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15 Jan 2007 : Column 436
Lord Foulkes of Cumnock: My Lords, I am very good at reading as well. They have been arguing for more money for waterways, for museums and galleries and for post offices. At the same time, Mr David Cameron and Mr George Osborne seek to cut the budget of the Government by £21 billion. Does my noble friend not discern some contradiction in those two positions?
Lord Truscott: My Lords, I agree with my noble friend. I think I will leave it at that.
Lord Roberts of Llandudno: My Lords, the Government propose to introduce 69 personal interview offices for first-time applicants for passports. Have they thought it through to see how that will again undermine our post offices?
Lord Truscott: My Lords, the way people buy goods and services is changing. A lot of people, for example, now buy their driving licence online; a lot of people pay by direct debit; the vast majority of pensioners now receive their pensions directly into bank accounts; and people increasingly use the internet. We have to recognise that the Post Office needs to change with the times as well.
Railways: First Great Western
3.05 pm
Lord Berkeley asked Her Majesty’s Government:
Whether the conduct of the new Great Western Trains franchise has met the Government’s performance criteria.
Lord Davies of Oldham: My Lords, First Great Western has met the Government’s performance criteria to date. Improving rail performance is nevertheless a key objective for the Government and joint action plans are in place between Network Rail and First Great Western to address performance issues. These are monitored monthly.
Lord Berkeley: My Lords, I am grateful to my noble friend. Does First Great Western’s meeting the performance criteria include the fact that 60 trains a day have been cancelled since December; that there is so much congestion in Bristol and the Thames Valley that people cannot even get on the trains; that some fares are up by 11 per cent and there have been 9,000 complaints; and that, meanwhile, First Great Western has sent 12 trains back to the depot to do nothing? Do the Government think that that is satisfactory? The Railways Act 2005 gave the Secretary of State the power to specify trains, numbers of coaches, stopping patterns and so on. Does the Minister believe that the Secretary of State actually has the time to do that, or even the expertise?
Lord Davies of Oldham: My Lords, Great Western meets the minimum contractual requirements but performance has long been poor compared with long-distance operations elsewhere on the network.
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The Earl of Mar and Kellie: My Lords, in Scotland the First Group is performing quite well on the ScotRail franchise as specified by the Liberal Democrat Minister for Transport. However, the department’s over-specification on the Great Western franchise is clearly leading to cancellations and overcrowding. Is the Minister satisfied that First Group is a competent organisation to be bidding for the east coast franchise, where very high standards are expected and have been for several years?
Lord Davies of Oldham: My Lords, each franchise bid is considered on its merits and First Group’s bid for the very important east coast main line franchise will be considered in due course. As the noble Earl will recognise, there have been weaknesses in train performance in the west of England. The rail authorities are appropriately making demands on the operator to ensure that the necessary investment is in place to improve performance.
Lord Marsh: My Lords, is it not a bit absurd for privatisation to be implemented and then for Governments to criticise and show surprise when the private sector’s decisions are not the same as the Government’s? Is it not time that we woke up to the fact that railway privatisation is verging on the edge of a disaster? It is about time that we at least re-looked at it.
Lord Davies of Oldham: My Lords, in the past decade there has been unparalleled investment in rail services, leading each year to a greater number of passenger miles than we have known before. Although punctuality is still not at levels that we want to see, punctuality even in the south-west was at 85 per cent, which is the norm across the network. We want to see improvement, and investment will produce improvement in more reliable rolling stock. The noble Lord should not underestimate the gains made in the past 10 years through government and private investment in rail.
Lord Crickhowell: My Lords, is it not more relevant that First Great Western so often fails to meet customers’ performance criteria? Far from the service improving, trains are more and more frequently very late or are cancelled.
Lord Davies of Oldham: My Lords, First Great Western is aware that it could have more constructively handled recent complaints by the travelling public about a weakness in service, particularly in the Bristol
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Baroness Warnock: My Lords, is the Minister aware—I am afraid that he may not be—that since the beginning of the year there has been almost a tripling of the cost of the journey on the First Great Western line which I frequently use because the trains have been rescheduled as long-distance rather than short-distance trains? On the past three occasions that I have travelled from Paddington to Great Bedwyn I have had to stand from Paddington to beyond Newbury, which is almost in Wiltshire. Does he agree that the claim that the rolling stock has improved and is fit for purpose is a bit of an exaggeration?
