Mental Health Bill [ Lords ] (Ninth sitting)

Debate between Stephen Kinnock and Aphra Brandreth

Committee stage
Tuesday 24th June 2025 Public Bill Committees

[Aphra Brandreth]

My hon. Friend is absolutely right. We have seen examples where regulators have not intervened quickly or robustly enough, and where systemic issues went unnoticed or unaddressed for far too long. We need to strengthen the remit and ensure that the CQC is properly equipped and held to the high standards that we expect of it.

I am an economist by background, so evaluation is something I think about a great deal. Reform, however well intentioned, must be followed by evidence, scrutiny and a willingness to learn and improve. The new clause ensures that we do not just set change in motion, but that we stop to ask whether it is working, whether the right things are being done, and if not, how we can improve.

The review required by the new clause would look not only backwards at whether the regulator has effectively carried out its existing duties under the Act, but, crucially, forwards, assessing whether it is ready to meet the responsibilities placed on it by the new reforms. I particularly welcome the requirement for the review to be published and laid before Parliament. Transparency is essential. It would allow Parliament to scrutinise but also gives patients, families, professionals and the public confidence that those questions are being asked seriously and answered publicly.

Ultimately, the new clause is about improving outcomes. When regulation works well it safeguards dignity, prevents harm, identifies and spreads good practice, develops trust and helps us build a system where the principles of this Bill—choice, autonomy, less restriction and greater therapeutic benefit—are not just written in statute, but visible in practice. That is especially important in mental health care, where so often the people subject to the Act are among the most vulnerable. Those in in-patient settings, particularly those who are detained, are often not in a position to advocate for themselves. They rely on a system that is vigilant, takes its safeguarding responsibilities seriously and puts patients’ rights first.

I hope that all members of this Committee will support the new clause. It is collaborative in its intent, constructive in its purpose and essential to delivering the meaningful reform that we all want to see. It reinforces the importance of accountability, transparency and listening to those most affected by this legislation. We owe it to those individuals and their families to make sure that we not only change the law, but also the culture and oversight that surrounds it. This review would help us do exactly that.

[Stephen Kinnock]

I am grateful to the Opposition spokesman, the hon. Member for Hinckley and Bosworth, for bringing this issue forward.

Two major independent reviews into the Care Quality Commission have reported under this Government: one by Dr Penny Dash, on the CQC’s operational effectiveness as a regulator of all health and social care providers including those in mental health, the other by Professor Sir Mike Richards on its single assessment framework. The CQC has accepted those recommendations in full, and although we are confident in the progress that the CQC is making, we recognise that the reviews did not closely inspect its statutory role in relation to monitoring the use of the Mental Health Act.

Those powers and duties are entirely distinct from those that the CQC uses to regulate the health and social care sector under the Health and Social Care Act 2008. In recognition of that gap, as the Opposition spokesman pointed out, we committed in the other place to report on that specific aspect of the CQC’s role in the first of the Government’s annual reports on the implementation of the Bill, which will be laid before Parliament one year after Royal Assent.

Mental Health Bill [ Lords ] (Sixth sitting)

Debate between Stephen Kinnock and Aphra Brandreth

Committee stage
Tuesday 17th June 2025 Public Bill Committees

[Stephen Kinnock]

The clause seeks to strengthen the protocol on discharging individuals under the Act by introducing a statutory requirement on the person who makes the discharge decision to consult with another. Currently, a patient’s responsible clinician can, in law, unilaterally decide to discharge a hospital in-patient from certain powers of the Act. Under our amendments, they will be required to consult someone else who is professionally concerned with the patient’s treatment, whether that be in the hospital or in the community. Where the responsible clinician is a consultant psychiatrist, the consultee may be a nurse, psychologist or occupational therapist. That is to ensure a more rounded perspective on the patient’s readiness for discharge from the Act.

The clause will introduce a similar protocol for the discharge of people under guardianship, guardianship orders and community treatment orders. For guardianship and guardianship orders, the person who makes the decision to discharge from the powers under the Act may need to consult either the responsible local social services authority or a person’s designated social worker. For patients under a community treatment order, the responsible clinician is required to consult the community clinician, in recognition of the fact that they will likely have a much clearer understanding of the patient’s progress in the community and whether they are ready for discharge under the Act.

Although multidisciplinary-based decisions represent best practice, we know that they are not always taken. The clause seeks to change that by helping to make sure that the decision to discharge is carefully considered and receives greater professional oversight.

[Aphra Brandreth]

I rise to speak to the implications of clause 34 for clinical decision making, patient safety and the operation of the Mental Health Act more broadly. The clause introduces a new requirement for the responsible clinician to consult another professional, from a different professional discipline, who is involved in the patient’s care before they make a decision to discharge a patient from detention or from a community treatment order under section 23 of the Mental Health Act 1983. If the patient is on a community treatment order, the clinician must consult the relevant community clinician.

