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6.14 pm

Mr. Mark Wolfson (Sevenoaks): I shall not need to detain the House for very long because a number of points that I would have covered in more detail have been most adequately and effectively dealt with by my hon. Friend the Member for Hendon, South (Mr. Marshall), whose speech was a model contribution towards the sensible passage of the Bill. He was speaking from obvious experience of the families of severely mentally ill people, and the Bill specifically addresses the concerns of such families and patients.

I have always taken the view that the decision to close rapidly all the large mental hospitals was in some ways wrong. We should have moved rather more slowly. Although I accept that at the end of the day care in the community is more beneficial than those old asylums, nevertheless such institutions provided a level of care for very sick people which was of real value to them. We all carry a heavy responsibility for cases where the quality of people's lives has worsened.

I appeal to my right hon. and hon. Friends to move with extreme care in future closures and to ensure that the facts live up to their commitments; that they will not implement such closures until adequate care is available in the community. There is nothing in itself wrong with residential care and we should not forget that. Often it is right for people who are severely ill.

I cannot support the Bill, let alone vote for it tonight, without signalling the fact that I find the wording in the Bill on financial effects unrealistic. It says:

"The Bill should give rise to no additional costs for Health Authorities (in England and Wales), Health Boards (in Scotland) or local authorities. The new provisions . . . provide a legislative framework for existing good practice."

In the purest terms, that may be right, but we should talk about reality and practicalities. If more social workers and all other agencies involved are doing a better job under the supervision orders, their time will be used for such work and, as other hon. Members have said, there will be less time to deal with less severely ill people. Therefore, I argue that the Bill will require more resources.

All too often we in the House pass legislation, often with support--in principle--from all parties, yet we do not accept that additional resources will be needed as a result. I put my flag up on that issue now. I am absolutely certain that additional resources will be necessary. The work requires additional case conferences. Others have mentioned the involvement of up to eight different agencies and their staff when the orders are put in place. Giving support to the mentally ill in the community is a cumbersome process. I am not denigrating the process, but it is very time consuming. The problem has been that so many of the individuals who may require such assistance have dropped out of the net, and picking them up again, let alone giving them continuing treatment, will be very time consuming. Let there be no mistake--I emphasise the point to my right hon. and hon. Friends in the Department of Health--mental health service staff, whether they are employed by local authorities or by the NHS, are severely overstretched already.

So much progress has been made in looking after people better that those engaged in that work are now suffering a great deal of stress. I am not being soft about that, nor am I suggesting that management methods cannot be improved to achieve better productivity from

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those who care for the mentally ill. It would be unrealistic, however, to believe that such care will not involve additional time, and therefore additional resources.

I support the Bill because it is absolutely essential that we establish a legislative framework to deal with those who are discharged, but who are still severely ill. As has already been said, those people often come out into the community and are pleased to be in a freer, more comfortable and pleasant environment. They often do not, however, take the very medication that has enabled them to be discharged in the first place. It is essential for them to take that medication. Without the proposed legislative framework to ensure that, I cannot see how those people will continue to improve, let alone make progress in the community or not put themselves and others at risk. On that basis, the Bill is long overdue.

6.20 pm

Mr. John Gunnell (Morley and Leeds, South): I have listened to the entire debate, so I intend to underline briefly certain points that have been raised. The unanimity that has marked hon. Members' contributions is perhaps not surprising, because I assume that those present are interested in mental health services and the particular problems posed by the Bill. I have identified three particular weaknesses in the Bill and it is interesting to note that two of them have already been the subject of much comment.

I do not think that the closure of the large mental health institutions caused the difficulties that the Bill is designed to address. As the hon. Members for Hendon, South (Mr. Marshall) and for Bournemouth, East (Mr. Atkinson) said, those difficulties have arisen because of the loss of 35,000 acute psychiatric beds between 1981 and 1991. Without that loss, a certain number of people living in the community now would still be receiving hospital care from time to time, if not long term. Unfortunately, such care is no longer available to them.

