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Points of Order
4.6 pm
Mr. Max Madden (Bradford, West): On a point of order, Madam Speaker. I wish to raise a matter of which I have given you notice. A document has been passed to me headed "Parliamentary Question by Max Madden MP", signed by an entry clearance officer in the British high commission in Nigeria, dated 17 February 1995. On the second page, under the heading:
"Not for inclusion in draft reply",
considerable concern is expressed by the entry clearance officer that
"we may face criticism on the handling of this application." It goes on to catalogue unacceptable delays and inexplicable failures of routine procedures. It speculates about action that I might take and that which may be taken by solicitors.
I shall certainly suggest to my constituent that he consider making a complaint of maladministration to the Parliamentary Commissioner, but I wonder whether you, Madam Speaker, would be prepared--clearly, you have not had the opportunity to consider the detail--to deprecate in general terms any actions that are taken by officials or Ministers which are clearly designed to conceal maladministration and to treat Members of Parliament, our constituents and the general public with clear and obvious contempt.
Madam Speaker: That is barely a point of order for me, but the hon. Gentleman was kind enough to give me just a little indication of what he might raise. He tells me that he was concerned about the advice given by officials to Ministers at the Foreign and Commonwealth Office in drafting the reply to a parliamentary question. As the hon. Gentleman knows, the Chair has no responsibility for ministerial answers to questions, still less for officials' advice to Ministers. I am sure that the hon. Gentleman will pursue the matter with the Minister involved. As I said, it is barely a point of order, but the point that he has brought to the attention of the House today is very revealing.
Sir Patrick Cormack (Staffordshire, South): On a point of order, Madam Speaker. I have just been out to check the tape, following the exchanges that took place earlier. It would appear from the tape that at 4 pm President Yeltsin was alive.
Madam Speaker: I am sure that the House is pleased to have that news. We are always too much interested in bad news. It is nice to have a little good news for a change.
BILL PRESENTED
Northern Ireland (Remission of Sentences)
Secretary Sir Patrick Mayhew, supported by the Prime Minister, Mr. Secretary Howard, Mr. Secretary Forsyth and Sir John Wheeler, presented a Bill to provide for the release on licence of persons serving sentences to which section 14 of the Northern Ireland (Emergency Provisions) Act 1991 applies; and for connected purposes: And the same was read the First time; and ordered to be read a Second time tomorrow, and to be printed. [Bill 183.]
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Orders of the Day
Mental Health (Patients in the Community) Bill [Lords] As amended (in the Standing Committee), considered.
New clause 1
Patients discharged after sentences of imprisonment
`After section 49 of the Mental Health Act 1983 there shall be inserted the following section--
"Patients discharged after sentences of imprisonment
49A. Where a patient has been admitted to a hospital under the provisions of sections 47 or 49 above, discharge shall only take place on the signed assent of the responsible medical officer after consultation with persons nominated by each statutory body responsible for after-care.".'.-- [Mr. Timms.]
Brought up, and read the First time.
4.9 pm
Mr. Stephen Timms (Newham, North-East): I beg to move, That the clause be read a Second time.
The new clause arises from an appalling incident in Newham on 27 July 1994, when Mr. Bryan Bennett, a constituent of my hon. Friend the Member for Newham, South (Mr. Spearing)--who is unable to be in the Chamber this afternoon--and a user of a social services day centre was tragically killed by another user, Mr. Stephen Laudat, just a few months after the latter's discharge from psychiatric treatment at Kneesworth hospital.
Mr. Laudat pleaded guilty on the ground of diminished responsibility and was committed by the central criminal court to an indefinite period of treatment in Rampton hospital in December 1994. The district health authority and the local council jointly commissioned an independent review of the circumstances surrounding the tragedy in January 1995, under the chairmanship of Mr. Len Woodley QC. That inquiry reported last month. The Minister will be aware that the Woodley report is sharply critical of the Bill. It states:
"it is difficult to imagine how the proposed legislation would have enhanced Stephen Laudat's care or prevented the death of Mr. Bennett."
