 House of Commons |
Session 2006 - 07 Publications on the internet General Committee Debates Mental Health |
Mental Health Bill [Lords] |
The Committee consisted of the following Members:John
Benger, Committee
Clerk
†
attended the Committee
Public Bill CommitteeTuesday 8 May 2007(Afternoon)[Ann Winterton in the Chair]Mental Health Bill [Lords]Clause 24Children
and young
people
Question
proposed [this day], That the clause stand part of the
Bill.
4.30
pm
Question
again
proposed.
‘(1)
After section 38 of the 1983 Act
insert—
“38A
Hospital and guardianship orders
(minors)
In the case of an
offender who has not attained the age of 18 years the court
shall not make an order under sections 35 (remand to hospital for
report), 36 (remand to hospital for treatment), 37 (hospital and
guardianship orders) or 38 (interim hospital orders) unless satisfied
that the services and accommodation to be provided are sufficient for
the particular needs of that
offender.”’.
Angela
Browning (Tiverton and Honiton) (Con): I am delighted to
see you in the Chair again, Lady
Winterton.
I shall
reiterate my points quickly for the benefit of hon. Members who may not
have heard me. I was talking about the Minister’s concern about
unintended consequences in respect of the addition to clause 24 and I
mentioned briefly before we broke for lunch the report by a former
member of the Mental Health Act Commission, Penny Stafford, who spoke
about the research that she undertook in respect of children and
adolescents and in particular—I am sure that we will come to
this at a different stage—the impact on children and adolescents
of section 136 of the Mental Health Act 1983. She pointed out that, far
from them having the opportunity to be taken to a place of safety
within a hospital with appropriate services and specialisms for
children and adolescents, all too often they are left to languish in
police custody
suites.
I put that to
the Minister because she has, from time to time during our discussion
of the clause, suggested that if the Government legislate, it will be
for others to have to implement that legislation, with the resource
implications that that may involve—in this case, we are talking
particularly about children’s and adolescent services. There is
a precedent for this. In fact, there are many precedents in the way the
Government have legislated elsewhere on behalf of
children.
Let us
consider, for example, children’s services supplied through
local authorities. There is a statutory
obligation on a local authority. The Government do not say, “You
will do this if you can afford it” or “when resources
permit.” For children’s services in the main, when a
local authority looks at its annual budget it has a statutory
obligation to protect children, as defined by national
legislation.
I
therefore find it rather incongruous that the Government are prepared
to legislate for the protection of children in one area, but when it
comes to children and adolescents in the mental health system, a
different set of values or rules applies. That is not just
inconsistent; it is unacceptable. We all know that throughout mental
health services—indeed, the whole area of mental
health—there is stigma. There is the old clichÃ(c) that it
is seen as the Cinderella service. I am sure that all of us who take an
interest in the subject recognise such descriptions, but we are now
talking about children and adolescents in that system. It would be
invidious to choose one group of people over another, but if we cannot,
through our legislation nationally, protect children, we fail—we
fail as politicians and we fail as
legislators.
I
therefore return to the point that I made to the Minister at the
beginning of the debate. If there is one aspect of the Bill that she
feels she might be able to come to an accommodation on in terms of the
Lords amendments, given the overwhelming evidence of the need for us to
do something different in this Bill compared with the original 1983
Act, it is surely the aspect that deals with the provision of services
for children and
adolescents.
I will
stop speaking shortly, much to the relief of the hon. Member for
Rhondda, who is hanging on my every word as usual, but first I will say
this. This is a very serious subject, on which we would all like to see
some progress. I must ask the Minister, in considering the
issue—I am sure that she will consider it—to take a look
at the evidence before her and the legal counsel provided by YoungMinds
and to return to the issue on Report. I am sure that she can make a
difference to the improvement of services for children and adolescents
in respect of mental health—indeed, she has a duty to do
so.
Mr.
Tim Boswell (Daventry) (Con): I am deeply impressed and
moved by the eloquence of my hon. Friend. The debate has gone on for
some time and I do not intend to prolong it, but as someone who
normally tries to seek a degree of accommodation and
consensus—and may even be criticised for that from time to
time—I am encouraged that matters seem at least to be working
towards a common position, even if one has not yet been reached. That
is true with respect to the central importance of doing something for
children’s mental health services, and even with respect to the
Minister’s assurance, from which we take some comfort, that, as
she snatches away the provision before the Committee, she has made a
commitment—although not a precise one in legislative
terms—to reflect again before Report. I have a profound hope
that she will do that, and come up with something practical to meet the
needs that hon. Members on both sides of the Committee, including the
hon. Member for Stafford, have described. We need to move on the
issue.
Not only have
Committee members received representations from YoungMinds and others
but they
will almost all have been involved in constituency cases. I have not had
much experience of the kind, but an example that occurred this year has
been very much on my mind. It brings together three points. The first
is the importance of education as well as the health services in the
support required for what the clauses define as the needs of young
people. The young person in question is doing his GCSEs this year. He
has suffered severe and acute depression, and difficulties have been
encountered about where to accommodate him, including the question of
putting him in adult mental health wards. There has been a fight for
better provision, which has now been secured, but it has not been easy.
A consequence has been the breaking of the link with his county, which
has supported him for education purposes, because he has now crossed
the boundary into another county.
The second point to make in
that context, which has not been brought up so far, but which I think
is a subset of the point already discussed by my hon. Friend the Member
for East Worthing and Shoreham, is the remote provision of services.
They may not be available readily and reliably in each of our local
authority areas. That is not unusual in my constituency because of the
geography, but people are going outside their area for services and
having to deal with different local authorities and primary care
trusts. That becomes difficult and stressful at a stressful
time.
My third point
has not really been made except in the context of carers, and that is
the stress that such situations bring on the whole family: the parents
and of course the siblings. There was a sibling in the case that I have
recalled. Those people see the illness of their close relative and the
desperate fight to get appropriate provision at a reasonably convenient
point.
Dr.
Brian Iddon (Bolton, South-East) (Lab): Some Labour
Members remain reticent, but does the hon. Gentleman accept that there
is not much difference between his side of the Committee and this side
as far as acceptance of the basic principle that children should be
much better looked after by the mental health services than has
hitherto happened? Does he also accept that the Minister has already
promised more than once to go back to YoungMinds, examine the clause,
and table a more acceptable one on Report? That is why we remain
reticent on the Labour Benches. I believe that the Minister will do
that.
Mr.
Boswell:
I am grateful for the hon. Gentleman’s
intervention. I agree with him about the common commitment, in
principle, of the Committee. I have no doubt about that or about the
fact that there is a genuine wish to enact that commitment in a
suitable and viable form. We have not yet quite got from the Minister
an absolute assurance that that will be achieved in the Bill. The
purpose of the interventions, as much as anything else, because we all
feel strongly about this subject, is to reinforce the Minister’s
will to try to seek a common solution. If she does so, none of my
colleagues, to my knowledge, would want to claim any particular credit.
It would be a victory for our discussions and our commitment.
The only
other point that I wish to make in response to the hon. Gentleman on
the general importance of the topic is that this debate comes on the
back of a
widespread national debate on the importance of mental health services.
That is why the fact that there is a cadre of members of the Committee
who are committed to pursuing the matter properly is
encouraging.
I shall
briefly make some other points. It is important that we do not confine
our attention to under-16s. The Minister has not done that, although
once or twice in her presentation she began to do so. Such figures as
we have and the rate of pick-up of the undertakings given by her
colleague, which will now be transmitted through regional strategic
health authorities to primary care trusts to be monitored and reported
back, would suggest a fairly slow rate of progress, even on under-16s.
Even if the rate is secured to the 99 per cent. or better confidence
limit for which we hope, it will leave a problem for adolescent mental
health in the 16 to 18 age group. That is of great importance, not
least because that group is likely to be the better part of the
population or, to put it another way, the age group in which mental
health problems tend to present themselves.
I would like to associate
myself with the comments made by my hon. Friends on offenders in
relation to proposed new clause 23. In my constituency, there is a
secure training centre and, adjacent to that, a young offenders
institution, which neatly spans the 16-year-old divide. Sadly, I am
only too well aware of the risks of self-harm and suicide in those
establishments. It is important that there is an appropriate setting
and that that is maintained when people have to leave such
establishments for more intensive treatment.
As the hon. Member for Bolton,
South-East rightly said, we are close to, or are edging toward,
consensus. It is important that those on the Government’s side
do not caricature what we are saying in new clause 23, and that we do
not pretend that there are no difficulties. We need to get it right. It
has already been made clear to the Committee—if not, it is clear
to me—that there is no question of diverting
people’s attention; emergencies override, although somebody will
have to deal with them. However, we are anxious that an emergency
situation does not slide effortlessly into a kind of prescription for
the duration that is not appropriate for the young person
involved.
My next
point is that there is nothing to stop treatment for a young person
being administered in an adult ward when that is appropriate. There is
no text to suggest otherwise in the clause as it appears. The measure
is about giving treatment wherever it is most appropriate for the young
person in question. There may be times, for example when there is a
condition that requires expertise or a group or peer group. It might be
sensible for treatment for a young person to be given in adult
provision, but that should at least be run past a judgment and not
assumed.
That brings
us to the question of resources, which I am sure is a motivator of the
Minister’s reticence, and rightly, because we should not pretend
that resources are unlimited. I would be prepared to concede that, if
there is a short-term lack of resources—a ward might have to
close temporarily because of a building emergency or for
refurbishment—it might be more difficult to meet the tests than
otherwise. My abiding concern is that we do not allow short-term
considerations to develop into a long-term prescription for the young
person
involved.