The Bill's efforts to overcome the difficulties of care provision prompt me to raise three points. First, there is some confusion between the role of a health authority and that of social services departments. The health authority is clearly the lead authority, which nominates the responsible medical officer and supervisor. No doubt the health authority will take overall responsibility for taking and conveying patients who are subject to supervised discharge. No doubt health authorities will turn to the police to get that job done on many occasions, but according to the Bill, they are the lead authority. Social services take the lead, however, in providing community services and community care. Perhaps social services should also take the lead after the responsible medical officer has done his work. A greater input from social services is warranted rather than simply one social worker's approval of a supervised discharge. Baroness Jay suggested in the other place that the guardianship principles in the Mental Health Act 1983 could have served the Government's purpose instead of the Bill. She suggested that the guardianship powers envisaged in the 1983 Act could be beefed up to accommodate difficult cases, but that the original role of the guardian would be better suited to the needs of the mentally ill generally. I urge the Government to consider revising the 1983 Act to bring it up to date in line with current practice and available facilities.

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If social services are not at least an equal party to the health authority when considering an application for a supervised discharge, their professional partnership, which is vital to making a success of care in the community, will be downplayed. There should be a partnership and liaison not just between health authorities and social services, but between voluntary agencies. Some of those organisations have already expressed their concerns to us about the Bill. Housing authorities should also be party to that partnership, which should be as extensive as possible. As my hon. Friend the Member for Motherwell, South (Dr. Bray) said, it should embrace carers and those who use the services.

We must develop such partnerships and liaison rather than simply rely on the strong-arm-of-the-law approach, which seems to be explicit in the Bill, given the role of the police in taking and conveying those who are described as mentally disordered patients to a place of residence or training. I have no doubt that the public safety aspect is important and must be taken into account, but we proceed best through partnership. Certain powers must be invested in that partnership, but I am not convinced that the power to take and convey should be one of them.

Secondly, people are confused about the scope of the

take-and-convey power. I know that in the Bill it applies to those under supervised discharge, but that is not clearly understood by those in the community. The Government estimate that around 3,000 people may be affected by the Bill, because should they not take their medication, they might be a danger particularly to themselves, but also, on occasion, to others. Far more than those 3,000 people were discharged from institutions ages ago. There is no likelihood of them being affected by the Bill, but many believe that they are under threat from what they judge to be a power of arrest. Were it applied loosely, that power would be draconian. No explanation has to be offered when someone is taken and conveyed, provided that the appropriate care workers have agreed to that.

The meaning of the term "mentally disordered", to whom the procedure will apply, is not clear to those in the outside world. It may be clear when seen in the context of the Bill, but more effort must be made to explain it, because some of my constituents are worried by the Bill for no reason. Their fear may be explained by the fact that many former mental health patients have been scarred by their earlier experiences. Some were kept for years in institutions that were unable to offer them any help. That happened either because of errors in their diagnosis or, in the not too distant past, because they had been sent to such institutions as inappropriate punishment for alleged offences. We have all heard of women who were put in institutional care when they became pregnant out of wedlock. I know of one constituent who spent 25 years in institutional care because he stole a bottle of milk. It is not surprising that people with such experience, who are now settled in the outside world, living unobtrusively, still feel under some kind of threat and in a sense discriminated against. They are worried that the Bill might apply to them and that the police might come to take and convey them without being told on whose authority that decision has been taken. Their anxiety is due to the experiences that they have suffered.

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We have to make it crystal clear to whom the Bill might apply. The Minister will be aware that we are not happy about its phraseology, nor about the manner in which he will seek to implement the take-and-convey procedures. I believe that the extent to which those procedures might apply must be clarified.

Thirdly, nearly all hon. Members have said that it is unrealistic and impractical to offer no financial resources for the Bill's implementation. The Bill's necessary measures should not be implemented at the expense of the overall standard of general mental health services.

