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1 Apr 2003 : Column 861—continued
Community Care (Delayed Discharges etc.) Bill
The Lords do not insist on their amendment No. 2, to which the Commons have disagreed, but propose the following amendment in lieu thereof—
No. 2B, in page 6, line 23, leave out from "regulations" to end of line 24 and insert
"or an order under this Part is exercisable by the appropriate Minister by statutory instrument".
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The Minister of State, Department of Health (Jacqui Smith): I beg to move, That this House agrees with the Lords in the said amendment.
Madam Deputy Speaker (Sylvia Heal): With this, it will be convenient to discuss Lords amendments Nos. 2C to 2E.
Jacqui Smith: In our previous discussions on this matter, Opposition Members argued that mental health patients should be permanently excluded from the provisions of the Bill because it would not be possible to carry out an assessment and arrange a care plan for such patients within a minimum time scale, because their needs differed from those of others. That argument took no account of the fact that the Bill already allows us to make different provision for different cases. Of course, as I pointed out earlier, permanently excluding such patients would mean that we ran the risk of being seen to discriminate permanently against patients with mental health problems.
However, I listened—as I always do—to the hon. Member for West Chelmsford (Mr. Burns), who said:
- "The group could be included in the future, but it should not be included at the moment."—[Official Report, 19 March 2003; Vol. 401, c. 963.]
We have added a requirement to clause 8 to provide that regulations that prescribe mental health care must be subject to affirmative procedure. That means that we also need to define mental health care. My hon. Friend the Member for Wakefield (Mr. Hinchliffe) made that point powerfully in our previous debate on the subject. It is therefore necessary to add an order-making power to deal with the problem of definition in the most straightforward way. We intend the order to prescribe mental health care as care that is received by a patient
who is under a consultant psychiatrist. Two further consequential amendments would affect clauses 9 and 11.When it is appropriate, we will lay before the House regulations that bring patients who receive mental health care within the scope of the definition of "qualifying hospital patient". Parliament will then be able to debate—and, if it wishes, disagree to—any such regulations.
Mr. Simon Burns (West Chelmsford): Has the Minister any time scale in mind for reaching that point?
Jacqui Smith: No, we do not have a time scale. As we said throughout our discussions, we should take a pragmatic approach to ensuring that we develop the policy in the most appropriate way. I would want to consider what I anticipate to be the success of the approach for those in acute care as we examine its further extension.
I believe that we have taken the right approach. The Bill does not exclude the patients whom we are considering, but Parliament will be able to scrutinise the timing and the basis of their inclusion. I therefore hope that hon. Members will agree with Lords in their amendments.
Mr. Burns: I sincerely thank the Minister for her kind and generous comments about me. It was refreshingly unusual and especially gratifying because she is admitting, as we approach the Bill's last parliamentary stage, that she agrees with the arguments that my hon. Friends and I have presented on the subject of our discussion.
I was fascinated to hear the Minister say that the Government had sought throughout our proceedings to take a "pragmatic approach" on the way in which to progress. It is unfortunate that the Minister did not extend her bonhomie towards my views further because my hon. Friends, the hon. Member for Sutton and Cheam (Mr. Burstow) and I have urged the Minister and the Department from the start to take a pragmatic approach. We suggested that they got rid of the Bill because it will not achieve the Minister's hopes. It will simply set the health service against social services through fines, if I may use, for the final time, the f-word about which the Minister has been in denial most of the time. However, we always welcome a sinner who repents, and the Minister repenteth with a vengeance. We do not hold that against her, as it shows what we have suspected for a long time: if common sense stares her in the face and she is told often enough, the desired effect will result. However, rather sadly for me, she said during our previous proceedings that she had heard my speech many times before, although that shows that it was worth repeating.
I certainly do not want to rub the Minister's nose in it, but she has, very graciously, conceded the points that the Opposition have been putting to her. I am only saddened that, due to other commitments, the hon. Member for Wakefield (Mr. Hinchliffe), the Chairman of the Health Committee, cannot be present. I imagine that he may be deliberately absent, because although he argued vigorously last time that the proposal was wrong and his Government have now conceded the point, once
again we see the Labour Chairman of that Committee out of synch with his Secretary of State and his Government on a health matter.To all intents and purposes, the amendment goes along with what we have been urging with regard to patients suffering from mental health problems. We have always said that there are a number of reasons for such patients being treated differently from those with acute illnesses and needs for surgery due to the nature of their illness and the problems associated with mental illness. That is why we tabled amendments originally and why we have pressed them so vigorously on the Government.
We believed that exempting sufferers of mental illness or postponing until the appropriate time, as the Minister said, their being brought into the ambit of the fining regime would help to enhance a fairly poor Bill. I am glad that the Government have agreed to what are, in effect, amendments to amendments, which will ensure that sufferers from mental illness do not come within the Bill's ambit until, at some later stage, the Government consider issuing a statutory instrument that will, I believe, go through both Houses of Parliament. That is good news, because the Government have recognised a real problem with the care of the mentally ill. I warmly welcome that.
Also, there is a knock-on effect. For a variety of reasons, not least the damage that could be done to the rest of the health service and social services, the legislation will probably no longer be relevant when the time comes—if it ever does—for it to take effect in this respect, as the Government may be seeking to use another approach or the problem may have gone away, which would make the legislation redundant. I cannot predict which of those scenarios might happen, but I am pleased that the Government have, in principle, conceded the point and I welcome the way that they are seeking to address it.
The Minister talks about regulations being made under section 1 of the legislation and the Government perhaps wanting to include people who suffer mental health problems, but what rather amuses me is the fact that that will be done through a statutory instrument. This is novel: we had regular debates upstairs in Committee, the Bill was considered on Report on the Floor of the House and the Government listened to our arguments, but, sadly, they did so in isolation.
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The amendment says that the regulations under section 1
- "may not prescribe a description of care which is, or includes, mental health care unless a draft of the regulations has been laid before . . . Parliament."
- "and approved by a resolution of, each House of".
I congratulate the Minister from the bottom of my heart on seeing sense and finally conceding that secondary legislation emanating from important primary legislation should be subject to the affirmative procedure in both Houses. What disappoints me is the fact that she has conceded that point so late in the day. As my right hon. Friend the Member for North-West Hampshire (Sir George Young) will recall, in Committee we engaged in debate after debate on all the other secondary powers in the Bill that would be dealt with through the negative procedure—although they related to issues of great concern and significance—because they flowed from what could be described as a skeleton of a piece of primary legislation, and the power to determine and implement the fleshing out of that skeleton must come from statutory instruments. The Minister was adamant that it was unnecessary to deal with the matter other than through the negative procedure. I am sorry about that, because I believe that the House should have the right to debate important secondary legislation and question Ministers on it. As I have said, I am glad that the Minister has accepted our arguments, but wish that she had done so earlier.
I thank the Minister for being prepared to think again. Notwithstanding what she may have said in the past and what some of her Back Benchers have said, she was—"tough enough" is probably the wrong term, and "man enough" certainly is—magnanimous enough to realise that the Opposition were saving her from herself and improving the Bill, while also improving the care of the mentally ill. She recognised reality when it stared her in the face, and gave us the amendments to the amendment.
My colleagues and I will not oppose this change to the Bill. We look forward to seeing it on the statute book, because we believe that our initial gut reaction was right and that this is in the best interests of those who suffer from mental illness.
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