar for their discharge. I welcome the intent behind the clause to create coherence to improve the legal precision of our mental health law, but will the Minister reflect on its practical effects? Will it make discharges harder? Will it reduce the tribunal’s role to tick-boxing? Will it truly serve the interests of the patient?

Mental health tribunals are not merely administrative bodies; they are guardians of liberty for people who are often too unwell to speak for themselves. Any change that touches their powers must be approached with care, compassion and rigorous scrutiny. I ask the Minister to clarify how the clause will affect discharge rates in practice. Will tribunal members retain discretion to consider the individual circumstances of the patient beyond the bare statutory criteria? How will that be monitored? Has an impact assessment been carried out on the proposed change?

Finally, in the Minister’s speech on clause 6, he said that he expects more people to be automatically referred. How many more does he expect the Government to see? I believe in his answer he said that 129 out of 4,000 were overturned. Is there any work to be done to see how many more automatic referrals would come in, how many more would be challenged, and what the impact of that would be? We must be mindful that mental health law is about not only treatment, but trust, autonomy and justice, so let us ensure that these reforms reflect that.

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

It is a pleasure to serve under your chairmanship, Mr Vickers. I rise to speak briefly to clause 7, which in many ways is a tidying up of the other changes in the Bill to ensure alignment. In that sense, it is a necessary part of this legislation.

For too long, mental health tribunals, which have an important function, have been operating under criteria that are too broad. As my hon. Friend the Member for Hinckley and Bosworth pointed out, that can lead to inconsistencies with modern clinical practice. It is therefore right that we move to clearer, more risk-based criteria to ensure that detention is maintained only where absolutely necessary. There are obvious reasons behind that, such as to ensure greater consistency in tribunal decision making and strong safeguards to ensure that patients are only detained or kept under community treatment orders when absolutely necessary.

I want to pick up some of the arguments my hon. Friend the Member for Hinckley and Bosworth was developing around the demands on the tribunal service. The Minister will be well aware of the challenges facing the court and tribunal system in this country. If, as anticipated, this will lead to an increase in the number of hearings—both in first instance and potentially in appeal—what assessment has been made as to the number of not only judges, but wing members that will be required to facilitate this process?

What has been determined regarding the capacity of the resources of His Majesty’s Courts and Tribunals Service—in terms of not only physical hard standing, but the vital role that clerks and tribunal staff play in ensuring that hearings are done in a timely manner and the paperwork is completed consistently? Thirdly, what is the expectation of the sustainability of that workload as the Bill comes into fruition? I pick up on that in particular, because, given the transition arrangements that appear to be within the legislation, this will be a retrospective as well as a prospective change. I would be grateful if the Minister in summing up could address those issues.

[Stephen Kinnock]

It is a little bit dangerous for us to get into a numbers game, because I do not think it is particularly useful or productive to say, “As a result of the changes that we are making, we think it will decrease by x number or increase by y number”, because, by definition, we do not have a crystal ball and we cannot be sure. However, the impact assessment for the Bill— I do not have a copy of that with me right now—includes a range of scenarios and some predictions of the impact and associated costs that go with that. Those are important considerations that led us to the conclusion that we need a 10-year implementation period. It is not just about capacity in the communities and the community mental health services; it is also about capacity in the court system, the number of judges and the whole additional capacity and workload required for that, which is an important part of those considerations.

[Dr Evans]

If the Minister will forgive me, I was not being facetious when asking for numbers; I was simply using it as an example. I am grateful to his officials for providing the numbers so quickly when I asked for them during the debate on clause 6. When he has the chance, could he write to Opposition Members setting out how that interaction works with the Ministry of Justice and what the numbers might look like? Forgive me if I have missed it, but I could not see it in the impact assessment. There is an implication not only for health, but for the justice side, which, as my hon. Friend the Member for Solihull West and Shirley said, makes a difference. My question was more to make sure that we are pragmatic in our approach, rather than getting into hardcore numbers at this stage.

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[Stephen Kinnock]

The numbers that I gave the hon. Gentleman earlier were things that had happened, rather than gazing into the future and reading the tea leaves, but I will do as he asks, and I will ask officials to take him up on the point about the capacity of the legal and judicial system, in particular the tribunals.

On the questions the shadow Minister asked about retrospective application, we are supporting the tribunal to make decisions about whether a person should continue to be detained or subject to a community treatment order by providing clear and consistent criteria that focuses on the need for there to be a risk of serious harm and a reasonable prospect that the patient is benefiting from their detention in order justify continued detention for treatment under part 3 of the Mental Health Act 1983.

As has been said, that will apply to everybody who is currently detained. The key point is the balance of two things: harm to the patient him or herself and harm to others, and therapeutic benefit. Those will be the guiding lights of this entire process. I hope that I have managed to respond; I did not have a huge amount of time to take note of all the points, because there were not very many speakers on this clause. If there is anything I have not addressed, we can of course do so in writing.

Question put and agreed to.

Clause 7 accordingly ordered to stand part of the Bill.

Clause 8

Appropriate medical treatment: therapeutic benefit

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

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

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

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

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

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

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

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

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

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

Amendment 45, by inserting the words

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

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

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

[Stephen Kinnock]

I will start by commenting on amendment 12, which was tabled by the hon. Member for Winchester. We do not consider the amendment necessary, as section 13(2) of the Mental Health Act 1983 already requires an “approved mental health professional” to consider all the “circumstances of the case” before making an application for admission, which could include the appropriateness of the setting.

Clause 8 embeds the principle of therapeutic benefit into the Bill by providing a new definition of “appropriate medical treatment”. That requires that there must be “a reasonable prospect” of therapeutic benefit to justify detention for treatment, and that medical must be “appropriate in a person’s case”. We would expect a setting in which someone is going to be detained to be considered as a part of those considerations. The code of practice already states that patients should be offered treatment and care in safe, supportive and therapeutic environments, so that also addresses that point.

I turn to amendments 44 and 45. We recognise the significant impact that childhood trauma can have on a person’s psychological wellbeing throughout their life. Mental disorder is defined in the 1983 Act as

“any disorder or disability of the mind”,

and that is already broad enough to include the impact of childhood trauma.

Clause 8 requires decision makers to take into account

“the nature and degree of the disorder”,

what is “appropriate” in the person’s case and “all other circumstances” when considering whether medical treatment has a reasonable prospect of therapeutic benefit. That could include consideration of childhood trauma. Although we recognise that childhood trauma may be a factor for many patients, it will not be a factor for all patients. It is critical that consideration of appropriate treatment is tailored to, and reflects, individual experiences and needs. All treatment interventions should include the aim of minimising distress and promoting psychological wellbeing. As well as legislative requirements, it is vital that all aspects of care in in-patient settings should be trauma-informed and that patients are always put at the heart of effective, compassionate care. That expectation is set out in NHS England’s “Culture of care standards for mental health inpatient services” and will be further emphasised in the revised Mental Health Act code of practice.

I turn to clause 8 stand part. The clause strengthens the concept of therapeutic benefit in the Mental Health Act to ensure that patients are detained for treatment or placed on a community treatment order only when there is a reasonable prospect they will benefit from their treatment. The current criteria for detentions under section 3 of the 1983 Act is that

“appropriate medical treatment is available”,

and the definition of medical treatment focuses only on the purpose of the treatment. In practice, that means that clinicians may not consider whether the treatment under section 3 will be effective. If we are going to deprive people of their liberty, it is vital that detention is of therapeutic benefit to them, regardless of whether the patient is detained for treatment under part II or part III of the Act, so the new therapeutic benefit criteria apply to both.

Under the Bill, for treatment to be considered appropriate, there will need to be a reasonable prospect that the patient will benefit from it. The therapeutic benefit criteria will apply at the point of detention and renewal to patients detained under section 3 in part II of the Act, patients on a community treatment order when they are first subject to the order and at the point of renewal, and all part III patients.

The clause also retains the definition of the purpose of “medical treatment” in the 1983 Act:

“to alleviate, or prevent a worsening of, the disorder or one or more of its symptoms or manifestations.”

A focus on therapeutic benefit will ensure that patients receive the care and treatment they need to support their recovery and enable discharge when it is safe for them to leave hospital.

[Dr Evans]

There are a few questions to be answered. Given the nature of acquired brain injury—for example, the capacity of someone who has had a stroke can fluctuate—it is very hard from a clinical position to know where the benefit of treatment starts or finishes. We must future-proof the Bill. We have an ageing population, so we will see more people with dementia, strokes and acquired brain injuries for various reasons. There is a natural tension there, but it is only going to get worse over the next 20 or 30 years. How do the Government plan to address that? It is a concern.

[Stephen Kinnock]

I was intending to come to the questions that the hon. Gentleman and others asked, but as he has asked that now, I can tell him that the revised detention criteria and definition of appropriate medical treatment do not exclude patients with uncertain treatment outcomes, as long as they have a psychiatric disorder. Treatment must offer a reasonable prospect of benefit, considering both its purpose and likely outcome. The introduction of the principle of therapeutic benefit is aimed at ensuring that care and treatment provided under the Act will promote recovery and facilitate patients to get better so that they can be discharged as soon as possible. That applies right across the board on the basis of the psychiatric disorder.

I will now turn to clause 9. Sections 50 to 53 of the 1983 Act provide for the remission of prisoners or other detainees with severe mental health needs back to their prison or other place of detention; or, where relevant, direct their release where no effective treatment for the mental disorder can be given. Those provisions differ slightly from the detention criteria in the Bill, because in practice this cohort of patients may refuse to engage with treatment or behave in a disruptive manner such that treatment cannot practically be given. Clause 9 standardises the type of treatment to “appropriate medical treatment” for consistency with the rest of the Act, which will allow the therapeutic benefit changes in clause 8 to flow through to transfer decisions. This change has no other practical or legal effect and is technical in nature.

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[Stephen Kinnock]

In many ways, that is a question for clinicians, because they always have to make judgments in individual cases. In tragic cases such as eating disorders, at times it gets to the point where a person cannot be saved. If a patient is refusing to eat, it is notoriously challenging for clinicians to try to get that position reversed through talking therapies or other forms of treatment. Is about how we put in place legislation and a code of practice that give the system the best possible steer while recognising that clinicians make decisions on a daily basis in reacting to the circumstances that they face. I will take the hon. Gentleman’s point away and think about it, but I wonder whether there is a definitive answer to his question because of that interplay between the macro system and the micro challenges within that system.

My hon. Friend the Member for Thurrock raised several important points. She wisely said that the clause is about not just the principle of therapeutic benefit, but seeing the person as an individual and the principle of doing least harm. I thank her for those points, which are important for the Committee to take on board.

My hon. Friend asked about the impact of the therapeutic benefit provisions on the 1.5% of people with particularly complex needs. That is an important question, and to some extent touches on the intervention by the hon. Member for Hinckley and Bosworth about what we do in those really challenging situations. Where hospital admission is needed, the fundamental principle is that we believe it must be therapeutic, the least restrictive option and for the shortest time possible. Section 131A of the Mental Health Act 1983 places a duty on hospital managers to ensure that the hospital environment suits the patient’s age and needs. Current efforts, including NHS England’s quality transformation programme, aim to address the root causes of poor in-patient care by working with patients, families and professionals.

That is a roundabout way of answering the question, but fundamentally, the hospital manager has a duty to ensure that the environment suits the patient’s needs. Those needs will range from the most complex and challenging 1.5% of cases that my hon. Friend the Member for Thurrock mentioned through to the cases of others who may have milder disorders or challenges. Needs must be met across that landscape, and the duty is on the hospital manager to ensure that they are. My hon. Friend may also be interested to look at the quality transformation programme, which seeks to address some of the challenges that she mentioned.

In the light of those comments, I hope that hon. Members will not press their amendments. I commend clauses 8 and 9 to the Committee.

[Dr Chambers]

I appreciate the Minister’s considered reply to the amendments. I just spoke in a debate in the main Chamber about NHS infrastructure and buildings. Although I understand that that is not specifically in scope of the Bill, it is another good example of how the Bill is only as good as the system that it works within.

I will happily withdraw my amendment, but it is good to hear that the Minister understands the importance of hospital infrastructure. When substandard Victorian-era asylums are still being used for mental health care, not only is it inadequate for patients, but it affects the public perception of mental health and mental health treatment, which is an important aspect of the issue. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

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

[Stephen Kinnock]

Under clause 10, a responsible clinician is an “approved clinician”, which refers to a mental health professional, usually a consultant psychiatrist, who is approved by or on behalf of the Secretary of State for the purposes of the Mental Health Act and has statutory roles and responsibilities. The responsible clinician has overall responsibility for a patient’s care under the Act. Only they can make certain decisions, such as renewing a patient’s detention or placing them on supervised community treatment.

The clause seeks simply to clarify the current position on how a responsible clinician is assigned overall responsibility for a patient’s care, and makes no practical change to the role of a responsible clinician or to how they are appointed. It is intended to make clear the distinction between the definition and role of the “responsible clinician” and the new definition of a “community clinician”, who will have an increased role in managing patients on community treatment orders.

The responsible clinician would retain overall responsibility for the patient’s care, including in hospital, while the community clinician would be responsible for the patient in the community. The community clinician is involved in decision making around community treatment orders, which we will discuss in greater detail in relation to clause 22, alongside the responsible clinician. It is therefore important to explain how a responsible clinician is nominated. I commend clause 10 to the Committee.

[Dr Evans]

I am grateful for the opportunity to speak to clause 10, which addresses the nomination of the responsible clinician under the Mental Health Act. As we have heard, the responsible clinician is a pivotal figure in the operation of the Act, holding substantial legal powers in relation to detention, treatment and discharge. The Government’s explanatory notes make it clear that the clause is intended as a clarification, rather than a reform, of how a responsible clinician is designated by formally acknowledging that they are nominated by managers of the relevant hospital. That may well reflect current practice, but in legislation as sensitive and consequential as this, particularly where it relates to rights and liberties of people with serious mental illnesses, even clarification warrants scrutiny.

I would like to raise a few points of constructive concern and seek reassurances from the Minister. First, although the clause is presented as technical, it alters the statutory language around who is responsible for nominating the RC from an implied clinical judgment to an explicit managerial nomination. Even if that reflects what already happens, there is still a de facto risk of blurring the lines between clinical decision making and administrative oversight. Can the Minister confirm that this change will not give hospital managers discretion to override clinical suitability in selecting the responsible clinician?

Secondly, the clause distinguishes the responsible clinician from the soon-to-be defined community clinician role, which the Minister touched on. Although that separation may be helpful, it might help to guard that from confusion. Will clear published guidance accompany this change to explain to professionals, patients and families how roles are differentiated and how nominations are made?

Thirdly, on the matter of transparency and accountability, will patients be informed when a responsible clinician is nominated for their care? Will there be a mechanism for a patient to raise concerns if they believe that their nominated clinician is not appropriate for their needs and, if necessary, to change them? If so, what will that mechanism be?

Finally, although I accept the Government’s assertion that the clause is primarily clarificatory, we should keep it in mind that the Mental Health Act should not be amended lightly. The responsible clinician is not merely an administrative figure; they are central to the person’s liberty, treatment and legal rights. Have the Government considered whether additional safeguards could be introduced, in either guidance or statute, to ensure that this clarification does not lead to unintended consequences or the dilution of clinical independence?

The clause may be a small piece of a much wider reform, but, as ever with mental health legislation, the details matter. They shape people’s experience of care and of coercion.

[Stephen Kinnock]

I thank the Opposition spokesman. The role and nomination of the responsible clinician are well established and represent current practice, and the clause seeks merely to clarify the current position in legislation in order to avoid confusion regarding the roles of the existing responsible clinician and the community clinician, who will have new roles under the reforms to community treatment orders. I therefore think that the answer to his question—whether the clause will somehow change the clinical role of hospital managers, or whether hospital managers will be able to move the goalposts in how the nomination process happens—is no. The measure is simply a continuation of a well-established practice.

I think that challenging the nominated clinician would be a role for the independent mental health advocate. If a patient wishes to challenge any aspect of his or her treatment, that would be the role of the IMHA, once they are in place.

The issue of unintended consequences brings us back to the code of practice. I emphasise the two tiers—or three tiers, really—of consultation that will happen. First, there will be consultation with a wide range of stakeholders, including approved mental health practitioners, psychiatrists, clinicians and all the representative bodies. That will bring us a very well-developed draft of the code of practice. We will then go to public consultation, which will be open to input from anyone who has a view, and then to Parliament. That will give us a fairly high degree of assurance that the code of practice will address any area where there is a risk of unintended consequences.

Question put and agreed to.

Clause 10 accordingly ordered to stand part of the Bill.

Clause 11

Making treatment decisions

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

[Stephen Kinnock]

Clause 11 will introduce a new clinical checklist that the patient’s responsible clinician must follow when making decisions about a patient’s treatment. This seeks to put the patient at the heart of clinical decision making. Specifically, the checklist will require that the clinician supports the patient to engage in decision making concerning their treatment. That could include nursing, psychological interventions, specialist care and medication. They must also consult with those close to the patient to consider the patient’s wishes, feelings, beliefs and values, including those expressed in advance, and avoid making decisions based solely on factors such as the patient’s age or condition.

Where the patient is too unwell and lacks the capacity or competence to make decisions concerning their treatment, the checklist will require the clinician to consider any wishes, feelings, views and beliefs that they think the patient might have had if they had had capacity. They might establish this by consulting with those close to the individual or looking at their advance choice document.

The checklist represents best practice, but sadly it does not represent standard practice. The independent review identified multiple incidents of patients feeling disempowered and unsupported to share their wishes and feelings, and unfairly ignored when they did. That can undermine the patient’s sense of self-worth, their recovery and their trust in mental health services.

We consider the checklist fundamental to delivering the guiding principle of patient choice and autonomy. We therefore consider it necessary to put the checklist on the face of the Bill. That was the approach taken with the best interests checklist under the Mental Capacity Act 2005, which in many ways is analogous. That checklist has come to be widely recognised and highly regarded by practitioners. I commend the clause to the Committee.

[Dr Evans]

Clause 11 will introduce new section 56A into the Mental Health Act 1983. The clause represents an important reform to the framework for how treatment decisions are made to detain patients under part IV of the Act. The clause effectively establishes a statutory clinical checklist. It imposes a duty on the approved clinician in charge of treatment to consider a set of factors before giving medical treatment to the patient—whether or not the patient consents, lacks capacity or is refusing treatment. It applies to all treatments under part IV and to patients of all ages, including children.

As the Government’s explanatory notes set out, that duty includes considering alternative treatment options, taking steps to assist and encourage the patient’s participation in decisions, giving proper weight to the patient’s past and present wishes, feelings, beliefs and values, including advance statements, avoiding the reliance on discriminatory assumptions such as those based on a patient’s age or behaviour, and consulting others involved in the patient’s life, such as families, carers, nominated persons or advocates. Importantly, where a patient lacks capacity, the clinician is still required to consider what the patient would want if they had capacity. We welcome the fact that it reflects a commitment to person-centred care, even in the most complex clinical situations.

I recognise and welcome the intention behind the clause. The principle that patients should not be passive recipients of care but active participants in decisions about their treatment is well established in modern mental health practice. The clause gives that principle a stronger legal footing, aiming to embed it in everyday clinical decision making. The Government rightly acknowledge that many patients have felt, in the past, that their views and preferences have been overlooked. Proposed new section 56 is intended to prevent that and promote autonomy, dignity and respect, even where coercive treatment is being considered.

I note that clause 11 amends the existing provision on second opinions and treatment certification, such as sections 57 and 58 of the Mental Health Act. It would appear that clinicians must now confirm in writing that they have complied with new section 56A checklists. Could the Minister confirm that that is correct? If so, that is a welcome move towards accountability and transparency.

I want to raise a few areas where further clarification or strengthening might be needed. First, the clause still leaves substantial room for clinical discretion. Much of the checklist is qualified by what is “reasonably practicable” or “reasonably ascertainable”. That is understandable from a legal drafting perspective, but it raises questions about how robustly the duties will be applied in practice, particularly in under-resourced or overstretched services. Can the Minister confirm what support will be given to clinicians, such as the statutory guidance or training, to ensure that new section 56A is implemented meaningfully and consistently across the system?

Secondly, although clinicians must now record that the checklist has been completed, the patient or their family currently have no direct route to challenge non-compliance. There does not seem to be an appeal mechanism, so I wonder what or who might fulfil that role. It would be helpful if the Minister could set out the process. Is there a formal role for advocates in contesting whether the process was followed properly? If found wanting, are there sanctions for failing to comply? Is it perceived to be part of the integrated care board commissioning role, for example? Could the Minister say more about what resources are available to patients or carers who believe their views were not properly considered? Would the Government consider a statutory right to request a review where the checklist appears to have been bypassed?

Thirdly, I note that the clause applies only to patients treated under part IV of the Act. It does not apply to patients subject to community treatment orders, unless they are recalled to hospital, yet those patients may still face significant pressure to comply with treatment, often under the threat of recall. Forgive me if I am a little muddled, but I would welcome some clarification on the rationale for excluding CTO patients from these protections. Are the Government open to extending these duties to cover community settings, particularly as part of future of reform, especially as they did not accept the amendments tabled in the Lords?

Fourthly, the checklist applies to all ages, including children and young people. That raises important questions about how capacity, consent and participation will be judged in younger patients, and how the duty to consult parents or carers will be balanced with the rights of the child. Will specific guidance be issued to support clinicians applying this clause in cases involving children and adolescents?

Further still, while proposed new section 56A emphasises consultation and participation, the weight to be given to the views of others—whether an advocate, nominated person or family member—remains at the discretion of the clinician. That may be clinically appropriate, but it raises the question: how will clinicians be supported to navigate competing or conflicting views, and will they be required to provide reasons for how they have balanced those perspectives? I will not delve into it now, but when we come to nominated persons, there is a reason that this particular point is poignant. We need to understand how decisions are being made when there are challenges.

While I welcome the clear emphasis in clause 11 on patient voice, autonomy and dignity in treatment decisions, I must raise a matter of considerable concern and spend a little bit of time on it: the absence of any explicit reference to public safety or risk to others within the proposed new section 56A. It could be argued that this is not a minor omission. As legislators, we have a duty not only to protect the rights of the individuals in clinical care but to safeguard the wider public. While risk to the public is rightly a key consideration in detention decisions under sections 2, 3 and 20A of the Mental Health Act, it is not reflected at all in the new duties governing treatment decisions, even when the treatment may directly affect behaviour inciting compliance.

We sadly know that the stakes here are not hypothetical. When we were discussing clause 5, the Minister turned around and asked what the point was of over-embroidering the Bill, especially if such duties already exist in these cases. I will tread carefully here, because there are both legal and emotional sensitivities, but there are good examples of why this really matters. A deeply troubling case, and one that continues to resonate when we talk about risk, public safety and clinical decision making under the Mental Health Act, is that of Nicola Edgington and whether the Bill does enough to address it.

In 2011, Nicola Edgington, a woman with a diagnosis of paranoid schizophrenia, walked into a police station and an A&E department in south-east London. She told the staff that she was relapsing and desperately begged to be detained, warning them that she posed a danger to others. Despite her history—she had previously killed her mother during an earlier episode—she was allowed to leave hospital. Within hours, she murdered a complete stranger, 58-year-old Sally Hodkin, and seriously injured another woman. Serious incident reviews concluded that the risk she posed to the public was severely underestimated. Professionals focused on her current presentation, not the pattern of risk, and key warnings were missed. She asked to be sectioned; she was not, and someone died.

Since that case, there have been some important reforms, including stronger guidance on the risk assessment, improved information sharing between agencies, and enhanced care co-ordination through the care programme approach. Crucially, even today, there is still no statutory duty requiring clinicians to explicitly consider risk to the public when making treatment decisions under the Mental Health Act, including decisions about whether to detain or treat someone who is deteriorating.

That brings me to clause 11 and proposed new section 56A. The Government rightly propose a clinical checklist for treatment decisions—one that includes a patient’s wishes and beliefs, as well as views from family or advocates. These are welcome steps, but the checklist is silent on public protection. It recognises autonomy, but not risk to others. It includes past preferences, but not past violence. Should we not at this moment consider an explicit legal duty to assess and document the risk that a patient may pose to others when treatment decisions are made, especially for those with a serious history of violence or relapse?

--- Later in debate ---

[Stephen Kinnock]

May I say what a pleasure it is to follow my hon. Friend the Member for Thurrock? I found her contribution incredibly insightful. She is a tremendous asset to the Committee and indeed to the parliamentary Labour party, we are fortunate to have her with us on the Committee.

The Opposition spokesman mentioned a number of cases, including Nicola Edgington and Valdo Calocane, so I will take the opportunity to express my condolences to those who were so terribly affected by those tragic events. We are in ongoing engagement with the families of Barnaby Webber, Grace O’Malley-Kumar and Ian Coates, and it is appropriate that we take a moment as a Committee to reflect on the terrible tragedy they have gone through and to express our condolences to them.

The Opposition spokesman’s question was, broadly speaking, about risk and public safety. I will make a number of points on that. First, the clinical checklist does not bind clinicians to following the wishes of patients; it requires that clinicians consider them when deciding on the patient’s treatment, but, by definition, a checklist is not binding. If a preferred treatment is not clinically appropriate or feasible, clinicians must explain why and, where possible, discuss alternatives with the patient or their loved ones.

The purpose of the checklist is to ensure that the patient’s wishes play a more central role in clinical decision making, as we are aware that that is not always the case. However, the checklist does not bind the clinician to the patient’s wishes, nor does it prevent the use of compulsory treatment. We recognise that compulsory treatment is sometimes necessary to get a person well again, including by managing the potential risk that they might pose to themselves or others.

My other point is that there is not a binary choice between consulting and engaging with the patient, and enhancing and consolidating public safety; very often, the two go together. One of the learning points from the tragic Nottingham incident is that there was not enough consultation with Mr Calocane’s family. If there had been, there might have been opportunities to note his episodic behaviour and the fact that he was not always taking his medication. Had the family been better consulted, it would have enhanced public protection and safety. It is important that we do not say that family consultation and engagement with the patient are opposed to public protection—in fact, they are two sides of the same coin.

[Dr Evans]

The Minister makes an excellent point, and that is part of the reason why the Opposition did not want to spring this question on the Government in an amendment or a vote, but rather to have the conversation first, because this is an important clause to get right. The two sides can be worked on in parallel when considering public safety more widely. Regarding safeguarding issues, as a GP dealing with children it is very common to share information with social services to allow them to have that central point, so that things are not missed.

The principle of the checklist is to ask whether we are thinking about the individual patient. We have heard from patient testimony that that has to be paramount— No. 1—and that is the prima facie reason for having these provisions in the Bill. But, as we are considering this clause, given some of the cases and some of the holes, should we not consider asking clinicians, in statute, to think specifically about the risk, and wider risk, and what could be involved in the treatment?

