Gregory Stafford MP: speeches

Speeches

• 12 Jun 2025 · Mental Health Bill [ Lords ] (Fourth sitting) · Hansard source

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  Hear, hear!

• 12 Jun 2025 · Mental Health Bill [ Lords ] (Fourth sitting) · Hansard source

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  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.

• 12 Jun 2025 · Mental Health Bill [ Lords ] (Fourth sitting) · Hansard source

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  On a point of order, Mr Vickers. Just to be clear, I counted six Noes, and I think you announced five. Can we just check on that?

• 12 Jun 2025 · Mental Health Bill [ Lords ] (Fourth sitting) · Hansard source

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  I rise briefly to dilate on clause 6, on Liberal Democrat amendment 11 and on Government amendment 30. Those of us on the Health and Social Care Committee recently had a fascinating panel about the disparities for black and minority ethnic groups in maternity, and it does not end there, as we can see from the evidence raised by my hon. Friend the Member for Hinckley and Bosworth and by the hon. Member for Shipley. When CTOs were introduced—for good reasons—the elements of controversy that hon. Members have raised were not predicted. The overuse of CTOs, especially among black and minority ethnic patients, should give us all concern, although I have to say that there is some limited evidence of effectiveness in reducing relapse or readmission. Will the Minister give us the Government’s view on that and how they might seek improvement going forward? What we are trying to achieve in the clause is to bring legislation in line with the 2018 independent review of the Mental Health Act, which recommended tightening the use of CTOs, or indeed abolishing them altogether for some groups. I support the clause because it brings in stronger safeguards, a clearer commitment and time limits to reduce the risk of indefinite or inappropriate use. It also improves patient involvement, because it requires a consultation and review, promoting shared decision-making, and increases accountability because it aligns with the code of practice and introduces external oversight. It focuses on the reality, ensuring that CTOs are used only where truly needed. I am slightly concerned about Government amendment 30, which will remove the detailed provision that would have introduced new statutory limits and review procedures for community treatment orders, specifically under subsection (3), and inserted new subsections (8) to (11) into section 17B of the Mental Health Act. The implication of removing subsection (3) is that essentially we will maintain the current legal framework, which does not impose a fixed maximum duration or the same level of structured review currently written into the clause. I am afraid that that would not bring in the safeguards and oversight mechanisms that would, at least to some degree, start to tackle the problems that hon. Members on both sides of the Committee have been talking about. It may be seen as taking a step back from what campaigners and professionals who are advocating for stronger patient rights and accountability on the use of CTOs would like to see. I ask the Minister for the same reassurances that the hon. Member for Shipley asked for in this area. If the Government are to move Government amendment 30 successfully, we will need to see how they intend to deal with these issues going forward. Liberal Democrat amendment 11 would ensure that people subject to a CTO receive information about their right to advocacy. That is an entirely laudable aim, but I ask Liberal Democrat Members to answer a few questions. First, how do they see the administrative burden on clinicians to ensure that both oral and written communications are documented? Secondly, what additional training do they think those professionals might need to ensure that the information is both consistent and correct? Thirdly, might there be delays in issuing a CTO if, for some reason, advocacy information is not immediately available?

• 12 Jun 2025 · Mental Health Bill [ Lords ] (Fourth sitting) · Hansard source

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  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.

• 12 Jun 2025 · Mental Health Bill [ Lords ] (Fourth sitting) · Hansard source

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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?

• 12 Jun 2025 · Mental Health Bill [ Lords ] (Fourth sitting) · Hansard source

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  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.

• 12 Jun 2025 · Mental Health Bill [ Lords ] (Fourth sitting) · Hansard source

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  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).

