Showing every spoken contribution, including 5,779 under 12 words. Hide short remarks

1. 10 Jun 2025·Parliament·Dr Neil Shastri-Hurst

   Mental Health Bill [ Lords ] (First sitting)

   I have a certain degree of sympathy for the amendments, but I am sure the hon. Lady will recognise that patients and their families often find the review process overwhelming in and of itself. Bringing it forward to six months, when such reviews would often not be required, can cause a huge amount of stress and place pressure on those family units and patients. Of course, reviews can be brought forward when clinical need requires it. To stipulate that within the legislation puts an enormous burden upon those families and, most importantly, the patients.

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2. 10 Jun 2025·Parliament·Dr Neil Shastri-Hurst

   Mental Health Bill [ Lords ] (First sitting)

   Will the hon. Lady give way?

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3. 10 Jun 2025·Parliament·Dr Neil Shastri-Hurst

   Mental Health Bill [ Lords ] (First sitting)

   Does my hon. Friend share my concerns that not resolving housing and accommodation at the point of discharge could lead to a delay in transition? Patients would remain in hospital for longer than might be beneficial to them.

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4. 10 Jun 2025·Parliament·Dr Neil Shastri-Hurst

   Mental Health Bill [ Lords ] (First sitting)

   Not quite: Solihull.

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5. 10 Jun 2025·Parliament·Dr Neil Shastri-Hurst

   Mental Health Bill [ Lords ] (First sitting)

   Does my hon. Friend agree that there is a risk that the amendment would not only increase the workload of practitioners, but divert attention from patient care?

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6. 10 Jun 2025·Parliament·Dr Luke Evans

   Mental Health Bill [ Lords ] (Second sitting)

   The Minister makes a fair point about best practice. However, did the Government consider any mechanism for how best to share best practice across areas? Especially as the Bill also covers Wales, as heard this morning, it might be useful—across the integrated care boards—to understand the Government’s thinking on how to ensure that best practice in exemplar places, where care is really good, can be shared to help places where care might not be so good.

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7. 10 Jun 2025·Parliament·Dr Luke Evans

   Mental Health Bill [ Lords ] (Second sitting)

   The Minister makes a good point about the differences in the country, one of which is how the Care Quality Commission looks at the standards. Especially as the CQC is under new leadership, will it be taking a role in looking at how best practice is implemented while ensuring standards?

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8. 10 Jun 2025·Parliament·Dr Luke Evans

   Mental Health Bill [ Lords ] (Second sitting)

   The Minister is right about the absolute nature of the Liberal Democrat amendment, but we talked about the duty to respond requiring a body to set out why it has decided to take action or not. The Minister seemed to allude to that, but he then jumped to talking about being challenged in court. Is there a hybrid version within that duty to respond so that it could stipulate the setting out of why the body is accepting the recommendations or not, because that may well help transparency?

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9. 10 Jun 2025·Parliament·Dr Luke Evans

   Mental Health Bill [ Lords ] (Second sitting)

   The hon. Member is correct to establish the evidence base and the guidance. Broadly, we need to balance that with the logistics and the impact on the clinician, the patient and the resources. Move too far one way and it becomes a tick-box exercise or more resource-heavy; move too far the other way and the safeguards that we are trying to implement are lost or watered down. When I look at the amendments, that is the balance I am trying to understand; if the guidelines are written with that in mind, that makes sense. The job of this House is to scrutinise the numbers and decide whether we agree that they are right, or whether we should push a bit harder—whether we should tighten the safeguards or relax them a little to allow clinicians more freedom of choice. I guess that is the purpose of the Bill—getting the right boundary between the safety of the individual patient, support for the wider public, and making sure that clinicians have the freedom to make their judgment so that we are not stepping on expert opinion or, worse, creating bureaucratic processes. I hope the hon. Member understands that is why we are probing further on the rationale.

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10. 10 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Second sitting)

    The hon. Gentleman makes a pertinent point about the pressure on CAMHS. In Leicestershire, about 45% of CAMHS referrals are for things like autism and ADHD, and the problem is that it takes a lot of services away from those who have eating disorders or depression, or who self-harm. Does he believe there is scope to reorganise services to make sure they are appropriate where there needs to be treatment? A child suffering with severe anxiety and self-harming tendencies should not be on a pathway with someone who has autism, for example. Has he given any thought to how this Bill might be a way of opening that door?

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11. 10 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Second sitting)

    We have certain registers of carers, for example in primary care. There is a stipulation about moving towards veterans being included. Who does the hon. Gentleman think might hold the register, in the light of his amendment?

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12. 10 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Second sitting)