As the Minister rightly pointed out, if it was considered that certain individuals were not conforming with their medication regimen, or that there was a risk of them not doing so, or that they had a violent tendency when they relapsed, and had not met a threshold because they had never actually gone to prison or been through a court, but were known to police services, that grey area might pick something up if it were simply added to the checklist. I cannot think of many things, bar the patient—who is No. 1—more important than public safety. I put that point to the Minister to consider further in the light of those cases. I do not want to go into specifics, because it is not right to do so and he will be much closer to details than I am, but there is a widening principle over what we can do in this space.

[Stephen Kinnock]

I can absolutely confirm that the Government’s understanding of the way in which the system must function is that, if any risk at all to public safety is perceived, that must be documented. The risk to others and self must be assessed and documented, and that then informs the care and treatment plan. It is a basic expectation of the professional management of a particular patient that any risk identified to public safety and protection must be in there. However, I take the hon. Gentleman’s point on whether or not it should be in the Bill. I will come back to him on that, because I would be rather surprised if it were not made very clear somewhere that that is a basic expectation; if it were not, that would obviously need to be looked at, but I am reasonably confident that it is.

The hon. Gentleman asked whether the second opinion doctor would confirm that the checklist had been complied with by the approved clinician: yes, and that must be documented in the second opinion doctor’s certificate. He also asked whether we will support clinicians with statutory guidance. Yes, we will provide guidance on the delivery of the checklist in the code of practice.

Question put and agreed to.

Clause 11 accordingly ordered to stand part of the Bill.

[The Chair]

I understand that the Government intend the Committee to sit until 7 o’clock. I therefore think that it would be appropriate to take a short break.

--- Later in debate ---

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

[Stephen Kinnock]

The clause will simply clarify existing legislation concerning the second opinion appointed doctor so that it more closely reflects current practice and terminology. It sets out the role of the regulatory authority in appointing a second opinion appointed doctor and the criteria that the second opinion appointed doctor must meet, and it updates terminology so that it is more in keeping with that used by practitioners. I therefore commend clause 12 to the Committee.

[The Lord Commissioner of His Majesty’s Treasury (Taiwo Owatemi)]

On a point of order, Mr Vickers. We did not actually cover clause 11. [Interruption.] Did we vote on clause 11?

[The Chair]

Yes, it was agreed.

[Stephen Kinnock]

It happened—it was real!

[Dr Evans]

It is a relief that we have not dropped clause 11, an important clause. Equally important is clause 12, on the appointment of a doctor to provide a second opinion. The clause will introduce the new framework for appointing second opinion appointed doctors under the Mental Health Act, which is indeed important.

I begin by acknowledging the Government’s efforts to clarify and strengthen the role of these doctors, who play a vital part in safeguarding the rights and wellbeing of patients subject to compulsory treatment. The emphasis on the independence of the second opinion appointed doctor is a positive step. Ensuring that that doctor is not the patient’s responsible clinician or treating doctor reinforces impartiality. Furthermore, the clear responsibility for this doctor to assess therapeutic benefit and to verify that clinicians have followed the clinical checklist, considering patients’ wishes and preferences and treatment alternatives, reflects an encouraging commitment to embedding autonomy and choice in the clinical discussions.

Having said that, I would like to raise some constructive points and seek clarifications on certain operational aspects that I believe are critical to the clause’s effective implementation. First, the Bill requires the regulatory authority, namely the Care Quality Commission in England and Care Inspectorate Wales, to appoint the second opinion doctor

“as soon as reasonably practicable”.

The absence of a specific maximum timeframe could raise concerns about potential delays. Given the importance of timely second opinions in safeguarding patient rights, will the Minister clarify what safeguards are in place to prevent undue waiting times? Forgive me: I could not find it, but has any clear data been recorded on timings for second opinion appointed doctors? Has any consideration been given to whether a timescale should be implemented in legislation in order to ensure that there is no slipping through the cracks? That may be appear to be overkill; I defer to experts in the Department, but given the acute needs of some patients who will encounter the legislation, it is worth considering.

Secondly, the role of the regulatory authority is pivotal in the process. In England, that role falls to the Care Quality Commission, so it is worth spending a few moments reflecting on the CQC’s role not in general terms, but specifically in relation to mental health settings. Strangely, I speak today from a position of both continuity and change. Having been a Government Member during a period when there was reform of the CQC and it was under active discussion, I now speak for the Opposition, but with an equally strong commitment to ensuring that reforms are delivered and that people with mental health needs receive care that is not only safe, but dignified and therapeutic.

It is no secret that mental health services, particularly in-patient units, have faced significant challenges in recent years. Some high-profile failures in care, including abuse and neglect in mental health hospitals, have understandably shaken public confidence. As a regulator, the CQC has struggled at times to respond quickly or decisively enough. In some cases, failings persisted despite earlier inspections raising concerns. We need to be honest about the fact that the pace of regulatory response has not always matched the urgency of the risk, particularly for detained patients, who are among the most vulnerable people in our society and our care system.

Two recent independent reports—the Dash review, which began in May 2024 just before the election, and the follow-up work by Sir Mike Richards on its findings—have offered a candid but constructive diagnosis of what went wrong inside the CQC. They have identified serious weaknesses: a sharp reduction in inspection activity; delays in publishing reports; an overcentralised system that dilutes expertise in specialist areas such as mental health; and a lack of transparency that sometimes makes it difficult for families and professionals alike to understand how services are monitored.

Both reports were also forward-looking, however. They have informed a programme of reform, which began under the previous Government and is, I hope, continuing under this Government. What has changed? The CQC has started to take action. It now has a renewed commitment to sector-specific expertise, which should help mental health, with dedicated inspection teams for mental health returning. The backlog of unpublished reports has been significantly reduced and the CQC’s digital systems are starting to be overhauled. Perhaps most importantly, the regulator is beginning to work on increasing transparency in order to engage better with service users and staff in mental health settings.

These changes are welcome, but fragile. Reform takes time and momentum can easily be lost. Context matters when we are considering giving an organisation more work in primary legislation, which is why I have raised the issue and given a potted history.

The Bill gives us the opportunity to ensure that the rights and safety of people subject to detention or treatment under the Mental Health Act are properly safeguarded, but legislation alone will not guarantee good care. The role of the CQC as a proactive and trusted regulator is essential. That means ensuring that inspections are sufficiently frequent, especially in settings in which patients are detained and find it hard to raise concerns; ensuring that de-escalation, restraint and seclusion practices are being scrutinised not just in policy, but in practice; ensuring that the voices of patients and families are actively heard in regulatory processes; and ensuring that any concerns that are raised, whether by whistleblowers, staff or external professionals, are acted upon promptly.

I do not say all this to assign blame. Indeed, many of the problems that the CQC has faced have been years in the making, and I accept that some of them arose while I was on the Government Benches. However, I am saying this now because I believe that there is cross-party agreement that regulatory failure is not an option for mental health services. As we look ahead to implementing this legislation, I hope that the Committee will keep it in mind that a reformed Mental Health Act must be matched by a reformed regulatory framework that is resourced, responsive and rooted in the lived experience of those it is designed to protect.

We know that the CQC has undergone significant changes and is under new leadership after the concerns, complaints and issues. Do the Government have faith in the CQC? I ask the Minister to provide assurances that both the CQC and—

--- Later in debate ---

[Stephen Kinnock]

On the Opposition spokesman’s question about a specific timeframe, the wording of the clause—

“as soon as reasonably practicable”—

is a sufficient and fairly strong steer to the system that avoids the need to tie our hands with a specific timeframe.

Consistency, training and monitoring are going to be important elements of the code of practice. We need to ensure that those questions are answered and that those are put in place.

On the hon. Gentleman’s question about the CQC, we are grateful to Dr Penny Dash and Professor Mike Richards for their recommendations, which the CQC has accepted in full. We are greatly encouraged by the reforms it has made so far, and we particularly welcome the appointment of Dr Arun Chopra as the CQC’s first chief inspector of mental health, which will improve the voice of mental health patients and help to better uphold their rights. We are confident that those changes will ensure that the CQC is better placed to regulate mental services.

Question put and agreed to.

Clause 12 accordingly ordered to stand part of the Bill.

Clause 13

Medicine etc: treatment conflicting with a decision by or on behalf of a patient

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

[The Chair]

With this it will be convenient to discuss clause 14 stand part.

[Stephen Kinnock]

The power to give compulsory treatment is sometimes necessary to get a person well again, but unfortunately some clinicians can too easily resort to this course of action without considering alternatives. Compulsory, and sometimes forced, treatment can cause distress and trauma to the patient, and some say that this has caused them to lose trust in mental health services.

One individual told us that she was forcibly treated with a medication, despite its having caused serious side effects in the past. Sadly, her appeal to staff to offer her an alternative that had previously proven effective was ignored, and she was forcibly treated without any explanation as to why. That situation might have been avoidable if staff had only stopped to listen to the individual and consider other options.

Clause 13 seeks to shift the culture around administering compulsory medication to patients under the Mental Health Act, while maintaining the power to do so. Under the clause, a “compelling reason” will be required to overrule a patient’s refusal of a medication, whether that refusal is made with capacity at the time, in advance or by a representative, for example through a lasting power of attorney. A clinician will be able to overrule a decision to refuse medication only if they cannot identify a clinically viable alternative or one that is acceptable to the patient.

The aim is to encourage clinicians to take the time to consider alternative medications, for example by speaking with the patient or those close to them, or consulting their advance choice document. That will potentially avoid the need for non-consensual medication. Many clinicians already care for patients in this way, but others do not.

Where the clinician thinks that there is a compelling reason to treat compulsorily, a second opinion doctor, appointed by the regulator, must confirm this, as well as other matters, before treatment can go ahead. This marks a significant shift away from the current system, in which compulsory treatment can last three months before a review by a second opinion doctor is required. We believe that the measure will help to cement the desired cultural change that we all aim to achieve. The clause is critical to making the patient’s voice more central to their treatment.

Clause 14 will ensure that where a person does not or cannot agree to their treatment under the Mental Health Act, they receive the safeguard of a second opinion doctor appointed by the regulator. Currently, if a patient lacks capacity or competence to consent, a second opinion appointed doctor is to assess whether their treatment is appropriate, three months after the treatment course began. Although that is an important safeguard, it happens too late in a patient’s treatment course.

Clause 14 will shorten the timeframe for that safeguard so that it occurs after two months, rather than three. The timeframe within which the patient’s responsible clinician must review and provide a certificate indicating that the patient is consenting to medication is also being shifted from three months to two months. By introducing scrutiny at an earlier point in the process, we will better protect those patient groups who may be very unwell and highly vulnerable. That is particularly true for patients who lack capacity to consent. For those reasons, I commend clauses 13 and 14 to the Committee.

--- Later in debate ---

Clause 14, on treatment in other circumstances, makes three key changes to section 58 of the Mental Health Act, as my hon. Friend mentioned. Again, I have some questions about the shortening of the period from three months to two months. Clearly, a reduced period for assessment is to be welcomed, and we do welcome it. However, we need to understand what would happen if, for some reason, the second opinion appointed doctors are unavailable and therefore the treatment is delayed. What might be the legal consequences for a patient who did not receive an assessment within two months? As the hon. Member for Southend West and Leigh mentioned, people are currently not being assessed within three months. What would happen if the assessment was not received in two months and what legal recourse would be open to them, either through the Bill or through any civil court interaction?

[Stephen Kinnock]

Defining “compelling” will be an important part of the code of practice. We will include case studies and examples to help to put flesh on the bones of that and to illustrate it. But it is important to emphasise that a clinician would only be able to overrule a decision to refuse medication if they cannot identify a clinically viable alternative or one that is acceptable to the patient.

On training and the capacity in the system, it is important to note that we plan to switch on the new safeguards impacting the second opinion appointed doctor service only when we are confident that there is sufficient capacity in the system to deliver those safeguards.

On the point that my hon. Friend the Member for Southend West and Leigh made, we absolutely must ensure that the reviews are happening. That will be a really important part of the enforcement process.

The hon. Member for Farnham and Bordon asked about legal recourse. The independent mental health advocate will be an important part of having recourse—for want of a better phrase, they will be somebody to really give back-up to the patient. There is then the legal process, if there is a tribunal or court. Ultimately, someone can go through the court system if there is a dispute about a particular issue. However, one would want to ensure that there had been an objective assessment, through routes such as the independent mental health advocate or through professionals in the system really looking at the issue. Of course, the second opinion appointed doctor plays a crucial role in that.

[Dr Evans]

I would be grateful if the Minister could comment on the certificates being combined. There is a concern, if we go from two certificates to one, that the reason why two certificates were chosen in the first place could be lost, especially if the certificates are competing. There could be an incumbent preponderance towards one decision, when there were actually two conflicting decisions in the first place. I understand that this is about trying to reduce the administrative burden and having all the information in one place. Equally, however, it does make clinicians think twice, especially when they are supposed to be independent, about what is happening and why.

[Stephen Kinnock]

The content of the Bill, in this context, has been produced on the basis of engagement with the second opinion appointed doctor service and clinical experts. That was partly around the decision to shorten the period to two months, as that allows time for medication to take effect, so that the appropriateness of the medication for the individual can be properly assessed. Is that what the hon. Member is talking about—that there might be confusion about whether or not medication should continue to be administered?

[Dr Evans]

I am frantically trying to find the exact point in the explanatory notes—I think it is in either paragraph 114 or paragraph 115—about where the second opinion comes together. There is a reference to having a combined certificate. That seems to be a practical solution, but I worry about the crossover relating to who may or may not be affected. If the Minister wrote to me on that point, it might be easier to move the Committee on.

[Stephen Kinnock]

I will do that.

Question put and agreed to.

Clause 13 accordingly ordered to stand part of the Bill.

Clause 14 ordered to stand part of the Bill.

Clause 15

Electro-convulsive therapy etc

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

[The Chair]

With this it will be convenient to discuss the following:

Clause 17 stand part.

Amendment 13, in clause 18, page 27, line 22, at end insert—

“(1A) Regulations under subsection (1) may only be made to provide for circumstances where—

(a) the treatment is immediately necessary to save the patient’s life,

(b) obtaining a second opinion would cause a delay that places the patient at a significant and imminent risk of death or serious physical harm, and

(c) the treatment is reversible.”

The amendment limits the power to dispense with a second medical opinion for urgent electro-convulsive therapy to exceptional, life-threatening cases, introduces periodic reviews of its use, and ensures transparency by prohibiting retrospective application.

Clause 18 stand part.

--- Later in debate ---

[Stephen Kinnock]

I will discuss a number of issues concerning the topic of urgent electroconvulsive treatment. Clause 15 makes a small practical change to the current protocol around administering electroconvulsive therapy. Currently, where the responsible clinician wishes to administer electroconvulsive therapy and the patient lacks capacity or competence to consent, the second opinion appointed doctor must certify, among other things, that it does not conflict with an advance refusal or the decision of an attorney or deputy.

We have heard from stakeholders that it would make much more practical sense and save the second opinion appointed doctor time if that was established before they were invited to assess the patient. Therefore, the clause makes it the role of the responsible clinician to ascertain if treatment is in conflict with an advance refusal or the decision of an attorney or deputy before they secure the second opinion appointed doctor. I commend the clause to the Committee. It improves the patient’s right to self-determination by minimising the circumstances under which urgent treatment can be given compulsorily under section 62 of the 1983 Act.

I turn to clause 17. Currently, section 62 of the 1983 Act sets out four main scenarios under which the normal treatment safeguards do not apply, allowing urgent compulsory treatment to be given without such safeguards. The clause removes from section 62 the power to give medication compulsorily where its purpose is to alleviate the patient’s serious suffering. The act of forcibly treating an individual can be a highly traumatising and distressing experience. The clause recognises that, where someone is well enough to make a capacitous or competent refusal to treatment, they are also well enough to decide the level of suffering that they are willing to undergo.

The clause is critical to improving the patient’s autonomy over their care and treatment. It does not affect the clinician’s ability to administer compulsory treatment where it is immediately necessary to prevent the patient from behaving violently or being a danger to themselves or others, to prevent their serious deterioration or to save their life.

I am grateful to the hon. Member for Winchester for tabling amendment 13. Its intention is largely already met by the Bill—that is, a second opinion doctor’s certificate can be dispensed with only in the following limited circumstances: first, the regulator determines that there will be a delay in appointing a second opinion doctor due to exceptional circumstances; and secondly, urgent electroconvulsive therapy is immediately necessary to save the patient’s life. The Bill also requires that those exceptional cases are monitored and reported on by the regulator.

This process prevents the treating hospital retrospectively requesting a second opinion doctor after treatment has commenced. Although those policies are not achieved by the amendment, they appear to meet objectives outlined in the explanatory notes. This process was included in the Bill following a recommendation made by the Delegated Powers and Regulatory Reform Committee, and an amendment was tabled in the other place. For those reasons, I ask the hon. Member for Winchester not to press the amendment.

I turn to clause 18. Currently, a patient’s approved clinician can overrule a refusal of electroconvulsive therapy and administer it compulsorily, so long as that is considered urgent under the 1983 Act. The clause introduces the need for a second opinion doctor, appointed by the regulator, to certify electroconvulsive therapy before it can go ahead. The second opinion doctor must examine the patient to establish whether the circumstances are truly urgent. If feasible, they must also consult a nurse and the patient’s nominated person, drawing on the valuable perspectives that each brings. It is important that this new protocol occurs within a tight timeframe, to ensure the patient’s safety and to prevent unnecessary suffering. That is why there is the power to impose, by way of regulations, duties on specific bodies and professionals to ensure that treatment is certified by the second opinion doctor within a particular period.

Where exceptional circumstances result in a delay in appointing the second opinion doctor, the clause permits the patient’s approved clinician to certify the use of life-sustaining electroconvulsive therapy. The hospital must inform the regulator each time that happens, and efforts should continue to appoint a second opinion doctor as soon as possible. In recognition of the seriousness of the situation, the clause requires that those exceptional cases be monitored and reported on by the regulator.

This clause is another important shift towards increasing the power of the patient over their care and treatment, within parameters that still enable the use of compulsory treatment where that is absolutely necessary.

[Dr Evans]

I rise to speak to clauses 15, 17 and 18 and Liberal Democrat amendment 13.

Clause 15 will amend section 58A of the Mental Health Act 1983 in regard to ECT. It is worth understanding the law as it stands. At present, if a patient lacks capacity to consent to ECT, treatment may be administered only if a second opinion appointed doctor certifies that the treatment does not conflict with any valid advance decision, or a decision made by an attorney, a deputy or the Court of Protection. That acts as an important safeguard, ensuring independent scrutiny of patients’ prior wishes or of proxy decisions before such an invasive treatment can proceed.

This clause will shift the responsibility. Under the Bill, the initial determination about whether ECT would conflict with any advance decision or proxy decision is moved from the second opinion appointed doctor to the patient’s approved clinician. Only if the clinician finds no conflict would the SOAD then be involved to certify that the patient lacks capacity, that the treatment is appropriate and that the clinician’s decision aligns with proposed new section 56A safeguards. The Government’s explanatory notes clarify that that reflects the unique nature of ECT: if a valid refusal exists, treatment must be prevented outright. The clinician therefore acts as a gatekeeper before SOAD involvement. Clause 15 marks a significant shift in the role of the SOAD with respect to ECT. The whole point is to transfer the responsibility to ensure that treatment does not conflict with advance decisions or refusals.

That contrasts with the approach under proposed new section 57A, under which the SOAD must certify the presence of a valid decision before compulsory treatment. The rationale, as explained in the Government’s notes, is that for ECT, the mere presence of an advance refusal should prevent treatment, whereas in the case of other compulsory treatments, the content of the advance decision is integral to deciding whether treatment can proceed.

I recognise the rationale for the change and the introduction of a clinical checklist—I assume that we are talking about new section 56A—but I have some questions for the Minister. Does shifting the initial responsibility to the approved clinician risk reducing the independent oversight currently provided by the SOAD, especially given the invasive nature of ECT? How can we be confident that clinicians will rigorously check for and respect valid advance refusals or proxy decisions? What practical safeguards will be in place to ensure that clinicians have full and timely access to any relevant advance decisions or proxy appointments? Will there be a standard process for verifying those, especially where records may be fragmented?

The SOAD’s role is now more focused on assessing appropriateness of treatment and capacity but, it appears, without responsibility for confirming the absence of conflicts with advance refusals. Will the SOAD therefore be empowered with sufficient information to make the judgment confidently? How will the clinical checklist be implemented and monitored across services to ensure consistent application? Can we be assured that it will effectively embed the principles of therapeutic benefit and least restrictive option, especially when dealing with ECT? What mechanisms will be available to family members or advocates who believe that a patient’s prior wishes, or proxy decisions, are being overlooked? Will there be accessible avenues by which to raise concerns or seek timely review?

--- Later in debate ---

[Gregory Stafford]

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

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

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

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

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

[Stephen Kinnock]

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

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

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

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

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

Question put and agreed to.

Clause 15 accordingly ordered to stand part of the Bill.

Clause 16

Review of treatment

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

[Stephen Kinnock]

The purpose of clause 16 is twofold. First, it seeks to maintain the status quo around when the responsible clinician must report to the regulatory authority on the patient’s treatment and their condition. Currently, the Mental Health Act requires that the responsible clinician give a treatment report to the regulatory authority when they renew the patient’s detention. However, changes to clause 28 that increase the frequency at which the clinician must renew a patient’s detention would have unintentionally increased the frequency of treatment reports for patients under certain sections. Clause 16 will prevent that, thereby avoiding unnecessarily placing additional burden on clinicians or the regulator.

Secondly, the clause will give the regulatory authority the power to request a report on a patient’s treatment and their condition, where they are consenting to treatment. That will expand an important safeguard to individuals who are potentially vulnerable and may benefit from additional oversight. I therefore commend the clause to the Committee.

[Dr Evans]

The clause will amend section 61 of the Mental Health Act 1983 on the review and treatment of detained patients. The 1983 Act requires approved clinicians to provide reports on the treatment and condition of detained patients, particularly where patients do not consent to treatment. Those reports are integral to the scrutiny and safeguarding of the patients’ rights. The Act sets out timing requirements for such reports, which generally coincide with detention renewals, helping regulatory authorities such as the CQC in England and the Healthcare Inspectorate Wales to oversee treatment appropriately. I imagine that you are expecting me to continue my speech on the CQC, Mr Vickers, but I will spare you; you are august in your understanding of the health inspectorates, so I will not put the Committee through that.

The clause updates the timing and scope of the reporting requirements, and we welcome the fact that it will introduce a more structured reporting schedule. It will require reports to be provided after six months, then every six months and then every 12 months, as well as for the reports to be provided within two months of those periods. The clause also explicitly includes part III patients—those under forensic orders—especially those transferred from guardianship or those whose community treatment orders have been revoked. Importantly, the clause grants regulatory authorities the power to require reports not only from non-consenting patients but where patients are found to be consenting under certain treatment sections. That enhances the regulator’s oversight role, allowing it to request additional information should concerns arise.

We acknowledge that the intent behind these changes—to align reporting practices across different patient groups and to strengthen regulatory oversight—could improve consistency in monitoring, ensure that concerns about treatment are promptly addressed and, ultimately, enhance patient safety and rights. However, several questions arise. How will the increased power for regulatory authorities to require reports, including from consenting patients, be balanced to avoid placing excessive administrative burdens on clinicians? Will the changes to the timings of reports, particularly the delay of the first report to three months for certain cohorts, risk any gaps in early detection of treatment issues? What safeguards or limits will exist to prevent potential overuse of the power to request additional reports? Could that put further strain on mental health services and regulatory bodies that are already stretched?

How clear and workable are the definitions distinguishing different patient groups, such as part III patients transferred from guardianship or those with revoked community treatment orders? Might that complexity lead to inconsistent application? The clause distinguishes those groups because it assigns them different reporting schedules and rules. For example, part III patients transferred from guardianship and CTO-revoked patients after 6 months have a specific reporting timetable—every 6 months, then 12 months. In contrast, CTO-revoked patients within six months of their hospital order and other part III patients retain their existing, presumably different, reporting periods. That layering risks creating complexity. The Bill uses technical terms, and references to a patient being transferred from guardianship under section 19 or to a community treatment order being revoked are not immediately clear and may not be uniformly interpreted by all clinicians and regulatory staff.

Why is that a potential problem? If these terms or categories are not clearly defined and communicated, or if the practical implications are not straightforward, there is a risk that clinicians might misclassify a patient’s status, leading to incorrect timings or absence; regulatory authorities might struggle to apply the rules consistently; and patients might inadvertently fall through gaps in reporting. For example, let us imagine a patient who was initially under guardianship, which means that someone was legally responsible for their care, but who was then transferred to a hospital order under part III of the 1983 Act. If the clinician or regulator is unclear whether the patient fits into the “transferred from guardianship” category for the revised six-month reporting cycle, they might apply the wrong schedule, and thereby delay important reviews or misunderstanding opportunities for intervention.

Concern about definitions is really about ensuring clarity and practicality and making sure that everyone involved in patient care and oversight understands precisely which patients fall under which reporting categories, so that the intended protections and reviews happen without there being confusing gaps.

[Stephen Kinnock]

The classification of which part III patients the clause applies to is at the heart of the shadow Minister’s question about ensuring that everything is co-ordinated and we do not have conflicting reports and timeframes. I think that that classification is clear, but to recap, the changes will apply to the following patients detained under part III of the Act: patients who have been transferred from guardianship to hospital, and patients whose community treatment order has been revoked and more than six months has passed since their original hospital order was made. That classification is important. It is also important to bear in mind that the clause is all about maintaining the current frequency. We are not really injecting a new reporting rhythm; it is about maintaining the current frequency, but having that clarity around the classification of patients, as I outlined.

Question put and agreed to.

Clause 16 accordingly ordered to stand part of the Bill.

Clauses 17 and 18 ordered to stand part of the Bill.

Clause 19

Remote assessment for treatment

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

[Stephen Kinnock]

I will discuss the clause and review of treatment. Under the Act, the regulator, the CQC, is responsible for appointing individuals to provide independent second opinions on the administration of certain treatments. As part of that, the appointed person may visit, interview or examine the patient to make their determination of whether treatment is appropriate. The clause permits the use of remote interview and examination for the purpose of any second opinion functions, which relate to treatment under part IV or 4A of the Mental Health Act.

Allowing interviews or examinations to occur in person or remotely is expected to result in more timely involvement of second opinion appointed doctors, an important safeguard. In turn, patients will have access to a greater diversity of second opinion doctors, as opposed to only those in the local area.

