Mental Health Bill [ Lords ] (Eighth 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

[Carolyn Harris in the Chair]

Mental Health Bill [Lords]

14:00:00

If any Member wishes to take their jacket off, I am happy for them to do so, as this is an extremely warm room. I am hoping to finish at 5 pm, so in the interests of making progress, Members should keep interventions to a minimum. If there were no repetition in speeches, that would be very welcome. Clause 46 Tribunal power to recommend after-care Question (this day) again proposed, That the clause stand part of the Bill.

I remind the Committee that with this we are discussing the following: Clause 47 stand part. New clause 21—Duty to provide advice and support to families and carers— “(1) The Mental Health Act 1983 is amended as follows. (2) After section 117B, insert— ‘117C After-care: provision of support and advice to families and carers (1) The responsible integrated care board must ensure that, as part of the provision of after-care services under section 117 of this Act, advice and support is offered to the family or carers of the person discharged. (2) This support must include— (a) information about the person’s condition and recovery; (b) guidance on how to support their recovery at home and avoid relapse; (c) access to financial, housing, and social care advice services relevant to the situation of the person’s family; and (d) procedures for family members or nominated persons to notify the integrated care board of concerns that the person is at future risk of detention under Part 2 of this Act. (3) Where a concern is raised under subsection (2)(d), the integrated care board must— (a) consider whether the individual meets criteria to be included on the register of persons at risk under section 125D of this Act; and (b) take reasonable steps to involve the family or nominated person in planning of subsequent support, subject to— (i) the person’s consent; or (ii) if they lack capacity, the person’s best interests. (4) The Secretary of State must publish guidance under section 125B of this Act on the format and provision of support under subsection (3)(b).’” This new clause would require the integrated care board, as part of the aftercare services offered under the Mental Health Act 1982, to offer support and advice to the family or carers of the person being discharged from treatment.

I will take a few moments to reflect on clauses 46 and 47. They deal with aftercare, which is at the heart of how we help people to recover from serious mental illness and reduce the chance of their readmission. Clause 46 will give mental health tribunals the ability to make recommendations about aftercare services—a welcome shift in emphasis towards recognising that recovery is something that happens not at the point of discharge, but in the weeks, months and even years that follow. Until now, tribunals could recommend things like hospital leave or transfer, but they had no say in the vital question of what happens after discharge. Clause 46 gives them a voice in shaping that next phase. It is a step that could help to ensure that aftercare is not an afterthought, but a core part of discharge planning. The effectiveness of this change, however, depends on whether there are services to recommend. As the independent review made clear, the challenge is not just in writing aftercare into law, but in making sure that it is there in practice. Clause 47 takes a welcome step in providing greater clarity and accountability around which local authority is responsible for arranging section 117 aftercare. By clarifying the rules on ordinary residents, especially for people who received care as children, and by requiring that local authorities and NHS bodies jointly issue written notice when aftercare is ending, the clause helps to ensure that decisions are made in a timely and transparent way. That improved clarity should support smoother transitions from hospital to community, reduce disputes between services and, ultimately, help to prevent relapse and readmission. Clarity in law must be met by capacity on the ground, which is why the core question is not just what the clauses enable, but whether the system is equipped to deliver on them. I therefore ask the Minister what assessment has been made of the availability of appropriate aftercare services in the community. Can we be confident that NHS and social care teams have the resources that they need to meet the duty effectively? We know that aftercare, under section 117 of the Mental Health Act 1983, can include support with housing, employment, social engagement and culturally appropriate services, all of which can mean the difference between recovery and relapse, but they only work when they are properly joined up, tailored to the individual and delivered in a timely way. The independent review put it well: “priority should be given to making sure that good services are available to all…But we also believe that it is right that people who have been detained should have additional support to ensure a successful transition to the community.” I agree with that principle. If we want to see fewer people detained, we must do better at supporting people once they leave hospital. I support clauses 46 and 47. They are sensible, necessary reforms that will give structure and clarity to a part of the system that has often been patchy or overlooked. But if we want them to work as intended, they must be backed up by investment in community services, good local commissioning and effective partnership between health and social care. In short, these are good steps but must be followed through with real delivery on the ground if we are to achieve the lasting outcomes that we all want.

It is a pleasure to serve under your chairmanship, Mrs Harris. Having taken your clear instructions, I will be very brief in speaking to clauses 46 and 47. Clause 46 is a positive step in principle, but there are concerns that the recommendations remain non-binary and may therefore lack the practical effect—or the teeth —without enforcement or review mechanisms. I have three questions that I hope the Minister will address. First, will he clarify whether there are any plans to give legal weight to tribunal recommendations, perhaps by requiring a written response or justification where those recommendations are not followed? Secondly, how will the Government ensure that resource-constrained local authorities can implement recommended aftercare plans promptly and fully? Thirdly, could he please provide data on the expected impact of this provision on readmission rates? Clause 47 clearly sets out and improves on the legal clarity, which is welcome, but I have a couple of questions. What steps will be taken to ensure that frontline practitioners understand and consistently apply the revised ordinary residence test? Has the Department conducted an assessment of the administrative burdens or delays that may result from the implementation of the clause? Apart from those questions, I welcome the provision.

It is a pleasure to serve under your chairship this afternoon, Mrs Harris. I will go through the questions that have been asked. The shadow Minister, the hon. Member for Hinckley and Bosworth, asked whether there will be any duty on ICBs or local authorities to respond to recommendations. The tribunal will have the power to recommend that plans are put in place for a patient’s aftercare. To assist in ensuring that these recommendations are followed, the tribunal can reconvene if its recommendations are not acted on, ensuring accountability from aftercare bodies. The shadow Minister asked what mechanisms are in place to resolve disputes between authorities. There is already a process in place under the Care Act 2014 for resolving disputes and an opportunity to escalate decisions to the Secretary of State and Welsh Ministers, if required. He also asked what the notice must contain. We will absolutely look at the guidance in the code on the process for ending aftercare and notifying the person. The hon. Member for Solihull West and Shirley asked about plans for legal weight, resourcing and data. I will write to him on his questions about plans for legal weight and data. I think that resourcing will be a constant theme. Obviously, we have to assess all the resourcing implications once the Bill receives Royal Assent, and we will develop an implementation plan on that basis. The first annual written ministerial statement will be the hon. Gentleman’s opportunity to hold the Government to account on that. Question put and agreed to. Clause 46 accordingly ordered to stand part of the Bill. Clause 47 ordered to stand part of the Bill. Clause 48 Tribunal powers in guardianship cases: burden of proof Question proposed, That the clause stand part of the Bill.

Currently, where an application is made to the appropriate tribunal by or in respect of a patient who is subject to guardianship, the patient can be discharged only if they can prove to the tribunal that they do not continue to meet the guardianship criteria. The burden of proof is on the patient. The clause will amend the Mental Health Act so that it will now be for the local authority responsible for the guardianship to prove to the tribunal that the patient continues to meet the guardianship criteria. As the independent review pointed out, the current burden of proof is “out of line” with all other applications to the tribunal. The Government consider that this should be remedied.

I fear that I may test your patience a little further on this occasion, Mrs Harris, but I rise to address clause 48. Although much of the Bill aims to modernise and humanise our mental health framework, and in many ways it does so commendably, clause 47 presents not only an opportunity, but a challenge: to ensure that we get the balance right between liberty and protection. The clause will make an amendment to section 72(4) of the Mental Health Act 1983. As the Minister said, it will shift the burden of proof in tribunal proceedings concerning patients who are subject to a guardianship order. Under the current legal framework, it is the patient who must demonstrate that the criteria for guardianship are no longer met, by showing either that they are no longer suffering from a mental disorder or that continued guardianship is no longer necessary for their welfare or the protection of others. Clause 48 would reverse that burden. It would place the onus instead upon the local authority to demonstrate, in the mental health tribunal, that the individual still meets the statutory test. The tribunal would be required to direct a discharge unless the authority can prove otherwise. Let me be clear: I am not opposed to the principle of this reform. On the contrary, I believe that there is a strong case for rebalancing the legal dynamics in favour of the individual, particularly when we reach situations in which their liberty and autonomy are at stake. The principle of least restriction is not, or should not be, merely aspirational; it should be foundational to any mental health regime in a liberal democracy. I say with equal conviction that the practical operation of such a change requires careful thought and adequate resourcing. It must be done under clear legal parameters. Precisely on those fronts, I seek clarification from the Minister and, if I may be so bold, I seek some improvements to this aspect of the Bill. First, we must consider the legal principle at play. A reversal of the burden of proof in this context is not technical or incidental; it marks a constitutional shift in the relationship between the citizen and the state. Traditionally, as the Minister well knows, the burden of proof lies on the party making an assertion that departs from the status quo. In this case, that would ordinarily be the patient applying for discharge from the guardianship. However, when the state exercises more coercive powers—particularly powers that have an impact on an individual’s liberty and private life—it is appropriate that the state be required to justify those powers afresh, especially when challenged. That is the logic that clause 48 seeks to embrace. In broad terms, as I say, I support it. The approaches are reinforced by our obligations under article 5 of the European convention on human rights, which protects the right to liberty and security of the person. It is clear that any deprivation of liberty must be justified not just initially, but on an ongoing basis. Jurisprudence from Strasbourg has repeatedly emphasised that periodic review mechanisms must be substantive and not merely procedural in nature. The state must show continuing justification and must not rely on past assessments or presumptions in its favour. Clause 48 helps us to move closer to compliance with those principles, but the legislation, as drafted, does leave some important questions unanswered. What, precisely, is the standard of proof that local authorities must meet? Is it the civil standard on the balance of probabilities, or is it something higher, given the gravity of what is at stake? If we are to take this shift seriously, we must also give tribunals clear statutory guidance on how to interpret the new burden. Otherwise, we will fall into the trap of risking inconsistency in decision making, confusion among professionals and a potential increase in appeals and legal challenges. Secondly, and crucially, I would like to press the Minister on the question of practical implementation. Changing the legal burden is not merely a matter of legislative drafting; it requires a systematic adjustment in how evidence is gathered, how professionals prepare for tribunal hearings, and how decisions are reviewed internally within local authorities. As hon. Members will know, local authorities are already operating under intense financial and operational pressures. Mental health social workers are often working with caseloads that stretch the limits of what may be considered reasonable. Legal teams within councils are often overstretched and under-resourced; if we now place them under a legal obligation to present a comprehensive, evidentially sound case for continued guardianship—perhaps at multiple intervals across an individual’s care pathway—we must ensure that they are adequately supported to do so. What assessment have the Government made of the financial and operational impact of clause 48? Will local authorities receive new funding to enable them to meet that duty? Will social care professionals receive specific training on the evidential requirements now expected of them? Without such support, we risk not only undermining the intent of the clause, but creating a perverse outcome in which discharges may occur not because the patient no longer meets the criteria, but because the local authority lacks the capacity to make the evidential case in time. I also caution against the risk of overcorrection. Although I fully support the principle that individuals should not bear an unfair evidential burden, we must not move so far in the other direction that we weaken the legitimate protective mechanisms that should be in place. Guardianship is not detention; it is a community-based measure designed to provide oversight and structure for individuals who may struggle to live independently due to serious mental illness. It is used infrequently and only where strictly necessary.

