Mental Health Bill [Lords]

Public Bill Committee, 17 June 2025.

Desmond Swayne (Conservative, New Forest West)

Please ensure that mobile phones are turned to silent mode. If hon. Members and officials wish to remove their jackets, they have leave to do so.

Clause 22 - Consultation of the community clinician

Desmond Swayne (Conservative, New Forest West)

With this it will be convenient to discuss the following:

Clause 23 stand part.

Stephen Kinnock (Labour, Aberafan Maesteg)

It is a pleasure to serve under your chairmanship, Sir Desmond. I will discuss a number of issues concerning community treatment orders and ensuring sufficient resources for community-based care.

Clause 22 will add the community clinician as a third key decision maker for community treatment orders, alongside the responsible clinician and approved mental health professional, ensuring additional professional oversight. Involving the community clinician in the initial request for a community treatment order will improve the planning and implementation of community treatment orders by ensuring good communication between ward and community doctors, aiding continuity of care. It should also help to prevent the inappropriate use of community treatment orders, for instance to free up beds where there are pressures on acute wards.

Making sure that only those who need to be on a community treatment order will be put on one supports the principles behind the reform of the Mental Health Act 1983, including the principles of least restriction, of therapeutic benefit and of treating the person as an individual. It should also positively impact the racial disparities that have been seen in the use of community treatment orders. The community clinician’s opinion is important when a patient is under a CTO, because the clinician may have a better understanding of the patient’s progress, including how well the patient is engaging with their treatment while in the community. Their insights are valuable in deciding whether the patient should be discharged to a community treatment order or recalled to the hospital if their symptoms worsen. Those who are supporting the patient in the community should be a part of the decision of whether the restrictions of the CTO are still required.

I turn to clause 23. In addition to reducing the number of people placed on CTOs, as has been referred to in relation to clauses 6 and 22, we aim to provide greater protection to those subject to them. CTOs extend the coercive powers of the Mental Health Act into people’s lives beyond hospital. CTOs should be used only when necessary, with conditions tailored to the individual rather than applying blanket restrictions. Currently, some CTO conditions display an overreach of power, such as requiring abstinence from alcohol even if this is unrelated to the person’s mental health condition. The clause will remove the ability of the responsible clinician to apply conditions to a person’s community treatment order which are appropriate but not necessary, giving a higher threshold for conditions to be set.

The clause will allow the mental health tribunal to recommend that the responsible clinician reconsider the necessity of conditions specified in a CTO if the tribunal determines that the patient is not yet suitable for discharge. For example, while not set out in the Bill, the tribunal may use this power if it finds the conditions imposed in a CTO to be possibly disproportionate, overly restrictive, lacking clinical benefit or not treating the person as an individual.

New clause 4 would place a general duty on integrated care boards in England to ensure that community services have the necessary resources to meet demand, and to report on this every two years. This duty to commission local services based on local need is already placed upon integrated care boards by the National Health Service Act 2006, as amended by the Health and Care Act 2022. An integrated care board must arrange for the provision of services as it considers necessary to meet the reasonable requirements of the people for whom it is responsible. Integrated care boards and their mental health trusts are required to prepare a joint forward plan that describes how the ICB will arrange for NHS services to meet their population’s physical and mental health needs. For that reason, we do not think the new clause is necessary, and it could place a disproportionate burden on ICBs and mental health providers. I therefore hope that the hon. Member for Winchester will be satisfied not to press it. I commend clauses 22 and 23 to the Committee.

Luke Evans (Conservative, Hinckley and Bosworth)

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

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

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

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

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

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

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

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

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

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

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

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

Gregory Stafford (Conservative, Farnham and Bordon)

It is a pleasure to serve under your chairmanship, Sir Desmond. Taking a step back to my hon. Friend’s point about “necessary”, is he concerned, as I am, that it is not clear to those responsible what “necessary” means? We could open ourselves up to potential legal challenges and disputes, which would give lawyers lots of money but would have no benefit for the patients.

Luke Evans (Conservative, Hinckley and Bosworth)

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

Desmond Swayne (Conservative, New Forest West)

Order. I am afraid we have to suspend the sitting, as the sound is unworkable. I am assured that a sound engineer is on the way.

9.37 am

Luke Evans (Conservative, Hinckley and Bosworth)

Brevity is an important skill that you have exemplified in this House for many years, Sir Desmond, so I will not subject the Committee again to matters that I have already covered.

I ask again the question that I posed just before the suspension: how will clinicians be guided in applying the new “necessary” test? Will the code of practice be updated with examples and scenarios? Crucially, what measures will be taken to ensure that patients are clearly informed that a breach of CTO conditions is not, in itself, an automatic ground for recall? That concern has come across in evidence and is a long-standing source of misunderstanding and mistrust, as has been highlighted in cases and in the Wessely report.

Clause 23(2) will insert new subsection (3B) into section 72 of the Mental Health Act, giving mental health tribunals the power to recommend that the responsible clinician reconsider whether a CTO condition is necessary, even when they do not discharge the patient. That is a welcome enhancement of patient rights. Currently, if a tribunal decides not to discharge a patient, it has no power to challenge potentially excessive conditions. The clause strikes a useful middle ground, offering oversight without overturning clinical decisions. Having said that, will there be any requirement for the responsible clinician to formally respond to the tribunal’s recommendations? Without such a duty, there is a risk that recommendations may be quietly disregarded and the benefit of the provision may be undermined.

Clause 23 is a positive and proportionate reform, but to strengthen its practical impact I suggest that the Government consider updating the code of practice to clarify what constitutes a “necessary” condition under section 17B of the Mental Health Act; introducing a duty to respond to tribunal recommendations under proposed new section 72(3B), with a short time limit and a written explanation if the recommendation is rejected; and providing clear information to patients.

New clause 4, tabled by the Liberal Democrats, seeks to place a general duty on ICBs to ensure that sufficient resources are available for community-based mental health services, particularly in the context of implementing provisions under the Mental Health Act. It speaks to a concern that many Committee members will have heard time and again from patients, practitioners and families alike: that the success of any reform to the Mental Health Act will ultimately rest on the capacity of community services to deliver. We know the reality: patients can be discharged to under-resourced settings or subject to CTOs that depend on clinicians who may be overstretched or unavailable. Clause 22 will rightly expand the role of community clinicians in CTO decisions, but that works only if they exist, are available and have the time and tools to engage meaningfully.

I acknowledge that new clause 4 identifies a genuine structural risk in the way in which we approach reform, and I commend colleagues for raising it, but should it sit in primary legislation? I am not so sure. I have some questions for the hon. Member for Winchester not about the intention of the new clause, but about the appropriateness and practicality of placing such a duty in primary legislation. Primary legislation is best used where duties are clear, enforceable and universal. The duty proposed in the new clause, although admirable, is qualified by the words

“insofar as is reasonably practical”,

which reflects the reality that integrated care boards do not control all the levers of workforce, capital investment or even, in many cases, service design.

With that in mind, I ask the hon. Member the following questions. What mechanism would be used to enforce the duty? If an ICB fails to meet the duty, what would the consequences be? Would the duty not create legal ambiguity or even the potential for judicial review where service users feel that resources are inadequate, or even where the ICB has acted reasonably in difficult circumstances? Furthermore, how would the duty interact with the existing statutory duties on ICBs under the Health and Care Act 2022, including the duties around health inequalities and integration?

A stronger element of the new clause, which merits closer consideration, is the assessment and publication of findings on local community mental health capacity. This kind of transparent, data-led accountability could be an effective tool not only for Parliament and regulators, but for local patients and advocacy groups. Perhaps that element could be taken forward in secondary legislation as part of the updated NHS England commissioning guidance. The Minister will forgive me, but I am not sure whether such a tool already exists, so perhaps he will address that point.

Does the Department plan to require ICBs to assess and report on community mental health capacity in the light of the new duties being created by the Bill? Could there be scope for a reporting duty to be included in regulations or guidance, even if a general resourcing duty is not placed in primary legislation? The Bill refers to commissioning, and under earlier clauses we have talked about dynamic registers. Will the Minister set out whether the issue is covered here or in another way?

We cannot ignore the resource dimension, so I am grateful to colleagues for pressing the Committee to address it. However, we must be careful about the tools we use, what we write into law, and what we deliver through planning, commissioning and political will. I look forward to hearing from the hon. Member for Winchester and the Minister in response to my questions.

Sojan Joseph (Labour, Ashford)

It is a pleasure to serve under your chairmanship, Sir Desmond. I welcome the changes proposed in clauses 22 and 23. Clause 22 seeks to amend the Mental Health Act to require the community clinician responsible for overseeing the patient’s care as a community patient to be involved in decisions regarding the use and operation of community treatment orders.

While I was practising as a mental health professional, I was personally involved in many community treatment orders and in recalling patients to hospital. Although I acknowledge the concerns raised by various charities and members of the Committee about the overuse of community treatment orders and restrictions on patients, such orders have many benefits. As the Minister has highlighted, they help to release the pressure on in-patient settings. They also help patients to live in a home environment: without such provision, some patients would have to stay in hospitals for longer, which can be more restrictive than being in the community.

The Committee needs to understand the kinds of patient who are often considered for community treatment orders. These patients are already well known to mental health services. They may have a long-term serious mental illness and may have to take medication continuously. More often, they are on regular injections of what is called depot medication; mental health professionals administer such medication either once a month or once every three months. Community treatment orders enable clinicians to make sure that patients receive the medication they need, so that they do not relapse and so they can have a good quality of life.

By introducing an additional professional check on whether the patient really needs the support of a community treatment order, and by requiring more evidence that the patient needs the support of the community treatment order to get better, clause 22 will adopt two of the four principles of treatment proposed in Sir Simon Wessely’s independent review, namely the principle of least restriction and the principle of therapeutic benefit.

Luke Evans (Conservative, Hinckley and Bosworth)

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

Sojan Joseph (Labour, Ashford)

I thank the hon. Member for that important intervention. Healthy conflicts between professionals can be useful and can be used as a reassurance to people who are concerned about the overuse of CTOs. However, capacity can sometimes be an issue, especially in community settings, an issue that new clause 4 addresses.

It is also important to understand that mental health services have changed over the years. The consultant who treats the patient in hospital may not know much about them or how they are in the community. In the past, all those patients were followed by a care co-ordinator—not necessarily a mental health psychiatrist, but a mental health nurse or social worker who followed the patient throughout their journey and kept an eye on them. We do not have enough capacity these days, so nobody is following the patient. A community treatment order helps them to have at least minimum contact when they have to go and see a patient to administer medication. I support that conflict—sometimes it can be very healthy—but I also acknowledge that we need more capacity in the community.

Clause 22 makes a new distinction between a patient’s responsible clinician with overall responsibility for them, including in hospital, and a community clinician with the responsibility for the patient in the community. It will impose specific duties on the community clinician where they are not the responsible clinician. For example, subsection (2) will amend section 17A(4) of the Mental Health Act to require that where the responsible clinician is not the clinician who will have care for the patient in the community after their discharge, that community clinician must also agree in writing that the community treatment order criteria are met. That will ensure continuity of care of the patient from the hospital into the community, and it will have the added benefit of additional professional oversight in respect of the need for a community treatment order. That is to be warmly welcomed.

I also highlight subsection (4), on the power to recall a community patient to hospital. That will mean that if the community clinician is not the responsible clinician, the community clinician will still need to be consulted before a patient can be recalled under the community treatment order, unless such a consultation would lead to an unreasonable delay. That seems an entirely welcome and sensible reform. In some cases, an unreasonable delay may not be helpful, because some patients need to have their medication at regular intervals. For example, a patient on clozapine who misses their medication for three or four days in a row may have to restart their whole treatment regime, which will mean an even longer in-patient admission process.

Subsection (6) will require a community clinician to make a statement in writing, if they are not the responsible clinician, in support of the renewal of a patient’s community treatment order, if that is the conclusion of the responsible clinician. Getting written confirmation from the community clinician who is intimately involved in the patient’s care that a renewal of the community treatment order is both necessary and appropriate and is the correct thing to do. Once again, it is about ensuring that a further professional opinion is considered; it is also about checking whether the patient still needs the support of a community treatment order.

Clause 23 will make changes in relation to the conditions that a person subject to a community treatment order may be required to follow. It will amend section 17B of the Mental Health Act so that conditions can be imposed only if they are “necessary”. This is a simple and welcome update from the current wording, “necessary or appropriate”.

Clause 23’s second modernisation is to give the tribunal a new power to

“recommend that the responsible clinician reconsider whether a condition…in the community treatment order is necessary”.

This would apply when the tribunal has decided not to discharge a patient completely from a community treatment order, but has come to the conclusion that not all its conditions are required. Once again, this is a welcome reform and is in line with the principle of therapeutic benefit. Some conditions put on patients can be seen as restrictive: for example, if a condition states that patient cannot use alcohol or illicit drugs, the clinicians will be looking at whether the patient’s use of alcohol or illicit drugs has an impact on their mental state or on their non-compliance with treatment. That is very important. I welcome the changes in clause 23.

Danny Chambers (Liberal Democrat, Winchester)

It is an honour to serve under your chairship, Sir Desmond. I thank the Minister and the hon. Member for Hinckley and Bosworth for their comments on Liberal Democrat new clause 4.

This is another good example of how, although we are aware that it has laudable aims, the Bill will fail without the supporting infrastructure. As everyone will be aware, community mental health services are among the issues that generate the most emails and correspondence—certainly in Winchester, where young people especially are struggling to access mental health care. In that context, we are alarmed that mental health spending has fallen as a share of overall health spending in the last financial year. That has been coupled with the decision to drop a number of mental health targets, including targets for the number of people receiving mental health interventions such as talking therapy, and the target to ensure that 75% of people with a severe mental health illness receive an annual physical check. Priority has not been given to the services necessary to deliver better mental health care.

For the Bill to make a meaningful difference, the Government must ensure that community mental health care services receive the investment that they need to fulfil their obligations under the Bill—I know that that is a bit of a circular argument—and reduce the overwhelming pressure on in-patient services.

There is also the impact on schools, police services and families. When I went out with the police in Winchester not long ago, they told me that between 40% and 50% of their time is spent dealing with people who have a mental health issue in some capacity. The lack of community mental health care is not just a resource burden on the health service; a lot of our other services are also affected.

Luke Evans (Conservative, Hinckley and Bosworth)

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

Stephen Kinnock (Labour, Aberafan Maesteg)

Where is the evidence for that?

Danny Chambers (Liberal Democrat, Winchester)

Would the Minister like to intervene?

Stephen Kinnock (Labour, Aberafan Maesteg)

No, thank you. I am chuntering from a sedentary position.

Danny Chambers (Liberal Democrat, Winchester)

I broadly agree. We were really heartened that in the King’s Speech, the Government said that mental health needs to be treated as seriously as physical health. There are many reasons to join a political party but, given my long history of working in mental health charities, one major reason for joining the Lib Dems was that they had been saying that for years. I was pleased to hear that in the King’s Speech too, but we have to ensure that the percentage of spend on mental health does not slip in proportion to other very important resources.

Anna Dixon (Labour, Shipley)

I think we are all agreed that, in order to implement the changes to the Bill, we need investment in mental health services, particularly community mental health services, but does the hon. Gentleman recognise that the Labour Government have kept the mental health investment standard, ensuring that there is sufficient and increasing investment in mental health in this country?

Danny Chambers (Liberal Democrat, Winchester)

I hope that that is the case. I know that is the aim, but I suppose we will see in four, five or six years’ time what the mental health resources are. No one aims to underfund these services, but the demand on them changes and they need to be resilient. Darzi said that in April 2024 there were 1 million people on mental health waiting lists, and we know that some children wait 15 months, so we must not just maintain the current investment standard, but try to catch up on the huge backlog, which will not change unless we reform the system or invest in more staff and resources.

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

The hon. Gentleman makes a good point—mental health services are in a very bad place—but does he agree that the Government have already announced investment in mental health specialists in all schools, and in mental health crisis centres? I have no doubt that once the 10-year plan for the NHS comes out, there will be an even clearer path for how we tackle mental health issues.

Danny Chambers (Liberal Democrat, Winchester)

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

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

Gregory Stafford (Conservative, Farnham and Bordon)

I rise to speak to clauses 22 and 23 and to Liberal Democrat new clause 4.

As my hon. Friend the Member for Hinckley and Bosworth said, the Opposition support clauses 22 and 23 generally. Clause 22 addresses the concern that community clinicians—essentially, those responsible for overseeing a patient’s care outside hospital—have historically had limited formal input into decisions about community treatment orders, even though they are central to the patient’s ongoing care. It ensures that community clinicians not only are consulted but, in some cases, must provide written agreement before key decisions are made. It aims to improve continuity of care, ensure decisions reflect the realities of community-based treatment, and reduce inappropriate and poorly co-ordinated use of CTOs.

The benefits of the clause are obvious, but they are worth restating. Clearly, it improves the continuity of care and ensures that clinicians with direct knowledge of the patient’s community care are involved in those key decisions. It enhances safeguards, adding an additional layer of professional oversight before coercive measures are imposed or suggested. It promotes collaboration by encouraging joint decision making between the hospital-based and community-based clinicians, and it reduces the risk of inappropriate CTOs by ensuring they are used only when genuinely appropriate and supported by those delivering care.

However, I ask the Minister to touch on three points. First, requiring a written agreement or consultation could delay urgent decisions if not managed efficiently, so will he explain how, under the clause, any potential delay—a disagreement or just administrative inertia—can be removed to ensure treatment is not delayed?

That moves me on to the administrative burden. Clearly, the clause adds a level of complexity and requires more documentation and co-ordination. Although I understand that that is a necessary outcome, I would again be grateful for the Minister’s thoughts on how to ensure effective and speedy implementation.

As my hon. Friend the Member for Hinckley and Bosworth said, the ambiguity in the roles of the two clinicians may create confusion or disputes over responsibilities if they are not clearly defined or agreed. My reading of the clause is that there is no such clear definition; will the Minister look to provide one through other agencies, or will he put something into the clause in Committee or later in the Bill’s proceedings?

Clause 23, on the conditions of community treatment orders, addresses the concerns that the threshold for imposing conditions on community treatment orders has been too low, allowing conditions that may be clinically unnecessary or overly restrictive. By removing the “appropriate” test, the clause will tighten the legal standard to ensure that only necessary conditions are imposed.

Additionally, the clause will empower tribunals to play a more active role in scrutinising CTO conditions by allowing them to recommend that clinicians review specific conditions, even if the patient is not discharged. This reflects the Bill’s broader aim of enhancing patient rights and removing unnecessary restrictions.

The clause is a welcome addition. It will ensure that CTO conditions are imposed only when strictly necessary, meaning that there are stronger safeguards, and it will enhance the role of tribunals in protecting patient rights without requiring full discharge. It will reduce clinical overreach by preventing the use of overly broad or vague conditions that may not be clinically justified.

However, as with the previous clause, I have some questions. First, the tribunal power is limited in that it can only recommend, not require, the reconsideration of conditions. Is that the intention, or will the Minister strengthen the clause at some point to ensure that the tribunal can require a reconsideration of conditions? If he will not, what issues does he see arising from there not being a reconsideration?