Lord Davies of Oldham: My Lords, it is certainly unacceptable for passengers regularly to stand during long journeys. The ambition is that passengers should not stand for journeys of more than 20 minutes. The noble Baroness has identified a weakness in the First Great Western service. As I indicated, some but not all of this is attributable to unreliable rolling stock, and that is being put right.
Lord Hanningfield: My Lords, the Minister did not mention that passengers are holding a day of protest, boycotting trains in the south-west on 22 January. Has he no comment on or support for that?
Lord Davies of Oldham: My Lords, what I hope will result from the passenger protest is a very clear appreciation by First Great Western that improvements are necessary and—as the noble Lord, Lord Crickhowell, indicated—that it will improve its passenger relations. I therefore hope that there will be a step forward on 22 January.
Piped Music and Showing of Television Programmes (Hospitals) Bill [HL]
3.13 pm
Lord Beaumont of Whitley: My Lords, I beg to introduce a Bill to provide for the Secretary of State to draw up a plan to prohibit piped music and the showing of television programmes in the public areas of hospitals and to require the wearing of headphones by persons listening to music in public areas of hospitals. I beg to move that this Bill be now read a first time.
Moved accordingly, and, on Question, Bill read a first time, and ordered to be printed.
Statutory Instruments Committee
The Chairman of Committees (Lord Brabazon of Tara): My Lords, I beg to move the Motion standing in my name on the Order Paper.
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Moved, in accordance with Standing Order 74 and the resolution of the House of 16 December 1997, that, as proposed by the Committee of Selection, the following members be appointed to join with a Committee of the Commons as the Joint Committee on Statutory Instruments:
L Dykes,B Gale,L Gould of Brookwood,L Kimball,C Mar,L Walpole.—(The Chairman of Committees.)On Question, Motion agreed to, and a message was sent to the Commons.
Concessionary Bus Travel Bill [HL]
Lord Davies of Oldham: My Lords, I beg to move the Motion standing in my name on the Order Paper.
Moved, that the amendments for the Report stage be marshalled and considered in the following order:
Schedule 1,Clauses 6 to 13,Schedules 2 and 3,Clauses 14 to 16.—(Lord Davies of Oldham.)On Question, Motion agreed to.
Mental Health Bill [HL]
3.15 pm
The Minister of State, Department of Health (Lord Hunt of Kings Heath): My Lords, I beg to move that the House do now again resolve itself into Committee on this Bill.
Moved accordingly, and, on Question, Motion agreed to.
House in Committee accordingly.
[The CHAIRMAN OF COMMITTEES in the Chair.]
Lord Carlile of Berriew moved Amendment No. 8:
(a) for paragraph (a), substitute— “(a) if he is a medical practitioner, to examine the patient and to arrange for another registered medical practitioner to examine the patient, or (b) if he is not a medical practitioner to arrange for two registered medical practitioners to examine the patient”; (b) in paragraph (b)— (i) for “him” substitute “them”, (ii) for “if it appears to him that the conditions set out in subsection (4) below are satisfied, to” substitute “if the requirements of subsection (4) are satisfied the responsible clinician shall”.15 Jan 2007 : Column 440
“(3A) The report to be furnished under subsection (3) shall be founded on the written recommendations in the prescribed form of the two registered medical practitioners including in each case a statement that in the opinion of the practitioner the conditions set out in subsection (2) are complied with and each such recommendation shall include—
The noble Lord said: My Lords, the purpose of Amendment No. 8 is to ensure that, before a patient’s detention is renewed, the renewal receives the same degree of consideration as the original order. The principle behind this is that the renewal of a detention might—and is often certain to—raise considerations as complex as those which underpin the making of the original order.
The amendment therefore requires that the process involved in the initial section is duplicated. This is achieved by requiring two medical practitioners to examine the patient before renewal can take place. I have already summarised how the renewal of an order on a patient, after six months or a year, raises the same issues as those in the decision to make the first order.
When a patient is in the first stages of a very acute crisis that gives rise to the original order, the symptoms the patient shows are often very florid. The diagnosis at that stage may make the initial order rather easier to make than a renewal some time later. When one reaches the stage of a potential renewal, it is very likely that the patient will have undergone some treatment and that their symptoms may therefore be less florid. They may appear, in certain ways, to be irrational. Irrationality, however, is not a qualification for falling into the category of mental disorder, as speeches, at least in another place, often illustrate.