    I rise to speak to Liberal Democrat amendments 8, 47 and 9 to clause 4, which seek to expand the scope of the at-risk register, define risk factors and protect children and young people from unnecessary detention under the Mental Health Act. Let me start by acknowledging the intent behind the proposals. There is genuine merit in ensuring that those who are at risk of detention, particularly children, are visible to the system before crisis point. That view is shared on both sides of the House. I also share the concern that we are too often intervening too late, after a child or young person has already reached breaking point; I would add families to that, because they also bear a lot of the brunt, especially when it comes to waiting. By extension, when there are waiting lists, as the hon. Member for Winchester mentioned, the clinicians themselves—often the GP—will struggle to deal with patients and families when they do not have the clinical expertise necessary for the most severe interventions. Amendment 9, which would include all under-18s at risk of detention on the register, reflects that preventive ambition. Likewise, the proposed list of risk factors, including bereavement, homelessness and domestic abuse, rightly recognises the social determinants of mental ill health, which are all too often overlooked. However, I have some reservations about the proposals in their current form. First, on the register for all under-18s, expanding the duty so broadly raises serious questions about safeguarding, data protection and deliverability. Children and young people are already subject to multiple overlapping systems, from social care to CAMHS and education, health and care plans. Before laying on a new national register, we should ask what safeguards will be in place, who will manage the data, and how it will integrate with existing responsibilities such as those under the Children Act 1989 and the special educational needs frameworks. Secondly, although I agree that we must understand the drivers of detention, the list of mandatory risk factors, including miscarriage, bereavement and even armed conflict—all of which are profoundly serious—could widen the scope of the register so far that it loses operational focus, as we have heard. That is why the Opposition have tabled a later amendment to define it as childhood trauma instead, which is a more encompassing way of dealing with it. Also, we risk casting the net too wide without necessarily improving outcomes for targeting the right support or, conversely, missing something. For example, looking at that list, I would argue that gang violence or gang involvement is a key factor that Members on both sides of the House would agree is very pertinent, and yet it is not mentioned. Therein lies a problem. Thirdly, amendment 9 seeks to prevent the detention of children and young people unless it is absolutely necessary, which is a principle that I wholeheartedly support, but how do the Lib Dems propose that it be enforced? What levers are in place if a service fails to deliver that community-based service? Without resourcing CAMHS, investing in crisis alternatives and reforming commissioning models, the duty risks being symbolic rather than systemic. In essence, the hon. Member for Winchester is trying to make the point that we should have these discussions. Although I support the goals of the amendments—visibility, prevention and early support—I am not sure that the specific mechanisms in them are the best way to safeguard achieving them. Instead, I wonder whether consideration has been given to piloting regional early intervention panels for under-18s at risk of admission, building on existing safeguards in educational frameworks, rather than creating separate registers. Alternatively, we could include risk indicators in statutory guidance, rather than setting them rigidly in legislation, which I think was the point made by the Government. That would allow some clinical judgment and flexibility. Above all, we must ensure that ICBs are not just given duties, but held to account. How are they are going to deliver them? That means having the right metrics and oversight and a strong role for advocacy and families.

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13. 10 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Second sitting)

    I entirely agree with the hon. Lady’s end point and with the thrust of what she says. Causality is not causation, and we need to be very careful. When we get to the later clauses of the Bill, that will be at the forefront of our discussion. We cannot deny the reason we are having this legislative debate in the first place: the observation that black men in particular are subject to community treatment orders far more than any other group in the country. However, we must not make a lazy causal analysis and say, “Well, just because that is the case.” For example, black men have a higher risk of prostate cancer, and white people a higher chance of coeliac disease, because of the genetic basis. Is there something in that? Is there systemic bias by clinicians, as she hinted? That all needs to be explored. The hon. Member for Shipley beat me to the punch when it comes to my closing statement. We owe it to our children and young people not to legislate in haste, so I welcome the spirit of the amendments, and I welcome the debate, but we must be careful to ensure that we are truly legislating for and defining exactly what we know. Otherwise, we risk creating other inequalities and unintended consequences or, worse still, a system that becomes even more flabby and difficult to manoeuvre through. That is the last thing we want for our patients, clinicians and the public.

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14. 10 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Second sitting)

    Does my hon. Friend share my opinion that it makes sense to agree with the Government? The impact of social media and the evidence coming out about using mobile phones and about the impact of certain sites have been debated in this House for the last five years—since I have been here—and there have been advances. Legislation has been brought forward, but there is a growing consensus on both sides of the House that it never quite keeps up. Allowing the Secretary of State to add risk factors as they come up, even in policy guidance, might be a shrewder way to future-proof the Bill against those difficulties. In 1983, we were not discussing or even thinking about the likes of Facebook, yet here we are. With the advent of artificial intelligence, who knows where we will be in another 40 years?

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15. 10 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Second sitting)

    The Minister is right about the registers, but I did notice that the Children’s Wellbeing and Schools Bill introduced the unique identifier number. That came about after the Lord Laming report into Victoria Climbié, who was “lost in the system.” It also builds on the work of the Children’s Commissioner, which found that around 10,000 children are not in school. Is there a role for getting some of the identifiers that we are looking at here in place along with that unique identifier number? Equally, how does that unique identifier input into the Bill’s provisions on risk registers, now that that piece of legislation has passed Third Reading? There will be an interaction, but the unique identifier is much broader and the dynamic support register is held slightly differently. What work have the Government done to ensure that there is bridging and understanding about what that would look like, not only in the short term but in the long term?

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16. 10 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Second sitting)

    Let me take the example of a young person with deteriorating or fluctuating problems. They may be in school or out of school. We know that people with autism and learning disabilities are at greater risk of abuse and of being taken advantage of. If the Minister is not aware of it, would he look at how this duality could work, because clearly there is scope? One benefit that the Government argued for in having this unique number was that it could be shared across these registers. It sounds as if there is work that could be done. The Minister is absolutely right, and I am not suggesting merging the two, but on the risk register, there could be a nice piece of crossover work to pull that all together, so that the information moves across agencies. What we know from people with severe learning disabilities, autism and mental health issues is that they are often in contact with multiple agencies at multiple times—from social services to, potentially, the police, the NHS, dentistry and, of course, educational settings, which might be multiplicitous. Is that a consideration that the Minister will take forward?

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17. 10 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Second sitting)

    I will direct my remarks at new clause 11 and the amendments spoken to by the hon. Member for Guildford. New clause 11 seeks a clear, costed and consultative plan to help ensure that integrated care boards and local authorities are properly equipped to deliver the community-based services that individuals with learning disabilities and autism need and, of course, deserve, so that they are not unnecessarily detained under part 2 of the Mental Health Act. Let me begin by recognising the good intentions across the House when it comes to reducing inappropriate and prolonged detentions in mental health settings. There is broad consensus that detention should be the last resort. However, good intentions must be matched by a concrete, deliverable plan because, as the evidence has shown, too many people are being held in hospitals or other facilities, not because of clinical need, but because the right community support simply is not there.

