Luke Evans MP: speeches

Speeches

• 19 Jun 2025 · Mental Health Bill [ Lords ] (Seventh sitting) · Hansard source

  More

  The hon. Gentleman is spot on. We do not want people making decisions about their care when they do not have capacity. The whole point of what we are trying to do—as is the Government’s intent—is to allow people to make advance care decisions when they have capacity, so that when they are not lucid in the future and come back into contact, their preferred decisions are already set out. The clause does allow for a handbrake mechanism for clinical safety, to overstep them. However, what I am worried about is finding ourselves in a situation where patients never even find out that they have the right to create one of these ACDs. The hon. Gentleman will know, as I do from my time, that good clinical practice is to ensure that patients have a plan. We do that for asthma: we expect patients to have an emergency plan for what happens, who they contact, where they go, what they take and what it looks like, personalised to them. Why should mental health be any different? My amendment actually gives ACDs legal footing, rather than simply saying that the system should offer it to them. The amendment is cost-effective. Evidence suggests that ACDs can reduce the use of coercive powers, prevent relapse and improve continuity of care. That reduces costs, not adds to them. It is already good clinical practice; many mental health trusts already encourage care planning conversations. Our amendment would simply raise the standard across the country. The Opposition understand that the Government have the numbers on this Committee. Will the Government clarify the role of the code of conduct? Do the Government intend to issue national guidance or benchmarks to ensure that ICBs do not apply widely different criteria for who is appropriate to be informed or held? Could the Government explain further, in response to the letter and in this Committee, why they do not accept ACDs as a basic right, narrowly defined, for only the most vulnerable individuals to be offered this opportunity? What mechanism will be used to monitor compliance with these new duties? How will patients know whether they are being fulfilled? To my eyes, Government amendments 34 and 35 will do the same as amendments 32 and 33, but covering the Welsh system and local health boards, so I will not rehearse the arguments that we have just had. However, I would be interested to know whether this creates an issue for data collection on compliance across the two countries. We touched on this in relation to clause 2, but if different health authorities take different approaches to monitoring data, does that not risk making it even more opaque when we try to see both good and bad performance? Could the Minister address that point?

• 19 Jun 2025 · Mental Health Bill [ Lords ] (Seventh sitting) · Hansard source

  More

  I am grateful for the hon. Lady’s point. It would be interesting to know if that advice came when the Bill was debated in the Lords, because these clauses were not in place, but were introduced through the Government’s amendments. This is an extension to that. Our amendment to give a right to a patient would be a further strengthening. I entirely agree that the Bill is a good step forward, but if we are not going to address this again in the next 40 years, the Opposition would like that right to be enshrined. To be offered the opportunity is the key bit here—no mandation. It is good practice to let people know their rights, and we are affirming that. The worry is that while there is good intention to allow it based on the system, what happens if times are stretched? The amendment would give someone a statutory chance to say they have that right, and that it is upheld in law. That is what the Opposition are pushing for. In essence, we are both trying to solve the same problem, but taking different approaches. The key distinction between the approach of the Government and that of the Opposition is that the Government’s creates a duty on the system, but no individual entitlement, while the Opposition’s proposes a patient right matched by a clear responsibility to inform and support the individual. The Government’s clause says that NHS England and ICBs must make arrangements as they consider “appropriate”. We say all eligible patients should have an informed right to create one. I anticipate that the Government might turn around and say, “Well, this is too rigid,” or that it imposes unfunded burdens on the ICB. I argue that it is targeted; we are not extending the right to everyone with a mental health condition but only to those at the most risk of future detention.

• 19 Jun 2025 · Mental Health Bill [ Lords ] (Seventh sitting) · Hansard source

  More

  If I am correct, the Minister said “if” a patient “approaches”. That is the fundamental point: that the onus is on the patient to know what their right is to approach the authorities. We are trying to do it the other way, by saying that their right is to be told about what is going on. Will the Minister clarify what he meant, because this is essentially what we are concerned about?

• 19 Jun 2025 · Mental Health Bill [ Lords ] (Seventh sitting) · Hansard source

  More

  Forgive me if I missed it, but I did not hear any discussion of this point. I am slightly concerned about the way the new clause is written, as it could be a duplication of the support, protections and duties put in place through the Care Act 2014. Could the hon. Member set out how the new clause would run in parallel with the Care Act? Is it complementary, or does it work against it?

