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We are trying to future-proof the Bill as much as possible. Does my hon. Friend think that the clause has enough future-proofing to deal with mental health issues that we are currently unaware of, or issues whose nature or treatment we do not fully understand?
I will keep my remarks relatively brief. As my hon. Friend the Member for Hinckley and Bosworth has pointed out, Members on this side of the House entirely support clause 8, mainly because of the change towards a therapeutic focus, which ensures that all compulsory treatment must have a clear clinical benefit. The clause is much more patient-centred; it gives legal clarity and stronger safeguards than currently exist in the law. I will also touch briefly on amendments 44 and 45, which my hon. Friend the shadow Minister tabled. The key point about amendment 44 is the promotion of the therapeutic environment, which is absolutely key to this. It aligns with the best practice in mental health care and supports recovery-orientated approaches. The key point about amendment 45 is the reinforcement of the compassionate, person-centred care that we are all trying to achieve. It ensures that responses to symptoms or behaviours are not punitive but supportive, and complements amendment 44 by applying the same principle to clinical interpretation of patient behaviours, which ultimately will encourage understanding of trauma-related behaviours, reduce risks of re-traumatisation and promote the psychological safety in treatment settings. I entirely support the view expressed by the hon. Member for Thurrock, my colleague on the Health Committee, that a requirement to consider other trauma factors could be added to the Bill, either now or at a future point. I would be interested to hear the Minister’s thoughts on that subject. I will also touch briefly on amendment 12, which was tabled by the Liberal Democrats, on treatment centres. Like my hon. Friend the shadow Minister, I support the overall context of what the amendment tries to achieve, but I have some concerns about how clinical decisions might be complicated if disagreements arise over the suitability of a treatment environment; and again, additional resources might be required to ensure that appropriate settings are available and accessible. When the hon. Member for Winchester winds up for the Liberal Democrats on that amendment, I will be interested to see whether he can assuage my concerns in that regard. Finally, we support clause 9. It brings the consistency that we want. The alignment, between the treatment standard for prisoners that would be used for non-prisoner patients, adds clarity. Again, it is rights-based, and I think it will reduce the possibility of misuse, thereby helping to prevent inappropriate or unnecessary hospital transfers.
I rise to talk briefly about clauses 13 and 14, which I generally and genuinely support. Clause 13 addresses a long-standing ethical and legal tension: how to balance the need for treatment with a patient’s right to refuse it, especially when they may have made advance decisions or have legal representatives. Let me expand the point that my hon. Friend the Member for Hinckley and Bosworth made about the level of potential appeal around the compelling reasons test. If the patient he was talking about continued to have an episode where it was believed that they did not have the capacity to act and they did not have a legal representative or family members who could advocate on their behalf, has the Minister given any thought to there being an external or independent person who could advocate on behalf of that patient during that period of incapacity and who is not a medical professional? In the current drafting of the clause, that seems to be a potential loophole. When someone regains capacity, they could potentially instruct legal counsel, but that may be too late if the treatment they have received has had an adverse impact on their life. I would like to hear more on that element, if possible.
I rise to speak to clauses 15, 17 and 18 and Liberal Democrat amendment 13 to clause 18. I note the hon. Member for Winchester is not here; I do not know whether he intends to push amendment 13 to a vote but, just in case he does, I shall speak to it. As colleagues across the Committee have said, ECT is a very controversial treatment, particularly when administered without consent. Under current law, it can be given to patients who lack capacity, but concerns have been raised about insufficient safeguards, especially where the treatment may conflict with prior decisions or a legal representative’s view. Clause 15 responds to recommendations from the 2018 independent review of the Mental Health Act and aims to ensure that ECT is used only when absolutely necessary, with independent oversight and respect for patient autonomy—something that everyone in this House can agree with. I have a couple of questions for the Minister on clause 15. Clearly, the Opposition support the intention of the clause, but I would like to ask him about the challenges in interpretation. For example, determining whether a decision conflicts with an advance directive may be complex, so has he or his Department given any thought to how we might deal with some of those potentially complex, conflicting points of view? Likewise, clause 17 updates section 62 of the Mental Health Act, allowing for urgent treatment without consent in specific circumstances. Once again, I welcome this provision because it gives some new legal clarity, supports clinical judgment, safeguards capacity and, most importantly, protects life and health. However, without strict oversight, there is a risk that the urgent treatment exception could be overused. What discussions has the Minister had with both his Department and, more importantly, campaign groups and mental health professionals to ensure that the urgent treatment exemption is understood and put forward in a way that satisfies both those undertaking the treatment and those receiving it? Clause 18 also changes section 62 of the Act, which I again support; I mention this clause only because I wish to talk briefly about Liberal Democrat amendment 13. Like other Members, I believe that this amendment is extraordinarily well intentioned, but I have some questions about its wording. Specifically, subsection (c) says “the treatment is reversible”, but I do not necessarily know what the legal or medical definition would be of a reversible treatment. I cannot think how ECT could in any way be reversible, so paragraph (c) of the amendment would potentially mean that nobody could receive ECT. I do not fully understand how it could ever possibly be reversible. I think I have made that point as strongly as I possibly can but, if the Liberal Democrats are going to move the amendment, I ask for some understanding of what definition—either legal or medical—is being used for paragraph (c).
I want to pick up on a few points made by my gallant and learned hon. Friend the Member for Solihull West and Shirley. He talked about people who, like many of us, have seen the benefits of assessments online. There could well be benefits from clause 19 for that. He also talked about how some people did not find that an appropriate way to have their assessment. My understanding is that if someone has a physical ailment, they might be pushed strongly down a route to have an online assessment for whatever reason, whether that be at a primary care setting or at a secondary care or acute setting, but that if they wanted to see a doctor—for example, a GP—physically to talk about their ailment, although it might take them a little bit of time, they had the right to do so. My concern about the clause is the suggestion that in certain circumstances, some patients would not have the right to a face-to-face assessment. The Minister talked about where things will be taken into account, where it is appropriate and where “it would be discouraged”. “Discouraged” is not the same as “it will not happen”. We need clarification, either within the Bill or very strongly in the code of conduct, so that a patient has the right to a face-to-face consultation. I would be very keen to hear the Minister’s thoughts on that.