We understand that remote interview or examination may not always be appropriate, compared with the in- person option. That is why the clause only permits the use of remote where it is considered appropriate by the second opinion appointed doctor, taking into account the patient’s preferences and other factors. We will provide specific guidance on the circumstances under which remote may be appropriate, and where we discourage its use, in the Mental Health Act code of practice. I commend the clause to the Committee.

[Dr Evans]

I welcome the Government’s recognition that modern technology can play a valuable role in improving care in the mental health system. The move to allow remote interviews and examinations for second opinion appointed doctors, through live audio or video links, reflects the realities of healthcare today and the potential for greater flexibility and efficiency. In particular, the so-called hybrid model, as set out in the explanatory note, could help speed up access to important second opinions and reduce delays in treatment decisions. That is especially welcome given the well documented pressures on mental health services and the vital role of second opinions in safeguarding patient rights.

While the intention is laudable, however, I have a number of concerns to go through, because I believe that the House must consider them carefully. First, the clause leaves the clinician significant discretion to decide whether a remote assessment is appropriate, but it does not set out clear criteria or safeguards for how that decision should be made. Given the serious nature of second opinion assessments, which often authorise treatment without consent, we must ensure that the discretion does not lead to inconsistent or inappropriate use of remote methods.

Secondly, mental health patients are a diverse group, and many face particular communication challenges. For example, a patient who has experienced a stroke may have speech impediments or difficulty understanding complex questions. Others may have conditions such as autism or dementia that make remote communication difficult or distressing.

This was a really big topic in the other place, particularly as there are several esteemed colleagues who are part of the speech and language therapy fraternity, so it warrants a bit of attention. For example, we need to look at access to speech and language therapists. We also think about how these important communications needs will be assessed and accommodated. Will there be a statutory requirement for a clinician to consider patients’ communications abilities and preferences before opting for a remote interview? I am concerned that, without such safeguards, patients may be subjected to assessments that do not fully capture their conditions or views, undermining the quality and fairness of the process. The Minister—I think—hinted that this may be covered in the code of practice. I hope it is.

Thirdly, the clause does not specify the role of patient consent or objection to remote access. Should patients have the right to request an in-person interview if they find remote contact unsuitable? This is not simply a matter of convenience; it is a question of whether we ensure the dignity, respect and meaningful participation in decisions about their own care. There is much debate in primary care about the role of video calls versus seeing a person face to face, and I would be interested to understand where the Government sit on that point.

The Bill lacks any specific provision for regulatory oversight or standards to govern the use of remote assessments. How will the regulator—presumably the CQC, but I would be grateful for clarification on that point—monitor whether remote assessments are being used appropriately, given the vulnerability of these types of patients? What mechanisms will patients or their advocates have to raise concerns or complaints if they feel remote assessment was not adequate or, even worse, harmful?

Finally, while technology can bring great benefits, it should never become a default substitute for face-to-face contact in mental health treatment decisions, especially where the stakes are so high. I assume the Minister appreciates that. Will this be set out clearly in the code of practice? Whose job is it to enforce that? Will there be a right to request an in-person interview, should the patient choose to? Has an equality impact assessment been undertaken to ensure that remote access does not disproportionately disadvantage those who suffer with communications difficulties or other vulnerabilities, or is that something that the Minister will implement in the code of practice? I would be grateful for some clarifications on those points, because it is really important to get it right when it comes to difficulties in communication, especially in this patient cohort.

--- Later in debate ---

[Gregory Stafford]

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

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

[Stephen Kinnock]

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

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

Question put and agreed to.

Clause 19 accordingly ordered to stand part of the Bill.

Clause 20

Capacity to consent to treatment 

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

[The Chair]

With this it will be convenient to discuss new clause 5—Report: statutory competency test for under-16s—

“Within 12 months of day on which this Act is passed, the Secretary of State must undertake a review of whether a statutory competency test for under-16s in determining their ability to make a relevant decision would be expedient for the purposes of this Act or the Mental Health Act 1983.”

This new clause requires the Secretary of State to undertake a review of whether a statutory competency test for under-16s would be expedient for the purposes of this Bill and the Mental Health Act 1983.

[Stephen Kinnock]

Clause 20 will make changes to wording under the Mental Health Act regarding the patient’s capacity and competence to consent to treatment so that it reflects the terminology used as standard by clinicians. While this amendment is not expected to create a practical change, it ensures consistency with other sections of the Mental Health Act and the Mental Capacity Act 2005.

As for new clause 5, it is our assessment that, were we to bring about legislative change which sought to introduce a statutory test of conscience for people under 16 in a single setting—that is, under the Mental Health Act—this could have unintended consequences for how competence is assessed, both in mental health settings and other linked areas of decision making. This could create additional confusion for clinicians and impact the ability of children to exercise choice and autonomy over their care and treatment in mental health and other settings, and cannot be justified. We therefore do not consider a statutory test under the Mental Health Act, or a review of that issue, to be necessary. We will consult on the guidance for assessing competence for under-16s in mental health settings in the revised code of practice, with the intention of providing further clarity to decision makers.

For those reasons, I commend clause 20 to the Committee and ask the hon. Members for Winchester and for Guildford not to press new clause 5.

[Dr Evans]

Clause 20 addresses a central principle in healthcare, ethics and law: the right of individuals to make informed decisions about their treatment, and the conditions under which that right can be overridden.

Let me begin by recognising the objective of clause 20 as both important and welcome. It replaces the outdated and potentially ambiguous language in the Mental Health Act 1983—language that speaks of whether a patient is

“capable of understanding the nature, purpose and likely effects”

of treatment—with a clearer legal standard based on whether a patient has capacity to consent, in accordance with the Mental Capacity Act 2005.

This reform aligns the Mental Health Act with how capacity is already understood and applied across health and social care, and it harmonises part IV of the Act with part 4A, which already uses that language in the context of community patients. So far, so sensible. However, as the Opposition, our role is not only to acknowledge the intention, but to ensure that the implementation matches the ambition, and that patients’ rights are not merely affirmed in law but upheld in practice.

What do these changes actually do? Under clause 20, we see a wholesale substitution of terminology. For example, in sections 57 and 58 of the Act, which deal with certain serious treatments such as neurosurgery and ECT, the language shifts from “capable of understanding” to having or lacking capacity to consent as defined in the Mental Health Act. It also explicitly incorporates advance decisions to refuse treatment under section 25 of the MCA, the role of a donee of lasting power of attorney, and the authority of a deputy appointed by the Court of Protection. This is a welcome acknowledgement of patients’ rights to plan ahead and to have their wishes respected, even when they later lose capacity.

While the Government’s explanatory notes suggest that this is not expected to create practical change, I think we should pause and ask: what if it does? We are told that clinicians interpret “capable of understanding” as meaning “having capacity” under the Mental Capacity Act. But the MCA test is precise: it requires the person to understand the information relevant to the decision, retain that information, use or weigh it as part of the decision-making process, and communicate their decision. So are clinicians routinely applying this test fully, or are they relying on informed judgment?

Can the Minister confirm, for example, whether NHS trusts have audited how consistently the MCA test is being applied in mental health settings? I was a clinician and am now an MP, so I understand the intent behind it, but the legal clarity—now with my MP hat on—is really important to ensure that we truly are interpreting the legislation we pass in this House for this country in the correct way when we are acting as clinicians.

When it comes to advance decisions in acute settings, clause 20 provides that an advance decision to refuse treatment must be both valid and applicable, as per section 25 of the Mental Capacity Act, but in the real world of psychiatric in-patient care, clinicians may encounter such decisions during a crisis, when patients are at serious risk of self-harm or suicide. How will the Government support clinicians in determining validity and application quickly, safely and lawfully? I assume— I think the Minister hinted at this—that that will be part of the code of practice.

On the power to override consent, perhaps most crucially the Mental Health Act allows for treatment without consent, even when the person has capacity, if they are detained under the Act. Again, we touched on this in relation to amendments discussed on the first day. That is a profound legal power. Does the clause change it in any way, or does it simply confirm that capacity is assessed, but not necessarily respected, under compulsion? If the Government intend the law to remain as it is—that patients with capacity can still be treated without their agreement—they may well need to specify and set that out. I urge Ministers to consider how we communicate that reality to patients, whose sense of agency and trust in the system may otherwise be undermined.

I turn to the matter of Gillick competence for children under 16. The clause clarifies that the standard for under-16s is Gillick competence, not capacity under the Mental Capacity Act. This reflects the long-standing legal test established in the 1986 case of Gillick v. West Norfolk and Wisbech Area Health Authority. Under Gillick, a child can consent to their own medical treatment if they have sufficient understanding and intelligence to comprehend what is proposed.

The Gillick test has advantages. It allows for a case-by-case assessment, not a rigid age threshold, and respects the emerging autonomy of young people. However, there are also risks: it can lead to inconsistency between clinicians and does not offer the same structured framework as the MCA. What safeguards will be put in place to ensure consistency and rigour in applying the Gillick test? Will the Government commit to updating the code of practice with guidance on assessing Gillick competence specifically in mental health contexts?

I turn to deputies, attorneys and verifying authority. The clause references lasting powers of attorney and deputies—that is right and proper—but we need to ask how a clinician will verify that a donee is acting within the scope of their authority. Will the Government consider a national standard protocol to support clinicians in checking LPAs and court orders, particularly in urgent situations? For example, could this be part of the checklist, which we have already discussed, or is it implied that it will be part of that in the first place?

Many of those concerns were shared in the other place. They were partly addressed in the letter for Baroness Merron, which is worth reviewing. It sought to clarify a number of concerns raised on Second Reading in the other place. I welcome the tone of the letter and the Minister’s stated willingness to listen. In particular, I acknowledge the recognition of the “challenges…to decision makers” that may be presented by

“the complex interface between the Mental Health Bill and the Mental Capacity Act”,

and I welcome the Government’s commitment to engage with clinicians and stakeholders during the revision of the code of practice. That is important.

However, the letter also raises some further issues that deserve scrutiny. First, the Minister says:

“Both Acts provide appropriate procedural safeguards to ensure that the individual’s Article 5 human right to liberty and security is protected during their detention. The nature of the safeguards provided under the two Acts are different”.

That is undeniably true, but therein lies the concern: where the safeguards differ, so too may the thresholds, the review mechanisms and the practical experience of those subject to detention. In cases in which a person might meet criteria under both Acts, what clear guidance will clinicians be given on how to decide which legal framework to apply and how to ensure that the individual receives the most appropriate and proportionate protection?

In the same letter, the Minister addresses the potential unintended consequences of reforms to section 3 of the Mental Health Act, namely that

“people with a learning disability and autistic people, who lack capacity, could, in certain circumstances, be detained under the Mental Capacity Act rather than the Mental Health Act”.

The Government’s stated intention is to prevent that outcome by strengthening community-based services. The letter states that

“the proposed changes to Part 2, section 3…will only be commenced when we are assured that there are strong community services in place.”

In the absence of clear statutory criteria, that could be seen as moving the target, so will the Government publish a set of benchmarks or a public readiness test? The Minister has said that the implementation will take place over 10 years, but a readiness test with criteria setting out how that will apply would help us to deal with a lot of the issues that we have talked about during the passage of the Bill.

--- Later in debate ---

[Zöe Franklin]

I rise to speak in favour of new clause 5, which would require the Secretary of State to undertake a review into whether the statutory competency test for under-16s would be expedited under the Mental Health Act. It has been great to hear so many contributions from colleagues on the Committee about the challenges that young people face when discussing their mental health and wellbeing and being involved in decision making around their health.

As my colleague Baroness Tyler noted in the Lords, and as the hon. Member for Hinckley and Bosworth noted in his early comments, the consistency with which Gillick competency is interpreted in the case of young people is a bit of a grey area. That is the key reason why we have tabled this new clause. We want young people to be empowered to be involved with decisions around their mental health. It is not hard to imagine how traumatic it must be for an under-16 to refuse treatment when they fully understand and object to it, yet be overridden because no one is quite sure how to assess their competency robustly. We believe that, at the very least, we owe it to young people to ensure that our legal framework is coherent, fair and protective of their rights.

The new clause would allow the Government to lead that conversation in a measured and consultative way. A statutory review would bring much-needed evidence and direction to a complex but critical issue. I am disappointed that the Minister will not consider the new clause, but I will withdraw it for expediency. However, it has been good to hear the commitment from the Minister to consulting on and reviewing this issue. The Liberal Democrats look forward to hearing more detail on it in the future and to being part of that conversation.

[Stephen Kinnock]

One theme raised by hon. Members on both sides of the Committee is the need for clarity and safeguards so that clinicians are clear on how best to assess competence. The Mental Health Act code of practice already provides guidance on establishing competence in under-16s. We will consult on the guidance for assessing competence in mental health settings in the revised code of practice, with the intention of providing further clarity to decision makers. That will include engagement with key stakeholders and clinical decision makers with experience of assessing competence in children.

We think it is better to focus on improving the practical application of Gillick and assessment of competency rather than reinventing the wheel, with the risk that that might cause confusion. The Department will work with NHS England, Social Work England and other partners to develop appropriate training for staff on the reforms. Once the code of practice has been updated, professionals working under the Act will be required to undergo training to maintain their competence and awareness of the Act.

[Dr Evans]

I cannot resist the opportunity to probe the Minister on something so important. He said that NHS England will predominantly look at this, but changes are happening there. Will he ensure that Gillick competence and the assessment of capacity will be at the heart of this? It is unclear now, given that it will take two years for NHS England to be abolished, who will take that on. Will he ensure that that is given due attention, as we have with physical health?

[Stephen Kinnock]

Absolutely. We must ensure that we act rapidly as soon as the Bill gets Royal Assent by launching the consultation process on the code of practice. It will be vital that the question of the practical application of Gillick and the need for clarity is universalised right across the system.

The shadow Minister asked about the interface between the Bill and the Mental Capacity Act. We recognise the complex nature of that interface, which presents challenges for decision makers. We will continue to consider this interface as we implement our reforms, and we will engage with stakeholders to understand what support and guidance could help to improve application of the interface when we consult on the new code of practice.

My hon. Friend the Member for Croydon East made some powerful and important points about the risk of unintended consequences if we try to reinvent the wheel on this. She is absolutely right. She asked what we want to see in the consultation on the code of practice. For me, the two key areas would be clarity and ensuring practical application of Gillick, by understanding the case law and the complexity of the interface between the pieces of legislation. It is about ensuring that we get that clarity. We cannot do that in an ivory tower. We have to do it with Social Work England and a range of partners with practical, hands-on experience to ensure that the code of practice is the bible for addressing these important issues.

Question put and agreed to.

Clause 20 accordingly ordered to stand part of the Bill.

Clause 21

Care and treatment plans

[Zöe Franklin]

I beg to move amendment 48, in clause 21, page 30, line 28, at end insert—

“(ab) containing steps to alleviate social and financial stressors contributing to the patient’s risk of requiring detention in future; and”.

This amendment would require social and financial stressors be addressed in care and treatment plans.

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[Dr Evans]

Clause 21 will introduce a statutory duty to provide care and treatment plans for most patients detained under the Mental Health Act in England. It is, in the Government’s own words, a cornerstone of the reform package, so it warrants thorough scrutiny.

Under the current legal framework, there is no universal statutory requirement for a written care and treatment plan for detained patients. Although the care programme approach is widely used in England, and the Mental Health (Wales) Measure 2010 provides a statutory framework for care planning in Wales, provision in England is more variable. There is also the section 117 duty to provide aftercare for some patients, but there is no legal requirement to produce a personalised plan that spans care, treatment and discharge planning from the point of detention.

Clause 21 attempts to fill that gap. We welcome its aim of ensuring that all eligible detained patients in England have comprehensive, personalised and reviewable care and treatment plans in place. We particularly support the requirement for the plans to address both clinical and social needs such as housing and employment. The aim to embed transparency and collaboration will ensure that patients and those close to them are meaningfully consulted when it is practicable. The ambition to create a consistent national framework, which will improve the quality and equity of care, is also commendable, as is the recognition that restrictive interventions, including compulsory treatment, should be clearly justified in the plans.

Nevertheless, I have several important questions for the Minister. We have talked about the draft regulations; I assume that these plans will be encoded in them. Does the Minister have an idea of when the draft regulations are likely to be published? Given the interest in the plans, that is important. Much of the substance of what a plan must include, including how often it will be reviewed and how much information can be disclosed, is left to regulations. Without sight of it, how can Parliament be confident that the framework will be robust, enforceable and fit for purpose? I trust the Minister, but what if he is shuffled away and we get a different Minister? We may not know.

I turn to timeliness. Will the Government consider setting a clear deadline in regulations, for example within seven or 14 days of detention, for the creation of a care and treatment plan? The benefit of personalised planning can be realised only if plans are produced promptly.

That point leads me to enforcement and accountability. What happens if a care and treatment plan is not produced or is not updated appropriately? Will patients and their advocates have any legal recourse? What oversight mechanisms are being developed to ensure compliance?

Proposed new section 130ZA(6) of the Mental Health Act requires consultation with the patient and with their family or advocate, but only where practicable and appropriate. Can the Minister explain how that will be interpreted in practice? Would the Government consider strengthening the consultation duty to require a recorded justification when a consultation does not occur? It seems to me that in most cases it should happen, so providing a justification when it does not would allow accountability and ensure that it is being put in place.

How will the plans integrate within existing frameworks? Many detained patients already have a CPA plan, or a section 117 aftercare plan. How will the Government ensure that these new statutory plans complement existing requirements, rather than duplicating them?

On forensic patients and privacy, the clause allows for the inclusion of information about victim and public protection arrangements in plans for patients detained under part III of the Act. I completely understand why that is, but it raises a question: how will the Government balance the patient’s right to privacy, rehabilitation and focus with safety? We support the principle that everyone detained under the Act deserves a clear, person-centred plan that outlines not only why they are detained, but how they will move forward, recover and return to life in the community.

I turn briefly to the Liberal Democrat amendments. I assume that many of the points will be addressed in the regulations, so I will not go through all the individual applications, because I think that there is space there and the plan would be able to pick things up. However, I completely understand what the hon. Member for Guildford is trying to achieve. The thrust of all the amendments that the Liberal Democrats have tabled has been accountability and making sure that we consider all points. I just hope to make sure that the Bill is practicable, and I hope on behalf of His Majesty’s Opposition that we can strike a balance between accountability and practicability and ensure that we have both.

The Minister clearly has support from both sides of the Committee for getting this right. I look forward to hearing his answers and hearing about how Members can work together to ensure that.

[Stephen Kinnock]

I thank hon. Members for this useful and insightful debate on care and treatment plans. I will begin by discussing amendments 14, 15 and 48. I reassure Members that the scope of the new statutory care and treatment plan has been made purposefully broad, so that wider matters relevant to a person’s mental health recovery, such as financial support and social care needs, are captured. We recognise that they can play a significant part in a person’s mental illness and can increase the risk of people with mental illness, learning disabilities and autistic people experiencing crisis leading to detention under the Act. Consideration of those issues can be critical to providing a comprehensive and effective programme of care and support.

As was promised by Baroness Merron and referred to by the hon. Member for Guildford and my hon. Friend the Member for Shipley, the required contents of the care and treatment plan, which we publicly consulted on, will be set out in regulations. More information on what we intend to include in relation to financial matters, housing and accommodation needs, and other issues can be found in the relevant policy paper in the parliamentary Libraries.

We will provide guidance in the revised code of practice that will set out that in-patients receiving acute mental health care should be offered financial support, among other interventions, aimed at meeting the person’s holistic needs. To ensure that a person’s wider needs are identified as early as possible by mental health professionals, we intend to encourage individuals to include this information in their advance choice document.

I turn to housing and accommodation protection, which are referred to in amendment 15. Where a person is detained in hospital and is receiving housing benefit, or their housing is paid for via universal credit, there are provisions already in place that allow for them to be temporarily absent from their property for a limited duration. We will use the code of practice to set clear expectations on mental health staff around care planning, including consideration of accommodation and housing needs. We will also highlight existing provisions that protect a person’s living arrangements while they are in hospital.

I turn to amendment 23, which was tabled by the hon. Member for St Neots and Mid Cambridgeshire. Under the Bill, all patients will receive a statutory care and treatment plan, excluding those under short-term sections. The patient’s statutory care and treatment should be created by the clinician in consultation with the patient and those who care for them, such as family members and carers. The clinician is expected to make reasonable adjustments to meet any communication needs, so that they can participate as fully as possible in making the plan to ensure that their wishes and feelings are reflected.

It is already our intention for care and treatment plans to cover information relating to a patient’s communication or sensory needs, if it links to their mental health recovery. That includes their wishes and preferences, information pertaining to their family or carers, and arrangements relating to their safe and effective discharge, which may include crisis planning. We will of course provide detailed guidance in the code of practice to ensure effective care planning for people with learning disabilities and autistic people that takes into account their specific needs.

I turn to amendment 50. Last year, the Government issued statutory guidance under the National Health Service Act 2006 on discharge from all mental health and learning disability and autism in-patient settings. That guidance underlines best practice on discharge planning and multi-agency collaboration between NHS bodies and local authorities, in line with statutory duties to co-operate under the 2006 Act. We intend to make the discharge plan a required part of the patient’s statutory care and treatment plan, and that will be made explicit in regulations. The scope of the care and treatment plan is broad, allowing for consideration of the patient’s holistic needs as part of their discharge plan. Under the Bill, the plan should be prepared and reviewed in consultation with the patient and others, such as their advocate, carer or family members, where appropriate and practically achievable.

Statutory guidance on discharge planning sets out that it should start on admission of the person to hospital, if not before. All detained in-patients are supported by a multidisciplinary team responsible for their care and treatment. Discharge planning should involve input from other agencies and the community team responsible for the individual’s ongoing care and treatment once discharged. Where a person is eligible for section 117 aftercare, planning should involve commissioners and local authorities too—

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[The Chair]

Order. The Minister must finish his remarks first.

[Stephen Kinnock]

I did not know that, Mr Vickers. Thank you for clarifying that point.

To promote a patient-centred approach to discharge planning, we would prefer to avoid mandating in law which professionals should be present at discharge planning meetings. To formalise best practice, the Bill requires that the responsible clinician consults with another professional who has been involved in the patient’s treatment before discharge can take place.

I turn to amendment 16. We agree that a young person turning 18 is at an important transition point in their care and treatment, which usually involves the young person being transferred to adult services. Under the Bill, the responsible clinician is already required to review a person’s care and treatment plan following any change in their condition or circumstances that they consider significant. The transition to adult services clearly represents a significant change in circumstances, which rightly instigates a review of the patient’s plan by the responsible clinician. We intend to make that expectation explicit in the code of practice. In line with existing care standards and guidelines, we will also underline the importance of planning in advance of a patient’s transition to adult services and of collaboration between clinical teams, as well as other measures that seek to minimise disruption to the young person’s care and treatment journey.

We support the intention of amendment 17. However, there are existing provisions, both within the Bill and across other legislation and guidance, that aim to safeguard children and young carers. For example, statutory guidance on working together to safeguard children already sets out the importance of health and social care professionals acting proactively and in collaboration with other agencies to identify and respond to children in need, including where a parent requires mental health support. There is also an existing statutory duty on local authorities to assess the support needs of young carers.

The Children’s Wellbeing and Schools Bill contains provisions that will strengthen multi-agency working with children and families, helping to ensure that local authorities deliver on their child protection duties. We also plan to reflect key requirements in the revised code of practice to ensure that children and young carers are safeguarded.

We understand that sometimes, when a person is detained, young carers are not appropriately identified. To address that, we plan to encourage individuals to use their advance choice document to ensure that the appropriate services are made aware. Under the Bill, carers should be consulted on the preparation and review of a patient’s care and treatment plan, where appropriate. We will include guidance in the code to ensure that young carers are appropriately involved and supported. We therefore believe that an additional duty would be unnecessary.

Clause 21 will introduce statutory care and treatment plans for all patients detained under the Mental Health Act, including patients under community treatment orders and those who are subject to guardianship. Only those who are subject to extremely short detention periods, such as those lasting a matter of days, are excluded.

The clause sets out in broad terms what the plans should cover, and provides the Secretary of State with the power to specify the contents in regulations. Setting out the requirements in primary legislation and further details in regulations will ensure that every patient’s care and treatment plan is comprehensive and that there is consistency across plans, which we know is not currently the case.

Under the clause, the clinician must prepare and review the plan with the patient and their close contacts, such as family members, carers or their nominated person. That helps to ensure that the patient’s wishes, feelings, beliefs and values shape the plan, thereby increasing the likelihood of their engagement with it. To help to ensure that the plan is kept up to date, the clause specifies important trigger points at which the patient’s clinician should review the plan with a view to potentially revising it.

Beyond providing a clear strategy for how the patient will be supported towards their recovery, it is envisaged that the plan will provide an important audit trail of key decisions made by the patient’s responsible clinician. To embed those new statutory requirements in practice, the clause will place requirements on the managers of a hospital, or the relevant authority, to monitor compliance with the duties. Sir Simon Wessely described statutory care and treatment plans as the cornerstone of the proposed reforms, delivering on each and every one of the guiding principles.

For the reasons that I have outlined, I hope that hon. Members will not press their amendments and will support clause 21.

[Zöe Franklin]

I thank the Minister for going in detail through the points raised in our amendments. It is good to hear how each of them is being addressed through the code of practice and in the Bill. I am reassured, so I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 21 ordered to stand part of the Bill.

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

Mental Health Bill [ Lords ] (First sitting)

Stephen Kinnock Excerpts

Tuesday 10th June 2025 Public Bill Committees

[The Chair]

With this it will be convenient to discuss clause 2 stand part.

[The Minister for Care (Stephen Kinnock)]

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

I thank the many hon. Members who spoke on Second Reading. It is clear that in this place, as in the other place, the Bill will proceed in a collaborative and constructive spirit, with the single motivation of getting the reforms right. On Second Reading, we heard numerous powerful accounts from hon. Members arising from their personal experience of supporting family, friends or constituents with a serious mental illness, a learning disability or neurodiversity, or drawing on their own experiences to underscore the importance of the need for reform. I was heartened to hear from so many Members who set out the positive impact of the changes that the Bill will introduce, particularly the vital changes to ensure that patients’ voices are heard and that—as we would expect in any modern mental health service—the patient is at the heart of all decision making.

In our manifesto, we committed to modernising the Mental Health Act 1983 to give patients greater choice, autonomy, enhanced rights and support, and to ensure that everyone is treated with dignity and respect throughout their treatment. I am proud that we included this critical Bill in our first King’s Speech, and I look forward to constructive engagement with the Committee on this important legislation.

