Zöe Franklin

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I beg to move, That the clause be read a Second time.

The new clause would introduce a dedicated veterans’ mental health oversight officer, recognising that those who serve or have served in the UK or Commonwealth armed forces face distinct mental health challenges that are not always adequately met by the current system. Far too many veterans experience post-traumatic stress disorder, depression, anxiety or substance misuse that, sadly, is linked to their service. Yet they are often treated within a system that does not fully take account of those experiences, and they are sometimes detained under the Mental Health Act without the benefit of trauma-informed, veteran-specific pathways of care.

New clause 9 seeks to change that. It would create an independent officer, tasked with monitoring the use of the Mental Health Act in relation to veterans, advocating for tailored assessment and care linked to veterans’ service history, promoting alternatives to detention where appropriate, particularly through veteran-specific services, and reporting annually to Parliament on outcomes including rates of detention, recidivism and systemic barriers. It is not just about oversight; it is about respect and responsibility.

Zöe Franklin

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I see them as absolutely sympathetic to each other and working in concert. We want to ensure that veterans have specific, tailored mental health care, as is outlined in the Bill. That is why the new clause would ensure that veterans’ unique needs are not just recognised but actively addressed. It is a practical and overdue step to improve care, safeguard rights and deliver the joined-up service that veterans deserve. After all, they give so much to our nation through their service.

I hope that the Minister will support the new clause, but if he does not, I hope that he will outline for the Committee how the Government will ensure that the aims of the new clause will be addressed through the Bill and its accompanying documents as they stand.

Aphra Brandreth (Chester South and Eddisbury) (Con)

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It is a pleasure to serve under your chairmanship, Mr Vickers. I rise to speak in strong support of new clause 13, tabled by the shadow Minister. The new clause would place a duty on the Secretary of State to review the functions and effectiveness of the regulatory authority, which is currently the Care Quality Commission, within one year of the passage of the Bill. The new clause is a timely, necessary and constructive addition to the Bill.

As colleagues will know, the Care Quality Commission plays a dual role in relation to the Mental Health Act. First, as the regulator of services, it ensures that providers meet fundamental standards of care and safety. Secondly, through its specific responsibilities in visiting and speaking to those detained under the Act, it ensures that people’s rights are protected and that the law is used appropriately and humanely. That is no small task. It is a balance that requires the CQC to be not only reactive but proactive, and not only independent but responsive to the lived experiences of patients—especially to the voices of the most vulnerable. That is why the new clause matters. As we bring forward significant reforms to the Mental Health Act through the Bill, and rightly modernise and improve safeguards and place greater emphasis on autonomy, dignity and therapeutic benefit, we must also ensure that our system of oversight and regulation is fit for purpose.

I welcome the direction that the Bill sets. Its four core principles are rightly placed at the heart of the legislation: choice and autonomy, least restriction, therapeutic benefit, and seeing the person as an individual. Those principles must shape the way that care is delivered on the ground. That means they must also shape the way that care is monitored, inspected and held to account. A review of the regulator’s role is not about criticism for its own sake; it is about ensuring that the regulatory framework supports and reinforces the ambitions of the Bill and that it can respond to emerging challenges, shine a light where services are falling short and, crucially, act to protect patient rights.

Aphra Brandreth

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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.

Josh Dean (Hertford and Stortford) (Lab)

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It is a pleasure to serve under your chairship once again, Mrs Harris. The Minister has set out in detail the function of clause 54, so I will not cover that in detail for reasons of time. I welcome the clause, which represents a step forward in regulating the placement of children and young people in adult treatment settings, and in ensuring their safeguarding. I welcome the fact that it recognises the need to review the existing safeguards available to young people.

The independent review of the Mental Health Act made recommendations in this area, including that when an under-18 is placed on an adult ward, the CQC should be notified within 24 hours, and that the reasons for and the proposed length of the placement should be recorded. I would be grateful if the Minister would set out what consideration the Government have given to those recommendations, and whether they will form part of the review.

I turn to the important matter of children and young people who are under 18 placed in adult treatment settings. I think we all recognise the extremely difficult context in which these detentions take place. We know that there is a serious shortage of specialist in-patient beds for children and young people, which means that places are often full or may not be available at a time of urgent crisis.

When someone under 18 is placed in an adult treatment setting, they are more likely to witness or even experience high levels of restraint, be denied support from their peers, and lack access to educational opportunities. These placements can actually cause further harm to children and young people’s mental health, and therefore be detrimental to their recovery. I will be grateful if the Minister can assure me of the actions that the Government will take to further safeguard those children and young people who hit crisis point and find themselves in adult treatment settings because of the shortage of beds. How will we ensure that they are protected from being placed in inappropriate treatment settings?

I do not wish to test your patience, Mrs Harris, but before I conclude I want to examine the point about children and young people a little further, given the interaction of clause 54 and associated new clauses with their treatment. I welcome the Government’s consistent restatement of the importance of getting the Bill right for children and young people. I know that the Minister takes such matters incredibly seriously, and I have listened carefully to what he has said this afternoon and throughout the Committee.

The Minister has stated that a number of the reforms relating to children and young people will be addressed in the code of practice, but that contrasts with the approach of many of the welcome safeguards set out for over-18s in the Bill. Will the Minister clarify why these issues are being addressed differently when it comes to children and young people, compared to adults? Children and young people are a uniquely vulnerable group.

On the point about the code of practice, I note that any deviation from that would need to be justified, but my understanding is that the code cannot impose duties on practitioners or require them to exercise their functions under the Act. I am concerned that putting safeguards for under-18s on a different footing from those for adults could make it harder for young people to access those safeguards. I welcome much of the work being done by the Bill, and I want to make sure that children and young people can also access its safeguards. I will be grateful if the Minister can address those points in his response.

In conclusion, I welcome the step forward that clause 54 represents, because it addresses an important issue that we need to get to grips with. I look forward to the Minister’s response.

Stephen Kinnock

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I will speak first to amendment 46. We agree with the principle of the amendment, but do not think it necessary. Under the Bill, if an individual who is likely to benefit from making an advance choice document approaches services to create one, they should be offered information and appropriate support to do so. The approach that we have taken in the Bill is therefore functionally equivalent to a right to request an advance choice document.

The Chair

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

Amendment 54, in schedule 2, page 77, line 21, at end insert—

“(3) Where the patient has not attained the age of 16 years, a nominated person must have parental responsibility for the patient.”

This amendment would stipulate that the nominated person for a patient under 16 must have parental responsibility for the patient.

Amendment 55, in schedule 2, page 80, line 13, after “2(2))” insert

“, has parental responsibility for the patient (see paragraph 2(3))”.

This amendment would stipulate that the nominated person for a patient under 16 must have parental responsibility for the patient.

Government amendments 40 and 41.

Schedule 2 stand part.

Clauses 25 to 28 stand part.

Jen Craft (Thurrock) (Lab)

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

The Minister for Care (Stephen Kinnock)

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It is a pleasure to serve under your chairship, Mrs Harris, not least because I understand you have just returned from New Zealand, where you had duties as the Government’s trade envoy. I thought perhaps we should do a haka in your honour to mark it, but you might rule against that.

Aphra Brandreth

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My hon. Friend makes an important point. This is not a simple or straightforward addition; it would require potentially substantial training. We would not want somebody in a role that they were not adequately prepared for. With any amendment, we would need to ensure that training, and the time and expense of it, had been factored in.

Even with the best intentions, the success of any extended support role, such as that envisaged in the amendment, will ultimately rely on the availability and integration of local services. Where appropriate services are in place and are working well together, advocates can play a valuable role in signposting and supporting access. Rather than placing additional responsibilities on the IMHA, our focus should be on working with community providers to ensure that the necessary support, particularly for social and financial needs, is consistently available and is effectively joined up across the system.

Having said that, I recognise and welcome the emphasis placed by the hon. Member for Winchester on the role of carers and family members. Too often, they are overlooked in discharge planning, yet their involvement can make a critical difference to a patient’s successful transition from hospital to home. When carers feel informed, supported and prepared, it gives patients the reassurance and stability that they need to continue their recovery with confidence. The primary responsibility of the independent mental health advocate, however, must remain their responsibility to the patient. I am concerned that the drafting of the amendment could create ambiguity about who the IMHA is principally there to support.

Financial stress is undoubtedly a real and urgent concern. Mental ill health can severely affect an individual’s capacity to work, to manage their finances or even to engage with systems of support. Equally, financial instability can exacerbate mental health difficulties. Those are serious challenges that must be addressed, but I would question whether the IMHA is the right professional to take on that role directly. Instead, we should ensure that they are well placed to refer individuals to appropriate services without assuming responsibility for co-ordinating that support themselves.

Aphra Brandreth

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That is an important point. These are quite substantial changes, and we do not know the full impact that they would have on the system. We have talked about issues such as whether there is sufficient training for advocates and a joined-up approach with what is happening in the community. A pilot would provide the opportunity to see where it is working and where there might be things that need to be changed or considered. It would certainly be a sensible approach. We all want to ensure that we are supporting individuals to be discharged in a safe way that minimises the likelihood of their being readmitted, but we need to do so without overcomplicating the roles and the system that are currently in place.

I commend the hon. Member for Winchester for bringing these important issues to the attention of the Committee. His amendment raises legitimate and timely concerns around the support offered to individuals leaving hospital, as well as the wider context in which recovery takes place. I hope that I have been able to offer some reflections that will assist hon. Members in considering the matter further.

Stephen Kinnock

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Currently, under the Mental Health Act, a person detained for treatment can be kept in hospital initially for six months before the responsible clinician must make an assessment to decide whether to continue their detention or to discharge them. The independent review raised concerns that six months is too long. It heard evidence that patients were sometimes detained longer than necessary and were only considered for discharge when a tribunal hearing was due. It found that in up to 17% of cases referred to the mental health tribunal, discharge happened in the 48 hours before the hearing. That suggests that some patients are being detained longer than is necessary.