Hear, hear!
As my hon. Friend the Member for Gordon and Buchan (Harriet Cross) made clear earlier, the ONS statistics are very clear: 109,000 fewer on payroll in May alone and 276,000 fewer since the autumn Budget. As UKHospitality points out, the NICs changes were “felt most intensely by foundational sectors like hospitality,” which “necessitates an urgent review”. My question to the Minister is simple: where will his red line sit? How many more jobs have to come off payroll before the Department for Business and Trade will stand up to the Treasury on this? Another 100,000? A million? Where is the line?
The Retail Jobs Alliance is very clear in its warning that the Government’s changes to business rates will “accelerate the decline of high streets, reducing footfall…and creating a cycle of economic downturn.” That letter was also signed by the Union of Shop, Distributive and Allied Workers—a Labour-affiliated trade union. Once again, the Minister and the Department for Business and Trade have a choice. Will they stand up for high street retailers, actual employers and even their own affiliated trade union, or will they just go along with Treasury diktat?
We support business rates reform, but when Labour’s own trade union says that its plan is not going to work, Ministers should really sit up and listen. Let me turn to another issue affecting our high streets: shoplifting—which continues to devastate many high street retailers. I see that in my own constituency in high streets in Princes Risborough, Wendover and Great Missenden. How is the Minister actively engaging with the Home Office, police and crime commissioners and police forces to move shoplifting up the agenda across the board, just as my home force of Thames Valley has done with its Disc scheme? Before he comes back with police numbers, let me tell him that there are more police in Thames Valley than ever before, let alone since 2010. Just talking the talk on numbers is not enough. What is he going to do proactively to make this issue go up the agenda?
The Government’s own projections showed that their vindictive education tax would drive 3,000 children out of private education. The latest data shows that the exodus is already 11,000, with projections saying it will get worse. May we have a debate in Government time to find out why the Government’s projections were so horrendously out, and the cost to the state sector of now having to educate those children?
Notwithstanding the Foreign Secretary’s commitment to the sovereignty clause, the question of sovereignty can only really be answered once we have the full detail of the treaty. That scrutiny is made poorer by the Government’s decision when they took office to abolish the European Scrutiny Committee, which did detailed work on this subject in the last Parliament. If I may tease out a further response, given the unique nature of Gibraltar airport, where the runway and aerodrome are owned by the Ministry of Defence and operated by the Royal Air Force, will a member of the British armed forces landing in Gibraltar have to prove their British identity to anyone in order to go to work?
We have been here before with Governments of all different political persuasions. Ministers come to the Dispatch Box and trumpet what seem like very attractive amounts of money for the NHS, but the reality on the ground is that that money just about covers pay rises and inflationary pressures. On care, Buckinghamshire council and no doubt all councils are worried that the money being offered up may only just cover things such as the fair pay agreement. Can the Minister confirm from the Dispatch Box that with increasing amounts of councils’ budgets rightly being spent on care, they will get funded for things such as the fair pay agreement separately from core social care spend?
I congratulate the right hon. Gentleman on his statement and his Committee’s report, which is welcome. The summary clearly says: “Britain’s economic institutions and markets—especially in public procurement, energy, skills” and, critically, “the diffusion of innovation and finance—must be modernised for new times.” In the spirit of the partnership he spoke of between the public sector and private sector, he will no doubt have been glued to the debate on the Sustainable Aviation Fuel Bill yesterday, when I pointed out that most of the Government’s advanced fuels funding is going on foreign-owned technologies. How does he think, and did his Committee consider, the way that the approach to Government grant schemes for innovation needs to change to ensure that we keep talent and innovation here at home?
What’s it called?
If the book that the hon. Member for Central Ayrshire (Alan Gemmell) has written is a political thriller about fighting for small business, I am sure it features five heroes on the Government Front Bench doing everything they can to promote small business. But readers will ask, “Who is the villain of the piece?” Is it not obvious that it is the Chancellor of the Exchequer, who is doing everything possible to undermine business, with 276,000 people having lost work since the autumn statement, and 109,000 in the month of May alone? When will the Ministers—the heroes of this story—fight against the Chancellor, who is getting so much so wrong?
T3. In the US trade agreement, the Prime Minister gave access to the UK market for 1.4 billion litres of US bioethanol. The Secretary of State will know that that is the entire size of the UK market. Yesterday, apprentices came here from Vivergo in my constituency. The hundreds of people directly employed there, and the thousands in the supply chain, wonder how this Government, on the verge of producing an industrial strategy, can want to abandon the nascent bioethanol industry in this country entirely. What will he do to stop that?
The hon. Member for North Herefordshire (Ellie Chowns) is absolutely right about social care. We have a system in which healthcare is dependent on social care—Lord Darzi says so, and I think even Ministers have said so—yet all funding is going into the NHS, not into social care. We are fundamentally pouring the money into a bucket with a hole in the bottom. The Minister pretends the exact opposite of the truth. Will she share a more honest assessment with the House? What went on? Labour had 14 years to think about it, and here we are with the funding going into the NHS. As the Father of the House, my right hon. Friend the Member for Gainsborough (Sir Edward Leigh), said, the Minister is following on from the last Conservative Government and pouring more and more money into an unreformed NHS with a social care system underneath it that is broken, and she is not doing anything about it.
I beg to move, That this House has considered the distribution of SEND funding. I am delighted to have secured this debate, as it gives us an opportunity to highlight the situation we are facing in England, where children with special educational needs and disabilities are being left behind due to the inherent regional inequality in the high-needs national funding formula. There is a bigger issue. The more typical thing we talk about is the overall quantum of spending based on overall need, but too little attention is given to the distribution of the funding that exists, whether in healthcare, education, policing or otherwise. I know I am not the only Member being turned to by constituents at their wits’ end, trying to navigate what feels to be a broken system; I thank colleagues across the House for their continued advocacy on behalf of some of the most vulnerable children in all our communities. My argument is a simple yet deeply important one: the current model of SEND funding is not only inconsistent but in too many cases profoundly unfair. It fails to account for genuine levels of need, the realities faced by families, and the systemic pressures that schools and local authorities are under. Unless that changes, we will continue to fail children who rely on Members to make their case and to get this right.
