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8.20 pm
Lord Davies of Oldham: My Lords, I express my gratitude to the noble Lord, Lord Bradshaw, who introduced this debate with his customary insight and provided a framework for what has been a lively, although short, discussion on bus issues. I congratulate the noble Lord, Lord Marland, on his contribution and thank him for it. He came to the House with a reputation before him. He spoke trenchantly. He mentioned the words faux pas in the plural; I am not quite sure what the plural of faux pas is—he did not commit any anyway. In any case, we speak Norman French in this House, so the issue probably does not arise. I very much enjoyed his contribution and I hope that he will join in these transport debates, because there is no doubt that we gain a great deal from the exchange of views in the Chamber on these important issues.
I shall address the significant issues which the noble Lord, Lord Bradshaw, raised, but he was partly engaged by my noble friend Lord Snape, who indicated that it is all too easy to criticise existing operators from the perspective of the difficulties of getting into the market. He also said that a pretty heavy investment in buses is needed for regular and punctual services in urban areas. The disagreement between the noble Lords was more imagined than
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I was glad that my noble friend Lord Berkeley emphasised information about bus services and new technology. We are on the brink of enormous opportunities in being able to communicate with individuals in all circumstances where they wish to be engaged. Certainly, I cannot think of a situation in which people want more to be in the know than when they are at a bus stop and wanting to know when their local bus is going to appear. Those days when people would have to stand at the bus stop and hope and pray that the bus would arrive in the next hour, although it was timed to arrive in the next five minutes, ought to be behind us. We ought to reach a position in due course where not only are we able to communicate at the bus stop through screens and so on, but where people are able through their mobile phones to pick up signals of just where the bus is and arrange to meet it at a convenient time.
Punctuality is of the greatest significance for all forms of public transport. Nothing is more frustrating than the waste of time when one is expecting a service and then learns that it is not available, although it is advertised. Punctuality is especially important for buses because people often wait in rather more hostile environments than our railway stations or our airports might provide. Moreover, people who use buses are more inconvenienced by unpunctuality. If mothers with children or elderly people are standing at bus stops in unfriendly weather, punctuality is crucial. My noble friend Lord Berkeley said that we can, and ought to, improve punctuality through the structures which we impose on bus operators to improve performance. I accept his point, and the Government put a great deal of emphasis on it. However, I want to introduce the technological dimension, which will assist us in this area.
I was very pleased that the noble Baroness, Lady Scott, emphasised the significance of the bus for a large number of our fellow citizens, whose interests we need to put very much to the fore. I heard what she said about bus lanes, but my noble friend Lord Snape indicated how Liberal Democrats can be pretty cavalier in their approach to them in certain circumstances. As the person who introduced the Bill that created bus lanes in London, I can stand here with a good conscience when it comes to bus lanes. I agree that if we are to see regular, punctual and effective services, we need to protect the bus. That means an increase in bus lanes and attaching priority to them. I hope and expect that we will see big metropolitan areas putting greater emphasis on this. Certain areas have introduced light-rail systems,
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Perhaps I may say without appearing evasive that we will discuss funding very shortly. At least two more sessions on the Concessionary Bus Travel Bill remain, at the heart of which is funding for local authorities. We will have time to develop those arguments then. The noble Baroness said that concessions may need to be extended to 16 to 18 year-olds. That is already a given for those who are in full-time education, but the noble Baroness rightly said that if we are to look forward to a day when young people stay in some form of education and training up to the age of 18 and are therefore in a non-earning capacity, concessionary fares will be important for them. So it will, but noble Lords will forgive me if I try to walk before I run. We are some way off making effective the introduction of an age up to which education and training will be compulsory. The question of concessionary travel may be attached as a corollary to it, but the costs involved in the main proposition are substantial. We intend to bring these proposals to fruition in due course, but the noble Baroness will not expect me to produce a time scale just at the moment.
I was grateful also for the contribution of the noble Lord, Lord Hanningfield, who adopts a uniformly constructive approach in these debates. He always looks for ways in which he can add to, and develop, government proposals in ways which will make them more effective. I am grateful to him for that approach, which he has adopted on many occasions, and, characteristically, he did so again today. However, he, too, will forgive me if I do not go too far into the funding of local authorities: we will exchange views on that in the fairly near future.
