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Lord Mackay of Drumadoon: The issue which arises in Amendment No. 93 is to some extent related to that which also arises in Amendment No. 94. For the convenience of the Committee, perhaps I may explain the Government's position. We do not consider it would be appropriate for a mental health officer, who would be a local authority official, to have in any sense a right of veto over a court's consideration as to whether to impose a hospital direction. That would, we believe, be the effect in particular of Amendment No. 93. It refers in paragraph (b) to confirming that,
- "in the opinion of the mental health officer, a hospital direction would be the only appropriate disposal in all the circumstances of the case".
It is for the court to decide the matter in the light of the medical evidence laid before it. We do not think this is an instance where the mental health officer can have a role of the nature which lies behind Amendments Nos. 93 and 94.
Lord Macaulay of Bragar: I am grateful to the noble and learned Lord for that explanation in relation to Amendments Nos. 93 and 94. I quite accept that the amendment as presented to the Committee is defective. Perhaps instead of "the only appropriate disposal" it should read "might be an appropriate disposal". That would leave the discretion to the court. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Lord Macaulay of Bragar moved Amendment No. 95:
The noble Lord said: This is the last of this group of amendments relating to mental health. Again, it is self-explanatory. The reasoning behind it is that it should not be the responsibility of the local authority to convey prisoners--call them what you may. The police or the prison or hospital authorities should bear the burden of transport rather than putting it on the community. With that short explanation, I beg to move.
Lord Mackay of Drumadoon: Again, we believe that this amendment is unnecessary. It seeks to define who should convey a person to a place of safety. The court already has power to make additional directions as
Lord Macaulay of Bragar: I am grateful to the noble and learned Lord for that explanation, but what options are open to the court? Who is going to take the person at the behest of the court? Will it be the police or what other options are open to the judge?
Lord Mackay of Drumadoon: The options are to be found in Clause 6 at the foot of page 14 of the Bill:
That leaves flexibility to the court in a way which this amendment might not. The section is referred to in the amendment and, on reflection, we hope that it will not be insisted on.
Lord Macaulay of Bragar: With that explanation, I also shall be flexible. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
The Earl of Courtown: I beg to move that the House be resumed. In moving that Motion, I suggest that the Committee stage begin again not before five minutes past eight o'clock.
Moved accordingly, and, on Question, Motion agreed to.
Page 14, line 6, at end insert--
("(8) The conveyance of the person mentioned in subsections (6) and (7) above shall only be undertaken by such persons as specified in section 62A(1)(a) below.".").
7 p.m.
"A hospital direction [order] made under the [new] section 59A ... shall be sufficient authority--
(a) for a constable, a mental health officer, an officer on the staff of the hospital specified in the direction or other person directed to do so by the court to convey the person in respect of whom the direction has been made".
7.2 p.m.
Baroness Cumberlege rose to move, That the draft order laid before the House on 6th February be approved [12th Report from the Joint Committee].
The noble Baroness said: My Lords, the order before your Lordships creates an Arts Therapists Board under the Professions Supplementary to Medicine Act 1960. Arts therapists are specialist practitioners who use techniques to help clients with severe communication problems through painting, drama, music and other arts. The broad effect of the order is to extend the 1960 Act to include arts therapists along with chiropodists, dietitians, occupational therapists, physiotherapists, orthoptists, medical laboratory scientific officers, radiographers, and, as of this month, prosthetists and orthotists.
The board's function will be to promote high standards of professional education and conduct, within the umbrella of the Council for Professions Supplementary to Medicine (CPSM) whose duty it is to co-ordinate and supervise the activities of all the boards. The board's main duties are to prepare and maintain a register; approve training courses leading to state registration and the institutions providing them; determine applications for admission to the register on the basis of qualifications and experience acquired either in the UK or elsewhere; and to set up investigation and disciplinary committees to produce guidance on conduct and deal with individual cases of misconduct.
Practitioners who are registered by the board will be entitled to call themselves "state registered arts therapists". The use of that title by a person who is not registered will be an offence, as will the use of any title or description which falsely implies that he or she is registered under the 1960 Act.