The hon. Gentleman takes me to a point further on in my speech, but he is absolutely right. He makes the case to the Minister, exactly as I intend to: given that we have a broken distribution system and given the severity of its impact on so many children and families, will she ensure that the money in the spending review is, as the hon. Gentleman rightly says, used precisely for that purpose and that we target those who are most left behind? At the heart of this debate, I am calling on the Government to identify and commit to a clear baseline cost for delivering effective SEND support per pupil. The figure must reflect what it genuinely takes, in both urban and rural settings, to support children with complex needs across the country. Only then can we ensure that no child’s opportunity is limited by where they live. I want to bring to the attention of the House a stark example that illustrates the postcode lottery in SEND funding: the disparity between the East Riding of Yorkshire, which covers my own constituency of Beverley and Holderness, at the lowest end of the funding spectrum—we are the lowest funded in the country—and the London borough of Camden, which happens to be the highest. Camden, by any standard, is a well-resourced inner-city borough with strong proximity to specialist services. It currently receives £3,564.95 of SEND funding for each pupil in its area. Meanwhile, in East Riding—a rural area with fewer nearby services, longer travel distances and greater challenges in recruitment and retention—per-pupil high-needs funding comes in at around £968. That is a gap of over £2,500 for every single child requiring extra support. In real terms, if East Riding’s funding was matched not with Camden but with the second most poorly funded local authority, we would have an extra £18 million per year on top of the £43 million we receive in the higher needs block—£18 million extra. If we were brought into line with Camden, we would have an extra £100 million. Some might argue that urban areas face different pressures, and of course they do, but let us be clear: the cost of delivering quality SEND provision in rural areas is not lower. In fact, it is often significantly higher. Transport costs—colleagues across the House will be aware of children who have to be moved great distances to access their support—for children with complex needs can be astronomical. Recruiting specialist staff, such as special educational needs co-ordinators, to work in isolated schools is a constant challenge. When services such as educational psychologists or speech and language therapists are not based locally, schools and families face unacceptable delays in accessing the assessments needed to unlock further support. Why, then, is rurality not factored into the high-needs funding formula? What that means in practice is that two children with identical needs, living in different parts of the country, will receive vastly different levels of support. One might have their education, health and care plan reviewed on time, access in-school provision, and benefit from local therapy services. The other might be left waiting months for assessment, with a school already at breaking point trying to bridge the gap. This disparity will have a long-term detriment to children’s outcomes. This is not a criticism of any local authority—Camden, like all areas, faces its own pressures and challenges—but the system we have allows such disparities to persist without sufficient recourse or flexibility. These widely varying funding allocations create a two-tiered system in what should be a national commitment. Colleagues from across the House will be familiar with constituents whose stories lay bare the human cost of this imbalance, whether it is parents desperately trying to navigate the EHCP system, the lack of suitable school places nearby to cope with the measures required by their EHCP, or schools struggling to cope. This is also certainly not a party political point. Successive Governments have sat over funding disparities and struggled with the politics. They have been unprepared to reallocate, perhaps for understandable reasons. The people you take money from tend to be much angrier than the people you give it to are happy: one marches on Westminster, the other grunts and says, “About time.” It is a truly difficult thing. I have been in this place for 20 years and have struggled to get Ministers to accept reallocation and reapportionment. Rather than asking for that demand, which I have so far failed in 20 years of effort to get anybody to implement, I hope to come up with something more practical, if compromised as a result.
My hon. Friend, the Opposition Deputy Chief Whip—and indeed my Whip—is very welcome. Thanks very much; I am grateful for that. We have this issue of how we fix a broken and clearly unfair system. Newer colleagues, and there are many of them in the House, might think, “Well, surely people would want to fix it. There is no perfect system and there will always be dispute, but if the Government did a map of need—fundamentally, an assessment of what fair would look like—and then mapped against that line where everyone was, newer Members might think, “The Government might be prepared to do something with those who are most overfunded to help compensate the underfunded.” My experience is that they do not and will not, so I will discuss practical ways of getting change. What typically happens is that despite Ministers’ talk in debates like this one, we end up with the Treasury at a spending occasion like yesterday giving 3%; if inflation is 2.5%, it gives 3% to everybody. That means that the cash gap between one authority and another grows, and in a sense the injustice grows with it.