We all know that the deregulation of buses did not produce the anticipated expansion of bus traffic and usage. We have made some progress since what was a period of very steady decline until the 1990s. We have slowed down the decline since we have been in office, but we have not slowed it down enough. There are areas to which we can point with great pride. The noble Lord, Lord Marland, being reasonably controversial in his maiden speech, referred to London in not always glowing terms, although he will recognise that the increase in bus usage is an important and impressive development. However, progress has been made not just in London: York, Cambridge and Brighton are all showing real increases in bus usage, and local authorities can learn a lot from the successes of those towns. It is clear that if we are going to improve local bus services, passengers want them to be regular, punctual, affordable and reliable. We recognise, particularly but not just in our cities, that they have to be safe. There is no doubt that one element of anxiety about using buses is whether there are sufficient safety measures. That is why all modern bus fleets have better communication between the driver and the bases to guarantee some safety, but we need to ensure that happens right across the bus fleets.
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Several constructive points were made about the Government’s conclusions published in the document, Putting Passengers First. There is a realisation on our part that our attempts at increasing bus usage did not reap rewards as quickly as we would want; that is why within the framework of the document we considered measures to address poor punctuality and create better partnership working, including, when appropriate, through quality contracts. I think that we can do that. The noble Lord, Lord Bradshaw, has berated me many times in the past that we could be more constructive and imaginative about our quality contracts, and I think that we can. We need to look at that somewhat along the lines of how he has suggested in the past that those contracts could be improved.
As emerged from many speeches this evening, we also need to give community transport a bigger role. We need the flexibility of that sort of transport. It may be that, as the noble Lord, Lord Marland, hinted, school buses could be used more extensively than they are, certainly in those areas where school buses are being developed on the American system. Yellow buses have been introduced in Surrey and a part of Yorkshire, which is a declaration of commitment to the successful transport of young people—but we may also be able to use those buses more extensively than just on the school run. I know that this day is a long way off, but there is no doubt that we would benefit enormously if our communities depended on, respected and used the school bus as the Americans do. It is such a feature of their localities and such an important part of the successful and safe conveyance of children to school that it gets past a great deal of what is a nightmare for all our citizens, and not just bus users—the congestion of the school run. I quoted the other day in the House the figure that 70 per cent of all British vehicles are on the road at 10 minutes to nine in the morning, which happens to be the peak of the school run.
I am restricted on time. This has been a short but enormously encouraging debate. I hope that the noble Lord, Lord Marland, will recognise how much we benefit from the exchange of views across the Chamber on these issues. We are a fairly select group, and we could do with a few additions.
Baroness Crawley: I beg to move that the House do now adjourn during pleasure until 8.40 pm.
Moved accordingly, and, on Question, Motion agreed to.
[The Sitting was suspended from 8.33 to 8.40 pm.]
Mental Health Bill [HL]
Schedule 3 [Supervised community treatment: further amendments to 1983 Act]:
Lord Patel of Bradford moved Amendment No. 43:
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“(4A) The Secretary of State shall, after consultation with the Commission and with such other bodies as appear to him to be concerned, direct the Commission to keep under review the care and treatment, or any other aspect of treatment, of all patients in hospitals, independent hospitals and in such other settings as he may decide who are subject to sections 4A and 4B of the Mental Capacity Act 2005.
(4B) Where the Commission has good cause to suspect that a patient who is neither liable to be detained under this Act, nor subject to safeguards under sections 4A and 4B of the Mental Capacity Act 2005, is being deprived of his liberty as a consequence of admission to a hospital or an independent hospital, it may—
The noble Lord said: I shall speak also to Amendment No. 44.
Section 120 of the Mental Health Act 1983 empowers the Mental Health Act Commission to,
- “keep under review the exercise of the powers and the discharge of the duties conferred or imposed by this Act so far as relating to the detention of patients or to patients liable to be detained under this Act”.