14:15:00

Clearly, there will be many cases in which guardianship remains the least restrictive and most proportionate option for someone at risk of relapse, exploitation or neglect. In those cases, a discharge made prematurely or without full understanding of the risks could result in serious harm to the individual or those around them. For that reason, I urge the Government to consider whether the clause should be accompanied by a statutory review mechanism to monitor its early impact. Initially, I suggest a review after 12 months, drawing from tribunal data, feedback from local authorities and, crucially, the voices of service users themselves.

I do not wish any of my comments to be seen as obstructive. I recognise the ethical imperative to place dignity, autonomy and liberty at the heart of our mental health law. We must never lose sight of the fact that the people subject to these orders are not merely patients or cases; they are individuals. They are citizens with histories, hopes and rights. In the past, mental health legislation has too often prioritised institutional convenience over the dignity of individuals.

The clause represents an effort to rebalance that equation. I commend the Government for recognising that need, but with such an effort comes a responsibility: to ensure that the legal tools that we use to protect rights are not merely symbolic, but effective, clear and properly resourced. The noble intention behind the clause has to be matched by operational reality. Otherwise, we risk repeating the same patterns of procedural unfairness under a different guise.

You will be pleased to know, Mrs Harris, that I am drawing to a conclusion. I offer this respectful challenge to the Minister: although the clause is principled, it is incomplete. It offers a justifiable shift in the legal approach, but it demands clear evidential standards. It reflects a desire to protect liberty, but it requires resourcing to avoid risk. It seeks to support the most vulnerable, but it must be implemented in a way that does not inadvertently increase their exposure to harm.

I urge the Government to provide guidance, oversight and support, to engage not only with the legal professionals but with those who live under guardianship regimes, and to use the noble principle of least restriction not as a slogan but as a functional safeguard. If the Government can do that, and if they can meet the high standards to which the clause aspires, that will represent meaningful reform. If not, I fear that we risk crafting a well-meaning provision with good intentions that will be undermined by poor execution. I urge the Government to get this right for those living with mental health illnesses, for the professionals who support them and, crucially, for the integrity of our legal system as a whole.

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

On the assessment of impact, it might be useful for the Committee to know, for context, that the use of guardianships under the Act is small: the number of new cases has declined from 470 in 2004-05 to just 40 in 2024-25. The number of open cases has also fallen in recent years. I think pretty much all the questions from the hon. Member for Solihull West and Shirley and the shadow Minister are addressed by that point. We are talking here about small numbers, so the cost would be relatively minor.

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

I do not have any data to suggest that the numbers will go back up. That relates to the question that the hon. Member for Solihull West and Shirley asked about having a statutory review. We will be vigilant. As with all the changes in the Bill, we will closely monitor implementation and impact. That goes right across the board and, hopefully, addresses the Member’s questions. Question put and agreed to. Clause 48 accordingly ordered to stand part of the Bill. Clause 49 Removal of police stations and prisons as places of safety Question proposed, That the clause stand part of the Bill.

Police stations are not appropriate places to hold people in need of mental health treatment. The Mental Health Act 1983 (Places of Safety) Regulations 2017 amended the 1983 Act to set a high threshold for using police stations as places of safety. Uses have reduced from over 8,000 in 2012-13 to just 322 in 2023-24 across England and Wales. While that number is mercifully low, the Bill will, under the principles of therapeutic benefit, end the use of police cells as places of safety. Instead, when police exercise powers to remove a person from a public space or private premises for the purpose of a mental health assessment, they will take them to a suitable place of safety, such as a hospital.

I declare an interest: my sister practises as a psychiatrist within the NHS, as the Minister knows. She has seen the important shift away from the use of police stations as places of safety and towards making sure that all patients have access to a place of safety in a healthcare setting. I know from my local police that, while they do their best to support people in distress in a police station, it is not the right place. This is the right thing to do, and I support the Government’s move.

I ask my hon. Friend to pass on our thanks to her sister for the vital work that she does in what I know can often be a challenging environment—we appreciate it. My hon. Friend is absolutely right that this is an important principle. There has been a remarkable drop in the use of police cells, which is to be warmly welcomed. We think that now is the time to make it clear, on the face of the Bill, that a police cell is not an appropriate place for these purposes. The clause’s amendment to sections 135 and 136 of the Mental Health Act will not change the police’s ability to intervene when someone is in a mental health crisis, nor their ability to detain someone in a cell when exercising their powers in relation to criminal, or suspected criminal, activity. The clause will prevent courts from temporarily detaining people with severe mental illness in prison as a place of safety while they are waiting to access a bed for treatment or assessment under the Mental Health Act. Under the reforms, a defendant or convicted person who meets the criteria for detention under the Mental Health Act for treatment or assessment must be transferred directly to hospital, or, in the case of children, to a hospital, surgery, community home or other place that the court considers suitable, ensuring that they receive swifter access to the care they need. I commend the clause to the Committee.

You will be pleased to know that I will be briefer this time, Mrs Harris; I want to leave room for my Opposition colleagues. The intent of the clause is entirely sound: to treat mental health as a health issue, not a criminal one. However, the capacity of NHS services to provide timely and suitable alternatives remains in question. With that in mind, I have three questions that I hope the Minister will be able to address. First, will the Government commit to publishing the implementation plan for ensuring adequate numbers of health-based places of safety across regions before the clause comes into force? Secondly, what contingency measures are currently in place or foreseen if no place of safety is available and police powers have been limited? Thirdly, can the Minister commit to an annual publication of data on hospital-based places of safety, their capacity and their use?

As we have heard, the clause removes police stations and prisons as designated places of safety for individuals in mental health crises, ensuring that they are instead taken to appropriate healthcare settings. In my view, this is a pragmatic and practical part of the Bill that supports patients going through an extremely challenging time. Perhaps, in the past, it has been all too easy to look to police stations as, if not the default option for those suffering a mental health crisis, certainly an easy one. That is not because police stations are the right place for patients, but because alternative provisions were not readily accessible. Clause 49 brings about several critical changes. First, it redefines “place of safety” so that for adults it now refers exclusively to hospitals that are willing and able to provide care. For children and young people, the definition aligns with the Children and Young Persons Act 1933 but crucially, it explicitly excludes police stations. Furthermore, the clause repeals section 136A of the Mental Health Act 1983, which previously allowed police stations to be used in so-called exceptional circumstances. The crux of the clause is to recognise that a mental health emergency is a medical crisis rather than a criminal one, and our system must reflect that.

14:30:00

I want to mention an example of why I support the changes that the clause brings in. There was a case involving Surrey police and a 26-year-old man who was in the middle of a clear mental health crisis in 2024. He was arrested for criminal damage before officers, who were concerned for his wellbeing, took him to hospital where he was sedated and discharged before being held overnight in a police cell. With no mental health bed available, the police were advised to use their powers under section 136 of the Mental Health Act. Despite a formal recommendation for hospital detention under section 2, no bed could be found. He remained in custody, agitated and repeatedly sedated.

With no legal option to extend section 136, officers understandably sought emergency court authorisation to hold him safely until a bed could be secured. The court had to invoke its inherent jurisdiction to permit that, because the Mental Capacity Act 2005 could not be used; he was objecting to treatment and was legally ineligible. That is a clear example of why change is needed. Of course, it also raises the question of whether, in making these changes, sufficient provisions are in place to accommodate patients such as that man within the system, as my hon. Friend the Member for Solihull West and Shirley raised.

Crucially, the clause follows the recommendations of the independent review of the Mental Health Act 1983, which highlighted the traumatic and inappropriate nature of placing individuals in custody when they are at their most vulnerable. It is right, therefore, that we seek to include those recommendations in the Bill.

I have some concerns, and I would be grateful for the Minister’s thoughts on them. Some have raised legitimate concerns about the practical implications, the strain on NHS services, the availability of hospital-based places of safety and the operational challenges facing our police and ambulance services. In the other place, assurances were given that sufficient attention and subsequent support would be given to services to deliver on this change in the legislation. I welcome that, but further clarification on that and the timeline of implementation would be reassuring. We need to make sure that in rightly lifting pressures on the police, we are not overloading the NHS.

This is also about recognising the role of the police and playing to the force’s strengths. As I and other Committee members have said throughout, the police are not trained professionals to the extent needed to able to deal with some of the mental health cases that are presented to them. We therefore cannot expect them to deal with situations relevant to the Bill.

