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1. 17 Jun 2025·Parliament·Gregory Stafford

   Mental Health Bill [ Lords ] (Sixth sitting)

   I rise to speak in favour of clauses 42, 43 and 44, which together strengthen the duty to inform patients—whether detained in the community or conditionally discharged—about how to make a complaint about their treatment and the outcome of that complaint. The Mental Health Act has long included duties to tell patients their rights, but too often that information has been patchy, hard to understand or buried in paperwork. The clauses tackle that by requiring clear, repeated information about not just detention, but treatment and the complaints process. Clause 42 relates to information about complaints for detained patients. Section 132 of the Mental Health Act 1983 originally required hospitals to inform detained patients of their rights, but that was often inconsistently applied. This clause responds to long-standing concerns about transparency and patient empowerment, aligning with the broader goals of the Bill to enhance autonomy and dignity in mental health care. Specifically, there is an expanded duty of information. Hospital managers must now ensure that detained patients understand how to make complaints, not only about their detention, but about their treatment, along with the outcomes of any complaints. There are some timing requirements, i.e. that the information must be provided as soon as practicable after detention begins and be repeated annually for restricted patients, or after each section 20 report for others. That will improve patient’s awareness of their rights and how to seek redress. It will promote accountability and mental health services by encouraging feedback and complaints, and support better outcomes by addressing grievances early and constructively.

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2. 17 Jun 2025·Parliament·Greg Smith

   Hydrogen-powered Aviation

   It is a pleasure to serve under your chairmanship, Mr Stringer. I congratulate the hon. Member for North Somerset (Sadik Al-Hassan) not only on securing the debate but on setting out the case for hydrogen aviation so clearly in his opening remarks. The Second Reading of the Sustainable Aviation Fuel Bill last week was but the precursor to this Westminster Hall debate—this debate was trailed in that one. I also congratulate all other hon. Members who have spoken in the debate. It is a pleasure to speak for His Majesty’s Opposition in this important debate on the policies of the Government of the United Kingdom on hydrogen-powered aviation. Aviation is a sector that underpins global connectivity, international trade, and regional economic growth, but its long-term sustainability requires bold innovation, and a clear policy framework that supports low-carbon propulsion technologies while enabling British industry to lead. Let me be clear: hydrogen is not a hypothetical solution. It is a practical, viable and strategically critical path forward for decarbonising flight. The UK has a golden opportunity to lead the world in this technology, not just by developing aircraft but by creating the entire hydrogen aviation value chain, from production and distribution to propulsion and maintenance. When combusted purely, hydrogen emits only water vapour, unlike kerosene, obviously, which produces carbon dioxide. Moreover, unlike battery electric aircraft, hydrogen aviation scales better over distance and payload, making it suitable for not just short-term hops but future regional and potentially transcontinental routes. That is not only good for the planet, but good for Britain. According to the Aerospace Technology Institute, the UK could generate up to £34 billion in GVA and support 60,000 jobs by 2050 through hydrogen powered aviation. That is thousands of skilled engineering, manufacturing and research and development roles across the country. These areas stand to benefit significantly from hydrogen aircraft production, airport infrastructure retrofitting and fuel supply chain development. In Bristol and Gloucestershire, Airbus and GKN Aerospace are already laying the groundwork for hydrogen propulsion and systems integration. In the midlands, particularly in Derby and Coventry, Rolls-Royce is developing hydrogen combustion engines in work that has the potential to sustain and expand our world leading turbo machinery industry. In Teesside, the Conservative Government-designated hydrogen transport hub is pioneering fuel production and logistics, with Teesside international airport poised to become a hydrogen aviation testbed. In Scotland, Prestwick airport is leading hydrogen aircraft trials and Aberdeen is already a recognised centre for hydrogen fuel development. Belfast, home to Spirit AeroSystems, is well positioned to play a central role in manufacturing structural components for the hydrogen aircraft of the future. A successful future-focused aviation sector means more than environmental progress; it means greater reliability and connectivity for passengers, and competitive ticket prices driven by fuel efficiency. For business, it means faster, lower emission logistics, better access to export markets and the growth of regional airports as hubs for commerce and investment. There is an important distinction to be made here, and one that we in this place must be honest about. While hydrogen fuel cells offer lower energy losses and may suit smaller aircraft or drones, it is pure hydrogen combustion that offers the best chance of achieving decarbonisation for medium to large aircraft, especially within the constraints of airframe weight and power density. Combustion also enables more rapid retrofit of existing aircraft designs and is more compatible with current maintenance ecosystems and airport infrastructure. Simply put, hydrogen combustion is the most practical, scalable route for commercial aviation and the UK should be focusing investment accordingly. It was the Conservatives in government who recognised that early on. Under the jet zero strategy established in 2022, we committed funding to Project FlyZero, supported by trials by ZeroAvia and Rolls-Royce. We ringfenced funding for hydrogen infrastructure at UK airports. We laid the groundwork for the SAF price mechanism that this current Government is carrying through with the SAF Bill. We established the hydrogen transport hub in Teesside, where our fantastic mayor Ben Houchen, now Lord Houchen, oversaw a combined £23 million funding package to kick-start the local hydrogen-based economy. We also made Britain one of the first countries to support regulatory frameworks for hydrogen-powered flight trials. Turning to the new Government, the mantle has clearly democratically passed to them, and the test on whether hydrogen aviation can succeed lies with them. The promised expansion of the aerospace growth partnership, sadly, has been watered down. The Aerospace Technology Institute’s hydrogen propulsion roadmap seems to have stalled, and companies at the cutting edge, from Cranfield to Kemble to Prestwick, report difficulty in accessing follow-on support, despite clear potential and private co-investment. The Government must stop conflating hydrogen policy with overreliance on electric-only solutions, which simply cannot be scaled to long-haul aviation. A narrow vision such as that would be misguided; it is actively stifling British leadership in this vital sector. If we want to lead the next aviation revolution to match our leadership in jet engines with leadership in zero carbon propulsion, then ambition must be matched by action. That means committing long-term funding for hydrogen combustion propulsion research and development, providing meaningful and long-term support for airport hydrogen infrastructure trials, especially in regional hubs, accelerating the certification and regulatory pathway for hydrogen aircraft and aligning hydrogen production strategies with the wider UK aviation sector. The hydrogen age is not coming. It is here, and unless the Government correct course, the opportunity to lead it will pass us by. The last Conservative Government laid the foundations for hydrogen-powered aviation. I very much hope that this Government, and this Minister, do not allow the UK to lose that legacy through indecision. I challenge the Minister, who is very thoughtful on this subject and has the best interests of aviation at heart, to ensure that hydrogen is part of that future.

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3. 17 Jun 2025·Parliament·Graham Stuart

   Care in the Community

   Dental patients with untreated need end up in hospitals. In places like Hedon in my constituency, we have seen more and more dental practices moving away from the NHS. I have a constituent who found it took her three years to get her child their first check-up, and that dental practice has now ceased to look after NHS patients. She also cannot get the NHS treatment she deserves herself, even though she had a child in February. What in the 10-year plan will change that and ensure that everyone can get access to NHS dentistry?

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4. 17 Jun 2025·Parliament·Edward Argar

   Topical Questions

   May I, through the Secretary of State, pass on my best wishes to the Under-Secretary of State for Health and Social Care, the hon. Member for West Lancashire (Ashley Dalton)? In front of the Health and Social Care Committee in January, NHS England’s then chief financial officer set out that pretty much all the additional funding to the NHS last year would be absorbed by pay rises, national insurance contributions and inflation. What proportion of the latest additional funding will be absorbed in the same way?

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5. 17 Jun 2025·Parliament·Edward Argar

   Topical Questions

   The right hon. Gentleman could not answer that question, but hopefully we will get a more positive response to this one. I recently had the privilege of meeting Dr Susan Michaelis and her husband Tristan, who have set up the Lobular Moon Shot Project, which large numbers of Members of all parties across the House have backed. They are seeking £20 million over five years—a tiny sum in the context of the overall NHS budget—to research lobular breast cancer, which Susan is currently battling, to help improve outcomes. Her immediate ask is even simpler: it is for the Secretary of State to meet her in person to discuss the campaign and its aims. He is a decent man. Will he agree to do that?