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18. 10 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Second sitting)

    Far be it from me to tell the Minister what to do, but if I were a wise Minister, I might look at where my predecessors had benefitted from further information and where they may have stumbled. The Bill has been looked at for a number of years by many people from outside and inside the House. Many have been involved throughout its progress, including a former Prime Minister, who tabled amendments in the other place. There is definitely the ability to learn from what the last Government found and to use that information in the kinds of plans that we need.

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19. 10 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Second sitting)

    I shall be interested to know what the hon. Lady’s rose-tinted spectacles show when we consider Scotland or Wales. One of my biggest frustrations in debates about the NHS is that in each nation health is devolved, each is run by a different political party, and each has challenges. We in this place enjoy the political football, scoring points without seeing what is blindingly obvious: that across the board, across all the countries, health and mental health services are struggling to keep pace and keep our population healthy with the workforce and technology provided.

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20. 10 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Second sitting)

    Let me address these points, then I will be happy to give way. When we come to clause stand part, I will address the other amendments, but I specifically said that my comments would be on new clause 11. When scrutinising the Bill, it is important that we talk about how we will deliver, as the hon. Member for Shipley rightly pointed out. It is entirely right to try to put together a plan to ensure that the Government are held accountable. We are not saying how the plan should be formulated; we simply stipulate that a plan should be formulated and introduced. That is a very different argument. My concern about previous Lib Dem amendments was that they were too specific. We have to get the balance right. New clause 11 simply provides that the Government have 18 months to introduce a fully costed plan, so that we can again have a debate in this House. Especially as a spending review will, I believe, be announced tomorrow, we need to consider how we will match budgets in the future. We accept that it is a 10-year project.

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21. 10 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Second sitting)

    I am still addressing the hon. Lady’s first point. The Conservatives understand that it will take a long time to put in place, but a credible plan is needed. There was a credible plan in place, as I have said, in the 2011 and 2016 strategies, with the funding to match. I use that as an illustration because it is provides an apt evidence base for the new clause. Otherwise, I might well be challenged by someone saying, “What is your evidence base of a delivery network and a delivery ability from a Government?” I hope that by talking through these points, I am giving the Government the chance to learn from the mistakes we made and from the way we took forward mental health. Regardless of political party, I hope hon. Members that the debate has moved on a long way from when we started in 2010 with the work done partly under the coalition Government. I will now take the intervention.

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22. 10 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Second sitting)

    There is quite a lot to unpack in the hon. Lady’s intervention. As I pointed out, reflecting on what the previous Government learned is also important—for example, when considering Wales. Objectively, the data shows that Wales is struggling more than England, and the same is true of Scotland. Wales and Scotland have been run by different parties from England for a long time, so my natural inclination is to attack back and say, “Well, actually, the Conservatives did better,” but my fundamental point is that we all need to do better because we have seen the problems rising. As I mentioned, over the last 10 years the number of people turning up in mental health facilities has increased by a quarter. On the hon. Lady’s point about people with autism and learning disabilities, I sat on the Health and Social Care Committee that looked specifically at that issue. We looked at some of the best models in the world, including that of Trieste, where community care is in place. When we took evidence, we found that most people were supportive of that model, but fearful people did come forward to say that the community was not the best place for their daughter, son, husband or wife. Managing the nuance is really important. It takes time to get this right. In 2018, when the last Government looked to legislate on this issue, there was pre-legislative scrutiny, which does not always happen in this place. It was done because there was fundamental agreement that we must get the legislation right, because it applies to the most vulnerable people. The hon. Lady is right that Lord Darzi identified three shifts that will be really important, but when he looked at this issue, he missed a fundamental point. His report starts from 2010, but when I was a junior doctor— I qualified in 2007—we had issues that affect the culture now: for example, how we managed MRSA and C. diff. That was not a brilliant time to be a patient. The medical training application service fiasco affected doctors applying for jobs so much that in 2004 the Government had to apologise and change the system, because so many people who wanted to get into specialist training could not go through that service. We are still paying for IT infrastructure that the last Labour Government tried to introduce. The last report, in 2018, said that that cost the taxpayer almost £14 billion. We wonder why, when we try to make a shift to introduce more tech, as recommended by Darzi, people in the NHS are reticent, but they have been burnt by IT projects before. They have seen what happened under a Conservative Government, a coalition Government, and a Labour Government. All that has an immediate and impregnable effect on the legislation and the practicalities that we are dealing with today. I am not trying to talk facetiously about the legislation; the point is to give some pragmatic direction and to actually say something tangible. On that basis, I look forward to the Minister hopefully supporting proposed new clause 11, which would give the Government the flexibility to have a plan that they choose, as is their democratic right, but also the safeguards to know that it will be delivered and we will not have more delay. There is a balance between making legislation in haste and making sure that we avoid inaction. Would the hon. Member for Shipley like to intervene?

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23. 10 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Second sitting)

    You may want to set me straight, Ms Furniss, but as we have agreed, I will directly address those points in the clause 4 stand part discussion. The hon. Member for Shipley rightly talks about community settings, but where does she think primary care staff come from? They come through medical training. When we talk about the Darzi impact, it is important that we fully understand why people choose not to go into mental health or primary care and become a GP. Without establishing that, which is a problem that this Government have to deal with, we will run into real problems when it comes to delivery.

