Mental Health Bill [ Lords ] (Seventh 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

[Sir Desmond Swayne in the Chair]

Mental Health Bill [Lords]

11:30:00

Hon. Members may wish to remove their jackets. Please make sure that electronic devices are switched to silent mode. Hansard will be grateful if you email speaking notes. I remind Members to rise in their place if they wish to speak. Clause 42 Information about complaints for detained patients Question (17 June) again proposed, That the clause stand part of the Bill.

I remind the Committee that with this we are considering clauses 43 and 44 stand part.

I know that the Committee has been waiting in earnest for me to deliver this speech on clauses 42 to 44. As the temperature gets to almost 30° today, I will try to maintain the same gumption that President Trump had when introducing his flagpoles, because this is an exciting topic and I am keen to treat it with verve. Clauses 42 to 44 will introduce new duties on hospital managers to provide information about complaints procedures to patients under different legal regimes within the Mental Health Act 1983. The clauses move important safeguards from the code of practice into primary legislation, thereby giving them statutory force, which is a welcome step. I acknowledge the Government’s intentions to strengthen patients’ rights and accountabilities within the mental health system. Clause 42 concerns information for detained patients. Under the current law, section 132 of the Mental Health Act 1983 requires hospital managers to give patients information about their rights under the Act, including their rights to apply to the mental health tribunal and to access independent mental health advocates. Although complaint procedures are mentioned in the code of practice, however, they are not explicitly covered in statute. Clause 42 will amend section 132 to impose a new statutory duty to provide information on how to make complaints about: the carrying out of functions under the Act, any medical treatment received while detained, and the outcome of any such complaint, including routes for escalation such as through the Parliamentary and Health Service Ombudsman. Importantly, the information must be provided both orally and in writing, and steps must be taken to ensure that the patient actually understands it. Those duties must be carried out on initial detention and then repeated either annually for restricted patients or on the submission of renewed report under section 20 of the Act. The Opposition welcome that positive and necessary step. We know from independent reviews, including the Wessely review, that many patients do not know how to complain or fear that doing so will affect their care. By placing these requirements in primary legislation, we provide more robust legal protection. I would be grateful if the Minister clarified some points. How will “understanding” be assessed or evidenced in practice? For example, what guidance will be issued to ensure that the needs of patients with a learning disability, cognitive impairment or limited English are met? Will independent mental health advocate services play a formal role in supporting patients to understand the Act with regard to this information about complaints? Is that part of their expanded role? Will complaints about poor complaint handling, not just about the original matter, be clearly included in the framework, as implied in the explanatory notes? To whom would such complaints be reported: NHS England, the Department, the integrated care board or a regulator such as the Care Quality Commission? As we are talking about complaints, I notice that paragraph 327 of the explanatory notes states: “New subsection (2A)(c) ensures the duty covers information about the patient’s right to complain to the Parliamentary and Health Services Ombudsman about the maladministration of complaints about medical treatment.” That is very welcome, but it brings up an entirely new set of questions about the role of the Parliamentary and Health Service Ombudsman in this guise—an institution that embodies the public’s right to accountability, redress and justice when our health and public services fall short. In essence, it is the final arbiter; at best, it is the final safety net for those who feel they have nowhere else to turn. In particular, I want to focus on its critical yet often underappreciated work in relation to mental health complaints and how it intersects with the new Bill. The ombudsman investigates unresolved complaints about NHS services in England, including those related to mental health care, alongside complaints against Government Departments and other bodies. For many families affected by failings in mental health provision, be that in crisis care, discharge planning or secure settings, the ombudsman provides a route to independent evidence-based resolution. We must therefore ask whether it is functioning with the efficiency, compassion and authority that patients deserve. To pick just some of the data, in 2022-23 the PHSO received more than 35,000 complaints, which was an increase of 20% on pre-pandemic levels. If we look at timelines, performance remains under pressure: only 32% of investigations were completed within 13 weeks, 50% within 26 weeks and 81% within 52 weeks—that comes from the annual report. In the mental health sphere, such delays can exacerbate trauma and deepen distrust in public systems, in particular if the complainant is already experiencing severe distress. The PHSO has reported a rise in callers exhibiting suicidal ideation, a tragic indicator of the depth of need and the urgency of timely reform. Over the past few years, to its credit, the ombudsman has introduced reforms for a new case severity assessment framework to triage cases more effectively; investment in digital case management; training for frontline staff to deal more sensitively with mental health complaints; and a proactive push for transparency, including publishing more case outcomes and data. That is important work, but there is still some way to go. What assurances can the Government provide that PHSO’s funding is sufficient to cope with increased volumes of complex mental health cases, especially as it has a somewhat unique structure? The PHSO reports to the Public Accounts Committee. It does not have a departmental home. It is appointed by the King on the advice of the Prime Minister, after scrutiny by the PAC, but it is funded through the House of Commons Commission. That makes the PHSO rightly independent, but we need to ensure that it has the ability to deal with the top level of complaints about severe cases of mental health issues. Under this legislation, we will be creating more automatic referrals to tribunals; we are rightly empowering more patients to complain; and we are putting more reports in for accountability. We need to ensure that when there are complaints—as there could well be—they will still be dealt with. Therefore, has an impact assessment been carried out, or will one be carried out, about PHSO funding, capacity and ability to deal with more mental health complaints? As we debate a new Bill, we must ensure that accountability mechanisms fully integrate with any legislative reform. The Bill will, rightly, enhance patient rights and restrict inappropriate detention, but the ombudsman must be equipped to robustly investigate breaches of those rights. We should also ensure a clear reporting pathway for detained individuals when their families go to the ombudsman. My overarching question for the Minister, which I hope he will address is: how will the Bill, empowered in this way, interface with the PHSO? Will it strengthen the ombudsman’s ability to investigate complaints relating to involuntary treatment or detention? Clause 43, on information about complaints for community patients, will make an equivalent amendment to section 132A of the Mental Health Act, which governs patients subject to a community treatment order. Again, patients are currently told about their rights to tribunal and IMHA support, but not necessarily about how to raise concerns or complaints about their care in the community. The clause will therefore require hospital managers to provide information about how to make complaints about functions carried out under the Act, about medical treatments for mental disorder while on a CTO, and about the outcome of any such complaint. Clause 43 will also add a new requirement to repeat the information as soon as practicably possible after the CTO renewal. Again, that seems sensible and overdue, because clear repeat information can help to balance the power dynamics and support the patient voice. However, what steps will be taken to ensure that community patients who do not have regular contact with hospital staff are still given the information promptly and meaningfully? Will that be the duty of the new community clinician, for example? What is the role of community mental health teams or primary care staff, such as GPs or community psychiatric nurses, in delivering or enforcing the duties? Will the Minister confirm whether patient carers or families beyond the nominated person will be supported in understanding how someone can make a complaint? Finally, clause 44, on information for conditionally discharged patients, will introduce proposed new section 132B of the Mental Health Act, extending the same principles to patients who are conditionally discharged, including restricted patients under section 42, 73 or 74. Such individuals often remain subject to significant restrictions in the community, such as curfews, reporting conditions or residence in supervised accommodation, and they can be recalled to hospital at any time, yet under the current law they have no statutory right to be informed of how to complain about or challenge decisions that affect them. Clause 44 will require hospital managers to inform those patients about which section they are discharged under, how the Mental Health Act continues to apply, their rights to apply to a tribunal, and—crucially—how to make complaints about the carrying out of MHA functions, medical treatments and complaints outcomes. That requirement must be met as soon as practicable, in both oral and written form. A copy must also be given to the nominated person. The explanatory notes state that the duty applies to “patients subject to transfer directions” from prison, and that the information should be given before discharge if possible. That is welcome, but it raises a question why, unlike clause 42, clause 44 does not impose a duty to repeat that information periodically. Given that conditionally discharged patients may remain under conditions for many years, have the Government considered adding a requirement to re-provide the information, say, annually? What support or advocacy will be available to conditionally discharged patients, particularly those in forensic or community forensic services, to help them to make complaints or understand their rights? Finally, will the Minister clarify how the provisions will work for patients who lack capacity, or who have no nominated person? Will there be a fall-back or safeguard in those cases? In clauses 42 to 44, the Government are rightly seeking to embed the right to complain, and to understand that right, into the framework of the Mental Health Act. These are technical but powerful reforms. As ever, however, the challenge lies in not what is required but how it is delivered, especially for the patients who are most marginalised, restricted or isolated. I hope that the Minister can provide some reassurances about monitoring for compliance, clear statutory guidance, and the support of the advocacy structure, particularly at the very top, for dealing with complaints.