4.45
pm
Angela
Browning:
I think that the Minister indicated this morning
that it is her intention to consider an inappropriate admission of a
child to an adult ward as an untoward incident. It would follow that
appropriate action would then be taken. In my experience, untoward
incidents are very serious matters that usually involve some sort of
inquiry—more often than not an external rather than an internal
one. At the end of the inquiry, specific recommendations are made. It
seems to me that if one were subject to a series of untoward incidents
with resource implications at the end, one might as well start off with
the resources, rather than be dragged to the same position by one
inquiry after
another.
Mr.
Boswell:
My hon. Friend is right. One should get things
right from the start rather than have to make excuses if they go wrong
or—dare I say it—produce the old canard that no treatment
will be given because of concern that potential treatment might be
inappropriate. That is not proper, nor is it professionally likely in
the real world; people will do their
best.
I am
acknowledging to the Minister that there are practical constraints in
any situation, including short-term constraints in particular. If I
correctly remember this morning’s debate, I may say that it
would be of assistance in relation to any defence under human rights
legislation if Ministers could show that they were working towards
improvements, rather than just folding their
arms.
There might be a
need for short-term derogations, which the Minister needs to think
about and come back to us on, but I want to emphasise that there is no
excuse for long-term systemic failure of the kind reported recently in
relation to services. The hon. Member for Rhondda rightly said that we
are a lot better off than we were 20 or 30 years ago, and I am glad
about that; we shall not have a party political argument about it, as
it is true. However, that does not absolve us from seeking a better
basis for further progress, which is what the debate is really
about.
If the
Government are confident that they can deliver the improvements, that
is all well and good. We have the Minister’s assurances.
However, if they can indeed give delivery, why are they reluctant to
underwrite that confidence by means of
legislation?
The
Minister of State, Department of Health (Ms Rosie
Winterton):
I welcome you back to the Chair, Lady
Winterton. The debate has been a good one and the Committee has now
agreed that the subject is important. We all want to make changes of
the kind for which YoungMinds has been campaigning. However, I thought
that the contributions from the Labour Benches were more constructive
in that they acknowledged the need to be honest about some of the
problems that might arise and to avoid legislating for changes that
might have the opposite effects to those intended.
I felt that my offer to
reconsider was slightly ignored by some Opposition Members. We are all
determined to achieve proper accommodation for young people. YoungMinds
has actually been very understanding, and it is as anxious as the
Government are to ensure
that there is nothing that could be
counter-productive. I am sure that no Committee members would actually
want that, but it is important to realise that we are legislating on an
important issue that affects very vulnerable people and that we need to
do that properly.
Tim
Loughton (East Worthing and Shoreham) (Con): I do not
think that anyone would argue that the Minister does not agree with the
principle, but we need a commitment that there will be delivery. It is
true that she said that she would consider the matter. What will it
take to make her change her mind so that there is express provision of
the type that is being suggested? She has had some months to consider
the matter. Does she need to consult more with counsel or other
practitioners? Can she give us some indication of that? Otherwise, we
cannot take on trust what she is saying that she would like to achieve
in principle. In practice, we need to see more evidence of
that.
Ms
Winterton:
I am afraid that if the hon. Gentleman does not
trust me, whatever I say will not change his
mind.
Mr.
Boswell:
Would it not be possible, in this spirit of
discovering mutual trust, for the Minister to let the clause lie, go
away in good faith and consider what should be done later and, if
necessary, excise the offending clause or substitute one of her own on
Report? She does not need to remove it now to make her
point.
Ms
Winterton:
I cannot do that, I am afraid. I need to ask
the Committee to vote against the clause. However, I shall take the
proposals away. I need to consider the legal advice that YoungMinds
supplied and to talk with service providers and professionals about
some of the issues. I also need—my hon. Friends the Members for
Rhondda and for Bridgend mentioned this point—to consult Welsh
Ministers about the implications. As the hon. Member for Tiverton and
Honiton said, some changes are taking place, not least in her
constituency, and I hope that hon. Members will accept that it would be
wrong to introduce legislation that could have the perverse incentive
of making children not get the treatment that they
needed.
I will take
the proposed amendments away, and I undertake to hold a consultation. I
am more than prepared to keep in touch with both Opposition Front-Bench
spokesmen about the progress that we are making. I undertake to do
that. I hope that, in that way, we can reach consensus on what is the
right way to
proceed.
Tim
Loughton:
That is helpful. However, the Minister must
appreciate that, just as we need to see more beef, she is apparently
unable to trust us not to vote to keep the clause. Is she specifically
saying that she has not taken any legal opinion about the viability of
the amendment that was added to the Bill in the House of Lords some
months ago? The only thing that instigated her asking for legal advice
is that an organisation called YoungMinds met her and gave her its own
commissioned legal opinion. Surely, she must already have sought legal
advice on the viability of the clause. If so, perhaps she can tell us
what it was.
Ms
Winterton:
Basically, the advice that I have been given on
the clause is as I set it out this morning: there are some problems
with it. The proposed terminology discussed this morning talked about
the registered medical practitioner, when we are talking about the
responsible clinician. There are lots of areas where the proposal is
faulty, and there are some problems with
it.
I suspect that the
hon. Gentleman just wants to vote against what we are saying. I accept
that, but all I can say is that I have undertaken to take the proposal
away, keep in touch with the Opposition Front-Bench spokesmen and to
have close contact with YoungMinds about a range of issues that it
raised with me, not least the legal advice that it gave us. I hope
that, with that reassurance, the Committee supports me in opposing
clause 24.
Question
put, That the clause stand part of the
Bill:—
The
Committee proceeded to a
Division.
Tim
Loughton:
On a point of order, Lady Winterton. I do not
think that there were 12 noes. Could we have a recount,
please?
The
Chairman:
What I announced was correct. Actually, I think
that the hon. Gentleman said “No
way”!
The
Committee
having
divided: Ayes
7, Noes
12.
Division
No.
8
]
AYESNOES
Question
accordingly negatived.
Clause 24 disagreed
to.
Clauses 25
to 28 ordered to stand part of the
Bill.
<++++>
Clause 29Civil
partners
Question
proposed, That the clause stand part of the
Bill.
The
Chairman:
With this it will be convenient to discuss the
following: New clause 1—Independent mental health
advocacy
—
‘(1) The 1983 Act is amended as
follows.
(2) After section 59
insert—
“59A
Independent mental health advocacy
etc.,
(1) The appropriate
authority must arrange, to such extent as it considers necessary to
meet all reasonable requirements, for help from persons to be known as
independent mental health advocates, to be available to qualifying
patients.
(2) The help
available under the arrangements must
include—
(a) help in
obtaining information about and
understanding—
(i) what
medical treatment is being provided to the
patient,
(ii) why it is being
provided,
(iii) under what
authority it is being
provided,
(iv) the requirements
of this Act which apply in connection with the patient’s
treatment, and
(v) the rights
which can be exercised by or in respect of him under this Act,
and
(b) help (by way of
representation or otherwise) in exercising those
rights.
(3) An independent
mental health advocate authorised by a patient or his nearest relative
on his behalf may at any reasonable time, for the purpose of providing,
in accordance with the arrangements, help requested by the patient or
his nearest relative, meet the patient in
private.
(4) The appropriate
authority may by regulations provide that a person may act as an
independent mental health advocate
only—
(a) if
requirements specified in the regulations are met in respect of him;
or
(b) if requirements
specified in the regulations are met in respect of any person with whom
arrangements are made for him to act as an independent mental health
advocate; or
(c) in
circumstances otherwise specified in the
regulations.
(5) In making
arrangements under this section, the appropriate authority must have
regard to the principle that the provision of help under the
arrangement should, so far as practicable, be independent of any person
responsible for the patient’s
treatment.
(6) This section
applies in respect of the following
patients—
(a) a patient
who is liable to be detained by virtue of an application for admission
for assessment or an application for admission for treatment under Part
II of this Act;
(b) a community
patient;
(c) a patient who is
removed to a place of safety within the meaning of section
135—
(i) in the
execution of a warrant under section 135;
or
(ii) by a constable under
section 136,
(d) an accused
person within the meaning of section 35 remanded under that section to
hospital for a report on his mental
condition;
(e) an accused
person within the meaning of section 36 remanded under that section to
hospital for treatment;
(f) a
patient in respect of whom there is in
force—
(i) a hospital
order,
(ii) a transfer
direction,
(iii) a hospital
direction,
(g) a patient, not
being liable to be detained under this Act, who is asked to consent to
any form of treatment to which section 57
applies.’.
New
clause 2—Duty to inform patient of the right of access to an
advocate
—
‘(1)
The 1983 Act is amended as follows—
(2) After section 59A, inserted by this Act,
insert—
“59B Duty
to inform patient of advocacy
provision
(1) The appropriate
authority shall have a duty to inform a qualifying patient of the right
to seek the services of an independent mental health advocate as soon
as is reasonably practicable after the patient becomes a qualifying
patient and thereafter, at reasonable
intervals—
(a) at all
points where decisions are made about care and
treatment;
(b) on the use of
interventions to manage
behaviour;
(c) in any case
where an allegation of abuse, including offences relating to sections
38 to 41 of the Sexual Offences Act 2003, is made by a qualifying
patient.
(2) In any case where
it is proposed that treatment specified by regulations made by the
Secretary of State pursuant to section 58(1)(a) should be given to a
patient, the appropriate authority shall have a duty to inform, or as
the case may be, remind the patient of the right to seek the services
of an independent mental health
advocate—
(a) before the
patient is asked to consent to the specified treatment;
or
(b) before a certificate has
been given under section
58(3)(b).
