Mental Health Bill [ Lords ] (Ninth sitting)

The Committee consisted of the following Members:

Chairs: Gill Furniss, Carolyn Harris, Sir Desmond Swayne, † Martin Vickers

† Bloore, Chris (Redditch) (Lab)

† Brandreth, Aphra (Chester South and Eddisbury) (Con)

† Burton-Sampson, David (Southend West and Leigh) (Lab)

† Chambers, Dr Danny (Winchester) (LD)

† Craft, Jen (Thurrock) (Lab)

† Dean, Josh (Hertford and Stortford) (Lab)

† Dixon, Anna (Shipley) (Lab)

† Evans, Dr Luke (Hinckley and Bosworth) (Con)

† Franklin, Zöe (Guildford) (LD)

† Irons, Natasha (Croydon East) (Lab)

† Joseph, Sojan (Ashford) (Lab)

† Kinnock, Stephen (Minister for Care)

† Morris, Joe (Hexham) (Lab)

† Owatemi, Taiwo (Lord Commissioner of His Majesty’s Treasury)

† Shastri-Hurst, Dr Neil (Solihull West and Shirley) (Con)

† Stafford, Gregory (Farnham and Bordon) (Con)

† Wrighting, Rosie (Kettering) (Lab)

Claire Cozens, Harriet Deane, Committee Clerks

† attended the Committee

Public Bill Committee

[Martin Vickers in the Chair]

Mental Health Bill [Lords]

09:25:00

I have a few preliminary reminders. Please switch electronic devices to silent. No food or drink, except the water provided, is permitted during the sittings of this Committee. Hansard would be grateful if Members could email their speaking notes or pass them on to the Hansard colleague in the room. Members are reminded to bob and catch my eye if they wish to speak in any debate. New Clause 1 Reporting: racial disparities relating to community treatment orders “(1) Within a period of 12 months following the day on which this Act is passed, the Secretary of State must undertake a review of racial disparities which relate to the use and administering of community treatment orders. (2) The review under subsection (1) must include, but is not limited to— (a) an assessment of whether certain racial or ethnic groups are disproportionately represented among individuals subject to community treatment orders compared to their representation in the general population; (b) a review of the outcomes and effectiveness of community treatment orders across different racial groups, including health outcomes, and patient experiences. (3) The Secretary of State must lay a report of the findings of the review before Parliament within 18 months of the day on which this Act is passed.”—(Zöe Franklin.) This new clause seeks to gauge the Government’s view on prevalent racial disparities as they relate to the use of community treatment orders under the Act. Brought up, and read the First time.

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

With this it will be convenient to discuss new clause 3—Addressing and reporting on racial disparities and other inequalities in the use of the Mental Health Act 1983— “After section 120D of the Mental Health Act 1983, insert— ‘120E Mental health units and services to have a responsible person (1) A relevant health organisation that operates a mental health unit or community mental health service for qualifying patients must appoint a responsible person for that unit or service for the purposes of addressing racial disparities and other disparities based on protected characteristics related to functions discharged under the Mental Health Act 1983. (2) The responsible person must— (a) be employed by the relevant health organisation, and (b) be of an appropriate level of seniority. (3) Where a relevant health organisation operates more than one mental health unit or service, that organisation must appoint a single responsible person in relation to all of the mental health units or services operated by that organisation. (4) A patient is a qualifying patient if they are— (a) liable to be detained under this Act, otherwise than by virtue of section 4 or 5(2) or (4) or section 135 or 136; (b) subject to guardianship under this Act; (c) a community patient. 120F Policy on racial disparities and other disparities based on protected characteristics (1) The responsible person must publish a policy on how the unit plans to reduce racial disparities and other disparities based on protected characteristics in that unit or service. (2) The policy published under subsection (1) must cover the following topics— (a) the application of the guiding principles to all aspects of operation of this Act; (b) staff knowledge and competence in connection with promoting equality and anti-discriminatory practice in relation to this Act; (c) workforce demographics, recruitment, retention and progression; (d) implementation of the patient and carer race equality framework (England only) and any other requirements of relevant national policies; (e) care planning and decision-making in the use of this Act including section 56A (making treatment decisions); (f) the availability of alternatives to detention and involuntary treatment; (g) take-up of independent mental health advocacy; (h) the cultural appropriateness of independent mental health advocacy; (i) access to and use of advance choice documents; (j) what steps will be taken to reduce racial disparities and other disparities based on protected characteristics in that unit or service. (3) Where a responsible person is appointed in relation to all of the mental health units operated by a relevant health organisation, the responsible person must publish a single policy under subsection (1) in relation to those units or services. (4) Before publishing a policy under subsection (1), the responsible person must— (a) consult any persons that the responsible person considers appropriate; (b) have regard to the following matters— (i) the views, wishes and feelings of people from ethnic minority communities who have been detained; (ii) the views, wishes and feelings of people with other protected characteristics who have been detained. (5) The responsible person must keep under review any policy published under this section. (6) The responsible person may from time to time revise any policy published under this section and, if this is done, must publish the policy as revised. (7) If the responsible person considers that any revisions would amount to a substantial change in the policy, the responsible person must consult any persons that the responsible person considers appropriate before publishing the revised policy. 120G Training in racial disparities and other disparities based on protected characteristics (1) The responsible person for each mental health unit or service must provide training for staff that relates to addressing racial disparities and other disparities based on protected characteristics in that unit or service. (2) The training provided under subsection (1) must include training on the topics covered in section 120F(2). (3) Subject to subsection (4), training must be provided— (a) in the case of a person who is a member of staff when this section comes into force, as soon as reasonably practicable after this section comes into force, or (b) in the case of a person who becomes a member of staff after this section comes into force, as soon as reasonably practicable after they become a member of staff. (4) Subsection (3) does not apply if the responsible person considers that any training provided to the person before this section came into force or before the person became a member of staff— (a) was given sufficiently recently, and (b) is of an equivalent standard to the training provided under this section. (5) Refresher training must be provided at regular intervals whilst a person is a member of staff. (6) In subsection (5) “refresher training” means training that updates or supplements the training provided under subsection (1). 120H Annual report by the Secretary of State (1) As soon as reasonably practicable after the end of each calendar year, the Secretary of State must conduct a review in consultation with relevant bodies with commissioning functions on the use of treatment and detention measures contained in the Mental Health Act 1983 broken down by race and other demographic information. (2) Having conducted a review under subsection (1), the Secretary of State must publish a report on the progress made in reducing inequalities in treatment outcomes and the use of detention measures in the use of this Act on people who have protected characteristics under the Equality Act 2010.’” This new clause requires mental health units and services to appoint a responsible person tasked with addressing racial disparities related to functions discharged under the Mental Health Act 1983.

It is a pleasure to serve under your chairmanship, Mr Vickers. New clause 1 seeks to ensure that racial disparities in the use of community treatment orders are properly understood, monitored and addressed. We have known for many years that black individuals are disproportionately subjected to coercive powers under the Mental Health Act 1983, including detention, restraint and community treatment orders, yet progress has been painfully slow. The new clause would require the Secretary of State to undertake a review within 12 months of the Bill passing and to publish the findings within 18 months. It would look specifically at whether certain racial or ethnic groups are over-represented among those who are subject to community treatment orders, and whether there are disparities in outcomes—including treatment effectiveness and patient experience—across racial groups. The aim is not just to collect data, but for meaningful scrutiny of how coercive community powers are applied and whether they are serving all groups equally. The 2018 independent review of the Mental Health Act found that black individuals were more than eight times more likely to be placed under a CTO than white individuals. That is not a minor discrepancy, but a structural injustice. The review also raised concerns that CTOs were not necessarily used because they are clinically effective, but because they are seen as a way to manage risk, particularly where racialised assumptions come into play. We must ask, are CTOs truly supporting recovery, or are they disproportionately used to control and surveil? Are they fostering trust or fear in mental health services? The new clause would give Parliament the information we need to answer those questions. It would set a timeline for transparency and create a foundation for future policy reform that is rooted in fairness and equality. In the absence of this new clause, we risk continuing a system where racial injustice is baked into mental health practice, without sufficient oversight or accountability. If this Government are serious about tackling racial inequality in mental health, they will have no objection to this basic measure of review and reporting. We have discussed specific disparities in previous clauses, but new clause 3 aims to ensure that systematic and sustained action is embedded in the way that mental health services are run. The disproportionate detention and coercive treatment of black and minority ethnic people under the Mental Health Act has been evidenced for decades, yet progress on addressing these inequalities has been too slow and too inconsistent across the country. New clause 3 takes a structural approach. It would require each mental health provider to appoint a dedicated senior lead to take responsibility for reducing inequalities within their services—not in name only, but through published plans covering staff diversity, culturally appropriate advocacy care planning and the use of advance choice documents. It would also ensure that frontline staff receive ongoing training that equips them to recognise and respond to disparities and uphold anti-discriminatory practice, with regular refreshes to ensure that this learning stays live. Importantly, it would place a duty on the Secretary of State to publish an annual report breaking down how the Bill is used across racial and other demographic groups, and what progress is being made to close those gaps. This is not about creating more paperwork; it is about requiring leadership, transparency and accountability at every level, from clinical teams through to Government. If this Bill is to earn the title of a reform, it must act decisively on the most pertinent inequalities in the system. I urge the Committee to support the new clauses.

It is a pleasure to serve under your chairship, Mr Vickers. Sadly, there are clear racial inequalities within the mental health system, as in other areas of health, and this must change. People from ethnic minority communities are more likely to experience a mental health problem, are less likely to receive support, and have poorer outcomes from services. It is very concerning that black and ethnic minority people are over-represented in detentions in our mental health system, and there are well-documented worries over disparities in the quality of care that they receive. Decades of evidence and lived experience testimony point to systemic injustice. Black British people suffer a 6% higher rate of common mental health problems than white British people, and black adults are twice as likely to show symptoms of post-traumatic stress disorder—at 8%, compared with 4% of the white British population. Black men are over 10 times more likely to be placed under community treatment orders, and black women are more likely than any other group of women to experience common mental health problems. Studies have shown that experiences of racism link to depression, psychosis and post-traumatic stress. When people are assaulted—not just physically, but emotionally and psychologically—by the structures around them, it leaves a lasting impact. I have witnessed at first hand the racial disparities at a visit to my local in-patient mental health care at Rochford community hospital, where I could see a visibly disproportionate number of black men on the ward, compared with the percentage of black men I know live in my community. People from ethnic minority communities are more likely to come into contact with mental health services through crisis pathways, the police, accident and emergency, and detention. They are more likely to be restrained, isolated and subjected to coercive treatment. We must listen to what these communities are telling us. Research by Mind identified nine key barriers to accessing care, from stigma and discrimination to Eurocentric models of treatment, language and cultural barriers. People feel othered by a system that was not built with them in mind. We need to rebuild trust and recognise that mental health cannot be separated from the broader social and political context. Austerity, Brexit, the Windrush scandal and covid-19 have all disproportionately affected the black, Asian and minority ethnic community. That has led to a decrease in trust towards the establishment, and that bleeds into general distrust of organisations and officials working in healthcare settings and mental health. People from BAME communities have shared many examples of direct and indirect discrimination they have experienced within mental health services. Those negative lived experiences further erode trust in the system and often deter people from seeking help. Racial disparities in mental health are a pressing issue that requires immediate and sustained action. New clauses 1 and 3, tabled by the hon. Member for Winchester and outlined by the hon. Member for Guildford, have good intentions, but we need to reflect on whether they fit in the Bill. I would suggest not. The drivers of disparity here are much deeper than the scope of the Bill, and it would be wrong to attempt to wrap up the solution to this issue within it. That does not mean that action should not be taken. I am hopeful that this Government are doing wider work to drive down racial inequalities, including with the challenge we can see here with mental health. Perhaps the Minister will outline more about the Government’s work, and therefore why the new clauses are not needed. I support the intent of the hon. Member for Winchester, but I cannot support the new clauses as an addition to the Bill. I would be happy to meet the Minister and others to discuss further ongoing overall inequalities for the BAME community.