It says that its findings do not support the enactment of the Bill and that the key lies in better resourcing of community care--a point to which I shall return if I am able to on Third Reading later today.
The new clause relates to one aspect of the Laudat case with which the Bill does not deal. There is immense concern in Newham, especially among the relatives of the man who died, naturally, about how Mr. Laudat came to be released from Kneesworth hospital in December 1993, just seven months before the killing. The Woodley report shows that the hospital had great concerns about him immediately before he was released. There was a series of difficult incidents in October and November 1993 and the ward manager wrote, prior to an after-care planning meeting on 25 November, that Mr. Laudat was subject to the
"potential and threat of violence to both males and females",
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and that he was"vulnerable and a threat to himself and others".
Mr. Laudat's prison sentence--the reason for his detention in the first place--meant that he could be released on 6 December 1993. At the meeting on 25 November, it was noted that there were insufficient grounds to warrant his detention beyond the end of the restriction order on 6 December and that he had, therefore, to be released. That is the matter that has so deeply concerned myself and my hon. Friends the Members for Newham, South and for Newham, North-West (Mr. Banks) and which lead to the drafting of the new clause. Mr. Laudat was released because his prison sentence expired and not because anyone had positively concluded that he was ready to re- enter the community. The limited grounds in the Mental Health Act 1983 under which it would have been possible to detain Mr. Laudat further were felt not to have been complied with, so it was felt that there was no alternative but to release him, despite the severe misgivings of those responsible for his care. The truth is that he should not have been released.
The new clause shifts the onus, so that in such circumstances discharge could take place only on the explicit authority of a medical officer and not merely because the prison sentence had expired, as in the case described in the Woodley report. The length of the sentence clearly bore no relation to the state of Mr. Laudat's health.
Under the new clause, the patient would be released only if his doctor was positively satisfied that he was not a danger to himself or others. If it had been enacted prior to December 1993, it is likely that my hon. Friend's constituent would be alive today. I hope that the Minister will be able to accept it, to prevent similar tragic incidents.
Ms Tessa Jowell (Dulwich): I commend my hon. Friends the Members for Newham, North-East (Mr. Timms) and for Newham, South (Mr. Spearing) for tabling the new clause. We believe that it should be supported.
Although such patients will be entitled, when discharged, to after-care under section 117 of the Mental Health Act 1983, there is no legal requirement in that section to consult prior to discharge and on many occasions, as my hon. Friend made clear, discharge is poorly, if at all, planned and co-ordinated. We believe that new clause 1 is a practical way of addressing those concerns.
4.15 pm
The Parliamentary Under-Secretary of State for Health (Mr. John Bowis): I am grateful to the hon. Member for Newham, North-East (MrTimms) for bringing the matter forward. The hon. Member for Newham, South (Mr. Spearing) did me the courtesy of writing to explain that he could not be here, but that his hon. Friends the Members for Newham, North- East and for Newham, North-West (Mr. Banks) would be here to support new clause 1.
I understand well the concern that lies behind new clause 1 following the Woodley inquiry into the care of Stephen Laudat. However, the present wording of the
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Mental Health Act 1983 already meets the aims of the new clause, while the introduction of supervised discharge will of course strengthen the provisions.The Home Secretary may direct that a patient be transferred from prison to hospital; he may also direct that a patient should be subject to special restrictions. The patient may not then be discharged, given leave of absence or transferred to another hospital without the consent of the Home Secretary. The issue that the new clause seeks to address arises at the point when the prison sentence of a patient in hospital expires. At that point, the restrictions exercised by the Home Secretary also expire. That does not mean that the patient must then be discharged immediately. The patient remains liable to be detained for a further six months unless a positive decision is taken to discharge him or her.
At the end of the six months, the responsible medical officer must review the case and the detention may then continue if the renewal conditions in section 20 of the Mental Health Act 1983 are met. When the patient is eventually discharged, he or she is subject to section 117 in the same way as anyone else who has been detained for treatment under the Act; that is, the relevant health and local authorities are obliged to provide after-care services for as long as the patient needs them.