Removing police stations is patient-focused and police-focused. My concern about this—perhaps, again, the Minister can clarify and reassure me—is ensuring that there is sufficient support in place for the police and ambulance services to deal with the transition. Again, at the heart of my support for the clause is that I think it will deliver a more therapeutic, suitable and effective process for the patient, while also, I hope, allowing our public services to do the job they are intended to do with the right support and resources.

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

I think it is probably right to say that the questions asked by the hon. Members for Solihull West and Shirley and for Chester South and Eddisbury and the shadow Minister basically all relate to building capacity to ensure that we are ready to absorb this change. We have committed to lay an annual report on implementation, which will set out progress made and future plans for implementation. We are working closely with the Home Office, the police and NHS England to better understand the implementation requirement for switching on this change. There is considerable variation across the country in the way in which police stations are being used, so there is a need to target support. I would add that the number and shape of dedicated health-based places of safety that are needed in a local authority will depend on the mental health needs of that population and the wider mental health crisis pathway provision. We are taking steps to ensure that people in crisis receive support and treatment sooner, so that fewer people need to be taken to a place of safety. It is worth noting that the Government have hit the ground running on this issue since we came into office last July. We are committing £26 million in capital investment to open new mental health crisis centres, which will aim to provide accessible and responsive care for individuals in mental health crisis. Evidence from systems with established crisis centres indicates that they can help to streamline urgent mental health care pathways and reduce unnecessary conveyance to A&E by ambulance, health-based transport or the police. We have also selected six areas to trial a new approach to mental health support by providing 24-hour neighbourhood mental health centres, seven days a week, bringing together all aspects of community mental health services.

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

We have selected six areas, but off the cuff I cannot tell the shadow Minister exactly what they are or whether they have been announced yet. If they have not been announced, I will not be able to tell him, but if they have been, of course I can share that information. I suspect that the areas will primarily be based on assessed need, but they are trial pilots, so there is no reason to suspect that they will be limited to six. Let us see how much traction they get. Question put and agreed to. Clause 49 accordingly ordered to stand part of the Bill Clause 50 Removal of patients by authorised persons Question proposed, That the clause stand part of the Bill.

We have previously discussed Government amendments 26 to 29, which seek to overturn amendments tabled in the other place by Lord Kamall, Earl Howe and Baroness May, which added police and other authorised persons to sections 2, 3 and 5 of the Mental Health Act. As I said in the earlier debate, the police currently have no powers under those sections, and the decision makers on whether to use those sections are health and social care professionals. We do not support extending police powers to health and social care professionals in this way, and the police do not support such an extension either. We are therefore seeking to remove clause 50 from the Bill. The clause extends legal powers currently held by the police under sections 135 and 136 to other professionals. That would enable other professionals to enter premises by force, if necessary, to remove a person believed to be suffering from a mental health disorder under section 135. Under section 136, other professionals would have the power to remove a person from a public space to a place of safety. Both those changes would represent a major shift in roles and responsibilities for health and care professionals. Indeed, the co-chair of the approved mental health professional leads network has said that extending police powers in this way to health and care professionals would have “disastrous unintended consequences for both individuals in crisis and those responding to mental health emergencies.” Nine organisations, including the Royal College of Psychiatrists, the Royal College of Nursing, the Royal College of Emergency Medicine and the Association of Ambulance Chief Executives, have made a joint statement of concern about extending police powers to health and care professionals in this way.

14:45:00

It is clear from what the Minister is saying that there are widespread concerns among health professionals about the change that was proposed in the other place, which would effectively give police powers to health and care professionals. Can he reassure psychiatrists such as my sister, and others working in mental health services, that they will always be able to rely on and work closely with their police colleagues to have that back-up when they are entering somebody’s home to potentially detain them?

I absolutely can give my hon. Friend that assurance. There has to be a team-based approach to this work. In any successful team, it is about ensuring that everybody knows their role and that everybody’s role within that team is appropriate. There has to be good collaboration and co-ordination. That is why I must say that I am quite taken aback by the attempts in the other place to insert these clauses; I do not think that is a safe way to make legislation. That is why it is so important that we remove the clause from the Bill. The statement that I referred to earlier, by all those eminent organisations, called it a “radical proposal with a number of serious and potentially dangerous consequences”. It also says: “Delegating police powers to professionals without consulting them, or patients would be a very damaging way to make policy.” It is important to restate what I said in an earlier sitting, namely that the majority of assessments under the Mental Health Act happen without police involvement, and that action is already under way to further reduce the amount of police involvement. However, we of course recognise the pressures that the police are facing and that police involvement can be stigmatising for people who are detained. Almost all police forces in England and Wales are implementing the “right care, right person” approach, a police-led initiative to reduce inappropriate police involvement in cases where people have health or social care needs. There has already been a 10% decrease in section 136 detentions in the year ending March 2024. There remain certain circumstances in which the police play a vital role in keeping particular people and the wider public safe. A blanket approach of extending powers in sections 135 and 136 to other professionals may not necessarily address the issues being faced by police officers and could create other unintended challenges. For example, while the current Act deliberately sets out who has what powers in what situations, a blanket extension of the police’s powers under sections 135 and 136 to other professionals—giving multiple agencies the same powers—risks confusion over who should respond in an emergency situation and could lead to delays in action as services try to decide who should act. That would be counter to our shared aim of ensuring that people in a mental health crisis get the right support as rapidly as possible. We are also concerned that giving health and social care staff statutory powers that increase the number of situations in which they may have to use reasonable force could have unintended risks for the safety of staff, patients and the public.

I rise to speak briefly to clause 50, which expands the authority to remove individuals under Mental Health Act powers by allowing trained and authorised non-police personnel to carry out removals that previously could be carried out only by police constables. A couple of key changes arise from the clause. First, the clause provides for the inclusion of authorised persons by amending sections 135 and 136 of the 1983 Act. That will allow individuals other than police officers, if they are authorised—“authorised” is the important word—to remove and transport people under Mental Health Act powers. That provides wider operational flexibility, and includes removals under warrant, by virtue of section 135, and without a warrant in public places. It is predicated on the fact that those authorised persons are appropriately trained and designated. Prior to the clause being inserted into the Bill, only police officers could carry out removals.

I am hearing that the hon. Gentleman supports clause 50, despite the very clear joint statement from organisations such as the Association of Directors of Adult Social Services, the British Association of Social Workers, the British Medical Association, the Royal College of Nursing and the Royal College of Psychiatrists. They see huge risks, not least the risk of the measure having an impact on the therapeutic relationship between clinicians and their patients. Is he ignoring that?

I am grateful to the hon. Lady for her intervention, but I am doing no such thing. I hope that I am doing my constitutional duty, which is to scrutinise the legislation and put some respectful challenges to the Minister about the operability of the clause were it to remain part of the Bill. Call me old fashioned, but I think that is what we are here to do. The intent behind clause 50 is to support a more health-led response to enabling trained healthcare or crisis responders to act. That aligns with the Bill’s broader goals of reducing the perception of criminality around mental health illness and improving patient experiences.

Does the hon. Member agree that section 136 is used when the police are alerted to a disturbance in a public place? If I saw a disturbance outside the Palace of Westminster, I would call the police, not a mental health professional. If the police arrive and think that the person is suffering from a mental illness, they will use the power under section 136. How can we give powers to health professionals to attend a public disturbance?

The hon. Gentleman speaks with a huge amount of experience and knowledge in this area. Of course, what he describes would be the default setting, but there may be scenarios in which a qualified healthcare worker is in the vicinity and can provide the support that that individual needs before the police can get there. The clause seeks to provide that flexibility. I acknowledge the split in the Committee on this, but the clause has some significant advantages: reducing police involvement in mental health crises, where that is most appropriate; improving response times, as I have just touched on; and supporting de-escalation. I accept that there are operational and legal questions to be addressed, but we are here to look at all the potential scenarios. The Minister has clearly set out the consequences of removing the clause from the Bill, but it is perfectly possible that a Government Member on the Committee will choose to support it, and I therefore seek some clarification from the Minister on the operational and legal challenges around training, oversight and the uniformity of authorised roles were the clause to remain part of the Bill. How would training standards be mandated for authorised persons and who would accredit them? How would consistency in practice be ensured across NHS trusts and ambulance services? Will the Minister also clarify the liability position in a case in which an authorised person used force or restraint during a removal?

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

Does the hon. Gentleman recognise that health professionals do not wear stab vests or cameras? They are not equipped to go into dangerous situations. It is essential to protect healthcare workers and not put them at risk. We should maintain the current situation, whereby they work in tandem with the police, but the police are present for the detention.

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

Before I call the Minister, I remind Members that interventions are meant to be short and to the point, and that responses are meant to be short and to the point.

15:00:00

Extending the police powers in section 135 and 136 to other authorised persons would represent a major shift in the roles and responsibilities of health and social care professionals. Our key health and social care stakeholders have warned us that extending the powers could have dangerous consequences, and that making changes to them without proper consultation is not the right way to go about making policy. I again extend my thanks to those stakeholders for their efforts to share their views on the role of police in mental health-related incidents. We of course recognise the pressures that police face. However, I must emphasise that the majority of assessment under the Mental Health Act already happen without police involvement. Action under the “right care, right person” approach is already reducing that further: there was a 10% decrease in section 136 detentions in the year ending March 2024. Simply taking the blanket approach of extending the powers may not actually address the issues the police face and could have unintended negative consequences, such as risks for staff, patients and the public, and delays in response. The Government are profoundly concerned about making such a change without proper engagement with the groups that would be impacted. I therefore do not commend clause 50 to the Committee. Question put, That the clause stand part of the Bill.

14|0|3|10|The Committee divided:|Question accordingly negatived.||0|0

Clause 51

Remand for a person’s own protection etc

Question proposed, That the clause stand part of the Bill.

With this it will be convenient to discuss clauses 52 and 53 stand part.