The review recommended reducing from six months to three months the initial detention period for people admitted for treatment, so that a patient’s detention is reviewed sooner to ensure that patients are not detained when they are no longer benefiting from treatment and can be safely discharged.

Clause 29 will mean that patients detained for treatment have their detention reviewed three times—up from twice—in the first year: at three, six and twelve months from the date of detention. The new renewal periods will not apply to part III patients, except in very specific circumstances when an unrestricted patient changes status. I commend the clause to the Committee.

Dr Evans

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Clause 29 addresses the length and renewal of detention periods under the Mental Health Act. I begin by acknowledging the important step that this clause represents in shifting towards a more rights-based, patient-centred model, as enshrined in the Bill.

Clause 29 would shorten the initial period of detention for treatment under section 3 of the Mental Health Act from six months to three months. Subsequent renewal periods are, likewise, reduced from six months to three months and then from one year to six months. This is clearly informed by the principle of least restriction, as is rightly highlighted in the explanatory notes in paragraph 212.

On that basis, we welcome the direction of travel, but, while we agree with the principle of moving towards shorter, more proportionate detention periods, we have questions and concerns about implementation, consistency and safeguards, which I hope the Minister will address.

First, will shorter periods lead to better outcomes, or just more paperwork? The goal here is to ensure that detention is not allowed to drift and that patients are not held in hospital for longer than is necessary without rigorous justification. However, the clause still allows for indefinite renewal in increments, once those shorter initial periods expire. Can the Minister assure us that these changes will result in more meaningful reviews and not just more frequent rubber-stamping of detention? It would be helpful to understand whether the Government have assessed the clinical capacity, particularly among responsible clinicians and approved mental health professionals, to conduct these reviews with real rigour. If not resourced properly, we risk replacing one form of inertia with another.

Secondly, what safeguards exist against the resetting of detention periods on transfer? I am by no means a legal expert, so forgive me if I have completely misinterpreted this, and I bow to the legal expertise of the Minister, the Government and, most importantly, to able staff in the Box. However, clause 29(2) introduces into section 19 of the Mental Health Act new subsection (2A), which provides that if a guardianship patient is transferred to hospital, they will be treated as if they had been admitted on the day of transfer. In practical terms, does that not reset the detention clock?

To my eyes, this concept of resetting the detention clock appears most clearly in subsections (2) and 29(5)(d) of clause 29, where a patient who is transferred from guardianship to hospital, or who has their community treatment order revoked, is treated as if they had been newly admitted to hospital on that day. This effectively resets the start date of the detention period. Clause 29(2), which will insert proposed new section 19(2A) into the Mental Health Act, states:

“But, in the case of a patient falling within subsection (2)(d), section 20 has effect as if the patient has been admitted to hospital in pursuance of an application for admission for treatment on the day on which the patient is transferred.”

New paragraph 5B of schedule 1 to the Mental Health Act states that the modifications

“apply in relation to a patient transferred from guardianship to a hospital in pursuance of regulations made under section 19…In section 20(1)(a)…for “admitted”…there is to be substituted “transferred”.

In new paragraphs 5C and 5D of that schedule, the same resetting principle applies to patients whose CTOs are revoked, with renewal detention starting from the date of revocation, not from their original hospital admission or order.

In practice, this could mean that if a patient is placed under guardianship on 1 January and transferred to hospital on 1 April under section 19(2)(d) of the Mental Health Act, then under proposed new section 19(2A), they would be treated as if they had been newly admitted on 1 April. Therefore, even though they have been under compulsion since 1 January, the new three-month detention clock begins on 1 April. Likewise, a patient under a community treatment order that was issued on 1 February and revoked on 1 August will, under paragraph 5D, start a new in-patient detention period on 1 August, not 1 February.

On one hand, that makes sense. We do not want people whose state is fluctuating to be released, or simply to time out. On the other hand, if we are looking purely from the patient’s perspective, as the legislation asks us to do, with regard to the principles in clause 1, that could be a problem. Will the Minister clarify how many times such a reset could occur for a single individual? Is there any form of oversight, review or reporting requirement where this happens? That mechanism might be necessary in some clinical contexts, but without safeguards it could become a back door to prolonging detention, which is something that the clause seeks to reduce. Is there some kind of register or mandatory recording of these incidents to spot repeat patterns?

Thirdly, another issue that needs addressing is the creation of possible complexity. Paragraphs 218 and 219 of the explanatory notes set out a separate but equally important issue. Clause 29’s welcome shortening of detention periods—from three months to start with, then three months, then six months, then annual reviews—is not applied evenly to patient groups. Who gets the shorter periods? Most civil patients detained under part II and some patients on revoked community treatment orders. Who does not get them? Patients detained by a hospital order from a court, if their CTO is revoked within six months of the order, as in paragraph 218. And, of course, restricted patients—typically those involved in more serious offences.

Dr Shastri-Hurst

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It is a pleasure to serve under your chairmanship this afternoon, Mrs Harris. I rise to speak on clauses 30 to 33, which go to the core of the rights architecture that surrounds mental health law in this country—namely, the oversight and challenge mechanisms available to individuals subject to detention, supervision or conditional discharge. I think we are all aware that the 1983 Act, although fit for its time, has failed to keep pace with the evolving understanding of mental health illness and modern expectations of legal accountability or procedural fairness. The clauses, although technical in nature, seek to rectify a number of the long-standing shortcomings in the operation of the mental health tribunal system.

Clause 30 will extend and clarify the time period within which patients may apply to tribunals. Essentially, it will do two things. First, it will extend the application window for section 2 patients—those detained for assessment—from 14 to 21 days. Secondly, it will reduce the initial waiting period for section 3 patients and those under guardianship from six months to three months. Those are sensible and overdue changes, because 14 days is a narrow window for any legal action, let alone one initiated by an individual who may be experiencing acute psychological distress.

Extending the application window to 21 days provides a fairer opportunity to seek representation and prepare a meaningful application. Equally, the reduction of the initial period for section 3 and guardianship patients to three months offers an important safeguard against prolonged detention without scrutiny. It restores a measure of clarity between the gravity of the detention order and the speed with which it may be challenged.

The clause will also clarify the rights of conditionally discharged restricted patients who are subject to deprivation of liberty conditions—that is, those who are discharged from hospital but required to comply with supervisional residence requirements that are so restrictive that they cross the legal threshold for a deprivation of liberty. At present, those individuals occupy a legal grey zone: they are not formally detained, yet the liberty they enjoy is so curtailed that it raises significant questions as to their article 5 rights. Clause 30 will properly address that anomaly by creating a defined, regular route of appeal, initially between six and 12 months from the imposition of the deprivation of liberty conditions, and biannually thereafter. Those are measured and proportionate changes that enhance access to justice, improve compliance with human rights obligations and restore clarity to a field that has suffered, at times, from legal opacity.

The reforms are not without consequences. A wider cohort of eligible applicants and more frequent review periods will inevitably increase the burden on the tribunal service, on legal aid provision and on clinical teams who must prepare documents and attend hearings. That challenge is not to be dismissed lightly.

Dr Shastri-Hurst

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My hon. Friend makes a pertinent point. We all know, from our casework or personal experiences outside of this place, about the pressures on the Courts and Tribunals Service. Mental health tribunals are not exempt from that pressure. Changing the timeframe on which tribunals operate, and the frequency with which reviews take place, will inevitably increase the burden on the service. Therefore, although these changes are broadly welcome, it is important that we are cognisant of their impact on the resources that will be required, the number of judges and wing members that will be needed, and of course the hard standing of the court and tribunal infrastructure that will need to be made available. Other issues, such as those around the digitalisation of the service, will also need to be addressed.

Clause 31 will recast the regime for automatic tribunal referrals, replacing the prior six-month structure with the concept of “a relevant period”. For detained patients, referrals will now occur at three months, then 12 months, and annually thereafter. For community patients, they will occur at six months, then 12 months, then annually. Most significantly, hospital managers will be under a new duty to refer a case when no review has occurred in 12 months, regardless of whether an application has been made. That is a sound reform.

The clause will introduce coherence to a previously fragmented system, and establishes a minimum standard of legal oversight. The inclusion of a backstop provision—that no individual should go more than 12 months without review—is essential. In a system in which patients may not always have the means or capacity to apply for a review themselves, it offers a critical safety net. Clause 31 will also repeal section 68A of the 1983 Act, which has become unwieldy and duplicative. By streamlining the referral process, the Bill enhances legal clarity and administrative efficiency, but I would caution that the increased complexity of the new timeframes may require significant training of those responsible for their implementation.

Clause 32 will provide for restricted patients who are subject to deprivation of liberty conditions. It goes further than clause 30 by imposing mandatory referral duties on the Secretary of State. Under the clause, a tribunal must be convened after 12 months, every two years thereafter, and at four years if no review has occurred. Crucially, the clause also codifies the tribunal’s powers. It may now vary or impose conditions, including those that constitute a deprivation of liberty, provided that they are necessary to protect the public from serious harm and are no more restrictive than hospital detention. That clause introduces a principled, proportionate framework for balancing public protection with patient liberty, and avoids vague or discretionary use of such powers.

Finally, clause 33 will apply the same principles to restricted patients not subject to deprivation of liberty orders. Such individuals, although under fewer constraints, are none the less subject to significant legal orders. The new requirement for a tribunal review at two years, and every four years thereafter, ensures that oversight is regular and non-discriminatory.

All four clauses are united by a clear objective to rationalise tribunal access, enhance procedural safeguards and bring the Mental Health Act into alignment with modern standards of fairness and proportionality. However, I will close with a caveat: rights without resourcing are hollow. If we are to place greater demand on the tribunals service, and to rely on it as the guardian of liberty for thousands of individuals, it must be adequately funded, staffed and supported. Legal representation must be accessible. Tribunal members must be properly trained. Hospital managers must be equipped to meet their new responsibilities.