(3) In the case of a
patient who is a qualifying patient by the virtue of section 59A(6)(g)
the appropriate authority shall have a duty to inform, or as the case
may be, remind the patient of the right to seek the services of an
independent mental health advocate before he is given any form of
treatment to which section 57
applies.’.
New
clause 15—Advanced decision (nearest
relative)
—
‘(1)
The 1983 Act is amended as
follows.
(2) After section
26(4)
insert—
“(4A)
Where a patient has made an advance decision with regard to the choice
of a relative or other person to be his nearest relative, his nearest
relative shall, subject to the power of the court under section 29 to
appoint an acting nearest relative be determined by giving preference
to that choice.
(4B)
‘Advance decision’ means a decision made by a patient
(‘P’), after he has reached 18 and when he has capacity
to do so and in contemplation that he shall become subject to any act
or decision exercisable under the provisions of this Act that his
choice of nearest relative shall take precedence over the provisions of
subsection (3).
(4C) For the
purposes of subsection (4A) a decision may be regarded as expressing a
choice of nearest relative even though expressed in layman’s
terms.
(4D) P may withdraw or
alter an advance decision at any time when he has capacity to do
so.
(4E) A withdrawal
(including a partial withdrawal) need not be in
writing.
(4F) An alteration of
an advance decision need not be in
writing.
(4G) An advance
decision does not affect the liability which a person may incur for
carrying out or continuing a treatment in relation to P unless the
decision is at the material time
valid.
(4H) An advance decision
is not valid if P—
(a)
has withdrawn the decision at a time when he had capacity to do so,
or
(b) has done anything else
clearly inconsistent with the advance decision remaining his fixed
decision.
(4I) A decision or
statement complies with this subsection only
if—
(a) it is in
writing,
(b) it is signed by P
or by another person in P’s presence and by P’s
direction,
(c) the signature is made or acknowledged by P in
the presence of a witness,
and
(d) the witness signs it,
or acknowledges his signature, in P’s
presence.
(4J) The court may
make a declaration as to whether an advance
decision—
(a) exists;
and
(b) is
valid;
(4K) Nothing in an
apparent advance decision stops a
person—
(a) providing
life-sustaining treatment,
or
(b) doing any act he
reasonably believes to be necessary to prevent a serious deterioration
in P’s condition, while a decision as respects any relevant
issue is sought from the
court.”.’.
New
clause 20—Nearest relative (named
persons)
—
‘(1)
Section 26 of the 1983 Act (“definitions of relative” and
“nearest relative”) is amended as
follows.
(2) In the
cross-heading preceding Section 26 after “functions of
relatives” insert “, persons acting as
relatives”.
(3) Before
subsection (1)
insert—
“(A1) In
this Part of the Act “named person” means any
person—
(a) described in
subsection (1) below; or
(b)
not described in subsection (1) below who is the patient’s
carer;
who has been nominated
by the patient in accordance with subsection (1A)
below.
(B1) In this Part of the
Act “carer” has the same meaning as in Section 1(1)(a) of
the Carers and Disabled Children Act
2000.”.
(4) After
subsection (1)
insert—
“(1A) A
person is a named person in accordance with this subsection
if—
(a) the nomination
is signed by the nominator and the named
person;
(b) the
nominator’s and named person’s signatures are witnessed
by two prescribed persons;
(c)
each prescribed person certifies that, in the opinion of the prescribed
person, the
nominator—
(i)
understands that the effect of nominating a person to be the named
person will give him the role of nearest relative;
and
(ii) has not been subjected
to any undue influence in making the
nomination;
(d) each prescribed
person certifies that, in the opinion of the prescribed person, the
named person—
(i)
understands and is capable of performing the functions of the nearest
relative; and
(ii) has not been
subjected to any undue influence in agreeing to the
nomination;
(e) the nomination
has been forwarded to and registered with the local social services
authority;
(f) in this part a
prescribed person
is—
(i) an Approved
Mental Health
Professional,
(ii) an Approved
Clinician,
(iii) a provider of
reserved legal service,
(iv) an
Independent Mental Capacity
Advocate.
(1B) A nomination
under subsection (1A) above may be revoked by the nominator in
accordance with subsection (1D)
below.
(1C) The nomination of a
named person is revoked in accordance with this subsection
if—
(a) the revocation
is signed by the nominator;
(b)
the nominator’s signature is witnessed by a prescribed
person;
(c) the prescribed person certifies that, in the
opinion of the prescribed person, the
nominator—
(i)
understands the effect of revoking the appointment of a person as named
person; and
(ii) has not been
subjected to any undue influence in making the
revocation.
(1D) The nomination
of a named person shall be effective notwithstanding the
nominator’s becoming, after making the nomination,
incapable.
(1E) A person
nominated under subsection (1) above may decline to be the
nominator’s named person by giving notice
to—
(a) the nominator;
and
(b) the local social
services authority in which the nominator
resides,
to that
effect.”.
(5) For
subsection (3)
substitute—
“(3)
In this Part of the Act, subject to the provisions of this section and
to the following provisions of this Part of this Act, the
“nearest relative” means, in descending
order—
(a) the named
person,
(b) the person first
described in subsection (1) above who is for the time being surviving,
relatives of the whole blood being preferred to relatives of the same
description of the halfblood and the elder of eldest of two or more
relatives described in any paragraph of that subsection being preferred
to the other or others of those relatives, regardless of
sex.”.
(6) In Section
26(4) after “his nearest relative”, insert “under
subsection 3(b)
above”.
(7) In Section
26(5) leave out “(3)” and insert
“(3)(b)”.’.
New
clause 21—Independent mental health
advocate
—
‘(1)
The 1983 Act is amended as
follows.
(2) After Section 59
insert—
“59A
Independent mental health
advocate
(1) The appropriate
authority shall have a duty to arrange for assistance to be provided
from independent mental health advocates to be available to
patients—
(a) detained
under this Act, or
(b) subject
to a compulsory treatment
order,
at the end of the
compulsory period of their
treatment.
(2) Assistance
provided under subsection (1) shall ensure that each of the following
matters is
addressed—
(a) help is
available to patients in obtaining comprehensible information
about—
(i) the medical
treatment available to them in the community and access to such
treatment,
(ii) social and care
support in the community and access to such support,
and
(b) help is available to
patients to exercise their rights and entitlements in accessing
treatment.
(3) The Secretary of
State may by regulations specify the qualifications necessary for a
person to act as an independent mental health
advocate.”’.
New
clause 24—Independent mental health advocacy (young
persons)
—
‘After
section 125 of the 1983 Act
insert—
“125C
Independent mental health advocacy (young
persons)
(1) The appropriate
authority must arrange, to such extent as it considers necessary to
meet all reasonable requirements, for help from persons to be known as
independent mental health advocates, to be available for patients aged
18 years or under.
(2) The help
available under the arrangements must
include—
(a) help in
obtaining information about and understanding
of—
(i) what medical treatment is being provided to the
patient;
(ii) why it is being
provided;
(iii) under what
authority it is being
provided;
(iv) the requirements
of this Act which apply in connection with the patient’s
treatment; and
(v) the rights
which can be exercised by or in respect of him under this Act;
and
(b) help (by way of
representation or otherwise) in exercising those
rights.”.’.
Ms
Winterton:
As you said, Lady Winterton, this debate is
fairly wide ranging, and it includes clause stand part. Hon. Members
have tabled new clauses that would provide for statutory independent
mental health advocacy and a duty to inform patients of their right to
it. Further new clauses would change the way in which a
patient’s nearest relative is identified. New clauses 15 and 20
relate also to the nearest relative. New clause 15 would provide for an
advanced decision and a written statement in which a patient can chose
his nearest relative. New clause 20 provides that any patient capable
of doing so could nominate a person to be their nearest relative. That
named person would be on the existing list of relatives provided for in
section 26(1) of the 1983 Act or defined as a carer under the Carers
and Disabled Children Act 2000. I shall provide some background to the
debate about the nearest
relative.
Ms
Winterton:
I shall move on, as my remarks might deal with
where the hon. Lady is coming from. In the 2004 draft Bill, we removed
the nearest relative because detention was to be authorised not by an
authorised medical health professional supported by two medical
recommendations, but by an independent mental health tribunal after 28
days. In the light of that fundamental change in the legislation, the
powers of the nearest relative were no longer
appropriate.
5
pm
We did create
the role of nominated person. As hon. Members might be aware, the
pre-legislative scrutiny Committee recommended that the nominated
person be given similar powers over the patient’s discharge to
those of the nearest relative. In our response, we rejected that
recommendation because the safeguards in the 2004 draft were
constructed differently from those in the 1983 Act, and we did not
agree that the nominated person should be given the powers of the
nearest relative in order to provide the patient with the
necessary safeguards. The nominated person was, in a sense, a patient
representative and did not have the nearest relative’s powers of
discharge or detention. The nominated person and nearest relative are
thus fundamentally different, and we cannot simply replace one with the
other.
The changes
that we have made in the Bill will allow patients to apply to the
county court to displace their nearest relative in certain
circumstances and to nominate a replacement. The change is an addition
to the existing provisions and will allow an AMHP, any relative of the
patient or anyone living with them to apply. No matter who makes the
application, if the person nominated in it is suitable and willing to
act in
the role, the courts must appoint that person. By
making that change, we have therefore increased patients’ input
into the choice of an acting nearest relative when they do not have
one, or when the one they have is
replaced.
Mr.
Boswell:
I welcome in principle the extension of
choice—there is no problem with that—but bearing in mind
our shared experiences with the Mental Capacity Act 2005 and the
analogy with a lasting power of attorney, even though it is not a
precise one, will the Minister advise the Committee either now or on
reflection whether there is any provision, presumably in the court, to
remove a nearest relative nominated by the person concerned if,
although suitable at the time, they subsequently become unsuitable or
evidence emerges as to their unsuitability for continued functioning in
that
role?