Clause 51 will reform the Bail Act 1976 to prevent courts from remanding a defendant for their own protection where the only concern relates to their mental health.In response to the independent review, a commitment was made to end the use of prison as a place of safety. Those reforms were welcomed, but concerns were raised about the use of a similar power under the Bail Act 1976 to remand a defendant to prison for their “own protection”. That power can sometimes be used when the court is concerned that the defendant’s mental health presents a risk to their own safety. Nobody should be sent to prison because they are struggling with their mental health, so the clause will amend the Bail Act to prevent the remand of a defendant for their own protection solely on mental health grounds. Instead, courts will be directed to bail the defendant and work with local health services to put in place appropriate support and care to address risks to their safety. The clause does not amend the court’s power to refuse bail in respect of a child or young person for their own welfare, because it is already the case that youths cannot be subject to a custodial remand solely for mental health reasons. However, in exceptional circumstances it may still be necessary for a court to remand a child to local authority accommodation for their mental wellbeing, and for that reason the power is preserved. On clause 52, patients from the Crown dependencies—the Channel Islands and the Isle of Man—currently cannot be transferred to England and Wales under sections 35, 36 and 38 of the Mental Health Act. The clause will introduce new powers to enable the Crown dependencies’ courts to send patients who are subject to their equivalent of remand under sections 35 or 36, or an interim hospital order under section 38, to suitably secure hospitals in England and Wales for treatment and assessment. The changes will ensure that that vulnerable cohort of patients can receive appropriate and secure treatment in England and Wales, while enabling the Crown dependencies’ courts to maintain control of the criminal proceedings, so that justice can be done swiftly and efficiently. Finally, clause 53 will ensure that where provisions in the Mental Health Act provide for the processing of personal data, any such processing, including the sharing of data, is subject to data protection legislation, including the Data Protection Act 2018 and the UK general data protection regulation principles. For example, personal data—including special category data such as health data—is likely to be contained in a report produced under clause 4, which inserts clauses specific to people with a learning disability and autistic people, so that their care, treatment and differing support needs are identified, and recommendations are made to ensure that those needs can be met. That report will be shared with the bodies set out in the clause, including the patient’s responsible clinician, the relevant integrated care board and the local authority. Clause 53 will ensure that such processing of personal data must comply with the controls and safeguards in the legal framework that governs the use of personal data. That includes compliance with key principles such as lawfulness and fairness, and adherence to high standards of information security, privacy and transparency. In essence, the provision means that where there is a duty or power under the Mental Health Act to process personal data, the processing—including the sharing—of the information must be done in a way that will not contravene data protection legislation, including the UK GDPR and the Data Protection Act 2018. In turn, among other things, that requires personal data to be processed lawfully, fairly and transparently, and confers certain rights on data subjects to access that data and have any errors rectified. That gives vital reassurance to patients about the processing of their personal data under the Mental Health Act. For those reasons, I commend clauses 51 to 53 to the Committee.

I ask for a series of clarifications from the Minister about all three clauses. On clause 51, how will the courts be supported in identifying community-based alternatives to remand? What training or guidance will be provided to judges in applying the provisions effectively? What assurances can the Minister give that support pathways will be available before and after the changes have taken effect? I accept that clause 52 is a technical a change to the legislation, but it is an important clarification none the less. It will require some robust co-ordination between jurisdictions and clearer procedural safeguards. How will the Government monitor the implementation of proposed new schedule A2 to ensure that patients’ rights are preserved during transfers? Will guidance be issued to courts and practitioners in the UK and the Crown dependencies about the new procedures, particularly their cross-jurisdictional nature? What consultation has taken place, and will continue to take place, with authorities in Jersey, Guernsey and the Isle of Man before the measures are implemented in law? Finally, I recognise that clause 53 is arguably a sensible safeguard. The challenge will be to ensure compliance on the frontline, especially where legal duties to share information and duties to protect confidentiality can butt against some degree of tension. With that in mind, what support or training will be given to health and care professionals to navigate overlapping legal duties? Will the Minister publish sector-specific guidance on data sharing as a consequence of the Bill? How will the Government assess whether the legal framework strikes the right balance between patient safety and privacy?

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

15:15:00

Clause 52 deals with the Channel Islands and Crown dependencies, following logically from the provisions in clause 51. Together, the clauses represent a recalibration of how our legal system interacts with severe mental health needs in criminal justice contexts. Clause 51 rightly seeks to limit the use of custody as a means of protecting individuals regarding their mental health. By contrast, clause 52 addresses a different but equally delicate matter: the cross-jurisdictional transfer of mentally ill individuals involved in criminal proceedings, specifically from the Crown dependencies of the Channel Islands and the Isle of Man.

Under the existing law, part VI of the Mental Health Act 1983 provides for transfers of patients between England and Wales and other UK jurisdictions, including Crown dependencies. However, there are notable exceptions: sections 83, 85 and 91 currently exclude individuals who are remanded under section 35, 36 or 38—that is, those subject to hospital remand for a psychiatric report or treatment or under an interim hospital order. Clause 52 proposes to remove the exclusions.

The explanatory notes describe the problem plainly. Due to the exclusions, courts in the Crown dependencies currently have limited powers to deal appropriately with offenders with complex mental health needs, particularly where secure hospital provision is lacking locally. Clause 52 aims to resolve this by allowing such individuals to be transferred to England and Wales for assessment or treatment and, crucially, then to be returned to their home jurisdiction to continue proceedings. This is an important and pragmatic development, and I welcome the Government’s recognition that mental health services —particularly secure forensic services—are not evenly distributed across the British Isles, and that the legal framework must support effective care pathways that are clinically appropriate and procedurally fair and safe.

However, in welcoming the clause, I wish to offer a number of questions and suggestions for consideration. First, on the safeguards for legal limbo, the explanatory notes are clear that once a patient is transferred into England and Wales, the original order from the Crown dependency ceases to have effect, and that the English court can exercise only a narrow set of powers—notably, to renew the remand, to notify the Secretary of State, or to recommend a return. In effect, that creates a legal limbo for the patient: they are not facing charges in England and Wales, yet are subject to detention under modified domestic law—if I am reading it correctly. Therein lies the issue.

When a patient is transferred from Guernsey, or another Crown dependency, to England under clause 52, their original legal order—say, a court remand for a psychiatric assessment—stops applying the moment they arrive in England. That is because each place has its own laws. They are, then, no longer officially under Guernsey’s legal powers, but at the same time they are not an accused person under English criminal law either, because they have not committed an offence here. That means that English courts have very limited powers over them—only what is specifically written into proposed new schedule A2. Unless everything is working smoothly—the court recognises the right type of remand, the hospital accepts the patient, and all the paperwork and clinical records arrive in time—there is a legal and practical gap. The patient is in a hospital in England, but the usual legal and clinical systems do not fully fit them. That is, by definition, limbo.

Let us take another example. Imagine that someone in Guernsey is accused of an offence and is believed to be mentally unwell. The court there issues a remand to hospital for a psychiatric report order, equivalent to a section 35 in England, but Guernsey does not have a secure psychiatric facility so, under clause 52, it transfers the patient to a hospital in England. When the patient arrives, Guernsey’s legal order no longer applies, as it has no force in England; the English court steps in, but only under the tightly defined powers in proposed new schedule A2.

If the patient’s medical files do not arrive at the same time, or are in a format that the NHS does not understand, clinicians may not know the patient’s medications, their risks and history, or why they were sent. If there is a delay in getting a report or renewing the order, the court might not have the clear power to continue the detention, but the patient obviously cannot simply be released. That is the limbo: legally here, but not fully under English jurisdiction; mentally unwell, but not clearly under the right safeguards; detained, but in a system that was not originally set up for them. I appreciate that these may be fringe cases, but they should be considered none the less in this United Kingdom.

I have some solutions that the Government might want to consider. They could create a legal bridge status —a formal legal status for transferred patients, like that of a transferred remand patient, that exists until the domestic English court has fully assumed jurisdiction under proposed new schedule A2. That would avoid gaps in lawful detention or oversight. They could introduce automatic continuity of detention, and write into law that the patient’s original order—from Guernsey, for example—continues to apply until the English court officially replaces it with a domestic equivalent. That way, there would be no legal vacuum during transfer. Alternatively, they could mandate timeframes to require that within, say, 24 or 48 hours of a patient’s arrival, a domestic court must review and confirm their detention under the new framework, ensuring both legal clarity and prompt judicial oversight. Those are ways to solve the problems in practice, and I would welcome the Minister’s thoughts on them. Alternatively, could he tell me whether this is just a hypothetical problem, or whether the Government have another way to solve it?

My second point is about judicial consistency and oversight. The Bill provides that the relevant English court for managing the patient will be one with “functions most closely corresponding” to the original Crown dependency court. That is a practical solution, but potentially ambiguous. Will the Government provide guidance on how that determination will be made in practice? For example, will it be a matter for judicial discretion, or will it be in secondary legislation? Is it up to the Crown dependency itself to decide? What training and guidance will be provided to the courts that manage these unusual and highly sensitive cases?

I turn to the clinical discretion and return recommendations. Under proposed new schedule A2, the English court may recommend to the Secretary of State that the individual be returned, yet it appears that the court has no power to order such a return. Is that correct? Paragraph 371 of the explanatory notes states:

“Schedule A2 restricts the powers of the court to deal with the patient, as the patient has no extant criminal proceedings in England and Wales, the court is unable to exercise any of its criminal jurisdictional powers in relation to the patient”.

To my understanding, that means that the court cannot convict, sentence, dismiss the case or terminate the remand order; it can only adjourn, renew the remand or recommend return.

Paragraph 371 continues:

“The court can also recommend to the Secretary of State the patient be returned to the sending Crown Dependency…The modifications prevent the court from terminating a remand…and dealing with the patient in any other manner which it would be able to, were the patient accused of an offence in England and Wales.”

