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Access to Justice Bill
31. Mr. Dominic Grieve (Beaconsfield): If he intends to publish a White Paper in advance of the Access to Justice Bill. [61254]
The Minister of State, Lord Chancellor's Department (Mr. Geoffrey Hoon): The Government published their White Paper "Modernising Justice" on 2 December 1998.
Mr. Grieve: I am obliged to the Minister for pointing out that which had already been brought to my attention. May I take him to the reference in paragraph 6.18 of the White Paper on whether salaried defenders will be sanctioned by the Government? He knows that that issue has caused much disquiet in the legal profession and that the White Paper suggests that it will be kept under consideration. Will he explain why clause 13 of the Access to Justice Bill, which was published simultaneously, provides that Parliament will be asked to sanction exactly such a step and will be deprived of the opportunity of legislative scrutiny thereafter?
Mr. Hoon: The explanation is that it is clearly necessary for the Government, subject to parliamentary approval, to have powers to employ salaried lawyers who may one day, if appropriate, constitute a public defender service. The Government have no plans to take forward any comprehensive scheme, but it is right that Parliament should have the opportunity to debate in principle whether that may one day become a feature of our criminal defence service.
Dr. Alan Whitehead (Southampton, Test): Will my hon. Friend acknowledge the bewilderment that members of the public who have recourse to the law feel when they have dealt with a lawyer whom they trust and believe is competent to carry out their business and that lawyer is suddenly replaced in court by someone whom they have barely met and do not know? Will he emphasise to me the Government's commitment to ensuring that access to audience is seriously pursued?
Mr. Hoon: I am grateful for my hon. Friend's question. He will know that the Bill and the White Paper set out proposals to eliminate the remaining restrictive practices between solicitors and barristers to allow all those who have qualified as either a solicitor or a barrister to appear in all the higher courts. That is a welcome improvement in the rights of ordinary people to secure legal representation and will eliminate the problems that my hon. Friend so well describes.
Mr. Edward Garnier (Harborough): The Minister will recognise that the Access to Justice Bill will deny citizens the right to select a defence lawyer of their choice. How does that comply with the Human Rights Act 1998?
Mr. Nicholas Winterton (Macclesfield): Difficult, Geoffrey.
The provisions that we have set out in the White Paper and the Bill will ensure that those who are represented under legal aid schemes paid for by taxpayers' money have access to specialist representation. We will contract with only those lawyers who are specialists in particular fields. For the moment, anyone who is eligible for legal aid can go to any lawyer, irrespective of whether that lawyer knows anything about the subject in hand. We will ensure through contracting that people still have a choice of lawyer, but they will have a choice of those lawyers who are qualified and experienced in the relevant field of practice. That is a considerable improvement on the present arrangements.
Mr. Gareth Thomas (Clwyd, West):
Does my hon. Friend agree that, whatever the leader of the Bar may say, the majority of those of progressive opinion within the legal profession accept the need to modernise the profession, eliminate unnecessary restrictive practices and improve access to justice?
Mr. Hoon:
I was slightly surprised to discover that members of the Bar welcomed our proposals. Although they had one or two "predictable moans", according to a leader in The Times, on balance they felt that our proposals would improve access to justice and would be to the benefit of all those citizens who have to use legal services.
32. Mr. Andrew Lansley (South Cambridgeshire):
What representations he has received concerning the closure of magistrates courts in East Anglia. [61255]
The Minister of State, Lord Chancellor's Department (Mr. Geoffrey Hoon):
I have recently received 12 representations from hon. Members, justices of the peace and other local interested parties, following the Cambridgeshire magistrates courts committee's determination to close the March magistrates courts with effect from 31 December 1998. I have previously received representations in relation to the Suffolk magistrates courts committee's decision to close magistrates courts in Suffolk.
Mr. Lansley:
I am grateful for that reply. Does the Minister agree that Haverhill in Suffolk is a good instance of a market town--it is in the constituency of my hon. Friend the Member for West Suffolk (Mr. Spring)--that is forecast to grow and should have local infrastructure, but that will see access to justice denied and the abandonment of an important part of the local infrastructure?
Mr. Hoon:
I understand the hon. Gentleman's concern about Haverhill and other courthouses in Suffolk, but those decisions were taken by the Suffolk magistrates courts committee. It is curious that the hon. Gentleman should come here and make representations to a
Mr. Bob Russell (Colchester):
Does the Minister agree that every magistrates courts committee is a quango?
Mr. Hoon:
I do not accept for one moment either that magistrates courts committees are quangos or that they are starved of financial resources.
Mental Health Services
3.30 pm
The Secretary of State for Health (Mr. Frank Dobson): I should like to make a statement on the Government's proposals to modernise the mental health services as part of our drive to ensure that we enter the new century and new millennium with health and social services that are modern and dependable.
Last year we published our proposals for radical reform of the national health service, and last week we did the same for social services. The strategy document we are publishing today brings together our proposals for far-reaching changes and improvements in the treatment and care which both services provide for people who are mentally ill. We are doing that to emphasise that mental health is not some marginal responsibility of the NHS and local social services--far from it: it must be at the heart of both. That is because mental health is not an obscure minority concern. It is just as important as physical illness and the two can be closely interlinked.