I therefore suggest that to secure the safety of the patient—who may be in a rather more benign condition and may be at risk of misdiagnosis—the same quality of assessment, by appropriately qualified medical practitioners, is required. I do not begin to understand why the Government say that the examination by two medical practitioners is necessary only at the outset of the compulsory process. From talking to the many experts in this House on the diagnosis of mental disorder and various psychiatric conditions, and to many others involved in the world of psychiatry, I know that diagnosis does not necessarily become easier as the patient’s disease progresses.
The amendment also includes a requirement for examination and certification by two medical practitioners if the renewal is supervised by a health professional other than a medical practitioner. In this context, the 2004 Bill, which the Joint Committee considered, was an improvement on the Mental Health Act 1983, in that a renewal was overseen by the mental health
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Earl Howe: I support all that the noble Lord, Lord Carlile, has said, and I hope that the Minister will acknowledge that there is a real issue here that deserves a positive reaction from the Government. We have to listen to what the professionals are telling us. They are saying that renewing a detention order should not be an easy process, and that the 1983 Act facilitates the continuation of compulsory detention in too easy and straightforward a way. As the noble Lord said, the circumstances in which a decision to detain a patient is made initially are often much more clear-cut than those that obtain later, when the patient has received treatment and has been stabilised. At that later stage all sorts of question marks can arise over how ill a patient still is and what the nature of his illness is. Diagnoses frequently change over time, and they do not necessarily remain set in stone. All this argues for as much clinical rigour to be applied to the renewal decision after six months or a year as to the decision to detain the patient in the first place. If one accepts that idea, the proposals in the amendment are surely compelling.
We are at a time when increasingly the evidence base for medical decisions has assumed paramount importance, and rightly so. Any diagnosis of a mental disorder needs to be based on objective clinical evidence. The weight and validity of such evidence can only be evaluated by those who have the necessary medical qualifications to do so. I was 100 per cent with the noble Lord when he said that it should not be enough for someone who is not medically qualified and who may have played no part in the original decision to detain a patient to assume responsibility for renewing the detention order; yet that is what we shall get if the Bill goes through in its current form. The noble Lord was right to remind us that in the 2004 draft Bill renewals would have been overseen by a tribunal with access to a panel of experts, and in this Bill we no longer have that safeguard.
I am worried by the fact that we live in a risk-averse culture. If we leave decisions about renewal of detention to one individual—and not necessarily a medically qualified individual at that—we may well see defensive practice rearing its head even more than we do now. That prospect is not appealing. I hope the Minister will listen carefully to these arguments and above all will listen to the united voice of the profession, which is saying that the Government have quite simply got this one wrong.
Baroness Meacher: The Government have rightly upheld the 1983 Act requirement that a detention order, whether made under Section 2 or 3, must be
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It is important to note on a different side of this that the UK’s Council of Disabled People is opposed to these clauses, which extend the range of professionals who can detain patients. It asserts that,
- “individuals will not have the same positive therapeutic relationship with their counsellor, psychologist, psychotherapist or community mental health nurse if they have detainment powers. It is less likely that individuals will seek help if the healthcare professional has these powers”.
That is the service user view. The professional view on the one hand and the service user view on the other seem to line up behind one another.
I understand that the assumption behind the proposed change is that a skilled psychologist may be able to decide upon the renewal of detention in the case of patients with personality disorders whose treatment may be predominantly psychotherapeutic or educational. I agree that in cases where there is no mental illness a consultant clinical psychologist could act as the responsible clinician. However, if the Government wish to leave the legislation open to this possibility—in my humble view, reasonable—then the Bill will need to be amended to clarify the extent of qualification required for the job. My key point is that the legislation must also be clear that for the renewal of detention of a patient with a mental illness—we are talking about a psychosis here—two medical recommendations should be required, just as the Bill requires for the original detention. It is a matter of being clear about psychotic illness on the one hand and personality disorder on the other.
We have a personality disorder unit in the East London and The City Mental Health NHS Trust, where I am chairman. My understanding is that the treatment regime for our patients in the unit can be complex, including a mixture of medication and a range of therapies. In such cases two medical recommendations would be essential. Of course, if the therapeutic benefit test amendment is lost and people can in future be detained for behaviour, control and education alone, then we could find that a nurse who is providing some basic skills classes could approve the renewal of detention in order to continue her classes. I am sure that this is not the intention of the Government. I raise this slightly extreme example only because I think that we need to be conscious of where this Mental Health Bill is leading our mental health services. Is this really the direction of travel that we want?
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