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(b) has been committed to the court to be sentenced for such an offence and has not yet been sectioned or otherwise dealt with for it, or (c) has been committed to the court under section 43 and has not yet been dealt with under that section. (a) remands on bail a person to whom this section applies, and (b) is satisfied on the evidence of a registered medical practitioner that there is reason to suspect that the person is suffering from mental disorder. (a) the person’s mental condition, or (b) the appropriate medical treatment for that condition, (or both) in order to assist the court in dealing with the person for the offence.

The noble Lord said: My Lords, I shall speak to this amendment only briefly; we have already had a debate on its subject matter. I simply want to glean whether there has been any movement on the part of the Government. The proposal would provide a smoother passage of some cases through the courts. I hope that the Government share that aim. I beg to move.

The Minister of State, Department of Health (Lord Hunt of Kings Heath): My Lords, the noble Lord invites me to give a short response. I am afraid that we were not moved by the noble Lord’s eloquence in Committee or when he described himself as astonishingly and wretchedly depressed by my response, because there is legislative provision to achieve what he wants. However, I accept that behind his amendment is an issue about problems that the courts have had. That is down to good practice rather than legislative requirement. I understand some of the practical issues that face courts when dealing with the kind of problems that the noble Lord raised in Committee.

My department and the Home Office commissioned a report on the state of court psychiatric schemes, which was published in September 2005. The report found that provision had grown up piecemeal. We need to do all that we can to even out that practice. Models of good practice in co-operation and commissioning are being identified and evaluated. A pilot has also been established based on a service level agreement for the provision of psychiatric reports to courts in the south-west. Evaluation of the pilot is due for completion in 2008 and will provide a good practice guide for other regions of the Courts Service.

We are not complacent about the issues that the noble Lord raised. We believe that this is best done through best practice. A pilot is in place and we will use its results to spread good practice throughout the court system.

Lord Carlile of Berriew: My Lords, I am grateful to the Minister for his very helpful response. As he realises, I am concerned about ensuring uniform good

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practice in courts. Delays with psychiatric reports are very much to the detriment of mentally disordered defendants and cause delays in courts, which these days—in the Crown Court at least—cost between £15,000 and £20,000 a day to run. I hope that the pilot will prove successful and that, if it is, it can be rolled out quickly throughout all the circuits so that these difficulties will no longer occur. Having regard to the Minister’s helpful assurance of progress, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendment No. 29 not moved.]

Lord Hunt of Kings Heath moved Amendments Nos. 30 and 31:

(a) electro-convulsive therapy; and (b) such other forms of treatment as may be specified for the purposes of this section by regulations made by the appropriate national authority. (a) he has consented to the treatment in question; and (b) either the approved clinician in charge of it or a registered medical practitioner appointed as mentioned in section 58(3) above has certified in writing that the patient is capable of understanding the nature, purpose and likely effects of the treatment and has consented to it. (a) that the patient is not capable of understanding the nature, purpose and likely effects of the treatment; but (b) that it is appropriate for the treatment to be given; and (c) that giving him the treatment would not conflict with— (i) an advance decision which the registered medical practitioner concerned is satisfied is valid and applicable; (ii) a decision made by a donee or deputy or by the Court of Protection; or (iii) an order of a court. (a) a reference to an advance decision is to an advance decision (within the meaning of the Mental Capacity Act 2005) made by the patient; (b) “valid and applicable”, in relation to such a decision, means valid and applicable to the treatment in question in accordance with section 25 of that Act;

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(c) a reference to a donee is to a donee of a lasting power of attorney (within the meaning of section 9 of that Act) created by the patient, where the donee is acting within the scope of his authority and in accordance with that Act; and (d) a reference to a deputy is to a deputy appointed for the patient by the Court of Protection under section 16 of that Act, where the deputy is acting within the scope of his authority and in accordance with that Act. (a) in a case where the treatment in question would, if given, be given in England, the Secretary of State; (b) in a case where the treatment in question would, if given, be given in Wales, the Welsh Ministers.”” (a) in subsection (1)(b), after “section 57 above” insert “or section 58A(1)(b) below”, and (b) in subsection (3)(b), before “has not consented to it” insert “being so capable”. (a) in subsection (1), for “or 58(3)(b)” substitute “, 58(3)(b) or 58A(4)”, and (b) in subsection (3)— (i) for “or 58(3)(b)” substitute “, 58(3)(b) or 58A(4)”, and (ii) for “and 58” substitute “, 58 and 58A”. (a) in subsection (1), for “and 58” substitute “, 58 and 58A”, and (b) in subsection (2), for “or 58” substitute “, 58 or 58A”.

