| Previous Section | Back to Table of Contents | Lords Hansard Home Page |
Lord Macaulay of Bragar: I said at the outset that this was a rather convoluted amendment. At this time of the evening it is rather difficult to follow the explanation in response by the noble and learned Lord the Lord Advocate. It might be better to leave it until tomorrow to see the Official Report. No doubt what the noble and learned Lord said will be looked at with interest. It is not without significance that there is a ship in the harbour at Dundee called the "Discovery". Perhaps the Government will take a voyage of discovery and in due course report back to the House on their findings. I hope that they find a pilot when they get to Dundee. We shall see how it works out. In the meantime, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Clause 6 [Effect of hospital direction]:
Lord Macaulay of Bragar moved Amendment No. 99:
The noble Lord said: The objective behind the amendment is to retain some measure of control over what happens to an offender who has been dealt with by the court and who for some reason has to be moved from one hospital to another. The amendment does its best--it may not be a very good best--to paint a picture of the people who should be consulted before any change is made in the patient's status and to give the patient a measure of protection to ensure that any good work that has been done is not undone by moving him unnecessarily from hospital to hospital. I beg to move.
Lord Mackay of Drumadoon: We consider that this amendment is inappropriate. At an earlier stage the Government accepted proposals from the Opposition that the maximum time it must take to convey a person from court to hospital is seven days. We accept that, if a person is in immediate need of hospital treatment, they should go to hospital as quickly as possible. However, we must accept that within that seven-day period certain emergencies could arise in relation to the hospital concerned: a fire, a medical epidemic of some sort or a serious incident involving patients which would make it impracticable to admit the person as originally planned. In such an event the priority should surely be to get the prisoner to hospital so that the treatment can start, even if that involves going to a hospital different from that originally specified. If the Secretary of State had formally to consult and obtain reports from at least three more people, it is unlikely that that could be done within seven days. Pending its being done, the person would in any event require to remain in limbo, presumably in gaol, and their access to hospital treatment would be delayed.
The Opposition cannot have it both ways. If Members of the Committee are satisfied, as I am sure they will be, that the priority is swift admission to hospital to start treatment, some flexibility is required. I therefore hope that, to take care of the rare events that I have indicated, the noble Lord will be persuaded to withdraw this amendment.
The Earl of Mar and Kellie: I should like to return briefly to a point we were discussing before the dinner break; namely, the mental health officer's involvement. It strikes me that we are bringing a bit of English practice into this. In Scotland the normal process has been that the Scottish ambulance service takes people to hospital and the mental health officer--who is, after all,
I am worried that we are going down the English route, which ends up with social workers having to transport people in their own private cars. I shall not bore the Committee by reminiscing on my exploits with the social services department in Sheffield, but I believe that it is better that social workers should not have to transport such prisoners in private cars.
Lord Macaulay of Bragar: I am grateful to the noble and learned Lord the Lord Advocate for his explanation concerning what I have already described as a very delicate area of life. The main objective is to protect the person, who is not, to say the least, in a very fit or stable position. The noble and learned Lord said that these Benches could not have it both ways. We do not look at the matter in that way at all.
This is a specialist area in which, to be honest, I do not have any particular expertise--indeed, I doubt whether many Members of the Committee have such expertise. As laymen, we can only do our best to protect the individual from himself and protect society from the individual. I shall read with interest what the noble and learned Lord said. In the meantime, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Lord Sewel moved Amendment No. 100:
The noble Lord said: This is perhaps one of the more important amendments that we have discussed recently. Its effect is quite clear. It is to ensure that a person subject to a hospital direction is only transferred from hospital to prison when the sentencing court is satisfied that his mental health will not deteriorate as a result of admission to prison.
This is a very difficult and sensitive area. It concerns people whose mental health is such that they require help from the hospital services but who have achieved a state in which it is appropriate to move on to the more punitive aspects of the disposal. The amendment ensures that the decision to admit to prison lies with the court. That is important. That does not endanger the patient-doctor relationship. One can imagine a situation
Basically and fundamentally, the argument behind the amendment is that people should not be punished for mental disorder. They should be treated for mental disorder and not punished. The amendments are also designed to guard against the risk of transferring to prison offenders who would more appropriately continue to receive hospital treatment.
The amendment seeks to reduce the risks of persons being moved to prison and subsequently becoming ill as a result of the transfer. There is absolutely no point in bringing about a transfer from hospital to prison if that endangers the mental health of the offender. That is a legitimate cause for concern. We do no one any service by going down that path.
After all, what is the purpose of providing treatment? It is to improve the mental health of a patient. If a return to prison of itself would jeopardise the gains that had been made as the result of quite extensive hospital interventions in many cases. That is surely not in the public interest.