Secondly, as I mentioned in my intervention on my hon. Friend the Member for Hinckley and Bosworth, I have a concern about the potential ambiguity in the shift from “appropriate” to “necessary” leading to uncertainty or dispute over interpretation. As we touched on in relation to other clauses, clinicians will need additional guidance or training to apply the revised standard consistently. Where will that revised training and guidance be located, and what is the timeframe for its implementation? We need to ensure that all clinicians are fully trained and ready to use this new power.

I will briefly touch on new clause 4, tabled by the Liberal Democrats, because although I understand that the hon. Member for Winchester may not press it, somebody else might. It would place a general duty on integrated care boards to ensure that services in the community have the necessary level of resource to meet demand such that the provisions of the Bill function as intended, and to assess and report on this every two years. As my hon. Friend the Member for Hinckley and Bosworth mentioned, the Opposition generally support the overall aims of the new clause, but as ever, there are some issues with the detail, so I have five questions for the hon. Member for Winchester if he responds, or for the Minister to answer in his summing up.

First, if we imposed a statutory duty on ICBs to ensure sufficient resources for the CTOs, what mechanisms would there be to monitor and enforce compliance? Secondly, what would be the consequences if an ICB failed to meet this duty? Would there be formal accountability or a sanction process? Thirdly, how would the duty interact with existing NHS budgetary constraints and competing priorities? Would it become a statutory obligation with no clear means of redress if unmet? Fourthly, could the duty set a precedent whereby Parliament mandates resource guarantees without providing additional central funding? Finally, what constitutes “sufficient” resources in the context of the CTOs? Who defines that standard, and it is defined locally or nationally?

Stephen Kinnock (Labour, Aberafan Maesteg)

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

Luke Evans (Conservative, Hinckley and Bosworth)

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

Stephen Kinnock (Labour, Aberafan Maesteg)

Yes, the responsible clinician has primacy.

On the workforce impact, our impact assessment, which was published alongside the Bill, sets out the additional hours of required clinician activity. We will invest in implementing these reforms.

On the meaning of the word “necessary”, we will provide further guidance in the code of practice to provide for a range of scenarios to help to clarify necessary conditions, as well as to clarify that failure to meet those conditions should not always result in recall to hospital.

On the requirement for a responsible clinician to respond to recommendations, we considered giving the tribunal the power to change or remove conditions on a person’s community treatment order. However, the outcome of our stakeholder engagement was that tribunal colleagues did not consider that it was appropriate for them to make clinical judgments, for example whether a condition is of clinical benefit. Providing the power to recommend that the responsible clinician reconsiders the conditions allows the tribunal to provide additional scrutiny but also allows for clinical discretion in decision making.

The hon. Member for Farnham and Bordon asked about training. The training plan will be in the first written ministerial statement.

On where the terms are defined, clause 10 defines responsible clinician and clause 22 defines community clinician. We will define the distinction between the roles in the code of practice.

Clause 24 - Nominated person

Desmond Swayne (Conservative, New Forest West)

With this it will be convenient to discuss the following:

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

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

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

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

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

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

Government amendments 40 and 41.

Schedule 2.

Clauses 25 to 28 stand part.

Stephen Kinnock (Labour, Aberafan Maesteg)

I will discuss a number of issues concerning the topic of the nominated person, one of the Bill’s key reforms. I will first address clause 24 and schedule 2, which seek to replace the current nearest relative provisions with the nominated person, chosen by the patient, who can protect their rights when they are detained. The independent review found the nearest relative provision to be outdated and inappropriate. It allocates someone based on a hierarchical list, which does not reflect modern families and could result in someone unfamiliar or potentially risky to the patient being given the role.

We have ensured that appropriate safeguards are in place to protect patients as well as to enable choice. A health or social care professional or an advocate must witness the nomination and confirm in writing that the nominee meets the criteria and that no undue pressure has been put on the patient. Children and young people with the relevant capacity or competence can choose their own nominated person. We expect this will be their parent or guardian, but sometimes a step-parent or other relative over 18, without parental responsibility, may be more suitable to protect a patient’s rights. Safeguards will be put in place to support children in making this choice.

If a patient of any age lacks capacity or competence to make a nomination, an approved mental health professional will appoint a nominated person on their behalf. For children under 16, this will be someone with parental responsibility, including the local authority if the child is subject to a care order. This appointment is temporary until the patient has capacity or competence to make their own appointment.

For all patients, the responsible clinician or approved mental health professional can temporarily overrule the use of a particular nominated person’s power, for example to discharge the patient, if the patient is likely to act in a manner that is dangerous to themselves or others. A nominated person can be removed by the county court if deemed unsuitable—for example, if they misuse their powers or neglect the patient’s welfare or the public interest. Anyone with an interest in the patient’s welfare, such as their parents, can apply to the court. The Bill extends the nominated person safeguard to some restricted part III patients, but their nominated person’s powers will be limited, as appropriate, in the interests of public safety and criminal justice.

Amendments 54 and 55 would require nominated persons for patients under 16 to have parental responsibility for the child, whether chosen by the child or appointed for them. The Bill currently requires this if the child lacks competence to appoint their own nominated person. However, where a child has competence to decide, we think it is right that they can choose the person to represent their interests. That view was supported by the majority of respondents to the White Paper consultation on reform of the Mental Health Act, and it is in keeping with the principles of choice, autonomy and treating the person as an individual.

Like the current “nearest relative” provision, which the nominated person will replace, the amendments do not take into account the greater diversity of modern family structures—for example, where a step-parent may play a vital role in a young person’s life but does not have formal parental responsibility. Our engagement with children and young people during the development of the Bill suggests that the vast majority will appoint a parent as their nominated person. However, we think having choice is important to prevent children from having to have a nominated person who may not engage with the role or act in accordance with their best interests, just because they have formal parental responsibility.

Where children have competence to choose their own nominated person, a health or social care professional, or advocate, will be required to witness the nomination and confirm in writing that the nominated person is over 18 and suitable to take up the position. Regardless of nominated person status, parents should be involved in a child’s care and treatment, and they will retain their legal rights under parental responsibility. Safeguards are in place to allow for the overruling and displacement of the nominated person if they are behaving in a way that is not in the child or young person’s best interests.

Government amendments 40 and 41 will remove paragraph 11(3) to 11(5) of schedule 2 from the Bill, as it is unnecessary to specify in legislation which person with parental responsibility the approved mental health professional must appoint as nominated person for an under 16-year-old. A prescriptive list of who an approved mental health professional must appoint for a child under 16 may prevent a more suitable adult from being chosen as the nominated person. The Bill states that for under-16-year-olds lacking competence, an approved mental health professional must appoint a parent, or whoever has parental responsibility, to be the child’s nominated person. This would include consideration of special guardians and child arrangement orders.

The Government do not agree that a person with residual parental responsibility should always be blocked from being a nominated person, as the child arrangement order or special guardianship may be in place for reasons other than the parent being a risk to the child. For example, the parent might struggle with their own health issues, but that does not necessarily mean that they would not be an effective nominated person. The situation is different in the case of a care order because the local authority is being given lead parental responsibility. We have engaged with the Children’s Commissioner on that point.

If there is no suitable person with parental responsibility willing to act, the approved mental health professional must take into account the patient’s past and present wishes and feelings, so far as reasonably ascertainable, when deciding who to appoint. We will establish an expert taskforce to support the development of the statutory code of practice to provide clear guidance for professionals involved in the nominated person appointment process for children and young people.

Clause 25 will require the approved mental health professional to consult the nominated person before they make an application for admission for treatment or guardianship. This is an existing right for the nearest relative. However, currently if the nearest relative exercises one of their powers, such as the ability to block admission, but the professional believes their objection is unreasonable, the only means of overruling them is to remove or displace them as the nearest relative. This can leave patients without someone to represent their interests during detention.

Clause 25 will allow the approved mental health professional to make use of the existing barring order to temporarily overrule the nominated person, if the patient would be likely to act in a manner dangerous to other persons or themselves if their admission was blocked. This is a well-established process. Although the nominated person can continue to represent the patient in other ways, they can still be displaced by the court from the role entirely if their actions indicate they are unsuitable for the role—for example, if they are repeatedly objecting to admission without considering the welfare of the patient or the interests of the public. Approved mental health professionals can continue to use that process.

Clause 26 will transfer the nearest relative provisions relating to the power to order discharge of a patient to the new nominated person role. The power can be temporarily overruled by a responsible clinician if they think that the patient’s discharge would result in danger to themselves or others. It is a well-established process that allows for clinical discretion, but means that the nominated person can continue to represent the patient’s rights in other ways. Clause 26 also reduces from six months to three months the time period during which the nominated person cannot make another order for discharge. That reflects the changes in detention periods under clause 29.

Clause 27 will give the nominated person a new power to object to the use of a community treatment order. We also recognise, however, the importance of protecting patients and the public, so if the responsible clinician is concerned that without a community treatment order, there would be a risk of danger to the patient or others, they can overrule the nominated person’s objection. Those changes will help both to reduce the number of inappropriate community treatment orders and to ensure that safeguards are in place for patient safety and public protection.

Finally, clause 28 provides that before deciding to transfer a patient, the person responsible for taking that decision must consult the patient’s nominated person, unless consultation is not reasonably practicable or would involve unreasonable delay. The nominated person will not be able to object to a transfer, because there may be good reasons for transferring a patient—for example, if a different trust can provide better care, such as a specialist eating disorder unit. Consulting the nominated person, however, means that they are aware of the reasons for transfer and how it will benefit the patient. That will help the nominated person to remain actively involved in protecting patients’ rights and kept informed about a patient’s care and treatment.

Luke Evans (Conservative, Hinckley and Bosworth)

I welcome the chance to contribute to the debate on clauses 24 to 28. I will then turn to Government amendments 40 and 41 and to amendments 54 and 55, tabled by my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer).

Clauses 24 to 28 represent a significant reform to the Mental Health Act 1983. They seek a shift from the traditional concept of a nearest relative to giving patients more control by allowing them to nominate a person to act on their behalf. Clause 24 is the cornerstone of the reform, establishing the role of a nominated person as the patient’s chosen individual to take over certain rights and responsibilities previously held by the nearest relative. It represents a fundamental change from a fixed family-based system to one centred on patient choice and autonomy.

Currently, the nearest relative, often by blood relation, holds a range of statutory powers under the Mental Health Act, regardless of the quality of their relationship with the patient. The clause will enable patients, especially adults, to nominate a trusted person—a family member, friend or advocate—who can act in their best interests. That is a progressive and patient-focused change relating to modern social realities, where family ties are complex and a biological relative is not always the best supporter.

Empowering patients to select their nominated person can enhance trust, improve communication and ultimately lead to better care outcomes. It does, however, raise pressing questions. For children and young people, particularly those aged 16 and 17, who gain legal capacity to nominate, what safeguards ensure that parental concerns and children’s welfare remain adequately considered? How will disputes between nominated persons and relatives, or between the nominated person and clinicians, be resolved? Part of that might be addressed in Government amendments 40 and 41, but I am keen to understand a little more. What training and oversight will ensure that nominated persons understand their duties and, importantly, their boundaries? Finally, for a patient who does not or cannot nominate someone, will the nearest relative still have a role, and how will that be managed?

Clause 25, on applications for admission or guardianship, builds on clause 24. It will require the approved mental health professional to consult the nominated person before making applications for admission or guardianship, except where consultation is not reasonably practicable or would cause unreasonable delay. It will also allow the nominated person to object to such applications, requiring a barring report from the approved mental health professional if an objection is made.

The clause will formalise the nominated person’s involvement at a critically early stage of the intervention, ensuring that their voice can influence decisions that deeply affect the patient. The power to object introduces an important check, though it is balanced by the professional’s ability to override objections on the grounds of safety. The Opposition agree with that, but there are still some questions. How will professionals navigate conflicts between their clinical judgment and objections by the nominated person? Will there be clear guidance to avoid delays that could jeopardise patients or public safety?

Clause 26 will replace references to the “nearest relative” with “nominated person” in discharge decisions and shorten the time interval before another discharge application can be made from six months to three. That reflects the updated detention periods and reinforces the nominated person’s role in advocating for timely discharge. Although this change could accelerate patient recovery and reduce unnecessary detention, it also necessitates careful monitoring to ensure that short intervals do not result in rushed or unsafe discharges—I flag that point to the Minister. However, we broadly support clause 26.

Currently, the nearest relative must be informed but has no formal role in the CTO decisions. Clause 27 will rectify that by requiring consultation with the nominated person before a CTO is made and granting them a right to object. That enhances oversight of CTOs, which are often controversial due to their coercive nature. None the less, the power remains ultimately with the responsible clinician to override objections if they feel that the patient poses a danger without the CTO. That raises a question for the Minister: how will transparency and accountability be maintained in these potentially high-stakes overrides?

Clause 28 will require consultation with the nominated person before transferring the patient between hospitals, expanding their involvement in care decisions that affect the patient, as well as wellbeing and continuity of support. Again, exemptions exist where consultation is impractical or will cause unreasonable delays. Clarity is again needed on how those exemptions will be applied, particularly in emergencies.

As an overall reflection, taking them all together, these clauses will modernise the Mental Health Act by embedding patient choice and strengthening nominated persons’ roles. However, there are questions about these clauses. The ability of a patient aged 16 or over to choose their nominated person could cause conflicts with parents or guardians. What protections exist to ensure that young patients are not pressured or isolated from family support when it might be needed? When it comes to professional discretion and safeguards, the repeated provision allowing professionals to override nominated persons’ objections if a patient poses danger concentrates significant power. What mechanisms will ensure oversight and fairness and prevent misuse?

When it comes to definition and monitoring, “not reasonably practicable” and “unreasonable delay” are subjective terms that could limit meaningful consultations. The Minister hinted in the debate on the previous clause that this will be set out in the code. I assume that is the case, but will he clarify? On supporting patients without nominated persons, how will the system protect those who have no one to nominate or whose nominated person is unavailable or unwilling? Ultimately, the success of these reforms will depend on clear guidance, robust safeguards, staff training and ongoing evaluation.

Schedule 2, which does the heavy lifting in the legislation, introduces the concept of the nominated persons within the framework of the Bill alongside the related clauses 24 to 28. That is a significant development in ensuring that patients have a meaningful voice. There is clear intent behind schedule 2 to empower patients by enabling them to appoint a nominated person—a trusted individual who can support them during the treatment journey.

The schedule offers a balanced framework for appointment, termination and resignation of nominated persons, with safeguards built in to protect patients from inappropriate appointments or actions that could harm their welfare. I appreciate the inclusion of the court oversight allowing for termination orders if a nominated person acts contrary to the patient’s best interest or public safety. The schedule also sets out the criteria for eligibility, age requirements and procedural safeguards, such as the need for written instruments witnessed by professionals, and offers appropriate safeguards, checks and balances.

However, as with any framework seeking to balance patients’ rights, professional oversight and public safety, there are challenges and potential areas for refinement. One concern I have is about ensuring that patients fully understand the role of and implications of appointing a nominated person. The schedule requires that the appointment is witnessed by health or care professionals, but we must also ensure that adequate information and support are provided to patients, so that the appointment is truly informed and, most importantly, voluntary. Clear guidance and training for both patients and professionals will be essential to avoid confusion or misuse.

Furthermore, the power of approved mental health professionals to appoint a nominated person where the patient lacks capacity, while necessary, must be exercised with transparency and in close consultation with family or carers whenever possible. That could be supported by robust review mechanisms to prevent any potential conflicts of interest or erosion of patient autonomy over time. Could the Government confirm that that will be the case?

Finally, the grounds for the termination of an appointment, including objections to applications for treatment or community treatment orders, are necessarily broad. While that protects patients and public safety, there is a risk that disputes over treatment decisions could lead to instability in the nominated person role, which may ultimately unsettle the patient’s support network. It will be important to monitor how these provisions are applied in practice, and to ensure that the process is not misused to remove legitimate advocates.

Government amendments 40 and 41, which would amend schedule 2, relate to the appointment of a nominated person for children and young people under the Bill. The amendments may appear technical on the surface, but they touch on something fundamental: how we recognise and uphold parental responsibility in the care and treatment of children detained under the Mental Health Act. The first amendment makes it clear that where no local authority holds parental responsibility and there are others who do—whether parents, guardians or specialist guardians—and who are willing to act, an approved mental health professional must appoint one of them as a nominated person. The second amendment is a consequential change to reflect the revised structure.

In effect, that removes any ambiguity around whether someone with parental responsibility can be passed over simply because a child arrangement order or special guardianship order is in place. It strengthens the voice of those who are legally, and often emotionally, central to the child’s life, and who in many cases will be best placed to advocate for their rights and best interests during a period of detention and treatment. I welcome the intention behind the amendment. It places proper weight on the legal significance of parental responsibility and avoids an overly discretionary or arbitrary approach to who gets appointed to this critical role.

I will be grateful if the Minister can clarify a point about the two amendments. Amendment 40 would narrow the discretion of the approved mental health professional—where multiple people have parental responsibility and are willing to act, one must be chosen—but in cases where there are safeguarding concerns, perhaps where family breakdown or allegations of harm are involved, what safeguards exist to ensure that the appointed person will act in the best interests of the child? We must, of course, protect children from being placed in the care of someone whose involvement might undermine their safety or wellbeing, even if that person holds responsibility in law. It would be helpful to hear whether the statutory guidance will support professionals in navigating such complexities. The success of this provision will rest not only on the strength of the law but on the clarity in practice.

Amendments 54 and 55, which also relate to the schedule, would require the nominated person for a patient under the age of 16 to have parental responsibility. The amendments aim to insert a clear statutory safeguard that only individuals who hold parental responsibility can be nominated to serve in the vital role for a child patient. This is a well-intentioned and important proposal and I want to engage with it in good faith, because it is not a trivial issue. It cuts to the heart of how we protect our children while also respecting their rights and agency, and diverse family situations.

The Bill already makes significant reforms to the nearest relative system, replacing it with a person-centred, flexible approach based on the idea of a nominated person chosen by a patient or appointed by an approved mental health professional. Under schedule 2, children under 16 can nominate a person to act on their behalf as long as that person is over 18. AMHPs may also appoint a nominated person when one is not nominated, using a hierarchy that considers parental responsibility but does not require it.

Amendments 54 and 55 would alter the balance by stipulating that in all cases involving patients under 16, the nominated person must have responsibility. That would, in effect, significantly narrow the pool of eligible nominees. I understand the rationale for that: by legal definition, children under 16 are minors. Their capacity to make decisions about their healthcare is rightly subject to additional safeguards. The nominated person who has access to personal information can object to the treatment or detention and can challenge decisions. They wield serious influence.

Gregory Stafford (Conservative, Farnham and Bordon)

I thank my hon. Friend for his comprehensive analysis of the provisions under discussion. Does he understand amendments 54 and 55 to mean that, although there would be a narrowing of who can be chosen as the nominated person, there would still be some flexibility for the child to choose? Does he have any concerns about a situation in which a minor—someone under the age of 16—may, for whatever reason, choose somebody who the health professionals believe is not the most appropriate person, and does he have any sympathy with the idea that, given a parent has responsibility for the child in every other aspect of their life, the parent should have that same responsibility in this context?