It is a pleasure to serve under your chairmanship, Sir Desmond. I will respond to the questions that have been asked. The hon. Member for Farnham and Bordon asked what training would be provided to staff on communicating the information clearly and compassionately. We will seek to clarify the complaints process and, when we come to revise the code of practice, we will consult on the guidance for how information on complaints should be provided. The Department will work with the NHS, Social Work England and other partners to develop appropriate training for staff on the reforms. Once the code of practice has been updated, professionals working under the Act will be required to undergo training to maintain their competence and awareness of the Act. The hon. Member also asked how to ensure that information is genuinely accessible. It is important that the complaints process is accessible to all patients. Hospital managers must take practicable steps to ensure that patients have understood complaints procedures, and information about complaints must be provided both verbally and in writing. We expect all healthcare organisations to meet people’s communication needs to support equitable access, experience and outcomes, including when someone is in hospital for their mental health. NHS England sets out guidance for providers on how to support individuals with their communication needs. That support may involve providing access to interpreters, providing information in a range of formats—such as in translation, large print, braille and easy read format—or the use of augmentative and alternative communication, video clips and visual diagrams to aid understanding. The accessible information standard requires all applicable organisations to identify, record, flag, share and meet the information and communication support needs of patients, service users, carers and parents with a disability, impairment or sensory loss. On the question of whether there will be an audit of whether patients feel genuinely informed and empowered to complain, we know that some service users are not aware of the avenues by which they can make a complaint. The changes in clauses 42 to 44 seek to address that problem, and to increase awareness of the complaints system. To ensure that patients are supported and empowered to exercise their rights, we are expanding the right to an independent mental health advocate to all mental health in-patients. Complaints information must be provided to both the patient and the nominated person. Family and carers also have a right to complain about care and treatment given under the Mental Health Act. The hon. Member for Solihull West and Shirley asked for reassurance on oversight, and that feedback from complaints will identify issues. I think that the hon. Member for Chester South and Eddisbury also asked about that, as well as asking what mechanisms will be in place to give feedback on how the system is working. Complaints data enables CQC Mental Health Act reviewers and mental health inspectors to understand trends and focus on areas of concern in their respective monitoring and inspection activities. Focused activity— for example, a focused Mental Health Act visit or inspection activity—can also be scheduled in response to concerns raised in MHA complaints. When looking at trust and provider-level MHA inspection activity, complaints information informs the CQC’s questioning of trusts or independent providers about their complaints processes.

11:45:00

Inspectors can ask for evidence from the trust to demonstrate organisational learning from the complaints feedback to improve the care and treatment it delivers and its systems and processes. The CQC reports on complaints data in its annual “Monitoring the Mental Health Act” report. That includes data on the number of complaints investigated, the outcome of those investigations, and examples of action taken in response to CQC recommendations. I commend clauses 42 to 44 to the Committee.

Clause 45

Advance choice documents

I beg to move amendment 46, in clause 45, page 57, leave out lines 5 to 11 and insert— “(1) All eligible patients shall have a right to create an advance choice document. (1A) For the purposes of this section, an ‘eligible patient’ is a patient who— (a) has previously been detained under Part 2 or Part 3 of this Act, (b) has been diagnosed with a mental disorder which may lead to the possibility they will be detained under this Act in the future, or (c) is an English qualifying informal patient (see section 130CA). (1B) NHS England and each integrated care board must make such arrangements as it considers appropriate for— (a) ensuring that all eligible patients for whom it is responsible for the purposes of this section are informed of their right to create an advance choice document, and (b) helping an eligible patient to create an advance choice document.” This amendment gives all eligible patients the statutory right to create an advance choice document if they so wish.

With this it will be convenient to discuss the following: Government amendments 32 and 33. Amendment 18, in clause 45, page 57, line 33, at end insert— “(3A) An ‘advance choice document’ under subsection (3) should include consideration of the person’s financial circumstances.” This amendment ensures that the advance choice document includes matters relating to the patient’s financial circumstances. Government amendments 34 and 35. Clause stand part.