With those reservations, I broadly welcome clauses 30 to 33 as a necessary recalibration of our mental health law. They reflect the dignity of the individual, the demands of public safety, and the enduring principle that no one should be deprived of liberty without fair or timely review.

Dr Evans

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That is a difficult balance to get right. I appreciate that the Government have said that the Bill will take 10 years to implement, but if these measures come into force from day one, we will start to see automatic referrals come through. There will be a lag as the transition happens, but my hon. Friend is absolutely right: we can foresee scenarios where patients who want to be referred into the tribunal are waiting in inappropriate care places, which may be to the detriment of their personal care and may actually make their recovery worse. He is right to highlight that question, which is why having a broad understanding of how many extra referrals are coming would be useful.

Clause 32 focuses on conditionally discharged restricted patients who are subject to deprivation of liberty conditions. It rightly ensures that those patients are brought within scope of automatic referral, first after 12 months and then every two years. Again, that is a positive step, ensuring that even those not detained in hospital will still have access to a review of their conditions. Crucially, the clause also gives the tribunals the power to vary or remove those DoL conditions.

Can the Minister say more about how that important power will be used? What criteria will the tribunals apply to assess whether a condition is genuinely necessary and proportionate? Will patients be legally represented in those hearings by default? Will another advocate be there, or will it be someone else in their place? Here, too, I would welcome some clarification from the Minister. I hope he will forgive my legal naivety, but my mother always said, “It’s better to ask a dumb question than stay dumb forever.”

The explanatory notes talk about DoL conditions. The current legal framework for authorising the deprivation of liberty for individuals who lack capacity is complex and in transition. Under the Mental Capacity Act 2005, deprivation of liberty safeguards have been the established mechanism since 2009 to ensure lawful deprivation of liberty in care settings. However, the Mental Capacity (Amendment) Act 2019 introduced liberty protection safeguards as modernising replacements, designed to simplify and broaden protections.

LPS are widely seen as an improvement to DoLS, because they extend safeguards to a wider range of settings, including hospitals and people’s own homes where deprivation of liberty might occur. They also streamline the assessment process, reducing bureaucratic delays and better reflecting person-centred decision making. The Law Commission and various stakeholder groups have supported LPS as a way to address the significant practical and legal challenges posed by DoLS, including the so-called DoLS backlog, where assessments have been delayed for many vulnerable individuals.

Despite that, I do not believe that LPS have yet been implemented, leaving DoLS still in force. I wonder if we are therefore creating ambiguity as we update the Mental Health Act through the Bill’s clauses, such as those addressing conditional discharge and deprivation of liberty, without clarity on how those will intersect with the forthcoming LPS framework that will be introduced under separate legislation. That raises important questions about the sequencing and co-ordination of legislation reform. How will the Government ensure coherence and avoid conflicting provisions when different statutes address overlapping issues at different times?

Given that context, have the Government abandoned the planned implementation of LPS, or do they remain committed to bringing them into force? If the implementation is still planned, will the Government provide a clear timeline for when LPS will replace DoLS? How do the Government intend to ensure that the provisions we are debating will align with or adapt to the introduction of LPS? What steps are being taken to ensure that vulnerable individuals and professionals who navigate this complex legal landscape will have clear, consistent safeguards and guidance through the transition? Clarification on those points is essential to avoid legal uncertainty and to ensure that the reforms provide coherent protection for those deprived of their liberties.

Clause 33 deals with patients who are not under DoLS conditions. It will ensure that even those who are under DoLS conditions, such as detained restricted patients or conditionally discharged patients with lesser restrictions, receive automatic tribunals. It will reduce the current three-year referral intervention for detained restricted patients to 12 months and introduce automatic referrals for non-DoL conditionality discharge patients after two years and then every four years. Again, that is a step forward, but four years feels like a long gap between reviews for those discharged with conditions that still significantly affect their daily lives. Will the Minister explain the thought behind the chosen timeframe? If a person’s condition changes, is there a mechanism to trigger an early referral outside the normal cycle?

The clauses show progress. They reflect a clear intention to strengthen patients’ rights, increase oversight and address historical injustices, particularly for those living under deprivation of liberty conditions in the community. But with complexity comes risk, and we need to ensure that patients understand their rights and the legal support available. The tribunal system must be properly resourced to uphold the safeguards that we place in the legislation.

Stephen Kinnock

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My hon. Friend makes an important point. We are absolutely committed to ensuring that we create a space for young people to provide feedback. Some of that will be around past experiences when making their advance choice documents, but much broader opportunities for feedback will absolutely be built into the system. We want this to be a learning process. It is important that the code of practice is not just a document that sits on the shelf gathering dust; it should be a live document. That is why the feedback is so important.

It should be noted that although reflecting on past experiences may be therapeutic for some individuals, for others it can be traumatic, so the measure should be entirely service-user led. We also continue to be concerned about the burden that the amendment would place on independent mental health advocacy services, which are already under strain.

Stephen Kinnock

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I don’t know what that nod means.

Stephen Kinnock

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We will figure it out as we go along. I have now lost my place. [Interruption.] My answer to the hon. Member for Farnham and Bordon is that the Government are voting against clause 35 stand part.

Stephen Kinnock

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

Jen Craft

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

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

Dr Evans

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I rise to speak to clause 35, which would insert new section 23A into the Mental Health Act 1983. It was introduced and passed in the Lords, and rightly so. As the hon. Member for Thurrock said, it seems surprising that anyone might want to take it out.

The clause was introduced as a new duty to offer all patients detained under the Act a consultation with an IMHA within 30 days of discharge. The purpose is to review their experience of hospital and learn from that experience through a report shared with hospital managers. Currently, the Mental Health Act makes provisions for access to IMHAs primarily during detention, particularly around decisions concerning treatment and care planning. However, once a patient is discharged, formal advocacy tends to fall away, unless pursued through broader NHS complaints mechanisms. There is no statutory duty to engage with patients post discharge, to understand how they have experienced their care or to systematically learn from those experiences.

In that context, the clause represents a welcome and important step forward. We know from successive reviews from the Care Quality Commission, NHS England and, of course, the independent review of the Mental Health Act, led by Sir Simon Wessely, that patients often feel disempowered during their detention. Many describe experiences of coercion, poor communication or even trauma. Yet those experiences frequently go unheard: lost in the silence that can follow discharge. Clause 35 seeks to change that, creating a pathway for those voices to be heard, and, more importantly, for services to learn from them. I strongly support that principle.

We need to clarify one thing first: the clause says a patient must “be offered” a consultation within 30 days —it is no more formalised than that. It is not a statutory requirement to take part, but purely to offer. That is important when it comes to making sure that reports are made in partnership with the patient. That is positive language, which would help to support the decision making and feedback loop.

In their rebuttals, I appreciate that the Government may ask whether the clause would mean hospital managers marking their own feedback. They might also ask how we would deal with CQC capacity. Those are reasonable questions, but at the heart of the clause, as agreed by the Lords, is the fact that all too often patients’ thoughts after discharge are not fully taken into account.

Dr Evans

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My hon. Friend makes a strong point. In clinical practice, we know that reflective learning is important, but that is not mandated. As we have seen from the reports, part of the reason why we do not see improvements is that we do not know about them. The clause gives patients the chance to empower themselves in a statutory, regulated way, which then allows us further transparency on how those issues arise.

Let us not forget that patients with good experiences would also have the chance to feed those back, further helping to support the services and hopefully leading to beacons of best practice up and down the nation so that we could then learn from those. That is the idea behind the clause: making sure that the likes of the regulator would be able to share lessons about not only those who have struggled but those who have done well. Clause 35 really offers a rare opportunity to hardwire the patient voice into the feedback loop of mental health services. That is a principle that I and my Opposition colleagues strongly support.

The Chair

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I remind Members that if they want to take their jackets off, they may. It is very warm.

Anna Dixon

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It is a pleasure to serve under your chairship, Mrs Harris. I will briefly speak in support of clauses 36 to 40. These clauses reflect the principle of least restriction, albeit for people who are subject to part III, and who are therefore subject to the deprivation of liberty conditions. It is really important that there are frameworks around conditional discharge, and these clauses will do a lot to bring it in line with best practice, and to put the limit set out in the best practice guidelines on a statutory footing to ensure that there is a 28-day transfer. To be successful, that will require multidisciplinary working between the health and justice systems. With that in mind, will the Minister give an assurance that he is confident that the 28-day limit can be met? If there is already data on how many transfers are made within that time limit, in line with best practice guidelines, that would give some assurance that the new statutory time limit is likely to be met.

I am pleased to see that the time limit should be breached only in exceptional circumstances, and that the Bill specifies that a shortage of hospital beds or staff does not constitute exceptional circumstances. It is really important that that is not used as a reason not to transfer or discharge people later than the 28-day limit. Some of the discharge test rests not only on whether there is a risk of harm to another person, but on a public test. Can the Minister clarify how those two tests will work in tandem? Is that already being done in practice?

Finally, I note that the evidence that we have received from the Care Quality Commission says that it welcomes closing the legal gap following the High Court ruling, as set out in the explanatory notes. However, the CQC believes that supervised discharge should be used only “when strictly necessary”, and I know that there are ongoing discussions between the Department’s officials and the Care Quality Commission. Can the Minister give an update on those discussions and clarify what role, if any, the CQC will play in the oversight of these measures?

As the hon. Member for Farnham and Bordon said, clauses 67 to 70 bring the Bill in line with youth justice practices and terminology, and with immigration policy. It is important that we take the opportunity to make sure that the Bill is fully up to date and in line with other pieces of legislation, so I support the clauses.

Dr Chambers

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I do not know whether we could combine yoga with our proceedings, Mrs Harris.