The Select Committee on Health studied mental health provision and envisaged an expanded service. It wanted more resources to be devoted to it. Even more significantly, the Department of Health's own review team-- whose report back in August 1993 led to the Secretary of State's points on mental health--made it clear that extra financial provision was necessary for this measure to work. In these cash-straitened times, it is impractical to expect health authorities or social services departments to find those extra resources.

The original Mental Health Act saw itself as an expression of the commitment to supporting the role of the community, rather than institutions, in the care of the mentally ill. Without resources, the new Bill's intentions to ensure that that is not at the expense of the safety of the public will be just that--good intentions. Unless people with mental illnesses are dealt with by adequately resourced support services in an atmosphere of understanding, the Bill's objectives will not be realised.

Nobody denies that the public must be protected from potentially violent patients in the community. But denying those patients the means to reintegrate themselves into the community by depriving the responsible agencies of additional cash is what makes the Bill more about control than about care in the community.

6.30 pm

Mr. David Hinchliffe (Wakefield): We have heard a range of concerns expressed in the debate, both about the current state of community care-- especially for those facing mental illness--and about the implications of some of the measures proposed in the Bill. I reiterate the comments of my hon. Friend the Member for Newcastle upon Tyne, East (Mr. Brown) that the Opposition recognise the extent of public concern about the difficulties which have arisen in a number of instances with tragic consequences, where vulnerable mentally ill patients have slipped through the net of care services. I am conscious that some of the cases which have occurred away from London have not been reported, and I am aware of the case to which my hon. Friend the Member for Doncaster, North (Mr. Hughes) referred, of a tragedy affecting a child. Other cases have occurred elsewhere in the country.

While we share the Government's desire to move towards care in the community provision for vast numbers of people who would previously have been incarcerated in mental hospitals, we have serious worries that the policy of bringing about a rapid rundown of large, long-stay psychiatric hospitals has not been accompanied by a similar commitment to proper development provision within the community. It is that one-sided community care policy that is at the heart of the problems that the Government seek to address with the Bill.

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While we will use the opportunities provided by the measure to offer constructive proposals to safeguard the public and the patients, our central concern is to press the Government to take seriously the fact that community care is about rather more than just closing mental hospitals.

A number of hon. Members present for today's debate were also present for the debate on mental illness initiated by the hon. Member for Hendon, South (Mr. Marshall) on 10 May. They will recall that I posed two key questions to the Government that day of direct relevance to the measure that we are considering this evening. First, I asked what happened to the patients concerned when 70,000 psychiatric beds were removed in the 10 years up to 1992-93. Secondly, I asked what happened to the public resources released by that huge closure programme.

The record shows that the Minister answered neither question when he wound up, because the Government have admitted on several occasions in answer to myself and to other hon. Members that they simply do not know the answers. There is no year-by-year breakdown of how many patients have been discharged to independent or semi-independent accommodation or to hostel provision, or how many have been discharged to attend day centres, day care or other forms of community provision. There is no record of what subsequently happened to them on their discharge or as they moved on from care provision within the community.

As we are charged as Members of Parliament with safeguarding public resources, we must be concerned at the fact that we have lost not only the patients but apparently billions of pounds of funding which was previously tied up in the resourcing of hospital care. The Government cannot tell us where that money has gone, but it is obvious from the problems to which the Bill is a response that it has not been diverted into the programme of re- provision within the community that is obviously required to ensure that the rundown of hospital care means improving the quality of patients' lives. Our central concerns in relation to the measure relate to the two new orders at the heart of the Bill--the supervised discharge order and the community care order in Scotland. They are the culmination of a lengthy period of debate on whether a change in the law was needed to ensure that patients within the community could be required to follow a particular care plan. The initial proposals some years ago for compulsory treatment orders have reappeared in a range of forms, with the Government finally opting for supervised discharge orders and their Scottish equivalent.

It is surprising--given the length of time that this debate has been under way--that the Bill's central proposals have so little support from the individual organisations that will have the task of applying the legislation in practice. Virtually all those directly concerned have been vociferous in their criticisms, especially of the new powers introduced by clauses 1 and 4. The Community Psychiatric Nurses Association, the British Association of Social Workers, the Royal College of Nursing and the Royal College of Psychiatrists have all expressed reservations, as has the Law Society.

