Aphra Brandreth
MP for Chester South and Eddisbury · Conservative · United Kingdom
“It is a pleasure to serve under your chairmanship, Sir Alec. I start by thanking the hon. Member for Bexleyheath and Crayford (Daniel Francis) for securing this important debate, and for sharing his family’s experience.”
“That is crucial because, for too many people, more typical public toilet spaces are not just inconvenient but not fit for purpose, rendering the space effectively unusable.”
“The debate has featured powerful testimonies from constituents on how their lives are impacted every day by the inaccessibility of many public toilets, and how this affects them both physically and mentally. I would like to add one more example from my Chester South and Eddisbury constituency.”
“The 2019 consultation showed that the vast majority of the individuals and organisations that responded believed that an increase in the number of Changing Places toilets would give individuals with multiple or complex disabilities, as well as their carers and families, greater ability to leave home and visit different places.”
“It is also why I was proud to see the previous Conservative Government launch the Changing Places toilets fund, which was worth £30.5 million.”
“After the fund closed, the current Labour Government were petitioned on this matter in December last year. They concluded that local authorities are best placed to assess and manage toilet provision.”
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“It is a pleasure to serve under your chairmanship, Mrs Harris. I rise to make some brief comments on amendment 49. I am sympathetic to aims of the hon. Member for Winchester in tabling the amendment. A patient who is being discharged from hospital may indeed require specific, targeted support. The overall success of their treatment and continued recovery can be greatly enhanced where the right structures are in place to support them in the community. The amendment rightly draws attention to social and financial stressors that may affect an individual at the point of discharge and in the weeks and months that follow. We all recognise that there is a pressing need for a more joined-up approach between in-patient services and community provision.”
“The primary responsibility of the independent mental health advocate, however, must remain their responsibility to the patient. I am concerned that the drafting of the amendment could create ambiguity about who the IMHA is principally there to support. Financial stress is undoubtedly a real and urgent concern. Mental ill health can severely affect an individual’s capacity to work, to manage their finances or even to engage with systems of support. Equally, financial instability can exacerbate mental health difficulties. Those are serious challenges that must be addressed, but I would question whether the IMHA is the right professional to take on that role directly. Instead, we should ensure that they are well placed to refer individuals to appropriate services without assuming responsibility for co-ordinating that support themselves.”
“Rather than placing additional responsibilities on the IMHA, our focus should be on working with community providers to ensure that the necessary support, particularly for social and financial needs, is consistently available and is effectively joined up across the system. Having said that, I recognise and welcome the emphasis placed by the hon. Member for Winchester on the role of carers and family members. Too often, they are overlooked in discharge planning, yet their involvement can make a critical difference to a patient’s successful transition from hospital to home. When carers feel informed, supported and prepared, it gives patients the reassurance and stability that they need to continue their recovery with confidence.”
“My hon. Friend makes an important point. This is not a simple or straightforward addition; it would require potentially substantial training. We would not want somebody in a role that they were not adequately prepared for. With any amendment, we would need to ensure that training, and the time and expense of it, had been factored in. Even with the best intentions, the success of any extended support role, such as that envisaged in the amendment, will ultimately rely on the availability and integration of local services. Where appropriate services are in place and are working well together, advocates can play a valuable role in signposting and supporting access.”
“His amendment raises legitimate and timely concerns around the support offered to individuals leaving hospital, as well as the wider context in which recovery takes place. I hope that I have been able to offer some reflections that will assist hon. Members in considering the matter further.”
“That is an important point. These are quite substantial changes, and we do not know the full impact that they would have on the system. We have talked about issues such as whether there is sufficient training for advocates and a joined-up approach with what is happening in the community. A pilot would provide the opportunity to see where it is working and where there might be things that need to be changed or considered. It would certainly be a sensible approach. We all want to ensure that we are supporting individuals to be discharged in a safe way that minimises the likelihood of their being readmitted, but we need to do so without overcomplicating the roles and the system that are currently in place. I commend the hon. Member for Winchester for bringing these important issues to the attention of the Committee.”
