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Lord Lyell: I wonder whether the Minister or any noble Lords who have spoken could give me some assistance over the definition of a 24-hour nursed bed, compared to in-patient facilities. Otherwise, perhaps they could tell me where I might look for information. I have had only one brief experience of the subject; many years ago, with my noble friend Lord Trefgarne, I visited the state hospital at Carstairs, with which the noble Baroness may be familiar. Perhaps the noble Baroness or my noble friend, or perhaps even the noble Lord, Lord Alderdice, could point me in the direction of a precise definition and set out what are the aspects of a nursed bed. I am learning a great deal from this debate and from all the work that my noble friend has done on this Bill. I should be grateful if the Minister could assist me, either during the debate today or in the future.

Baroness Ramsay of Cartvale: During the debate at Second Reading, I spoke in some detail about why the Government are unable to support this Bill. I shall not rehearse all those arguments again. Suffice it to say that the Government do not favour piecemeal changes to a complex piece of legislation such as the Mental Health Act. Significant changes to the legislative framework should, in our view, be taken as part of a full review of the Act. I can confirm that we are considering the need for such a review, and will take into account the views of all interested parties.

The noble Lord, Lord Rowallan, asked me whether a Green Paper would be published. My honourable friend Mr. Paul Boateng is taking a long, hard look at mental health and all related services. Nothing has been agreed yet, and discussion of the plans is therefore premature. At the appropriate time plans for mental health services will be looked at in the light of the comprehensive spending review, and we will set out our plans to build a new basis of confidence in our mental health services, making sure that we secure the welfare of those with a mental illness while safeguarding the public.

At that point, it will also be important to share our ideas with experts and professionals, as well as users, and to hear the range of views. We are committed to ensuring that the right structures, the right staffing, the right care systems, and the right legislation are in place. We are firmly committed to building those elements of effective mental healthcare and to building public confidence.

With the addition of the proposed amendment, Clause 1 of the Bill would now refer to two elements of services where the noble Lord, Lord Rowallan, would like to see specific action: separate in-patient facilities and 24-hour nursed beds. In response to the noble Lord, Lord Lyell, I shall attempt, perhaps inadequately, to give a definition based on my understanding of 24-hour nursed beds. These beds are not necessarily in hospitals--they could

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be in special homes or hostels--but they are covered by 24-hour nursing care. I see the experts nodding, so I think I have the definition right.

The noble Lord, Lord Thurlow, asked me specifically in his very interesting and well-received intervention what progress has been made in introducing 24-hour nursed beds. I am happy to say that some progress has been made. That has been assisted through targeted funding under the Mental Health Challenge Fund, which increased the number of such beds by 200. A further review of provision has recently been undertaken and we shall publish the results in due course.

To return to the amendment, separate in-patient facilities and 24-hour nursed beds are just two elements of a range of local services which we expect to see in health services strategic plans and available to vulnerable mentally ill people. The Government already support the concept of 24-hour nursed beds. Other elements include: acute hospital beds; hostels and supported housing; occupational rehabilitation; secure provision; crisis care intervention; day care; and a full range of effective treatments.

It is vital that health authorities should retain the flexibility to commission and develop services within government priorities and guidelines but according to local need. The original clause, and the proposed amendment, would severely restrict their capacity to do so. The Government therefore do not consider that there would be any merit in enshrining these provisions in legislation. Therefore we cannot support the amendment.

Lord Renton: I regret that the Government do not support the Bill. I was interested to hear that the Secretary of State is to consider the previous legislation on this matter. I wish to draw attention to the fact that both mental illness and mental handicap are covered by the present legislation. I hope that the Government will bear in mind that, whereas mental illness is often curable, mental handicap is quite incurable. People who suffer from mental handicap should be kept quite separately, in different types of hospital or other places, from those who are mentally ill. Will the Government bear that clear distinction in mind?

Baroness Ramsay of Cartvale: I note very carefully what the noble Lord has said. It will be on record and I am sure the Government will take it into account.

Lord Mottistone: In supporting this Bill, perhaps I may leave with the Minister the thought that the Bill's purpose is to ensure that there is accommodation for people who need it, and that they are not left out in the community when they should not be there. There are far too many instances where accommodation is not available for them. The noble Lord, Lord Alderdice, made these points specifically. I hope that the Government will pay particular attention to the noble Lord's contribution to the debate and to the remarks of other noble Lords.

It is all very well taking a long time to sort out what needs to be done about possible amendment to the Mental Health Act 1983--which would probably be a

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very good thing--but if in the meantime we have disasters because people are inadequately cared for in the community, and they do some harm either to themselves or others, then the Government are failing. Perhaps the Minister will encourage her honourable friend Mr. Boateng to get on with it and do something positive quickly. Then, Bills like this will not be required.

Lord Swinfen: Before the Minister replies, perhaps I may support the point made by my noble friend Lord Mottistone, but emphasise that such accommodation should be supervised. Very often, patients who are mentally ill can leave hospital and live in the community; but where they are on medication, if that medication is not supervised and they do not take it, their condition deteriorates. They can become dangerous to themselves or to other people. They might then need to go back into hospital, at considerably greater expense.

Baroness Ramsay of Cartvale: I very much appreciate the concerns raised by both previous speakers. I also appreciate that behind the Bill, the amendments and the statements by the noble Lords, Lord Rowallan and Lord Alderdice, there are excellent intentions. I would say to the noble Lord, Lord Mottistone, that, because we are taking care of what is, after all, a most important and wide-ranging piece of legislation and examining it very carefully, that does not mean that the Government, over the 10 or 11 months that they have been in office, have not been doing everything that they can to rectify the problems raised. I hope I made clear that, while we object to the Bill on some points of principle, our main objection is to having piecemeal legislation such as this.

11.30 a.m.

Lord Lucas of Chilworth: The noble Baroness's appreciation will come as somewhat thin beer to those of us who want something to be done now. While appreciating what the Minister said in her opening remarks in response to my noble friend Lord Rowallan, the problem is that, as she said, her right honourable friend and the Government want to take a long, hard look at this matter, it being only part of a much wider problem, and that in due course it might be felt necessary to have a full review. We are therefore a couple of years away from doing anything. No doubt after two years a Green or White Paper will appear and after another year or 18 months legislation may eventually appear before Parliament. That means that it will be five or six years before anything is done.

As all noble Lords who took part in the debate at Second Reading and this morning have said, this matter is urgent. Can the Minister tell us now what action she foresees to alleviate the situation underlined by this Bill?

Baroness Ramsay of Cartvale: I do not have the crystal ball which the noble Lord, Lord Lucas, has which tells him that it will be five or six years before anything is done and I shall not make any predictions. We are looking at the situation and are very alive to all

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the issues. There are already positive moves on many points raised by noble Lords today and at Second Reading. I am afraid that the noble Lord, Lord Lucas, will have to wait and see until the Government report on their careful considerations and consultations on this wide-ranging and important subject.

Lord Campbell of Alloway: Having listened to this fascinating and rather worrying discussion, perhaps I may ask the noble Baroness whether the Government are looking at the reform of certain existing statutes--and, if so, which--as part of the work they are doing or whether they are looking at the matter with a view to introducing an entirely new legislative structure. It would be interesting, and a source of comfort to many concerned, to know exactly what the Government are doing. I am not criticising from the point of view that the work will take a long time; the problem is serious and difficult. However, it would be interesting to know whether the Government are looking at the amendment of existing statutes or at an overall new approach in a new statute.

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