Luke Evans MP: speeches 2025

Speeches

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

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  Clause 20 addresses a central principle in healthcare, ethics and law: the right of individuals to make informed decisions about their treatment, and the conditions under which that right can be overridden. Let me begin by recognising the objective of clause 20 as both important and welcome. It replaces the outdated and potentially ambiguous language in the Mental Health Act 1983—language that speaks of whether a patient is “capable of understanding the nature, purpose and likely effects” of treatment—with a clearer legal standard based on whether a patient has capacity to consent, in accordance with the Mental Capacity Act 2005. This reform aligns the Mental Health Act with how capacity is already understood and applied across health and social care, and it harmonises part IV of the Act with part 4A, which already uses that language in the context of community patients. So far, so sensible. However, as the Opposition, our role is not only to acknowledge the intention, but to ensure that the implementation matches the ambition, and that patients’ rights are not merely affirmed in law but upheld in practice. What do these changes actually do? Under clause 20, we see a wholesale substitution of terminology. For example, in sections 57 and 58 of the Act, which deal with certain serious treatments such as neurosurgery and ECT, the language shifts from “capable of understanding” to having or lacking capacity to consent as defined in the Mental Health Act. It also explicitly incorporates advance decisions to refuse treatment under section 25 of the MCA, the role of a donee of lasting power of attorney, and the authority of a deputy appointed by the Court of Protection. This is a welcome acknowledgement of patients’ rights to plan ahead and to have their wishes respected, even when they later lose capacity. While the Government’s explanatory notes suggest that this is not expected to create practical change, I think we should pause and ask: what if it does? We are told that clinicians interpret “capable of understanding” as meaning “having capacity” under the Mental Capacity Act. But the MCA test is precise: it requires the person to understand the information relevant to the decision, retain that information, use or weigh it as part of the decision-making process, and communicate their decision. So are clinicians routinely applying this test fully, or are they relying on informed judgment? Can the Minister confirm, for example, whether NHS trusts have audited how consistently the MCA test is being applied in mental health settings? I was a clinician and am now an MP, so I understand the intent behind it, but the legal clarity—now with my MP hat on—is really important to ensure that we truly are interpreting the legislation we pass in this House for this country in the correct way when we are acting as clinicians. When it comes to advance decisions in acute settings, clause 20 provides that an advance decision to refuse treatment must be both valid and applicable, as per section 25 of the Mental Capacity Act, but in the real world of psychiatric in-patient care, clinicians may encounter such decisions during a crisis, when patients are at serious risk of self-harm or suicide. How will the Government support clinicians in determining validity and application quickly, safely and lawfully? I assume— I think the Minister hinted at this—that that will be part of the code of practice. On the power to override consent, perhaps most crucially the Mental Health Act allows for treatment without consent, even when the person has capacity, if they are detained under the Act. Again, we touched on this in relation to amendments discussed on the first day. That is a profound legal power. Does the clause change it in any way, or does it simply confirm that capacity is assessed, but not necessarily respected, under compulsion? If the Government intend the law to remain as it is—that patients with capacity can still be treated without their agreement—they may well need to specify and set that out. I urge Ministers to consider how we communicate that reality to patients, whose sense of agency and trust in the system may otherwise be undermined. I turn to the matter of Gillick competence for children under 16. The clause clarifies that the standard for under-16s is Gillick competence, not capacity under the Mental Capacity Act. This reflects the long-standing legal test established in the 1986 case of Gillick v . West Norfolk and Wisbech Area Health Authority. Under Gillick, a child can consent to their own medical treatment if they have sufficient understanding and intelligence to comprehend what is proposed. The Gillick test has advantages. It allows for a case-by-case assessment, not a rigid age threshold, and respects the emerging autonomy of young people. However, there are also risks: it can lead to inconsistency between clinicians and does not offer the same structured framework as the MCA. What safeguards will be put in place to ensure consistency and rigour in applying the Gillick test? Will the Government commit to updating the code of practice with guidance on assessing Gillick competence specifically in mental health contexts? I turn to deputies, attorneys and verifying authority. The clause references lasting powers of attorney and deputies—that is right and proper—but we need to ask how a clinician will verify that a donee is acting within the scope of their authority. Will the Government consider a national standard protocol to support clinicians in checking LPAs and court orders, particularly in urgent situations? For example, could this be part of the checklist, which we have already discussed, or is it implied that it will be part of that in the first place? Many of those concerns were shared in the other place. They were partly addressed in the letter for Baroness Merron, which is worth reviewing. It sought to clarify a number of concerns raised on Second Reading in the other place. I welcome the tone of the letter and the Minister’s stated willingness to listen. In particular, I acknowledge the recognition of the “challenges…to decision makers” that may be presented by “the complex interface between the Mental Health Bill and the Mental Capacity Act”, and I welcome the Government’s commitment to engage with clinicians and stakeholders during the revision of the code of practice. That is important. However, the letter also raises some further issues that deserve scrutiny. First, the Minister says: “Both Acts provide appropriate procedural safeguards to ensure that the individual’s Article 5 human right to liberty and security is protected during their detention. The nature of the safeguards provided under the two Acts are different”. That is undeniably true, but therein lies the concern: where the safeguards differ, so too may the thresholds, the review mechanisms and the practical experience of those subject to detention. In cases in which a person might meet criteria under both Acts, what clear guidance will clinicians be given on how to decide which legal framework to apply and how to ensure that the individual receives the most appropriate and proportionate protection? In the same letter, the Minister addresses the potential unintended consequences of reforms to section 3 of the Mental Health Act, namely that “people with a learning disability and autistic people, who lack capacity, could, in certain circumstances, be detained under the Mental Capacity Act rather than the Mental Health Act”. The Government’s stated intention is to prevent that outcome by strengthening community-based services. The letter states that “the proposed changes to Part 2, section 3…will only be commenced when we are assured that there are strong community services in place.” In the absence of clear statutory criteria, that could be seen as moving the target, so will the Government publish a set of benchmarks or a public readiness test? The Minister has said that the implementation will take place over 10 years, but a readiness test with criteria setting out how that will apply would help us to deal with a lot of the issues that we have talked about during the passage of the Bill.