• 19 Jun 2025 · Mental Health Bill [ Lords ] (Eighth sitting) · Hansard source

  More

  I welcome the opportunity to speak on these important provisions, which apply the Human Rights Act 1998 to certain private care providers delivering mental health services. At present, the Human Rights Act applies directly to public authorities and to those exercising functions of a public nature. However, an increasing proportion of mental health care and aftercare services are delivered by private providers, under arrangement with NHS bodies and local authorities. The current legislation leaves some ambiguity about whether private providers are legally bound to comply with the Human Rights Act when delivering such services. That creates a potential accountability gap that risks undermining the protections that we want to guarantee to vulnerable patients. The Government’s proposal to explicitly extend the application of the Human Rights Act to registered private care providers when they deliver specific services commissioned or paid for by public authorities is a welcome step towards closing the gap. By doing so, it will ensure that these providers are treated as performing public functions under section 6 of the Act. That means that they will be directly accountable for upholding the rights enshrined in the Human Rights Act, including the rights to liberty, dignity, privacy and freedom from inhuman or degrading treatment. This approach is not without precedent. For example, in the case of prison outsourcing, courts have established that private companies running prisons are subject to the Human Rights Act because they perform public functions. Similarly, private care providers delivering publicly funded mental health services should be held to the same standard as NHS bodies or local authorities. It is worth noting that although this explicit statutory extension of the Human Rights Act to private providers is a new provision in the Mental Health Act 1983 for England and Wales, similar principles already apply in Scotland through case law and existing legislation. Under the Mental Health (Care and Treatment) (Scotland) Act 2003, local authorities have a statutory duty to provide aftercare services, which may be delivered by private providers. Scottish courts recognise that when private providers perform public functions, such as delivering those statutory services, they are subject to the Human Rights Act, following key judgments such as YL v. Birmingham City Council. This Government proposal provides much-needed clarity and an explicit statutory footing across all four nations of the UK. It also ensures consistency across the four nations, referencing equivalent legislation in Scotland, Wales and Northern Ireland. This helps to remove ambiguity and ensure consistency. However, we must also consider the practical impact. Although these changes strengthen rights and protections, they also increase the regulatory burden on private providers. Providers may face new compliance costs, legal challenges and the need for enhanced training and oversight. That could have a knock-on effect on service availability, particularly in a market already facing staffing pressures and financial constraints. The Government should therefore consider how to support providers to meet the new obligations without destabilising service provision. There is also a need to ensure that commissioners and regulators have the necessary resources and powers to monitor and enforce compliance effectively. In that spirit, I will pose some questions to the Minister for clarification and look for reassurance. How will the Government monitor compliance with the Human Rights Act among private providers, and what enforcement mechanisms will be used? Has there been any consultation with private care providers about the potential operational and financial impacts of this extension, and will the extension apply only to services arranged or paid for by NHS bodies? What protections exist for patients receiving private mental health care outside these arrangements? How do the Government plan to ensure consistency in application across all four nations? Do the Government foresee private provision of mental health-related services expanding? If so, by how much? I agree that the final two amendments look like two small consequential amendments that clarify and ensure that the human rights extension applies equally across England and Wales, Scotland and Northern Ireland. The insertion of “subject to subsection (2)” appears to be technical. I would just welcome confirmation from the Minister that it will not inadvertently limit the scope of the new protections. Otherwise, Opposition Members will support them.