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6. 17 Jun 2025·Parliament·Dr Neil Shastri-Hurst

   Mental Health Bill [ Lords ] (Fifth sitting)

   It is a pleasure to serve under your chairmanship, Sir Desmond. I am grateful for the opportunity to speak to amendments 54 and 55, which propose that where a nominated person is appointed to represent the interests of a patient under the age of 16, that individual must hold parental responsibility. At face value, that is a concise and apparently straightforward proposal. However, as with much in the Bill and in our mental health legislation more broadly, what appears simple can raise intricate legal and ethical questions. I therefore wish to probe both the merits and the challenges of these amendments. I do so not to come down firmly on one side of the argument or the other, but in the hope of assisting the Committee to think through the implications of the amendments. I hope to prompt the Minister to provide further clarification as our consideration of the Bill proceeds. I will start by setting out the case in favour of the amendments. There is an intuitive and, I would argue, legally grounded rationale behind amendment 54. It rests on the principle that serious decisions concerning a child’s mental health—decisions that might involve treatment without consent, or even deprivation of liberty—ought to be taken, or at least overseen, by somebody who already holds recognised legal responsibility for that child. Parental responsibility is not merely administrative. It carries statutory and common-law duties to protect, support and advocate for a child’s welfare. By requiring the nominated person to have such responsibilities, the amendment seeks to ensure a level of legal legitimacy and continuity. It would strengthen the position of those with a formal bond to the child and might help to guard against the risk of unsuitable or ill-informed individuals stepping in to play such a critical role. In that sense, amendment 54 reflects what many would see as good legal hygiene. It would bring new legislation into closer alignment with the Children Act 1989 and with broader child welfare practice. It would create a baseline expectation that only those with legal authority over a child should make, or help to make, decisions of such magnitude. It would also offer reassurances to families. For parents and guardians already concerned about the complex and sometimes opaque processes of mental health detention, the amendment offers a clear signal that their role cannot be set aside lightly. That reassurance may be particularly important when children are subject to long-term care or involuntary treatment. However, questions begin to surface at precisely that point, because although the principle appears sound, the practice is far from straightforward. It is therefore important that we probe both the advantages and disadvantages of the amendment.

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7. 17 Jun 2025·Parliament·Dr Neil Shastri-Hurst

   Mental Health Bill [ Lords ] (Sixth sitting)

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

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8. 17 Jun 2025·Parliament·Dr Neil Shastri-Hurst

   Mental Health Bill [ Lords ] (Sixth sitting)

   It is a pleasure to serve under your chairmanship this afternoon, Mrs Harris. I rise to speak on clauses 30 to 33, which go to the core of the rights architecture that surrounds mental health law in this country—namely, the oversight and challenge mechanisms available to individuals subject to detention, supervision or conditional discharge. I think we are all aware that the 1983 Act, although fit for its time, has failed to keep pace with the evolving understanding of mental health illness and modern expectations of legal accountability or procedural fairness. The clauses, although technical in nature, seek to rectify a number of the long-standing shortcomings in the operation of the mental health tribunal system. Clause 30 will extend and clarify the time period within which patients may apply to tribunals. Essentially, it will do two things. First, it will extend the application window for section 2 patients—those detained for assessment—from 14 to 21 days. Secondly, it will reduce the initial waiting period for section 3 patients and those under guardianship from six months to three months. Those are sensible and overdue changes, because 14 days is a narrow window for any legal action, let alone one initiated by an individual who may be experiencing acute psychological distress. Extending the application window to 21 days provides a fairer opportunity to seek representation and prepare a meaningful application. Equally, the reduction of the initial period for section 3 and guardianship patients to three months offers an important safeguard against prolonged detention without scrutiny. It restores a measure of clarity between the gravity of the detention order and the speed with which it may be challenged. The clause will also clarify the rights of conditionally discharged restricted patients who are subject to deprivation of liberty conditions—that is, those who are discharged from hospital but required to comply with supervisional residence requirements that are so restrictive that they cross the legal threshold for a deprivation of liberty. At present, those individuals occupy a legal grey zone: they are not formally detained, yet the liberty they enjoy is so curtailed that it raises significant questions as to their article 5 rights. Clause 30 will properly address that anomaly by creating a defined, regular route of appeal, initially between six and 12 months from the imposition of the deprivation of liberty conditions, and biannually thereafter. Those are measured and proportionate changes that enhance access to justice, improve compliance with human rights obligations and restore clarity to a field that has suffered, at times, from legal opacity. The reforms are not without consequences. A wider cohort of eligible applicants and more frequent review periods will inevitably increase the burden on the tribunal service, on legal aid provision and on clinical teams who must prepare documents and attend hearings. That challenge is not to be dismissed lightly.

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9. 17 Jun 2025·Parliament·Dr Neil Shastri-Hurst

   Mental Health Bill [ Lords ] (Sixth sitting)

   My hon. Friend makes a pertinent point. We all know, from our casework or personal experiences outside of this place, about the pressures on the Courts and Tribunals Service. Mental health tribunals are not exempt from that pressure. Changing the timeframe on which tribunals operate, and the frequency with which reviews take place, will inevitably increase the burden on the service. Therefore, although these changes are broadly welcome, it is important that we are cognisant of their impact on the resources that will be required, the number of judges and wing members that will be needed, and of course the hard standing of the court and tribunal infrastructure that will need to be made available. Other issues, such as those around the digitalisation of the service, will also need to be addressed. Clause 31 will recast the regime for automatic tribunal referrals, replacing the prior six-month structure with the concept of “a relevant period”. For detained patients, referrals will now occur at three months, then 12 months, and annually thereafter. For community patients, they will occur at six months, then 12 months, then annually. Most significantly, hospital managers will be under a new duty to refer a case when no review has occurred in 12 months, regardless of whether an application has been made. That is a sound reform. The clause will introduce coherence to a previously fragmented system, and establishes a minimum standard of legal oversight. The inclusion of a backstop provision—that no individual should go more than 12 months without review—is essential. In a system in which patients may not always have the means or capacity to apply for a review themselves, it offers a critical safety net. Clause 31 will also repeal section 68A of the 1983 Act, which has become unwieldy and duplicative. By streamlining the referral process, the Bill enhances legal clarity and administrative efficiency, but I would caution that the increased complexity of the new timeframes may require significant training of those responsible for their implementation. Clause 32 will provide for restricted patients who are subject to deprivation of liberty conditions. It goes further than clause 30 by imposing mandatory referral duties on the Secretary of State. Under the clause, a tribunal must be convened after 12 months, every two years thereafter, and at four years if no review has occurred. Crucially, the clause also codifies the tribunal’s powers. It may now vary or impose conditions, including those that constitute a deprivation of liberty, provided that they are necessary to protect the public from serious harm and are no more restrictive than hospital detention. That clause introduces a principled, proportionate framework for balancing public protection with patient liberty, and avoids vague or discretionary use of such powers. Finally, clause 33 will apply the same principles to restricted patients not subject to deprivation of liberty orders. Such individuals, although under fewer constraints, are none the less subject to significant legal orders. The new requirement for a tribunal review at two years, and every four years thereafter, ensures that oversight is regular and non-discriminatory. All four clauses are united by a clear objective to rationalise tribunal access, enhance procedural safeguards and bring the Mental Health Act into alignment with modern standards of fairness and proportionality. However, I will close with a caveat: rights without resourcing are hollow. If we are to place greater demand on the tribunals service, and to rely on it as the guardian of liberty for thousands of individuals, it must be adequately funded, staffed and supported. Legal representation must be accessible. Tribunal members must be properly trained. Hospital managers must be equipped to meet their new responsibilities. With those reservations, I broadly welcome clauses 30 to 33 as a necessary recalibration of our mental health law. They reflect the dignity of the individual, the demands of public safety, and the enduring principle that no one should be deprived of liberty without fair or timely review.

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10. 17 Jun 2025·Parliament·Dr Neil Shastri-Hurst

    Mental Health Bill [ Lords ] (Sixth sitting)

    I rise to speak in support of clauses 36 to 40, which provide critical legal clarification and technical refinements to the 1993 Act. While differing in scope and impact, each of these provisions is underpinned by a clear shared commitment to enhance public protection, uphold patient rights, and ensure that the legal framework reflects both current clinical practice and developments in case law. Let me begin with clause 36, which addresses a long-standing lacuna in the legislative architecture governing conditionally discharged restricted patients. It follows the 2018 Supreme Court ruling in the case of Secretary of State of Justice v. MM, where it became clear that the existing Mental Health Act did not permit the imposition of conditions amounting to a deprivation of liberty as part of conditional discharge. The decision created uncertainty for clinicians, tribunals and, most crucially, risk-managed patients living in the community. It is therefore pleasing to see that clause 36 seeks to address that gap. The clause introduces new statutory powers for both the Secretary of State and the first-tier tribunal, in respect of imposing deprivation of liberty conditions in the community. It does so with some stringent safeguards.