The hon. Member for Hertford and Stortford spoke really well in a similar vein to what I am about to say. Our amendment 19 to clause 41 would extend the provision of opt-out advocacy services in England to informal patients under 18 years old. Young people and their families and carers often face a nightmare navigating the mental health system. We find this on every level. A psychiatrist who came into my office in Winchester said that he and his wife, who is also a medical professional, were struggling to navigate the system to get care for their own child. His words were quite profound: “If we can’t navigate the system, what hope has anyone else got?”

Even when young people have secured desperately needed in-patient care, often after many months of delay, they can face real challenges in understanding the care being implemented and its impact. Often, such young people are cared for far from home. Enabling them to benefit from mental health advocacy that ensures the pressures on the system do not lead to unfair or damaging decisions for mentally ill young people is crucial. It can help to ensure that the patient’s whole situation and entire history is always taken into account, and that treatment is always appropriate, rather than symptoms just being addressed in isolation. We should be looking to empower patients and their families and carers across the whole system, not just in relation to those who are sectioned.

Stephen Kinnock

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The clauses will amend section 132 of the Mental Health Act in relation to detained patients, and section 132A in relation to community patients, and insert a new provision in relation to conditionally discharged patients. They place a statutory duty on hospital managers to supply complaints information to detained patients, community patients and conditionally discharged respectively, as well as to their nominated person.

Patients, their family and carers have a right to complain about the treatment they receive, including care and treatment under the Mental Health Act. The patient’s rights to complain are enshrined in the NHS constitution. Although the code of practice currently sets out that information about complaints should be provided to patients when they are detained, there is no statutory duty to do so. Under the clauses, hospital managers will be required to provide information on how to make a complaint about: first, functions under the Bill; secondly, any medical treatment for mental disorder received during their detention; and thirdly, the outcome of any complaint about medical treatment. That includes providing information about how to make a complaint to the Parliamentary and Health Service Ombudsman about the mismanagement of complaints about medical treatment, where the person believes their complaint to another body—for instance the hospital or CQC—was not appropriately investigated.

Hospital managers must take practicable steps to ensure that patients have understood complaints procedures, and information about complaints must be provided both verbally and in writing. The duty requires that information must be provided as soon as practicable after the patient is first detained, when the section that they are detained under changes, when the detention is renewed, or every 12 months for restricted patients under part III of the 1983 Act. For community patients, a duty is triggered as soon as it is practical after being placed on a community treatment order and as soon as practical each time the community treatment order is renewed. For conditionally discharged patients, it is triggered as soon as practicable after being conditionally discharged. I commend clauses 42 to 44 to the Committee.

Dr Luke Evans (Hinckley and Bosworth) (Con)

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It is a pleasure to serve under your leadership, Sir Desmond, especially on such a warm day. I hope that there is not too much hot air in the Committee to keep us even warmer.

Clause 22 will introduce a series of important amendments to the operation of community treatment orders under the Mental Health Act 1983. The clause has the stated aim of strengthening clinical safeguards and ensuring continuity of care between hospital and community settings. The Opposition support these goals in principle.

Let me set out the current legal position. At present, decisions to place a person on a CTO require two professional inputs: the patient’s responsible clinician and an approved mental health professional. The responsible clinician can vary, suspend, recall or revoke the order, often with no statutory obligation to consult the clinician who will be managing the patient’s care in the community. 

Clause 22 will change that. It introduces the new role of the community clinician—defined as the approved clinician who will oversee the patient’s care in the community—and requires their involvement at key decision points in the life of a CTO. Specifically, it requires a written statement from the community clinician that the CTO criteria are met, where they are not the responsible clinician. It obliges the responsible clinician to consult the community clinician before varying conditions, recalling or revoking a CTO, unless such consultation would cause unreasonable delay. It also includes the community clinician in the process of renewing a CTO, again via a written statement. 

These are not insignificant changes. They mark a shift towards multidisciplinary accountability and a greater emphasis on the continuity of care between in-patient and community settings. The Opposition strongly support both principles. However, there are several points that I would like to probe constructively, and I hope the Minister will respond in the spirit of improving what is clearly a well-intentioned clause. 

First, the term “unreasonable delay” appears multiple times in the clause as an exception to the duty to consult the community clinician, but I cannot see it defined in the Bill or in the explanatory notes. Could the Minister clarify what constitutes “unreasonable delay” in practice? Will guidance be issued to ensure consistency across trusts and clinicians? We must ensure that this exception does not swallow the rule or become a loophole in time-sensitive situations.

Secondly, what happens when clinicians disagree? The clause requires the agreement of the community clinician in writing before a CTO can be made, but it is silent on what happens when there is disagreement between the responsible clinician and the community clinician. This is not a hypothetical concern; differing clinical views are common and can be a healthy part of multidisciplinary practice. Could the Minister confirm whether there is a proposed resolution mechanism where clinicians differ? Would the decision default to a tribunal or a second opinion, or is the CTO simply not made?

Thirdly, as the Minister has mentioned, on the operational readiness to implement this clause, the new duties on community clinicians are not trivial. They are being asked to produce written statements, engage in formal consultations and be available to advise on time-sensitive decisions such as recalls and condition changes. Can the Minister reassure the Committee that a workforce impact assessment has been or will be conducted? Will there be investment in community mental health staffing and digital infrastructure to ensure that this duty is workable?

Fourthly, I want to raise the issue of handover and role clarity. The clause will introduce a new statutory role—the community clinician—but patients often transition rapidly between settings. There may be uncertainty about who holds that responsibility at a given time. Will guidance ensure that community clinicians are formally designated and that responsibilities are clearly recorded at the point of discharge?

I want to end on a constructive note. Clause 22 is a step in the right direction. It reflects many of the recommendations of the independent review of the Mental Health Act, including the emphasis on least restriction and on therapeutic benefit. I encourage the Government to consider defining or clarifying unreasonable delay in regulations or guidance, introducing a clear process for resolving professional disagreement, and committing to publish a plan detailing workforce support, guidance and digital infrastructure to ensure that this takes place.

Clause 23, which is linked to clause 22, will introduce two important amendments to the operation of community treatment orders under the Mental Health Act 1983. As things stand, section 17B(2) allows a responsible clinician to attach conditions to a CTO if they are necessary or appropriate, to ensure the patient receives treatment, to prevent risk to health or safety or to ensure engagement with services. Such conditions can include where the person lives, their attendance at appointments and even lifestyle restrictions such as abstaining from alcohol or drugs. However, we know that these conditions can be seen as coercive. Patients often feel that breaching them means automatic recall to hospital. In practice, some CTO conditions may drift toward overreach rather than clinical necessity.

The clause responds to these concerns in two ways. Subsection (1) will remove the words “or appropriate” from section 17B(2), meaning that CTO conditions must now be strictly necessary, not just advisable or convenient. The Opposition support this narrowing of the threshold. It sends a clear message that CTO conditions must be clinically justified, proportionate and tailored to the individual’s needs. However, I ask the Minister how clinicians will be guided in applying the new “necessary” test. Will the code of practice be updated with examples and scenarios? Crucially, what measures will be taken to ensure that patients are clearly informed that a breach of a CTO condition, in itself, is not automatic grounds for recall?

Dr Evans

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My hon. Friend makes an incredibly important point. Some later clauses try to address a problem where a patient was consenting to a community order, but the restrictions were so tight that it worked out as deprivation of liberty. My hon. Friend is absolutely right that knowing what is necessary is important to provide a clearly defined structure for the patient. Patients worry that if they breach that protocol, they will be automatically recalled. That might prevent them from breaching the conditions in the first place, but on the other hand it is a sword of Damocles above them. In no way does that create a beneficial therapeutic environment for them.

Dr Chambers

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I am really looking forward to the 10-year plan and reading about how it will improve mental health. We shared Labour’s manifesto commitments to mental health practitioners in each school and mental health hubs, so we certainly support that.

The hon. Member for Hinckley and Bosworth made some very good points and said that this proposal should possibly not be in primary legislation. I accept that integrated care boards do not have control over how every part of the service is delivered, so I am happy not to press the new clause to a vote, but I think the second part, which says that integrated care boards should have a duty to assess and report on the resource needed to meet the demands on services every two years, is important.

Stephen Kinnock

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The term “unreasonable delay” is subject to review by the courts, and further guidance will be given in the code of practice. On what happens if the responsible clinician and the community clinician disagree, the addition of a third decision maker is not about overruling the responsible clinician, who continues to have overall responsibility for the patient on the community treatment order. Including the community clinician at the point of putting someone on a community treatment order helps to ensure continuity of care for the patient. Involving the community clinician in other decisions around the community treatment order, particularly recall, revocation, renewal and discharge, means they can provide an additional insight into the patient’s status while in the community.

Dr Evans

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My hon. Friend has identified the nub of the issue, and his intervention leads me on to an example that demonstrates the problems that we are talking about. I have chosen to debate these provisions in the order shown on the selection list because I wish to understand whether the Minister believes that Government amendments 40 and 41 will deal some of the issues that I am about to raise. There clearly has to be flexibility in dealing with these situations, but it is worth exploring what could go wrong. The nub of the issue is that they may well go wrong. Let us take an example.

Say that A is 16, and she is struggling with anxiety and behavioural issues. She has had serious suicidal episodes and previous drug use. She lives at home with her loving, supportive parents, who have always acted in her best interests and want to engage constructively with her care, but A is under pressure from a 19-year-old boyfriend. He is controlling, and discourages her from speaking to her parents or professionals. When asked to nominate a trusted adult, A names him. Under the Bill as drafted, the nominated person could be accepted, provided A is deemed to be competent. That would give her boyfriend access to her care decisions and significant legal standing. Under amendments 54 and 55, that would not be possible because he does not have parental responsibility, and therefore could not be appointed.

That example illustrates why the amendments matter. Children, especially those in crisis, may be vulnerable to coercion, grooming, or misplaced trust. Loving parents, who have legal obligations to protect and care for their children in every other walk of life—as my hon. Friend the Member for Farnham and Bordon pointed out—could find themselves legally sidelined.