The hon. Lady is two things: she is quite right, and she is tempting me down a path I do not want to go down—I want to focus on the distribution, because it does not get the attention. However, she is absolutely right. Labour criticises the performance of the then Conservative Government, but I think funding for SEND actually grew 60% from 2019 to 2024. She is right that it is not about who is in government—somehow, we need to find ways of capping this demand, which will outstrip any Chancellor, however well intentioned. That is an issue. I will turn back to the point on which I am focusing, which is distribution. If demand in a system is growing at a scale that no Government can meet, distribution, although ignored, becomes even more important. If a system is straining and struggling, having grossly unfair distribution that no one seeks to or is able to defend—it is not a case of one party or the other claiming they are getting it right; they recognise it is unjust—is a major mistake, and we must find ways to balance it over time. It is not obvious at the moment that anyone is able to stop this imbalance between supply, which is so small, and demand, which is so big. Colleagues will have local champions back home who do their best to fight against regional inequalities. I take this opportunity to pay tribute to Councillor Victoria Aitken in the East Riding, who is the portfolio holder responsible for SEND, and her role with the f40 group. For any newer Members present, the f40 group fights on the issues of and focuses on the funding formula disparities. It is technical and quite dull, but it is vital for the provision of services to our constituents. In her role with the f40 group, Victoria has been tireless in campaigning to address these issues within the SEND system, but sadly, the work of Victoria and others like her is not enough. I want to share the story of my constituent Ellie and her son Harry, who is nine and a half years old and has ADHD. From the very start of his education—as early as foundation stage—both Ellie and his teachers recognised that Harry needed extra support. However, without an EHCP in place, the help he required simply was not available, despite the school doing all that it could. Last summer, as Harry was preparing to enter year 4, Ellie contacted me in desperation. Harry was still only just beginning to read, and was spending his break times playing with children much younger than himself. Ellie had fought tirelessly to secure an assessment so that he could access one-to-one support, but the process was gruelling, and caseworkers were at capacity. Ellie had to give up her job to dedicate herself to the countless hours needed to complete forms, lodge appeals, chase responses and provide support at home. She put her own education on hold and, in her own words, has had to “battle the system” every step of the way. Just last week, after years of delay, Harry was finally granted an EHCP. However, the school still does not know when the funding will arrive to put the support, which has now been recognised, in place. Harry will start year 5 this September, several years behind his peers. Ellie describes Harry as a kind and lovely boy who has been failed—not by his school, but by a system that delays, deflects and denies the support that children like Harry need. Yet Ellie remains determined to keep fighting, no matter the cost to her or her family, to ensure that Harry gets the help he deserves.
The hon. Gentleman is right. There is a capacity issue, as I say, relating to demand. Getting people—not just specialists, but the whole system and everyone in it—to have a better understanding is really important. The hon. Gentleman will see that in his constituency, as I do in mine. It is not enough just to have the SENCO; it is about getting the leadership, the training and the right protocols in place to ensure that the whole system is better able to meet the needs of children, and that will then reduce some of the other impacts, including cost impacts, on the system. In recent weeks, I had the privilege of visiting Inmans primary school in Hedon, where staff spoke candidly about the mounting pressure created by soaring demand for SEND provision—pressures that far exceed the funding currently available. At St Mary’s school in Beverley, headteacher Laura Wallis expressed her deep concern at the growing gap between pupils’ needs and the resources she has at her disposal, making it ever-more difficult to provide the tailored support every child deserves.
I have to agree with the hon. Gentleman, who makes a powerful point. My appeal to colleagues in the Chamber—particularly, perhaps, to newer Members —is to focus on the distribution. It can be quite hard to get one’s head around the many issues that are involved—the overall national issues of quantum, service delivery, training and the rest of it—and distribution can easily get left behind, yet it is vital. I cannot say that it brings a great deal of joy or satisfaction to Members of Parliament to pursue it, because so many people look blank when it is mentioned, but distribution is important, and I hope that colleagues will want to take on the issue.
As usual, the hon. Gentleman hits the nail on the head. Many across this House will recognise the stories of the schools I have just mentioned, because the same thing is playing out in constituencies across the country. Parents are becoming de facto care co-ordinators; schools are dipping into ever-shrinking budgets to fund specialist provision; and local authorities are caught between legal responsibilities and budgetary reality.
The hon. Lady is absolutely right. I was chairing the Education Committee when the coalition Government introduced the reforms that brought in EHCPs as a replacement for statements. I remember thinking then that lots of good improvements were made—there were very sincere Ministers working hard at it, and they brought in a better system—but the fundamentals remained as they were. One of the aims was to get away from an adversarial, legalistic process, in which articulate and typically better-off people were able to use sharp elbows to get their child what they needed, but pity the inarticulate single mother unable to engage with the system. What would she get? The then Government’s promise was to make that better, but the fundamentals remained. If demand is so much bigger than supply, this is what we will get. With the best will in the world, local authorities will end up being defensive and saying no as a matter of course, and will give way only when they are forced to. Am I going on too long, Madam Deputy Speaker?
For years, I have fought for a fairer distribution of SEND funding, and for years, I have got nowhere, as successive Governments—Labour and Conservative—have lacked the courage to rebalance the system. I hope Labour will not lack that courage again. I do not pretend to have all the answers to this problem, but I know that we must work out what fairness looks like and the minimum per-pupil cost required for SEND support, and commit to meeting that basic need, if not immediately, then at least over time. This Government need to be prepared to take from those above the baseline and give to those below. Would they be prepared to do that? No previous Government have been, but perhaps this one will. If not, we must find some other way. We could identify, through a mapping exercise, those who have been left behind, and we could say as a matter of principle that whenever there is an above-inflation increase in the Budget—such as the £760 million that the Chancellor came up with in the spending review yesterday—it will always be used first and foremost to lift up those below the line, while doing nothing to cause a below-inflation increase for those who are above the line. Even if the Minister agrees with that idea, there will still be crisis management. How do we begin to tackle systemic inequality? Above all, it is vital that we revisit the high needs national funding formula, because it does not sufficiently account for regional cost differences, or for the genuine cost of delivering services in dispersed or under-served areas. The formula must reflect both complexity of need and the geography of the area in which that need arises. It needs to account for the added cost of providing services in rural areas. It is vital, too, that the formula moves away from the historical spend factor—the part of the formula that bases current funding on what a local authority spent on SEND provision in the 2018-19 financial year, and how it administratively described that spend. The formula means that a large section of funding is determined by pre-covid demand for SEND services, despite a post-pandemic spike. The Government have stated their intention to remove that factor, but progress has been painfully slow. Every year that we fail to act, we condemn another group of children with complex needs to struggling without the support that they deserve. The issue is not simply how much money is available; it is also how accessible and responsive the system is. Families are forced into adversarial processes, schools are burdened with bureaucracy, and children are too often treated as numbers on a spreadsheet, rather than individuals with potential. We need a system that is focused on early intervention, not crisis management. I am here not simply to raise a problem, but to call for action. That action would ensure a fairer, more transparent funding formula that reflects real-world costs across the country, accounting for rurality and discounting historical spend. It would establish a clear baseline per-pupil cost for delivering effective SEND support, and ensure that every local authority was brought up to that level—if not quickly, then at least over time. It would create better accountability mechanisms, so that areas that are underperforming on delivering SEND provision can be supported and, where necessary, challenged. At the very least, I ask that the Government recognise the injustice of the system and the inequality that it produces. Those are not radical asks; they are practical, deliverable reforms that would make a meaningful difference for my constituents in Beverley and Holderness—and, I believe and hope, across the rest of the country. We have a duty as parliamentarians to ensure that every child, regardless of background, diagnosis, or postcode, has the support that they need to thrive. The disparities in SEND funding undermine that duty. If we believe in a truly inclusive education system, we cannot continue to turn a blind eye to the structural inequities built into the funding model. We owe it to our constituents, our schools and, most importantly, the children to fix this.
