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Ms Hewitt:
There are more training places for junior doctors now than ever before. As for the important issue of applicants who were not given interviews during the initial shortlisting process and who will be given them now, of course I can assure the hon. Gentleman that all applicants will be treated fairly and
equally. I am sure that the House would expect nothing less of the interviewing panels.
Let me also take this opportunity to wish the hon. Gentleman a speedy recovery.
Dr. Richard Taylor (Wyre Forest) (Ind): I understand the Secretary of State’s problems. She has to accept the opinions of the sources that feed information to her. However, I want to make her aware of the grass-roots feeling of senior consultants in the NHS who oppose the views of the Academy of Medical Royal Colleges.
I have received no fewer than 40 letters in the last four or five days from senior consultants involved in medical training, and with only one exception they have said three things: that the national selection process has failed, that despite the review the morale of the juniors is still at rock bottom, and that the only answer is to scrap the medical training application service. Some have suggested ways of filling the posts by 1 August even if MTAS is scrapped.
Ms Hewitt: I always listen carefully to the hon. Gentleman’s views on these matters, but I must stress to him that the review group, which includes some rather distinguished members of the medical profession, has looked very carefully at proposals from various quarters for scrapping this year’s system and returning to the old system, or doing something else in order to fill the posts by August. As I said when I quoted from the group’s statement of 4 April, it concluded that that was simply not credible or possible. On that basis, we need to move forward and I hope that all consultants involved in education and, in particular, interviewing for training places will, despite the difficulties, be able to make the necessary time available to ensure that candidates are treated fairly and that the NHS can appoint the best people.
Mike Penning (Hemel Hempstead) (Con): We have heard evidence from Government Members this afternoon of a great deal of complacency about how this whole situation occurred. May I ask the Secretary of State about the scoring system? The right hon. Lady said in her statement that it was created in conjunction with the medical bodies, but those bodies have indicated that it was imposed on them. Who will bear the cost of this debacle? I hope that it will not be the professional bodies. Will she let us know how much this has all cost?
Ms Hewitt: I am advised that the scoring system was devised with the full involvement of the medical profession and others. No doubt that is one of the issues at which the wider review that I have announced today can look. Clearly, regardless of how it came about, the system needs to be looked at for the future, since so many objections have been made to it now.
At this stage I do not know the additional costs of the changes that need to be made for this year. I have said that there will be some practical problems for the service in making consultants available and freeing them from their normal duties so that they can take part in the additional interviews. We will need to see what the additional costs will be, and in conjunction with the review group we are doing everything possible to keep them to a minimum.
Justine Greening (Putney) (Con): May I ask the Secretary of State about nurses? There are currently nearly 75,000 students training on nursing courses who will graduate over the next three years. What assurances can she give the House that when they finish their courses in the summer they will not find themselves in a similar position to the many doctors about whom we have heard today?
Ms Hewitt: Modernising medical careers obviously does not affect nurses. It is perfectly true that some newly qualified nurses and other health care professionals have found it extremely difficult to get posts in the current year, given the financial difficulties that the NHS has had to grapple with over the past 12 months, but we do not expect those problems to continue—certainly not on that scale—in future years. We are working with the newly strengthened social partnership forum to see, for instance, whether it might be possible to offer guaranteed employment in some cases to newly qualified health professionals.
Mr. Desmond Swayne (New Forest, West) (Con): Who were the 1,300 ineligible applications from?
Ms Hewitt: As I understand it, they were from people who either did not have the necessary permission to work in this country or simply did not meet the basic educational and qualification criteria for the post.
Mr. Crispin Blunt (Reigate) (Con): I have yet to receive a satisfactory reply to this narrow point, which I have raised with the Secretary of State before. It will not be quite such a narrow point if one needs hospital care on 1, 2 or 3 August, when every junior doctor will be either moving or undertaking induction training at their hospital. What arrangements have been put in place to ensure that there is satisfactory doctor cover in our hospitals between 1 and 3 August?
Ms Hewitt: Each hospital must ensure that it has the staff available to meet the needs of patients coming in for planned care and of those who may well arrive as emergencies. In the light of the question that the hon. Gentleman asked me on a previous occasion in this House, I have asked for a full briefing on that subject and I shall be happy to write to him when I have more information.
Point of Order
5.9 pm
Mike Penning (Hemel Hempstead) (Con): On a point of order, Mr. Deputy Speaker. Many colleagues on both sides of the House tried to contribute to the statement on Iraq, but as a result of the length of the Secretary of State’s answers many, including those who have served in the armed forces, did not have the opportunity to ask a question. Can anything be done about such protracted answers from Secretaries of State?
