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The Earl of Caithness: I am grateful to the noble Lord, Lord Clinton-Davis, and to my noble friend Lord McColl of Dulwich for their able support for my amendment. Having heard the Minister's remarks, I must congratulate the noble Lord, Lord Alderdice, even more strongly than I did to begin with. The noble Lord, Lord Wedderburn of Charlton, put his finger on the pulse: if the Minister intends to use Section 60 of the 1999 Act, we do not have a hope of having a discussion anything like we have had this afternoon in this kind of atmosphere, constructively trying to get some agreement. We shall be presented with an affirmative resolution, which we either take or leave. We cannot amend it; and we shall not have any sort of sensible discussion on these issues. Indeed, what the Government decide will be forced upon us.
By bringing forward the Bill and allowing for such discussion, the noble Lord, Lord Alderdice, has not only done this House and Parliament a huge service; he has also done the whole of the psychotherapy world a bigger service than I expected. I hope that the Minister will not kill the Bill too prematurely. I believe that this sort of discussion is extremely beneficial. It will also benefit the Minister's negotiations with the bodies concerned. They will be mightily confused because, after having talked to the noble Lord, Lord Alderdice, for so long, they will now have to face the challenge of having to talk to the Minister's civil servants.
The reason for my amendment was confirmed by what the noble Lord, Lord Alderdice, said at the beginning of his remarks. He said that the results of the discussion of the sub-committee would be an
authoritative word on the subject. When you have two bodies of the Freudian and the Jungian sets, if I may so describe them, that are divided--my division is more 50:50 compared with that of the noble Lord, Lord Alderdice; but that is immaterial--by such a long-standing philosophical split, I think that such a sub-committee offering the authoritative word will lead to many problems.In view of what the Minister said, I believe it would be quite wrong for me to press my amendment at this stage. The more discussion that can take place between now and a later stage--indeed, even at a later stage--the greater the benefit will be. I am so glad to note that we are all on the same side as regards trying to get a sensible solution to the problem. I wish the noble Lord, Lord Alderdice, well in his discussions before we reach the next stage. I beg leave to withdraw my amendment.
Amendment No. 2, as an amendment to Amendment No. 1, by leave, withdrawn.
On Question, Amendment No. 1 agreed to.
Lord Alderdice moved Amendment No. 3:
- Page 9, line 27, at end insert--
The noble Lord said: My Lords, aside from the differences occasioned by different psychological theories and by the range of skills and procedures that may be brought to bear on psychological disorders and on their sufferers--we have already discussed something of the range involved--there are also differences occasioned by the varying settings and patient groups.
As someone who has worked both inside and outside the NHS, I am aware of the special and more onerous responsibilities usually borne by NHS facilities and practitioners. This was a matter mentioned by the noble Lord, Lord Burlison, on Second Reading. Forensic psychotherapy is also practised in a setting--namely, the criminal justice system--which has very particular problems and requirements. Moreover, working with children is much more than just working with small adults. Indeed, working with young people is a specialism that is quite separate from that of working with children or with adults.
Those reasons have led me to propose Amendment No. 3, which would open up the possibility of advisory committees dealing with particular groups, or settings. That would include psychotherapy with children, psychotherapy within the NHS and psychotherapy within the criminal justice system. These are not intended to be separate modalities with separate theories, and so on. In a sense, they are cross-cutting issues that bring together therapists from different
On Second Reading, the noble Earl, Lord Listowel, mentioned his own extensive experience in working with young people. I believe that both he and others in that field will be aware that those who work with young people do not necessarily do so in all the same modalities. There are some who come with group-work background; there are some who come with a humanistic background; and there some who come from a more psychoanalytical background. The proposal for advisory committees is an effort to try to help bring these cross-cutting issues together. They are not separate modalities but they constitute no less important differences. That is why I have opened up this new way of addressing them in the structure of the Bill. I beg to move.
The Earl of Listowel: I speak in support of the amendment. It was my privilege some time ago to visit Buffy House, Centrepoint's facility for homeless young people with high support needs; for instance, young people who self-harm or who have previously drifted from hostel to street to hostel. For several years a psychotherapist working with the staff as a group helped them to make sense of the troubling behaviour of their residents and the sometimes disturbing feelings that behaviour called up in the staff. Before and after my visit I heard from several practitioners in the field--workers with young homeless people--about how very good Buffy House was at preventing troubled young people returning to the street. I have met on several occasions one resident who was in the habit of harming herself. She still has crises but she is sufficiently recovered to exhibit and obtain commissions for her art work. The staff of Buffy House were recorded as taking the least sick leave of any within the whole Centrepoint organisation. They worked with its most challenging clients.