The Act requires that the board should have a majority of members from the professions concerned. It is proposed to have 17 members appointed by the CPSM, of whom nine will be nominated by the profession in the first instance and thereafter elected by registrants. Of the remaining members, three will be doctors nominated by the Scottish and English royal colleges and one will be an expert in professional education; two will represent the interests of employers; one will represent the interests of patients and carers; and one will be from the health or social care professions other than medicine or the professions regulated under the Act. Neither patients nor employers have hitherto had a voice on boards. The creation of this board, and the recently approved Prosthetists and Orthotists Board, offers a good opportunity to fill that significant gap.
The size of the CPSM itself will also increase from 24 to 27 because the Act requires that all boards have a professional representative on council and that the number of medical and professional members should be equal. The third "lay" member preserves the balance of representation between professional, medical and other members.
The Act does not require the profession to do more than satisfy the CPSM, the Privy Council, and your Lordships' House that it is a profession supplementary to medicine. The underlying intention is, however, clearly to afford the public a degree of protection that it would not otherwise have.
Arts therapists comprise a small, highly specialised group--about 1,500 practitioners in the UK. All were originally hospital-based, but now increasingly work in the community, general practice, education, social services and prisons, generally in the mental health field. Only a minority (about 30 per cent.) are directly employed in the NHS, although practitioners in other sectors accept referrals of NHS patients.
The profession combines the three disciplines of art, music and drama. All share common approaches to training and practice, but vary in the medium used. All combine artistic proficiency with psychotherapeutic
techniques to enable patients with severe communication problems to express feelings which might otherwise remain unexpressed--in short, to promote self-esteem and personal growth through self-awareness. Patients typically include profoundly damaged people who may be beyond the reach of other therapies--child victims and adult survivors--and indeed perpetrators of sexual, physical and emotional abuse or other trauma; sufferers from acute depression, severe mental illness or behavioural problems, as well as those with progressive or terminal disease. The therapeutic process can be intense and sustained, and the techniques used are powerful and potentially dangerous to both patient and practitioner if mishandled, particularly where the latter is inappropriately trained or motivated. It is for this reason that members of the professions seek and are trained to provide a safe and secure environment in which to help healing.Admission to professional membership normally entails the possession of a degree in the creative discipline concerned followed by a period of one to three years' relevant work experience in health, education or social services. There follows a postgraduate diploma course of at least one year and mostly two years at an approved higher education institution. This UK model is one that a number of other countries, particularly in Europe, have adopted.
In their practice, arts therapists will often work independently or with limited supervision, but they readily identify themselves as members of multidisciplinary teams accountable to the clinician with overall responsibility. In turn, arts therapy is accepted by other professionals as making a valuable contribution to the treatment of a wide range of disorders. The profession has secured the support of representatives of medicine, nursing, psychology, and of all the groups now covered by the 1960 Act, for this proposal.
Essentially, the case for state registration of arts therapists is that it gives a clear and objective signal to the public and to colleagues making referrals. It ensures the high standards of training, conduct and practice that they can expect. The paramount interest is that of patients and carers who will often be in no position to judge the standing of practitioners. They can be assured that both those falsely claiming those standards, and those falling short of them, will be effectively dealt with. In addition, state registration will provide a benchmark for employers; offer an opportunity to strengthen the collaboration between the health professions; provide a coherent mechanism for dealing with overseas qualified practitioners, including those from the European Economic Area, wishing to exercise the right of freedom of movement; and assist in workforce planning by keeping a continuous record of the pool of qualified practitioners.
This measure, if approved, will provide a scheme of self-regulation at arm's length from government and funded by practitioners themselves. The Government are satisfied that arts therapists (though still a relatively young profession) have sufficiently developed to join the family of mature professions regulated by the CPSM, and I commend the making of this order by the Privy Council.
Moved, That the draft order laid before the House on 6th February be approved [12th Report from the Joint Committee].--(Baroness Cumberlege.)
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