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

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  I appreciate the hon. Lady’s insight, both as a politician and as a patient. I guess the Opposition are concerned that there is no explicit duty here, which is why legislating for that is so important. There was a huge number of inquiries about the case from 2011. There have been sufficient changes, but in 2023, as we saw in Nottingham, there was yet another case. There are still ongoing proceedings, so I will not comment too much on that, but this is an opportunity that the Committee should seriously consider. This harks back to what I was talking about on Tuesday. It is another step—an escalation—in this concerning pattern of behaviour, and it is hard, from a clinician’s point of view, to work out whether something is going to happen. I see this as part of the checklist to make sure that consideration is there, or, if public safety is not there, that it does not fall into a statutory role as it would anywhere else. Those are my concerns. We have not put down an amendment, but I am interested in the hon. Lady’s thoughts on how that should be approached from both the politician and the patient side.

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

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  You have actually caught me at a perfect point, Mr Vickers. The concept of therapeutic benefit is central to the second opinion doctor’s assessment. However, in clinical practice, interpretations of therapeutic benefit can vary considerably. How do the Government propose to ensure consistency and fairness in such assessments? Will there be clear and standardised guidance for the training of doctors giving a second opinion, to avoid subjective discrepancies? The introduction of the clinical checklist is a welcome enhancement, especially the requirement to consider patients’ past and present wishes and available treatment alternatives. However, it is essential that the checklist is not just a mere bureaucratic box-ticking exercise, as we have discussed. What mechanisms will be in place to monitor compliance with the checklist? What recourse will patients have through the assigned second doctor? Finally, I note that the clauses following clause 12 move towards tailoring safeguards around patients’ capacity or competence. That seems more humane and targeted than a one-size-fits-all approach, but this added complexity may increase administrative burdens on second opinion doctors and treating teams. Have the Government considered the potential impact on workload? Are there plans for adequate training and support to manage the transition effectively? In conclusion, clause 12 represents an important evolution in protecting the rights of patients undergoing compulsory treatment. The Opposition recognise that progress has been made. However, the effectiveness of the reforms hinges on clear operational frameworks, adequate resources and a robust regulator. I look forward to the Minister’s response to my questions and hope that the Government will take them on board to strengthen the Bill.

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

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  The clause will amend section 61 of the Mental Health Act 1983 on the review and treatment of detained patients. The 1983 Act requires approved clinicians to provide reports on the treatment and condition of detained patients, particularly where patients do not consent to treatment. Those reports are integral to the scrutiny and safeguarding of the patients’ rights. The Act sets out timing requirements for such reports, which generally coincide with detention renewals, helping regulatory authorities such as the CQC in England and the Healthcare Inspectorate Wales to oversee treatment appropriately. I imagine that you are expecting me to continue my speech on the CQC, Mr Vickers, but I will spare you; you are august in your understanding of the health inspectorates, so I will not put the Committee through that. The clause updates the timing and scope of the reporting requirements, and we welcome the fact that it will introduce a more structured reporting schedule. It will require reports to be provided after six months, then every six months and then every 12 months, as well as for the reports to be provided within two months of those periods. The clause also explicitly includes part III patients—those under forensic orders—especially those transferred from guardianship or those whose community treatment orders have been revoked. Importantly, the clause grants regulatory authorities the power to require reports not only from non-consenting patients but where patients are found to be consenting under certain treatment sections. That enhances the regulator’s oversight role, allowing it to request additional information should concerns arise. We acknowledge that the intent behind these changes—to align reporting practices across different patient groups and to strengthen regulatory oversight—could improve consistency in monitoring, ensure that concerns about treatment are promptly addressed and, ultimately, enhance patient safety and rights. However, several questions arise. How will the increased power for regulatory authorities to require reports, including from consenting patients, be balanced to avoid placing excessive administrative burdens on clinicians? Will the changes to the timings of reports, particularly the delay of the first report to three months for certain cohorts, risk any gaps in early detection of treatment issues? What safeguards or limits will exist to prevent potential overuse of the power to request additional reports? Could that put further strain on mental health services and regulatory bodies that are already stretched? How clear and workable are the definitions distinguishing different patient groups, such as part III patients transferred from guardianship or those with revoked community treatment orders? Might that complexity lead to inconsistent application? The clause distinguishes those groups because it assigns them different reporting schedules and rules. For example, part III patients transferred from guardianship and CTO-revoked patients after 6 months have a specific reporting timetable—every 6 months, then 12 months. In contrast, CTO-revoked patients within six months of their hospital order and other part III patients retain their existing, presumably different, reporting periods. That layering risks creating complexity. The Bill uses technical terms, and references to a patient being transferred from guardianship under section 19 or to a community treatment order being revoked are not immediately clear and may not be uniformly interpreted by all clinicians and regulatory staff. Why is that a potential problem? If these terms or categories are not clearly defined and communicated, or if the practical implications are not straightforward, there is a risk that clinicians might misclassify a patient’s status, leading to incorrect timings or absence; regulatory authorities might struggle to apply the rules consistently; and patients might inadvertently fall through gaps in reporting. For example, let us imagine a patient who was initially under guardianship, which means that someone was legally responsible for their care, but who was then transferred to a hospital order under part III of the 1983 Act. If the clinician or regulator is unclear whether the patient fits into the “transferred from guardianship” category for the revised six-month reporting cycle, they might apply the wrong schedule, and thereby delay important reviews or misunderstanding opportunities for intervention. Concern about definitions is really about ensuring clarity and practicality and making sure that everyone involved in patient care and oversight understands precisely which patients fall under which reporting categories, so that the intended protections and reviews happen without there being confusing gaps.

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

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  It is an excellent and eagle-eyed point. I would point to the evidence base that I cited, starting from 1988 onwards. That is three and half decades’ worth of evidence that points to a causal factor. In my clinical background, I have seen patients that I think it relates to. Perhaps I will stand corrected, but I am not sure that domestic violence has been shown as a causal factor of mental health conditions. We know that in the developmental stages that children go through, when their brains are developing and growing, as the 2016 study showed, there are intrinsic changes. That is why the Opposition chose to put that wording in. I agree that the definition could be wider, and we discussed that on the first day of debate with the Liberal Democrat definitions. I see the hon. Lady’s intent, but the main point is the evidence base. Maybe in the future that would be something, if we have evidence, that the Minister could consider taking forward. At this point in time, I think it is undeniable that childhood trauma makes a difference, and that is why the amendments specifically say “childhood trauma”, not anything wider.