It is a pleasure to serve under your chairship this morning, Mr Vickers. New clause 1, tabled by the hon. Member for Winchester, would require the Secretary of State to undertake a review of racial disparities in the use of community treatment orders. It is our view that the evidence base is already strong, and further reviews are not necessary. There are significant racial disparities in the use of community treatment orders. In 2023-24, black or black British people were issued with CTOs at seven times the rate of white or white British people. The use of community treatment orders as a proportion of overall detention numbers is higher for all minority ethnic groups compared with the white British population. We are committed to reducing these disparities through our reforms and through the patient and carer race equality framework, which was a recommendation of the independent review. This includes a greater focus on prevention and early intervention, in part by promoting the use of advance choice documents, rather than an approach that simply makes it harder to impose CTOs. We are developing and monitoring an evaluation strategy, and we will continue to monitor and report on ethnic disparities via the published Mental Health Act statistics and our annual implementation report to Parliament. New clause 3 would create the new “responsible person” role. They would have a duty to report on racial disparities and other inequalities in the use of the Mental Health Act. However, as drafted, the remit is significantly broader than that, to the extent that it would not be practical to combine all the stated functions into one role. We agree that there is a need to strengthen organisational leadership, improve data collection and change cultures across the mental health system. We also agree that it is important to have more targeted responsibilities to monitor and address racial disparities at board level in trusts, and that is already an explicit requirement of the PCREF. The PCREF is a contractual requirement of mental health providers under the NHS standard contract. It builds on the statutory duties that apply already under the Equality Act 2010. These existing requirements cover the key responsibilities needed to monitor and address racial disparities. The PCREF can be updated more regularly than primary legislation, allowing us to take an iterative approach throughout implementation to ensure that we are capturing reporting and acting on the right data from frontline services. Ultimately, we feel that the PCREF will be more effective at reducing racial inequalities than the very broad remit outlined in this new clause, and that the addition of a responsible person in legislation is duplicative and unnecessary. My hon. Friend the Member for Southend West and Leigh asked about implementation. The PCREF is the key instrument that we will use, but we are seeking to improve and strengthen decision making in three important ways: first, by requiring that an individual must be at risk of serious harm to be made subject to a CTO; secondly, by requiring the community clinician to be involved in all community treatment order decisions; and thirdly, by increasing the frequency of automatic reviews of patient cases by the tribunal, so that CTOs can be removed as soon as it is safe and appropriate to do so. I hope that that gives my hon. Friend some reassurance around the work that we are doing, but of course I would be happy to discuss these matters with him. For those reasons, I ask the hon. Member for Guildford to withdraw new clause 1, on behalf of the hon. Member for Winchester.

I thank the Minister for outlining the PCREF and the focus that it will have in addressing these issues. I was particularly interested in the explanation of the iterative approach that it will allow. I also thank the hon. Member for Southend West and Leigh for his insights into the issue. I beg to ask leave to withdraw the motion. Clause, by leave, withdrawn. New Clause 2 Mental Health Crisis Breathing Space “(1) Any person detained under sections 3, 37, 41 or 47 of the Mental Health Act 1983 must be offered support from the mental health crisis breathing space debt respite scheme.”—(Dr Chambers.) This new clause ensures that MHCBS, a debt respite scheme, is offered and available to patients detained under sections 3, 37, 41 and 47 of the Mental Health Act 1983. Brought up, and read the First time.

I beg to move, That the clause be read a Second time. The new clause relates to the mental health crisis breathing space debt respite scheme, and would allow it to be “offered and available to patients detained under sections 3, 37, 41 and 47 of the Mental Health Act 1983.” The mental health crisis breathing space mechanism is another vital tool that can protect people in a mental health crisis from the impacts of problem debt, by pausing enforcement action, contacting creditors and freezing interest and charges on any debts. However, the number of people benefitting from an MHCBS are significantly below its potential, largely because both patients and healthcare professionals do not know about it. Ensuring that everyone detained under the longer provisions of the Act would automatically be offered access to the scheme would ensure that many more people could benefit from it. We have discussed in previous sittings the impact of debt on mental health, and the work of Winchester Citizens Advice. I am really pleased to say that this week, I presented them with a huge award for best social enterprise at the Hampshire business awards, so my congratulations go to them.

I am grateful to the hon. Member for Winchester for bringing this issue before the Committee. The Government’s breathing space programme plays an important role in protecting people experiencing problem debt. We recognise that that can be particularly critical for people whose mental illness is worsened or even triggered by financial problems. Let me reassure the hon. Gentleman that people under the sections identified by his new clause are already eligible for breathing space. In fact, eligibility covers all individuals detained in hospital for assessment or treatment under the Mental Health Act, as well as those receiving crisis treatment in a community setting from a specialist mental health service. Furthermore, NHS England guidance already sets out that financial support, including referral to breathing space, should be offered to patients receiving acute in-patient mental health care, whether detained or voluntary patients. We will make explicit the need for staff to offer proactively that support in the Mental Health Act code of practice. For those reasons, I ask the hon. Member for Winchester to withdraw his new clause.

I thank the Minister for his comments. I am concerned about the lack of knowledge among patients and healthcare professionals. We cannot see any downside to making this an automatic right, so we will press new clause 2 to a vote. Question put, That the clause be read a Second time.

15|0|2|11|The Committee divided:|Question accordingly negatived.||0|0

New Clause 6

Duty to promote mental health wellbeing

“After section 142B of the Mental Health Act 1983, insert—

‘Duty to promote mental health wellbeing

(1) It is a general duty of local authorities and anybody in carrying out functions under this Act or the Mental Health Act 2025 to promote mental health wellbeing.

(2) In carrying out the duty under subsection (1), local authorities and commissioning bodies must have regard to—

(a) the prevention of mental illness,

(b) the promotion of positive mental health,

(c) the reduction of stigma and discrimination associated with mental health conditions, and

(d) the provision of accessible and appropriate support services to individuals experiencing mental health challenges.

(3) Local authorities and commissioning bodies must publish an annual report outlining the steps taken to discharge their duty under subsection (1), including an assessment of—

(a) progress in improving mental health wellbeing in their area for persons affected by the provisions of this Act, and

(b) any barriers to promoting mental health wellbeing for such persons and proposed actions to address them.

(4) The Secretary of State may issue guidance on the discharge of the duty under subsection (1), and local authorities and commissioning bodies must have regard to such guidance.’”—(Zöe Franklin.)

I beg to move, That the clause be read a Second time. The new clause would require local authorities and commissioning bodies to promote and report annually on mental health wellbeing in regard to any guidance published by the Secretary of State.

I thank the hon. Lady for giving way so early in her speech. I mentioned my concern about this provision on Second Reading: a rough road is not the same as a broken bridge. We are dealing here with the most severe mental health issues. The new clause talks about wellbeing, which affects everyone. Trying to report that and fit it into this criteria risks diluting the very aim of the Bill in trying to deal with the most severe mental health issues. I would be grateful for clarification on the difference between mental wellbeing, which affects everyone, and mental health issues, which not everyone has.

When it comes to enabling the Mental Health Act to function, having an understanding on the ground of the picture across our communities regarding mental health wellbeing is very important. That is why we tabled the new clause, which would allow us to get community care right. That would then feed into the crisis care that we are discussing in this Committee.

09:45:00

It is simply not enough to provide care to those with the most acute mental health problems; we must look at preventive measures to ensure that people are supported through difficult times in their lives. The new clause would require a report from local authorities so that we could ensure that they are providing tailored support to those in need. We Liberal Democrats strongly believe that early intervention and preventive services are key to tackling mental health issues, and the new clause would urge mental health service providers to look beyond putting out fires, and move towards a place where we understand our local communities and the situation in relation to mental health and wellbeing, so that we do not reach crisis point in the future.

I am grateful to the hon. Member for Winchester for tabling the new clause. Like him, we are committed to preventing mental ill health and promoting good mental health. Achieving our vision for mental health requires a spectrum of interventions across the whole of society and across the life course, from prevention and early intervention through to treatment and specialised care for those with a severe mental illness in community and in-patient settings. We are committed to the shifts from treatment to prevention, hospital to community and analogue to digital, and our forthcoming NHS 10-year health plan will affirm those commitments. With our commitment to neighbourhood health, we are encouraging stronger partnership working between local government, mental health services and the voluntary and community sector. As part of our shift to community, we have already launched six pilot neighbourhood mental health centres to deliver a 24/7 service, with open access to anyone who requires mental health support. Through the shift to prevention, we are putting more emphasis on early intervention and recovery to support people to live well and thrive, ensuring that we improve the conditions for creating good mental health. Alongside that, I remind the Committee of the existing prevention concordat for better mental health: a voluntary agreement signed by local authorities and integrated care boards. Signing the concordat involves a commitment to take evidence-based, preventive and promotional action to support the mental health and wellbeing of their populations. The new clause would be duplicative of that existing programme, and could introduce an unnecessary resource burden on local authorities and commissioning bodies. We are committed to moving to a meaningful partnership between central and local government, and to letting local leaders lead within their communities. For those reasons, I hope that the hon. Member for Guildford feels able to withdraw the motion.

I thank the Minister for his comments. In particular, I was interested to hear about the mental health centre pilot schemes. I look forward to their further roll-out. They will be crucial in addressing the issues that we sought to address in the new clause. I was also very pleased to hear about the focus on a meaningful partnership between local government, national Government and mental health providers. On that basis, I beg to ask leave to withdraw the motion. Clause, by leave, withdrawn. New Clause 7 Funding and reporting “(1) For each financial year until all sections of this Act have come into force, of the total health service expenditure by the bodies (taken together) in subsection (2), the proportion which relates to mental health spending— (a) under the Mental Health Act 1983, and (b) under this Act or which, in future, would be made under provision inserted into the Mental Health Act 1983 by this Act, (taken together) must not decrease. (2) The bodies are the Department of Health and Social Care, NHS England and integrated care boards.”—(Dr Chambers.) This new clause would require that mental health spending as a proportion of health service expenditure must not decrease in the implementation period of the Act. Brought up, and read the First time.

I beg to move, That the clause be read a Second time. We are aware from the Darzi report that mental health cases account for about 20% of the NHS burden, and currently receive about 10% of the funding. Our mental health services urgently need investment. Children at risk of self-harm, anorexia and suicide often wait months to be seen. I keep thinking about a few people I spoke to in Winchester who have teenage daughters with anorexia. They have been told that their daughters have to reach a lower BMI before they hit the threshold for treatment. That is horrific for the individuals, and we know that their anorexia will be more difficult to treat, will require more intensive, longer treatment, and will cost the NHS more in resources and finances. Many people cannot access the care in the community that they need. In a context in which suicide and mental ill health is on the rise, it is therefore disappointing to us that the Government have removed key NHS targets on mental health, such as physical health checks for those with mental disorders. Supporting those with mental health conditions is a fundamental pillar of the Government’s welfare reforms and economic agenda, but we know there were about 1 million people waiting in 2024 for mental health services. That is why we need to ensure that the spend on mental health care does not decrease and that, if anything, it increases.

As a member of the Public Accounts Committee, I carefully scrutinise the annual accounts of the Department of Health and Social Care. We have been urging that exactly how the breakdown of expenditure relates to issues is made more transparent within those accounts, such as how much is spent on mental health. Does the hon. Gentleman agree that there are other ways in which we can scrutinise and hold the Department to account for its spend on mental health?

That sounds very sensible.

I thank the hon. Member for Winchester for his new clause. This was raised in the other place and there are several issues with it that have not yet been fully addressed. First, the new clause would apply only to spend under the Mental Health Act. The mental health system, and its accounting, is not structured based on the legal framework that patients are subject to. A single ward may contain a mix of patients under the Mental Health Act and informal patients who would not usually be considered to be under the Act. Community services will support some patients on community treatment orders, who are therefore subject to the Mental Health Act, but also many who are not and have never been subject to the Act. It would not be feasible or desirable to try to restructure accounting and reporting based on which patients are subject to the Act and which are not. Secondly, the Government believe in prevention. We want to see better mental health outcomes, with more people cared for in the community so that the need for use of the Act is reduced. Over time, we want to see a shift in spend into preventive community services, which should in turn lead to a fall in the need for the use of the Mental Health Act. Few would disagree with that general aim, but the new clause would prevent that. By requiring share of spend under the Act to increase or remain the same, we are necessarily limiting the share of spend that could instead go towards preventing people from needing to use the Act in the first place. We will need to invest to deliver these reforms, as the impact assessment makes clear; however, the new clause is flawed and not the right mechanism to achieve the necessary investment. Parliament already has the power to scrutinise departmental spend via the estimates process. We are required to report on the share of spend on mental health under the National Health Service Act 2006. This is sufficient to hold the Government to account. I therefore hope that the hon. Member for Winchester feels able to withdraw the motion.