Ms
Winterton:
Yes, of course, because there will be an
ability to return to the court to remove that person if they become
unsuitable.
Angela
Browning:
On a point of clarification, when we talk about
carers, are we excluding paid professional
carers?
Ms
Winterton:
I am pretty certain that if the court feels
that it is suitable for any individual nominated to be the nearest
relative, that will be up to the court to decide. If the court feels
that a paid carer is the appropriate person, that will be possible, but
it is up to the court to decide whether such a person, if nominated by
the patient, will be a suitable choice. It will have to be a court
decision whether that is right. If the person is considered suitable,
the court must appoint
them.
Mr.
David Kidney (Stafford) (Lab): As for going to a court to
overturn a nearest relative, court proceedings must be much less
daunting for a big mental health trust or a primary care trust than for
an individual patient suffering a mental disorder. As a matter of
principle, would it not be better for the person to choose their
nearest relative and, if that person were unsuitable, for the trust to
go to court to set the person
aside?
Ms
Winterton:
My hon. Friend makes a good point. Of course,
we want as much patient choice as possible in such difficult
circumstances, but it is important to remember what we are expecting of
a nearest relative. That person has the power to block an admission to
hospital or to request a discharge, for example. Such matters are quite
sensitive, because the nearest relative may be the continual carer for
the person, but we all recognise circumstances in which a person
becomes very ill and sometimes rejects the
carer.
Mrs.
Madeleine Moon (Bridgend) (Lab): Let us consider a
situation in which I am mentally capable and decide that I want someone
to manage my affairs in the event of my losing capacity. I can take out
an enduring power of attorney in which I specify an individual to
manage my financial affairs. It can be any individual of my choice. If
I lose my capacity, that must be watched.
Why is it not right for me as an
individual, when mentally well, to have an equivalent of an enduring
power of attorney and to decide on the person who, in the event of my
losing capacity, I wish to act as my nearest relative? No one needs to
go to court to carry out an enduring power of attorney when they are
mentally rough. Why is it necessary for someone who perhaps for many
years has suffered mental health problems to face the additional trauma
of going to court to dislodge a nearest
relative?
Ms
Winterton:
That is when the judgment has to be made about
what are sensitive issues. We need to be clear about the role of the
nearest relative in such circumstances. It is a great responsibility to
have the ability to block an admission or to try to discharge someone.
The decisions that we have to weigh up are on those circumstances
whereby one might wish constantly to change the nearest relative and on
very sensitive issues when an individual might feel that the most
appropriate person was not just the relative who might be most willing
to block an admission or try for a discharge, but someone whom the
individual might have met
recently.
We have
extended the powers to say that, if the person wishes to remove their
nearest relative, they can nominate someone else. It is quite important
to recognise that we had to weigh up the issue of someone perhaps
constantly changing their mind because an individual had not
necessarily done what that person had wished them to do, and weigh up
the ability to make an application to change the nearest relative and
have before the court good reason to make that change. That was why we
had to get that balance between those two situations, which are very
sensitive because of the powers involved. If a person wanted to
nominate an individual to whom power would be given if they were to
lose capacity, because their nearest relative was not considered
appropriate, they could apply to the court and do so if they thought it
the right thing to do and the court said that that person was suitable.
I admit that it is a fine judgment, and it is sensitive because of the
particular role of the nearest relative and the fact that we did not
want a situation whereby somebody could constantly change their nearest
relative and make the management of care extremely
difficult.
James
Duddridge (Rochford and Southend, East) (Con): The
Minister has explained that there is a balancing act. On one side of
that balancing act, what costs and time will be involved for the
individual going through that court process? I would be scared to go
through the process as an able-bodied, able-minded individual, although
other people might not be. Also, what will be the cost and time
implications for the already stressed court
system?
Ms
Winterton:
On the cost to society, if one can put it that
way, there needs again to be a balance. We do not want people
constantly to go to court, which is why we set strict limits. We want
to ensure that there is an adequate check so that somebody cannot
decide on a different person over and over again.
The other issue that comes into
the equation relates to the point made by my hon. Friend the Member for
Bridgend. There may well be people who do not want
to be a nearest relative because of the
responsibilities that they would have to take on, so it is important
that we have a system that includes the right not to be in that
position.
Mr.
Boswell:
I have been listening to these exchanges with
interest. The Minister mentions somebody making a decision to change
their nearest relative. Will she clarify whether a person making that
decision must have mental capacity at the time? I believe that the
inference is that they must, just as they would have to if they were to
appoint somebody with the lasting power of attorney for their health
care under the Mental Capacity Act 2005. If such a person wished to
manipulate the situation to change day by day the person nominated as
their nearest relative, would not that be exactly the kind of problem
that could in principle arise under mental capacity legislation? Or is
the Minister thinking of a situation whereby somebody has a mental
disorder and therefore lacks capacity at the time of making the
decision, in which case the individual concerned would only be
expressing their opinion? Which set of circumstances bites in this
case?
Ms
Winterton:
I need to clarify the fact that it is not just
the patient who will be able to apply for a nearest relative to be
displaced. An AMHP, a relative or a carer who lives with the individual
in question could do so if it were considered that something was wrong
in the position of the nearest relative and they had become unsuitable.
In that sense, it goes wider than just the patient. Whether with or
without capacity, they could still apply, but to reassure the hon.
Member for Daventry, I point out that there are others who can apply on
the patient’s behalf if it is felt that the nearest relative has
become
unsuitable.
5.15
pm
Let
me deal with some of the new clauses. As I am sure hon. Members will
know, there are already advance decisions under the Mental Capacity Act
2005, but those relate only to refusals of treatment and they come into
play when a patient loses capacity. That should not be confused with
the advance decision under new clause 15, which relates specifically to
the patient choosing his nearest relative and is to be effective as
soon as it has been made. Although new clauses 15 and 20 adopt
different approaches, they aim for the same goal: to provide the
patient with choice over his nearest relative. We are certainly not
opposed to the principle of patient choice, but we must be clear that
the nearest relative is not the same as a patient representative or
next of kin and should not be treated as
such.
It
is important to remind ourselves that, obviously, compulsion is imposed
only when patients do not accept or do not understand that they need
help—help that independent professionals agree is necessary. We
need to remember that it is not unusual for there to be a disagreement
between a patient who wants to be discharged and the nearest relative,
who in very difficult circumstances will sometimes reluctantly have to
accept that compulsion is the best course of action. If the nearest
relative is to continue to exercise the right to block detention or to
discharge the patient—both are important safeguards from the
patient’s point of view—it is important to have that
degree of independence of both practitioners and the patient, and the
ability to exercise those powers in the way he thinks best.
The problem with the new clauses
is the possibility that that independence would be undermined.
Obviously, there are very difficult issues to do with the relationship
between the patient and the nearest relative, who may be the carer.
There are disagreements. The nearest relative may on occasion feel
rejected because the patient feels that they have not done everything
possible to discharge them, but we are talking about difficult
circumstances in which the patient is under compulsion because they do
not accept that they need the treatment in the first
place.
There
is an issue about whether there is an incentive for prospective nearest
relatives who do not believe in compulsion, for example, to put
themselves forward and offer to discharge patients whatever the
circumstances. That is why we need to build a protection into the
system to ensure that the person is
suitable.
I hope that
hon. Members will accept that the objection is not to the principle of
patient choice per se. However, we need a system that keeps a proper
check and balance on the issues to do with the nearest relative, while
at the same time making some of the changes that we have made in the
Bill by extending the ability to replace the nearest
relative.
Dr.
John Pugh (Southport) (LD): On new clause 24, where the
right of the patient to nominate is given paramount significance, what
specific damage does the Minister think that that is doing or is likely
to
do?
Ms
Winterton:
In terms of the nomination, we have made it
clear that if the patient wishes to displace a nearest relative, they
can go to court and put an individual forward. However, we want people
to go through that system to ensure that things are not constantly
changing, which is a possibility, and that there is a proper check to
ensure that the person is suitable to undertake the role. It is a
matter of getting those two things
right.
On new clauses
1, 2, 20 and 24, which deal with advocacy, I should say at the outset
that, of course, the Government recognise the important contribution
that advocates can and do make to patients’ care and treatment
and we value highly the work done by many advocates who are already
working in the health services across England and Wales. The Government
are committed to supporting and developing that important role,
particularly in mental health services. We have commissioned work to
develop specialist training in standards for mental health advocates,
as well as systems to support the commissioning of services. However,
as a result of what was said in the other place, we have agreed to
consider advocacy and return to the matter in this House. The work that
we have commissioned is helping to inform that
consideration.
The
draft illustrative code of practice provides guidance to practitioners
on when advocates should be involved. It is true to say that advocates
can support patients in understanding the information that is presented
to them. Perhaps even more importantly, they support patients in
increasing their own involvement in decisions about their care and
treatment, including decisions about care and treatment after a patient
has been discharged from compulsion. With the support of advocates,
communication
between patients and practitioners can be greatly
improved. There is no doubt that support of that nature can make a
dramatic difference to a patient’s experience of
detention.
We
committed in the other place to consider and return to how advocacy can
best be made available to detained patients as well as to those who
receive community treatment orders. Although we recognise the huge
benefit that advocacy can bring, we must not miss the opportunity to
develop an effective tailored advocacy service by rushing through
measures on some of the important issues, such as those that have been
brought to the fore by hon. Members in the new
clauses.
