Examination of Witnesses (Questions 20
- 39)
TUESDAY 18 APRIL 2000
JANE KENNEDY
MP, SIR HAYDEN
PHILLIPS KCB AND
MR NICK
SMEDLEY
20. I must say, I understand your brief and
your responsibilities, Minister, and you will not misunderstand
me when I say that obviously a lot of this must have been decided
at a more senior level than your ministerial position, and that
would be hardly surprising. I have to say to you, through the
chair, that the correspondence we have received, which I looked
through yesterday, does not give the feeling that they are particularly
happy about what is being proposed.
(Jane Kennedy) Would it be helpful if I spelt out
what we are talking about in terms of the Protection Division,
the actual detail of what we are proposing. If we go through that
point by point you may get a better flavour of what we are actually
putting forward. The Court of Protection currently appoints receivers,
and we will be introducing pre-appointment assessment of those
receivers which may involve face-to-face interviews with the proposed
receiver, or it may involve some other form of consultation with
the receiver; but the Court will have a much clearer idea of the
abilities and circumstances of that receiver before the appointment
is made. It will also serve the dual purpose of informing the
proposed receiver of the responsibilities that they are being
invited to undertake. One of the issues that has been made clear
to me from the staff of the Public Trust Office is that they have
a great deal of work generated by receivers who undertake the
role without fully understanding the real responsibilities of
the role they are taking on. That initial pre-assessment interview
should reduce that and it should benefit the receiver, and it
should enable the Court to make a much more informed decision
as to who should undertake the role of receiver in a particular
case. We are also going to introduce a comprehensive system of
risk assessment to enable the resources of the Public Trust Office
to be targeted more effectively. That will enable the Court, and
the Mental Incapacity Support Unit, to determine just what level
of supervision that particular receiver is going to require—not
just supervision but help, assistance and advice as well. At the
moment none of those things happen. That will be an enormous step
forward for the people who are already acting as receivers in
the community at large. I will pause at that point to see if that
has prompted any questions. There is a long list of changes that
we are making.
Chairman
21. Some of the evidence speaks about how much
they value the length of these relationships, and how these relationships
are extremely important -particularly for people with head injuries.
It is very difficult to get a response and a lot of that (we have
evidence) depends upon building up this relationship. Is there
not a great risk that it will never be the same person twice who
turns up to see people are getting the service?
(Jane Kennedy) That is an important point we would
obviously want to avoid.
(Sir Hayden Phillips) Sustaining those personal relationships
is clearly important in this exercise. One of the transitional
management tasks is to make sure those relationships are not damaged.
What we believe to be the case is, if we can find other organisations
out there who are physically and geographically closer to the
patients and receivers than, as it were, the far distant bureaucracy
in London, that should be an advantage. What the Minister has
said about the basis of new work to give us a sense of the degree
of risk will then underpin a new visiting arrangement. We are
committed to and will do two sorts of things: one, to make sure
both the number of visits is increased; and that, from the beginning
of the next financial year, every new receiver gets a visit within
six months; and, secondly, that those visits are targeted on the
higher risk receiver/patient relationship, and not just mechanistically
in a bureaucratic way across the board. There is a real difference
from what you have described, Minister, and what I have described,
to what goes on now. It concentrates on the actual service being
delivered to people rather than the organisational structure through
which it has been delivered in the past.
(Mr Smedley) Could I comment on views expressed about
the consultation and what we have done about that. I think it
is very understandable in any period of change that people are
unsettled by it, but most of the views expressed are in relation
to the Quinquennial Review, which caused a lot of concerns. Over
the last six months, by setting up this stakeholders forum, which
we call the Consultative Forum, on which all the major mental
health groups are represented, and by inviting members of the
public who are receivers to come in and discuss with me, for the
first time in the history of the PTO, what their concerns are,
both professional receivers and members of the public, we have
moderated the proposals in the Quinquennial Review; and the document
now on the table, as the Minister said, has had a much more positive
response. I do feel we have tried to do a lot to address the concerns.
Mr Winnick
22. Could I take one particular case which has
come to our notice. A wife writes[6]
to the Chairman (which has obviously been circulated to us) that
her husband was awarded compensation after a serious road traffic
accident in 1992. She says that each year a visitor from the Public
Trust Office visits [her husband] to ensure his individual needs
are being met, and she is very much appreciative of what is being
done. She writes as follows later in the letter: "He [her
husband] is particularly distressed when a panel of solicitors
may replace the role of the trustees. The relationship he has
developed he feels would be lost". I am quite happy, if the
Chairman is of the same view, to give you a copy of this letter.
Obviously I do not want to give the name and address in public—I
have no authority to do anything of the kind. I would imagine
that is not the only person who is worried, perhaps without justification
for all I know, and anxious about the position which may develop.
