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18 Jun 2007 : Column 1154

Mr. Charles Walker (Broxbourne) (Con): Thank you, Mr. Deputy Speaker, for calling me to speak in this good-natured debate. I assure you and the Minister that there will not be any strops from this Member of Parliament. There have been strops in the past, but he is in a very good mood and has had supper, so he is well balanced and his sugar levels are where they should be.

I welcomed the Minister’s statement on new clause 4, which represents a great step forward, but I must express my concerns, although I will do so less eloquently than my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton). Adult wards are accommodating children, which suggests that there is a shortage of appropriate facilities in this country for young people with mental health problems. My hon. Friend said that people would rather go to appropriate facilities in Scotland than an adult mental health ward near their home. I hope that young people will not have to make such a choice and that appropriate facilities will be available near their homes. It is important that young people have their family and friends nearby at a difficult and traumatic time in their lives.

Will the Minister clarify where the resources will come from to fund the creation of additional suitable environments? She will be aware that Hertfordshire’s mental health trust is having to make significant cuts to its budget to contribute towards addressing the PCT deficit. I hope that the money for the creation of appropriate facilities will not be taken from another part of the mental health budget through a process of robbing Peter to pay Paul. The money should be additional to that already in the system and overall budgets should expand to ensure that young people are given suitable accommodation so that we can make them well as quickly as possible and return them to their families and friends in good time.

Ms Rosie Winterton: I thank the hon. Member for East Worthing and Shoreham (Tim Loughton) for his support. He talked about perverse incentives, which have been mentioned before. We did not want the Bill to lead to people being turned away from treatment, which is why we have adopted our approach. I assure him that we will engage with YoungMinds and the children’s commissioner. For the purpose of the debate, I will not use the title “11 Million” in case that gives the impression that we will consult 11 million people, given that that would probably be slightly beyond what we could achieve. I am sure that the Opposition will continue to hold us to account until 2010 and beyond.

Tim Loughton: We will be in government by then.

Ms Winterton: Obviously, there will still be a Labour Government.

I thank the Committee chaired by my hon. Friend the Member for Hendon (Mr. Dismore) for its interest in the Bill and its probing and detailed approach. I thank him for his comments about the way in which I have engaged with the Committee and for saying that he will not press new clause 8 to a Division, in recognition of the fact that the Government’s position has moved.

The hon. Member for Romsey (Sandra Gidley) was ably assisted by the hon. Member for Southport (Dr. Pugh)—I am sure that his relatives will note the interest that he declared. I have tried to explain why
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amendment No. 83, which was tabled by the hon. Member for Romsey, is unacceptable.

The hon. Lady called for greater clarity. As I said, we will examine the code. We will also continue to discuss with YoungMinds and the children’s commissioner the way in which we develop consolidated CAMHS guidance for practitioners, which is her particular concern, so that we can bring together a lot of necessary information and existing guidance. I assure her that we will keep her informed, perhaps through the organisations on behalf of which she spoke. If she knows of other organisations with concerns outwith those that I have named, she might like to let me have that information so that I can ensure that officials liaise with them on the guidance.

The hon. Member for Broxbourne (Mr. Walker) raised the question of cost and talked about the importance of services near to home. In my opening remarks, I pointed out how we are examining the commissioning of services with the Care Services Improvement Partnership. If we can get proper commissioning and the performance management about which we have talked—perhaps we could ask the Healthcare Commission to examine this matter—we can ensure that services are as near to home as feasible and that people are aware of where beds are available.

We will give funding estimates, and we will ensure that the health service has the necessary funds available. Our estimates suggest that there will be overall capital costs of £10 million as well as ongoing revenue costs. We will work closely with the health service. As hon. Members will know, we have already made announcements about this matter.

My hon. Friend the Member for Bridgend (Mrs. Moon) was right that 16 and 17-year-olds—those affected by amendment No. 4, which she tabled—are at an extremely vulnerable time of their lives. I was struck by the fact that she said that YoungMinds and the children’s commissioner were especially supportive of the amendment. I get the feeling that it is supported by hon. Members on both sides of the House, and we will certainly accept it. I congratulate her on introducing it.

Mrs. Moon: Should I withdraw the amendment?

Ms Winterton: No, my hon. Friend should not withdraw her amendment at this stage. The best thing would be to leave it in the hands of the House so that the Government can accept it.

I urge the House to support all the amendments that I have talked about, but to oppose amendment No. 83, which the hon. Member for Romsey tabled.

Question put and agreed to.

Clause read a Second time, and added to the Bill.

Clause 9

Amendments to Part 2 of the 1983 Act

7.30 pm

Mr. Dismore: I beg to move amendment No. 70, page 5, line 37, at end insert—

‘(aa) in subsection (3)—

(i) after paragraph (a) insert—

“(aa) to arrange for the patient to be examined by the registered medical practitioner or chartered clinical
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psychologist who has been professionally concerned with the medical treatment of the patient; or if no such practitioner is available, a registered medical practitioner or chartered clinical psychologist who is an approved clinician; and,”

(ii) in paragraph (b), for “if it appears to him that the conditions set out in subsection (4) are satisfied, to” substitute “if the responsible clinician and the medical practitioner or chartered clinical psychologist (as the case may be) agree that the requirements of subsection (4) are satisfied, the responsible clinician shall”’.