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24. 10 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Second sitting)

    My hon. Friend speaks to the heart of what we all know from our constituency day jobs, where many of us here in this place speak to outside organisations and families. On Second Reading, the hon. Member for St Neots and Mid Cambridgeshire talked passionately about the impacts and the sorry stories that we have all heard about. The whole point of this Bill is to make mental health care patient-centred, but also family and advocate-centred. That is a driving thrust of what the Secretary of State for Health and Social Care was asking us for, and it is why we have enshrined the individual in the first clause of the Bill. My hon. Friend is absolutely right: if we are committed to the principle enshrined on the front of the Bill, we need co-production. That must be more than a tick-box exercise. If the Government believe that the necessary plan is already in place, will the Minister say where that is covered, and would he put that plan in the House of Commons Library? Is it fully costed? Has it been fully consulted on? Will it be published within 18 months and incorporated in the NHS long-term plan? If not, how will the ICBs and local authorities be expected to deliver? How will the changes to NHS England affect plans to deliver the legislation? Having the legal duty to produce a costed plan will provide a focal point and fulcrum to build around, to ensure that the most serious mental health conditions receive the attention they need. I know the Minister cares deeply and wants to do his best. He wants the legislation to be enacted as swiftly as possible. I also recognise the commitments and priorities facing the country, but this new clause is about turning good intentions into action. I simply aim to strengthen the hand of the Minister when it comes to negotiating with the Chancellor about funding, so that he has the evidence base required to bolster his position. I hope hon. Members across the Committee, especially on the Government Benches, see it as a supportive, sensible, balanced and practical solution to have this debate and then campaign with the Chancellor to get the money needed for the services. Turning to the Lib Dem amendments, I begin by recognising the genuine intent behind amendments 10, 22, 24 and 21. Addressing the needs of people with autism and learning disabilities, particularly ensuring appropriate crisis accommodation and reducing unnecessary detention, is unquestionably important. That said, I have specific concerns about legislating for service provision in the Bill. I understand why we do not legislate for the number of intensive care units, hospices or detox centres in the health system. There is an argument that that might be a good idea. Those are critical services, yet their commissioning and capacity are generally managed through policy funding decisions and local planning, rather than through statutory duties. Introducing a statutory duty for crisis accommodation risks unintended consequences. It may limit the flexibility of integrated care boards to respond to local needs, and could impose significant new resource burdens without clear funding commitments. That risks setting a precedent for increasingly prescriptive legislation across health and social care, which we should approach cautiously. We do not want to pit one condition against another. On the proposed requirement on the Secretary of State to produce a commissioning plan within four months, I acknowledge the desire for a timely response. The choice of a four-month deadline, however, seems arbitrary and may not allow sufficient time for robust consultation and realistic planning. We need to be mindful that rushed plans can undermine long-term success. On the proposed reporting requirements, although transparency is vital, I highlight that new clause 11, which we are proposing, would provide stronger and more detailed mechanisms to hold the Government to account on implementation and resource allocation, while allowing flexibility. We should focus on supporting those provisions rather than layer on multiple overlapping reporting duties, which risk duplication and confusion. In conclusion, the amendments raise important points and I look forward to the Minister’s response.

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25. 10 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Second sitting)

    The hon. Member mentioned Baroness Casey, for whom I have the utmost respect, but herein lies the problem: she is still currently undertaking a review for the Home Office that has now been delayed and has not concluded. This is at the same time that she is supposed to be looking at social care. The whole idea of an amendment that asks for a statutory plan is to stop these kind of slippages. Given his point about wanting to see progress, is that something that he would consider if he were voting on this new clause?

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26. 10 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Second sitting)

    It is a shame that the hon. Member for Shipley is not in her place to hear me speak to the rest of the clause 4, having considered the amendments to it first—[Interruption.] Oh, she is here just in time. I am grateful to the Government and the Chair, as the clause stand part debate allows things to be more structured. I want to discuss proposed new part 8A of the Mental Health Act 1983, which will introduce welcome changes to provisions specific to people in England with autism or learning disabilities who are subject to detention under the Act. At the outset, let me say that the Opposition welcome the Government’s recognition that people with autism or learning disabilities require a tailored and rights-based approach within our health system. We know—the evidence points clearly to the fact—that such individuals have been inappropriately detained in institutional settings, often for years, without the care and support that they truly need. The creation of a statutory care, education and treatment review in legislation was a step in the right direction. It therefore makes sense in this part of our proceedings to discuss such reviews. The background is really important to understanding what the measure will do. Care, education and treatment reviews were introduced in 2015 as part of the Transforming Care programme, a joint initiative between NHS England and the Department of Health and Social Care under the last Government. The TCP was launched in response to the Winterbourne View scandal, which we have heard mentioned a few times, where serious abuses of people with learning disabilities and autism in private hospitals were exposed. The purpose of CETRs in the Transforming Care programme was to ensure multi-agency oversight of care plans for people with learning disabilities and/or autism, particularly those with complex needs detained in in-patient or secure settings. They were there to promote person-centred care by involving patients, families and a broad range of professionals; to identify barriers to discharge and support safe, timely moves to community or less restrictive settings; and to improve care quality and reduce inappropriate long-term in-patient stays. The implementation timetable started in 2015 with CETRs introduced as a mandatory part of the TCP, initially focusing on children and adults with learning disabilities and/or autism in in-patient settings. In 2017 to 2019, CETRs were expanded and refined, with NHS England producing guidance and a framework for conducting reviews consistently. Ongoing, CETRs are now embedded across the health and social care systems, extending beyond learning disabilities to other groups with complex mental health needs, including secure mental health services. CETRs are multidisciplinary independent reviews designed to improve the care and treatment of people with complex mental health needs, particularly those detained in secure hospitals or secure settings, such as children and young people with learning disabilities, autism or complex mental health needs, or in other in-patient settings where there are concerns about the appropriateness of their care, treatment or placement. The purpose is to ensure that the care, education and treatment plans are appropriate, person-centred and holistic; to identify and address any barriers to overcoming recovery and discharge; to promote co-ordinated working between health, social care, education and other relevant services; and to support the least restrictive care principle, one that we have now enshrined in the Bill—helping people to move to less restrictive settings where possible. There are, however, some complications. The number of CETRs has increased over recent years, especially with the growing recognition of the need for better oversight of complex needs. Several hundred CETRs take place annually across England and Wales, primarily within secure and specialist mental health services. Exact numbers are quite difficult to pin down and vary by service user populations, health trusts, NHS England monitoring and the reporting of the activity. What is a CETR made up of? That is really important. A typical CETR involves a multidisciplinary panel including independent clinical reviewers such as a senior psychiatrist or clinician not involved in direct care; representatives from social care services; educational specialists, especially for children and young people; advocates or independent mental health advocates; the patient or service users themselves, where possible, to ensure their voice is central; family members or carers where appropriate and with consent; and commissioners and other relevant professionals involved in the person’s care pathway. Under the review process, the panel examines the individual care, the treatment, the education and progress. It assesses whether the current placement and treatment plan are meeting the person’s needs and whether there is scope to support transition to less restrictive or more appropriate settings. Recommendations may be made on changes to care, treatment plans, discharge or support arrangements. CETRs are a very valuable safeguard. They bring together the independent clinicians, the social care professionals, the educators, the advocates and, crucially, the patients and their families to review the care and treatment being provided. The aim is to ensure that the treatment is person-centred, appropriate and geared towards recovery, while also exploring opportunities to move people to less restrictive environments when safe to do so. That said, while CETRs are increasingly used, questions remain about their consistency, effectiveness and impacts on outcomes. On page 12 of the explanatory notes, paragraph 46 states that “recommendations are not always being acted upon”, which is contributing to “the perpetuated detention of people with a learning disability and autistic people, often without therapeutic benefit.” That is really significant. To that end, how many CETRs are conducted annually and what are the mechanics in place to ensure that the reviews lead to meaningful change in care, rather than becoming a procedural exercise? I must admit that I struggled to find that information. If I, as someone looking into it, am struggling, there is a concern about how wide that information and data is.