I will also take a moment to thank the Liberal Democrat Member, the name of whose constituency escapes me, and other MPs who have shone a light on the experiences of Fiona Laskaris and other families. No one should lose a child in that way. I thank Fiona for meeting me and I commend her tireless campaign efforts. The engagement that my officials and I have had with Fiona and the hon. Member has been incredibly valuable. Unfortunately, the Bill is not the appropriate vehicle to address those concerns, but I have committed to continuing engagement with Fiona and the hon. Member to further explore those issues and how we might tackle them.

[Dr Danny Chambers (Winchester) (LD)]

I know that my hon. Friend the Member for Dorking and Horley (Chris Coghlan) has been pushing forward on that very emotive and difficult issue of capacity; he brought it up in his maiden speech and has been campaigning tirelessly on it. My hon. Friend said that the Minister was very constructive in his engagement on the issue, which we very much appreciate. Even though we cannot include it in the Bill, we look forward to working on it.

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[Stephen Kinnock]

I thank the hon. Member for that intervention, not least because it gave me the opportunity to remember the constituency of the hon. Member for Dorking and Horley—please pass my apologies to him for forgetting that important point. He has been a tireless campaigner and I believe that we can find a way forward; this Bill is just not the correct vehicle for it.

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

I also want to assess the amendment that could potentially have been tabled. The Opposition were struggling to see how it would fit in, and it looks as if there is a crossover with the Mental Capacity Act 2005. Can the Minister set out why he felt that it did not quite fit into this area and how it could be taken forward, so that with cross-party work outside this Committee we can see how we can make it happen?

[Stephen Kinnock]

There were a number of technical and drafting issues. The Public Bill Office ruled that the amendment, as drafted, was out of scope. One of the key concerns was about the unintended consequences of the relationship between physical disability and mental disorder. The drafting of the amendment could have caused confusion, because it could have started to bring physical disability into the scope of the Bill, which is clearly not what it is about. There were a number of technical and drafting issues, but I do not think that they are insurmountable. We can get to where we need to be, just not through a legislative vehicle.

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

I support the comments of the Minister and the hon. Member for Winchester on the issue. On a cross-party basis, I know that my right hon. Friend the Member for Godalming and Ash (Sir Jeremy Hunt) has taken a close interest. Could he also be included in those discussions?

[Stephen Kinnock]

Yes, absolutely. We had a very constructive meeting with the right hon. Member for Godalming and Ash, along with the hon. Member for Dorking and Horley, and we are certainly open to working with that team of people, who are clearly focused on getting the results that we all want to see.

Clause 1 will make it a statutory requirement for the Secretary of State to include, in the statement of principles in the Mental Health Act code of practice, the wording of the four principles identified by the independent review. Those principles are choice and autonomy, least restriction, therapeutic benefit and the person as an individual. This will ensure that the review’s principles underpin the implementation of the Mental Health Act 1983 and are considered when making decisions related to care, support or the treatment provided to patients under the Act.

Embedding the principles in day-to-day practice will help to drive the culture change envisaged by the independent review. We are including the principles in the Act so that they govern the content of the code of practice and can changed only by Parliament. The Government are firmly supportive of the four principles, which were co-designed with service users during the independent review. They have informed every decision made in developing the Bill. We have embedded the principles in measures throughout the Bill, such as via the inclusion of therapeutic benefit in the detention criteria and several measures to improve patient choice and autonomy, including new treatment safeguards, introducing advance choice documents and the right to choose a nominated person.

I turn to clause 2. The code of practice for Wales already includes a statement of principles, although it is not a statutory requirement under section 118 of the Mental Health Act 1983 for Welsh Ministers to do so. Clause 2 will amend section 118 to extend subsection (2A) to Wales, along with the new subsection (2B) inserted by clause 1. To do so, clause 2 will also make amendments elsewhere in section 118 to clarify the application of each subsection, which will be to the Secretary of State in relation to England, to Welsh Ministers in relation to Wales, by virtue of the transfer of devolved functions, or to both.

The extent of the Mental Health Act is England and Wales, and there are separate codes of practice for England and Wales. Both codes of practice currently include a statement of principles, although the principles themselves vary slightly. Clause 2 will place a statutory requirement on Welsh Ministers to include the wording of the four principles identified by the independent review in the statement of principles when preparing the Mental Health Act code of practice for Wales.

As in clause 1, we are putting these principles explicitly in the Act so that they govern the content of the code of practice and so that they cannot be changed except by Parliament, or by the Senedd in respect of Wales. The Welsh code is already required to undergo scrutiny by Senedd Cymru, but clause 2 will also update the position in relation to the Senedd Cymru scrutiny procedure for the Welsh code. I commend clauses 1 and 2 to the Committee.

[Dr Evans]

It is a pleasure to serve under your chairmanship, Mr Vickers. I thank the Minister for his collaborative tone on some of the difficult amendments that we have discussed.

I will open where the shadow Secretary of State, my right hon. Friend the Member for Melton and Syston (Edward Argar), left us on Second Reading. As he rightly emphasised, the importance of updating the Mental Health Act cannot be overstated. I fully share his view that it was right to take the necessary time to get this legislation right. The cross-party commitment to reform in this area, spanning both previous and current Governments, reflects a shared recognition of the urgent need to modernise our approach to mental health, particularly for those who are most vulnerable.

I welcome the Bill’s focus on enhancing patients’ voice and autonomy, including through the expansion of independent advocacy and the shift away from using police and prison cells as a place of safety. Those are positive and overdue steps. At the same time, as my right hon. Friend outlined, the Opposition’s role is to engage rigorously and constructively with the details of the Bill. Over the next few weeks, I look forward to working with colleagues on the Committee to ensure that, for example, the principle of patient choice is embedded not only in policy but in practice, such as through the use of advance choice documents.

We will continue to scrutinise the Bill in good faith, proposing improvements where needed, with the aim of delivering the strongest possible protections and outcomes for patients, their families and the community. How we begin a conversation often determines whether it becomes dialogue or dispute, so I hope that the Committee can take a constructive and productive look at what lies ahead of us.

I support clause 1, which will rightly update section 118(2B) of the Mental Health Act 1983 and embed a refreshed code of practice at the very heart of the mental health framework. This is not merely a procedural amendment; it is a statement of values, placing humanity, dignity and recovery at the centre of how we treat some of the most vulnerable people in our society, who are profoundly affected by mental health legislation. It is vital that the framework guiding professionals be clear, principled and rooted in respect for individuals.

Why do we need these changes? For too long, the Mental Health Act has been criticised as outdated and insufficiently centred on patient autonomy and dignity. Concerns raised by successive independent reviews, clinicians and, crucially, by people with lived experience have pointed to inconsistencies in how decisions are made, which can often result in over-restriction, lack of patient involvement and insufficient therapeutic focus.

The independent review of the Mental Health Act, which was published in 2018, made a landmark contribution by recommending the adoption of the four core principles in front of us today: choice and autonomy, least restriction, therapeutic benefit and recognition of the person as an individual. These principles are designed to shift the culture and practice towards one that respects autonomy while safeguarding wellbeing and public safety.

The historical context is that the Mental Health Act has undergone several amendments since its introduction—notably, in 2007, updates were made to some of the detention criteria and safeguards—but it was clear that the Act remained predominantly paternalistic. The 2018 independent review was a comprehensive, evidence-based re-examination of the entire Act, informed by extensive consultation, including with patients, families and clinicians. It concluded that embedding the principles formally into the law and code of practice was essential to modernise and humanise mental health law.

The four key principles—choice and autonomy, least restriction, therapeutic benefit and the person as an individual to be treated with dignity—are not abstract ideals. They are the foundations of compassionate, lawful and effective care. They echo the spirit of the UN convention on the rights of persons with disabilities and signal a move away from paternalism and towards genuine co-production of care plans. Involvement ensures that decisions are not made about patients without them. The principle of choice and autonomy reminds us that the mental illness must not be a justification for blanket restrictions. The principle of least restriction challenges us to find community-based alternatives before defaulting to detention. Therapeutic benefit ensures that care is not custodial, but meaningful healing. These principles are what most of us would hope to see for our own family.

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Finally, we hope that the new structure will not inadvertently lead to inequality. We already see that in the wider Welsh-English NHS approach. With something as sensitive as severe mental health issues, we need to do our best to guard against that. We welcome the locally tailored codes, but we must maintain shared standards of care, dignity and human rights across the UK.

[Stephen Kinnock]

I thank the shadow Minister for his questions. I will answer to the best of my ability, but I may need to write to him on one or two points.

On enforcement and accountability, the code of practice is underpinned by the Bill and is therefore legally binding. Any divergence from the code of practice would need an extremely strong justification. That could well end up being a matter for the courts. I think that we will see a fairly strong line of sight from this primary legislation through to the code of practice and its implementation. Enforcement and accountability will be provided on that basis.

On balancing conflict, we will consult on the code of practice. Consultation will launch as soon as the Bill becomes an Act. That will be an important part of getting to the nub of some of these nuanced issues. It is quite difficult to put all that down in a document—a lot is about the culture, as the shadow Minister said—so we need an approach that has sufficient flexibility, but with clear outcomes and accountability. The consultation process will help us to get that.

[Dr Evans]

I agree with the Minister. Does the Department have a rough idea of the timetable for putting in place the code of practice? How long will the consultation need to take? When will it be implemented? How many rounds go with it? How wide is it to be—will it consult across England and Wales, or just in England?

[Stephen Kinnock]

We expect the entire process to take about a year from Royal Assent. My colleague Baroness Merron made a strong commitment from the Dispatch Box in the other place that we will present a written ministerial statement to the House every year. That will be the opportunity for us to report on the progress of all the measures that need to be implemented. A pressing task is to build the community capability required in this shift from hospital to community, which is very much part of the Bill and of our broader strategy for mental health and, indeed, health across the board. We need to report every year on that, but the first year will also be a report on the consultation and its conclusion, including the conclusion of a draft code of practice. We expect that to take approximately 12 months.

That, in some ways, has also answered the shadow Minister’s question about training and resources. A big part of the reason for the 10-year implementation period is the time that it will take to do the training and the training needs analysis, to identify trainers to deliver the training, and to get the system up to speed. That will be a fairly large chunk of the 10-year process.

[Dr Evans]

The Opposition appreciate the timescale taken to skill-up in this area, but the workforce plan is soon to be announced by the hon. Member’s Government. Has any consideration been made of what the capacity might look like, and of the crossover between having this legislation not quite in place—although likely to happen, upon Royal Assent—and its impact on updating the workforce plan on mental health?

[Stephen Kinnock]

The shadow Minister is tempting me to reveal the details of the workforce plan. While I have a huge amount of respect for this Committee, I do not think that it is where we will launch it. Absolutely, however, that is built into our thinking about the plan. There is a huge mental health challenge in our country, and those with acute and severe disorders and conditions which the Bill is designed to address are absolutely a part of that. A skilled and compassionate workforce is required, and I pay tribute to the amazing staff, mental health professionals and others who work in this area, often in incredibly challenging circumstances. We recognise and value that. The Bill does need to hook up with the workforce plan, and we are focused on that.

On Wales and the risk of divergence, the shadow Minister makes an interesting point. I guess it is about ensuring that that there is devolution, but not divergence, in the sense that we have a framework here—much of the legal framework is reserved—but the delivery of mental health services is devolved. That balance has to be right, but it is something that the two Governments have been working on since devolution started in 1998. There is a fairly mature and sophisticated culture in the interface between the two Governments. The shadow Minister is right to flag that point, and I am more than happy to seek some assurances from officials and write to him. However, as things stand, I do not see any particular risks.

[Dr Evans]

The Minister is right that there is shared working. However, part of the problem between devolved nations, such as Scotland and Wales, is that the datasets and definitions of data are often changed. Actually, the comparison of data across the UK can be quite hard to manage. Given that we are talking specifically about mental health, including some of the most at-risk people with the most severe mental health illnesses, will the Government commit to pushing for shared data that is comparable between Scotland and Wales, which we are legislating on in this case, to ensure that there is data transparency, so no one country can hide behind a different comparison or by saying, “We are looking at apples and pears”?

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[Stephen Kinnock]

It is important that we do not see devolution as a wall between the two countries; in fact, we should be sharing information and best practice—nobody has a monopoly on good ideas. The Welsh Government have achieved some things, particularly in mental health, that England could learn from, and vice versa. There is no reason why the data cannot be shared from my own practicable and pragmatic point of view. There may be some issues with data protection, but data protection law really should be implemented in the same way right across the board because it is reserved.

[Dr Evans]

I entirely agree, and I hope that data is and will be shared. The question is about the definitions and standards, such as those used for waiting times. We often use the A&E waiting time of four hours. When it comes to the most vulnerable patients who will potentially be on waiting lists, or looking at specific data, if it is categorised differently in Wales, Scotland and England, that makes it very hard to see where best practice is so that it can be shared. That is the Opposition’s concern. I know that both sides of the House have shared that concern in my five years in Parliament. Is there a mechanism to address that issue either in the Bill or in the Minister’s wider portfolio?

[Stephen Kinnock]

I see. I am sorry; I had misunderstood the shadow Minister’s point. I thought it was about sharing data on particular patients, especially those who are crossing borders. The point about waiting lists is a more difficult issue. The Welsh Government have taken a view on how best to define them. For example, I know that ambulance waiting times have been quite controversial because there is a different definition in Wales to England. Many feel that the definition adopted by the Welsh Government sets the bar at a higher standard, which can then sometimes framed, in the hurly-burly of politics, as failing more than they would be if they had used a different metric, but they have chosen to use that metric.

In the context of devolution, it is up to the Welsh Government to decide how best to evaluate the Welsh health service and its performance. I take the shadow Minister’s point on having the best alignment that we can, but when it comes to this UK Government, we will determine how performance is evaluated for England, and the Welsh Government will determine how best to evaluate performance for Wales. I think that the Welsh media, the UK media, this Parliament and the Welsh Parliament will then decide who is failing and who is succeeding.

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

I represent an English constituency on the border with Wales; on some streets, one side is considered Welsh and the other English. Does the Minister recognise that it matters to people in England and Wales that there is consistency across both parts of our fantastic country, and that it is not sufficient to say that what happens in Wales will affect only Welsh people, or what happens in England will affect only English people?

[Stephen Kinnock]

I absolutely accept the point that there are deeply integrated communities on that border. A huge number of people live in England and work in Wales, or live in Wales and work in England. However, the fact of the matter is that health is a devolved policy area. It is, therefore, up to the devolved Administrations to determine how they want to measure the performance of their respective systems. It would be a violation of the principles of devolution if one Government in our United Kingdom were to dictate to another how they should evaluate their devolved policy areas—whether that is health, education or any other devolved area. I hope that I have responded to the best of my ability.

Question put and agreed to.

Clause 1 accordingly ordered to stand part of the Bill.

Clause 2 ordered to stand part of the Bill.

Clause 3

Application of the Mental Health Act 1983: autism and learning disability

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[Dr Evans]

The hon. Member is correct about the way in which the world looks at this issue. The problem is that we are sat here debating definitions in legislation that is 40 years old. Will we be here in 40 years debating definitions that have moved on? The amendment suggests that, somehow, we need to try to ensure that legislation is flexible and updated enough, and has the scrutiny and safeguards in place. That relates to not just health, but any part of government that we tend to look at in the House.

I wanted to speak to the amendment to probe the Government on how they will safeguard the legislation. I do not have all the answers, but this is important. I do not want to see my successors—the hon. Member for Hinckley and Bosworth from whatever party—sat here debating this issue in 40 years’ time because the definitions that we happen to set today have become outdated and have unintended consequences.

That is the balance that I am looking for. I do not see a body across the UK, given that this is UK legislation, that fulfils this role. It could be a transitory role or fully established. A psychiatrist could take it on, or it could come under NICE. With the abolition of NHS England, it could be a new role for the Department of Health to take on. All those are viable vehicles that could potentially look into the definitions. I want to ensure that what we pass in Parliament actually translates into the real world for clinicians, patients and the public.

The Opposition can see the argument both ways, as I mentioned. Perhaps it would be useful to have an expert panel, with representatives of clinicians, legal experts and service users to support regulatory updates. I put those questions to the Minister and I look forward to his answers.

[Stephen Kinnock]

I am grateful to the hon. Member for Solihull West and Shirley for moving the amendment on behalf of the hon. Member for Runnymede and Weybridge, and to the shadow Minister for speaking to it.

As this regulation-making power would amend primary legislation, it would signify a Henry VIII power that the Government consider to be unjustified. We have significant concern that it could change the way in which the Bill applies to people with certain conditions without appropriate consultation or parliamentary scrutiny. The serious matter of detention for compulsory treatment should be considered in primary legislation.

The hon. Member for Solihull West and Shirley spoke about the need to stay in touch with our evolving understanding of these terms and conditions. My view is that the Bill does that. We have modified the meaning of mental disorder by including new definitions of autism, learning disability and psychiatric disorder. That acknowledges the advancement in our understanding of learning disabilities and autism, and how the Bill should apply in respect of those conditions. Any future change to the definitions should be a matter for Parliament, informed by strong evidence and consultation with the public.

For those reasons, I ask the hon. Member for Solihull West and Shirley to withdraw the amendment.

[Dr Shastri-Hurst]

I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

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

[The Chair]

With this it will be convenient to discuss schedule 1.

[Stephen Kinnock]

Currently, a person with a learning disability can be detained for treatment under section 3 of the Mental Health Act when their learning disability

“is associated with abnormally aggressive or seriously irresponsible conduct”.

A person can be detained under section 3 on the basis of being autistic, which is classed as a mental disorder under the Act. However, we know that people with a learning disability and autistic people may sometimes be detained because of needs that have arisen due to insufficient community support, rather than for treatment of a mental health condition, and compulsory treatment in hospital settings is rarely likely to be helpful, particularly for autistic people.

Clause 3 and schedule 1 will insert new definitions in the Act and make amendments using those definitions throughout the Act. Those amendments will remove, for the purposes of part 2 of the Act, learning disability and autism from the conditions for which a person can be detained for compulsory treatment. It will be possible to detain someone for treatment under part 2 only if they satisfy the conditions set out in section 3, as amended by the Bill. These include that they have a “psychiatric disorder”, which is a

“mental disorder other than autism or learning disability”.

The changes will not apply to section 2 of the Act, under which a person can be detained for a maximum of 28 days for assessment to understand whether they have a psychiatric disorder that warrants detention under section 3. The revised detention criteria will not apply to part 3, so people in the criminal justice system can continue to be diverted to hospital, where appropriate, to access the specialist support they may need.

We recognise the importance of implementation in ensuring these reforms have their intended effect. For this reason, the proposed changes will be commenced only when there are strong community services in place. I commend the clause and schedule to the Committee.

--- Later in debate ---

[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.

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

It is a pleasure to serve under your chairship, Mr Vickers. I, too, have received messages from organisations in my constituency that welcome clause 3 and clause 4, which I will speak to later. On the implementation, however, they have made it very clear that it is really important to hear the voices of the individuals who will be impacted and their families. As we work with the ICBs, local authorities and commissioners to implement these new regulations, I seek an assurance that the voices of the community will be heard.

[Stephen Kinnock]

My hon. Friend is absolutely right that those voices must be heard. One example is that we must produce a code of practice to ensure that approved mental health professionals are better supported in their decision making, including when assessing whether somebody with a learning disability or an autistic person has a co-occurring mental disorder. At the heart of the process are the assessment and the definition, and the pathway that flows from that. That code of practice can be developed only on the basis of dialogue and engagement with precisely the people he has talked about.

[Dr Shastri-Hurst]

Building on the Minister’s last point, can he reassure the Committee that any consultation will have a strong focus on ensuring that practitioners have the training and, most importantly, the resources that they need to achieve a seamless transition from one set of regulations to another?

[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.

[Gregory Stafford]

On the point made by the hon. Member for Ashford about local authorities, given that the Government are devolving and reorganising local government structures across parts of the country, how will the Minister ensure that the standards around this issue—and other health and social care issues—are maintained? That restructuring means that we will have a whole load of new local authorities that do not necessarily have experience of dealing with this area.

[Stephen Kinnock]

The devolution Bill and the process of reorganising and restructuring are based on two really strong principles: that it is up to us through legislation to create the outcomes that we need to see delivered across the country and that there are clear standards and targets that we need to see met. But the implementation work needs to be done to deliver those desired outcomes and targets. Local authorities are empowered to do that, which is why we are seeing, for example, a lot of breaking down of ringfencing. The Government are keen to massively reduce the amount of ringfencing, because that has become a straitjacket for local authorities, integrated care boards and others in how they can best manage their portfolio of activities and deliver that devolved power and responsibility.

The answer to the hon. Gentleman’s question is that we want to devolve. We are absolutely committed to decentralising and we believe that is an important part of modern governance. Of course, that has to be done within a framework of set targets and the development of community services that the Bill commits to. All of that will come together to enable those at the coalface, who are best placed to understand them, how to deliver those services to their communities.

[Dr Evans]

Will the hon. Gentleman give way?

[Stephen Kinnock]

I just need to turn to the question asked by my hon. Friend the Member for Shipley. On strong duties, the code of practice flows from the primary legislation and therefore has a statutory power. There is no stronger power to ensure that people with learning disabilities and autism get the treatment, service and support that they require. The system will have a statutory duty to ensure that that happens within the framework of the legislation.

My hon. Friend is right that the transition from children’s to adult services is a major challenge. I am engaging with colleagues in the Department for Education about that to ensure that conversations about the transition happen upstream. We do not want a situation where an individual is looked after until they are 18 and then handed over without any prior conversations and engagement. We want the handover from one service to the other to be as seamless as possible. Our commitment to dynamic support registers will help in this context. They will be an important tool for understanding the needs of individuals who are at risk of admission and for getting that information into the system across the board prior to any detention.

My hon. Friend also asked about carers who so often pick up the baton in the gaps in community provision. She is absolutely right to flag that. We owe a huge debt of gratitude to the millions of unpaid carers across our country, many of them dealing with extremely challenging family situations. The system would simply collapse without them, so she is right to pay tribute to those people.

[Dr Evans]

I want to expand a little on the practicalities and respond to the question asked by my hon. Friend the Member for Farnham and Bordon about local authorities. I declare an interest because Leicestershire is one of the 21 county councils going through a devolution process. About 85% of its budget deals with special educational needs and social care. It is part of an ICB where the mental health team and primary and secondary care come together, but there is oversight from NHS England.

With so many moving parts, including the legislation we are putting in place, the budgetary constraints for ICBs, and the fact that we are getting rid of NHS England, there is a real worry among Opposition Members that things could drop through the gap, or more likely, that because we are moving all these things at the same time, we do not decide which is the fixed point that leads where others follow. If we are trying to cut costs in the ICBs, if NHS England is going over the next two years, and if devolution of responsibilities is also happening over the next couple of years with unitary councils forming, we will create a sticky situation for who is actually leading on this issue. At the heart of it are the clinicians and the patients who could fall through the gap.

What consideration has been given to the top-down strategy for how to incorporate all that? The Minister has talked about a red thread that runs through it all, but is there a running plan? Different Departments, agencies and areas of the country are involved. They are trying to come together to manage their budgets, legislation and policies. It is a complex situation to work through. The imperative part—the legislation—is almost the easier part to get in place; it is the delivery that is all-important. Can the Minister explain further how those three things tessellate?

[Stephen Kinnock]

I do not know whether I will be able to answer the hon. Gentleman’s question in its entirety, because quite a lot of that is being led by my colleagues in the Ministry of Housing, Communities and Local Government—in the English devolution Bill, for example. On the part of his question relating to the Department of Health and Social Care, we came to the view following the general election last year that NHS England was an unnecessary layer of bureaucracy. We think it is important that there is a clear line of accountability from the Secretary of State to Ministers, to ICBs, to trusts and to the system per se for delivery. That line of accountability was being blurred by NHS England, which is why we have removed it from the equation.

The hon. Gentleman is right that there are a lot of moving parts, but, by definition, a reform agenda creates change and some turbulence. We believe that is the only way we will get the system to where we need it to be so that we can deliver the three big shifts in our 10-year health plan: the shifts from hospital to community, from sickness to prevention and from analogue to digital. Many of the questions he is asking will be answered in the 10-year plan. He does not have long to wait for that to be published; it is coming very soon.

I reiterate that the principle underlying all of this is about empowering, devolving and giving agency to those closest to the communities they serve, because they are best placed to deliver. That all has to fit into the Bill, but the fundamental principle underpinning the Bill is the right one: it is about devolution, and about being patient-centric. The Bill deals with a cohort of people whose needs should drive the services that we design and deliver.

Question put and agreed to.

Clause 3 accordingly ordered to stand part of the Bill.

Schedule 1 agreed to.

Clause 4

People with autism or learning disability

[Dr Chambers]

I beg to move amendment 1, in clause 4, page 4, line 41, at end insert—

“(iv) housing.”

This amendment ensures that housing needs are considered as part of care, education and treatment review meetings.

Mental Health Bill [ Lords ] (Second sitting)

Stephen Kinnock Excerpts

Committee stage
Tuesday 10th June 2025 Public Bill Committees

[The Chair]

I remind the Committee that with this we are discussing the following:

Amendment 51, in clause 4, page 4, line 41, at end insert—

“(iv) accommodation and relocation, and”.

This amendment ensures that the impact of accommodation and relocation is considered in care and treatment reviews for patients with autism or learning disabilities.

Amendment 2, in clause 4, page 5, line 23, at end insert—

“(v) the patient,

(vi) the patient’s nominated person, and

(vii) the patient’s independent mental health advocate.”

This amendment would ensure that nominated persons and independent mental health advocates receive copy of a care, education, and treatment review meeting report for children and young people with autism or a learning disability.

Amendment 3, in clause 4, page 5, line 31, for “12” substitute “six”.

This amendment would shorten the length between care and treatment reviews from 12 months to six months.

Amendment 4, in clause 4, page 7, line 6, at end insert—

“(iii) housing, and”.

This amendment ensures that housing needs are considered as part of care and treatment review meetings.

Amendment 5, in clause 4, page 7, line 32, at end insert—

“(v) the patient,

(vi) the patient’s nominated person, and

(vii) the patient’s independent mental health advocate.”

This amendment ensures that nominated persons and independent mental health advocates receive a copy of a care and treatment review meeting report.

Amendment 6, in clause 4, page 7, line 40, for “12” substitute “six”.

This amendment would shorten the length between care and treatment reviews from 12 months to six months.

Amendment 7, in clause 4, page 8, line 12, leave out “must have regard to” and insert

“have a duty to carry out”.

This amendment ensures that integrated care boards and local authorities responsible for a patient's treatment and care have a duty to implement recommendations arising from a care and treatment review.

