Mental Health Bill [Lords]

Public Bill Committee, 10 June 2025.

Martin Vickers (Conservative, Brigg and Immingham)

We are sitting in public and our proceedings are being broadcast. I remind hon. Members to switch off or silence their electronic devices. Tea and coffee are not allowed during sittings.

Before we move on to line-by-line scrutiny of the Bill, we will first consider the programme motion on the amendment paper, and then a motion to enable the reporting of written evidence for publication. In view of the time available, I hope to take these initial matters formally, without debate. The programme motion was discussed yesterday by the Programming Sub-Committee for the Bill.

Martin Vickers (Conservative, Brigg and Immingham)

Copies of written evidence that the Committee receives will be made available in the Committee Room.

We will now begin line-by-line consideration of the Bill. The selection list for today’s sitting is available in the room and on the parliamentary website. It shows how the clauses, schedules and selected amendments have been grouped for debate. The purpose of the grouping is to avoid undue repetition in debate.

I remind the Committee that the Member who has put their name to the lead amendment in the group is called first. In a stand part debate, the Minister will be called to speak first. Other Members will then be free to indicate, by bobbing, whether they wish to speak. At the end of a debate on a group of amendments, new clauses or schedules, I shall again call the Member who moved the lead amendment or new clause. Before they sit down, they will need to indicate whether they wish to withdraw the amendment or new clause or to seek a decision.

If any Member wishes to press any other amendment, new clause or schedule to a vote, they will need to let me know. I shall use my discretion to decide whether to allow a separate stand part debate on individual clauses and schedules following the debate on the relevant amendments. I hope that that explanation was helpful.

Clause 1 - Principles to inform decisions

Martin Vickers (Conservative, Brigg and Immingham)

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

Stephen Kinnock (Labour, Aberafan Maesteg)

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

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

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

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

Danny Chambers (Liberal Democrat, Winchester)

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

Stephen Kinnock (Labour, Aberafan Maesteg)

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

Luke Evans (Conservative, Hinckley and Bosworth)

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

Stephen Kinnock (Labour, Aberafan Maesteg)

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

Gregory Stafford (Conservative, Farnham and Bordon)

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

Stephen Kinnock (Labour, Aberafan Maesteg)

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.

Luke Evans (Conservative, Hinckley and Bosworth)

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

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

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

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

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

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

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

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

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

Anna Dixon (Labour, Shipley)

I thank the hon. Gentleman for his comments. Does he agree that the Wessely independent review setting out these four principles gets right the balance that even though people may need to be detained, they should not lose their personhood and control, and that embedding these principles in this updated Bill will ensure that those rights are enshrined in law?

Luke Evans (Conservative, Hinckley and Bosworth)

The hon. Member is absolutely right. The key part is about trying to change not only the legislative framework, but the culture around clinicians and society as a whole. We saw that impact in 1983, we saw it in 2005 with the update on capacity, and we saw it in 2007. Now is the right time to look again at this, and it is well overdue.

I am glad that it has taken a while to ensure that the Bill has been thoroughly thought out. As we heard in the House of Lords debate, this is exactly the kind of framework that we need to make sure that society moves forward in a collaborative way that puts the patient at the centre, but also protects the wider community. Given some of the high-profile incidents that we have seen, we must also make sure that relatives, the community and the wider public at large are all protected.

As the Minister has rightly highlighted, the core principles must be the default for everyone. Clause 1 therefore represents an important step forward: by requiring the Secretary of State and the Welsh Ministers to include the four principles explicitly in the code of practice and by making it a legal duty for decision makers to have regard to them, the clause will strengthen the ethical foundation of mental health law. However, we must be honest about the challenges. The success of the principles depends on the culture, not just the codification. Training, supervision and leadership across clinical settings will be essential to bringing the values off the page and into practice.

These principles will also require resource backing. We cannot call for the least restrictive or most therapeutic interventions while community mental health services remain as they are. A plan for investment and a timeline for delivery will be imperative, or else we risk embedding principles we cannot fulfil. Members on both sides of the House understand that. I know that the Minister will have to think carefully about setting out a timetable, but it is key.

We must also guard against tokenism. We must guard against lofty principles being left unenforced and becoming rhetorical wallpaper. If we are to legislate for these values, we must look for accountability, with regular auditing, patient feedback mechanisms and a duty on the provider to report on how the principles are being upheld. Those are all areas that His Majesty’s Opposition will scrutinise.

To that end, I wish to raise several important questions for the Government and the Committee to consider. The first is about enforcement and accountability. How will the Government ensure that decision makers truly have regard to the principles in practice, and is there a robust mechanism for monitoring compliance and addressing breaches?

The second question is about balancing conflicts. In some cases, principles may conflict: for example, the imperative to respect patient autonomy may clash with the need to impose restrictions for safety. How does the code intend to guide practitioners to navigate these difficult trade-offs?

The third question is about care and interested parties. Although the clause highlights patient involvement, what explicit protections and roles will be afforded to carers and other interested parties, and how will their sometimes divergent perspectives be balanced?

The fourth question is about training and resources. Embedding the principles requires more than words on paper. What investments are planned to equip practitioners with the skills and understanding necessary to apply these principles sensitively and consistently?

The fifth question is about the timeline and consultation. The explanatory notes mention that the code must be consulted on and presented for scrutiny. What is the proposed timeline for that process, and how will people with lived experience continue to be involved?

Clause 1 builds on the Wessely review and marks a necessary and welcome shift in the ethical framework of the Mental Health Act. It will bring us closer to a system that treats people not merely as patients, but as partners in their own care. Let us ensure the implementation matches the ambition. The Opposition support clause 1, but we urge the Government to ensure that it is more than symbolic. It must be real, resourced and rigorously applied.

I turn to clause 2, on the application of the principles to Wales. Rightly, the clause will update section 118 of the Mental Health Act to reflect on the constitutional reality of devolution and will ensure clear lines of accountability between England and Wales in the development of codes of practice under the Act.

As hon. Members will know, the Mental Health Act remains a shared legal framework. Health is devolved, and the people of Wales have the right to expect a mental health system that reflects their own priorities, values and institutions. Clause 2 is not just a technical tidy-up; it gives clear legal effect to Welsh self-determination in this area. By replacing the reference to the Secretary of State with the term “appropriate national authority”, it affirms that Welsh Ministers are responsible for mental health policy and practices in Wales, including the power to prepare, revise and lay a code of practice before the Senedd. This clarity matters. It ensures that all professionals working in Wales understand the legal and ethical guidance that they are expected to follow.

There is also the opportunity for the Senedd to exert control in a swift and timely manner. Proposed new section 118(5B) sets out that when a new code or revised version of a code is presented to the Senedd, it will have 40 days to review it and, if necessary, to formally reject it or comment on it for a resolution. If the Senedd does nothing within 40 days, it will lose the chance to formally object under the specific legal process. After the 40 days, the code can automatically take effect or remain in force even if some Members of the Senedd do not agree, because they have missed the window to act.

Can the Minister foresee a time when this provision might be used? Does he worry about the risk of divergence in the Welsh and English approach? The very nature of the clause enables Wales to craft a code of practice informed by its own culture, language and health service architecture. That is not divergence for its own sake—it is the very purpose of devolution—but therein lies the potential risk, so we must remain alert to a few practical realities. There is a risk of fragmentation, particularly for professionals who work across the English-Welsh border. Divergent codes may, over time, create confusion in training, compliance or even expectations.

What work does the Department have planned with its Welsh counterpart to ensure clear communication and professional guidance to support consistency of understanding, not only of the policy but of content? What impact will the abolition of NHS England have on any cross-border working?

There is also an extra potential administrative burden to consider, should there be further divergence in drafting and maintaining two codes, each with consultation, approval and implementation stages, which will require resources, time and co-ordination. That could be a concern. After all, we do not want to see quality compromised by bureaucracy.

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

Stephen Kinnock (Labour, Aberafan Maesteg)

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

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

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

Luke Evans (Conservative, Hinckley and Bosworth)

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

Stephen Kinnock (Labour, Aberafan Maesteg)

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

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

Luke Evans (Conservative, Hinckley and Bosworth)

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

Stephen Kinnock (Labour, Aberafan Maesteg)

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

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

Luke Evans (Conservative, Hinckley and Bosworth)

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

Stephen Kinnock (Labour, Aberafan Maesteg)

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

Luke Evans (Conservative, Hinckley and Bosworth)

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

Stephen Kinnock (Labour, Aberafan Maesteg)

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

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

Aphra Brandreth (Conservative, Chester South and Eddisbury)

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

Stephen Kinnock (Labour, Aberafan Maesteg)

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

Clause 3 - Application of the Mental Health Act 1983: autism and learning disability

Neil Shastri-Hurst (Conservative, Solihull West and Shirley)

I beg to move amendment 56, in clause 3, page 3, line 19, at end insert—

“(4) The Secretary of State may by regulations update the definitions in subsection (2) in response to scientific advancements.

(5) A statutory instrument containing regulations under this section may not be made unless a draft of the instrument has been laid before and approved by a resolution of each House of Parliament.”

This amendment would allow the definitions for mental disorder, autism, learning disability and psychiatric disorder to be updated by secondary legislation as science evolves.

It is a pleasure to serve under your chairmanship, Mr Vickers. I rise to speak to amendment 56, which is in the name of my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer), who has extensive clinical experience. The amendment provides for a narrowly drawn but important power, namely, to update, via regulations and subject to affirmative procedure, the statutory definitions in clause 3, in response to developments in scientific and clinical understanding.

I recognise that any clause that confers powers on the Executive to amend the statutory definitions must be treated with due caution. There could be concerns that changes could be made without broad clinical consensus. However, on this occasion, I believe that my hon. Friend, who brings to the debate the weight of his clinical expertise, has struck the right balance. The proposed power is tightly scoped. It is triggered only by new scientific knowledge. It cannot be exercised on ministerial whim. Crucially, it is subject to the full rigour of parliamentary approval under the affirmative resolution procedure. It is not a case of Executive overreach; it is a recognition that the pace of medical and neuroscientific research is such that legislation risks obsolescence unless we allow for responsible adaptation.

One need only look at the evolution of our understanding of conditions such as autism spectrum disorder and complex post-traumatic stress disorder to appreciate how quickly definitions can move on. Clearly, any change must reflect best practice and take place under broad consultation. However, I argue that we are not opening the back door to arbitrary change; we are safeguarding the front door against stagnation. For that reason, I support the amendment.

Luke Evans (Conservative, Hinckley and Bosworth)

I rise to speak to amendment 56, tabled by my hon. Friend the Member for Runnymede and Weybridge. The amendment proposes to grant the Secretary of State the power to update the definitions of “mental disorder”, “autism”, “learning disability” and “psychiatric disorder” by secondary legislation, subject to affirmative resolution by both Houses of Parliament. Currently, the Bill sets out fixed definitions of those terms in the primary legislation—the Mental Health Act, as amended. Those definitions can be changed only through further primary legislation. That means that any further change, reflecting new scientific knowledge or evolving clinical consensus, would require a full legislative process. Given that the Act was passed in 1983, and we are here more than 40 years later, I think that the problem is clear.

Anna Dixon (Labour, Shipley)

Does the hon. Gentleman recognise the work of the World Health Organisation in producing the international classification of diseases and ICD-11, which provides a scientific, evidence-based update, including on psychiatric disorders, autism and other neurodevelopmental disorders? Has he considered whether that is an appropriate reference point for the Bill?

Luke Evans (Conservative, Hinckley and Bosworth)

The hon. Member makes a good point. We have had ICD-10 and DSM-5, which aim to codify those disorders. Part of the problem is that someone with Korsakoff syndrome, which is brain damage from alcohol, or with Rett’s disease would potentially come under the scope of these definitions. That makes it very difficult. What about acquired brain injury? That is an emerging field—the House has looked at it and has put a strategy in place. However, there could be problems in the legislation going forward.

The amendment is asking, I think, how we scientifically proof the Bill so that we do not need to introduce further primary legislation. That is the question that the Government need to grapple with. As a doctor, I have seen the difficulties and practicalities of these definitions, and of trying to put people in a box. For example, where does Asperger’s fit on the autism scale? What does that look like on the spectrum of conditions? Are we trying to codify that? These are the real, pragmatic problems of putting definitions in place. That means it is all the more important to look at definitions, but, as the hon. Member for Shipley has rightly pointed out, the definitions have already moved on while we have been discussing the Bill. Introducing a mechanism that allows the House to update the legislation in keeping with advances in scientific knowledge is really important. The question is whether this is the right amendment to do that.

The amendment would allow the Secretary of State to make updates through regulations—secondary legislation—which would thereby enable a more flexible and responsive approach. Importantly, it requires that any such regulations must be laid before Parliament and approved by both Houses, which maintains parliamentary scrutiny and democratic oversight.

The potential benefits of this approach are clear. It offers the possibility of allowing the law to evolve and stay aligned with scientific evidence and clinical best practice without undue delay. That could prevent outdated or overly rigid definitions from adversely impacting vulnerable people, and better reflects the complexities of mental health conditions. It would allow the law to keep pace with advances in the scientific understanding of autism, learning disability and mental disorders, without the need for primary legislation. It could help ensure that the definitions remain clinically accurate and relevant, improving how the law is applied and reducing the risk of outdated criteria causing harm or confusion.

As the hon. Member for Shipley pointed out, that is part of the problem. As new criteria come up, there is a delay in the uptake of definitions. From my experience in clinical practice, keeping up to date with definitions can sometimes be a challenge. It is part of the personal development plan to make sure there is that understanding, but there is always a drip through as change in practice comes through, along with clinicians being comfortable and happy to use the new definitions. With any new medication, it is important to understand the side effects and the pros and cons of what it is trying to achieve, and to be able to explain that fully so that a patient can consent when taking that medication. The same applies when trying to explain a condition to patients. If there is a change and a new aspect to the way in which a definition is being applied, it is important that we have some flexibility.

The affirmative procedure preserves Parliament’s role, offering safeguards against unchecked ministerial power. However, there are some important considerations and potential drawbacks. Definitions of mental health conditions have profound legal and social implications. Delegating this power, even with parliamentary approval, risks politicisation or inconsistent application if regulations are used too frequently or without adequate consultation.

Secondary legislation typically receives less parliamentary debate and public scrutiny than primary legislation, even with the affirmative procedure, which may not suffice for such significant changes. There is also a risk that the changes could be made in a reactive or piecemeal way rather than with a coherent legislative framework, potentially leading to legal uncertainty or unintended consequences.

Given those points, I have several questions for the Minister. How do the Government propose to keep the legislation updated, given that we are only updating the Mental Health Act now, 40 years on? Do they have a mechanism in mind to ensure that any updates to the definitions are accompanied by robust clinical and expert consultation, while reacting to advances in medical understanding? Would the Government consider a formal review mechanism such as a mandated periodic independent review of the definitions? That could solve the problem of legislation becoming outdated, and put the safeguards in place. If there is a difference in the scientific community, we need to make sure that any changes are broadly in agreement with the direction of travel of scientific knowledge.

Furthermore, in considering the need for balanced, flexible and democratic accountability, the Government could introduce a sunset clause on any regulations, so that any changes would be revisited and renewed by primary legislation within a set period, unless Parliament agrees otherwise.

Crucially, to my knowledge, there are no standing statutory bodies or panels tasked with reviewing or advising the Government on the legal definitions of mental health conditions. There is an argument that without a dedicated expert body to guide the Secretary of State, we cannot be sure that any changes are robustly evidence-based and clinically sound. Currently, we have the National Institute for Health and Care Excellence, the royal colleges, the Department of Health and Social Care and the intermittent mental health review bodies, but have the Government considered establishing a formal advisory mechanism to address problems in the future? The Opposition can see the argument both ways, but to govern is to choose, and it would be useful to understand the Minister’s thoughts on this area.