Under the terms of the Bill, as soon as the restriction direction has lapsed, it is open to the responsible medical officer to make a supervision application if, and only if, he or she is satisfied that the after-care arrangements are agreed and in place. New clause 1 would treat transferred prisoners differently from those admitted directly under hospital orders made by the courts. I do not think that that is desirable or necessary and I hope that the hon. Gentleman will feel able to withdraw the new clause.
Mr. Timms: I am disappointed that the Minister has not accepted the new clause, but I am encouraged by what he said. I hope that he is right that the arrangements will ensure that such incidents do not take place in future. In the light of what the Minister said, I shall not seek to press the new clause to a vote and I beg to ask leave to withdraw the motion.
Motion and clause, by leave, withdrawn.
Clause 1
After-care under supervision
Mr. Archy Kirkwood (Roxburgh and Berwickshire): I beg to move amendment No. 1, in page 2, line 25, at end insert--
`(7A) If, on the date when a patient ceases to be liable to be detained in a hospital under this Part of this Act, a supervision application has been made in respect of him but the Health Authority have not yet accepted the application, his liability to be so detained shall continue--
(a) until the end of the period of three months commencing with that date, or
(b) until the Authority either accept or refuse the application whichever is the earlier.'.
The amendment aims to press the Government to reconsider the issue with which it deals, which has run through the proceedings on the Bill all the way through from the House of Lords.
As a Scottish Member, I am entitled to ask the Government to reconsider because clause 4(1), which inserts a section 35A(6) into the Mental Health (Scotland)
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Act 1984, makes Scottish provisions precisely like those in the amendment. Briefly stated, the objective of the amendment is to prevent patients from being able to walk straight out of hospital just when attempts are being made to arrange their supervised discharge. That is balanced by providing that patients can be detained for only three months so that they cannot be detained for an indeterminate or excessive period.The amendment is supported by experience especially in respect of the treatment of schizophrenics. I fully understand the Government's problem in getting the legislative balance right in dealing with schizophrenia, which can cause people to be so ill that they act completely irrationally, as opposed to what I might call normal mental illness. It is difficult to legislate for both sets of patients.
I understand, too, that there are potential civil liberties arguments, as there always are when we deny people their liberty, even for a determined period of three months. I am not persuaded by the Government's position as stated by the Minister in the other place at the beginning of the Bill's passage, when it was suggested that there would be a gap in the procedure. The Government seemed to accept that there would be a gap and took the view that the patient would be much more likely to stay as a voluntary patient in those circumstances. I wish that I had that confidence. Some schizophrenic patients--perhaps only a small number--might simply go walkabout, which would disrupt the after-care package being put in place.
I hate to be superior, but we tend to do things better in Scotland. If the provision is good enough for Scotland, why should not it be in the English part of the Bill?
Mr. David Atkinson (Bournemouth, East): I hope that my hon. Friend the Minister will respond positively to the amendment because the Bill presupposes that all the appropriate accommodation and after-care arrangements for the patient will have been put in place by the time his or her detention period is over and that, if they have not, the patient will accept a continuation of his detention voluntarily until they have. As the National Schizophrenia Fellowship has repeatedly pointed out, that flies in the face of experience and reality. Appropriate accommodation is not always in place, sometimes for the best of reasons.
Nevertheless, patients can walk out, claiming their rights under the Bill, and then disappear through the safety net. That is of great concern to us. The National Schizophrenia Fellowship has suggested that it is better to keep the stable door bolted until we can be assured that proper after-care and accommodation are in place before the release of patients. I hope that my hon. Friend will respond positively to the amendment.
Mr. Bowis: I am grateful to the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) for raising this issue and to my hon. Friend the Member for Bournemouth, East (Mr. Atkinson) for bringing the expertise of the National Schizophrenia Fellowship to bear on this point. I hope that I can fill the gap for the hon. Gentleman and, in so doing, reply positively to my hon. Friend.
