Stephen Kinnock MP: speeches 2025

688 published records · newest first.

Speeches

12 Jun 2025 · Mental Health Bill [ Lords ] (Third sitting) · Hansard source
More
I beg to move amendment 26, in clause 5, page 11, line 22, leave out— “by a constable or other authorised person”. One of the tests for detaining a person under the mental health legislation is that harm may be caused, or that treatment is not possible, without detention. This amendment and amendments 27, 28 and 29 remove wording stipulating that the detention that is necessary must be detention by a constable or other authorised person (as defined).
12 Jun 2025 · Mental Health Bill [ Lords ] (Third sitting) · Hansard source
More
It is a pleasure to serve under your chairship, Ms Furniss. Government amendments 26 to 29 seek to remove previous amendments to the clause tabled by Lord Kamall, Earl Howe and Baroness May of Maidenhead, which added police and other authorised persons to sections 2, 3 and 5 of the Mental Health Act 1983, giving the police additional powers to detain people under the Act where they currently have no powers to intervene. We do not support extending police powers in that way, and we understand that the police do not support an extension either. It would not be appropriate to involve police officers in clinical decision making about whether a person meets the criteria for detention for assessment or treatment under the Act, or to involve them unnecessarily in the temporary detention of patients who are already in hospital to enable a Mental Health Act assessment to take place. We also seek to remove clause 50 from the Bill; we look forward to discussing that at the appropriate time on a future day in Committee. I will now move on to clause 5 in its entirety. The grounds for detention provide decision makers with criteria that must be applied when deciding whether it is appropriate to detain, or to continue to detain, a person under the relevant sections of part II of the Mental Health Act, covering civil patients. The clause will replace the existing criteria, which the independent review of the Mental Health Act found were too vague, and will take forward changes recommended by the review. It will strengthen and clarify the criteria to require a risk of “serious harm” to justify detention. Consideration must also be given to the nature, degree and likelihood of the harm. For a patient to be detained for treatment under section 3, there must be a “reasonable prospect” of therapeutic benefit. The code of practice already directs clinicians to consider the “nature”, “likelihood” and “severity” of harm. We believe it is right to formalise those considerations by putting them in primary legislation. We have not defined serious harm in the Bill. We will work with stakeholders to provide guidance on that in the code of practice. We are not seeking to raise the bar on detention, which could put patients and the public at risk. However, we think that when the serious decision is taken to deprive someone of their liberty, and potentially to treat them against their wishes, there needs to be consistent consideration of the potential risk of harm to a person or to others to justify that. The revised risk criteria will not apply to part 3 patients. There are already tailored risk criteria for patients in the criminal justice system. Those are considered by the court and the Secretary of State for Justice, and allow for all relevant factors, including public protection, to be considered on a case-by-case basis. For those reasons, I commend Government amendments 26 to 29 and clause 5 to the Committee.
12 Jun 2025 · Mental Health Bill [ Lords ] (Third sitting) · Hansard source
More
I will touch on the questions that have been asked on cumulative and escalating behaviour, on having a review of public safety and on the training plan. The details will be provided for in a mixture of the code of practice and the annual written ministerial statement. The code of practice will be based on consulting both those who use the new criteria, such as clinicians, approved mental health professionals and members of the tribunal and, then, of course, on the other side, those with lived experience, service users, families and carers. It will be shaped and drafted on that basis. It will then go out to public consultation and will be laid before Parliament so that Parliament will have an opportunity to debate it. It will be a comprehensive and detailed development of the code of practice, and will address the issues around cumulative and escalating behaviour, the public safety issues and training. On cumulative and escalating, it is worth noting that under the reforms in both the Bill and the current Act, clinicians have the power to detain on the basis of a risk of harm that may occur, not that already has or is happening at the time. That power already exists.
12 Jun 2025 · Mental Health Bill [ Lords ] (Third sitting) · Hansard source
More
I thank the hon. Member for the intervention, but I simply repeat that under both the Act and this Bill, which will reform that Act, clinicians have the power to detain on the basis of a risk of harm that may occur, not one that has already or is happening at the same time, so, in my opinion, this power already exists. What is the point of over-embroidering and adding more questions and considerations when those questions and considerations are already answered? Let us just try and streamline things, please, and make things simple rather than complicated. We had a lengthy debate on the amendment. Let us just boil this point down to its essence: the majority of mental health incidents are managed without police involvement. Approved mental health professionals have powers under section 115, section 6 and section 137 to enter a person’s home and to assess and convey said person to a hospital. That is the first point: all the concerns that have been raised by the Opposition are very clearly addressed by the powers that already exist for AMHPs. We support “right care, right person”. Policing is of course operationally independent, and those “right care, right person” arrangements are planned and developed through detailed multi-agency partnerships on the ground. We need to be pragmatic and recognise that “right care, right person” is the right way forward. The Government are committed to it, so let us let the practitioners, the experts and the police on the ground work in a practical and pragmatic way to address these incidents as they occur. In many cases, it is simply impossible to legislate for these incidents. By definition, every person experiencing trauma experiences it for different reasons, and it manifests itself in different ways, so top-down micromanagement of that would be deeply counterproductive and unhelpful. Officials in the Department of Health and Social Care and in the Home Office have engaged with senior representatives of the police on these amendments in great detail. I can give the Committee an 100% assurance that the police do not support an extension of their powers to sections 2, 3 and 5. I am therefore baffled by the fact that Opposition Members appear to be claiming that they know better than the police whether their powers should be extended. Let us stop trying to pretend that we have the police’s expertise. Let us please take a pragmatic approach to this. The police do not want an extension of these powers, and the Home Office is clear that that is the case. There seems to be a fundamental misunderstanding at the heart of the lengthy debate that we have just had. On that basis, I thank hon. Members for their interventions and I commend the amendments to the Committee. Question put , That the amendment be made.