• 19 Jun 2025 · Mental Health Bill [ Lords ] (Eighth sitting) · Hansard source

  More

  As we have heard, the proposals set out to remove police stations and prisons as places of safety. It does this in both relation to people detained under civil powers—sections 135 and 136—and in respect of certain part III patients involved in the criminal justice system, who may currently be held in such settings when a hospital bed is not available. The Government’s explanatory notes describe the rationale clearly: “This is in response to evidence that suggests these settings are not suitable environments for individuals with a severe mental health, in crisis, awaiting assessment and treatment.” As we have discussed in some of the earlier clauses, it is not just treatment, but the environment that plays a part in helping harbour a holistic care approach, so this is very much welcome. To that end, the Opposition can agree on this position in principle. A police station or prison cell is no place for someone with acute mental distress. They are not therapeutic environments; they can be frightening, disorientating and, in some cases, re-traumatising, particularly for children and young people. The clause aims to remove that contradiction in the law. As the law stands, when police officers encounter someone in a public place who appears to be suffering from a mental disorder and is in immediate need of care or control, they can detain them under section 136 and take them to a place of safety. Under section 135, a magistrate can issue a warrant to remove a person from their home or another place to a place of safety. Currently, that place of safety includes a police station, although section 136A limits that to exceptional circumstances—for example, when the individual poses an imminent risk of serious injury to themselves. Similarly, under part III of the Act, a person appearing before a criminal court can be held in a place of safety, which can currently include a police station or prison, pending hospital admission. Clause 49 will remove that. It amends section 55 to redefine “place of safety” and exclude police stations and prisons. It alters section 35, repeals section 136A, which has previously allowed police stations to be used in limited situations, and retains transitional protections for individuals already detained under early directions before the clause comes into place. That is a bold and principled legislative step, and I acknowledge that it builds on progress under the last Government. The 2017 Conservative Government, following public outcry and recommendations from the Care Quality Commission and the Wessely review, pledged to eliminate police cells as a place of safety for children. Since then, the numbers of such detentions have significantly decreased. Data from NHS Digital shows a downward trend in the use of police stations under section 136, which is evidence that change is possible with the right investment and inter-agency collaboration. That work deserves credit, so I thank the Minister for that. Clause 49 must not only move the law forward, but ensure that the practice can be followed. I therefore want to raise a number of questions, which I hope the Minister will take in good faith. The classic one is “Where would people go instead?” The explanatory notes are right to say that hospitals and healthcare-based settings are more appropriate, but do those settings exist in sufficient numbers, with trained staff, beds and security protocols to receive safely all those who would otherwise have been taken to police stations? If they do not, we risk creating a gap between the law and the real world—a dangerous vacuum, whereby someone in crisis may end up in an ambulance bay, in a police car or in a general A&E without specialist support. It could have wider impact on the safety of not only the individual patient suffering, but other patients in healthcare settings such as A&E, interacting with an acutely ill mental patient. Without proper capacity, we risk many more police officers having to be at health settings to keep the mental unwell patients safe from themselves and others. I appreciate that the Government have said that it will take 10 years to implement the Bill fully, but this clause will come into force immediately. What assurances can the Government give that there will be not only capacity, but capacity in the right places, so that, for example, people are not transferred to other areas of the country to ensure that the legal requirement is met? Although it is welcome not to be in a police station, being miles from family and support circles would be just as detrimental. What provisions are being made for children and young people? The clause rightly states that for minors, the place of safety must now comply with the Children and Young Persons Act 1933, but excluding police stations. Are there sufficient CAMHS—child and adolescent mental health services—crisis beds and child-friendly places of safety in each region? What guarantees are there that children will not end up in adult settings, or worse, in informal or unlawful detention? I turn to the transitional support given to the police. Officers may no longer be able to use their custody suites, but what training, resources and alternative pathways are being made? What happens in the middle of the night in a rural police force, where there is no mental health professional on call and the nearest hospital bed is 80 miles away? How would the Government monitor performance? Will the Government commit to publishing annual data on delays in finding a place of safety, the use of inappropriate settings post reform, and outcomes for those detained under sections 135 and 136? Will the CQC or another body be tasked with auditing local compliance? Clause 49 reflects a consensus that mental healthcare belongs in health settings, not custodial ones. I urge the Minister to answer the questions in the good faith in which they were asked, because we all want to see this become a reality.

• 19 Jun 2025 · Mental Health Bill [ Lords ] (Eighth sitting) · Hansard source

  More

  That is a staggering drop in numbers. Is there a reason behind it? Is it that the burden of proof was always put on the patient, so they did not feel that they were in a position to do something? If we are inverting that, does the Minister expect the numbers to go back up?