Are there risks in amendments 54 and 55? We must consider the edge cases. Not all children under 16 live with those who are trusted and have parental responsibility. There are estranged families, kinship carers, informal fostering arrangements and situations of abuse. A strict parental responsibility requirement could exclude the very people relied on by a child. I ask the Minister whether there is flexibility in the amendments for exceptional cases in which someone without PR may be appropriate, with oversight. Do Government amendments 40 and 41 already address that point? Forgive me if I have misinterpreted, but they seem to be bridging amendments. Would guidance or a statutory code of practice provide a better mechanism to balance protection and flexibility? What assessment has been made of children in care or informal arrangements, where parental responsibility might technically lie with a local authority or estranged parent, especially under the changes proposed by Government amendments 40 and 41?

There are potential routes forward. One option might be to require PR by default but allow exceptions if the child expresses a clear competence preference, the AMHP agrees that a person is suitable and poses no safeguard risks, and a senior commissioner or legal oversight has sign-off. That is a possible way of keeping amendments 54 and 55 alive, and it would keep within the spirit of the amendments by protecting children from harmful influence without removing their voice in complex or marginal cases. We could also explore adding an explicit safeguard power to override a child’s nomination where there is concern of coercion or abuse, regardless of parental responsibility status. Again, I think that may be what Government amendments 40 and 41 are trying to do, but I would be grateful to see whether that is the case.

David Burton-Sampson

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It is a pleasure to serve under your chairship, Sir Desmond. I rise to speak to clauses 24 to 28, and I will start by sharing the story of two of my constituents: Carol and her husband John.

John had been an active member of the local community before he was sadly diagnosed with dementia. As his dementia progressed, John was settled into a good care home and Carol was happy with the care that he was receiving. Due to a change in his medication, Carol was told that John had become more agitated and aggressive than usual. She was asked whether she would agree to John being assessed. Although she did not really understand what that meant, she did not see any reason to refuse.

From that point on, Carol says that she felt like she had lost control over her husband’s care. John was assessed by four strangers, and Carol was told that she could not be present. Following the assessment, Carol was told that John would need to be detained under the Mental Health Act within the next two weeks. Carol was very concerned to hear that John would be detained, but despite having power of attorney, she was not able to overrule that decision. She hoped that he would be able to get help with his medication and that he would be discharged.

In the end, Carol had only half an hour’s notice that John was going to be detained. She rushed to the care home to see her husband, who had been sat in the garden having a cup of tea with some friends, being abruptly put into a van by two men and taken away. She was not allowed to come with him, and for the first time in her life, Carol had a panic attack. She could not imagine how traumatic it was for John, who was disorientated and confused because of his dementia, to be taken by people he did not know to a strange place.

John was taken to a secure mental health ward that was very different from the familiar environment of his care home. Carol was told that she could not visit him, but she was insistent and turned up anyway. She was then allowed to meet his doctors on his first day and was reassured to hear that he would be detained for only two weeks while his medication was reviewed.

In the end, John was detained for eight months. Carol continued to visit every day, spending as much time as possible with him. She had specially adapted her home to accommodate John’s needs, but she was not able to have him discharged to either his home or a care home. Precious time was taken up with the endless fight to get John into a more appropriate environment. Sadly, John’s health significantly declined while he was detained. He lost the ability to walk and speak, and Carol felt that, in his declining state, he could not pose any danger to himself or anyone else. However, it was only after he was admitted to hospital for a catheter fitting that Carol was able to get him discharged, thanks to a doctor telling her that she could use her power of attorney to take him home—something she was told she was unable to do in the mental health facility.

She took him to a care home, where, sadly, he died two weeks later. John’s cause of death was listed as Parkinson’s, but Carol feels strongly that the anxiety and fear of his final months contributed to his death. Carol understood that her husband was dying; all she wanted was to be included in making decisions about his care. She knew very clearly what she wanted for him. She told me:

“I wanted him to die in a bed with clean sheets, with a window open and with me by his side.”

Those wishes were not taken into account.

As John’s wife and carer, Carol spent every day with him, yet she felt excluded from the decision-making process for his care. She should have been able to focus on what was important: spending time with him. The changes in clauses 24 to 28 would have helped Carol to feel more involved in representing John during his time in care. Clearly, there were failures to allow Carol, as John’s nearest relative, the rights that she was entitled to in order to support him.

With the move from “nearest relative” to “nominated person”, the new rights afforded by the Bill would have given Carol even greater engagement. Given that she had power of attorney, it is likely that she would have been appointed the nominated person by the AMHP. However, moving forward, it is important that those rights are properly afforded to the nominated person, so that we do not have another situation like John and Carol’s.

Although I welcome and fully support the changes in clauses 24 to 28, I seek an assurance from the Minister that all efforts will be made to ensure that the rights of nominated persons are fully recognised and assigned, and that nominated persons will be made fully aware of their responsibilities and powers, allowing advocacy for the patient under care.

I turn briefly to amendments 54 and 55 and Government amendments 40 and 41. I agree with the Government’s view that if a child has capacity, they should be able to have the choice to appoint their own nominated person. I appreciate the intent of the amendments from the hon. Member for Runnymede and Weybridge, but I think that the Government’s approach is more appropriate.

David Burton-Sampson

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I appreciate the hon. Member’s intervention. He makes the point that there may be situations in which the young person’s request might be inappropriate. However, on the flip side, there may be a situation in which it might be inappropriate for the person with parental responsibility to be the nominated person. They could have been involved in the situation that has led to that young person entering a mental health spiral—an abuse situation, for example, which has not been discovered by the authorities. That person would still have parental responsibility at that time. I think it is important that the young person can choose the person to support them in their ongoing care. I will be supporting clauses 24 to 28 and Government amendments 40 and 41.

Aphra Brandreth (Chester South and Eddisbury) (Con)

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It is a pleasure to serve under your chairmanship, Sir Desmond. I rise to support amendments 54 and 55, tabled by my hon. Friend the Member for Runnymede and Weybridge, but I will first briefly speak to clause 24, which is an important and long-overdue step towards modernising the Mental Health Act 1983, crucially strengthening the rights, dignity and autonomy of individuals subject to it.

The reform of the existing nearest relative provisions, replacing them with a new system that allows for the appointment of a nominated person, is an important part of ensuring that individuals get the right support, and modernises an outdated system. The current model is based on a rigid and outdated hierarchy in which the role of the “nearest relative” is determined by law, not by the wishes of the patient. This one-size-fits-all approach fails to account for the complexities and nuances of individual relationships. It can result in someone unsuitable, or even actively harmful, being placed in a central role in a person’s care and treatment journey. Indeed, the limitations of the system have been acknowledged by practitioners, patients and policymakers alike. It is too often disempowering, and the patient can lose agency at a time when they need to be empowered to feel in control of the situation as much as possible.

As the shadow Minister says, clause 24 is the cornerstone of the reforms. It is an important change to the current legislation to reaffirm the commitment to patient-centred care, to dignity and to the principle that those receiving treatment under the Mental Health Act should have a voice in decisions about their support network. The aim of the clause—to put the patient first—is important. It acknowledges that the person best placed to advocate for the patient may not be their closest relative. In some cases, family dynamics are fraught. In others, the designated relative may hold views about treatment that conflict with the patient’s wishes or medical advice. We have seen real-world examples in which the imposition of the “nearest relative” role has led to tension, distress and, ultimately, a breakdown in trust. That is not the kind of environment in which recovery is fostered.

Amendments 54 and 55 would address the specific issue of nominated persons and those with parental responsibility for children under the age of 16. It is important that we consider situations in which a young person may be in a vulnerable position and their decision on who their nominated person should be may not be in their best interests. We have a particular duty to ensure that children are safeguarded. Clause 24 as it stands will allow under-16s to choose someone who is not the parent to have significant power, including the ability to discharge the child from hospital.

We must listen to and actively try to support any young person who needs that kind of intervention—it is not that their views should not be considered. However, there is a very real risk that a vulnerable child or teenager might be coerced by or under the control of an older partner, for example, as my hon. Friend the Member for Hinckley and Bosworth pointed out. Perhaps they might choose an older friend. We need to consider that a decision made by the nominated person, such as an older friend, may have implications for those with parental responsibility. For example, that older friend may decide to discharge a child from hospital and into the care of the parents, who would not provide advocacy or be part of that decision making.

The Minister said that safeguards will be put in place, but can he expand on that? There are some real concerns here. Let us consider a situation in which there has been a decision by a court to determine which parent has responsibility for the child. If complex family issues have already been considered by the family court, it is right that the decision be followed. I respectfully ask the Minister to reconsider this point. We must respect the fact that parents of those under 16 are best placed to advocate for, support and act for their children. This is about capacity, consent and, ultimately, safeguarding.

Aphra Brandreth

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My hon. Friend makes an important point. If parents are not acting in the best interests of their children, there is a wider safeguarding issue that needs to be considered. One would question why such parents had been left in a situation in which they have responsibility for their children and are potentially harming them.

That leads me nicely to another point, which is that introducing the additional wording would bring mental health in line with physical health. For someone under the age of 16, it is their parents who have the responsibility to act in the best interests of their physical health; it seems to me that one would expect the same for mental health. I therefore urge the Committee to support amendments 54 and 55.

Let me return briefly to the overarching aims of clause 24. I underscore the point that the wider principle at stake—patient autonomy—is one that I support. The ability to make informed choices about one’s care should be a central component of our care system. In mental health, where individuals can feel particularly vulnerable, that becomes even more essential. Granting patients the power to nominate someone who will advocate for them, advise them and represent their wishes is a powerful act of empowerment. Moreover, this change enhances safeguards for patients. It ensures that the person acting on their behalf is someone they have chosen and trust. It reduces the potential for conflict and opens the door to a more collaborative and compassionate model of care.

