Stephen Kinnock MP: speeches

Speeches

• 17 Jun 2025 · Health of the Elderly · Hansard source

  More

  The spending review announced increases in NHS spending alongside more money for adult social care. By investing in DEXA scanners, we can more rapidly treat conditions such as osteoporosis, which particularly affect elderly women. Our urgent and emergency care plan promotes falls prevention technology for longer independent living and fewer hospital admissions. GPs are now incentivised to improve continuity of care, benefiting patients with long-term conditions.

• 17 Jun 2025 · Pharmacies · Hansard source

  More

  Part of that is about the financial arrangements for Pharmacy First, which need to be set at a level that incentivises pharmacists. Sadly, given the way in which the scheme was set up under the previous Government, those incentives were not working, which is one reason why the take-up of Pharmacy First has not been what it needs to be. It is a question not of capping but much more one of getting the right level of financial compensation for Pharmacy First so that it works and incentivises the system.

• 17 Jun 2025 · Pharmacies · Hansard source

  More

  My hon. Friend is absolutely right, and I commend him for the work he is doing in his constituency, including with pharmacies. In many ways, what we want to see is a culture change, because the interface between general practice and community pharmacy is not where it should be. We believe that pharmacists have a huge amount more to offer, but that requires a better digital interface and better information sharing—a single patient record. That sort of vehicle will be really important for delivering some of those reforms.

• 17 Jun 2025 · Pharmacies · Hansard source

  More

  After years of underfunding, the Government agreed a record uplift of £3.1 billion for ’25-26 for the pharmacy sector. The pharmacy access scheme provides £19 million to support pharmacies in areas with fewer pharmacies, including in rural areas, but funding must always come with reform. Our hub and spoke legislation, if it is passed in the other place today, will allow pharmacies to streamline their dispensing processes, and it is a major step in the right direction in marrying reform with investment.

• 17 Jun 2025 · Pharmacies · Hansard source

  More

  The hon. Gentleman will have seen—and I am sure will welcome—the record uplift of £3.1 billion that we are putting into the pharmacy sector after years of underfunding, incompetence and neglect from the Conservative party. A big part of this is ensuring that the shift from hospital to community takes place, and we want pharmacists to be taking pressure off primary care. We have to make Pharmacy First work effectively, which means getting the allocation of funding right. That is what we are working on in terms of reforms. Now that we have the spending review and the package, that is what we will be delivering.

• 17 Jun 2025 · Pharmacies · Hansard source

  More

  The hon. Lady is right that pharmacies will play a central role in the shift from hospital to community that we will be putting at the heart of our 10-year plan. An important part of that, of course, is Pharmacy First. The take-up of Pharmacy First is not what we would like it to be, so we are looking at options to increase awareness of Pharmacy First and to free up pharmacists to be able to operate at the top of their licence. Part of that is about streamlining the dispensing side of what they do, and the hub and spoke legislation that I mentioned earlier will be really important in that context.

• 17 Jun 2025 · Pharmacies · Hansard source

  More

  The pharmacy sector is facing huge challenges after massive cuts over the past 14 years. We are beginning to rebuild, but the hon. Lady is right that there are particular challenges for rural pharmacies. We are looking at comprehensive reform in the pharmacy sector involving the better use of technology, hub and spoke dispensing, and a range of other options that would enable better remote dispensing for rural pharmacies.

• 13 Jun 2025 · Terminally Ill Adults (End of Life) Bill · Hansard source

  More

  I can confirm that it is absolutely the policy intent of the sponsor for that to be a backstop. The Government are working on that basis to ensure that it is a backstop and not a target. Amendment 42 seeks to remove the four-year backstop. Although that is a matter for Members to decide, we note that if both that amendment and amendment 94, tabled by my hon. Friend the Member for Spen Valley, were accepted, nobody would have the power to commence reserve provisions in Wales. That would create major workability concerns for the service in Wales.