I thank the Minister for his comments. If there is a duty to report the spend on mental health as a share of the whole budget, then I beg to ask leave to withdraw the motion. Clause, by leave, withdrawn. New Clause 8 Mental Health Commissioner “After section 142B of the Mental Health Act 1983, insert— ‘Mental Health Commissioner 142C Independent Mental Health Commissioner: establishment (1) There is to be an office known as the Office of the Mental Health Commissioner. (2) The Office in subsection (1) must be established by the Secretary of State three months after the day on which the Mental Health Act 2025 is passed. (3) The Office of the Mental Health Commissioner will be led by an individual appointed by the Secretary of State titled the “Independent Mental Health Commissioner”. (4) The role in subsection (3) is referred to as the “Mental Health Commissioner”. (5) The Mental Health Commissioner may appoint staff to the Office of the Mental Health Commissioner they consider necessary for assisting in the exercise of their functions in section 142D. 142D Functions of the Commissioner (1) The Mental Health Commissioner is responsible for overseeing the implementation and operability of functions discharged by relevant bodies and persons under the provisions of this Act, the Mental Health Act 1983, and the Mental Capacity Act 2025 particularly regarding the provision of treatment, care, and detention of people with a mental disorder. (2) The Mental Health Commissioner must publish an annual report on the use of functions discharged under this Act, which must assess— (a) the quality of mental health care treatment provided by relevant services; (b) the accessibility of mental health care treatment services; (c) the relationship between mental health and the criminal justice system; (d) inequalities of mental health care provision regarding protected characteristics under the Equality Act 2010; (e) the use and effectiveness of detention measures under this Act, including but not limited to Community Treatment Orders, for the purposes of therapeutic benefit outlined in section 1(2B); (f) challenges surrounding stigma of mental health conditions; (g) the accessibility of advice and support to mental health service users, their families and carers on their legal rights; (h) other issues deemed appropriate by the Mental Health Commissioner. (3) In fulfilling their duties under subsection (1), the Mental Health Commissioner may review, and monitor the operation of, arrangements falling within subsection (1), (2) and (3) for the purpose of ascertaining whether, and to what extent, the arrangements are effective in promoting the principles in section 118(2B) of this Act. (4) Subject to any directions from the Secretary of State, the Commissioner may take action necessary or expedient in connection for the purposes of their functions. (5) This may include— (a) collaborating with health services, public authorities, charitable organisations, and other relevant entities, including NHS bodies, the Care Quality Commission, and the Parliamentary and Health Service Ombudsman; (b) ensuring enforcement authorities and public bodies under the Mental Health Act 1983 have the necessary capacity and resources to adequately discharge duties under the Mental Health Act 1983 and this Act. 142E Appointment, Tenure, and Remuneration of the Mental Health Commissioner (1) The Secretary of State may by regulation make provision for the appointment, tenure, removal, and general terms of appointment of the Mental Health Commissioner. (2) The Secretary of State may also by regulation determine the Commissioner’s remuneration, allowances, and pension entitlements. 142F Examination of cases (1) The Secretary of State may, by regulations, make provision for the examination by the Mental Health Commissioner of the cases of those who are detained under this Act receiving treatment by authorised mental health care providers. (2) The Secretary of State may, by regulations, provide for the Office of the Mental Health Commissioner to access and examine relevant data on mental health treatment provision held by NHS England and any other authorities the Secretary of State considers appropriate. 142G Regulations A statutory instrument containing regulations under sections 142E and 142F may not be made unless a draft of the instrument has been laid before and approved by a resolution of each House of Parliament.’”—(Dr Chambers.) This new clause establishes the office of the Mental Health Commissioner and makes provisions for relevant duties and responsibilities. Brought up, and read the First time.

I beg to move, That the clause be read a Second time. New clause 8 would establish the office of a mental health commissioner and makes provision for relevant duties and responsibilities. The commissioner would have a strategic, cross-government focus, working to promote mental health and tackle inequalities, and would be a powerful advocate for the rights and wellbeing of those living with mental health problems, who would finally have a voice at the top table. The commissioner would also play a vital role in the public sphere, tackling stigma and discrimination, and championing policies that support good mental health across society. The commissioner would have an independence to comment on the implementation of the reform of the Mental Health Act and any subsequent changes or issues that arise. International evidence highlights the impact that such a role can have in improving communities. I keep coming back to a conversation I had in my office in Winchester with a psychiatrist whose wife also worked in the medical profession. He said that they were struggling to navigate the mental health system to get the healthcare that their child desperately needed. He made a really good point: if they, with their knowledge, expertise and experience, could not navigate the mental health system, what hope does anyone else have? That is why it is important to have someone with an overview who can advocate for patients, and the patient journey in general, to ensure that the process is streamlined and that people have the information they need to access the care they are entitled to.

I am grateful to the hon. Member for Winchester for bringing this issue, which was also debated extensively in the other place, before the Committee. Our view has not changed: the functions of the proposed commissioner clearly duplicate existing responsibilities of other organisations, most notably the Care Quality Commission. The Children’s Commissioner has expressed concerns that introducing a new mental health commissioner risks interfering with her own role in relation to children and young people’s mental health. We recognise that the patient quality and oversight landscape is not working effectively, but I strongly doubt that inserting another body whose role overlaps with those already in place would help to address that issue. The landscape is already cluttered and fragmented. That is why last year we asked Dr Penny Dash to assess whether the current range and combination of organisations deliver effective leadership, listening and regulation for the health and care systems in relation to patient and user safety, or whether a new delivery model is needed. We will shortly see the results of her much-anticipated review. We appreciate that our argument that the proposed mental health commissioner’s role would be duplicative of the CQC has previously been met with concerns about the effectiveness of that organisation. I reiterate that two major independent reviews into the wider role of the Care Quality Commission have reported under this Government, the recommendations from which the CQC has accepted in full. While we are confident in the progress that the CQC is making, we recognise that those reviews did not closely inspect the CQC’s statutory role and responsibilities in relation to monitoring the use of the Mental Health Act. Therefore, in response to an amendment tabled in the other House, we committed to report on the CQC’s monitoring functions under the Act in the first of the Government’s annual reports on the implementation of the Bill. That will include reflections from the new chief inspector of mental health, Dr Arun Chopra, on the CQC’s statutory functions and its role as a key partner in delivering the reforms. I am looking forward to meeting Dr Arun Chopra very shortly in his new role. Lastly, creating a mental health commissioner with a supporting office would require significant resources that we simply cannot justify. The original Mental Health Act commission was brought within the CQC to reduce Government spending and realise the benefits of aligning the CQC’s functions under the Mental Health Act with its functions under the Health and Social Care Act 2012, and to give it new powers to monitor via potential enforcement. Bearing in mind the radical reforms that we are making to the national health system to rid it of duplication, inefficiency and waste, we believe that now is not the time to reverse course on these matters.

I commend the work that the Minister and Penny Dash are doing to look at patient safety and the changes going on at the CQC. Could he reassure us that, within scope, he is also looking at the role of the Parliamentary and Health Service Ombudsman? There seems to be some confusion about whether complaints under the Act fall to the CQC or the PHSO.

The Dash review is looking at the landscape regarding all the different institutions and organisations, including the PHSO and the CQC, to map out how they interact with each other. Our view is that there is a lot of confusion and a lack of clarity, but we await the outcome of the review. I can confirm, however, that Penny Dash is looking at those matters. For those reasons, I ask the hon. Member for Winchester to withdraw the motion.

I thank the Minister for his reassurances. The issue is that the ability of the CQC to oversee implementation is limited, and it does not have a policy advisory function, which is something that a commissioner could do. Although we understand the Minister’s concerns about the office of a commissioner, the issue is important enough that we put it in our manifesto. We stood on a manifesto commitment to improve mental health access and streamline services via a commissioner. For that reason, we will press new clause 8 to a vote.

10:00:00

16|0|2|11|The Committee divided:|Question accordingly negatived.||0|0

New Clause 9

Veterans’ Mental Health Oversight Officer

“After section 142B of the Mental Health Act 1983, insert—

‘Veterans’ Mental Health Oversight Officer

(1) The Secretary of State shall appoint a Veterans’ Mental Health Oversight Officer (“the Officer”) to oversee the treatment and care of veterans under this Act.

(2) The Officer shall—

(a) oversee the cases of veterans who are:

(i) at risk of detention under this Act;

(ii) currently detained under this Act; or

(iii) following detention under this Act, subject to community or outpatient treatment or other post-discharge mental health provisions;

(b) advocate for mental health assessments and care tailored to veterans’ service-related experiences;

(c) collaborate with mental health professionals, veterans’ services, legal representatives, and third-sector organisations to safeguard veterans’ rights and well-being within relevant treatment settings;

(d) promote diversion from detention where clinically appropriate, including the use of veteran-specific support services; and

(e) submit an annual report to Parliament detailing:

(i) detention rates of veterans under this Act;

(ii) outcomes and recidivism rates for veterans detained under this Act;

(iii) recommendations for service improvement.

(3) In this section:

(a) “veteran” refers to a person who has served or currently serves in the armed forces of the United Kingdom or a Commonwealth nation.

(b) “relevant health authority” includes NHS England, regional NHS boards, or their successors.’”—(Zöe Franklin.)

I beg to move, That the clause be read a Second time. The new clause would introduce a dedicated veterans’ mental health oversight officer, recognising that those who serve or have served in the UK or Commonwealth armed forces face distinct mental health challenges that are not always adequately met by the current system. Far too many veterans experience post-traumatic stress disorder, depression, anxiety or substance misuse that, sadly, is linked to their service. Yet they are often treated within a system that does not fully take account of those experiences, and they are sometimes detained under the Mental Health Act without the benefit of trauma-informed, veteran-specific pathways of care. New clause 9 seeks to change that. It would create an independent officer, tasked with monitoring the use of the Mental Health Act in relation to veterans, advocating for tailored assessment and care linked to veterans’ service history, promoting alternatives to detention where appropriate, particularly through veteran-specific services, and reporting annually to Parliament on outcomes including rates of detention, recidivism and systemic barriers. It is not just about oversight; it is about respect and responsibility.

I am very sympathetic to the hon. Member’s concerns, but how does she see the new clause fitting in with the already established armed forces covenant, which protects and promotes healthcare for veterans across the country?

I see them as absolutely sympathetic to each other and working in concert. We want to ensure that veterans have specific, tailored mental health care, as is outlined in the Bill. That is why the new clause would ensure that veterans’ unique needs are not just recognised but actively addressed. It is a practical and overdue step to improve care, safeguard rights and deliver the joined-up service that veterans deserve. After all, they give so much to our nation through their service. I hope that the Minister will support the new clause, but if he does not, I hope that he will outline for the Committee how the Government will ensure that the aims of the new clause will be addressed through the Bill and its accompanying documents as they stand.

I am grateful to the hon. Member for Guildford for bringing the issue before the Committee. While most veterans lead healthy and successful lives following their service in the armed forces, we know that some may need mental health support. This Government are proud of the courage and dedication of our armed forces, and we are committed to ensuring that those who serve and served in the armed forces receive the best possible care. All service personnel have access to mental health support throughout their career. The Defence Medical Services provide a responsive, flexible, accessible and comprehensive treatment service and, for leavers from the armed forces, NHS mental health services are available that are specially designed to support the unique needs of veterans. That includes veterans in mental health in-patient settings under the Mental Health Act and those within the criminal justice system. In England, these services are Op Courage and Op Nova, and in Wales there is Veterans NHS Wales. These bespoke services link with wider NHS mental health services to advocate for and support veterans to receive care tailored to their needs. We are committed to giving veterans and armed forces personnel fair access to mental health care services and special consideration where appropriate. That is reflected in the core principles of the armed forces covenant, to which public bodies such as the NHS are legally bound to give regard. It is our firm view that a wealth of measures are already in place that respond to the unique needs and experiences of those who serve and have served in our armed forces. For that reason, I ask the hon. Member for Guildford to withdraw new clause 9.