As the hon. Gentleman said, the amendment was tabled in the light of the Scottish provisions, under which the sheriff may defer the making of a community care order until he is satisfied about the after-care and medical services to be provided. That reflects the concern, which
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has been expressed on both sides of the House, about what might happen if the authority to detain a patient were about to expire for whatever reason--possibly because the after-care services that the patient needed were not yet in place--and the health authority had not yet accepted the supervision application.However, the way in which the provisions for supervised discharge have been framed for England and Wales makes the amendment unnecessary. First, the detailed requirements for consultation by the responsible medical officer with all those concerned are designed to ensure that a supervision application is made only once all necessary preparations are in place. The requirement for the health authority to consult the local authority before it accepts the application provides a double check on that, and there should be no reason to delay acceptance of the application once consultation has been completed.
However, in the unlikely event of a delay for some unforeseen reason, I commend to the hon. Gentleman and my hon. Friend section 20 of the Mental Health Act 1983. The renewal provisions of that section would remain available to enable a patient's detention in hospital to be renewed for as long as necessary. The existing provision is therefore adequate for that purpose without requiring a new procedure for renewing detention to be included in the Bill. The current measures add to that provision. I hope that the hon. Gentleman accepts the existence of that basic assurance and I invite him to withdraw the amendment.
Mr. Kirkwood: I think that I am reassured by that reply. I know the Minister well enough to know that he will monitor this matter carefully. If there are experiences like those that have been raised as genuine and legitimate concerns, particularly at the hands of schizophrenic patients, I hope that he will make it his business to ensure that any gaps that remain despite what he has said are closed at some stage in the future.
I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Mr. Bowis: I beg to move amendment No. 13, in page 3, line 29, leave out
`unless the patient has otherwise requested,'.
Mr. Deputy Speaker (Sir Geoffrey Lofthouse): With this, it will be convenient to discuss Government amendments Nos. 14 to 24.
Mr. Bowis: The amendments relate to the rights of a patient's nearest relative to be consulted and the position that arises when a patient objects. They fulfil the commitment that I gave in Committee to my hon. Friends the Members for Bournemouth, East (Mr. Atkinson), for Hendon, South (Mr. Marshall) and for Sevenoaks (Mr. Wolfson) and to the hon. Member for Wakefield (Mr. Hinchliffe) to table amendments to provide for that objection to be overridden in certain circumstances.
The amendments define two tests that must be satisfied if a patient's objection is to be overridden. First, he or she must have a propensity to violent or dangerous behaviour towards others. Secondly, the responsible medical officer must believe that it is appropriate for the nearest relative to be consulted.
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I am sure that all hon. Members on both sides of the House will understand that, in those amendments, we have found it necessary to walk a tightrope in maintaining a balance between all the different interests. I believe that the balance that we have struck is the right one.I commend those amendments to the House.
Mr. Nicholas Brown (Newcastle upon Tyne, East): The Minister is right; he is walking a tightrope. Despite his build--and perhaps my build as well--he appears to have made a successful job of it. The amendments were a Government response to requests from my hon. Friend the Member for Wakefield (Mr. Hinchliffe) and Conservative Members to reconsider that aspect. The Government have tabled amendments relating to the rights of patients to object to their responsible medical officer consulting a nearest relative about placing the patient on a supervision order. As the Bill stands, the patient has the right to object to such consultations.
I believe that we all understand why, in normal
circumstances--inasmuch as any of those circumstances may be described as normal--the patient should have the right to object to such consultations. However, the amendments mean that the patient loses his right to object to the consultation if he has a history of violence or threatening behaviour-- and that is where the Minister says that he is walking a tightrope.
The purpose of the amendments is to strike a balance between the reasonable rights of the patient and the rights of relatives and close family. The amendments are intended to serve as protection for the families of violent patients. They make it less likely that a potentially violent patient can be discharged under supervision without his family being consulted and warned.
The Government probably have achieved the right balance, and I support the amendments.
Mr. David Atkinson: I thank my hon. Friend the Minister for responding so positively to the anxieties of the National Schizophrenia Fellowship about the amendments, and I thank our right hon. Friend the Secretary of State for Scotland for the amendments that are the equivalent for Scotland in those respects. I welcome the amendments wholeheartedly, and once again thank my hon. Friend for his positive response in listening to us.
