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19 Mar 2003 : Column 965—continued
Mrs. Patsy Calton (Cheadle): I wish to support amendment No. 2, and I shall argue that it deserves particular consideration.
I accept the Minister's argument that no one in the House wishes to stigmatise mental health patients or to treat them as a completely separate group. However, we are considering an imperfect Bill that deals with particularly vulnerable groups of people, such as mental health patients, who, on occasions, are not able to articulate their own needs. Therefore, particular care should be taken when they are discharged from hospital.
I hope that the amendment will remain in the Bill. Mentally ill people and other vulnerable groups should not be among the patients for whom a charge is made.
Ms Meg Munn (Sheffield, Heeley): Surely the point about the process is that the patient is deemed able to be discharged at the appropriate time. Therefore, the decision that it is right for the patient to move on to more appropriate care is taken by the health care professionals who are charged with taking care of the patient's mental health. By agreeing to the amendment, we would be going against the advice of the professionals who have that responsibility.
Mrs. Calton: I thank the hon. Lady for that intervention. I am interested to hear that she perceives this to be a very much one-sided decision process. The reason Opposition Members are concerned about the Bill and its references to vulnerable patients is that it will speed up the process by which particularly vulnerable people are removed to the exclusion of assistance from other carers and expert advocates.
Mr. Burns: Does the hon. Lady agree that the flaw in the logic of the intervention of the hon. Member for Sheffield, Heeley (Ms Munn) is that, at the moment, the Government have exempted other groups from the Bill even though they may bring those groups within the Bill's ambit at a later stage?
Mrs. Calton: A further flaw results from the fact that, as the Minister said, the Government have taken a pragmatic approach to mental health patients. For the time being anyway, they have exempted them. If the charge of stigmatisation applies, it applies to that pragmatic approach.
I am concerned that because of the different procedures for mental health and acute discharges and because of the differences in working across health and social services, the onward journey of services users will not be facilitated by the Bill. Under the draft regulations, the local authority would not be made liable if the patient was waiting for an NHS or another community service, such as psychiatric or mental health care provision, after the care assessment, but found that service unavailable because of the lack of social care provision. The Minister and the Government cannot have it all ways. If it is now right to exempt mental health patients, it must be right at a later date unless we can be absolutely sure that all the necessary provision is available.
Mr. Hinchliffe: My worry is that these debates increasingly tend to consider segments of care. We put
people into compartments, and that is where they remain. I intervened on the hon. Member for West Chelmsford (Mr. Burns) because I believe the Lords amendment to be flawed. For example, an elderly patient could be initially admitted to a psychiatric bed before being put into an elderly care bed in an acute hospital as they get ready for discharge. Is that person a mental health patient or not?
Ms Munn: They might have Alzheimer's.
Mr. Hinchliffe: As my hon. Friend suggests, Alzheimer's and a whole range of conditions lead to people being moved from an acute psychiatric environment in a general hospital to a psychogeriatric situation or to an acute ward. At what stage is someone a mental health patient? It is inconceivable that anyone could genuinely operate the Bill if it contained this amendment.
Mrs. Calton: I thank the hon. Gentleman for that point, but the Minister has accepted that there is a problem. She has decided that there will be an exemption for mental health services and I presume that she, like the rest of us, has read the relevant section of the amendment. The arguments that have been made could be given credibility, but it would not take much more precision for the amendment to make it clear in line 10 of clause 1 that those receiving mental health services are those
- "accommodated at—
(a) a health service hospital; or
(b) an independent hospital in pursuance of arrangements made by an NHS body".
2 pm
The Government's national services framework for mental health identifies the lack of capacity in community mental health services, not inefficiencies in social services departments, as the key cause of delayed discharges for psychiatric patients. That will not disappear just because the Bill causes fines to be levied. There will be a tendency to rush assessments of psychiatric patients' fitness for discharge, which entails a complex package of considerations. Patients must be assessed in terms of whether they will self-harm, whether they are a risk to others, and whether they will have appropriate accommodation. It is rare that that can be worked through in a three-day period, even if all the various services are in place.
There is no provision in the Bill for specialist advocates and for carers to take part in the discharge planning process. There is a risk that pressure to reduce prolonged hospital admissions will concentrate resources on the acute sector at the expense of community care provision. Hard-pressed councils will tend to divert resources into services that avoid penalties, instead of the longer-term preventive work
that would reduce the need for acute admissions. There is a further danger that patients discharged earlier than they should be will be given inappropriate medication to control symptoms, rather than a range of therapeutic interventions, because of inappropriate accommodation and a lack of essential support services.There is a basic flaw in the Government's argument that they need to make interim provision now, but are not prepared to write that into the Bill for the longer term for particularly vulnerable groups of patients.
Mr. Nigel Waterson (Eastbourne): I shall contribute briefly, as some of the related issues will arise more naturally later in the Bill's consideration today. There were two major errors in the approach adopted by Members on the Government Benches. One was a gross caricature of what their lordships were trying to achieve by the amendment. The other was the notion that the Bill would be of unalloyed benefit to the average patient. It is precisely because the Bill still is not patient centred that the issue arises.
The most powerful argument to be deployed in favour of the exclusion, as the hon. Member for Cheadle (Mrs. Calton) said, is the extent to which the concerns of patients and their carers are taken into account. Perhaps it is a matter of first thoughts are best, which is clearly the Government's view at present. At an earlier stage of the Bill's progress, we had some very good briefing from organisations such as the Alzheimer's Society about patients suffering from dementia and more specifically Alzheimer's, and so on. Surely patients with mental health problems, particularly severe mental health problems, will be the most vulnerable category.
Even if there are proper arrangements for the discharge of such patients and proper consultation—we shall deal with that in more detail later—will they be able to express a view, let alone an informed view? Will the views of their carers be taken into account on their behalf? For that central reason, the official Opposition have always opposed the Bill. There are many reasons for opposing it—not least, the fact that it will not work—but the most human reason for opposing it is that it ignores the needs and wishes of individual patients. That is true in spades in respect of those with mental health problems. That is the overwhelming argument for the amendment.
I shall not dwell on the point as we have a great deal of progress to make. I commend my hon. Friend the Member for West Chelmsford (Mr. Burns), who was right to argue that we should support the Lords amendment.
Jacqui Smith: I shall begin by responding to the question from my hon. Friend the Member for Hampstead and Highgate (Glenda Jackson) with respect to amendments Nos. 1 and 3 and the case that she described. Obviously, I do not know the details of the case, but the principle of defining ordinary residence is intended to make it clear which authorities are responsible for the necessary community care provision. The case does not have to come within the ambit of the Bill for social services to have that responsibility.
Anybody who establishes ordinary residence will be within the provisions of the Bill. That is established on the facts of the case, and can sometimes be established virtually immediately. Although that is not very clear, the answer probably is that it depends. There would not be an automatic bar against somebody who had come from abroad.The main point of contention was Lords amendment No. 2. Let us be clear what the Lords are proposing. It is not that there might be particular issues that make the way in which we respond to patients with mental health problems different from the way in which we respond to other patients in acute care. It is that in perpetuity we should exclude from any benefits that might come from the Bill those people with mental health problems.
I agree with the hon. Member for West Chelmsford (Mr. Burns) that during the 1980s and 1990s our mental health services were underfunded and poor.
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