I thank the Minister for his comments—particularly about Op Courage, Op Nova and the armed forces covenant—and for his commitment to the veterans who have served this country and their courage, even when they face challenges with their mental health. The Liberal Democrats are willing to withdraw the amendment, but we will observe the passage of the Bill closely to ensure that it serves our veterans well across the UK. I beg to ask leave to withdraw the motion. Clause, by leave, withdrawn. New Clause 11 Costed plan to ensure community provision for individuals with learning disabilities and autism who are at risk of detention “(1) Within 18 months of the day on which this Act is passed, the Secretary of State must publish a fully costed plan for how Integrated Care Boards and local authorities will ensure provision of adequate community services for individuals with learning disabilities and autistic people who are at risk of detention under Part 2 of the Mental Health Act 1983. (2) As part of the development of that plan, a formal consultation process must take place to determine how the decision to enact the relevant parts of this Act will be made. (3) The consultation must include input from relevant stakeholders, including— (a) individuals with learning disabilities and autistic people; (b) carers for people with learning disabilities and autistic people; (c) healthcare professionals; and (d) advocacy groups.”—(Dr Evans.) This new clause requires a costed plan to ensure that ICBs and local authorities are able to provide adequate community services for individuals with learning disabilities and autistic people at risk of detention under Part 2 of the 1983 Act, informed by a consultation with a range of stakeholders. Brought up, and read the First time. Question put, That the clause be read a Second time.

17|0|4|11|The Committee divided:|Question accordingly negatived.||0|0

New Clause 12

Age-appropriate treatment for children

“(1) Section 131A of the Mental Health Act 1983 is amended as follows.

(2) After subsection (1), insert—

‘(1A) A patient to whom this section applies must not be detained in, or admitted to, an adult ward unless the managers of the hospital consider that—

(a) there are exceptional circumstances which justify the patient’s detention in, or admission to, an adult ward; and

(b) the decision is in accordance with the best interests of the child.’

(3) After subsection (3) insert—

‘(3A) Where a patient has been detained in, or admitted to, an adult ward, the managers of the hospital must record in writing the reasons for the admission, including—

(a) the reason, or reasons, why other options for accommodation were not available or suitable for the patient;

(b) details of the measures to be taken by the hospital to ensure that, while the patient is detained or otherwise accommodated in the adult ward, the patient is provided with care in a safe environment; and

(c) unless it has been determined that an adult ward is the most appropriate environment for the patient in accordance with subsection (1A), the steps being taken by the hospital to transfer the patient to more appropriate accommodation.

(3B) Where a patient to whom this section applies is—

(a) detained in, or admitted to, an adult ward or placed out of area; and

(b) the detention or admission is of more than 24 consecutive hours’ duration,

the managers of the hospital must notify the regulatory authority immediately, setting out why they consider that the requirements under subsection (1A) above are met and providing the information set out in subsection (3A).

(3C) Subsection (3D) applies when—

(a) the managers of a hospital accommodate a patient to whom this section applies in an adult ward for a consecutive period of at least 28 days; or

(b) detain or admit a patient to whom this section applies who—

(i) was ordinarily resident immediately before being detained or admitted in the area of a local authority other than the local authority within whose area the hospital is situated, or

(ii) was not ordinarily resident within the area of any local authority.

(3D) Where this subsection applies, the managers of the hospital must immediately inform the appropriate officer of the responsible local authority—

(a) of the patient’s detention or admission, and

(b) when the patient’s detention or admission ceases.’

(4) Leave out subsection (4) and insert—

‘(4) In this section—

(a) “adult ward” means a ward in a hospital to which persons aged 18 or over are detained in or admitted to;

(b) “the appropriate officer” means—

(i) in relation to a local authority in England, their director of children’s services, and

(ii) in relation to a local authority in Wales, their director of social services;

(c) “hospital” includes a registered establishment; and

(d) “the responsible authority” means—

(i) the local authority appearing to the managers of the hospital to be the authority within whose area the child was ordinarily resident immediately before being detained or admitted, or

(ii) where it appears to the managers of the hospital that the patient was not ordinarily resident within the area of any local authority, the local authority within whose area the hospital is situated.’”—(Dr Evans.)

Question put, That the clause be read a Second time.

18|0|4|11|The Committee divided:|Question accordingly negatived.||0|0

New Clause 13

Duty to review the functions of the regulatory authority

“(1) Within the period of one year from the passage of this Act, the Secretary of State must carry out a review of the regulatory authority’s role under the Mental Health Act 1983.

(2) The review under subsection (1) must include an assessment of the effectiveness of the regulatory authority’s role—

(a) in carrying out its duties under the Mental Health Act 1983, and

(b) in regulating the provision of mental health services under the Mental Health Act 1983.

(3) The review under subsection (1) must also include an assessment of whether the regulatory authority will be able to effectively carry out its duties under this Act.

(4) The Secretary of State must publish the results of the review in a report and must lay that report before both Houses of Parliament.”—(Dr Evans.)

I beg to move, That the clause be read a Second time. I rise to speak in support of the new clause, which was tabled by the Conservative party. It would place a duty on the Secretary of State to review the effectiveness of the regulatory authority’s role under the Mental Health Act 1983 within one year of the Act’s passage. Allow me to provide the current legal and regulatory context. Under the framework in the Mental Health Act 1983, the Care Quality Commission, which is the regulatory authority in England, is tasked with monitoring and regulating providers of mental health services. We have debated some of this, and there are issues still to be addressed. The CQC inspects hospitals, community mental health teams, and other relevant services to ensure compliance with statutory safeguards and standards. It publishes reports on providers and issues recommendations where it identifies failings. Additionally, there is an existing reporting framework under the Act whereby the Secretary of State is expected to oversee and ensure the Act’s proper implementation, with periodic ministerial reports to Parliament and CQC inspection outcomes made publicly available. However, there is currently no statutory requirement to review the CQC’s own role and effectiveness in carrying out these specific mental health functions. The gap means that although providers are scrutinised, the regulator itself escapes similar structured accountability and review. This question was debated in the other place and I welcome the comments from the Minister in the Lords, Baroness Merron, who, in a letter, rightly highlights existing transparency measures. She states that, “findings from CQC’s monitoring activity are reported annually in their Monitoring the Mental Health Act report, which is laid before Parliament and published publicly.” That is true. She also notes the annual quality account reports produced by NHS healthcare providers under the Health Act 2009, which cover patient safety, treatment effectiveness, and patient feedback. True. Those are indeed important components of the current oversight framework, and we support the continuation and strengthening of those transparency mechanisms.

My hon. Friend makes a powerful point about transparency, but it is not just about that. Does he agree that it is also about having an evidence base that allows reform and improvement of the regulator?

I do, and to expand the point, this is about understanding the performance of CQC as well. We know from the Dash report and from Mike Richards that there are, and have been, concerns about CQC performance. That is at the heart of this new clause—to try to make sure we actually look at the performance and regulation of the regulator. Those reports focus on the performance of mental health services and providers, but they do not amount to a dedicated statutory review of the regulator itself—specifically, the CQC’s role, effectiveness, and capacity under the Mental Health Act. Annual reports primarily reflect the CQC’s monitoring outcomes rather than a comprehensive, independent evaluation of whether its regulatory functions are being discharged optimally, or whether it is adequately equipped to meet the new challenges posed by the legislation. In other words, reporting on what the regulator monitors is not the same as reviewing how well the regulator performs its duties. The new clause would address that distinct gap by mandating a focused review with a parliamentary report and a Government response, thereby strengthening accountability at the regulatory level. The new clause aims to establish an additional layer of scrutiny, not duplicative reporting. It would require the Government, within 12 months of the Bill becoming law, to conduct a formal review of the CQC’s effectiveness, specifically in regulating mental health services under the 1983 Act. It mandates an assessment of whether the CQC is adequately fulfilling its duties, including monitoring, inspection, and enforcement responsibilities, as well as whether it will be capable of carrying out its duties under the new legislation. Given the well-documented problems in mental health, it seems entirely appropriate to address the key point: is the regulator regulating effectively?

My hon. Friend makes a strong point about having a review to ensure that the regulator is operating effectively. Does he share some of my concerns that a one-off review may not demonstrate ongoing oversight and scrutiny of the performance of the regulator?

We do not want to introduce too much bureaucracy, but ensuring an accountable statutory mechanism to ensure adequate oversight is incredibly important. Much of the debate about the Bill has been about whether we put things in primary legislation or in policy, or whether we allow policy and legislation to be done at a secondary level—or even leave them for the organisation to deal with. My concern with the CQC is that we have not seen the organisation step up in the way that it should do. That does not mean that it is not making progress, but we need to see further progress.

10:15:00

The new clause would require the results of the review to be published and laid before both Houses of Parliament. Furthermore, it would require the Secretary of State to respond publicly within three months, outlining what actions will be taken in the light of the review findings. In effect, the new clause would establish a transparent and accountable process to scrutinise the regulator, not just the providers, and demand clear ministerial accountability for the regulator’s effectiveness.

In recent years, we have seen reports such as those from the CQC highlighting issues in mental health in-patient care, but also criticisms from watchdogs and campaigners that the CQC has at times been reactive rather than proactive. Some high-profile cases, such as the scrutiny of conditions at certain NHS mental health trusts, suggest that the regulator’s powers or approach may need reinforcement or reform. By mandating the review, Parliament can ensure the regulatory framework is fit for purpose and that the CQC is sufficiently empowered and resourced to protect the vulnerable.

I anticipate that the Government might respond in several ways. First, they might say that the CQC is already subject to oversight and scrutiny, so a statutory review is unnecessary. However, although it is true that the CQC reports to Parliament and is subject to existing oversight mechanisms, they tend to focus broadly on health and social care, rather than on the regulator’s specific role under the Mental Health Act. The new clause ensures a focused, formal assessment and avoids regulatory drift or complacency when we are making such big changes in the mental health space.

The Government may also argue that the new clause duplicates existing requirements or imposes unnecessary administrative burdens. On the contrary, itis time-limited, with a clear deadline for the review and publication. It is not an ongoing administrative requirement but a one-off statutory check to safeguard standards during the implementation of the Bill. Finally, the Government might argue that mental health regulation is complex and involves devolved Administrations. However, the new clause explicitly applies only to England, respecting devolution. Even within England, there is a pressing need to ensure the CQC’s effectiveness. In conclusion, this new clause is a sensible and necessary safeguard.

I noticed that in answer to Liberal Democrat new clause 8, the Minister seemed to acknowledge that some changes were brought forward from the other place. I am interested in whether the Minister thinks that that was in response to this provision being debated in the other place. How much do those changes step into new clause 13? From what I understand, there was no statutory basis for what the Minister said in response to new clause 8. I would be grateful if the Minister could clarify that.

The Opposition believe that new clause 13 enhances transparency, strengthens accountability, and ensures that as we update mental health legislation, the regulator charged with its enforcement is fit for the challenge. I urge the Committee to support it.

It is a pleasure to serve under your chairmanship, Mr Vickers. I rise to speak in strong support of new clause 13, tabled by the shadow Minister. The new clause would place a duty on the Secretary of State to review the functions and effectiveness of the regulatory authority, which is currently the Care Quality Commission, within one year of the passage of the Bill. The new clause is a timely, necessary and constructive addition to the Bill. As colleagues will know, the Care Quality Commission plays a dual role in relation to the Mental Health Act. First, as the regulator of services, it ensures that providers meet fundamental standards of care and safety. Secondly, through its specific responsibilities in visiting and speaking to those detained under the Act, it ensures that people’s rights are protected and that the law is used appropriately and humanely. That is no small task. It is a balance that requires the CQC to be not only reactive but proactive, and not only independent but responsive to the lived experiences of patients—especially to the voices of the most vulnerable. That is why the new clause matters. As we bring forward significant reforms to the Mental Health Act through the Bill, and rightly modernise and improve safeguards and place greater emphasis on autonomy, dignity and therapeutic benefit, we must also ensure that our system of oversight and regulation is fit for purpose. I welcome the direction that the Bill sets. Its four core principles are rightly placed at the heart of the legislation: choice and autonomy, least restriction, therapeutic benefit, and seeing the person as an individual. Those principles must shape the way that care is delivered on the ground. That means they must also shape the way that care is monitored, inspected and held to account. A review of the regulator’s role is not about criticism for its own sake; it is about ensuring that the regulatory framework supports and reinforces the ambitions of the Bill and that it can respond to emerging challenges, shine a light where services are falling short and, crucially, act to protect patient rights.