Luke Evans (Conservative, Hinckley and Bosworth)

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

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

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

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

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

This is a sensitive and difficult area, but it really matters. The proposed amendment raises a real and pressing concern that we must not let vulnerable children be led astray under the guise of autonomy. We must also ensure that we do not write out the agencies of those who have legitimate reasons not to trust those with responsibilities, so I look forward to hearing from the Minister.

Finally, and briefly, I would like to address Lib Dem amendment 49, which seeks to expand the duties of independent mental health advocates under section 130B of the Mental Health Act. This amendment would introduce two important additional responsibilities: to support the patient’s carer and family in preparing for discharge, and to support the patient in accessing help with social and financial stresses that might otherwise contribute to relapse or re-detention.

At its core, amendment 49 is clearly about prevention. We know that discharge is not an endpoint but a transition, and too often the transition is undermined by poverty, housing instability or overwhelmed family carers who receive little support. These added duties would help independent mental health advocates to bridge the gap between meeting clinical recovery and real-world stability. They also recognise that mental health is social, not just medical.

However, I invite the Lib Dem spokesperson, the hon. Member for Winchester, to answer some questions. First, will the role expansion be backed by additional resources or training for IMHAs, and if so, what is the proposed plan for that? Secondly, does this already cross the remits of, for example, care co-ordinators or social workers? How do we ensure clarity of roles in the multidisciplinary team? Could existing codes of practice simply be strengthened to reflect these aims without requiring legislative support? None the less, the Opposition are pleased to engage with the Government on this issue. We think that the clauses broadly go in the right direction in dealing with patient welfare. The question really revolves around ensuring that children are protected.

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

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

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

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

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

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

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

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

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

Those wishes were not taken into account.

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

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

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

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

Gregory Stafford (Conservative, Farnham and Bordon)

I appreciate that the hon. Gentleman sees the potential benefit in the amendments standing in the name of my hon. Friend the Member for Runnymede and Weybridge. However, my hon. Friend the Member for Hinckley and Bosworth gave an example, which I do not think is entirely distanced from reality or possibility, in which a person could well choose someone who is deeply inappropriate. In that situation, the person or people—that is, the parents—who had in every other part of life had responsibility for that child would now potentially not have responsibility for the child, in what is probably the most important part of that responsibility.

Does the hon. Member for Southend West and Leigh really not have any concerns about that? If he does, does he not support at least the intentions behind those two amendments, if not the exact wording or drafting? If he does accept those intentions, would he like to see the Government table similar amendments, drafted in a way that he would find more appropriate?

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

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

Danny Chambers (Liberal Democrat, Winchester)

Amendment 49 extends the support offered by mental health advocates to cover social and financial stresses and to family carers and other members of the household when the patient is discharged.

Other hon. Members have today discussed how social and financial struggles can play a major role in someone’s mental ill health and in blocking their recovery, and how those are often the areas where someone can most benefit from advocacy and advice. As we are all aware, patients should not be viewed as a collection of symptoms, but within their whole context, including the situation they are living in. Addressing someone’s housing insecurity, debt or family breakdown should not be viewed as a separate consideration, but as a core part of supporting them to live happily, healthily and independently. Furthermore, family carers and the wider household are absolutely critical for people’s wellbeing and recovery, and should be properly equipped to prepare for their loved one returning from hospital. They, too, may need advocacy and may be missing out on support that they can and should receive.

A good example comes from Winchester, where Winchester Citizens Advice has a member of staff—a former mental health nurse—based at Melbury Lodge in-patient mental health unit. Often, someone may be admitted for two, three or four months, and when they are discharged, they go home to all their life admin—there will be final demands for credit cards or requirements to repay personal independence payments and that type of thing. It is very overwhelming, particularly for those who already have fragile mental health, to have to sort out a whole backload of administration—especially financial and complicated administration. For two days a week, that staff member supports in-patients in sorting out all their administration from anything that needs to be done.

What is interesting is that when these patients are discharged from Melbury Lodge in Winchester, if they have had that help, they end up being hospitalised and on medication for a shorter time. They are also more likely to engage with various support and community services once they have been discharged and are much less likely to be readmitted to hospital. For every £1 spent on that initiative, £14.08 is saved in cost avoidance. That initiative run by Melbury Lodge and Winchester Citizens Advice was up for an NHS award last year. It is a proven concept and something that should be done across the entire country. It has been running for two years and has proved how much money can be saved. Unfortunately, it was a pilot project and is struggling to secure money to continue indefinitely. I urge the Government to look at how that type of initiative could be rolled out around the whole country.

Sojan Joseph (Labour, Ashford)

The hon. Member is making a very valid point that all patients need help with their finance and accommodation to keep them in the community and make discharge more appropriate. However, those provisions are already in place as part of the patient’s care plan. Different hospitals have different settings, such as a discharge or enablement team, or even the nurses on the ward itself can help and look into those provisions. Does the hon. Member think that that is the role for independent mental health advocates, who prioritise detention and the Mental Health Act, rather than the finance and accommodation issues, which need to be resolved by a different team?

Danny Chambers (Liberal Democrat, Winchester)

I accept that point. It is a very sensible point. There has been a huge amount of discussion about what is in scope. Given that this is focused primarily on both current in-patients and preventing readmittance to an in-patient unit, I think it is within scope. I am aware that a lot of staff support patients, but it is not a core part of their role. It is something they squeeze in among all their other duties. When we have the expertise of someone at citizens advice, who knows how to navigate the huge complexity of various organisations and businesses that have to be dealt with, it is a lot more efficient. The figures speak for themselves.

Luke Evans (Conservative, Hinckley and Bosworth)

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

Desmond Swayne (Conservative, New Forest West)

Order. We have strayed on to amendment 49, which is a separate debate. Can we come back to the amendments before us?

Danny Chambers (Liberal Democrat, Winchester)

My apologies, Sir Desmond. I thought amendment 49 was included in the debate on clause 24.

Rosie Wrighting (Labour, Kettering)

I rise to speak to clauses 24 to 28 and the Government amendments to them. They cover an important and long overdue reform, which introduces a new statutory role: the nominated person, replacing the outdated concept of the nearest relative. I think, cross party, we all agree that this is about protecting some of the most vulnerable people in society and children.

The clauses and amendments make important changes to the current Act, which too often forces an individual to rely on someone they may not trust or even have contact with, just because of their family relationship. As the Minister said, the White Paper found that the vast majority would choose their parents, but we must have legislation that reflects the diversity of society and families. Growing up in a single parent family, it would have been inappropriate for my other parent—who is one of my nearest relatives, but who I did not live with, know or particularly trust—to be my representative or make decisions on my treatment and care. In my upbringing, the people who knew me best were not always my closest blood relatives.

The nominated person model gives individuals the right to decide who should speak for them when they are at their most vulnerable. That might seem like a small change, but it is a powerful one and aligns with the Bill’s overall goal of placing patient voices at the heart of mental healthcare. Having someone a person trusts—someone who knows them and can advocate for them—is vital. I was contacted by a constituent whose brother was sectioned and assessed at hospital as needing ongoing support in sheltered accommodation. His social worker challenged the decision and recommended private accommodation. That confusion, despite his sister continually challenging the recommendation, meant he was discharged, with nowhere to go, in the middle of the night.

It is crucial that safeguards will remain. Where an individual cannot nominate someone themselves, a person can still be appointed on their behalf, but with far clearer guidelines and recourse if concerns arise. It is not about removing protection; it is about modernising it to reflect the society we represent. Mental health legislation must reflect the value and diversity of the society it serves, and the clauses and amendments before us bring us a step closer to that.

Aphra Brandreth (Conservative, Chester South and Eddisbury)

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

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

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

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

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

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

Gregory Stafford (Conservative, Farnham and Bordon)

My hon. Friend makes a powerful point. I remember the comments made by the hon. Member for Southend West and Leigh, who is chuntering from a sedentary position—I think he disagrees with my hon. Friend’s point. In his reply to my intervention, he made the point that there are situations in which things are the other way round, where those who have parental responsibility are not necessarily the appropriate persons.

Does my hon. Friend agree that, on first principles, the parent should have parental responsibility in all areas of life, including the ones that she is talking about, unless there are specific reasons, such as the court decision to which she referred, that suggest that the parent is not the correct person to have responsibility? Surely, in the balance of danger or risk, there is a far greater risk if the nominated person is not a parent than if the nominated person is a parent.

Aphra Brandreth (Conservative, Chester South and Eddisbury)

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

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

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

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

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

It is a pleasure to serve under your chairmanship, Sir Desmond. I am grateful for the opportunity to speak to amendments 54 and 55, which propose that where a nominated person is appointed to represent the interests of a patient under the age of 16, that individual must hold parental responsibility. At face value, that is a concise and apparently straightforward proposal. However, as with much in the Bill and in our mental health legislation more broadly, what appears simple can raise intricate legal and ethical questions. I therefore wish to probe both the merits and the challenges of these amendments. I do so not to come down firmly on one side of the argument or the other, but in the hope of assisting the Committee to think through the implications of the amendments. I hope to prompt the Minister to provide further clarification as our consideration of the Bill proceeds.

I will start by setting out the case in favour of the amendments. There is an intuitive and, I would argue, legally grounded rationale behind amendment 54. It rests on the principle that serious decisions concerning a child’s mental health—decisions that might involve treatment without consent, or even deprivation of liberty—ought to be taken, or at least overseen, by somebody who already holds recognised legal responsibility for that child.

Parental responsibility is not merely administrative. It carries statutory and common-law duties to protect, support and advocate for a child’s welfare. By requiring the nominated person to have such responsibilities, the amendment seeks to ensure a level of legal legitimacy and continuity. It would strengthen the position of those with a formal bond to the child and might help to guard against the risk of unsuitable or ill-informed individuals stepping in to play such a critical role.

In that sense, amendment 54 reflects what many would see as good legal hygiene. It would bring new legislation into closer alignment with the Children Act 1989 and with broader child welfare practice. It would create a baseline expectation that only those with legal authority over a child should make, or help to make, decisions of such magnitude. It would also offer reassurances to families. For parents and guardians already concerned about the complex and sometimes opaque processes of mental health detention, the amendment offers a clear signal that their role cannot be set aside lightly. That reassurance may be particularly important when children are subject to long-term care or involuntary treatment. However, questions begin to surface at precisely that point, because although the principle appears sound, the practice is far from straightforward. It is therefore important that we probe both the advantages and disadvantages of the amendment.

First, I ask the Minister how the Department envisages the requirement working in cases in which the child is not in the care of somebody with parental responsibility. That is not a hypothetical scenario. Many children, especially those receiving mental health treatment, are in informal care arrangements. Grandparents, older siblings or long-term foster carers may play a daily, dedicated role in the child’s life without holding formal parental status. Does the Minister consider that they would be automatically excluded under the amendment? If so, what provision would be made to prevent disruption to continuity of care, particularly where the child has built a strong relationship of trust with a non-parental caregiver?

Secondly, there are safeguarding contexts to consider. In some cases, the individual who holds parental responsibility may in fact be the person from whom the child needs protection. We know that mental health difficulties among children are disproportionately common among those who have suffered abuse or neglect. I ask the Minister whether the amendment would place an undue burden on professionals to override the default position in safeguarding cases. Would it potentially delay or complicate the appointment of a nominated person who is actually in the child’s best interests?

A third point concerns the voice of the child. Our legal system recognises, through the Gillick competence test, that some children under 16 have the capacity to make informed decisions about their care. In such cases, a child may express a clear preference for who should advocate on their behalf, and yet, under the amendment, that preference could be overridden—not because the individual is unsuitable necessarily, but because they lack legal parental status. I ask the Minister what assessment has been made as to how the amendment would interact with a Gillick competent child’s right to be heard. Would it remove a degree of autonomy from children who are, in law, capable of forming and expressing valid preferences?

Fourthly, there is the matter of delay. Parental responsibility is a formal legal status. Acquiring it where it does not already exist can take time, but the decisions covered by this legislation are often urgent. Would there be a mechanism to appoint an interim nominated person while legal responsibility is conferred, or would the process be held up in the meantime? From a service delivery point of view, that could introduce delay, confusion and fragmentation at precisely the moment when a child most needs stability and clarity.

Finally, there is the wider issue of proportionality. The amendment introduces a hard rule in an area that has previously been guided by principles and professional judgment. There is nothing inherently wrong with that. It provides statutory clarity, which has an important place, but it raises the question whether the amendment introduces rigidity where flexibility may be more appropriate.

I ask the Minister what assessment has been made of the number of cases in which this amendment would prevent the appointment of a trusted and competent adult without parental responsibility. Is there evidence that the existing framework has caused harm or confusion that justifies a statutory intervention? I pose none of these questions purely for the purposes of rhetoric. They are asked in good faith and in a spirit of constructive scrutiny, because the role of the nominated person is not a mere formality; it touches at the very heart of the legislation’s protective architecture.

If we get this right, we will strengthen the rights of the child, the role of families and the legitimacy of mental health interventions; if we get it wrong, we will risk introducing legal friction, professional uncertainty and, worse than that, barriers to the compassionate child-centred care that the Bill is supposed to guarantee. These amendments reflect an important concern to ensure that those representing children in mental health settings do so from a position of legal authority. That must be balanced against the diversity of family arrangements, the voice of the child and the need of practical workability.

I am minded to support the amendments, but I urge the Minister and all members of the Committee to reflect carefully on the questions that I have raised and consider whether the amendments, as currently framed, strike the right balance where legal formality and humane flexibility are required. If they do not, I encourage the Minister to set out how he can work with my hon. Friend the Member for Runnymede and Weybridge to ensure that the legislation reflects the complex issues he has raised.

We all want a robust system that protects children and supports those who care for them. The task before us is to ensure that the Bill advances those aims rather than inadvertently obstructing them. I make these remarks with the intention of being constructive. If the Government are minded not to support the amendments, I ask for some clarity on how they will work with my hon. Friend to reflect his genuine and heartfelt concerns.

Carolyn Harris (Labour, Neath and Swansea East)

As it is quite warm, any hon. Member who wishes to remove their jacket may do so.

Carolyn Harris (Labour, Neath and Swansea East)

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

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

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

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

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

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

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

Government amendments 40 and 41.

Schedule 2 stand part.

Clauses 25 to 28 stand part.

Gregory Stafford (Conservative, Farnham and Bordon)

It is a pleasure to serve under your chairmanship, Mrs Harris. I rise to speak in support of clauses 24 to 28, schedule 2, and the vital amendments 54 and 55 in the name of my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer). Together, those provisions form a crucial pillar of the Bill, which must modernise our framework for the 21st century while not forgetting one of the oldest truths in our social contract: that parents, not the state, bear the first and deepest duty to protect their children.

The Bill will reform an Act that has stood in various forms since 1983, and which was itself built on a much older legacy of how this country balances individual liberty with the need, in rare cases, to deprive someone of that liberty for the sake of that person’s safety, or the safety of others. For decades, that balancing act has been shaped by the so-called “nearest relative” rule. However well intentioned that rule was, it has often failed to serve the people it is meant to protect. Patients have found themselves legally represented by estranged parents, distant cousins or an ex-spouse with whom they have had no contact for years. In the worst cases, that has compounded trauma and undermined recovery. Clause 24 will address that problem by giving patients the power to appoint a “nominated person” of their choosing: someone whom they trust, who understands their needs, and who can speak up when they themselves cannot. That is, quite simply, the right approach for modern mental health care. It is grounded in autonomy, and respect for the individual’s right to shape their own care and safeguard their own dignity.

Good principles must be matched by good machinery. That is why schedule 2 is not a mere administrative detail, but the backbone of this reform. It sets out, step by step, how a nomination is made, who may be nominated, how conflicts are avoided, and how mistakes are corrected. Under part 1 of schedule 2, a patient must make the appointment in writing. It must be signed and witnessed by

“a health or care professional or independent mental health advocate”.

That is a safeguard against casual or coerced choices. The nominated person must themselves consent: they are not a passive bystander but an active participant. If the relationship breaks down, the patient may revoke the nomination, or the nominated person may resign. Crucially, the county court may step in to remove or bar a nominated person if that person acts unreasonably, abuses their power, or is clearly unsuitable.

Part 2 of proposed new schedule A1 to the Mental Health Act 1983, inserted by schedule 2 to the Bill, addresses an issue that we must take seriously: capacity. Not every patient will have the capacity to make the appointment at the moment it matters most. The proposed new schedule therefore provides a fall-back system. A court may appoint a nominated person on the patient’s behalf, or a default can be determined under criteria set by regulation. The court again retains ultimate oversight to resolve disputes or replace a default, if the circumstances require it. It is thoughtful, practical and rights-based lawmaking, and I commend the drafters for getting the balance broadly right.

Clauses 25 to 28 will give the nominated person real power. They are not a figurehead. Clause 25 demands that professionals consult the nominated person before applying for detention or guardianship. If the nominated person objects, the professional must provide a report showing why detention is none the less necessary, with a clear risk-based justification. The nominated person can then challenge that decision. Clause 26 shortens the duration of the bar on discharge requests from six months to three. If a nominated person believes that the person no longer needs to be detained, they can press for release sooner and more effectively than before.

Jennifer Craft (Labour, Thurrock)

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

Gregory Stafford (Conservative, Farnham and Bordon)

I thank the hon. Lady for her point, but I shall continue in the same vein unless I am told to do otherwise.

Clause 27 will ensure that when community treatment orders are considered, with all the restrictions they bring, the nominated person’s voice must be heard and an objection must be properly countered with evidence. Clause 28 addresses hospital transfers, recognising that being moved to another hospital can uproot fragile support networks and compound distress. By embedding a consultation duty here, too, the Bill will make it harder for patients to be moved arbitrarily or without explanation.

In summary, the clauses and the schedule empower patients, embed transparency and build trust, but they do so through a lens rightly focused on adults—capable, consenting adults who make choices freely. That brings me to my fundamental point: we must be absolutely certain that this approach will not inadvertently erode a bedrock of child protection: that a parent is the default legal protector for their child. For an adult, autonomy means freedom of choice, but for a child, especially one under 16, autonomy must never mean being left alone to navigate a labyrinth of legal forms and healthcare powers without the protection of a parent. That is why I strongly support amendments 54 and 55, which would ensure that for under-16s, parents remain the lawful decision makers and the first safeguard for their child’s welfare.

Let us imagine for a moment a vulnerable 14-year-old who, in the confusion and fear of a psychiatric admission, is persuaded by a well-meaning adult—or, worse, someone with a hidden agenda—to appoint them as the nominated person. That child may be separated from their parents—the very people who know the child best and have a legal duty to care for them—while an outsider gains rights to object to treatment or discharge decisions. Once that nomination is made and witnessed, it carries weight in law and could marginalise the very people who brought that child into the world and have a moral and legal duty to protect them.