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11. 17 Jun 2025·Parliament·Dr Neil Shastri-Hurst

    Mental Health Bill [ Lords ] (Sixth sitting)

    I will speak briefly on schedule 3, which makes a number of important amendments to the 1983 Act concerning the role of independent mental health advocates. The schedule implements several practical reforms to provide consistent and accessible advocacy and support for individuals receiving mental health care. It builds upon existing statutory provisions by extending the right to advocacy beyond detained patients and setting out clearer expectations of how and when advocacy services should be made available. One of the most notable changes is the extension of IMHA eligibility to include informal patients—individuals receiving voluntary treatment rather than under compulsion. This responds directly to the recommendations made in both the independent review and the 2021 White Paper, which identified disparities in support available to different patient groups. Under these reforms, access to advocacy is no longer limited to those detained under the Act. Instead, all qualifying patients, including informal ones, will be eligible for IMHA support where appropriate. This change reflects the recognition that voluntary status does not necessarily equate to full understanding or confidence in navigating care decisions. To ensure that eligible individuals are aware of and able to use this support, hospital managers will now be required to notify advocacy services when a patient becomes eligible. This automatic referral mechanism removes the onus from patients themselves to initiate contact, many of whom may not be aware of their rights or may face barriers to asserting them. In turn, advocacy providers will have a duty to arrange an interview with each referred patient to establish whether they wish to use the service. This helps to close the loop between eligibility and engagement, and ensures that advocacy is offered in a timely and structured manner. Schedule 3 also sets out clearer responsibilities on both hospital managers and advocacy providers. Clearly, that will improve co-ordination and ensure the consistent application of the policy across different care settings and regions. In practice, it should help to reduce gaps where eligible patients might otherwise miss out on support due to ambiguity around who holds the responsibility for initiating contact. It is worth noting that these reforms complement the broader set of changes proposed in clauses 41 to 44, which collectively aim to strengthen patient rights, increase transparency in decision making and improve the overall quality of patient experience in mental health services. This approach has a number of potential benefits. First, it is likely to improve access to advocacy for groups who have historically been underserved. These include informal patients, individuals with communication difficulties and those less familiar with the mental health system. Secondly, it enhances procedural fairness by ensuring that patients are supported in understanding their options, raising their concerns, or appealing decisions where necessary. Thirdly, it brings the statutory framework into closer alignment with human rights principles and best practice standards, particularly in terms of informed participation and supported decision making. There are, however, three specific practical challenges that I wish the Minister to acknowledge. First, these reforms will require sufficient resources for advocacy services, particularly as demand is likely to increase once eligibility is broadened. Secondly, effective implementation will depend upon robust co-ordination between hospital managers and external advocacy providers, which may vary in capacity and capability across regions. I would be interested to hear the Minister’s approach to ameliorating that. Thirdly, there is a risk of inconsistency in delivery without clear national guidance and adequate oversight mechanisms, so I would be grateful if the Minister could address the mechanisms that are intended to be put in place. These are not insurmountable issues, but they highlight the importance of a carefully planned implementation strategy, supported by training, monitoring and adequate funding. Schedule 3 represents a targeted and proportionate set of amendments that support the underlying aims of the Bill to ensure that all individuals receiving mental health care, whether formally detained or not, are able to access independent support, understand their rights and participate more fully in decisions about their treatment. [Interruption.]

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12. 17 Jun 2025·Parliament·Dr Neil Shastri-Hurst

    Mental Health Bill [ Lords ] (Sixth sitting)

    You will be delighted to know that I will be mercifully brief, Mrs Harris, because I am broadly supportive of all three clauses. Having worked as a doctor in clinical practice, and as a barrister, I am cognisant of the importance of transparency, patient autonomy and procedural fairness, in particular with vulnerable patients who are often seen in a mental health care setting. I welcome this trio of clauses, but I have some gentle challenges to put to the Minister for when he gets to his feet. First, how will data be captured on the information that is to be provided to patients and their families? What feedback mechanisms will be in place, not just for patients but for those who support them—their carers and families—and for clinicians, on the practicalities of how the system is working?

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13. 17 Jun 2025·Parliament·Dr Neil Shastri-Hurst

    Mental Health Bill [ Lords ] (Sixth sitting)

    The hon. Member makes a very valid point. There is that mechanism, but this is also about ensuring that the quality of the information that has been imparted—not just the process of it being done—is recorded. An audit process must ensure that the important conversations and information are imparted in a way that the patient and their family understand, in sufficient detail and as part of a process whereby, if there are concerns or doubts, they can be addressed in a ready manner. I take his point that there are metrics by which to measure things, but it is not just about capturing data; it is about capturing quality data in order to ensure that that is being fulfilled. To pick up on the point made by my hon. Friend the Member for Chester South and Eddisbury about regional variability, consistency across the board is important not only in the regions, but in the delivery methods and capacity that underpin this crucial service. Finally, on potential confusion and legal information being communicated in inaccessible ways, it is important that legalese does not get in the way of clarity for individuals who will have to navigate the information. I am interested to hear the Minister’s views on how we can ensure that the information is imparted in an accessible way for all those concerned—importantly, not just for patients and their families, but for clinicians who have to impart the information. They need to feel comfortable navigating their way around what can often be a complex set of regulations and legislation. Ordered, That the debate be now adjourned.—(Taiwo Owatemi.)

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14. 17 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Fifth sitting)

    It is a pleasure to serve under your leadership, Sir Desmond, especially on such a warm day. I hope that there is not too much hot air in the Committee to keep us even warmer. Clause 22 will introduce a series of important amendments to the operation of community treatment orders under the Mental Health Act 1983. The clause has the stated aim of strengthening clinical safeguards and ensuring continuity of care between hospital and community settings. The Opposition support these goals in principle. Let me set out the current legal position. At present, decisions to place a person on a CTO require two professional inputs: the patient’s responsible clinician and an approved mental health professional. The responsible clinician can vary, suspend, recall or revoke the order, often with no statutory obligation to consult the clinician who will be managing the patient’s care in the community.  Clause 22 will change that. It introduces the new role of the community clinician—defined as the approved clinician who will oversee the patient’s care in the community—and requires their involvement at key decision points in the life of a CTO. Specifically, it requires a written statement from the community clinician that the CTO criteria are met, where they are not the responsible clinician. It obliges the responsible clinician to consult the community clinician before varying conditions, recalling or revoking a CTO, unless such consultation would cause unreasonable delay. It also includes the community clinician in the process of renewing a CTO, again via a written statement.  These are not insignificant changes. They mark a shift towards multidisciplinary accountability and a greater emphasis on the continuity of care between in-patient and community settings. The Opposition strongly support both principles. However, there are several points that I would like to probe constructively, and I hope the Minister will respond in the spirit of improving what is clearly a well-intentioned clause.  First, the term “unreasonable delay” appears multiple times in the clause as an exception to the duty to consult the community clinician, but I cannot see it defined in the Bill or in the explanatory notes. Could the Minister clarify what constitutes “unreasonable delay” in practice? Will guidance be issued to ensure consistency across trusts and clinicians? We must ensure that this exception does not swallow the rule or become a loophole in time-sensitive situations. Secondly, what happens when clinicians disagree? The clause requires the agreement of the community clinician in writing before a CTO can be made, but it is silent on what happens when there is disagreement between the responsible clinician and the community clinician. This is not a hypothetical concern; differing clinical views are common and can be a healthy part of multidisciplinary practice. Could the Minister confirm whether there is a proposed resolution mechanism where clinicians differ? Would the decision default to a tribunal or a second opinion, or is the CTO simply not made? Thirdly, as the Minister has mentioned, on the operational readiness to implement this clause, the new duties on community clinicians are not trivial. They are being asked to produce written statements, engage in formal consultations and be available to advise on time-sensitive decisions such as recalls and condition changes. Can the Minister reassure the Committee that a workforce impact assessment has been or will be conducted? Will there be investment in community mental health staffing and digital infrastructure to ensure that this duty is workable? Fourthly, I want to raise the issue of handover and role clarity. The clause will introduce a new statutory role—the community clinician—but patients often transition rapidly between settings. There may be uncertainty about who holds that responsibility at a given time. Will guidance ensure that community clinicians are formally designated and that responsibilities are clearly recorded at the point of discharge? I want to end on a constructive note. Clause 22 is a step in the right direction. It reflects many of the recommendations of the independent review of the Mental Health Act, including the emphasis on least restriction and on therapeutic benefit. I encourage the Government to consider defining or clarifying unreasonable delay in regulations or guidance, introducing a clear process for resolving professional disagreement, and committing to publish a plan detailing workforce support, guidance and digital infrastructure to ensure that this takes place. Clause 23, which is linked to clause 22, will introduce two important amendments to the operation of community treatment orders under the Mental Health Act 1983. As things stand, section 17B(2) allows a responsible clinician to attach conditions to a CTO if they are necessary or appropriate, to ensure the patient receives treatment, to prevent risk to health or safety or to ensure engagement with services. Such conditions can include where the person lives, their attendance at appointments and even lifestyle restrictions such as abstaining from alcohol or drugs. However, we know that these conditions can be seen as coercive. Patients often feel that breaching them means automatic recall to hospital. In practice, some CTO conditions may drift toward overreach rather than clinical necessity. The clause responds to these concerns in two ways. Subsection (1) will remove the words “or appropriate” from section 17B(2), meaning that CTO conditions must now be strictly necessary, not just advisable or convenient. The Opposition support this narrowing of the threshold. It sends a clear message that CTO conditions must be clinically justified, proportionate and tailored to the individual’s needs. However, I ask the Minister how clinicians will be guided in applying the new “necessary” test. Will the code of practice be updated with examples and scenarios? Crucially, what measures will be taken to ensure that patients are clearly informed that a breach of a CTO condition, in itself, is not automatic grounds for recall?