My background before entering Parliament in 1987 was as a social worker, and a number of colleagues here today--including my hon. Friends the Members for Dulwich (Ms Jowell) and for Stockport (Ms Coffey)--have similar backgrounds. I approach my evaluation of the measure with a particular eye on its application in practice. From that perspective, I--like others--am at a

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loss to understand the need for the introduction of a completely new order when the existing power of guardianship offers an almost identical provision.

During my time in local authority social work, I worked for many years as an authorised mental welfare officer. I looked to guardianship to offer the safeguards necessary when, in a few situations, it was felt that some statutory supervision was required. That power was used sparingly, but my experience was that it was used in a positive way to enhance the opportunities available in the community to a small number of patients who would otherwise have spent lengthy periods in hospital under section. Guardianship facilitated community care, while offering protection to the patient and to the public.

My hon. Friend the Member for Doncaster, North said that the supervised discharge orders and the similar Scottish provision duplicate the existing guardianship powers in a way that will inevitably cause confusion among those who have to differentiate between the two. The main difference that has been proposed is a new power to take and convey the patients to a place where they are required to live or to attend. That power has been mentioned by a number of hon. Members, and has been the subject of particular criticism as a provision that could totally undermine the consensual relationship upon which the most successful after-care supervision is based.

It is important to underline the fact that one cannot care for people in a community environment without some consent and trust between the person being supervised and the supervisor. Those involved are concerned about how the measure will operate when it is implemented, as they recognise that that element will cause difficulties between the person supervising the patient and the person being supervised. I hope that the Government will listen to that. It is not a partisan political point, but a point of practicality that has been raised with us--and with Conservative Members-- by the organisations and individuals concerned.

The provision to take and convey could have been understood if the Government had taken the step of also including compulsory treatment within the new order, although I emphasise that I am not suggesting that that should have been done. But as it stands, a patient taken or conveyed under the order would be within his or her rights to refuse subsequent medical treatment. It will be necessary to make an application under a separate section of the Mental Health Act to enforce such treatment. As one writer with a legal background has put it, the community psychiatric nurse would have the power to take a horse to water, but not to make him drink.

The hon. Member for Worcestershire, South (Mr. Spicer)--who was critical of the provision--failed to grasp the key issue in this measure which is causing great concern to a number of organisations and individuals. If a patient no longer complies with a care plan, the only additional provision is the obligation on the care team to inform an approved social worker, who may consider applying for compulsory admission to hospital. But nearest relatives can do that already under existing law. Unlike guardianship, the new powers would be in the hands of health authorities in a move away from the lead agency status on community care which the Government introduced in the National Health Service and Community Care Act 1990.

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As well as the confusion with guardianship that I have mentioned, the shift from local authorities will raise more questions about who is responsible at a local level. The organisational responsibility question is another area that causes us extreme concern. We need to know exactly who is doing what. The clear similarity with the guardianship provisions organised by local authorities will cause immense confusion among practitioners at a local level.

While I understand that the measure is intended to formalise the care programme approach in some respects, that could have been achieved with fairly minor amendments to existing guardianship powers, with health authorities given similar status in law to local authorities. Amending guardianship would have been more in line with the wider policy moves in the direction of care in the community, because it would have enabled the development of a non-hospital route to formalised supervision in a way that the Bill does not allow. It is not helpful to convey the clear message--as the Bill does--that the legal enforcement of key elements of the care plan within the community depends upon discharge from in-patient hospital care. While I appreciate that the prime motivation for the measure has been severe problems concerning patients who have left hospital, it is important to recognise within the context of current policy that care does not necessarily have to begin with an experience of hospital in-patient treatment. The hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) touched on that point.