Angela
Browning:
Under the Minister’s proposals, will
there be a right in the Bill for a person who is undergoing treatment
and who seeks an advocate—an advocate would certainly be needed
for an in-patient who wanted to make a challenge through the court, for
example—to request advocacy and receive
it?
Ms
Winterton:
That is exactly the sort of issue that we are
considering. It is about identifying the instances when advocates are
going to be most particularly needed and making the best use of their
time. That is what we had to do with the Mental Capacity Act 2005, as
the hon. Lady knows. During the passage of the 2005 Act, we looked
closely at how we could make proper provision, but gave ourselves the
ability to widen it through regulations if
necessary.
Mr.
Boswell:
We have indeed continued the dialogues that we
initiated in Committee on the 2005 Act in subsequent discussions, for
which I am grateful to the Minister. I take it that her response to my
hon. Friend the Member for Tiverton and Honiton is a conditioned yes; I
do not wish to take the Minister further than she wishes to go at this
stage, but the Committee needs to know. The principle of having
advocacy for which there might be some public provision is conceded.
Rightly, she now wants to consider what the coverage and structure of
that provision should be, and how much will need to appear in
regulations. Most of us want to see something happen, but we would not
necessarily wish to tie her down at this stage; we would like some
assurance that measures will be forthcoming before the Bill has
completed its parliamentary passage.
Ms
Winterton:
That is absolutely right. On the point made by
the hon. Member for Tiverton and Honiton, there would be legal
representation for those going before a tribunal, but sometimes
advocates can help ensure that the legal representation gets the point.
We need to look at what are the most appropriate circumstances for
people both with and without capacity.
Tim
Loughton:
I cannot help but admit that I am a bit
perplexed. The Minister has just said that she is looking at the issue
of advocacy, but the Government have had rather a long time to do
that—the issue was in the original draft Bill, and the
Government appeared to accede to its inclusion. Only a few months ago,
when debating regulations relating to the Mental Capacity Bill, we
discussed the success of the pilots of advocates, which is now leading
to their expansion. What further research does she need to do on the
subject?
Ms
Winterton:
First, it is vital to get the views of the
Committee. The point of having a Committee such as this is to explore,
with such great brains as are here in the room, some of the issues that
are now being raised, and to give my hon. Friends and Opposition
Members the opportunity to contribute to the formulation of policy. I
can assure the Committee that I would not miss such an opportunity for
the world. It is important that we have the ability to take the
Committee’s ideas on board.
We need to
ensure that advocates can function properly and meet the needs of the
patients with whom they work and that they can have access to
patient’s care plans if necessary and meet the practitioners
involved with a patient’s care and treatments. Obviously,
certain groups of patients—children, adolescents and those from
black and minority ethnic communities, for example—might have
specific advocacy needs. We wish to ensure that any statutory provision
of advocacy services can take account of such needs by providing
advocates with the right skills to do the job.
It is important to say that the
Government recognise the point being made in new clause 2 and that it
is vital that advocacy services are not underused simply because
patients are not told about them. Patients should be told about
advocacy services when they need them; not afterwards. For example,
informal patients for whom section 57-type treatments are being
considered could benefit from advocacy when the treatment is first
being discussed, before consent is sought. Patients should be informed
or reminded of the availability of advocacy services when the issues
are being discussed and not only when the decision to pursue such
treatments has been
made.
5.30
pm
It is important
that the new clauses give us the opportunity to discuss some of the
issues of advocacy that I am sure hon. Members want to address, and to
emphasise how important it is to get it right. That is the importance
of this debate. As I said, I hope to return to the issue on Report. In
light of that, I hope that hon. Members will accept my assurance that I
recognise the vital importance of the
issue.
Dr.
Pugh:
I thank the Minister for adopting such a
constructive and positive approach to the amendments. The Committee is
turning out more as I hoped than as I feared. We are making some
progress, albeit fairly slowly, and the Minister must take some of the
praise for it.
In her
explanation of the nearest relative’s replacement by a nominated
individual, I understood the Minister to be suggesting that it was not
the principle of new clause 24 that she objected to but the route that
would be followed to identify the person to be nominated. I am quite
happy to take away new clause 24 and reconsider that, but the issue of
advocacy, as was emphasised on Second Reading, is a big issue for a lot
of hon. Members. Advocacy is well understood, and the Mental Capacity
Act 2005 illustrated how successful, useful and positive it can be. New
clause 24, which would simply establish the right to advocacy, and new
clause 2, which would establish the right to be informed about such
advocacy, are
relatively detailed amendments. We are suggesting that a well-understood
phenomenon be attached to the
Bill.
I am happy to
accept the Minister’s assurances and to look forward to what
might occur on Report, but I should like to make a few fairly simple
points about why advocacy is so important. The general assumption in
mental health is that the therapist has the good of the patient at
heart. Most therapeutic relationships are entirely satisfactory, but
some can be difficult and problematic, and that is where advocacy has a
place and a part to play.
I had the opportunity many
years ago to teach evening classes at what was then Park Lane special
hospital, later called Ashworth hospital. In that class were a number
of people. One chap, whom I remember particularly, was a gentleman
called Peter who was astonishingly articulate, very good at arguing his
case and forceful in putting points and constructing arguments,
although in a perfectly friendly and amicable way.
Many years later, I saw the
same gentleman on TV in a programme about Park Lane. He was arguing
with the consultant psychiatrist exactly as he had done in my classes.
I had encouraged that behaviour, because we were discussing things, but
the programme carried on to show that the psychiatrist thought that his
very stubbornness in failing to admit that there was something wrong
with him was indicative of the fact that he was still ill and should be
detained. I believe that he was originally detained for putting a
Molotov cocktail through a letterbox after an unfortunate romantic
relationship had turned out wrong. He knew that and had changed, but
the very fact that he was arguing his case left him in a Catch-22.
Because the psychiatrist presupposed that he had a mental disorder,
almost anything that he did was seen as indicative of that mental
disorder.
In a classic
experiment called the pseudo-patient experiment done years ago by
American psychologists, people with absolutely nothing wrong with them
were admitted to a mental hospital to see exactly how they would be
treated. They behaved entirely normally. At the end of the day, as they
were researchers and it was their project, they retired to their rooms
and secretly wrote up the notes of their day’s observation on
the mental wards. The ward staff spied on them, went back to the office
and wrote down, “Exhibits strange writing
behaviour”.
It
is sometimes quite hard for a therapeutic relationship to be
satisfactory without sufficient subtlety on the part of the therapist.
Many patients, including Peter, will therefore at times require an
advocate to get the right outcome—one in which their ailment is
properly identified, therapy is properly in place, and detention is
either put into effect or not.
New clause 24 would introduce
similar rights for children. It might quite rationally be suggested
that children already have advocates in their parents. However, some of
us know how complex parenting can be, and how strange is the take of
some parents on the process. I have genuinely observed a little lad
waiting to see a consultant psychiatrist. He was as good as gold, but
every time he moved a limb or his tie moved out of place, his father
shot across the room, straightened the tie or removed the crease in his
trousers or whatever, and told him to sit up. I could see the problem
there
and then, and I would hate that father to be the sole advocate for this
child, because he was part of the problem.
I do not subscribe to the R. D.
Laing theory, as set out in “Sanity, Madness and the
Family”, that it is our family that actually drives us mad.
However, it sometimes happens that way, so there is a case for advocacy
for children, and there is certainly a case of advocacy for adults. If
the Minister is considering the point, however, I am prepared to
develop it further and bide my time.
Mr.
Kidney:
There are two groups of proposed new clauses. One
group relates to the role of nearest relatives and the other to the
advocacy role. I shall first speak on new clause 15, which was tabled
in my name and which relates to the role of the nearest
relative.
The Mental
Capacity Act 2005 has opened the gates both in this area of law and in
others. We shall be dealing later with the Bournewood class of
vulnerable individual, and there is a raging debate among mental health
practitioners on issues of capacity and mental disorder. New clause 15
seeks to bring a further issue to the fore—that of advance
decisions.
The Mental
Capacity Act formally established independent mental capacity
advocates, and some of us are seeking to replicate that concept in the
Bill. That Act was a landmark piece of legislation in many ways, though
it did not, of course, mark the beginning. The common law and the
courts had already recognised so-called living wills and advance
directives for medical treatment long before the Act was
passed.
I accept what
my right hon. Friend the Minister has said about there being a world of
difference between the nearest relative under the Mental Health Act
1983 and somebody’s next of kin or advocate; they carry out
completely different roles. The nearest relative carries out some
important formal roles under the 1983 Act that have real substance and
meat, and we are seeking to amend that
Act.
My proposal is
that adults with mental capacity who are not suffering from mental
disorder should be able to specify the person whom they would want as
their nearest relative to make crucial interventions on their behalf
were they to be ill at a later date, rather than having to rely on the
list in the 1983 Act. I am not decrying the value of the list, although
in kinship terms the language of it—with its approach based on
ties of blood and with references to “whole blood”, and
“half-blood”—is slightly old-fashioned. The order
of individuals in the same class, such as brothers and sisters, is
determined by age and nothing else. There is very little mention of
carers at all, except that a relative who has been living with the
patient as a carer can displace all the other relatives.
The list is a little staid and
out of date, and its role should be that of a useful default position.
I would prefer that it be used only if a patient has said nothing,
rather than being the decisive factor even when a patient wants
something different.
Mr.
Boswell:
Conversely, does the hon. Gentleman agree that if
a person takes the step when they have capacity, perhaps with the
knowledge of previous mental health problems, of appointing someone
with
the lasting power of attorney in relation to their health care
decisions, as they can under the 2005 Act, there should be a
presumption that that person can discharge the functions of the nearest
relative unless there is an issue of suitability for a court to
consider?