• 19 Jun 2025 · Mental Health Bill [ Lords ] (Eighth sitting) · Hansard source

  More

  I will first speak to clause 54, to give context to my comments about new clause 12, which is in my name, and new clauses 17 and 20, tabled by the Liberal Democrats. Currently, under regulation 18 of the Care Quality Commission (Registration) Regulations 2009, registered providers must notify the CQC if a child under 18 is placed in an adult psychiatric unit for longer than 48 continuous hours. The notification duty enables the CQC to monitor such placements and take appropriate action to protect young people. The clause places a statutory duty on the Secretary of State to review whether the duty to notify should be extended to other cases when a child is admitted to a hospital or registered establishment for treatment or assessment of a mental disorder—that bit is really important. It also requires a review of whether the current 48-hour notification timeframe remains appropriate. As the explanatory notes make clear, the purpose of the review is “to ensure that where a child is admitted...notifications are made to the CQC in appropriate circumstances”, so that the regulator can respond effectively. That is a welcome and sensible provision. It recognises that safe-guarding in mental health settings must be comprehensive and responsive in changing circumstances. For example, children placed in settings other than adult psychiatric units, such as specialist units or community hospitals, may also face risks that warrant timely CQC oversight. However, I have a few questions for the Minister. Given the potential risks to children placed even briefly in adult psychiatric units or other settings, is the 48-hour threshold for notification too long? Would early notification—perhaps on admission—provide better protection for young people? Are there known gaps in the current notification system? For instance, how often do incidents involving children in mental health treatment go unreported under the existing framework? The review is to be completed within two years of Royal Assent. Given the urgency of safeguarding children’s mental health and wellbeing, would it be possible to provide interim updates to Parliament to maintain transparency? Will that be part of the written statement, or stand alone? Will the review consider notifications from private and third sector providers, as well as NHS trusts, to ensure that no setting is overlooked? We must look at the role of the CQC. In another letter from Baroness Merron, the Minister in the House of Lords, she addressed some of the issues raised and laid out the rationale for her confidence in the CQC as it stands. The letter emphasises the CQC’s “multiple roles” under the Mental Health Act as an independent regulator of services, an investigator of complaints and part of the national preventive mechanism to safeguard human rights. It points out that in 2022-23, the CQC carried out 860 monitoring visits and spoke to over 4,500 patients and 1,200 carers. Those impressive figures speak to a considerable degree of activity and reach. However, as we have debated, the Bill puts significantly more requirements on the CQC, and clause 54 is a further one. The letter also stresses the CQC’s evolving role and notes that the creation of a new chief inspector of mental health is under way—a recommendation from Professor Sir Mike Richards. The aim, we are told, is to “put mental health on an equal footing with physical health in CQC” and to ensure “better information sharing” and “stronger focus on Mental Health Act compliance.” All that is welcome, but we also need to scrutinise what is not said. While the letter asserts that “we will have a regulator that all of us can trust”, it concedes that that “will take time to achieve.” That is a fair admission, but it weakens the case for relying on the status quo while reforms are still being bedded in. If the CQC’s systems are currently being rebuilt or recalibrated, can we be confident that they are robust enough right now to identify and respond to safeguarding concerns, especially when they are about children? Then, there is the 48-hour threshold for notification when children are placed in adult units, which clause 54 seeks to address. Do we really believe that a child being in an inappropriate or unsafe environment for 47 hours is acceptable? Should the default not be real-time notification on admission, with durations used only to prioritise the level of scrutiny? We should aim for real-time notification in the 21st century—after all, we can track a bus on our phones anywhere in the world. Should we not aim for real-time data to spring services into action? Forty-eight hours is a long time in a young person’s life. The clause rightly instructs the Secretary of State to review those questions, but I urge the Government to approach the review with openness—not just to minor procedural tweaks, but to the possibility that more fundamental changes might be necessary. On that point, does the Minister envisage the review as a desktop-type data review, or will it engage with children and families who have experienced these placements? Will it examine how well the notifications currently translate into timely action by the CQC? Seeing the data is important, but acting on it is more so. How will Parliament be kept informed before the two-year deadline for reporting? Will that be part of the written statement? All that leads me to our new clause 12, which aims to address a lot of the background I have set out. At present, the Mental Health Act provides for the detention of patients who require treatment for mental health disorders, including children. Section 131A of that Act governs the accommodation of patients in hospital wards, but lacks explicit safeguards preventing children from being placed in adult wards, except in limited circumstances. That has led to troubling examples across the country, where children have been admitted to adult wards because of a lack of appropriate CAMHS beds.

• 19 Jun 2025 · Mental Health Bill [ Lords ] (Eighth sitting) · Hansard source

  More

  It is a pleasure to follow my hon. Friend the Member for Solihull West and Shirley. I would expect nothing less from him than a fantastic canter through this important clause. I will not repeat a lot of what he said, but I will try to emphasise it. Although clause 48 is short, it speaks to the much larger principle of the balance between public protection and individual liberty. I will not go through all the details, as the Minister laid out the changes, but the burden of proof is currently on the patient to convince the tribunal that they no longer meet the criteria for guardianship. The clause will change that. Instead, the burden will fall on the local authority or relevant public body to prove that guardianship remains justified. The Government’s explanatory notes put it plainly: “the patient should be discharged by the Tribunal unless the local authority can prove that the patient continues to meet the guardianship criteria.” The clause is not just a technical amendment; it is a fundamental realignment of legal principle. It reinforces the presumption of liberty. It aligns guardianship cases with the principle that when the state restricts an individual freedom, it is for the state to justify that restriction, not the individual to justify their freedom. It echoes the evolution of mental health law towards a less restrictive approach, a principle we put in place on the first day of our deliberations on the Bill. Although clause 48 amends only a few words, it reflects a big change in principle: liberty is the default, and restriction must be justified and not presumed. There are some important questions that I want to echo and emphasise, again leading on from my hon. Friend the Member for Solihull West and Shirley. Are local authorities prepared for the reversal of burden? Have they been consulted? Do they have the legal resources, documentation, standards and evidential processes to meet the burden before the tribunal? On top of that, we have already agreed that there will be automatic referrals. We would therefore expect more referrals to the tribunal as well as a change in how they operate. This is a huge undertaking. If they fail through a lack of capacity organisation, we risk a situation in which patients are discharged not because they no longer meet the criteria, but because the case was poorly presented. How will the Government ensure that that does not happen? Secondly, will the Government issue statutory guidance or regulations to ensure that consistency in how the burden is discharged? We do not want a postcode lottery in the quality of guardianship applications or tribunal evidence. Thirdly, we must always consider public protection. The guardianship regime is not designed for high-risk individuals, but it can still apply in cases where behaviour poses a serious risk to self or others—for example, individuals with profound learning difficulties who might place themselves in danger if not properly supported. We also talked about cumulative or escalating behaviour in one of our first debates. The reason for doing so is that we are at the fringe of significant cases. What safeguards are in place to ensure that public safety considerations are given due weight in cases where the evidence might be incomplete or borderline? Finally, do the Government intend to monitor the impact of the clause? Will data be published on whether tribunal discharge rates increase following this reform, and whether that leads to any unintended consequences? I want to be clear that His Majesty’s Opposition support the principle behind the clause. We support a mental health system that is rights-based, person-centred and built on the presumption of liberty. But that principle must be matched by a system capable of meeting the duties it imposes. Rights on paper are meaningful only if public authorities are resourced and able to support them and uphold them in practice. I look forward to the Minister addressing those points.