• 10 Jun 2025 · Mental Health Bill [ Lords ] (First sitting) · Hansard source

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  I thank the hon. Member for her helpful intervention. If that is correct, I will draw my comments on that point to a close. Amendment 6 concerns CETR frequency. It seeks to change the timetabling of these reviews. The same issues, both positive and negative, run through it as in amendment 3. Amendment 7 would strengthen the legal obligation on integrated care boards and local authorities by requiring them to implement recommendations from the care, education and treatment reviews rather than merely considering them. That would ensure that review outcomes lead to concrete action and improved care. I do not think that anyone in the Committee could possibly disagree with that point. It would lead to greater accountability and would ensure that CETR recommendations are not ignored or delayed. That would clearly improve outcomes, because it would increase the likelihood that patients receive timely and appropriate care. The amendment would also introduce stronger legal clarity. By removing “must have regard to” and replacing it with “have a duty to carry out”, it would remove ambiguity around the responsibilities of the ICBs and local authorities, supporting the rights-based care and the principles of transparency and enforceability in service provision that we all support. I hope that the hon. Members for Winchester and for Guildford will be able to clarify the problem of resource pressures, which applies to all these amendments. Local authorities and ICBs may struggle to implement all the recommendations due to funding or capacity constraints. What would be the legal sanction for ICBs and local authorities if, through no “fault” of their own—although one might argue that they should have the necessary resources in place—they genuinely do not have the resources to implement all the recommendations? I would hope that such a sanction did not put them into further financial difficulty. The reduction in flexibility concerns me. It may limit professional discretion in cases in which recommendations are impractical or outdated. It may require new systems for monitoring and enforcement, and if recommendations are not implemented it could increase the likelihood of legal challenges.

• 10 Jun 2025 · Mental Health Bill [ Lords ] (First sitting) · Hansard source

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  I have a lot of sympathy with what the hon. Lady is trying to achieve with these amendments. My question is about how she would ensure, within the context of the provisions, that the patient’s confidentiality would be maintained where it needed to be.

• 10 Jun 2025 · Mental Health Bill [ Lords ] (First sitting) · Hansard source

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  My hon. Friend is entirely correct. We operate in a resource-confined area. It does not matter what the resource envelope is; it will always be confined. If we use resource to service the very laudable aims of the amendment, it will take resource and money away from another area.

• 10 Jun 2025 · Mental Health Bill [ Lords ] (First sitting) · Hansard source

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  I knew it began with S and was somewhere that is not Surrey or Hampshire—because where else would you want to be, Mr Vickers? The amendment would potentially increase the workload, because more frequent reviews place additional pressure on professionals and services.

• 10 Jun 2025 · Mental Health Bill [ Lords ] (First sitting) · Hansard source

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  I support the comments of the Minister and the hon. Member for Winchester on the issue. On a cross-party basis, I know that my right hon. Friend the Member for Godalming and Ash (Sir Jeremy Hunt) has taken a close interest. Could he also be included in those discussions?

• 10 Jun 2025 · Mental Health Bill [ Lords ] (First sitting) · Hansard source

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  Moving on from the confidentiality point, if there is going to be sharing—again, I have a lot of sympathy with the amendments—how would the hon. Lady ensure that disagreements between family members and the patient are safeguarded against?

• 10 Jun 2025 · Mental Health Bill [ Lords ] (First sitting) · Hansard source

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  I will do my best, Mr Vickers. The hon. Lady raises some good points. She made a slightly party political point, but I will forgive her because I made one earlier. Maybe that is our party politicking done for the day. As the vice-chair of the all-party parliamentary group for SEND, I recognise the issues that the hon. Lady has raised. I would be surprised if there were any hon. Member on this Committee who did not recognise her point. Across the piece, there is a significant problem with the process and the funding of EHCPs. I look to the Minister; I know it is not his responsibility, but I understand that the Government are introducing something around EHCPs. I will draw my comments to a close, but I ask the hon. Members for Winchester and for Guildford to address those concerns.

• 10 Jun 2025 · Mental Health Bill [ Lords ] (First sitting) · Hansard source

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  My hon. Friend makes a key point that I was about to address. Clearly, where there is a supportive family structure with the best interests of the individual at heart, the amendment will work extraordinarily well. However, we have to be realistic about the practical implications. Not every patient has a strong family structure around them. Unfortunately, some patients may even have family members who, for financial or other reasons, actively do not have their best interests at heart. There is a potential concern around confidentiality. I ask the hon. Members for Winchester and for Guildford how they would balance that conflict in practical terms, especially when the CETR includes sensitive clinical information that could be used in a way that is not beneficial to the patient by someone who does not have their best interests at heart. As my hon. Friend the Member for Chester South and Eddisbury points out, disputes can happen if patients or families disagree with professional assessments or recommendations. Finally, although this is probably not the strongest point, we should think about the administrative burden. Given the increased workload that we are putting on all our health and care workers and services, there will clearly be an administrative burden in sharing these reports.

• 10 Jun 2025 · Mental Health Bill [ Lords ] (First sitting) · Hansard source

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  On the point made by the hon. Member for Ashford about local authorities, given that the Government are devolving and reorganising local government structures across parts of the country, how will the Minister ensure that the standards around this issue—and other health and social care issues—are maintained? That restructuring means that we will have a whole load of new local authorities that do not necessarily have experience of dealing with this area.