This is not just theoretical. We know from real cases in family courts that unscrupulous individuals can exploit vulnerable young people. The risk that the new system could unintentionally open the door to manipulation must be taken seriously. Let us not be naive about how exploitation works: groomers, traffickers and abusers thrive in grey areas of the law; they will find loopholes and drive a coach and horses through them. If we do not make it crystal clear that no child under 16 can override parental responsibility without a court’s explicit order, we risk creating an invitation for abuse.

Can the Minister assure the Committee that no child under 16 will be permitted to override parental responsibility simply by nominating someone else without a full and proper process? Schedule 2 does include fall-back arrangements and eligibility checks, and those are welcome, but unless the law is explicit that only a court can displace a parent’s right to act for their child, those safeguards are not watertight.

Amendment 54 addresses a related area, the notification of incidents. It would require the Secretary of State to review whether the law should be strengthened so that all admissions of children and young people for mental health treatment trigger mandatory incident reporting, and whether the timeframes for that reporting are still appropriate. It would require the Secretary of State to review whether incident reporting requirements are robust enough for all under-18s in mental health settings. Are all incidents of restraint, seclusion, injury or absconding being reported promptly and comprehensively? If not, what must change?

We have seen far too many tragic cases in which harm or abuse in children’s mental health units came to light only after a scandal broke, because the system did not catch it in time. Proper oversight is not an optional extra; it is essential for the trust of families. In my view, a review alone is not enough, so I urge to the Minister to confirm that, if the review finds gaps, the Government will legislate swiftly to close them. In the meantime, what interim steps will be taken to ensure that no child is left unprotected?

Amendment 55 is the final safeguard in this suite of amendments. It would allow the Secretary of State to make consequential amendments to other laws to implement the Bill cleanly. That is good housekeeping, but it must not become a blank cheque. When it comes to parental rights or child safeguarding, no technical tweak should be done behind closed doors by negative procedure; Parliament must approve it in full daylight, on the record. Will the Minister confirm without ambiguity that any consequential amendment that touches on parental powers or child protections will come before both Houses under the affirmative procedure?

To illustrate things in the starkest terms, let me paint one more scenario for this Committee. A 15-year-old girl, already vulnerable, is detained following a self-harm incident. Her parents, distressed but committed, wish to be involved in her care plan and discharge, but in her fragile mental state the child is persuaded by an older friend—perhaps well-meaning, perhaps not—to nominate them instead. That friend, now a legally recognised nominated person, blocks discharge, disagrees with treatment and excludes the parents from updates. The clinicians are caught in a legal tangle. The child is caught in the middle, and the parents must fight in court to reclaim their rightful role. As I said before, that is not a theory; it is the sort of real-life pitfall that sloppy drafting can enable. If we see it coming and fail to stop it, we will have failed as legislators.

I wish to be clear that I support clauses 24 to 28 and schedule 2 because they modernise mental health law for adults in a way that is respectful and empowering. I support amendment 54, because it would strengthen transparency and accountability where children’s lives and safety are at stake. I support amendment 55, because it would keep our statute book coherent, but it must never be misused to erode rights by stealth. Above all, I support the amendments because they ensure that the new nominated person system does not inadvertently weaken the oldest and strongest protection we have, which is the legal responsibility of parents to care for their own child.

I urge this Committee to adopt the clauses, the schedule and amendments 54 and 55 as essential guardrails to ensure that what we pass here is not just legally sound, but morally right. Let us modernise this law and strengthen patient voice, but let us never allow a child to lose their parents’ protection by accident or bureaucratic slip. Let us be in no doubt: when the state removes or limits parental rights, it must do so under the strictest scrutiny of a court of law, with evidence tested and the child’s welfare paramount. A signed piece of paper at a bedside should never be enough. That is the dividing line between a humane, modern health system and one that risks creating new injustices in the name of progress.

I ask the Minister again: will the Government enshrine in this Bill or elsewhere that parents are the legal representatives for under-16s unless a court directs otherwise? Will he guarantee rigorous checks to prevent the manipulation of young minds at their most vulnerable? Will he commit that any necessary changes found by the incident review under amendment 54 would be acted on without delay? I commend this package of reforms to the Committee, and I trust that the Government will listen carefully to these warnings and act to make the legislation watertight.

Stephen Kinnock (Labour, Aberafan Maesteg)

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

Carolyn Harris (Labour, Neath and Swansea East)

I have seen you dance.

Stephen Kinnock (Labour, Aberafan Maesteg)

I have no comment on that, and we are not going to divide on it either.

Let me address the questions raised in this morning’s debate. First, I was asked how disputes will be resolved when the nominated person and clinicians disagree. Where a specific nominated person, power or right is being used, the nominated person’s decision applies, because these are statutory powers and rights under the Mental Health Act. However, clinicians will have discretion and can overrule a nominated person’s decision, if there is a danger to the patient or others. That will be clarified in the code.

Secondly, I was asked how we will ensure that nominated persons are aware of their powers. In addition to the broader training and familiarisation required alongside the reforms for clinicians, the statutory forms used to appoint a nominated person will set out that the witness should explain the role of the nominated person and make sure that the nominated person and patient understand the powers and requirements of the role. I think my hon. Friend the Member for Southend West and Leigh raised that point, too.

Thirdly, I was asked whether there is a mechanism to appoint an interim nominated person, and yes, there is. The interim nominated person is the nominated person appointed by an approved mental health professional when a person lacks the competence or capacity to appoint their own nominated person. While the legislation does not refer to the term “interim nominated person”, that in practice is what they are.

A lot of the discussion today has focused on how the provision will apply to children and young people. I understand the concerns raised and the importance of getting this right. In summary, we object to amendments 54 and 55, which would require nominated persons for patients under 16 to have parental responsibility for the child, whether chosen by the child or appointed for them, on the basis that children with the relevant competence should have the ability to choose their own nominated person. That is in line with the recommendations of the independent review, and in keeping with the principles of choice and autonomy and treating the person as an individual. We have put safeguards in place to ensure that their selection is appropriate and to remove anyone who does not exercise those powers in the best interests of the child.

Anna Dixon (Labour, Shipley)

Can the Minister assure us that there are powers in schedule 2 for the removal of a nominated person? One of the grounds is that any person engaged in caring for the patient or interested in the patient’s welfare may raise concerns—for example, a parent or other unpaid carer who has information that the nominated person is not acting in the best interests of the patient.

Stephen Kinnock (Labour, Aberafan Maesteg)

I can assure my hon. Friend on that. We have safeguards in place both to ensure that the selection is appropriate in the first place and that, if there are behaviours that indicate that the person is not right for the task, they will be removed and their powers taken away.

Luke Evans (Conservative, Hinckley and Bosworth)

Can the Minister clarify where these powers are and what they look like? For example, if a 15-year-old decides to appoint someone who is 23—maybe a boyfriend, maybe not—the problem is that once they make that nomination, we are waiting for something to happen. The idea behind the clauses we have been debating, and the use of exceptional circumstances to try to solve this problem, is to ensure that we prevent any problem from happening in the first place. That is the bit I am not clear on. I thought that Government amendments 40 and 41 were possibly intended to address that point, but my worry is that once the person is chosen, we do not know how they will behave. The whole idea is to give parental responsibility first. Could the Minister address where this is in the Bill, or what it looks like in the code? This is the critical bit to get right for children.

Stephen Kinnock (Labour, Aberafan Maesteg)

My understanding is that it is in schedule 2.

Luke Evans (Conservative, Hinckley and Bosworth)

I would be grateful if the Minister pointed it out.

Stephen Kinnock (Labour, Aberafan Maesteg)

With all due respect to the hon. Gentleman, I am not going to spend time shuffling my papers around. If he cares to look at schedule 2, I think he will find it there.

Government amendments 40 and 41 have been tabled because we believe that it is not necessary to specify in legislation which person the parental responsibility the approved mental health professional must appoint as nominated person for an under-16-year-old. We have committed to clarify this in the code of practice. We have committed to establishing an expert taskforce to support the development of a statutory code of practice to provide clear guidance for professionals involved in the nominated person appointment process.

The fourth question was whether we need parental responsibility by default. The current nearest relative provision assigns an automatic relative according to a hierarchical list, which does not reflect modern family structures. For instance, step-parents and parents who live abroad are not included. That can mean that children and young people may have a nearest relative who can make decisions about their care but who may not know the child well or engage with the role, or who could even be a risk to them. Without formal care proceedings, the child would be left to be represented by a relative who will not act in their best interests.

Fifthly, questions were raised about how to ensure that young patients are not isolated from family support if needed. Engagement with children and young people suggests that they are most likely to appoint their parent as a nominated person. If they appoint someone who is not their parent, then parents could still be involved in their care and treatment where appropriate. Safeguards are in place to allow for the overruling and displacement of the nominated person if they are behaving in a way that is not in the child or young person’s best interests.

Similarly, where a child is under a care order and parental responsibility sits primarily with the local authority, the local authority will retain its parental responsibility for the child even if the child chooses a nominated person who is not the local authority. The code of practice will provide guidance on how practitioners should include those with parental responsibility and care in key processes and decisions.

Sixthly, in cases where there are safeguarding concerns, what safeguards exist to ensure that the nominated person acts in the best interests of the child? The witness will determine whether the child’s nomination is suitable. Clinicians will also have the power to overrule decisions made by a nominated person if they think there is a danger to the patient or to others. The patient, an approved mental health professional, parents and anyone with an interest in the child’s welfare can apply to the court to displace the nominated person if they think they are behaving in a way that is not in the child’s best interests.

Finally, there was a question about how we will ensure that there is no coercion, including in the example involving an older partner. We will provide guidance to the witness on how to check that no coercion has taken place, as well as wider suitability criteria. A nominated person cannot be appointed if coercion or undue pressure has taken place. We intend to state in the code, subject to consultation, that an advocate should be involved early on to provide support to the child or young person throughout the nomination process. Advocates could work with witnesses to ensure that they have the relevant information about the child to make an informed appointment.

I hope that hon. Members are satisfied with those answers and will not press their amendments. I commend Government amendments 40 and 41, clauses 24 to 28 and schedule 2 to the Committee.

Schedule 2 - Nominated persons

Danny Chambers (Liberal Democrat, Winchester)

I beg to move amendment 49, in schedule 2, page 87, line 13, at end insert—

“(18A) In section 130B (arrangements in relation to independent mental advocates: England), after subsection (3)(d), insert—

‘(e) support the patient’s carer and family members to prepare for the patient’s discharge from hospital treatment, and

(f) support the patient to access help with social and financial stressors that might otherwise increase their likelihood of future detention.’”

This amendment extends the support offered by Mental Health advocates to cover social and financial stressors and support for family carers and other members of the household when the patient is discharged.

It is an honour to serve under your chairmanship, Mrs Harris. I jumped the gun this morning, so I have already spoken in detail about the amazing initiative at Melbury Lodge with Winchester Citizens Advice. I will not bore the Committee with the details again, except to say that it is a brilliant example not only of delivering really good care for patients, but of a really good cost-effective intervention for the taxpayer. If it is not appropriate for it to be set out in secondary or primary legislation, will the Minister consider a meeting with me, Melbury Lodge and Winchester Citizens Advice to discuss how this type of initiative could be rolled out across the country?

Aphra Brandreth (Conservative, Chester South and Eddisbury)

It is a pleasure to serve under your chairmanship, Mrs Harris. I rise to make some brief comments on amendment 49.

I am sympathetic to aims of the hon. Member for Winchester in tabling the amendment. A patient who is being discharged from hospital may indeed require specific, targeted support. The overall success of their treatment and continued recovery can be greatly enhanced where the right structures are in place to support them in the community. The amendment rightly draws attention to social and financial stressors that may affect an individual at the point of discharge and in the weeks and months that follow. We all recognise that there is a pressing need for a more joined-up approach between in-patient services and community provision. Without that, we risk patients falling through the cracks and suffering unnecessary and distressing re-admissions. Better discharge planning must be at the heart of our efforts.

I have some concerns, however. Although I acknowledge the good intentions behind the amendment, it risks expanding the remit of independent mental health advocates beyond what might be appropriate. There is a delicate balance, but an important distinction, between advocacy and care co-ordination. Independent mental health advocates play a vital role, and it is essential that their independence and clarity of purpose be preserved. If we are not careful, we risk blurring that boundary. In doing so, we may undermine the very effectiveness of the independent mental health advocate in fulfilling their primary function.

The role of an IMHA is to support patients in understanding and exercising their rights under the Mental Health Act. They may already be involved in supporting an individual to prepare for discharge, including by contributing to plans for ongoing care and support. The amendment would significantly increase the breadth of that role and might shift the focus away from the core purpose of advocacy.

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

My hon. Friend makes a pressing point. Does she agree that if the amendment is accepted, there will be a requirement for additional training to deal with financial and social support, which goes outside the current scope of these important advocates?

Aphra Brandreth (Conservative, Chester South and Eddisbury)

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

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

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

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

Gregory Stafford (Conservative, Farnham and Bordon)

I do not know whether the hon. Member for Winchester will press his amendment to a vote, but if he does, would my hon. Friend support the idea of having a pilot roll-out of the system before we go the whole hog, because of all the potential problems that she has highlighted?

Aphra Brandreth (Conservative, Chester South and Eddisbury)

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

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

Luke Evans (Conservative, Hinckley and Bosworth)

This morning, we touched on amendment 49, so I will not repeat my remarks. I will simply ask a pithy question of the hon. Member for Winchester. He rightly talked about the incredible work that his local citizens advice bureau carries out. How will the amendment blur the lines between social workers, caseworkers and the independent advocates who are already doing this work? How does he perceive that working? I worry about the complexity that it would create. I would be grateful if the hon. Member addressed that point.

Stephen Kinnock (Labour, Aberafan Maesteg)

I am grateful to the hon. Member for Winchester for bringing this issue before the Committee. The intention of his amendment is to extend the support offered by independent mental health advocates

“to cover social and financial stressors and support for family carers and other members of the household when the patient is discharged.”

It would amend paragraph 18 of schedule 2, which deals with amendments relating to nominated persons. It should more properly be inserted into schedule 3, which deals with independent mental health advocates.

The Bill will already extend the support that advocates can provide to help patients to be involved in decisions about their care and treatment, to be able to make a complaint and to be provided with information about other available services. Those other services could include support following discharge from statutory or voluntary organisations, which may cover social and financial issues, and help to support carers. Those organisations would be better placed to support patients with these specific needs, rather than independent mental health advocates, whose skillset is specific to supporting patients to understand their rights under the Mental Health Act and participate in decisions about their care and treatment. We will consult on guidance in the code of practice to help independent mental health advocates to understand their extended role.

In addition to policy regarding independent mental health advocacy, advance choice documents give individuals the chance to give instructions about practical aspects of their life. Examples of such aspects include domestic, financial or caring responsibilities, such as children or pets. This provision allows the individual to be looked after when unwell and aims to ease additional anxieties. For those reasons, I ask the hon. Member for Winchester to withdraw his amendment.

Danny Chambers (Liberal Democrat, Winchester)

I appreciate the valid points that hon. Members have made. The point about running a pilot was a sensible suggestion. We have had something that could be viewed as a pilot in Winchester for two years. We know that it works well, and every £1 spent on it saves £14.08. If I have suggested this amendment in the wrong part of the Bill through my naivety and inexperience, or if mental health advocates are not the right people to deliver a solution that we know works, may I ask the Minister whether there is a more appropriate part of the Bill in which to include it or another way to implement this proven system, such as by amending a different Bill, before I decide whether to press the amendment to a vote?

Stephen Kinnock (Labour, Aberafan Maesteg)

I thank the hon. Gentleman for that question. Fundamentally, our view is that the role that he is proposing is not the right one for an independent mental health advocate. The role of an independent mental health advocate is to work with the patient around their legal rights, rather than to deal with some of the more practical issues that he is talking about here. Our sense is that there are both statutory and voluntary organisations who are better placed to carry out that work. I do not think that a pilot would work with IMHAs, because by definition that is not the right role for IMHAs.

Danny Chambers (Liberal Democrat, Winchester)

In that case, can we have a discussion outside the Committee about how to do this?

Carolyn Harris (Labour, Neath and Swansea East)

Order. Does the hon. Gentleman wish to press the amendment?

Danny Chambers (Liberal Democrat, Winchester)

indicated assent.

Clause 29 - Detention periods

Stephen Kinnock (Labour, Aberafan Maesteg)

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

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

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

Gregory Stafford (Conservative, Farnham and Bordon)

I have some brief questions for the Minister about this important clause, which has serious implications for patient liberty and for public protection. We must ensure that decisions are clinically and legally sound. First, how will the proposed changes to initial and renewal detention periods help conditions and services and manage public risk more effectively, particularly in forensic or high-risk cases? Secondly, do longer detention periods after revocation of a community treatment order reflect a higher perceived risk, and if so, is there clear clinical evidence supporting that extension to six months? Thirdly, are we confident that the new timelines strike the right balance between protecting the public and ensuring patients are not detained longer than necessary? Finally, and as an adjunct to that, what other considerations are there in the clause or the Bill to keep the public safe and to make sure that decisions are correct in the context of clause 29?

Luke Evans (Conservative, Hinckley and Bosworth)

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

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

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

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

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

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

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

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

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

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

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

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

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

The differentiation looks justified, especially in cases in which public protection is a concern. Indeed, I support a cautious approach when it comes to public safety. However, does it not create a patchwork of timeframes, where some patients have three months, others have six months and some move between the two, depending on the time of their CTO revocation or guardianship transfers? Therefore, is there scope to put it in the checklist? That might ensure that no one falls through the gaps, while also guarding against mistakes. We must be careful not to undermine consistency or clarity for patients and clinicians alike.

Fourthly, are tribunals adequately prepared for more frequent reviews? We welcome the linked reform, which we have discussed in relation to other parts of the Bill, to increase access to mental health tribunals, including automatic referrals for those unable to initiate reviews themselves. It is a crucial safeguard for patients who may be especially vulnerable. However, as detention periods shorten, more reviews will be needed, and more often. That is good in principle, but only if the tribunal system has the capacity to respond in a timely and effective manner.

We raised those concerns on Second Reading, when we discussed numbers. I pointed out then, as I do now, that I do not want to put the Minister on the spot about specific numbers, although I have to admit that he did incredibly well last time by producing them. I want to understand how more automatic referrals, and now shorter time periods, will impact the tribunal system. Can the Minister confirm what assessment has been made of the tribunals’ resources, particularly in the health, education and social care chamber in England, and in the mental health review tribunal for Wales? Patients must not face delays or be left in limbo because the system cannot cope with the very safeguards that Parliament is rightly seeking to strengthen.

With that complexity, the changes introduced in clause 29 are legally intricate. Different rules apply to different patients, such as forensic patients, transfer guardianship patients and CTO revocations—some before six months and some after. Will the Government commit to providing clear, practical guidance to help clinicians, advocates and patients understand those new rules? A principle of least restriction must be matched by one of clear communication, so patients can exercise their rights and professionals can uphold them with confidence.