• 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. Clause 15 will amend section 58A of the Mental Health Act 1983 in regard to ECT. It is worth understanding the law as it stands. At present, if a patient lacks capacity to consent to ECT, treatment may be administered only if a second opinion appointed doctor certifies that the treatment does not conflict with any valid advance decision, or a decision made by an attorney, a deputy or the Court of Protection. That acts as an important safeguard, ensuring independent scrutiny of patients’ prior wishes or of proxy decisions before such an invasive treatment can proceed. This clause will shift the responsibility. Under the Bill, the initial determination about whether ECT would conflict with any advance decision or proxy decision is moved from the second opinion appointed doctor to the patient’s approved clinician. Only if the clinician finds no conflict would the SOAD then be involved to certify that the patient lacks capacity, that the treatment is appropriate and that the clinician’s decision aligns with proposed new section 56A safeguards. The Government’s explanatory notes clarify that that reflects the unique nature of ECT: if a valid refusal exists, treatment must be prevented outright. The clinician therefore acts as a gatekeeper before SOAD involvement. Clause 15 marks a significant shift in the role of the SOAD with respect to ECT. The whole point is to transfer the responsibility to ensure that treatment does not conflict with advance decisions or refusals. That contrasts with the approach under proposed new section 57A, under which the SOAD must certify the presence of a valid decision before compulsory treatment. The rationale, as explained in the Government’s notes, is that for ECT, the mere presence of an advance refusal should prevent treatment, whereas in the case of other compulsory treatments, the content of the advance decision is integral to deciding whether treatment can proceed. I recognise the rationale for the change and the introduction of a clinical checklist—I assume that we are talking about new section 56A—but I have some questions for the Minister. Does shifting the initial responsibility to the approved clinician risk reducing the independent oversight currently provided by the SOAD, especially given the invasive nature of ECT? How can we be confident that clinicians will rigorously check for and respect valid advance refusals or proxy decisions? What practical safeguards will be in place to ensure that clinicians have full and timely access to any relevant advance decisions or proxy appointments? Will there be a standard process for verifying those, especially where records may be fragmented? The SOAD’s role is now more focused on assessing appropriateness of treatment and capacity but, it appears, without responsibility for confirming the absence of conflicts with advance refusals. Will the SOAD therefore be empowered with sufficient information to make the judgment confidently? How will the clinical checklist be implemented and monitored across services to ensure consistent application? Can we be assured that it will effectively embed the principles of therapeutic benefit and least restrictive option, especially when dealing with ECT? What mechanisms will be available to family members or advocates who believe that a patient’s prior wishes, or proxy decisions, are being overlooked? Will there be accessible avenues by which to raise concerns or seek timely review?

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

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  I would be grateful if the Minister could comment on the certificates being combined. There is a concern, if we go from two certificates to one, that the reason why two certificates were chosen in the first place could be lost, especially if the certificates are competing. There could be an incumbent preponderance towards one decision, when there were actually two conflicting decisions in the first place. I understand that this is about trying to reduce the administrative burden and having all the information in one place. Equally, however, it does make clinicians think twice, especially when they are supposed to be independent, about what is happening and why.

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

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  There are a few questions to be answered. Given the nature of acquired brain injury—for example, the capacity of someone who has had a stroke can fluctuate—it is very hard from a clinical position to know where the benefit of treatment starts or finishes. We must future-proof the Bill. We have an ageing population, so we will see more people with dementia, strokes and acquired brain injuries for various reasons. There is a natural tension there, but it is only going to get worse over the next 20 or 30 years. How do the Government plan to address that? It is a concern.

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

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  I cannot resist the opportunity to probe the Minister on something so important. He said that NHS England will predominantly look at this, but changes are happening there. Will he ensure that Gillick competence and the assessment of capacity will be at the heart of this? It is unclear now, given that it will take two years for NHS England to be abolished, who will take that on. Will he ensure that that is given due attention, as we have with physical health?

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

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  The Minister makes an excellent point, and that is part of the reason why the Opposition did not want to spring this question on the Government in an amendment or a vote, but rather to have the conversation first, because this is an important clause to get right. The two sides can be worked on in parallel when considering public safety more widely. Regarding safeguarding issues, as a GP dealing with children it is very common to share information with social services to allow them to have that central point, so that things are not missed. The principle of the checklist is to ask whether we are thinking about the individual patient. We have heard from patient testimony that that has to be paramount— No. 1—and that is the prima facie reason for having these provisions in the Bill. But, as we are considering this clause, given some of the cases and some of the holes, should we not consider asking clinicians, in statute, to think specifically about the risk, and wider risk, and what could be involved in the treatment? As the Minister rightly pointed out, if it was considered that certain individuals were not conforming with their medication regimen, or that there was a risk of them not doing so, or that they had a violent tendency when they relapsed, and had not met a threshold because they had never actually gone to prison or been through a court, but were known to police services, that grey area might pick something up if it were simply added to the checklist. I cannot think of many things, bar the patient—who is No. 1—more important than public safety. I put that point to the Minister to consider further in the light of those cases. I do not want to go into specifics, because it is not right to do so and he will be much closer to details than I am, but there is a widening principle over what we can do in this space.

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

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  If the Minister will forgive me, I was not being facetious when asking for numbers; I was simply using it as an example. I am grateful to his officials for providing the numbers so quickly when I asked for them during the debate on clause 6. When he has the chance, could he write to Opposition Members setting out how that interaction works with the Ministry of Justice and what the numbers might look like? Forgive me if I have missed it, but I could not see it in the impact assessment. There is an implication not only for health, but for the justice side, which, as my hon. Friend the Member for Solihull West and Shirley said, makes a difference. My question was more to make sure that we are pragmatic in our approach, rather than getting into hardcore numbers at this stage.