I am grateful for the opportunity to speak to clause 45 and amendment 46. I will also speak to the amendments from the Government and the Liberal Democrats. The Bill introduces advance choice documents as a new tool to empower people with lived experience of mental health conditions. This is a significant development in mental health law and policy. Currently, people who are detained or treated under the 1983 Act often have limited ability to influence decisions about their care at times when they lack capacity. Although the Act includes some mechanisms such as advance statements, they have been criticised for their limited legal weight and inconsistent application. Clause 45 will insert proposed new sections 130M and 130N into the Act, and place duties on NHS England, integrated care boards in England and local health boards in Wales to facilitate access to information about ACDs and to provide support to individuals who want to create such documents. As the Government’s explanatory notes state, ACDs are written statements “made by an individual while they have capacity or competence …setting out their decisions, wishes and/or feelings about matters that may be relevant to their assessment for admission…and treatment” should they lack capacity. That extends the scope of patients’ involvement in care planning and respects autonomy in a way that the current law does not fully achieve. I commend the Government for recognising the importance of enabling people to set out their wishes in advance, especially when they have previously been detained or treated informally. That can help to reduce stress, improve trust between patients and professionals, and potentially prevent crisis escalation to detention. Nevertheless, I have some constructive questions that I hope the Committee will consider. On the strength of duty on the NHS bodies, proposed new section 130M(1) will require NHS England and each ICB to “make such arrangements as it considers appropriate” to provide information about and support with ACDs, which leaves considerable discretion. Will that discretion lead to inconsistencies across regions and vulnerable populations? Should the Bill include clear minimum standards or benchmarks for what constitutes “appropriate” arrangements, for example by mandating proactive outreach to high-risk groups, such as those in secure children’s homes or immigration centres, where awareness of rights or access to support is often poor? There is then the legal status and practical use of ACDs. The clause defines ACDs but does not specifically set out their legal weight in decisions about treatment or detention. How will clinicians balance these documents with their clinical judgment or clinical care needs? The explanatory notes mention that ACDs may include “advance decisions under the Mental Capacity Act 2005.” The Bill could clarify how conflicts will be resolved; this is a recurring theme in our discussions. It would be helpful to have explicit guidance on safeguards to ensure that ACDs are given full weight and respect while maintaining clinical safety. I turn to the issues of training, resourcing and monitoring. This is a big change, and supporting people to make meaningful ACDs requires skilled staff and resources. Who is expected to provide that support? Is it the CPN, the community clinician, the IMHA or even the GP? Will there be training programmes for clinicians and care staff on how to discuss, record and use ACDs effectively? Furthermore, will there be monitoring and reporting requirements so that Parliament and public can hold the services to account? Who will those requirements sit with if NHS England is abolished? Will it be the CQC, the ICBs or even the Department of Health and Social Care? We then have the issues of access and equity. We have already identified that people with learning difficulties and certain racial groups find themselves in contact with mental health services more than other groups. These groups can be less keen then to interact with services, either by choice or due to ability, so how do the Government intend to ensure that ACDs are accessible to people from diverse backgrounds, including those with communication difficulties, learning disabilities or limited English? What consultation will there be with charity and representative groups to ensure that documentation is accessible enough for all, yet thorough and robust enough to properly reflect wishes correctly? Clause 45 is a welcome step towards enhancing patient autonomy and improving mental health care, but to ensure that the new powers deliver real benefits, the Government should consider how to strengthen the duties placed on various bodies. That leads me to amendment 46, tabled in my name. Embedding ACDs into mental health is long overdue, but the clause places duties on NHS England and integrated care boards only to “make such arrangements” as they consider “appropriate” for providing information and support for ACDs. The intention is good, and a marked step from where we were, but the language risks creating a postcode lottery in which patients’ access to this important right depends on where they live or how proactive their local systems happen to be. That is why my amendment seeks to move from discretion to entitlement. It would replace the current discretionary wording of the clause with a clear legal right for eligible patients to create an advance choice document. The amendment defines “eligible patient” as a patient who has previously been detained under parts II or III of the Act, who has a diagnosis that may lead to future detention, or who qualifies as an informal patient under proposed new section 130CA. It would also require NHS England and ICBs to proactively inform eligible patients of their rights and offer them support in exercising them. This is a targeted and proportionate amendment. It would not mandate ACDs for all, nor would it impose burdensome new duties; it would simply create a right to be offered and supported to make an ACD. The letter of 3 June from Baroness Merron to my colleague in the Lords appears, in part, to address the issue, so I will talk a little about what she wrote. I thank Baroness Merron for the letter and the tone of the letter, which reflects genuine engagement on the issue and acknowledges the importance of reflective care after detention. She notes: “The impact assessment for the Bill accounts for multiple hours being spent with the individual by health and care professionals to inform and support them to make choice in advance of a potential future mental health crisis.” That is welcome. She also stated that the Government had tabled an amendment that day that “requires commissioners to make arrangements for bringing information and help available regarding ACDs, to the attention of people…especially those in the 12 months following their discharge from hospital.” I believe that that is a reference to one of the Government amendments to this clause. I hope I am right; if so, I will return to that amendment once I have set out the position on ours. As set out in the letter, the Government amendment is another step forward, and I acknowledge that the Government have appeared to move in response to concerns raised by my colleagues in the Lords and by many stakeholders, but I gently suggest that it falls short. It retains the same permissive language—duties to do what is a “appropriate”, decided locally by commissioners. That may allow for good practice in some areas, but it does not create enforceable rights for individuals. Without a clear entitlement, patients who need this the most may never even be told that it was an option. Let me give a practical example to illustrate why statutory rights matter. A person with bipolar disorder may be detained under the 1983 Act during an acute episode, but once well, they may want to specify in writing that in future they do not want a particular medication or that they want to be admitted to a specific hospital near family. Those are reasonable, clinically relevant requests, but unless the person is informed of the right to make an ACD and offered support to do so, that opportunity could be lost, especially for those facing health inequalities or language barriers, or those who have a history of mistrust with services. The Government have said that those conversations will happen anyway within the care planning or under the community mental health framework, but the reality is that the systems are patchy. People discharged from hospital often face month-long waits to be re-engaged by community teams. They may not have a named worker. They may receive support only from overstretched primary care. ACDs must not rely on assumptions about care pathways, which too often do not work as intended. On trauma and mandating reflection, I want to take seriously a point that Baroness Merron raises in her letter: for some individuals, reflecting on past detention may be traumatic, and that support should be user-led. Absolutely—that is why my amendment would create a right, not an obligation. No one should be forced to make an ACD, but people should be informed that they can, and they should receive its support if they so choose. Choice is not trauma; it is autonomy. Let us remember that, for many, reflecting on what went wrong in past care is not re-traumatising but restorative. It is how people regain control and how the services learn. I believe this is a thoughtful and sensible amendment. It would strengthen clause 45 by creating clear, predictable entitlements for those most at risk of future detention. It would respect clinical discretion while affirming patients’ rights. It would not undermine the Government’s intent but fulfil it. We all agree that ACDs could be transformative. Let us give them the best chance to succeed by ensuring those who need them the most are offered them, not just as a maybe. I will touch quickly on amendment 18, tabled by the Liberal Democrats, and spend the rest of my speech addressing the Government amendments. I am grateful to the hon. Member for Winchester for highlighting an important part of dealing with mental health, but I simply wonder whether primary legislation is the correct place to do what he suggests. Could it be done in codes of practice? What if people are admitted, but when they produce plans do not want to disclose their financial arrangements? Might compulsions have to be created for them to do so? I wonder about the unintended consequences of amendment 18, and I look forward to the hon. Gentleman’s addressing them. I think the Minister in the other place was referring to Government amendments 32 and 33, so I am grateful to be able to address what has come forward. Government amendment 32 appears to be a step in the right direction. It seeks to insert new paragraph (c) into proposed new section 130M(1), with the following wording: “bringing the availability of that information and help to the attention of such people as it considers appropriate.” That is welcome, as it moves beyond simply making information available, which could mean leaving a leaflet in a waiting room or uploading something to a website, and instead encourages proactive communication. However, the language still leaves a significant loophole: it is limited to “such people as it considers appropriate”. That allows NHS England or integrated care boards to withhold communication for individuals who may be eligible, based on subjective judgment or resource constraints. Although it improves the duty, it still falls short of a universal and consistent approach to ensure people with serious mental health needs know their rights. Government amendment 33 will insert two further subsections, (1A) and (1B). Proposed new subsection (1A) states: “The arrangements that must be made…include such arrangements…for people to be given information or help by having a conversation with someone who is suitably qualified”. Proposed new subsection (1B) states: “NHS England or an integrated care board must have regard to the particular benefits to a person of making an advance choice document within 12 months of their discharge”. The amendment rightly recognises that a conversation, not just a form, is often essential for meaningful care. It also acknowledges that the post-discharge period is a crucial window in which individuals are stabilising and may be open to shaping a future care plan in a thoughtful way, but again the language is discretionary. There is no guarantee that the conversation will happen, even where a person is recently discharged from hospital and known to be at high risk of readmission. Who is “suitably qualified”? Is it the clinician, an independent advocate or a voluntary sector worker with lived experience? If the amendment is to be meaningful, the Government must provide clarity in the codes of practice or in regulations.