If the Committee agrees to the amendments, which would provide the necessary safeguards for children, who I believe should be considered separately to adults, my overall view is that clause 24 represents a pragmatic, compassionate and patient-focused update to the Mental Health Act. It aligns with our modern understanding of mental healthcare and puts trust, respect and dignity at the heart of our legislative framework.

Kim Leadbeater

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I thank the hon. Gentleman for the intervention, although I am not sure that it is relevant to the banning of advertising for assisted dying services, which I will try to stay focused on.

Kim Leadbeater

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I am afraid that I am going to have to make some progress, based on the number of Members who wish to speak today.

I thank the hon. Member for West Worcestershire and the hon. Member for Reigate (Rebecca Paul) for working with me on amendment 73, and I am very pleased that they support it.

Madam Deputy Speaker (Ms Nusrat Ghani)

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As Mr Speaker has already mentioned, in order for everybody to get in—well, in order for most to get in—we need speeches to be shy of six minutes, and interventions to be short. I call Gregory Stafford.

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

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Does the hon. Member agree that the barbiturates that we are considering are conventional agents? They have been used in anaesthesia to cause loss of consciousness and suppression of respiration for generations. These are not novel substances.

Dr Andrew Murrison (South West Wiltshire) (Con)

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Will my hon. Friend give way?

Caroline Voaden (South Devon) (LD)

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Will the hon. Gentleman give way?

Dr Murrison

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My hon. Friend was right to table his amendment, which I certainly support. Does he agree that the Medicines and Healthcare products Regulatory Agency would insist that a barbiturate or any other substance used in medicine should be approved for a specific cause? We cannot translate that to a completely different cause or reason for using it. Would he also agree that the way to deal with the issue is for it to be properly regulated through the MHRA?

Sadik Al-Hassan

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Will the hon. Gentleman give way?

Sadik Al-Hassan

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I would like to share my expertise as a pharmacist with the hon. Member. Drugs can be used for many indications and are quite commonly used in unlicensed situations, where there would be less evidence to support them than in the situation that we are discussing today with new clause 13: an idea that is incredibly well researched, practised and evidenced in multiple countries.

Sir John Hayes

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Will my hon. Friend give way?

Sir John Hayes

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The reason why what my hon. Friend has said is so important is that it is yet another important safeguard, particularly given that, as we learn from analysis in the impact assessment, much of this is outsourced to private organisations. Those organisations need to be regulated in precisely the way he has described.

Adam Jogee (Newcastle-under-Lyme) (Lab)

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I am grateful to you, Madam Deputy Speaker, for giving me my first opportunity to speak in the Chamber on this most important of issues. As I do so, I think of all those who were killed in the horrendous plane crash in India yesterday. I think of their families, their friends and the lives they have left behind. May their collective and individual memories be a blessing.

I rise to speak to amendment 42, tabled in my name and those of more than 60 colleagues from the majority of parties in the House, representing constituencies in all four nations of our United Kingdom. It would remove the automatic commencement of the Bill’s provisions in England. It is a safeguard, good and proper.

As it stands, the entire assisted dying process will commence automatically in England four years after the Bill is passed. Notwithstanding some of the comments we have heard, that will happen regardless of how far along the plans and preparations are—plans for the manufacturing and supply of the drugs that will be used to end the life of anyone who chooses this step; for the identification and training of those on the panel; for the impact on the national health service in England and Wales and its budgets; and all the rest.

Colleagues will know that, as the Bill was originally drafted, the process would have commenced two years after it was passed. I welcome the fact that my hon. Friend the Member for Spen Valley (Kim Leadbeater) amended that period from two years to four. That was a genuinely welcome acknowledgment that such a serious and consequential change to every aspect of our country, from our healthcare system to our legal system, should not, must not and cannot be rushed. Therein lies the basis of my amendment. If this change is going to happen, let us do it properly. Let us not impose a timeframe that puts us in a bind—one that means we are driven by timing over purpose, and the pressure that comes with a ticking clock, rather than by the need to do it properly.

People living in Newcastle-under-Lyme and York Outer, in Buckingham and Bletchley and Pembrokeshire, are counting on us parliamentarians—those of us who are concerned about assisted dying and those who passionately support it. The Bill’s supporters have won every single vote, apart from on this issue in Committee. Our people are counting on us to make sure, if the Bill passes, that it is a success, that it will be consistent and, most importantly, that it will be safe. If the Bill passes, it will introduce assisted dying in the biggest jurisdiction yet by population. These are uncharted waters; this will not be like anything else. The last thing we should do is rush this process.

In Committee, the hon. Member for Richmond Park (Sarah Olney), who spoke excellently earlier today, tabled an amendment to remove the automatic commencement deadline for Wales. It provided that assisted dying could be rolled out only once Welsh Ministers deemed that everything was ready for a safe roll-out. The Committee voted by a majority to give that extra safeguard to the people of Wales. If it was good enough for the people of Wales in Committee, it is good enough for the people of England today. We face a situation in which assisted dying may proceed in England months or even years before it does in Wales. The provisions and systems may look different. The process of organising the English system to meet the arbitrary four-year deadline would almost certainly lead to rushed decision making.

My hon. Friend the Member for Spen Valley has sought to remedy the disparity, but her solution is not to extend to my constituents in England the safeguard that the members of the Bill Committee—members that she appointed—voted for. No, her remedy is to allow for automatic commencement to happen in Wales as well, removing the safeguard that the Committee voted for. The answer is not to fast-track the roll-out of assisted dying in both England and Wales, potentially putting the lives of some of the most vulnerable at even greater risk due to rushed decisions that are not fully thought through.

I have not been on these Benches for very long, but I know that arguing for the automatic commencement of legislation is generally, in the kindest interpretation, unusual. For legislation of this magnitude it is, I am afraid to say, reckless, and reinstating automatic roll-out in Wales when the Committee explicitly voted against it borders on the undemocratic.

Dr Evans

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My hon. Friend is spot on about training. It is one thing to enshrine these measures in primary legislation; it is another thing to have the training and interpretation that go with them. One of the reasons that we have not tabled an amendment on the matter, as yet, is that there could be some concerns about what “cumulative” or “escalating” behaviour looks like. Ask any clinician and they will say that they have seen patients who are on the borderline and are struggling. It can be unclear whether they are within or outside the definition; they could be wavering between the two, given the state of their mental health. That is a real concern, but the broader pattern of identifying the picture of what is happening could be helpful and important.

One way to address the issue would be to review the data and legislation. Would the Government consider carrying out a review two years after the implementation of the Bill, specifically to look at the working of the legislation through the lens of public safety? I hope that there will be no concerns, but that would provide a backstop and a legal safety net. We do not want to wait another 40 years if there are changes that need to be made.

Dr Evans

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My hon. Friend makes an incredibly important point. We heard on day one how these services interact, and that is completely correct. We need to look through the lens of public safety, because while we are quite rightly enshrining the autonomous nature of the patient as an individual, there is also the question of what we look at as a society. It includes the likes of local councils, mental health care and NHS care. Schooling could also be involved, as well as the judiciary and the Home Office. I think it is reasonable to ask the Government to look at that, in the light of recent high-profile cases, and say, “What are we doing? Does the legislation really do what we think it does?”

Clause 5 is a good step forward, but we must make sure that it is fit for purpose and that we have a review mechanism in place. I do not think that it necessarily needs to be in statute yet, but it will be interesting to hear the Minister’s response. Conducting a review on such a change, through the lens of patient safety, would be very useful.

There is also the matter of resources, which we keep coming back to. Change in detention criteria will rightly push us towards community-based alternatives—that is the whole point of what we are doing—but unless those alternatives are properly resourced with staffing, crisis services, housing and follow-up care, we will risk replacing one form of system failure with another. I appreciate that the Secretary of State is committed to reporting each year to the House, but will the Government publish a timetable and framework to support the implementation?

As we heard from my hon. Friend the Member for Solihull West and Shirley, training is also critical. Professionals need the tools and time to learn the framework. They need support, implemented in real time, often under pressure and in complex, high- stakes circumstances.

Clause 5 is a welcome and thoughtful step in modernising mental health law. It will strengthens patients’ rights, sharpen clinical practice and bring us closer to a system that balances safety, liberty and humanity. However, we must be mindful about the risk of delayed intervention. In borderline cases in which the threshold is not clearly met but concerns remain high, we must ensure that there is still a route to timely, compassionate support. Otherwise, we may swing the pendulum too far in the opposite direction, from the overuse of detention to the underuse of care.

On Second Reading, I said:

“There is little greater moral burden than deciding for someone who cannot decide for themselves where care ends and control begins.”

Clause 5 typifies that burden: we are deciding who should be detained and why. I said:

“Make no mistake, this is what this House is grappling with”,

and indeed it is what our Committee is now looking at in detail. I also said:

“Involuntary care should never be the first instinct or answer, but a resort to prevent harm to both the individual and those around them.”

I said that compassionate care demands precision not only in its delivery, but in its design. I concluded:

“Without precision, we simply have sentiment.”

I promised then, as I promise now, that

“we will endeavour to ensure that the Government’s sentiment becomes a commitment.”—[Official Report, 19 May 2025; Vol. 767, c. 850-851.]

That neatly sets the scene for discussing Government amendments 26 to 29.

Dr Evans

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My hon. Friend makes an important and poignant point. The Government have rightly stated that this change could take up to 10 years to implement, but we need to ensure that the most important safeguards are set out. Elsewhere, the Government have suggested that they will be in the code of practice. When we were discussing section 5 of the Mental Health Act and other issues, I said to the Minister that we need a constructive timetable, not only to know what the roll-out will look like but so that we can consult with the professions and ensure that they are able to deal with it.

Later, we will again discuss the interface between the Mental Capacity Act 2005 and the changes that bring in new tests. That will be really important. We will also discuss the change of statutory safeguards for electroconvulsive therapy and changes to the statutory safeguards around who the second clinician will be—there is quite a feast of movements through this legislation. Make no mistake: that is what the country wants, but the Government must clearly set out some rationale for the timetable.