Mr. Deputy Speaker (Sir Michael Lord): That is not a matter for the Chair directly, as I am sure the hon. Gentleman appreciates. However, it is always helpful if both answers and questions are no longer than is entirely necessary.
Orders of the Day
Mental Health Bill [Lords]
[Relevant document: Fourth Report from the Joint Committee on Human Rights, Session 2006-07, Legislative Scrutiny: Mental Health Bill, HC 288.]
Order for Second Reading read.
5.9 pm
The Secretary of State for Health (Ms Patricia Hewitt): I beg to move, That the Bill be now read a Second time.
As the House knows, I am very strong on productivity in the NHS, and I apply that to the ministerial team as well.
The Bill has been the subject of more debate and consultation than most Bills that come before this Chamber: there has not only been the 45 hours of debate that has already taken place in another place, but there has been eight years of public consultation and parliamentary scrutiny, including the work of a joint scrutiny Committee on an earlier draft Bill.
The debate has been intense and it has also been effective, leading us to change substantially our original proposals—a point that many of our critics, including some Opposition Members, tend to ignore. It is unsurprising that the debate has been so intense as we are dealing with the law as it applies to some of the most vulnerable people in our community—people whose mental illness is agonising for themselves and their families—and with restrictions on people’s liberty, and often with matters of life or death.
Mr. David Kidney (Stafford) (Lab): On that vulnerability point, one good aspect of the previous draft Bill was the right to advocacy for all those who were at risk of being detained compulsorily, and that does not appear in the current Bill. Is there a commitment to add that right to the Bill before it completes its passage?
Ms Hewitt: My hon. Friend raises an extremely important point and, as Lord Hunt said in another place on this Bill, we are looking in detail at how we can best move forward on patient advocacy services. I am sure that we will return to that matter in Committee.
At any one time, one in six adults—some 9 million people—reports a mental health disorder. One in every four GP consultations is about mental health. More than 1 million of the people who are out of work and claiming incapacity benefits list a mental health problem as their main disability. Every Member will have dealt with constituents whose lives have been affected, often tragically, by mental illness. Many of us, too, have cared for a family member suffering from mental ill health—as I did over many years for one of my sisters. Our debates on the Bill will therefore be affected by the experiences of our constituents and, for many of us, by personal experience as well. Therefore, although I do not endorse all the views expressed about the Bill, I entirely respect the strength of those views. [Interruption.] In that spirit, I shall give way.
Mike Penning (Hemel Hempstead) (Con): I thank the Secretary of State for being so generous in giving way. She is right that many constituents who come to us need our help as their MPs and the help of the mental health services. Sadly however, many wards around the country are closing, such as the St. Julian’s ward that caters for my constituents, so such people have nowhere to go even when they want to put themselves forward for help. What plans do we have to open more units, and where will the secure units that the Bill’s provisions require come from?
Ms Hewitt: I will address that point in detail shortly, but let me say now that over the last 10 years or so there has been a radical shift in the nature of the care given to many people with mental illnesses. There has been a great shift in emphasis from hospital treatment to community treatment. As I shall explain, there has also been a substantial increase in the resources available to address the needs of such patients. We are also undertaking a review of provision for secure accommodation, to which the hon. Gentleman also referred. In the light of his intervention, before I turn to the provisions of the Bill it might be helpful if I refer briefly to the wider context of mental health services.
Tim Loughton (East Worthing and Shoreham) (Con): The Secretary of State mentions that she had personal experience of caring for someone with mental illness. Does she therefore agree with the findings of the YouGov poll announced today that 88 per cent. of people who knew somebody with a mental illness admitted that those people posed no danger whatever to themselves or anybody else?
Ms Hewitt: There is no controversy or disagreement about that. Those who pose a risk to themselves or to others are a very small minority of the large numbers of people with mental health problems.
Eight years ago, with the new national service framework for mental health, we embarked on a substantial programme to improve mental health services—a programme that in England has been backed by an extra £1 billion investment in the last five years alone. According to the European Commission, the UK now has one of the highest proportions of its overall health budget devoted to mental health of any EU member state. As a result, the NHS has more than 9,000 more psychiatric nurses, more than 1,000 more consultant psychiatrists and more than 3,000 more clinical psychologists than we had in 1997. Because the national service framework signalled a decisive shift of emphasis towards treatment in the community rather than in hospital, the NHS now has 343 new home treatment teams, more than 250 new assertive outreach teams, and more than 100 early intervention teams.
Mark Pritchard (The Wrekin) (Con): Is the Secretary of State comfortable with the civil liberties principle that the Bill, as not amended, would see people who have not committed a crime being locked up—at the same time as the Home Office is releasing people who we know have committed crimes?