“For example, will guidance be issued to support clinicians in understanding their duties under the clause and to ensure consistency across services? Overall, the clause represents a thoughtful and measured reform. It strengthens patient safety, promotes professional collaboration and introduces a safeguard that is both reasonable and necessary. Notwithstanding the clarifications I have raised, I hope that it will help to ensure that discharge decisions are made with greater confidence and care without becoming unduly bureaucratic.”
“Secondly, although I welcome the intention to improve the rigour of decision making, will the Minister reassure the Committee that the additional consultation requirement will not introduce unnecessary delays into the discharge process? It is, of course, essential to get these decisions right, but it is also important that we do not create new barriers to discharge when a patient is clinically ready to move on. Delays in discharge can have a negative impact on patient outcomes, as well as increasing pressure on services. Although the consultation must be meaningful, it should also be proportionate, timely and clearly understood by all involved. Will the Minister comment on how the requirement will be implemented in practice?”
“I would be grateful if the Minister provided further clarity on a few practical points about how the clause will operate. First, it requires consultation but does not appear to specify whether the consulted clinician must agree with the responsible clinician’s decision in order for discharge to proceed. In cases where there is disagreement between clinicians of different professional backgrounds, what is the expected course of action? Is the responsible clinician ultimately free to proceed, or will there be an escalation mechanism? It would be helpful to understand how differing professional opinions are to be balanced and how potential deadlock is to be managed.”
“These are often complex decisions that involve vulnerable individuals, and a single viewpoint may not always capture the full clinical picture. By requiring consultation with someone from another discipline, be that a nurse, an occupational therapist or a psychologist, we can help to ensure that decisions are more thoroughly considered and less likely to overlook risks. The clause provides an important safeguard against premature or inappropriate discharge, particularly in cases where a patient may continue to pose a risk to themselves or others. It builds in a degree of professional scrutiny that supports safer and more consistent practice and, in doing so, should improve confidence among patients, families and practitioners.”
“I rise to speak to the implications of clause 34 for clinical decision making, patient safety and the operation of the Mental Health Act more broadly. The clause introduces a new requirement for the responsible clinician to consult another professional, from a different professional discipline, who is involved in the patient’s care before they make a decision to discharge a patient from detention or from a community treatment order under section 23 of the Mental Health Act 1983. If the patient is on a community treatment order, the clinician must consult the relevant community clinician. At its heart, the clause seeks to ensure that decisions about discharge are not taken in isolation. It reflects a wider shift in mental health care towards collaborative, multidisciplinary approaches. We should welcome that in principle.”
“On the discipline of the second clinician consulted, is there any guidance as to who might be appropriate? I mean not just the list of potential professions but whether there is guidance on who would be appropriate in different situations. We welcome the multidisciplinary approach, but I would like some clarification. Given your earlier response, saying that they need to agree, it is not really clear how this would add to the process. It would help if there were clarity on the professions.”
“The reinforcement of the independent mental health advocate’s involvement should be mirrored by greater investment in advocacy services, stronger integration with care planning and more regular engagement with patients themselves on how these services work in practice. In our earlier discussions, my hon. Friend the Member for Farnham and Bordon suggested that we use trials, which could also be considered here to ensure that, as changes are brought in, they are matched by appropriate service levels. I am largely supportive of clause 41, which I think moves us in the right direction towards a transparent mental health system that is there for patients, ensuring that they have a voice and are not an afterthought. As long as it is deliverable in practice, and does not give false hope to patients, the clause strengthens the Bill.”
“Again, I emphasise the vulnerability of patients at times of crisis. If we are to tell patients that support in the form of an advocate is there for them, we need to ensure that it is accessible and easy to reach and understand. Clause 41 moves us in the right direction, but implementation is everything. It must be backed by local accountability, adequate funding and clear operational guidance. This includes ensuring that all patients, regardless of background, language or capacity, are given support that is appropriate and effective. It is vital to consider the wider implications of this clause.”