12 Jun 2025 · Mental Health Bill [ Lords ] (Fourth sitting) · Hansard source
More
I thank hon. Members for this useful and insightful debate on care and treatment plans. I will begin by discussing amendments 14, 15 and 48. I reassure Members that the scope of the new statutory care and treatment plan has been made purposefully broad, so that wider matters relevant to a person’s mental health recovery, such as financial support and social care needs, are captured. We recognise that they can play a significant part in a person’s mental illness and can increase the risk of people with mental illness, learning disabilities and autistic people experiencing crisis leading to detention under the Act. Consideration of those issues can be critical to providing a comprehensive and effective programme of care and support. As was promised by Baroness Merron and referred to by the hon. Member for Guildford and my hon. Friend the Member for Shipley, the required contents of the care and treatment plan, which we publicly consulted on, will be set out in regulations. More information on what we intend to include in relation to financial matters, housing and accommodation needs, and other issues can be found in the relevant policy paper in the parliamentary Libraries. We will provide guidance in the revised code of practice that will set out that in-patients receiving acute mental health care should be offered financial support, among other interventions, aimed at meeting the person’s holistic needs. To ensure that a person’s wider needs are identified as early as possible by mental health professionals, we intend to encourage individuals to include this information in their advance choice document. I turn to housing and accommodation protection, which are referred to in amendment 15. Where a person is detained in hospital and is receiving housing benefit, or their housing is paid for via universal credit, there are provisions already in place that allow for them to be temporarily absent from their property for a limited duration. We will use the code of practice to set clear expectations on mental health staff around care planning, including consideration of accommodation and housing needs. We will also highlight existing provisions that protect a person’s living arrangements while they are in hospital. I turn to amendment 23, which was tabled by the hon. Member for St Neots and Mid Cambridgeshire. Under the Bill, all patients will receive a statutory care and treatment plan, excluding those under short-term sections. The patient’s statutory care and treatment should be created by the clinician in consultation with the patient and those who care for them, such as family members and carers. The clinician is expected to make reasonable adjustments to meet any communication needs, so that they can participate as fully as possible in making the plan to ensure that their wishes and feelings are reflected. It is already our intention for care and treatment plans to cover information relating to a patient’s communication or sensory needs, if it links to their mental health recovery. That includes their wishes and preferences, information pertaining to their family or carers, and arrangements relating to their safe and effective discharge, which may include crisis planning. We will of course provide detailed guidance in the code of practice to ensure effective care planning for people with learning disabilities and autistic people that takes into account their specific needs. I turn to amendment 50. Last year, the Government issued statutory guidance under the National Health Service Act 2006 on discharge from all mental health and learning disability and autism in-patient settings. That guidance underlines best practice on discharge planning and multi-agency collaboration between NHS bodies and local authorities, in line with statutory duties to co-operate under the 2006 Act. We intend to make the discharge plan a required part of the patient’s statutory care and treatment plan, and that will be made explicit in regulations. The scope of the care and treatment plan is broad, allowing for consideration of the patient’s holistic needs as part of their discharge plan. Under the Bill, the plan should be prepared and reviewed in consultation with the patient and others, such as their advocate, carer or family members, where appropriate and practically achievable. Statutory guidance on discharge planning sets out that it should start on admission of the person to hospital, if not before. All detained in-patients are supported by a multidisciplinary team responsible for their care and treatment. Discharge planning should involve input from other agencies and the community team responsible for the individual’s ongoing care and treatment once discharged. Where a person is eligible for section 117 aftercare, planning should involve commissioners and local authorities too—
12 Jun 2025 · Mental Health Bill [ Lords ] (Fourth sitting) · Hansard source
More
Clause 11 will introduce a new clinical checklist that the patient’s responsible clinician must follow when making decisions about a patient’s treatment. This seeks to put the patient at the heart of clinical decision making. Specifically, the checklist will require that the clinician supports the patient to engage in decision making concerning their treatment. That could include nursing, psychological interventions, specialist care and medication. They must also consult with those close to the patient to consider the patient’s wishes, feelings, beliefs and values, including those expressed in advance, and avoid making decisions based solely on factors such as the patient’s age or condition. Where the patient is too unwell and lacks the capacity or competence to make decisions concerning their treatment, the checklist will require the clinician to consider any wishes, feelings, views and beliefs that they think the patient might have had if they had had capacity. They might establish this by consulting with those close to the individual or looking at their advance choice document. The checklist represents best practice, but sadly it does not represent standard practice. The independent review identified multiple incidents of patients feeling disempowered and unsupported to share their wishes and feelings, and unfairly ignored when they did. That can undermine the patient’s sense of self-worth, their recovery and their trust in mental health services. We consider the checklist fundamental to delivering the guiding principle of patient choice and autonomy. We therefore consider it necessary to put the checklist on the face of the Bill. That was the approach taken with the best interests checklist under the Mental Capacity Act 2005, which in many ways is analogous. That checklist has come to be widely recognised and highly regarded by practitioners. I commend the clause to the Committee.