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27. 10 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Second sitting)

    I appreciate what the Minister is saying. The blue threat, or blue and yellow thread, running through the debate is the question of how much needs to be in the primary legislation. The argument from the Conservative side has been that, while some of the Lib Dem amendments are too restrictive, the danger is that the freedom and flexibility at the Government’s end is too loose. I trust the Minister implicitly—but, having seen Ministers on our side come and go, there could be a change within Government or a change of colour of Government, and no Government are bound by the one that went before. I am trying to get the balance right by asking questions around procedure to assess whether some of these things should be in the legislation. I agree that there has to be a balance. That is why the Opposition chose to say 18 months, as opposed to four months; it was to have accountability and safeguards in place and to urge good delivery, but not to curtail the ICBs or clinicians—the people delivering stuff—and make them simply check boxes. I appreciate the Minister’s offer to write to me. I would be grateful for that data, because where we find it will be important in future debates and in his future written or oral statements. I hope he understands that these probes are to make sure that we get the balance right between primary legislation, what is going in the code of practice and what is well intentioned, but could be left to blow in the wind.

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28. 10 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Second sitting)

    Further to that point of order, Ms Furniss. To follow up on what the Government Whip, the hon. Member for Coventry North West, said, when a vote was called—although I appreciate that it was not carried on the voices—a number of members of the Committee who have since returned were not present. Ms Furniss, could you speak to the Clerk to clarify at what point the Committee divided? There was a very clear point at which the Adjournment was moved. I appreciate it is your call whether the Question was carried on the voices, but you said that it seemed to have been carried, which implies that the Committee should now adjourn. I appreciate that there are some difficulties.

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29. 10 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Second sitting)

    Like me, my hon. Friend has served as a clinician on the frontline. As this point is sometimes lost, can he explain the practicalities of what turning up at a hospital versus actually being admitted means? They are two distinct things. Can he walk us through what the process entails?

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30. 10 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Second sitting)

    Amendment 52 would amend clause 5 to introduce an important distinction in the grounds for detention under section 2 of the Mental Health Act, namely on whether a person has the mental capacity or competence to consent to admission. This amendment, tabled by my hon. Friend the Member for Runnymede and Weybridge, raises questions that go to the heart of how we balance liberty and protection, autonomy and risk in our mental health system. Under the current Mental Health Act, and indeed under the Bill as drafted, an individual can be detained for assessment if they are experiencing a mental disorder and if serious harm could be caused to themselves or others unless they are detained. There is no distinction based on whether they have the capacity to consent to care. In other words, a person who has full understanding and decision-making ability may still be detained against their will to protect them from themselves. The amendment proposes a change to that approach, so that if someone lacks the capacity to make a decision about admission and treatment, the current protection should apply—they can be detained if they are at risk of harming themselves or others. But if someone has capacity, understands what is happening and what the risks are, and still refuses care, they should be detained only if they pose a risk to others and not just to themselves. I will give a brief example to try to bring that to life. Imagine a young adult, aged 22 and living with long-standing depression. They have attempted suicide in the past, but they now clearly and repeatedly say that they do not want to be admitted. They understand the risks, are coherent, consistent and judged by clinicians to have capacity. Under the Bill as it stands, that person could still technically be detained, but under this amendment they could not unless they pose a risk to someone else. Why does this amendment have merit? There is much in it that is compelling. It puts autonomy at the centre of the mental health framework, which the Committee discussed and agreed on earlier. It aligns more closely with the Mental Capacity Act 2005, which already allows people to make unwise decisions so long as they understand what they are doing. It also echoes the principles in the UN convention on the rights of persons with disabilities, which calls for supported decision making over substitute decision making. It could reduce unnecessary or overly paternalistic detentions, especially of people from marginalised groups who are already disproportionally affected by coercive care.