Is it correct that only the Secretary of State, and not the court, can authorise the transfer back, and that the court is powerless to act if the Secretary of State does not? Is that intended, or have I misunderstood the Bill? I hope I am wrong. Otherwise, a patient held beyond the clinically required period, waiting for action, would be in a different kind of limbo. Will the Minister consider whether a court should be able to require, rather than merely recommend, the return of a patient once the clinical criteria are met and the remand is no longer justified? That could ensure a clearer safeguard against unnecessary or prolonged detention.

I turn to continuity of care, data sharing and the practical implementation of clause 52. Data sharing—particularly the secure, lawful and clinically useful transfer of patient information across jurisdictions—is a critical issue. Clause 52 enables the transfer of interim remand patients from the Crown dependencies, including Guernsey, to England and Wales. These are often vulnerable patients with complex mental health needs, subject to legal processes and detailed clinical oversight. To safely detain and treat them, clinicians in England and Wales must have prompt access to the relevant medical histories, risk assessments and legal documentation originating from the home jurisdiction. Clause 53 helpfully clarifies that any such data sharing under the Bill is subject to the Data Protection Act. That is important because it protects patients’ rights, but clause 53 does not establish any mechanism or guidance for how lawful data sharing should occur. It tells us the legal test, but not how to do it in practice.

What arrangements will be in place to ensure secure and timely data sharing across different legal and digital systems—for example, between a psychiatric unit in Guernsey and an NHS secure facility in England? Are there already agreed protocols or memorandums of understanding between each of those dependencies to ensure the necessary flow of clinical and legal information?

Let me offer a real-world example: a patient is detained in Guernsey under an interim hospital order, and it becomes clear that they need a level of secure forensic care that is available only in England. Under clause 52 and proposed new schedule A2, they are transferred to a unit in England and Wales. However, the Guernsey system may not use the same electronic format, and its mental health legislation differs. Risk assessments, medical histories, prior incidents or capacity decisions may all be recorded in formats unfamiliar to receiving clinicians. Without structure or data-sharing protocols, care may be delayed or, worse, unsafe. While clause 53 is a welcome statement of legal compatibility—as it should be—it may not be the whole answer. That is something I hope the Minister will address. We also see this issue across borders, for example between Wales and England, when it comes to sharing patient data. There is a wider issue here, but I am raising it purely in the specificity of what we are dealing with in these clauses.

Clause 52 is a sensible and overdue reform to an obscure but important part of the Mental Health Act. It will allow for humane, clinically appropriate and legally managed transfers of individuals caught between criminal justice and serious mental illness. However, it raises important operational and ethical questions about legal safeguards, court oversight and administrative accountability.

The hon. Member for Solihull West and Shirley asked how the courts would be supported in training for judges and so on. To safely enact that reform, it is vital that the appropriate pathways are in place from first contact with the criminal justice system into the right care and support, whether that is community mental health services or receiving treatment in hospital under the Mental Health Act, where appropriate. We will work with courts, health service commissioners and clinicians to ensure that sentencers have the confidence to bail vulnerable defendants into the community, with the appropriate package of support and smooth pathways into treatment in a healthcare setting for those who need it. We will confirm the timelines for commencement in due course. The shadow Minister, the hon. Member for Hinckley and Bosworth, asked about people who are under 18. Custody should be a last resort for children, and the legislative threshold for remanding a child to custody is already very high. Under-18s are not included in this provision, as the Legal Aid, Sentencing and Punishment of Offenders Act 2012 already precludes the remand of children to custody solely for mental health reasons. When the court’s concerns relate only to the child’s welfare, the preferred option would usually be bail. In exceptional circumstances, a court might remand a child to local authority accommodation, such as a children’s home or foster care, for their own mental wellbeing. Including children in this provision would remove that important safeguard. On the question of legal limbo, courts in England and Wales will not be able to exercise any criminal jurisdictional powers in relation to these patients. Their powers are restricted to renewal of the remand or interim order, ancillary powers and recommendations for the patient’s return, as well as obligations to inform the Secretary of State. We have included additional provisions in the Bill to allow courts in England and Wales to order a section 36 for treatment for a patient who has previously been transferred from the Crown dependencies on the equivalent of a section 35 for assessment. That is aimed at enabling access to treatment for the patient and preventing the need for the patient to be required to travel back and forth between jurisdictions. Question put and agreed to.  Clause 51 accordingly ordered to stand part of the Bill.  Clauses 52 and 53 ordered to stand part of the Bill.  Clause 54 Review of duty to notify incidents Question proposed, That the clause stand part of the Bill.

With this it will be convenient to discuss the following: 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.’” This new clause seeks to ensure that children are only placed on adult wards where there are exceptional circumstances, and it is in their best interests. It includes procedural safeguards for determining the reasons behind (and suitability of) admitting a child to a hospital environment in which adults are simultaneously accommodated or in an out of area placement. New clause 17—Children detained on adult wards— “(1) The Mental Health Act 1983 is amended as follows. (2) After section 131A (Accommodation, etc. for children), insert— ‘131B Children detained on adult wards (1) The Secretary of State must reduce to zero, within five years of the passage of the Mental Health Act 2025, the number of children detained on adult wards. (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.’” This new clause would require the number of children detained on adult wards to be reduced to zero within 5 years, and for the Secretary of State to produce a report on how this will be achieved. New clause 20—Report and Guidance: Transition to Adult Mental Health Treatment— “(1) The Secretary of State must, within 18 months of passing of this Act, prepare and lay before Parliament a report on improving provision for patients transitioning from treatment in a hospital environment for children and young people to one for adults when they attain the age of 18. (2) The report under subsection (1) must include an assessment of— (a) the current pathways and outcomes for young people transitioning between hospital environments for children and for adults; (b) any gaps in care or support experienced by patients during this transition; (c) best practices for ensuring safe and effective transitions. (3) Following the report under subsection (1), the Secretary of State must publish guidance for integrated care boards, local authorities, and providers of mental health treatment on improving outcomes and ensuring continuity of care for patients transitioning to a hospital environment for adults. (4) The guidance under subsection (3) must include— (a) specific steps to guarantee continuity of care for patients transitioning between treatment in a hospital environment for children and young people and one for adults; (b) measures to identify young people requiring transition support at an appropriate stage; (c) provisions for joint working and information sharing between providers of treatment for children and young people and for adults; (d) requirements for the review and updating of care and treatment plans to reflect the needs of patients transitioning to a hospital environment for adults. (5) Integrated care boards, local authorities, and providers of mental health treatment 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) young people with experience of transitioning between children and young people’s and adult mental health services, and their carers and guardians; (b) relevant professional bodies; (c) integrated care boards; (d) local authorities; (e) providers of mental health treatment; (f) 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.” This new clause would require the Secretary of State to review and report on the transition of patients from children's to adult mental health settings for treatment at age 18 and publish guidance for relevant bodies on improving provision and ensuring continuity of care during this transition.

I rise to speak to clause 54 and to a number of new clauses relating to the treatment of children and young people. I turn first to clause 54. The Care Quality Commission (Registration) Regulations 2009 require the CQC to be notified of specified events, one of which is where a child is placed in an adult psychiatric unit and the placement has lasted more than 48 hours. When the CQC is notified, the circumstances are reviewed and the risk is assessed. These notifications can trigger further assessments and inspections, and require the trust to provide regular updates and give assurance that the children concerned are being safeguarded.

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The clause will require the Secretary of State to review the regulations and look at whether the requirement to be notified should be extended to other cases where a child is admitted to hospital or a registered establishment for treatment for, or assessment in relation to, a mental disorder. They will also consider whether the current 48-hour time period that triggers a notification when an adult is placed in an adult psychiatric unit remains appropriate.

The Secretary of State will be required to publish and lay a report in Parliament on the conclusions of that review within two years of Royal Assent. The review will determine what, if any, changes to current regulations are required. Any potential changes to regulations identified by the review would be taken forward via secondary legislation following any public consultation where required.

The review forms part of wider work to clarify what we mean by “an inappropriate placement”, the circumstances in which such placements would be necessary, and how to consider whether they are in the child’s best interests. The work would be taken forward alongside the development of the revised code of practice and the new service specification, which defines the standard of care to be provided for specialised children and young people’s mental health services.

I turn to new clauses 12 and 17, which were tabled by the hon. Members for Hinckley and Bosworth and for Winchester, respectively. Guidance is clear that children should not be placed in adult wards; it is rarely in their best interests. However, there are circumstances in which such placements are clinically necessary for patient safety. I am pleased that the number of notifications of children placed in adult wards received by the CQC has reduced in recent years.

We want to see the number of children who are placed in adult wards decrease further, but we do not believe that placing more limitations and prescription in legislation is the best vehicle for reducing such placements. It would risk leaving clinicians without viable options in emergency situations. We have already amended the Bill to require the Secretary of State to review whether current notification requirements to the CQC should be extended to other circumstances beyond the placement of a child in an adult ward.

Further guidance on the process of determining if such placements are in a child’s best interests—as well as who should be notified and in what circumstances— will be set out in the revised code of practice and NHS England’s new service specification for specialised mental health services for children and young people. The new model will help to ensure that children and young people are treated in the least restrictive, age-appropriate environment possible, close to their home and family.

Turning to new clause 20, we recognise the transition from children and young people’s mental health services to adult mental health services can be daunting. As the Health Services Safety Investigations Body recently reported, there are significant challenges around providing effective continuity care for young people. We are committed to ensuring that patients are supported appropriately by all relevant local organisations at that important milestone.

Existing care standards and guidelines are clear regarding the specific support that should be provided to young people from six months prior to the patient turning 18, and their care being transferred to adult services. Work is already underway to develop NHS England’s new service specification for specialised children and young people’s mental health services, which sets the standard that service providers must adhere to. It will be developed with clinical leads and reflect any changes effecting the transition from children to adult mental health services. Therefore, a further review is not necessary.

Further bespoke guidance on the care and treatment of patients who are under 18 will also be included in the new code of practice. That will account for the specific needs and vulnerabilities of this group of in-patients, and will cover the critical issue of transition to adult services. The revised code will be developed in collaboration with stakeholders, including clinicians and young people. Separate, additional guidance, which the new clause calls for, will not be required, as this will already be provided in the code and in NHS England’s service specification.