Anna Dixon (Labour, Shipley)

The hon. Gentleman seems to be overcomplicating the need for additional scrutiny. Will he acknowledge the work of the World Health Organisation to review the evidence on a global basis and update the definitions of psychiatric disorders?

Luke Evans (Conservative, Hinckley and Bosworth)

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

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

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

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

Stephen Kinnock (Labour, Aberafan Maesteg)

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

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

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

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

Neil Shastri-Hurst (Conservative, Solihull West and Shirley)

I beg to ask leave to withdraw the amendment.

Martin Vickers (Conservative, Brigg and Immingham)

With this it will be convenient to discuss schedule 1.

Stephen Kinnock (Labour, Aberafan Maesteg)

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

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

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

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

“mental disorder other than autism or learning disability”.

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

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

Luke Evans (Conservative, Hinckley and Bosworth)

It is a pleasure to speak to clause 3, which brings forward the vital and long overdue changes to the way our laws treat autism and learning disabilities under the Mental Health Act. The clause responds to a persistent injustice: the inappropriate detention of autistic people and people with learning disabilities in mental health hospitals, often for years at a time, without meaningful therapeutic benefit. Those individuals are not mentally ill, yet they have too often been detained, medicated and restrained as if they were.

As the law stands, individuals with learning disabilities and autistic people can be detained both for assessment, under section 2 of the Act, and for treatment, under section 3. Notably, people with learning disabilities may be detained under section 3 when their condition

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

whereas that does not currently apply to autistic people. Evidence and reports show that some such detentions can be lengthy and may not always provide therapeutic benefit. That raises concerns about the appropriateness of detention on the basis of disability alone. In my time on the Health and Social Care Committee, we looked specifically at this topic and produced a report, some of which has influenced the Bill.

The clause aims to directly address the issue of lengthy detentions for such individuals. For the first time, the law will clearly define autism and learning disability—something that has not happened for 40 years. As science has moved on, legislation must follow. Autism will now be recognised as a “lifelong developmental condition” that affects perception, communication and interaction, and learning disability will be defined as “significant impairment” of intellectual functioning.

Supported by schedule 1, the clause seeks to clarify and refine that position by introducing formal definitions of “autism”, “learning disability” and “psychiatric disorder”. Crucially, it removes autism and learning disability as stand-alone grounds for compulsory treatment and detention under section 3. Instead, detention for treatment will be permitted only if a person has a co-occurring psychiatric disorder—that is, a mental disorder other than autism or learning disability. Additionally, the change applies to community treatment orders, meaning that they cannot be applied solely on the basis of autism or a learning disability. However, the Act makes it clear that the changes do not apply to people detained under part 3 of the Act who are within the criminal justice system. For that group, autism and learning disabilities with serious behavioural consequences remain grounds for detention and treatment disorders.

The Bill introduces the new term, “psychiatric disorder”, meaning any mental disorder excluding autism or a learning disability. That distinction matters because detention under section 3 of the Act—compulsory admission for treatment—will no longer be permitted solely on the basis of someone being autistic or having a learning disability. From now on, a person may be detained only if they have a co-occurring psychiatric disorder or their learning disability is associated with “serious behavioural consequences”, such as

“abnormally aggressive or seriously irresponsible conduct”.

That reflects a fundamental shift in the philosophy of the Act from using hospitalisation as a containment tool to ensuring that any detention has a clear clinical and therapeutic purpose.

This reform is rooted in the recommendations of the 2018 review of the Mental Health Act, which was led by Professor Simon Wessely, and has been championed by groups such as the National Autistic Society. It represents a more modern understanding, as we currently see things, so there are many positives—it protects people’s rights, preventing detention simply for being different, it promotes community-based care rather than institutionalisation, it modernises the law in line with current clinical understanding and it seeks to end the harm caused by prolonged non-therapeutic hospital stays, which often involving over-medication and restraint.

However, I also sound a note of caution: the clause alone will not be enough. There is rightly concern about the provision for robust community services. We risk creating legal protections that are admirable on paper but ineffective in practice. I know that the Minister appreciates this dilemma. If people cannot get the right support in the community, they will still end up in crisis, and possibly still be detained—just under a different part of the law.

There are also concerns about ambiguity. The phrase “serious behavioural consequences” may be open to a wide interpretation. Without clear guidance and training, we risk inconsistencies and even potential loopholes that could undermine the intent of this reform. I commend the Government’s intention to protect autistic people and people with learning disabilities from potentially inappropriate detentions, and to ensure that compulsory treatment is targeted to those with mental disorders warranting hospital care.

The emphasis on therapeutic benefit and the principle of least restriction aligns well with the human rights standard and the UN convention on the rights of persons with disabilities. However, I have several questions that I hope the Government will be able to address. How will clinicians reliably distinguish between behaviours arising from autism and learning disabilities and behaviours arising from co-occurring psychiatric disorders, given the complexity of presentations in this population? Is there, or will there be, clear guidance and training to support those assessments? For individuals with severe autism or learning disabilities who display challenging behaviours but do not have a diagnoseable psychiatric disorder, what alternative pathways and supports are envisaged to ensure their safety and wellbeing without resorting to detention?

On the issue of patients under part 3 of the Bill, I know the Government’s rationale for maintaining broader detention definition criteria, but will there be additional safeguards or oversight to ensure those patients are not subject to unnecessarily prolonged or restrictive detention? The removal of “social functioning” from the definition of learning disability is intended to create a clearer distinction from autism, but could the changes create any unintended legal or clinical ambiguities in practice?

The changes could introduce some unintended consequences. Previously, impairments in social function were considered part of the learning disability definition, which helped capture individuals whose social difficulties accompanied intellectual impairments. Without that, there may be legal and clinical uncertainty for people with borderline or overlapping conditions. For example, someone with moderate intellectual impairment and significant social difficulties might no longer clearly fit the learning disability definition. Similarly, autistic individuals with mild intellectual disability who experience social challenges could find their diagnosis and legal status less certain. Those ambiguities risk inconsistent assessments and potential gaps in access to appropriate care unless the Government provide clear guidance to clinicians and tribunals on how to navigate complex presentations. What plans are in place to monitor and evaluate the impact of the changes on detention rates, patient outcomes and the availability of community-based alternatives?

In closing, this is an important clause that moves us closer to a system that respects autonomy, delivers appropriate care and upholds the rights of neurodivergent people. But we must be mindful that passing this legislation must not be seen as the end of the job. As the Minister understands, it is the beginning. If we are to drive reform, the Government will need to set out the funding and workforce pathway for the services that will deliver it. We must train professionals, empower families and support voices of lived experience at every level. Only then will clause 3 deliver on its promise not just to change law, but to change lives.

I turn to schedule 1. Schedules are an important and yet often overlooked part of the legislative process. It is worth reminding the Committee that a schedule is a part of a Bill’s function, like a detailed appendix. It contains the granular, often technical amendments that give practical and legal effect to the broad principles set out in main clauses. In other words, the clause tells us what Parliament intends to do and schedules show us how it will be done: amending existing statutes, updating definitions and ensuring consistency across legal frameworks.

In this Bill, schedule 1 is particularly consequential. It does the heavy lifting of applying the reforms in clause 3 to the existing Mental Health Act 1983, especially with regard to how we treat autism and learning disabilities within the scope of mental health law. Let us be clear that the schedule is not simply technical. It is transformational in what it attempts to do. Where the 1983 Act spoke broadly of mental disorder, schedule 1 now creates a more precise legal category—“relevant disorder”—defined to include psychiatric disorder, autism and learning disability with serious behavioural consequences. That matters enormously. In fact, it is one of the key reasons for the review of this entire piece of legislation. Individuals with autism or learning disabilities have been subject to compulsory powers, including detention, as we have heard, in the absence of any co-occurring mental illness. That is a practice with which the Committee should rightly be uncomfortable.

Schedule 1 amends not only the criteria for compulsory admission under section 3, but those for guardianship, community treatment orders, tribunal discharge and even the treatment provisions in part 4 of the Act. This breadth shows that clause 3 is not merely a rhetorical shift; it is being operationalised throughout the entire Act. With such significant implications, the schedule raises serious and legitimate questions that I am sure will form the backbone of the ongoing discussions in Committee over the next few weeks.

First, what is the threshold for serious behavioural consequences? Will that be clearly defined? Without precision, we risk substituting one vague standard for another. Secondly, do the transitory provisions offer enough clarity for frontline practitioners, in particular approved mental health professionals and tribunal panels who will be making decisions in grey areas between new and old law? Again, what about the cross-border issue between Wales and England? Thirdly, given the change from mental disorder to psychiatric disorders in some sections but not others, what is the Government’s rationale for that linguistic differentiation? Is there a risk of confusion among legal and clinical practitioners? To clarify—I am happy to share this with the Minister—I went through it and there appear to be a few occasions where the definition was changed, but some areas where it was not. Now, that may be my naïve understanding as a mere shadow Minister, but I would welcome the clarification and I am happy to pass them on to the Clerks to ensure that, if we are going to update the Bill, all parts are updated. Finally, and critically, do we have the workforce, training and services in place to support this cultural and clinical shift away from paternalism towards community-based and rights-respecting alternatives?

Schedule 1 shows us that reform is not just about good intentions, but getting the detail right. It is about ensuring the law reflects modern clinical understanding and human dignity. I support the direction of travel, but I gently remind the Minister to ensure that the operational mechanisms of the schedule are tested, clarified and, where necessary, strengthened. We owe that to the individuals and the families for whom we are producing this legislation to improve their lives.

Anna Dixon (Labour, Shipley)

It is a pleasure to serve under your chairship, Mr Vickers. I will make a few brief remarks on clause 3. For many of us, the detention and long-term institutionalisation of people with autism and learning disabilities is a shameful part of the NHS’s history. The Bill, and particularly this clause, will finally make it very clear that that is no longer acceptable. It is a further shame that, despite the Winterbourne View report in 2012, so little progress has actually been made on providing for people to be cared for in the community and closer to home.

How will the Minister make sure that the duties on mental health in the NHS are sufficiently strong to ensure that people with autism and learning difficulties receive the social care and healthcare that they need, and can be cared for in the community? How will that be monitored, and reported on?

The other issue pertains to people in the 18 to 24 age group, although I think the Bill talks about adults with EHCPs. How will there be full alignment between the age group covered by the NHS and the age group covered by EHCPs to make sure that that transition is dealt with under the Bill?

Finally, I want to recognise that where there are gaps in community provision, as we have said, it is essential for the Bill’s implementation to ensure that the clause actually works in practice. When those gaps fall on carers, particularly parent carers of people with disabilities, it will ultimately make their lives much better if we implement the Bill with community provision alongside it.

Stephen Kinnock (Labour, Aberafan Maesteg)

The red thread that goes through all those questions, from both my hon. Friend and the Opposition spokesman, is very much about how we are going to build a clear and strong understanding of what good community support looks like, and then build towards it so that we achieve the aims that we set out for ourselves. In many ways, that is a difficult question to answer in this Committee, because an important part of the answer will come from the consultation on the code of practice that will be launched as soon as the Bill gets Royal Assent.

The Government believe passionately in making policy on the basis of evidence, so we need that consultation and input for the code of practice. We need a clear definition based on engagement with those who are at the cutting edge of delivering these services, so that we can define the new reality that we want to work towards, and then implement it step by step.

I apologise to Committee members for the fact that in some ways that is a step beyond what we are doing here in scrutinising the Bill. We will, I hope, pass the Bill, and then it will get Royal Assent. From that day, we will be straining every sinew to get community services to where they need to be.

Jennifer Craft (Labour, Thurrock)

I do not want to speak outside the scope of the clause, but I would very much welcome a commitment from the Minister on ensuring that people with learning disabilities and/or autism are part of the process of the consultation to produce guidance on what good community services look like, and that they are engaged with from the start in a very real and meaningful way.

Stephen Kinnock (Labour, Aberafan Maesteg)

Absolutely, and I pay tribute to my hon. Friend for her outstanding work in the all-party parliamentary group; I am looking forward to meeting with the APPG as soon as diary time can be organised. There is absolutely no point in the Government making policy in an ivory tower in Westminster or Whitehall. Policy must be evidence-based and based on the real, lived experience of patients—we are very committed to building a patient-centric national health service—and practitioners. If we try to make policy without involving the voices of those people, the policy will fail; we know that from bitter experience.

David Burton-Sampson (Labour, Southend West and Leigh)

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

Stephen Kinnock (Labour, Aberafan Maesteg)

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

Neil Shastri-Hurst (Conservative, Solihull West and Shirley)

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

Stephen Kinnock (Labour, Aberafan Maesteg)

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

Sojan Joseph (Labour, Ashford)

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

Stephen Kinnock (Labour, Aberafan Maesteg)

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

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

Gregory Stafford (Conservative, Farnham and Bordon)

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

Stephen Kinnock (Labour, Aberafan Maesteg)

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.

Luke Evans (Conservative, Hinckley and Bosworth)

Will the hon. Gentleman give way?

Stephen Kinnock (Labour, Aberafan Maesteg)

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

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

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

Luke Evans (Conservative, Hinckley and Bosworth)

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

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

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

Stephen Kinnock (Labour, Aberafan Maesteg)

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

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

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

Clause 4 - People with autism or learning disability

Danny Chambers (Liberal Democrat, Winchester)

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

“(iv) housing.”

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

Martin Vickers (Conservative, Brigg and Immingham)

With this it will be convenient to discuss the following:

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

“(iv) accommodation and relocation, and”.

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

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

“(v) the patient,

(vi) the patient’s nominated person, and

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

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

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

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

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

“(iii) housing, and”.

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

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

“(v) the patient,

(vi) the patient’s nominated person, and

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

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

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

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

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

“have a duty to carry out”.

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

Danny Chambers (Liberal Democrat, Winchester)

It is an honour to serve under your chairmanship, Mr Vickers. I will speak to amendments 1, 51 and 4 together, as they all relate to housing. Amendment 1 ensures that housing needs are considered as part of care, education and treatment reviews. Amendment 51 ensures that the impact of accommodation and relocation is considered in care and treatment reviews for patients with autism or learning disabilities. Amendment 4 ensures that housing needs are considered as part of care and treatment reviews.

Appropriate housing is critical for people’s wellbeing and cannot be viewed as separate from effective and safe care. Ensuring that housing or any temporary or crisis accommodation supports the safety and independence of people with a learning disability should be a key part of care, education and treatment reviews. We believe that it is essential for fulfilling the duties of the Bill.

Without that provision, it will be far harder for patients to leave detention and for care to be facilitated in the community. If people with learning disabilities who are detained risk being discharged into insecure or inappropriate housing, their recovery from mental ill health could be jeopardised. Patients should be viewed in their whole context, not just as a collection of conditions or symptoms. Housing is among the most fundamental social needs that should be considered.

Zöe Franklin (Liberal Democrat, Guildford)

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.

Gregory Stafford (Conservative, Farnham and Bordon)

I have a lot of sympathy with what the hon. Lady is trying to achieve with these amendments. My question is about how she would ensure, within the context of the provisions, that the patient’s confidentiality would be maintained where it needed to be.

Zöe Franklin (Liberal Democrat, Guildford)

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.

Gregory Stafford (Conservative, Farnham and Bordon)

Moving on from the confidentiality point, if there is going to be sharing—again, I have a lot of sympathy with the amendments—how would the hon. Lady ensure that disagreements between family members and the patient are safeguarded against?

Zöe Franklin (Liberal Democrat, Guildford)

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.

Aphra Brandreth (Conservative, Chester South and Eddisbury)

Like my hon. Friend the Member for Farnham and Bordon, I have a lot of sympathy with some of the things that the hon. Lady is trying to achieve through the amendments. If there is to be an additional requirement for six-monthly rather than annual checks, how will the balance be struck to ensure that there is a focus on care rather than on the administrative burden that might be required?