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31. 10 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Second sitting)

    I will try to elucidate a little further. We know that some people have fluid capacity, such as those with dementia or depression. How do we ensure that people have safeguards for themselves and the wider community, while respecting their capacity and allowing them to be masters of their own destiny? The Bill literally says that we want to see individual autonomy, and by definition, there is always a balance to be struck. The Bill shifts more to the paternalistic side, which brings some challenges because it could create gaps in protections, as I will explain. There are clinical situations in which a person in mental health crisis—for example, in the early stages of a manic episode or a severe personality disorder crisis—may present with superficial capacity but be at grave risk of harm. Are we confident that clinicians can assess capacity accurately in real time, in often pressured and emergency contexts? Might we inadvertently tie the hands of practitioners trying to prevent suicide or serious self-injury? If capacity becomes the gateway to protection, what support and guidance will be provided to ensure that it applies fairly, consistently and safely? That is important when we talk about detention, because detaining people is one thing; the next thing is how we get them out. To understand that, it is worth focusing on the crucial interaction between the Bill and liberty protection safeguards. It is worth my briefly explaining to the Committee what LPS are, how they evolved and why they matter. Liberty protection safeguards are the new legal framework that replaces the old deprivation of liberty safeguards, or DoLS. DoLS were designed to protect people who lack capacity, but had become widely criticised as complex, slow and limited mainly to hospitals and care homes. In response, the Conservative Government introduced LPS through the Mental Capacity (Amendment) Act 2019, to simplify the process and extend protections to community settings such as supported living and people’s own homes. Given that we are talking about Darzi’s shift, that is important. With that context, I turn to the key concerns before us today: how the Bill interacts with LPS, especially when individuals move from hospital detention to community care. To illustrate why this matters, let us consider the case of Mrs A. She is a 55-year-old woman with bipolar disorder and mild dementia. She was detained under the Mental Health Act after a severe manic episode put her at risk. While in hospital, the Act governed her detention and treatment. After several months, Mrs A stabilises enough to be discharged, but because of her dementia, she lacks the capacity to consent to her care arrangements in the community. She requires supported living, with 24/7 care, which means that she will continue to be deprived of her liberty, but now in the community. Because she is no longer detained under the Mental Health Act upon discharge, the liberty protection safeguards must authorise the deprivation of liberty in the community. This requires careful consideration. An LPS assessment and best intention decisions are required, and formal authorisation must be in place before she leaves hospital. This transition point is critical, because without clear protocols, Mrs A could find herself deprived of liberty without lawful authorisation—a breach of her human rights. Information sharing between hospital staff, community providers and local authorities may be delayed or incomplete. There may be confusion among professionals about who is responsible for co-ordinating the handover. Training gaps might lead to the inconsistent application of safeguards. The Bill reforms detention in hospitals, but there is some opacity regarding how the handover to LPS in the community will be managed. Will the Bill ensure a seamless transition, with no gaps in safeguards? If it does not, then how will this be provided? Will there be statutory duties to mandate information sharing and co-ordinate reassessments? How will professionals across health and social care be trained to navigate both systems effectively? The Bill rightly aims to reduce inappropriate detentions and enhance patient autonomy in hospital, but protections under LPS in the community must be equally robust to maintain dignity and rights post discharge. How will the Government guarantee parity of safeguards across settings? The Bill also seeks to address disproportionate detention rates among ethnic minorities. We must be equally vigilant that the reforms and the wider LPS regime do not perpetuate inequalities once individuals leave hospital. We therefore need to ask the questions: what monitoring is done and what safeguards will be in place? On detention, I gently ask the Minister to clarify the Government’s plan to manage the vital interface between the Mental Health Act and LPS, even as the Bill stands, to embed clear statutory duties, guidance and accountability to protect all individuals like Mrs A throughout her care journey. What is the Government’s view on distinguishing between those with and without capacity in the context of detention for self-harm risk? Has the Department assessed the clinical and operational implications of requiring real-time capacity judgments before detaining someone at risk to themselves? Will the Government consider a limited override provision in extreme cases where the risk is immediate, catastrophic and the capacity assessment is finely balanced? We will see more of these kinds of cases as we go forward, with more and more people living with the likes of dementia or acquired brain injuries. If the Government do not support the amendment as drafted, might they consider refining the code of practice to provide clear guidance on how capacity, autonomy and right to self are waived? The amendment presents a thoughtful and principled intervention. It is not perfect in my eyes, but it challenges us, rightly, to consider whether our mental health laws strike the right balance between protection and personal freedom. Amendment 53, like its partner on section 2, reflects a growing consensus that the law should better respect the autonomy of people with mental health conditions, especially when they have the capacity to make informed decisions. In introducing a necessary distinction, if someone can truly understand the consequences of refusing treatment and they pose no risk to others, should the state override their decision on their own behalf? The amendment would add a capacity-based distinction into section 3, mirroring the earlier amendment on section 2. Specifically, if a patient lacks capacity to consent to a medical treatment, they may be detained if there is risk of serious harm to themselves or others. If a person has capacity, they may be detained only if there is risk to others. In short, if a person is mentally unwell but understands the consequences of refusing treatment in this case and only poses a risk to themselves, they would not be eligible for detention under this amendment. Imagine a woman with anorexia nervosa who is dangerously underweight, has a good understanding of her condition and the risk, and refuses in-patient treatment. Under the Bill as it stands she can be detained, but under the amendment if she is judged to have capacity and only poses a risk to herself, she could not be detained under section 3. Therefore, there are huge and far-reaching consequences to the amendment. The wider science is moving towards capacity, but it needs to answer some of these questions. Some are even being grappled with now—take the Terminally Ill Adults (End of Life) Bill. This truly cuts to the heart of humanity and I am sure there are varying views not only across the Committee, but across society. Similar questions will arise when it comes to capacity. To that end, the question posed is not simple. In some cases, such as severe anorexia or chronic suicidal tendencies, capacity may be technically present but clinically contested. The stakes could not be higher. The amendment challenges us, and therefore the Government—and rightly so—to ask: are we doing enough to balance liberty and care? Do we have the right clinical tools, legal thresholds and ethical safeguards in place? New clause 24 is on a different but related subject. This Back-Bench amendment relates to the application for admission in respect of patients who are already on hospital grounds but have not yet been formally admitted. This is really important, because it comes down to the ability. As my hon. Friend the Member for Solihull West and Shirley said, when it comes to the mechanism this is the day-to-day reality. Someone, just because they turn up in A&E, is not under the care of A&E per se until they are admitted. That is when the clinicians will take control. If they just give their name, at what point do we have that grey area? That is the matter of contention in day-to-day working. Currently, under section 5(1) of the Mental Health Act, applications for detention or admission can be made only in relation to patients who are already admitted to hospital—that is the key part. This leaves a grey area for people who come to hospital voluntarily, perhaps by walking into A&E and seeking help or being brought by an ambulance or the police, but have not yet been formally admitted. The amendment would explicitly allow applications for admission to be made as soon as someone attends or is brought into hospital to seek help, even before formal admission.