“If we are to rely further on advocates, we need to ensure that they are in a position to deal with that, so that we do not create statutory entitlements that are difficult to act upon. Actions, as well as words, are needed. At present, many areas already struggle with advocacy coverage. If we now place additional expectations on the service, and I believe that we will through this provision, we must ensure that there are sufficient numbers of trained, experienced independent mental health advocates across the country to meet rising demand. Can the Minister reassure the Committee that the necessary people with the skills and training are available to fulfil this expanded role? We must also consider the patients’ experience, as has been the focus of so many of the remarks made in the Committee today.”
“Clause 41 rightly reinforces the importance of independent mental health advocates, and it is important that we match that ambition with the legal and practical steps to support them. It is entirely right that we welcome the recognition of the role of independent mental health advocates, who serve a vital function in ensuring that patients’ voices are heard and their views represented, especially when navigating what can be an incredibly complex legal and clinical environment. Their independence is fundamental to not only their effectiveness but the confidence that patients and families can place in the system, which brings me back to my point. It is therefore important that we support independent mental health advocates with the resources that they need to do their job effectively.”
“This support is important; no person should be expected to navigate the complexities of mental health legislation, or their rights under it, without proper guidance. However, where there is a duty “on hospital managers and others to notify providers of advocacy services about qualifying patients”, can the Minister clarify who is meant by “others”? Will there be a list of people and roles who are given this responsibility? The role of an independent mental health advocate is vital. These individuals can be a lifeline. They can help people to understand their rights and any medical treatment, and crucially, can support an individual to have their say about any treatment.”
“It empowers patients to know that independent advocacy is available, but we must ensure that there are sufficient resources so that those who choose this help are given sufficient support when they are in a potentially vulnerable position. As someone representing a constituency that is in England but borders Wales, I also welcome that these changes bring care into line so that advocacy help is offered to informal patients, regardless of which side of the border they are accessing treatment. The clause places a renewed duty on services to ensure that information is given to patients clearly, promptly and in a form that they can understand. It introduces an obligation for advocacy providers to determine, through an interview, whether a qualifying patient wishes to use the service.”
“I rise to speak to clause 41, which brings into sharper focus two pillars of a fair and rights-based mental health system: the provision of clear information to patients and the strengthening of independent mental health advocacy. It rightly recognises that, when a person is detained under the Mental Health Act 1983, often during a period of acute crisis and difficulty in their life, they need to feel that their clinical needs are being met, but in a way that respects them as individuals, with the same entitlements to dignity and agency as any other member of our society. The clause provides for informal patients to be eligible for an independent mental health advocate. I welcome the extension to enable more individuals to access this vital advocacy.”
“Does the Minister have any more detail on that? Is there a timeframe for recruiting these advocates and putting the training in place? That would help reassure the Committee that there is provision to ensure that the timing will fit with the introduction of the changes in the Bill.”
“It will promote accountability in mental health services by encouraging feedback and complaints. I would like reassurance of some oversight to ensure feedback on any complaints that come forward so that we identify where consistent issues come up, to provide better services not just to the individual but to future individuals. Overall, the clauses support better outcomes by addressing potential grievances and ensuring that they are addressed early and constructively, so I am supportive of them.”
“Like many of the measures that we have discussed, these clauses might have administrative implications. We need to ensure that we have fully considered and are able to put in place the necessary support for hospital managers to deal with complaints appropriately. It is important that if someone comes forward with a complaint, it can be dealt with swiftly. As mentioned on some other matters, we need to ensure consistency for patients, so that they understand the information that they are being provided and that, whatever region they might live in or hospital they might be at, consistent information is provided. I would like the Minister’s reassurance on that point. Overall, however, the clause improves patients’ awareness of their rights and how they can seek redress. I think we all agree that that is extremely important.”
“We all agree that the ability to speak out to make a complaint is important, but we need to ensure that proper safeguards and parameters are in place on how that will happen. I also welcome the provision requiring that the information must be provided as soon as is practicable. That is important to give patients confidence. The timing requirements will potentially make a huge difference. The journey of a patient may change rapidly over the course of their treatment, so not leaving it too long will potentially make a substantial difference to their ability to recover swiftly, and ensure that they have been able to speak out if they are concerned not just about their detainment but about the way that their treatment is being carried out, and the potential implications of that.”