Zöe Franklin (Liberal Democrat, Guildford)

Helpfully, I was about to move on to a point about amendments 3 and 6, which would shorten the length between care and treatment plan reviews from 12 to six months.

We need to reflect on the fact that sometimes we do not get it right when we support an individual. In such circumstances, it is particularly important that we are able to have reviews every six months, rather than 12. It does not have to be a detailed, full-scale review. If all involved in the patient’s care come to the conclusion that the care needs are being met, that review could be incredibly short. If someone’s care is inadequate or inappropriate, it is not right that they should have to suffer unnecessarily for a year without the changes that are needed. Halving the time between the care and treatment reviews ensures that patients are not left languishing and instead have care that truly reflects their individual needs. I would reiterate that a six-month review can be incredibly short, and it also benefits patients by making them aware of where their care is not working for them, so that it can be reviewed.

Neil Shastri-Hurst (Conservative, Solihull West and Shirley)

I have a certain degree of sympathy for the amendments, but I am sure the hon. Lady will recognise that patients and their families often find the review process overwhelming in and of itself. Bringing it forward to six months, when such reviews would often not be required, can cause a huge amount of stress and place pressure on those family units and patients. Of course, reviews can be brought forward when clinical need requires it. To stipulate that within the legislation puts an enormous burden upon those families and, most importantly, the patients.

Zöe Franklin (Liberal Democrat, Guildford)

I return to my point that a review can be short when clinicians and those involved in a patient’s treatment deem it appropriate. Again, where the system is working for a patient, it is good and proper that we do a short review, and they can then carry on with their treatment. When it is not working, why should the patient struggle on for 12 months alongside their families, who will also be struggling?

Neil Shastri-Hurst (Conservative, Solihull West and Shirley)

Will the hon. Lady give way?

Zöe Franklin (Liberal Democrat, Guildford)

No, I will move on to amendment 7, which I also want to cover. This amendment is very important, as it would ensure that the integrated care boards and local authorities responsible for a patient’s treatment and care would have a duty to implement the recommendations arising from a care and treatment review. The legislation states “must have regard to”, but we believe that that is too weak and could see crucial parts of care and treatment reviews left unimplemented.

As it stands, this part of the Bill could be considered to be implemented even if no adequate resourcing was required, with the care and treatment review left as an empty exercise. One of the key parts of this legislation is to ensure that resources are there to implement treatment for patients. Will the Minister reassure us that adequate resources will be provided to ensure that patients’ treatment needs are met, that training for clinicians and others supporting an individual is made available through resourcing, and that we do not again find ourselves in a situation like the current one, in which patients too often struggle because there are not the resources to meet their care needs?

Luke Evans (Conservative, Hinckley and Bosworth)

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?

Gregory Stafford (Conservative, Farnham and Bordon)

To take that point slightly further, given that pretty much every local authority has a different set of criteria by which to determine people’s housing needs, how would, for example, an ICB that potentially crosses multiple local authorities with differing housing needs be able to understand the complexities within the current structure, and ensure that the patient is served best?

Luke Evans (Conservative, Hinckley and Bosworth)

Those are exactly the kind of practical questions that we really need to think about when we definitively put into legislation what that would look like. My constituency now has several boundaries across the borders with Warwickshire and Staffordshire, which causes problems when it comes to deciding who will look after what. On the criteria, my hon. Friend raises another point: will there be a regulatory fight or even infighting between the ICB and the local authorities to determine whose criteria cover what, and who trumps who? To top that off—I raised this matter with the Minister earlier—I would be interested to understand how the Liberal Democrats would deal with that problem, given that the Government are pushing through their devolution agenda. We have already heard about the complexity of everything tessellating together. That makes it very interesting, to put it politely, to consider how it would work in practice.

On the related point of the duty imposed on ICBs and local authorities to have regard to review recommendations, I note that amendment 7 would insert the phrase

“have a duty to carry out”.

I have concerns in this area too, which I will raise in later comments, but let me explain a little further. The aim is to address accountability, but the Liberal Democrats’ solution would change the provision from “must have regard to” to “have a duty to carry out”. There is an important distinction here: a duty to “have regard to” requires that recommendations may be properly considered and responded to but does not legally compel implementation; a duty to carry out, however, would impose a legal obligation to act on every recommendation, regardless of feasibility, availability or agreement.

That raises a crucial question: if the Government intend to hold ICBs to account for meeting those needs, how would they ensure that the necessary resources, powers and accountabilities for the mechanisms are in place? What oversight would the Liberal Democrats establish to guarantee not just consideration but effective delivery, and how would conflicts be resolved where recommendations are impractical, or local capacity is lacking?

Perhaps a more balanced approach would be to strengthen the duty to respond with clear timelines and a requirement for transparency about decisions, while investing in cross-sector co-ordination mechanisms and adequately resourcing local authorities and housing providers. We could provide statutory guidance to clarify roles and responsibilities, and enhanced oversight to monitor outcomes, rather than simply prescribing an inflexible duty to implement.

In essence, a duty to respond means that the responsible body, whether an integrated care body or the local authority, must formally consider and reply to the recommendations arising from the care and treatment review. It does not legally compel it to carry out every single recommendation, but it requires the body to explain what it will and will not implement, and why it cannot implement a recommendation. That promotes transparency and accountability without creating unrealistic legal obligations. For example, an ICB might say, “We will implement recommendations 1, 3 and 5 within six months, but recommendation 2 is not feasible due to current resource constraint.” That kind of structured response is both practical and responsible.

Gregory Stafford (Conservative, Farnham and Bordon)

It is a pleasure to serve under your chairmanship, Mr Vickers. As I have indicated, I have a lot of sympathy with the amendments, but some practical constraints need to be teased out.

Amendment 1 seeks to ensure that housing needs are explicitly considered during a care, education and treatment review meeting. I can see the pros of that. Clearly, a holistic approach recognises that stable housing is fundamental to mental health and recovery, especially for vulnerable individuals. Addressing housing barriers may reduce unnecessary hospital admissions. Likewise, it could lead to improved discharge planning, ensuring that patients are not delayed in hospital due to a lack of suitable accommodation. All Governments, of every colour and political party, want to see collaboration between health, social care and housing services, and the amendment brings those things together.

As I said in an intervention, however, local authorities and NHS bodies such as ICBs may face challenges to co-ordinating housing assessments within the CETRs. As my hon. Friend the Member for Hinckley and Bosworth mentioned, his constituency crosses a number of local authority boundaries, while my seat of Farnham and Bordon, with two thirds of it in Surrey and one third in Hampshire, has that same issue. The county councils are wonderful and Conservative run, but Waverley is run by Liberal Democrats.

The hon. Member for Winchester, who moved the amendment, recognised the issue of implementation capacity, but there are also likely to be resource constraints. These days, local authorities spend most of their money on social care, education and the bits of health that sit within their remit, so there may be insufficient housing stock or funding to meet the identified needs that the amendment would bring forward. There are therefore practical implications.

Luke Evans (Conservative, Hinckley and Bosworth)

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.

Gregory Stafford (Conservative, Farnham and Bordon)

I agree. Even if the Government build the number of houses that they propose—I have some scepticism—there will always be the potential conflict or disagreement on prioritisation in the housing register and list. As my hon. Friend says, that might well lead to local authorities having to change their criteria, which are not necessarily consistent across local authorities, and, as in his example, potentially pitting a homeless person against someone with mental health needs.

The amendment would also have the potential for scope creep. I have a lot of sympathy with what it is trying to achieve, but expanding CETRs to include housing might dilute their focus and overburden the process. I am interested to hear from the mover and supporters of the amendment how they would ensure that the CETR continues to have that core focus on the health and wellbeing of the individual, rather than potentially be bogged down in the mire of housing issues.

Moving on, amendment 51 would ensure that the care and treatment of individuals with autism or learning disabilities explicitly considered the impact of accommodation and relocation in the planning and decision-making process. Again, I have a lot of sympathy with that. It would promote holistic care planning, reduce trauma and disruption, support continuity of care and, I think, align with the person-centred principles throughout the Bill, which all of us support. Again, however, amendment 51 might complicate discharge planning, if suitable accommodation were limited.

Neil Shastri-Hurst (Conservative, Solihull West and Shirley)

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.

Gregory Stafford (Conservative, Farnham and Bordon)

I agree entirely. That could be the unintended consequence of amendment 51: in essence, if the housing provision is not there, discharge will be delayed. From my understanding of the amendments in the group, those who tabled them are trying to speed up and improve discharge. My hon. Friend is absolutely right that we need to think about the practical implications of the Bill.

The amendment would require co-ordination among health, social care and housing services, which may be challenging in under-resourced areas. Frankly, because parts of those organisations are not used to working in the ways that the amendment would require, it might fall over without suitable training, the necessary lead-in time and a practical understanding of how it will work.

Amendment 4 would ensure that housing needs are formally considered during the care and treatment review meetings for adults with autism or a learning disability, without an EHCP. I understand that the aim is to support more effective discharge planning and reduce the risk of unnecessary or prolonged hospital stays. That is entirely in keeping with what we should be trying to do in the Bill. Holistic care planning reduces delays in discharge, improves cross-sector collaboration and supports community-based care, which we all support.

Once again, however, there is potential for complexity in the implementation. New processes may be required to involve the housing authorities. Resources and local housing shortages could limit the amendments’ practical impact. Another layer of complex review processes could add to that administrative burden. If there is inconsistent local capacity, the effectiveness of the amendment will almost certainly vary depending on the local housing infrastructure, which could lead to a postcode lottery, for want of a better phrase, in who receives the adequate care and housing.

Amendment 2 would ensure that children and young people with autism or learning disability, as well as their nominated persons and independent mental health advocates, receive a copy of the care, education and treatment review meeting report. I have a lot of sympathy with that. It potentially increases empowerment and transparency, ensuring that patients and their advocates are fully informed, which could enable better participation in care decisions. It has a legal and ethical alignment with the principles of the Mental Capacity Act 2005 and the UN convention on the rights of persons with disabilities, both of which emphasise supported decision making. It might also improve advocacy, as independent mental health advocates can more effectively represent a patient’s interest when they have access to the full report.

Aphra Brandreth (Conservative, Chester South and Eddisbury)

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?

Gregory Stafford (Conservative, Farnham and Bordon)

My hon. Friend makes a key point that I was about to address. Clearly, where there is a supportive family structure with the best interests of the individual at heart, the amendment will work extraordinarily well. However, we have to be realistic about the practical implications.

Not every patient has a strong family structure around them. Unfortunately, some patients may even have family members who, for financial or other reasons, actively do not have their best interests at heart. There is a potential concern around confidentiality. I ask the hon. Members for Winchester and for Guildford how they would balance that conflict in practical terms, especially when the CETR includes sensitive clinical information that could be used in a way that is not beneficial to the patient by someone who does not have their best interests at heart. As my hon. Friend the Member for Chester South and Eddisbury points out, disputes can happen if patients or families disagree with professional assessments or recommendations.

Finally, although this is probably not the strongest point, we should think about the administrative burden. Given the increased workload that we are putting on all our health and care workers and services, there will clearly be an administrative burden in sharing these reports.

Amendment 5 would ensure that patients, their nominated persons and their independent mental health advocates receive a copy of the care and treatment review meeting report. That is intended to improve transparency, support advocacy and empower individuals and their support networks in care planning. If everything goes well, it would empower patients, ensuring that individuals understand and can engage with their care plans. It would support advocacy, as the independent mental health advocates could better represent the patient’s interests with full access to information. Where they have a supportive family, nominated persons would be better equipped to support care and discharge planning. It would also promote transparency, aligning with rights-based and person-centred care principles.

However, the same concerns apply to amendment 5 as to amendment 2. There is sensitive clinical information that must be handled carefully; there are confidentiality concerns. There is potential for disagreement, an administrative burden and a logistical burden, for want of a better phrase. I would be keen to hear from the hon. Members for Winchester and for Guildford about how those practical concerns can be addressed.

Amendment 3, on the frequency of meetings, aims to make care more responsive, improve oversight and support earlier interventions and discharge planning. I do not think anyone would be against having more timely interventions, which would allow for an early identification of issues and changes in care needs. It would improve oversight, increase the frequency and increases accountability, ensuring that care plans remain appropriate. It would support discharge planning and potentially help to reduce the risk of delayed or prolonged hospitalisation. It would also ensure person-centred care, which is the theme of the Bill.

I return to the practical parts, which were raised by my hon. Friend from Shropshire—

Neil Shastri-Hurst (Conservative, Solihull West and Shirley)

Not quite: Solihull.

Gregory Stafford (Conservative, Farnham and Bordon)

I knew it began with S and was somewhere that is not Surrey or Hampshire—because where else would you want to be, Mr Vickers? The amendment would potentially increase the workload, because more frequent reviews place additional pressure on professionals and services.

Neil Shastri-Hurst (Conservative, Solihull West and Shirley)

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?

Gregory Stafford (Conservative, Farnham and Bordon)

My hon. Friend is entirely correct. We operate in a resource-confined area. It does not matter what the resource envelope is; it will always be confined. If we use resource to service the very laudable aims of the amendment, it will take resource and money away from another area.

Luke Evans (Conservative, Hinckley and Bosworth)

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.

Gregory Stafford (Conservative, Farnham and Bordon)

My hon. Friend attributes to me a level of clairvoyance that I do not possess, but I am sure that the hon. Member for Winchester or the hon. Member for Guildford will pick up that point.

The resource implications are not just about the funding. They are about increased workload and the pressure put on the professions and services. As my hon. Friend the Member for Solihull West and Shirley said, the amendment would divert attention away from delivering care, if it is not balanced properly. My hon. Friend the Member for Hinckley and Bosworth is right to ask, “Why six months?” Why not nine months, eight months or any other period? Is there a clinical basis for six months?

Jennifer Craft (Labour, Thurrock)

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.

Gregory Stafford (Conservative, Farnham and Bordon)

I thank the hon. Member for her helpful intervention. If that is correct, I will draw my comments on that point to a close.

Amendment 6 concerns CETR frequency. It seeks to change the timetabling of these reviews. The same issues, both positive and negative, run through it as in amendment 3.

Amendment 7 would strengthen the legal obligation on integrated care boards and local authorities by requiring them to implement recommendations from the care, education and treatment reviews rather than merely considering them. That would ensure that review outcomes lead to concrete action and improved care. I do not think that anyone in the Committee could possibly disagree with that point. It would lead to greater accountability and would ensure that CETR recommendations are not ignored or delayed. That would clearly improve outcomes, because it would increase the likelihood that patients receive timely and appropriate care.

The amendment would also introduce stronger legal clarity. By removing “must have regard to” and replacing it with

“have a duty to carry out”,

it would remove ambiguity around the responsibilities of the ICBs and local authorities, supporting the rights-based care and the principles of transparency and enforceability in service provision that we all support.

I hope that the hon. Members for Winchester and for Guildford will be able to clarify the problem of resource pressures, which applies to all these amendments. Local authorities and ICBs may struggle to implement all the recommendations due to funding or capacity constraints. What would be the legal sanction for ICBs and local authorities if, through no “fault” of their own—although one might argue that they should have the necessary resources in place—they genuinely do not have the resources to implement all the recommendations? I would hope that such a sanction did not put them into further financial difficulty.

The reduction in flexibility concerns me. It may limit professional discretion in cases in which recommendations are impractical or outdated. It may require new systems for monitoring and enforcement, and if recommendations are not implemented it could increase the likelihood of legal challenges.

Anna Dixon (Labour, Shipley)

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.

Martin Vickers (Conservative, Brigg and Immingham)

There is one minute left, Greg.

