Luke Evans MP: speeches

Speeches

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

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

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

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  The hon. Member makes a good point. We have had ICD-10 and DSM-5, which aim to codify those disorders. Part of the problem is that someone with Korsakoff syndrome, which is brain damage from alcohol, or with Rett’s disease would potentially come under the scope of these definitions. That makes it very difficult. What about acquired brain injury? That is an emerging field—the House has looked at it and has put a strategy in place. However, there could be problems in the legislation going forward. The amendment is asking, I think, how we scientifically proof the Bill so that we do not need to introduce further primary legislation. That is the question that the Government need to grapple with. As a doctor, I have seen the difficulties and practicalities of these definitions, and of trying to put people in a box. For example, where does Asperger’s fit on the autism scale? What does that look like on the spectrum of conditions? Are we trying to codify that? These are the real, pragmatic problems of putting definitions in place. That means it is all the more important to look at definitions, but, as the hon. Member for Shipley has rightly pointed out, the definitions have already moved on while we have been discussing the Bill. Introducing a mechanism that allows the House to update the legislation in keeping with advances in scientific knowledge is really important. The question is whether this is the right amendment to do that. The amendment would allow the Secretary of State to make updates through regulations—secondary legislation—which would thereby enable a more flexible and responsive approach. Importantly, it requires that any such regulations must be laid before Parliament and approved by both Houses, which maintains parliamentary scrutiny and democratic oversight. The potential benefits of this approach are clear. It offers the possibility of allowing the law to evolve and stay aligned with scientific evidence and clinical best practice without undue delay. That could prevent outdated or overly rigid definitions from adversely impacting vulnerable people, and better reflects the complexities of mental health conditions. It would allow the law to keep pace with advances in the scientific understanding of autism, learning disability and mental disorders, without the need for primary legislation. It could help ensure that the definitions remain clinically accurate and relevant, improving how the law is applied and reducing the risk of outdated criteria causing harm or confusion. As the hon. Member for Shipley pointed out, that is part of the problem. As new criteria come up, there is a delay in the uptake of definitions. From my experience in clinical practice, keeping up to date with definitions can sometimes be a challenge. It is part of the personal development plan to make sure there is that understanding, but there is always a drip through as change in practice comes through, along with clinicians being comfortable and happy to use the new definitions. With any new medication, it is important to understand the side effects and the pros and cons of what it is trying to achieve, and to be able to explain that fully so that a patient can consent when taking that medication. The same applies when trying to explain a condition to patients. If there is a change and a new aspect to the way in which a definition is being applied, it is important that we have some flexibility. The affirmative procedure preserves Parliament’s role, offering safeguards against unchecked ministerial power. However, there are some important considerations and potential drawbacks. Definitions of mental health conditions have profound legal and social implications. Delegating this power, even with parliamentary approval, risks politicisation or inconsistent application if regulations are used too frequently or without adequate consultation. Secondary legislation typically receives less parliamentary debate and public scrutiny than primary legislation, even with the affirmative procedure, which may not suffice for such significant changes. There is also a risk that the changes could be made in a reactive or piecemeal way rather than with a coherent legislative framework, potentially leading to legal uncertainty or unintended consequences. Given those points, I have several questions for the Minister. How do the Government propose to keep the legislation updated, given that we are only updating the Mental Health Act now, 40 years on? Do they have a mechanism in mind to ensure that any updates to the definitions are accompanied by robust clinical and expert consultation, while reacting to advances in medical understanding? Would the Government consider a formal review mechanism such as a mandated periodic independent review of the definitions? That could solve the problem of legislation becoming outdated, and put the safeguards in place. If there is a difference in the scientific community, we need to make sure that any changes are broadly in agreement with the direction of travel of scientific knowledge. Furthermore, in considering the need for balanced, flexible and democratic accountability, the Government could introduce a sunset clause on any regulations, so that any changes would be revisited and renewed by primary legislation within a set period, unless Parliament agrees otherwise. Crucially, to my knowledge, there are no standing statutory bodies or panels tasked with reviewing or advising the Government on the legal definitions of mental health conditions. There is an argument that without a dedicated expert body to guide the Secretary of State, we cannot be sure that any changes are robustly evidence-based and clinically sound. Currently, we have the National Institute for Health and Care Excellence, the royal colleges, the Department of Health and Social Care and the intermittent mental health review bodies, but have the Government considered establishing a formal advisory mechanism to address problems in the future? The Opposition can see the argument both ways, but to govern is to choose, and it would be useful to understand the Minister’s thoughts on this area.