Mr.
Kidney:
The hon. Gentleman makes an important point. I was
flattered to find that I have attracted the support of Rethink for new
clause 15. In its briefing in support of the new clause it refers to
the point that he has just made: that a person with capacity and not
suffering from a mental disorder can appoint with a lasting or enduring
power of attorney someone whom they want to make decisions about their
health treatment for them in the future. That might be mental health
treatment. However, the Bill refers to the nearest relative instead of
the person appointed. I am trying to bring mental health legislation in
line with the more modern mental capacity legislation. The person
appointed should make the decisions, not the nearest relative, but if
nobody is appointed the nearest relative list is fine and dandy to take
over and have its
role.
I know from the
debates in the other place that my right hon. Friend the Minister will
say that we do not want people to make fanciful appointments of the
person next door, who will do everything possible to get them out of
the hospital rather than have their interests at heart. That itself is
a fanciful argument. The new clause that I have drafted—I
confess that I have drafted it—would require a certain amount of
formality for a person to consider the matter and appoint someone to
the role of their nearest relative. They would have to put it in
writing and it would have to be witnessed by somebody else. They would
have to sign it and understand and acknowledge their signature in front
of the witness, who would then sign as well. There would be a proper
element of formality in appointing
someone.
Dr.
Gibson:
Does that also mean that they would not have to
give reasons for picking one advocate over another and that it would be
their decision
absolutely?
We
might assume that the nearest relative’s role is to have the
patient’s best interests at heart. To harp back to the
discussions that I had with psychiatrists in the Stafford constituency
before we began our deliberations, they told me that many times their
problem is that they cannot engage the nearest relative according to
the list in the 1983 Act, with the treatment being given to the
patient. They know who the relevant person is by looking up the
patient’s family tree and the 1983 Act, but they cannot get them
to come and take an interest in what is going on with the patient. That
seems a terrible indictment of a law under which we want the nearest
relative to act as a supervisor of what is going on on behalf of a
person who temporarily, because of a mental disorder, cannot do it for
themselves.
The
Government acknowledge that that is sometimes a problem by making the
provision for the nearest relative to be displaced through an
application to the county court. All Governments have done so.
My point to the Minister in my intervention on her earlier was that it
is one thing for a well-resourced trust, with great experience of
lawyers and courts, to go to court to try to get an unsuitable nearest
relative displaced, but quite another for a vulnerable patient to be
told that the 1983 Act states that someone in particular is their
nearest relative and the person whom they must
have.
We
have received briefings from other organisations. New clause 20, which
proposes the named person, is supported by the Mental Health Alliance.
Its briefing mentions some of the court cases in recent years that have
shown the limitations in the current approach. In the case of J. T.
v. United Kingdom in 2000, a woman did not want her mother to be
her nearest relative because her mother was living with her stepfather,
whom she alleged had abused her. In answer to that European Court case
the Government gave undertakings to change the law. The only law that
is being proposed is that the vulnerable woman must apparently go to
the county court to say that she does not want her mother to be her
nearest relative because she is living with the man who abused her. It
is quite an uphill job to expect the person to do
that.
5.45
pm
Ms
Winterton:
I want to make it clear that, under the
changes, we are saying that it is not only up to the individual; we
recognise that such issues could put an individual in difficulties. An
approved mental health professional or another relative can make an
application on the patient’s behalf. We are not entirely leaving
matters up to the
patient.
It is also
important to recognise that the role of the nearest relative is not to
act as the patient’s representative or on behalf of them. It is
a different role from that. It is not a replacement for an advocate,
for example, or a patient representative. The person needs a certain
degree of independence because of the issues involved in being able to
block admission or ask for discharge. That careful balance must be
reached.
Mr.
Kidney:
My right hon. Friend has made two points, neither
of which I accept. First, she said about the specific example that I
cited that perhaps another relative could go to court instead of the
vulnerable patient, and that that person should challenge the mother
and say that she should not be the nearest relative. That is an
unlikely scenario. It is more likely that the patient appoints someone
else instead of the mother, and that the trust, which thinks that the
mother would be a better appointment, takes the matter to court to
challenge it.
As for
the second point, I entirely agree with my right hon. Friend that the
nearest relative is much more than the representative or the
spokesperson of the patient. The person has important rights, such as
the right to apply for admission to hospital; the right to apply for
guardianship; the right to try to block compulsory admission for
treatment; the right to require an approved social worker to consider
the need for admission to hospital; the right to discharge the patient
from section and the right to be consulted about any decision to
detain.
A relative who perhaps has not
been in touch with the patient for a year or two will not necessarily
be the person to exercise those rights compared with, say, a best
friend who has lived with the person for many years but is not married
them and has been the carer, but who is not even on the list at
present. That is the
difference.
Mr.
Boswell:
I have just reflected on what the hon. Gentleman
said. Does he agree that it is almost possible to argue to the
Committee that a nearest relative might be, if not formally unsuitable
or judged unsuitable, in a position that gave rise to concern? A person
might need an independent advocate to approach the court to review the
possibility of appointing a separate person as the nearest
relative.
Mr.
Kidney:
Mostly, I do not find that intervention helpful
because I was trying to keep separate the argument about nearest
relatives from that about advocates. I suppose the intervention made it
clear that the role of advocacy is completely different. The hon.
Gentleman is right. An advocate then might help by standing shoulder to
shoulder with the patient to put forward their case for
them.
Dr.
Iddon:
I have a problem with advance decisions, which I
put strongly on the record when the Mental Capacity Bill was being
discussed. In fact, together with other hon. Members, I fought placing
advance decisions in statute law. I should have preferred them left
under common law. My hon. Friend’s new clause clashes with some
of the proposals in respect of the advance decisions that were agreed,
sadly, in the debate on the Mental Capacity
Bill.
For example,
proposed new subsection (4K) refers to an “apparent advance
decision” stopping a person. Will my hon. Friend clarify the
meaning of “apparent”? The proposed subsection
states:
“Nothing
in an apparent advance decision stops a
person—
providing
life-sustaining
treatment”.
When
discussing the Mental Capacity Act, we had a terrible debate on
artificial hydration and nutrition, which the medical profession
regards as medical treatment. Has my hon. Friend considered his new
clause along with the agreed part of the Mental Capacity Act? There
seems to be
conflict.
Secondly, it
is generally
recognised—
Mr.
Kidney:
Again, my hon. Friend takes me down an avenue that
I do not wish to go down. He has some strong views on a slightly
different subject that is not at all relevant to this one. However,
just to deal with the question that he asked me about proposed new
subsection (4K), the point is that if there is some doubt at the time
of presentation for treatment in a mental health facility as to whether
there exists such an appointment, or there might be some legal
challenge to that appointment or some court case necessary as a result
of disagreement about it, people can carry on and give treatment in the
meantime until that doubt is resolved.
I want to
complete my arguments about how the present law is not currently as
effective as it might be, due to court decisions arrived at since it
was enacted. The latest one was R (E) v. Bristol city council in
2005. The court said that a patient with capacity could decide that
their nearest relative under the Act must not be consulted by health
professionals. It seems that a person can say, “All right, the
Act says that’s my nearest relative, but I forbid you to have
anything to do with them.” The treating practitioners will
respect that decision, because a court now says that that is the right
thing to do as well. Yet that person cannot go a step further and say,
“I don’t want you to tell them, but I want this person to
be my nearest relative.” The two things do not hang together. It
would not surprise me, if we just leave the law as it is now, if there
were another court challenge later, saying that that was not
acceptable. Let us please get the legislation right first time and not
wait for the courts to tell us that we got it wrong. Making an
appointment would give us a procedure that is more flexible and more
tailored to the circumstances of the individual patient, avoids the
great expense of court challenges in most cases and gives us a degree
of speed and certainty from the
outset.
I
should like to say a little bit about the other new clauses on
advocacy, because I am a strong supporter of what I would call citizen
advocacy. Once upon a time, I was a lawyer. Many lawyers are good at
some kinds of advocacy, but they charge a lot of money for it. However,
in this debate, we are not talking about that kind of advocacy. I have
a slight interest to declare, because in Staffordshire, back in the
1980s, I was a founding member of Advocacy Services in Staffordshire or
ASIST—a citizen advocacy scheme. Over 20 years, both as a member
of that organisation—I am its honorary patron—and as a
Member of Parliament, I have had contact with advocates on behalf of
the people for whom they advocate and I know how important their role
is.
Back in the 1980s,
giant hospitals housing many people, some with nothing more than
learning difficulties, were being closed and people were being given
proper homes in the community. At that time, advocates were appointed
who did fantastic work to ensure that those people were not just taken
from one dumping ground to another. Vulnerable people received a superb
service in the community, because of the help given by advocates. Many
times as a Member of Parliament, I have been contacted by advocates who
are simply standing shoulder to shoulder with a person who is entitled
to ensure that their voice is heard in the right places. I have never
seen anything other than appropriate contact with MPs to enlist help
for a person where an MP’s intervention is warranted. That is
why I support
advocacy.
I understand
that the Government support advocacy, too. I have just mentioned that
the Mental Capacity Act 2005 makes more provision for independent
advocates to help people in cases involving mental capacity. We are
looking for the Government to provide for similar independent advocacy
in mental health cases. The Government have paid for research and for
formal courses of study to be worked up, leading to recognised
qualifications for people to be citizens advocates. A lot of work is
being done in that regard at present. I understand the
Minister’s saying that it takes time to reach a position of
being satisfied
that a body of advocates is available, we know what their role is, we
can rely on them to do their job well and we know how to fit them into
the legal framework affecting everybody else. I am prepared to be
patient and to see the Government’s proposals, but I
congratulate those who have drafted the new clauses dealing with
advocacy on making sure that the issue is on the agenda as the Bill
passes through the
House.