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15. 17 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Fifth sitting)

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

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16. 17 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Fifth sitting)

    Brevity is an important skill that you have exemplified in this House for many years, Sir Desmond, so I will not subject the Committee again to matters that I have already covered. I ask again the question that I posed just before the suspension: how will clinicians be guided in applying the new “necessary” test? Will the code of practice be updated with examples and scenarios? Crucially, what measures will be taken to ensure that patients are clearly informed that a breach of CTO conditions is not, in itself, an automatic ground for recall? That concern has come across in evidence and is a long-standing source of misunderstanding and mistrust, as has been highlighted in cases and in the Wessely report. Clause 23(2) will insert new subsection (3B) into section 72 of the Mental Health Act, giving mental health tribunals the power to recommend that the responsible clinician reconsider whether a CTO condition is necessary, even when they do not discharge the patient. That is a welcome enhancement of patient rights. Currently, if a tribunal decides not to discharge a patient, it has no power to challenge potentially excessive conditions. The clause strikes a useful middle ground, offering oversight without overturning clinical decisions. Having said that, will there be any requirement for the responsible clinician to formally respond to the tribunal’s recommendations? Without such a duty, there is a risk that recommendations may be quietly disregarded and the benefit of the provision may be undermined. Clause 23 is a positive and proportionate reform, but to strengthen its practical impact I suggest that the Government consider updating the code of practice to clarify what constitutes a “necessary” condition under section 17B of the Mental Health Act; introducing a duty to respond to tribunal recommendations under proposed new section 72(3B), with a short time limit and a written explanation if the recommendation is rejected; and providing clear information to patients. New clause 4, tabled by the Liberal Democrats, seeks to place a general duty on ICBs to ensure that sufficient resources are available for community-based mental health services, particularly in the context of implementing provisions under the Mental Health Act. It speaks to a concern that many Committee members will have heard time and again from patients, practitioners and families alike: that the success of any reform to the Mental Health Act will ultimately rest on the capacity of community services to deliver. We know the reality: patients can be discharged to under-resourced settings or subject to CTOs that depend on clinicians who may be overstretched or unavailable. Clause 22 will rightly expand the role of community clinicians in CTO decisions, but that works only if they exist, are available and have the time and tools to engage meaningfully. I acknowledge that new clause 4 identifies a genuine structural risk in the way in which we approach reform, and I commend colleagues for raising it, but should it sit in primary legislation? I am not so sure. I have some questions for the hon. Member for Winchester not about the intention of the new clause, but about the appropriateness and practicality of placing such a duty in primary legislation. Primary legislation is best used where duties are clear, enforceable and universal. The duty proposed in the new clause, although admirable, is qualified by the words “insofar as is reasonably practical”, which reflects the reality that integrated care boards do not control all the levers of workforce, capital investment or even, in many cases, service design. With that in mind, I ask the hon. Member the following questions. What mechanism would be used to enforce the duty? If an ICB fails to meet the duty, what would the consequences be? Would the duty not create legal ambiguity or even the potential for judicial review where service users feel that resources are inadequate, or even where the ICB has acted reasonably in difficult circumstances? Furthermore, how would the duty interact with the existing statutory duties on ICBs under the Health and Care Act 2022, including the duties around health inequalities and integration? A stronger element of the new clause, which merits closer consideration, is the assessment and publication of findings on local community mental health capacity. This kind of transparent, data-led accountability could be an effective tool not only for Parliament and regulators, but for local patients and advocacy groups. Perhaps that element could be taken forward in secondary legislation as part of the updated NHS England commissioning guidance. The Minister will forgive me, but I am not sure whether such a tool already exists, so perhaps he will address that point. Does the Department plan to require ICBs to assess and report on community mental health capacity in the light of the new duties being created by the Bill? Could there be scope for a reporting duty to be included in regulations or guidance, even if a general resourcing duty is not placed in primary legislation? The Bill refers to commissioning, and under earlier clauses we have talked about dynamic registers. Will the Minister set out whether the issue is covered here or in another way? We cannot ignore the resource dimension, so I am grateful to colleagues for pressing the Committee to address it. However, we must be careful about the tools we use, what we write into law, and what we deliver through planning, commissioning and political will. I look forward to hearing from the hon. Member for Winchester and the Minister in response to my questions.

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17. 17 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Fifth sitting)

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

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18. 17 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Fifth sitting)

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

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19. 17 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Fifth sitting)

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

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20. 17 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Fifth sitting)

    I welcome the chance to contribute to the debate on clauses 24 to 28. I will then turn to Government amendments 40 and 41 and to amendments 54 and 55, tabled by my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer). Clauses 24 to 28 represent a significant reform to the Mental Health Act 1983. They seek a shift from the traditional concept of a nearest relative to giving patients more control by allowing them to nominate a person to act on their behalf. Clause 24 is the cornerstone of the reform, establishing the role of a nominated person as the patient’s chosen individual to take over certain rights and responsibilities previously held by the nearest relative. It represents a fundamental change from a fixed family-based system to one centred on patient choice and autonomy. Currently, the nearest relative, often by blood relation, holds a range of statutory powers under the Mental Health Act, regardless of the quality of their relationship with the patient. The clause will enable patients, especially adults, to nominate a trusted person—a family member, friend or advocate—who can act in their best interests. That is a progressive and patient-focused change relating to modern social realities, where family ties are complex and a biological relative is not always the best supporter. Empowering patients to select their nominated person can enhance trust, improve communication and ultimately lead to better care outcomes. It does, however, raise pressing questions. For children and young people, particularly those aged 16 and 17, who gain legal capacity to nominate, what safeguards ensure that parental concerns and children’s welfare remain adequately considered? How will disputes between nominated persons and relatives, or between the nominated person and clinicians, be resolved? Part of that might be addressed in Government amendments 40 and 41, but I am keen to understand a little more. What training and oversight will ensure that nominated persons understand their duties and, importantly, their boundaries? Finally, for a patient who does not or cannot nominate someone, will the nearest relative still have a role, and how will that be managed? Clause 25, on applications for admission or guardianship, builds on clause 24. It will require the approved mental health professional to consult the nominated person before making applications for admission or guardianship, except where consultation is not reasonably practicable or would cause unreasonable delay. It will also allow the nominated person to object to such applications, requiring a barring report from the approved mental health professional if an objection is made. The clause will formalise the nominated person’s involvement at a critically early stage of the intervention, ensuring that their voice can influence decisions that deeply affect the patient. The power to object introduces an important check, though it is balanced by the professional’s ability to override objections on the grounds of safety. The Opposition agree with that, but there are still some questions. How will professionals navigate conflicts between their clinical judgment and objections by the nominated person? Will there be clear guidance to avoid delays that could jeopardise patients or public safety?