12 Jun 2025 · Mental Health Bill [ Lords ] (Fourth sitting) · Hansard source
More
In many ways, that is a question for clinicians, because they always have to make judgments in individual cases. In tragic cases such as eating disorders, at times it gets to the point where a person cannot be saved. If a patient is refusing to eat, it is notoriously challenging for clinicians to try to get that position reversed through talking therapies or other forms of treatment. Is about how we put in place legislation and a code of practice that give the system the best possible steer while recognising that clinicians make decisions on a daily basis in reacting to the circumstances that they face. I will take the hon. Gentleman’s point away and think about it, but I wonder whether there is a definitive answer to his question because of that interplay between the macro system and the micro challenges within that system. My hon. Friend the Member for Thurrock raised several important points. She wisely said that the clause is about not just the principle of therapeutic benefit, but seeing the person as an individual and the principle of doing least harm. I thank her for those points, which are important for the Committee to take on board. My hon. Friend asked about the impact of the therapeutic benefit provisions on the 1.5% of people with particularly complex needs. That is an important question, and to some extent touches on the intervention by the hon. Member for Hinckley and Bosworth about what we do in those really challenging situations. Where hospital admission is needed, the fundamental principle is that we believe it must be therapeutic, the least restrictive option and for the shortest time possible. Section 131A of the Mental Health Act 1983 places a duty on hospital managers to ensure that the hospital environment suits the patient’s age and needs. Current efforts, including NHS England’s quality transformation programme, aim to address the root causes of poor in-patient care by working with patients, families and professionals. That is a roundabout way of answering the question, but fundamentally, the hospital manager has a duty to ensure that the environment suits the patient’s needs. Those needs will range from the most complex and challenging 1.5% of cases that my hon. Friend the Member for Thurrock mentioned through to the cases of others who may have milder disorders or challenges. Needs must be met across that landscape, and the duty is on the hospital manager to ensure that they are. My hon. Friend may also be interested to look at the quality transformation programme, which seeks to address some of the challenges that she mentioned. In the light of those comments, I hope that hon. Members will not press their amendments. I commend clauses 8 and 9 to the Committee.
12 Jun 2025 · Mental Health Bill [ Lords ] (Fourth sitting) · Hansard source
More
I will discuss a number of issues concerning the topic of urgent electroconvulsive treatment. Clause 15 makes a small practical change to the current protocol around administering electroconvulsive therapy. Currently, where the responsible clinician wishes to administer electroconvulsive therapy and the patient lacks capacity or competence to consent, the second opinion appointed doctor must certify, among other things, that it does not conflict with an advance refusal or the decision of an attorney or deputy. We have heard from stakeholders that it would make much more practical sense and save the second opinion appointed doctor time if that was established before they were invited to assess the patient. Therefore, the clause makes it the role of the responsible clinician to ascertain if treatment is in conflict with an advance refusal or the decision of an attorney or deputy before they secure the second opinion appointed doctor. I commend the clause to the Committee. It improves the patient’s right to self-determination by minimising the circumstances under which urgent treatment can be given compulsorily under section 62 of the 1983 Act. I turn to clause 17. Currently, section 62 of the 1983 Act sets out four main scenarios under which the normal treatment safeguards do not apply, allowing urgent compulsory treatment to be given without such safeguards. The clause removes from section 62 the power to give medication compulsorily where its purpose is to alleviate the patient’s serious suffering. The act of forcibly treating an individual can be a highly traumatising and distressing experience. The clause recognises that, where someone is well enough to make a capacitous or competent refusal to treatment, they are also well enough to decide the level of suffering that they are willing to undergo. The clause is critical to improving the patient’s autonomy over their care and treatment. It does not affect the clinician’s ability to administer compulsory treatment where it is immediately necessary to prevent the patient from behaving violently or being a danger to themselves or others, to prevent their serious deterioration or to save their life. I am grateful to the hon. Member for Winchester for tabling amendment 13. Its intention is largely already met by the Bill—that is, a second opinion doctor’s certificate can be dispensed with only in the following limited circumstances: first, the regulator determines that there will be a delay in appointing a second opinion doctor due to exceptional circumstances; and secondly, urgent electroconvulsive therapy is immediately necessary to save the patient’s life. The Bill also requires that those exceptional cases are monitored and reported on by the regulator. This process prevents the treating hospital retrospectively requesting a second opinion doctor after treatment has commenced. Although those policies are not achieved by the amendment, they appear to meet objectives outlined in the explanatory notes. This process was included in the Bill following a recommendation made by the Delegated Powers and Regulatory Reform Committee, and an amendment was tabled in the other place. For those reasons, I ask the hon. Member for Winchester not to press the amendment. I turn to clause 