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Baroness Barker: My Lords, it is a great pleasure to take part, for the first time in many years, in the debate on the gracious Speech. The greatest pleasure this afternoon has been that of listening to the maiden speeches made from the Benches opposite. They were fine speeches and I congratulate all those who, for the first time, have known the terror of speaking in your Lordships' House.
I have something of a challenge before me, speaking for the first time as an opposition health spokesperson from these Benches. I have to speak on a gracious Speech in which there is practically nothing about health. It is rather like the curious incident of the dog in the night; it was not there. What is going on in the world of health is taking place in the background to the speech, and that is partly what I want to explore.
Curiously, most of the health proposals emanate not from the Department of Health but from other departments. There is nothing new in that; we are familiar with health policy originating in the Treasury. As my noble friend Lady Miller said, it is a shame that Defra has not been more involved in the formulation of health policy because then we might truly begin to consider the environmental causes of ill health. But when health policy starts to emanate from the Home Office, it is time to be worried.
The Liberal Democrats have a long and proud tradition of support for the NHS. It has always been our belief that, while people have ultimate responsibility for their own health, it is the role of government to remove barriers and to create opportunities for people to make healthy choices. Every day the NHS has successes in achieving this. Skilled and dedicated professionals,
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including NHS managers, are used every day to deliver, efficiently and effectively, life chances to people which in times gone by they would not have had.
For us, health is an essential part of liberty—it is perhaps one of the greatest contributions to the freedom of citizens in our society—and I want to consider what is happening in the world of health against that perspective. We on these Benches very much welcome the Disability Discrimination Bill, which extends the duties of public authorities to eliminate unlawful discrimination against and harassment of disabled people. It is long overdue. The legislation will be ably steered from these Benches by my noble friend Lord Addington.
We also welcome the opportunity to discuss the details of the Mental Capacity Bill. This legislation has been in gestation since the Law Commission report in 1995. It is urgently needed to protect the rights of some of the most vulnerable people in our society. People who lack capacity need the full force of primary legislation to enable them to make known their wishes and to have their preferences taken into account by service providers. There are many aspects of the Bill which we on these Benches welcome, not least the proposals which will make the Court of Protection more accessible.
However, there are two major aspects in which the Bill is deficient. First, the proposals to change the powers of attorney remain unclear. The Bill does not specify at which point a lasting power of attorney will be triggered. Without any such guidance it is difficult to see how a third party, such as a bank, will know whether or not a power of attorney is operative. Furthermore, there are no proposals to monitor lasting powers of attorney. Without such safeguards, proposals which are intended to offer greater protection could result in far greater abuse.
The second deficiency in the legislation is the lack of provision for an advance statement, a means by which a person can request treatment in advance. Some people with a temporary mental illness or a temporary incapacity would benefit from the ability to say in advance that if they were to become incapacitated for any reason they would wish treatment to be given to them even if at the stage they experience that incapacity that is not what they say. The Mental Health Alliance has stated:
"The importance of advance statements for patients should not be underestimated. They are a means of giving details of the care and treatment they would like to receive should they lack capacity. Advance statements can promote individual autonomy and can enhance communication between patients and those involved in their care".
The gracious Speech also mentioned the draft Mental Health Bill. I am delighted to be a Member of the Joint Committee which is currently scrutinising the draft Bill. If ever there was a Bill which needed scrutiny, this is it. In his introduction the noble Lord, Lord Warner, gave an extremely benign and brief description of the Bill. I do not want to pre-empt the recommendations of the Joint Committee but it is fair to say that, from the evidence submitted to date, there is a deep and widespread fear that measures which
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should be confined to the relatively few people who have a severe mental illness which makes them a danger to other people will be extended to many people who have a mental illness but should not be treated in such a way.
Furthermore, there is a widely held view that much of the benefit currently derived from therapeutic services entered into by service users on a voluntary basis will be lost because of the extension of compulsion. When we have the opportunity to debate the legislation in detail, we on these Benches will be arguing very hard that there should be reciprocity; that any compulsion should be matched by entitlement to appropriate care and treatment.
It has been interesting to consider both Bills—not quite together but in parallel—not least because it has enabled parliamentarians to become familiar with a problem known as the "Bournewood Gap". I do not intend at this stage to give the House a detailed briefing on that, not least because I know that the noble Lord, Lord Filkin, knows all about it. I simply say this: situations arise where people enter treatment as voluntary patients and there comes a point where service providers deem that the patients do not have the capacity to make a decision about their ability to leave such treatment, and they are subject to detention. That has been pointed up as unlawful by a recent European Court of Human Rights ruling. It is a matter that this House will have to spend a great deal of time discussing to ensure that citizens are not unlawfully detained.
On every Bill in which I have taken part in your Lordships' House, one issue has arisen time and again—that is, the need for advocacy services. On any health and social care Bill in which I have taken part the issue of independent advocacy has arisen. The Government have danced around the matter in various Bills. Sometimes they have dodged the issue because of a lack of definition; sometimes they have been straight up and said that it is a matter of resources.
The Mental Capacity Bill presents us with something called "independent consulteeship". This appears to be advocacy that does not dare to speak its name. It is a limited form of advocacy which is supposed to be confined solely to those who do not have a friend in the world. That presupposes that carers and families always act in the best interests and according to the wishes of all patients and vulnerable people. While that is so in the majority of cases, it is not universal.
We shall have to wait until after the general election to see the legislation which flows from the White Paper on public health. It is sad that the Government are choosing to delay some of the measures in the Bill and seeking further consultation when it is evident that there is widespread public support for many of them. If we had simply got on with implementing them it would have been to the benefit of everyone's health.
One of the key issues in the gracious Speech is the drug and alcohol abuse Bill. We will study its provisions with care. Alcohol abuse has a devastating
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effect on health and social care. I learnt recently that in an inner London borough 95 per cent of all children in care are there because of problems with alcohol and drug abuse within their families.
On a recent visit to mental health facilities in south London, we were told by service users and staff, in very graphic and powerful terms, about the extent to which alcohol and drugs are contributory factors to mental health. What was most alarming is that while service users told us of an urgent and deep need to receive treatment, the waiting times for access to treatment were anything up to eight months or a year. The Government have talked about the need to expand treatment but figures from the National Treatment Agency show that the Government's claims in this respect are overstated. It is a shame that the Government's alcohol strategy published earlier this year focused on the punitive aspects of legislation rather than on treatment.
We on these Benches believe that health policy should, above all, be about enabling people within communities to take responsibility for their own health and, through that, to liberate them and their families. I hope that the Department of Health will be resolute in its discussions with the Home Office about deciding where responsibility for health lies.
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