• 13 Jun 2025 · Terminally Ill Adults (End of Life) Bill · Hansard source

  More

  I associate the Government with the words of the Opposition spokesman regarding the tragic incident in India. As Members will know, the Government remain neutral on the passage of the Bill and on the principle of assisted dying. We have always been clear that this is a decision for Parliament. However, the Government are responsible for ensuring that the Bill, if passed, is effective, legally robust and workable. Let me start with a brief observation about the process and, in particular, the time made available to Parliament to scrutinise the Bill. The Bill has received over 90 hours of parliamentary time, which is more than most Bills receive. More than 500 amendments were tabled and considered in Committee. I thank Members on all sides of the debate for their contributions during the extensive consideration and scrutiny that the Bill has received. Given the time, I will confine my remarks on the amendments to those about which the Government have significant legal or operational concerns, and those tabled by my hon. Friend the Member for Spen Valley (Kim Leadbeater) to address significant workability concerns. Before I get into the detail, I remind the House that a full list of amendments tabled by my hon. Friend that the Government deem essential or highly likely to contribute to the workability of the Bill can be found in the letter sent to all Members by me and the Minister of State at the Ministry of Justice, my hon. and learned Friend the Member for Finchley and Golders Green (Sarah Sackman), on 15 May. Let me start with amendments tabled by my hon. Friend the Member for Spen Valley. New clause 13 and amendments 69, 53 and 72 would allow the Government to create or change legislation to set out the end-to-end process in relation to approved substances to be used for assisted dying. They would allow for monitoring and for a regulatory regime to be designed that will offer robust oversight of approved substances and the devices used to administer them, specifically in the context of assisted dying. Amendment 54 and new clause 15 would replace clause 35, which is currently unworkable in the wider legal context. They would align the scrutiny and certification of assisted deaths with the existing process for deaths that are not deemed unnatural. That means that assisted deaths would be scrutinised by a medical examiner rather by a coroner unless reported to the coroner by anyone who has concerns about the death. Amendments 92 to 94 would ensure that the Secretary of State and Welsh Ministers have powers to make necessary regulations to approve assisted dying services in Wales. Amendment 95 would bring the Welsh commencement powers in line with the devolution settlement and remove the requirement in clause 54 for Welsh Ministers to lay commencement regulations before the Senedd for approval, to align with usual procedure. I now turn to amendments tabled by other Members that the Government assess as creating potentially significant workability challenges. Amendment 97 would require the MHRA to license the approved substances to be used in assisted dying. That may present workability challenges, as licensing is not possible if the approved substances do not meet the definition of “medicinal product” under the current relevant legislation. Furthermore, licensing is reliant on the manufacturer applying to the MHRA for a marketing authorisation for that indication and providing the necessary evidence of safety and efficacy in support. Should the Bill pass, the Government would work to put in place an appropriate regulatory regime for the approval of substances. It may be helpful to note that my hon. Friend the Member for Spen Valley has tabled new clause 13, which recognises the need for a robust regulatory framework and would provide the powers needed to introduce such a framework. Amendments 105 to 107, amendment (a) to new clause 13 and amendment (a) to new clause 14 would restrict the scope of Henry VIII powers available to the UK and Welsh Governments to make provision about assisted dying services. They would further restrict the use of powers in relation to the regulatory framework for approved substances and the devices used to administer them, and to the prohibition on advertising. I point Members towards the delegated powers memorandum published by the Government, which sets out our consideration of the Henry VIII powers in the Bill. As with legislation more broadly, the Government recognise the need, in appropriate cases, for amendment by Henry VIII powers. Members will be aware that the Delegated Powers and Regulatory Reform Committee will issue its own consideration of the Bill, which will of course be made available to all parliamentarians. Amendment 3 seeks to shorten the commencement period to three years. Should the Bill pass, an entirely new service with robust safeguards and protections will need to be carefully developed and tested, with input from a range of delivery partners. The Government’s view is that the Bill, as amended in Committee, with a four-year backstop for commencement would be more likely to provide for safe and effective implementation.

• 13 Jun 2025 · Terminally Ill Adults (End of Life) Bill · Hansard source

  More

  I refer the hon. Lady to the impact assessment, which is of course not a forecast but a set of scenarios. In it, detail is given on expected numbers and the capacity of the system to deal with the service. Amendments 13 and 82 to 85 relate to the appointment of the voluntary assisted dying commissioner and panel members. The amendments would put the process for the appointments out of kilter with standard practice for public or non-judicial appointments and could significantly limit the pool of individuals available. Amendment 86 would give the panel the same powers, privileges and authority as the High Court, which are significant in scope and are set out across different court rules and legislation. It is unclear how those would apply to panels in practice. They may be unworkable given that the panel is not designed to be a court. New clause 4 and amendment 28 would put various responsibilities on the chief medical officers for England and Wales. Imposing duties in primary legislation on an individual civil servant may cause difficulties in the future if the role does not exist or if the title changes. It is usual practice for duties in primary legislation to be conferred on the Secretary of State, who may decide to delegate to the chief medical officer. I would like to briefly respond to a number of questions directly asked of the Government. The hon. Member for South Antrim (Robin Swann) asked about medicines regulation in Northern Ireland. The amendments will not affect the application of EU law; they will instead ensure coherence between the different legislative frameworks. The sponsor will lead engagement with the devolved Governments, supported by officials. The hon. Member for Richmond Park (Sarah Olney) asked about the equality impact assessment. The EQIA considers the nine protected characteristics alongside socioeconomic background, geography and mental health. The hon. Member for West Worcestershire (Dame Harriett Baldwin) asked about the Suicide Act and advertising. I can confirm that encouraging or facilitating suicide will remain a crime under the Suicide Act. On advertising, new clause 14, if passed, would oblige the Secretary of State to make regulations prohibiting certain forms of advertising that promote voluntary assisted dying services. The exemptions to that, which may be provided under subsection (2), will not cut across the criminal offences elsewhere in the Bill or in the Suicide Act. I hope that those observations were helpful to Members in their consideration of the technical workability of the amendments that we have debated today.

• 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.