I therefore commend clause 54 to the Committee, and hope that the hon. Members will not press their new clauses.

It is a pleasure to serve under your chairmanship, Mrs Harris. I thank the Minister for his comments on new clause 17, but I will speak to it briefly along with new clause 20, and then consider not pressing it later. New clause 17 aims to end the harmful and inappropriate practice of detaining children on adult mental health wards. We know that children in mental health crises are among the most vulnerable in our care system. Placing them in an adult ward is not only developmentally inappropriate; it risks causing further trauma and harm. The practice continues not because it is clinically justified but because of a lack of specialist child and adolescent mental health provision. Despite the existing statutory guidance under section 131A of the Mental Health Act, hundreds of children are still admitted to adult settings each year. That is a systematic failure. The new clause sets a clear goal: reduce the number of children detained on adult wards to zero within five years. It would also require the Secretary of State to publish within six months a concrete plan of how this will be achieved, including how children’s mental health services will be expanded. It is a question of not just capacity but political will. I urge the Committee to support the new clause if we press it to a Division. I say to the Minister that we are still looking for timelines. We need to protect young people from going into inappropriate adult mental health settings, as I have heard too often from residents in my constituency. New clause 20 would place a statutory duty on the Secretary of State to report within 18 months how to improve transitions between in-patient settings for children and young people and those for adults. I heard a particularly distressing case in my constituency recently, where an individual turned 18 and almost the next day was placed in an adult mental health setting. It was completely inappropriate for that individual, and no real transition work had been done. I appreciate that the Minister says that there is clear guidance, but that guidance has clearly not been adhered to at all times. The new clause would require statutory guidance for integrated care boards, local authorities and providers, covering essential components, such as clear pathways and timelines, joint working across services, early identification of those needing transition support, and updates to care plans that reflect changing needs. We believe that the new clause is clear, proportionate and achievable. It asks for a plan and for consultation and guidance that can support more stable, person-centred care at a critical point in a young person’s life. The Minister has indicated that he will not support the new clause. If he is unwilling to do so, my request is that he sets out how the Government will ensure the issues around transitioning between child and adult mental health services are addressed—particularly a clear timeline. He has mentioned a number of documents coming forward that start to address these issues, but as I have expressed, clearly the guidance already exists but it has not been adhered to in all cases, so we would like to see the timeline.

It is a pleasure to serve under your chairship once again, Mrs Harris. The Minister has set out in detail the function of clause 54, so I will not cover that in detail for reasons of time. I welcome the clause, which represents a step forward in regulating the placement of children and young people in adult treatment settings, and in ensuring their safeguarding. I welcome the fact that it recognises the need to review the existing safeguards available to young people. The independent review of the Mental Health Act made recommendations in this area, including that when an under-18 is placed on an adult ward, the CQC should be notified within 24 hours, and that the reasons for and the proposed length of the placement should be recorded. I would be grateful if the Minister would set out what consideration the Government have given to those recommendations, and whether they will form part of the review. I turn to the important matter of children and young people who are under 18 placed in adult treatment settings. I think we all recognise the extremely difficult context in which these detentions take place. We know that there is a serious shortage of specialist in-patient beds for children and young people, which means that places are often full or may not be available at a time of urgent crisis. When someone under 18 is placed in an adult treatment setting, they are more likely to witness or even experience high levels of restraint, be denied support from their peers, and lack access to educational opportunities. These placements can actually cause further harm to children and young people’s mental health, and therefore be detrimental to their recovery. I will be grateful if the Minister can assure me of the actions that the Government will take to further safeguard those children and young people who hit crisis point and find themselves in adult treatment settings because of the shortage of beds. How will we ensure that they are protected from being placed in inappropriate treatment settings? I do not wish to test your patience, Mrs Harris, but before I conclude I want to examine the point about children and young people a little further, given the interaction of clause 54 and associated new clauses with their treatment. I welcome the Government’s consistent restatement of the importance of getting the Bill right for children and young people. I know that the Minister takes such matters incredibly seriously, and I have listened carefully to what he has said this afternoon and throughout the Committee. The Minister has stated that a number of the reforms relating to children and young people will be addressed in the code of practice, but that contrasts with the approach of many of the welcome safeguards set out for over-18s in the Bill. Will the Minister clarify why these issues are being addressed differently when it comes to children and young people, compared to adults? Children and young people are a uniquely vulnerable group. On the point about the code of practice, I note that any deviation from that would need to be justified, but my understanding is that the code cannot impose duties on practitioners or require them to exercise their functions under the Act. I am concerned that putting safeguards for under-18s on a different footing from those for adults could make it harder for young people to access those safeguards. I welcome much of the work being done by the Bill, and I want to make sure that children and young people can also access its safeguards. I will be grateful if the Minister can address those points in his response. In conclusion, I welcome the step forward that clause 54 represents, because it addresses an important issue that we need to get to grips with. I look forward to the Minister’s response.

It is a pleasure to serve under your chairmanship, Mrs Harris. I rise to speak in support of clause 54, but with the caveat that it would be much more effective if new clause 12, in the name of my hon. Friend the Member for Hinckley and Bosworth, were added to the Bill. Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 requires healthcare providers to notify the Care Quality Commission of certain serious incidents. However, it may not comprehensively cover all mental health-related admissions of minors. Clause 54 responds to concerns about transparency and safeguarding in child and adolescent mental health services, and aims to ensure that all relevant incidents are properly monitored and reported. Like other hon. Members who have spoken, we welcome the Government’s shift to improve these standards; there is support for that across the Committee. The clauses about children and young people are some of the most vital parts of the Bill. They are vital not only to get the Bill right but, more importantly, to ensure that children are protected. That is why new clause 12, in the name of my hon. Friend the Member for Hinckley and Bosworth, is so essential to strengthen the Bill. The new clause would amend section 131A of the Mental Health Act 1983, which governs the accommodation of children in mental health settings. It responds to ongoing concerns about the inappropriate placement of children on adult wards, which can be distressing and unsafe, and which is clearly contrary to best clinical practice. The new clause would introduce a requirement that hospital managers must justify such placements in writing, including an explanation of why no alternative was available, and the steps being taken to ensure the child’s safety and transfer to more suitable accommodation. The new clause would also introduce mandatory reporting to regulatory authorities when a child was placed on an adult ward for more than 24 hours, and to local authorities when the placement exceeds 28 days, or involves an out-of-area admission. The new clause would ensure that children are placed on adult wards only when absolutely necessary. It requires the written justification and formal notification of placements. It involves local authorities and regulators in monitoring prolonged or out-of-area placements, and strengthens and clarifies existing provisions of the Mental Health Act. Most importantly, it aligns with clinical guidance on age-appropriate mental health care. I turn to new clauses 17 and 20, tabled by the Liberal Democrats. I think that their purpose is in some ways similar to that of our new clause 12. However, they put the cart before the horse, or the horse before the cart —it depends on which way round we are. We are trying to fix the system by ensuring that nobody enters an inappropriate place unless there are exceptional circumstances; new clauses 17 and 20 try to exclude those circumstances, but without necessarily fixing the problem in the first place. Although I understand, as ever, the motivations and sentiments of the new clauses tabled by the Liberal Democrats, I do not think they will have the intended consequences; at least, I do not think they will be effective. I have two questions for the Minister about clause 54. First, will the Department publish regular summaries of the notifications mentioned in the clause showing trends and disparities across the services or regions? Secondly, will the Care Quality Commission be resourced and empowered to act swiftly where patterns of overuse or misuse emerge?

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It is a pleasure to continue to serve under your chairship, Mrs Harris. I rise to speak in support of new clause 12, which has been tabled by the shadow Minister, my hon. Friend the Member for Hinckley and Bosworth, and to comment on clause 54, which has been grouped for this debate alongside it. Those two provisions both deal with the care and treatment of children and young people admitted to hospital for mental health reasons. In doing so, they touch on one of the most sensitive and critical responsibilities we have as legislators: safeguarding vulnerable children at a moment of profound crisis in their lives. Clause 54, as introduced in the Lords, will place a duty on the Secretary of State to review whether the current requirement to notify the Care Quality Commission should be extended. Currently, notifications are required only when a child or young person is placed in an adult ward for more than 48 hours. The clause asks whether that threshold remains appropriate, and whether other scenarios—for example, where a child is admitted for assessment or placed in an adult setting even for less than 48 hours—should also trigger notification. That is a welcome first step, and I support the clause. However, I also recognise the limitations of a clause that asks the Secretary of State only to review existing safeguards, rather than requiring that those safeguards be strengthened. That is why I also support the aims of new clause 12, which sets out a more detailed and practical framework to ensure that children are admitted to adult wards only when there are truly exceptional circumstances, and always with appropriate scrutiny and documentation. The issue has been a consistent concern across multiple reviews, including the independent review of the Mental Health Act, the Joint Committee on the Draft Mental Health Bill, and the Joint Committee on Human Rights. Each has made clear that existing protections are insufficient and that too often, vulnerable children are still being placed in inappropriate settings. That concern was echoed in evidence submitted to this Bill Committee by the Children and Young People’s Mental Health Coalition. Their written submission sets out the risks in stark terms. In 2023-24, the CQC was notified of 120 instances in which a child or young person was placed on an adult ward. We also know that between December 2023 and November 2024, 319 children were sent out of area to receive treatment, often far from their families, schools and local support networks—that is nearly one child every single day. Those are not just numbers; they are children and teenagers, many already facing significant trauma, mental health challenges or adverse life experiences. They are often the most vulnerable young people in our society. How they are treated in the days and weeks following a mental health crisis may have lifelong consequences for their wellbeing, development and future. The Mental Health Act and the code of practice are already clear: children should not be admitted to adult wards except in emergency situations, and even then, only if it is in their best interests. But as the Committee heard in written evidence, that standard is not always met in practice. Young people have reported feeling terrified on adult wards, with an expectation that they behave like adults in environments that were never designed for their needs. That is why new clause 12 is so important: it would give legal weight to existing guidance by requiring that any such admission was explicitly justified in writing, with clear reasons why no other options were available or suitable. The new clause would also ensure that steps were taken to protect the young person during their time on the ward and, crucially, to transfer them to a more appropriate setting as soon as possible. It would also require immediate notification to the regulator when a child was placed on an adult ward or was out of area for more than 24 hours. Those are simple procedural safeguards, but they really matter. Requiring decisions to be explained and recorded helps ensure they are properly thought through, and provides transparency, oversight and a route to accountability. I appreciate that the Government are seeking to address the issue through updates to the Mental Health Act code of practice. I welcome that intention and I recognise the role that the code can play in setting out professional guidance, but, with respect, I do not believe that is sufficient on its own. When children are being placed in adult psychiatric wards, potentially for weeks at a time, or being sent far from home in moments of crisis, we must do more than issue guidance—we must provide clear legal safeguards. This is not about placing unrealistic constraints on the NHS or criticising frontline professionals, who we know are working under significant pressure with limited resources. It is about ensuring that when difficult decisions are made, they are made transparently, in the best interests of the child and only when absolutely necessary. We have a rare opportunity in the Bill to put those protections in place. I hope the Minister will consider the evidence submitted to the Committee, the recommendations of previous reviews and the cross-party consensus on the importance of getting this right. Let us not miss this opportunity to ensure that our mental health system treats every child with the care, dignity and protection they deserve, and to set out clearly and transparently the standards we expect when they are at their most vulnerable.