18. Currently, a patient’s approved clinician can overrule a refusal of electroconvulsive therapy and administer it compulsorily, so long as that is considered urgent under the 1983 Act. The clause introduces the need for a second opinion doctor, appointed by the regulator, to certify electroconvulsive therapy before it can go ahead. The second opinion doctor must examine the patient to establish whether the circumstances are truly urgent. If feasible, they must also consult a nurse and the patient’s nominated person, drawing on the valuable perspectives that each brings. It is important that this new protocol occurs within a tight timeframe, to ensure the patient’s safety and to prevent unnecessary suffering. That is why there is the power to impose, by way of regulations, duties on specific bodies and professionals to ensure that treatment is certified by the second opinion doctor within a particular period. Where exceptional circumstances result in a delay in appointing the second opinion doctor, the clause permits the patient’s approved clinician to certify the use of life-sustaining electroconvulsive therapy. The hospital must inform the regulator each time that happens, and efforts should continue to appoint a second opinion doctor as soon as possible. In recognition of the seriousness of the situation, the clause requires that those exceptional cases be monitored and reported on by the regulator. This clause is another important shift towards increasing the power of the patient over their care and treatment, within parameters that still enable the use of compulsory treatment where that is absolutely necessary.
12 Jun 2025 · Mental Health Bill [ Lords ] (Fourth sitting) · Hansard source
More
I thank the Opposition spokesman. The role and nomination of the responsible clinician are well established and represent current practice, and the clause seeks merely to clarify the current position in legislation in order to avoid confusion regarding the roles of the existing responsible clinician and the community clinician, who will have new roles under the reforms to community treatment orders. I therefore think that the answer to his question—whether the clause will somehow change the clinical role of hospital managers, or whether hospital managers will be able to move the goalposts in how the nomination process happens—is no. The measure is simply a continuation of a well-established practice. I think that challenging the nominated clinician would be a role for the independent mental health advocate. If a patient wishes to challenge any aspect of his or her treatment, that would be the role of the IMHA, once they are in place. The issue of unintended consequences brings us back to the code of practice. I emphasise the two tiers—or three tiers, really—of consultation that will happen. First, there will be consultation with a wide range of stakeholders, including approved mental health practitioners, psychiatrists, clinicians and all the representative bodies. That will bring us a very well-developed draft of the code of practice. We will then go to public consultation, which will be open to input from anyone who has a view, and then to Parliament. That will give us a fairly high degree of assurance that the code of practice will address any area where there is a risk of unintended consequences. Question put and agreed to. Clause 10 accordingly ordered to stand part of the Bill. Clause 11 Making treatment decisions Question proposed, That the clause stand part of the Bill.
12 Jun 2025 · Mental Health Bill [ Lords ] (Fourth sitting) · Hansard source
More
On the point about situations in which just the approved clinician provides certification, because of potential delays in appointment of the SOAD, such certification by the approved clinician can only occur in a very narrow set of circumstances, when the regulator has determined “that there will be a delay in appointing a second opinion doctor,” and the treating clinician considers urgent and compulsory electroconvulsive therapy to be life-sustaining. Our intention is that certification will be documented in a statutory form, to be set out in regulations, to ensure that there is an administrative record of the decision. Each time ECT is administered under an approved clinician’s certificate, it must be reported to the regulator so that such instances can be closely monitored and reported on publicly. While an approved clinician can approve treatment in those limited circumstances, there is still a duty on the regulator to appoint a second opinion doctor. Once that occurs, the approved clinician certificate ceases to apply. My hon. Friend the Member for Hertford and Stortford made an important point about how these provisions highlight choice and autonomy, and I thank him for putting that front and centre. On additional safeguards, with particular reference to nasogastric interventions, there are already regulation-making powers in the Mental Health Act to subject treatments such as the one he mentions to new safeguards. We have always intended to engage with stakeholders to determine which treatments should be subject to which safeguards. That is an ongoing and important piece of work. The hon. Member for Farnham and Bordon asked what happens when a decision conflicts with advance choice. There will be an important process of arbitration around that. The advance choice, as articulated by the patient, is vital and should in principle take primacy, but there are certain circumstances in which a compulsory treatment is necessary. Nothing in the Bill removes the ability to carry out those compulsory treatments, albeit subject to the safeguards that we have debated. Ensuring that the urgent treatment exemption is understood by everyone will be an important part of drafting the code of practice, as will ensuring that the code of practice addresses that important point about maximising and universalising awareness and understanding of the urgent treatment exemption. Question put and agreed to . Clause 15 accordingly ordered to stand part of the Bill . Clause 16 Review of treatment Question proposed, That the clause stand part of the Bill.