Amendment agreed to.
Amendment made: No. 14, in page 3, line 36, at end insert-- `(2A) Where the patient has requested that paragraph (b) of subsection (2) above should not apply, that paragraph shall not apply unless--
(a) the patient has a propensity to violent or dangerous behaviour towards others, and
(b) the responsible medical officer considers that it is appropriate for steps such as are mentioned in that paragraph to be taken.'.-- [Lord James Douglas-Hamilton.]
Ms Jowell: I beg to move amendment No. 45, in page 7, line 12, leave out lines 12 to 16.
Mr. Deputy Speaker: With this, it will be convenient to discuss the following amendments: No. 46, in page 7, line 12, leave out
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`A patient subject to after-care under supervision may' and insert`An application for a patient subject to after-care under supervision to be taken and conveyed (in this Act referred to as a "conveyance application") duly completed in accordance with subsection (4A) below, shall be sufficient authority for the patient to'.
No. 47, in page 7, line 16, at end insert--
`(4A) A conveyance application may be made by the supervisor in respect of a patient subject to after-care under supervision, on the grounds that--
(a) he continues to suffer from a mental disorder, being mental illness, severe mental impairment, psychopathic disorder, or mental impairment, and
(b) it is necessary for the health and safety of the patient or for the protection of others that he should be taken and conveyed in accordance with subsection (4) above.
(4B) A conveyance application shall be made to the Health Authority which accepted the supervision application in respect of the patient.'.
Ms Jowell: These amendments deal with the take and convey powers that the Bill will give to those responsible for supervision or anyone who is nominated by the supervisor. In our opinion, they are the changes in the law that are most likely to create serious difficulties.
Amendment No. 45 removes the new powers altogether from the Bill. The aftercare organisations responsible for supervision and care would still be able to formulate and impose requirements on the person subject to supervision and would have to conduct a review if the person failed or neglected to comply with them. However, the supervisor would not be able to exercise physical force in seeking compliance. That is not to say that community psychiatric nurses, social workers and other people who will be involved in supervision would be left without legal powers to tackle problems when they occur.
One can imagine the circumstances in which the new power may have to be used. For example, the person under supervision may be behaving in such a way that the supervisor believes that an urgent assessment is required; or the person may be preventing access to their home, one of the most common difficulties in offering support to seriously mentally ill people in the community.
Very occasionally, the person's behaviour may be so disturbed as to pose an immediate threat to their own safety or to that of other people or property.
In each of those situations, ample legal powers already exist and are routinely used by those who are allowed to do so in order to deal with the matter. Assessments are undertaken, if necessary, after a social worker has obtained a warrant requiring a person to give him and the doctor access. The Mental Health Act 1983 and other laws clearly allow professionals to intervene when behaviour is so disturbed as to justify the need for further assessment or to restrain violent or threatening behaviour.
High-quality supervision and support for mentally ill people in the community depends for their effectiveness not on new coercive legal powers, but on the appropriate use of existing powers and the more effective deployment of professional resources and services for people needing intensive support and help. If the essential success of after-care plans relies on the agreement and consent of the patient and his or her partnership with the professional team, the Minister must tell us how he justifies the creation of new powers that are so controversial with
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those who will be called on to implement them and so potentially damaging to the relationships that professionals are to have with those in their care.4.30 pm
Let us consider what the Minister is proposing in the Bill. He has not drafted the power so that the supervisor can compel the patient to submit to treatment, occupation, education or training--if one could even contemplate the last two options being possible in practice. The power does not give the supervisor the right to use force to enter premises, nor can the supervisor detain the patient after he or she has been conveyed. Even doctors who have called for new powers find that difficult to understand.
Professor Chris Thomson, registrar of the Royal College of Psychiatrists, has written:
"To many psychiatrists and others this is the worst of both worlds. The mentally ill would be subject to the power of `arrest' to no apparent purpose. Psychiatrists remain deeply sceptical and believe that the Bill will not provide the extra public safety which the Government is hoping for."