• 19 Jun 2025 · Mental Health Bill [ Lords ] (Eighth sitting) · Hansard source

  More

  The Minister has partially answered my question. He talked about the £26 million investment being targeted at certain areas of the country, but will that be based on the areas of highest priority? The danger is that if the highest priorities are all in the north, the south will be left out.

• 19 Jun 2025 · Mental Health Bill [ Lords ] (Eighth sitting) · Hansard source

  More

  Clause 51 amends the Bail Act 1976 to restrict the court’s ability to remand individuals in custody for their own protection or, in the case of children, for their welfare, where the sole concern is mental health. Under existing law, the court may refuse bail to a defendant if it is satisfied that the individual should be kept in custody for their own protection. For those under 18, the relevant test is whether custody is required for their own welfare. Those provisions are found in schedule 1 to the Bail Act. There is currently nothing in statute that precludes the court from remanding someone entirely on the basis of their mental health conditions—for example, if the defendant appears to pose a danger to themselves but no suitable mental health provision is immediately available. Clause 51 aims to change that. It amends all three parts of schedule 1 to the Bail Act—those dealing with imprisonment and non-imprisonment offences—so that the adult defendant, aged 18 or over, may not be remanded in custody for their own protection if the only concern is mental health. Paragraph 360 of the Government’s explanatory notes states: “Evidence suggests that in some cases this power is being used by the courts to remand defendants into custody where they would otherwise have been bailed were it not for the court’s concern for their mental health.” The intent here is good: to end the inappropriate use of custody—especially in prison, as we have been discussing—as a place of safety for people with acute mental health needs. The clause is consistent with the wider direction of the Bill, which seeks to ensure that people in crisis are met with healthcare and not handcuffs. Although I support the clause, I have a few questions and concerns about how it will operate in practice, and invite the Minister to consider further safeguards. Where is the alternative provision? That is a question we will keep asking, not in the form of an attack, but as something helpful for our consideration. We are told that instead of custody, courts may impose bail conditions under section 3(6) of the Bail Act, such as requirements to engage with mental health services or, where the statutory criteria are met, remand the person to hospital under the Mental Health Act. That sounds reasonable, but the reality on the ground is often different. We know from NHS data, and from countless reports by inspectors and charities, that community mental health services are stretched, beds are scarce and out-of-hours support can be lacking. What assessment has been made of local mental health capacity to absorb those individuals who, under clause 51, will no longer be eligible for a custodial remand? Do the Government know, for example, how many are currently in that position? If the law changes overnight, how much extra provision will be needed for these specific patients? How will the Government, specifically on remand patients, ensure that there are places? What are the requirements, if any, on NHS integrated care boards to ensure that a place of safety or support is available in every local area? Without that, there is a real risk that the courts will be left with no safe options, particularly when a person presents in crisis late at night, in distress and with nowhere else to go. Are the bail and hospital powers workable substitutes? The explanatory note refers to courts using the power to remand for mental health reports or treatment, but the orders depend on medical evidence, the availability of beds and local agreement. They are not always available at the moment when bail is being considered. Meanwhile, bail conditions, however well-meaning, cannot guarantee care or prevent harm if services are not responsive. Has the Department considered issuing new statutory guidance to accompany the clause, outlining what courts should do when no hospital or community support is available, but the defendant is clearly at risk? Further to that, will there be a formal route for courts to escalate concerns to NHS bodies where no safe custodial options exist? We also need to consider children and young people. As I read it, the clause applies only to adults. The Government are arguing that section 98 of the Legal Aid, Sentencing and Punishment of Offenders Act 2012 already prevents the remand of children solely for mental health reasons. Does that not potentially leave a loophole? I am no lawyer, but the Bail Act still allows for remand for the child’s own welfare, and the revised wording in clause 51(2) and (4) does nothing to prevent that being interpreted in practice as the mental health concern that we have been discussing. Why have the Government not taken the opportunity to clarify in statute the status of children? They must not be remanded to custody solely on the basis of mental health-related welfare concerns. Finally, how will we track the effects of the changes? I suggest that there must be ongoing scrutiny of how the clause operates. To that end, will the Minister commit to releasing annual statistics on the number of people refused bail under the provisions, to reporting on incidences where a safe, non-custodial alternative was not available, and to monitoring outcomes for those affected by the changes? Does the data fall under NHS or Ministry of Justice datasets? It is important that we understand who is responsible.