12 Jun 2025 · Mental Health Bill [ Lords ] (Fourth sitting) · Hansard source
More
Under clause 10, a responsible clinician is an “approved clinician”, which refers to a mental health professional, usually a consultant psychiatrist, who is approved by or on behalf of the Secretary of State for the purposes of the Mental Health Act and has statutory roles and responsibilities. The responsible clinician has overall responsibility for a patient’s care under the Act. Only they can make certain decisions, such as renewing a patient’s detention or placing them on supervised community treatment. The clause seeks simply to clarify the current position on how a responsible clinician is assigned overall responsibility for a patient’s care, and makes no practical change to the role of a responsible clinician or to how they are appointed. It is intended to make clear the distinction between the definition and role of the “responsible clinician” and the new definition of a “community clinician”, who will have an increased role in managing patients on community treatment orders. The responsible clinician would retain overall responsibility for the patient’s care, including in hospital, while the community clinician would be responsible for the patient in the community. The community clinician is involved in decision making around community treatment orders, which we will discuss in greater detail in relation to clause 22, alongside the responsible clinician. It is therefore important to explain how a responsible clinician is nominated. I commend clause 10 to the Committee.
12 Jun 2025 · Mental Health Bill [ Lords ] (Fourth sitting) · Hansard source
More
It is a pleasure to serve under your chairship, Mr Vickers. I turn to amendment 11, tabled by the hon. Member for Winchester. Under the Bill, English qualifying patients subject to the Mental Health Act 1983, including those on a community treatment order, will be covered by a new opt-out approach to advocacy. That means that the relevant hospital manager must provide the advocacy provider with information about the patient so that they can arrange for an advocate to interview them to determine whether they wish to use advocacy services. Requiring oral and written information about their right to an advocate would therefore be unnecessary. I hope that that is satisfactory, and I encourage the hon. Member for Guildford to withdraw the amendment. Government amendment 30 would remove clause 6(3) from the Bill on the basis that it is unnecessary. The requirement in section 118(2D) of the Mental Health Act for decision makers to have regard to the code of practice already ensures that they must take it into account when making decisions in relation to community treatment orders. Imposing a maximum duration of 12 months on community treatment orders, with the option to renew them after a review every six months, is also unnecessary. That is because the Bill already requires community treatment orders to be reviewed before renewal after the initial six months, again after the next six months and then yearly. The responsible clinician can renew the CTO only if there is a risk of serious harm without it and a reasonable prospect of it having therapeutic benefit for the patient. The Bill increases professional oversight by requiring the community clinician to be involved in all decision making relating to CTOs. That aligns with Lord Scriven’s amendment, but, rather than that person being a General Medical Council-registered psychiatrist, it is more appropriate that they be an approved clinician, meaning that they have specific training regarding the Mental Health Act and approval to make decisions under the Act. We have also increased the frequency of tribunal reviews so that they will happen automatically at renewal periods following the initial six-month period, after a further six months and after any subsequent 12-month periods. We are already providing a new power for the tribunal to recommend that the responsible clinician reconsider whether a CTO condition is necessary. Clause 6(3) would duplicate that.
12 Jun 2025 · Mental Health Bill [ Lords ] (Fourth sitting) · Hansard source
More
Clause 7 will amend the grounds for discharge by the tribunal to align with the revised grounds for detention set out in clause 5. The tribunal must consider whether the patient continues to meet the criteria when deciding whether to discharge a patient. These changes will provide decision-makers with a clear and consistent set of considerations when assessing whether a patient continues to meet the detention criteria, and therefore whether detention or a community treatment order continues to be justified. The tribunal must consider all elements of the detention criteria, including whether there is a reasonable prospect that the patient is receiving therapeutic benefit from treatment and whether there is a risk of serious harm. The detention criteria ensure public and patient protection, while also protecting patients from lengthy and unnecessary detentions when they no longer pose a risk to themselves or others. I therefore commend clause 7 to the Committee.
12 Jun 2025 · Mental Health Bill [ Lords ] (Fourth sitting) · Hansard source
More
My hon. Friend raises a very valid point that, as he says, we will come on to in greater detail. Right across our health service, in every aspect, early intervention is always better than trying to pick up the pieces after a crisis. That is the same for both physical and mental health. We believe that the advance choice documents will be a helpful tool in building an earlier understanding of the challenges that a particular individual faces and, on the basis of that earlier understanding, enabling earlier intervention. Giving the opportunity to patients, while they are in a position to do so, to set out what their advance choices are will enhance their autonomy and enhance trust in the interaction between the patient and the system. That trust piece is so important to the entire picture.
12 Jun 2025 · Mental Health Bill [ Lords ] (Fourth sitting) · Hansard source
More
I will discuss the clause and review of treatment. Under the Act, the regulator, the CQC, is responsible for appointing individuals to provide independent second opinions on the administration of certain treatments. As part of that, the appointed person may visit, interview or examine the patient to make their determination of whether treatment is appropriate. The clause permits the use of remote interview and examination for the purpose of any second opinion functions, which relate to treatment under part IV or 4A of the Mental Health Act. Allowing interviews or examinations to occur in person or remotely is expected to result in more timely involvement of second opinion appointed doctors, an important safeguard. In turn, patients will have access to a greater diversity of second opinion doctors, as opposed to only those in the local area. We understand that remote interview or examination may not always be appropriate, compared with the in- person option. That is why the clause only permits the use of remote where it is considered appropriate by the second opinion appointed doctor, taking into account the patient’s preferences and other factors. We will provide specific guidance on the circumstances under which remote may be appropriate, and where we discourage its use, in the Mental Health Act code of practice. I commend the clause to the Committee.