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

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

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  The hon. Member is correct about the way in which the world looks at this issue. The problem is that we are sat here debating definitions in legislation that is 40 years old. Will we be here in 40 years debating definitions that have moved on? The amendment suggests that, somehow, we need to try to ensure that legislation is flexible and updated enough, and has the scrutiny and safeguards in place. That relates to not just health, but any part of government that we tend to look at in the House. I wanted to speak to the amendment to probe the Government on how they will safeguard the legislation. I do not have all the answers, but this is important. I do not want to see my successors—the hon. Member for Hinckley and Bosworth from whatever party—sat here debating this issue in 40 years’ time because the definitions that we happen to set today have become outdated and have unintended consequences. That is the balance that I am looking for. I do not see a body across the UK, given that this is UK legislation, that fulfils this role. It could be a transitory role or fully established. A psychiatrist could take it on, or it could come under NICE. With the abolition of NHS England, it could be a new role for the Department of Health to take on. All those are viable vehicles that could potentially look into the definitions. I want to ensure that what we pass in Parliament actually translates into the real world for clinicians, patients and the public. The Opposition can see the argument both ways, as I mentioned. Perhaps it would be useful to have an expert panel, with representatives of clinicians, legal experts and service users to support regulatory updates. I put those questions to the Minister and I look forward to his answers.

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

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  Thinking that through, how does my hon. Friend feel that existing statutory requirements to provide accommodation will balance out if we provide another statutory requirement on accommodation in these plans? Does he worry, as I do, about creating a risk, for example, of pitting someone with severe learning disabilities against a homeless person if there is resource rationing thanks to the practicalities of how many houses we have? Members throughout the House agree that we need to build more houses, but until that happens, such local authorities have the resources issue.