You will be disappointed to know, Mrs Harris, that the notable contributions from my hon. Friends the Members for Chester South and Eddisbury and for Farnham and Bordon mean that my contribution will be even briefer than usual. [Interruption.] Rapturous support across the Committee—exactly the consensus-building that we are seeking to achieve. I rise to speak in support of new clause 12. It necessarily addresses the inappropriate placement of children on adult wards, which is not just distressing but deeply damaging to those involved. The issue is about having child-centred safeguards. It is essential that we ensure that children under 18 are placed on adult wards only when it is absolutely necessary and there is no alternative. The new clause would not only support best practice—it aligns with clinical guidelines on age-appropriate care—but provide welcome legal clarity. It would strengthen and clarify the existing provisions within the Mental Health Act. For those reasons, I encourage all hon. Members to support it. On clause 54, the Minister would be disappointed if I did not put a couple of questions to him.

Yes, I would.

That is an invitation that I will remember as we go on in this Committee. On this occasion, I have just two questions. First, will any interim guidance be issued while the review is ongoing? Secondly, can the Minister commit that the consultation will be undertaken on a wide basis, and include patient advocates, child psychologists and safeguarding boards? Because I cannot count, I will add a third question: did the Government consider an alternative to a two-year review period, either through an immediate extension of regulation 18 or perhaps a shorter period, so that these important changes can be put in place without delay?

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

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A recent report by the Health Services Safety Investigation Body, an independent patient safety organisation, highlights multiple concerns associated with these admissions. For example, 13 out of 18 paediatric units surveyed by the HSSIB described their ward environment as “not safe” for caring for children and young people with high-risk behaviour related to mental health concerns. Issues included a lack of resources to provide therapeutic engagement for the children and young people, challenges related to physical ward space, difficulties managing children and young people who required sedation, and concerns about the impact of these admissions on other patients and staff morale.

The study noted that work is ongoing around the country to address those issues, and the researchers hope that their study will highlight the urgent need for better integration of acute mental health and social care services to support children and young people admitted with mental health conditions. It is clear that the consequences of such placements can be severe. Children exposed to an adult ward environment face risk to their safety, development and dignity. There are documented cases where young people have been vulnerable or exploited in adult wards, which is completely unacceptable.

What does our new clause 12 seek to achieve? It aims to put into statutory form essential guidance to ensure that children are admitted to adult wards only in truly exceptional circumstances, and only when it is demonstrably in their best interest. The requirement for a hospital manager to provide a detailed, written justification for such admissions would introduce much-needed transparency and accountability. Furthermore, it would mandate immediate notification to regulatory authorities if the child is on the ward or placed out of area for more than 24 hours. That would ensure oversight and timely review, reducing the risk of prolonged inappropriate placements. Finally, it would require notification to the responsible local authority if the placement extends beyond 28 days or involves out-of-area admission, fostering local authority involvement in safeguarding and care planning.

By strengthening those protections, the new clause encourages hospitals to prioritise child-appropriate placements and invest in expanding CAMHS capacity. It reduces the likelihood of children experiencing the significant distress and harms associated with adult ward admission, it provides families, advocates and oversight bodies with clear information and recourse, and it promotes better multi-agency working between hospitals, local authorities and regulatory bodies. The Government may argue that existing guidance and regulation already covers those concerns sufficiently, but guidance lacks the force of law and enforcement mechanisms.

Without statutory requirements, children will remain vulnerable to inconsistent practice. Our new clause introduces enforceable obligations and transparency that guidance alone cannot provide. The Government may argue that adding such requirements could delay urgent admissions or reduce hospital flexibility, but the new clause allows for admission to adult wards in exceptional circumstances, and explicitly requires that it be in the child’s best interest. That strikes the right balance between safeguarding and clinical judgment, ensuring flexibility without compromising safety. The Government may say that notification duties may be a bureaucratic burden, but I would argue that the welfare of children must take precedence over administrative convenience. Clear notification promotes oversight and prevents harmful, long-term placements that ultimately create far greater burdens on the system.

We have discussed this before, but it is worth fleshing out: if the new clause is not accepted, what will happen? It is important to distinguish clearly between the protections offered in clause 54 and those in our new clause. Clause 54 requires the Secretary of State to review the duty of notification incidents to the Care Quality Commission, particularly where a child under 18 is admitted to an adult psychiatric unit. The review will consider whether to extend notification requirements and whether the existing 48-hour threshold of reporting such admissions remains appropriate. Although that review is welcome in principle, it is fundamentally a forward-looking exercise—a study to consider future changes. The statutory requirement to produce a report within two years is far from an immediate safeguard.

By contrast, our new clause would offer an immediate statutory safeguard. It would place a clear legal duty on hospital managers to avoid admitting children to adult wards, except in exceptional circumstances with their best interest at heart. It would mandate detailed written justifications and require immediate notification to regulatory and local authorities when such admissions occur, rather than after a 48-hour delay.

To put that into context, consider the following example. Under clause 54, a child could be admitted to an adult ward due to a lack of CAMHS beds and remain there for two full days, or more, before the CQC is even notified. This delay risks serious harm to the child and delays intervention or escalation. Under our new clause, the hospital managers must notify the regulatory authority immediately if the child remains on the ward for more than 24 hours. This ensures timely oversight and potential intervention, significantly reducing the risk of prolonged and inappropriate placements.

The eagle-eyed among us may have spotted that I was previously calling for real-time notification, and I hope that that will happen. However, if we are to implement and enact legislation immediately, the 24-hour period seems reasonable and workable, and it appears to have immediacy. As the hon. Member for Hertford and Stortford pointed out, it also fits with current NHS good practice guidance. Remember that this is all a backstop and a legal minimum; we should aim much higher when it comes to our children. Moreover, clause 54 does not require hospital managers to justify why a child has been placed on an adult ward, or to document measures that were taken to ensure the child’s safety and welfare during that placement. Our new clause would introduce these critical transparency and accountability measures by default.

I anticipate that the Government may argue that the review process in clause 54 is sufficient and that imposing stricter duties risks creating administrative burdens or delaying urgent admissions. To that, I say that the welfare of our children must always take precedence over bureaucracy. In summary, clause 54 lays the groundwork for further improvements but does not replace the urgent need for statutory safeguards, which is what our new clause would introduce. Should the Government decline our new clause, I urge the Minister to set out the safeguards that he feels need to be applied in practice.

It is also worth setting out the challenge that the Minister faces in the seat of power. Some recent research from January 2025, carried out by UCL researchers, found that there was a 65% increase in the number of children and young people being admitted to general acute medical wards in hospitals in England because of mental health concerns between 2012 and 2022. The study was published in The Lancet Child and Adolescent Health journal and was funded by the National Institute of Health and Care Research and the Great Ormond Street hospital biomedical research centre.

That study analysed all the admissions of children and young people aged five to 18 to medical wards—this is not just mental health wards but medical wards—in England from 1 April 2012 to 31 March 2022. General acute medical wards are specialised hospital wards designed to provide rapid assessment, treatment and care for patients. These units serve as a bridge between the emergency department, GPs and other hospital wards, and they are separate from specialised mental health wards, such as eating disorder units.

The study found that children and young people are commonly admitted to general wards from accident and emergency because they are too unwell or it is not safe for them to go home. The researchers found that, over the course of 10 years, mental health admissions increased from 24,198 to 39,925, a 65% increase, which compares with an increase in all-cause admissions of just 10%. Increasing admissions were greatest in girls aged 11 to 15 and for eating disorders, rising from 478 to 2,938, which is a 514% increase.

The study is the first to analyse national trends in mental health admissions among children and young people to acute wards. The senior author, Dr Lee Hudson, said:

“Over the past decade, we’ve observed a significant rise in mental health admissions among children and young people to acute medical wards. Although there has been attention paid to increased referrals to community mental health services and inpatient mental health settings, admissions to general acute medical settings feels like a piece of the jigsaw missing in the story…Acute medical wards are important places for caring for young people with mental health concerns – especially those with co-existing physical health problems like starvation from an eating disorder…However, the increased intensity we describe is presenting real challenges for acute wards, both for patients and their families and the staff supporting them. They may not be set up with an appropriate ward environment for this care, and sometimes staff working there need more training and support with relevant skills. This calls for better co-working between physical and mental health professionals across hospital and community teams, including, for example, adequate provision of psychiatrists”.