Finally, I return to the question of balancing patient rights with public protection. While our focus rightly remains on the principle of least restriction and ensuring therapeutic benefit for patients, we must be mindful of the protection of the public, which is a key objective of the Mental Health Act. Some categories of patients, particularly those under part III forensic orders, pose complex challenges in which the risk to others needs to be carefully managed alongside patients’ rights. Can the Minister explain how the Bill ensures that shorter detention and renewal periods do not inadvertently compromise public safety?

Part of the reason for suggesting including public safety consideration in the clinical checklist, as we discussed last week—in my eyes, to strengthen the system—is that we are changing the detention periods. To that end, I offer the following additional step: would the Government consider tailoring renewal periods or review frequencies based on individual risk assessments, rather than applying uniform timeframes? If there have been checklist concerns, this could be added as a simple way of flagging in the system to tailor renew periods to those specific individual risks. I am open to other suggestions about ways to do that, and to working with the Government on approaches, but it is in this House’s interest—and, more importantly, the country’s interest— to get it right. Of course, my suggestion would likely involve closer collaboration between clinicians, teams, the tribunal and criminal justice agencies for forensic patients. However, that is no bad thing.

Alternatively, the Government could consider introducing enhanced risk review panels or multidisciplinary risk assessments prior to renewal. That might provide an additional safeguard without unduly extending detention periods. Such approaches could maintain the spirit of the Bill, promoting liberty and least restriction, while recognising the legitimate need for proportionate safeguards to protect the public. I understand that my suggestions would mean resource considerations and implications. That is why we have not put them to a vote. However, I am keen that the Government consider public safety as part of the Bill’s reform.

Clause 29 makes a welcome effort to bring our mental health laws more closely in line with modern principles, particularly around liberty, autonomy and therapeutic benefit. However, the real test lies not just in the statute book but in practice. We support the principle of the clause, but we urge the Minister to work with stakeholders —including patients, clinicians, legal advocates and tribunal members—to ensure that it is not just a procedural change but a shift in how we treat those living with mental ill health.

Stephen Kinnock (Labour, Aberafan Maesteg)

The aim of the clause is to ensure that a patient’s detention is reviewed sooner. The planned reforms will not change the fundamental power and purpose of the Act, which is to detain and treat people when they are so unwell that they become a risk to themselves or others. Where a patient continues to meet the criteria, their detention will be renewed.

Opposition Members have asked about extra paperwork and workload in general for both clinicians and tribunals. In the impact assessment that we published alongside the Bill, we set out the estimated costs and benefits of the reforms and the expected workforce requirements that are critical to our implementation planning. That includes consideration of the impact on clinicians of additional detention reviews, which we have calculated is estimated to be around four hours of additional workload by the clinician for each patient who is detained beyond three months.

On the clinical evidence for shortening the detention period, in the independent review we found that in 17% of cases referred to the mental health tribunal, discharge happened in the 48 hours before the hearing, which strongly suggests that some patients are being detained for longer than is necessary.

Luke Evans (Conservative, Hinckley and Bosworth)

Could I ask the Minister—

Carolyn Harris (Labour, Neath and Swansea East)

Order. I am afraid that the Minister had sat down.

Luke Evans (Conservative, Hinckley and Bosworth)

On a point of order, Mrs Harris. The Minister had not sat down. He had said that he was finishing, but he had not sat down. There is an important point that was not addressed: the issue of resetting, which is fundamental to detention.

Carolyn Harris (Labour, Neath and Swansea East)

Minister, do you wish to answer the question?

Stephen Kinnock (Labour, Aberafan Maesteg)

I did not catch the question to which the hon. Gentleman is referring. Could he repeat it, please?

Luke Evans (Conservative, Hinckley and Bosworth)

The issue is about resetting. As the legislation is written, it would suggest that because people are moving from one place to another, the clock resets. Clinically, that could make sense, but part of the problem is that every time the clock resets, so does the person’s detention. That is a key part. Fundamentally, in this clause we are trying to stop people being detained when they do not need to be. In fact, the Minister has just said that 17% of people were discharged before the tribunal could happen. The question is around specifying, when it comes to admission and transfer, that the clock resets. What safeguards do we have to make sure that we are counting the number of times it is reset, that it is clinically appropriate and, most importantly, that we are not substituting one way of dealing with this with a back-door way of creating a reset motion?

Carolyn Harris (Labour, Neath and Swansea East)

Order. Dr Evans, this is an intervention. Can we please keep it as such?

Stephen Kinnock (Labour, Aberafan Maesteg)

I am struggling a little to understand what the hon. Gentleman is driving at. I pointed out in my opening remarks that the review clearly recommended reducing the initial detention period for people admitted for treatment from six months to three months, so that a patient’s detention is reviewed sooner to ensure patients are not detained when they are no longer benefiting from treatment and can be safely discharged. The clause means that patients detained for treatment will have their detention reviewed three times in the first year: at three, six and 12 months from the date of detention—up from two, as it was previously. I do not think that there is any implication that it is resetting the detention; it is just a rolling set of reviews.

Carolyn Harris (Labour, Neath and Swansea East)

I will not tolerate any further speaking outside the structure. It is the second time that it has happened this afternoon, and I will not tolerate it any further.

Clause 30 - Periods for tribunal applications

Carolyn Harris (Labour, Neath and Swansea East)

With this it will be convenient to discuss clauses 31 to 33 stand part.

Stephen Kinnock (Labour, Aberafan Maesteg)

Clause 30 will introduce important reforms to the tribunal process by adjusting the timeframes for when patients can apply to the tribunal regarding their detention. Section 2 patients will now have 21 days rather than the current 14 to apply. This reform addresses concerns that patients in crisis often need more time to fully understand their rights, access legal advice and make an application.

For section 3 patients and transferred guardianship patients, clause 30 will reduce the initial application period from six months to three months. This aligns the application period with the new, shorter initial detention period of three months, reduced from six months, for these patients. This change maintains the current rights for these patients to make an application once during each successive period of detention.

For conditionally discharged restricted patients, clause 30 provides different application periods. These vary depending on whether the patient has been conditionally discharged with or without conditions that amount to a deprivation of liberty. Conditionally discharged restricted patients who are subject to deprivation of liberty conditions—also known as patients on a supervised discharge—can make an application to the tribunal sooner, between six months and 12 months from the date that they become subject to said conditions, and thereafter every two years. In contrast, conditionally discharged restricted patients who are not subject to deprivation of liberty conditions will have application periods between 12 months and two years, and thereafter every two years.

The different application periods reflect the need to consider a patient’s detention more frequently and earlier where more restrictive deprivation of liberty conditions are present. These changes improve access to the tribunal, ensuring greater protection for some of society’s most vulnerable individuals.

Clause 31 will strengthen the system of automatic referrals to the tribunal for patients detained under the Mental Health Act. It ensures that patients who may not be able to make an application to the tribunal themselves are still afforded regular judicial oversight. For patients detained under section 2, this clause reduces the automatic referral period from six months to three months. This improves the current safeguard by bringing the trigger for the automatic referral sooner. This will apply when a section 2 patient’s detention has been extended beyond 28 days and no application or referral has been made to the tribunal for review of the patient’s detention.

The clause will also improve the automatic referrals for patients detained under section 3. It does this by triggering referrals on the expiry of three months and 12 months and annually thereafter, where the tribunal has not considered the patient’s case. Additionally, this clause removes the automatic referral trigger on revocation of a community treatment order. It was found in practice that the automatic referral was an ineffective safeguard, as often the patient either was back in the community and subject to a new CTO or had reverted to being a section 3 patient before the tribunal reviewed their case. Now, where a patient’s CTO is revoked, they will be automatically referred at three months and 12 months after revocation, and then every subsequent 12 months. This allows the automatic referral periods to apply afresh from the date on which the CTO is revoked.

The clause will ensure that patients detained under the Mental Health Act are subject to regular and timely tribunal reviews, particularly when they are unable to advocate for themselves.

Clause 32 will deliver important tribunal oversight for the small cohort of restricted patients discharged into the community under conditions that amount to a deprivation of liberty, who are also known as supervised discharge patients. The clause will require patients subject to supervised discharge to be referred initially at 12 months after deprivation of liberty conditions are imposed, followed by a further referral every two years, where the patient’s case has not been heard by the tribunal in this period. The clause will also provide a safeguard for patients who may fluctuate between conditional and supervised discharge, to ensure that no supervised discharge patient will go more than four years without their case being considered by the tribunal. Automatic referrals to the tribunal ensure that patients under some of the most restrictive conditions have routine oversight of their detention where independent review would otherwise be absent.

The clause will also clarify the powers of the tribunal when considering the application or reference of a conditionally discharged patient, which include the power for the tribunal to impose conditions amounting to a deprivation of liberty. Deprivation of liberty conditions may be imposed or retained only where the tribunal is satisfied that they are necessary to protect another person from serious harm and are no less beneficial to the patient than a recall to hospital. This test preserves public protection, while enhancing the safeguards in place for conditionally discharged patients, ensuring that their care and liberty are subject to regular independent scrutiny.

Together, these changes will promote a more robust system of oversight for patients subject to long-term detention and restrictive conditions, ensuring that their rights are respected and their detention is regularly reviewed.

Clause 33 will extend the same principles of regular, proportionate scrutiny to restricted patients who are not conditionally discharged subject to deprivation of liberty conditions. For restricted patients detained in hospital, section 71 will be amended to reduce the automatic referral period from three years to one year. That amendment aligns with the amendments to increase the frequency of automatic referrals introduced in the Bill for part II patients. Through annual tribunal reviews, it is intended that those individuals are safeguarded against inappropriate detention. That aligns with the broader principles of fairness and accountability, ensuring that individuals in long-term detention are subject to appropriate judicial oversight.

For restricted patients conditionally discharged without deprivation of liberty conditions, we are introducing an initial automatic referral at two years after discharge, or since deprivation of liberty conditions ceased to apply, and every four years thereafter, where the tribunal has not previously considered the patient’s case. The automatic referral every four years safeguards against a restricted patient being left without tribunal scrutiny of their detention where they change status.

By making automatic referrals more frequent for restricted patients and introducing automatic referrals for conditionally discharged patients, we are improving access to the tribunal. That will ensure that patients who lack the ability or initiative to make an application to the tribunal can benefit from the safeguard of increased independent judicial scrutiny of their detention by the tribunal.

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

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

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

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

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

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

Gregory Stafford (Conservative, Farnham and Bordon)

Does my gallant and learned hon. Friend have any information on the current waiting times for tribunals? What does he expect the effect of the changes proposed in these clauses to be on waiting times?

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

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

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

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

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

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

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

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

Natasha Irons (Labour, Croydon East)

It is a pleasure to serve under your chairmanship, Mrs Harris. I rise to speak in support of clauses 30 to 33. I echo many of the remarks of the gallant and learned hon. Member for Solihull West and Shirley, but I will try not to go over too much of the same ground.

These clauses seek to provide clarity and improvement in access to the tribunal process, both for patients detained under the Mental Health Act and for those on conditional discharge, and seek to implement key recommendations from the independent review. Section 66 of the Act is amended to extend the period in which a patient detained under section 2 can apply to the tribunal from 14 days to 21 days. Clause 30 also allows for auto-enrolment in a hearing, reducing that time from six months to three months. It clarifies that conditional discharge patients are included in this package, so they also have the right to have their treatment reviewed at a tribunal. Providing for auto-enrolment simplifies the system for people who, as the hon. Member mentioned, are perhaps not in the best position to make administrative decisions and fill in the paperwork to apply to a tribunal.

Although this framework and these changes are necessary to bring clarity and autonomy back into people’s healthcare, it would be good to hear from the Minister about how we will support patients throughout these processes as we learn about the different timelines. How will we ensure people can access this change in the system and understand what they are entitled to under this new provision?

Luke Evans (Conservative, Hinckley and Bosworth)

Clauses 30 to 33 deal with the tribunal access and automatic referrals of patients detained or conditionally discharged under the Mental Health Act. Let me begin, again, by welcoming these provisions, which seek to improve safeguards, ensure timely oversight, and extend the rights of individuals, particularly those under deprivation of liberty conditions in the community. These are serious matters of liberty and I acknowledge the Government’s intention to modernise and strengthen protection. Nevertheless, it is important that we look carefully at how the clauses operate in practice. I will take each in turn.

Clause 30, on tribunal application periods, will make important changes to when patients can apply for the tribunal. First, it will extend the time that patients detained under section 2 of the Act have to apply from 14 to 21 days. This is a welcome change. We know that the first few days in hospital are incredibly disorientating, so allowing patients a bit more time to seek legal advice is entirely sensible.

Secondly, the clause will reduce the period for patients detained under section 3 to apply from six months to three. I can understand the logic of that, given that clause 29 also shortens the initial detention period, but is there any reason for choosing that mark? Is there any evidence that the three-month window will still allow patients to have sufficient time and support to exercise their rights?

Thirdly, the clause will introduce new provisions for conditionally discharged restricted patients, setting out different application timeframes depending on whether the patient is subject to conditions amounting to deprivation of liberty. Those under the deprivation of liberty safeguards will be able to apply between six and 12 months after discharge and then every two years. For those not under such conditions, the window begins at 12 months. That reflects the impact of conditions on a person’s liberty, and I recognise that distinction, but can the Minister clarify how patients will be informed about which track they are on? That will be fundamental to exerting their rights. Will any guidance be issued to ensure consistency? Will patients have access to advocacy or legal advice at this point?

On clause 31, automatic tribunal referrals are a crucial safety net for those who for whatever reason do not exercise their right to apply. The clause introduces a new framework of relevant periods after which the hospital managers must refer, as we have heard. For section 2 patients, it will be three months. For section 3 and CTO patients it will be three months, then 12 months and every year thereafter. Significantly, the current three-year review period for many detained patients is reduced to one year.

The clause marks a substantial increase in oversight, which I support, but it also raises practical questions. Given that we have put these backstops in place, have the Government made any estimate of how many extra tribunals will be needed and how much extra work they will generate? The Minister was kind enough to say that there were four hours of clinical work involved in doing the plans, but I do not think we have yet heard how much work the Government estimate that the tribunals will take.

More importantly, what support is being provided to ensure that the tribunal system can meet that increased demand? I am particularly concerned that the benefits of these reforms may not be felt if backlogs or delays undermine the safeguards they are intended to deliver.

Gregory Stafford (Conservative, Farnham and Bordon)

Does my hon. Friend think that if there is a backlog, that could undermine patient rights or clinical progress in some way? How will the tribunal system be able to cope with that increased workload and meet its legal obligations to provide timely tribunals so that patients get the best care?

Luke Evans (Conservative, Hinckley and Bosworth)

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

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

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

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

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

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

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

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

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

Stephen Kinnock (Labour, Aberafan Maesteg)

I will try to answer some of the questions. On tribunal capacity, people who are conditionally discharged and those with restrictions that amount to a deprivation of liberty represent only a small fraction of tribunal business—well under 1% of all mental health tribunal cases. The modest increase in hearings is therefore expected to be absorbed within existing capacity, while delivering significant rights benefits to the individuals concerned. It is worth noting, too, that the mental health tribunal continues to perform strongly. Amazingly, it is one of the very few areas of our public services not to be left with a massive backlog by the previous Government. The open caseload has remained stable at approximately 3,700 cases for a decade, despite 31,226 appeals in 2024-25.

I was asked about LPS and replacing DoLS. The previous Government paused the implementation of the liberty protection safeguards; they decided to focus on other priorities. In the absence of LPS, the deprivation of liberty safeguards system will continue to apply. The Department has made it clear that all bodies with legal duties under the DoLS must continue to operate these important safeguards to ensure that the rights of people without the relevant mental capacity are protected.

Luke Evans (Conservative, Hinckley and Bosworth)

Does the Minister have any plan or implementation timetable for LPS, given that their introduction has been paused?

Stephen Kinnock (Labour, Aberafan Maesteg)

We have made it clear that we are going to continue with DoLS. Basically, we have to look at whether replacing them with LPS will achieve the stated objectives of the exercise, and I am not entirely convinced about that. It is under review.

On supporting patients, the independent mental health advocate will ensure that patients are aware of their rights. Throughout the Bill we are ensuring that patients have support by moving to an opt-out model. Additionally, if a patient does not bring a case, they will be referred automatically to the tribunal if a specified period has passed. Patients will be supported in getting tribunal oversight, as the referrals are made by a hospital manager.

Clause 34 - Discharge: process

Stephen Kinnock (Labour, Aberafan Maesteg)

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

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

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

Aphra Brandreth (Conservative, Chester South and Eddisbury)

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

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

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

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

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

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

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

Luke Evans (Conservative, Hinckley and Bosworth)

I rise to speak to clause 34, which inserts new consultation requirements into section 23 of the Mental Health Act 1983. The requirements relate to the discharge of individuals detained under parts II and III of the Act, as well as those subject to community treatment orders or guardianship.

Currently, under the Act, the responsible clinician has the power to discharge patients detained under sections 2 and 3, as well as unrestricted patients subject to a hospital order under part III, without any formal requirement to consult other professionals. This is already considered outdated practice in most clinical settings, where decisions are typically made within the multi-disciplinary team. However, that is not required by law. By contrast, discharge decisions for restricted patients remain with the Secretary of State for Justice or the mental health tribunal and are not affected by the clause.

Clause 34 seeks to change the current situation. It will insert proposed new subsections (2A) to (2C) into section 23 of the 1983 Act, placing a statutory consultation duty on responsible clinicians, local authorities and, in some cases, the patient’s nominated person. The aim, as outlined in the Government’s explanatory notes and by the Minister, is to formalise best practice and ensure that no discharge decision is made unilaterally without appropriate professional oversight. The Opposition welcome the intention behind the clause—strengthening safeguards, encouraging multidisciplinary collaboration and protecting patients from unsafe or premature discharges are all necessary and overdue steps—but we have a few questions about it that I hope the Minister will address.

First, proposed new subsection (2A) requires the responsible clinician to

“consult a person—

(i) who has been professionally concerned with the patient’s care or treatment, and

(ii) who belongs to a profession other than that to which the responsible clinician belongs

That is a sound principle, but there is an ambiguity in the phrase “has been professionally concerned”. Who do the Government have in mind? The Minister set out that it could be a nurse or a counsellor, but would it stretch as far as a GP or a practice nurse? Will there be a codifying list, either in statute or in the code of practice, so that we know who is expected to speak to that person? Does it require current involvement in the patient’s care? For example, could a professional who saw the patient only briefly many months ago qualify? If so, is that adequate to meet the clause’s intention? We would welcome clarification from the Minister on whether a definition of who and what an appropriate consultee looks like will be covered in guidance or regulations.

Secondly, I fully understand the good intent behind proposed new subsection (2B)(c), but as a good Opposition we should point out a possible unforeseen problem. It states that when the nominated person—that is, the person chosen by the patient to act in their interests—is making a discharge decision under guardianship, they

“must consult the responsible local social services authority.”

That raises both legal and practical questions. Is it appropriate to place a statutory duty on a layperson, who may be a relative, a friend or a carer with no formal training or professional support? What is the consequence if they fail to consult? Would their decision be invalid, or could it be legally challenged?

