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Lord Skelmersdale: My Lords, before the noble Lord answers that point, perhaps I may say, as a Member of the Joint Committee on Statutory Instruments, how much I welcome this Motion. The joint committee deals with some 3,000 statutory instruments a year. The idea of having what one might call the "double jeopardy" of two committees of the two Houses considering orders under the Deregulation and Contracting Out Act fills me with total horror, so I congratulate the House authorities, led by the noble Lord the Chairman of Committees, on the Motion.

The Chairman of Committees: My Lords, I am grateful to the noble Lord, Lord Skelmersdale, for his intervention. He has considerable experience of such matters in your Lordships' House.

Turning to the issue raised by the noble Lord, Lord Monkswell, the first point to bear in mind is that when the documents first go before the Select Committee, the Delegated Powers Scrutiny Committee, they are not yet orders; they are proposals only. I am happy to say that I am this very day able to give the noble Lord an example of the way in which the provisions will come to the notice of your Lordships. Indeed, I am grateful to have this information. The Minutes of Proceedings which came out this morning contain a reference to one such document which arrived only yesterday. When that document has been before the Select Committee it will then become an order. To illustrate that point, perhaps I may mention particularly Item 11 in the Minutes which states:

It then refers to the proposal for the Draft Deregulation (Greyhound Racing) Order 1995.

I commend the Motion to the House.

On Question, Motion agreed to, and a Message was sent to the Commons to acquaint them therewith.

Jobseekers Bill

Lord Lucas: My Lords, on behalf of my noble friend Lord Mackay of Ardbrecknish, I beg to move the Motion standing in his name on the Order Paper.

Moved, That it be an instruction to the Committee of the Whole House to whom the Jobseekers Bill has been committed that they consider the Bill in the following order:

Clauses 1 to 18,

Schedule 1,

Clauses 19 to 37,

Schedules 2 and 3.—(Lord Lucas.)

On Question, Motion agreed to.

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Mental Health (Patients in the Community) Bill [H.L.]

11.44 a.m.

The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege): My Lords, I beg to move that the House do now again resolve itself into Committee on this Bill.

Moved, That the House do now again resolve itself into Committee.—(Baroness Cumberlege.)

On Question, Motion agreed to.

House in Committee accordingly.


Clause 4 [Community care orders]:

Lord Carmichael of Kelvingrove moved Amendment No. 70:

Page 17, line 2, leave out from beginning to ("may") in line 4 and insert:
("Where a patient—
(a) is liable to be detained in a hospital under section 18 of this Act; and
(b) has attained the age of 16 years,
either the responsible medical officer or a mental health officer or both jointly").

The noble Lord said: I hope that the Minister will be able to supply good answers to this amendment which strikes me as being important. The effect of the amendment would be to limit community care orders to people who have been on long-term sections—that is, for six months. It would ensure that only people over the age of 16 can be subject to community care orders, and would enable an application to be made by either the mental health officer from the social work department or the responsible medical officer, or in some cases perhaps both.

We understand that the intention of the Government is that the new orders should apply only to people who have serious mental health problems who have been on long-term sections. We understand that that is the intention of what will be new Section 35B. That appears on page 18 at lines 37 to 40. However, on examining the provisions, we do not believe that they would achieve that result. Under Sections 24 and 26 of the Mental Health (Scotland) Act a person can be detained in hospital for a total of 31 days. An application could then be made for a community care order during the last three days of the patient's detention. I hope that the amendment would remove that possibility.

Turning to children and young people, the English provisions (which appear in Clause 1, on page 1, line 12) limit supervised discharge to young people who have attained the age of 16. The reason would appear to be that such young people would more appropriately be dealt with under the Children Act. Similar concerns would apply to young people in Scotland, who could have the benefit of supervision by the social work department and reference to a children's panel.

Is it appropriate for the application to come from the responsible medical officer in all cases? It is the social work department which takes the lead role in community care after the medical officer has done his

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work. The social work department continues the work. There may be times when a mental health officer (MHO) would want to initiate the process. We believe that it would be more in keeping with the care programme approach of community care if an application was made jointly by the RMO and the MHO. I believe that this amendment is fundamental, and I hope that the Minister will be able to satisfy the Scottish people on it. I beg to move.

The Earl of Lindsay: In moving this amendment, the noble Lord is seeking to limit community care orders to those detained under Section 18 of the 1984 Act and to patients who are over 16 years. The amendment allows application for the order to be made by the responsible medical officer, any mental health officer, or both. I regret that we are not able to accept any of those suggestions, and I shall explain why.

I think it is only proper that community care orders should be made available in respect of any patient detained in hospital under Section 18 and those detained under Part V, which includes those detained following their involvement in criminal proceedings. The discharge arrangements of such patients are rightly a matter for the responsible medical officer. It is only appropriate that community care orders should therefore be available, as indeed leave of absence already is, as a further stage in rehabilitation. We are not, of course, considering restricted (or "state") patients here; responsibility for their case management ultimately rests with my right honourable friend the Secretary of State for public safety reasons. But I am sure that the noble Lord would not seek to hamper the rehabilitation of any patient.

On the question of an age limit, I think we can all appreciate that the detention of children under the age of 16 years in a psychiatric hospital is a disturbing topic. However, the existing position is that it is possible for a child to be detained in hospital, but it is recognised that this should not be used for children unless absolutely necessary.

If there is the possibility of a person under 16 being detained in a hospital, it is also fair that that person should have the same rehabilitation opportunities as all others so detained, including community care orders. It is for this reason that the age limit of 16 years should not be imposed. Again, I am sure that the noble Lord would not wish to hamper any person's rehabilitation.

We do not consider it appropriate that the mental health officer in addition to, or instead of, the psychiatrist should be allowed to make the application. Where patients are currently maintained in the community on leave of absence, the medical lead is particularly strong. The responsible medical officer can bring a person back into hospital without the need to consult anyone else involved in the patient's care.

With the indulgence of the House, I should like to clarify a point made by my noble friend the Minister in the course of Tuesday's Sitting. A responsible medical officer in Scotland is not required by statute to be approved for the purposes of Section 20 of the 1984 Act. However, he is required to be employed on the staff of the hospital and must be authorised by the managers

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of the hospital to act as a responsible medical officer. In practice, we understand that it is rare for a responsible medical officer not to be approved for the purposes of Section 20. The terms in which the special medical officer is defined in new Section 35A(4) (b) introduced by Clause 4 therefore follow the common practice in relation to responsible medical officers in Scotland.

The leading role of the medical professionals under the community care order reflects the necessarily high level of medical content. The aftercare officer must nevertheless support the application for the order before it can go forward. The initial impetus in making an application for a community care order must remain with the psychiatrist. The patient is previously liable to be detained in hospital, and the psychiatrist must be the first person to decide whether the patient is making sufficient progress.

I very much regret that we do not consider the idea of a joint application to be appropriate. It would be complex. We have nevertheless given both the doctor and the social worker a very significant role. In effect, by the time the matter has reached the sheriff it will have become a joint application. I believe that that answers the point made by the noble Lord. There is a significant involvement by either the mental health officer or aftercare officer in the progress of the application. On those grounds, I hope that the noble Lord will feel able to withdraw his amendment.

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