At its heart, the clause seeks to ensure that decisions about discharge are not taken in isolation. It reflects a wider shift in mental health care towards collaborative, multidisciplinary approaches. We should welcome that in principle. These are often complex decisions that involve vulnerable individuals, and a single viewpoint may not always capture the full clinical picture. By requiring consultation with someone from another discipline, be that a nurse, an occupational therapist or a psychologist, we can help to ensure that decisions are more thoroughly considered and less likely to overlook risks.

The clause provides an important safeguard against premature or inappropriate discharge, particularly in cases where a patient may continue to pose a risk to themselves or others. It builds in a degree of professional scrutiny that supports safer and more consistent practice and, in doing so, should improve confidence among patients, families and practitioners.

I would be grateful if the Minister provided further clarity on a few practical points about how the clause will operate. First, it requires consultation but does not appear to specify whether the consulted clinician must agree with the responsible clinician’s decision in order for discharge to proceed. In cases where there is disagreement between clinicians of different professional backgrounds, what is the expected course of action? Is the responsible clinician ultimately free to proceed, or will there be an escalation mechanism? It would be helpful to understand how differing professional opinions are to be balanced and how potential deadlock is to be managed.

Secondly, although I welcome the intention to improve the rigour of decision making, will the Minister reassure the Committee that the additional consultation requirement will not introduce unnecessary delays into the discharge process? It is, of course, essential to get these decisions right, but it is also important that we do not create new barriers to discharge when a patient is clinically ready to move on. Delays in discharge can have a negative impact on patient outcomes, as well as increasing pressure on services. Although the consultation must be meaningful, it should also be proportionate, timely and clearly understood by all involved.

Will the Minister comment on how the requirement will be implemented in practice? For example, will guidance be issued to support clinicians in understanding their duties under the clause and to ensure consistency across services?

Overall, the clause represents a thoughtful and measured reform. It strengthens patient safety, promotes professional collaboration and introduces a safeguard that is both reasonable and necessary. Notwithstanding the clarifications I have raised, I hope that it will help to ensure that discharge decisions are made with greater confidence and care without becoming unduly bureaucratic.

--- Later in debate ---

[Stephen Kinnock]

The hon. Member for Chester South and Eddisbury asked about differences of opinion. The second professional does not have to agree. The ultimate decision in such cases sits with the responsible clinician, to ensure the clear accountability of decision making.

The hon. Lady also asked about delays. We see consultation with another professional as important to making a more informed decision on whether the patient is ready for discharge under the Act. It is especially important that the second professional involved in discharge decisions is from a discipline different from that of the responsible clinician. That will ensure a broader perspective, particularly when the second professional, such as a nurse, may have had more frequent contact with the patient.

[Aphra Brandreth]

On the discipline of the second clinician consulted, is there any guidance as to who might be appropriate? I mean not just the list of potential professions but whether there is guidance on who would be appropriate in different situations. We welcome the multidisciplinary approach, but I would like some clarification. Given your earlier response, saying that they need to agree, it is not really clear how this would add to the process. It would help if there were clarity on the professions.

[The Chair]

Order. When you say “you”, you are referring to the Chair.

--- Later in debate ---

[Stephen Kinnock]

I will first discuss clause 41 and schedule 3. Independent mental health advocates are specially trained advocates who can support patients detained under the Mental Health Act to understand their rights and participate in decisions about their care and treatment, but not everyone who would benefit from an independent mental health advocate currently has access to one. In view of the benefits that advocacy can bring, we are expanding the right to an independent mental health advocate to all mental health patients, including informal or voluntary patients who are not detained under the Act.

We know that some informal patients are not told about their rights and legal status. Informal patients in Wales already have the protection, and we want to extend it to patients in England. It will help ensure that the voices of individuals are heard and their rights respected, and that potentially vulnerable groups, including children and young people, do not go without important advocacy protections.

Moreover, the Bill provides an additional enhanced mechanism for ensuring that the most vulnerable mental health patients, those compulsorily detained under the Mental Health Act, are able to benefit from advocacy. We are introducing an opt-out system for that particular cohort, to put the onus on hospital managers rather than patients themselves to request independent mental health advocacy services. Hospital managers must notify providers of advocacy services about the patients who are eligible for IMH advocacy. Advocacy providers must then arrange for independent mental health advocates to interview those patients to find out whether they want to use their services.

The right to an independent mental health advocate will also be expanded to include part III patients who are subject to the new supervised discharge, which allows for part III patients to be conditionally discharged into the community and still deprived of their liberty. The Bill also enables independent mental health advocates to provide extra help to patients to have a greater say in their treatment or to make a complaint. Together, these changes increase the access that patients have to advocacy, which contributes to improved patient rights.