00:00:00

My amendment would deal with some of that, and our approach would strengthen clause 45 to embed a clear and consistent right. We have included in the amendment the statement:

“All eligible patients should have the right to create an advance choice document.”

It is a powerful, rights-based framing. The amendment promotes parity with physical health, where patients often have clear rights in advance planning. It reflects key principles under the United Nations convention on the rights of persons with disabilities, particularly articles 12 and 25. It also targets the right cohorts. Our definition of “eligible patient” is precise yet inclusive. Unlike the Government’s discretionary language, our amendment would require NHS England and ICBs to inform all eligible patients of their rights and to help them to create the document without the hedge of only doing so if they think that it is appropriate. That empowers patients and sets a more consistent expectation across England.

The hon. Gentleman makes some very good points about the importance of patients being offered advance choice documents and being supported to make them, as the Bill describes. The evidence submitted from the General Medical Council makes it clear that it supports the duties as set out in the Bill, and it says that they are in line with the current good medical practice guidelines for professionals. Does the hon. Gentleman agree that the Bill, as it stands, fits very well with current medical practice?

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

As a clinician, I hope that the hon. Gentleman will understand what I am trying to say. There are many mental health patients who do not have any insight into their illness and often refuse to take medications. It is important that, as the clause says, “‘qualifying person’ means a person who has capacity or competence to make the statement,” so that people do not make inappropriate decisions in their advance choice documents. It is important to keep the clause as it is, whereby a qualifying person is someone who can make a competence decision.

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

I rise to speak briefly to clause 45, Government amendments 32 and 33, Lib Dem amendment 18 and Opposition amendment 46. I am very supportive of clause 45. The ability to make an advance choice document is incredibly important to people who may come under the scope of the 1983 Act and be subject to detention under mental health legislation. We have spoken at length about the importance of patients’ input into their care and the improvements in outcomes when they feel that they have been involved and their wishes and feelings are taken into account. An advance choice document allows someone at risk of being detained under the Act to set out their choices, thoughts and opinions before becoming so unwell that they may need to be admitted to hospital. Other hon. Members have spoken about how an advance choice document can help prevent detention in a mental health unit, as it can stop issues escalating to the point where there is no option but detention, to ensure patient safety or the safety of others. I am broadly supportive of clause 45, and I urge the Committee to be. I turn briefly to Opposition amendment 46. I have heard the thoughts of the hon. Member for Hinckley and Bosworth. My understanding is that clause 45, along with Government amendments 32 and 33, will effectively create the rights for those who should have an advance choice document to be able to take advantage of them. Government amendments 32 and 33 will go further in ensuring that people who may benefit most from an advance choice document are informed of their ability to do so. I note that Government amendment 32 will put a duty on an integrated care board to bring information to such people as it deems appropriate. I welcome the duty being on an integrated care board or commissioner locally, particularly because there are such nuances in localised care and localised populations. There are areas of the country in which the prevalence of things like learning disability and autism is higher than in others. The amendment will allow an ICB or local commissioner to consider what may be appropriate for the population in their area.

I appreciate what the hon. Lady is saying. There are differences—rightly so—and regional variation. By definition, different regions will take different approaches to dealing with this issue. My argument is simply that someone with a learning disability should have the right to decide to make an ACD, as should someone with bipolar disorder or anorexia. There should be no regional variance in that; it should be a right given to the individual there and then. Regional discrepancy should not come into the system to deal with this. I appreciate that there will be regional discrepancy, but, fundamentally, we want to engage the right, not just the responsibility for the ICB to decide who it thinks is appropriate. I am interested in the hon. Lady’s take—I think this goes to the heart of what we are trying to do.

I agree on the notion of a right; where we vary is that I think that the Bill as written, and Government amendments 32 and 33, enshrine the notion of a right without it having to be spelled out as such. Local variation includes localised populations, such as those from marginalised communities. We might consider different translations of support that is available. That will not be the case across the board—it will vary from area to area. This does not remove people’s ability to make an advance choice document; it simply gives local commissioners the ability to determine what is most appropriate for their area, how that support should look and how it will be targeted. Without getting ahead of the Minister, I hope that he will say what guidance on best practice for local commissioners and ICBs will be set out, particularly in relation to those with learning disabilities and autism. We have spoken about easy-read documents, for example, which should probably be made available, as should advice on how commissioners can best make sure that all those who might benefit from an advance choice document are meaningfully engaged and informed of their right and ability to do so. The Minister has agreed previously to make sure that he works with disabled people’s organisations, including those run by and for people with learning disabilities and autism, on bringing forward a code of practice on the Mental Health Bill. Input on patient experience into how best to contact and meaningfully engage people who would benefit from an advance choice document would be particularly beneficial. Very briefly, the aim of Liberal Democrat amendment 18 is to include consideration of financial circumstances in an advance choice document. I have looked into this—in my opinion, it is outside the scope of what an advance choice document does. An advance choice document sets out how an individual would wish to be treated if they became so unwell that they were unable to make those decisions for themselves. I am not fully sure how one’s financial circumstances fit into how one would be treated relative to detention or, potentially, in a community-based setting. I understand that financial circumstances have an impact on people’s mental health—we have talked about that in debates on other clauses—but they do not necessarily have a place in this specific part of the Bill. I encourage the Committee to support clause 45 and to adopt Government amendments 32 and 33. This is, once again, a big step forward in ensuring that those with serious mental illnesses are able to input into their care and treatment in a real and meaningful way.

It is a pleasure to serve under your chairship, Sir Desmond. In the previous sitting of the Committee, I spoke extensively about the close link between money worries and poor mental health. That link is why I have sought, through amendment 18, to ensure that advance choice documents include a specific section on money. This would give people greater choice and control over their finances when they are in crisis. Without that provision, financial worries could be an even greater hurdle to recovery. We have talked a lot about financial problems being a major contributor to mental health crises, and they can make it much more difficult to recover from one. I will not go through all the details again, but the numbers show how significant the problem is. Last year, nearly 21,000 people in England alone were struggling with problem debt while in hospital for their mental health, so it is not a small cohort of patients for whom this is a specific issue. Ensuring that people’s finances are taken into consideration when they are in a mental health crisis will prevent future illness, reduce waiting lists and help people to return to daily life more smoothly, including to work. If we ignore it, that will end up costing the NHS more in time and resources.

12:15:00

I accept the point made by the Minister and others that mental health advocates are perhaps not best placed to deliver an initiative similar to the Winchester Citizens Advice project, which supports mental health in-patients. I understand the point made that advance choice documents are potentially not the way to implement this type of support either. I want to press the issue again, because it is so important; it affects so many people and the economic viability of mental health care. If advance choice documents are not the appropriate mechanism through which to run a scheme to help people with their life admin and debt, whatis the way to deliver that support, in a way that is linked to the Bill in some way?