“I rise to make a few brief remarks about clauses 42 to 44, which would amend the 1983 Act to place statutory duties on hospital managers to supply complaints information to both the patient and the nominated person in respect of detailed patients, patients subject to a CTO and conditionally discharged patients. These are important clauses. The people concerned are potentially vulnerable individuals. They need to know that they have a voice in this process and feel empowered to speak out and complain, should they wish. There is a duty on hospital managers to ensure that detained patients understand how to make complaints. However, I ask the Minister how that duty will be checked and evaluated.”
“Situations involving mental health crises can often be tense, and support in the early moments can be critical. De-escalation is a vital skill; the presence of a calm, trained mental health nurse, for example, in those early moments can change the outcome of a person’s crisis. Having the right professional present—someone who can act without waiting for the police to attend—can be the difference between escalation and calm. The identity of the responder matters. This is not just about outcomes, but about the experience of the individual. Removing the criminal justice framing from the outset is essential to delivering dignity and the right kind of care.”
“Removing the specification will not free professionals; it will expose them, and it will expose patients to the possibility of being handled by someone without the right qualifications, which may worsen their condition or create a longer-term distrust of mental health services. I hope that the Minister can offer some reassurances, both about who will be expected to carry out these detentions and about how we can ensure that they have the proper training, resourcing and protection. Without a clear definition of “authorised person”, we cannot be confident that those involved will have the right expertise to support extremely vulnerable individuals at times of acute need. I want to touch briefly on the importance of early intervention and de-escalation.”
“1525.] I would add that, for the individual experiencing a mental health crisis, being approached by the police may feel criminalising rather than supportive. It reinforces a justice-led response rather than a health-led one. That is not the direction in which we should be going. Although I welcome the Government’s intention to offer more flexibility in emergency and clinical settings, we have to be careful about how we achieve that. Removing the wording inserted into the Bill will not create clarity; it will create confusion. In a system already under pressure, confusion tends to mean delay, risk aversion and inappropriate responses.”
“The College of Policing’s 2019 mental health snapshot found that almost 95% of police call-outs flagged as involving mental health did not actually require a police response, yet police officers continue to be sent out because the system lacks clarity and capacity elsewhere. Baroness May, speaking from real experience as a former Home Secretary, made that very point in the other place. She said that police officers were being sent to mental health incidents for which they had no training or clinical expertise, and were being asked to make judgments that they simply were not equipped to make. She went on to say that “the very essence of a police presence—somebody in the uniform coming to deal with them—could actually exacerbate their mental health situation”. —[ Official Report, House of Lords, 20 January 2025; Vol. 842, c.”
“Friend the Member for Hinckley and Bosworth, said, it provides a framework of accountability, not a free-for-all. By removing that structure, the Government’s amendments will leave a legal vacuum. The law will say that someone must be detained, but not by whom. That uncertainty will create a risk that services will simply revert to defaulting to the police. I stress again that that is not fair on the police, who are already under immense pressure. Yes, they are used to seeing people at their most vulnerable, but dealing with someone in a mental health crisis is a very particular challenge, and one that they might not be fully trained to manage.”
“We all recognise that the police should not be the default option in every case. The amendments made in the Lords acknowledged that and broadened the group of people who could respond to mental health crises beyond police officers to trained and equipped professionals: mental health nurses, approved mental health professionals, paramedics and, crucially, someone trained and equipped to carry out detentions under the Act and who would not be put at unnecessary risk by doing so. “Trained and equipped”—that is the key point. The definition of “authorised person” in the Bill as it stands makes it clear that those given such a serious responsibility must have the appropriate training and experience and must not be “put at unnecessary risk” when carrying out that role. That wording is important. As the shadow Minister, my hon.”