Gregory Stafford (Conservative, Farnham and Bordon)

I will do my best, Mr Vickers. The hon. Lady raises some good points. She made a slightly party political point, but I will forgive her because I made one earlier. Maybe that is our party politicking done for the day.

As the vice-chair of the all-party parliamentary group for SEND, I recognise the issues that the hon. Lady has raised. I would be surprised if there were any hon. Member on this Committee who did not recognise her point. Across the piece, there is a significant problem with the process and the funding of EHCPs. I look to the Minister; I know it is not his responsibility, but I understand that the Government are introducing something around EHCPs.

I will draw my comments to a close, but I ask the hon. Members for Winchester and for Guildford to address those concerns.

Martin Vickers (Conservative, Brigg and Immingham)

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

Gill Furniss (Labour, Sheffield Brightside and Hillsborough)

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

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

“(iv) accommodation and relocation, and”.

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

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

“(v) the patient,

(vi) the patient’s nominated person, and

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

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

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

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

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

“(iii) housing, and”.

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

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

“(v) the patient,

(vi) the patient’s nominated person, and

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

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

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

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

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

“have a duty to carry out”.

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

Stephen Kinnock (Labour, Aberafan Maesteg)

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

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

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

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

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

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

Luke Evans (Conservative, Hinckley and Bosworth)

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

Stephen Kinnock (Labour, Aberafan Maesteg)

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

Luke Evans (Conservative, Hinckley and Bosworth)

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

Stephen Kinnock (Labour, Aberafan Maesteg)

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

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

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

Luke Evans (Conservative, Hinckley and Bosworth)

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

Stephen Kinnock (Labour, Aberafan Maesteg)

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

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

Danny Chambers (Liberal Democrat, Winchester)

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

Gregory Stafford (Conservative, Farnham and Bordon)

Thrilled.

Danny Chambers (Liberal Democrat, Winchester)

Unfortunately, I was busy meeting Brian May and talking about farming, so I have not had a chance to work up a really good response.

The point of the Liberal Democrat amendments is to recognise that mental ill health requires holistic care and that many non-clinical factors directly influence mental health. Although the Bill’s scope is understandably narrow, very much focusing on people once they are admitted to hospital for treatment, we need to recognise that, if someone is discharged back into the situation from which they were admitted, they are very likely to have a relapse and to need treatment again. Some of those factors are non-clinical. For example, people living in poverty—those in the lowest 20% of income—are more than twice as likely to suffer mental health issues than those on an average income.

We strongly support the Bill, but we need to recognise that, on its own, it will not improve mental health or do anything to prevent people from developing mental health issues. If our amendments are not within scope or are not appropriate for the Bill, we urge the Minister to work with other Departments, such as the Ministry of Housing, Communities and Local Government, to ensure that this good piece of legislation, which we support, can be successful.

The hon. Member for Farnham and Bordon made a point this morning about local authorities. He is right that local authority reorganisation is a challenge, especially when it comes to providing accommodation for young people and for people being discharged from mental health care centres. It is also an opportunity, because the current situation is not fit for purpose. Hampshire county council is struggling to provide the care these people need. Housing, which often affects young people’s mental health, is probably the single biggest issue that comes up in my inbox and when I knock on doors.

I thank the hon. Member for Hinckley and Bosworth. As a clinician, his point about the evidence base, especially when it comes to reviews, is really important. We are discussing a Mental Health Bill that may not be changed significantly for another 40 years, so it is important that we use the best evidence. As a long-time trustee of an evidence-based medicine charity, I am passionate about this.

I thank the hon. Member for Thurrock for pointing out that clinical guidelines suggest six-month reviews. Yearly reviews are used for many medical conditions, and I would argue that a year is also an arbitrary period, rather than one based in evidence. Why six months and not a year, or why a year and not six months?

Luke Evans (Conservative, Hinckley and Bosworth)

The hon. Member is correct to establish the evidence base and the guidance. Broadly, we need to balance that with the logistics and the impact on the clinician, the patient and the resources. Move too far one way and it becomes a tick-box exercise or more resource-heavy; move too far the other way and the safeguards that we are trying to implement are lost or watered down.

When I look at the amendments, that is the balance I am trying to understand; if the guidelines are written with that in mind, that makes sense. The job of this House is to scrutinise the numbers and decide whether we agree that they are right, or whether we should push a bit harder—whether we should tighten the safeguards or relax them a little to allow clinicians more freedom of choice.

I guess that is the purpose of the Bill—getting the right boundary between the safety of the individual patient, support for the wider public, and making sure that clinicians have the freedom to make their judgment so that we are not stepping on expert opinion or, worse, creating bureaucratic processes. I hope the hon. Member understands that is why we are probing further on the rationale.

Danny Chambers (Liberal Democrat, Winchester)

I completely agree with everything the hon. Member just said. Atul Gawande did a fantastic piece of work on checklists that emphasised the need for them not to become tick boxes. They are meant to involve active thinking and decision making.

I thank the Minister for reassuring us about housing. I beg to ask leave to withdraw the amendment.

Danny Chambers (Liberal Democrat, Winchester)

I beg to move amendment 8, in clause 4, page 8, line 27, at end insert—

“(ba) the person is under 18 years old and satisfies the conditions in (b)(ii).”

This amendment inserts a new subsection that extends the duty on integrated care boards to establish and maintain a register for those at risk of detention to all children and young people under the age of 18.

Gill Furniss (Labour, Sheffield Brightside and Hillsborough)

With this it will be convenient to discuss the following:

Amendment 47, in clause 4, page 9, line 20, at end insert—

“(6) The risk factors specified in regulations under subsection (5) must include—

(a) homelessness;

(b) addiction;

(c) domestic abuse;

(d) miscarriage and traumatic birth;

(e) experience of armed conflict; and

(f) bereavement.”

This amendment would specify risk factors for detention for people on the register of people at risk of detention under Clause 4.

Amendment 9, in clause 4, page 9, line 29, at end insert—

“(c) seek to ensure that the needs of children and young people can be met without detaining them under Part 2 of this Act.”

This amendment extends the duty on integrated care boards and local authorities to exercise their marketing functions in a way that seeks to ensure that children and young people’s needs can be met without detaining them.

Danny Chambers (Liberal Democrat, Winchester)

Amendments 8 and 9 would insert a new subsection to extend to all children and young people under the age of 18 the duty on integrated care boards to establish and maintain a register of those at risk of detention. Amendment 9 would extend the duty on integrated care boards and local authorities to exercise their marketing functions in a way that seeks to ensure that children and young people’s needs can be met without detaining them.

Far too many children are unable to access the mental health care they need, leaving them more vulnerable to experiencing a mental health crisis that then requires detention, which all too often ends in tragedy. Child and adolescent mental health services are in a state of near collapse, with many children unable to access the care and treatment they need until their mental ill health has reached the point of crisis. Waiting 15 months in great mental distress is far too long, especially for children. It is a huge disruption not only to their personal development but to their education. Waiting up to two years for treatment is a huge proportion of a 12-year- old’s life.

We are pleased that the Bill, as it currently stands, includes specific provisions to prevent people with learning disabilities from requiring detention under the Act. The Government should take that approach for more people, especially our young people. Early intervention, delivered through regular check-ups and cutting waiting times for treatment by community services, is critical. We should not pretend that acute mental health services and in-patient care exist in a vacuum. The pressures they face are directly impacted by the quality of community services. We need stronger steps to ensure that fewer people require detention in the first place, especially children.

We are pleased that the Government are taking steps towards having mental health support in every school, for which we have long campaigned. We would like them to go further by ensuring a dedicated professional in every school. We are alarmed that the targets for mental health are being dropped, so I press the Government for assurances that the upcoming 10-year plan will ensure that children who are referred can expect swift and efficient support and treatment, with binding duties on health bodies to deliver that.

Alongside this Bill, what requirements and resources will ICBs have for preventing mental health crises? As part of that, will the Department make specific changes to CAMHS?

Luke Evans (Conservative, Hinckley and Bosworth)

The hon. Gentleman makes a pertinent point about the pressure on CAMHS. In Leicestershire, about 45% of CAMHS referrals are for things like autism and ADHD, and the problem is that it takes a lot of services away from those who have eating disorders or depression, or who self-harm. Does he believe there is scope to reorganise services to make sure they are appropriate where there needs to be treatment? A child suffering with severe anxiety and self-harming tendencies should not be on a pathway with someone who has autism, for example. Has he given any thought to how this Bill might be a way of opening that door?

Danny Chambers (Liberal Democrat, Winchester)

On the surface, what the shadow Minister says seems logical and makes sense. I am not a mental health clinician, so I want to be really careful about pushing in one direction. Whether someone has an eating disorder or is waiting for a diagnosis of something like ADHD, the waiting times are too long. We must better structure a system that ensures that everyone gets healthcare when they need it, rather than prioritising what we perceive as most important.

One of the most heartbreaking things that I hear from parents in Winchester, who are worried sick, is that young teenagers with an eating disorder have been told that they have to hit a lower BMI to reach the threshold to qualify for treatment. That is essentially saying that someone has to be sicker for longer. No one would ever say, “We’ll wait until your cancer reaches stage 4 before we start treatment,” but that is happening with eating disorders. The treatment will end up being longer, more complicated, more costly for the taxpayer and maybe less successful.

A question often comes up—the hon. Member for Farnham and Bordon alluded to this—about the pressures on local authorities to deliver mental health care. Actually, the question is “How we can afford not to deliver it?” People with mental health disorders are ending up in A&E or prison and costing police time. It costs £52,000 a year to keep someone in prison, yet apparently we cannot afford to give them the community interventions that might stop them going there in the first place.

David Burton-Sampson (Labour, Southend West and Leigh)

The Labour Government are working on a range of early interventions for young people in the area of mental health and to stop them spiralling into crime, such as the Young Futures hubs and introducing mental health support in every single school. The hon. Gentleman makes a valid point, but it sits outside the Bill, and there is plenty that the Government are doing. Regrettably, there will always be a need, at certain times, for a young person to be under a section 2 notice and to be brought into care for a period of time, for their own safety. That is unavoidable and will be the right thing for that individual, but there is so much work being done outside this Bill to help young people and others with their mental health.

Danny Chambers (Liberal Democrat, Winchester)

We support all efforts to keep young people happy and healthy in their communities. I visited Winchester Youth Counselling recently, where pupils can self-refer to talk through their issues. That does not involve any clinical personnel. It is hugely impactful and cost-effective and is part of the community. We support those community hubs.

Amendment 47 would specify risk factors for detention for people on the register of people at risk of detention under clause 4, including homelessness, addiction, domestic abuse, miscarriage and traumatic birth, experience of armed conflict, and bereavement. For anyone, including people with learning disabilities, life events can have a profound impact on mental ill health and can drive mental disorders. Well over a third of women with mental health problems have been a victim of domestic violence, and 50% of rough sleepers have mental health problems. The disastrous impact that bereavement can have on anxiety and depression, which are key factors in suicide, has been well documented.

It seems obvious, frustratingly, that public services do not currently reflect that key fact. There are no registers of bereaved children to ensure that they get the right support in the community and in school. There are no registers of veterans, despite their far higher risk of mental ill health and suicide. Women who have suffered a miscarriage do not receive an automatic referral, including to mental health services. The Government need to ensure that people can get mental health assessment and support at key points in their life, including the most traumatic moments.

Luke Evans (Conservative, Hinckley and Bosworth)

We have certain registers of carers, for example in primary care. There is a stipulation about moving towards veterans being included. Who does the hon. Gentleman think might hold the register, in the light of his amendment?

Danny Chambers (Liberal Democrat, Winchester)

I do not know the best place for it to be held. That is an important point. For a lot of the issues that Members are bringing up, we are not expecting there to be answers today. However, we want to ensure that they are all being considered, given that the subject might not return to Parliament for another 40 years.

Jennifer Craft (Labour, Thurrock)

I have a question about the list of risk factors that has been provided. Is there not a concern that it might be too prescriptive or restrictive, and that putting it in primary legislation prevents local authorities or ICBs from widening it, from having registers and risk factors that might be appropriate to their areas, and from focusing on what the appropriate level of care is that they are best placed to meet?

Danny Chambers (Liberal Democrat, Winchester)

That is a very insightful point. The list could be longer and is not meant to be exclusive. I am not sure of the answer to the hon. Lady’s question but, taking a step back, we know that the single most common cause of death in women 12 months after giving birth is suicide, and there is no proactive automatic care. If a person is addicted to alcohol, they are admitted to hospital for treatment for their physical symptoms. When they are physically well enough to go home and they are discharged, there is no automatic enrolment or follow-up in mental health care. I would not want to bring in a system, as the hon. Lady says, that ends up being too prescriptive. However, at the moment, we have one that is not prescriptive enough. I could list a handful of demographics of people who desperately need that proactive care.

Sojan Joseph (Labour, Ashford)

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

Danny Chambers (Liberal Democrat, Winchester)

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

Sojan Joseph (Labour, Ashford)

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

Danny Chambers (Liberal Democrat, Winchester)

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

Gregory Stafford (Conservative, Farnham and Bordon)

I have been listening carefully to the hon. Member’s argument. I do not disagree with anything in it; I just fail to see how the amendment fits with the clause that we are discussing, which I think may be the point that the hon. Member for Ashford is making.

As far as I can tell, clause 4 is about producing a register of people who have a learning disability or autism, who are at risk of being detained for a mental health episode and for whom those risk factors are active, for example because they have been sectioned before or have presented at A&E. Those are specific incidences. What the hon. Member for Winchester is talking about is more wide-ranging; it is not about touchpoints in the same sense. I can see how he could potentially say, “Well, domestic abuse has led to a mental health episode and therefore to a presentation at A&E or in the system.” However, if we put in societal factors, for want of a better phrase, we could end up putting most people on the list, because most people will have experienced a bereavement. I get what the hon. Member is trying to do, but I fail to see how the amendment matches the overall purpose of clause 4.

Danny Chambers (Liberal Democrat, Winchester)

I thank the hon. Member for his intervention. In my maiden speech, I focused primarily on mental health and on the fact that there are so many demographics of people who we know are at significantly higher risk of suicide and mental ill health than the general population. Whether the issue is more appropriately addressed in the Bill or outside it, but using the Bill as a mechanism to highlight it and to cause the proactive engagement of other relevant Departments and other pieces of legislation, I am determined that we are not going to discuss the biggest piece of mental health legislation in 40 years and not even have a discussion about how we proactively engage with groups of people who we know are at very high risk of mental health issues.

Gregory Stafford (Conservative, Farnham and Bordon)

Will the hon. Member give way?

Danny Chambers (Liberal Democrat, Winchester)

I will carry on, if that is okay.

Our social and health services need to see the whole person, including their social needs and the factors in their environment that threaten their wellbeing. Trying to treat a mental disorder but failing to account for that person’s lack of housing, which drove their anxiety and depression in the first place, is doomed to fail. A lack of support for a child who has lost their parents at a young age could lead to significant harmful consequences further down the line.

There are a huge range of areas that require change, but for now we would like to press the Minister on three specific issues. We understand that some of them may turn out not to be within the scope of this Bill, but it is still important that they be addressed in some capacity.

Will the Government finally implement a register of all bereaved children to ensure that they get the support they need? Will the Government ensure that all women who go through miscarriage, stillbirth or traumatic birth access mental health support quickly and effectively? Will the Government establish a veterans register to ensure that those who have served in the armed forces and who face particular challenges as a result get the tailored mental health support that they need and do not reach the point of requiring detention?

Gill Furniss (Labour, Sheffield Brightside and Hillsborough)

I need to remind the hon. Member that issues that are not within the scope of the Bill are not within the scope of the debate—but we have let you get away with it this time.

Luke Evans (Conservative, Hinckley and Bosworth)

I rise to speak to Liberal Democrat amendments 8, 47 and 9 to clause 4, which seek to expand the scope of the at-risk register, define risk factors and protect children and young people from unnecessary detention under the Mental Health Act.