It is a pleasure to serve under your chairmanship, Sir Desmond. I want to speak in support of amendment 46. It is eminently sensible and would give all eligible patients the statutory right to create an advance choice document to record their treatment preferences in a formal legal document. Those preferences would be enjoyed only in the event of a future mental health crisis or detention under the Mental Health Act. The amendment would give important control to patients and to those around them to know that their future care decisions would be applicable at the point at which they become incapacious. It would quite rightly place a requirement on NHS England—for as long as it continues to exist—and ICBs to ensure that those individuals are aware of their rights and, more importantly, that they are not just aware of them but are supported in creating an advance choice document if they so wish. The amendment is all about empowering patients. The more we can empower patients who face these challenges, the better. It would increase their autonomy and help with the planning of their future care. It would help both in the understanding and the honouring of patients’ wishes. Critically, it would reduce conflict. In these circumstances, tensions are high and pressures are acute, so conflict can arise in the most unintended of ways. Having an advance choice document minimises that risk. If the Government will not support amendment 46, what reassurances can the Minister give in relation to the code of practice? How will this be accounted for in the code of practice to ensure consistency in the information imparted to patients across the country by NHS England and the ICBs? We must ensure that there is not a postcode lottery and that everybody, regardless of where they live in the country, gets the consistency of care that they are entitled to.

It is a pleasure to serve under your chairmanship, Sir Desmond. I rise to speak in support of amendment 46, tabled by the shadow Minister, my hon. Friend the Member for Hinckley and Bosworth, which seeks to strengthen clause 45, an already welcome and progressive clause, by creating a statutory right for all eligible patients to create advance choice documents if they so wish. Let me begin by saying that I think everyone on the Committee recognises the importance of advance choice documents. They are an excellent initiative, and I am glad that the Bill introduces a framework to support their use. I hope we can all agree that they represent a constructive and compassionate shift in how we think about mental health care—one that puts the patient’s voice at the centre. ACDs are fundamentally about empowerment. They allow individuals, while they are well and have full capacity, to record their wishes, preferences and concerns regarding their treatment, so that during future periods of unwellness, when they may lack capacity, their past self can still be heard and respected. As Bipolar UK has rightly put it: “The idea behind an ACD is that you use your past to plan your future.” That simple principle holds immense power. Individuals with lived experience of severe mental illness like bipolar disorder are often experts in their own care. They know what works, what does not and what signs to look out for. An ACD allows that hard-earned knowledge to be recorded, shared and used to guide clinical decisions. By identifying early warning signs and outlining preferred treatments, ACDs can enable families, friends and professionals to intervene earlier, potentially avoiding a crisis or reducing the severity of an episode. This is not just about better care; it is about safer care and, crucially, more timely care. The research is persuasive. Studies suggest that ACDs can reduce rates of compulsory detention under the Mental Health Act by up to 25%. That is not a small statistic; it is a significant reduction in trauma for patients, in the use of force and in resource pressures on services. It is hard to think of a better example of a policy that both improves outcomes and reduces system strain. ACDs can also play a vital role in reducing inequalities, especially among racial minority groups, who, as we have all said, are statistically more likely to be detained under the Act. Ensuring that those patients can express their wishes in advance gives them greater agency and helps to address long-standing disparities in the system. ACDs are not just a useful administrative tool; they are, as Earl Howe put it in the House of Lords, “are a major component part of one of the Bill’s key strands, which is to give mental health patients better control over their own care—which, of itself, carries a therapeutic value.”—[Official Report, House of Lords, 27 January 2025; Vol. 843, c. 79.] I absolutely agree, which brings me to amendment 46. The clause as drafted places duties on NHS England and integrated care boards to consider making information about ACDs available, and to help those people whom they consider “appropriate” to create one. That is a start, but it falls short of what is needed. The shadow Minister’s amendment would take us further and create a statutory right for eligible patients to create an advance choice document. It would define clearly who is eligible—for example, those previously detained under the Act, those diagnosed with a condition that may require future detention and qualifying informal patients—and would put a clear duty on NHS bodies to inform these patients of their right and to help them to exercise it. This is not about placing a burden on services; it is about ensuring that everyone who stands to benefit from an ACD knows that they can make one and is supported to do so if they wish. I appreciate that the Government have tabled amendments 32 and 33 to clause 45, and I welcome the intention behind them. Amendment 32 requires that NHS England and integrated care boards must bring the availability of this information and help to the attention of such people “as it considers appropriate.” Amendment 33 expands on how that might be delivered, including through conversations with qualified individuals and by having specific regard to the benefits of ACDs in the 12 months following discharge from hospital. Although these are improvements, I must respectfully say that they stop short of what is needed. They continue to frame the duty in terms of who the board considers appropriate, yet the very point of ACDs is that we should not be gatekeeping access. We should not be making assumptions about who would or would not benefit from having one. Every eligible patient should be offered the choice, not just those whom the system deems suitable. We are dealing here with people’s autonomy and right to shape their future care, and if we start from a place of selective provision, we immediately disempower many of the very individuals we claim to support.

I would welcome the hon. Lady’s thoughts on where clause 45 or the Government’s amendments allow for selective provision. My understanding is that they place an onus on mental health commissioners to make sure that all those who are deemed appropriate to be in receipt of an ACD should be given the ability to make one. I do not think that is selective; it is very much related to the purposes of the Bill, and it spells out who may come under the provision.

The hon. Lady has just made my exact point: that it is who they deem appropriate. That is the point I am trying to make. It is for the individual—of course, with support of people looking after them—to decide whether it is appropriate for them and to be offered it.

Will the hon. Lady give way on that point?

I will make progress, as I know that a few Members wish to speak on this point, and we have a long day ahead. I will touch briefly on amendment 18, tabled by the hon. Member for Winchester, which suggests that ACDs should include a person’s financial circumstances. I recognise the sentiment behind the amendment. As both I and the hon. Member for Winchester have said in Committee, financial stress can be a major factor in mental health, but I gently suggest that prescribing the content of an ACD in this way is unhelpful. The point of the document is choice. The individual decides what they want to include, not us. That is the strength of the approach. It is personal and voluntary; it is theirs. Amendment 46 respects that principle. It does not tell patients what to include in their ACD; it simply gives them the right to make one, and ensures they are informed of that right and supported to act on it. ACDs can be lifesaving, and they help people to stay well, safe and in control. They are especially valuable for those who have been detained before or who are at risk of detention in the future. We know that they are already supported by a wide range of stakeholders and experts by experience. The question for us is not whether to support ACDs—I think we all do. The question is: do we want to make access to ACDs a universal right for those eligible, or do we want to continue to leave it to the discretion of the system? I believe the answer is clear: we must empower people, honour their voice and do so not only when they are well and able to speak, but when they are unwell and most vulnerable. That is what the amendment seeks to do. I urge all colleagues on the Committee to support amendment 46 and strengthen clause 45. Let us make the right to create an advance choice document a reality for everyone who needs one.