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

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  It is a pleasure to speak to clause 3, which brings forward the vital and long overdue changes to the way our laws treat autism and learning disabilities under the Mental Health Act. The clause responds to a persistent injustice: the inappropriate detention of autistic people and people with learning disabilities in mental health hospitals, often for years at a time, without meaningful therapeutic benefit. Those individuals are not mentally ill, yet they have too often been detained, medicated and restrained as if they were. As the law stands, individuals with learning disabilities and autistic people can be detained both for assessment, under section 2 of the Act, and for treatment, under section 3. Notably, people with learning disabilities may be detained under section 3 when their condition “is associated with abnormally aggressive or seriously irresponsible conduct”, whereas that does not currently apply to autistic people. Evidence and reports show that some such detentions can be lengthy and may not always provide therapeutic benefit. That raises concerns about the appropriateness of detention on the basis of disability alone. In my time on the Health and Social Care Committee, we looked specifically at this topic and produced a report, some of which has influenced the Bill. The clause aims to directly address the issue of lengthy detentions for such individuals. For the first time, the law will clearly define autism and learning disability—something that has not happened for 40 years. As science has moved on, legislation must follow. Autism will now be recognised as a “lifelong developmental condition” that affects perception, communication and interaction, and learning disability will be defined as “significant impairment” of intellectual functioning. Supported by schedule 1, the clause seeks to clarify and refine that position by introducing formal definitions of “autism”, “learning disability” and “psychiatric disorder”. Crucially, it removes autism and learning disability as stand-alone grounds for compulsory treatment and detention under section 3. Instead, detention for treatment will be permitted only if a person has a co-occurring psychiatric disorder—that is, a mental disorder other than autism or learning disability. Additionally, the change applies to community treatment orders, meaning that they cannot be applied solely on the basis of autism or a learning disability. However, the Act makes it clear that the changes do not apply to people detained under part 3 of the Act who are within the criminal justice system. For that group, autism and learning disabilities with serious behavioural consequences remain grounds for detention and treatment disorders. The Bill introduces the new term, “psychiatric disorder”, meaning any mental disorder excluding autism or a learning disability. That distinction matters because detention under section 3 of the Act—compulsory admission for treatment—will no longer be permitted solely on the basis of someone being autistic or having a learning disability. From now on, a person may be detained only if they have a co-occurring psychiatric disorder or their learning disability is associated with “serious behavioural consequences”, such as “abnormally aggressive or seriously irresponsible conduct”. That reflects a fundamental shift in the philosophy of the Act from using hospitalisation as a containment tool to ensuring that any detention has a clear clinical and therapeutic purpose. This reform is rooted in the recommendations of the 2018 review of the Mental Health Act, which was led by Professor Simon Wessely, and has been championed by groups such as the National Autistic Society. It represents a more modern understanding, as we currently see things, so there are many positives—it protects people’s rights, preventing detention simply for being different, it promotes community-based care rather than institutionalisation, it modernises the law in line with current clinical understanding and it seeks to end the harm caused by prolonged non-therapeutic hospital stays, which often involving over-medication and restraint. However, I also sound a note of caution: the clause alone will not be enough. There is rightly concern about the provision for robust community services. We risk creating legal protections that are admirable on paper but ineffective in practice. I know that the Minister appreciates this dilemma. If people cannot get the right support in the community, they will still end up in crisis, and possibly still be detained—just under a different part of the law. There are also concerns about ambiguity. The phrase “serious behavioural consequences” may be open to a wide interpretation. Without clear guidance and training, we risk inconsistencies and even potential loopholes that could undermine the intent of this reform. I commend the Government’s intention to protect autistic people and people with learning disabilities from potentially inappropriate detentions, and to ensure that compulsory treatment is targeted to those with mental disorders warranting hospital care. The emphasis on therapeutic benefit and the principle of least restriction aligns well with the human rights standard and the UN convention on the rights of persons with disabilities. However, I have several questions that I hope the Government will be able to address. How will clinicians reliably distinguish between behaviours arising from autism and learning disabilities and behaviours arising from co-occurring psychiatric disorders, given the complexity of presentations in this population? Is there, or will there be, clear guidance and training to support those assessments? For individuals with severe autism or learning disabilities who display challenging behaviours but do not have a diagnoseable psychiatric disorder, what alternative pathways and supports are envisaged to ensure their safety and wellbeing without resorting to detention? On the issue of patients under part 3 of the Bill, I know the Government’s rationale for maintaining broader detention definition criteria, but will there be additional safeguards or oversight to ensure those patients are not subject to unnecessarily prolonged or restrictive detention? The removal of “social functioning” from the definition of learning disability is intended to create a clearer distinction from autism, but could the changes create any unintended legal or clinical ambiguities in practice? The changes could introduce some unintended consequences. Previously, impairments in social function were considered part of the learning disability definition, which helped capture individuals whose social difficulties accompanied intellectual impairments. Without that, there may be legal and clinical uncertainty for people with borderline or overlapping conditions. For example, someone with moderate intellectual impairment and significant social difficulties might no longer clearly fit the learning disability definition. Similarly, autistic individuals with mild intellectual disability who experience social challenges could find their diagnosis and legal status less certain. Those ambiguities risk inconsistent assessments and potential gaps in access to appropriate care unless the Government provide clear guidance to clinicians and tribunals on how to navigate complex presentations. What plans are in place to monitor and evaluate the impact of the changes on detention rates, patient outcomes and the availability of community-based alternatives? In closing, this is an important clause that moves us closer to a system that respects autonomy, delivers appropriate care and upholds the rights of neurodivergent people. But we must be mindful that passing this legislation must not be seen as the end of the job. As the Minister understands, it is the beginning. If we are to drive reform, the Government will need to set out the funding and workforce pathway for the services that will deliver it. We must train professionals, empower families and support voices of lived experience at every level. Only then will clause 3 deliver on its promise not just to change law, but to change lives. I turn to schedule 1. Schedules are an important and yet often overlooked part of the legislative process. It is worth reminding the Committee that a schedule is a part of a Bill’s function, like a detailed appendix. It contains the granular, often technical amendments that give practical and legal effect to the broad principles set out in main clauses. In other words, the clause tells us what Parliament intends to do and schedules show us how it will be done: amending existing statutes, updating definitions and ensuring consistency across legal frameworks. In this Bill, schedule 1 is particularly consequential. It does the heavy lifting of applying the reforms in clause 3 to the existing Mental Health Act 1983, especially with regard to how we treat autism and learning disabilities within the scope of mental health law. Let us be clear that the schedule is not simply technical. It is transformational in what it attempts to do. Where the 1983 Act spoke broadly of mental disorder, schedule 1 now creates a more precise legal category—“relevant disorder”—defined to include psychiatric disorder, autism and learning disability with serious behavioural consequences. That matters enormously. In fact, it is one of the key reasons for the review of this entire piece of legislation. Individuals with autism or learning disabilities have been subject to compulsory powers, including detention, as we have heard, in the absence of any co-occurring mental illness. That is a practice with which the Committee should rightly be uncomfortable. Schedule 1 amends not only the criteria for compulsory admission under section 3, but those for guardianship, community treatment orders, tribunal discharge and even the treatment provisions in part 4 of the Act. This breadth shows that clause 3 is not merely a rhetorical shift; it is being operationalised throughout the entire Act. With such significant implications, the schedule raises serious and legitimate questions that I am sure will form the backbone of the ongoing discussions in Committee over the next few weeks. First, what is the threshold for serious behavioural consequences? Will that be clearly defined? Without precision, we risk substituting one vague standard for another. Secondly, do the transitory provisions offer enough clarity for frontline practitioners, in particular approved mental health professionals and tribunal panels who will be making decisions in grey areas between new and old law? Again, what about the cross-border issue between Wales and England? Thirdly, given the change from mental disorder to psychiatric disorders in some sections but not others, what is the Government’s rationale for that linguistic differentiation? Is there a risk of confusion among legal and clinical practitioners? To clarify—I am happy to share this with the Minister—I went through it and there appear to be a few occasions where the definition was changed, but some areas where it was not. Now, that may be my naïve understanding as a mere shadow Minister, but I would welcome the clarification and I am happy to pass them on to the Clerks to ensure that, if we are going to update the Bill, all parts are updated. Finally, and critically, do we have the workforce, training and services in place to support this cultural and clinical shift away from paternalism towards community-based and rights-respecting alternatives? Schedule 1 shows us that reform is not just about good intentions, but getting the detail right. It is about ensuring the law reflects modern clinical understanding and human dignity. I support the direction of travel, but I gently remind the Minister to ensure that the operational mechanisms of the schedule are tested, clarified and, where necessary, strengthened. We owe that to the individuals and the families for whom we are producing this legislation to improve their lives.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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