• 19 Jun 2025 · Mental Health Bill [ Lords ] (Eighth sitting) · Hansard source

  More

  I am pleased that the Minister has clarified that the Government intend to take out clause 50, because that allows me to take out some of my speech. It would not be appropriate for me to retread the entirety of the argument—we have been through it, and I am aware of the numbers on the Committee—but I will address a few points, because the clause is important. The clause would keep the role of authorised persons for the purposes of sections 135 and 136. Hon. Members will know that this is not a new issue, as we debated the removal of the definition of authorised person in relation to clause 5. On that occasion, I expressed my concerns about the risk of doing so, which were shared by Baroness May, who rightly argued that we must stop treating mental health as a policing issue and start enabling care to be delivered by the right person in the right way at the right time. This clause gives us a chance to make that principle real. Clause 50 allows certain non-police professionals, defined as authorised persons, to use existing powers under section 135 to enter premises under a warrant and remove a person in a mental health crisis to a place of safety or assessment of care. It also allows those professionals to use powers under section 136, which is even more sensitive, permitting the removal and detention of a person from a public place without a warrant if they appear to be suffering from a mental health disorder. The clause is not about weakening safeguards. It is about strengthening the frontline and moving away from a model where the police are the default responders to every mental health crisis, which is often not because they are best placed, but because no one else has the authority. As modelling has shown, 95% of mental health-related police calls do not require a criminal justice response. Officers are spending hours, even days, sitting in A&E with patients in distress, because no one else is trained and empowered to act. Clause 50 helps to break that cycle. It creates a legal basis for trained health professionals—mental health nurses, paramedics and approved mental health practitioners —to intervene in crisis situations, rather than relying solely on the police. The hon. Member for Ashford asked how we decide, but we already triage people when they ring 999 or 111. How do we decide who gets an ambulance for what sounds like a heart attack or stroke? That decision is made by clinicians. We have the ability to make those triaging decisions, and I think it is completely appropriate to try to empower the health services to find a better way of dealing with these people.

• 19 Jun 2025 · Mental Health Bill [ Lords ] (Eighth sitting) · Hansard source

  More

  The hon. Lady is absolutely right. A paramedic never knows what they are going to when they are called out. It could be a terrorist incident; it could just be a person in distress who is hysterical. A paramedic never knows, but that is part of the point—when they get there, they would be able to make that assessment rather than having to call the police out. At the moment, they do not have those powers, so that is a reason to give them the option. I am not saying that that is always the right option, but it gives them the option. The clause allows us to think of new, innovative ways to deal with the complex, changing world of mental health in the modern age. The Government have argued elsewhere that the definition of who detains could be too rigid or unnecessary, but I would say the opposite. Professionals on the ground need clarity—a lawful mandate to act in the best interests of a person in crisis, with clear boundaries of competence and training. The Lords were right to include a definition of “authorised person” that sets out the conditions of suitability. Clause 50 builds on that framework. Having these powers in the Bill gives NHS trusts the chance and confidence to design alternative crisis responses. The clause is by no means a blanket approach—it actually drives innovation. Health professionals have the clarity to act and police forces have the breathing space to return to their core purpose: preventing and investigating crime. Of course, the power must come with safeguards; it is not a blank cheque. The use of coercive powers by the police or anyone else must always be subject to training, regulation and oversight. Entering someone’s home or detaining them in public is a profound interference with their liberty and dignity, so the power must be exercised with care and caution. We believe that clause 50 takes us in the right direction towards a health-led approach to mental health crisis, rather than a security-led one, as my hon. Friend the Member for Solihull West and Shirley said. It supports the police by lightening a burden from which they have long asked to be freed. It supports patients by increasing the chance that they will be met by someone who understands their needs. It supports the wider public by allowing police officers to return to doing what they are trained to do and passionate about doing: keeping communities safe. We should be building on this type of reform, not rowing back from it. I urge the Government to reconsider.

• 18 Jun 2025 · Educational Outcomes for Boys · Hansard source

  More

  9. Whether she plans to take steps with Cabinet colleagues to develop a strategy to improve educational outcomes for boys.