My hon. Friend is being slightly charitable to the CQC. Given Penny Dash’s review, we all know that the CQC has significant problems, otherwise we would not be reviewing it. Does my hon. Friend agree that the new clause is absolutely vital because of the failures of the CQC up to this point, and our lack of faith in it being able to meet the challenges that this legislation will bring to the mental health sector? Does she also share our concern about the CQC’s ability to regulate and scrutinise properly?

My hon. Friend is absolutely right. We have seen examples where regulators have not intervened quickly or robustly enough, and where systemic issues went unnoticed or unaddressed for far too long. We need to strengthen the remit and ensure that the CQC is properly equipped and held to the high standards that we expect of it. I am an economist by background, so evaluation is something I think about a great deal. Reform, however well intentioned, must be followed by evidence, scrutiny and a willingness to learn and improve. The new clause ensures that we do not just set change in motion, but that we stop to ask whether it is working, whether the right things are being done, and if not, how we can improve. The review required by the new clause would look not only backwards at whether the regulator has effectively carried out its existing duties under the Act, but, crucially, forwards, assessing whether it is ready to meet the responsibilities placed on it by the new reforms. I particularly welcome the requirement for the review to be published and laid before Parliament. Transparency is essential. It would allow Parliament to scrutinise but also gives patients, families, professionals and the public confidence that those questions are being asked seriously and answered publicly. Ultimately, the new clause is about improving outcomes. When regulation works well it safeguards dignity, prevents harm, identifies and spreads good practice, develops trust and helps us build a system where the principles of this Bill—choice, autonomy, less restriction and greater therapeutic benefit—are not just written in statute, but visible in practice. That is especially important in mental health care, where so often the people subject to the Act are among the most vulnerable. Those in in-patient settings, particularly those who are detained, are often not in a position to advocate for themselves. They rely on a system that is vigilant, takes its safeguarding responsibilities seriously and puts patients’ rights first. I hope that all members of this Committee will support the new clause. It is collaborative in its intent, constructive in its purpose and essential to delivering the meaningful reform that we all want to see. It reinforces the importance of accountability, transparency and listening to those most affected by this legislation. We owe it to those individuals and their families to make sure that we not only change the law, but also the culture and oversight that surrounds it. This review would help us do exactly that.

I am grateful to the Opposition spokesman, the hon. Member for Hinckley and Bosworth, for bringing this issue forward. Two major independent reviews into the Care Quality Commission have reported under this Government: one by Dr Penny Dash, on the CQC’s operational effectiveness as a regulator of all health and social care providers including those in mental health, the other by Professor Sir Mike Richards on its single assessment framework. The CQC has accepted those recommendations in full, and although we are confident in the progress that the CQC is making, we recognise that the reviews did not closely inspect its statutory role in relation to monitoring the use of the Mental Health Act. Those powers and duties are entirely distinct from those that the CQC uses to regulate the health and social care sector under the Health and Social Care Act 2008. In recognition of that gap, as the Opposition spokesman pointed out, we committed in the other place to report on that specific aspect of the CQC’s role in the first of the Government’s annual reports on the implementation of the Bill, which will be laid before Parliament one year after Royal Assent.

The Minister mentioned the Government’s annual reports, but at other times he has said that they will issue written ministerial statements. Will he clarify which it will be? There is a big difference between a couple of paragraphs in a written ministerial statement laid before the House, and a full report. When debating the other clauses, new clauses and amendments, the Government’s answer has been that they will report back to Parliament in a year’s time. I am grateful for that, but clarity would be helpful, because a full and comprehensive report would give more weight to the Opposition in terms of understanding and transparency.

I can confirm that the information will be in a section of the written ministerial statement that will be tabled within 12 months of Royal Assent. We think that requirement makes the Bill more robust and effective, because it is an integral part of the entire ecosystem that we are looking at in terms of implementing this legislation and making sure we have the institutional capacity and capability. We think it helps to have the information as an integral part of the written ministerial statement, but the hon. Gentleman is right to point out that we should be clear in the definitions and language we use. The written ministerial statement will be an overall implementation report. It will contain a number of sections, one of which will be on the role of the CQC and the inspection function. It will include reflections from the new chief inspector of mental health, Dr Arun Chopra, on the CQC’s statutory functions under the Mental Health Act, as well as its role as a key partner in the delivery of the reforms. The written ministerial statement—the report—will be laid before both Houses of Parliament within 12 months of Royal Assent. I hope the hon. Member for Hinckley and Bosworth therefore feels able to withdraw his new clause. Question put, That the clause be read a Second time.

19|0|6|11|The Committee divided:|Question accordingly negatived.||0|0

New Clause 14

Adequacy of accommodation: review

“(1) The Mental Health Bill 1983 is amended as follows.

(2) After Section 131A (Accommodation etc. for children) insert—

‘131B Adequacy of accommodation

(1) The Secretary of State must, within 12 months of the passage of the Mental Health Act 2025, publish a review of the quality of accommodation for any patient who is—

(a) liable to be detained in a hospital under this Act;

(b) admitted to, or remains in, a hospital in pursuance of such arrangements as are mentioned in section 131(1) above.

(2) The Secretary of State must, within six months of the publication of the review under subsection (1), publish a strategy to implement the recommendations of that review.’”—(Dr Chambers.)

I beg to move, That the clause be read a Second time. The new clause would require a review of the quality of accommodation for people detained or admitted to hospital under the Mental Health Act, and require the Secretary of State to publish a strategy to implement the recommendations of that review. Lord Darzi found that many people are being treated in Victorian-era asylums. Many mental health hospitals are crumbling and the wards are not fit for purpose. Both the Care Quality Commission and the independent review of the Mental Health Act confirmed that many mental health wards are unsafe for staff and patients, and provide poor-quality care in unsuitable buildings. One CQC inspection report found that the seclusion rooms had low ceilings that contained electrical wires overhead, creating a safety hazard, and that staff could not see people clearly through the window panels because they were cloudy. Is the Minister confident that the mental health estate is adequate to fulfil the Bill’s objectives? In particular, is the Minister satisfied that the mental health estate is sufficiently safe, in structural terms, and designed appropriately for those using it? For example, is it free of ligature points, and does it have sufficient in-patient capacity for children and young people?

10:30:00

I am grateful to the hon. Member for Winchester for bringing this issue before us. We are committed to closely monitoring the quality of in-patient care and driving continuous improvement in services. Indeed, we are already in the process of doing that, and a further review is not necessary to drive the changes forward. The CQC’s role is to monitor the quality of in-patient services. Its annual “Monitoring the Mental Health Act” report specifically discusses the in-patient environment, and considers the quality of accommodation under the 1983 Act. The independent review in particular made a recommendation to replace dormitory provision with private rooms. To date, the NHS has invested £575 million in doing that, and we are committed to completing our programme of investment.

I draw attention to Lynfield Mount hospital in my constituency, which provides mental health in-patient care. It has a fantastic plan for upgrading its facilities, but at the moment it has secured only a proportion of the capital funding. Will the Minister meet me and local NHS leaders to see whether we can close the gap in the capital funding for that facility?

I congratulate Lynfield Mount on the important work it is doing—and I congratulate my hon. Friend on that extremely strategic intervention. Yes, I would of course be more than happy to meet her, and we will make sure to get that in the diary. The Government have allocated £750 million for estates safety in 2025-26, to address high-priority estate issues across the NHS systems, including in the mental health estate. The CQC will continue to monitor the impact of the reforms through its existing monitoring and reporting duties. A further statutory review is therefore not required, so I ask the hon. Member for Winchester to withdraw his new clause.

I thank the Minister for his reassurances, especially on the ongoing reviews. I will withdraw the new clause, but I make the obvious point that this is about not only the health and safety of the staff and patients, but the public perception of mental health, and the stigma surrounding it if we are treating people in Victorian-era asylums. I beg to ask leave to withdraw the motion. Clause, by leave, withdrawn. New Clause 15 Review of impact of this Act on detention “(1) The Secretary of State must, within a period of 12 months following the day on which this Act is passed, commission an independent review into the impact of relevant provisions on reducing the number of people detained under Part 2 of the Mental Health Act 1983. (2) In subsection (1), ‘relevant provisions’ include— (a) sections 4, 5 and 6, (b) section 8, (c) section 21, and (d) sections 46 and 47. (3) The Secretary of State must, within 12 months of the publication of the review in subsection (1), publish a strategy to implement the recommendations of that review.”—(Zöe Franklin.) This new clause would require the Secretary of State to commission a review into the impact of relevant provisions in the Act in reducing the number of people detained, in particular the provisions relating to people with autism or a learning disability, on grounds for detention and for community treatment orders, medical treatment, care and treatment plans, and on after-care, and to implement any recommendations within 12 months of the publication of the review. Brought up, and read the First time.

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

With this it will be convenient to discuss the following: New clause 18—Report on the impact of this Act on patients with eating disorders— “(1) Within a period of 12 months following the day on which this Act is passed, the Secretary of State must publish a report on the impact of relevant provisions in this Act on patients with eating disorders. (2) In subsection (1), ‘relevant provisions’ include— (a) section 5 (Grounds for detention), (b) section 11 (Making treatment decisions), (c) section 17 (Urgent treatment to alleviate serious suffering), (d) section 21 (Care and treatment plans), and (e) section 47 (After-care services).” This new clause would require the Secretary of State to report on the impact of this Bill on patients with eating disorders within 12 months of the passage of this Bill. New clause 23—Impact assessment: children and young people in temporary foster care— “(1) The Secretary of State must, within 18 months of the passing of this Act, publish and lay before Parliament an impact assessment on the impact of this Act on children and young people who are in temporary foster care. (2) The impact assessment under this section must consider— (a) whether the ordinary residence provisions result in delays or inequities in accessing treatment or after-care under this Act; (b) the effect of transitions between placements on continuity of treatment under this Act; and (c) any unintended consequences for children and young people in temporary foster care arising from the application of subsections (3) to (5) of section 125G of the Mental Health Act 1983.” This new clause would require the Government to publish an impact assessment on the impact of this Act on children and young people in temporary foster care.

New clause 15 calls for an independent review of whether the legislation achieves one of its core aims: reducing unnecessary detention under the Mental Health Act. People with learning disabilities and autistic people are still far too often detained in hospital settings, sometimes for months or years, despite clear evidence that community-based support would be more effective and humane. The Bill’s provisions—including those on grounds for detention, care and treatment planning and aftercare—are supposed to address that, but if we do not review their impact, there is a risk that they remain warm words without real change. The new clause would ensure that the Government must review how well the new law is working, in particular for those most vulnerable to inappropriate detention, and then act on that evidence within a year. If we are serious about reform, which I believe the Government are given the content of the Bill, then the new clause would ensure serious scrutiny and accountability. I turn to new clause 18. Eating disorders are complex, often misunderstood and frequently mismanaged in the mental health system. Too many patients face delayed interventions, inappropriate detention or a lack of tailored care, particularly when their condition does not fit into a narrow clinical threshold. The Bill introduces reforms to detention criteria, treatment decisions and care planning, but we must ensure that the changes actually work for people with eating disorders. The new clause would require the Secretary of State to publish a report within 12 months that assesses the Bill’s impact on patients with eating disorders, including whether it is has improved access to appropriate treatment, safeguarded against unnecessary detention and strengthened aftercare. This is a matter not just of policy but of real people’s lives. We owe it to this vulnerable group to ensure that the reforms deliver real change, and that they are not left behind in a system that is still too often shaped by other conditions. Finally, on new clause 23, children and young people in temporary foster care are some of the most vulnerable in our system. They often face multiple disruptions in care, placement and support, all of which can significantly impact their mental health. The new clause asks for a focused impact assessment on how the changes in the legislation will affect them. In particular, the new clause looks at whether the ordinary residence rules delay or block access to mental health treatment, whether placement changes disrupt continuity of care, and whether the provisions in section 125G of the Mental Health Act unintentionally harm this group. Foster children should not fall through the cracks of bureaucracy. If we are serious about improving mental health services for all, we must understand and address the unique risks that face those who are moved frequently, often with little warning or support. An impact assessment is a necessary first step to ensure that their needs are not overlooked. I commend all the new clauses to the Committee and look forward to hearing from the Minister.