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32. 10 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Second sitting)

    I have spoken to my hon. Friend the Member for Runnymede and Weybridge and looked into this issue a bit further. Psychiatry is already looking towards future capacity and trying to bring the two pieces of legislation together. I believe that Scotland has already moved in that direction. We are therefore into the cycle of chasing legislation for something behind us. I appreciate the concerns, but that is why the Government need to be alive to these situations. At the end of the day, the nub of the issue is patients getting caught up between capacity and safety under the Mental Health Act. Does my hon. Friend agree?

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33. 10 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Second sitting)

    I am grateful to the Minister for how seriously he is taking this issue, and I agree that there is not necessarily a consensus even within the Opposition. Having the debate is therefore really important. It may be useful to collect data on the number of incidents and where these handovers are. Would the Government commit to that? We would be better able to have this debate, and to decide how much of a problem this is and to work out what the solutions are. Again, I struggle to find data that indicates where this is an issue, but I have spoken to clinicians who I know and colleagues who I have worked with when I have seen it. It happens enough that I was aware of it as a bog-standard GP who has worked in A&E, but it is clearly not rampant and we are not seeing it every single day. Would the Government commit to collecting data on it? If so, in what format would it come?

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34. 10 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (Second sitting)

    That would be a very useful piece of data, but I was in fact talking about new clause 24 and the grey area of hospital detentions. That data is probably easier to collect. I specifically ask the Minister to keep in mind the collection of data on those who turn up to A&E but end up having to be taken out of the hospital to be sectioned, for example. That is the nub of the issue and the practicality of what is going on. In a number of incidents, although the law is set in a way that is supposed to be helpful, the interface unfortunately becomes very difficult. The Minister has rightly pointed out that there are different ways to deal with this. The new clause is one such potentially heavy-handed way of dealing with it. At the same time, it comes from the good place of trying to address what clinicians deal with in A&E day in, day out. However, we need some data and some teeth behind that to understand and appreciate how much of a problem it is and to then come up with a solution. I hope that clarifies my question.

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35. 10 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (First sitting)

    I also want to assess the amendment that could potentially have been tabled. The Opposition were struggling to see how it would fit in, and it looks as if there is a crossover with the Mental Capacity Act 2005. Can the Minister set out why he felt that it did not quite fit into this area and how it could be taken forward, so that with cross-party work outside this Committee we can see how we can make it happen?

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36. 10 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (First sitting)