The amendment would provide a safeguard, through the independent scrutiny of the court, against the possibility of inappropriate or premature transfer brought about by a shortage of bed spaces or disruptive patient behaviour. Such subsequent changes in the way in which the offender is treated should come back to the court for decision and not be subject to a routine process. I beg to move.
Lord Mackay of Drumadoon: As the noble Lord, Lord Sewel, will be aware, these amendments were discussed in another place. At that time it was indicated that they were not acceptable to the Government, for reasons which I should explain to the Committee. We are not attracted by the proposals because they appear to be based on the assumption that hospital doctors will recommend to the sheriff, or indeed to the Secretary of State, a course of action which would run contrary to the patient's best interests; in other words, a course which would be injurious to his or her mental health.
We are dealing with these issues in the context of hospital direction orders, but they arise when prisoners are subject to a transfer from prison to hospital because they have become ill and are then transferred back to prison. Perhaps I should explain what is done on such occasions.
The Committee will appreciate that if the illness is recovered from or is sufficiently treated while the offender's sentence of imprisonment is still running and the patient does not require to remain in hospital, the only exit route from hospital is back to prison. But at the present time that can take place only when the Secretary of State is satisfied that certain criteria set out in the 1984 Act have been fully met. Those criteria are to be found in Section 74(2) of that Act. They are either
Before the Secretary of State makes an order, very detailed consideration is given to it. The condition of the patient will be thoroughly and painstakingly assessed by the doctors in the hospital in which he is detained. It goes without saying that no recommendation for the prisoner's return to prison will be made unless the doctors are satisfied that the statutory criteria to which I referred have been met. I am sure that the Committee will be satisfied that it would be difficult to suggest otherwise.
Furthermore, any recommendation from the hospital for return to prison is at present considered by the Secretary of State's own psychiatric adviser. I hope that the Committee will not misunderstand what is meant by that reference. I am sure that my right honourable friend would not do so. The psychiatric adviser requires to be satisfied also that the relevant criteria will be met before transfer to prison is authorised.
Our experience has been that the system has worked very well. That is an indication of the thoroughness of the procedure and the care taken by all psychiatrists who have occasion to handle prisoners who suffer from mental illness susceptible of treatment. I have already mentioned earlier this evening that there are some 60 transfers a year from prison to hospital, but a much smaller number of prisoners are transferred in the other direction, being somewhere in the region of only 20 every year. Most prisoners who leave prison to go to hospital remain there and are released direct into the community on expiry of their sentence.
We believe that that demonstrates the rigorous attention which those involved in the field of psychiatric health pay to treating those people. We doubt whether it would be appropriate to give an appeal by the patient to the sheriff for the reason that it would involve challenging the view of people who have had day-to-day care of the patient while in hospital.
However, there are other fundamental difficulties with what is proposed. If the sentencing court originally considered it appropriate to pass a sentence of imprisonment and at the same time to make a hospital direction, it would be wrong to go back to the court some months or even years later and effectively invite the court to reconsider the matter. The procedure in dealing with sentence is that the sentence is imposed by the trial court, subject to review by the Court of Appeal. It is the latter court which should set aside the original sentence, not the original sentencing court.
I hope the Committee will be satisfied that this issue has been carefully considered. The proposal is a new one to fill the gap in the scheme of sentencing, as I mentioned earlier. The alteration to our proposals spelt out in the amendments would not be of value; they
Page 15, line 23, leave out from ("appropriate") to end of line and insert ("and before making such a direction the Secretary of State shall consult and obtain reports from--
(a) the managers of the hospital concerned;
(b) the medical practitioners who furnished their reports to the court under section 59A(3)(a) of this Act;
(c) the mental health officer who appeared before the court pursuant to section 59A(d) of this Act; and
(d) any other person who, in the opinion of the Secretary of State, might be appropriate in the circumstances.
(3A) The Secretary of State shall not be entitled to name a state hospital when making such a direction.").
Page 16, line 8, at end insert--
( "(6) A patient shall not be remitted to prison in accordance with subsection (5)(a) above until and unless--
(a) the case has been referred back to the court that imposed the hospital direction; and
(b) the court is satisfied that the remittance to prison would not be injurious to the patient's mental health.
(7) In order to determine the impact of the remittance to prison on the patient's mental health, the court shall consider the written or oral evidence of two medical practitioners (complying with section 61 of this Act).
(8) Where a court is satisfied under subsection (6)(b) above that the remittance to prison would be injurious to the patient's mental health, the court may revoke the hospital direction and--
(a) impose a hospital order (with or without a restriction order); or
(b) impose no further penalty." "
8.45 p.m.
Next Section
Back to Table of Contents
Lords Hansard Home Page