[The Minister for Care (Stephen Kinnock)]

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

I thank the hon. Members for Winchester and for Guildford for tabling this group of amendments. I will address each in turn, beginning with amendments 1, 4 and 51. We recognise that a lack of appropriate housing can be a barrier to discharge for some patients. That is why we have put the important reviews on a statutory footing. I am pleased to provide an assurance that the Bill already makes provision for any relevant recommendation about a patient’s discharge, including meeting their housing needs.

Statutory guidance will assist the responsible commissioner to determine who to involve in review meetings. That will include guidance on when the involvement of partners such as housing departments and organisations may be appropriate. Placing a specific requirement to consider the housing needs of every patient would mean that housing would have to be considered in every case, even if it is not a relevant issue. Potentially, that could divert focus from factors more relevant to the patient’s care and treatment.

On amendments 2 and 5, the Bill makes it clear that a copy of the review report must be provided to those who have a legal duty to have regard to the review recommendations, so that any recommendations are implemented as appropriate. The patient should receive the report, in line with good practice. However, we are concerned that requiring a longer list of people to receive the report in every case might increase the chance of patients withdrawing their consent for a review to be held, especially if they do not wish for those people to see the report. We recognise that it is often appropriate for the report to be provided to other people, such as those listed in the amendments, but the Bill was amended in the other place to make it clear that a copy of the report may be provided to other persons not listed in the legislation, with the patient’s consent.

Amendments 3 and 6 are unnecessary. The current drafting provides that review meetings take place at least once every 12 months. That is in addition to the requirement that arrangements must be made for an initial review meeting to take place within 14 days of admission for children and for some people aged 18 and over, and within 28 days for other adults. We also know that more frequent reviews may not be appropriate for all patients. For example, for a patient who is unable to be discharged for a long time, reviews that focus on discharge may be rather distressing.

Commissioners should use their judgment to determine whether the individual needs of a patient might mean that a more frequent review is appropriate. NHS England policy makes it clear that patients, their families and advocates can request a review meeting at any point. Statutory guidance will provide commissioners with further information on factors to consider when determining whether more frequent reviews should take place. For example, current practice, in line with NHS England policy, is that children under 18 should have a review meeting at least every three months—that will be made clear in the guidance. We consider it preferable to set out that information in statutory guidance, which can provide detailed case studies and be readily updated in line with emerging best practice, including on frequency and considering particular circumstances.

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

The Minister makes a fair point about best practice. However, did the Government consider any mechanism for how best to share best practice across areas? Especially as the Bill also covers Wales, as heard this morning, it might be useful—across the integrated care boards—to understand the Government’s thinking on how to ensure that best practice in exemplar places, where care is really good, can be shared to help places where care might not be so good.

[Stephen Kinnock]

The shadow Minister is right, and one of the overarching objectives of this Government is to take the best of the NHS to the rest of the NHS. We are very keen to ensure that we identify best practice right across the board in all the services that we provide, and that it is then replicated and scaled up. We also recognise, though, that every community and area of the country is different, so it is not about exporting and importing best practice. It is more about looking at those exemplars and asking, “How could we use some of this, without reinventing the wheel?” That is absolutely the culture of how we want our health service to run—I think it is a cultural point.

[Dr Evans]

The Minister makes a good point about the differences in the country, one of which is how the Care Quality Commission looks at the standards. Especially as the CQC is under new leadership, will it be taking a role in looking at how best practice is implemented while ensuring standards?

[Stephen Kinnock]

The CQC has a key inspection role, which is an important check and balance in the system. I would rather see the incremental building of a culture of excellence across the board, including within upstream institutions, ICBs, local authorities, healthcare professionals, mental health professionals and social workers. We need to create a collaborative approach across the board so that best practice is developed within a culture of excellence. One would hope that the CQC, when it does its inspections, is then finding positive results. Of course, it also plays an important role in identifying, investigating and holding to account when things are not going as they should.

Finally, I will address amendment 7. The Bill requires named persons and bodies to have regard to the review recommendations. This is a well-established duty that clinicians, integrated care boards and other public bodies are used to applying and already exists within the Act. Where effective care and treatment is the central aim, we expect careful consideration of all recommendations. Where these bodies decide not to accept a relevant recommendation, we expect them to have a very good reason.

It is inappropriate to place an absolute duty on a body to follow recommendations in every case, as flexibility is required to depart from a recommendation where appropriate, for example if a recommendation is outside the body’s purview or not in the patient’s best interests. As currently drafted, the Bill already requires that certain named persons or bodies carefully consider the recommendations and give them appropriate weight. Where a body does not consider a recommendation appropriately, that may be subject to review by the courts. In the light of all this, I therefore thank the Liberal Democrats—

[Dr Evans]

The Minister is right about the absolute nature of the Liberal Democrat amendment, but we talked about the duty to respond requiring a body to set out why it has decided to take action or not. The Minister seemed to allude to that, but he then jumped to talking about being challenged in court. Is there a hybrid version within that duty to respond so that it could stipulate the setting out of why the body is accepting the recommendations or not, because that may well help transparency?

[Stephen Kinnock]

I see where the shadow Minister and the amendments are coming from, but there is a risk of over-embroidering the Bill if we try to load additional duties on to something that we believe is already happening. It is a very well-established duty that clinicians, integrated care boards and other public bodies are used to applying, and this already exists within the Act. I think there is an element here of “If it ain’t broke, don’t fix it.”

If there is compelling evidence that it is not working, clearly we need to intervene as a system, which is about real leadership at the ICB level. As things stand, we feel that this amendment is surplus to requirements for the reasons I have set out. I thank the hon. Members for Winchester and for Guildford for this exchange of views, and I hope that they are content to withdraw amendment 1.

[Dr Danny Chambers (Winchester) (LD)]

It is an honour to serve under your chairpersonship, Ms Furniss. I know that the hon. Member for Farnham and Bordon will have spent his lunch time anticipating the responses to his long series of questions. The tension is palpable— I hope he is excited to hear our replies.

--- Later in debate ---

[Gregory Stafford]

My hon. Friend is right; although a number of the Liberal Democrats are entirely worthy, there are some concerns about the drafting, which could give rise to ambiguity, legal loopholes and definitional issues. In that example, I do not think that “seek to ensure” is helpful. When the hon. Member for Winchester is summing up, perhaps he might explain how “seek to ensure” can be robustly defined within the law, or if it cannot be, suggest a different form of wording that he may wish to use in a future amendment if this amendment fails to be agreed.

Part II of the Mental Health Act 1983 covers the powers to detain individuals for assessment and treatment. Detention can clearly be traumatic, especially for children and young people. Amendment 9 reflects a growing consensus that detention should be the last resort— I think hon. Members on both sides of the House agree with that—and that community-based preventive and therapeutic alternatives should be prioritised. Again, I think it would be very hard to disagree with that ambition.

On the positive side, community-based care is clearly better than detention in most cases, and, if we can get to a point where people are assessed earlier, as is the intention of some of the other amendments, clearly—hopefully—that would lead to community-based care and not detention. The amendment would also protect children’s rights and support the trauma-informed approaches to mental health that were raised previously regarding amendment 47.

The amendment could also reduce the long-term harm associated with institutionalisation and potentially coercive treatment. As we have heard from Members on both sides, that would align with best practice in child and adolescent mental health services and it would promote and encourage a system of accountability by making ICBs and local authorities responsible for proactive care planning. All of that is extraordinarily laudable.

On the potential downsides, there is an ambiguity about the enforcement of the amendment, as my hon. Friend the Member for Solihull West and Shirley said, because of the lack of legal force or clarity in some of the phraseology. There would be also resource implications and, if there are resource limitations at the ICB or local authority level, that might hinder their ability to provide adequate, community-based alternatives.

I do not say that as an excuse for not supporting the amendment, but the hon. Member for Winchester has to understand the reality of the world we live in. Although I want local authorities and ICBs in every area to be entirely fully funded and resourced—and frankly, I do not think the Government’s cut of 50%, or indeed more in some ICBs, will do anything to help community-based care—there would be resource challenges. There would also be implementation challenges in areas where mental health services are already underfunded or overstretched that could lead to delays in care.

This is the key question that I ask the hon. Member to respond to in his summing up. Members on both sides of the House want to ensure that all people of all ages get the best, most appropriate mental health care as early as possible. But in an imperfect world, if there are potential delays in care because community services are struggling to find alternatives to detention, the unintended consequence could be that someone may not be treated at all because of the onus on defined community-based care rather than detention. Will the hon. Member explain how that would work?

I draw my remarks to a close by saying I, certainly, and the Opposition, entirely agree with the ambitions of the amendments. However, some practical and legal issues would need to be ironed out before I could wholeheartedly support them.

[Stephen Kinnock]

Again, I thank the hon. Member for Winchester for his amendments. I understand the intent behind amendments 8 and 9, but the clauses on registers and the associated duties on integrated care boards and local authorities are specifically aimed at people with a learning disability and autistic people, because of the detrimental outcomes that these groups of people may suffer when detained.

We recognise the concern around the treatment of children and young people, which is why we have several provisions in the Bill aimed at improving their care. However, dynamic support registers are particularly tailored to the needs of people with a learning disability and autistic people, and have been established in NHS England’s policy for some time. We do not have evidence that they would be an appropriate mechanism for wider cohorts.

We do recognise that bereavement, miscarriage, the experience of trauma and difficult life transitions can all have a bearing on mental health. However, access to mental health support is based on clinical need, not on the circumstances that might give rise to that need.

[Dr Evans]

The Minister is right about the registers, but I did notice that the Children’s Wellbeing and Schools Bill introduced the unique identifier number. That came about after the Lord Laming report into Victoria Climbié, who was “lost in the system.” It also builds on the work of the Children’s Commissioner, which found that around 10,000 children are not in school. Is there a role for getting some of the identifiers that we are looking at here in place along with that unique identifier number?

Equally, how does that unique identifier input into the Bill’s provisions on risk registers, now that that piece of legislation has passed Third Reading? There will be an interaction, but the unique identifier is much broader and the dynamic support register is held slightly differently. What work have the Government done to ensure that there is bridging and understanding about what that would look like, not only in the short term but in the long term?

[Stephen Kinnock]

The dynamic support register is specifically focused on people, both children and adults, who have learning disabilities and people who are autistic. I think it is quite a separate thing. I am not familiar with the detail of that education legislation but, as the hon. Gentleman says, it is a very broad identifier not based at all on the clinical conditions of the persons, as I understand it, whereas this is very focused and specific for people with the conditions that we are debating. I do not think that there would be a connection between the two.

[Dr Evans]

Let me take the example of a young person with deteriorating or fluctuating problems. They may be in school or out of school. We know that people with autism and learning disabilities are at greater risk of abuse and of being taken advantage of. If the Minister is not aware of it, would he look at how this duality could work, because clearly there is scope?

One benefit that the Government argued for in having this unique number was that it could be shared across these registers. It sounds as if there is work that could be done. The Minister is absolutely right, and I am not suggesting merging the two, but on the risk register, there could be a nice piece of crossover work to pull that all together, so that the information moves across agencies. What we know from people with severe learning disabilities, autism and mental health issues is that they are often in contact with multiple agencies at multiple times—from social services to, potentially, the police, the NHS, dentistry and, of course, educational settings, which might be multiplicitous. Is that a consideration that the Minister will take forward?

[Stephen Kinnock]

The hon. Member makes an interesting point. I am certainly happy to discuss that with officials, just as long as everybody is clear that there are two very different things going on here, with different types of risk and therefore different agencies. But I am all in favour of joined-up government wherever we can deliver it.

I turn now to amendment 47. It is important that robust measures are in place to support people with a learning disability and autistic people who are at risk of admission. That is why the Bill will, for the first time, put dynamic support registers on a statutory footing and, via regulations, set out the factors that the Secretary of State considers increase the probability of someone being detained. That is the most appropriate approach in order to provide sufficient flexibility for updates in line with emerging best practice, evidence and clinical and commissioner understanding.

As the factors are likely to be updated regularly, returning them to Parliament at every such instance would be disproportionate and unmanageable. Additionally, although putting them in primary legislation would not prevent the Secretary of State from providing and updating a longer list in regulations, having some factors but not others in the Bill could be perceived to give them primacy—for example, having a history of in-patient admissions or presenting in A&E in crisis. That could have unintended consequences and divert support from those most at risk.

We will of course engage with expert stakeholders, who are best placed to advise on what the list of risk factors for detention should be, taking into account the existing NHS England policy on dynamic support registers. I am pleased to provide assurance to the Committee that current NHS England policy provides examples of factors such as those in the amendment—for example, having no fixed address, having drug and alcohol addiction and having had significant life events such as bereavement and abuse. For those reasons, I hope the hon. Member for Winchester will not press his amendments.

[Dr Chambers]

I know how much the hon. Member for Farnham and Bordon enjoys speaking in Bill Committees—we were on the Tobacco and Vapes Bill Committee together a few months ago—and I am really pleased that our amendments have given so much material for discussion. I really appreciate the input from Members on both sides of the Committee; it has been really insightful, useful and constructive.

It has been rightly pointed out that the current state of local authorities—their funding and their capacity—means that they might not be able to deliver the more holistic care we are pushing for in the amendments, but I do not think that the Mental Health Bill should be limited by the current state of local services and funding. If that is the underlying problem, that is what should be addressed, not the measures in the Bill.

--- Later in debate ---

[Aphra Brandreth]

I rise to make a few remarks on new clause 11, which would require a costed plan to ensure that ICBs and local authorities are able to provide adequate community services for individuals with learning disabilities and autistic people at risk of detention under part II of the 1983 Act.

We need to ensure that there is a fully cost-effective plan with accountability to support those with learning disabilities. For instance, Cheshire West and Chester council, one of the local authorities in my constituency of Chester South and Eddisbury, has let down parents, families and those with learning difficulties because of its poor management. It has come at the cost of adequate provision, particularly in school places, and therefore puts more people at risk of mental health problems because they are not getting the support they need in the community.

With the measures outlined in new clause 11, we could go a long way to ensuring accountability. I am sure the Minister will agree that we need to ensure that commitments are backed by funding for the good of those who need SEND support. I urge all those on the Committee to reflect on the value of the new clause. Crucially, it would also require the costed plan to be informed by a consultation with a range of stakeholders. That is incredibly important, because we need to listen to the lived experience of those who are often extremely vulnerable to ensure that they receive the right support. In my intervention, I referred to some of the important groups in my constituency. Down Syndrome Cheshire and the Cheshire West and Chester SEND Accountability group are just two examples, but there are so many more. They are clear that they value being listened to, so that they can inform the process.

The new clause would ensure a costed plan, where commitments are not just words, but backed by funding. Crucially, it would mandate a formal consultation process to inform the plan, incorporating the view of a broad range of stakeholders, including those with lived experience such as those I mentioned in my constituency. There are individuals, carers, healthcare providers and advocacy groups whose voices all matter. We need a plan that is costed so it can be delivered, and that, crucially, reflects the needs and rights of those most affected. I fully support the new clause.

[Stephen Kinnock]

I thank hon. Members for this set of amendments, which draw attention to the important matter of implementation and community support for people with a learning disability and autistic people. I heard this issue raised many times on Second Reading.

I will begin with amendment 20. I am grateful that this important issue has been raised. Although he has not been appointed to the Committee, I know that the hon. Member for St Neots and Mid Cambridgeshire has spoken powerfully and movingly about the tragic circumstances surrounding the death of Declan Morrison, his constituent, and the need to ensure effective and timely community-based support.

Proposed new section 125E of the Mental Health Act, provided within the Bill, already requires integrated care boards and local authorities to seek to ensure that the needs of autistic people and people with a learning disability can be met without detaining them. That should be driven by the specific needs of the local population, informed by the dynamic support register. That requirement already covers any relevant needs for crisis accommodation. We expect, and will set out in statutory guidance on dynamic support registers, that they will cover any relevant needs for crisis accommodation.

In contrast, the amendment seeks to place a prescriptive legal requirement to ensure provision of a specific service in all circumstances, irrespective of what people in the area actually need. That would have the unintended effect of restricting integrated care boards in designing provision and allocating resources in the most effective way to meet people’s needs.

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[Anna Dixon]

I thank the Minister for setting out so clearly the importance of the annual ministerial statement. Does he envisage that the statement will also give an update on the extent of community provision available and the execution of the transition of people with learning disabilities and autism from institutional settings to community settings closer to home? Is that within scope of the statement?

[Stephen Kinnock]

I think the short answer to my hon. Friend’s question is yes. The written ministerial statement will be an update on the work done over the preceding 12 months, but it absolutely will also be a forward plan, so it will set out the next actions that the Government will take, what the broader, long-term change delivery process will be, the institutions that will need to change and how they will change.

A number of colleagues have also asked the question, “What does good look like?” In many ways, it is absolutely right that we, as a Government, are being held to account on the content of the Bill, but there will be a really important accountability moment 12 months after it gets Royal Assent, which will be that written ministerial statement. I fully expect every colleague in this room to read that in great detail and hold the Government to account, both on what has been achieved over the preceding 12 months and, importantly, on what the forward plan looks like.

I think that covers most of what I wanted to say, although one additional point I would make is that the amendments could have the unintended consequence of requiring Government and local areas to set out unfunded or speculative plans ahead of any funding settlements, which would affect their credibility. It is more effective to set out plans when they are ready, when we have a clear line of sight on funding and deliverability.

We also need time to engage with expert stakeholders to inform implementation planning. We know that sufficient community services cannot be achieved without wider system reforms beyond health, and details contained in any plan must also consider the context of the 10-year health plan and the independent commission into adult social care, chaired by Baroness Casey. For that reason, I thank hon. Members for their contributions and invite them to withdraw amendment 20 and not to press amendments 24, 10, 22, 21 and new clause 11.

[Dr Chambers]

I thank everyone for all their insights into our amendments; they were very useful and constructive. I will address a couple of them briefly.

First, I thank the hon. Member for Ashford; we totally agree that we want to be moving mental health care—any care, actually, but mental health care specifically—back into the community and have more community care. We are not advocating for more hospital care. There is a specific point to amendment 20: my hon. Friend the Member for St Neots and Mid Cambridgeshire, who is in the Public Gallery, had a tragic case of a constituent, which resulted from there not being enough available safe places for someone in crisis to be cared for.

A lot of our amendments have rightly been criticised for possibly being outside the scope of the Bill, because this Bill is for when people are in a mental health crisis, and a lot of our amendments are about how we can improve community care. To me, amendment 20 appears to be very in scope, because it addresses a failure of someone who was admitted for mental health care.

I thought that the insightful comments on most of our amendments from the hon. Member for Solihull West and Shirley, given his legal and medical background, were very useful, and we will take those on board. The only one that I would disagree with, and I think he might feel the same, is on amendment 20 specifically. His main criticisms of that were that it might result in variability across the nation, that there are currently staff shortages and that there could be implementation delays. I do not see any of those three reasons to be strong enough to not want to maintain crisis accommodation.

I thank the Minister for his comments and his serious consideration of all our amendments. We will press amendment 20 to a vote, but will not press any of our other amendments.

Question put, That the amendment be made.

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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.

[Zöe Franklin]

Having had a conversation with my hon. Friend the Member for Winchester, I can say that we will withdraw the amendment. However, we hope that the Minister will ensure that the provisions addressing the need for training in such situations will come soon, and with a timeline, so that all members of the Committee understand when we will see the statutory guidance. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

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

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[Gregory Stafford]

Given that we have discussed the proposed new sections in depth, I do not intend to dilate upon this clause for long. Suffice it to say that the Opposition, notwithstanding the questions asked by the shadow Minister, support the clause, which is essential to ensure the safeguards and progress that we are trying to achieve through the Bill.

Clearly, the clause is prevention-focused and helps avoid unnecessary and traumatic hospital admissions. It leads to better planning because it supports tracked admission of services tailored to individual needs. It also has an element of legal accountability, given that it makes it a legal duty for ICBs to monitor and support at-risk individuals. It is also data driven because it encourages the use of real-time data to inform care decisions.

That being said, a number of the concerns that we raised during debate on the amendments apply to the clause itself. In the Minister’s summing up, can he touch once again on the privacy concerns, as well as the resource demands and the risk of stigma? By that, I mean that being placed on a register could be seen as labelling or pathologising. How do we ensure that the register does what it is supposed to without that risk? Can he also touch on some of the vague criteria and definitional phrases, such as “at risk”, and how they might potentially lead to inconsistent application?

[Stephen Kinnock]

I am conscious that we will be voting imminently, so I will try to rattle through. Going back to my phrase “the red thread”, the thread running through all the shadow Minister’s questions is delivery. The proof of the pudding in all legislation is whether we convert it into action in a way that best delivers for the interests of the British people, and in a way that absorbs the risks, builds resilience in the system and ensures that we are constantly monitoring, evaluating, reviewing and learning from what is happening on the ground and, through a constant process, improving delivery.

The shadow Minister asks some very good questions, but the problem is that so many will relate to the work that we need to do at pace as soon as the Bill receives Royal Assent. This is a sequential process; we first need the legislation and the comprehensive spending review, so that we know our funding package. We then need to start work consulting on the code of practice, getting that feedback and shaping a plan that defines what good community services look like, because we all know that we are a million miles from having good community services at the current time. We are in a state of crisis and the system is on its knees; we are very conscious of all those facts. There is an immense urgency with all this.

The shadow Minister asked about evaluating and updating pathways and CETRs, duty to respond, the information collected, managing the risks, preventing paternalism and ensuring that people do not get labelled. All those things will have to be set out and explained in the project plan. That is something we will all be working very hard on as soon as the Bill gets Royal Assent.

One of the shadow Minister’s factual questions was on how many CETRs have been issued. I cannot give him that number, but I can tell him that, as set out in the impact assessment, 86% of in-patients received a CETR in the last year. If my answer that this is about delivery does not satisfy him and he thinks there are issues that relate directly to the Bill rather than to the implementation plan, I am happy to write to him on that.

[Dr Evans]

I appreciate what the Minister is saying. The blue threat, or blue and yellow thread, running through the debate is the question of how much needs to be in the primary legislation. The argument from the Conservative side has been that, while some of the Lib Dem amendments are too restrictive, the danger is that the freedom and flexibility at the Government’s end is too loose. I trust the Minister implicitly—but, having seen Ministers on our side come and go, there could be a change within Government or a change of colour of Government, and no Government are bound by the one that went before.

I am trying to get the balance right by asking questions around procedure to assess whether some of these things should be in the legislation. I agree that there has to be a balance. That is why the Opposition chose to say 18 months, as opposed to four months; it was to have accountability and safeguards in place and to urge good delivery, but not to curtail the ICBs or clinicians—the people delivering stuff—and make them simply check boxes.

I appreciate the Minister’s offer to write to me. I would be grateful for that data, because where we find it will be important in future debates and in his future written or oral statements. I hope he understands that these probes are to make sure that we get the balance right between primary legislation, what is going in the code of practice and what is well intentioned, but could be left to blow in the wind.

[Stephen Kinnock]

That is a valid question, and one that has probably been asked in pretty much every Bill Committee that has ever taken place. It is always a challenge to get the balance right, having the right level of steer to the system in primary legislation without tying the hands of the system. Everything is constantly evolving, particularly in the age of technology in which we live, so it would be foolish to tie our hands too tightly given the changing nature of the landscape we are working in.

My answer to the question—I say this personally and from the point of view of the Government—is that we are satisfied that we have the balance more or less right. That is in the eye of the beholder, and not everybody will agree, but we feel that clause 4 gets that balance right, and sends clear signals to the system through primary legislation. The proof of the pudding will then be in the eating, and that is for the code of practice, the regulations and the programme planning. On that basis, I commend the clause to the Committee.

Question put and agreed to.

Clause 4 accordingly ordered to stand part of the Bill.

Clause 5

Grounds for detention

[Dr Shastri-Hurst]

I beg to move amendment 52, in clause 5, page 11, leave out lines 20 to 22 and insert—

“(b) in the case of a patient who lacks capacity or competence to consent to admission for assessment (or for assessment followed by medical treatment), serious harm may be caused to the health or safety of the patient or of another person unless the patient is so detained by a constable or other authorised person, or in the case of a patient who does not lack capacity or competence to consent to admission for assessment (or for assessment followed by medical treatment) serious harm may be caused to the health or safety of another person unless the patient is so detained by a constable or other authorised person; and”

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[Stephen Kinnock]

My understanding was that we would all come back after the final vote, which was on Third Reading.

[The Lord Commissioner of His Majesty’s Treasury (Taiwo Owatemi)]

I am the only one who can move the Adjournment.

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[Gregory Stafford]

I thank my hon. Friend for his extraordinarily helpful intervention. I was not aware of the changes, and I certainly had not heard of fusion before, or about what is going on in Scotland. Of course, if the new clause had already been enacted in another part of the United Kingdom in some form, I would be much more comfortable with it. But, as I said in relation amendments 52 and 53, if the new clause is to pass in its current form in this Bill or in some future form in another Bill, there has to be a focus on proper training and guidance. Because there is potentially such a legal quagmire, we must ensure that people understand the legal framework within which they can do this.

[Stephen Kinnock]

Once again, I am grateful to the hon. Member for Solihull West and Shirley for moving the amendments and the new clause on behalf of the hon. Member for Runnymede and Weybridge.

I will first speak to amendments 52 and 53. The new detention criteria explicitly require decision makers to consider the risk of serious harm and the likelihood of harms occurring in order to justify detention. It is right that clinicians have the power to intervene when a patient is at risk of seriously harming themselves, both when they do and when do not have mental capacity.

If we were to accept the amendments and the new clause, we think that patients would be left without the protections that the Mental Health Act provides. For example, let us consider a patient with a serious eating disorder who is assessed as having capacity but is refusing treatment. If there were no longer an option to detain that patient under the Mental Health Act, that could leave clinicians and families without a route for treatment, potentially leading to tragic results.

The pre-legislative scrutiny Committee highlighted concerns about cases where the concept of capacity had been used to justify denying individuals care that they had sought voluntarily, particularly in relation to very ill and potentially suicidal patients. That goes against the spirit of the Mental Health Act and could fall short of professional standards.

Patient choice is, of course, critical, and the changes that we are making recognise that when patients have a say in their treatment, they are more likely to engage. We also think that it is right that when those decisions put people at risk of serious harm, including risk to their own life, there is a duty to intervene.

We recognise that detaining and treating patients with capacity without their consent is a very serious step to take. However, we think that it is right that we intervene when someone is a risk to themselves, not just to other people. That is in line with the Government’s commitment to delivering a cross-sector suicide prevention strategy for England. We should deprive somebody of their liberty and detain them only as a last resort. The threshold of serious harm in the new criteria reflects the gravity of that decision.