Let me start by acknowledging the intent behind the proposals. There is genuine merit in ensuring that those who are at risk of detention, particularly children, are visible to the system before crisis point. That view is shared on both sides of the House. I also share the concern that we are too often intervening too late, after a child or young person has already reached breaking point; I would add families to that, because they also bear a lot of the brunt, especially when it comes to waiting. By extension, when there are waiting lists, as the hon. Member for Winchester mentioned, the clinicians themselves—often the GP—will struggle to deal with patients and families when they do not have the clinical expertise necessary for the most severe interventions.

Amendment 9, which would include all under-18s at risk of detention on the register, reflects that preventive ambition. Likewise, the proposed list of risk factors, including bereavement, homelessness and domestic abuse, rightly recognises the social determinants of mental ill health, which are all too often overlooked. However, I have some reservations about the proposals in their current form.

First, on the register for all under-18s, expanding the duty so broadly raises serious questions about safeguarding, data protection and deliverability. Children and young people are already subject to multiple overlapping systems, from social care to CAMHS and education, health and care plans. Before laying on a new national register, we should ask what safeguards will be in place, who will manage the data, and how it will integrate with existing responsibilities such as those under the Children Act 1989 and the special educational needs frameworks.

Secondly, although I agree that we must understand the drivers of detention, the list of mandatory risk factors, including miscarriage, bereavement and even armed conflict—all of which are profoundly serious—could widen the scope of the register so far that it loses operational focus, as we have heard. That is why the Opposition have tabled a later amendment to define it as childhood trauma instead, which is a more encompassing way of dealing with it. Also, we risk casting the net too wide without necessarily improving outcomes for targeting the right support or, conversely, missing something. For example, looking at that list, I would argue that gang violence or gang involvement is a key factor that Members on both sides of the House would agree is very pertinent, and yet it is not mentioned. Therein lies a problem.

Thirdly, amendment 9 seeks to prevent the detention of children and young people unless it is absolutely necessary, which is a principle that I wholeheartedly support, but how do the Lib Dems propose that it be enforced? What levers are in place if a service fails to deliver that community-based service? Without resourcing CAMHS, investing in crisis alternatives and reforming commissioning models, the duty risks being symbolic rather than systemic. In essence, the hon. Member for Winchester is trying to make the point that we should have these discussions.

Although I support the goals of the amendments—visibility, prevention and early support—I am not sure that the specific mechanisms in them are the best way to safeguard achieving them. Instead, I wonder whether consideration has been given to piloting regional early intervention panels for under-18s at risk of admission, building on existing safeguards in educational frameworks, rather than creating separate registers. Alternatively, we could include risk indicators in statutory guidance, rather than setting them rigidly in legislation, which I think was the point made by the Government. That would allow some clinical judgment and flexibility. Above all, we must ensure that ICBs are not just given duties, but held to account. How are they are going to deliver them? That means having the right metrics and oversight and a strong role for advocacy and families.

Anna Dixon (Labour, Shipley)

The shadow Minister is making some useful observations about best practice. One of the real injustices that we are seeing with detention at the moment is the racial disparities in detention rates. One could argue that such a disparity is a potential risk factor, but behind it is something that we should be addressing through dealing with inequalities in the mental health system, particularly the unwarranted variation in practice from clinicians perhaps making discriminatory judgments in these cases. Does the shadow Minister agree that that is another reason why we should not be over-specifying some of these points where we see associations between risk factors and detention rates under the Mental Health Act, and that therefore we should not be including them in the Bill?

Luke Evans (Conservative, Hinckley and Bosworth)

I entirely agree with the hon. Lady’s end point and with the thrust of what she says. Causality is not causation, and we need to be very careful. When we get to the later clauses of the Bill, that will be at the forefront of our discussion.

We cannot deny the reason we are having this legislative debate in the first place: the observation that black men in particular are subject to community treatment orders far more than any other group in the country. However, we must not make a lazy causal analysis and say, “Well, just because that is the case.” For example, black men have a higher risk of prostate cancer, and white people a higher chance of coeliac disease, because of the genetic basis. Is there something in that? Is there systemic bias by clinicians, as she hinted? That all needs to be explored.

The hon. Member for Shipley beat me to the punch when it comes to my closing statement. We owe it to our children and young people not to legislate in haste, so I welcome the spirit of the amendments, and I welcome the debate, but we must be careful to ensure that we are truly legislating for and defining exactly what we know. Otherwise, we risk creating other inequalities and unintended consequences or, worse still, a system that becomes even more flabby and difficult to manoeuvre through. That is the last thing we want for our patients, clinicians and the public.

Gregory Stafford (Conservative, Farnham and Bordon)

It is a pleasure to serve under your chairmanship, Ms Furniss. I have some criticisms of the specifics of the amendments tabled by the hon. Member for Winchester, but I entirely support him and congratulate him on the passion with which he spoke about them. As I remember, his maiden speech touched on a number of these issues. Whether they are within the scope of the Bill is for the Clerks and the Committee to decide, but he made several extraordinarily good points that I hope the Government will take away. If the Bill is not the appropriate place for them, there should be another avenue.

The lead amendment is about the ICB register. It would insert a new subsection to extend the duty on integrated care boards to establish and maintain a register for those at risk of detention to cover all children and young people who meet certain risk criteria. As drafted, the duty to maintain a register under clause 4 may not explicitly include all under-18s. Therefore, the amendment would ensure that children and young people are proactively identified and supported before reaching a crisis point that might lead to detention.

Clearly, there are positives. As the hon. Member stated, early intervention might help to prevent unnecessary detention by identifying risk earlier, which is especially important for children. Likewise, there is a strong argument about equity and care to ensure that young people receive the same proactive planning as adults. That would clearly lead to improved safeguarding through better tracking of vulnerable minors in the mental health system. A corollary to that would be better data collection on youth mental health needs, which I think we would all support. We would be able to use that information to support more informed policymaking and resource decisions.

As my hon. Friend the Member for Hinckley and Bosworth highlighted, however, and as I highlighted in the debates on other clauses, there would clearly be a resource demand, especially on ICBs, from expanding registers and services. Likewise, there is the complexity of implementation, because defining who qualifies as being “at risk” may be subjective. I therefore ask the hon. Member for Winchester, when he sums up on the amendments, to give us some indication of how “at risk” would be defined, or whether that would simply be down to the mental health professional or some other medical professional. There are also, of course, privacy and consent concerns related to maintaining a register for minors. Again, the hon. Member may have thought about some practical things that could assuage my concerns about that.

There may also be a risk of stigmatisation. We have to be very careful, especially with children and young people, because being labelled or treated differently due to being on the register would not help their mental health. We would have to have some really strict privacy and data-sharing controls to ensure that they were protected within the proposed system.

As I said in my intervention, I entirely support the aims of amendment 47 because it would specify the risk factors for detention for those on the register of people at risk of detention under clause 4. The criteria for identifying such individuals are left to be defined in regulations as the Bill stands. The amendment would mandate in law specific evidence-based risk factors—which I agree are risk factors for the issues that the hon. Member is talking about, particularly those linked to trauma and social disadvantage—rather than leaving them to discretion.

At a general level, the amendment recognises the role of trauma and social determinants in mental health crises—I congratulate the hon. Member on clearly explaining some of the factors. Going back to our debate on the previous group of amendments, that would improve the early identification of individuals at risk, promote preventive care, strengthen equity and provide clarity and consistency. However, like my hon. Friend the Member for Hinckley and Bosworth, I am concerned about prescribing a relatively small list and therefore limiting the clause’s flexibility—there may be risk factors that are not listed in the amendment or ones that we have not even thought of.

Jennifer Craft (Labour, Thurrock)

Does the hon. Gentleman agree that the Bill makes allowances for the Secretary of State to introduce appropriate risk factors via regulation, and that it is more appropriate to list the risk factors that ICBs should take into account in secondary legislation issued by the Secretary of State than in primary legislation, as amendment 47 seeks to do?

Gregory Stafford (Conservative, Farnham and Bordon)

I agree with the hon. Lady; that is my understanding, but perhaps the Minister can confirm that when he sums up. The flexibility in the clause is one of its strengths.

Luke Evans (Conservative, Hinckley and Bosworth)

Does my hon. Friend share my opinion that it makes sense to agree with the Government? The impact of social media and the evidence coming out about using mobile phones and about the impact of certain sites have been debated in this House for the last five years—since I have been here—and there have been advances. Legislation has been brought forward, but there is a growing consensus on both sides of the House that it never quite keeps up. Allowing the Secretary of State to add risk factors as they come up, even in policy guidance, might be a shrewder way to future-proof the Bill against those difficulties. In 1983, we were not discussing or even thinking about the likes of Facebook, yet here we are. With the advent of artificial intelligence, who knows where we will be in another 40 years?

Gregory Stafford (Conservative, Farnham and Bordon)

I entirely agree with my hon. Friend. To touch on his point about social media, it is a very useful tool, but is deeply pervasive and can cause the bullying, harassment and mental health issues that he describes. As far as I can tell, the risk factors in amendment 47 would not cover something like that unless it was part of something else—for example, part of domestic abuse, armed conflict and so on.

Anna Dixon (Labour, Shipley)

This discussion of the list of risk factors throws up a concern for me: one of the risk factors that has been facing families and other constituents of mine in Shipley for some years is the inability to get appropriate support for their children from children’s social care, for example, because there are very long waiting times for child and adolescent mental health services. Even when people have EHCPs, they are often not fulfilled. Does the hon. Gentleman recognise that we need to address special educational needs and disabilities and children’s social care and put those things in place, as the Government are doing? Children with autism and learning disabilities will remain at high risk of much more complex mental health needs if they do not get the support they need at an early stage.

Gregory Stafford (Conservative, Farnham and Bordon)

Once again, the hon. Lady tempts me to make a party political point, but I shall resist. On her general point, there are factors, such as the ones she described, that would not necessarily fall within the list in amendment 47. [Interruption.]

Gill Furniss (Labour, Sheffield Brightside and Hillsborough)

We will resume where we left off.

Gregory Stafford (Conservative, Farnham and Bordon)

Thank you, Ms Furniss. I was coming to my closing remarks on amendment 47. Suffice it to say that some of the concerns that I raised on amendment 8 about the administrative burdens, the data sharing, and the potential safeguarding and privacy concerns transfer through. Again, perhaps the hon. Member for Winchester could give some reassurance on that when summing up.

Amendment 9, as far as I can tell, would extend the duty on integrated care boards and local authorities to exercise their marketing functions in a way that seeks to ensure that children and young people’s needs can be met without detaining them.

Neil Shastri-Hurst (Conservative, Solihull West and Shirley)

Does my hon. Friend agree that, although the intention behind the amendment may be worthy, there is a lack of clarity in the drafting? In particular, it is unclear what “seek to ensure” means and how that would be legally defined.

Gregory Stafford (Conservative, Farnham and Bordon)

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

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

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

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

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

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

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

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

Stephen Kinnock (Labour, Aberafan Maesteg)

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

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

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

Luke Evans (Conservative, Hinckley and Bosworth)

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

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

Stephen Kinnock (Labour, Aberafan Maesteg)

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

Luke Evans (Conservative, Hinckley and Bosworth)

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

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

Stephen Kinnock (Labour, Aberafan Maesteg)

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

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

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

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

Danny Chambers (Liberal Democrat, Winchester)

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

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

Gregory Stafford (Conservative, Farnham and Bordon)

I accept that we should aim for the pinnacle and the best. What I was trying to say was that because the amendments restrict us, rather than giving us the space to, hopefully, reach the pinnacle, or to explore other options if we cannot, they could have unintended consequences if we cannot reach that pinnacle.

Anna Dixon (Labour, Shipley)

rose—

Danny Chambers (Liberal Democrat, Winchester)

I give way to the hon. Lady.

Anna Dixon (Labour, Shipley)

The hon. Gentleman may want to take these points together. We drew attention to proposed new section 125. Subsection (1) relates to integrated care boards, while subsection (2) relates to local authorities. They do exactly what he wants: strengthen the requirements on ICBs and local authorities to better meet the needs of people with autism or learning disabilities in order to avoid detention. The very essence of the Bill therefore provides the duties that the Minister reassured us on in response to my earlier point. The expectation is that commissioners will meet needs as identified in these dynamic registers.

Danny Chambers (Liberal Democrat, Winchester)

I thank both hon. Members for their input and their valid points. We appreciate the Minister addressing these concerns. We will not press amendment 9 or 47, but we would like to vote on amendment 8.

Zöe Franklin (Liberal Democrat, Guildford)

I beg to move amendment 20, in clause 4, page 9, line 38, at end insert—

“

(1) In exercising its functions under section 125E, an integrated care board must seek to ensure that there is appropriate crisis accommodation for people with autism or a learning disability within its area.

(2) For the purposes of this section, ‘appropriate crisis accommodation’ means accommodation which—

(a) is designed to meet the specific needs of people with autism or learning disability during periods of acute mental health crisis;

(b) is staffed by persons with specialist training in supporting people with autism or a learning disability;

(c) maintains appropriate staffing ratios determined by guidance issued by the Secretary of State; and

(d) provides a safe alternative to detention under section 136 of this Act.

(3) The Secretary of State must issue guidance about the exercise of functions under this section, and integrated care boards must have regard to this guidance.”

This amendment would require integrated care boards to establish and maintain appropriate crisis accommodation specifically designed for people with autism or learning disability as one of its duties in relation to registers of people at risk of detention.

Gill Furniss (Labour, Sheffield Brightside and Hillsborough)

With this it will be convenient to discuss the following:

Amendment 10, in clause 4, page 10, line 5, at end insert—

“

(1) Within four months of the day on which the Mental Health Act 2025 is passed, the Secretary of State must lay before Parliament a plan to allocate sufficient resources for commissioning services regarding the treatment and detention of autistic people and people with learning disabilities to ensure operability of provisions in this Act.

(2) The plan must include—

(a) revised assumptions of the number of autistic people and people with learning disabilities who may require detention under this Act;

(b) the actions that the Secretary of State will take to ensure community services are available to meet demand after the 28-day detention period;

(c) plans for data collection to support commissioning sufficient services;

(d) plans to allocate appropriate resource to ensure operability of services, including, but not limited to, financial resource;

(e) plans to ensure that responsible bodies and individuals receive the necessary training to carry out support, diagnostic, and treatment plans.”

This amendment requires the Secretary of State to present a plan within four months to ensure sufficient services, resources, data, and training are in place to support autistic people and those with learning disabilities under the Act.

Amendment 22, in clause 4, page 10, line 5, at end insert—

“

(1) Each financial year, an integrated care board must—

(a) conduct an assessment of the availability and adequacy of services within its area for people with autism or a learning disability who have specified risk factors for detention under Part 2 of this Act;

(b) publish the results of the assessment; and

(c) publish an action plan to address any gaps in provision identified.

(2) The assessment under subsection (1) must include consideration of—

(a) the availability of appropriate crisis accommodation;

(b) the availability of appropriate community support services;

(c) the adequacy of training for responsible bodies and individuals to carry out support, diagnostic and treatment plans; and

(d) the experiences of people with autism or a learning disability who have specified risk factors for detention under Part 2 of this Act and their families or carers.

(3) The integrated care board must consult the following in conducting the assessment—

(a) persons with autism or a learning disability who have specified risk factors for detention under Part 2 of this Act and their families or carers;

(b) the relevant local authority or authorities;

(c) providers of relevant services; and

(d) such other persons as the integrated care board considers appropriate.

(4) The Secretary of State must issue guidance about the conduct of assessments under this section, and integrated care boards must have regard to this guidance.”

This amendment would require integrated care boards to conduct and publish annual assessments of the provision available for people with autism or learning disability at risk of detention and to prepare action plans to address any identified gaps.