I know that the Government are trying to ensure that relatives and advocates are consulted, which is commendable. I am sure there will be no issue in the vast majority of cases, but there is a risk that the duty may unintentionally create legal uncertainty and administrative burdens for families. Has the Minister thought about whether it might be better framed as a duty on the local authority to advise or support the nominated person, rather than vice versa? I am sure we both agree on the motive and principle of shared decision making; it is simply a question of where to place the burden.

Thirdly, under proposed new subsection (2C), if someone is on a community treatment order, the responsible clinician and hospital managers must consult the community clinician before they discharge the person from that order. Again, that seems sensible, but what happens if there is no identified or available community clinician? As we have discussed, they are legally named, so could that requirement create a bottleneck to discharge? Will there be provision for proceeding with discharge if consultation is not practicable within a reasonable time? Without such a safeguard, there is a risk that patients remain subject to detention, such as conditions under a CTO, even when all parties agree that discharge is clinically appropriate.

Furthermore, the clause does not appear to require the consultation outcome to be documented, nor any disagreement to be recorded. If the responsible clinician consults someone and then disregards their view—as we heard earlier, according to the Minister they have precedence—that may be entirely justified, but surely transparency demands the recording of the reasons. Will the Government consider adding a requirement to document consultation, perhaps in the code of practice, to ensure that reasons are given when discharge proceedings are taken against clinical advice?

The clause represents an important step towards improving safety, accountability and multidisciplinary care in discharge planning, but the Opposition believe that to realise its full potential and avoid creating uncertainty or delay, the Government should look again at the clarity of key terms, such as “professionally concerned”; the appropriateness of placing duties on laypeople, such as the nominated person; the practical challenges around consultations when key professionals are not available; and the need for clear documentation requirements to uphold transparency and safeguarding in decision making. I look forward to hearing the Minister address those points.

Stephen Kinnock (Labour, Aberafan Maesteg)

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

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

Aphra Brandreth (Conservative, Chester South and Eddisbury)

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

Carolyn Harris (Labour, Neath and Swansea East)

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

Stephen Kinnock (Labour, Aberafan Maesteg)

We will absolutely provide guidance on that in the code, but the consultee in the case of a detained person is someone who is professionally concerned with the patient’s treatment, whether that be in the hospital or in the community, and who is from a discipline different from that of the responsible clinician. Those criteria will be applied throughout the process.

Finally, on the question from the Opposition spokesman, the hon. Member for Hinckley and Bosworth, yes, reasons will have to be given whenever there is a difference of opinion. All the relevant documentation and how that should work will be set out in the code of practice.

Clause 35 - Ascertaining and learning from patients’ experiences of hospital treatment

Stephen Kinnock (Labour, Aberafan Maesteg)

This amendment seeks to overturn the previous amendment tabled—sorry, I should have said “the clause”. The clause seeks to overturn the previous amendment, tabled by Earl Howe and Lord Kamall. Although we support the intention of the amendment, our view continues to be that it would be duplicative.

There are already many ways in which service user feedback is used to inform policy and practice. For instance, every year the Care Quality Commission conducts thousands of interviews and visits with people detained under the Mental Health Act 1983. That may result in the CQC investigating a complaint or requiring an action statement from providers about service improvements. Although there may be room to enhance existing feedback mechanisms, we would prefer to improve what we have rather than create something new that would risk confusion.

If the objective is to provide time and space for the person to reflect on their past experiences post-discharge, I reassure the Committee that that should already form a part of co-producing a person’s care in the community plan. We also intend to create space for individuals to reflect on past experiences when making their advance choice document, with facilitation from a suitably qualified person.

Josh Dean (Labour, Hertford and Stortford)

Young people who have been through detention often report challenging circumstances following that detention. Rather than supporting them, that sometimes increases their trauma. Can the Minister assure me that, as part of the changes he just set out, we will still ensure that young people have the opportunity to feed their experiences back? What specific work will the Government undertake to gather those views from young people?

Stephen Kinnock (Labour, Aberafan Maesteg)

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

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

Gregory Stafford (Conservative, Farnham and Bordon)

I apologise—this may be due to the terminology of “amendment” versus “clause”—but is the Minister saying that the Government are likely to vote against clause 35 as it currently stands? He is talking about amendments and clauses, and that is slightly confusing me. [Interruption.] His officials are nodding.

Stephen Kinnock (Labour, Aberafan Maesteg)

I don’t know what that nod means.

Carolyn Harris (Labour, Neath and Swansea East)

The Minister may want to write to the hon. Member.

Stephen Kinnock (Labour, Aberafan Maesteg)

Yes, but the issue may have a bearing on a potential Division. The challenge that I am facing is that my notes said,

“This amendment seeks to overturn”,

Jennifer Craft (Labour, Thurrock)

I am equally confused; I did not think we were talking about an amendment. I thought we were talking about a clause. Apologies.

Carolyn Harris (Labour, Neath and Swansea East)

Clause 35 was added by a Lords amendment; maybe that is where the confusion has come from. The Government tabled an amendment to leave out clause 35.

Stephen Kinnock (Labour, Aberafan Maesteg)

But we are tabling an amendment.

Carolyn Harris (Labour, Neath and Swansea East)

The amendment is not selected.

Stephen Kinnock (Labour, Aberafan Maesteg)

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

Gregory Stafford (Conservative, Farnham and Bordon)

Thank you, Minister.

Stephen Kinnock (Labour, Aberafan Maesteg)

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

Jennifer Craft (Labour, Thurrock)

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

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

Gregory Stafford (Conservative, Farnham and Bordon)

Like the hon. Lady, I see many benefits from the clause. Like many Committee members, I am surprised that the Government intend to vote against it.

As has been mentioned, the clause was inserted in the House of Lords by my noble Friends Earl Howe and Lord Kamall. I think it introduces a very valuable and forward-looking provision—namely, a mandatory debrief session within 30 days of discharge. It introduces a formal mechanism for learning from patient experiences following detention under the Mental Health Act. Although patient feedback mechanisms exist in some services, they are not consistently applied or mandated. The clause ensures that every detained patient has the opportunity to reflect on their care with an independent advocate, and that their feedback contributes to service improvement. It reflects a broader shift in mental health law towards transparency, accountability and the patient voice, and aligns with the recommendations from the 2018 independent review of the Mental Health Act, which the Government have used as an argument in favour of many of the other clauses.

Clause 35 is more than just a procedural addition. It represents a shift in culture towards embedding the patient voice and accountability in the mental health care system. It recognises the importance of empowering individuals after detention, supporting their recovery, and learning from their lived experience to improve future services. Mental health charities and third sector organisations have strongly endorsed the clause, seeing it as a meaningful step towards a more rights-based, transparent approach to care.

Clearly, the clause empowers patients, because it gives them a structured opportunity to share their experiences and influence service provision. It promotes transparency by requiring hospitals to report publicly on what they have learned and how they have responded. It supports quality improvement by encouraging services to reflect on and address systemic issues in the delivery of care. Furthermore, it has independent oversight through the involvement of IMHAs, which helps to ensure that feedback is gathered impartially and respectfully.

The reforms prioritise professional clinical opinion, safeguard children from inappropriate influence during periods of acute vulnerability, and elevate the patient voice in the post-care process. In doing so, they align the Mental Health Act much more closely to modern standards of care, international best practice and evolving public expectations. I believe that the clause is essential to strengthening the Bill and ensuring that our mental health system becomes not only more effective but more compassionate, responsive and just.

Luke Evans (Conservative, Hinckley and Bosworth)

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

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

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

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

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

Gregory Stafford (Conservative, Farnham and Bordon)

Surely the fundamental part of the Bill is self-assessment and self-reflection. That does happen in some cases, and certainly in other parts of the healthcare system, but in this area generally does not; when it does happen, it is done in an inconsistent manner. The clause seeks to formalise things and to ensure that there is a benchmark by which service users and patients can feed back to the service they have just come from, to improve services. Does my hon. Friend share my confusion about why the Government would want to take that out?

Luke Evans (Conservative, Hinckley and Bosworth)

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

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

Stephen Kinnock (Labour, Aberafan Maesteg)

Fundamentally, we do not support the clause because it is overkill. It simply puts too much burden on to a system that is already carrying out the tasks that the clause seeks to impose on the system, particularly through the CQC. Given that advocates currently have no role in relation to discharged patients, it is clear that the clause would present a new burden; that has been confirmed through my officials’ engagement with advocates and other stakeholders. One hospital manager said that within their small trust alone, the clause would result in contacting and interviewing more than 1,000 individuals discharged from the Act each year.

Luke Evans (Conservative, Hinckley and Bosworth)

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

Stephen Kinnock (Labour, Aberafan Maesteg)

The CQC visits and interviews thousands of detained patients each year under its statutory duty to monitor the use of the Mental Health Act. Those visits can lead to the CQC requesting improvements from service providers. The CQC publishes annual reports highlighting key findings and themes from those visits.

Trust boards are responsible for collecting and acting on service user feedback to improve services. Under the NHS contract, the patient and carer race equality framework requires trusts to have clear and visible systems in place for gathering and responding to feedback from patients and carers. What is more, Healthwatch England and its local branches also play a key role in representing the views of health and social care users. I do not really know what more the system could do. The clause simply over-embroiders and over-complicates; when that happens, we usually end up with vast numbers of unintended consequences.

We appreciate that concerns have been raised around the CQC’s role in collecting in-patients’ views. As I said, we would prefer to work with stakeholders to understand those concerns and improve the feedback mechanisms that we have, rather than reinvent the wheel and create something new. We recognise that, although there are multiple aims to the clause, the primary one is to provide a space for people to heal from their experiences of being detained. We are strongly of the view that inviting the individual to share their experiences as part of their advance choice document or care plan—

Jennifer Craft (Labour, Thurrock)

I am glad that the Minister is explaining how capturing feedback and experience is being allowed for in other parts of the Bill. To clarify, in my own head I feel that the clause aims to capture the experience immediately after it has happened, just as hospitals offer women who have just given birth the opportunity to talk through their experience. It is healing for the patient to understand what happened to them, and it provides immediate feedback to the hospital. Is that kind of level captured in other parts of the Bill?

Stephen Kinnock (Labour, Aberafan Maesteg)

I understand and recognise my hon. Friend’s concerns, but we can rattle through all the different forums where feedback can be captured: the CQC, the trust boards, the patient and carer race equality framework, Healthwatch England and all the other informal channels in the mental health ecosystem. Our view is that adding another layer into all that would in the end be counterproductive. That is the Government’s position.

Natasha Irons (Labour, Croydon East)

The Minister mentioned the complex network of ways in which patients can give their feedback; perhaps the aim of the clause is to try to simplify that and, as my hon. Friend the Member for Thurrock mentioned, make it a bit more direct and immediate after treatment. Are there any plans to simplify the process in another way? The complex cobweb that the Minister described is perhaps the reason why the patient voice is not always captured and utilised in a way that we would want if the services that people rely on are to be improved.

Stephen Kinnock (Labour, Aberafan Maesteg)

My hon. Friend raises an important point. I do worry about the list of different organisations and agencies throughout the system, and not just in mental health—so many parts of the system have had layer upon layer of bureaucracy added in. That is one of the reasons why we are abolishing NHS England: we want to try to find greater simplicity and clearer channels of communication.

Through the development of the code of practice and the consultation process, simplifying and clarifying the system will be a key objective. Adding another layer would have the opposite effect. But my hon. Friend makes an important point, which will definitely be a part of the process of consultation and development of the guidelines and code of practice. On the basis of those answers, I recommend that we do not adopt the clause.

Carolyn Harris (Labour, Neath and Swansea East)

Order. I am expecting four Divisions imminently, so I will suspend the Committee.

Clause 36 - Conditional discharge subject to deprivation of liberty conditions

Carolyn Harris (Labour, Neath and Swansea East)

With this it will be convenient to discuss clauses 37 to 40 stand part.

Stephen Kinnock (Labour, Aberafan Maesteg)

Clause 36 will introduce a subset of the current conditional discharge power where deprivation of liberty conditions are expressly allowed, otherwise known as supervised discharge. The aim of the clause is to prevent a small group of criminal justice patients with specialised support needs from remaining in hospital unnecessarily, while ensuring the risk they pose in the community is robustly managed. The reform responds to a Supreme Court decision, which found that there was no power under the current Act to impose discharge conditions that amount to a deprivation of liberty. Prior to the judgment, such conditions were used in a small number of cases in which patients with specialist needs required stringent arrangements to protect themselves and the public from harm.

Careful consideration has been given to the ethical and legal balance of the arrangements. We are clear that the threshold for use of the power is very high, and it will be accompanied by appropriate safeguards. A stringent test will be applied. The conditions will only be applied if the tribunal or Justice Secretary views the conditions as necessary to protect others from serious harm and, for the tribunal, if it considers the conditions would be no less beneficial than if the patient remained in hospital. We are also introducing additional safeguards, which ensure that supervised discharge patients are automatically referred to the tribunal after 12 months and every two years thereafter. That is more frequent than patients subject to conditional discharge, given the restrictive nature of the conditions being placed upon them.

I turn to clause 37. Prisoners and other detainees who become acutely mentally unwell in prison or another place of detention, such as an immigration removal centre or youth detention accommodation, can be transferred to hospital for treatment under sections 47 and 48 of the Act. Clause 37 will make two minor changes to those provisions.

Currently, the criteria for detention under the Act provides that appropriate treatment must be “available” for the patient or other detainee. The Court of Appeal, however, ruled that due to the specialised provision and security requirements relating to this cohort of patients, treatment must be available in practice for the detention criteria to be met, meaning that a hospital place must be identified. That diverges from how “available” treatment is interpreted across the rest of the Act, and it risks creating an additional barrier for this cohort of patients in accessing the care they need.

We are therefore clarifying the detention criteria to ensure that they can still be met, based on the patient’s clinical need, even when no hospital place has yet been identified. The change is also necessary for the effective implementation of the statutory time limit in clause 38, so that the Secretary of State is not delayed in issuing a transfer warrant when a specific bed space has not yet been identified. Clause 37 will also update the list of immigration legislation provided in section 48 to expand the scope of immigration detainees who can be transferred under that section.

I will now address clause 38. Prison and other places of detention are not the right environment for people with severe mental illness. We recognise that vulnerable people detained in prison, youth detention accommodation or immigration detention facilities, who may require treatment in hospital under the Mental Health Act, continue to experience delays. This Government are committed to ensuring that people in contact with the criminal justice system can access appropriate and timely support to meet their mental health needs. The clause will create a statutory time limit of 28 days for transfers from prison and other places of detention to hospital. It will place the existing NHSE best practice guidance on a statutory footing. Together with operational improvements, it aims to reduce unnecessary delays and deliver swifter access to treatment.

The transfer process is multidisciplinary, requiring input from numerous health and justice agencies. Clause 38 will enshrine the time limit by placing a new duty on authorities and bodies involved in a potential transfer, seeking to ensure that the transfer takes place within 28 days from the initial referral for a report to admission to hospital, unless there are exceptional circumstances. The clause will also allow the Secretary of State to amend the time limit, as well as the list of relevant authorities and bodies involved in the transfer, to ensure that the duty continues to sit with the appropriate bodies if there are changes to commissioning arrangements or responsibilities.

Clause 39 will remove reference to remand centres in section 48 of the Mental Health Act. Since 2012, remand centres have not been used in the criminal justice system, and children arrested for, or formally charged with, a crime have instead been remanded to youth detention accommodation. When the Crown court remands children to youth detention accommodation, there is currently no provision for the Secretary of State to make a transfer direction in respect of them under section 48. Transfer to hospital for those children would need to be ordered by the Crown court under section 35 or 36 of the Mental Health Act.

Clause 39 will rectify the situation by removing references to remand centres, and it adds youth detention accommodation to the scope of section 48. That will allow children remanded by any court to be transferred directly to hospital. There are also uncommenced repeals of “remand centre” references in schedule 8 to the Criminal Justice and Court Services Act 2000. As we are making the change in this Bill to ensure that the references are accurate, clause 39(2) removes the entry referring to section 48 from schedule 8 to the 2000 Act.

Finally, I turn to clause 40. Hon. Members may have noticed that the Bill is technically complex, and this clause is indeed one of its complex provisions. It is a technical clause, which clarifies that part III patients who are not subject to special restrictions are omitted from applications to the tribunal 28 days after a report is furnished under section 25 of the Mental Health Act in respect of a patient who is detained in pursuance of an application for admission for treatment. Section 25 allows the responsible clinician to override a nearest relative’s power of discharge. That does not apply to unrestricted part III patients, as discharge will always be at the discretion of the responsible clinician, not the nearest relative. The Committee should rest assured that there is no legal effect to the clause, which is merely correcting drafting that currently does not work in the way that it was intended. I therefore commend clauses 36 to 40 to the Committee.

Carolyn Harris (Labour, Neath and Swansea East)

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

Gregory Stafford (Conservative, Farnham and Bordon)

I rise to support clauses 36 to 40. Clause 36 addresses a legal gap identified in case law, which held that the Mental Health Act 1983 did not permit the imposition of conditions amounting to a deprivation of liberty for conditionally discharged patients. The clause provides a clear statutory basis for such conditions, but only under strict safeguards. It aims to balance public protection with patient rights, ensuring that DoL conditions are used only when absolutely necessary and proportionate. This is a positive step, because it clarifies the legal authority, resolving any uncertainty, following court rulings, about the legality of DoL conditions in conditional discharges. It protects public safety by ensuring that high-risk patients can be managed safely in the community, under appropriate restrictions. It includes safeguards that require DoL conditions to be justified and proportionate, with a focus on patient welfare, and it aligns with notable human rights law, especially the definitions and principles from the Mental Capacity Act and the relevant case law.

However, I have a couple of questions for the Minister. My view is that there is potential for overuse. Without robust oversight, there is a risk that DoL conditions could be used too readily. What safeguards is the Minister putting in place to ensure that that does not happen? There is clearly an impact on patient liberty, and we need to get the balance right. Even with the safeguards, these conditions significantly restrict individual freedom and therefore must be carefully monitored. How is the Minister ensuring that that will happen? In relation to the legal thresholds, determining whether conditions meet the legal test may require detailed clinical and legal assessment. We have talked about the practical implications of this Act on numerous occasions. I again ask the Minister whether he is certain that we have the relevant clinical and legal assessors out there to ensure that we can push that forward.

Clause 37, entitled “Transfers of prisoners and others to hospital: conditions”, will update the legal framework for transferring individuals from prison or immigration detention to hospital under the Mental Health Act. The previous wording of the Act required that treatment be “available”, but did not specify that it must be appropriate for the individual’s condition. This clause will align the criteria with more modern clinical standards and broader reforms in the Bill, which emphasise person-centred care and treatment suitability. It will also ensure that immigration detainees are clearly included in the scope of these provisions. Again, it is positive, because it updates and consolidates the list of immigration-related detention powers covered by the Act. It supports human rights compliance, because it aligns with principles of lawful and proportionate deprivation of liberty under article 5 of the European convention on human rights; it brings the Act in line with the current clinical and legal terminology; and, most importantly, it ensures that transfers are made only when appropriate treatment—not just any treatment—is available.