Ms Hewitt:
The hon. Gentleman has forgotten that mental health laws have included compulsory powers for more than 150 years. The Mental Health Act 1983
already provides for the detention of someone who is seriously mentally ill who has not committed an offence, for the purpose of assessment or treatment.
Hywel Williams (Caernarfon) (PC): Will the Secretary of State bear in mind that the Bill applies to both England and Wales? It is widely recognised that mental health services in Wales are behind—perhaps by as much as four years—those in England.
Ms Hewitt: I thought that that might be the hon. Gentleman’s point and I was just about to say that in Wales the Assembly Government’s Health and Social Services Minister announced £5 million additional recurrent funding for mental health services, to help implement the revised national service framework for Wales, and an additional £75 million capital investment. That demonstrates the Assembly’s commitment to improving standards in our mental health services.
Of course there is more to be done: there always will be. But I pay tribute—as I hope we all would—to the outstanding care that is being given by NHS staff to extremely vulnerable and sometimes very difficult and challenging patients. That work is reflected in the fact that the number of suicides is at the lowest level since records began, and is among the lowest in Europe.
Kate Hoey (Vauxhall) (Lab): The Secretary of State mentioned vulnerable people. Does she agree that children with mental health problems need to be carefully safeguarded and does she not think that the changes that the House of Lords has made to the Bill will improve that safeguarding?
Ms Hewitt: My hon. Friend makes an important point. We have already made the decision to give 16 and 17-year-olds with mental health problems more rights than they previously had. In relation to the amendment by the other place, unfortunately changing the law does not always change the reality on the ground. My understanding is that since the new law was introduced in Scotland, with a requirement for age-appropriate accommodation, the number of young people and children being treated in adult wards has actually increased, not fallen, which is the opposite of the intention of the amendment —[ Interruption. ]
Mr. Deputy Speaker (Sir Michael Lord): Order. It is important that interventions are made in the normal way, not from a sedentary position, if we are to have a civilised debate.
Ms Hewitt: I will give way again to the hon. Gentleman.
Tim Loughton: The truth about the point that the right hon. Lady made is that before the arrangements for young people under the 2003 legislation the numbers entering adult wards were not counted, so how can she make that comparison?
Ms Hewitt:
I am not sure whether we were counting at that stage, so I shall come back to the hon. Gentleman on that point. I was simply pointing out
that the provisions introduced in Scotland, which were the subject of an amendment to the Bill in another place, have not so far had the intended results.
As I indicated a moment ago, we have had mental health laws, including compulsory powers, for more than 150 years. Most countries have similar laws, so I hope that we are debating not the principle of compulsion but the form it should take, and how best to strengthen the safeguards that are essential when someone is deprived of their liberty or treated without their consent.
The main provisions of the Bill deal with the very small number of patients—fewer than 15,000 at any one time—whose problems are so severe that they need to be detained in hospital for assessment or treatment and to protect themselves or others from harm.
Angela Browning (Tiverton and Honiton) (Con): The difference between the right hon. Lady’s proposals and the Mental Health Act 1983 is not just to do with the compulsion elements, which I agree were already in place; the difference is that the Bill couples them with a redefinition of mental disorder. Broadening the definition from a clinical to a behavioural judgment and combining it with the Bill’s powers is what makes the measure so dangerous.
Ms Hewitt: I completely disagree with the hon. Lady. Far from broadening the clinical definition of a mental disorder, what we are doing—by simplifying the definition of a mental disorder in the 1983 Act—is removing four legal categories that have no particular correspondence to clinical categories. The categories of definition of mental disorder in the 1983 Act are not clinical, so by removing that confusion and having a single simplified definition we will ensure that people who need treatment in such circumstances will actually receive it. The Bill will bring the law into line with modern developments in mental health services, deal with human rights incompatibilities and strengthen patient safeguards.
Mr. Tom Watson (West Bromwich, East) (Lab): If ever there was a piece of legislation that proved that we cannot please all the people all the time it is this Bill. However, is my right hon. Friend aware that many Members on both sides of the House have been convinced by the advocacy of the mental health charity, YoungMinds? The charity is looking for reassurance during the passage of the Bill that we will never again allow children as young as 10 to be treated in the same way as older people; we do not want to see them on adult mental health wards.
Ms Hewitt: I completely agree with my hon. Friend. Of course, we do not want to see young children treated in adult wards, but nor do we want to put clinicians into a kind of legal straitjacket that could have the wholly unintended result that a young person in desperate need of care is turned away because a child bed or a child ward is not available for them. In my view, we need to focus on continuing to improve the services we provide for children and adolescents rather than believe that simply making changes to the law will solve the problem.
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