On Question, amendments agreed to.

Lord Williamson of Horton moved Amendment No. 32:

(a) help in obtaining information about and understanding— (i) what medical treatment is being provided to the patient; (ii) why it is being provided; (iii) under what authority it is being provided; (iv) the requirements of this Act which apply in connection with the patient’s treatment; and

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(v) the rights which can be exercised by or in respect of him under this Act, and (b) help (by way of representation or otherwise) in exercising those rights.””

The noble Lord said: My Lords, this amendment was tabled in Committee by the noble Baroness, Lady Howells of St Davids, whose name is again attached to it, and spoken to by the noble Baroness, Lady Massey, who has now moved on to even greater things.

I draw the Minister’s attention to the fact that this is what I described on the last occasion as the mini-amendment; that is, it deals with advocacy for children and young people. It does not deal with the other question of advocacy. I did not retable that amendment, although the noble Lord, Lord Patel of Bradford, has done so, and it is not grouped with this amendment. I will deal only with advocacy for children.

We have convincing evidence that children and young adults who are admitted to in-patient units do not always have information and are subject to confusion and fear. That is shown, for example, by the report from the office of the Children’s Commissioner, which was specific on this point. I want briefly to refer to two elements. The Children’s Commissioner made it clear that difficulties did arise and quoted specific examples, so we are basing our argument to a considerable degree on facts and evidence. Many of the young people were dissatisfied and unhappy about the in-patient services. In one case, no education was made available, although the patient was well within the “young” category for education. We believe that a specific requirement to make advocacy available to children and young people would be helpful in preventing them from switching off from the services and that it would provide a better basis for treatment and rehabilitation.

The amendment is in line with the national service framework for children. In our view, the costs would not be high—perhaps about £100,000 a year for compulsory admissions and up to £1 million for all children and young people. In so far as the Minister may insist that much of this work is already being done, the new expenditure is correspondingly lower.

I have brought this amendment forward now because it would be helpful to have the Minister’s assurances about the action that the Government and the authorities are encouraging in this area. That is what we are interested in; we want to know that we are making progress in making advocacy for children and young people more widely available. I beg to move.

5.15 pm

Baroness Howells of St Davids: My Lords, when I proposed this amendment in Committee, I related to noble Lords the story of a young Asian girl. Today, I will not give any further case studies but, as I am sure noble Lords know, there are many more.

The amendment would give children and young people under the age of 18 the right to receive counsel from an independent advocate when they are about to be, or have been, admitted for treatment for a mental

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health problem, whether the admission is voluntary or under compulsion. Independent advocacy for young people provides a safeguard against the improper use of powers to detain or treat them. All children and young people should have the right to know what will happen to them if they are admitted to an in-patient unit, what to expect on admission and when they might be discharged.

With an advocate present, a young person can be sure that someone independent of their parents, carers or clinicians will communicate their interests and ensure their right of appeal. It is very difficult for children to overturn any parental responsibility. It requires a court order, so children who do not feel that their views are being heard by parents and staff might have to seek extreme measures in order to be heard, possibly compromising their own beliefs.

I feel sure that the Government should look very carefully at the amendment and come back to the House with something that they may feel is more appropriate. However, we feel strongly that this amendment should receive the best care and attention from the Minister.

Baroness Walmsley: My Lords, we on these Benches also support the amendment. The Minister will know that there are precedents for groups of people having a right to advocacy services. The Mental Capacity Act 2005 enshrines the right to advocacy for people lacking capacity through the independent mental capacity advocacy service, and the Adoption and Children Act 2002 gives young people looked after by the state the same right to advocacy.

There are many reasons why a young person may need an independent person on whom they can rely to express their wishes to the appropriate authorities. I am particularly concerned about the right to education. The Children’s Commissioner report contains a case study about a young woman called Amber, who was not offered any education during her seven-month stay on an adult psychiatric ward, despite being 14 at the time of her admission. A child’s right to education and all the other rights are matters with which an advocate would be able to help them. An advocate could also ensure that children were properly informed, understood the treatment that was being made available to them, and many other matters. I support the noble Baroness, Lady Howells, on this.