• 10 Jun 2025 · Mental Health Bill [ Lords ] (First sitting) · Hansard source

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  To take that point slightly further, given that pretty much every local authority has a different set of criteria by which to determine people’s housing needs, how would, for example, an ICB that potentially crosses multiple local authorities with differing housing needs be able to understand the complexities within the current structure, and ensure that the patient is served best?

• 10 Jun 2025 · Mental Health Bill [ Lords ] (First sitting) · Hansard source

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  It is a pleasure to serve under your chairmanship, Mr Vickers. As I have indicated, I have a lot of sympathy with the amendments, but some practical constraints need to be teased out. Amendment 1 seeks to ensure that housing needs are explicitly considered during a care, education and treatment review meeting. I can see the pros of that. Clearly, a holistic approach recognises that stable housing is fundamental to mental health and recovery, especially for vulnerable individuals. Addressing housing barriers may reduce unnecessary hospital admissions. Likewise, it could lead to improved discharge planning, ensuring that patients are not delayed in hospital due to a lack of suitable accommodation. All Governments, of every colour and political party, want to see collaboration between health, social care and housing services, and the amendment brings those things together. As I said in an intervention, however, local authorities and NHS bodies such as ICBs may face challenges to co-ordinating housing assessments within the CETRs. As my hon. Friend the Member for Hinckley and Bosworth mentioned, his constituency crosses a number of local authority boundaries, while my seat of Farnham and Bordon, with two thirds of it in Surrey and one third in Hampshire, has that same issue. The county councils are wonderful and Conservative run, but Waverley is run by Liberal Democrats. The hon. Member for Winchester, who moved the amendment, recognised the issue of implementation capacity, but there are also likely to be resource constraints. These days, local authorities spend most of their money on social care, education and the bits of health that sit within their remit, so there may be insufficient housing stock or funding to meet the identified needs that the amendment would bring forward. There are therefore practical implications.

• 10 Jun 2025 · Mental Health Bill [ Lords ] (First sitting) · Hansard source

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  My hon. Friend attributes to me a level of clairvoyance that I do not possess, but I am sure that the hon. Member for Winchester or the hon. Member for Guildford will pick up that point. The resource implications are not just about the funding. They are about increased workload and the pressure put on the professions and services. As my hon. Friend the Member for Solihull West and Shirley said, the amendment would divert attention away from delivering care, if it is not balanced properly. My hon. Friend the Member for Hinckley and Bosworth is right to ask, “Why six months?” Why not nine months, eight months or any other period? Is there a clinical basis for six months?

• 10 Jun 2025 · Mental Health Bill [ Lords ] (First sitting) · Hansard source

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  I agree entirely. That could be the unintended consequence of amendment 51: in essence, if the housing provision is not there, discharge will be delayed. From my understanding of the amendments in the group, those who tabled them are trying to speed up and improve discharge. My hon. Friend is absolutely right that we need to think about the practical implications of the Bill. The amendment would require co-ordination among health, social care and housing services, which may be challenging in under-resourced areas. Frankly, because parts of those organisations are not used to working in the ways that the amendment would require, it might fall over without suitable training, the necessary lead-in time and a practical understanding of how it will work. Amendment 4 would ensure that housing needs are formally considered during the care and treatment review meetings for adults with autism or a learning disability, without an EHCP. I understand that the aim is to support more effective discharge planning and reduce the risk of unnecessary or prolonged hospital stays. That is entirely in keeping with what we should be trying to do in the Bill. Holistic care planning reduces delays in discharge, improves cross-sector collaboration and supports community-based care, which we all support. Once again, however, there is potential for complexity in the implementation. New processes may be required to involve the housing authorities. Resources and local housing shortages could limit the amendments’ practical impact. Another layer of complex review processes could add to that administrative burden. If there is inconsistent local capacity, the effectiveness of the amendment will almost certainly vary depending on the local housing infrastructure, which could lead to a postcode lottery, for want of a better phrase, in who receives the adequate care and housing. Amendment 2 would ensure that children and young people with autism or learning disability, as well as their nominated persons and independent mental health advocates, receive a copy of the care, education and treatment review meeting report. I have a lot of sympathy with that. It potentially increases empowerment and transparency, ensuring that patients and their advocates are fully informed, which could enable better participation in care decisions. It has a legal and ethical alignment with the principles of the Mental Capacity Act 2005 and the UN convention on the rights of persons with disabilities, both of which emphasise supported decision making. It might also improve advocacy, as independent mental health advocates can more effectively represent a patient’s interest when they have access to the full report.