“It is a pleasure to serve under your chairship, Ms Furniss. Government amendments 26 to 29 risk undoing some of the good work done in the other place, where careful improvements were made to strengthen the Bill and ensure a more compassionate and effective response to mental health crises. I am concerned that by removing the words “by a constable or other authorised person” and deleting clause 5(7), which provides a clear definition of who the authorised persons are, we will open up ambiguity about who is permitted to detain someone under the Mental Health Act. This is not just a technical or drafting issue; it has very real consequences for the people involved. I understand and support the principle of enabling more flexible and clinically led responses to mental health incidents.”
“It is extremely important that people are not put at risk, and that is exactly the point I have been making. People need to be properly trained, and we need to set out who those individuals can be, rather than leaving ambiguity in the wording. The Government amendment will undo exactly the protection that the hon. Lady rightly points out.”
“My hon. Friend helpfully expands on the points that I and other Opposition Members have been making. If we are not careful, the Government amendments will move us further away from the aim of a person-centred approach. I urge the Minister to reconsider the amendments. The wording inserted in the other place struck a thoughtful balance. The wording inserted in the other place struck a thoughtful balance. It allowed flexibility, but grounded it in clear criteria of training, safety and competence. Removing that definition will weaken the Bill. It will make it harder, not easier, to ensure that the right person is supporting someone at their moment of greatest need. We owe it to patients, professionals and the police themselves to get this right.”
“Setting the right culture to support patients, recognising the trauma that they carry and ensuring that there is adequate support and provisions in the legislation and the legal framework, is the right approach. I am therefore pleased to support these amendments, which would strengthen clause 8.”
“This amendment, by adding a new criterion to the definition of “appropriate medical treatment” to require that treatment to aim to minimise distress and to support recovery from childhood trauma, would embed trauma-informed care into the legal framework. Amendment 45, by inserting the words “seeks to minimise the patient’s distress and promote their psychological wellbeing and recovery from any childhood trauma”, would reduce the risk of re-traumatisation. Responses to symptoms or behaviours must be supported; it is about helping people to move towards genuine recovery. Childhood trauma is unique, and it presents symptoms that are different from other mental health illnesses. Therefore, having a dedicated, compassionate and person-centred approach to care is incredibly important.”
“Many of these challenges are the most severe ones linked to childhood trauma, and although there are many wonderful organisations stepping in to support young people at an early stage, for some the impacts of childhood trauma continue to affect psychological wellbeing into adulthood. Sadly, childhood trauma is a societal issue that we face, and it is more common that we might imagine. Therefore, a step to embed trauma-informed care into the legal framework, specifically for childhood trauma, is a step in the right direction. Childhood trauma can lead to self-destructive behaviour in adults. There is, as my hon. Friend pointed out, evidence to show that it is a causal factor. We must recognise the long-term impact of adverse childhood experiences on mental health.”
“It is based in Wrexham, but it is now moving and expanding to cover parts of my constituency, Chester South and Eddisbury. It does a fantastic job supporting young people who have struggled in the conventional education system, are absent from school or have dropped out of the system. We discussed childhood trauma and the rise in the number of young people not currently in any kind of education. One of the points that Alison made that resonated with me is that absence from school is linked not just to deprivation, but many contributing factors, including difficult domestic situations, isolation and rural isolation.”
“People who present with serious mental health concerns need to know that they are receiving support and care in the right environment. They are at their most vulnerable, and having the confidence in their environment can make a world of difference. That is particularly pertinent for those who have suffered childhood trauma. It is important that we deal with the consequences of mental ill health, and adequately address the root causes. Among these, childhood trauma is one of the most serious and persistent factors contributing to long-term psychological conditions. By supporting this amendment, we would create a more resilient system that is equipped to respond to the reality and prevalence of childhood trauma in our society. I recently met with Alison, who heads up a fantastic organisation called WeMindTheGap.”
“Clause 8 provides for a new definition of “appropriate medical treatment”, which requires that treatment to have “a reasonable prospect of alleviating, or preventing the worsening of…a patient’s mental disorder.” Amendment 44 would introduce an additional criterion to the definition of “appropriate medical treatment” by establishing that an appropriate medical treatment should not only address the individual’s immediate health needs, but be designed with the intent to reduce psychological distress and actively support an individual’s recovery from the effects of childhood trauma. This recognises the long-term impact that early, adverse experience can have on mental and emotional wellbeing and ensures that treatment approaches are trauma-informed, compassionate and conducive to long-term improvement.”