Angela
Browning:
I should like to touch on two points, the first
being the question of the nearest relative. I am of the view that the
current legislation—the list set out in section 26 of the 1983
Act—is now somewhat anachronistic. It reads like an inheritance
tax situation in which the bloodline goes down through the family and
people find that they have been left a lot of money by a nearest
relative whom they have never met. The idea when talking about
somebody’s mental health that a person, simply because of a
blood relation, is suddenly responsible for or even interested in them,
is not how society works now. Many years on from the 1983 Act, families
tend to be more disparate, and other relationships come into
play.
The Government
would do well to reform the definition of the nearest relative. Like
others, I advocate the views of Rethink and others in the mental health
world who have offered proposals, such as the suggestion that the
primary carer should be top of that list. The primary carer may well be
a blood relative—it may be a mother—and they may not, but
their views should be taken into account and the patient should have
the opportunity to nominate them if they are the person whom the
patient trusts the most and with whom they have the most day-to-day
contact. They might be somebody who takes day-to-day responsibility for
the patient’s
well-being.
Ms
Winterton:
I want to take this opportunity to clarify for
the hon. Lady and my hon. Friend the Member for Stafford that someone
living with the person for five years will be a nearest relative, and
that a relative who cares for a patient is prioritised in the proposals
and will go to the top of the list. The position is not quite as simple
as it was. The hon. Lady is quite right to say that the 1983 Act was
somewhat out of date. That is why we want to make some of the changes
that we are
making.
Angela
Browning:
I welcome that intervention, but I also want to
flag up the fact that the patient’s view of the nearest
relative, whether there is a bloodline or not, is also very important.
I hope that the Minister will listen carefully to the representations
made today about how patients themselves should have input into
deciding who the nearest relative is likely to be. From many of the
case studies provided to the Committee, we can see that that would be a
step forward.
I remind
the Minister that in the famous Bournewood case, HL’s carers,
although they were paid carers, had responsibility for his day-to-day
care, whereas his nearest blood relative had nearly no contact with him
at all. They were well placed, had the psychiatrists at the time been
willing to engage them in conversation, to explain his behaviours, how
he reacted
to certain situations and so on. For some patients, advocacy is not just
about their mental disorder, but about their additional difficulty in
expressing themselves or communicating, particularly to people with
whom they are not familiar, and about the complex situations that arise
if the right person is not there to interpret how they respond and
behave on a day-to-day basis. I have probably bored the Committee
enough by now with my accounts of how people with autistic spectrum
disorders behave, but I return to discussing that group of people
because they are particularly vulnerable, as are people with learning
disabilities, in terms of how they present and how important it is that
the person who interprets that behaviour is the person who really
understands them on a day-to-day
basis.
6
pm
May I move on
briefly to advocacy? Advocacy needs to be there for the patient, but in
some circumstances it will be the nearest relative who may need to ask
for advocacy on behalf of the patient. The nearest relative may not
feel that they can cope with a certain situation. I still have concerns
about the idea that the court is the only route down which someone can
go. For someone who is an in-patient, the stress and strain of that
being virtually the only route worries me considerably. I ask the
Minister to examine that point. I believe that advocacy should be
available not only to the patient but to the nearest relative or the
patient’s representative if, in certain circumstances, they feel
that advocacy is
needed.
I put it to
the Minister that the nearest relative may well be a close blood
relative. I hope that hon. Members will understand this. If someone is
a blood relative of a person who is mentally ill or incapacitated,
although they try to do their best for them and to put the case for
them, emotionally that is a very difficult thing to do. I can stand up
and advocate for any of my constituents with an autistic spectrum
disorder, but when I have tried to do it for my own son, I have found
it enormously difficult. People may find that difficult to understand,
because I can usually bat for England on just about anything, but the
emotion is quite intense and you really want to do your best for them.
I can think of times when I have called on other people to make the
case for me even if I am sitting in the
room.
I
therefore ask the Minister to bear in mind the need for the advocacy
service, however she determines it in her deliberations, to be
available in certain circumstances not only for the patient but, often,
for the patient’s nearest relatives, who may well say,
“In these circumstances, we understand the situation, but the
case will be better put by somebody who is one step away emotionally
from the situation we’re dealing
with.”
Meg
Hillier (Hackney, South and Shoreditch) (Lab/Co-op): It is
a pleasure to serve under your chairmanship, Lady Winterton. It is also
a pleasure to speak on this issue, which is of great importance to so
many people in the mental health system and particularly to many of my
constituents. If I may, I shall preface my remarks with thanks to some
of the groups that I have managed to speak to over recent weeks and
months since arriving in the House. My local Mind group has been
particularly helpful. The
Psychiatric Rehabilitation Association, the Turkish and Kurdish advocacy
group, Derman, and the Revolving Doors Agency in particular have been
very helpful. I have also had the opportunity to talk to a number of
mental health service users in my constituency and professionals in
Hackney and elsewhere, who have all had views on the
issue.
I shall speak
to new clause 21, which I tabled, and make some general comments about
advocacy as outlined in new clause 1. Since tabling my new clause, I
have been advised that it might be better placed under section 117 of
the Mental Health Act 1983, which relates to aftercare, but I leave
that to those who are more expert than me at drafting to debate,
because the main aim of tabling the new clause was to raise the issue
of advocacy. I was comforted somewhat by the comments of my
right hon. Friend the Minister, but I thought it important to flag up
the issue, because it affects so many
people.
In Hackney,
people are disproportionately affected in respect of the mental health
system by being admitted to hospital. In fact, admissions for
schizophrenia are three times higher for my area than the English
average. The issue also affects many residents in my constituency who
do not suffer from mental health problems themselves, but who deal with
the fallout from people not having support systems. I wanted to
highlight their concerns, too. It is partly about health, and partly
about advocacy for social and ongoing care support, which is
the focus of new clause 21.
An advocacy-armed hospital is
important because of the overlap between mental health and social
services. There is a revolving door of people going in and out of
hospital. I do not believe that the proposed measures will stop that,
because if a person refuses to receive their medication, advocacy will
not necessarily make them take it or get a better service, but it will
help them to access other services. Maybe in the long run, that will
ensure that chaotic lives are made better.
We can see the impact that
advocates for people with chaotic lives who are in the mental health
system when they use other services could have; for example, people in
A and E or those who have been admitted to prison could be helped to
access their welfare rights. Excellent outreach work is done up and
down the country, including my constituency, that supports people
through maintaining work and in the community. We need such a continuum
of support, but unless people have the right to argue for support and
the advocate to help them, they often lose out.
This quite startling example
was given to me by the Revolving Doors Agency: half the people referred
to mental health treatment from police stations have not made a
legitimate benefit claim. That is to say that they are entitled to
benefits, but they have not made a claim. As I said on Second Reading,
not making a benefit claim can lead to other problems. It might mean
that a person gets no housing benefit; without that, they can lose
their tenancy. Those things impact on a person’s lifestyle and
mental health and might lead to unnecessary readmissions to hospital.
If we tackle the issue of advocacy, we can tackle some of the
longer-term issues.
I will not go
into issues concerning particular instances of mental health among
black and minority ethnic
groups as the new clause does not deal with them. However, it raises the
issue of the complexities of dealing with people with mental health
problems who might have language issues such as English not being their
first language, or literacy issues. Those complexities arise in my
constituency and others. Also, cultural differences might not be fully
recognised by professionals. With the right type of advocacy, the
issues can be better addressed and understood by the professionals
dealing with them. For example, who is best placed to advocate for a
middle-aged Turkish man, who is not literate in Turkish and unable to
speak English well, who also has other issues arising from his arrival
in this country? We need to look sensitively at who can provide
advocacy for such people in particular.
Professionals in Hackney deal
with much more than health when they deal with mental health. The
issues of advocacy help them to tackle that. The professionals to whom
I have spoken would welcome good advocacy. I mentioned residents. As
one consultant said:
“In Hackney at any time
on a 20-bed ward, there are one or two people we can’t send back
to their flat because there is a residents’
petition.”
If those
people were able to return home and access the full support services
that they need, there would be fewer problems from residents. I will
not go into some of the residents’ issues that I deal with, but
many understand mental health issues—they are not negative or
stereotypically against people with mental health problems. They simply
say that such people need help and access to help. Without proper
advocacy and support, many people cannot access that level of support,
particularly single people and those who do not have family support,
which is the case for many of my constituents.
There is a huge issue about the
dearth of support available in police stations and courts in accessing
health and social care, which is why the new clause is framed as it is.
The system and, to a degree, the Bill focus on high-level risk, but
ensuring that people at the lower end have access to the support
services that I mentioned can prevent high-level risk in the first
place. Advocacy can make a positive difference to people’s
ability to access
support.
The new
clause deliberately does not go into the definitions of what an
advocate may be. I have been an advocate for someone with a learning
disability, but I recognise that there are different types of advocate.
However, there is an issue about rights and choice. In the benefits
system there is the role of an appointed person who can act for someone
without mental capacity. As we have heard, a family member can often be
a good advocate, but they can equally have problems in being an
advocate. Mental health professionals have said to me that an
experienced solicitor can often be the best advocate for a patient when
dealing with the compulsion element of treatment involved in that
narrow but important area of law. I have seen good social workers
acting as advocate for their patients.
Should the advocate be
independent? The point is that there should be a right to independent
advocacy. I hope that my right hon. Friend the Minister will consider
explaining and outlining that right to patients, as it is outlined in
some of the new clauses. The Bill has previously included advocacy, so
I take what she says in good heart. I recognise that new clause 1 is
effectively
the same as part of the draft Bill of 2004, which included the issue of
advocacy.