The fact that the proposals seem to be at odds with wider policy developments to some extent underlines the Mental Health Act Commission's argument that existing legislation, which was based substantially on policies that were in place in the 1950s--the 1983 Act was based primarily on the framework of the Mental Health Act 1959--has been largely overtaken by radical moves in the direction of community care. It is pretty obvious that those who are charged with the task of overseeing the legislation believe strongly that simply tampering with elements of existing mental health law will not succeed in making current legislation relevant to current circumstances.

The need for a new mental health Act, which offers a framework reflecting current policy, will clearly not go away. I was pleased to hear the Minister concede that his mind was not closed to a much wider review of the legislation. Clearly, the legislation is grossly outdated. The Mental Health Act Commission has stated that there is a need for new legislation that reflects contemporary policies in contemporary times, and I hope that the Government will take that call seriously.

The prime reason for introducing the Mental Health (Patients in the Community) Bill is, as the Government said, public protection. As my hon. Friend the Member for Newcastle upon Tyne, East made clear at the outset, the Labour party is as concerned as the Government to ensure that the public and the patients themselves should not be put at risk by inadequate care policies. As our amendment shows, we take a wider view of the causes of the problem and of the solutions.

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Public protection must be a key objective, but as the Mental Health Foundation inquiry put it last year:

"If everyone with a severe mental illness had appropriate services, sensitively provided and adequately funded, there would be much less concern about this issue".

Such services and provisions do exist in some areas, but, as the Audit Commission and the Health Select Committee have pointed out, they vary markedly in their quality and availability.

There are good examples of patients being offered long-term supported accommodation. There are some excellent models of asylum within the community, with safe houses and other forms of sanctuary along the lines that my hon. Friend the Member for Motherwell, South (Dr. Bray) mentioned.

There are excellent mental health resource centres in some areas, with round-the-clock crisis services and outreach provision. But in other areas, such key elements of community care provision are either minimal or non- existent. They have not been developed alongside the hospital closure programme, and that fact must be addressed. We must recognise also that access to acute hospital-based services offers an important back-up to care in the community, but it is clearly grossly inadequate in some parts of Britain. A number of Conservative Members made that point today.

Those factors have an important bearing on the reasons for the mental health Bill, but the Bill itself will clearly do nothing to ensure that adequate services are available to patients who are subject to the new order. The Department of Health review team said that the use of the new power implied a reciprocal obligation on statutory services to provide the support that patients need, but the Government tell us that it is a nil- cost measure. Without the necessary back-up support and services, any formalised

supervision--whether under discharge orders or guardianship--will mean very little.

That point is central to our amendment, which reflects the very serious concerns about the Bill expressed by a range of organisations. There is a clear need to ensure that patients and the public are protected. However, we believe that the Government were very badly advised in bringing forward a measure that has not been thought out properly. For that and for the other reasons that I have outlined tonight, I urge hon. Members to support the amendment. 6.45 pm

Mr. Bowis: With permission, Madam Deputy Speaker, I shall respond to some of the points that have been raised by hon. Members on both sides of the House.

I think that there has been something of a competition--which is unusual in this place--to catch the eye of the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood), who has identified himself as the guardian of the Select Committee on Selection. Conservative Members have appealed to him to look after their interests as the legislation moves towards the Committee stage, and there have been similar hints from Labour Members as well. I hope that we have established in the hon. Gentleman's mind that there is a lot of interest in the measure.

Mr. Kirkwood: A lot of talent.

Mr. Bowis: And a lot of talent. Despite some of the comments made during the debate, hon. Members have

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expressed broad agreement that we should look carefully at the measure, and that we must protect those people in the community who have severe mental illnesses, while also protecting their families, their carers and members of the general public.

Madam Deputy Speaker, you have graciously allowed the debate to range quite widely today. Perhaps that is inevitable, when one examines the background to the measure. It is interesting to see how the pieces of the jigsaw to which I referred in my opening speech will come together. I make it absolutely clear that the measures in the Bill are not an end in themselves. They will operate with all the other pieces of the strategy to secure the safety and well-being of severely mentally ill people and of the wider community.