On new clause 15, we want more people cared for in the community and fewer people reaching a point of crisis and detention, but we do not think it is right to use the legislation to drive down the numbers in an arbitrary way that could interfere with clinical decision making and create a risk that people do not receive the help that they need. An evaluation of the relevant clauses should therefore focus not purely on the reduction in detentions, but on the overall improvement of experience and outcomes. Such improvement is predicated on the independent review principles of choice and control, therapeutic benefit, and the person as an individual, as well as the principle of least restriction. The timescales suggested in new clause 15 are not feasible. Following Royal Assent, our priority will be to update the code and for staff to be trained on the new legislation and code, before commencing the first phase of the reforms. The first phase of significant reforms cannot take effect until the work on the code and the training of staff are completed. Few, if any, of the sections mentioned in new clause 15 could therefore be commenced within 12 months, and it would be premature to commission a review of their effect on detention rates within that time period. We plan to commission an independent evaluation of the reforms, subject to funding and fundable research applications. This will be a long-term, staged exercise, given the long period over which different reforms are expected to be sequentially commenced following the initial primary legislation. We will monitor the impact of the reforms on the number of detentions and disparities in detention rates, all of which are already published under the monthly Mental Health Act statistics. We have also committed to providing Parliament with an annual update on the implementation of the reforms. As we already plan to commission an independent evaluation of the Bill, and as the timescale set out in new clause 15 would not be feasible, I ask the hon. Member for Guildford to withdraw the new clause. On new clauses 18 and 23, we have already published an impact assessment alongside the Bill, which was scrutinised by the Regulatory Policy Committee and rated fit for purpose. We have also committed to laying an annual report on the Bill’s implementation, through the written ministerial statement. We are committed to monitoring and evaluating the reforms to understand their impact on different groups affected by the legislation. On new clause 18, we recognise the devastating impact that an eating disorder can have on someone’s life. The earlier treatment is provided, the greater the chance of recovery. The implementation and evaluation of the reforms will be a long-term, staged exercise. It would not be possible to assess the impact of the reforms on people with eating disorders within 12 months, as not all reforms will have been implemented. We will continue to work closely with NHS England to improve access to appropriate and timely care and treatment for people with an eating disorder. On new clause 23, we recognise that there are inequalities in mental health prevalence and outcomes for children and young people in care. We are committed to ensuring that all children are able to access the care and treatment they need. We plan to develop bespoke guidance in the revised code on the care and treatment of children and young people, to account for the specific needs of that cohort. I hope that hon. Members will not press their new clauses.

I thank the Minister for his comments; it was really helpful to hear about how he sees the timings in our new clause fitting with the ongoing work to implement the Mental Health Act and the commissioning of the independent review. I am concerned about his comment that the work will be dependent on funding. I hope that the funding for the important independent review will be ensured. However, on the basis of the Minister’s comments, I am happy not to press any of the new clauses. I beg to ask leave to withdraw the motion. Clause, by leave, withdrawn. New Clause 16 Transfer of patients: out of area placements “(1) The Mental Health Act 1983 is amended as follows. (2) After section 19 (transfer of patients), insert— ‘19A Transfer of patients: out of area placements (1) The Secretary of State must reduce to zero, within five years of the passage of the Mental Health Act 2025, the number of patients transferred to a hospital outside of the area in which the patient is ordinarily resident. (2) The Secretary of State must publish, within six months of the passage of the Mental Health Act 2025, a report to outline how the duty under this section will be met, including how provision for treatment under this Act will be increased.’”—(Dr Chambers.) This new clause would require the transfer of patients to hospitals outside of their area to be reduced to zero within 5 years, and for the Secretary of State to produce a report on how this will be achieved. Brought up, and read the First time.

I beg to move, That the clause be read a Second time. The new clause would require the number of patients transferred to hospitals outside their area to be reduced to zero within five years, and the Secretary of State would have to produce a report on how this would be achieved. We should not underestimate the harm and distress caused to patients and their families when they are allocated an out-of-area mental health placement. At the end of March 2024, there were 900 active out-of-area placements in England, of which 89% were deemed inappropriate. Patients must be treated in a centre close to their home and family, and that can be achieved by increasing capacity and co-ordination between services. The new clause calls on the Secretary of State to publish guidance within six months of the Bill’s passage, setting out what processes and funding will be available for that purpose. Vulnerable people deserve to be treated near to their families and home, and the new clause would ensure that happens.

The new clause is underpinned by noble intentions, but does the hon. Gentleman believe that patients would be better served if such a process were in guidelines rather than in the Bill? That would ensure that it is deliverable.

I welcome the hon. Gentleman’s comments. That is a sensible and insightful point, and I will take on board the Minister’s response too.

We believe that everyone should receive treatment for mental illness as close to home as possible, but there are circumstances in which placement on a ward outside the area where a person usually resides is clinically necessary. Some specialised services—for example, treatment for an eating disorder—may require a person to be transferred to a placement away from home, and we wish to retain that option. However, we know that too many patients are placed outside their local area, which is why we have set aside £75 million in capital funding for local systems to invest in reducing such placements for all patients. We are also trialling new models of care, including six pilots of 24/7 neighbourhood mental health centres, with the aim of treating more people in their local communities. Similar international models have achieved significant reductions in hospitalisation. NHS England is developing a new model for specialised children’s and young people’s mental health services that aims to ensure that children and young people are treated in the least restrictive environment close to their family and home. I hope that that satisfies the hon. Gentleman and that he will withdraw the new clause.

I thank the Minister for his comments. He recognises the issue and is taking steps to address it, so I beg to ask leave to withdraw the motion. Clause, by leave, withdrawn. New Clause 19 Report and Guidance: Improving Outcomes for LGBT Patients “(1) The Secretary of State must, within 12 months of the day on which this Act is passed, prepare and lay before Parliament a report on the mental health outcomes of patients who are treated under the Mental Health Act 1983 and who identify as lesbian, gay, bisexual, or transgender (LGBT). (2) The report under subsection (1) must include an assessment of— (a) any differences between non-LGBT patients and LGBT patients in— (i) the extent of the use of detention measures under the Mental Health Act 1983; and (ii) treatment outcomes following detention, and (b) the availability and accessibility of ‘culturally competent’ mental health treatment under the 1983 Act for LGBT patients. (3) Following publication of the report under subsection (1), the Secretary of State must publish guidance for responsible bodies and individuals working with patients under the Mental Health Act 1983, including but not limited to those working in— (a) mental health hospitals; (b) places of safety; (c) crisis accommodation; and (d) relevant community mental health services. (4) The guidance under subsection (3) must include— (a) provisions about updated training standards for staff regarding the specific mental health needs and experiences of LGBT individuals, including training on non-discriminatory practice and inclusive communication approaches; (b) steps to improve safety for LGBT patients in relevant mental health settings, with particular regard to addressing discrimination and harassment; and (c) a definition of ‘cultural competent mental health treatment’ for the purposes of subsection (2). (5) Responsible bodies and individuals working with patients under the Mental Health Act 1983 must have regard to guidance published under subsection (3). (6) In preparing the report under subsection (1) and the guidance under subsection (3), the Secretary of State must consult— (a) patients with a mental disorder who identify as LGBT; (b) the families or carers of patients with a mental disorder who identify as LGBT; (c) relevant professional bodies; (d) integrated care boards; (e) local authorities; (f) providers of mental health treatment; and (g) such other persons as the Secretary of State considers appropriate. (7) The Secretary of State must update the guidance under subsection (3) at regular intervals, and no less frequently than every three years.”—(Zöe Franklin.) This new clause would require the Secretary of State to report on mental health outcomes and disparities for LGBT patients in treatment under the Mental Health Act 1983 and publish guidance covering training and safety for this specific group. Brought up, and read the First time.

I beg to move, That the clause be read a Second time. New clause 19 would require the Secretary of State to report on mental health outcomes for LGBT patients detained or treated under the Mental Health Act 1983, and to publish clear guidance to improve staff training, patient safety and inclusive care for that group. We all deserve appropriate support when experiencing poor mental health, and that support must be fair and respectful, no matter whether the patient identifies as lesbian, gay, bisexual or transgender. Members of the LGBT community should have confidence that they will be treated with dignity and should not face unequal or inappropriate treatment because of who they are. Unfortunately, we know that that is not always the reality. Stonewall’s “LGBT in Britain—Health” report revealed deeply concerning findings: almost one in four LGBT individuals had heard discriminatory or negative remarks about them from healthcare staff, one in eight had experienced unequal treatment, one in 10 had been outed without their consent in healthcare settings, and one in seven had avoided treatment altogether for fear of discrimination. That is unacceptable anywhere in our health system, but it is especially alarming in mental health settings, where patients are already in distress and often detained, and may not be in a position to advocate for themselves.

10:45:00

New clause 19 would begin to address the injustice. It would require an assessment of outcomes and experiences for LGBT patients and ensure that services take practical steps to improve, including through staff training on inclusive practice, reducing harassment and discrimination, and setting out what culturally competent mental health care looks like in this context. If we are serious about modernising mental health care and making it equitable, we must collect the right data, confront the disparities and embed inclusive practice across the board. That is why we have tabled the new clause. I hope that the Minister will address our concerns.

I am grateful to the hon. Member for bringing this issue before the Committee. This Government are committed to tackling health inequalities. The NHS continues to pursue its advancing mental health equalities strategy, which sets out plans to address inequalities in access, experience and outcomes in mental health care, including for LGBTQ+ people. However, we do not think that a review within 12 months of the passage of this Bill is the right approach. First, there are known data quality issues with the recording of sexual orientation in the mental health services dataset, which, combined with small numbers, limits our ability to monitor outcomes accurately and reliably. Secondly, we do not need a review before acting to improve patient experience under the Act. We will update the code of practice following the passage of this Bill, including the statutory guidance to the Mental Health Act, and will work with patient groups to consider what further guidance is needed to reduce disparities in use of the Act. That consideration will cover issues based on sexuality, gender, race and other protected characteristics. We are also committed to monitoring and evaluating the reforms, which will include an assessment of whether new safeguards and support mechanisms are being equitably accessed through different groups. For those reasons, I ask the hon. Member to withdraw the new clause.

I thank the Minister for his comments, for the recognition that individuals in the LGBT community clearly have concerns about the way that mental health care is provided, and for the commitment to addressing those. I hope that at some point he will be able to advise on the timeline for looking to resolve the issue of the unreliability of data; it is crucial that we have accurate data in order to ensure good outcomes and improvements in mental health care. However, in the light of the Minister’s comments and commitment on the issue, we will not press the new clause, although I look forward to observing closely, as this Bill continues through the House, how it will address the current inequalities for the LGBT+ community. I beg to ask leave to withdraw the motion. Clause, by leave, withdrawn. New Clause 22 National strategy on mental health units “(1) The Mental Health Act 1983 is amended as follows. (2) In Part VIII (Miscellaneous Functions of Local Authorities and the Secretary of State), after section 118, insert— ‘118A National strategy on mental health units (1) The Secretary of State must, within 12 months of the passing of the Mental Health Act 2025, publish a national strategy to set out how the Government will ensure that all relevant mental health units meet or exceed ‘good’ safety standards as assessed by the Care Quality Commission (CQC). (2) A strategy issued under this section must address the following matters— (a) recruitment, retention and training of mental health staff, (b) patient-to-staff ratios, and (c) safe staffing levels during crises and night shifts. (3) Following publication of the strategy, a report on implementation progress must be laid before Parliament annually. (4) For the purposes of this section, a ‘relevant mental health unit’ is a facility used for treatment under this Act.”—(Dr Chambers.) This new clause would require the Secretary of State to publish a strategy, followed by an annual progress report, on how the Government will ensure that all mental health units used for treatment under the Mental Health Act 1983 are rated “good” or above by the CQC. Brought up, and read the First time.