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[Dr Evans]

I am grateful to the Minister for how seriously he is taking this issue, and I agree that there is not necessarily a consensus even within the Opposition. Having the debate is therefore really important. It may be useful to collect data on the number of incidents and where these handovers are. Would the Government commit to that? We would be better able to have this debate, and to decide how much of a problem this is and to work out what the solutions are. Again, I struggle to find data that indicates where this is an issue, but I have spoken to clinicians who I know and colleagues who I have worked with when I have seen it. It happens enough that I was aware of it as a bog-standard GP who has worked in A&E, but it is clearly not rampant and we are not seeing it every single day. Would the Government commit to collecting data on it? If so, in what format would it come?

[Stephen Kinnock]

I ask the hon. Gentleman to clarify his question about data collection. Is he looking for clarity on the number of people who are judged to have mental capacity but who trigger the deprivation of liberty condition because they are seen to be either of severe risk of harm to themselves or to society?

[Dr Evans]

That would be a very useful piece of data, but I was in fact talking about new clause 24 and the grey area of hospital detentions. That data is probably easier to collect. I specifically ask the Minister to keep in mind the collection of data on those who turn up to A&E but end up having to be taken out of the hospital to be sectioned, for example. That is the nub of the issue and the practicality of what is going on. In a number of incidents, although the law is set in a way that is supposed to be helpful, the interface unfortunately becomes very difficult.

The Minister has rightly pointed out that there are different ways to deal with this. The new clause is one such potentially heavy-handed way of dealing with it. At the same time, it comes from the good place of trying to address what clinicians deal with in A&E day in, day out. However, we need some data and some teeth behind that to understand and appreciate how much of a problem it is and to then come up with a solution. I hope that clarifies my question.

[Stephen Kinnock]

That does clarify it. I will absolutely discuss that with officials. It is clear that we need a complete picture of the prevalence of people reporting to emergency departments and then having to be extracted from them and put into other facilities. That is an important point. We clearly need to think more about this issue and consult further. Obviously, understanding the data is a very important part of that. I cannot give the hon. Gentleman a nailed-on commitment to do that, but I give him a nailed-on commitment to discuss it with officials. It is possible that the data is already out there. We need to find that out.

We have heard concerns that there is a lack of clarity about what legal powers are available to health professionals to hold someone in emergency departments until they can be assessed. However, it is a complex issue that requires extreme care and caution. We have committed to continue to explore the issue. We will engage with stakeholders to understand how the current legal framework is applied, and identify solutions to the problems raised. We will provide further guidance on the existing legal framework, including the handover process from police to health, in the next revision of the code of practice. We are also taking steps to address current operational pressures. NHS operational and planning guidance for this year tasks local health systems to improve patient flow through mental health crisis pathways and to reduce waits of more than 12 hours in emergency departments.

[Anna Dixon]

Will the setting up of more health settings—places of healthcare and of safety—help to address the issue?

[Stephen Kinnock]

Yes, I think that is right. We have a commitment to creating—either building or repurposing—facilities for more acute mental health settings. We have also created the 111 mental health line. We have a commitment to 8,500 more mental health specialists. We are committed to having a mental health-trained person in every school in the country.

I hope that all those wraparound measures will help in the overall role that we play in the community, and identify people with challenges in a way that will help to support them and, one hopes, avoid them getting to the acute stage. My hon. Friend is absolutely right to point to some of the wraparound measures that the Government are pushing forward.

For the reasons that I have outlined, I ask the hon. Member for Solihull West and Shirley not to press amendments 52 and 53 and new clause 24 to a vote.

[Dr Shastri-Hurst]

I have listened carefully to the Minister, who has addressed the issue with his usual thoughtfulness. I ask that he looks into sharing that data, particularly around new clause 24, but on the basis of the reassurances that he has provided, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

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

Mental Health Bill [ Lords ] (First sitting)

Stephen Kinnock Excerpts

Committee stage
Tuesday 10th June 2025 Public Bill Committees

[The Chair]

With this it will be convenient to discuss clause 2 stand part.

[The Minister for Care (Stephen Kinnock)]

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

I thank the many hon. Members who spoke on Second Reading. It is clear that in this place, as in the other place, the Bill will proceed in a collaborative and constructive spirit, with the single motivation of getting the reforms right. On Second Reading, we heard numerous powerful accounts from hon. Members arising from their personal experience of supporting family, friends or constituents with a serious mental illness, a learning disability or neurodiversity, or drawing on their own experiences to underscore the importance of the need for reform. I was heartened to hear from so many Members who set out the positive impact of the changes that the Bill will introduce, particularly the vital changes to ensure that patients’ voices are heard and that—as we would expect in any modern mental health service—the patient is at the heart of all decision making.

In our manifesto, we committed to modernising the Mental Health Act 1983 to give patients greater choice, autonomy, enhanced rights and support, and to ensure that everyone is treated with dignity and respect throughout their treatment. I am proud that we included this critical Bill in our first King’s Speech, and I look forward to constructive engagement with the Committee on this important legislation.

I will also take a moment to thank the Liberal Democrat Member, the name of whose constituency escapes me, and other MPs who have shone a light on the experiences of Fiona Laskaris and other families. No one should lose a child in that way. I thank Fiona for meeting me and I commend her tireless campaign efforts. The engagement that my officials and I have had with Fiona and the hon. Member has been incredibly valuable. Unfortunately, the Bill is not the appropriate vehicle to address those concerns, but I have committed to continuing engagement with Fiona and the hon. Member to further explore those issues and how we might tackle them.

[Dr Danny Chambers (Winchester) (LD)]

I know that my hon. Friend the Member for Dorking and Horley (Chris Coghlan) has been pushing forward on that very emotive and difficult issue of capacity; he brought it up in his maiden speech and has been campaigning tirelessly on it. My hon. Friend said that the Minister was very constructive in his engagement on the issue, which we very much appreciate. Even though we cannot include it in the Bill, we look forward to working on it.

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[Stephen Kinnock]

I thank the hon. Member for that intervention, not least because it gave me the opportunity to remember the constituency of the hon. Member for Dorking and Horley—please pass my apologies to him for forgetting that important point. He has been a tireless campaigner and I believe that we can find a way forward; this Bill is just not the correct vehicle for it.

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

I also want to assess the amendment that could potentially have been tabled. The Opposition were struggling to see how it would fit in, and it looks as if there is a crossover with the Mental Capacity Act 2005. Can the Minister set out why he felt that it did not quite fit into this area and how it could be taken forward, so that with cross-party work outside this Committee we can see how we can make it happen?

[Stephen Kinnock]

There were a number of technical and drafting issues. The Public Bill Office ruled that the amendment, as drafted, was out of scope. One of the key concerns was about the unintended consequences of the relationship between physical disability and mental disorder. The drafting of the amendment could have caused confusion, because it could have started to bring physical disability into the scope of the Bill, which is clearly not what it is about. There were a number of technical and drafting issues, but I do not think that they are insurmountable. We can get to where we need to be, just not through a legislative vehicle.

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

I support the comments of the Minister and the hon. Member for Winchester on the issue. On a cross-party basis, I know that my right hon. Friend the Member for Godalming and Ash (Sir Jeremy Hunt) has taken a close interest. Could he also be included in those discussions?

[Stephen Kinnock]

Yes, absolutely. We had a very constructive meeting with the right hon. Member for Godalming and Ash, along with the hon. Member for Dorking and Horley, and we are certainly open to working with that team of people, who are clearly focused on getting the results that we all want to see.

Clause 1 will make it a statutory requirement for the Secretary of State to include, in the statement of principles in the Mental Health Act code of practice, the wording of the four principles identified by the independent review. Those principles are choice and autonomy, least restriction, therapeutic benefit and the person as an individual. This will ensure that the review’s principles underpin the implementation of the Mental Health Act 1983 and are considered when making decisions related to care, support or the treatment provided to patients under the Act.

Embedding the principles in day-to-day practice will help to drive the culture change envisaged by the independent review. We are including the principles in the Act so that they govern the content of the code of practice and can changed only by Parliament. The Government are firmly supportive of the four principles, which were co-designed with service users during the independent review. They have informed every decision made in developing the Bill. We have embedded the principles in measures throughout the Bill, such as via the inclusion of therapeutic benefit in the detention criteria and several measures to improve patient choice and autonomy, including new treatment safeguards, introducing advance choice documents and the right to choose a nominated person.

I turn to clause 2. The code of practice for Wales already includes a statement of principles, although it is not a statutory requirement under section 118 of the Mental Health Act 1983 for Welsh Ministers to do so. Clause 2 will amend section 118 to extend subsection (2A) to Wales, along with the new subsection (2B) inserted by clause 1. To do so, clause 2 will also make amendments elsewhere in section 118 to clarify the application of each subsection, which will be to the Secretary of State in relation to England, to Welsh Ministers in relation to Wales, by virtue of the transfer of devolved functions, or to both.

The extent of the Mental Health Act is England and Wales, and there are separate codes of practice for England and Wales. Both codes of practice currently include a statement of principles, although the principles themselves vary slightly. Clause 2 will place a statutory requirement on Welsh Ministers to include the wording of the four principles identified by the independent review in the statement of principles when preparing the Mental Health Act code of practice for Wales.

As in clause 1, we are putting these principles explicitly in the Act so that they govern the content of the code of practice and so that they cannot be changed except by Parliament, or by the Senedd in respect of Wales. The Welsh code is already required to undergo scrutiny by Senedd Cymru, but clause 2 will also update the position in relation to the Senedd Cymru scrutiny procedure for the Welsh code. I commend clauses 1 and 2 to the Committee.

[Dr Evans]

It is a pleasure to serve under your chairmanship, Mr Vickers. I thank the Minister for his collaborative tone on some of the difficult amendments that we have discussed.

I will open where the shadow Secretary of State, my right hon. Friend the Member for Melton and Syston (Edward Argar), left us on Second Reading. As he rightly emphasised, the importance of updating the Mental Health Act cannot be overstated. I fully share his view that it was right to take the necessary time to get this legislation right. The cross-party commitment to reform in this area, spanning both previous and current Governments, reflects a shared recognition of the urgent need to modernise our approach to mental health, particularly for those who are most vulnerable.

I welcome the Bill’s focus on enhancing patients’ voice and autonomy, including through the expansion of independent advocacy and the shift away from using police and prison cells as a place of safety. Those are positive and overdue steps. At the same time, as my right hon. Friend outlined, the Opposition’s role is to engage rigorously and constructively with the details of the Bill. Over the next few weeks, I look forward to working with colleagues on the Committee to ensure that, for example, the principle of patient choice is embedded not only in policy but in practice, such as through the use of advance choice documents.

We will continue to scrutinise the Bill in good faith, proposing improvements where needed, with the aim of delivering the strongest possible protections and outcomes for patients, their families and the community. How we begin a conversation often determines whether it becomes dialogue or dispute, so I hope that the Committee can take a constructive and productive look at what lies ahead of us.

I support clause 1, which will rightly update section 118(2B) of the Mental Health Act 1983 and embed a refreshed code of practice at the very heart of the mental health framework. This is not merely a procedural amendment; it is a statement of values, placing humanity, dignity and recovery at the centre of how we treat some of the most vulnerable people in our society, who are profoundly affected by mental health legislation. It is vital that the framework guiding professionals be clear, principled and rooted in respect for individuals.

Why do we need these changes? For too long, the Mental Health Act has been criticised as outdated and insufficiently centred on patient autonomy and dignity. Concerns raised by successive independent reviews, clinicians and, crucially, by people with lived experience have pointed to inconsistencies in how decisions are made, which can often result in over-restriction, lack of patient involvement and insufficient therapeutic focus.

The independent review of the Mental Health Act, which was published in 2018, made a landmark contribution by recommending the adoption of the four core principles in front of us today: choice and autonomy, least restriction, therapeutic benefit and recognition of the person as an individual. These principles are designed to shift the culture and practice towards one that respects autonomy while safeguarding wellbeing and public safety.

The historical context is that the Mental Health Act has undergone several amendments since its introduction—notably, in 2007, updates were made to some of the detention criteria and safeguards—but it was clear that the Act remained predominantly paternalistic. The 2018 independent review was a comprehensive, evidence-based re-examination of the entire Act, informed by extensive consultation, including with patients, families and clinicians. It concluded that embedding the principles formally into the law and code of practice was essential to modernise and humanise mental health law.

The four key principles—choice and autonomy, least restriction, therapeutic benefit and the person as an individual to be treated with dignity—are not abstract ideals. They are the foundations of compassionate, lawful and effective care. They echo the spirit of the UN convention on the rights of persons with disabilities and signal a move away from paternalism and towards genuine co-production of care plans. Involvement ensures that decisions are not made about patients without them. The principle of choice and autonomy reminds us that the mental illness must not be a justification for blanket restrictions. The principle of least restriction challenges us to find community-based alternatives before defaulting to detention. Therapeutic benefit ensures that care is not custodial, but meaningful healing. These principles are what most of us would hope to see for our own family.

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Finally, we hope that the new structure will not inadvertently lead to inequality. We already see that in the wider Welsh-English NHS approach. With something as sensitive as severe mental health issues, we need to do our best to guard against that. We welcome the locally tailored codes, but we must maintain shared standards of care, dignity and human rights across the UK.

[Stephen Kinnock]

I thank the shadow Minister for his questions. I will answer to the best of my ability, but I may need to write to him on one or two points.

On enforcement and accountability, the code of practice is underpinned by the Bill and is therefore legally binding. Any divergence from the code of practice would need an extremely strong justification. That could well end up being a matter for the courts. I think that we will see a fairly strong line of sight from this primary legislation through to the code of practice and its implementation. Enforcement and accountability will be provided on that basis.

On balancing conflict, we will consult on the code of practice. Consultation will launch as soon as the Bill becomes an Act. That will be an important part of getting to the nub of some of these nuanced issues. It is quite difficult to put all that down in a document—a lot is about the culture, as the shadow Minister said—so we need an approach that has sufficient flexibility, but with clear outcomes and accountability. The consultation process will help us to get that.

[Dr Evans]

I agree with the Minister. Does the Department have a rough idea of the timetable for putting in place the code of practice? How long will the consultation need to take? When will it be implemented? How many rounds go with it? How wide is it to be—will it consult across England and Wales, or just in England?

[Stephen Kinnock]

We expect the entire process to take about a year from Royal Assent. My colleague Baroness Merron made a strong commitment from the Dispatch Box in the other place that we will present a written ministerial statement to the House every year. That will be the opportunity for us to report on the progress of all the measures that need to be implemented. A pressing task is to build the community capability required in this shift from hospital to community, which is very much part of the Bill and of our broader strategy for mental health and, indeed, health across the board. We need to report every year on that, but the first year will also be a report on the consultation and its conclusion, including the conclusion of a draft code of practice. We expect that to take approximately 12 months.

That, in some ways, has also answered the shadow Minister’s question about training and resources. A big part of the reason for the 10-year implementation period is the time that it will take to do the training and the training needs analysis, to identify trainers to deliver the training, and to get the system up to speed. That will be a fairly large chunk of the 10-year process.

[Dr Evans]

The Opposition appreciate the timescale taken to skill-up in this area, but the workforce plan is soon to be announced by the hon. Member’s Government. Has any consideration been made of what the capacity might look like, and of the crossover between having this legislation not quite in place—although likely to happen, upon Royal Assent—and its impact on updating the workforce plan on mental health?

[Stephen Kinnock]

The shadow Minister is tempting me to reveal the details of the workforce plan. While I have a huge amount of respect for this Committee, I do not think that it is where we will launch it. Absolutely, however, that is built into our thinking about the plan. There is a huge mental health challenge in our country, and those with acute and severe disorders and conditions which the Bill is designed to address are absolutely a part of that. A skilled and compassionate workforce is required, and I pay tribute to the amazing staff, mental health professionals and others who work in this area, often in incredibly challenging circumstances. We recognise and value that. The Bill does need to hook up with the workforce plan, and we are focused on that.

On Wales and the risk of divergence, the shadow Minister makes an interesting point. I guess it is about ensuring that that there is devolution, but not divergence, in the sense that we have a framework here—much of the legal framework is reserved—but the delivery of mental health services is devolved. That balance has to be right, but it is something that the two Governments have been working on since devolution started in 1998. There is a fairly mature and sophisticated culture in the interface between the two Governments. The shadow Minister is right to flag that point, and I am more than happy to seek some assurances from officials and write to him. However, as things stand, I do not see any particular risks.

[Dr Evans]

The Minister is right that there is shared working. However, part of the problem between devolved nations, such as Scotland and Wales, is that the datasets and definitions of data are often changed. Actually, the comparison of data across the UK can be quite hard to manage. Given that we are talking specifically about mental health, including some of the most at-risk people with the most severe mental health illnesses, will the Government commit to pushing for shared data that is comparable between Scotland and Wales, which we are legislating on in this case, to ensure that there is data transparency, so no one country can hide behind a different comparison or by saying, “We are looking at apples and pears”?

--- Later in debate ---

[Stephen Kinnock]

It is important that we do not see devolution as a wall between the two countries; in fact, we should be sharing information and best practice—nobody has a monopoly on good ideas. The Welsh Government have achieved some things, particularly in mental health, that England could learn from, and vice versa. There is no reason why the data cannot be shared from my own practicable and pragmatic point of view. There may be some issues with data protection, but data protection law really should be implemented in the same way right across the board because it is reserved.

[Dr Evans]

I entirely agree, and I hope that data is and will be shared. The question is about the definitions and standards, such as those used for waiting times. We often use the A&E waiting time of four hours. When it comes to the most vulnerable patients who will potentially be on waiting lists, or looking at specific data, if it is categorised differently in Wales, Scotland and England, that makes it very hard to see where best practice is so that it can be shared. That is the Opposition’s concern. I know that both sides of the House have shared that concern in my five years in Parliament. Is there a mechanism to address that issue either in the Bill or in the Minister’s wider portfolio?

[Stephen Kinnock]

I see. I am sorry; I had misunderstood the shadow Minister’s point. I thought it was about sharing data on particular patients, especially those who are crossing borders. The point about waiting lists is a more difficult issue. The Welsh Government have taken a view on how best to define them. For example, I know that ambulance waiting times have been quite controversial because there is a different definition in Wales to England. Many feel that the definition adopted by the Welsh Government sets the bar at a higher standard, which can then sometimes framed, in the hurly-burly of politics, as failing more than they would be if they had used a different metric, but they have chosen to use that metric.

In the context of devolution, it is up to the Welsh Government to decide how best to evaluate the Welsh health service and its performance. I take the shadow Minister’s point on having the best alignment that we can, but when it comes to this UK Government, we will determine how performance is evaluated for England, and the Welsh Government will determine how best to evaluate performance for Wales. I think that the Welsh media, the UK media, this Parliament and the Welsh Parliament will then decide who is failing and who is succeeding.

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

I represent an English constituency on the border with Wales; on some streets, one side is considered Welsh and the other English. Does the Minister recognise that it matters to people in England and Wales that there is consistency across both parts of our fantastic country, and that it is not sufficient to say that what happens in Wales will affect only Welsh people, or what happens in England will affect only English people?

[Stephen Kinnock]

I absolutely accept the point that there are deeply integrated communities on that border. A huge number of people live in England and work in Wales, or live in Wales and work in England. However, the fact of the matter is that health is a devolved policy area. It is, therefore, up to the devolved Administrations to determine how they want to measure the performance of their respective systems. It would be a violation of the principles of devolution if one Government in our United Kingdom were to dictate to another how they should evaluate their devolved policy areas—whether that is health, education or any other devolved area. I hope that I have responded to the best of my ability.

Question put and agreed to.

Clause 1 accordingly ordered to stand part of the Bill.

Clause 2 ordered to stand part of the Bill.

Clause 3

Application of the Mental Health Act 1983: autism and learning disability

--- Later in debate ---

[Dr Evans]

The hon. Member is correct about the way in which the world looks at this issue. The problem is that we are sat here debating definitions in legislation that is 40 years old. Will we be here in 40 years debating definitions that have moved on? The amendment suggests that, somehow, we need to try to ensure that legislation is flexible and updated enough, and has the scrutiny and safeguards in place. That relates to not just health, but any part of government that we tend to look at in the House.

I wanted to speak to the amendment to probe the Government on how they will safeguard the legislation. I do not have all the answers, but this is important. I do not want to see my successors—the hon. Member for Hinckley and Bosworth from whatever party—sat here debating this issue in 40 years’ time because the definitions that we happen to set today have become outdated and have unintended consequences.

That is the balance that I am looking for. I do not see a body across the UK, given that this is UK legislation, that fulfils this role. It could be a transitory role or fully established. A psychiatrist could take it on, or it could come under NICE. With the abolition of NHS England, it could be a new role for the Department of Health to take on. All those are viable vehicles that could potentially look into the definitions. I want to ensure that what we pass in Parliament actually translates into the real world for clinicians, patients and the public.

The Opposition can see the argument both ways, as I mentioned. Perhaps it would be useful to have an expert panel, with representatives of clinicians, legal experts and service users to support regulatory updates. I put those questions to the Minister and I look forward to his answers.

[Stephen Kinnock]

I am grateful to the hon. Member for Solihull West and Shirley for moving the amendment on behalf of the hon. Member for Runnymede and Weybridge, and to the shadow Minister for speaking to it.

As this regulation-making power would amend primary legislation, it would signify a Henry VIII power that the Government consider to be unjustified. We have significant concern that it could change the way in which the Bill applies to people with certain conditions without appropriate consultation or parliamentary scrutiny. The serious matter of detention for compulsory treatment should be considered in primary legislation.

The hon. Member for Solihull West and Shirley spoke about the need to stay in touch with our evolving understanding of these terms and conditions. My view is that the Bill does that. We have modified the meaning of mental disorder by including new definitions of autism, learning disability and psychiatric disorder. That acknowledges the advancement in our understanding of learning disabilities and autism, and how the Bill should apply in respect of those conditions. Any future change to the definitions should be a matter for Parliament, informed by strong evidence and consultation with the public.

For those reasons, I ask the hon. Member for Solihull West and Shirley to withdraw the amendment.

[Dr Shastri-Hurst]

I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

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

[The Chair]

With this it will be convenient to discuss schedule 1.

[Stephen Kinnock]

Currently, a person with a learning disability can be detained for treatment under section 3 of the Mental Health Act when their learning disability

“is associated with abnormally aggressive or seriously irresponsible conduct”.

A person can be detained under section 3 on the basis of being autistic, which is classed as a mental disorder under the Act. However, we know that people with a learning disability and autistic people may sometimes be detained because of needs that have arisen due to insufficient community support, rather than for treatment of a mental health condition, and compulsory treatment in hospital settings is rarely likely to be helpful, particularly for autistic people.

Clause 3 and schedule 1 will insert new definitions in the Act and make amendments using those definitions throughout the Act. Those amendments will remove, for the purposes of part 2 of the Act, learning disability and autism from the conditions for which a person can be detained for compulsory treatment. It will be possible to detain someone for treatment under part 2 only if they satisfy the conditions set out in section 3, as amended by the Bill. These include that they have a “psychiatric disorder”, which is a

“mental disorder other than autism or learning disability”.

The changes will not apply to section 2 of the Act, under which a person can be detained for a maximum of 28 days for assessment to understand whether they have a psychiatric disorder that warrants detention under section 3. The revised detention criteria will not apply to part 3, so people in the criminal justice system can continue to be diverted to hospital, where appropriate, to access the specialist support they may need.

We recognise the importance of implementation in ensuring these reforms have their intended effect. For this reason, the proposed changes will be commenced only when there are strong community services in place. I commend the clause and schedule to the Committee.

--- Later in debate ---

[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.

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

It is a pleasure to serve under your chairship, Mr Vickers. I have received contact from Send the Right Message, an organisation in my constituency of Southend West and Leigh. It welcomes clause 3 and clause 4, which I will speak to later, but it makes it very clear that during the implementation it is really important to hear the voices of the individuals who will be impacted and their families. As we work with the ICBs, local authorities and commissioners to implement these new regulations, I seek an assurance that the voices of the community will be heard.

[Stephen Kinnock]

My hon. Friend is absolutely right that those voices must be heard. One example is that we must produce a code of practice to ensure that approved mental health professionals are better supported in their decision making, including when assessing whether somebody with a learning disability or an autistic person has a co-occurring mental disorder. At the heart of the process are the assessment and the definition, and the pathway that flows from that. That code of practice can be developed only on the basis of dialogue and engagement with precisely the people he has talked about.

[Dr Shastri-Hurst]

Building on the Minister’s last point, can he reassure the Committee that any consultation will have a strong focus on ensuring that practitioners have the training and, most importantly, the resources that they need to achieve a seamless transition from one set of regulations to another?

[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.

[Gregory Stafford]

On the point made by the hon. Member for Ashford about local authorities, given that the Government are devolving and reorganising local government structures across parts of the country, how will the Minister ensure that the standards around this issue—and other health and social care issues—are maintained? That restructuring means that we will have a whole load of new local authorities that do not necessarily have experience of dealing with this area.

[Stephen Kinnock]

The devolution Bill and the process of reorganising and restructuring are based on two really strong principles: that it is up to us through legislation to create the outcomes that we need to see delivered across the country and that there are clear standards and targets that we need to see met. But the implementation work needs to be done to deliver those desired outcomes and targets. Local authorities are empowered to do that, which is why we are seeing, for example, a lot of breaking down of ringfencing. The Government are keen to massively reduce the amount of ringfencing, because that has become a straitjacket for local authorities, integrated care boards and others in how they can best manage their portfolio of activities and deliver that devolved power and responsibility.

The answer to the hon. Gentleman’s question is that we want to devolve. We are absolutely committed to decentralising and we believe that is an important part of modern governance. Of course, that has to be done within a framework of set targets and the development of community services that the Bill commits to. All of that will come together to enable those at the coalface, who are best placed to understand them, how to deliver those services to their communities.

[Dr Evans]

Will the hon. Gentleman give way?

[Stephen Kinnock]

I just need to turn to the question asked by my hon. Friend the Member for Shipley. On strong duties, the code of practice flows from the primary legislation and therefore has a statutory power. There is no stronger power to ensure that people with learning disabilities and autism get the treatment, service and support that they require. The system will have a statutory duty to ensure that that happens within the framework of the legislation.

My hon. Friend is right that the transition from children’s to adult services is a major challenge. I am engaging with colleagues in the Department for Education about that to ensure that conversations about the transition happen upstream. We do not want a situation where an individual is looked after until they are 18 and then handed over without any prior conversations and engagement. We want the handover from one service to the other to be as seamless as possible. Our commitment to dynamic support registers will help in this context. They will be an important tool for understanding the needs of individuals who are at risk of admission and for getting that information into the system across the board prior to any detention.