We would not support moves to compel treatment on patients in the community and we believe that the measure may do harm even if it remains largely unused. That harm will be greater than any benefit that may accrue from having this power on the statute book. One of the most harmful effects may be to encourage poor professional practice. As I think we all accept, good community care depends on high quality relationships, built on trust, confidence and sensitivity to a person's individual needs and circumstances. The threat or use of force can offer the short cut of gaining a person's compliance with a plan or programme. In place of the careful and diligent development of an effective relationship with the patient, a supervisor can merely call in aid his or her power to take and convey or threaten to get the police in order to use it. We are sure that that will damage community care--driving people from services rather than encouraging them to use them, especially if, as will be likely, supervisors try to get the police involved in using coercion rather than use it themselves. Many professionals are unhappy about the prospect of having these powers. Therefore, the provision may be irrelevant because, as I have said, it may simply not be used. We recognise that the House may not be persuaded that the powers should be removed from the Bill. The House may consider it possible to regulate their use in order to deal with the concerns that I have outlined. We have also tabled a compromise amendment. Amendments Nos. 46 and 47 preserve the powers, but require those who wish to use them, first, to submit to the health authority which accepted the supervision a written application setting out the grounds. Those grounds require the supervisor to confirm that the person is still suffering from a mental disorder within the meaning of the Act and that the use of the power to take and convey is necessary, not just beneficial or convenient, for the sake of the patient's health and safety and for the protection of others. The amendment therefore links the use of the power to some threat to patients' health or risk to their or other's safety.
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We believe that the power can be justified only when it is subjected to such clear and explicit regulation. It is only in those circumstances that professionals and patients will be able to see the reason for using the power and any justification there may be for it.Mr. Kevin Hughes (Doncaster, North): I shall be brief in my remarks today as the points were explored in great depth on Second Reading and in Committee. I welcome the fact that the Government have decided to put the issues regarding the provision of care for the mentally ill on the agenda. However, I must also voice my concerns about the legislation that is now before Parliament.
The Government claim that the Mental Health (Patients in the Community) Bill is "uncontroversial", but my hon. Friend the Member for Dulwich (Ms Jowell) has pointed out that that is certainly not so. The Government have failed completely to listen to the widespread opposition to their proposals. We know that leading health professionals and patient organisations are united in their opposition to the Bill. They are particularly concerned about the proposed power to take and convey people with mental illness to places of treatment. Therefore, I support the amendments moved by my hon. Friend that would remove that power from the Bill.
First, the proposal is an affront to civil liberties and we covered that ground in Committee. The Bill provides no restrictions on who can exercise the power to take and convey and there is no requirement to inform the patient of the reasons for its use. The Bill allows the patient's supervisor to nominate any other person or agency to take and convey the patient. The supervisor does not have to obtain any additional authority before delegating that power and there are no safeguards to protect the person being conveyed or the person effecting the conveyance.
Secondly, I question the workability of the proposal. The Bill proposes that patients be taken and conveyed to a specified place, but it does not suggest what should happen to patients once they have been taken and conveyed. It is difficult to see how an unwilling patient could be forced to take part in activities such as education and training, even if that patient has been successfully taken and conveyed to a specified place.
The proposal seeks to compel patients to use services but, amazingly, it provides no guarantee that those services will be provided. The proposal threatens to damage the relationship of trust between patient and supervisor and there are concerns that, as a result of the Bill, patients in the community will be discouraged from remaining in contact with the mental health services. Many social workers and community psychiatric nurses are not keen to take on the new power as they believe that it could put them at risk from potentially violent patients. Some professionals have said that they would not use any of the Bill's provisions--which they regard as unnecessary--as they believe that the Mental Health Act 1983 is adequate. Leading mental health professionals have expressed strong reservations about the proposals on take and convey. My hon. Friend has quoted the remarks of Professor Chris Thomson, registrar of the Royal College of Psychiatrists. It is worth repeating, and I hope that the Minister will listen:
"To many psychiatrists and others this is the worst of both worlds. The mentally ill would be subject to the power of `arrest' to no apparent purpose."
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