I beg to move, That the clause be read a Second time. New clause 22 is quite similar to new clause 14, on the state of in-patient facilities. It would require the Secretary of State to publish a national strategy to ensure that all mental health units meet or exceed a good rating for safety, as assessed by the Care Quality Commission. It would also mandate annual progress reports to Parliament. We all know that far too many mental health settings fall below acceptable standards. The CQC has repeatedly flagged serious failings in in-patient mental health services, including unsafe staffing levels, poor physical conditions and risks of harm to patients. These are not isolated issues but persistent and systemic problems. The new clause calls for a proper, co-ordinated response. It would require the Government to set out how they will address staffing shortages, improve recruitment and retention, and ensure safe staffing levels, particularly at night and during crisis periods, when the risk is often highest. It is not enough to rely on reactive inspections or piecemeal initiatives; we need a national strategy backed by data, accountability and regular reporting to the House. Too many vulnerable people are currently treated in mental health units that are overstretched, understaffed and, in some cases, unsafe. The new clause would begin to change that by setting clear expectations on monitoring progress and holding the Government to account. I commend the new clause to the Committee.

We all agree that patient safety is paramount. Anyone who receives treatment in an in-patient mental health facility deserves safe and high-quality care. There have been too many incidents of poor-quality and unsafe care resulting in trauma and sometimes tragedy. Although we agree with the principle of the new clause, the overriding objective duplicates NHS England’s in-patient quality transformation programme, a national initiative aimed at improving the quality and safety of care in in-patient mental health, learning disability and autism services. The programme has been developed with service users, families and staff, and sets out a long-term vision for improving in-patient services. The new clause focuses specifically on staffing arrangements. Although we of course agree that the workforce is an important consideration in ensuring safe in-patient care, it is not the only factor. By comparison, NHS England’s in-patient quality transformation programme takes a more comprehensive view of the factors that contribute to safe and effective in-patient care. For example, it includes support for the cultural changes required to create and sustain an in-patient environment in which patients and staff can flourish. The programme’s progress will be measured using a range of data and evidence, for example on patient and staff experience. We know that more needs to be done to support the providers of mental health care to improve the quality of their services in a sustainable way, which is why we are putting in place a robust package of reforms to help to improve performance. There will be no more rewards for failing; instead, ICBs and providers that do well will be rewarded with greater freedoms, while the most challenged will receive focused intervention. For those reasons, I ask the hon. Gentleman to withdraw the new clause.

I thank the Minister for his comments and reassurances. I beg to ask leave to withdraw the motion. Clause, by leave, withdrawn. New Clause 24 Application in respect of patient already on hospital grounds “(1) The Mental Health Act 1983 is amended as follows. (2) In section 5(1) (Application in respect of a patient already in hospital), after ‘or,’ insert ‘that the patient has attended a hospital or been brought to a hospital to seek help or admission as a patient or,’”.—(Dr Shastri-Hurst.) This new clause would allow people who have attended or been brought to a hospital to seek help or admission as a patient to pursue an application for admission under the Mental Health Act. Brought up, and read the First time. Question put, That the clause be read a Second time.

20|0|4|11|The Committee divided:|Question accordingly negatived.||0|0

New Clause 25

Deaths in detention: independent investigations

“(1) The Mental Health Act 1983 is amended as follows.

(2) In Part X (Miscellaneous and Supplementary), after section 139, insert—

‘139A Death in detention

(1) If an approved clinician in charge of the treatment of a patient is made aware that a patient has died while in detention under this Act, the approved clinician must, as soon as reasonably practicable, commission an independent investigation into the patient’s death.

(2) An investigation under this section—

(a) must be conducted by a legal or medical professional with no personal or professional connection to—

(i) the facilities in which the death occurred, or

(ii) a clinician supervising the patient’s care at the time of death;

(b) must be concluded within 12 months of the date of death; and

(c) must result in a report to be submitted to—

(i) the approved clinician,

(ii) the local authority,

(iii) the local integrated care board, and

(iv) the patient’s next of kin.

(3) The Secretary of State may by regulations make further provision under this section.’”—(Natasha Irons.)

I beg to move, That the clause be read a Second time. The new clause seeks to ensure that if a patient dies while in detention under the Mental Health Act, an independent inquiry into their death will be required. Unlike deaths in prison or police-related deaths, deaths while a person is detained under the Mental Health Act are not automatically investigated independently. Currently, if a person dies while detained under the Act, the trust responsible for their care should carry out an internal investigation into their death to find out what happened and whether lessons can be learned. Those investigations, known as serious incident investigations or root cause analysis, do not have any independent oversight and can vary a lot from trust to trust. Inquest, the only charity in England and Wales providing expertise on state-related deaths and their investigation, has found that the current system for investigating such deaths is not fit for purpose. In its statement to the Lampard inquiry, it outlined an anonymised case from 2010 in which there was a stark contrast between the findings of the NHS trust that investigated the death of a patient detained under its care and the inquest that took place two years later. The trust found very few failings in care, whereas the jury at the later inquest were critical of the patient’s treatment, which directly led to their death. The question we must ask ourselves is why we would allow deaths while in detention under the Mental Health Act to be investigated by those in charge of custody, when deaths in any other setting would not be. We do not allow the police to judge their own actions if a death occurs in custody, so why should it be any different for those detained under the Mental Health Act?

My hon. Friend is making a fantastic speech. In the really dire circumstances of a death in detention, we are dealing with the most difficult and, for family members and loved ones, the most devastating circumstances. Given that, does she agree that it is important to make sure that the circumstances are reviewed thoroughly and independently?

My hon. Friend is absolutely right. This is about transparency and providing answers for the families of patients when the very worst happens. Independence has allowed investigations into deaths in places of custody to improve significantly. As outlined by the independent advisory panel on deaths in custody, patients detained under the Mental Health Act now have the highest mortality rate across all places of custody. Indeed, the rate is three times higher than in prisons, when taking into account estimates of time in custody and the number of people in each setting. Behind each of these tragedies are families who have unanswered questions and who have had to fight to find out what happened to their loved ones, and vulnerable people who should have received better care. In my constituency, there is the story of Catherine Horton, who died in 2017 while in the care of the South London and Maudsley NHS trust. The inquest into her death found that the risk assessment was not properly updated, with no formal risk assessment conducted, and no care plan on her arrival or while at the facility. There is also the story of Tia Wilson, who died in 2021 in the care of the same trust. The inquest into her death found that there were multiple failures in managing her risk, which contributed to her death. Then there is the story of the brother of one of my constituents, who absconded from his care, went missing, and was later found dead in a wooded area a stone’s throw from her home. For each of those cases, we know that internal reviews will have taken place and assurances of improvements will have been made, and yet issues with risk assessments remain and families are left pushing for answers. This is not unique to south London; the internal review process is failing to deliver the necessary improvements across the country. Without embedding independence into the process, we risk undoing a lot of the good work that the Bill seeks to achieve. Adding independence into the investigation of these incidents where the very worst things happen gives trusts a genuine space to learn the lessons. It would improve patient safety and provide families with the transparency they need. Although we must all acknowledge the incredible work that trusts do across our country to provide care for people at their most vulnerable, we must also provide a proper framework for challenge and improvement. The new clause is an opportunity to treat the deaths of people detained under the Mental Health Act with the same seriousness and care as deaths in other custody settings, to embed transparency, and to make the meaningful improvements that all patients deserve.

I am very grateful to my hon. Friend for bringing this issue to the Committee. I thank her for her powerful speech, which drew on specific experiences of people who have been through very terrible and tragic processes. I have discussed some work on the broader issue of quality of care, but this is a vital issue, and I reiterate how grateful I am to her for enabling us to discuss it on the public record. We recognise that there have been too many incidents of poor-quality and unsafe care, which sometimes result in tragedy. I hope my hon. Friend is reassured by the measures we are taking to support providers of mental health care to improve the quality of their services. We have carefully considered her new clause, and I am afraid that we do not think this needs to be addressed through the Bill.

11:00:00

Currently, if a patient dies while detained under the Mental Health Act, that automatically results in an investigation, including a mandatory inquest by the coroner and independent judge. Where the coroner conducts an investigation and finds that action should be taken to prevent future deaths, they have a duty to make reports to the appropriate person or body. Any death also triggers the application of the NHS learning from deaths national policy framework. If there were reason to believe that the death of a patient was due to problems in care, the death must be reported to the mental health provider’s commissioner as a serious incident and investigated appropriately.

Consideration would also need to be given to commissioning an independent investigation, as detailed in the patient safety incident response framework. If the trusts or integrated care boards commission an investigation, it should be performed independently of the patient’s care and treatment team. The patient safety incident response framework was introduced last year as a contractual obligation for all trusts. It overhauls the way they respond to patient safety incidents. Under the new framework, the focus is on how incidents happen, more effective learning and meaningful engagement with service users, families and carers. The aim is to deliver a more transparent and compassionate approach to learning, responses and investigations.

In regard to the creation of a new body to investigate deaths under the Act, we are concerned that the patient quality and oversight landscape is already overly cluttered and fragmented. That is why we have asked Dr Penny Dash to make recommendations on whether greater value could be achieved through a different delivery model. We will shortly be seeing the results of her review. I once again thank my hon. Friend for this important discussion, and I hope she is content to withdraw her new clause.

I thank the Minister for his comments. The cluttered and chaotic way in which we investigate these things is part of the problem, so I am glad to hear that there is a wider review of how we streamline the process better for patients, because we are seeing mistakes repeated over and over again. I am content to withdraw the new clause, but I would be grateful if the Minister would meet me to discuss the wider plans in this area and how I can support that work and take it forward.

I would be more than happy to meet my hon. Friend. It is also worth mentioning the independent advisory panel on deaths in custody report, which she mentioned. We are considering that carefully, so we should include it in our discussions.

I beg to ask leave to withdraw the motion. Clause, by leave, withdrawn. New Clause 26 Use of restraint and restrictive intervention “(1) The Mental Health Act 1983 is amended as follows. (2) In Part II (Compulsory Admission to Hospital and Guardianship), after section 7, insert— ‘7A Use of force in connection with admission for assessment or treatment (1) A relevant organisation that operates a hospital must appoint a responsible person for the purposes of this section. (2) The responsible person must— (a) be employed by the relevant health organisation, and (b) be of an appropriate level of seniority. (3) The responsible person must keep a record of any use of force by staff who work in that hospital against a person (“P”) who— (a) has been admitted for assessment or treatment under sections 2 to 5 of this Act; or (b) is on the hospital premises and is at risk of detention under this Act. (4) The Secretary of State must by regulations provide for the risk factors to be considered under subsection (3)(b). (5) A record kept under this section must include— (a) the reason for the use of force (b) the place, date and duration of the use of force (c) whether the type or types of force used on the patient formed part of the patient's care plan; (d) the name of the patient on whom force was used; (e) a description of how force was used; (f) the patient's consistent identifier; (g) the name and job title of any member of staff who used force on the patient; (h) the reason any person who was not a member of staff in the hospital was involved in the use of force on the patient; (i) the patient's mental disorder (if known); (j) the relevant characteristics of the patient (if known); (k) whether the patient has a learning disability or autistic spectrum disorders; (l) a description of the outcome of the use of force; (m) whether the patient died or suffered any serious injury as a result of the use of force; (n) any efforts made to avoid the need to use force on the patient; and (o) whether a notification regarding the use of force was sent to the person or persons (if any) to be notified under the patient's care plan. (6) The responsible person must keep the record for three years from the date on which it was made. (7) The Secretary of State must ensure that, at the end of each year, statistics are published regarding the use of force by staff who work in hospitals under the conditions set out in this section.’”—(Jen Craft.) This new clause would require hospitals to record information on all incidents in which force is used against patients with mental disorders, in line with the reporting currently required in mental health units, including force against those at risk of detention for assessment or treatment. It would also require the Government to publish annual figures on the same topic. Brought up, and read the First time.

I beg to move, That the clause be read a Second time. I will speak briefly to the new clause, which was tabled by my hon. Friend the Member for Sheffield Hallam (Olivia Blake). Its aim is to close a loophole in the current framework by which use of restraint is recorded. Currently, the use of restraint is governed by the Mental Health Units (Use of Force) Act 2018, which mandates that where force or restraint is used in a mental health unit, that must be recorded and reported. There are, however, a number of patients who are treated outside mental health units and therefore do not fall within the scope of the Act. My hon. Friend the Member for Sheffield Hallam has spoken about the issue, to which her attention was particularly drawn in the context of the treatment of patients with eating disorders. This happens quite often, either where there is a shortage of beds in a mental health unit or where the patient in question has co-occurring physical health conditions that require treatment outside such a unit. Restraint is used regularly and often on patients with eating disorders, by which I mean restraining them to force them to eat, but there is currently no mechanism by which its use must be recorded. If a patient, particularly a young person, who is in hospital but is not in a mental health unit is subject to this restraint, which may be deemed necessary to preserve life and in their best interests, there is currently no mechanism by which that is recorded.