(Sir Hayden Phillips) I would want to
reassure patients, individuals and carers who are concerned about
issues which I believe the Making Changes document addresses.
I agree with Mr Smedley, I think a lot of these anxieties are
responses to the earlier report, which we have brought forward
a response to, which is not the privatisation that was proposed;
the term being used could not apply to what we are now proposing.
(Mr Smedley) As you say, there are concerns
and they may not be justified. In that particular case I think
there is a confusion between private receivers and potentially
panel solicitors. I think there is a very important point behind
that which is that I do need now to do a lot of very active work
to communicate to all 25,000 of our clients exactly what is happening
here. I am about to write a personal letter to all of the clients
and their carers to explain where we are, and then to invite again
more groups of receivers and sometimes patients (they are more
difficult to consult, but we can do that) to come in and talk
to me about their concerns. I think that is how we would like
to handle it.
Chairman
23. Mr Smedley, I must put it to you: about
the first promise made in your December newsletter about that
Quinquennial Review you said that, "he [the Lord Chancellor]
will make a detailed statement on the way forward in February
next year". That did not happen until six or seven weeks
after that. It may seem a small thing, but you give a promise
of that sort, the first promise you give of action following that
Review, and you break it, and then you wonder why people have
got concerns. Why did that happen?
(Jane Kennedy) To be fair to Mr Smedley—
24. I am not blaming him; I am blaming your
Department!
(Jane Kennedy) We delayed the announcement precisely
because we were being criticised for not taking time to consult.
25. Why was the promise made then? You must
have seen this before it was printed and you accepted that deadline?
(Jane Kennedy) Yes.
26. Then you accept it should be broken. Can
you see the point I am making?
(Jane Kennedy) Yes, I can see absolutely the point
you are making. At the same time, when we announced we were going
to delay our response to the Quinquennial Review we did it on
the basis that we were continuing to receive representations and
we wished to allow the consultation, before we made our initial
announcement, to be extended by the six week period you have criticised.
We find ourselves between a rock and a hard place.
Chairman: Maybe you should not have given that
commitment.
Mr Winnick
27. Can I give you a copy of this letter?
(Jane Kennedy) Before we move off this very important
subject and the question of criticism of the proposals and anxieties
being caused to patients, clients and carers, I would also say
I have actually seen criticism of the Public Trust Office. I have
heard criticism of the performance. I am pleased there are patients
who are satisfied with the work of the Public Trust Office; that
is clearly the case. The work of the staff in the Receivership
Division and the Protection Division is to be commended, because
at all stages throughout this process their primary concern has
been for patients and clients they look after. I think it is important
to get that on the record. Having said that, there is also valid
criticism of receivers and carers that there is too intrusive
a role of the Public Trust Office; that they find it difficult
to get decisions—that decisions take too long to be made;
that the visits do not always happen as regularly as the case
you have cited describes. I think, therefore, if we were just
to take that one case we would conclude there was no case at all
for reform; but because of the other weight of evidence there
is a clear need for change, and for change in the short-term as
well as in the long-term.
28. No doubt after the hearing you will read
the letter for yourself.
(Jane Kennedy) Yes.
Mr Russell
29. Minister, when the Public Trust Office ceases
on 1 April will anybody notice?
(Jane Kennedy) Certainly the patients and receivers
should notice, because they will be receiving a better service.
30. Could you explain how it will be a better
service?
(Jane Kennedy) I think I have tried to explain that.
In the first instance, where receivers are appointed, the receivers
will get more advice and assistance from the Public Trust Office
than they have hitherto received. They will be monitored more
closely, and on a case-by-case basis the monitoring will be effectively
tailored to the case. Where we believe, having made the risk assessment,
there is a case for closer monitoring of the receiver then that
monitoring will take place. There will be increased visits, and
there will be visits to receivers which has not happened before.
There will be greater activity, greater supervision, closer monitoring
of the role of receivers.
31. If we can take that forward, Minister, the
voluntary work which the Government has encouraged through the
Active Community Initiative—the way I understand it, and
the way you have answered colleagues, there will be less involvement
of lay receivers?
(Jane Kennedy) I am not quite sure of the definition
of "lay receivers" you are referring to.
32. Visitors. The letter Mr Winnick read out
is a classic case of somebody who is fearful that the current
person who is visiting will be replaced (as the letter referred
to) by solicitors. The perception is that the voluntary aspect
is to be removed and replaced by paid professionals.
(Jane Kennedy) The proposals on visiting are very
much open to consultation. We will be consulting on who should
perform the visiting function and what that function should be.
I have also described how we are going to increase the frequency
of visits. We are in consultation with the Local Government Association
about a referral system, where a visitor is made aware of dissatisfaction
with the care or the accommodation of the patient or client in
question; and we will develop with the Local Government Association
and other interested Government Departments referral systems which
will allow the visitor to flag up concerns about particular aspects
of care.