My hon. Friend also asked about carers who so often pick up the baton in the gaps in community provision. She is absolutely right to flag that. We owe a huge debt of gratitude to the millions of unpaid carers across our country, many of them dealing with extremely challenging family situations. The system would simply collapse without them, so she is right to pay tribute to those people.

[Dr Evans]

I want to expand a little on the practicalities and respond to the question asked by my hon. Friend the Member for Farnham and Bordon about local authorities. I declare an interest because Leicestershire is one of the 21 county councils going through a devolution process. About 85% of its budget deals with special educational needs and social care. It is part of an ICB where the mental health team and primary and secondary care come together, but there is oversight from NHS England.

With so many moving parts, including the legislation we are putting in place, the budgetary constraints for ICBs, and the fact that we are getting rid of NHS England, there is a real worry among Opposition Members that things could drop through the gap, or more likely, that because we are moving all these things at the same time, we do not decide which is the fixed point that leads where others follow. If we are trying to cut costs in the ICBs, if NHS England is going over the next two years, and if devolution of responsibilities is also happening over the next couple of years with unitary councils forming, we will create a sticky situation for who is actually leading on this issue. At the heart of it are the clinicians and the patients who could fall through the gap.

What consideration has been given to the top-down strategy for how to incorporate all that? The Minister has talked about a red thread that runs through it all, but is there a running plan? Different Departments, agencies and areas of the country are involved. They are trying to come together to manage their budgets, legislation and policies. It is a complex situation to work through. The imperative part—the legislation—is almost the easier part to get in place; it is the delivery that is all-important. Can the Minister explain further how those three things tessellate?

[Stephen Kinnock]

I do not know whether I will be able to answer the hon. Gentleman’s question in its entirety, because quite a lot of that is being led by my colleagues in the Ministry of Housing, Communities and Local Government—in the English devolution Bill, for example. On the part of his question relating to the Department of Health and Social Care, we came to the view following the general election last year that NHS England was an unnecessary layer of bureaucracy. We think it is important that there is a clear line of accountability from the Secretary of State to Ministers, to ICBs, to trusts and to the system per se for delivery. That line of accountability was being blurred by NHS England, which is why we have removed it from the equation.

The hon. Gentleman is right that there are a lot of moving parts, but, by definition, a reform agenda creates change and some turbulence. We believe that is the only way we will get the system to where we need it to be so that we can deliver the three big shifts in our 10-year health plan: the shifts from hospital to community, from sickness to prevention and from analogue to digital. Many of the questions he is asking will be answered in the 10-year plan. He does not have long to wait for that to be published; it is coming very soon.

I reiterate that the principle underlying all of this is about empowering, devolving and giving agency to those closest to the communities they serve, because they are best placed to deliver. That all has to fit into the Bill, but the fundamental principle underpinning the Bill is the right one: it is about devolution, and about being patient-centric. The Bill deals with a cohort of people whose needs should drive the services that we design and deliver.

Question put and agreed to.

Clause 3 accordingly ordered to stand part of the Bill.

Schedule 1 agreed to.

Clause 4

People with autism or learning disability

[Dr Chambers]

I beg to move amendment 1, in clause 4, page 4, line 41, at end insert—

“(iv) housing.”

This amendment ensures that housing needs are considered as part of care, education and treatment review meetings.

Dementia Care

Stephen Kinnock Excerpts

Tuesday 3rd June 2025 Commons Chamber

[The Minister for Care (Stephen Kinnock)]

I thank the hon. Member for South Devon (Caroline Voaden) for securing this debate, and I commend her for her work as a member of the all-party parliamentary group on dementia. It has been a thoughtful and constructive debate, with a number of truly powerful and moving personal contributions from Members across the Chamber.

This is a cause that is close to my heart. I thank all Members for their kind words about my own family, but our history is far from unique. We know that one in two of us will be affected by dementia in our lifetime—by caring for someone with the condition, developing it ourselves, or both. It is predicted that just under 1.5 million people in England will be living with dementia by 2040. Each person, along with their loved ones and carers, has a unique journey and their own heartbreaking stories. On behalf of the Government, I thank everyone working to support people with dementia, as well as their friends, families and carers. This Government will back them every step of the way. We are also backing our scientists to deliver new treatments and ways to care for people living with dementia, and I recently had the pleasure of visiting the UK Dementia Research Institute’s centre for care and technology, where I saw some of its innovative smart-home tools.

A timely diagnosis is vital to ensure that everyone can access the advice, information and support that can help them to live well with dementia and remain independent for as long as possible. This Government remain committed to the national ambition for two thirds of people living with dementia to receive a formal diagnosis. We are funding evidence-based improvement projects to pilot the diagnosing advanced dementia mandate in 14 trusts. I am delighted that best practice is currently being shared and promoted with regional and local partners, following an impact assessment of the pilots.

Dementia can impact anyone, but there is varying and unequal access to health services. That is why the Office for Health Improvement and Disparities is working to make our country fairer by developing a tool that provides a clear assessment of population characteristics, such as rurality and socioeconomic deprivation.

[Joe Robertson]

I welcome the Minister’s confirmation of his commitment to the diagnosis target of two thirds. Will he put that in a key document—the equivalent of the planning guidance for NHS England? Will he ensure that that is well documented and set out in a strategic document, so that we can be absolutely clear and are not relying on his oral assertions in this Chamber?

[Stephen Kinnock]

We are absolutely on the record with the 66.7% target.

I want to take this opportunity to set out what appears to be a philosophical difference between this Government’s approach to our health and care system and that of many Opposition Members. We believe in devolution, we believe in decentralisation, and we believe in empowering those who are closest to the citizen to make the decisions that need to be made. If others have a more centralising and deeply anachronistic approach to managing our health and care system, which I heard from Liberal Democrat and Conservative Members, that is up to them, but we believe in modernising our system, not micromanaging or having shopping lists of targets. It is about providing support and agreeing on outcomes, but leaving those who are best placed at the coalface to decide how best to meet the unmet needs of their communities. That is a very clear dividing line between us.

On research, it is worth pointing out that we have done studies with UK Research and Innovation, the Alzheimer’s Society and the People’s Postcode Lottery. We have found that through our investment, ADAPT and READ-OUT are working to produce clinical and economic data that could bring blood tests to the NHS within five years to support the diagnosis of dementia. All of this means that the rate of diagnosis is improving. The latest data from April shows that the diagnosis rate has inched up to 65.5%, up 0.3% since July 2024, and it is worth noting that the 66.7% ambition has not been met since 2020.

The quality and availability of care services is variable, as Members have pointed out. We are empowering local leaders with the autonomy they need. We are supporting integrated care boards. I am pleased to say that we recently published the Dementia 100 pathway assessment tool, which brings together multiple resources into a single, consolidated training tool. That launched last month, and there has been huge interest and support from the sector, with 1,000 people registering to attend the launch webinar. We have the dementia care pathway full implementation guidance, and we are supporting the implementation of that guidance through a dashboard, to enable targeted support where it is needed.

All those who have dementia deserve to receive high-quality care. We must have a workforce that is equipped with the skills that are needed. We are incredibly proud of everyone who works in the care sector, and they deserve the training that many Members have mentioned. The care workforce pathway provides guidance for progression and development for professionals across adult social care with the knowledge, skills, values and behaviours that our carers need. It links learning outcomes to existing frameworks, including the dementia training standards framework.

Some of those learning outcomes can be achieved through the training and qualifications eligible for funding under the learning and development support scheme. That scheme, launched in September last year, supports adult social care employers to invest in their workforce through funded training opportunities, including a range of dementia-related qualifications. I am pleased to confirm that we have backed the scheme with a £12 million investment. Pay and conditions are also vital elements of our workforce strategy, so I am sure Members across the House will welcome our groundbreaking fair pay agreement legislation in the Employment Rights Bill for adult social care workers, which is hugely significant in this context.

On the question of our care workforce, a number of Members have highlighted the vital role that unpaid carers play. To support them, on 7 April the Government increased the carer’s allowance weekly earnings limit from £151 a week to £196 a week, which is the equivalent of 16 hours at the national living wage—the largest increase in the earnings limit since the carer’s allowance was introduced in 1976. We are very proud of that change.

I understand that every person with dementia, alongside their friends, families and carers, has their own unique and important story of living with dementia. I know that I am not alone in this fight. I want to pay tribute to the Alzheimer’s Society, Dementia UK and Alzheimer’s Research UK for all their vital work. Together, we will build a society where every person with dementia receives high-quality care from diagnosis through to the end of life. I once again thank the hon. Member for South Devon for raising this vital topic.

Draft Human Medicines (Amendments Relating to Hub and Spoke Dispensing etc.) Regulations 2025

Stephen Kinnock Excerpts

Monday 2nd June 2025 General Committees

[The Minister for Care (Stephen Kinnock)]

I beg to move,

That this Committee has considered the draft Human Medicines (Amendments Relating to Hub and Spoke Dispensing etc.) Regulations 2025.

It is a pleasure to serve under your chairship, Mr Stuart. These regulations amend the Medicines Act 1968 and the Human Medicines Regulations 2012 to enable hub and spoke dispensing for pharmacies and dispensing doctors that are not within the same legal entity.

Pharmacies play a vital role in our healthcare system, ensuring that patients have access to medicines and acting as an easily accessible front door to our NHS. This Government recognise the importance of community pharmacies and are committed to supporting the sector. That is why we have increased the core contract for community pharmacy funding to £3.073 billion, with the deal representing the largest uplift in funding for any part of the NHS in 2025-26—over 19% across 2024-25 and 2025-26.

Community pharmacies work hard for the NHS and the patients they serve. In England alone they dispense around 1.1 billion NHS medicines every year, and that number grows year on year. Dispensing of a medicine is not just handing out a package, but covers a number of processes: the receipt of a prescription; clinical and accuracy checks to ensure the prescribed medicine regime is suitable and safe for the patient; sourcing and buying the medicines on behalf of the NHS; the preparation, assembly and supply of medicines; and advising patients to ensure they know how and when to take the medicine. It is complex and important work.

As the number of prescriptions rises, we need to support our pharmacists to focus on the provision of advice and support to patients in order to optimise their use of the medicines on which the NHS spends nearly £10 billion in primary care each and every year. That is why the Government have introduced these regulations to allow all pharmacies, should they choose, to make use of hub and spoke dispensing.

In hub and spoke dispensing, the routine elements of dispensing—such as sourcing products, the preparation and assembly of medicines, and labelling—take place on a large scale in a hub pharmacy, separate from the pharmacy at which the prescription was handed in, which is the spoke. There are typically many spokes to one hub. Existing hubs often make use of automated processes to realise economies of scale and increased efficiencies. Not all pharmacy businesses are able to invest in their own hub, and businesses are currently not able to engage a hub that they do not own. The Government propose changes that would level the playing field in community pharmacy by enabling all pharmacies and dispensing doctors to use hub and spoke dispensing, if they choose.

Hub and spoke arrangements already exist in the UK, but the 1968 Act restricts their use to community pharmacies that are part of the same legal entity. That has limited the use of hub and spoke arrangements to the larger pharmacy chains. The proposed changes to the 1968 Act and the 2012 regulations will remove that legal restriction and allow all pharmacies, including small independents and dispensing doctors, to utilise the arrangement as and when best suits them, levelling the playing field and cutting red tape.

We propose to amend the 2012 regulations and the 1968 Act using the powers in the Medicines and Medical Devices Act 2021. The amendments go beyond simply removing the barrier that currently limits hub and spoke dispensing to pharmacies within the same legal entity, and they include additional elements to ensure the policy’s safe and effective implementation by putting in place provisions to ensure accountability, governance and transparency for patients.

We propose to amend the 1968 Act to remove the restriction that prevents a medicine from being sold or supplied from a different pharmacy from the one at which it was dispensed, unless those pharmacies belong to the same legal entity, and to remove section 131 of the Act, which covers the definitions of wholesale dealing, retail sale and related expressions. The definitions of those terms will now be those found in the 2012 regulations to ensure clarity across the legislation.

The proposed changes to the 2012 regulations create a new model of hub and spoke dispensing. They establish a framework for the sharing of patient information between the hub and the spokes and set the following criteria for the newly permitted arrangements. Both a hub and a spoke must be pharmacies registered with the pharmacy regulator. There must be written arrangements between any hub and spoke that must include a comprehensive statement about their responsibilities to ensure that each party is clear about the process and activities for which they are responsible. The medicine label must include the name and address only of the spoke so that patients know where to address any questions about their medicines. The spoke must conspicuously display a notice on its premises and its online presence about hub and spoke dispensing arrangements, where they are in use.

The changes also establish an information gateway that includes conditions for lawful sharing of relevant patient data between the different legal entities that operate hub and spoke arrangements. There is potential for this model to increase patient safety. Evidence shows that, where businesses have implemented hub and spoke systems with tracking technology, automated systems in the hub have had a dispensing error rate six times lower than manual processes.

During the consultation on the proposals in 2022, respondents shared evidence suggesting that the working environment in both the hub and the spoke can be calmer and more focused, reducing some of the stresses on our valued pharmacy workforce. Providing space and time at the spoke gives staff more time to deal with complex issues and carry out patient-facing work, including explaining to patients how to get the best outcomes from their prescribed medicines.

All the amendments will come into force in October 2025. They will apply across the UK, and the timescale allows time for secondary legislation to be amended, as appropriate, across the four nations. It also gives the pharmacy sector time to explore the relevance of the new hub and spoke arrangement.

I hope I have explained the rationale behind amending the 2012 regulations and the 1968 Act to enable hub and spoke dispensing arrangements across different legal entities. I commend the regulations to the Committee, and I hope hon. Members will join me in supporting them.

--- Later in debate ---

[Stephen Kinnock]

I will endeavour to answer all the questions that have been asked, but there may well be some that I am not able to. I will be more than happy to write to hon. Members accordingly.

Let me say a word on the rationale for choosing model 1. The main driver was the view that the most important aspect is the interface between the pharmacist and the patient. We felt that the spoke-to-hub-to-spoke-to-patient model best ensured the connection, at high street level, between the pharmacist and the patient, whereas the spoke-to-hub-to-hub-to-patient model would somewhat cut the high street pharmacist out of the loop. That was a balanced judgment—it was not a slam dunk.

That leads on to one of the questions asked by the hon. Member for Hinckley and Bosworth, which was about whether the Government are still open to looking at model 2. We certainly keep things under review, and we want to see how model 1 goes. If there is a feeling that it needs to be reviewed, we would be happy to do so. However, as things stand, we do not have any plans to do anything other than go with model 1, for the reason that I set out.

The hon. Member also asked about further funding. We have set out a pretty substantial uplift— £3.073 billion—for the pharmacy sector. We are hopeful that that will go some way to easing the tremendous pressures that the sector is facing. We also feel that the hub and spoke model will drive productivity, which we hope will enable pharmacies to do more with less. That will be a good way to address some of the funding challenges.

On recording data and where the data will be held, I will write to the hon. Member. I do not have that technical information to hand.

On the incentives, we are clear that this is a flexible business arrangement. All we have said is that we need to see set out in writing how the relationship between the hub and the spoke will work. That is in the draft regulations. Letting that business relationship work with the greatest possible flexibility—rather than trying to micromanage it too much with incentives set from the centre—is the best way for it to work. As I say, however, every time we will want the assurance of a clear written relationship between the two.

I thank my hon. Friend the Member for North Somerset for his kind words. I have absolutely welcomed his relentless lobbying during various Divisions over the past few months—I promise him that is the truth and nothing but the truth. On VAT status, however, I will dodge the question, because of course decisions on VAT are the responsibility of His Majesty’s Treasury. I strongly encourage him to ask his question of my ministerial colleagues in the Treasury.

Finally, I thank the hon. Member for South Antrim for his engagement. We have had excellent engagement with his colleagues in the Northern Irish Government. He has my absolute, 100% assurance that we will continue that engagement and, given the time available, which I set out in my speech, we will ensure that all nations are able to take this legislation on board and make the necessary changes in a way that works for devolution and for the entire system across the UK.

Question put and agreed to.

Parkinson’s Disease

Stephen Kinnock Excerpts

Wednesday 21st May 2025 Westminster Hall

[The Minister for Care (Stephen Kinnock)]

It is a great pleasure to serve under your chairship, Mr Stuart.

I pay tribute to my hon. Friend the Member for Colne Valley (Paul Davies) for securing this important debate. He spoke with real passion and conviction, as did hon. Members from across the Chamber. I do not know whether we have a full house from Dorset, but we have the hon. Member for West Dorset (Edward Morello), my hon. Friend the Member for South Dorset (Lloyd Hatton) and the hon. Member for Mid Dorset and North Poole (Vikki Slade); it was great to hear their thoughts. We also heard from the hon. Member for Strangford (Jim Shannon), who spoke, as always, with great passion and conviction. This debate follows closely on the heels of the Backbench Business debate on Parkinson’s Awareness Month, which was led by my hon. Friend the Member for Dunfermline and Dollar (Graeme Downie). I thank the Members who have spoken in both debates.

I pay tribute to the invaluable work of NHS clinicians, charities and care workers who spend every single day improving the lives of people with Parkinson’s disease. I am particularly encouraged by the Parky charter, which is raising public and professional awareness about the needs of the Parkinson’s community and the importance of timely diagnosis, comprehensive care and dignity for all people with Parkinson’s. Organisations that fight for patients, such as Parkinson’s UK, are at the heart of our policies for the NHS, which is broken but not beaten. We look forward to working with them to fix the foundations of the NHS and to make it work for people with Parkinson’s in Colne Valley, throughout Yorkshire and across the country.

Parkinson’s disease can severely impact every aspect of a person’s daily life, as well as the lives of their family and unpaid carers. It can put people under immense strain, and they deserve additional support to help them live with the condition. Around 153,000 people live with Parkinson’s in the UK, and it is the fastest growing neurological condition in the world. About 16.5 million people in the UK, or one in six of the population, have a neurological condition, and 600,000 people are diagnosed with one each year. Together, neurological conditions cause around 140,000 deaths every year in the UK—one fifth of all deaths—and they are the leading cause of disability.

In 2019, the NHS spent just under £4.5 billion on neurological conditions and they cost the UK economy £96 billion, so tackling them presents a real opportunity not just for the Government’s health mission but for our growth mission. We must face the fact that patients are facing significant challenges, including not enough people in the places we need them, and delays to treatment and care, with long waiting times. We also listen to patients who tell us that they have experienced a lack of information and support.

We are acting to address those challenges, starting with our workforce. Parkinson’s nurses and neurologists are worth their weight in gold, and they are key to meeting patient demand. This summer, we will publish a refreshed long-term workforce plan, as a first step towards rebuilding our workforce over the next decade and treating patients on time again. We will ensure that the NHS has the right people, in the right places, with the right skills, to deliver the care that patients need when they need it. We will set out in black and white the numbers of doctors, nurses and other professionals who will be needed in five, 10 and 15 years’ time.

Turning to waiting lists, the NHS constitution sets out that patients should start consultant-led treatment within a maximum of 18 weeks from referral for non-urgent conditions. At the start of the year, my right hon. and learned Friend the Prime Minister announced our elective reform plan, which sets out our approach to hitting that target by the end of this Parliament. We have already surpassed our manifesto pledge to deliver an extra 2 million elective appointments, seven months ahead of the deadline; we are now on 3 million appointments and counting. Many of those were appointments for treating Parkinson’s.

I know that there may be some people with Parkinson’s watching the debate at home and shouting at their telly, “Well, I am still waiting for treatment.” Although waiting lists are coming down, and recently fell for six months in a row, they are still high. I completely understand why people who are still waiting feel frustrated. I say to them: we are throwing the proverbial kitchen sink at waiting lists, and we will not stop until you see and feel the results.

The NHS has begun some important initiatives to improve its neurology services, including the neuroscience transformation programme, the Getting it Right First Time initiative, a strengthened clinical reference group and the appointment of a national clinical director for neurology. The NHS is focusing on improving patient experiences, addressing the disparities in care and ensuring that patients are given their medicines on time. The neuroscience transformation programme is focusing on faster diagnoses, better co-ordinated care and improved access to specialist services.

At the at the recent Backbench Business debate—and, of course, in this debate—a number of hon. Members spoke about personal independence payment as an important way of helping people to cope with the extra living costs of a disability or health condition. I am sure all Members would agree that those who can work should work. However, I am happy to reassure colleagues that our “Pathways to Work” Green Paper will make sure that people with the most severe lifelong health conditions who cannot work will see their incomes protected. We are consulting on the Green Paper to hear how best we can support those impacted by our reforms.

We continue to encourage research, which is advancing our understanding of Parkinson’s at breakneck speed, through targeted funding, infrastructure support and collaboration. For example, the UK Dementia Research Institute, sponsored by this Government, is partnering with Parkinson’s UK to establish a new £10 million research centre. The NIHR is supporting research that has discovered that eye scans can detect Parkinson’s disease up to seven years before symptoms appear, which helps people to receive treatment earlier and prepare themselves as best they can.

Research also underpins the entire drug discovery and development process. Produodopa is a groundbreaking new treatment for Parkinson’s disease, particularly for patients with advanced disease and severe motor fluctuations. It is revolutionary because it provides a continuous 24-hour infusion of medication via a small pump, allowing more consistent symptom control. The NHS rolled it out in February last year. It has been shown to improve motor function and has proved its worth by significantly improving the quality of life for people with advanced Parkinson’s.

At the debate on 1 May, many Members emphasised the importance of staying active. Indeed, there is strong scientific evidence that being physically active can help people to lead a healthier and happier life. For example, exercise can reduce the risk of major illnesses and lowers the risk of early death by up to a third. Our social prescribing programme is a key component of the NHS’s universal personalised care and a way for GPs or local agencies to refer people to a social prescribing link worker. Those workers give people time, focusing on what matters to them and taking a holistic approach to people’s health and wellbeing. They connect people to community groups and statutory services for practical and emotional support.

Looking forward, we have committed to publishing a 10-year plan for health to shift the focus of our NHS from hospital to community, from analogue to digital and from treatment to prevention. In the meantime, we have taken steps towards those shifts through the home-based care pathway, which is providing comprehensive support and care for people with Parkinson’s in their own home, and through the NIHR project to test a non-invasive vibrational cueing system, helping people with Parkinson’s to maintain their walking as they go about their everyday lives.

[Chris Bloore (Redditch) (Lab)]

I congratulate my hon. Friend the Member for Colne Valley (Paul Davies) on securing the debate. I declare an interest as a member of the APPG on Parkinson’s, as the son of a sufferer of Parkinson’s, and as the grandson of someone who died suffering of Parkinson’s. We all agree that, while there are real challenges, we must secure a cure for Parkinson’s. Does the Minister agree that we owe a great debt of gratitude to the partners, spouses and community groups that do so much to support people suffering from Parkinson’s as they go through not only horrific mobility loss but the associated deep psychiatric problems?

[Stephen Kinnock]

My hon. Friend is absolutely right; our system could not survive without the amazing and heroic work of our unpaid carers. One of our Government’s actions that I am most proud of is the change to the carer’s allowance. We increased the number of hours for which a carer can work and still keep their carer’s allowance by raising the threshold from £151 to £196. I hope that is giving carers the flexibility that they need. Many carers want to work but it is immensely stressful for them to balance their working and caring responsibilities. I was very pleased that we could announce that change back in January, but my hon. Friend is absolutely right that there is a lot more that we can do. I am working with colleagues in DWP and the Department for Business and Trade to look at how we can do more as a Government for unpaid carers. My hon. Friend is absolutely right to pay tribute to them; they are the lifeblood of our care system.

The consultation on our 10-year plan received over 190,000 responses, giving people with Parkinson’s and other conditions a voice in the future of healthcare. I want to conclude this debate by quoting just one of those voices—that of Winston, a former St John Ambulance worker from Lewisham. He said:

“People don’t always see what’s happening to me, or what Parkinson’s looks like on me. They don’t see me early in the morning. They see me looking nice and managing the condition as best I can. But I have to deal with my own bubble sometimes, and it gets burst, and things go all over the place.”

I am pleased that Winston is doing fantastically well and now sharing tips with people on how to improve their public speaking abilities. His words will resonate with anyone who has a long-term condition. Stories like his should remind us why we need a health service that sees the whole person, not just the condition, to give patients the dignity, care and respect that they deserve.

I thank my hon. Friend the Member for Colne Valley again for securing this important debate, and I pay tribute to all Members for making it constructive and powerful. I look forward to working with Members on this matter.

Mental Health Bill [Lords]

Stephen Kinnock Excerpts

2nd reading
Monday 19th May 2025 Commons Chamber

[The Minister for Care (Stephen Kinnock)]

It was truly a privilege to be in the Chamber this evening to hear so many moving, powerful and thoughtful contributions. It really was Parliament at its best, and it is an honour for me to close the debate.

The Bill has been a long time coming. Patients, practitioners, campaigners and charities have all long awaited the introduction of this legislation and have played a hugely important role in getting the Bill to this point. I would like to put on record my thanks on behalf of the Government and pay testament to their commitment to change. I thank Members in both this House and the other place, including our brilliant and esteemed colleague Baroness Merron, for all their work.

As the Bill started in the other place, it has already been through extensive detailed scrutiny under the eyes of peers, many of whom were there when the Act was last revisited in 2007—I am sure they will enjoy me reminding them of that. It is testament to the cross-party consensus that has so far underpinned the Bill that the debates were constructive and largely led to the betterment of the Bill. I trust that this collegiate spirit will now continue in this House, and I thank the Opposition and the Liberal Democrats for the constructive spirit in their approach to this debate.

Every speech we heard sought to improve processes and outcomes for patients and their loved ones, and there is broad cross-party support for the overall ambitions of the Bill. However, some specific issues and queries were raised in the course of the debate that need addressing. Many hon. Members asked about our implementation plans, rightly stating that legislation is only as good as its application. Indeed, we know that community service provision is very far from where it needs to be—an issue that we intend to address alongside the implementation of the Bill.

Our first priority after Royal Assent will therefore be to draft and consult on the code of practice. It is essential that we listen both to practitioners and to those with experience of the Act when we draw up the statutory guidance.

[Helen Hayes (Dulwich and West Norwood) (Lab)]

The review of the Mental Health Act 1983 is very welcome. It started its life close to my constituency with the work of Professor Sir Simon Wessely, who drew on the experience of many residents in south-east London, particularly with regard to his work on racial inequalities. As the Minister is talking about the implementation of the Bill, I wonder whether he can reassure my constituents, who want to know that this Bill will do the job of eliminating racial inequality from mental health services, by committing to putting the patient and carer race equality framework on the face of the Bill.

--- Later in debate ---

[Stephen Kinnock]

We are already working to reduce inequalities under the Mental Health Act. The patient and carer race equality framework is now a contractual requirement for all providers of NHS-commissioned care. It will support trusts to improve their interaction with racialised and culturally diverse communities and improve governance, accountability and leadership on improving experience of care for those communities and drive concrete actions to reduce racial inequalities within mental health services.