It is a pleasure to serve under your chairmanship, Sir Desmond. You and the Committee will be pleased to know that my hon. Friends have made most of the points I wanted to flag. In poll after poll and survey after survey, patients feel they do not get information in a timely and constructive way. Our amendment 46 would give patients a stronger say in their future care if they lose capacity. It clarifies that patients must be given clear, proactive support to understand, prepare and use the documents. It is about ensuring that advance choice documents are not just theoretical paperwork, but living, respected statements of a patient’s wishes. I therefore support the clause and the amendment, and I ask the Minister three questions. How will NHS England and local integrated care boards ensure that commissioners are trained to respect and use ACDs in practice, especially in emergencies? Secondly, what oversight will ensure that ACDs are not simply ignored at the bedside, when a patient is most vulnerable? Will the Government consider a review mechanism so that we can assess how well ACDs are working in a few years’ time, after the Bill is passed? I turn briefly to Liberal Democrat amendment 18. Like other hon. Members, I feel that the inclusion of financial information in an ACD is not appropriate, both from a practical and a personal security, safety and information point of view. I do, however, completely support the hon. Member for Winchester’s overall view that there is a significant problem with how financial stress can affect a person’s mental health. Like him, I call on the Minister to think about how we as a country, whether in this Bill or somewhere else, can address the impact of financial stress on mental health.

I will speak first to amendment 46. We agree with the principle of the amendment, but do not think it necessary. Under the Bill, if an individual who is likely to benefit from making an advance choice document approaches services to create one, they should be offered information and appropriate support to do so. The approach that we have taken in the Bill is therefore functionally equivalent to a right to request an advance choice document.

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

12:30:00

What I meant is what I said. I will read it again: if an individual who is likely to benefit from making an ACD approaches services to create one, they should be offered information and appropriate support to do so. The approach that we have taken in the Bill is therefore functionally equivalent to a right to request an advance choice document. We are also concerned about prescribing that commissioners inform and support some of the groups of individuals identified by the amendment. For example, it may be practically challenging and not always appropriate to contact people who were detained or admitted informally many years ago about making an ACD. We agree, however, that that there is a good rationale for encouraging past voluntary and involuntary patients, especially those discharged in the past 12 months, to create an ACD. That is reflected in the Government amendments to strengthen the duties on health commissioners, which I will come to shortly. The approach is based on research findings that suggest that the optimal time to write an advance choice document is shortly after discharge from hospital. That also recognises that many of the individuals are likely still to be under the care of mental health services and therefore well positioned to receive support and advice from services to make their ACD. Ultimately, the amendment was debated in the other place and not considered workable. In recognition of concerns expressed by Earl Howe and Lord Kamall, however, my noble Friend Baroness Merron made a commitment to strengthen duties on health commissioners in relation to the advance choice documents. Government amendments 32 to 35, which we tabled in response to the amendment, will strengthen the duties in three ways. First, they will require that health commissioners proactively make arrangements to bring information on and help with making an advance choice document to the attention of the appropriate people. That is to prevent the risk of commissioners taking a minimal approach to discharging the duties. Secondly, the Government amendments will require that information and help is provided through discussion with a suitably qualified person, such as a health or care professional, advocate, support worker or peer support worker. That is to ensure that people can rely on the guidance and support of a professional, where they wish to receive it. Lastly, the Government amendments will encourage commissioners to have regard to the benefits of a person making an advance choice document within 12 months of discharge from a mental health hospital. That builds on research findings that suggest the optimal time to write an advance choice document is shortly after detention. Government amendments 32 to 35 will help to further secure the success of advance choice documents by ensuring that people who are at risk of contact with the Act are given the opportunity to make an ACD, as well as being offered the dedicated support that they may need to do so. On amendment 18, we agree that there is value in encouraging people to include details of any relevant financial matters within their ACD. Financial matters, such as problem debt, can worsen or even trigger a person’s mental illness. We expect that doing so will help to ensure that people receive the care and support that they need if they later experience a mental health crisis. We feel that it is important for individuals to have autonomy over what they include in their ACD, however, rather than prescribing the contents in legislation. We therefore think that the intention behind the amendment is better achieved by other means. We plan to develop guidance and a template ACD to support service users in making their document. Those will include prompts to consider any relevant financial matters. Furthermore, the guidance that we plan to include in the code of practice for mental health professionals will cover the need to support the person to consider any relevant financial matters that may be important to their mental health recovery. Finally, I turn to the clause in its entirety. Advance choice documents provide a place for people to set out their wishes, feelings, decisions, values and beliefs, while they are well, regarding their care and treatment. That is in preparation for the scenario in which they are too unwell and lack capacity to express such things at the time. At that point, the contents of their ACD should be considered by mental health professionals to inform their decision making regarding the person’s admission to hospital, detention under the Act, and care and treatment. Research shows that ACDs can have a range of benefits, including reducing the risk of hospital admissions. To help to unlock those benefits and ensure the uptake of ACDs among service users, the clause will place duties on health commissioners to make appropriate arrangements so that relevant individuals are informed and supported to make an ACD. The duty aims to ensure that individuals who are likely to benefit most from making an ACD are proactively given the opportunity to make one while they are well. Other clauses create the framework to ensure that the contents of a person’s ACD have a real impact on care and treatment decisions, for example the clinical checklist, the compelling reason test and the new framework for creating a nominated person. I therefore ask the hon. Member for Hinckley and Bosworth to withdraw amendment 46, and I ask Liberal Democrat Members not to press amendment 18. I commend Government amendments 32 to 35 and clause 45 to the Committee.

I would like to press amendment 46. Question put, That the amendment be made.

13|0|6|9|The Committee divided:|Question accordingly negatived.||0|0

Amendments made: 32, in clause 45, page 57, line 11, at end insert

“, and

(c) bringing the availability of that information and help to the attention of such people as it considers appropriate.”

Amendment 33, in clause 45, page 57, line 11, at end insert—

“(1A) The arrangements that must be made under subsection (1) include such arrangements as NHS England or the integrated care board considers appropriate for people to be given information or help by having a conversation with someone who is suitably qualified, whether in-person or remotely.

(1B) In deciding how to discharge the duty under subsection (1), NHS England or an integrated care board must have regard to the particular benefits to a person of making an advance choice document within 12 months of their discharge from a hospital or a registered establishment where they were receiving medical treatment for, or assessment in relation to, mental disorder.”

Amendment 34, in clause 45, page 58, line 10, at end insert

“, and

(c) bringing the availability of that information and help to the attention of such people as it considers appropriate.”

Amendment 35, in clause 45, page 58, line 10, at end insert—

“(1A) The arrangements that must be made under subsection (1) include such arrangements as the Local Health Board considers appropriate for people to be given information or help by having a conversation with someone who is suitably qualified, whether in-person or remotely.

(1B) In deciding how to discharge the duty under subsection (1), a Local Health Board must have regard to the particular benefits to a person of making an advance choice document within 12 months of their discharge from a hospital or a registered establishment where they were receiving medical treatment for, or assessment in relation to, mental disorder.”—(Stephen Kinnock.)