33. Can I just concentrate on the voluntary
side. Will the present level of voluntary involvement be maintained,
reduced or increased?
(Mr Smedley) First of all, the present visitors are
self-employed visitors who have worked for us on a contract basis.
I would not want you to feel they were volunteers in any sense,
they are not. What I think we are trying to achieve, which is
not in the Quinquennial Review but where we have got to subsequently,
is having discussed this with the Consultative Forum and others,
we need to define what are these visits there to achieve. Then
we need to define the skills the visitors require; and then we
need to work out whether there are existing organisations that
can provide that service, or whether we need to recruit new visitors.
One of the options open to us is to increase the amount of contribution
from the voluntary and not-for-profit sector. Some members of
the Consultative Forum have said, "We would be quite interested
in doing that". My first answer would be that it may increase;
indeed, we may introduce a voluntary element. We have got to do
a lot more visits. We already intend this financial year to double
the number of visits from 2,000 to 4,000.
34. Has the Public Trust Office discussed all
this with the Active Community Unit?
(Mr Smedley) No, we have not. I am very happy to take
that on board.
35. Would you not agree this is something that
should have been done at the beginning, rather than at the end?
(Mr Smedley) If I have missed a trick here I would
be the first to apologise. I have got the Consultative Forum with
the major not-for-profit groups on it who work in this field.
We have all the major groups like MIND, MENCAP, Age Concern, the
Alzheimers Disease Society, Headway, and all of those major voluntary
bodies. I am in discussion with them.
36. Minister, why has the Active Community Unit
at the Home Office not been consulted prior to now on something
as major as this? We have heard the promise of a statement being
made in February, that has not been kept, and here we are now
into April and the voluntary sector, which is looked after to
a certain extent by the Active Community Unit, has not even been
consulted. It seems odd.
(Jane Kennedy) We have involved, from a very early
stage of Nick Smedley's work, the group he has referred to. I
do not know for certain because I do not know the membership of
the Active Community Unit, but I would expect that they will be
represented in similar organisations like that. To a degree you
could argue you are asking us to duplicate the consultation.
37. Chairman, I do want to press this point
because much has been made of Government's wish for the voluntary
sector to become involved; and the Active Community Unit at the
Home Office is there for that very purpose. We have another arm
of Government which has not even consulted it on something as
major as this.
(Sir Hayden Phillips) I do not think we have missed
a trick, in the sense that we are now in the consultative process.
We are now talking about options in relation to the voluntary
sector. I think, if I may say so, that what Nick has done in relation
to many of the voluntary organisations that work in this field
has been exemplary so far, and I would not expect the Home Office
to have said other than, "Well done". We will certainly
consult them and make sure we are joined up in the process as
we take this forward. The document we sent round makes it very
clear in relation to this that we are looking for views from everybody
about the pros and cons and the balance to be struck here, and
those of the Committee will be helpful. Could I just emphasise
one other thing which I think it would be wrong for the Minister
and I to fail to get across. We totally understand the point about
the building of personal relationships between people in this
position and those who visit and care for them. I think one of
the key things that both the Minister and I will need to be satisfied
of as we take the work forward is that that is not undermined
but is improved and developed. One of the potential advantages
of local voluntary organisations as we said earlier is getting
that care closer geographically to the people. That will provide
a better service in which they can have contact. If we can persuade
the person who wrote this that that is actually what we are about,
and demonstrate that that is true, then we will have done a large
part of our job.
38. Chairman, it is quite clear that a lot of
further work has got to be done here, because we are now getting
confused messages. On the one hand, it appears that at some stage
of the proceedings the service is to be privatised, and we are
now being told there is going to be increased voluntary involvement.
They both cannot be right.
(Jane Kennedy) I have been making the point from the
outset that to describe the process that we are putting in place
and the proposals we are making for further consultation as "privatisation"
is wrong; it is a misnomer, that is not what we are proposing.
We are in fact considering very clearly involving the not-for-profit
and voluntary sector in precisely some of the roles—visiting
roles, for example, and receivership roles—which previously
they have been excluded from and have been critical of.
39. Could you then spell out some of the other
bodies you feel would be required to be responsible for visiting
who currently are not involved?
(Jane Kennedy) We are consulting about local authorities
undertaking visiting; one of the proposed organisations that may
undertake visiting is the Benefits Agency—that was proposed
in the Quinquennial Review, and we are not ruling that out at
this stage; there are other charities and not-for-profit organisations
who have said to us that they also could undertake this role.
I should also add a very important group is an inhouse visiting
team; that is also one of the options we are considering.
6 See letter from Mr and Mrs Phillips. Back
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