Perhaps my question could go through the hon. Member to the Minister if he does not know the answer. The £740 million is very welcome, but as he says it is frontloaded in one year and then halves the following year, with no indication of where it is going thereafter. Although it may be a welcome short-term intervention, how is it part of a sustainable effort to improve SEN?
Will the Minister give way?
I am grateful to the Minister for giving way. She will be aware that the title of this debate, despite what it says on the screen, is “Distribution of SEND Funding”. I hope, therefore, that she will focus primarily on that particular technical point. The distribution of SEND funding across the country is, according to f40 and campaigners across the House, unfair, broken and needs to change. Is that the Government’s view and the Minister’s view? That is the first answer, and then we can turn to how it can best be fixed. The most important thing is to recognise whether it is broken or not. I feel it is unfair and broken, and I would like to hear the Minister say so, if she agrees.
I thank all colleagues for coming to the Chamber on this Thursday afternoon, because this issue is just so important. We have heard really interesting and reflective speeches from right across the House, as Members have sought to champion the children who probably most need help in our society, so it is right that we should be here. I thank the Minister for her response. I was slightly disappointed, because the title of this debate is “Distribution of SEND Funding”, and it is important to ask whether the distribution is right. Do the Government think that it is, or that it is not? I do not think that the system is defensible as it is, and it would be good to hear that said. Once one has recognised that the system is broken and unfair, the next question is: how shall we fix it? We did not get an answer to that, because we did not get an answer to the first question. The Minister’s response morphed into what we talk about generally, which is SEN overall, what the Government are doing, the £1 billion extra and all the other things, many of which are welcome, but the question underneath that is whether the distribution is right. If it is not, are we going to do something about it, while making these other changes? We did not get an answer to that. My appeal to the Minister—I think colleagues across the House will welcome this; I might even get a nod from some on the Government Benches—is to make sure that, in the White Paper, there is an opportunity to make the distribution fairer, if not immediately, then at least over time. We must recognise the problem and look to level up over time. That is not to penalise those who might be technically overfunded today, but to make sure that every child has a fairer and better chance of getting whatever we can best provide from the system. That is an important element of the overall discussion about SEND. We will doubtless hear more about this topic. The Minister did not seem absolutely clear whether EHCPs were here to stay. Resisting my own strictures on sticking to the subject of distribution, I will use the few seconds that I have left to talk about the EHCP system. When a child gets an EHCP, they get a better outcome. Perhaps that is driving parents to push their children to get one, and that may be contributing to the financial unsustainability of the system that we have today. It would be enormously controversial to look to remove it. At the moment we have a system that from 2019 to 2024 was increased by 60%. The Government are putting in another £1 billion, and another £760 million was announced yesterday, and that is welcome, but if we do not find a way of stabilising the system, we will still have those who are sharp-elbowed getting something for their kids and those who are not losing out. That is not a system that anyone across the House should be satisfied with. Question put and agreed to. Resolved, That this House has considered the distribution of SEND funding.
Yesterday, yet again, we saw the Chancellor do what the Labour party always does: default to high spending, more borrowing and higher taxes, leaving the public finances vulnerable. The Minister has spoken of additional funding for the NHS. To use the same comparison as the NHS England chief executive, the NHS budget will now be roughly the equivalent of the entire GDP of Portugal, yet we are still none the wiser as to how the Government actually intend to use most of the money—there is no real detail and no real plan. Just last September, the Prime Minister pledged that there would be no more money without reform. Despite the Minister’s words, that is exactly what the Government have done. There is still no plan for reform, and the Secretary of State is unwilling to set out the bold reforms that are needed. Despite 14 years in opposition and nearly one year in government, the Labour party has failed to come up with a plan for the NHS, with the exception of the abolition of NHS England, which will not happen for years and appears to be delayed and in chaos. Ministers respond to every written parliamentary question about it by saying they cannot set out the savings, how the people will change or how the structure will change at this stage—yet again, there is still no plan. We have been very clear that where the Government are wrong, we will oppose it, but where they get something right, we will work constructively with them. That includes reform, but there is still no reform for us even to consider supporting. Can the Minister tell us where the £29 billion she set out will be spent? The chief executive of the NHS Confederation said yesterday that increases in NHS staff pay will “account for a large proportion” of the funding increase. The former NHS chief financial officer echoed that view at the Health and Social Care Committee in January, saying that pretty much all the last tranche of additional spending was absorbed by pay rises, national insurance and inflation. Can the Minister confirm how much the pay offers from the independent pay review bodies, alongside increased national insurance, will cost, how much of this funding will have to go to cover that and how much will actually make it to the frontline to improve patient services? The Minister touched on the aim of meeting the NHS 18-week target for hospital waiting times within this Parliament. Of course, we wish the Government well in achieving that and hope they succeed, but just yesterday The Times reported that internal departmental modelling showed they are not on track and could only come close to meeting the target with “implausible” and “over-optimistic” assumptions. The independent Institute for Fiscal Studies agreed. Can the Minister set out how the Government will meet that target? Again, where is the plan? We need a plan, not empty rhetoric. It is clear that the NHS needs reforms, not just more funding, so when will the 10-year plan finally be published? Will it be before the one-year anniversary of the Labour party being in government? Will it be like their elective reform plan: simply a reheat of the plan that Sajid Javid brought forward in 2022, with nothing new? The Secretary of State needs to be more ambitious—words that I suspect will never be echoed by the Prime Minister or his team in No. 10. The capital budget remains broadly flat in real terms from this year onwards. The Minister has said she wishes to continue with the new hospitals programme and invest in technology to boost productivity, but it is unclear how that can be achieved with this settlement. These are not my warnings but those of respected independent think-tanks, including the Nuffield Trust and the King’s Fund. The Chancellor’s plan is clear—indeed, not one Treasury Minister has ruled it out: more tax rises are coming. Finally, and importantly, we have seen social care largely neglected again by this Government. There were just two sentences about it in a four-page statement. Social care deserves better. The Minister knows very well that we cannot improve the NHS without social care working well. Earlier today I met with social care providers. They want to see reform, yet the Government have apparently abandoned cross-party talks on social care reform for an independent commission led by the very able Baroness Casey, who is still doing her Home Office work on grooming gangs and is yet to be full time on this commission, which has a deeply unambitious finishing time of 2028. When will Baroness Casey be full time on the commission? These providers were clear that they want a seat at the table when better care funds are distributed by the NHS—they want to have their voices heard in decision making on that funding. Will the Minister agree to that? Finally, the Chief Secretary to the Treasury said he has modelled his assumptions on continued trends in local government finance and local government precepts —in other words, a 5% uplift in the precept. However, a large number of counties are now controlled by Reform—whose Members are, as ever, notably absent from the Chamber when we talk about health and social care—who have pledged no tax rises whatsoever in their councils. If they do that, what is the Minister’s plan to make sure social care is funded? As ever, the Government have gone for the headline announcement, but sadly without a plan, without delivery and with no real reform to benefit patients.