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21. 17 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Fifth sitting)

    My hon. Friend has identified the nub of the issue, and his intervention leads me on to an example that demonstrates the problems that we are talking about. I have chosen to debate these provisions in the order shown on the selection list because I wish to understand whether the Minister believes that Government amendments 40 and 41 will deal some of the issues that I am about to raise. There clearly has to be flexibility in dealing with these situations, but it is worth exploring what could go wrong. The nub of the issue is that they may well go wrong. Let us take an example. Say that A is 16, and she is struggling with anxiety and behavioural issues. She has had serious suicidal episodes and previous drug use. She lives at home with her loving, supportive parents, who have always acted in her best interests and want to engage constructively with her care, but A is under pressure from a 19-year-old boyfriend. He is controlling, and discourages her from speaking to her parents or professionals. When asked to nominate a trusted adult, A names him. Under the Bill as drafted, the nominated person could be accepted, provided A is deemed to be competent. That would give her boyfriend access to her care decisions and significant legal standing. Under amendments 54 and 55, that would not be possible because he does not have parental responsibility, and therefore could not be appointed. That example illustrates why the amendments matter. Children, especially those in crisis, may be vulnerable to coercion, grooming, or misplaced trust. Loving parents, who have legal obligations to protect and care for their children in every other walk of life—as my hon. Friend the Member for Farnham and Bordon pointed out—could find themselves legally sidelined. Are there risks in amendments 54 and 55? We must consider the edge cases. Not all children under 16 live with those who are trusted and have parental responsibility. There are estranged families, kinship carers, informal fostering arrangements and situations of abuse. A strict parental responsibility requirement could exclude the very people relied on by a child. I ask the Minister whether there is flexibility in the amendments for exceptional cases in which someone without PR may be appropriate, with oversight. Do Government amendments 40 and 41 already address that point? Forgive me if I have misinterpreted, but they seem to be bridging amendments. Would guidance or a statutory code of practice provide a better mechanism to balance protection and flexibility? What assessment has been made of children in care or informal arrangements, where parental responsibility might technically lie with a local authority or estranged parent, especially under the changes proposed by Government amendments 40 and 41? There are potential routes forward. One option might be to require PR by default but allow exceptions if the child expresses a clear competence preference, the AMHP agrees that a person is suitable and poses no safeguard risks, and a senior commissioner or legal oversight has sign-off. That is a possible way of keeping amendments 54 and 55 alive, and it would keep within the spirit of the amendments by protecting children from harmful influence without removing their voice in complex or marginal cases. We could also explore adding an explicit safeguard power to override a child’s nomination where there is concern of coercion or abuse, regardless of parental responsibility status. Again, I think that may be what Government amendments 40 and 41 are trying to do, but I would be grateful to see whether that is the case.

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22. 17 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Fifth sitting)

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

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23. 17 Jun 2025·Parliament·Dr Luke Evans

    Pharmacies

    I am pleased to hear the Minister speak about Pharmacy First, which was brought forward by the previous Government and welcomed by communities, the public and the pharmacists. Although I am pleased to see the Government continue it, why have they decided to cap the number of consultations that a pharmacist may do?

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24. 17 Jun 2025·Parliament·Dr Luke Evans

    Pharmacies

    I am grateful to the Minister for his answer, but part of the problem is that once pharmacists hit that cap, they are no longer paid the £17 per consultation. In turn, that means that either patients will be turned away, or the pharmacist must take the hit and pay for it themselves. That disjoins the system and could create extra costs, because patients who are turned away will turn up in other areas of primary care, such as their GP surgery. How does that fit with Darzi’s push towards community-based services?

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25. 17 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Sixth sitting)

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

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26. 17 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Sixth sitting)

    I would be grateful if the Minister pointed it out.

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27. 17 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Sixth sitting)

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

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28. 17 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Sixth sitting)

    Clause 29 addresses the length and renewal of detention periods under the Mental Health Act. I begin by acknowledging the important step that this clause represents in shifting towards a more rights-based, patient-centred model, as enshrined in the Bill. Clause 29 would shorten the initial period of detention for treatment under section 3 of the Mental Health Act from six months to three months. Subsequent renewal periods are, likewise, reduced from six months to three months and then from one year to six months. This is clearly informed by the principle of least restriction, as is rightly highlighted in the explanatory notes in paragraph 212. On that basis, we welcome the direction of travel, but, while we agree with the principle of moving towards shorter, more proportionate detention periods, we have questions and concerns about implementation, consistency and safeguards, which I hope the Minister will address. First, will shorter periods lead to better outcomes, or just more paperwork? The goal here is to ensure that detention is not allowed to drift and that patients are not held in hospital for longer than is necessary without rigorous justification. However, the clause still allows for indefinite renewal in increments, once those shorter initial periods expire. Can the Minister assure us that these changes will result in more meaningful reviews and not just more frequent rubber-stamping of detention? It would be helpful to understand whether the Government have assessed the clinical capacity, particularly among responsible clinicians and approved mental health professionals, to conduct these reviews with real rigour. If not resourced properly, we risk replacing one form of inertia with another. Secondly, what safeguards exist against the resetting of detention periods on transfer? I am by no means a legal expert, so forgive me if I have completely misinterpreted this, and I bow to the legal expertise of the Minister, the Government and, most importantly, to able staff in the Box. However, clause 29(2) introduces into section 19 of the Mental Health Act new subsection (2A), which provides that if a guardianship patient is transferred to hospital, they will be treated as if they had been admitted on the day of transfer. In practical terms, does that not reset the detention clock? To my eyes, this concept of resetting the detention clock appears most clearly in subsections (2) and 29(5)(d) of clause 29, where a patient who is transferred from guardianship to hospital, or who has their community treatment order revoked, is treated as if they had been newly admitted to hospital on that day. This effectively resets the start date of the detention period. Clause 29(2), which will insert proposed new section 19(2A) into the Mental Health Act, states: “But, in the case of a patient falling within subsection (2)(d), section 20 has effect as if the patient has been admitted to hospital in pursuance of an application for admission for treatment on the day on which the patient is transferred.” New paragraph 5B of schedule 1 to the Mental Health Act states that the modifications “apply in relation to a patient transferred from guardianship to a hospital in pursuance of regulations made under section 19…In section 20(1)(a)…for “admitted”…there is to be substituted “transferred”. In new paragraphs 5C and 5D of that schedule, the same resetting principle applies to patients whose CTOs are revoked, with renewal detention starting from the date of revocation, not from their original hospital admission or order. In practice, this could mean that if a patient is placed under guardianship on 1 January and transferred to hospital on 1 April under section 19(2)(d) of the Mental Health Act, then under proposed new section 19(2A), they would be treated as if they had been newly admitted on 1 April. Therefore, even though they have been under compulsion since 1 January, the new three-month detention clock begins on 1 April. Likewise, a patient under a community treatment order that was issued on 1 February and revoked on 1 August will, under paragraph 5D, start a new in-patient detention period on 1 August, not 1 February. On one hand, that makes sense. We do not want people whose state is fluctuating to be released, or simply to time out. On the other hand, if we are looking purely from the patient’s perspective, as the legislation asks us to do, with regard to the principles in clause 1, that could be a problem. Will the Minister clarify how many times such a reset could occur for a single individual? Is there any form of oversight, review or reporting requirement where this happens? That mechanism might be necessary in some clinical contexts, but without safeguards it could become a back door to prolonging detention, which is something that the clause seeks to reduce. Is there some kind of register or mandatory recording of these incidents to spot repeat patterns? Thirdly, another issue that needs addressing is the creation of possible complexity. Paragraphs 218 and 219 of the explanatory notes set out a separate but equally important issue. Clause 29’s welcome shortening of detention periods—from three months to start with, then three months, then six months, then annual reviews—is not applied evenly to patient groups. Who gets the shorter periods? Most civil patients detained under part II and some patients on revoked community treatment orders. Who does not get them? Patients detained by a hospital order from a court, if their CTO is revoked within six months of the order, as in paragraph 218. And, of course, restricted patients—typically those involved in more serious offences.

