House of Commons
Friday 12 March 1999
The House met at half-past Nine o'clock
PRAYERS
[Madam Speaker in the Chair]
Orders of the Day
Mental Health (Amendment) (Scotland) Bill
Order for Second Reading read.
9.33 am
Mr. Eric Clarke (Midlothian): I beg to move, That the Bill be now read a Second time.
This is a little Bill--in Scotland, we would call it a small or a wee Bill--but it will serve the major purpose of helping some of our most unfortunate and disadvantaged fellow citizens. It will address a gap in the legislation enacted by our predecessors 15 years ago. The Mental Health (Scotland) Act 1984 was a consolidation measure: it consolidated the Mental Health (Scotland) Act 1960 and later amendments. We are dealing with legislation that is 40 years old.
Time marches on, and with it changes take place. The intervening period has seen wide-ranging changes in society's attitudes to people who are mentally ill. I am glad to say that there is no longer the unacceptable stigma that once attached to the illness and to those who suffer from it. There have been welcome advances in treatment and, more relevant to the purpose of my Bill, there have been changes in where people are cared for.
The availability of good-quality community care has meant that far fewer patients are cared for in hospital: they are now looked after in the community, be it in their own home, a nursing home or a residential establishment. By and large, I welcome such developments if they are clearly shown to be in the patients' best interests.
However, the growth of community care has identified a difficulty in the 1984 Act relating to the finances of patients who leave hospital. I shall explain a little of the background. Section 94 of the 1984 Act makes provisions for hospital managers to manage the funds of patients who, because of mental disorder, cannot look after their own resources. The legislation provides that managers can do that only if a doctor states that, in his opinion, the patient is unable to manage his own affairs. If no other arrangements have previously been made--for example, a patient's funds may be managed by the Mental Welfare Commission, the local authority or a relative--the hospital managers may receive and hold money on behalf of the patient. That may be a regular income from a pension or savings in the patient's possession.
I am sure that hon. Members agree that patients should benefit from the money held by hospital managers. Their needs may be small, but they are important. Such
arrangements are part and parcel of the overall effort to ensure that such people enjoy an appropriate quality of life while in hospital. They may want a particular item of clothing, a magazine each week, flowers in their room or the occasional special outing. It is important that they should be able to benefit from their own resources for such purposes. The 1984 Act enables hospital managers to spend the funds that they hold in the patient's best interest.
Hon. Members will be wondering, given what I have just said, where the problem lies and why my Bill is necessary. The difficulty comes when the patient leaves hospital and is cared for in the community. As I have said, community care is now increasingly widespread, and many patients, such as people with a learning disability, who may at one time have expected to live their days in a long-stay hospital, can now live a fulfilling life in the community with appropriate support. Similarly, elderly patients may prefer the more homely surroundings of a care home.
Unfortunately, the 1984 Act did not envisage a time when the patient would live anywhere but in a hospital. We are dealing with legislation of considerable vintage, which has not kept pace with modern concepts of care and treatment. The problem is that, when those people leave hospital, managers cannot pass the money on to the carers or spend it on behalf of the patient who is no longer in their direct care. Sometimes special arrangements can be made, but they are costly.
The Act contains no provision for those circumstances, and the money becomes stuck in the hospital, out of reach of the patient and of those who look after him. The patient cannot benefit from his own resources. We cannot allow that situation to continue, and my Bill aims to address the problem. It will enable hospital managers holding funds on behalf of patients to continue to use that money in patients' best interests when the patients leave hospital to live in the community.
This may seem a relatively minor difficulty, but it is indefensible to deny patients access to their own resources simply because they have left hospital. We want to ensure that such people enjoy the highest possible quality of life. Moreover, statistics show that many patients are affected. I am sure that many hon. Members will describe the way in which the problem affects their constituents. The position can only get worse as time goes by, and more and more patients leave hospital. We are dealing with a growing problem, but my Bill offers a means of addressing it.
It is not my hope that the Bill will, like the 1960 Act, last for 40 years. My further wish is for the introduction of comprehensive legislation to deal with the finances of incapable people, based on the consultations on the Scottish Law Commission's report, at an early stage in the Scottish Parliament. That would not only deal with this problem, but, hopefully, provide new arrangements for the management of the resources of incapable adults that are appropriate to the 21st century.
I hope that hon. Members will feel able to support my Bill.
Mr. Tony Baldry (Banbury):
I congratulate the hon. Member for Midlothian (Mr. Clarke) on presenting a thoroughly worthwhile measure, which is doubtless supported by the Government. At least, I hope that it is. It clearly has a very good chance of becoming law.
Although I have a Scottish mother and many of my relations still live in Scotland, I realise that many Scottish Members wish to speak, so I promise to be brief.
Although welcome, the Bill will prove worth while only if adequate safeguards and protections for discharged patients are provided. Those who have read the Bill may have a number of specific concerns, but no doubt the hon. Gentleman and Ministers will be able to reassure us in due course.
It is impractical for hospitals to continue to manage money for any great length of time on behalf of patients who have moved to other locations. As I have said, there must be adequate safeguards, and the funds must be reviewed. The Bill can only serve as a stop-gap reform pending the introduction of comprehensive legislation, and I suspect that at some stage, the Government will want to introduce such legislation. Some aspects of the existing provision for hospital management are outmoded and unsatisfactory, and will have to be dealt with either in this Bill or, as soon as possible, in further legislation.
At present, if patients are still legally incapable when discharged from hospital--and most are--the hospital cannot hand over their money. It can no longer spend the money for them, and cannot pass it to someone else who can look after it. Under existing law, the only solution is the appointment of a curator, and that can make the situation worse, as it involves petition, formal medical certification and expensive management arrangements. No one who has considered the issue will think that such an appointment is suitable to deal with the modest amounts of savings typically managed by hospitals.
I have a few specific questions, with which I am sure the Minister will be able to deal. The Bill will allow hospital managers to spend the money that they hold on behalf of patients--the Bill refers to the "benefit" of patients--after their discharge from hospital. Section 94 of the Mental Health (Scotland) Act 1984 allows a manager to
9.42 am
"expend that money or dispose of those valuables for the benefit of that person and in the exercise of the powers conferred by this subsection the managers shall have regard to the sentimental value that any article may have for the patient, or would have but for his mental disorder."
First, what is the precise definition of benefit to the patient? Secondly, if the manager does spend money to the benefit of the patient, what rights have the patient's family if they disagree with that spending? Thirdly, in the event of such a disagreement, what provisions are there for arbitration?
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