The commission’s powers of visiting, interviewing patients in private and demanding access to documentation stem from this overarching remit. I should note for the benefit of noble Lords unfamiliar with the detail of this legislation that “liable to be detained” refers here essentially to patients who remain subject to the detention powers of the Act but who have been given leave of absence from the detaining hospital. Therefore, the commission’s monitoring remit and visiting powers are at present limited to patients who are subject to the detention powers under the 1983 Act.
From the very start of the commission’s existence, the situation has thrown up uncomfortable problems for its visiting commissioners. In the course of undertaking their statutory duties in visiting hospitals to interview detained patients, Mental Health Act commissioners will frequently become aware of matters of concern relating to informal patients. Although aware that the Mental Health Act Commission remit does not extend to informal patients, commissioners are understandably loath to ignore unlawful, negligent or abusive practices that are apparent to them. Therefore, the practical problem for the MHAC and its commissioners is how legitimately and effectively to raise concerns about vulnerable patients who may be denied legal rights or protections, or are subject to abuse or neglect.
The most frequently encountered cause of concern is that of unlawful deprivation of liberty of informal patients, sometimes called de facto detention. I will outline two of many examples that I could give to illustrate the sort of situations that commissioners encounter. First, on a visit to an independent hospital that predominantly cared for learning disability patients, a Mental Health Act commissioner found that many staff did not know which patients under their care were detained under the Act and which were informal. The commissioner met with and interviewed two patients at the unit who were not detained before she realised their legal status. Some 37 patients, of whom 21 were legally detained, resided at
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It was apparent that the majority of staff were inexperienced and had received little training in the legal aspects of their role. The clinician in charge of the patients’ treatment made it known to commissioners that he viewed detention under the Act as unnecessary and stigmatising for his patients. Yet those informal patients whom the commissioner had interviewed by mistake showed an alarming lack of understanding of their rights. One patient’s compliance with medication and general care was questionable, but he had little understanding of his rights regarding consent to treatment. Another patient, whose Section 3 detention had recently been rescinded after more than a decade of uninterrupted detention under the Act, said that she was “excited” that the section had been removed, yet the commissioner gained no sense that she appreciated how her rights might have been different, or that she was treated now any differently by the staff.
8.45 pm
My second example involves a commissioner who walked past a locked area containing a single informal patient who was isolated from patients and staff, despite a risk assessment recommending that he receive two-to-one nursing care. The area in which he spent his time was without furniture or apparent means of stimulation or activity. He appeared to have been given a makeshift rattle for diversion. The commissioner noted that inside the room there was an open drain and neither a toilet seat nor soap, towels or even a door to the toilet area. The toilet and bedroom area were cold and smelt of urine and faeces despite, according to the ward manager, regular cleaning. The service manager reported that he was unaware of the situation until we brought it to his attention. This example is just over one year old.
Those are just a couple of situations with which, according the commission’s remit, it has no business to be concerned. In such cases, commissioners may choose to raise their concerns directly with the clinicians or hospital management, who are responsible, although commissioners may not do so officially under Mental Health Act Commission powers. On a very basic level, it may be difficult for a Mental Health Act commissioner to ascertain the facts behind the situation that appears to be of concern. Many hospital managers welcome any comments or observations about their services and may be co-operative in clarifying the situation of patients when asked. However, a recent addition to the Mental Health Act Manual, a reference book to which every Mental Health Act practitioner regularly refers, states:
“Ward managers should be advised not to engage in discussions with commissioners about the circumstances of patients who are not detained under the formal powers of the Act”.
So we have to walk past people such as those I mentioned in the examples.
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The Mental Health Act Commission has a concordat agreement with the Healthcare Commission to share relevant concerns and information, and the latter is empowered to visit and investigate. However, not only does that cause delay and duplication of effort; the Healthcare Commission staff are not as expert as commissioners on the workings of the Act. Furthermore, while the Healthcare Commission may choose to follow up on the limited information that a visiting Mental Health Act commissioner might be able to pass on to it, the Healthcare Commission is not primarily a visiting body in the sense that the commission is.