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29. 17 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Sixth sitting)

    Could I ask the Minister—

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30. 17 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Sixth sitting)

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

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31. 17 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Sixth sitting)

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

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32. 17 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Sixth sitting)

    Clauses 30 to 33 deal with the tribunal access and automatic referrals of patients detained or conditionally discharged under the Mental Health Act. Let me begin, again, by welcoming these provisions, which seek to improve safeguards, ensure timely oversight, and extend the rights of individuals, particularly those under deprivation of liberty conditions in the community. These are serious matters of liberty and I acknowledge the Government’s intention to modernise and strengthen protection. Nevertheless, it is important that we look carefully at how the clauses operate in practice. I will take each in turn. Clause 30, on tribunal application periods, will make important changes to when patients can apply for the tribunal. First, it will extend the time that patients detained under section 2 of the Act have to apply from 14 to 21 days. This is a welcome change. We know that the first few days in hospital are incredibly disorientating, so allowing patients a bit more time to seek legal advice is entirely sensible. Secondly, the clause will reduce the period for patients detained under section 3 to apply from six months to three. I can understand the logic of that, given that clause 29 also shortens the initial detention period, but is there any reason for choosing that mark? Is there any evidence that the three-month window will still allow patients to have sufficient time and support to exercise their rights? Thirdly, the clause will introduce new provisions for conditionally discharged restricted patients, setting out different application timeframes depending on whether the patient is subject to conditions amounting to deprivation of liberty. Those under the deprivation of liberty safeguards will be able to apply between six and 12 months after discharge and then every two years. For those not under such conditions, the window begins at 12 months. That reflects the impact of conditions on a person’s liberty, and I recognise that distinction, but can the Minister clarify how patients will be informed about which track they are on? That will be fundamental to exerting their rights. Will any guidance be issued to ensure consistency? Will patients have access to advocacy or legal advice at this point? On clause 31, automatic tribunal referrals are a crucial safety net for those who for whatever reason do not exercise their right to apply. The clause introduces a new framework of relevant periods after which the hospital managers must refer, as we have heard. For section 2 patients, it will be three months. For section 3 and CTO patients it will be three months, then 12 months and every year thereafter. Significantly, the current three-year review period for many detained patients is reduced to one year. The clause marks a substantial increase in oversight, which I support, but it also raises practical questions. Given that we have put these backstops in place, have the Government made any estimate of how many extra tribunals will be needed and how much extra work they will generate? The Minister was kind enough to say that there were four hours of clinical work involved in doing the plans, but I do not think we have yet heard how much work the Government estimate that the tribunals will take. More importantly, what support is being provided to ensure that the tribunal system can meet that increased demand? I am particularly concerned that the benefits of these reforms may not be felt if backlogs or delays undermine the safeguards they are intended to deliver.

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33. 17 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Sixth sitting)

    That is a difficult balance to get right. I appreciate that the Government have said that the Bill will take 10 years to implement, but if these measures come into force from day one, we will start to see automatic referrals come through. There will be a lag as the transition happens, but my hon. Friend is absolutely right: we can foresee scenarios where patients who want to be referred into the tribunal are waiting in inappropriate care places, which may be to the detriment of their personal care and may actually make their recovery worse. He is right to highlight that question, which is why having a broad understanding of how many extra referrals are coming would be useful. Clause 32 focuses on conditionally discharged restricted patients who are subject to deprivation of liberty conditions. It rightly ensures that those patients are brought within scope of automatic referral, first after 12 months and then every two years. Again, that is a positive step, ensuring that even those not detained in hospital will still have access to a review of their conditions. Crucially, the clause also gives the tribunals the power to vary or remove those DoL conditions. Can the Minister say more about how that important power will be used? What criteria will the tribunals apply to assess whether a condition is genuinely necessary and proportionate? Will patients be legally represented in those hearings by default? Will another advocate be there, or will it be someone else in their place? Here, too, I would welcome some clarification from the Minister. I hope he will forgive my legal naivety, but my mother always said, “It’s better to ask a dumb question than stay dumb forever.” The explanatory notes talk about DoL conditions. The current legal framework for authorising the deprivation of liberty for individuals who lack capacity is complex and in transition. Under the Mental Capacity Act 2005, deprivation of liberty safeguards have been the established mechanism since 2009 to ensure lawful deprivation of liberty in care settings. However, the Mental Capacity (Amendment) Act 2019 introduced liberty protection safeguards as modernising replacements, designed to simplify and broaden protections. LPS are widely seen as an improvement to DoLS, because they extend safeguards to a wider range of settings, including hospitals and people’s own homes where deprivation of liberty might occur. They also streamline the assessment process, reducing bureaucratic delays and better reflecting person-centred decision making. The Law Commission and various stakeholder groups have supported LPS as a way to address the significant practical and legal challenges posed by DoLS, including the so-called DoLS backlog, where assessments have been delayed for many vulnerable individuals. Despite that, I do not believe that LPS have yet been implemented, leaving DoLS still in force. I wonder if we are therefore creating ambiguity as we update the Mental Health Act through the Bill’s clauses, such as those addressing conditional discharge and deprivation of liberty, without clarity on how those will intersect with the forthcoming LPS framework that will be introduced under separate legislation. That raises important questions about the sequencing and co-ordination of legislation reform. How will the Government ensure coherence and avoid conflicting provisions when different statutes address overlapping issues at different times? Given that context, have the Government abandoned the planned implementation of LPS, or do they remain committed to bringing them into force? If the implementation is still planned, will the Government provide a clear timeline for when LPS will replace DoLS? How do the Government intend to ensure that the provisions we are debating will align with or adapt to the introduction of LPS? What steps are being taken to ensure that vulnerable individuals and professionals who navigate this complex legal landscape will have clear, consistent safeguards and guidance through the transition? Clarification on those points is essential to avoid legal uncertainty and to ensure that the reforms provide coherent protection for those deprived of their liberties. Clause 33 deals with patients who are not under DoLS conditions. It will ensure that even those who are under DoLS conditions, such as detained restricted patients or conditionally discharged patients with lesser restrictions, receive automatic tribunals. It will reduce the current three-year referral intervention for detained restricted patients to 12 months and introduce automatic referrals for non-DoL conditionality discharge patients after two years and then every four years. Again, that is a step forward, but four years feels like a long gap between reviews for those discharged with conditions that still significantly affect their daily lives. Will the Minister explain the thought behind the chosen timeframe? If a person’s condition changes, is there a mechanism to trigger an early referral outside the normal cycle? The clauses show progress. They reflect a clear intention to strengthen patients’ rights, increase oversight and address historical injustices, particularly for those living under deprivation of liberty conditions in the community. But with complexity comes risk, and we need to ensure that patients understand their rights and the legal support available. The tribunal system must be properly resourced to uphold the safeguards that we place in the legislation.

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34. 17 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Sixth sitting)

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

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35. 17 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Sixth sitting)