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

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  I welcome the Government’s recognition that modern technology can play a valuable role in improving care in the mental health system. The move to allow remote interviews and examinations for second opinion appointed doctors, through live audio or video links, reflects the realities of healthcare today and the potential for greater flexibility and efficiency. In particular, the so-called hybrid model, as set out in the explanatory note, could help speed up access to important second opinions and reduce delays in treatment decisions. That is especially welcome given the well documented pressures on mental health services and the vital role of second opinions in safeguarding patient rights. While the intention is laudable, however, I have a number of concerns to go through, because I believe that the House must consider them carefully. First, the clause leaves the clinician significant discretion to decide whether a remote assessment is appropriate, but it does not set out clear criteria or safeguards for how that decision should be made. Given the serious nature of second opinion assessments, which often authorise treatment without consent, we must ensure that the discretion does not lead to inconsistent or inappropriate use of remote methods. Secondly, mental health patients are a diverse group, and many face particular communication challenges. For example, a patient who has experienced a stroke may have speech impediments or difficulty understanding complex questions. Others may have conditions such as autism or dementia that make remote communication difficult or distressing. This was a really big topic in the other place, particularly as there are several esteemed colleagues who are part of the speech and language therapy fraternity, so it warrants a bit of attention. For example, we need to look at access to speech and language therapists. We also think about how these important communications needs will be assessed and accommodated. Will there be a statutory requirement for a clinician to consider patients’ communications abilities and preferences before opting for a remote interview? I am concerned that, without such safeguards, patients may be subjected to assessments that do not fully capture their conditions or views, undermining the quality and fairness of the process. The Minister—I think—hinted that this may be covered in the code of practice. I hope it is. Thirdly, the clause does not specify the role of patient consent or objection to remote access. Should patients have the right to request an in-person interview if they find remote contact unsuitable? This is not simply a matter of convenience; it is a question of whether we ensure the dignity, respect and meaningful participation in decisions about their own care. There is much debate in primary care about the role of video calls versus seeing a person face to face, and I would be interested to understand where the Government sit on that point. The Bill lacks any specific provision for regulatory oversight or standards to govern the use of remote assessments. How will the regulator—presumably the CQC, but I would be grateful for clarification on that point—monitor whether remote assessments are being used appropriately, given the vulnerability of these types of patients? What mechanisms will patients or their advocates have to raise concerns or complaints if they feel remote assessment was not adequate or, even worse, harmful? Finally, while technology can bring great benefits, it should never become a default substitute for face-to-face contact in mental health treatment decisions, especially where the stakes are so high. I assume the Minister appreciates that. Will this be set out clearly in the code of practice? Whose job is it to enforce that? Will there be a right to request an in-person interview, should the patient choose to? Has an equality impact assessment been undertaken to ensure that remote access does not disproportionately disadvantage those who suffer with communications difficulties or other vulnerabilities, or is that something that the Minister will implement in the code of practice? I would be grateful for some clarifications on those points, because it is really important to get it right when it comes to difficulties in communication, especially in this patient cohort.

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

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  Forgive me, Mr Vickers; I will get to the point a little more briefly, but the whole point is that the person has to be appointed through the CQC. The CQC will make that decision, because by definition it is the body that makes such decisions. If it is not resourced properly or if it has problems, regulatory or otherwise, we will find ourselves in a very difficult position, which is why I am raising the issue. I am happy to curtail my speech.

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

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  I appreciate the answer that the Minister gave, but we would like to probe the opinion of the Committee, given the principles that are enshrined in the Bill and childhood trauma is an example of something with a causal factor. Amendment proposed: 44, in clause 8, page 15, line 17, at end insert— “(iii) seeks to minimise the patient’s distress and promote psychological wellbeing and recovery from any childhood trauma;”.— (Dr Evans.) Question put, That the amendment be made.

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

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  The Minister makes an excellent point about the services that are required, but key to all this is the underlying research. Has research already been commissioned into this? If not, would he look at commissioning in the space of ethnic minorities, the impacts of CTOs and mental health? That might shine a light on what further services will be needed, the reasons, and preventive measures, which the Government rightly put at the front of the agenda.

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

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  My hon. Friend is a shrewd surveyor of legislation, and even foresees the amendments that I have tabled, which may well expose and shine a little light on something that might make a difference. In essence, he is right: trying to future-proof the Bill, while ensuring that it is robust and applicable, was at the heart of the first day’s debate and seems to be at the heart of today’s debate. As I said, the Mental Health Act confers extraordinary powers to detain and treat without consent and to deprive someone of their liberty, but in exchange there needs to be a clear, evidence-based justification for doing so. The clause goes some way to strengthening that justification, but only if the principle of therapeutic benefit is applied rigorously and not just diluted. Let me turn to amendments 44 and 45, tabled in my name on behalf of His Majesty’s Opposition, which speak to what my hon. Friend the Member for Farnham and Bordon just said. They seek to embed trauma- informed principles into the definition of “appropriate medical treatment” under the Mental Health Act. These amendments aim to ensure that medical treatment for mental disorder not only addresses symptoms but actively minimises patient distress, promotes psychological wellbeing and supports recovery from childhood trauma. There is robust and compelling evidence demonstrating that childhood trauma is a causal factor in the development of a wide range of mental health conditions. The “Adverse Childhood Experiences Study”, by Felitti et al. in 1988, demonstrated a strong dose response relationship between the number of traumatic experiences in childhood and the likelihood of developing of mental health disorders later in life, including depression, anxiety, psychosis and substance misuse. Neuroscientific studies such as Teicher et al. in 2016 have revealed how early maltreatment alters brain structures and functions critical to emotional regulation and stress response. A review of trauma and psychosis by Read et al. in 2005 identified childhood trauma as a significant risk factor for several mental illnesses, including psychiatric disorders. Furthermore, clinical guidance such as NICE’s 2018 recommendations emphasises the importance of assessing trauma history and incorporating trauma-focused interventions into care. These findings are reflected in UK health policy, with the Department of Health recognising trauma-informed care as essential for effective mental health services. We also know from clinical studies that trauma history influences treatment outcomes, with trauma-uninformed care risking re-traumatisation and poor recovery. It is vital to stress that recognising trauma as a causal factor is not about excusing behaviour but about understanding behaviour. Such understanding enables clinicians and services to respond more compassionately and effectively, supporting genuine recovery and healing, rather than merely managing symptoms or controlling behaviour. Embedding trauma-informed care in law is a progressive step that aligns with modern mental health best practice and respects the lived experience of many retained under the Act, the majority of whom have experienced significant trauma in their lives. If the Government do not accept these amendments, can the Minister clarify what steps they will take to ensure that trauma-informed approaches are embedded in mental health services? Will there be guidance, training or oversight in the mechanisms to ensure that patient distress is minimised and psychological wellbeing promoted?