From their national-level data, the researchers were unable to pinpoint the reasons behind the dramatic increase in mental health admissions in their study, and they are now proceeding to collate the data to consider that. They hope to get a better understanding. Dr Hudson goes on to say,

“At a bigger level, we are all currently grappling with and trying to figure out why more and more young people are suffering with their mental health but it’s likely the bigger background prevalence of mental health problems, and possibly increased severity of individual cases, leading to increased presentations to hospitals that require an emergency admission to a general ward because it is not safe for the patient to go home.”

Therein lies the importance of our new clause. We ask that, when it comes to monitoring adult wards—the study talks about acute medical wards—it is a problem that is going to get worse. We need to be a long way ahead of it when it comes to understanding what is to be done. That is the challenge I set the Minister.

Finally, I would like briefly to address new clauses 17 and 20. Again, I welcome the intent of what the Lib Dems are trying to do, which is to ensure that children are not placed in adult wards, except in the most truly exceptional circumstances. However, I respectfully submit that while new clause 17 sets an ambitious goal, it lacks the immediate, enforceable safeguards that children in the system need now.

Let us examine what the new clause does. It sets a five-year target to reach zero children detained on adult wards, and it requires the Secretary of State to publish a plan within six months, explaining how the target will be met. I will be candid: we already have a target. As recently as 2022, the previous Government reaffirmed their commitment to ending inappropriate placements, and this Government have repeated that in good faith. While there has been progress, it has been patchy. On the ground, CAMHS beds remain scarce.

Publishing another report in six months’ time and setting a five-year goal will be of little comfort to a 17-year-old who, this week, might find herself placed on an adult ward for lack of a suitable alternative, or indeed a 15-year-old, detained miles from home, isolated and at risk. Those children do not need a long-term goal; I gently say that they need protection now. That is why our new clause does three critical things—which I will not state again. While I welcome the ambition of new clause 17, I believe that it must be complementary and enforced by duties today, not tomorrow. On that point, I will wait for the Lib Dems to wind up.

The hon. Member for Guildford asked about timelines. There is the timeline for the review on the face of the Bill, and then there is the broader question about implementation and how all the moving parts fit together. We have now had the spending review, which will provide a financial envelope for mental health more broadly, and for implementation of the Bill. We will be ready to move forward with implementation on that basis, which will include the code of practice. My hon. Friend the Member for Hertford and Stortford asked about a time limit for notification. It is already a legislative requirement for the CQC to be notified when a child or young person is placed on an adult ward for a continuous period of longer than 48 hours. In addition, the previous Government assessed that the current requirement of 48 hours was sufficient. As part of the review that is mentioned on the face of the Bill, we will consider whether that remains the case for receiving notifications, and whether it remains appropriate. My hon. Friend also asked about further safeguards for children and young people, including those in inappropriate settings. Obviously, the placement of a child or young person on an adult mental health ward only happens following a thorough clinical assessment. Trusts are required to have robust local safeguarding protocols in place, including mandatory staff training on safeguarding and incident-reporting mechanisms, to ensure accountability and oversight. Staff are appropriately trained in child and adolescent mental health care, and they must meet level 3 competency in safeguarding children. The hon. Member for Farnham and Bordon asked about data. The CQC already publishes “Monitoring the Mental Health Act”, a statutory annual report that must be laid before Parliament, in which it reports on the number of people under 18 who are admitted to adult wards. Additionally, it reports qualitative information on placements for children and young people, such as placements on children’s general wards. I hope that I have addressed that point.

16:15:00

The hon. Member for Solihull West and Shirley asked about interim guidance. NHS England monitors the number of children and young people treated on adult wards via the mental health services monthly statistics. Any concerning changes in the number of admissions of children and young people to an adult ward are shared with NHS England regional offices for close monitoring. When the CQC is notified of an inappropriate placement, it contacts the provider and assesses the risk and whether regulatory action is required.

The shadow Minister, the hon. Member for Hinckley and Bosworth, asked whether 48 hours is too long. As I said earlier, 48 hours was judged by the previous Government to be sufficient, but we have that under review. He asked whether the review will be stand-alone. Yes, the review that is mentioned in clause 54 will be a discrete piece of work, not specifically part of the written ministerial statement or implementation plan, but clearly it will feed into them and will be an important part of that reporting.

New Clause 10

Human Rights Act 1998: extension to certain care providers

“In the Mental Health Act 1983, after section 142B insert—

‘142C Human Rights Act 1998: extension to certain private care providers

(1) A registered care provider is to be regarded for the purposes of section 6(3)(b) of the Human Rights Act 1998 as exercising a function of a public nature in providing any of the services mentioned in subsection (2) (to the extent that it would not otherwise be so regarded).

(2) The services are—

(a) after-care services provided in pursuance of arrangements made under section 117;

(b) services provided in pursuance of arrangements made by a local authority in Scotland discharging its duty under section 25 of the Mental Health (Care and Treatment) (Scotland) Act 2003;

(c) the provision of medical treatment for mental disorder or assessment in relation to mental disorder, for an in-patient at a hospital, but only where that treatment or assessment is arranged or paid for by an NHS body.

(3) In this section—

“hospital” means any institution for the reception and treatment of people—

(a) suffering from mental disorder or other illness,

(b) convalescing, or

(c) requiring medical rehabilitation;

“illness” includes any injury or disability requiring medical treatment or nursing;

“NHS body” —

(a) in relation to England, has the meaning given by section 275(1) of the National Health Service Act 2006;

(b) in relation to Wales, has the meaning given by section 206(1) of the National Health Service (Wales) Act 2006;

(c) in relation to Scotland, a health board constituted by order made under section 2 of the National Health Service (Scotland) Act 1978;

(d) in relation to Northern Ireland means—

(i) the Department of Health, or

(ii) a Health and Social Care Trust;

“registered care provider” means—

(a) a person registered under Chapter 2 of Part 1 of the Health and Social Care Act 2008,

(b) a person registered under Part 2 of the Care Standards Act 2000 or Part 1 of the Regulation and Inspection of Social Care (Wales) Act 2016,

(c) a person providing—

(i) a care service which is registered under section 59 of the Public Services Reform (Scotland) Act 2010, or

(ii) an independent health care service registered under section 10P of the National Health Service (Scotland) Act 1978, or

(d) a person registered under Part 3 of the Health and Personal Social Services (Quality, Improvement and Regulation) (Northern Ireland) Order 2003. ’”—(Stephen Kinnock.)

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

With this it will be convenient to discuss Government amendments 37 and 38.

The new clause takes forward a commitment made in the Lords by Baroness Merron to address issues relating to the unequal application of the Human Rights Act 1998 for some mental health patients. Sadly, this issue was highlighted following the death of Paul Sammut. I extend my deepest condolences to his family. We now wish to take action to ensure a more equal application of the Human Rights Act, with the aim of extending its protection to certain mental health patients. Under this amendment, private providers will be taken to be exercising a function of a public nature for the purposes of section 6(3)(b) of the Human Rights Act when they are carrying out certain services and when those services are arranged and/or paid for by either local authorities or the NHS. Those functions are section 117 aftercare; services provided in pursuance of arrangements made by a local authority in Scotland, discharging its duty under section 25 of the Mental Health (Care and Treatment) (Scotland) Act 2003; and in-patient treatment and assessment for mental disorder, whether or not a patient is detained under the Mental Health Act. When carrying out those services, private providers will be required to act compatibly with the convention rights set out in the Human Rights Act. Many patients in private facilities already have those protections. Private providers are already taken to be exercising a function of a public nature for the purposes of section 6(3)(b) of the Human Rights Act when caring for patients detained under the Mental Health Act or providing care for patients due to the effect of section 73 of the Care Act 2014. The new clause seeks to extend those protections to other mental health patients in private provision, where care is arranged and/or paid for by the NHS or a local authority. As the new clause is a modification of the Human Rights Act, this is a reserved matter and the amendment will therefore apply in all four nations. Government amendments 37 and 38 are minor technical amendments to the Bill’s extent provision in clause 57 to ensure that our amendment—new clause 10—relating to the Human Rights Act extends UK-wide. The Human Rights Act, which the new clause 10 seeks to modify, extends UK-wide. The amendments are therefore necessary to ensure that the same Human Rights Act protections extend to all four nations. I hope that hon. Members feel able to support the amendments.

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

I thank the shadow Minister for those questions. I will have to get back to him in writing, because the questions that he asks obviously have an important legal dimension, and it was physically impossible to get the information in the time between his sitting down and my standing up to speak. I am not a human rights lawyer either, so it is best if I write to him on those points. Question put and agreed to. New clause 10 accordingly read a Second time, and added to the Bill. Ordered, That further consideration be now adjourned. —(Taiwo Owatemi.)

16:25:00

Written evidence reported to the House

MHB41 Independent Monitoring Boards

MHB42 Carers Trust

MHB43 Dr Evelyn Mensah

MHB44 Last Mafuba, researcher, founder and chief executive officer of Inini Initiative Ltd

MHB45 Community Coordination Action Group

MHB46 A community activist and carer

MHB47 Black Country healthcare NHS foundation trust

MHB48 Lincolnshire partnership NHS foundation trust

MHB49 General Medical Council

MHB50 Mental Health Foundation

MHB51 Zoe Dodd

MHB52 Dr Anthony Salla and Dr Karen Newbigging

MHB53 Muslim Mind Collaborative

MHB54 Croydon Black and Minority Ethnic Forum

MHB55 Birmingham and Solihull mental health NHS foundation trust

MHB56 East London NHS foundation trust

MHB57a Rethink Mental Illness (general submission on the Bill)

MHB57b Rethink Mental Illness (further submission on the statutory implementation of the patient and carer race equality framework)

MHB58 Aspiring Futures CIC

MHB59 Inclusion London