    It is a pleasure to serve under your chairmanship, Mr Vickers. I thank the Minister for his collaborative tone on some of the difficult amendments that we have discussed. I will open where the shadow Secretary of State, my right hon. Friend the Member for Melton and Syston (Edward Argar), left us on Second Reading. As he rightly emphasised, the importance of updating the Mental Health Act cannot be overstated. I fully share his view that it was right to take the necessary time to get this legislation right. The cross-party commitment to reform in this area, spanning both previous and current Governments, reflects a shared recognition of the urgent need to modernise our approach to mental health, particularly for those who are most vulnerable. I welcome the Bill’s focus on enhancing patients’ voice and autonomy, including through the expansion of independent advocacy and the shift away from using police and prison cells as a place of safety. Those are positive and overdue steps. At the same time, as my right hon. Friend outlined, the Opposition’s role is to engage rigorously and constructively with the details of the Bill. Over the next few weeks, I look forward to working with colleagues on the Committee to ensure that, for example, the principle of patient choice is embedded not only in policy but in practice, such as through the use of advance choice documents. We will continue to scrutinise the Bill in good faith, proposing improvements where needed, with the aim of delivering the strongest possible protections and outcomes for patients, their families and the community. How we begin a conversation often determines whether it becomes dialogue or dispute, so I hope that the Committee can take a constructive and productive look at what lies ahead of us. I support clause 1, which will rightly update section 118(2B) of the Mental Health Act 1983 and embed a refreshed code of practice at the very heart of the mental health framework. This is not merely a procedural amendment; it is a statement of values, placing humanity, dignity and recovery at the centre of how we treat some of the most vulnerable people in our society, who are profoundly affected by mental health legislation. It is vital that the framework guiding professionals be clear, principled and rooted in respect for individuals. Why do we need these changes? For too long, the Mental Health Act has been criticised as outdated and insufficiently centred on patient autonomy and dignity. Concerns raised by successive independent reviews, clinicians and, crucially, by people with lived experience have pointed to inconsistencies in how decisions are made, which can often result in over-restriction, lack of patient involvement and insufficient therapeutic focus. The independent review of the Mental Health Act, which was published in 2018, made a landmark contribution by recommending the adoption of the four core principles in front of us today: choice and autonomy, least restriction, therapeutic benefit and recognition of the person as an individual. These principles are designed to shift the culture and practice towards one that respects autonomy while safeguarding wellbeing and public safety. The historical context is that the Mental Health Act has undergone several amendments since its introduction—notably, in 2007, updates were made to some of the detention criteria and safeguards—but it was clear that the Act remained predominantly paternalistic. The 2018 independent review was a comprehensive, evidence-based re-examination of the entire Act, informed by extensive consultation, including with patients, families and clinicians. It concluded that embedding the principles formally into the law and code of practice was essential to modernise and humanise mental health law. The four key principles—choice and autonomy, least restriction, therapeutic benefit and the person as an individual to be treated with dignity—are not abstract ideals. They are the foundations of compassionate, lawful and effective care. They echo the spirit of the UN convention on the rights of persons with disabilities and signal a move away from paternalism and towards genuine co-production of care plans. Involvement ensures that decisions are not made about patients without them. The principle of choice and autonomy reminds us that the mental illness must not be a justification for blanket restrictions. The principle of least restriction challenges us to find community-based alternatives before defaulting to detention. Therapeutic benefit ensures that care is not custodial, but meaningful healing. These principles are what most of us would hope to see for our own family.

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37. 10 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (First sitting)

    The hon. Member is absolutely right. The key part is about trying to change not only the legislative framework, but the culture around clinicians and society as a whole. We saw that impact in 1983, we saw it in 2005 with the update on capacity, and we saw it in 2007. Now is the right time to look again at this, and it is well overdue. I am glad that it has taken a while to ensure that the Bill has been thoroughly thought out. As we heard in the House of Lords debate, this is exactly the kind of framework that we need to make sure that society moves forward in a collaborative way that puts the patient at the centre, but also protects the wider community. Given some of the high-profile incidents that we have seen, we must also make sure that relatives, the community and the wider public at large are all protected. As the Minister has rightly highlighted, the core principles must be the default for everyone. Clause 1 therefore represents an important step forward: by requiring the Secretary of State and the Welsh Ministers to include the four principles explicitly in the code of practice and by making it a legal duty for decision makers to have regard to them, the clause will strengthen the ethical foundation of mental health law. However, we must be honest about the challenges. The success of the principles depends on the culture, not just the codification. Training, supervision and leadership across clinical settings will be essential to bringing the values off the page and into practice. These principles will also require resource backing. We cannot call for the least restrictive or most therapeutic interventions while community mental health services remain as they are. A plan for investment and a timeline for delivery will be imperative, or else we risk embedding principles we cannot fulfil. Members on both sides of the House understand that. I know that the Minister will have to think carefully about setting out a timetable, but it is key. We must also guard against tokenism. We must guard against lofty principles being left unenforced and becoming rhetorical wallpaper. If we are to legislate for these values, we must look for accountability, with regular auditing, patient feedback mechanisms and a duty on the provider to report on how the principles are being upheld. Those are all areas that His Majesty’s Opposition will scrutinise. To that end, I wish to raise several important questions for the Government and the Committee to consider. The first is about enforcement and accountability. How will the Government ensure that decision makers truly have regard to the principles in practice, and is there a robust mechanism for monitoring compliance and addressing breaches? The second question is about balancing conflicts. In some cases, principles may conflict: for example, the imperative to respect patient autonomy may clash with the need to impose restrictions for safety. How does the code intend to guide practitioners to navigate these difficult trade-offs? The third question is about care and interested parties. Although the clause highlights patient involvement, what explicit protections and roles will be afforded to carers and other interested parties, and how will their sometimes divergent perspectives be balanced? The fourth question is about training and resources. Embedding the principles requires more than words on paper. What investments are planned to equip practitioners with the skills and understanding necessary to apply these principles sensitively and consistently? The fifth question is about the timeline and consultation. The explanatory notes mention that the code must be consulted on and presented for scrutiny. What is the proposed timeline for that process, and how will people with lived experience continue to be involved?

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38. 10 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (First sitting)

    I agree with the Minister. Does the Department have a rough idea of the timetable for putting in place the code of practice? How long will the consultation need to take? When will it be implemented? How many rounds go with it? How wide is it to be—will it consult across England and Wales, or just in England?

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39. 10 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (First sitting)

    The Opposition appreciate the timescale taken to skill-up in this area, but the workforce plan is soon to be announced by the hon. Member’s Government. Has any consideration been made of what the capacity might look like, and of the crossover between having this legislation not quite in place—although likely to happen, upon Royal Assent—and its impact on updating the workforce plan on mental health?

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40. 10 Jun 2025·Parliament·Dr Luke Evans

    Mental Health Bill [ Lords ] (First sitting)

    The Minister is right that there is shared working. However, part of the problem between devolved nations, such as Scotland and Wales, is that the datasets and definitions of data are often changed. Actually, the comparison of data across the UK can be quite hard to manage. Given that we are talking specifically about mental health, including some of the most at-risk people with the most severe mental health illnesses, will the Government commit to pushing for shared data that is comparable between Scotland and Wales, which we are legislating on in this case, to ensure that there is data transparency, so no one country can hide behind a different comparison or by saying, “We are looking at apples and pears”?

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