Amendment 24, in clause 4, page 10, line 5, at end insert—

“

(1) The Secretary of State must, within 12 months of this section coming into force and annually thereafter, prepare and lay before Parliament a report on—

(a) the availability of appropriate accommodation for people with autism or learning disability detained under this Act;

(b) the number of instances where appropriate accommodation could not be found within statutory timeframes;

(c) the progress towards implementation of sections 3 and 4 of the Mental Health Act 2025 and the impact of any delays to implementation on people with autism or a learning disability; and

(d) progress made towards meeting the needs of people with autism or a learning disability without detaining them under Part 2 of this Act.

(2) In preparing the report, the Secretary of State must consult—

(a) people with autism or a learning disability who have specified risk factors for detention under Part 2 of this Act and their families or carers;

(b) integrated care boards;

(c) local authorities; and

(d) such other persons as the Secretary of State considers appropriate.”

This amendment would require the Secretary of State to report annually to Parliament on the availability of appropriate placements for people with autism or learning disabilities and on progress implementing the relevant provisions of the Act.

Amendment 21, in clause 58, page 68, line 15, at end insert—

“(5A) The Secretary of State must by regulations make provision for sections 3, 4 and 21 to come into force in full no later than two years after the day on which this Act is passed.”

This amendment would establish an accelerated implementation timeline for provisions related to autism and learning disabilities, requiring them to be fully implemented within 2 years.

Zöe Franklin (Liberal Democrat, Guildford)

It is a pleasure to serve under your chairmanship, Ms Furniss. I am grateful to my hon. Friend the Member for St Neots and Mid Cambridgeshire (Ian Sollom), and I am sure many in this room will remember his passionate speech about his constituent Declan Morrison, who has inspired many of these amendments. I am grateful to my hon. Friend for his help with my notes.

Amendment 20 would require integrated care boards to establish and maintain appropriate crisis accommodation specifically designed for people with autism and learning disability, as one its duties in relation to registers of people at risk of detention. Currently, just over 2,000 people with autism or learning disabilities are detained in mental health hospitals for an average of five years. Over half of delayed discharges are due to a lack of suitable housing or accommodation.

The crisis provision created in Cambridgeshire after my hon. Friend’s constituent Declan passed away was operating at 90% capacity before funding was withdrawn. When we hear Declan’s story, we realise the severe implications behind the amendment and why it is being put forward. We must also recognise that there has been a significant increase in section 136 use over the past 10 years. Many of the suites being used are outdated, unable to keep up with demand and unfit for purpose.

The amendment would therefore make appropriate crisis accommodation a statutory duty, and I hope all Members would agree that there is a desperate need for such accommodation, specifically for autistic people and those with learning disabilities. It would also require there to be specialist training for staff. We have already referenced today how important training is when it comes to protecting those who are in crisis and who need support. Finally, it would provide for safe, alternative detention under section 136, preventing situations such as that experienced by the hon. Friend’s constituent, where a vulnerable person is held in inappropriate emergency settings for extended periods.

Amendments 10 and 22 are both designed to ensure that there are sufficient resources for people with autism or learning disabilities. On amendment 10, it is crucial that community services are properly resourced to meet the needs of people with autism and learning disabilities. Too many of us will have seen how inadequate community services make detention and in-patient care much more likely, which is worse for the person detained, far more costly and unsustainable in the long term. Our amendments place duties on the integrated care board at the local level, and the Secretary of State at the national level, to be transparent about gaps in provision and to take steps to eliminate them.

Amendment 22 would require an integrated care board to conduct an assessment of the availability and adequacy of the relevant services within its area for people with autism or learning disabilities who have specified risk factors for detention, and to set out a plan to respond to those findings. There is currently an absence of suitable placements, with over 100 places that were contacted having no single bed available. We cannot continue with such a situation, given the significant implications when things go wrong.

Through those amendments, we are asking for an assessment, because there is currently no systematic assessment of whether services match demand, which is crucial to ensuring that the Bill is workable in the long term. It is also acknowledged that it may take 10 years to fully implement the Bill and to ensure that additional clinical and judicial staff are trained.

Amendment 21 was also tabled by my hon. Friend the Member for St Neots and Mid Cambridgeshire. It would establish an accelerated implementation timeline for provisions related to autism and learning disabilities, requiring those provisions to be fully implemented within two years. Currently, just over 2,000 autistic people and people with learning disabilities are detained in mental health hospitals who are being let down by the system.

The Government have sadly already missed the targets, and we cannot afford to wait another decade—people’s lives are too important. In fact, the UN Human Rights Committee has called on the UK to end the detention of people with disabilities based solely on their disability. Every day that we wait means more people at risk of tragic outcomes. As I said, the amendment would establish a two-year deadline, and it recognises that these are some of the most urgent reforms in the Bill. I ask the Government to consider them as a priority.

Finally, amendment 24, which was also tabled by my hon. Friend the Member for St Neots and Mid Cambridgeshire, would establish an accelerated implementation timeline of services related to autism and learning disabilities, by again requiring them to be implemented within two years. I reiterate what we heard in the Chamber, which I am sure we will all hear in our inboxes and in conversations with our residents: it is crucial that we implement these changes at pace; otherwise, we risk failing individuals with autism and learning disabilities further.

Luke Evans (Conservative, Hinckley and Bosworth)

I will direct my remarks at new clause 11 and the amendments spoken to by the hon. Member for Guildford. New clause 11 seeks a clear, costed and consultative plan to help ensure that integrated care boards and local authorities are properly equipped to deliver the community-based services that individuals with learning disabilities and autism need and, of course, deserve, so that they are not unnecessarily detained under part 2 of the Mental Health Act.

Let me begin by recognising the good intentions across the House when it comes to reducing inappropriate and prolonged detentions in mental health settings. There is broad consensus that detention should be the last resort. However, good intentions must be matched by a concrete, deliverable plan because, as the evidence has shown, too many people are being held in hospitals or other facilities, not because of clinical need, but because the right community support simply is not there.

The new clause does not seek to overhaul the system overnight. It does not call for instant funding or new structures. It asks that, within 18 months of the Bill becoming law, the Government produce a fully costed plan, developed in partnership with the people who use and deliver the services, to ensure that community alternatives are genuinely available to those at risk of detention.

Some—including, I suspect, the Minister—may argue that the last Government had 14 years to sort this out. It is therefore worth touching on the last 14 years and what that Government did. Over that period, mental health steadily moved up the political agenda, leading us to the point we are at today, where mental health must be treated with the same seriousness as physical health. Back then, that was not always the case, and change was hard fought for under the coalition and then the Conservative Government. To that end, under successive Conservative-led Governments after 2010, we saw a range of policies introduced with the aim of embedding mental health in the core of our health system.

The 2011 “No health without mental health” strategy set a new tone, placing mental health within the broader public health framework. That was followed by the five-year forward view for mental health in 2016 and the NHS long-term plan in 2019, both of which committed to transforming community-based services, expanding access and promoting prevention and early intervention. Those strategies were backed by increased funding, notably the introduction of the mental health investment standard, which required local commissioning groups to increase mental health spending in line with or above their overall health budgets. The aim was clear: to protect mental health funding in real terms and ensure local accountability.

Between 2015 and 2024, we saw headline commitments of more than £1.4 billion for children and young people’s mental health, and a pledge of £2.3 billion annually by 2024 to expand those services. That included rolling out mental health support teams in schools, which we have heard about in the Committee. They started under the last Government, and I am pleased the current Government have continued in that vein. It also included integrating mental health into primary care and expanding crisis support.

Although investment and strategy have improved, the system remains under pressure. Between 2019 and 2023 alone, the number of people accessing secondary mental health care rose by nearly a quarter. Workforce shortages persist and continue to undermine delivery. To their credit, the previous Conservative Government brought forward the NHS long-term workforce plan, the first of its kind. With a new Government in office, we look ahead to the long-awaited 10-year NHS plan and revised workforce plan. Again, I am pleased to see the Government continuing in that vein.

Gregory Stafford (Conservative, Farnham and Bordon)

My hon. Friend is making an excellent case for new clause 11, which could potentially solve funding issues I have raised. He mentioned the NHS 10-year plan. Will he suggest that the Minister looks at ensuring that, if new clause 11 is not passed today, the details in it are fed through into the plan? When it is published, which the Minister has indicated will be relatively soon, the information and outcomes my hon. Friend is trying to achieve through the new clause could be in it.

Luke Evans (Conservative, Hinckley and Bosworth)

Far be it from me to tell the Minister what to do, but if I were a wise Minister, I might look at where my predecessors had benefitted from further information and where they may have stumbled. The Bill has been looked at for a number of years by many people from outside and inside the House. Many have been involved throughout its progress, including a former Prime Minister, who tabled amendments in the other place. There is definitely the ability to learn from what the last Government found and to use that information in the kinds of plans that we need.

Anna Dixon (Labour, Shipley)

The hon. Gentleman elaborates on the great history of the previous Conservative Government. From where I am sitting, the record is less rose-tinted—but perhaps I am wearing different spectacles. Might he return to the substance of new clause 11, which, it seems to me, is about community provision? I return to the points that I raised earlier about proposed new section 125E. I do not see what new clause 11 adds to the Bill in regard to duties relating to the commissioning of services. I encourage him to address the specifics of the amendment.

Luke Evans (Conservative, Hinckley and Bosworth)

I shall be interested to know what the hon. Lady’s rose-tinted spectacles show when we consider Scotland or Wales. One of my biggest frustrations in debates about the NHS is that in each nation health is devolved, each is run by a different political party, and each has challenges. We in this place enjoy the political football, scoring points without seeing what is blindingly obvious: that across the board, across all the countries, health and mental health services are struggling to keep pace and keep our population healthy with the workforce and technology provided.

Jennifer Craft (Labour, Thurrock)

Will the hon. Gentleman give way?

Luke Evans (Conservative, Hinckley and Bosworth)

Let me address these points, then I will be happy to give way. When we come to clause stand part, I will address the other amendments, but I specifically said that my comments would be on new clause 11. When scrutinising the Bill, it is important that we talk about how we will deliver, as the hon. Member for Shipley rightly pointed out. It is entirely right to try to put together a plan to ensure that the Government are held accountable. We are not saying how the plan should be formulated; we simply stipulate that a plan should be formulated and introduced. That is a very different argument.

My concern about previous Lib Dem amendments was that they were too specific. We have to get the balance right. New clause 11 simply provides that the Government have 18 months to introduce a fully costed plan, so that we can again have a debate in this House. Especially as a spending review will, I believe, be announced tomorrow, we need to consider how we will match budgets in the future. We accept that it is a 10-year project.

Anna Dixon (Labour, Shipley)

Will the hon. Gentleman give way?

Luke Evans (Conservative, Hinckley and Bosworth)

I am still addressing the hon. Lady’s first point. The Conservatives understand that it will take a long time to put in place, but a credible plan is needed. There was a credible plan in place, as I have said, in the 2011 and 2016 strategies, with the funding to match. I use that as an illustration because it is provides an apt evidence base for the new clause. Otherwise, I might well be challenged by someone saying, “What is your evidence base of a delivery network and a delivery ability from a Government?” I hope that by talking through these points, I am giving the Government the chance to learn from the mistakes we made and from the way we took forward mental health. Regardless of political party, I hope hon. Members that the debate has moved on a long way from when we started in 2010 with the work done partly under the coalition Government. I will now take the intervention.

Jennifer Craft (Labour, Thurrock)

I thank the hon. Gentleman for reflecting on the fact that mistakes were made by the previous Government—acknowledgment of that is often sorely lacking. I respect the fact that he says that the debate has moved on, but does he accept that while the debate may have moved on, policy to enact actual change for people who are detained under the Mental Health Act, particularly those with learning disabilities and autism, has not kept pace? The number of people in locked units, under detention, has remained solid, without much wavering, for the past 14 years. Despite the acknowledgement that this is a scandal, and we should all hang our head in shame that it continues to this day, not much has been done to get them out of those units.

While we look back on the history of the past 14 years, focusing specifically on the people who are detained under the Mental Health Act, let us remember that Lord Darzi pointed out in his report that some of the facilities are more redolent of the Victorian era than of a modern mental health care service. Perhaps those who were in government in those 14 years should reflect on why that is the case.

Luke Evans (Conservative, Hinckley and Bosworth)

There is quite a lot to unpack in the hon. Lady’s intervention. As I pointed out, reflecting on what the previous Government learned is also important—for example, when considering Wales. Objectively, the data shows that Wales is struggling more than England, and the same is true of Scotland. Wales and Scotland have been run by different parties from England for a long time, so my natural inclination is to attack back and say, “Well, actually, the Conservatives did better,” but my fundamental point is that we all need to do better because we have seen the problems rising. As I mentioned, over the last 10 years the number of people turning up in mental health facilities has increased by a quarter.

On the hon. Lady’s point about people with autism and learning disabilities, I sat on the Health and Social Care Committee that looked specifically at that issue. We looked at some of the best models in the world, including that of Trieste, where community care is in place. When we took evidence, we found that most people were supportive of that model, but fearful people did come forward to say that the community was not the best place for their daughter, son, husband or wife. Managing the nuance is really important. It takes time to get this right. In 2018, when the last Government looked to legislate on this issue, there was pre-legislative scrutiny, which does not always happen in this place. It was done because there was fundamental agreement that we must get the legislation right, because it applies to the most vulnerable people.

The hon. Lady is right that Lord Darzi identified three shifts that will be really important, but when he looked at this issue, he missed a fundamental point. His report starts from 2010, but when I was a junior doctor— I qualified in 2007—we had issues that affect the culture now: for example, how we managed MRSA and C. diff. That was not a brilliant time to be a patient. The medical training application service fiasco affected doctors applying for jobs so much that in 2004 the Government had to apologise and change the system, because so many people who wanted to get into specialist training could not go through that service.

We are still paying for IT infrastructure that the last Labour Government tried to introduce. The last report, in 2018, said that that cost the taxpayer almost £14 billion. We wonder why, when we try to make a shift to introduce more tech, as recommended by Darzi, people in the NHS are reticent, but they have been burnt by IT projects before. They have seen what happened under a Conservative Government, a coalition Government, and a Labour Government. All that has an immediate and impregnable effect on the legislation and the practicalities that we are dealing with today.

I am not trying to talk facetiously about the legislation; the point is to give some pragmatic direction and to actually say something tangible. On that basis, I look forward to the Minister hopefully supporting proposed new clause 11, which would give the Government the flexibility to have a plan that they choose, as is their democratic right, but also the safeguards to know that it will be delivered and we will not have more delay. There is a balance between making legislation in haste and making sure that we avoid inaction. Would the hon. Member for Shipley like to intervene?

Anna Dixon (Labour, Shipley)

Yes, briefly. I was trying to get the hon. Gentleman back to the point, which is people with autism and learning disabilities, rather than mental health policy in general. The point of reference I used earlier was the failure to deal with Winterbourne View in 2012. My hon. Friend the Member for Thurrock made the point very well: if we get down to it, we are talking about community provision for people with learning disabilities and autism. Too many people remain institutionalised, too far from their family, friends and community. I was pointing at that failing. I encourage the hon. Member to get back to that point. Would you like to give clarity on what is within scope of the group of amendments that we are currently debating, Ms Furniss?

Luke Evans (Conservative, Hinckley and Bosworth)

You may want to set me straight, Ms Furniss, but as we have agreed, I will directly address those points in the clause 4 stand part discussion. The hon. Member for Shipley rightly talks about community settings, but where does she think primary care staff come from? They come through medical training. When we talk about the Darzi impact, it is important that we fully understand why people choose not to go into mental health or primary care and become a GP. Without establishing that, which is a problem that this Government have to deal with, we will run into real problems when it comes to delivery.