12 Jun 2025 · Mental Health Bill [ Lords ] (Fourth sitting) · Hansard source
More
Defining “compelling” will be an important part of the code of practice. We will include case studies and examples to help to put flesh on the bones of that and to illustrate it. But it is important to emphasise that a clinician would only be able to overrule a decision to refuse medication if they cannot identify a clinically viable alternative or one that is acceptable to the patient. On training and the capacity in the system, it is important to note that we plan to switch on the new safeguards impacting the second opinion appointed doctor service only when we are confident that there is sufficient capacity in the system to deliver those safeguards. On the point that my hon. Friend the Member for Southend West and Leigh made, we absolutely must ensure that the reviews are happening. That will be a really important part of the enforcement process. The hon. Member for Farnham and Bordon asked about legal recourse. The independent mental health advocate will be an important part of having recourse—for want of a better phrase, they will be somebody to really give back-up to the patient. There is then the legal process, if there is a tribunal or court. Ultimately, someone can go through the court system if there is a dispute about a particular issue. However, one would want to ensure that there had been an objective assessment, through routes such as the independent mental health advocate or through professionals in the system really looking at the issue. Of course, the second opinion appointed doctor plays a crucial role in that.
12 Jun 2025 · Mental Health Bill [ Lords ] (Fourth sitting) · Hansard source
More
One theme raised by hon. Members on both sides of the Committee is the need for clarity and safeguards so that clinicians are clear on how best to assess competence. The Mental Health Act code of practice already provides guidance on establishing competence in under-16s. We will consult on the guidance for assessing competence in mental health settings in the revised code of practice, with the intention of providing further clarity to decision makers. That will include engagement with key stakeholders and clinical decision makers with experience of assessing competence in children. We think it is better to focus on improving the practical application of Gillick and assessment of competency rather than reinventing the wheel, with the risk that that might cause confusion. The Department will work with NHS England, Social Work England and other partners to develop appropriate training for staff on the reforms. Once the code of practice has been updated, professionals working under the Act will be required to undergo training to maintain their competence and awareness of the Act.
12 Jun 2025 · Mental Health Bill [ Lords ] (Fourth sitting) · Hansard source
More
We are very much on the same page in looking to harness the power of technology wherever we possibly can to shift from analogue to digital, but recognising the importance of putting the patient’s needs and disposition first. Telemental health is welcomed by many service users and has become an established part of delivering mental health care in a range of settings and scenarios. We expect the use of a hybrid approach involving both in-person and remote interview and examination to improve the efficiency of the second opinion appointed doctor service, and therefore to be of benefit to all patients. We understand that remote interview or examination may not always be appropriate compared with in-person options. That is why the clause permits the use of remote only where it is considered appropriate by the second opinion appointed doctor. We will provide specific guidance on the circumstances under which remote may be appropriate, and where we discourage its use. All of that will be in the Mental Health Act code of practice. Many of the answers to the questions asked by the shadow Minister and by the hon. Members for Solihull West and Shirley and for Farnham and Bordon asked are contained in that. We are going to develop detailed guidance in the Mental Health Act code of practice, which will clarify and specify very clearly where this should be implemented and where we would discourage it. Question put and agreed to. Clause 19 accordingly ordered to stand part of the Bill. Clause 20 Capacity to consent to treatment Question proposed, That the clause stand part of the Bill.