Mental illness is as common as asthma: it affects as many as one in six adults at any one time. It ranges from high levels of anxiety or deep depression to severe and enduring illnesses, such as schizophrenia, which affect one person in a hundred. Mental illness is extremely disturbing to sufferers and their families. It can leave people without insight into the consequences of their actions, which is very frightening; in addition, mental illness is little understood. Those factors combine so that mental illness carries a stigma. In turn, the stigma frightens sufferers and their families, and can lead to people postponing getting the treatment they need.
Partly because of that, mental illness does not get the prompt, effective and sympathetic attention it both deserves and needs. As a result, people who are mentally ill, their carers and the professional staff responsible for their welfare have suffered from ineffective practices, an outdated legal framework and lack of resources. We want to deal with all those aspects to bring about a dramatic change for the better in the treatment and care of all those who are mentally ill. In particular, we want to make sure that proper attention is given to the disturbing growth in the number of young people who are mentally ill, and to the particular needs of certain ethnic groups.
Most people who suffer mental illness are vulnerable people who pose no threat to anyone but themselves. Their condition may make it hard for them to keep a family together or hold down a job, but their behaviour is mild and inoffensive. Most of them are not getting all the low-intensity support they need. That is partly due to the fact that confidence in the whole system is in crisis, mainly because it is not coping with the small minority of mentally ill people who are a nuisance or a danger both to themselves and to others. That is where the policy of care in the community has failed: its failure to deal effectively with the most severe cases has dealt a blow to all mental health efforts and lost the confidence of the public.
Discharging people from hospitals brought benefits for some, but it has left many vulnerable people who find it difficult to cope. Others have become a danger to themselves and a nuisance to others. Too many have been left wandering the streets and sleeping rough, and a small but significant minority have become a danger to the
public as well as to themselves. That cannot go on, so we are putting in place a new strategy to tackle the problems faced by patients, professionals and public alike. We have to take steps to tackle the most extreme manifestations of mental illness, because if we do not, the other people who are mentally ill will not get the attention they deserve and need.
That is why we must bring the law on mental health up to date. That law was formulated at a time when most mentally ill patients were treated in hospitals, so it now reflects the practices of a bygone age and must be modernised to cope with the problems of today. At present, some people who would once have been left locked up in a hospital are fine living in the community; others are only safe providing they take their medication. However, some of those who can become a danger to themselves and others refuse to comply with the treatment they need. That cannot be allowed to go on, which is why I have set up a review of the law on mental health. We need a law that works in a crisis, not one that fails in a crisis.
Similarly, there is a small group of people with an untreatable psychiatric disorder, which makes them dangerous. At present, neither law nor practice are geared to cope with them. They cannot be taken into a mental hospital if they will not respond to treatment, and they cannot be put in prison unless they have committed an offence. If they are sent to prison, they can be a danger upon their release. Therefore, the Home Secretary and I are considering proposals to create a new form of renewable detention for people with a severe personality disorder who are considered to pose a grave risk to the public.
That raises all sorts of ethical and practical problems, but we are convinced that the safety of the public must be the prime concern. People whose mental illness poses a threat to others constitute a very small minority, but we must be able to deal with them. Their illness is often an even bigger threat to them, and our new system should be better both for them and for the public.
Our mental health strategy goes much wider than that, and there are huge developments in both policy and practice. We will put in place a national service framework, which will spell out for every part of the country the range of services that are needed to treat and care for the mentally ill and how best to deliver them. We are being advised about that by an external reference group chaired by Professor Graham Thornicroft from the Maudsley hospital. I thank him and his colleagues for their work in that area.
In the meantime, we are getting on with the improvements that are unarguably needed. There is a pressing need in some parts of the country for more mental health beds and for 24-hour services to be available. We want the services that are provided to be safe, sound and supportive: safe to protect the public and the most vulnerable patients; sound to ensure that patients get the best and most appropriate care and attention; and supportive by working with the patients, users, carers and local communities to help mentally ill people live as independent lives as possible. The strategy works best when patients and carers are involved in shaping services to meet local needs.
Those services, which back up informal carers, will be provided by the national health service, social services and voluntary bodies. All must work together to ensure
that people who are mentally ill get well-organised and unified treatment. Proposals in the forthcoming national health service Bill and Local Government Bill will promote that policy.
This year, the planning guidance issued to the national health service was issued as joint guidance to the health service and social services to emphasise the need for them to work together. The National Institute for Clinical Excellence, which we shall establish, will issue clear and authoritative guidance on the most effective drugs and therapies for use in treating mental as well as physical illnesses.
At the same time that those general improvements are being made to the NHS, we are going ahead with much better support for patients and carers. The measures include: access to NHS Direct 24 hours a day; 24-hour crisis teams to respond in emergencies; more mental health beds of the right sort, in the right place; more hostels and supported housing; home treatment teams; and improved mental health training for GPs and others responsible for providing primary care. Other new developments in the NHS, including health action zones and the obligation on health authorities to prepare and implement health improvement programmes, will contribute to improving mental health treatment and care.
I would like to pay a particular tribute to all those who care for people with a mental illness. A great deal of that caring is done by parents, children, friends and neighbours. It is also done by dedicated professional staff. Their work can be very stressful and is sometimes dangerous. We owe them a great debt. They must deal, day after day, with the consequences of policy failures, shortcomings in the law and a lack of resources.
What needs to be done will clearly cost money. Last week, I announced that we had found an extra £185 million to invest in mental health services provided by council social services. Today, I can announce that that sum will be more than matched by our extra investment in national health service mental health services, which will total £510 million over the next three years. That adds up to about £700 million extra investment in mental health services over the next three years on top of the £3 billion already going in.
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