• 10 Jun 2025 · Mental Health Bill [ Lords ] (First sitting) · Hansard source

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  I agree. Even if the Government build the number of houses that they propose—I have some scepticism—there will always be the potential conflict or disagreement on prioritisation in the housing register and list. As my hon. Friend says, that might well lead to local authorities having to change their criteria, which are not necessarily consistent across local authorities, and, as in his example, potentially pitting a homeless person against someone with mental health needs. The amendment would also have the potential for scope creep. I have a lot of sympathy with what it is trying to achieve, but expanding CETRs to include housing might dilute their focus and overburden the process. I am interested to hear from the mover and supporters of the amendment how they would ensure that the CETR continues to have that core focus on the health and wellbeing of the individual, rather than potentially be bogged down in the mire of housing issues. Moving on, amendment 51 would ensure that the care and treatment of individuals with autism or learning disabilities explicitly considered the impact of accommodation and relocation in the planning and decision-making process. Again, I have a lot of sympathy with that. It would promote holistic care planning, reduce trauma and disruption, support continuity of care and, I think, align with the person-centred principles throughout the Bill, which all of us support. Again, however, amendment 51 might complicate discharge planning, if suitable accommodation were limited.

• 10 Jun 2025 · Mental Health Bill [ Lords ] (Second sitting) · Hansard source

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  I am interested in the points that my hon. Friend is raising. Could he give any examples of the situations he is talking about? It would help the Committee, and certainly help me, to understand the practical realities of what he is talking about.

• 10 Jun 2025 · Mental Health Bill [ Lords ] (Second sitting) · Hansard source

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  I rise to speak to amendments 52 and 53, tabled by my hon. Friend the Member for Runnymede and Weybridge and moved by my hon. Friend the Member for Solihull West and Shirley. Clearly, both my hon. Friends have significant clinical experience, and I bow in many ways to their expertise. However, the amendments cause me some concerns. Amendments 52 and 53 “would add to the grounds for admission to hospital for assessment or treatment that the patient must lack the capacity to consent to that admission, if they would not be detained due to being a risk to others.” Clearly, both amendments would introduce a capacity-based distinction in the grounds for detaining a person for medical treatment under the Mental Health Act, as my hon. Friend the Member for Hinckley and Bosworth mentioned. That would ensure that, for patients who lack capacity or competence, detention is justified if serious harm may be caused to themselves or others unless they receive that treatment. For patients who have capacity or competence, detention is justified only if serious harm may be caused to others unless they received that treatment. The amendments build on the principle of autonomous individuals, which we have talked about and which, as my hon. Friend said, is in the Bill. People should not be detained solely for their own protection if they are capable of making informed decisions about their care. As my hon. Friend said, that aligns with the Mental Capacity Act and broader human rights principles, aiming to ensure that detention is used proportionately and, most importantly, ethically. Where the two amendments improve the current legislation is around the strengthening of patient autonomy by limiting the detention of capable individuals to cases where others are at risk. The amendments align the Bill with the human rights principles and the Mental Capacity Act, and clarify a number of legal thresholds for detention, reducing ambiguity in clinical decision making. That will help clinicians to make more sensible and consistent judgments when it comes to who should or should not be detained. Obviously, the amendments promote a proportionality element in the use of coercive powers, and support the person-centred care that we want. However, I am concerned that the amendments may increase complexity when assessing capacity in applying the correct legal tests. It will absolutely require training and guidance. Government Members have been concerned about mandatory training, and I make no apologies for hoping there would be significant training on this for clinicians when acting in this role, to ensure consistent application of these services. While I accept that the provisions clarify the legal thresholds, I think there is a potential for legal challenges if the distinction is misapplied or misunderstood, hence the need to return to my point about having the correct training. I hope the Minister is able to address some of those concerns, rather than just dismissing the amendments outright. New clause 24 was tabled by my hon. Friend the Member for Runnymede and Weybridge and moved by my hon. Friend the Member for Solihull and West Shirley—

• 10 Jun 2025 · Mental Health Bill [ Lords ] (Second sitting) · Hansard source

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  On a point of order, Ms Furniss. I called for a Division on the Adjournment before several members of the Committee who are now in the room came back. What is your ruling on whether members who were not here when the Division was called will be allowed to vote?