I do not promise to cope with every point raised in the short time available to me, but I have no doubt that some of them will be raised again during the Committee stage. The hon. Member for Greenock and Port Glasgow (Dr. Godman)--who explained that he had to leave the Chamber--inquired about the Bill's compatibility with the Children (Scotland) Bill. I am assured that the measures are compatible with both the existing and the proposed legislation. Children under 16 may, in very rare circumstances, be detained in hospital under the Mental Health (Scotland) Act 1984, and that is why we have made community care orders available for such patients.

The hon. Member for Doncaster, North (Mr. Hughes) referred to a tragedy of which I am aware, and emphasised the need to improve the system. He gave a qualified welcome to the Bill, and said that it does not address all of the problems. That is a perfectly fair comment: the Bill does not seek to achieve everything. It is a narrow, measured Bill and only one part of the Government's strategy. The hon. Gentleman is quite right to refer to the need for better community services. The Government preach that constantly to health and social services and to community health services, and we have made the money available to ensure that there can be improvements. However, we must ensure that those resources are targeted, and are used wisely.

My hon. Friend the Member for Bournemouth, East (Mr. Atkinson)--I hope that I have the geography right in this case--rightly paid tribute to the National Schizophrenia Fellowship. Tributes have been paid on both sides of the Chamber to the NSF and other voluntary organisations such as MIND and the Jewish Association for the mentally ill. I join in those tributes.

My hon. Friend the Member for Bournemouth, East rightly paid special tribute--as others have--to carers. We have done much to support carers in the House in recent months, and nowhere is that more important than where carers of people with severe mental illness are concerned. They have a tremendous burden to carry for people in their families whom they love, and we should do what we can to support them. The best way to support those carers is to ensure that they have the assurance that the services are there--the range of services, encompassing provision of beds and community services. I believe that those carers would welcome the measure.

The number of beds was mentioned several times. I can best respond to that by drawing attention to the survey of English mental hospitals published in March 1993, which showed that the number of places for people with mental illness had been steady, at about 80, 000. The difference

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is in the new range of provision that exists. That is not to suggest for a moment that I do not accept some of the arguments about beds, but the number of places has been fairly steady in recent years.

There is talk about new funding, and that was reflected in several speeches from both sides of the House about the resources needed to make the Bill work effectively. The specific figures on the face of the Bill refer to the tribunals and those specific additional costs. We must regard the reference to resources and the references to the cost of the Bill in the context of the greatly increasing resources that have been made available for mental health provision--for the national health service and social services--in recent years. I have no doubt that those resources will continue to increase, because mental health is a priority in the NHS and in social services. The more we are able to make progress--as we will--with our inter -agency purchasing guide and to encourage joint commissioning and so on, the more resources will be made available for those measures, but they will be made available for the whole of provision for mental health. In connection with the Bill, we have spoken about the numbers of people that we are dealing with. They are quite small numbers in any one district. Nevertheless, although it is unquantifiable, one needs to take account of the cost to the community and to the health and social services if that type of measure is not implemented. There are enormous costs in trying to locate and look after people who have not been adequately supervised, so the Bill could, in some ways, be a cost-saving measure. Certainly it will make for a more efficient service.

Compulsory medication was mentioned. Our line, as I said earlier, is that, where medication has to be compulsory, that should be decided in the setting of a clinical decision by psychiatrists in a hospital, not out in the community, but I know the opinions about that.

The hon. Member for Roxburgh and Berwickshire mentioned titles, and no doubt he will return to that in Committee. I do not believe that the title "community care order" is misleading to professionals. Perhaps I have a greater faith in their ability to understand guidance and titles than he has, but I am sure that we can consider that in Committee.

The hon. Member for Roxburgh and Berwickshire referred to the Scottish Select Committee. That has been considering the closure of psychiatric hospitals in Scotland, and when that report is published, it will be useful background to some of our discussions. However, as I said, we have an overall policy of ensuring that beds are provided. I shall return later to the argument of my hon. Friend the Member for Sevenoaks (Mr. Wolfson) about the range that we need, and I absolutely agree with what has been said.