I will next address amendment 19. We appreciate that people under 18 are a vulnerable group who would benefit from advocacy representation. For this reason, the Bill extends the right to an independent mental health advocate to informal patients, including under-18s, who are often admitted on a voluntary basis. We are introducing a duty on hospital managers to inform them of this right. That means that hospital managers will be expected to proactively approach all children and young people, and others, such as their parents or carers, to make sure they know that they are entitled to an advocate and help them to appoint one.

We will make it clear in the code of practice how independent mental health advocates should support children and young people with their particular needs. However, we think it is right that detained patients, including under-18s—rather than informal patients—receive advocacy on an opt-out basis. This is because they are subject to greater restrictions, meaning that it is even more important that they are supported to exercise their rights.

Finally, I will address Government amendments 42 and 43. Schedule 3 introduces the concept of “English qualifying informal patients”, who, for the first time in England, will be eligible for independent mental health advocacy services. We are amending this measure to change the definition of both English and Welsh qualifying informal patients. Amendments 42 and 43 are minor amendments to address a technical issue with the legislation. There is case law saying that the term “informal patient” would cover anyone there on a voluntary basis and not subject to any compulsory legislative framework. However, as currently drafted, the Bill’s definition is wider, defining an informal patient in England or Wales as an in-patient in hospital who is receiving assessment or treatment for a mental disorder at the hospital but not subject to the Mental Health Act. A person deprived of their liberty under any other legislation such as the Mental Capacity Act 2005 or under a court order would therefore be classed as an “informal patient”, which would be incorrect, as people who are detained cannot, under case law, be informal patients.

That would lead to complications in practice. A patient subject to the deprivation of liberty safeguards would be eligible for independent mental health advocacy as well as independent mental capacity advocacy. However, an independent mental health advocate cannot provide any help or support in relation to the Mental Capacity Act. The amendments address that issue by changing the definitions of “English qualifying informal patient” and “Welsh qualifying informal patient”, to be an in-patient receiving assessment or treatment for a mental disorder who is not detained under any other legislation or court order.

For those reasons, I hope that the hon. Member for Winchester is satisfied not to press his amendment, and I commend Government amendments 42 and 43, clause 41 and schedule 3 to the Committee.

[Aphra Brandreth]

I rise to speak to clause 41, which brings into sharper focus two pillars of a fair and rights-based mental health system: the provision of clear information to patients and the strengthening of independent mental health advocacy. It rightly recognises that, when a person is detained under the Mental Health Act 1983, often during a period of acute crisis and difficulty in their life, they need to feel that their clinical needs are being met, but in a way that respects them as individuals, with the same entitlements to dignity and agency as any other member of our society.

The clause provides for informal patients to be eligible for an independent mental health advocate. I welcome the extension to enable more individuals to access this vital advocacy. It empowers patients to know that independent advocacy is available, but we must ensure that there are sufficient resources so that those who choose this help are given sufficient support when they are in a potentially vulnerable position. As someone representing a constituency that is in England but borders Wales, I also welcome that these changes bring care into line so that advocacy help is offered to informal patients, regardless of which side of the border they are accessing treatment.

The clause places a renewed duty on services to ensure that information is given to patients clearly, promptly and in a form that they can understand. It introduces an obligation for advocacy providers to determine, through an interview, whether a qualifying patient wishes to use the service. This support is important; no person should be expected to navigate the complexities of mental health legislation, or their rights under it, without proper guidance. However, where there is a duty

“on hospital managers and others to notify providers of advocacy services about qualifying patients”,

can the Minister clarify who is meant by “others”? Will there be a list of people and roles who are given this responsibility?

The role of an independent mental health advocate is vital. These individuals can be a lifeline. They can help people to understand their rights and any medical treatment, and crucially, can support an individual to have their say about any treatment. Clause 41 rightly reinforces the importance of independent mental health advocates, and it is important that we match that ambition with the legal and practical steps to support them.

It is entirely right that we welcome the recognition of the role of independent mental health advocates, who serve a vital function in ensuring that patients’ voices are heard and their views represented, especially when navigating what can be an incredibly complex legal and clinical environment. Their independence is fundamental to not only their effectiveness but the confidence that patients and families can place in the system, which brings me back to my point. It is therefore important that we support independent mental health advocates with the resources that they need to do their job effectively.

If we are to rely further on advocates, we need to ensure that they are in a position to deal with that, so that we do not create statutory entitlements that are difficult to act upon. Actions, as well as words, are needed. At present, many areas already struggle with advocacy coverage. If we now place additional expectations on the service, and I believe that we will through this provision, we must ensure that there are sufficient numbers of trained, experienced independent mental health advocates across the country to meet rising demand. Can the Minister reassure the Committee that the necessary people with the skills and training are available to fulfil this expanded role?