We touched earlier on the safeguards around electroconvulsive therapy. Does my hon. Friend agree that when someone with an eating disorder is restrained, particularly in circumstances that involve the administration of nasogastric tube feeding, such safeguards are really important because of the invasive nature of the treatment and the potential restraint used in delivering it?

My hon. Friend is absolutely right. The crucial purpose of the new clause is to ensure that the use of restraint is recorded at all times, as well as highlighting that quite often the restraint may be carried out not by a member of the medical staff, but by hospital security, for example. I think we can only imagine the real horror and force involved in that.

I thank my hon. Friend for drawing attention to this gap in the current law. Would she acknowledge that there is now evidence that the use of restraint and restrictive interventions can have serious long-term effects on a patient’s health and wellbeing? Indeed, there can also be an impact on those staff members who are required to carry it out, often with poor training.

I completely agree. The long-term implications and impacts of restraint on health and wellbeing have been widely documented and acknowledged. It is vital, if a patient is subjected to these measures, that their use is recorded and the patient, in turn, can understand why. The Committee has spent significant time talking about the importance of patient inclusion in their treatment plans. Earlier clauses, which I will not revisit at length, deal with the importance of enabling patients to select how and where they are treated, as well as advance choice documents. They are vital to the patient experience, because they involve and include them in how they are treated. We acknowledge that such involvement has a massive impact on the patient’s ability to heal, get better, recover from their mental illness and, in some cases, get well enough to go home. It is vital, if people are subject to restraint and the use of force, that it is recorded in an appropriate manner. This new clause seeks to mandate the recording of its use by staff, as well as information such as the member of staff who applied the force, whether they are medical, and, vitally, demographic data. My hon. Friend the Member for Southend East and Leigh—I hope I have that right—

Southend West.

My apologies; they are both lovely places. My hon. Friend spoke earlier about the impact that mental health treatment can have on people in regard to race and ethnicity, and the importance of including demographic data. We know that black people are disproportionately subject to use of force and restraint, which is why recording this data in a mental health unit is acknowledged as important. However, if a patient is subject to restraint outside a mental health unit, there is currently no mechanism to record that. The new clause would also require the Secretary of State to publish annual statistics on how restraint has been used outside a mental health unit. I believe that the Minister’s predecessor agreed to look at closing this loophole. To date, however, action has not necessarily been forthcoming. People continue to be subject to the use of force or restraint, and we have no means of knowing how often it has occurred, to whom it has occurred or whether it has taken place inappropriately. I encourage the Minister and other members of the Committee to consider how we can ensure that the use of restraint and force is appropriately recorded in all medical settings, not just in mental health units.

I thank my hon. Friend the Member for Sheffield Hallam for tabling this important new clause, and I thank my hon. Friend the Member for Thurrock for moving it on her behalf. The new clause seeks to recreate some of the duties from the Mental Health Units (Use of Force) Act 2018, but apply them to patients detained under sections 2, 3, 4 or 5 of the Mental Health Act or those at risk of detention under that Act. This would cover patients receiving mental health treatment who are not in specialist mental health beds, such as young people with eating disorders who are detained in general paediatric wards. There are practical reasons why we do not support the new clause as it is drafted. For the vast majority of mental health patients, this duty would duplicate duties that already exist under the 2018 Act. Although the new clause would go further in requiring the recording of use of force outside mental health units, it does not require any further use of that data to develop policies or train staff, which is a key element of the 2018 Act. As drafted, the new clause would introduce new duties to record and report data, without there being any clear further use of that data. I accept, however, that we need to do more to reduce the use of restraint for all patients detained or at risk of detention under the Mental Health Act. NHS England has an ongoing programme of work, overseen by the reducing restrictive practice oversight group, to address this issue for people experiencing acute distress and mental health difficulties. My officials have also written to the CQC to commission it to develop a viable and proportionate mechanism for reporting use of restraint to the CQC, drawing on the views of NHS Providers and NHS England. Any potential changes can be made in regulations and would not require primary legislation, so we can continue this work in parallel with the passage of the Bill, delivering on our commitment to reduce the use of force for mental health patients. For those reasons, I hope that my hon. Friend the Member for Thurrock will withdraw the new clause.

I thank the Minister for his comments. I am reassured, as I am sure my hon. Friend the Member for Sheffield Hallam will be, to hear that he accepts the need to do more about the use of restraint, regardless of the setting in which it occurs. I am also pleased to hear about the measures by which he is seeking to do so in parallel with the passage of the Bill. I am content with what the Minister said, and I imagine my hon. Friend the Member for Sheffield Hallam will be, too. I beg to ask leave to withdraw the motion. Clause, by leave, withdrawn. Clause 55 Power of Secretary of State to make consequential provision Question proposed, That the clause stand part of the Bill.

With this it will be convenient to consider the following: Clauses 56 to 58 stand part. Government amendment 39. Clause 59 stand part. I should say to Members that we have 10 minutes left. If they want to conclude the Committee’s business this morning, they should bear that in mind.

Clauses 55 to 59 are the general provisions of the Bill. They include the powers to make provision that is consequential on the Bill by regulations. The clauses also set out the territorial extent of the measures, and the commencement and short title of the Bill. Clause 55 will allow the Secretary of State to make regulations that make provisions that are consequential on the Bill. The power may be used to “amend, repeal or revoke provision made by or under primary legislation passed— (a) before this Act, or (b) later in the same session of Parliament as this Act.” Clause 56 will provide an equivalent power for Welsh Ministers to make consequential provision in areas of their devolved legislative competence. Regulations that make consequential provision will be subject to the affirmative scrutiny procedure where they amend or repeal primary legislation, and to the negative procedure where they amend or revoke secondary legislation. Clause 57 sets out the extent of the Bill. The majority of the Bill will extend to England and Wales, but the general provisions in clauses 55 to 59 will apply UK-wide. We have tabled two amendments, Government amendments 37 and 38, that will modify section 6(3)(b) of the Human Rights Act 1998, extending its protection to cover private care providers when providing certain services arranged or paid for by public authorities. That change, if accepted, will extend UK-wide; we tabled the amendments to clause 57 to reflect that position.

11:15:00

Clause 58 provides for the commencement of the provisions of the Bill. In most cases, the Secretary of State has power to commence the provisions of the Bill by regulations at the appropriate time. The exceptions are clauses 30(2), 32, 36, 37(1) and (3)(b), 39 and 40, which will come into force automatically two months after Royal Assent; and the general back-of-the-Bill provisions, clauses 55 to 59, which will come into force on the day on which the Bill receives Royal Assent.

Government amendment 39 seeks to remove the privilege amendment inserted in the other place. Parliamentary procedure requires a privilege amendment to be included when a Bill starts in the Lords and has financial implications, to note the fact that the Commons has primacy in fiscal matters that control charges on the people and on public funds. It is therefore appropriate to remove that privilege, which this amendment seeks to do, in the Commons, as part of standard procedure.

Finally, clause 59 states that the Bill’s short title will be the Mental Health Act 2025, once it becomes an Act of Parliament. I therefore commend clauses 55 to 59 and Government amendment 39 to the Committee.

I will be brief. On this clause, I will be grateful if the Government can ensure good co-operation between the devolved powers, and if the Minister can set out how he will engage with the Welsh Government before exercising the power. On clause 57, what consideration has been given to cross-border issues to ensure that there are no unintended consequences between the likes of England and Wales or Scotland and England? Clause 58 covers commencement; will there be a clear published timetable for that over the next 10 years? Will Government allow Parliament sight of the transitional provisions? We have talked about the annual written ministerial statement, which we have clarified, but will there be further tracking reports that we can look at? Clause 59 states that the Bill will not impose new public spending or taxation, and yet the impact assessment lists £1.9 billion for the NHS in England, £396 million for local authorities, £2.5 billion for supporting housing and social care, and £287 million for legal costs and tribunals. Clearly, costs are associated with the Bill’s implementation over the next 10 years, so a money resolution is rightly required. When I raised those issues on our first and second days in Committee, the Minister rightly could not answer, because we had not had the Government’s settlement. We have now had that settlement, so I will be grateful to understand how the funding is to be applied to mental health on the community side and with regards to the Bill. Finally, given that we are dealing with Scotland, Wales and Northern Ireland, what are the Barnett consequentials of the Bill in ensuring the support implied in the clauses? I am grateful to the Committee, the Clerks, the Chairs, everyone here and everyone who has helped me prepare. Committee stage has been a joy, but also a long trial to get through. I am glad to be present as the Bill proceeds, because it is the right thing for the country.

I thank the shadow Minister for his question about devolved powers. We have worked closely with the Welsh Government on the Bill. The Senedd has yet to vote, but the Welsh Government in their legislative consent memorandum recommended that it grants consent to the Bill. We also seek a legislative consent motion from the Northern Ireland Executive for extending—in Government amendments 37 and 38—the remit of the Human Rights Act 1998 to cover private care providers when providing certain services arranged for or paid by local by public authorities. I will look into the cross-border issues and, if something is there, I will certainly write to update the shadow Minister. On the published timetable, the written ministerial statement will absolutely be a report on progress over the 12 months and will have a forward plan in it. I cannot say at this moment whether it will be a forward plan all the way through the proposed 10-year commencement period, because some of that will go beyond the spending review period, for example, but I assure the hon. Member that a timetable will at least cover the period of the initial spending review. I do not know whether there will be tracking reports—I will check that point with officials—but my sense is that the written ministerial statement will be the main hook to hang this on. The shadow Minister asked about the money resolution. We have the overall financial envelope for the DHSC. There is now—how should I describe this?—intense dialogue going on between departments within the DHSC and across portfolios, so I think it will take a couple of weeks before we get the carve-up of the envelope across the different portfolios. I note the shadow Minister’s point about the Barnett consequentials. I will look into it and come back to him. It remains for me to thank you, Mr Vickers; everyone in Committee, for their very hard work; and all the staff and officials, to whom we are hugely grateful. I commend the Bill to the Committee. Question put and agreed to. Clause 55 accordingly ordered to stand part of the Bill. Clause 56 ordered to stand part of the Bill. Clause 57 Extent Amendments made: 37, in clause 57, page 68, line 3, at end insert “subject to subsection (2).” This is consequential on amendment 38. Amendment 38, in clause 57, page 68, line 4, leave out “This section, section 55” and insert— “Section (Human Rights Act 1998: extension to certain private care providers), section 55, this section”.—(Stephen Kinnock.) This ensures that NC10 extends to England and Wales, Scotland and Northern Ireland. Clause 57, as amended, ordered to stand part of the Bill. Clause 58 ordered to stand part of the Bill. Clause 59 Short title Amendment made: 39, in clause 59, page 68, line 25, leave out subsection (2).—(Stephen Kinnock.) This removes the privilege amendment inserted in the Lords. Clause 59, as amended, ordered to stand part of the Bill. Bill, as amended, to be reported.

11:22:00

Committee rose.

Written evidence reported to the House

MHB60 Dr Peter Beazley (further evidence)

MHB61 Black Equity Organisation

MHB62 Local Government Association

MHB63 Dr Jacqueline Dyer

MHB64 Royal College of Nursing

MHB65 NHS Race and Health Observatory

MHB66 West Yorkshire health and care partnership

MHB67 St Andrew’s Healthcare

MHB68 Andrea Knowles, director, Staff Equality Networks

MHB69 Professor Jayati Das-Munshi, Professor Stephani Hatch, Professor Dawn Edge, Professor Scott Weich and Dr Josephine Ocloo

MHB70 Royal College of Psychiatrists

MHB71 Thrive LDN

MHB72 Synergi-Leeds Partnership

MHB73 Lelabari Kogbara

MHB74 BME Leadership Network of the NHS Confederation

MHB75 Chief Nursing Officer and Chief Midwifery Officer’s Black and Minority Ethnic Strategic Advisory Group, NHS England

MHB76 Royal College of Psychiatrists (further evidence on learning disability and autism)

MHB77 Professor Jeremy Coid

MHB78 Race Equality Partnership for Sheffield