The hon. Member for Roxburgh and Berwickshire spoke about the pressures on community psychiatric nurses. I understand the anxieties, but we need to get close to CPNs to talk them through the role because, as I said, we would regard them as being the supervisors and carrying out that role, just as we regard them on the whole as doing the key worker role under the care programme approach. The new role only formalises in law what they would have done under the old, and reflects the well-established principle that a patient's care plan should be the responsibility of a named person.

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CPNs will work as a team, with joint responsibilities for decision making. Numerically, that should not make a great difference to their case load. However, those are fair arguments to make.

My hon. Friend the Member for Taunton (Mr. Nicholson) rightly referred to the fact that suicide is the great threat to the people we are discussing, and one of our targets is to reduce the number of suicides. It is one of our "The Health of the Nation" strategies. The Somerset progress is encouraging. My hon. Friend rightly referred to the way in which Somerset got ahead of the game in care in the community.

My hon. Friend the Member for Taunton also mentioned homelessness. That is outside the scope of the Bill, but I would draw his attention to two things. One is the homeless mentally ill initiative, which has been remarkably successful in the streets of London. Various hon. Members mentioned central London and its needs. That initiative has helped to take people out of the boxes and blankets and into hostels and long-term accommodation. I believe that it can build on that. Yesterday--it seems a long time ago now--I took part in the third of the seminars that we have been holding jointly with the Department of the Environment, considering the way in which housing can play its part in community care as a whole, and especially the care of those with mental health problems. Much joint work is going on between Departments and between agencies.

The hon. Member for Stockport (Ms Coffey) mentioned the number of CPNs, which is important. They have quadrupled in our time, but we shall obviously need to continue planning the manpower and womanpower needed in that regard.

I pay tribute to the work of the hon. Member for Motherwell, South (Dr. Bray) as chairman of the all-party group, which has got off the ground again and has been very helpful to us. He emphasised the need to involve users, and I wholly agree with that. The Bill does that, and we shall ensure that they are consulted on any revision of the codes of practice that follows from the Bill.

Some of the most valuable times that I have spent have been with conferences of users and purchasers, at which they come together to consider local needs. Users are involved in the care programme approach to planning. We can build on that. Everyone seems to want a charter nowadays, and that is a tribute to the initiatives of my right hon. Friend the Prime Minister. Charters are obviously regarded as guarantees of good-quality service--guarantees of people being involved in planning the services they need--and we shall certainly consider those in mental health. I believe that much of what the hon. Member for Motherwell, South said will be covered in guidance. My hon. Friend the Member for Hendon, South (Mr. Marshall) made what has already been described as an excellent speech, supporting the Bill. He also mentioned some of the issues, not least concerning London. As he will know, the mental health task force has carried out its survey of London and followed it up. I believe that progress is already visible on that, but we need to do much more work, and work much harder, on London's problems to begin to solve them for the longer term. My hon. Friend is also right to mention families and their civil liberties, which we should remember.

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I said that I would return to my hon. Friend the Member for Sevenoaks on hospital closures. I understand his argument. We have said clearly that we are not closing hospitals until and unless we are sure that the services are there in the community. However, I go much further. I say that we need to ensure that there are hospital places for different categories of need for people with mental illness. That goes for medium-term needs, with hospital hostel-type concepts, it goes for secure accommodation, for acute beds, for 24-hour crisis beds, for long-term beds and for asylum. We need all that. We need the package of beds, just as we want the package in the community.

I know that I have not mentioned one or two hon. Members. I wanted briefly to mention the hon. Members who spoke from the Opposition Front Bench, to thank them for their broad support, if I may call it that, even if they will divide the House on their amendment. The Opposition acknowledged that we are trying to fill a gap that needed filling and which has been identified, as both Opposition Front Benchers said, by reports and inquiries. We have discussed the medium-secure beds, and their provision. We have talked about resources, too. I did not hear much from the Labour party as to what additional resources it will pledge over and above what we have provided. We have come to accept that; the Opposition talk about the general need for more resources but do not give any specific pledges. I am therefore not surprised that they changed the terms of their amendment tonight.