12 Jun 2025 · Mental Health Bill [ Lords ] (Fourth sitting) · Hansard source
More
The power to give compulsory treatment is sometimes necessary to get a person well again, but unfortunately some clinicians can too easily resort to this course of action without considering alternatives. Compulsory, and sometimes forced, treatment can cause distress and trauma to the patient, and some say that this has caused them to lose trust in mental health services. One individual told us that she was forcibly treated with a medication, despite its having caused serious side effects in the past. Sadly, her appeal to staff to offer her an alternative that had previously proven effective was ignored, and she was forcibly treated without any explanation as to why. That situation might have been avoidable if staff had only stopped to listen to the individual and consider other options. Clause 13 seeks to shift the culture around administering compulsory medication to patients under the Mental Health Act, while maintaining the power to do so. Under the clause, a “compelling reason” will be required to overrule a patient’s refusal of a medication, whether that refusal is made with capacity at the time, in advance or by a representative, for example through a lasting power of attorney. A clinician will be able to overrule a decision to refuse medication only if they cannot identify a clinically viable alternative or one that is acceptable to the patient. The aim is to encourage clinicians to take the time to consider alternative medications, for example by speaking with the patient or those close to them, or consulting their advance choice document. That will potentially avoid the need for non-consensual medication. Many clinicians already care for patients in this way, but others do not. Where the clinician thinks that there is a compelling reason to treat compulsorily, a second opinion doctor, appointed by the regulator, must confirm this, as well as other matters, before treatment can go ahead. This marks a significant shift away from the current system, in which compulsory treatment can last three months before a review by a second opinion doctor is required. We believe that the measure will help to cement the desired cultural change that we all aim to achieve. The clause is critical to making the patient’s voice more central to their treatment. Clause 14 will ensure that where a person does not or cannot agree to their treatment under the Mental Health Act, they receive the safeguard of a second opinion doctor appointed by the regulator. Currently, if a patient lacks capacity or competence to consent, a second opinion appointed doctor is to assess whether their treatment is appropriate, three months after the treatment course began. Although that is an important safeguard, it happens too late in a patient’s treatment course. Clause 14 will shorten the timeframe for that safeguard so that it occurs after two months, rather than three. The timeframe within which the patient’s responsible clinician must review and provide a certificate indicating that the patient is consenting to medication is also being shifted from three months to two months. By introducing scrutiny at an earlier point in the process, we will better protect those patient groups who may be very unwell and highly vulnerable. That is particularly true for patients who lack capacity to consent. For those reasons, I commend clauses 13 and 14 to the Committee.
12 Jun 2025 · Mental Health Bill [ Lords ] (Fourth sitting) · Hansard source
More
Clause 20 will make changes to wording under the Mental Health Act regarding the patient’s capacity and competence to consent to treatment so that it reflects the terminology used as standard by clinicians. While this amendment is not expected to create a practical change, it ensures consistency with other sections of the Mental Health Act and the Mental Capacity Act 2005. As for new clause 5, it is our assessment that, were we to bring about legislative change which sought to introduce a statutory test of conscience for people under 16 in a single setting—that is, under the Mental Health Act—this could have unintended consequences for how competence is assessed, both in mental health settings and other linked areas of decision making. This could create additional confusion for clinicians and impact the ability of children to exercise choice and autonomy over their care and treatment in mental health and other settings, and cannot be justified. We therefore do not consider a statutory test under the Mental Health Act, or a review of that issue, to be necessary. We will consult on the guidance for assessing competence for under-16s in mental health settings in the revised code of practice, with the intention of providing further clarity to decision makers. For those reasons, I commend clause 20 to the Committee and ask the hon. Members for Winchester and for Guildford not to press new clause 5.
12 Jun 2025 · Mental Health Bill [ Lords ] (Fourth sitting) · Hansard source
More
Absolutely. We must ensure that we act rapidly as soon as the Bill gets Royal Assent by launching the consultation process on the code of practice. It will be vital that the question of the practical application of Gillick and the need for clarity is universalised right across the system. The shadow Minister asked about the interface between the Bill and the Mental Capacity Act. We recognise the complex nature of that interface, which presents challenges for decision makers. We will continue to consider this interface as we implement our reforms, and we will engage with stakeholders to understand what support and guidance could help to improve application of the interface when we consult on the new code of practice. My hon. Friend the Member for Croydon East made some powerful and important points about the risk of unintended consequences if we try to reinvent the wheel on this. She is absolutely right. She asked what we want to see in the consultation on the code of practice. For me, the two key areas would be clarity and ensuring practical application of Gillick, by understanding the case law and the complexity of the interface between the pieces of legislation. It is about ensuring that we get that clarity. We cannot do that in an ivory tower. We have to do it with Social Work England and a range of partners with practical, hands-on experience to ensure that the code of practice is the bible for addressing these important issues. Question put and agreed to. Clause 20 accordingly ordered to stand part of the Bill. Clause 21 Care and treatment plans
12 Jun 2025 · Mental Health Bill [ Lords ] (Fourth sitting) · Hansard source
More