It is bang within the scope of this Bill to state how the Government are going to deliver it, but nowhere do we see specifics. We are simply saying that there should be a timeline for a plan to be brought forward. A legal timeline to bring something forward is very different from setting out how the Government see fit to solve the problems. We may not agree on the details of the plan, but one thing that we can agree on is that there should be a plan in the first place.

That leads me back to where I left off. Now that the new Government are in office, as we look ahead to the 10-year plan and a revised workforce plan, the question is: will mental health have the prominent place it deserves? There are already question marks, given that we have seen the percentage of NHS spending on mental health fall for the first time in years, adding weight to our argument that there should be a fully costed plan to ensure that the intention of investment becomes reality.

The Minister may argue that there is already a plan in place. We have the “Building the right support” national plan, ICB duties and long-standing ambitions to reduce in-patient care, and we welcome those measures. As has been pointed to, that is cumulative and dedicated work to move mental health up the agenda; but as we have seen in healthcare across the UK—under Labour in Wales, the SNP in Scotland and the Conservatives in England—delivering is another matter. We cannot escape the fact that in all four nations, individuals have continued to be locked away for months or years, far from home and without therapeutic benefit.

In part, the problem is not lack of policy, but lack of knowing how to ensure delivery. That is at the heart of the new clause. It offers a way to create accountability, clarity and a timeline for action. Others might say that it is too prescriptive or that it will reduce flexibility for local services, but as I have stated, nothing in the amendment dictates how services must be designed; it simply asks for a plan that is responsive to local needs, is backed by national co-ordination and provides clarity about funding. Flexibility works only when it is built on stable foundations; without them, we risk leaving the local system to struggle and individuals to fall through the cracks.

Concerns about the cost or capacity are valid, but it can be argued that the cost of doing nothing is far greater. Inappropriate in-patient care is expensive, often more traumatic for the patient, and not always effective. Investing in well-planned community services is not only more humane, but cost-effective. The new clause does not ask for the money now; it asks for a clear-eyed plan setting out how the money allocated will be used.

The new clause also requires a formal consultation process, ensuring that the plan is developed with the people it affects the most: individuals with learning disabilities, autistic people, their families, clinicians and advocates. I know that the Government will point to ongoing engagement with stakeholders and that is, of course, welcome. What we are asking for here is guaranteed participation that is enshrined in law.

Aphra Brandreth (Conservative, Chester South and Eddisbury)

My hon. Friend is making an excellent speech. The new clause is incredibly important. We do not want vulnerable people to slip through the cracks and not receive the right support, and it is really important to ensure that there is consultation with the right stakeholders. I recently met with Down Syndrome Cheshire, and last year I met with the Cheshire West and Chester SEND accountability group. They said that one of the things they value most is being listened to so that they can inform the process. Does my hon. Friend agree that that is a really crucial part of new clause 11?

Luke Evans (Conservative, Hinckley and Bosworth)

My hon. Friend speaks to the heart of what we all know from our constituency day jobs, where many of us here in this place speak to outside organisations and families. On Second Reading, the hon. Member for St Neots and Mid Cambridgeshire talked passionately about the impacts and the sorry stories that we have all heard about. The whole point of this Bill is to make mental health care patient-centred, but also family and advocate-centred. That is a driving thrust of what the Secretary of State for Health and Social Care was asking us for, and it is why we have enshrined the individual in the first clause of the Bill.

My hon. Friend is absolutely right: if we are committed to the principle enshrined on the front of the Bill, we need co-production. That must be more than a tick-box exercise. If the Government believe that the necessary plan is already in place, will the Minister say where that is covered, and would he put that plan in the House of Commons Library? Is it fully costed? Has it been fully consulted on? Will it be published within 18 months and incorporated in the NHS long-term plan? If not, how will the ICBs and local authorities be expected to deliver? How will the changes to NHS England affect plans to deliver the legislation? Having the legal duty to produce a costed plan will provide a focal point and fulcrum to build around, to ensure that the most serious mental health conditions receive the attention they need.

I know the Minister cares deeply and wants to do his best. He wants the legislation to be enacted as swiftly as possible. I also recognise the commitments and priorities facing the country, but this new clause is about turning good intentions into action. I simply aim to strengthen the hand of the Minister when it comes to negotiating with the Chancellor about funding, so that he has the evidence base required to bolster his position. I hope hon. Members across the Committee, especially on the Government Benches, see it as a supportive, sensible, balanced and practical solution to have this debate and then campaign with the Chancellor to get the money needed for the services.

Turning to the Lib Dem amendments, I begin by recognising the genuine intent behind amendments 10, 22, 24 and 21. Addressing the needs of people with autism and learning disabilities, particularly ensuring appropriate crisis accommodation and reducing unnecessary detention, is unquestionably important. That said, I have specific concerns about legislating for service provision in the Bill.

I understand why we do not legislate for the number of intensive care units, hospices or detox centres in the health system. There is an argument that that might be a good idea. Those are critical services, yet their commissioning and capacity are generally managed through policy funding decisions and local planning, rather than through statutory duties. Introducing a statutory duty for crisis accommodation risks unintended consequences. It may limit the flexibility of integrated care boards to respond to local needs, and could impose significant new resource burdens without clear funding commitments. That risks setting a precedent for increasingly prescriptive legislation across health and social care, which we should approach cautiously. We do not want to pit one condition against another.

On the proposed requirement on the Secretary of State to produce a commissioning plan within four months, I acknowledge the desire for a timely response. The choice of a four-month deadline, however, seems arbitrary and may not allow sufficient time for robust consultation and realistic planning. We need to be mindful that rushed plans can undermine long-term success.

On the proposed reporting requirements, although transparency is vital, I highlight that new clause 11, which we are proposing, would provide stronger and more detailed mechanisms to hold the Government to account on implementation and resource allocation, while allowing flexibility. We should focus on supporting those provisions rather than layer on multiple overlapping reporting duties, which risk duplication and confusion. In conclusion, the amendments raise important points and I look forward to the Minister’s response.

Sojan Joseph (Labour, Ashford)

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

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

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

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

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

Luke Evans (Conservative, Hinckley and Bosworth)

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

Sojan Joseph (Labour, Ashford)

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

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

Neil Shastri-Hurst (Conservative, Solihull West and Shirley)

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

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

I understand where the amendment is coming from. It reflects a societal concern about the lack of suitable crisis care options, and it honourably aims to ensure that specialist community-based alternatives are available. There are some clear merits to this position. It reduces inappropriate detention and offers a more tailored solution. That must be better for patient outcomes, and therefore anything we can do to help people to navigate through what is a sensitive area should be encouraged. It promotes dignity for individuals who find themselves in extremely vulnerable positions. I understand that there is a cogency to the amendment in that it provides a national consistency, which is to be commended.

However, I have a number of concerns about the amendment as it has been put forward, and I hope that the hon. Member for Winchester can speak to these when summing up. First, there is the potential for variability in how the concept of appropriate accommodation is defined and, more importantly, in how it is delivered across the regions of our nation. There are also challenges around workforce shortages, which may hinder the ability to staff such facilities with appropriately trained individuals. It is important that appropriately trained individuals are there to support those who need them.

There may be implementation delays, which can occur when there is infrastructure—in terms of hard infrastructure and funding constraints—associated with it. This may be the least powerful argument, but as with all these things, there are significant resource implications for integrated care boards, as they develop and subsequently maintain such accommodation.

The purpose of amendment 10 comes from a good place. It would require the Secretary of State to present a comprehensive plan within four months of the passage of the Bill, if it becomes law, to ensure that sufficient services, resources, data infrastructure and training are in place to support autistic people and those with learning disabilities under a new legal framework.

Again, there are some strong arguments for the amendment. It would ensure accountability by requiring a timebound plan from the Secretary of State. It would support the implementation of the Bill by addressing gaps in the service and resource needs. It would improve transparency through the publication of data plans and training strategies, and it would focus minds on promoting sustainable workforce development.

However, I would be grateful if the hon. Member for Winchester could comment on some of the challenges that are posed by the amendment. Any structure such as this may create a further delay if the plan is not delivered on time, or if there is a lack of detail underpinning it. It is inevitably resource-intensive—that is not necessarily a bad thing, but it requires significant financial and administrative investment, which creates its own challenges. There is the risk that we end up with a series of vague commitments, and if the amendment does not specify enforcement mechanisms, it is in effect toothless. As with all things in this place, it is dependent on political will, thus the quality and the ambition may vary depending on the political landscape.

Amendment 22 would require ICBs to carry out an annual assessment of the services available for people with autism or learning disabilities who are at risk of detention. It would also mandate the publication of these assessments and action plans to address any service gaps. This reflects a societal concern that inadequate local services often lead to crisis situations and detentions that could have been avoided had there been better support.

I can see how this amendment, by requiring regular assessment and action plans that follow through, seeks to increase not only accountability, but transparency and responsiveness in mental health service provision. That has a number of benefits: it encourages collaboration between ICBs, local authorities and service providers, which has to be a positive thing, and it also supports preventive care, focuses on early intervention and support, promotes transparency and improves service planning by identifying where there are gaps and trying to plug them. However, it also creates potential variability in the quality and thoroughness of assessment across the country, and is dependent on guidance from the Secretary of State, which may delay the implementation or vary the clarity. The proposed requirement is also a significant resource constraint, which may limit the ability to act upon the identified gaps—again, I make that as the least powerful point, but there is an administrative burden that lies with ICBs.

Amendment 24 would require the Secretary of State to produce an annual report to Parliament on the state of services for people with autism and learning disabilities, particularly in relation to detention and accommodation. Its aim is to ensure ongoing oversight, transparency and accountability, which are good things. Clauses 3 and 4 would introduce significant reforms to how people with autism and learning disabilities are treated within mental health services. Success in implementation depends on the availability of appropriate services and placements. This amendment seeks to ensure that Parliament is kept informed of progress and challenges, especially where there are unmet statutory obligations. It comes from a good place: promoting transparency, supporting accountability, highlighting gaps in services and also encouraging continuous improvement in service provision and the delivery of this policy. However, it does not come without downsides, and I would be grateful if the Liberal Democrat spokesperson addressed those when summing up.

There is a dependency on data quality. If there is inconsistent or incomplete data, that can undermine the report’s usefulness. The impact could be limited if reports are not followed up by concrete action. There is a risk of politicisation of any report, especially if the findings are critical of the Government’s performance. Finally—I say this for completeness—there is an administrative burden. That should not be an anchor on us taking action, but it is something we must be cognisant of. To compile and publish these reports places an administrative burden on the Department of Health and Social Care when there are huge pressures upon the wheels of government already. For those reasons, I cannot support these amendments on this occasion.

Jennifer Craft (Labour, Thurrock)

I will be reasonably brief, as Members have covered a lot of what I was going to talk about.

The intent behind amendments 10 and 24 and new clause 11 is to address the issue raised by a number of organisations, such as Mencap, the National Autistic Society and the NHS Confederation, around the delay in particular clauses being switched on for people with autism or with a learning disability due to insufficient community services. The concern is that there is not, as yet, an articulation of what sufficient community services look like or how we will know when we have reached that point, so that we can turn on parts of the Act. There is a sufficient community backing in place for that to happen. Therefore, I would welcome the Minister’s thoughts on how we will know that we have reached the point where we can address the issues that clause 3 looks to tackle.

As the Conservative Members mentioned, there are concerns about funding and access to fairly scarce resources, and a concern that rolling out this provision could put undue burdens on people who are unable to deliver certain parts of it.

However, it would definitely be welcome to have an understanding of where we are heading, what “good” looks like and how we are going to get there, and what the Minister might see as a road map for community services to reach the point where clause 3 can be switched on, so that autistic people and people with a learning disability do not need to be detained under the Mental Health Act purely because there is insufficient support for them in the community to enable alternative provision. I would welcome any thoughts from the Minister about how those concerns about the operability of the Bill can be addressed. If they will not be addressed via these amendments, how will they be taken forward?

Aphra Brandreth (Conservative, Chester South and Eddisbury)

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

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

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

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

Stephen Kinnock (Labour, Aberafan Maesteg)

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

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

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

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

Although we agree that strong community services for people with a learning disability and autistic people are important, we are concerned that amendment 22 would place unnecessary burdens on integrated care boards, duplicating existing roles and functions. In particular, dynamic support registers will assist ICBs in understanding the needs of and planning support for people with a learning disability and autistic people who may be at risk of being detained. Those registers will be maintained throughout the year; annal reports, in contrast, may quickly become out of date. As set out in guidance published by NHS England in May 2023, integrated care boards are also expected to assign an executive lead role for learning disability and autism to a designated person to support in planning to meet the needs of its local population.

As discussed, the annual written ministerial statement will detail work completed over the preceding year to implement this Bill and further implementation plans. The proposed reporting requirement in amendment 24 would therefore introduce unnecessary duplication.

We recognise that a lack of appropriate housing can be a barrier to discharge for some patients. That is why the Bill puts care, education and treatment reviews on a statutory footing. Reviews may make recommendations about meeting the patient’s housing needs upon discharge, and named persons and bodies would have to have regard to those recommendations.

On the abolition of NHS England, throughout the process Ministers are working with the new transformation team at the top of NHS England, led by Jim Mackey, to lead the transformation and take forward shared priorities, such as the Mental Health Act 1983. We will do that as we work to bring the two organisations together, and we will continue to evaluate impacts of all kinds.

On amendment 21, I share the desire for people with a learning disability and autistic people to feel the benefits of these reforms as quicky as possible. We know that people have been waiting a very long time for change, which is why we were determined to introduce this Bill in the first Session of this Parliament. We always intended to implement these reforms in phases when system capacity and funding allow. We have also committed to engaging with expert stakeholders to ensure we get the plans right, and we want to allow time for that.

Rather than having a fixed deadline for implementation, we believe it is more effective to use the flexibility in clause 58 to monitor progress and commence new powers when we are confident that it is the right time to do so, and to avoid any unintended consequences. As I have set out, we have committed to lay before Parliament an annual written ministerial statement on the implementation of the Bill post Royal Assent, which will include learning disability and autism elements, until such time as the Bill is fully implemented.

I understand the concerns behind amendment 10 and new clause 11, and I acknowledge the importance of having a clear plan for resource allocation and community provision for people with learning disabilities and autistic people. That is why we have already committed to lay before Parliament the annual written ministerial statement on the implementation of the Bill post Royal Assent until it is fully implemented.

Anna Dixon (Labour, Shipley)

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

Stephen Kinnock (Labour, Aberafan Maesteg)

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

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

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

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

Danny Chambers (Liberal Democrat, Winchester)

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

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

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

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

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

Zöe Franklin (Liberal Democrat, Guildford)

I beg to move amendment 25, in clause 4, page 10, line 5, at end insert—

“

(1) The Secretary of State must by regulations make provision about training standards for responsible bodies and individuals working with people with autism or a learning disability in—

(a) mental health hospitals;

(b) places of safety designated under sections 135 or 136 of this Act;

(c) crisis accommodation; and

(d) such other settings as the Secretary of State considers appropriate.

(2) Regulations under subsection (1) must—

(a) specify minimum training requirements;

(b) require training to be co-produced with people with autism or learning disability and their families or carers;

(c) require regular refresher training; and

(d) include training on de-escalation techniques and alternatives to restraint.

(3) The Secretary of State must publish guidance about the standards set out in regulations under subsection (1).

(4) A statutory instrument containing regulations under this section is subject to annulment in pursuance of a resolution of either House of Parliament.”

This amendment would require the Secretary of State to produce guidance on minimum training standards for staff working with people with autism or learning disabilities in mental health settings and require that training be co-produced with people with lived experience and their families.