Several hon. Members raised the issue of guardianship. I remind them that we want to encourage guardianship. It is not used a great deal; when it is, it is generally used for people with social functioning problems. We believe that it should be a medically led regime. Baroness Jay sought to promote guardianship by adding to it the power to convey. We do not think that is the way forward; we think that this Bill is.

We shall also examine the role of the Mental Health Act Commission when reviewing the Bill generally.

Black mental health is an issue that I take very seriously. I appreciate the way in which the hon. Member for Newcastle upon Tyne, East (Mr. Brown) raised it. The first initiative that I took as a Minister was to launch an inquiry into the reasons for the apparent variations in treatment and diagnosis and in the type of accommodation for black mentally ill people. We are going to look carefully and objectively--without too much emotion-- at this subject, without ducking any of the questions. I shall go on doing that, but it is separate from this Bill, and I hope that it will not be seen as a threat to these people.

The Bill seeks to protect some very vulnerable people, whose illness can cause harm to themselves or others. Tragedies are rare, but that is no reason not to try to avoid them by strengthening supervision. We must reassure the public and the families who have people with severe mental illnesses living among them. I have listened carefully to everything said this evening. I shall listen again in Committee.

Everything that I have heard confirms what I said earlier: that this Bill is but one measure in the overall strategy, together with the CPA, registers, key workers, discharge procedures and a range of bed and community services. The resources are important; their effective use even more so. Resources have risen and will no doubt go on doing so.

Column 207

Everyone has mentioned the revision of the Mental Health Act, but nobody has really told me what they want changing in it. In due course, we shall certainly look at the Act; in the meantime, a lot of people need not changes in the law, but a tightening of performance. The few who do need a change in the law are those whom we have dealt with in this Bill.

I hope that the House will reject the amendment, and give the Bill a Second Reading.

Question put, That the amendment be made:--

The House divided : Ayes 224, Noes 236.

Division No. 167] [7.02 pm

AYES

Column 207

Adams, Mrs Irene

Ainger, Nick

Ainsworth, Robert (Cov'try NE)

Allen, Graham

Anderson, Donald (Swansea E)

Armstrong, Hilary

Ashdown, Rt Hon Paddy

Ashton, Joe

Austin-Walker, John

Banks, Tony (Newham NW)

Barnes, Harry

Bayley, Hugh

Beckett, Rt Hon Margaret

Beith, Rt Hon A J

Benn, Rt Hon Tony

Bennett, Andrew F

Benton, Joe

Betts, Clive

Blair, Rt Hon Tony

Blunkett, David

Boateng, Paul

Bradley, Keith

Bray, Dr Jeremy

Brown, Gordon (Dunfermline E)

Brown, N (N'c'tle upon Tyne E)

Bruce, Malcolm (Gordon)

Burden, Richard

Byers, Stephen

Caborn, Richard

Callaghan, Jim

Campbell, Mrs Anne (C'bridge)

Campbell, Menzies (Fife NE)

Campbell, Ronnie (Blyth V)

Campbell-Savours, D N

Canavan, Dennis

Carlile, Alexander (Montgomery)

Chidgey, David

Chisholm, Malcolm

Clapham, Michael

Clark, Dr David (South Shields)

Clarke, Tom (Monklands W)

Clelland, David

Clwyd, Mrs Ann

Coffey, Ann

Connarty, Michael

Cook, Frank (Stockton N)

Cook, Robin (Livingston)

Corbett, Robin

Corbyn, Jeremy

Corston, Jean

Cunliffe, Lawrence

Cunningham, Jim (Covy SE)

Cunningham, Rt Hon Dr John

Cunningham, Roseanna

Dafis, Cynog

Davidson, Ian

Davies, Bryan (Oldham C'tral)

Davies, Ron (Caerphilly)

Denham, John

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