I did not know that, Mr Vickers. Thank you for clarifying that point. To promote a patient-centred approach to discharge planning, we would prefer to avoid mandating in law which professionals should be present at discharge planning meetings. To formalise best practice, the Bill requires that the responsible clinician consults with another professional who has been involved in the patient’s treatment before discharge can take place. I turn to amendment 16. We agree that a young person turning 18 is at an important transition point in their care and treatment, which usually involves the young person being transferred to adult services. Under the Bill, the responsible clinician is already required to review a person’s care and treatment plan following any change in their condition or circumstances that they consider significant. The transition to adult services clearly represents a significant change in circumstances, which rightly instigates a review of the patient’s plan by the responsible clinician. We intend to make that expectation explicit in the code of practice. In line with existing care standards and guidelines, we will also underline the importance of planning in advance of a patient’s transition to adult services and of collaboration between clinical teams, as well as other measures that seek to minimise disruption to the young person’s care and treatment journey. We support the intention of amendment 17. However, there are existing provisions, both within the Bill and across other legislation and guidance, that aim to safeguard children and young carers. For example, statutory guidance on working together to safeguard children already sets out the importance of health and social care professionals acting proactively and in collaboration with other agencies to identify and respond to children in need, including where a parent requires mental health support. There is also an existing statutory duty on local authorities to assess the support needs of young carers. The Children’s Wellbeing and Schools Bill contains provisions that will strengthen multi-agency working with children and families, helping to ensure that local authorities deliver on their child protection duties. We also plan to reflect key requirements in the revised code of practice to ensure that children and young carers are safeguarded. We understand that sometimes, when a person is detained, young carers are not appropriately identified. To address that, we plan to encourage individuals to use their advance choice document to ensure that the appropriate services are made aware. Under the Bill, carers should be consulted on the preparation and review of a patient’s care and treatment plan, where appropriate. We will include guidance in the code to ensure that young carers are appropriately involved and supported. We therefore believe that an additional duty would be unnecessary. Clause 21 will introduce statutory care and treatment plans for all patients detained under the Mental Health Act, including patients under community treatment orders and those who are subject to guardianship. Only those who are subject to extremely short detention periods, such as those lasting a matter of days, are excluded. The clause sets out in broad terms what the plans should cover, and provides the Secretary of State with the power to specify the contents in regulations. Setting out the requirements in primary legislation and further details in regulations will ensure that every patient’s care and treatment plan is comprehensive and that there is consistency across plans, which we know is not currently the case. Under the clause, the clinician must prepare and review the plan with the patient and their close contacts, such as family members, carers or their nominated person. That helps to ensure that the patient’s wishes, feelings, beliefs and values shape the plan, thereby increasing the likelihood of their engagement with it. To help to ensure that the plan is kept up to date, the clause specifies important trigger points at which the patient’s clinician should review the plan with a view to potentially revising it. Beyond providing a clear strategy for how the patient will be supported towards their recovery, it is envisaged that the plan will provide an important audit trail of key decisions made by the patient’s responsible clinician. To embed those new statutory requirements in practice, the clause will place requirements on the managers of a hospital, or the relevant authority, to monitor compliance with the duties. Sir Simon Wessely described statutory care and treatment plans as the cornerstone of the proposed reforms, delivering on each and every one of the guiding principles. For the reasons that I have outlined, I hope that hon. Members will not press their amendments and will support clause 21.
12 Jun 2025 · Mental Health Bill [ Lords ] (Fourth sitting) · Hansard source
More
We have piloted culturally appropriate advocacy models, which ran up to March 2025. An evaluation of the pilot will be published in the summer, and that will feed into the evidence base for the impact and deliverability of culturally appropriate advocacy at local level. We will use the learnings from our culturally appropriate advocacy pilots to inform our understanding of how to increase uptake of advocacy for community treatment order patients from black communities, who are disproportionately likely to be put on a CTO. A lot of that evaluation and investigation work is happening, and I am sure that hon. Members across this Committee will read the findings in the summer with great interest. The change in the criteria for a CTO is intended to reduce the number of inappropriate community treatment orders being given, reducing restrictions on patients and helping to protect against the disproportionate use of coercion among racialised communities. Only those for whom there is a risk of serious harm and who will benefit therapeutically should be subject to a community treatment order, and it should be removed when it no longer provides benefit. I want to touch on some of the questions that have been asked. The Opposition spokesman asked about the number of CTOs being overturned at tribunal. According to Care Quality Commission data from 2023-24, 129 discharges by tribunal took place following 4,438 applications against CTOs. I emphasise that people are often discharged without going to tribunal, so those numbers are not a full picture. On evaluation, we are developing a monitoring and evaluation strategy for the Mental Health Act, as the Bill will become once—one hopes—it gets Royal Assent. It will be important to monitor new processes such as discharges and changes to CTOs to assess whether reforms are being delivered as intended and to monitor uptake among patients. There was also a question about racial equalities, but I think I have answered that. With those remarks, I hope that the Committee will support Government amendment 30 and that the hon. Member for Guildford will withdraw amendment 11.
12 Jun 2025 · Mental Health Bill [ Lords ] (Fourth sitting) · Hansard source
More
The clause will simply clarify existing legislation concerning the second opinion appointed doctor so that it more closely reflects current practice and terminology. It sets out the role of the regulatory authority in appointing a second opinion appointed doctor and the criteria that the second opinion appointed doctor must meet, and it updates terminology so that it is more in keeping with that used by practitioners. I therefore commend clause 12 to the Committee.
12 Jun 2025 · Mental Health Bill [ Lords ] (Fourth sitting) · Hansard source
More
It is a little bit dangerous for us to get into a numbers game, because I do not think it is particularly useful or productive to say, “As a result of the changes that we are making, we think it will decrease by x number or increase by y number”, because, by definition, we do not have a crystal ball and we cannot be sure. However, the impact assessment for the Bill— I do not have a copy of that with me right now—includes a range of scenarios and some predictions of the impact and associated costs that go with that. Those are important considerations that led us to the conclusion that we need a 10-year implementation period. It is not just about capacity in the communities and the community mental health services; it is also about capacity in the court system, the number of judges and the whole additional capacity and workload required for that, which is an important part of those considerations.

Published records only — not a full account of an MP’s work. How we work →