I congratulate the hon. Member for West Ham and Beckton (James Asser) on his speech and on securing this important debate. The vast majority of contributions today have been measured, thoughtful and non-political, and I think they have done this House proud. It is right that we remember, reflect and learn. It is the least we owe those who lost loved ones during the pandemic. As someone who during the pandemic was doing the job of the Minister, I recall it incredibly well, as will so many in this House and outside it. The hon. Gentleman said—I know what he meant—that with the passage of five years, sometimes what happened then can feel a bit like a dream. It is something that still catches me in mine at night. I often wake with a jolt, suddenly remembering vividly something that took place then—something that we did or had to do, or a particular moment as a Minister. I suspect that that is true of many up and down this country in many different walks of life, particularly those who were on the frontline.
That is important, because people up and down this country still live with the impacts of the pandemic through long covid and mental health challenges. We see that huge impact still today on individuals and the NHS. We must remember how the country came together in the face of unprecedented events, about which we learned more every day. We had to adapt our approach to that changing knowledge. I am grateful to all Members from all parts of this Chamber for what they did. A few Members in the Chamber were in the House at the time, and they will remember the work of Jon Ashworth, which I recognise in particular. He was in this place at that time, and I remember his cross-party approach to so much that was done. I pay tribute to the emergency services, to councillors and to the people of this country, particularly those who worked in health and social care and those who lost someone. It was a traumatic time for the whole country. There are lessons that must be learned about planning for future pandemics and supporting those with long covid. The hon. Member for Honiton and Sidmouth (Richard Foord) was right—like so many, I have constituents who lost loved ones and family members who were affected by the vaccine, as has been recognised by a coroner. They have been dignified and courteous, but they call for the Government to review the vaccine damage payment scheme. I hope that the Minister will take that suggestion in the spirit in which it is intended. We owe it to this country to make sure that we are better prepared for any future pandemic. We owe it to those who lost loved ones and those who suffered in so many different ways: those with long covid, those with mental ill health, kids who were unable to attend school, domestic abuse sufferers and those who still suffer today. It is right that we remember, reflect and debate, as we do now, in order to learn. As a former Health Minister, I have memories that continue to surface. We will all of us live with our memories of that time till the end of our days. The least we can do is to ensure that this House and this country always remember and reflect carefully on what we can do better next time.
My hon. Friend is making a powerful point about some of the challenges around the interpretation of the Bill. Does he agree that there needs to be a clear plan for the training of professionals so that there is consistency across the board?
It is a pleasure to serve under your chairmanship, Mr Vickers. I rise to speak briefly to clause 7, which in many ways is a tidying up of the other changes in the Bill to ensure alignment. In that sense, it is a necessary part of this legislation. For too long, mental health tribunals, which have an important function, have been operating under criteria that are too broad. As my hon. Friend the Member for Hinckley and Bosworth pointed out, that can lead to inconsistencies with modern clinical practice. It is therefore right that we move to clearer, more risk-based criteria to ensure that detention is maintained only where absolutely necessary. There are obvious reasons behind that, such as to ensure greater consistency in tribunal decision making and strong safeguards to ensure that patients are only detained or kept under community treatment orders when absolutely necessary. I want to pick up some of the arguments my hon. Friend the Member for Hinckley and Bosworth was developing around the demands on the tribunal service. The Minister will be well aware of the challenges facing the court and tribunal system in this country. If, as anticipated, this will lead to an increase in the number of hearings—both in first instance and potentially in appeal—what assessment has been made as to the number of not only judges, but wing members that will be required to facilitate this process? What has been determined regarding the capacity of the resources of His Majesty’s Courts and Tribunals Service—in terms of not only physical hard standing, but the vital role that clerks and tribunal staff play in ensuring that hearings are done in a timely manner and the paperwork is completed consistently? Thirdly, what is the expectation of the sustainability of that workload as the Bill comes into fruition? I pick up on that in particular, because, given the transition arrangements that appear to be within the legislation, this will be a retrospective as well as a prospective change. I would be grateful if the Minister in summing up could address those issues.