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

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  I am frantically trying to find the exact point in the explanatory notes—I think it is in either paragraph 114 or paragraph 115—about where the second opinion comes together. There is a reference to having a combined certificate. That seems to be a practical solution, but I worry about the crossover relating to who may or may not be affected. If the Minister wrote to me on that point, it might be easier to move the Committee on.

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

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  I will speak to clause 8 first, then work my way through the other provisions in the group. The clause will introduce a statutory requirement that medical treatment under the Act must have a reasonable prospect of therapeutic benefit for the individual. This is a significant and, I believe, welcome development, bringing the law into closer alignment with modern principles of person-centred care and clinical justification. Again, the intention is clear: to ensure that no one is detained or treated under compulsion unless there is a realistic chance that they will benefit from the treatment. That is another laudable aim, and as a doctor myself, I fully support it. Significant concerns have been raised that individuals, especially those with complex or treatment-resistant conditions, have been subject to interventions where the purpose was therapeutic but the likelihood of benefit was minimal or uncertain. By introducing a consistent legal definition of appropriate medical treatment early in the Mental Health Act, and ensuring its application across both civil and forensic pathways, the clause marks a step forward in rights protection and clinical accountability. I welcome the shift away from vague references to appropriateness towards a test that is both objective and patient specific; however, several important questions remain, and I hope the Minister will address them. The first is on defining a reasonable prospect in practice. While the term “reasonable prospect” is a flexible one, that flexibility cuts both ways. The explanatory notes clarify that clinicians do not need to conclude that the benefit is more likely than not, only that it is reasonably possible, but what guidance will clinicians receive to ensure that this threshold is applied consistently and fairly across the country? Will the updated codes of practice provide clear examples or scenarios, and will the guidance be subject to consultation with patients, carers and professionals? When it comes to forensic patients, and equity and safeguards, I welcome the fact that the clause applies equally to part III patients, who are involved in the criminal justice system. Historically, this group has sometimes been subject to more coercive and less scrutinised care pathways. Will the Minister confirm that the same therapeutic benefit test will apply at every decision point—initial detention, transfer, conditional discharge and recall—so that forensic patients are not denied the safeguards enjoyed by civil patients? When it comes to legal remedies and review, what mechanisms will be available to patients who believe that the reasonable prospect test has not been met? Will this be a justifiable cause in tribunals or courts? Will mental health tribunals be empowered to scrutinise the clinical judgments behind this test, and if so, what training will be provided to tribunal members? While I welcome the statutory clarity that clause 8 brings, we must be mindful that legislative change is only the first step: implementation will be critical. I would hope the Government will publish a clear timetable for updating the codes of practice, as well as plans for training, auditing and evaluation. Without that, there is a risk that the reasonable prospect test becomes, again, a box-ticking exercise rather than a meaningful safeguard. Finally, I want to focus particularly on how the measure will apply to people who have long-term, complex or non-degenerative mental conditions where there may be limited, if any, prospect of clinical improvement through medical intervention. These include, but are not limited to, some forms of autism, learning disabilities and personality disorders, particularly those for which trauma-informed approaches may be more appropriate than medical ones. What about acquired brain injuries, or individuals with treatment-resistant psychosis or chronic conditions for which medication has been ineffective? Under the Mental Health Act, such individuals can be and are detained for prolonged periods, sometimes years, even when no clear therapeutic progress is being made. Families, advocates and patients themselves frequently describe a sense of clinical limbo—being held under compulsion with little hope of change, because the system has no better option. Of course, that is one of the big reasons for the Bill in the first place, and it brings with it an entirely new set of problematic scenarios that need careful consideration. In short, the prize of clause 8 is that that limbo should no longer happen: detention and compulsory treatment should occur only when there is a reasonable prospect of actual benefit. How will clinicians be expected to assess the prospect of benefit in cases in which a condition is not considered medically treatable in the conventional sense? For example, if a person with autism is detained during a crisis, but their underlying condition is not one that responds to medication, will the presence of social support or behavioural interventions be considered sufficient to meet the threshold of therapeutic benefit? Will the Government clarify that detention is not justified when the primary issue is risk management, rather than therapeutic progress? There is a long-standing concern that individuals are being detained primarily because of perceived risk, even when there is no viable treatment plan likely to improve their condition. Clause 8 provides an opportunity to set a clear boundary: that risk alone is not enough; there needs to be a reasonable prospect of improving the person’s mental health through treatment. How will the new test interact with decisions around discharge and the renewal of detention? If a person has been detained and the anticipated benefit of treatment has not materialised, will the failure to have achieved a benefit trigger a presumption of discharge, or at least a fresh review of the justification for ongoing detention? Will there be specific guidance in the revised code that addresses how the new tests apply to conditions such as brain injuries? After a recent question, I know that the Government are continuing with the brain injury strategy, but has there been any work on how that can be incorporated? Those are not mere technical questions; they speak to the ethical foundations of the Mental Health Act, which confers extraordinary powers to detain and treat without consent and to deprive someone of their liberty.