    I rise to speak to clause 34, which inserts new consultation requirements into section 23 of the Mental Health Act 1983. The requirements relate to the discharge of individuals detained under parts II and III of the Act, as well as those subject to community treatment orders or guardianship. Currently, under the Act, the responsible clinician has the power to discharge patients detained under sections 2 and 3, as well as unrestricted patients subject to a hospital order under part III, without any formal requirement to consult other professionals. This is already considered outdated practice in most clinical settings, where decisions are typically made within the multi-disciplinary team. However, that is not required by law. By contrast, discharge decisions for restricted patients remain with the Secretary of State for Justice or the mental health tribunal and are not affected by the clause. Clause 34 seeks to change the current situation. It will insert proposed new subsections (2A) to (2C) into section 23 of the 1983 Act, placing a statutory consultation duty on responsible clinicians, local authorities and, in some cases, the patient’s nominated person. The aim, as outlined in the Government’s explanatory notes and by the Minister, is to formalise best practice and ensure that no discharge decision is made unilaterally without appropriate professional oversight. The Opposition welcome the intention behind the clause—strengthening safeguards, encouraging multidisciplinary collaboration and protecting patients from unsafe or premature discharges are all necessary and overdue steps—but we have a few questions about it that I hope the Minister will address. First, proposed new subsection (2A) requires the responsible clinician to “consult a person— (i) who has been professionally concerned with the patient’s care or treatment, and (ii) who belongs to a profession other than that to which the responsible clinician belongs”. That is a sound principle, but there is an ambiguity in the phrase “has been professionally concerned”. Who do the Government have in mind? The Minister set out that it could be a nurse or a counsellor, but would it stretch as far as a GP or a practice nurse? Will there be a codifying list, either in statute or in the code of practice, so that we know who is expected to speak to that person? Does it require current involvement in the patient’s care? For example, could a professional who saw the patient only briefly many months ago qualify? If so, is that adequate to meet the clause’s intention? We would welcome clarification from the Minister on whether a definition of who and what an appropriate consultee looks like will be covered in guidance or regulations. Secondly, I fully understand the good intent behind proposed new subsection (2B)(c), but as a good Opposition we should point out a possible unforeseen problem. It states that when the nominated person—that is, the person chosen by the patient to act in their interests—is making a discharge decision under guardianship, they “must consult the responsible local social services authority.” That raises both legal and practical questions. Is it appropriate to place a statutory duty on a layperson, who may be a relative, a friend or a carer with no formal training or professional support? What is the consequence if they fail to consult? Would their decision be invalid, or could it be legally challenged? I know that the Government are trying to ensure that relatives and advocates are consulted, which is commendable. I am sure there will be no issue in the vast majority of cases, but there is a risk that the duty may unintentionally create legal uncertainty and administrative burdens for families. Has the Minister thought about whether it might be better framed as a duty on the local authority to advise or support the nominated person, rather than vice versa? I am sure we both agree on the motive and principle of shared decision making; it is simply a question of where to place the burden. Thirdly, under proposed new subsection (2C), if someone is on a community treatment order, the responsible clinician and hospital managers must consult the community clinician before they discharge the person from that order. Again, that seems sensible, but what happens if there is no identified or available community clinician? As we have discussed, they are legally named, so could that requirement create a bottleneck to discharge? Will there be provision for proceeding with discharge if consultation is not practicable within a reasonable time? Without such a safeguard, there is a risk that patients remain subject to detention, such as conditions under a CTO, even when all parties agree that discharge is clinically appropriate. Furthermore, the clause does not appear to require the consultation outcome to be documented, nor any disagreement to be recorded. If the responsible clinician consults someone and then disregards their view—as we heard earlier, according to the Minister they have precedence—that may be entirely justified, but surely transparency demands the recording of the reasons. Will the Government consider adding a requirement to document consultation, perhaps in the code of practice, to ensure that reasons are given when discharge proceedings are taken against clinical advice? The clause represents an important step towards improving safety, accountability and multidisciplinary care in discharge planning, but the Opposition believe that to realise its full potential and avoid creating uncertainty or delay, the Government should look again at the clarity of key terms, such as “professionally concerned”; the appropriateness of placing duties on laypeople, such as the nominated person; the practical challenges around consultations when key professionals are not available; and the need for clear documentation requirements to uphold transparency and safeguarding in decision making. I look forward to hearing the Minister address those points.

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36. 17 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Sixth sitting)

    I rise to speak to clause 35, which would insert new section 23A into the Mental Health Act 1983. It was introduced and passed in the Lords, and rightly so. As the hon. Member for Thurrock said, it seems surprising that anyone might want to take it out. The clause was introduced as a new duty to offer all patients detained under the Act a consultation with an IMHA within 30 days of discharge. The purpose is to review their experience of hospital and learn from that experience through a report shared with hospital managers. Currently, the Mental Health Act makes provisions for access to IMHAs primarily during detention, particularly around decisions concerning treatment and care planning. However, once a patient is discharged, formal advocacy tends to fall away, unless pursued through broader NHS complaints mechanisms. There is no statutory duty to engage with patients post discharge, to understand how they have experienced their care or to systematically learn from those experiences. In that context, the clause represents a welcome and important step forward. We know from successive reviews from the Care Quality Commission, NHS England and, of course, the independent review of the Mental Health Act, led by Sir Simon Wessely, that patients often feel disempowered during their detention. Many describe experiences of coercion, poor communication or even trauma. Yet those experiences frequently go unheard: lost in the silence that can follow discharge. Clause 35 seeks to change that, creating a pathway for those voices to be heard, and, more importantly, for services to learn from them. I strongly support that principle. We need to clarify one thing first: the clause says a patient must “be offered” a consultation within 30 days —it is no more formalised than that. It is not a statutory requirement to take part, but purely to offer. That is important when it comes to making sure that reports are made in partnership with the patient. That is positive language, which would help to support the decision making and feedback loop. In their rebuttals, I appreciate that the Government may ask whether the clause would mean hospital managers marking their own feedback. They might also ask how we would deal with CQC capacity. Those are reasonable questions, but at the heart of the clause, as agreed by the Lords, is the fact that all too often patients’ thoughts after discharge are not fully taken into account.

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37. 17 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Sixth sitting)

    My hon. Friend makes a strong point. In clinical practice, we know that reflective learning is important, but that is not mandated. As we have seen from the reports, part of the reason why we do not see improvements is that we do not know about them. The clause gives patients the chance to empower themselves in a statutory, regulated way, which then allows us further transparency on how those issues arise. Let us not forget that patients with good experiences would also have the chance to feed those back, further helping to support the services and hopefully leading to beacons of best practice up and down the nation so that we could then learn from those. That is the idea behind the clause: making sure that the likes of the regulator would be able to share lessons about not only those who have struggled but those who have done well. Clause 35 really offers a rare opportunity to hardwire the patient voice into the feedback loop of mental health services. That is a principle that I and my Opposition colleagues strongly support.

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38. 17 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Sixth sitting)

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

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39. 17 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Sixth sitting)

    I rise to address clauses 36 to 40, which focus on patients involved in criminal proceedings or serving custodial sentences, and how we better align their care and liberty and the protection of the public. These clauses engage serious and sensitive issues—individual liberty, the management of risk and the functioning of the justice and health systems in tandem. I turn first to clause 36. Under the current Mental Health Act, a restricted patient—typically someone who has been detained under a hospital order with restrictions due to the risk they pose—can conditionally be discharged under section 42 by the Secretary of State for Justice or under section 73 by the tribunal. Conditions can be placed on their discharge, but they cannot amount to deprivation of liberty. This is key. If conditions require constant supervision or control, such as being escorted at all times, then the patient cannot be discharged at all, even if they no longer need in-patient treatment. This was confirmed in the Supreme Court case, MM v. Secretary of State for Justice, in 2018. Essentially, at the heart of the clause is a group of individuals who have been detained in a hospital under a restricted hospital order. In other words, they are people who have committed serious offences but were found to be suffering from mental disorders at the time. These individuals are not sent to prison; instead, they are detained in secure hospitals under the Mental Health Act. In some cases, clinicians and tribunals decide that someone can be discharged from hospital, but only if they comply with very strict conditions. These can include requirements such as living in a particular place with 24-hour supervision, not leaving without permission, being monitored at all times and other limits that can seriously restrict their liberty. The issue arose in the case MM v. WL, in which a patient with capacity had consented to highly restrictive discharge conditions involving 24-hour supervision. The court found that the discharge under such conditions could not lawfully take place under the Mental Health Act, even with the patient’s consent, because it amounted to deprivation of liberty, and it was not lawful to call it a “conditional discharge”. The law as it stands does not provide for that, which is where this clause comes in. Clause 36 seeks to address the impasse by amending sections 42 and 73 of the Act. It allows both the Secretary of State and the tribunal to impose deprivation of liberty conditions upon discharge only where they are necessary to protect others from serious harm, and where conditional discharge is no less beneficial to the patient than continued hospital detention. I also welcome the intent of the clause: to introduce the principle of least restriction, ensuring that patients are not kept in hospital simply because the law offers no safe option. Paragraph 281 of the explanatory notes states: “This power supports the principle of least restriction by allowing patients to be discharged from hospital and treated in the community, where otherwise this might have been prevented.” However, I would like to raise several probing questions for the Minister. Do we know how many patients are currently affected by the MM judgment and held in hospital longer than clinically necessary? How will patients be supported to challenge these conditions, particularly if they have capacity and disagree with the restrictions? Equally, if we flip it and argue for more restrictions, what if there are concerns or disagreements from the services, clinicians or families? How will they be able to challenge the decision in reverse? I am pleased that my hon. Friend the Member for Solihull West and Shirley is here, as I am not legal expert, but when I was prepping for this, I also noted the retrospective effect of clause 36(5), which allows certain conditions to be applied to those already detained or conditionally discharged when the clause comes into force. The retrospective effect of clause 36 is noted specifically in subsection (5) and reinforced in the explanatory notes. Subsection (5) states: “The amendments made by this section apply in relation to any person who is a restricted patient within the meaning given by subsection (1) of section 79 of the Mental Health Act 1983, or is treated as a restricted patient as a result of that subsection, whether the person became such a patient (or treated as such a patient) before or after the coming into force of this section.” This is a clear signal of retrospective application. I believe, in legal terms, this has the effect of changing legislation to make a provision apply as if it has always been in law in the past, not just from the date of commencement. What does this mean? This clause effectively retroactively legalises conditional discharges that include deprivation of liberty before the Bill becomes law, even though under current law, following the MM judgment, that was not permissible. The explanatory notes to the Bill make this point more directly. For example, paragraph 284 on page 53 states: “Clause 36 subsection (5) allows the new measures to operate retrospectively by providing that deprivation of liberty conditions can be imposed on restricted patients who are already detained, or who are conditionally discharged, at the time the provisions come into force.” Again, I am no lawyer, but this makes it clear that the Government are intent on validating past decisions, particularly those made before that are contrary to the MM judgment, which held that the Mental Health Act did not permit deprivation of liberty as part of the conditional discharge. Can the Minister confirm that article 5 of the ECHR safeguards has been fully considered in that respect? On page 72 of the explanatory notes, paragraph 394 says that the right hon. Member for Ilford North (Wes Streeting) believes that the Bill is compatible with the ECHR. To my surprise, when I was working on this at the weekend, I noticed that it says, “in her view”—a small drafting error that highlights my hours and hours of prep for this. On a serious note, the real-world effect of clause 36(5) is to retroactively legalise the use of conditional discharges that involve deprivation of liberty even though, under current law as interpreted by the courts, such decisions were unlawful at the time that they were made. Why does that matter? The retrospective provision protects public authorities, particularly the Secretary of State for Justice, and mental health professionals from legal liability for decisions made before, or in disregard of, the MM judgment. It shields decisions that may have breached a patient’s rights, particularly their right to liberty under article 5 of the ECHR, by making those actions lawful after the fact.