Unfortunately, the Opposition’s proposal for a costed plan was defeated. We wanted to set out some kind of concrete timetable over 18 months to ensure that we do not slip back, and to give the Government the flexibility to make the necessary cultural and legal changes. I hope that that addresses some of my hon. Friend’s concerns, but he was right to put that point to the Minister.

I oppose Government amendments 26 to 29, which would remove the reference to detention

“by a constable or other authorised person”,

and to delete the proposed definition of “authorised person”. I support the argument advanced powerfully in the other place by Baroness May, whose experience as a former Home Secretary gives her deep insight into the interaction between policing and mental health. Of course, it was under her premiership that the entirety of this discussion was progressed. I thank her for everything she has done, although I am not quite so thankful for the workload that it has created for me in my evenings and weekends. Her central message was clear: we must stop treating mental health as a policing issue and start delivering the right care from the right person in the right place. I wholeheartedly agree, as I am sure the Committee does.

I understand what the Government are trying to achieve. On the face of it, the amendments are technical. They seek to ensure that detention under the Bill is solely based on necessity where there is a risk of serious harm or the need for urgent treatment, and that it is not tied to who is doing the detaining. On paper that sounds reasonable, but in practice those changes will remove vital clarity and will risk baking in a system that has already failed too many people in mental health crisis.

Let us look at the problem with removing “authorised person”. The Bill, as amended in the Lords, wisely recognises the need to broaden the group of people who can respond to mental health incidents so that they include not just police officers, but trained and equipped professionals, mental health nurses, paramedics and approved mental practitioners—people who are qualified to care, not just to detain. The definition of “authorised person” in clause 5(7) ensures that only those with training competence and safety considerations are empowered to act, so it provides a framework for accountability, not a free-for-all. By removing the framework, the Government amendment would create a legal vacuum: it tells us that someone must be detained, but not by whom. In doing so, it would leave NHS trusts, police forces and local authorities with a lack of legal guidance and with a risk-averse default to the police.

I think we agree that the police should not be the first responders. As Baroness May has reminded us, and as many officers have told me, the police are routinely called out to mental health incidents, not because they are best placed to respond but because there is no one else available or authorised. That is neither fair to the police nor fair to the individuals in crisis. A police uniform can escalate distress. A custody cell is not a place of recovery. An officer guarding a patient in accident and emergency for 29 hours, as the Metropolitan police have reported, helps no one—not the patient, not the police and not the public. The 2019 College of Policing snapshot found that 95% of mental health-related calls did not require a police response. That is staggering. It underlines why we must build up the capacity and legal authority of clinical professionals, not erase them from the statute.

I turn to the Government’s argument and why it falls short. The Government’s case is that removing the phrase

“by a constable or other authorised person”

will de-emphasise the police and make the law more flexible. Ironically, however, removing the clarity about who may act risks re-entrenching police dominance in these scenarios, simply because no one else will feel legally empowered to intervene. The Government argue that the definition is unnecessary or potentially restrictive, but I say the opposite: a well-drafted enabling definition gives confidence, clarity and a lawful mandate for healthcare-led responses. This is not about excluding the police altogether. There will always be situations in which an immediate threat to life or serious violence requires a police presence, but that should be the exception, not the structure around which our mental health law is designed.

Dr Evans

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My hon. Friend is right: we agree that this is not a place for the police unless there is an absolute sign of criminal intent. The problem is that what happens is a member of the public sees something, reports it to the police and, naturally, it is the police, the fire service or the paramedics who come forward. If a person is unsure about someone behaving in an irrational manner, which by definition someone with a mental health issue could well be doing, the likelihood is that they will call the police and the police will be the first responders. We know that they tend to be the fastest to respond.

Slightly widening and refining the definition of who can respond would allow us to build a framework and culture that might encourage a first responder—we often say that the AA is the fourth emergency service; it may well be that mental health services would be the fifth emergency service and could respond. That is what we need for service provision. The idea behind this is to try to crowbar the police out of that position, unless absolutely necessary, as my hon. Friend rightly says. Allowing a new framework would be good for safety and good for the police, because they would be freed up to do other stuff. More importantly, it would get the care as quickly as possible to the people who need it the most.

Dr Evans

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I bow to the hon. Member’s expertise on this; the problem is that all the evidence shows that the police are the first there. I would like to see much more of him and his colleagues being able to respond and carry this out. We are giving them the legal certainty to do so. That is the argument for making sure that we have codified safeguards around who is and is not able to make such decisions. At the moment, it is purely the police who are called out to these situations, but this gives us another legal weapon with which we could fight this inappropriate use.

The aim is to codify the safeguards around who can exercise detention, ensure accountability and, importantly, enable health-led alternatives to police detention. Are the Government confident that the decision does not leave a legal grey area around which profession or agency has the statutory power to detain, especially during urgent community or hospital-based crises?

On the authorised person category in the section 135 and 136 powers, the Government say in their letter:

“Extending these powers to ‘authorised persons’…could potentially lead to staff, patient and public safety issues.

That is precisely why the Lords amendment included a tightly defined category of authorised person, subject to the Secretary of State’s regulation, mandatory training and safety provision. The intent is to ensure that when a professional, such as a trained mental health nurse, is better placed to respond than the police, they can do so lawfully and appropriately.

The Government say:

“Section 135 and 136 powers have been designed for police officers who have specific training, equipment and access to rapid support”.

Many frontline NHS and social care professionals, including AMHPs, crisis team members and community psychiatric nurses, already respond to acutely distressed patients in highly volatile environments. They lack the police powers, but not the clinical expertise. The amendments would bring clarity and lawful backing to the situations they already manage. Take, for example, a mental health nurse in a community who arrives at a person’s home to conduct an urgent assessment. The individual is clearly experiencing psychosis, and is at immediate risk of self-harm. Under the current law, the nurse must call the police, delaying the care and potentially escalating the situation. Under the amendment, they could lawfully detain, provided they are authorised and trained.

There are also confusions over the emergency response roles. The Government letter states:

“There is a very real risk of confusion over who should respond in an emergency if multiple agencies have the same powers, which could lead to delays.”

That concern is valid, but confusion is far more likely under the current law, where roles are unclear and NHS professionals must sometimes act unlawfully or wait for overstretched police. A regulated and accountable authorised person category, established in law and detailed in the code of practice, would clarify responsibilities, not blur them. Have the Government done any modelling of the delays and safety risk caused by not empowering suitably trained healthcare professionals to act in urgent situations?

The letter also highlights concerns from stakeholders that this is

“a radical proposal with a number of serious and potentially dangerous consequences and should not be pushed through without proper consideration”.

These proposals were not developed in isolation; they were advanced in the House of Lords, where the former Mental Health Act reviewers, legal experts and mental health professionals carefully considered their scope. They are also consistent with the direction of the 2018 independent review, which emphasised reducing coercion, racial disparity and the overuse of police powers.

The “right care, right person” initiative already expects health professionals to step in, but—unless I stand corrected—the initiative is not underpinned by any legal reform. Without amending the Act, health staff are still expected to take on crisis care without the powers of protection that they need to safely or lawfully do so. How can we expect health-led responses to mental health crises without giving health professionals the power in law to act?

Turning to guidance and the code of practice, the Government say that they will issue further guidance on police handover protocols and the legal frameworks. While guidance is welcome, it is not a substitute for statutory reform. Guidance cannot grant powers to detain or protect professionals from liability. We can have legal clarity with this framework.

If the Government want to push ahead with removing the amendments, will the Minister consider committing to a formal consultation with NHS England, the AMHP leads, frontline staff and patients on creating a legally robust authorised persons role? Would he consider piloting models of community-based urgent response teams that include AMHPs and trained nurses with delegated powers? Would he legislate for police exit strategies in A&E and community crisis responses that are enforceable, not just guidance based? Given our discussion about new clause 24, there is clearly scope for a sensible piece of work in the grey area to improve the interface for patients, clinicians and police. I think that is one we can all agree on.

Dr Evans

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My hon. Friend is absolutely right. Under the last Government, the “right care, right person” initiative was launched with the Humberside police force to try to ensure appropriate care, but that is an example in isolation.

One solution would be to include guidance in the codes of practice, but it would not have the statutory footing to allow that legal certainty, which is the concern. Another would be to include something in the annual statement that we will receive from the Government. We should work collaboratively to try to find a decent piece of work to look for the evidence base and build a delivery plan to help the police extract themselves from situations, when appropriate, and care givers to insert themselves. It is admirable to share a problem that is difficult not just in England but in Wales, Scotland and Northern Ireland.

I agree that the Government are right to proceed with caution, but caution is not the same as inaction, especially when lives are at stake and the law no longer reflects the reality of mental health care. The amendments are not about expanding police powers; they are about reducing the need for police involvement by giving others the lawful authority to act. Although maths may not be my strong point, I am not blind to the make-up of this Committee; I realise that the change will inevitably happen. I want to press the Minister on how he proposes to reduce the burden on the police to safeguard them from thousands of hours spent dealing with mental health crisis issues. In extreme cases, they are not appropriate responders.

This is the key issue to improve so many aspects of our society. We could improve the working life of the police, allowing them to do what they are paid to do, trained to do and passionate about: policing and protecting their communities. We could improve life for the public, because it would free up the police to tackle crime and keep them safe. Most importantly, we could provide the correct care to those patients at their biggest time of need. I hope the Minister will set out how the Government plan to achieve that.

Sojan Joseph

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I rise to support the Government amendments, which will simply remove the words

“by a constable or other organised person”.

On Second Reading, I highlighted my concern about the amendments made to the Bill in the other place that sought to extend police powers of detention under sections 135 and 136 of the Mental Health Act to other organised persons, including medical practitioners, approved mental health professionals, mental health nurses or doctors and further healthcare and social care professionals.