Clause 46

Tribunal power to recommend after-care

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

With this it will be convenient to discuss 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 set out the details of two important clauses relating to aftercare. Clause 46 will provide the tribunal with an important new power to recommend that plans for aftercare arrangements are undertaken for patients who are not yet ready to be discharged from hospital. Under the Mental Health Act, the tribunal can make decisions about discharge, but it does not have a role in recommending aftercare while a patient remains detained. Giving the tribunal the power to make recommendations that aftercare planning should take place will encourage earlier planning for a patient’s eventual discharge from hospital. Those recommendations are particularly important for complex cases in which patients may require intensive support following their discharge. Early aftercare planning ensures that the necessary health and social care services are co-ordinated and in place when the patient is ready to leave the hospital. This will help to reduce the likelihood of delayed discharges or failed transitions back into the community. Although the tribunal’s recommendations are not legally binding, they are intended to carry significant weight with aftercare providers. If recommendations are not taken forward, the tribunal retains the power to review the patient’s case. That will ensure that there is both encouragement and accountability in the aftercare planning process, enhancing patient outcomes by making sure that care is appropriately planned and delivered. The clause will strengthen the role of tribunals in overseeing the care and treatment of patients under the Mental Health Act, ensuring that a patient’s needs are addressed holistically and in a timely manner. By encouraging earlier and more co-ordinated aftercare planning, we will reduce the risk of patients being discharged without the necessary support in place, leading to better overall patient outcomes and smoother transitions from hospital to community care.

It is a pleasure to serve under your chairship, Sir Desmond. Again, I reflect on stories that I have heard from local constituents on the issues that are being addressed in the Lampard inquiry. Does the Minister agree that these provisions will help to avoid the too early discharges that have led people either to go back into care or to get into even more difficult situations? One of my constituents ended up taking his own life because he was discharged too early from care.

My hon. Friend is absolutely right. In many ways, the best way to look at the issue of discharge is to start thinking about it almost as soon as the patient is admitted. We need to be thinking holistically about what place they are in, what the aftercare plan might look like and how it might relate to the discharge plan. The earlier we do so, the better. In so many cases, upstream intervention is important to avoid having to scramble to deal with a crisis further down the line. My hon. Friend is absolutely right to raise that point. I turn to clause 47. Section 117 of the Mental Health Act places a duty on the NHS and local social services authorities to provide aftercare to certain patients who have been detained under the Act once they leave hospital. Aftercare services seek to reduce the risk of readmission, and they must be provided until the NHS and local social services authorities are satisfied that the person is no longer in need of such services. However, there is currently no requirement to notify the person when that ends. Clause 47 requires that the provision of aftercare lasts until the NHS and local social services authorities jointly give notice to the person in writing that they are satisfied that the person is no longer in need of such services. This will clarify when aftercare services have ended. Decisions on entitlement to and responsibility for aftercare services are heavily contested. Deeming rules are used to deem a person to be ordinarily resident in one area, even though they are living in a different area. They ensure continuity of financial responsibility when a person is placed in a local authority area and prevent the local authority from placing someone out of area to ease its financial burdens. Currently, section 117 does not contain any deeming rules. Clause 47 will apply existing deeming rules under social care legislation to identify which local authority is responsible for arranging aftercare for an individual patient. This change will add clarity and consistency to an often litigious system and more closely align local authority social care and NHS rules for determining ordinary residents. This aims to support organisations to work together to provide and plan for aftercare services and reduce the number of disputes that have arisen in recent years. Finally, I thank the hon. Member for Guildford for tabling new clause 21, which seeks to place a duty on the responsible integrated care board to ensure that advice and support is offered to the family or carers of the patient being discharged. The statutory guidance on discharge from mental health in-patient settings sets out how NHS organisations should exercise duties to co-operate under sections 72 and 82 of the National Health Service Act 2006 in the discharge process. This includes providing information or support on housing, social services provision and financial support. The Mental Health Act code of practice also provides statutory guidance on the information that should be provided to patients, families and carers. We do not believe that it is necessary to place additional duties on integrated care boards to provide information and support, as existing duties are sufficient. We will consider whether to use the revised code to bring together guidance on discharge into one place and explore how to clarify best practice on information and support to carers. I hope that what I have set out satisfies the hon. Member for Guildford and that she will not press new clause 21. I commend clauses 46 and 47 to the Committee.

I will speak to clauses 46 and 47 and then to new clause 21. Clauses 46 and 47 form a significant part of the Government’s effort to strengthen discharge planning in continuity of mental health aftercare. Clause 46 extends tribunal power. Under the current Mental Health Act, when a first-tier tribunal considers a patient detained under part II of the Act and decides not to discharge them, it may still make non-binding recommendations, for example that the patient be transferred to another hospital or given leave of absence.

12:45:00

Clause 46, in amending section 72(3)(a) of the Act, will extend those powers. It will now be the case that

“the responsible after-care bodies make plans for the provision of after-care services for the patient”.

That is a forward-thinking and forward-looking proposal from the Government and we support it. It will help to designate facilities for a future discharge, even when the patient cannot yet safely leave hospital. That is welcome. We know from many patients, particularly those with complex needs or dual diagnoses, that discharge can be delayed for non-clinical reasons, such as lack of supportive housing or community services. Tribunals making recommendations may apply pressure upstream—the Minister hinted at how important that is—to promote earlier planning and reduce delays.

However, I do want to raise a few questions. Will there be any duty on local authorities or ICBs to respond to such recommendations in writing? A recommendation without response risks being ignored. A formal response process could promote transparency and accountability. Will patients be informed when such a recommendation is made and be given access to advocacy to support their views about their discharge planning? Could the clause go further by introducing a statutory timeframe of 28 days, for example, for responsible aftercare bodies either to develop a plan or explain why they have not done so? That would not convert recommendations into orders, but it would give them a little more teeth in the interests of patient progression.

Clause 47, which will reform section 117 aftercare, is important, because it imposes a joint duty on the NHS integrated care boards and local authorities to provide aftercare for certain patients, including those under section 3. Currently, section 117 does not specify how or when the duty ends. Clause 47 will make two key changes. First, the ICB and the local authority will jointly give notice in writing to the person, stating that they are satisfied that the person is no longer in need of such services. That is welcome, but it raises the question of what that notice must contain. Will the notice be required to set out the reasons for the decision, the evidence relied on and the right to challenge it? Should there be a statutory appeal or review process, or at the very least a mechanism for an independent second opinion if there is disagreement? We must remember that those affected are often highly vulnerable, and abrupt withdrawal of support may place them at risk of relapse or harm.

I now turn to the ordinary residence for aftercare responsibility in proposed new section 117(3A). With the introduction of the deeming provisions, as the Minister set out, we will allow local authorities to be responsible for the aftercare. In practice, that will resolve the long-standing confusion when, for example, a child is placed in another area before being detained, a person is discharged to supported housing out of an area or a person receiving section 117 aftercare moves of their own accord. The clause confirms that the person is usually deemed to remain ordinarily resident in the authority area they came from, even if services are provided elsewhere. That is clearly designed to stop disputes between authorities over financial responsibilities. The explanatory notes set out an example: local authority A places an adult into supported living in authority B, and later detains them, but local authority A remains responsible for their section 117 aftercare, even if the care is delivered in B or C.