I am not
naive enough not to recognise that there are resource implications, and
I hope that my right hon. Friend will comment on the work going on in
the Department to consider the issue. I argue that although there may
be such implications, of which none of us is unaware, there are also
potential savings both social and financial. If we tackle the issue the
right way around, we can save people from being bounced into admission
and compulsory treatment or at least reduce the likelihood of it,
particularly in relation to
after-care.
A pilot was
conducted by Derman, a very good group in my constituency that works
for the well-being of Turkish and Kurdish communities. It was set up 15
years ago by a visionary group of GPs, the health authority and members
of the community, and it has recently conducted a highly successful
pilot with the Latimer health centre, working with those with minor to
moderate mental health problems. It has been proven to reduce admission
to hospital and I recommend that my right hon. Friend examine it as
part of the work that she says is going on in the Department of
considering advocacy issues. Will she comment on whether the
Government’s agenda of delivering race equality in mental
health, which requires that everyone of a black and minority ethnic
background have an advocate, is working? Has any analysis of it been
done by the Department, and is there any likelihood of its being given
greater
resources?
When I
talked to a number of groups in my constituency about advocacy, the
range of views was interesting. The clear view was that advocates
needed to have good professional training, and that was backed up by a
long-standing consultant psychiatrist who said that sometimes the
advocates are a bit too timid, and that he would welcome advocates
being stronger in their views as it can make communication better and
enhance the patient-psychiatrist
relationship.
The
Making Decisions Alliance has made a number of submissions to the
Committee, which Members have no doubt had a chance to examine. It
calls for trained advocates and would like them to be separate from the
best interests assessor. Training, support and the definition of an
advocate are key, and I hope that the Minister will give some guidance
about what the Department thinks might work. One mental health
professional to whom I spoke said that advocates needed to be much more
focused, and another said that they were very useful, but needed
training and support. As I said, one said that stronger advocates would
make communication a great deal
better.
To return to
the issue of resources, the borough of Hackney as a whole—not
just my constituency—received only £40,000 for advocacy
for those who are unbefriended under the 2005 Act. Of the top 20 users
of the accident and emergency at my local hospital, Homerton hospital,
12 are known to the mental health trust. If we add to that the other
costs to the system, let alone MPs’ surgery time, taken up in
dealing with people who have problems but no one to help them to
access services, we see that we can make a breakthrough by including
advocacy in the
Bill.
My right hon.
Friend the Minister has said that the Government are committed to
supporting and developing the role of advocates, and I have indicated
to her that I see my new clause as probing, but it is important to
consider advocacy beyond the point of legal compulsion. If we do not
provide support for people after they are released into the community,
as patients have said to me, it can be frightening for them to be out
there on their own. Sometimes, however, being out there on their own is
the right next step. It is not necessarily right to carry on compulsory
treatment in the community, but sometimes that may be the case. I hope
to speak on that element of the Bill later. It is important that
someone is not left out there without knowing where to find support.
Therefore, the right to independent advocates in that situation is
particularly
important.
6.15
pm
I am glad that
my right hon. Friend the Minister has acknowledged a role for advocacy
post-detention. I am glad that she is looking into it, and I hope that
in her responses, she can pick up on some of the brief points that I
have made. Like my colleagues on this side, I trust that she is
genuinely looking at the issue. I have many users and professionals in
Hackney who will be listening closely to what she has to say
next.
Mr.
Boswell:
May I commend the remarks that have just been
made by the hon. Member for Hackney, South and Shoreditch both in terms
of looking at a more holistic approach to the needs of the people who
may have mental health problems and also in the reasonable point that
she made about early and appropriate intervention, or the maintenance
of support after discharge, which is very important in reducing the
overall cost of what may otherwise become a very expensive procedure?
We have all welcomed the fact that the Minister is edging towards an
advocacy service. I think that that is the main thrust of the
provisions, but not the exclusive one.
I will just add an insight
before I speak on the issue of advocacy. I feel that I have irked the
Committee because I served on the Committee which considered the Mental
Capacity Bill. Let me pick up the issue of the nearest relative and the
interesting remarks made by the hon. Member for Stafford. As a
professional—I am somebody who admires professionals from
afar—he understands the importance of not getting into too much
legal process, if that can be avoided. On reflection, it strikes me
that after 25 years we are sitting in a world in which legal process
comes first and the rest nowhere. We all know why that is, not least
because of the very severe powers of detention that exist under the
Mental Health Act 1983.
In developing the code of
practice, I hope that the Minister will emphasise wherever possible
alternative means of resolving disputes—mediation and otherwise.
I believe that advocates could be active participants in that. One of
the difficulties for people who have mental health problems and who may
have other and multiple problems—they may not be very articulate
and may not have mental capacity either—is to find somebody who
can express their views and opinions so that they
can have a civilised dialogue with the psychiatrist or other
professional in order to map a sensible course of treatment or to
challenge the treatment that is already being prescribed for them. That
is a grown-up debate that we need to have. Frankly, some of the people
involved and the carers and relatives themselves need support in
articulating that role. In our constituency work, not necessarily
linked with mental health, we are desperate to find out what
constituents want in order to come up with some means of helping them.
Therefore, the more that we can take the law out of the
area—necessary as it is—and make it at least possible to
have a grown-up discussion between articulate, well-trained, reasonable
and engaged professionals, the better it will be.
On advocacy, I think that the
innovation in the Mental Capacity Act 2005, which the Minister was
engaged in, was an entirely sensible one. It came from the common sense
of the Committee, as there is common sense in this Committee, that we
should move on that matter. As hon. Members have already said, the
exact nature of an advocate may change over time. The ones who are
appropriate and the categories of people for whom they are appropriate,
have got to be considered. It has been left rather late in the Bill,
but I hope that it will proceed.
If I may simply put down a case
for advocacy, I would put it in terms of the principles set out
in clause 10. There are two of those in particular. The first
is
“respect for
patients’ past and present wishes and
feelings,”
and the second
is the need to minimise “restrictions on liberty.” We
could have an endless and rather fruitless philosophical debate about
whether provisions for advocacy under the 2005 Act bear on more serious
cases—and in certain instances, more life-threatening or
life-changing decisions—than those dealt with under mental
health legislation. However, in both cases, wishes are extremely
important and need articulation and
support.
Thirdly, the
distinctive feature of the mental health legislation is that the power
of compulsory detention—the deprivation of liberty—hangs
over people. That is as strong a case for advocacy, perhaps an even
stronger one, than the one in relation to the 2005
Act.
We Committee
members have a general role to play, which we have not always
articulated. I sense that there will be debates in the next few years
about the powers of the state and coercion on one hand and, on the
other, the power of the individual and the need for the individual to
have appropriate support. We need to try to create parity between those
two needs. We will never decide what is needed at any one time and
needs may change over time. However, it is clear that there is a need
for somebody to stand up for a large population of distressed,
disempowered, perhaps not very articulate and very troubled people.
Such people need to be able to argue with officialdom in a way that
they can understand, because they are familiar with the terms, to
determine the best course for them, and their carers or relatives. That
is self-evident and, in the long run, it will be for the good of the
system and will not necessarily cost more.
The system would really be
destroyed if the whole thing exploded into litigation because it was
improperly handled or, perish the thought, some dramatic
incident—an assault, murder or whatever—took place
because the people in the system had not been adequately supported.
That is a strong argument for a move in the direction that the
Committee seeks through the new clauses and I do not think that the
Minister has ruled it out. We look forward to her
assurances.
Ms
Winterton:
I will be brief, as our debate has been
slightly curtailed due to the Liberal Democrat’s choice of
mental health as the subject for its Opposition day debate, which is
rather unfortunate, given that we were going along very well. I should
like to emphasise a couple of points for my hon. Friend the Member for
Stafford and the hon. Member for Tiverton and Honiton. It is important
to remember—it came up a couple of times—that the person
who has lived with someone for five years will be the nearest
relative.
Mr.
Kidney:
Is my hon. Friend planning to amend the 1983 Act
to say what she has just said? Currently, section 26(7) says that
someone who is not a relative and has lived with a person for five
years can become a relative in the list—but they are at the
bottom, not at the
top.
Ms
Winterton:
I gather that it will be fine.
[Laughter.] I promise to write to my hon. Friend about that.
That is the intention. It is also true to say that a person who has no
relationship and intends to have no further relationship with the
patient would be unsuitable to act or to continue to act as the
patient’s nearest relative. This goes back to striking the right
balance on a difficult issue. I assure my hon. Friend that I take on
board his comments. I hope that he is reassured. However, I am prepared
to look at the code of practice and see if there is anything that can
strengthen it. I have had meetings with carers organisations
about whether there could be too much movement in the opposite
direction on this issue.
I am grateful for the
contributions made by all the hon. Members who spoke on
advocacy—particularly my hon. Friend the Member for Hackney,
South and Shoreditch, who is a strong proponent of advocacy and who
made a very good speech about the importance of making sure that we get
it right. There were some helpful suggestions, and I hope that both she
and my hon. Friend the Member for Stafford will return to their local
organisations in the knowledge that their views have been reflected in
the debate. The same is true of the views of Opposition
Members—they have helped us to formulate the very best
solution.
I ask that
the Committee support clause 29 and reject the new
clauses.
Question
put and agreed
to.
Clause 29
ordered to stand part of the
Bill.
Further
consideration adjourned.—[Claire
Ward.]
Adjourned
accordingly at twenty-six minutes past Six o’clock till
Thursday 10 May at twenty-five minutes past Nine
o’clock.
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