Mr. Deputy Speaker: With this it will be convenient to discuss the following: amendment No. 93, page 5, line 37, at end insert—

‘( ) In subsection (3), leave out from end of paragraph (b) to end of subsection and insert—

“(3A) Where a report under subsection (3) above is furnished in respect of a patient the managers shall arrange for an approved clinician who is a member of a different profession to that of the responsible clinician to examine the patient;

(3B) If it appears to him that the conditions set out in subsection (4) below are satisfied the approved clinician shall furnish to the managers of the hospital where the patient is detained a report to that effect in the prescribed form and where such a report is furnished in respect of a patient the managers shall, unless they discharge the patient, cause him to be informed.”.’.

Government amendments Nos. 6 to 9.

Amendment No. 73, in clause 13, page 9, line 38, at end insert—

‘(3) In section 72 (powers of tribunals) after subsection (1) insert—

“(1A) In determining whether they are not satisfied that a patient is suffering from mental disorder of the requisite nature or degree for the purposes of subsections (1)(a)(i), (1)(b)(i), (1)(c)(i) or (4)(a) a tribunal must hear evidence from a registered medical practitioner approved for the purposes of section 12 of this Act or, in an appropriate case, from a chartered clinical psychologist.”.’.

Amendment No. 95, in clause 22, page 14, line 23, at end insert—

‘(c) an approved clinician shall not make a report for the purposes of renewal of detention under section 20’.

Government amendments No. 13, 15, 35, 38, 40, 44, 47 and 48.

Mr. Dismore: My right hon. Friend the Minister of State has yet to convince us on the point with which our amendments deal, and a meeting of minds may not occur. However, I hope that she will be able to make further progress on convincing us when she responds to the amendments.

Amendments Nos. 70 and 73 in this group, and amendment No. 79 in the next, are designed to give effect to the recommendations of the Joint Committee on Human Rights in its fourth report at paragraph 26, and its 15th report at paragraphs 1.7 to 1.14. Our amendments would ensure that registered medical practitioners provide objective medical evidence of a mental disorder to justify detention and to cases before mental health tribunals. Our concern is that case law from the European Court of Human Rights—in particular, Winterwerp v. Netherlands and Varbanov v. Bulgaria—requires that objective medical evidence of a true mental disorder justifying detention should come from a medically qualified expert who has recognised
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skills in psychiatric diagnosis and treatment. The Bill’s current provisions do not require that.

A surprisingly broad range of professional groups will be eligible to provide objective medical evidence of mental disorder, including occupational therapists and social workers. All must demonstrate an extensive list of competences, but some of the competences are very broad indeed. In our 15th report at paragraph 1.13, we make the point that it is not specified how people will demonstrate that they have those competences. We state:

The Committee points out that the approval process under section 12 of the 1983 Act that applies to doctors does not, in our view, work in relation to the competences, because many of the skills in question are medical skills, and occupational therapists and social workers do not already have the same baseline qualifications as doctors have.

Our report continues:

are sufficiently rigorous to

Our concern is that

In her helpful letter in response to that report and the question how competences might be demonstrated, my right hon. Friend the Minister of State said that

In other words, the detail is yet to be worked out. I believe that she accepts that the competences are rather broad. It is interesting to see how the problem is described in a briefing produced on behalf of a range of organisations, including Unison, the Royal College of Nursing, occupational therapists and the British Psychological Society. Those organisations say that

but point out that


and who

and so on. In other words, in anticipation of the details being worked out, they make favourable assumptions,
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which I am sure my right hon. Friend will confirm. However, the detail is simply not there yet.

The reason that is important is set out in the briefing from Mind, which points out that we are talking about a person potentially losing their liberty

Mind emphasises that

and says that

Dr. Evan Harris (Oxford, West and Abingdon) (LD): As a member of the Joint Committee chaired by the hon. Gentleman, I have co-signed the amendment. I rise to assure him that, as someone who is clinically qualified, I think that he is on to a critical point. I am always in favour of extending doctors’ roles to other professions, but in relation to a loss of liberty for a long period, it is necessary to have the assurance that competence has been adequately assessed.

Mr. Dismore: I am grateful to the hon. Gentleman, whose professional background has enabled him to play an important role in our consideration of the Bill.

The point made by Mind is repeated by the Mental Health Alliance, representing patients in this context. It states:

When looking at renewal of detention, the British Medical Association also says that renewal should require opinions from

In other words, the BMA makes the same point as the Joint Committee. The Royal College of Psychiatrists and the Royal Society reach similar conclusions in a briefing that they prepared on the Bill.

The Joint Committee is worried that, if the proposals in the Bill are passed as they stand—simply based on broad competences, without any of the detail fleshed out—the UK is at risk of falling foul of the European Court of Human Rights in cases where detention under the Mental Health Act has not been authorised by a properly qualified medical practitioner. That is a real risk. I know that there are other legal views, but the Joint Committee has a good track record in offering opinions on such matters. I suspect that our opinion is more likely to be correct than legal opinions produced by those who are perhaps not quite as objective and independent as the Committee, to justify a particular cause or pressure group’s views.

I hope that my right hon. Friend the Minister of State will provide more detail of what is going on in relation to competences. If she does, we might yet achieve the meeting of minds that has eluded us thus far.

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