• 18 Jun 2025 · Educational Outcomes for Boys · Hansard source

  More

  The logic behind having a Women’s Minister was the idea that women present and have different problems in society. By that logic, men and boys do, too; we know about suicide, and we have just heard about educational attainment. We hear about help-seeking opportunities, and I welcome the men’s health strategy, but is it not time we had a Minister for men and boys to look across Government and deal with education, unemployment, suicide and health, and really get to grips with the problems facing young men and boys?

• 17 Jun 2025 · Mental Health Bill [ Lords ] (Fifth sitting) · Hansard source

  More

  The Committee is very lucky to have the experience and expertise of someone who has used community treatment orders in the field. Will the hon. Member address my point about clinical conflict? We are introducing two new people: a community clinician and a responsible clinician. Has he seen any difficulties in practice with a difference of opinion between clinicians? How were they resolved? Does he see any way in which the clause could create or resolve a problem? My worry is that there is no clear resolution that would deal with discrepancies. I would love to know what is happening at the moment, as the law stands, in the hon. Member’s clinical experience.

• 17 Jun 2025 · Mental Health Bill [ Lords ] (Fifth sitting) · Hansard source

  More

  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.

• 17 Jun 2025 · Mental Health Bill [ Lords ] (Fifth sitting) · Hansard source

  More

  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.

• 17 Jun 2025 · Mental Health Bill [ Lords ] (Fifth sitting) · Hansard source

  More

  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?

• 17 Jun 2025 · Mental Health Bill [ Lords ] (Fifth sitting) · Hansard source

  More

  Brevity is an important skill that you have exemplified in this House for many years, Sir Desmond, so I will not subject the Committee again to matters that I have already covered. I ask again the question that I posed just before the suspension: how will clinicians 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 CTO conditions is not, in itself, an automatic ground for recall? That concern has come across in evidence and is a long-standing source of misunderstanding and mistrust, as has been highlighted in cases and in the Wessely report. Clause 23(2) will insert new subsection (3B) into section 72 of the Mental Health Act, giving mental health tribunals the power to recommend that the responsible clinician reconsider whether a CTO condition is necessary, even when they do not discharge the patient. That is a welcome enhancement of patient rights. Currently, if a tribunal decides not to discharge a patient, it has no power to challenge potentially excessive conditions. The clause strikes a useful middle ground, offering oversight without overturning clinical decisions. Having said that, will there be any requirement for the responsible clinician to formally respond to the tribunal’s recommendations? Without such a duty, there is a risk that recommendations may be quietly disregarded and the benefit of the provision may be undermined. Clause 23 is a positive and proportionate reform, but to strengthen its practical impact I suggest that the Government consider updating the code of practice to clarify what constitutes a “necessary” condition under section 17B of the Mental Health Act; introducing a duty to respond to tribunal recommendations under proposed new section 72(3B), with a short time limit and a written explanation if the recommendation is rejected; and providing clear information to patients. New clause 4, tabled by the Liberal Democrats, seeks to place a general duty on ICBs to ensure that sufficient resources are available for community-based mental health services, particularly in the context of implementing provisions under the Mental Health Act. It speaks to a concern that many Committee members will have heard time and again from patients, practitioners and families alike: that the success of any reform to the Mental Health Act will ultimately rest on the capacity of community services to deliver. We know the reality: patients can be discharged to under-resourced settings or subject to CTOs that depend on clinicians who may be overstretched or unavailable. Clause 22 will rightly expand the role of community clinicians in CTO decisions, but that works only if they exist, are available and have the time and tools to engage meaningfully. I acknowledge that new clause 4 identifies a genuine structural risk in the way in which we approach reform, and I commend colleagues for raising it, but should it sit in primary legislation? I am not so sure. I have some questions for the hon. Member for Winchester not about the intention of the new clause, but about the appropriateness and practicality of placing such a duty in primary legislation. Primary legislation is best used where duties are clear, enforceable and universal. The duty proposed in the new clause, although admirable, is qualified by the words “insofar as is reasonably practical”, which reflects the reality that integrated care boards do not control all the levers of workforce, capital investment or even, in many cases, service design. With that in mind, I ask the hon. Member the following questions. What mechanism would be used to enforce the duty? If an ICB fails to meet the duty, what would the consequences be? Would the duty not create legal ambiguity or even the potential for judicial review where service users feel that resources are inadequate, or even where the ICB has acted reasonably in difficult circumstances? Furthermore, how would the duty interact with the existing statutory duties on ICBs under the Health and Care Act 2022, including the duties around health inequalities and integration? A stronger element of the new clause, which merits closer consideration, is the assessment and publication of findings on local community mental health capacity. This kind of transparent, data-led accountability could be an effective tool not only for Parliament and regulators, but for local patients and advocacy groups. Perhaps that element could be taken forward in secondary legislation as part of the updated NHS England commissioning guidance. The Minister will forgive me, but I am not sure whether such a tool already exists, so perhaps he will address that point. Does the Department plan to require ICBs to assess and report on community mental health capacity in the light of the new duties being created by the Bill? Could there be scope for a reporting duty to be included in regulations or guidance, even if a general resourcing duty is not placed in primary legislation? The Bill refers to commissioning, and under earlier clauses we have talked about dynamic registers. Will the Minister set out whether the issue is covered here or in another way? We cannot ignore the resource dimension, so I am grateful to colleagues for pressing the Committee to address it. However, we must be careful about the tools we use, what we write into law, and what we deliver through planning, commissioning and political will. I look forward to hearing from the hon. Member for Winchester and the Minister in response to my questions.