We must also consider the patients’ experience, as has been the focus of so many of the remarks made in the Committee today. Again, I emphasise the vulnerability of patients at times of crisis. If we are to tell patients that support in the form of an advocate is there for them, we need to ensure that it is accessible and easy to reach and understand. Clause 41 moves us in the right direction, but implementation is everything. It must be backed by local accountability, adequate funding and clear operational guidance. This includes ensuring that all patients, regardless of background, language or capacity, are given support that is appropriate and effective.

It is vital to consider the wider implications of this clause. The reinforcement of the independent mental health advocate’s involvement should be mirrored by greater investment in advocacy services, stronger integration with care planning and more regular engagement with patients themselves on how these services work in practice. In our earlier discussions, my hon. Friend the Member for Farnham and Bordon suggested that we use trials, which could also be considered here to ensure that, as changes are brought in, they are matched by appropriate service levels.

I am largely supportive of clause 41, which I think moves us in the right direction towards a transparent mental health system that is there for patients, ensuring that they have a voice and are not an afterthought. As long as it is deliverable in practice, and does not give false hope to patients, the clause strengthens the Bill.

--- Later in debate ---

[Aphra Brandreth]

Does the Minister have any more detail on that? Is there a timeframe for recruiting these advocates and putting the training in place? That would help reassure the Committee that there is provision to ensure that the timing will fit with the introduction of the changes in the Bill.

[Stephen Kinnock]

As has been discussed, as soon as the Bill gets Royal Assent we will launch an extensive consultation around the code of practice. The code of practice will cover everything from training to recruitment to capacity building, and the plan will be set out in the first annual written ministerial statement, which will take place one year after the Bill receives Royal Assent.

My hon. Friend the Member for Hertford and Stortford asked about children admitted informally. We are introducing a duty on hospital managers to inform informal patients of their right to a mental health advocate. We will set out the importance of independent mental health advocate representation for children and young people in the code of practice. That could include the importance of a proactive approach for hospital managers.

We will also describe in the code the new role for independent mental health advocates in relation to informal patients, including vulnerable in-patient groups, such as children and young people, people from ethnic minority backgrounds and people with a learning disability or autism.

The hon. Member for Farnham and Bordon asked whether we have the money for it. The funding requirements will, I think, be related to our best estimate of likely workforce and funding requirements. If we are going for 330 additional IMHAs, the funding requirements will be defined by that number.

The shadow Minister, the hon. Member for Hinckley and Bosworth, asked whether it will be local authority funding. We are obliged to fund new burdens on local authorities to resource this expansion of the independent mental health advocates. He then asked a blizzard of additional questions; I got lost in the thread of them all. We will go through Hansard and write to him.

Mental Health Bill [ Lords ] (Fourth sitting)

Debate between Stephen Kinnock and Aphra Brandreth

Committee stage
Thursday 12th June 2025 Public Bill Committees

[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.

Mental Health Bill [ Lords ] (First sitting)

Debate between Stephen Kinnock and Aphra Brandreth

Tuesday 10th June 2025 Public Bill Committees

[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

Mental Health Bill [ Lords ] (Second sitting)

Debate between Stephen Kinnock and Aphra Brandreth

Committee stage
Tuesday 10th June 2025 Public Bill Committees

[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.

Mental Health Bill [ Lords ] (First sitting)

Debate between Stephen Kinnock and Aphra Brandreth

Committee stage
Tuesday 10th June 2025 Public Bill Committees

[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

Oral Answers to Questions

Debate between Stephen Kinnock and Aphra Brandreth

Tuesday 25th March 2025 Commons Chamber

[Stephen Kinnock]

I absolutely agree. The state of NHS dentistry in our country is shameful. The golden hello scheme enables 240 dentists to receive a £20,000 joining bonus payment to work in dental deserts, and we are negotiating with the British Dental Association the long-term reform of the contract. The issue is not the number of dentists in the country, but the paucity of dentists who are doing NHS work.

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

The north-west has some of the worst levels of children’s oral health in England, with Cheshire and Merseyside falling below the national average. In rural villages in my constituency like Bunbury, where bus services have been cut, and Kelsall, where a dentist is keen to open an NHS practice but faces barriers due to city centre prioritisation, residents are struggling to access NHS dental care. Given the challenges of rural access, what steps is the Minister taking to ensure that NHS dental provision is available in those rural communities?

[Stephen Kinnock]

I find it quite striking when Conservative Members stand up and describe the abysmal state of NHS dentistry. It makes me think, “Well, who created this mess in the first place?” But that is as an aside. The fact is that we have the golden hello scheme for dentists to come and work in so-called dental deserts. We recognise that the fundamental problem is around incentives for dentists to do NHS work. That is why we are doing a long-term contract negotiation to ensure we have an NHS dentistry contract that is fit for purpose and where every penny allocated to NHS dentistry is spent on NHS dentistry.