Amendment 25 was, again, tabled by my esteemed colleague, my hon. Friend the Member for St Neots and Mid Cambridgeshire. It would require the Secretary of State to produce guidance on minimum training standards for staff working with people with autism or learning disabilities in mental health settings, and would require that the training be co-produced with people with lived experience and their families.

I suggest to all colleagues on the Committee, particularly those who heard my hon. Friend’s passionate speech on Second Reading, that we need to reflect and learn from the tragic story of his constituent Declan, in which insufficient training sadly contributed to Declan’s death. Autistic people in hospitals risk being subject to unnecessary restraint, over-medication and solitary confinement. That raises real concerns about whether there is sufficient training available to staff working with them. I acknowledge that enormous numbers of incredible professionals work with individuals who are in crisis, but when such tragedies happen, we need to reflect on whether training is sufficient.

Across mental health hospitals, places of safety and crisis accommodation, training is crucial to ensuring good outcomes for those in crisis. Some 92% of people with learning disabilities or autism in hospitals are detained under the Mental Health Act, yet many staff lack specialist understanding. Research shows that training is most effective when it is developed with people with lived experience.

The amendment would ensure that all staff working with autistic people and people with learning disabilities receive specialist training. It would require co-production with families and people with lived experience, with which Conservative colleagues have already said that they agree. That would include mandatory training in de-escalation techniques and alternatives to restraint; create consistent national standards, rather than the unfortunate postcode lottery; and address fundamental staff knowledge gaps that contribute to inappropriate treatment. I ask the Minister to accept the amendment, which would enable us to ensure that those providing crucial mental health support to those in crisis have the appropriate training to prevent tragedies like the loss of Declan.

Jennifer Craft (Labour, Thurrock)

I rise to share a few brief reflections. I appreciate that the intent behind amendment 25 is to make sure that the relevant training is in place. I assume that the hon. Member for Guildford has in mind something similar to the Oliver McGowan training provided across hospital trusts, which mandates that all healthcare providers spend a certain amount of time training with someone who has lived experience of autism and of learning disabilities, in order to make sure that the very different ways in which people with autism or learning disabilities might present do not overshadow what they are attending hospital to demonstrate. Particularly for mental health, we all know that diagnostic overshadowing can be fairly significant. In a locked setting, someone with a learning disability or autism may be unable to demonstrate behaviours that show they are improving or getting better, which can undermine the care they receive.

I would just question whether primary legislation is the best vehicle by which to provide for this. We have spoken at length about how the NHS workforce plan and the 10-year plan are coming forward. I wonder whether this would be better placed within that wider framework. Training could be taken forward either as part of continual professional development, or for medical professionals at the start of their career.

Natasha Irons (Labour, Croydon East)

On the point about training in the round for NHS staff, or any staff dealing with someone in crisis, might it be about taking a more contextual safeguarding approach that relates to not just the one setting? I agree with the point about looking at the 10-year plan, and making sure that mental health training is provided for all staff, because we know that people can present in very different ways, in many different contexts across the health system.

Jennifer Craft (Labour, Thurrock)

I think there is a concern about having a prescriptive mandate in primary legislation, rather than using a vehicle that could implement real change. Again, I would welcome the Minister’s thoughts on how to ensure that those working in a mental health environment have sufficient training on learning disabilities and autism. We need to make sure that those with a specialism in learning disabilities and/or autism are present and people have access to them, so that things like diagnostic overshadowing do not continue to occur.

Sojan Joseph (Labour, Ashford)

I rise briefly to speak about training in our health settings. There is, in fact, too much mandatory training in NHS and care settings; the issue is that we are not complying with it. We also heavily rely on agency staff, whose training often nobody monitors. It is not that we are short of training. As my hon. Friend the Member for Thurrock mentioned, the Oliver McGowan training was rolled out across the NHS.

Gregory Stafford (Conservative, Farnham and Bordon)

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

Sojan Joseph (Labour, Ashford)

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

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

Stephen Kinnock (Labour, Aberafan Maesteg)

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

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

Zöe Franklin (Liberal Democrat, Guildford)

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

Luke Evans (Conservative, Hinckley and Bosworth)

It is a shame that the hon. Member for Shipley is not in her place to hear me speak to the rest of the clause 4, having considered the amendments to it first—[Interruption.] Oh, she is here just in time. I am grateful to the Government and the Chair, as the clause stand part debate allows things to be more structured.

I want to discuss proposed new part 8A of the Mental Health Act 1983, which will introduce welcome changes to provisions specific to people in England with autism or learning disabilities who are subject to detention under the Act. At the outset, let me say that the Opposition welcome the Government’s recognition that people with autism or learning disabilities require a tailored and rights-based approach within our health system. We know—the evidence points clearly to the fact—that such individuals have been inappropriately detained in institutional settings, often for years, without the care and support that they truly need. The creation of a statutory care, education and treatment review in legislation was a step in the right direction. It therefore makes sense in this part of our proceedings to discuss such reviews.

The background is really important to understanding what the measure will do. Care, education and treatment reviews were introduced in 2015 as part of the Transforming Care programme, a joint initiative between NHS England and the Department of Health and Social Care under the last Government. The TCP was launched in response to the Winterbourne View scandal, which we have heard mentioned a few times, where serious abuses of people with learning disabilities and autism in private hospitals were exposed.

The purpose of CETRs in the Transforming Care programme was to ensure multi-agency oversight of care plans for people with learning disabilities and/or autism, particularly those with complex needs detained in in-patient or secure settings. They were there to promote person-centred care by involving patients, families and a broad range of professionals; to identify barriers to discharge and support safe, timely moves to community or less restrictive settings; and to improve care quality and reduce inappropriate long-term in-patient stays.

The implementation timetable started in 2015 with CETRs introduced as a mandatory part of the TCP, initially focusing on children and adults with learning disabilities and/or autism in in-patient settings. In 2017 to 2019, CETRs were expanded and refined, with NHS England producing guidance and a framework for conducting reviews consistently. Ongoing, CETRs are now embedded across the health and social care systems, extending beyond learning disabilities to other groups with complex mental health needs, including secure mental health services.

CETRs are multidisciplinary independent reviews designed to improve the care and treatment of people with complex mental health needs, particularly those detained in secure hospitals or secure settings, such as children and young people with learning disabilities, autism or complex mental health needs, or in other in-patient settings where there are concerns about the appropriateness of their care, treatment or placement. The purpose is to ensure that the care, education and treatment plans are appropriate, person-centred and holistic; to identify and address any barriers to overcoming recovery and discharge; to promote co-ordinated working between health, social care, education and other relevant services; and to support the least restrictive care principle, one that we have now enshrined in the Bill—helping people to move to less restrictive settings where possible.

There are, however, some complications. The number of CETRs has increased over recent years, especially with the growing recognition of the need for better oversight of complex needs. Several hundred CETRs take place annually across England and Wales, primarily within secure and specialist mental health services. Exact numbers are quite difficult to pin down and vary by service user populations, health trusts, NHS England monitoring and the reporting of the activity.

What is a CETR made up of? That is really important. A typical CETR involves a multidisciplinary panel including independent clinical reviewers such as a senior psychiatrist or clinician not involved in direct care; representatives from social care services; educational specialists, especially for children and young people; advocates or independent mental health advocates; the patient or service users themselves, where possible, to ensure their voice is central; family members or carers where appropriate and with consent; and commissioners and other relevant professionals involved in the person’s care pathway.

Under the review process, the panel examines the individual care, the treatment, the education and progress. It assesses whether the current placement and treatment plan are meeting the person’s needs and whether there is scope to support transition to less restrictive or more appropriate settings. Recommendations may be made on changes to care, treatment plans, discharge or support arrangements.

CETRs are a very valuable safeguard. They bring together the independent clinicians, the social care professionals, the educators, the advocates and, crucially, the patients and their families to review the care and treatment being provided. The aim is to ensure that the treatment is person-centred, appropriate and geared towards recovery, while also exploring opportunities to move people to less restrictive environments when safe to do so. That said, while CETRs are increasingly used, questions remain about their consistency, effectiveness and impacts on outcomes. On page 12 of the explanatory notes, paragraph 46 states that

“recommendations are not always being acted upon”,

which is contributing to

“the perpetuated detention of people with a learning disability and autistic people, often without therapeutic benefit.”

That is really significant. To that end, how many CETRs are conducted annually and what are the mechanics in place to ensure that the reviews lead to meaningful change in care, rather than becoming a procedural exercise? I must admit that I struggled to find that information. If I, as someone looking into it, am struggling, there is a concern about how wide that information and data is.

Furthermore, are there sufficient resources and training to ensure that all participants, including independent reviewers and advocates, can fulfil their roles effectively? How is the patient’s voice and that of their family truly centred in the reviews, especially when dealing with highly vulnerable individuals? Most crucially, looking ahead, how do the Government plan to evaluate and improve the use of CETRs to ensure they are not only a safeguard on paper but a catalyst for better, more tailored care and timely discharge, given that the Government are abolishing NHS England? Will the Minister outline how the Transforming Care pathways and the CETRs will be evaluated, updated and enforced in practice? The Committee must be vigilant: good intentions are not enough. We must ensure the measures are not just decorative, but deliver real change for people who have often been failed by the system.

In recognition of progress, proposed new section 125A rightly mandates that review meetings take place for children and young people with autism or learning disabilities who are detained. We particularly welcome the requirement for the reviews to happen within 14 days of detention and then annually. We also welcome the multidisciplinary scope of the reviews, including education and social care alongside medical needs. The statutory requirement to share reports with clinicians, local authorities and integrated care boards also strengthens accountability. Likewise, proposed new section 125B extends similar provisions to adults with EHC plans, ensuring that no one is excluded from oversight purely because of their age or plan status. We welcome proposed new section 125D, which requires ICBs to keep registers of individuals at risk of detention and, crucially, to use them to commission better community-based services.

I would like to probe the Minister a little further here, first on the enforcement right to community provision. As we have discussed, ICBs and local authorities are told to have due regard to review recommendations to seek and need outside hospital detention. As it stands, however, there is no legal duty to act on them. I would be grateful if the Minister responded to the suggestion that we on the Conservative Benches made about a duty to respond, which would give them the flexibility to set out what is possible, what is not and why. How will the Government ensure that needs are met? How will that information be collected and followed up?

The next point is that delays could undermine safeguards. Proposed new section 125A requires the first review meeting to occur within 14 days—as we have said, that is very laudable—but only after an applicable day defined in a complex manner. There is a risk that people could fall through the cracks during emergency detentions or diagnostic ambiguity. Have the Government considered proactive review mechanisms as an immediate trigger of the timing? Has consideration been given to how to avoid the clock never starting in the first place?

On consent and capacity issues, there are appropriate provisions allowing reviews to occur in the absence of consent where it is in the patient’s best interest. However, the Bill does not appear to adequately set out safeguards for how such best interest decisions are to be scrutinised. There must be a clear guidance and advocacy involvement to prevent paternalism: one of our key concerns and why we are here today.

On the quality and independence of reviews, the Bill allows commissioners to convene an author report. It also includes clinicians and local authorities under proposed new section 125B. Forgive me, but it is not clear where the involvement of the patient’s family or advocates is. Given that the ICBs are the responsible commissioner, what safeguards are in place to ensure that they are not marking their own homework? Who will they report to given the abolition of NHS England?

The final point is about the register of people at risk. This is a double-edged sword because proposed new section 125D requires ICBs to maintain a register of people considered to be at risk of detention. While the intent of early identification of support is very much welcome, this raises questions about data privacy. Who has access? What rights do individuals have to object to or appeal against their inclusion? Who would have capacity and/or authority?

We also run the risk of labelling. Is there a danger that this becomes a list of problem people, rather than a tool for supporting early intervention? Have the Government given any thought to safeguards for the people on those lists when they want to move on in their lives, such as by having children, wanting to get insurance, mortgages, credit or any of the normal day’s activities? Given that we live in an ever more interconnected and digitalised world, we do not want to risk the creation of second-tier citizens.

Finally, on proposed new section 125F, when setting out how the guidance from the Secretary of State is placed, has any thought been given to how it takes into account those with lived experience, such as charities, patients and relatives? They could play a role in shaping this in a collaborative way. Whose function should that be? Is that under consideration by the Government?

This part of the Bill signals a positive shift, but the path to reform must be paved with more than just procedural reviews. It must be built on enforceable rights, strong community services and the principle that people with autism or learning disabilities deserve to live fulfilled lives with support, not detention.

Gregory Stafford (Conservative, Farnham and Bordon)

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

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

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

Stephen Kinnock (Labour, Aberafan Maesteg)

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

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

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

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

Luke Evans (Conservative, Hinckley and Bosworth)

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

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

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

Stephen Kinnock (Labour, Aberafan Maesteg)

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

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

Clause 5 - Grounds for detention

Neil Shastri-Hurst (Conservative, Solihull West and Shirley)

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

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

Gill Furniss (Labour, Sheffield Brightside and Hillsborough)

With this it will be convenient to discuss the following:

Amendment 53, in clause 5, page 11, leave out lines 27 to 29 and insert—

“(b) in the case of a patient who lacks capacity or competence to consent to admission for medical treatment, serious harm may be caused to the health or safety of the patient or of another person unless the patient receives medical treatment, or in the case of a patient who does not lack capacity or competence to consent to admission for medical treatment, serious harm may be caused to the health or safety of another person unless the patient receives medical treatment,”

This amendment, along with Amendment 52, would add to the grounds for admission to hospital for assessment or treatment that the patient must lack the capacity to consent to that admission, if they would not be detained due to being a risk to others.

Neil Shastri-Hurst (Conservative, Solihull West and Shirley)

All the amendments in this group have been tabled in the name of my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer). Amendments 52 and 53 deal with grounds for detention and treatment—specifically, with how those grounds differ depending on whether a patient has the capacity or competence to consent.

At the heart of both amendments is the simple but vital proposition that capacity matters, not only ethically, but legally. The ability of an individual to make decisions about their own care must shape the basis on which the state may act against their will.

The revised wording introduces an important distinction between the two scenarios, where a patient lacks capacity and where they retain it. In the first case, where a patient cannot consent because they are unable to understand or weigh up the relevant information, then serious harm either to the patient or to others may justify detention or compulsory treatment. However, in the second case, where capacity is intact, the threshold for overriding a person’s autonomy is rightly higher. In such circumstances, the justification for intervention must rest solely on the risk of serious harm to other people.

Gill Furniss (Labour, Sheffield Brightside and Hillsborough)

Order. We are now expecting three Divisions. I will therefore suspend the Committee for twenty-five minutes, until 5.30 pm—[Interruption.] Four Divisions? We have only been informed about three. [Interruption.] Yes—we would like you all back at 5.40 pm.

Gregory Stafford (Conservative, Farnham and Bordon)

I beg to move, That the debate be now adjourned.

Gill Furniss (Labour, Sheffield Brightside and Hillsborough)

I think everyone is in agreement.

Christopher Bloore (Labour, Redditch)

On a point of order, Ms Furniss. Could we have some clarity on what adjourning the Committee right now would mean? Several members of the Committee have not returned from the Division, and it would be good to know the implications if we adjourn now.

Aphra Brandreth (Conservative, Chester South and Eddisbury)

The Conservative members of the Committee all came back at 5.40 pm, when we were asked to return.

Stephen Kinnock (Labour, Aberafan Maesteg)

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

Taiwo Owatemi (Labour, Coventry North West)

I am the only one who can move the Adjournment.

Gregory Stafford (Conservative, Farnham and Bordon)

That is not true. Any member of the Committee can move the Adjournment.

Taiwo Owatemi (Labour, Coventry North West)

We can vote on it.

Gregory Stafford (Conservative, Farnham and Bordon)

On a point of order, Ms Furniss. I called for a Division on the Adjournment before several members of the Committee who are now in the room came back. What is your ruling on whether members who were not here when the Division was called will be allowed to vote?

The rest of the debate is in Hansard.