• 17 Jun 2025 · Mental Health Bill [ Lords ] (Fifth sitting) · Hansard source

  More

  I am grateful for the clarification. Does it mean that, in essence, there will be a hierarchy, so the responsible clinician is above the community clinician and trumps them? If a community treatment order cannot be signed off, it does not exist. I want to explore that angle; is that what the Minister is suggesting?

• 17 Jun 2025 · Mental Health Bill [ Lords ] (Fifth sitting) · Hansard source

  More

  I commend the team in Winchester and the citizens advice bureau for what they are doing, but the hon. Gentleman slightly undermines his case. He is arguing that, in legislation, we should expand the independent mental health advocates—

• 17 Jun 2025 · Mental Health Bill [ Lords ] (Fifth sitting) · Hansard source

  More

  The hon. Member rightly talks about resources and about the cuts as a proportion—although small, it is a cut in NHS spending. The last Conservative Government brought in the mental health investment standard to try to ensure parity between physical health and mental health in investment so that, regardless of how big the pot was, mental health was prioritised. Does the hon. Member agree that there is a concern that that could be slipping under this Government? Does he agree that that needs to be addressed in the context of the community provision that we are discussing?

• 17 Jun 2025 · Mental Health Bill [ Lords ] (Fifth sitting) · Hansard source

  More

  I welcome the chance to contribute to the debate on clauses 24 to 28. I will then turn to Government amendments 40 and 41 and to amendments 54 and 55, tabled by my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer). Clauses 24 to 28 represent a significant reform to the Mental Health Act 1983. They seek a shift from the traditional concept of a nearest relative to giving patients more control by allowing them to nominate a person to act on their behalf. Clause 24 is the cornerstone of the reform, establishing the role of a nominated person as the patient’s chosen individual to take over certain rights and responsibilities previously held by the nearest relative. It represents a fundamental change from a fixed family-based system to one centred on patient choice and autonomy. Currently, the nearest relative, often by blood relation, holds a range of statutory powers under the Mental Health Act, regardless of the quality of their relationship with the patient. The clause will enable patients, especially adults, to nominate a trusted person—a family member, friend or advocate—who can act in their best interests. That is a progressive and patient-focused change relating to modern social realities, where family ties are complex and a biological relative is not always the best supporter. Empowering patients to select their nominated person can enhance trust, improve communication and ultimately lead to better care outcomes. It does, however, raise pressing questions. For children and young people, particularly those aged 16 and 17, who gain legal capacity to nominate, what safeguards ensure that parental concerns and children’s welfare remain adequately considered? How will disputes between nominated persons and relatives, or between the nominated person and clinicians, be resolved? Part of that might be addressed in Government amendments 40 and 41, but I am keen to understand a little more. What training and oversight will ensure that nominated persons understand their duties and, importantly, their boundaries? Finally, for a patient who does not or cannot nominate someone, will the nearest relative still have a role, and how will that be managed? Clause 25, on applications for admission or guardianship, builds on clause 24. It will require the approved mental health professional to consult the nominated person before making applications for admission or guardianship, except where consultation is not reasonably practicable or would cause unreasonable delay. It will also allow the nominated person to object to such applications, requiring a barring report from the approved mental health professional if an objection is made. The clause will formalise the nominated person’s involvement at a critically early stage of the intervention, ensuring that their voice can influence decisions that deeply affect the patient. The power to object introduces an important check, though it is balanced by the professional’s ability to override objections on the grounds of safety. The Opposition agree with that, but there are still some questions. How will professionals navigate conflicts between their clinical judgment and objections by the nominated person? Will there be clear guidance to avoid delays that could jeopardise patients or public safety?

• 17 Jun 2025 · Mental Health Bill [ Lords ] (Sixth sitting) · Hansard source

  More

  The Minister says that advocates had no role in discharge, but they do when advising patients about their rights—that is fundamentally what they do. At the point of discharge, they enable patients to know what their rights are. I take his point about capacity issues. If the Government want to take the clause away, how will they hardwire patients’ feedback into the heart of the Bill?