I have just a couple of questions for the Minister on this clause. I see potential for disputes. Determining what constitutes appropriate treatment may lead to disagreements between clinicians and authorities. What are the Minister’s thoughts on those potential disagreements? There are also some resource implications. It may increase demand for secure hospital beds if more transfers are approved under the revised criteria. I would welcome any thoughts from the Minister on how to ensure that we have the right number of secure hospital beds, not just as a totality, but in the specific regions and areas where people may be being detained.

Clause 38 is also about the transfer of prisoners and others to hospital, but specifically about time limits. It responds to a long-standing concern about delays in transferring prisoners and immigration detainees to hospital for mental health treatment. Under the current system, there is no statutory time limit, and individuals can wait weeks or months in prison, despite being assessed as needing urgent psychiatric care. That has been criticised by mental health professionals, legal advocates and human rights bodies. The clause will introduce a legal framework for setting and enforcing time limits, aligning with the Bill’s broader goals, which I think we all agree with, of improving patient rights and dignity and timely access to care. Again, I support the clause, because it will reduce delays. It will help to ensure that mentally unwell detainees are transferred to appropriate care settings without unnecessary delay, and will introduce clear expectations and accountability for decision making. It enables some flexibility, I think, because it allows for tailored regulations, to accommodate different case types and operational realities.

Again, however, I have some questions. I think there will be some implementation challenges. Services may struggle to meet the deadlines without sufficient resources —an issue that I mentioned in relation to the previous clause. Also, time limits may be difficult to apply in complex or borderline cases without clear guidance. Does the Minister see a need for explicit guidance in the code of conduct, or in some other form, to ensure that the risk of a rigid application does not make things more complicated or, more especially, mean that a potential patient is sent to the wrong care simply because we are focusing on the time rather than the appropriateness of the care? Of course, I would welcome his thoughts on how any new tracking systems and co-ordination between prisons, hospitals and the Ministry of Justice might work in this case.

Finally, I will briefly touch on clause 39. This is a technical update regarding the term “remand centre”, because that is no longer used in law or in practice; instead, young people are remanded to youth detention accommodation. Given that the clause is purely technical, I support it.

Anna Dixon (Labour, Shipley)

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

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

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

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

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

I rise to speak in support of clauses 36 to 40, which provide critical legal clarification and technical refinements to the 1993 Act. While differing in scope and impact, each of these provisions is underpinned by a clear shared commitment to enhance public protection, uphold patient rights, and ensure that the legal framework reflects both current clinical practice and developments in case law.

Luke Evans (Conservative, Hinckley and Bosworth)

I rise to address clauses 36 to 40, which focus on patients involved in criminal proceedings or serving custodial sentences, and how we better align their care and liberty and the protection of the public. These clauses engage serious and sensitive issues—individual liberty, the management of risk and the functioning of the justice and health systems in tandem.

Anna Dixon (Labour, Shipley)

Does the hon. Gentleman agree that one of the challenges of that court ruling, which will stand unless the Bill amends the law, is that there will be people detained for longer than is appropriate because a conditional discharge is not possible under the law as it is currently interpreted? The whole Bill is about the principle of least restriction. Does he not agree that we need to make this change to fit with that principle?

Luke Evans (Conservative, Hinckley and Bosworth)

I agree on that, and we will support the clause. But, as the hon. Member rightly pointed out earlier, we need interoperability between the moving parts to make sure that they all align with the provision in the clause. She is absolutely right: this measure is in the Bill because the patient in the MM case had capacity and had agreed to being discharged with deprivation of liberty impositions, and that was found to be unlawful because of a parallel Act. What I am worried about, and the point that I am trying to make, is that there are so many moving parts in these Acts that we could be in danger of complicating the situation further.

Clause 36 seeks to address the uncertainty by legislating for a new power to impose deprivation conditions as part of a conditional discharge, as the hon. Member rightly pointed out. However, in doing so, the clause effectively runs parallel to, and perhaps even conflicts with, the as yet un-implemented LPS framework. The Government introduced the LPS framework through the Mental Capacity (Amendment) Act 2019. It was intended to be more flexible and responsive than DoLS. But given that the LPS framework has not been commenced, and that there is no clear timetable for implementation—the Minister seemed to suggest that he was unsure whether he will implement them, even though the 2019 Act was passed by Parliament—are we legislating for an entirely separate deprivation of liberty route under the Mental Health Act, and potentially bypassing or duplicating existing safeguards under the Mental Capacity Act?

It all comes back to the point made by my hon. Friend the Member for Solihull West and Shirley about good record keeping and legislative housekeeping. I ask the Minister how the new conditional discharge power will interact with either the DoLS or the liberty protection safeguards—if they are eventually implemented. Are they simply a subsection of the deprivation of liberty conditions, and therefore would not matter? Can the Minister foresee a time where a patient could be subject to both the new powers and the LPS, and if so, who is the decision maker and where do the appeals rightly lie? Should we not wait for the full implementation of the LPS before layering further deprivations in place? That is an open and rhetorical question, but one that vexes me when we are discussing this Bill in detail. There is a real risk here of fragmenting the legal landscape, leading to confusion for clinicians, patients and carers.

Stephen Kinnock (Labour, Aberafan Maesteg)

On safeguards, supervised discharge will only be used when necessary, given its restrictive nature and significant resource demands. A stringent test will apply. It must be deemed necessary by the tribunal or Justice Secretary to protect others from serious harm, and the tribunal must deem it to be no less beneficial than hospital care. Additional safeguards include automatic tribunal referrals after 12 months and every two years thereafter, if not previously reviewed.

On capacity, our expectation is that this will not have a significant impact on other restricted patients. The small cohort who are likely to be subject to supervised discharge will free beds, and that could positively impact any patient who needs a bed, but the numbers remain small and are unlikely to lead to widespread bed availability.

On demand for secure beds, clause 37 will correct a discrepancy in detention criteria caused by a Court of Appeal decision. Rather than creating further disparity, it aligns the criteria for sections 47 and 48 of the Mental Health Act with the consistent interpretation of available treatment used throughout the rest of the Act. Clause 37 does not alter the approach to clinical prioritisation of in-patient care, or the fact that a person will only be transferred once an appropriate bed has been found, in terms of both therapeutic care and level of security. That also addresses the question on implementation from the hon. Member for Farnham and Bordon.

I turn to the questions asked by my hon. Friend the Member for Shipley. She asked about the 28-day limit. Any change to the time limit would require an enhanced level of parliamentary scrutiny. Therefore, the power shall be subject to the draft affirmative procedure to ensure that both Houses are given the opportunity to debate any decision.

On dual tests, the Secretary of State for Justice applies a slightly different test from that of the tribunal in order to preserve their discretion in the interests of public protection, but conditions for patients must still be appropriate and proportionate. We will publish operational guidance to make it clear that the Secretary of State for Justice should have regard to the principle of therapeutic benefit and only use this type of discharge when the evidence indicates that it is in the best interests of the patient.

Under section 120 of the Mental Health Act, the Care Quality Commission and Health Inspectorate Wales have a duty to monitor the use of the Act. Patients subject to supervised discharge will be captured by section 120 for the purpose of regulatory oversight as a subset of conditionally discharged patients who are liable to be detained under the Mental Health Act.

Clause 41 - Independent mental health advocates

Carolyn Harris (Labour, Neath and Swansea East)

With this it will be convenient to discuss the following:

Amendment 19, in schedule 3, page 91, line 13, after “patient” insert

“or English qualifying informal patient under 18”.

This amendment extends the provision of opt-out advocacy services in England to informal inpatients under 18.

Government amendments 42 and 43.

Schedule 3.

Stephen Kinnock (Labour, Aberafan Maesteg)

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

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

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

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

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

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

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

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

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

Aphra Brandreth (Conservative, Chester South and Eddisbury)

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

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

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

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

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

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

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

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

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

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

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

Josh Dean (Labour, Hertford and Stortford)

It is a pleasure to see you in the Chair, Mrs Harris—when I wrote my speech, it said “this afternoon”, but it now says “this evening”. I rise to speak to clause 41 and schedule 3. I welcome the role that they will play in extending the right to access the services of an independent mental health advocate to voluntary patients in England not detained under the Mental Health Act, and ensuring that all detained patients are offered these services through an automatic referral, creating an opt-out system.

Independent mental health advocates play an important role in supporting patients detained under the Act to understand their rights and participate in decisions around their care and treatment. Clause 41 and schedule 3 seek to ensure that the individual needs of each patient are taken into account, even where they may not be able to engage in decision making about themselves. In doing so, they recognise the patient as an individual. This provides for important safeguards for patients and reinforces the Bill’s principles of autonomy and least restriction, which is a crucial part of bringing mental health legislation into the 21st century. I similarly welcome Government amendments 42 and 43, which seek to further strengthen the important safeguards in the Bill.

I hear the points that the Minister has made on children and young people admitted informally, but I would be grateful if he could address the matter further. As we know, informal patients are those who consent to an admission to a mental health hospital or whose parents consent to an admission on their behalf. Often, they are treated under the same or similar conditions as those detained under the Act. While detained patients will receive an automatic referral to advocacy services under the new opt-out scheme, my understanding is that that will not be the case for those admitted informally, meaning that informal patients would still be required to ask for the support of an independent mental health advocate.

Children admitted informally are likely to experience the same conditions as another child detained under the Act, but without the parity of access to advocacy services through the opt-out system. Because a parent is able to consent to informal treatment on their child’s behalf, they are one of few groups, if not the only one, able to be admitted informally without their own consent. Therefore, there is a concern that children and young people admitted informally may continue to experience problems accessing the support of an advocate. I seek the Minister’s assurance that the Government have considered fully the provision of advocacy services for informally admitted children and young people, and how this gap might be addressed.

I welcome how these parts of the Bill will embed those important principles of individuality, autonomy and least restriction, expanding the important safeguards offered by independent mental health advocates. I would be grateful if the Minister could touch on those points about children and young people in his response.

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

I will speak briefly on schedule 3, which makes a number of important amendments to the 1983 Act concerning the role of independent mental health advocates. The schedule implements several practical reforms to provide consistent and accessible advocacy and support for individuals receiving mental health care. It builds upon existing statutory provisions by extending the right to advocacy beyond detained patients and setting out clearer expectations of how and when advocacy services should be made available.

One of the most notable changes is the extension of IMHA eligibility to include informal patients—individuals receiving voluntary treatment rather than under compulsion. This responds directly to the recommendations made in both the independent review and the 2021 White Paper, which identified disparities in support available to different patient groups. Under these reforms, access to advocacy is no longer limited to those detained under the Act. Instead, all qualifying patients, including informal ones, will be eligible for IMHA support where appropriate. This change reflects the recognition that voluntary status does not necessarily equate to full understanding or confidence in navigating care decisions.

To ensure that eligible individuals are aware of and able to use this support, hospital managers will now be required to notify advocacy services when a patient becomes eligible. This automatic referral mechanism removes the onus from patients themselves to initiate contact, many of whom may not be aware of their rights or may face barriers to asserting them. In turn, advocacy providers will have a duty to arrange an interview with each referred patient to establish whether they wish to use the service. This helps to close the loop between eligibility and engagement, and ensures that advocacy is offered in a timely and structured manner.

Schedule 3 also sets out clearer responsibilities on both hospital managers and advocacy providers. Clearly, that will improve co-ordination and ensure the consistent application of the policy across different care settings and regions. In practice, it should help to reduce gaps where eligible patients might otherwise miss out on support due to ambiguity around who holds the responsibility for initiating contact. It is worth noting that these reforms complement the broader set of changes proposed in clauses 41 to 44, which collectively aim to strengthen patient rights, increase transparency in decision making and improve the overall quality of patient experience in mental health services.

This approach has a number of potential benefits. First, it is likely to improve access to advocacy for groups who have historically been underserved. These include informal patients, individuals with communication difficulties and those less familiar with the mental health system. Secondly, it enhances procedural fairness by ensuring that patients are supported in understanding their options, raising their concerns, or appealing decisions where necessary. Thirdly, it brings the statutory framework into closer alignment with human rights principles and best practice standards, particularly in terms of informed participation and supported decision making.

There are, however, three specific practical challenges that I wish the Minister to acknowledge. First, these reforms will require sufficient resources for advocacy services, particularly as demand is likely to increase once eligibility is broadened. Secondly, effective implementation will depend upon robust co-ordination between hospital managers and external advocacy providers, which may vary in capacity and capability across regions. I would be interested to hear the Minister’s approach to ameliorating that. Thirdly, there is a risk of inconsistency in delivery without clear national guidance and adequate oversight mechanisms, so I would be grateful if the Minister could address the mechanisms that are intended to be put in place.

Carolyn Harris (Labour, Neath and Swansea East)

My apologies for the noise in the corridor; there was meant to be a yoga event in here at 6 o’clock. I thank the Doorkeeper for trying very hard to keep everything under control.

Danny Chambers (Liberal Democrat, Winchester)

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

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

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

Gregory Stafford (Conservative, Farnham and Bordon)

You will be delighted to know that there will be no yoga from me, Mrs Harris.

I rise to support clause 41 and schedule 3, which will expand access to independent mental health advocates to not only those detained under the Mental Health Act but informal voluntary patients. Like many Committee members, I am sure, a number of IMHAs in my constituency have approached me about this, and they welcome the expansion. I pay tribute to the amazing work that they do across Farnham, Bordon, Haslemere, Liphook and the surrounding villages. Previously, only patients detained under specific sections of the Mental Health Act or subject to certain treatments were entitled to IMHA support.

The clause reflects the recommendations of the 2018 independent review of the Mental Health Act and the 2021 White Paper, and aims to enhance patient rights and reduce disparities in access to advocacy. That clearly empowers more patients by giving informal patients access to advocacy support. It improves transparency and accountability in mental health care settings. It ensures proactive outreach so that patients are not left unaware of their rights or support options, and supports informed decision making and potentially reduces coercive practices.

Clearly, there may be some resource implications for advocacy services, which the Minister may wish to touch on. Likewise, there may be some implementation challenges, which other hon. Members have raised, especially around ensuring timely and consistent notification and engagement. There could be potential delays in care co-ordination if advocacy processes are not well integrated. I would welcome the Minister’s thoughts on that.

This shift is long overdue. Too many vulnerable people, admitted voluntarily but feeling powerless, have lacked a clear, independent voice. The clause corrects that injustice by embedding advocacy deeper into the system, moving from passive availability to proactive engagement.

Schedule 3 underpins clause 41 by putting clear duties on hospital managers and advocacy providers alike to ensure that patients are automatically offered support. It is opt out, not opt in. That clarity of responsibility will reduce coercion, increase transparency and ultimately lead to fairer treatment decisions.

Schedule 3 operationalises the principles set out in clause 41 by embedding them in the structure of the Mental Health Act 1983. Like clause 41, it reflects recommendations from the 2018 independent review and the 2021 White Paper, aiming to reduce disparities in access to advocacy and ensure that all patients, regardless of detention status, are supported in understanding and exercising their rights. Like clause 41, it strengthens patient voice, reduces inequalities, improves compliance and encourages the early intervention and resolution of concerns.

Let me turn to Liberal Democrat amendment 19, which was tabled in the name of the hon. Member for Winchester. Clearly, its purpose is to extend the opt-out advocacy services in England to include informal patients under the age of 18. This ensures that children and young people who are not formally detained under the Mental Health Act, but who are receiving in-patient care, still have automatic access to an IMHA.

Currently, opt-out advocacy provisions primarily apply to patients who are formally detained. However, informal patients aged under 18, who may be in hospital with parental consent, can still experience significant restrictions and may not fully understand or exercise their rights. This amendment seeks to close the gap by ensuring that young informal patients are automatically offered advocacy support, recognising their vulnerability and limited legal autonomy.

My view is that this does strengthen patient rights. It safeguards vulnerable patients and promotes equality by aligning the rights of informal patients aged under 18 with those of detained patients. It supports informed decision making and helps young people to understand their rights and treatment options. If the hon. Member is minded to press the amendment, I hope that the Government will at least give it tacit support, even if they do not vote for it. That being said, I would welcome the Minister’s comments on why he does not feel that the amendment, or an alternative draft of the wording, if he does not like the specifics of it, should be included in the Bill. I do believe that this is important.

Government amendments 42 and 43 to schedule 3 are relatively technical but important elements of the Bill that align provision in England and Wales. I have just a few questions for the Minister. Robust rights must come with realistic resources. How will the Government ensure that advocacy services are funded and resourced properly to meet the new wider demand? Although they are technical, the Government amendments will still have an impact. What steps will be taken to monitor consistency so that a patient in Farnham, Bordon, Haslemere, Liphook or one of the villages surrounding my constituency has the same access to an advocate as a patient in Coventry, Aberafan or Swansea. We want to make sure that there is consistency.

Finally, will there be clear standards for timely engagement, especially given the risk of treatment delays if advocacy is not well integrated? If the Minister can answer those questions, I think that this will be a good step forward for patient voice and fairness in mental health, and I would support the clause and schedule 3.

Luke Evans (Conservative, Hinckley and Bosworth)

I rise to speak to clause 41 and schedule 3, which introduce the independent mental health advocate system under the Mental Health Act 1983. I recognise the positive intentions behind the reforms. The proposals respond to long-standing concerns about access to advocacy for people receiving mental health treatment, especially for those who are not detained, but are nevertheless vulnerable, and may struggle to understand the challenges within their care.

Currently, IMHA services are guaranteed only to a relatively narrow group—namely, patients detained under the Act, those under community treatment orders or guardianship, and certain patients undergoing serious medical treatments under sections 57 or 58A. As the explanatory notes make clear in paragraph 313, that excludes a substantial number of informal or voluntary patients, many of whom may be experiencing significant distress or coercion, even if they are technically not detained.

The clause expands eligibility to a new category of English qualifying informal patients, bringing England more in line with a system already used in places such as Wales. This welcome and overdue development reflects the principle that the right to advocacy should be grounded not in a legal status alone, but in need and vulnerability. The introduction of the opt-out referral system for detained patients is also a step forward. Concerns have been raised that eligible patients never access IMHA, often because they are unaware, overwhelmed or too unwell for self-referral. Making the referral automatic is likely to increase the uptake and strengthen patient voices in critical decisions about care, treatment and discharge.

Although the direction of travel is right, I want to raise several probing questions in areas of concern, particularly relating to implementation, scope and safe- guarding. On resource and workforce readiness, the Government are significantly expanding both the pool of eligible patients and the responsibility of advocacy providers. That is welcome, but it inevitably raises the question of capacity. Can the Minister confirm whether additional funding will be made available to local authorities, or is it up to the NHS and IMHA providers to ensure the expansion is deliverable? Are the new roles of the IMHAs explicitly addressed in the new workforce plan that he is introducing? What assessment has been done of the number of new IMHAs that will be required to meet the duties, particularly now we are using an opt-out model? Without the workforce and training in place, there is a risk that the rights introduced in the legislation will not be fully realised in practice.