I know that the noble Lords who introduced the amendments intended to remove the need for the police to be present at mental health incidents in the absence of any risk. However, they would grant the police greater powers; as an unintended consequence, they would also apply to detentions under sections 2, 3 and 5 of the Mental Health Act, where the police currently do not have power to intervene.

A section 2 application is completed by two doctors and a social worker, and the patient may already be in a clinical setting. Section 3 relates to somebody who is already receiving treatment or already has a known diagnosis in a clinical setting. Doctors’ powers extend to that section; the police currently do not have any role in completing a section 3 application. Section 5(4) provides nurses with a holding power for a patient who is already in the clinical setting, where the nurse believes that the patient is at immediate risk; again, the police have no role.

If we did not make the Government amendments, we would give more power to the police to get involved under those sections of the Mental Health Act and put more pressure on police services.

Sojan Joseph

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What the hon. Member read is absolutely right. I was talking about sections 135 and 136. I am talking here about sections 2, 3 and 5. I absolutely stand by what I said about sections 135 and 136, and I am happy to come to that. As a former mental health nurse, I certainly would not support giving the police greater powers under sections 2, 3 and 5 of the Mental Health Act.

I am also opposed to the amendments passed in the other place because I believe that the extension of legal powers held by the police to other healthcare professionals would represent a major shift in the roles and responsibilities of healthcare and care professionals, placing significant additional pressure on the NHS and social care providers.

The Royal College of Psychiatrists, the Royal College of Nursing and the British Medical Association are among the health and social care organisations that have warned against such an extension, saying that it is

“a radical proposal with a number of serious and potentially dangerous consequences”.

Those organisations also point out that the proposed extension has not been properly tested with relevant health and social care professionals and has been given minimal serious consideration during the eight years in which reform of the Mental Health Act has been under discussion.

The majority of assessment under the Mental Health Act already happens without police involvement. However, where the police may be required to make a detention, I know from my experience working in mental health that the presence of officers can often ensure that an otherwise risky situation remains contained and everyone remains safe.

Entering someone’s home without permission is fraught with huge risk and currently is done only with the assistance of police intelligence. Under section 135, health professionals ask the court for an order to remove somebody forcefully from their residence and the police use that order to do so; sometimes, they have to break in. That is the power that the hon. Member for Hinckley and Bosworth spoke to earlier. Without it, health and social care professionals would be expected to enter homes without police help, and without crucial intelligence that could ensure their safety. As Dr Lade Smith, the president of the Royal College of Psychiatrists, said:

“It is well known that at times, people experiencing a mental health crisis cannot be safely reached and cared for without the assistance of the police. Delegating police powers without proper consultation or planning is likely to disproportionately affect those from minoritised backgrounds and would increase risk to patients and compromise the safety of others. It sets a dangerous precedent.”

I am also concerned that the amendments passed in the other place granting police powers to authorised persons risk damaging their therapeutic relationships with patients. They would have the effect of lessening clinicians’ ability to treat patients, and I fear that patients would be less likely to attend an appointment if they thought they might be forcibly detained by the clinician.

Aphra Brandreth

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

Aphra Brandreth

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My hon. Friend helpfully expands on the points that I and other Opposition Members have been making. If we are not careful, the Government amendments will move us further away from the aim of a person-centred approach.

I urge the Minister to reconsider the amendments. The wording inserted in the other place struck a thoughtful balance. The wording inserted in the other place struck a thoughtful balance. It allowed flexibility, but grounded it in clear criteria of training, safety and competence. Removing that definition will weaken the Bill. It will make it harder, not easier, to ensure that the right person is supporting someone at their moment of greatest need. We owe it to patients, professionals and the police themselves to get this right.

Jen Craft

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

“by a constable or other authorised person”

which relates specifically to the phrase

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

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

Stephen Kinnock

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I will touch on the questions that have been asked on cumulative and escalating behaviour, on having a review of public safety and on the training plan. The details will be provided for in a mixture of the code of practice and the annual written ministerial statement.

The code of practice will be based on consulting both those who use the new criteria, such as clinicians, approved mental health professionals and members of the tribunal and, then, of course, on the other side, those with lived experience, service users, families and carers. It will be shaped and drafted on that basis. It will then go out to public consultation and will be laid before Parliament so that Parliament will have an opportunity to debate it. It will be a comprehensive and detailed development of the code of practice, and will address the issues around cumulative and escalating behaviour, the public safety issues and training.

On cumulative and escalating, it is worth noting that under the reforms in both the Bill and the current Act, clinicians have the power to detain on the basis of a risk of harm that may occur, not that already has or is happening at the time. That power already exists.

Stephen Kinnock

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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.

Stephen Kinnock

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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.

Stephen Kinnock

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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.

Stephen Kinnock

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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.

Zöe Franklin (Guildford) (LD)

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I rise to speak to amendments 2 and 5, which, in summary, would ensure that patients, named persons and independent mental health advocates would receive a copy of a care, education and treatment review meeting report for children and young people with autism or a learning disability.

Patients, along with all those tasked with helping to represent their wishes, should be able to see transparently what has been judged to be safe and appropriate care for them. Being given the opportunity to understand why their care or treatment is changing or remaining the same should be a basic right for patients, yet as it stands they are often frozen out of seeing that final report. Similarly, the nominated person, whether that is a friend, a mother, a sibling, or another parent, often has care of the patient; they know the whole person better than any NHS institution, and will often have a far fuller understanding of the patient’s history.

Zöe Franklin

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The hon. Member raises an interesting and pertinent point. There will always need to be balance when addressing the issues around patient confidentiality. I have seen from my own casework that when families who have been through mental health crises with their loved ones have not been involved in that process, unfortunately the crisis has lasted much longer and been more significant because those around them have been unable to support the individual. I do not have the answer, but we need to work collectively to find a way to strike that balance in order to address the needs of the patient.

Zöe Franklin

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That presents challenges, but again, I would refer back to my own casework, and I am sure there are Members on the Committee who will have had the same experience. There are examples across the UK where health boards and providers find ways to appropriately share information with families and other carers to get the best outcomes for patients. I simply ask that, when the Minister and colleagues in this space have those examples, they share them. I know that there are some areas where this is already done effectively, particularly in Scotland, and I seek to reference those examples.

My final point on amendments 2 and 5 is that we need to ensure that those around a patient are given the opportunity to raise concern or the alarm when part of the report does not meet the patient’s needs. We need to address the patient’s full needs, and to ensure that they are both reflected in the reports and met.

Dr Evans

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I rise to speak to Liberal Democrat amendments 1 to 7 and 51 to clause 4. I welcome the intention behind the amendments, which aim to enhance the care and treatment review process for people with autism and learning disabilities, particularly by addressing housing and accommodation needs and ensuring that key advocates receive reports.

There are positive elements of the amendments that are worth highlighting. I understand the good intent of including housing and accommodation considerations explicitly in reviews, as it recognises that a person’s living situation is often central to their wellbeing and recovery. Additionally, ensuring that nominated persons and independent mental health advocates receive reports promptly promotes transparency and patient advocacy. Shortening the review intervals from 12 to six months could lead to more responsive care planning.

However, I have some significant reservations about the statutory implications of blurring housing, for example, so directly with the care and treatment review process. Housing is traditionally managed under separate statutory frameworks from health and social care, so to embed housing as a statutory element within these reviews risks creating confusion about which agency holds responsibility and may expose health bodies or commissioners to legal obligations that they are neither funded nor structured for.

I have a few questions for the Liberal Democrats. In their eyes, how would the Government ensure clarity over the statutory duties applied to housing recommendations arising from the reviews? Would that not risk delaying or complicating discharges if housing issues became a statutory sticking point within health-led care reviews? Moreover, housing provision often depends on local authorities and housing departments that have their own complex eligibility criteria and resourcing constraints. Are we confident that ICBs and responsible commissioners would be able to co-ordinate effectively across these boundaries, especially given the patchwork of funding and powers in play?

Dr Evans

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Thinking that through, how does my hon. Friend feel that existing statutory requirements to provide accommodation will balance out if we provide another statutory requirement on accommodation in these plans? Does he worry, as I do, about creating a risk, for example, of pitting someone with severe learning disabilities against a homeless person if there is resource rationing thanks to the practicalities of how many houses we have? Members throughout the House agree that we need to build more houses, but until that happens, such local authorities have the resources issue.

Dr Shastri-Hurst

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Does my hon. Friend share my concerns that not resolving housing and accommodation at the point of discharge could lead to a delay in transition? Patients would remain in hospital for longer than might be beneficial to them.

Aphra Brandreth

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My hon. Friend is making valuable points about the benefits of the amendment. For vulnerable individuals, family involvement is often extremely important, but does he agree that that must be balanced with ensuring that potential disagreements do not put at risk what is best for the individual?

Dr Shastri-Hurst

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Not quite: Solihull.

Dr Shastri-Hurst

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Does my hon. Friend agree that there is a risk that the amendment would not only increase the workload of practitioners, but divert attention from patient care?

Dr Evans

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Would my hon. Friend speculate on a question that I hope will be answered by the hon. Member for Winchester? It is about the evidence base behind choosing six months instead of 12. GPs would do learning disability reviews every year, for example, and it is an annual thing with asthma and in similar areas. Is the hon. Member for Winchester aware of an evidence base for why it should be six months? There may not be one—often these can be arbitrary, in terms of just giving a clinical judgment—but I wonder whether there is a specific reason for choosing to reduce the period between reviews to six months.

Jen Craft

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

Anna Dixon

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The hon. Member is going into some detail on these amendments. There is a duty where EHCPs are in place. Local authorities have had their funding cut over many years, so they have found it difficult to meet their EHCP obligations for the many children with SEND needs. Is there not a similar risk that the amendments will put duties on local authorities that they will not be able to meet unless they have sufficient resources? There must be some flexibility as well as duty on local authorities and the NHS to balance their duties and responsibilities with resources.

The Chair

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There is one minute left, Greg.

The Chair

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You did very well there: we have two seconds left.