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40. 17 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Sixth sitting)

    I agree on that, and we will support the clause. But, as the hon. Member rightly pointed out earlier, we need interoperability between the moving parts to make sure that they all align with the provision in the clause. She is absolutely right: this measure is in the Bill because the patient in the MM case had capacity and had agreed to being discharged with deprivation of liberty impositions, and that was found to be unlawful because of a parallel Act. What I am worried about, and the point that I am trying to make, is that there are so many moving parts in these Acts that we could be in danger of complicating the situation further. Clause 36 seeks to address the uncertainty by legislating for a new power to impose deprivation conditions as part of a conditional discharge, as the hon. Member rightly pointed out. However, in doing so, the clause effectively runs parallel to, and perhaps even conflicts with, the as yet un-implemented LPS framework. The Government introduced the LPS framework through the Mental Capacity (Amendment) Act 2019. It was intended to be more flexible and responsive than DoLS. But given that the LPS framework has not been commenced, and that there is no clear timetable for implementation—the Minister seemed to suggest that he was unsure whether he will implement them, even though the 2019 Act was passed by Parliament—are we legislating for an entirely separate deprivation of liberty route under the Mental Health Act, and potentially bypassing or duplicating existing safeguards under the Mental Capacity Act? It all comes back to the point made by my hon. Friend the Member for Solihull West and Shirley about good record keeping and legislative housekeeping. I ask the Minister how the new conditional discharge power will interact with either the DoLS or the liberty protection safeguards—if they are eventually implemented. Are they simply a subsection of the deprivation of liberty conditions, and therefore would not matter? Can the Minister foresee a time where a patient could be subject to both the new powers and the LPS, and if so, who is the decision maker and where do the appeals rightly lie? Should we not wait for the full implementation of the LPS before layering further deprivations in place? That is an open and rhetorical question, but one that vexes me when we are discussing this Bill in detail. There is a real risk here of fragmenting the legal landscape, leading to confusion for clinicians, patients and carers. Clause 37, which is about conditions relating to the transfers of prisoners and others to hospital, addresses a barrier to timely transfers from prison to hospital. At present, under the case R (ASK) v. Secretary of State for the Home Department of 2019, a transfer from prison under section 47 or 48 of the Mental Health Act cannot be authorised unless a specific hospital bed has already been identified. While well intentioned, that threshold has arguably had a negative effect in deterring referrals and delaying access to treatment. Clause 37 rightly lowers that threshold. It amends section 47 and 48 of the Act so that a hospital place need not be available at the point of referral. Instead, the clinical decision about suitability for hospital can proceed earlier, allowing for better planning and quicker transfers. That seems a pragmatic response to a bureaucratic bottleneck, but how will this amendment be implemented in practice to ensure that it does not create the false expectation of imminent transfer? Will there be national guidance issued for uniform application of that new test across the entire prison estate? Clause 38 deals with transfers from prisons to hospitals, and their timeline. It introduces a new statutory duty for transfers from prison or detention to hospital to be completed within 28 days of initial review for assessment via proposed new sections 47A and 48A. As we have heard, that reflects good existing practice. The NHS England guidance already recommends that transfers should be completed within 28 days. However, clause 38 now gives that statutory force subject to exceptional circumstances, which the Bill carefully defines. For instance, as we have heard, shortages of staff and hospital beds do not qualify unless they are caused by exceptional events such as fires or flooding. This clause is welcomed as an important safeguard for therapeutic benefit, because delays in transfer can cause serious deterioration. It must, however, be supported by sufficient resources and capacity, on which I have a few questions. What assessment has been made of compliance with the 28 day target, and what proportion of cases currently fall outside of it? Will investment be made to ensure bed availability and staffing so that those statutory duties may be fulfilled? When this was debated in the other place, the Justice Minister said: “I am pleased to share that this Government have recently established a health and justice strategic advisory group, which will bring together key partners with responsibility for the various parts of the transfer process. This group will be chaired by a national clinical director, who will report regularly to Ministers and be responsible for agreeing a joint work plan to support implementation of the statutory time limit, identifying solutions to common barriers to timely transfers and holding partners to account.”—[Official Report, House of Lords, 31 March 2025; Vol. 845, c. 102.] That is laudable, so I tabled a written question to find out about the group that Lord Timpson talked about. Fortunately, the answer to my written question came back today. The group have not met and are not meeting until 1 July, so I ask for some clarification around that committee. It seems welcome, and this is a complex area. Given that the Justice Minister raised that issue, who will the group report to—the Ministry of Justice or the Department of Health? Later in his remarks, Lord Timpson talks about the written ministerial statement coming to Parliament. We have heard the Government say that a couple of times about reporting timescales, but in his speech Lord Timpson talked about reporting to Ministers. What kind of time- scales and frequency can we expect if the group has not even met yet? What reporting will there be to Ministers, either in the Ministry of Justice or the Department of Health, to address some of the issues that we are debating today? Clause 39 deals with transfer directions for persons detained in youth detention accommodation. It is rightly pointed out that this is a gap in the law. There is no power under section 48 to transfer to hospital a child who has been remanded to a youth detention accommodation by the Crown court, even if they urgently need in-patient care for mental disorders. That really does seem to be an anomaly. Such power exists for magistrates court remands, so clause 39 rightly corrects this, and I support it. Do we know how many children have been affected by that gap since 2012? I ask because if this is to come into law with immediate effect, it will have an immediate resource effect. We of course want to make sure that everyone—particularly young people—is in the right place. The fact that some of them legally are not may well cause another problem for us all. Finally, I turn to clause 40, which appears to be a technical clarification of schedule 1 of the 1983 Act, confirming that the whole of section 66(2)(d) is disapplied for unrestricted part III patients. It clarifies the right of application to the tribunal, and to me it seems uncontroversial and helpful. I acknowledge the thoughtful work being proposed in these clauses, and I understand what they are trying to do. They represent a clear attempt to modernise and humanise the way the Mental Health Act applies to some of the most vulnerable and high risk patients in our system, but we must ensure that any new powers, particularly those involving deprivation of liberty and retrospective legislation, are subject to clear safeguards, scrutiny and proper resourcing. I look forward to hearing the Minister’s response to my questions.

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