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

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  I will resist the temptation to go back to the start of my speech; I am sure that the Committee’s memories of it will have lasted over our short lunch break. I was saying that although the Government’s reforms are, on the whole, positive, we must remain vigilant. The consideration of risks must be applied carefully and consistently to avoid unintended consequences such as deterring clinicians from using community treatment orders when they are genuinely needed or, conversely, enabling an overly cautious approach that restricts patients unnecessarily. We should also be mindful that some patients may find the process of extension and review stressful or confusing. Clear communication and patient involvement, as mandated, must be prioritised to uphold dignity and autonomy. Will the code of conduct aim to ensure a clear and definitive process for keeping patients and their advocates informed as to their rights in the process and what to expect? The Committee must also address a key reason why this part of the law is being amended and why there is so much concern about the current state of mental health legislation: racial disparities. This concern is well documented. There is disproportionate use of CTOs on black men. We have known for years that black people, particularly black men, are more likely to be detained, more likely to be diagnosed with a psychiatric disorder and more likely to be subject to coercive interventions under the Mental Health Act 1983. Those things are clear for all to see, but the reasons are not so clear. We should address the well-documented racial disparities in the use of CTOs. The 2018 independent review of the Act makes it clear that black African and black Caribbean people are disproportionately detained under the Act and subject to CTOs. Despite representing a small percentage of the population, black patients account for a disproportionately high number of CTOs: digital data from the NHS in 2019-20 shows that they make up 13% of CTOs, compared with just 3% of the population. That is supported by research published in BJPsych Open , which found that black patients are roughly two to three times more likely than white patients to be subject to a CTO. The Care Quality Commission has highlighted the disproportionate impact of CTOs on the black and minority ethnic community, raising serious concerns about trust and engagement with mental health services. What does not seem so clear is the reason why. Although we are observing clear disparities in outcome and treatment experiences among ethnic minorities in the UK health system, including in mental health care and beyond, the precise cause remains complex and not fully understood. The patterns that we are seeing, such as disproportionate detention rates, difference in access and poor outcomes, raise serious concerns about care in the UK. However, it is important to recognise that correlation is not causation. These disparities may arise from a range of factors, including biological or genetic factors, socio-economic inequalities, cultural differences, health status or presentation and geographical settings, and there is even the possibility of biases within the service. To develop effective solutions, we must invest in rigorous and independent research that moves beyond correlation to explore the underlying causes and mechanisms. Only then can we decide on interventions that truly address the roots of inequality, rather than just the symptoms. To that end, what steps is the Minister taking to better understand what is happening with CTOs in the field of serious mental health specifically? What concrete action will the Government take to collect better and more granular data on the disproportionality? It is not just about the numbers; it is about understanding the root cause. Will the Government commit to commissioning quantitative as well as qualitative research into the lived experience under CTOs of black patients in particular? Will they consult community organisations as part of that work? I worry that not fully understanding the cause of the problem will mean that, at best, we might slightly mitigate it and, at worst, we will compound it or create a new problem that is harder to treat. Clause 6 represents a thoughtful step towards balancing patient liberty with patient safety and clinical necessity. It will strengthen safeguards, clarify criteria and promote regular oversight, all of which are crucial for the ethical and effective use of CTOs. However, in using CTOs, we must better understand what is happening in the real world. We must not jump to a simplistic cause of systemic bias without truly understanding that cause, and not simply the correlation. I look forward to hearing from the Minister on that point. With that in mind, I turn to Government amendment 30, which will remove the review of CTOs. It was tabled in the other place by the Lib Dem Lords but received support from across the House. The amendment would remove subsection (3) from clause 6. Subsection (3) is designed to introduce statutory safeguards around the use and duration of community treatment orders. In the Lords and more widely, there is, rightly, much debate about CTOs and their place and use. When used appropriately, in a careful and considered context, they can provide a less restrictive alternative to hospital detention and enable patients to continue their recovery in the community. However, the key word is “appropriately”. That is why the Opposition have concerns about the removal of the subsection. It contains reasonable, proportionate safeguards that do not undermine the purpose of CTOs but strengthen their legitimacy, transparency and accountability. Under the Government’s proposal, those safeguards—such as a 12-month maximum duration, regular six-month reviews, and the requirement to consult independent psychiatrists before extending a CTO—would no longer be set out in statute. Instead, we are told that clinicians will be guided by a code of practice and existing professional standards. However, why rely on guidance when we can legislate for clarity and protection? Will the Minister explain why the Government prefer a non-binding code of practice over statutory time limits and reviews, particularly as CTOs involve a significant curtailment of liberty? Does he believe that that is congruent with the principles now enshrined in the Bill? The stakes may be too high to depend on discretion alone. CTOs are one of the few mechanisms in the health system through which someone can be compelled to comply with treatment in the community and can potentially be recalled to hospital, even if they are not in crisis. That makes clear oversight essential. The Government assert that tribunals will serve as