Lord Ramsbotham: My Lords, this amendment has an application to those in custody and possibly to those who come into the criminal justice system during the period before custody.

Baroness Royall of Blaisdon: My Lords, this amendment is intended to ensure that advocacy services are available to all patients with a mental disorder aged 18 years or under. We recognise that there are certain groups of patients who will receive particular benefit from advocacy services and we have noted the views of the Children’s Commissioner. The noble Lord, Lord Patel of Bradford, and my noble friend Lady Howells of St Davids brought to our attention in our debate in Committee the experience of people from black and minority-ethnic

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communities treated under the Mental Health Act. In particular, they stressed that:

The noble Lords were, of course, absolutely right, in that properly trained, specialist advocacy can be of greater benefit to particular groups of patients than more generalised advocacy. The work that the Government have commissioned to develop training and standards for advocates, which is currently under way, is looking at the needs of particular groups from within the population of patients with mental disorder.

In Committee, we said that we would consider the best way to make advocacy services available. I want to assure the House that we are making progress. I am unable to confirm how we will proceed, as we wish to continue with that work before the Government announce how they will take this issue forward. We have listened not only to the strength of feeling expressed by noble Lords in Committee but also to their comments about the need for a service that will take account of the differing needs of different groups of patients.

The amendment would provide that all patients aged 18 years or under would have access to these services. The Act provides that a patient is any person suffering from a mental disorder or appearing to suffer from a mental disorder. That person need not be in hospital or under the supervision of a specialist doctor. There is a wide range of conditions and situations that fit into that definition. Of course, I do not wish to underestimate the significance of any person who is living with a mental health problem. However, I wonder whether this would provide for a service that would effectively target resources to those in need.

I am aware that many younger child patients who are in hospital for their mental disorder are not subject to the Mental Health Act where their parents provide consent for their treatment, as my noble friend Lady Howells outlined. In considering the best way to provide for advocacy services, I well understand that it is important that this group must not be forgotten.

As we said in Committee, we are considering the best way in which advocacy services can be made available, taking into account the differing needs of different groups of patients. We wish to see tailored advocacy services, which will bring the maximum benefit to all groups of patients, including children and young persons. We have not, however, been able to get provisions ready in time for Report stage.

The Government will continue to develop their proposals on how patients with mental disorder who are subject to the Mental Health Act can access appropriate advocacy services and we will bring them back when the Bill is considered in the other place. Indeed, in considering this subject we would be very happy to discuss our proposals with noble Lords who are interested in doing so. We very much hope that they will help us on this. As such, I hope that the noble Lord will feel able to withdraw his amendment.



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Lord Williamson of Horton: My Lords, I thank the Minister for that encouraging reply. I said at the beginning that this was a mini-amendment, and we always hope that the Government will make a mini-effort to accept it. We recognise, however, that the Government have gone quite a long way in following up their proposal at an earlier stage to consider the best ways to make advocacy services available. We note that their provisions are not yet ready for Report and that the Government expect to come forward with something to clarify their position when the Bill is in the other place. That is certainly encouraging for us.

This has been a short debate, but I am sure that the Minister feels that there is a strong feeling that this would be valuable and that we could make progress and improve on it. We shall be following the debates in the other place with great care and we hope that something of value will come forward. In the mean time, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendment No. 33 had been withdrawn from the Marshalled List.]

Baroness Neuberger moved Amendment No. 33A:

(a) any person described in subsection (1) below; or (b) any person not described in subsection (1) below who is the patient’s carer, who has been nominated by the patient in accordance with subsection (1A) below. (a) the nomination is signed by the nominator; (b) the nominator’s signature is witnessed by a prescribed person; (c) the prescribed person certifies that, in the opinion of the prescribed person, the nominator— (i) understands that the effect of nominating a person to be the named person will give him the role of nearest relative; and (ii) has not been subjected to any undue influence in making the nomination. (a) the revocation is signed by the nominator; (b) the nominator’s signature is witnessed by a prescribed person; and (c) the prescribed person certifies that, in the opinion of the prescribed person, the nominator—
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