I rise to address three broad points on clause 19. I entirely understand where this is coming from—it is to improve accessibility, efficiency and flexibility in delivering assessments. It reflects the broader observations from the independent review and aligns with the NHS digital transformation goals. However, I have three specific concerns. My first concern is about the risks around the assessment quality. I suspect we have all experienced virtual meetings or consultations with clinicians. Subtle cues can often be missed in a virtual hearing, particularly when it is on the sensitive issues we are dealing with in the Bill. I am concerned that we will miss those subtle signs that doctors would pick up on in a face-to-face assessment; they can easily be lost through the medium of a virtual assessment. My second concern is about the consistency in clinical judgment of when to use these virtual assessments. I suspect we all have experience through constituency or personal work of general practitioners who, since the covid-19 pandemic, have moved to more online and virtual assessments. Some patients enjoy that and like the flexibility; others would rather see a clinician face to face, but are not always offered that option. We must ensure a consistent approach to these assessments across the country. My third concern is about digital exclusion. The assumption is that individuals will be able to access this readily and be comfortable with the technology. Many will be able to, but a significant number will struggle with it. We must ensure that those individuals are not forced down a route of having a virtual appointment or assessment, when that would not allow them the satisfaction of the consultation they sought. It is important that patients are put at the front and centre, and that any change to the assessment process is made with them in mind.
It is a pleasure to be here on day two in Committee. I will first address clause 5 and then the Government amendments. The clause marks significant reform to the legal foundations of mental health detention in this country. At its core, the clause seeks to update the grounds for detaining individuals under the Mental Health Act. It will amend several critical sections—sections 2, 3, 5, 20 and 145—to ensure that detention is used only when absolutely necessary and in line with the principle of least restriction, which was put forward in the Wessely review and is now in the Bill. Let me outline what the changes will do in practical terms, as the Opposition see it. Under section 2 of the Mental Health Act, “Admission for assessment”, detention will now be justified only if “serious harm” may occur to the “health or safety” of patients or others. The decision must weigh the “nature, degree and likelihood” of that harm, a much more structured and risk-based framework than previously existed. Under section 3, “Admission for treatment”, we will see a clearer threshold. Detention will be permitted only if “serious harm” may occur without treatment, if the treatment is necessary, if the treatment cannot be provided unless the individual is detained and, crucially, if appropriate treatment is available. Section 5(4), on emergency hospital detention, will be updated to align with the same “serious harm” test, recognising that even urgent situations demand clear legal justification. Section 20, which governs the renewal of detention process, will be brought in line with the same standards, such that they apply not just once but every time detention is extended. That is an important safeguard. A statutory definition of “authorised person”, those empowered to detain, will be introduced in section 145, ensuring that such persons are appropriately trained and regulated. Those changes respond to real and long-standing concerns. The 2018 independent review of the Mental Health Act warned that our current criteria are too broad and that they allow for detention that is often unnecessary, sometimes prolonged and, in too many cases, distressing for patients and families. Clause 5 seeks to change that by grounding detentions in a clear, evidence-based assessment of risk and necessity. The clause has significant advantages. It will introduce stronger safeguards against inappropriate detention and will shift the focus away from diagnosis alone and towards the actual risk of serious harm. It will offer greater clarity for professionals, giving them structured criteria for making decisions that are ethically and legally sound. It will enhance patients’ rights by aligning the law more closely with the principles of autonomy and proportionate care. However, with every reform there are challenges, and we must not ignore them. The terms “serious harm” and “likelihood”, although essential, remain open to interpretation. We must ensure that the forthcoming code of practice offers clear, detailed guidance that minimises subjectivity and inconsistency in their application. Furthermore, there is a question mark over public safety, which the Minister seemed to point to but which I want to explore a bit further. We have not tabled an amendment, but I am keen to understand how this works. Given that the definition is potentially ambiguous and in practice quite difficult to judge, has the Minister considered inserting the words “cumulative” or “escalating”? To be clear, this is a call not to water down those safeguards, but to shore them up with a safety net, so that this reform does not inadvertently trade off liberty against safety, especially in communities. We need to ensure that we are not inadvertently introducing a real risk that someone, particularly someone on the margins of eligibility, may fall through the cracks. There are individuals whose behaviour is escalating and whose pattern of deterioration is known to services, but who do not yet meet the “serious harm” threshold at the time of assessment. I have seen this at first hand as a clinician—a picture that goes round and round. These are some of the most complex situations that one will ever have to deal with in one’s clinical career. The words “escalating” or “cumulative” may help to give further clarification to clinicians on the frontline. For those on the margins, what consideration have the Government given to the notion of a duty for professionals to produce a risk management plan in any case in which detention is considered but not authorised, so that we do not simply assess and walk away, but assess and act in a community setting? That would not lower the threshold, but contextualise it. It would ensure that detention remains a measure of last resort, but not too late a resort.
My hon. Friend is spot on about training. It is one thing to enshrine these measures in primary legislation; it is another thing to have the training and interpretation that go with them. One of the reasons that we have not tabled an amendment on the matter, as yet, is that there could be some concerns about what “cumulative” or “escalating” behaviour looks like. Ask any clinician and they will say that they have seen patients who are on the borderline and are struggling. It can be unclear whether they are within or outside the definition; they could be wavering between the two, given the state of their mental health. That is a real concern, but the broader pattern of identifying the picture of what is happening could be helpful and important. One way to address the issue would be to review the data and legislation. Would the Government consider carrying out a review two years after the implementation of the Bill, specifically to look at the working of the legislation through the lens of public safety? I hope that there will be no concerns, but that would provide a backstop and a legal safety net. We do not want to wait another 40 years if there are changes that need to be made.