a safeguard, with more frequent referrals. However, as many colleagues have pointed out, tribunals often defer to the clinical judgment presented to them, which risks creating a loop. Forgive me, but will the Minister tell the House how many tribunals overturn or terminate CTOs at those reviews? Does he believe that they are robust enough to act as an effective check? Are they simply a procedural step? To that end, what steps is the Minister taking to better understand what is happening specifically in the field of serious mental health? What concrete action can we expect in order to better collect the data? When the Government proposed the amendment that would remove subsection (3), they introduced important safeguards about the duration, review and oversight of community treatment orders. I acknowledge the Government’s position, and Ministers have been clear that they are responding to the concerns raised by stake-holders—including clinicians who support patients with eating disorders, and clinicians in forensic settings—that a rigid time limit on CTOs might remove necessary support from those who are still benefiting from them. That position was reflected in the letter circulated on 11 December 2024 by Baroness Merron, following the debate in the other place. It says that a “strict time limit risks removing support for those patients who were benefiting from Community Treatment Orders.” It continues: “This wouldn’t feel in keeping with the principle of treating the person as an individual.” I understand that concern. We all want a mental health system that recognises nuanced personal need and clinical judgment. However, the Government amendment goes well beyond preserving flexibility. By removing subsection (3), it strips away a carefully balanced set of protections—not just time limits but essential oversight that will prevent CTOs from drifting on indefinitely, without structured review or patient involvement. Removing subsection (3) is a backward step. As things stand, CTOs can be renewed, year after year, with limited scrutiny. The evidence from the 2018 independent review of the Mental Health Act suggests that CTOs do not demonstrate reduced readmission rates. Yet many patients, especially those from racialised communities, remain under CTOs for far longer than may be clinically justified. Subsection (3) did not ban long-term CTOs. It simply said that if a clinician wanted to go beyond 12 months, they must consult the patient, their nominated person and other professions involved, review whether the order was still working, and get a second opinion from a GMC-registered psychiatrist. That is not inflexible; it is good clinical governance. The code of practice is not enough. The Government say that they will address concerns in the code of practice. In the same ministerial letter, we are told: “We will set out the expectation that Community Treatment Orders should end after two years...whilst highlighting that this should take into account clinical discretion.” We all know that an expectation is not a guarantee. The code is important, but it is not binding. There is no requirement to follow it—only to “have regard” to it—and there are no consequences for ignoring it. Where is the accountability? The amendment deletes a provision that would have created a real legal framework for oversight and replaces it with possibly just a promise and a footnote. Tribunal oversight is not a substitute. The Government’s letter also highlights a plan to increase automatic tribunal referrals. That is welcome, but tribunals are not a substitute for proactive clinical reviews. Patients often lack the means or confidence to engage in hearings, and tribunals can only act on the evidence presented to them. Subsection (3) was about making sure reviews happened automatically, in a transparent and collaborative way—not at the point of breakdown or challenge, but as routine best practice. If a code of practice expectation is ignored, what recourse does a patient have? Why is it acceptable for a CTO to continue indefinitely without any formal review of its effectiveness? Why is a second clinical opinion seen as burdensome in mental health, when it can often be standard practice in many other areas of medicine? Given the maths of the Committee, we are unlikely to keep the subsection, but if the Government are determined to remove it, I urge them seriously to consider alternatives. For example, that could be a statutory requirement for annual review, especially after the first 12 months, mandatory consultation with the patient and key professionals before extension, or a duty to record and publish anonymised data on CTO use, disaggregated by duration, diagnosis, and ethnicity. If we are to “keep CTOs under review”, as the Government promised in their letter, why not put that commitment into legislation, with timelines, transparency, and lived experience input? Returning to the issue of the disproportionate use of CTOs on black men, we have known for years that they are more likely to be detained. I gently ask the Minister what concrete actions the Government will take to collect better, more granular data on that disproportionality, not just in terms of numbers, but the root cause. As my noble Friend Lord Kamall rightly asked, what do we know, what do we not know and what do we need to find out? Those are vital questions, but research alone will not solve the problem unless we embed fairness and accountability into the system now. The safeguards in subsection (3) are not bureaucratic red tape. They are vital protections to ensure that CTOs are used only when necessary, and that they are time-limited, reviewed regularly and subject to independent scrutiny. If a CTO is working and genuinely benefiting the patient, then what harm is there in requiring a transparent, collaborative review process to justify its continuation beyond 12 months? Those safeguards would also ensure that patients and their advocates, including their nominated person, are part of the decision making. That is entirely in line with the broader ethos of the Bill: respect, dignity, and least-restrictive care. The Bill is about modernising mental health law. CTOs sit at a crossroads of care and coercion. That is precisely why they demand more scrutiny, not less. The clause, as originally drafted, struck a sensible, balanced compromise. To strip it away is not clinical freedom; it is a loss of legal safeguards for some of the most vulnerable people in our care. I urge the Committee to retain these statutory provisions. They strike the right balance between preserving the appropriate use of CTOs and protecting patient rights and promoting accountability. We owe it to those who are subject to the powers, who are often some of the most vulnerable, to ensure that their care is just, proportionate and based on evidence.