“It is a pleasure to serve under your chairmanship, Mr Vickers. I rise to speak in support of amendments 44 and 45, which have been tabled by my hon. Friend the shadow Minister. These amendments seek to put patients at the centre of the Bill by promoting a safe therapeutic environment and recovery from any childhood trauma.”
“Chester South and Eddisbury is home to some truly special high streets, lined with independent shops and pubs that play a vital role in the life of our communities. I have spoken to local business owners, especially in hospitality, who are already feeling the pressure. Following the spending review, the chief executive of UKHospitality said that “the overwhelming challenge holding back hospitality from meeting its potential is the current tax burden”. Does the Minister accept that unless action is taken to ease the burden on high street businesses, especially in hospitality, the Government risk undermining the very communities they claim to support?”
“My hon. Friend is making an excellent speech. The new clause is incredibly important. We do not want vulnerable people to slip through the cracks and not receive the right support, and it is really important to ensure that there is consultation with the right stakeholders. I recently met with Down Syndrome Cheshire, and last year I met with the Cheshire West and Chester SEND accountability group. They said that one of the things they value most is being listened to so that they can inform the process. Does my hon. Friend agree that that is a really crucial part of new clause 11?”
“We need a plan that is costed so it can be delivered, and that, crucially, reflects the needs and rights of those most affected. I fully support the new clause.”
“In my intervention, I referred to some of the important groups in my constituency. Down Syndrome Cheshire and the Cheshire West and Chester SEND Accountability group are just two examples, but there are so many more. They are clear that they value being listened to, so that they can inform the process. The new clause would ensure a costed plan, where commitments are not just words, but backed by funding. Crucially, it would mandate a formal consultation process to inform the plan, incorporating the view of a broad range of stakeholders, including those with lived experience such as those I mentioned in my constituency. There are individuals, carers, healthcare providers and advocacy groups whose voices all matter.”
“It has come at the cost of adequate provision, particularly in school places, and therefore puts more people at risk of mental health problems because they are not getting the support they need in the community. With the measures outlined in new clause 11, we could go a long way to ensuring accountability. I am sure the Minister will agree that we need to ensure that commitments are backed by funding for the good of those who need SEND support. I urge all those on the Committee to reflect on the value of the new clause. Crucially, it would also require the costed plan to be informed by a consultation with a range of stakeholders. That is incredibly important, because we need to listen to the lived experience of those who are often extremely vulnerable to ensure that they receive the right support.”
“I rise to make a few remarks on new clause 11, which would require a costed plan to ensure that ICBs and local authorities are able to provide adequate community services for individuals with learning disabilities and autistic people at risk of detention under part II of the 1983 Act. We need to ensure that there is a fully cost-effective plan with accountability to support those with learning disabilities. For instance, Cheshire West and Chester council, one of the local authorities in my constituency of Chester South and Eddisbury, has let down parents, families and those with learning difficulties because of its poor management.”
“I represent an English constituency on the border with Wales; on some streets, one side is considered Welsh and the other English. Does the Minister recognise that it matters to people in England and Wales that there is consistency across both parts of our fantastic country, and that it is not sufficient to say that what happens in Wales will affect only Welsh people, or what happens in England will affect only English people?”
“Like my hon. Friend the Member for Farnham and Bordon, I have a lot of sympathy with some of the things that the hon. Lady is trying to achieve through the amendments. If there is to be an additional requirement for six-monthly rather than annual checks, how will the balance be struck to ensure that there is a focus on care rather than on the administrative burden that might be required?”
“My hon. Friend is making valuable points about the benefits of the amendment. For vulnerable individuals, family involvement is often extremely important, but does he agree that that must be balanced with ensuring that potential disagreements do not put at risk what is best for the individual?”
“My hon. Friend is making a wonderful point about the new clause I have tabled. Does he agree with me that this is about improving our environment and reducing pollution, and we need to think about all of that when we consider this Bill?”