My hon. Friend makes an incredibly important point. We heard on day one how these services interact, and that is completely correct. We need to look through the lens of public safety, because while we are quite rightly enshrining the autonomous nature of the patient as an individual, there is also the question of what we look at as a society. It includes the likes of local councils, mental health care and NHS care. Schooling could also be involved, as well as the judiciary and the Home Office. I think it is reasonable to ask the Government to look at that, in the light of recent high-profile cases, and say, “What are we doing? Does the legislation really do what we think it does?” Clause 5 is a good step forward, but we must make sure that it is fit for purpose and that we have a review mechanism in place. I do not think that it necessarily needs to be in statute yet, but it will be interesting to hear the Minister’s response. Conducting a review on such a change, through the lens of patient safety, would be very useful. There is also the matter of resources, which we keep coming back to. Change in detention criteria will rightly push us towards community-based alternatives—that is the whole point of what we are doing—but unless those alternatives are properly resourced with staffing, crisis services, housing and follow-up care, we will risk replacing one form of system failure with another. I appreciate that the Secretary of State is committed to reporting each year to the House, but will the Government publish a timetable and framework to support the implementation? As we heard from my hon. Friend the Member for Solihull West and Shirley, training is also critical. Professionals need the tools and time to learn the framework. They need support, implemented in real time, often under pressure and in complex, high- stakes circumstances. Clause 5 is a welcome and thoughtful step in modernising mental health law. It will strengthens patients’ rights, sharpen clinical practice and bring us closer to a system that balances safety, liberty and humanity. However, we must be mindful about the risk of delayed intervention. In borderline cases in which the threshold is not clearly met but concerns remain high, we must ensure that there is still a route to timely, compassionate support. Otherwise, we may swing the pendulum too far in the opposite direction, from the overuse of detention to the underuse of care. On Second Reading, I said: “There is little greater moral burden than deciding for someone who cannot decide for themselves where care ends and control begins.” Clause 5 typifies that burden: we are deciding who should be detained and why. I said: “Make no mistake, this is what this House is grappling with”, and indeed it is what our Committee is now looking at in detail. I also said: “Involuntary care should never be the first instinct or answer, but a resort to prevent harm to both the individual and those around them.” I said that compassionate care demands precision not only in its delivery, but in its design. I concluded: “Without precision, we simply have sentiment.” I promised then, as I promise now, that “we will endeavour to ensure that the Government’s sentiment becomes a commitment.”—[Official Report, 19 May 2025; Vol. 767, c. 850-851.] That neatly sets the scene for discussing Government amendments 26 to 29.
My hon. Friend makes an important and poignant point. The Government have rightly stated that this change could take up to 10 years to implement, but we need to ensure that the most important safeguards are set out. Elsewhere, the Government have suggested that they will be in the code of practice. When we were discussing section 5 of the Mental Health Act and other issues, I said to the Minister that we need a constructive timetable, not only to know what the roll-out will look like but so that we can consult with the professions and ensure that they are able to deal with it. Later, we will again discuss the interface between the Mental Capacity Act 2005 and the changes that bring in new tests. That will be really important. We will also discuss the change of statutory safeguards for electroconvulsive therapy and changes to the statutory safeguards around who the second clinician will be—there is quite a feast of movements through this legislation. Make no mistake: that is what the country wants, but the Government must clearly set out some rationale for the timetable. Unfortunately, the Opposition’s proposal for a costed plan was defeated. We wanted to set out some kind of concrete timetable over 18 months to ensure that we do not slip back, and to give the Government the flexibility to make the necessary cultural and legal changes. I hope that that addresses some of my hon. Friend’s concerns, but he was right to put that point to the Minister. I oppose Government amendments 26 to 29, which would remove the reference to detention “by a constable or other authorised person”, and to delete the proposed definition of “authorised person”. I support the argument advanced powerfully in the other place by Baroness May, whose experience as a former Home Secretary gives her deep insight into the interaction between policing and mental health. Of course, it was under her premiership that the entirety of this discussion was progressed. I thank her for everything she has done, although I am not quite so thankful for the workload that it has created for me in my evenings and weekends. Her central message was clear: we must stop treating mental health as a policing issue and start delivering the right care from the right person in the right place. I wholeheartedly agree, as I am sure the Committee does. I understand what the Government are trying to achieve. On the face of it, the amendments are technical. They seek to ensure that detention under the Bill is solely based on necessity where there is a risk of serious harm or the need for urgent treatment, and that it is not tied to who is doing the detaining. On paper that sounds reasonable, but in practice those changes will remove vital clarity and will risk baking in a system that has already failed too many people in mental health crisis. Let us look at the problem with removing “authorised person”. The Bill, as amended in the Lords, wisely recognises the need to broaden the group of people who can respond to mental health incidents so that they include not just police officers, but trained and equipped professionals, mental health nurses, paramedics and approved mental practitioners—people who are qualified to care, not just to detain. The definition of “authorised person” in clause 5(7) ensures that only those with training competence and safety considerations are empowered to act, so it provides a framework for accountability, not a free-for-all. By removing the framework, the Government amendment would create a legal vacuum: it tells us that someone must be detained, but not by whom. In doing so, it would leave NHS trusts, police forces and local authorities with a lack of legal guidance and with a risk-averse default to the police. I think we agree that the police should not be the first responders. As Baroness May has reminded us, and as many officers have told me, the police are routinely called out to mental health incidents, not because they are best placed to respond but because there is no one else available or authorised. That is neither fair to the police nor fair to the individuals in crisis. A police uniform can escalate distress. A custody cell is not a place of recovery. An officer guarding a patient in accident and emergency for 29 hours, as the Metropolitan police have reported, helps no one—not the patient, not the police and not the public. The 2019 College of Policing snapshot found that 95% of mental health-related calls did not require a police response. That is staggering. It underlines why we must build up the capacity and legal authority of clinical professionals, not erase them from the statute. I turn to the Government’s argument and why it falls short. The Government’s case is that removing the phrase “by a constable or other authorised person” will de-emphasise the police and make the law more flexible. Ironically, however, removing the clarity about who may act risks re-entrenching police dominance in these scenarios, simply because no one else will feel legally empowered to intervene. The Government argue that the definition is unnecessary or potentially restrictive, but I say the opposite: a well-drafted enabling definition gives confidence, clarity and a lawful mandate for healthcare-led responses. This is not about excluding the police altogether. There will always be situations in which an immediate threat to life or serious violence requires a police presence, but that should be the exception, not the structure around which our mental health law is designed.