My second point is about capacity, consent and best-interest decisions. I would like to clarify a couple of points on schedule 3. It would appear, as drafted, that IMHA providers will be required to assess whether a patient has the capacity to decide whether to receive advocacy, and if not, whether it is in their best interests to do so. That gives providers a significant and quasi-clinical responsibility.

Proposed new section 130B(2C) states:

“Arrangements under section 130A must require a provider of advocacy services, on becoming aware of an English qualifying compulsory patient for whom they are responsible, to arrange for an independent mental health advocate to visit and interview the patient (if possible) with a view to determining”,

first,

“whether the patient has the capacity or is competent to take a decision about whether to receive help from an independent mental health advocate”;

secondly,

“if the patient does have that capacity or competence, whether the patient wishes to receive such help”;

and thirdly,

“if the patient does not have that capacity or competence, whether it is nonetheless in the patient’s best interests to receive such help (which, if so, is to be provided under the arrangements).”

On the first point about whether the patient has the capacity or is competent to take a decision about receiving help from an IMHA, my understanding is as follows. The role of independent mental health advocates is to support people detained under the Mental Health Act, to understand their rights and to be involved in decisions about their care and treatment. IMHAs do not, I believe, have the legal authority to assess mental capacity. The assessment of mental capacity is typically carried out by a qualified healthcare professional such as a doctor, psychiatrist or specially trained nurse, following guidance under the Mental Capacity Act 2005. IMHAs are there to help patients understand the information about their treatment and their rights, and can support them in expressing their views, but they do not perform capacity assessments. So is this a change in professional scope? Is it an oversight? Is it an update? Or is it simply what is happening in practice, which now has legal backing?

Christopher Bloore (Labour, Redditch)

The hon. Gentleman makes an interesting point, but is not the point of an IMHA to ensure that the patient understands their rights under the previous Act and the Bill? That is how they participate in taking decisions about what is available to the patient. Although they might not be clinically trained, they know the legislation inside out, and that gives power and advocacy to the patient.

Luke Evans (Conservative, Hinckley and Bosworth)

The hon. Gentleman identifies exactly what the point of an IMHA is. The way the Bill is written, the IMHA determines whether a patient has capacity or competence to make a decision. That determining means that they are making the choice, which is quasi-clinical. According to the definition that the hon. Gentleman has just given, that would fall out of the IMHA’s scope, because that would involve the ability to make decisions about capacity.

My concern is whether we have scope creep here. If so, we should be explicit about it—perhaps it is something we want to consider—but the way it is written, IMHAs will make capacity-based decisions about whether a person has the capacity to decide whether they need help. I would argue that that should be done by someone who is qualified as a doctor, a psychiatrist or community psychiatric nurse, as currently happens. That is the clarification that I am looking for from the Government. If I have the wrong end of the stick, I will happily back down, but this area of the Bill needs clarifying.

To that end, and if the Bill is written as I fear, I would welcome it if the Minister can tell us how IMHA providers will be supported to make best interest decisions appropriately, especially in cases involving fluctuating capacity or complex presentations. Will there be clinical oversight or statutory guidance to avoid inconsistency or overreach in these assessments? Although I support the principle of proactively offering advocacy, we must ensure that the decisions made on a person’s behalf are done with the appropriate checks and accountability, and by the right people.

My third point is about the exclusion of emergency section patients. The welcome change in the clause and the schedule expands the pool of support, but we should also pay attention to those who are, by definition, excluded. Paragraph 317 of the explanatory notes make it clear that individuals detained under sections 4, 5, 135 and 136 will not benefit from IMHA support. Those are often people detained in crisis situations, sometimes in police custody, or brought in under emergency powers.

For completeness, will the Minister clarify why that group is being left out, given their heightened vulnerability and the likelihood of distress or disorientation? Are the Government satisfied that patients under these emergency powers are receiving adequate information and support at the most critical moments of intervention? Is there a mechanism to support the nominated person if the patient does not have capacity, so that the nominated person receives the information they need to make a fully informed decision? If the answer is that the duration of detention is too short to justify IMHA involvement, I ask the Minister: how short is too short when a person’s liberty and medical autonomy are in question?

It may be that Government amendments 42 and 43 address some of those points, so I will return to this in a second before moving on to my fourth point. In terms of information sharing and patient autonomy, I welcome the retention of the duty to inform patients, especially informal patients, of their right to advocacy, and for that provision to be given both orally and in writing. However, I note that the responsible person must also—except where the patient requests otherwise—be provided with written information to the nominated person. What safeguards are in place to ensure that that does not inadvertently breach the patient’s privacy, such as in situations involving estranged family members, controlling relationships or very personal health issues, which could be disclosed but are not relevant to mental health? It is essential that the nominated person framework enhances advocacy and support and does not undermine the person’s right to control who knows about their care.

Finally, I would welcome clarity from the Minister about how the uptake and impact of expanding the IMHA system will be monitored. Will there be reporting requirements on providers? If so, will that be through the integrated care boards, or is that part of the CQC? Will patients have the opportunity to feed back on the effectiveness of the support they receive?

Before I turn to the amendments, I reiterate that the Opposition support the principle of strengthening advocacy in mental health services. Clause 41 is an important step towards a more rights-based and person-centred system, but the detail of the implementation is key.

I note that proposed Government amendments 42 and 43 to schedule 3 specifically change the definition of “English qualifying informal patient” and “Welsh qualifying informal patient” to exclude patients detained under any

“legislation or by virtue of a court order”,

rather than limiting exclusion to those detained solely under the Mental Health Act. That important clarification partly improves on one of the problems I mentioned when discussing clause 41.

In simple terms, those amendments try to address the issue of clarity and coverage for patients detained under other laws, and I believe that this is how they do that. Originally, the Bill excluded only patients detained under the Mental Health Act from being classified as informal patients eligible for IMHA services, but some patients might be detained under other laws or court orders, such as criminal justice laws, which the original wording did not cover. The amendments change the definition to exclude anyone detained under any legislation or by a court, not just the Mental Health Act. In practice, this means that patients detained under other laws will not mistakenly be considered informal patients eligible for IMHA services under this part of the Bill.

The proposals close a gap so that the right groups get advocacy services, and there is less confusion for hospitals and advocates about who qualifies. In essence, by broadening and bettering the definition and defining the exclusion, this will ensure that patients detained under other legislation, such as the Criminal Justice Act, or other court-mandated detention powers, are not mistakenly classified as informal patients eligible for IMHA services under those provisions. That reflects a more comprehensive and legally coherent approach to defining eligibility.

This clarity is welcome, as it reduces potential ambiguity in respect of providers. That said, will the Minister comment further on how these changes will interact with existing IMHA provisions or advocacy entitlements for those detained under other legislation? Are there parallel safeguards or advocacy rights for those groups? What guidance will be provided to practitioners and IMHA providers to navigate the complexities of overlapping detention regimes, especially when a patient’s status might shift rapidly between voluntary Mental Health Act detention and court orders? Will this amendment necessitate any further changes in regulations or operational policies to ensure smooth implementation and clarity for patients, families and service providers? Ensuring that no patient falls through the cracks due to definitional nuances is crucial for integrity in our mental health advocacy services.

Finally, Lib Dem amendment 19 would insert after “patient”, in schedule 3, page 91, line 13,

“or English qualifying informal patient under 18”.

As the hon. Member for Hertford and Stortford and Opposition Members rightly pointed out, it is quite hard to see why the Government would not want to put that in place. The explanatory statement says that it aims to extend

“the provision of opt-out advocacy services in England to informal inpatients under 18.”

It seems clear in what it does and is a well-defined amendment to that end. I am keen to understand why the Government do not want to support it. Do they believe that this is currently balanced elsewhere in the system? Are there already provisions elsewhere? If not, why—if it is good for adults and we are strengthening their opportunities—should it not be the same for our children?

I will finish on that point. I would be grateful for answers on the clause, the schedule, the Government amendments and the Lib Dem amendment.

Stephen Kinnock (Labour, Aberafan Maesteg)

The hon. Member for Chester South and Eddisbury asked who can make referrals in addition to hospital managers. The list of responsible persons is in proposed new section 130CC, in paragraph 6 of schedule 3. In addition to hospital managers, the responsible local social services authority is also required to notify providers of advocacy services about qualifying patients; whether it is a matter for the hospital or the local authority depends on the patient.

I was asked whether there are enough people to fulfil the tasks of the IMHA. The impact assessment gives our current best estimate of likely workforce and funding requirements and sets out the expected expansion required for each workforce group. We will recruit approximately 330 additional IMHAs.

Aphra Brandreth (Conservative, Chester South and Eddisbury)

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

Stephen Kinnock (Labour, Aberafan Maesteg)

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

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

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

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

Luke Evans (Conservative, Hinckley and Bosworth)

Will the Minister give way on that point?

Stephen Kinnock (Labour, Aberafan Maesteg)

No, I have finished.

Schedule 3 - Independent mental health advocates

Carolyn Harris (Labour, Neath and Swansea East)

Does the hon. Member for Winchester wish to press amendment 19?

Danny Chambers (Liberal Democrat, Winchester)

I think the hon. Member for Farnham and Bordon has spent more time discussing our amendments than I have, so I would like to give him the opportunity to vote in favour of one of them.

Clause 42 - Information about complaints for detained patients

Carolyn Harris (Labour, Neath and Swansea East)

With this it will be convenient to discuss clauses 43 and 44 stand part.

Stephen Kinnock (Labour, Aberafan Maesteg)

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

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

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

Gregory Stafford (Conservative, Farnham and Bordon)

I rise to speak in favour of clauses 42, 43 and 44, which together strengthen the duty to inform patients—whether detained in the community or conditionally discharged—about how to make a complaint about their treatment and the outcome of that complaint. The Mental Health Act has long included duties to tell patients their rights, but too often that information has been patchy, hard to understand or buried in paperwork. The clauses tackle that by requiring clear, repeated information about not just detention, but treatment and the complaints process.

Clause 42 relates to information about complaints for detained patients. Section 132 of the Mental Health Act 1983 originally required hospitals to inform detained patients of their rights, but that was often inconsistently applied. This clause responds to long-standing concerns about transparency and patient empowerment, aligning with the broader goals of the Bill to enhance autonomy and dignity in mental health care. Specifically, there is an expanded duty of information. Hospital managers must now ensure that detained patients understand how to make complaints, not only about their detention, but about their treatment, along with the outcomes of any complaints.

There are some timing requirements, i.e. that the information must be provided as soon as practicable after detention begins and be repeated annually for restricted patients, or after each section 20 report for others. That will improve patient’s awareness of their rights and how to seek redress. It will promote accountability and mental health services by encouraging feedback and complaints, and support better outcomes by addressing grievances early and constructively.

Clause 43 is similar, but specifically for community patients rather than detained patients. Section 132A of the Mental Health Act 1983 originally required hospital managers to inform patients of their rights under the Act. However, that was limited in scope. This clause aligns with the Bill’s broader goal of improving transparency, patient empowerment and accountability in mental health services, especially for those under community treatment orders, who often face ongoing restrictions without being detained in hospital.

Like the previous clause, clause 43 expands information duties, as community patients must now be informed not only of their rights and treatment conditions, but also of how to make complaints about the use of the Mental Health Act powers or any mental health treatment received while under community care, and the outcomes of any such complaints. Again, the information must be provided as soon as practicable after the report is furnished under section 20A of the Act, which relates to periodic reviews of the community treatment orders.

Clause 44 relates to information for conditionally discharged patients, and is slightly different from the previous two clauses. It introduces a new duty requiring hospital managers to ensure that conditionally discharged patients are informed, both orally and in writing, about their legal status, rights and how to make complaints, and that that information is also shared with their nominated person unless they object. Specifically, proposed new section 132B to the Mental Health Act 1983 specifically addresses conditionally discharged patients. There is a clear explanation of legal status, as patients must be informed about the legal basis and the implications of their conditional discharge. There are new tribunal rights, where patients must be told what rights they have to apply to a tribunal while conditionally discharged.

Like in the other two clauses, the complaints procedures are changed so that patients must be informed about how to complain regarding the use of the Mental Health Act powers, any mental health treatment received while conditionally discharged and the outcome of such a complaint. However, key to this clause is that the information must be provided both orally and in writing, and that the nominated person has to be included. A copy of the written information must be given to the patient’s nominated person unless the patient requests otherwise. Those are all excellent parts of the Bill.

I have three questions for the Minister. First, how will we ensure that the information is genuinely accessible, especially for patients with limited literacy or cognitive difficulties? Secondly, what training will be provided to staff to communicate this information clearly and compassionately? Finally, will there be an audit of whether patients feel genuinely informed and empowered to complain?

These clauses will help to move mental health care towards greater openness and patient empowerment and therefore, hopefully with some positive answers from the Minister on those three questions, I commend them to the Committee.

Sojan Joseph (Labour, Ashford)

I welcome the strengthening of section 132 of the Mental Health Act in respect of information about complaints, as proposed in clauses 42 to 44.

Clause 42 deals with information about complaints for detained patients. Currently, through the code of practice, there is a requirement that hospital managers will pass on that information. They should do so both orally and in writing, ensuring that the information is accessible, including in easy-read format for people with learning disabilities. Hospital managers should also ensure that the information has been understood. The clause would amend section 132 of the Act by placing that statutory duty on hospital managers, supplying detained patients and the nominated person with the necessary information about complaints, and taking practicable steps to ensure that the information has been understood.

Proposed new subsection (2A) deals with the types of complaints covered by that duty. They include complaints about carrying out of functions under the Act and about medical treatment. Proposed new subsection (2A)(c) ensures that the statutory duty covers information about the patient’s right to complain to the Parliamentary and Health Service Ombudsman about the maladministration of such complaints. Proposed new subsection (2B) sets out that the duty is triggered

“as soon as practicable after the commencement of the patient’s detention”.

That means that the duty will be triggered each time the section under which the patient is detained changes, and when the authority to detain under that section is renewed.

In respect of part III of the 1983 Act, which concerns restricted patients to whom automatic renewals do not apply, the duty will be triggered every 12 months from the start date of detention. As I mentioned earlier, much of that process is already expected to take place, but ensuring it takes place in future by making it a statutory duty is a sensible and welcome strengthening of that safeguard.

That is also the case for clause 43, which relates to information about complaints for community patients and seeks to amend section 132A of the 1983 Act. As a result of the clause’s changes, there will be a statutory duty on hospital managers to supply information about the complaints procedure, as set out in clause 42, to community patients and the nominated person. That will mean that the patient must be provided with complaints information as soon as practicable after they are placed under a community treatment order, and each time that community treatment order is renewed.

Clause 44 deals with information about complaints for conditionally discharged patients and inserts proposed new section 132B, which requires hospital managers to give complaints information to conditionally discharged restricted patients. The proposed new section states that such information must be provided before the patient leaves hospital, or as soon as possible when the patient is conditionally discharged. Patients must receive the information when they are first detained in the hospital, and again whenever they are conditionally discharged. As with clause 42, the hospital manager must ensure that the patient has received such information both orally and in writing, and that practical steps have been taken to ensure that the patient understands the information. A copy of the information must also be given to the nominated person within a reasonable timeframe, unless the patient has requested otherwise. I support the clauses, as the changes made by it will strengthen the Act.

Aphra Brandreth (Conservative, Chester South and Eddisbury)

I rise to make a few brief remarks about clauses 42 to 44, which would amend the 1983 Act to place statutory duties on hospital managers to supply complaints information to both the patient and the nominated person in respect of detailed patients, patients subject to a CTO and conditionally discharged patients.

These are important clauses. The people concerned are potentially vulnerable individuals. They need to know that they have a voice in this process and feel empowered to speak out and complain, should they wish. There is a duty on hospital managers to ensure that detained patients understand how to make complaints. However, I ask the Minister how that duty will be checked and evaluated. We all agree that the ability to speak out to make a complaint is important, but we need to ensure that proper safeguards and parameters are in place on how that will happen.

I also welcome the provision requiring that the information must be provided as soon as is practicable. That is important to give patients confidence. The timing requirements will potentially make a huge difference. The journey of a patient may change rapidly over the course of their treatment, so not leaving it too long will potentially make a substantial difference to their ability to recover swiftly, and ensure that they have been able to speak out if they are concerned not just about their detainment but about the way that their treatment is being carried out, and the potential implications of that.

Like many of the measures that we have discussed, these clauses might have administrative implications. We need to ensure that we have fully considered and are able to put in place the necessary support for hospital managers to deal with complaints appropriately. It is important that if someone comes forward with a complaint, it can be dealt with swiftly.

As mentioned on some other matters, we need to ensure consistency for patients, so that they understand the information that they are being provided and that, whatever region they might live in or hospital they might be at, consistent information is provided. I would like the Minister’s reassurance on that point.

Overall, however, the clause improves patients’ awareness of their rights and how they can seek redress. I think we all agree that that is extremely important. It will promote accountability in mental health services by encouraging feedback and complaints. I would like reassurance of some oversight to ensure feedback on any complaints that come forward so that we identify where consistent issues come up, to provide better services not just to the individual but to future individuals. Overall, the clauses support better outcomes by addressing potential grievances and ensuring that they are addressed early and constructively, so I am supportive of them.

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

You will be delighted to know that I will be mercifully brief, Mrs Harris, because I am broadly supportive of all three clauses. Having worked as a doctor in clinical practice, and as a barrister, I am cognisant of the importance of transparency, patient autonomy and procedural fairness, in particular with vulnerable patients who are often seen in a mental health care setting.

I welcome this trio of clauses, but I have some gentle challenges to put to the Minister for when he gets to his feet. First, how will data be captured on the information that is to be provided to patients and their families? What feedback mechanisms will be in place, not just for patients but for those who support them—their carers and families—and for clinicians, on the practicalities of how the system is working?

Sojan Joseph (Labour, Ashford)

I was a clinician and I practised on wards; patient records are electronic for staff. When staff complete the explanation of section 132 rights, they record that on the electronic patient records. Does the hon. Member agree that that would be a good place to get the data?

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

The hon. Member makes a very valid point. There is that mechanism, but this is also about ensuring that the quality of the information that has been imparted—not just the process of it being done—is recorded. An audit process must ensure that the important conversations and information are imparted in a way that the patient and their family understand, in sufficient detail and as part of a process whereby, if there are concerns or doubts, they can be addressed in a ready manner. I take his point that there are metrics by which to measure things, but it is not just about capturing data; it is about capturing quality data in order to ensure that that is being fulfilled.

To pick up on the point made by my hon. Friend the Member for Chester South and Eddisbury about regional variability, consistency across the board is important not only in the regions, but in the delivery methods and capacity that underpin this crucial service.

Finally, on potential confusion and legal information being communicated in inaccessible ways, it is important that legalese does not get in the way of clarity for individuals who will have to navigate the information. I am interested to hear the Minister’s views on how we can ensure that the information is imparted in an accessible way for all those concerned—importantly, not just for patients and their families, but for clinicians who have to impart the information. They need to feel comfortable navigating their way around what can often be a complex set of regulations and legislation.

Written evidence reported to the House