Given that our first priority after Royal Assent will be to draft and consult on the code of practice, it is essential that we listen both to practitioners and to those with experience of the Act when drawing up the statutory guidance that supports the Act’s application. We will therefore engage with people with lived experience, their families and carers, staff and professional groups, commissioners, providers and others to do this. The code will be laid before Parliament before final publication.

Alongside the code, we will develop secondary legislation that will be laid before Parliament, subject to the parliamentary process as set out in the legislation. We have already published policy papers that set out more information on some of the delegated powers in the Bill and provide an early indication of what we intend to set out in regulations. We recognise the appetite to deliver after years of delay and the importance of parliamentary scrutiny and accountability in this crucial work. We have therefore committed to laying an annual written ministerial statement on progress, so that hon. Members will have ample opportunity to hold us to account for progress made and milestones achieved.

We have covered a wide range of topics and questions this evening, and I will not be able to cover all of them in the time allocated to me. I will therefore limit my comments to two areas that have come up repeatedly, namely the implementation plan and the treatment of people with autism and learning disabilities.

[Melanie Ward]

I thank the Minister for giving way. He is talking, rightly, about the importance of the implementation of legislation. He will be aware that new measures came into force two months ago under the Online Safety Act 2023, which introduced legal powers to remove online content that promotes suicide. Ahead of this, I wrote to Ofcom about a platform that is actively promoting suicide and suicidal ideation, and has been linked to the deaths of almost 100 young people and adults. The Ofcom chief executive replied to say that Ofcom was opening an investigation. Does the Minister agree that it needs to get on and remove this kind of content across the UK?

[Stephen Kinnock]

Of course, we have the Online Safety Act, and there are measures within that legislation that address this issue. However, my hon. Friend is absolutely right that it is time to crack on and deal with this deeply troubling issue. I pay tribute to her excellent work, and I hope she will continue to press Ofcom to do the right thing, and to do it rapidly.

We know that implementation will take time, as the pre-legislative scrutiny Committee recognised. We estimate that it will take around 10 years to fully implement all Bill’s measures, due largely to the time needed to train specialised workforce groups, including second opinion appointed doctors and tribunal judges, and the need to ensure that the right community support is available for people with a learning disability and autistic people. This timeframe necessarily spans multiple spending reviews and multiple Parliaments, so I am limited in the detail I can give today about future spend and timelines.

However, we have set out in the impact assessment what we think is required in both time and funding. We expect the process of drafting and consulting on the code of practice to take at least a year. Alongside the code, we will develop secondary legislation, which will be laid before Parliament. We have already published policy papers, which contain more information on some of the delegated powers in the Bill and provide an early indication of what will be set out in regulations.

We will then need time to train the existing workforce on the new Act, regulations and code, which will likely be in 2026 and 2027. Although we will commence some clauses, such as on supervised discharge, two months after Royal Assent, the first major reforms, including clauses concerning grounds for detention—excluding the changes to part 2 for people with learning disability and autistic people—and nominated persons, are expected to follow the training in mid-2027. The timelines for later phases are inevitably less defined, but we will expand the workforce and improve community support with the aim of implementing the reforms increasing the frequency of mental health tribunals from 2030-31. These timelines are indicative, and we will iterate the plans as we get more certainty on future funding and wider workforce plans.

The other issue that came up a lot is the treatment of people with autism and learning disabilities. Again, implementation should be well planned to ensure that the proposed legislative changes have the intended effect. The proposed changes to the detention criteria will be commenced only when strong community services are in place so that the alternatives to hospital care are robust. Members will understand that robust implementation plans are dependent on the final legislation that is passed and on future funding, which is subject to future spending reviews.

However, local systems do not need to wait for legislative changes to come into force to begin putting in place the necessary community services for people with a learning disability and autistic people. There is renewed funding in 2025-26 within ICB baselines to continue improving community support provision for people with a learning disability and autistic people.

We should recognise that the Bill is the result of the independent review commissioned by the now Baroness May of Maidenhead during her premiership. Many important contributions have also come from those with lived experience of the Act and their loved ones. It takes real courage to speak openly about those experiences and to channel pain into change.

As my right hon. Friend the Health Secretary said in his opening speech, the Government have demonstrated their commitment to funding mental health properly, and that commitment has been translated into real, tangible delivery: the £150 million multi-year capital investment to improve mental health urgent and emergency care pathways; 600 new or expanded crisis alternative services nationally, including crisis cafés, safe havens and crisis houses, providing an alternative to A&E or psychiatric admission; £26 million in capital investment to open new mental health crisis assessment centres, which aim to provide accessible and responsive care for individuals in mental health crisis; and 8,500 more mental health workers.

We are also committed to improving early intervention and shifting care to the community to support people to live well and thrive. We have committed to improve support for young people, with Young Futures hubs, making support workers more accessible to children. We are piloting in England the 24/7 neighbourhood mental health centre model, which builds on learning from international exemplars.

It is a privilege to be leading this transformational legislation through the House. I know that, because it matters so much, many people will have views on what is needed to get it right, and I look forward to further debates in that constructive and improving spirit. I commend the Bill to the House.

Question put and agreed to.

Bill accordingly read a Second time.

Mental Health Bill [Lords] (Programme)

Motion made, and Question put forthwith (Standing Order No. 83A(7)),

That the following provisions shall apply to the Mental Health Bill [Lords]:

Committal

(1) The Bill shall be committed to a Public Bill Committee.

Proceedings in Public Bill Committee

(2) Proceedings in the Public Bill Committee shall (so far as not previously concluded) be brought to a conclusion on Thursday 26 June 2025.

(3)The Public Bill Committee shall have leave to sit twice on the first day on which it meets.

Consideration and Third Reading

(4) Proceedings on Consideration shall (so far as not previously concluded) be brought to a conclusion one hour before the moment of interruption on the day on which those proceedings are commenced.

(5) Proceedings on Third Reading shall (so far as not previously concluded) be brought to a conclusion at the moment of interruption on that day.

(6) Standing Order No. 83B (Programming committees) shall not apply to proceedings on Consideration and Third Reading.

Other proceedings

(7) Any other proceedings on the Bill may be programmed.—(Anna Turley.)

Question agreed to.

Mental Health Bill [Lords] (Money)

King’s recommendation signified.

Motion made, and Question put forthwith (Standing Order No. 52(1)(a)),

That, for the purposes of any Act resulting from the Mental Health Bill [Lords], it is expedient to authorise the payment out of money provided by Parliament of any increase attributable to the Act in the sums payable under or by virtue of any other Act out of money so provided.—(Anna Turley.)

Question agreed to.

Oral Answers to Questions

Stephen Kinnock Excerpts

Tuesday 6th May 2025 Commons Chamber

[The Minister for Care (Stephen Kinnock)]

I am pleased to tell my hon. Friend that we have recruited over 1,500 additional GPs since October through an investment of £82 million, helping to fix the front door to the NHS. Today we have announced £100 million to unlock new capacity and more appointments in GP surgeries. We have also launched a red tape challenge and scrapped unnecessary targets in our new GP contract to cut down on bureaucracy and free up time to spend with patients.

[Alex Ballinger]

My constituents in Halesowen have written to me time and again complaining that they are calling their GP surgeries at 8 am, as instructed, but are still unable to get a same-day appointment. Can the Minister set out how the £100 million investment in GP surgeries, consulting rooms and other facilities will finally put an end to the frustrating 8 am scramble?

[Stephen Kinnock]

I absolutely share the frustrations of my hon. Friend and his constituents. The investment made today was in response to GPs telling us that they needed more space; the investment will lead to more capacity and better access and outcomes for his constituents. Today’s announcement was only possible thanks to the decisions made in the October Budget, which were opposed by every party opposite. The choice is clear: investment in our NHS with Labour, or cuts with the Tories and Reform.

[Rebecca Smith (South West Devon) (Con)]

My constituent Dr Toby Nelson, an NHS consultant dermatologist, has started a business that seeks to address the heavy demand on primary care for skin health screening. His business Map My Mole sends an image capture kit to patients to attach to their smartphones. The patients then send a high-resolution image remotely to be reviewed by a specialist consultant, bypassing the need for a GP appointment and freeing up time and resources for both doctor and patient. It has already resulted in a significant drop in skin cancer referrals in pilot GP surgeries. Will the Minister agree to meet Dr Nelson and me to discuss this revolutionary proposal?

[Stephen Kinnock]

The hon. Lady raises what sounds like an extremely interesting scheme. She will know that we have a strong commitment in our 10-year plan to shift from hospital to community, and indeed from analogue to digital. The digital aspects of that scheme sound very interesting, so I would be more than happy to take further representations from her.

[Marsha De Cordova (Battersea) (Lab)]

4. What steps he is taking to improve eye healthcare through the 10-year health plan.

[The Minister for Care (Stephen Kinnock)]

My hon. Friend is an outstanding campaigner on this issue, as I am sure everybody across the House is aware. She will know that the NHS England accelerator pilots have shown how improved IT connectivity and a single point of access can speed up eye care referrals and allow more patients to be managed in the community. That is a great example of the shift we want to make from analogue to digital. We are developing the 10-year health plan with input from the public, our partners and health staff, and that of course includes the eye care sector.

[Marsha De Cordova]

I thank the Minister for his response, and I welcome all the work that he and the Secretary of State are doing in rebuilding our NHS. However, we know that there is a capacity crisis within eye healthcare. NHS ophthalmology continues to be the busiest and largest outpatient service. That is essentially what is leading to many people not getting seen soon enough, which is resulting in many of them losing their sight unnecessarily. What we need is a joined-up healthcare plan. Will the Minister ensure that eye healthcare will be part of the Government’s wider 10-year health plan?

[Stephen Kinnock]

My hon. Friend is right that early intervention is crucial, and the interface between the high street and secondary care is a vital part of that. That means having a joined-up eye health strategy. The 10-year plan will have that joined-up strategy at its heart. She will be pleased to know that, since July, ophthalmology waiting lists have dropped by 24,000, so change has begun. There is still a long way to go to dig us out of the mess left by the Conservative party, but it is thanks to the decisions that the Government have made, opposed by Opposition parties, that we are beginning to see that change gaining traction.

[Sir James Cleverly (Braintree) (Con)]

Another part of the 10-year health plan is the use of digital technology. Auto-contouring with artificial intelligence reduces waiting times and frees up capacity for radiotherapists, which is why £15.5 million was allocated to it under the Conservative Government; money that has been cut under the Minister’s Government. Why?

[Stephen Kinnock]

I think that the right hon. Gentleman is referring to the single point of access digital technology, which is game changing in terms of improving the interface between high street and secondary care. It is probably worth reminding him that the question is about eye care. We are absolutely committed to single point of access technology, which we believe can be game-changing technology and is a vital part of our shift from analogue to digital.

[Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)]

The president of the Royal College of Ophthalmologists has stated that the widespread outsourcing of NHS cataract surgery to private, for-profit providers risks the integrity of hospital eye surgery departments meaning that there will be few services to treat patients with preventable blindness. How can we reassure the public that such services will be maintained?

[Stephen Kinnock]

Although the independent sector clearly has an important role to play in tackling waiting lists and backlogs, we will not tolerate any overpriced or sub-par care, and we will not tolerate any distortion of patient choice. The recently published partnership agreement between NHS England and the Independent Healthcare Provider Network commits to ending incentives that can lead to that, and to supporting equal access and genuine choice for all patients. We are working together to deliver on that.

[Jess Brown-Fuller (Chichester) (LD)]

NHS Sussex ICB is one of only five in England not to commission a minor eye conditions service—known as MECS—in community optometry settings. That means that patients in Chichester with urgent or minor eye issues have to either join the 8 am queue for a GP appointment or go to their hospital rather than being seen quickly on the high street. Given that 99.9% of MECS patients elsewhere in England are seen within 24 hours, will the Minister set out what action he is taking to ensure that those services are commissioned consistently across all ICBs within the 10-year health plan?

[Stephen Kinnock]

ICBs are responsible for the commissioning of these services, which are clearly extremely important, and the early intervention side of eye care is particularly important. I would be more than happy to look into that issue with the hon. Lady’s ICB if she wrote to me and made further representations.

[Blake Stephenson (Mid Bedfordshire) (Con)]

5. Whether he has had discussions with the Secretary of State for Housing, Communities and Local Government on the interaction between mayors and integrated care boards, in the context of the English devolution White Paper.

--- Later in debate ---

[Manuela Perteghella (Stratford-on-Avon) (LD)]

7. What recent assessment he has made of the adequacy of access to emergency dentistry.

[The Minister for Care (Stephen Kinnock)]

We are already rolling out our manifesto commitment of 700,000 extra urgent dental appointments per year. These appointments are available across the country for those experiencing painful dental issues such as infections, abscesses or cracked or broken teeth. We are committed to reforming the dental contract and making NHS dentistry fit for the future.

[Manuela Perteghella]

The dental contract imposed in 2006 is widely recognised as a key factor driving dentists out of the NHS. In my constituency of Stratford-on-Avon, there are no NHS dentists currently taking on new patients, and existing NHS patients are being actively pressured to go private or seek care out of county. Will the Minister commit to urgent reform of NHS dentistry, and set out a timeline for negotiations, so that I can reassure my constituents?

[Stephen Kinnock]

The hon. Member is right to say that the dental contract is fundamentally flawed and needs reform. I met representatives of the British Dental Association on 8 April, and had a productive discussion with them about dental contract reform. Officials from the Department of Health and Social Care are working hard with the BDA and other stakeholders to develop a dental contract that works for patients, for dental professionals and for the public purse. I will of course keep her and the House updated. I know this issue is of huge importance to the country, and to every Member of this House.

[Chris Webb (Blackpool South) (Lab)]

It is a year today since I was sworn into this House, and every single week, someone has raised with me the issue of getting access to an NHS dentist in Blackpool. Nowhere is taking on adults, and nowhere is looking after pregnant women. This has to change, so can the Minister outline to my constituents when they will be able to get access to an NHS dentist under this Labour Government?

[Stephen Kinnock]

There is no perfect payment system. We have to look at the issue around units of dental activity, and at options around capitation and sessional payments, and come to a conclusion about what works and about how to ensure that everything that we commit to NHS dentistry is spent on NHS dentistry. We are in a mad situation in which, although demand for NHS dentistry is going through the roof, we have an underspend every year on the contract. We have to fix that. It will take some time to work that out with the British Dental Association and other key stakeholders. What is tragic about this situation is that the Conservatives had 14 years to fix the situation and left it in a terrible mess.

[Laura Kyrke-Smith (Aylesbury) (Lab)]

8. What steps he is taking to improve perinatal mental health provision.

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[Josh MacAlister (Whitehaven and Workington) (Lab)]

T6.   West Cumbria, like many parts of the UK, is a dental desert. In some communities, urgent dental access centres have proved to be a real success at building up dental services, so will the Minister support my campaign to introduce an urgent dental access centre in west Cumbria?

[The Minister for Care (Stephen Kinnock)]

The Government have launched a scheme to provide 700,000 urgent dental appointments. There are 57,500 allocated to my hon. Friend’s integrated care board. He will know that ICBs are responsible for commissioning primary care services based on the needs of the population, but I know that he is a strong campaigner for his constituents. I understand that his dialogue with his ICB on this matter has been positive and constructive, and I am sure that he will continue to fly the flag.

[Sir Jeremy Hunt (Godalming and Ash) (Con)]

T2. The chief executive of the Royal College of Midwives has said that the axing of the maternity safety ringfenced pot would be a “wrecking ball” to the efforts being made to improve maternity safety. Just a single or a small group of babies being spared lifelong disability would pay for the cost of that ringfenced pot many times over. I know that the Secretary of State cares about this matter deeply, so will he reconsider?

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[Stephen Kinnock]

My hon. Friend will know that we have hired 1,500 more GPs, which will help with access. We have also renegotiated the contract, so there will be online booking systems in every practice in the country, and we have changed the contract to incentivise continuity of care in order to bring back the family doctor. There is a suite of reforms coupled with investment, which I hope will deliver for my hon. Friend’s constituents.

[Bob Blackman (Harrow East) (Con)]

T4. One of the great frustrations for medical professionals and patients alike is when patients have appointments but do not turn up. What action will the Secretary of State take to ensure that the system penalises people who miss appointments, so that patients can get the treatment they need when they need it?

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[Tessa Munt (Wells and Mendip Hills) (LD)]

T8. I have a constituent who has broken and rotting teeth. His GP referred him to the local dental hospital, but he has been refused treatment because the hospital said that the surgeon would take a referral only from a dentist, which my constituent and many others in Somerset just do not have. What does the Minister suggest my constituent should do to stop the pain?

[Stephen Kinnock]

As the hon. Lady knows, we now have a commitment to providing 700,000 more urgent dental appointments. Those who do not have an NHS dentist can call 111 and will be prioritised. We are very clear that every integrated care board has a target within those 700,000 appointments, and if they are not hitting that target, we will want to know why.

[Olivia Blake (Sheffield Hallam) (Lab)]

As someone with ADHD, it is disappointing to hear from many of my constituents about difficulties in accessing diagnosis, medication and other therapeutic inputs for ADHD, and the impact on their lives and livelihoods as a result. Whether for children or adults, waits of two, five or seven years are becoming the norm. What steps are the Government taking to make sure that individuals can exercise their right to choose?

[Stephen Kinnock]

I pay tribute to my hon. Friend for improving support for ADHD and recognise the valuable perspective that she brings through her lived experience. This Government inherited a broken NHS, with too many people facing long waits for an assessment. NHS England’s ADHD taskforce is looking at how support for people with ADHD can be improved. I look forward to reading its report, and I recently had a very productive meeting with the director of that taskforce.

[Mr Peter Bedford (Mid Leicestershire) (Con)]

T10. The Government have committed to providing 700,000 extra emergency dental appointments, but in the midlands the units of dental activity rate is just 83% and there is no additional funding for the integrated care boards. Will the Minister therefore give assurance to my constituents that he will fully deliver on that promise?

[Stephen Kinnock]

I give the hon. Member that assurance. We have been clear that every ICB has a target, and that was transparently published, and we will be monitoring it. I am holding regular meetings with officials to check that every single ICB is on track to hit those targets. If ICBs are not on track to hit those targets, we will want to know why.

[Markus Campbell-Savours (Penrith and Solway) (Lab)]

Earlier this year, I met the Cockermouth and Maryport primary care network, which told me about the increasing challenge of supporting my constituents with their mental health. Has the Secretary of State considered relaxing the additional roles reimbursement scheme funding rules to allow mental health nurses to be employed wholly by a PCN, and not need to be under the employment of a local mental health trust? That flexibility could help GP practices to intervene earlier and reduce referrals to secondary care quickly.

[Stephen Kinnock]

We have, in fact, relaxed the rules on ARRS so that a mental health worker can be employed by the PCN. My hon. Friend is absolutely right that that is an important part of stepping from hospital to community, but there is more we can do on that. We continue to do whatever we can to ensure that mental health and GP surgeries are actively integrating.

[Robin Swann (South Antrim) (UUP)]

Getting It Right First Time is a clinician-led programme that leads on improvement and transformation. Can the Secretary State give reassurance that in any restructuring of NHS England, that programme will not just be continued, but expanded and still available to the devolved Administrations?

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[Catherine Atkinson (Derby North) (Lab)]

Last week, this Labour Government announced the freezing of prescription charges, putting pounds back in the pockets of people in Derby. I have visited pharmacies, including the Littleover pharmacy, which provide essential care and support for their communities. The Conservatives underfunded pharmacies and more than 750 closed across England between 2021 and 2024. What is the Minister doing to support community pharmacies so that we do not lose these vital local services?

[Stephen Kinnock]

After years of neglect, this Government have agreed with the sector a record uplift to £3.1 billion for 2025-26 for this vitally important front door to our NHS. We are also supporting pharmacies to operate more efficiently, including enabling hub and spoke dispensing between all pharmacies later this year. I am pleased to say that the legislation for that has been laid. What a contrast that is with the previous 14 years. I am also pleased to see that the National Pharmacy Association has withdrawn its view on taking collective action. We are moving in the right direction, but there is still a lot more to do.

[Calum Miller (Bicester and Woodstock) (LD)]

I welcome today’s announcement of new money for GPs’ surgeries, but GPs in my constituency tell me that they cannot get capital out of the integrated care board and that the Valuation Office Agency consistently undervalues the cost of rents, making future building impossible. Will the Secretary of State agree to meet me, and GPs from my constituency, in order to understand the problem better?

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[Stephen Kinnock]

I pay tribute to my hon. Friend, who is a qualified physiotherapist, and who is right to refer to the value of community care. I would be happy to meet her to discuss the important issue that she has raised.

[Jim Shannon (Strangford) (DUP)]

What steps will be taken to support more community pharmacies that can offer a broad range of services to people in rural areas, to ensure that those who are most isolated from busy towns still have access to those important services?

[Stephen Kinnock]

As I said earlier, we are giving pharmacies a record 19% uplift to £3.1 billion, and I am pleased to confirm that of all the sectors in the NHS they received the best uplift in the 2025-26 settlement. We have also maintained the pharmacy access scheme, which provides £19 million to support pharmacies in areas where there are fewer of them, including the rural areas that the hon. Gentleman mentioned.

[Jon Trickett (Normanton and Hemsworth) (Lab)]

Pharmacies play a key role in communities in rural areas such as mine, but it is deeply frustrating when the supply chain breaks down and a pharmacy cannot deliver its medicine. Can the Minister tell me where we are now with the supply chain? Will she also thank all the heroic workers up and down the country who are doing their very best to deliver medicines, and will she thank in particular the 400 Superdrug workers in my constituency who are trying to make the supply chain work?

Community Health: Manchester Rusholme

Stephen Kinnock Excerpts

Monday 28th April 2025 Commons Chamber

[The Minister for Care (Stephen Kinnock)]

I congratulate my hon. Friend the Member for Manchester Rusholme (Afzal Khan) on securing this important debate. Before I begin my remarks, I would like to pay tribute to some of the stellar charities that are working to reduce health inequalities: the Health Foundation, which is leading the way with its Health Equals mission; the People’s Health Trust, which is providing funding and support to left-behind communities; and the BHA for Equality, which was founded in 1990 to address the lack of quality information and services for black communities in Manchester.

I am responding on behalf of the Minister for Public Health—the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for West Lancashire (Ashley Dalton)—but I am more than happy to take this debate because I recognise many of the issues that my hon. Friend the Member for Manchester Rusholme mentioned from my own constituency. I am responding not just on behalf of the Government, but as an MP from a constituency with some of the highest levels of deprivation in the United Kingdom.

I agree with my hon. Friend that the levels of inequality between the better-off and worse-off in our country are a national scandal. Fourteen years of austerity measures and stagnant wages have disproportionately affected lower-income households, exacerbating both income and regional disparities. Places such as Manchester and Port Talbot have borne the brunt. The life expectancy for Mancunian men and women is significantly worse compared with their compatriots in the rest of England. A baby boy born in the Manchester royal infirmary can expect to live for just over 75 years, which is four years less than the English average. A baby girl born in Manchester can expect to live to the age of about 79 and a half, which is also four years less than in England as a whole.

My hon. Friend raises some issues that are not within my Department’s remit, including housing, knife crime and fly-tipping, but I completely understand why he has done so, because the determinants of ill health are wide and it is much more than a single factor that predicts healthy life expectancy. The Government know that we cannot address the challenges we face in the north-west with each Department in Whitehall siloed one from another, so we are taking a whole-of-Government approach to tackling inequalities through our health mission. That is chaired by the Prime Minister, who is lending his weight and authority from the centre of Government.

We have a laser focus on addressing the social determinants of health in a truly strategic way, and addressing the wider determinants of health to improve healthy life expectancy for all, while halving the gap in healthy life expectancy between different regions of England. We are prioritising prevention, shifting more care into the community and intervening earlier in life to raise the healthiest generation of children in our history. Addressing healthcare inequity is a core focus of our 10-year health plan to ensure that the NHS is there for anyone who needs it whenever they need it. We have established 11 working groups to take forward policy development that will feed into the plan. That includes working groups focused on how care should be designed and delivered to improve healthcare equity, alongside ensuring that access to healthcare services is effective and responsive. We look forward to updating the House once the plan is published in June.

Proximity to fast food outlets is strongly associated with obesity. Kids living in the most deprived communities are in proximity to twice the number of fast food outlets compared with wealthier areas. Nearly 3,500 schools across the country now have a major food outlet within 400 metres; that is 1,000 more schools than 10 years ago.

We have an outstanding mayor in Andy Burnham. Devolution gives him and other leaders in Greater Manchester the freedom and flexibility to set priorities locally. In December, the Government published the revised national planning policy framework for local authorities, which gave them stronger, clearer powers to block new fast food outlets near schools and where young people gather. This will stop the relentless targeting of children and young people by the fast food industry.

I am delighted that just last week, the Tobacco and Vapes Bill passed its Second Reading in the other place. Smoking is a scourge on deprived communities and contributes to poverty, ill health and a lower life expectancy. Britain is leading the world through landmark legislation to break the cycle of addiction and disadvantage by gradually ending the sale of tobacco products across the country. The Bill contains powers to extend the ban on smoking indoors to certain outdoor settings to reduce the harms of second-hand smoking, particularly around children and vulnerable people.

Over the past 14 years, a two-tier health system has emerged in our country. People who can afford it are increasingly going private to skip the queue, while those who cannot are left behind. We are determined to end two-tier healthcare in this country, so whether someone is the richest or the poorest person in Manchester, they get timely, quality treatment that is free at the point of use. Our elective reform plan will see more NHS patients able to choose to be treated in a private hospital, where there is capacity, paid for by the state. More capacity will be available for people in working-class areas of the country and for women stuck on waiting lists for gynaecological care. Where we can treat working people faster, we will, and we will make no apology for doing so—working-class patients in this country deserve the same choice, control and convenience as the wealthy expect—and I am delighted that waiting lists have been falling now for six months in a row.

The previous Labour Government did so much to reduce inequality: lifting millions of children out of poverty through Sure Start; giving a lifeline to working families through child tax credits; creating the minimum wage; and fixing the NHS after almost two decades of under-investment. It is a matter of profound regret that so much of that legacy has been undone over the past 14 years, but the people of Manchester don’t just want us to look back in anger; they want us to get on with the job of building homes, fixing the NHS and putting more money in people’s pockets. My right hon. and learned Friend the Prime Minister has spoken about the “class ceiling” that prevents children from getting ahead. I look forward to working with my hon. Friend the Member for Manchester Rusholme to shatter the class ceiling that hangs above his constituency and mine.

Question put and agreed to.