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

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  I am grateful for the opportunity to scrutinise clauses 13 and 14. Clause 13 will make significant amendments to how medical treatment is administered under the Mental Health Act 1983 in circumstances in which a patient refuses, or is deemed to have refused, that treatment. The clause points us to significant questions about autonomy, capacity and compulsion. I hope that we can explore those issues in a way that does justice to the patients affected and to the clinicians working under the framework. Under current law, in particular section 63 of the Mental Health Act, a patient detained under the Act can be given medical treatment for their mental disorder without their consent, even if they have capacity to refuse. That includes in situations where the patient has made a valid and applicable advance decision, or where a donee under a lasting power of attorney, a court-appointed deputy or indeed the Court of Protection itself has indicated that the treatment should not be given. That power is curtailed only for certain treatments, such as electroconvulsive therapy, which falls under section 58A, and some surgical procedures under section 57, where either consent or a second opinion is already required. We will be debating those separately. Moreover, in the case of psychotropic medication under section 58, treatment can typically be given for up to three months without any second opinion, even if the patient objects. The clause will introduce a proposed new section 57A, significantly shifting the landscape. It will extend safeguards to cases in which a patient has capacity but refuses treatment, a valid and applicable advance decision refuses treatment, or a refusal is issued by a donee, a deputy or the Court of Protection. In such cases, treatment could be given only if a second opinion appointed doctor certifies that the treatment is clinically appropriate; there is a “compelling reason” to give it, such as no acceptable alternative; and the process has followed a newly required clinical checklist. This is a clear move to give greater legal weight to patient choice and prior decision making, echoing the long-standing principles of the Mental Capacity Act 2005. It would also mark a significant tightening of powers under section 63, making it harder to override refusals of treatment, and in effect it would end the practice of giving compulsory medication in the first three months without external oversight, at least where a refusal or conflicting decision exists. It is worth touching on the interaction between the Bill and the Mental Capacity Act. We have talked about that framework before, but it allows for advance decisions to refuse treatment and recognises the authority of donees under a lasting power of attorney, court-appointed deputies and the Court of Protection to look at best interests. Historically, however, the Mental Health Act 1983 has operated in parallel, and at times in conflict, by allowing compulsory treatment for mental disorder, even in cases where patients have capacity. By inserting proposed new section 57A, the clause attempts to bridge that gap by preventing certain treatments from being administered where they would conflict with an advance refusal or decision. That represents a welcome shift, but there are some concerns to which we need to turn our attention. For example, the “compelling reason” threshold is undefined in statute and could allow significant variation in interpretation. There is a reference to the checklist in section 56A, but—forgive me—I do not believe that that quite covers the definition. There is also a risk that, in practice, time pressures or institutional cultures may erode the intended safeguards, in particular if urgent treatment provisions under section 62 are overused, so I will discuss those a little further in detail. I recognise that the intent behind clause 13 is to place the principle of autonomy and choice at the heart of mental health care—that is a welcome and overdue shift—but given that it introduces the concept of compelling reason to override a refusal of treatment, will the Minister clarify how “compelling” will be interpreted in practice? Will statutory guidance define the term to ensure consistency, or will it be left to the discretion of individual clinicians and the second opinion appointed doctor? Secondly, the clause strengthens the role of the SOAD, requiring not just clinical oversight but legal and ethical judgment, including engagement with advance decisions and decisions of legal proxies. What training and support will be provided to SOADs to equip them for the expanded roles? How will the Government ensure that the system is properly resourced to avoid delays? Thirdly, will there be a clear right of appeal or review for patients or their legal representatives when an SOAD certifies treatment in the face of an objection? I am conscious that there are real-world examples. For instance, let us take the case of a patient with bipolar disorder who is detained under the Mental Health Act. When they are in a stable state, they might clearly and calmly refuse a particular medication because they have experienced harmful side effects from it in the past—the Minister even used that as an example. At that point, they have capacity and their decision is valid. However, during a later episode of acute illness, they might temporarily lose capacity, and in that window the clinician would potentially override their earlier decision, even if it was made with full understanding. This amendment aims to protect such refusals, but unless the law is clear about how to treat prior capacitous decisions during periods of incapacity, there is a risk that well-considered patient choice could still be sidestepped. This problem will get only more common, given the number of people with dementia and acquired brain injuries. Fourthly, the clause enhances safeguards, which is crucial, but it could result in unintended harms. What assessment has been made of the risk that necessary treatment may be delayed or denied in complex cases, especially where SOAD access is limited or where there is disagreement about whether an advance decision is valid or applicable? Although I support greater emphasis on patient autonomy, we must consider those at the greatest risk of harm. Do the Government believe that clause 13 strikes the right balance between protecting liberty and ensuring prompt, effective care for the most acutely unwell? Have they any concerns about what that could mean for public safety? Has an impact assessment been carried out on what that could mean in the real world and the implications, given the recent high-profile cases that we just talked about? Clause 14 shortens the period before a second opinion is required for certain types of treatment from three to two months. That is a positive step in principle, and ensures that patients who either lack capacity or have not consented are not left too long without independent oversight. It also allows, where clause 13 applies, for a single certificate to be issued by the second opinion appointed doctor, which covers both standard review under section 58 of the Mental Health Act and the more complex safeguards in proposed new section 57A. That may help to reduce duplication and administrative burdens. The table on page 25 of the explanatory notes gives an overview of how that might work, but I would welcome reassurance on a few points. How will the distinct legal tests, such as assessing a patient’s capacity, rather than determining a compelling reason for overriding an advance decision, be kept clear and robust in one single combined certificate? What safeguards will be in place to ensure that streamlining does not weaken the new protections in clause 13? Let us imagine that a patient has made an advance decision to refuse a particular antipsychotic medication—let us call it medication A. They are detained under the Mental Health Act, and the clinical team wants to give them medication A anyway. Because the patient lacks capacity and the proposed treatment goes against a valid advance decision, the special safeguards under proposed new section 57A apply, yet at the same time it has been nearly two months since the patient started treatment, so a second opinion under section 58 is also needed to check whether any medication is appropriate more generally. Clause 13 allows for those two approvals—one for the general treatment under section 58 and one for treatment despite the patient’s known refusal under proposed new section 57A—to be combined into one certificate. The concern is that, in streamlining, the different legal and ethical issues might be collapsed into a broader decision, making it harder to see whether the patient’s advance refusal was properly considered and whether the decision to override has met the compelling reasons test. Can the Minister specify how that might work, given that there will now be one certificate? Clinicians and reviewers might unintentionally treat the refusal as just another case of lack of capacity, rather than the serious, rights-based objections that require extra scrutiny. On the issue of practicality, with the review period being brought forward by a month, are the Government confident that a second opinion system is resourced to meet the demands without compromising quality? I could go on, but for the sake of the Committee, I will not.

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

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  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?

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

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  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”?

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

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  I rise to speak to Liberal Democrat amendments 1 to 7 and 51 to clause 4. I welcome the intention behind the amendments, which aim to enhance the care and treatment review process for people with autism and learning disabilities, particularly by addressing housing and accommodation needs and ensuring that key advocates receive reports. There are positive elements of the amendments that are worth highlighting. I understand the good intent of including housing and accommodation considerations explicitly in reviews, as it recognises that a person’s living situation is often central to their wellbeing and recovery. Additionally, ensuring that nominated persons and independent mental health advocates receive reports promptly promotes transparency and patient advocacy. Shortening the review intervals from 12 to six months could lead to more responsive care planning. However, I have some significant reservations about the statutory implications of blurring housing, for example, so directly with the care and treatment review process. Housing is traditionally managed under separate statutory frameworks from health and social care, so to embed housing as a statutory element within these reviews risks creating confusion about which agency holds responsibility and may expose health bodies or commissioners to legal obligations that they are neither funded nor structured for. I have a few questions for the Liberal Democrats. In their eyes, how would the Government ensure clarity over the statutory duties applied to housing recommendations arising from the reviews? Would that not risk delaying or complicating discharges if housing issues became a statutory sticking point within health-led care reviews? Moreover, housing provision often depends on local authorities and housing departments that have their own complex eligibility criteria and resourcing constraints. Are we confident that ICBs and responsible commissioners would be able to co-ordinate effectively across these boundaries, especially given the patchwork of funding and powers in play?

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

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  I entirely agree, and I hope that data is and will be shared. The question is about the definitions and standards, such as those used for waiting times. We often use the A&E waiting time of four hours. When it comes to the most vulnerable patients who will potentially be on waiting lists, or looking at specific data, if it is categorised differently in Wales, Scotland and England, that makes it very hard to see where best practice is so that it can be shared. That is the Opposition’s concern. I know that both sides of the House have shared that concern in my five years in Parliament. Is there a mechanism to address that issue either in the Bill or in the Minister’s wider portfolio?

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

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  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?