The law currently prevents the Mental Health Act Commission, as a visitorial body, dealing on the spot with issues of basic human rights such as those that I outlined in my examples. Indeed, with a quite dreadful irony, the law at present appears to require Mental Health Act commissioners to walk past those patients who may be incarcerated unlawfully in dirty, cell-like rooms on the grounds that formal powers under the 1983 Act have not been applied to deprive that patient of his or her liberty in a lawful manner.
I shall provide the Committee with a further example of this dreadful irony from the Healthcare Commission’s investigation into Merton and Sutton learning disability services, published today, which noble Lords may have seen reported on the front page of the Guardian. One of many examples provided states that,
- “one man who had no speech, sight or hearing was tied to his wheelchair or bed for up to 16 hours a day”.
The 2003 Mental Health Act Commission biennial report stated that learning disability patients, among others, might be most likely to be subjected to this kind of mechanical restraint. But the commission also pointed out that many of these patients are not formally detained and therefore are not subject to oversight from its visiting commissioners. The safeguard of the Mental Health Act Commission is therefore extended to those who are lawfully detained but not to those who are unlawfully detained. My amendment seeks to change that sorry state of affairs.
My amendment is simple in its effect. First, it would extend the Mental Health Act Commission’s remit to cover patients whose hospital treatment is subject to the new legal safeguards proposed under the Mental Capacity Act by the Bill. This would mean that the commission’s visits to hospitals would be able to keep under review the exercise of powers and duties in relation to all patients who are formally deprived of their liberty, whether it is under the Mental Health Act or the new Bournewood provisions of the Mental Capacity Act.
Secondly, it would allow that when the commission has good cause to suspect that a patient is being deprived of his or her liberty unlawfully—that is, without the use of either the Mental Health Act or Mental Capacity Act powers—it may also keep that patient’s care and treatment under review and raise its concerns with the appropriate authority, whether that is the hospital managers, the Healthcare Commission or any other body. For the purposes of keeping under review the care and treatment of all these patients, the
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I should emphasise that the amendment does not propose that the Mental Health Act Commission’s visiting activity be widened to include care homes, although there would be scope for such widening of the remit within the discretionary powers given to the Secretary of State. The intention behind this amendment is, rather, that the commission would be able to concern itself with de facto detained patients and Bournewood patients encountered in the NHS and independent-sector hospitals that it currently visits.
Finally, the Minister will no doubt know from his brief that the particular extensions to the Mental Health Act Commission’s remit called for here could be achieved within the discretionary powers already provided to the Secretary of State within Section 121(4) of the 1983 Act as it stands. It is now over 20 years since the Mental Health Act Commission first requested that the Secretary of State exercise those existing powers.
Over the past two years the Mental Health Act Commission has been in detailed discussions with the Department of Health, which has been broadly supportive, subject to legal advice, of widening the remit of the commission to include de facto detained patients. Unfortunately, this has not resulted in any change, as they have been unable to find the time to deal with the matter because of other pressing business. I understand that the Department of Health has been rather busy considering various changes to the 1983 Act over that time and that the Minister would want to consider my amendment in the light of other changes being made to the overall legal framework. My amendment may therefore serve as a model of one way to go about this. If the Minister prefers a different approach, the passage of the Bill is a good opportunity for that to be debated in Parliament and, if necessary, tested according to the will of this House and another place. I beg to move.
Lord Hunt of Kings Heath: That was a very useful contribution; I am grateful to the noble Lord for making it. I would like to take this opportunity to pay tribute to the work of the Mental Health Act Commission in keeping under review the operation of the 1983 Mental Health Act. I would commend to the Committee the commission’s reports and general work.
I understand that the noble Lord has put this forward as a debating point. We could not accept the amendments as such. The essential point is that it is our intention, as announced by the Chancellor in his Budget Statement of 2005, to create a new regulator in 2008. This will build on the work and successes of the Mental Health Act Commission, the Healthcare Commission and the Commission for Social Care Inspection, working across the health and adult social care sector in England. I see the noble Earl, Lord Howe, thinking back to some debates we had on that matter quite a few years ago. No doubt he will remind me in due course of what I said then.
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