That provides real clarity and is largely sensible, but I ask the Minister what mechanisms are in place to resolve disputes between authorities where there is disagreement about the ordinary residence. Have the Government considered a statutory dispute resolution process, perhaps with oversight by the Secretary of State, an independent body or someone else? The Opposition are not sure, but it would be worth looking at that, to stop local authorities getting into conflict. Clauses 46 and 47 are steps in the right direction, but I would appreciate it if the Minister addressed those points.

New clause 21, tabled by the Liberal Democrats—I thank them for their thoughtful contribution—speaks to an issue that often receives insufficient attention in legislative debate: the essential role that families and carers play in the recovery and long-term wellbeing of people with mental health issues. This matters, because when someone leaves hospital after being detained under the Mental Health Act, especially under section 3 or qualifying sections, it is not only a clinical transition, but a deeply human one.

Recovery happens not in isolation, but in the context of relationships, which are often strained by the experience of detention. Families and carers can be powerful allies in promoting recovery, preventing relapse and helping individuals reintegrate into everyday life, but—as many charities, service users and carers have long said—they are frequently left in the dark or unsupported. My understanding is that the new clause would insert a new section 117C to place a duty on integrated care boards to offer advice and support for families and carers, as part of the aftercare. That would include information about the person’s condition and recovery, guidance on how to support their recovery and avoid relapse, signposting for financial, housing and social care, and a mechanism for families to raise concerns if they believe that someone is at risk in future. It is also linked to the risk register under section 125D.

These are practical, sensitive and constructive proposals, and they align with the Government’s plans. However, I have some questions. To strengthen and future-proof the clause, will the Lib Dems clarify the scope? Should the duty apply to all section 117C cases, or should it be limited to those where family or carers are actively involved or identified? In essence, the policy question is: should integrated care boards be under a duty to offer advice and support in all cases, even when a person has no identified carers, or should the duty be triggered only when there is an identified carer or nominated person? This is a practical issue: ICBs have limited resources, and applying the duties to all cases, even when there is no carer, might create administrative burdens without necessarily improving outcomes. Will the hon. Member for Winchester address the balance that must be struck between the universal offer and individualised relevance?

There is also the issue of consent and confidentiality. New clause 21 refers to consent and capacity in proposed new subsection (3)(b), but might we need further clarification of the information sharing between families, as it may be complex and already cross existing confidentiality frameworks? Finally, there is a possibility of duplication. The Care Act 2014 already includes carers assessments and right to support. How does the hon. Member for Winchester see that interacting with his new clause? I will be grateful if he addresses those points, and if the Minister addresses my points about clauses 46 and 47.

It is a pleasure to serve under your chairmanship, Sir Desmond. I rise to speak in support of clauses 46 and 47, two vital reforms that place people instead of process at the heart of mental health care. Clause 46 will empower mental health tribunals to do more than simply decide on discharge. It will give them the ability to recommend aftercare planning even when a patient is not yet ready to leave hospital. As the Minister says, this is so important for the co-ordination of local services. In a previous sitting, I spoke about my constituent who was sectioned and then discharged from hospital in the middle of the night, in winter. The clause is vitally forward-thinking and will ensure that for people like my constituent, the necessary support structures—housing, therapy and community services—are in place early, smoothing the path to recovery and reducing the risk of relapse. It is about planning with people in mind, instead of reacting when it is too late. Clause 47 will strengthen the legal framework around aftercare itself. It will clarify when aftercare ends and, crucially, who is responsible for providing it. By aligning the rules of ordinary residence with existing social care legislation, it will remove ambiguity and ensure that patients receive care even when they have moved between areas. The impact of care continuity cannot be overstated, especially for people up and down the country who do not have stable housing or support networks, like many of my constituents in Kettering. My local council used to be Northamptonshire county council, but it then split into North Northamptonshire council and West Northamptonshire council. Some services are separated between the two, but others still operate across Northamptonshire as a whole. Having a local authority that is clearly responsible will be really important to my constituents and will offer a clear, accountable council for their care. Together, these clauses will reduce delays, improve accountability and, importantly, give people the best chance of rebuilding their lives, preventing them from relapsing or having to be sectioned again. They will promote a more compassionate, co-ordinated and consistent approach to mental health recovery. I am happy to support them.

It is a pleasure to serve under your chairmanship, Sir Desmond. I rise to speak to new clause 21, which would place a clear statutory duty on integrated care boards to offer advice and support to families or carers of patients receiving aftercare under section 117 of the Mental Health Act. I thank the Minister for his comments about the new clause. I acknowledge what he says about the statutory guidance and code of practice, but I hear from far too many patients and their families living in my constituency of Guildford that advice and support is often not being provided and that authorities are falling short. This new clause is rooted in a very simple principle: good mental health care does not end at the point of discharge. Recovery is often long, fragile and dependent on support at home, yet families and carers—the people holding things together day in, day out—are often left behind with little or no guidance. This clause seeks to change that: it would ensure that carers are given clear information about the patient’s condition and recovery journey, supported in helping to prevent relapse and readmission, linked to relevant support systems, including housing and social care, and provided with a route to raise concerns if they believe that someone is at risk in future.

Having looked at new clause 21, I have a rather large concern about consent. The hon. Lady is setting out what the integrated care board would have a duty to do, including giving information about a “person’s condition and recovery” to “the family or carers of the person discharged”. I have a significant concern that the person being discharged may not have the kind of relationship with their family or carers that would make that helpful. The clause, as drafted, does not seem to make allowance for consent, except where “the person is at future risk of detention” under part II of the Mental Health Act. I would welcome the hon. Lady’s thoughts on that.

The hon. Member makes a really good point. There is definitely a place for ensuring that we work on this further to make sure that it covers that. I will come on to that later, if she will allow me. We know that early intervention is key. We know that families, carers and those around an individual are often the first to spot the warning signs, and that they need to feel empowered, not sidelined. I hear time and again, as I am sure hon. Members across this Committee Room have heard, from people who have been left out of the discharge planning for their loved ones. They say that they have received no clear information and that they feel unsupported and unable to fully support their loved one when they return home. Importantly, the new clause sets out a process whereby, if a family member wants to raise a concern, the team must consider whether that individual should be added to the register of persons at risk of detention under part II of the Mental Health Act. We believe that this is a sensible, joined-up approach to prevention, spotting risks early and acting before a crisis point is reached. Finally, the new clause would require the Secretary of State to publish national guidance and ensure consistency and clarity across the system. We often speak of carers as the invisible workforce of our NHS. The new clause would make their contribution visible by recognising their role and giving them the information and support they need to fulfil it well.

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

In my final comments, I was going to say to the Minister that, having considered the points he set out in his opening statement in relation to this clause, I am prepared not to press the new clause. I appreciate that some of the information already exists in the Bill and in the existing documentation to which the shadow Minister referred. I also acknowledge the point made by the hon. Member for Thurrock, that some aspects around consent must be dug into. However, I ask the Minister to work with me, my hon. Friend the Member for Winchester and other hon. Members with an interest in the issue, so that he can hear our constituents’ experiences of where the current guidance is clearly not working, and ensure that appropriate additions are made to the supporting documents for the Bill to address the concerns that we have raised in the new clause. Ordered, That the debate be now adjourned.—(Taiwo Owatemi.)

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