I welcome the amendment because it provides the flexibility to include within this legislation innovative practice in different settings of the kind I have described.
Lord McColl of Dulwich: I, too, support the amendment which is a very constructive one.
Lord Hunt of Kings Heath: I welcome the amendment of the noble Lord, Lord Alderdice. The suggestion that advisory committees be established is a sensible one. However, in specifying the areas where committees should be established, is there not a danger of being inflexible and over-constraining the work of what in the end will be a self-regulatory body?
I respond to the comments of the noble Earl, Lord Caithness, on the Section 60 process. At the moment I am examining Section 60 processes in relation to the Health Professions Council which includes professions such as physiotherapists and chiropodists. Great care is being taken to talk with the professions and to take them and consumer interests with us in this
The Earl of Caithness: I am grateful to the Minister for giving way. I do not dispute what he says. I well remember undertaking those consultations myself. However, when the measure comes to the Chamber, there is nothing we can do about it. Therefore, our discussion is limited. We have to accept what the Government have produced for us or else reject the whole order.
Lord Wedderburn of Charlton: I am not sure whether my noble friend has finally sat down. I address a specific point in his remarks. Words matter and this debate matters a great deal to the forward march of the proposals among those who are perhaps by custom prone to disagree. He said that the measure is too inflexible. I ask the following question which deserves an answer. How would the order be more inflexible than setting up advisory committees in regard to groups and settings? How would he be more flexible than that?
Lord Hunt of Kings Heath: I think that there is a great argument for flexibility in the arrangements, certainly as far as any Section 60 proposal is concerned. One might take the view that it should be left to the regulatory body itself to decide in the first instance which advisory group should be set up. That was simply my point.
Lord Alderdice: An interesting question has been raised both by the Bill and by the Minister's response in terms of the use of Orders in Council and, indeed, by the comments of the noble Lord, Lord Wedderburn of Charlton.
In another setting, I have a measure of responsibility for legislation going through a unicameral assembly. That is also the case now in Scotland. We have increased the number of scrutiny opportunities, which were somewhat limited under the original Act. I suspect that we shall follow the good example being set by our colleagues in Scotland who have moved to pre-legislative scrutiny. It almost appears that a Private Member's Bill gives the opportunity for pre-legislative scrutiny of a possible Order in Council. What goes round comes round, as they say. I still want to hold the Minister to his promise that some measure will be brought forward.
Perhaps I may press the amendment. The noble Lord, Lord Wedderburn, made this point. My amendment states that,
The same argument applies to those who work in psychotherapy in the criminal justice system. Psychiatry in the criminal justice system is in a small minority. In Northern Ireland, during a period of serious civil trouble, there was no forensic psychiatrist let alone a psychotherapist. There is reasonable concern among those who work in relatively small specialisms. These provisions address that concern.
Whereas in most health professions the overwhelming majority of practitioners are employed within the NHS and only a small number are employed outside, in psychotherapy the overwhelming majority of practitioners work in the private, community and voluntary sectors. Only a small minority of those who call themselves psychotherapists are employed within the NHS. Many others--doctors, nurses, psychologists and social workers--practise psychotherapy within the NHS. But most of those who fall within the remit of the Bill and who wish to describe themselves as psychotherapists work outside the NHS. The NHS is the specific responsibility of the Government and Parliament. That is why the concern needs to be addressed, although in the most permissive way that I could devise.
I am grateful to noble Lords for their thoughts and responses. I commend the amendment.
On Question, amendment agreed to.
Clause 11, as amended, agreed to.
In the schedule:
("( ) The Education Committee may, where it deems fit, establish Advisory Committees in respect of particular patient groups or settings.
( ) The Education Committee shall in the first instance give consideration to the establishment of Advisory Committees for--
(a) psychotherapy with children,
(b) psychotherapy within the National Health Service, and
(c) psychotherapy within the criminal justice system.").
5.45 p.m.
"The Education Committee shall in the first instance give consideration".
It does not state that such committees shall be formed but simply that the committee "shall give consideration". Why? It is perhaps a sad reflection on our society that only a small number of therapists
work with children. Anxiety has been expressed on many occasions that in the hurly-burly of the psychotherapeutic world the interests and concerns of those who work specifically with children might have relatively little weight. Therefore the Bill requires that someone who has a qualification in child psychotherapy shall be on the education committee. That is to reassure the relatively small minority who work with children that they will have their say.
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