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Clearly, local authorities are compelled to come up with short-term solutions to language barriers in order to preserve what community cohesion there is. Surely it would be more productive to progressively rechannel funding from translation services to the teaching of English for speakers of other languages. We have come a long way from mother-tongue teaching, but this new policy should reflect so much more than a resolution to a funding crisis. What consideration has the Minister given to the fact that if English language provision is curtailed as soon as someone enters the job market with a basic level of English, that person, who is already contributing to the economy, stands to remain at exactly that point? Can the Minister inform noble Lords whether the Government will encourage the current provision that provides the needed results?

Mastering a country’s language is vital to the successful integration of migrants in their communities and in progression to the society as a whole. Dr Darra Singh, the chair of the Commission on Integration and Cohesion, summed that up expertly when he stated at the time of the CIC interim statement that:

This is at the heart of the matter, and its resolution can and should be a two-way process.

8.18 pm

The Parliamentary Under-Secretary of State, Department for Education and Skills (Lord Adonis): My Lords, the House is grateful to the noble Lord, Lord Greaves, for raising the important issue of teaching English to speakers of other languages and for the perspective that he brings to the subject from his experience and that of his wife in Pendle and Burnley. As the noble Lord said, nothing is more important to our country than that all our citizens should have effective English-language skills. Without that, we will not create a fair or an integrated society, least of all in an age of substantial migration.

My honourable friend Bill Rammell, the Minister of State for Lifelong Learning, Further and Higher Education, will be paying close attention to this debate, and I will draw to his attention all the points that have been raised by noble Lords. Indeed, he is speaking at the rally mentioned by the noble Lord. Perhaps by saying that, I will encourage even more people to attend. My honourable friend takes his responsibilities in this area very seriously and intends to be present. I am also grateful to the noble Baroness, Lady Maddock, for addressing us in English, not Swedish. She would have made her point very effectively if she had tried us in another language, but she enabled me to follow closely what she was saying.

The straight factual answer to the question posed by the noble Lord, Lord Greaves, is that the Government, through the Learning and Skills Council, will make available about £300 million for colleges and other organisations to provide for the teaching of English to

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speakers of other languages in the next academic year. I cannot be precise about the sum because the final figure will depend on local planning within the overall adult learning budget of the Learning and Skills Council, which will be £2.841 billion for the financial year 2007-08. The figure of about £300 million is about the same as indicative funding available for ESOL this year and last year—there have been no cuts in the budgets—and it represents a threefold increase on the funding available as recently as the financial year 2000-01, when it stood at £103 million. The Government’s bona fides in supporting this important area of teaching are strong, and it is not the case that there are cuts in the national budget.

The concerns in this debate are whether the provision is sufficient and what more we could and should be doing, so I shall address those wider issues. Since 2001, state funding for ESOL courses has tripled, as has the number of people taking ESOL courses. In that time, we have invested more than £3 billion in the national Skills for Life strategy, £1 billion of which has gone on ESOL programmes, thereby helping almost 2 million learners to improve their confidence as English-language speakers. As demand rises further, our aims are to ensure that public funding, which is obviously constrained, is targeted at those with the greatest need and to improve course availability for all those who need ESOL provision.

As the noble Lord, Lord Greaves, rightly said, the demand for ESOL learning has never been greater because significant demographic changes have accompanied our sustained economic growth. Only last month, the Audit Commission published a detailed report, Crossing Borders, revealing the pace at which legal economic migrants have entered the UK intent on securing work and taking advantage of all that this country has to offer. The noble Baroness, Lady Verma, particularly stressed the pressure being brought in this area by people from the A8 accession states. She is right to highlight that issue, but I should stress that they account for less than 12 per cent of total ESOL demand, so it needs to be kept in proportion, but this is clearly an issue that we face.

Migrant workers from the new EU member states make a significant and welcome contribution to our economy, but their demand for language skills has presented fresh challenges for ESOL providers. Rising demand for places on some courses is such that in London waiting times can be as long as two years, while elsewhere 18-month delays are not uncommon.

Moreover, as a recent report by the National Institute of Adult Continuing Education acknowledged, we are still not reaching all the priority learners who face the greatest barriers to employability and social integration. Among our priority groups, for example, are the group mentioned by the noble Lord, Lord Greaves—Bangladeshi women, some of whom face tremendous obstacles, including the risk of abuse or being ostracised for venturing out of their homes to attend English classes. It is essential that FE colleges and other providers are encouraged to reach such groups as a top priority for government-funded courses within what is an inevitably constrained budget, despite the threefold increase that has taken place during the past six years.



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That is why, together with the Learning and Skills Council, we have reviewed ESOL arrangements for next year. Although we expect funding to continue at broadly the same level as this year, we have made two changes: first, removing eligibility for ESOL places from asylum seekers who will not have the opportunity to settle in the UK; and, secondly, removing universal fee remission irrespective of income.

Let me take the two issues in turn. First, in respect of asylum seekers, about whom the noble Lord, Lord Avebury, spoke passionately, I have of course noted his views. As he knows, the change has been made in light of improvements to the time that the Home Office takes to resolve asylum claims. The great majority of initial decisions are now made within two months. With a high proportion of asylum seekers ineligible to remain in the UK, the Government believe that ESOL funding is rightly targeted at those learners either granted refugee status or already living in settled communities.

The noble Lord raised the issue of those asylum seekers who are here for longer waiting for their claims to be determined. I can tell him—this deals with a number of other points raised—that we will shortly publish a race equality impact assessment of the effect of the changes, which follows a good deal of consultation with interested parties. We will consider issues raised by the assessment. I can tell the noble Lord that that will include the issue of those whose claims take longer to assess.

In respect of the second change—the withdrawal of automatic fee remission from those who can afford to pay for ESOL courses—let me be frank. We see this as a hard choice but a justifiable one, given the pressures on the ESOL budget and the imperative to focus it on priority groups. On low-waged groups who may find it hard to demonstrate lower income under existing tests, again, I can say that we are considering the matter further in the light of the race equality impact assessment.

However, we believe it reasonable to expect those individuals who can afford it to make a contribution to the cost of their learning. That should not be a prohibitive sum. The Government’s contribution will remain substantial, covering 62.5 per cent of course fees. Those eligible for completely free courses will include the unemployed, the unwaged or the very low- paid, learners receiving jobseeker’s allowance, those on an income-related benefit, or those who claim the higher rates of working tax credit. As I said, the contributions sought from learners—even those who are not in those priority groups—will be a maximum of 37.5 per cent in the next financial year. The noble Lord, Lord Greaves, asked whether the typical course fee for a four-hour-per-week course over 30 weeks would be about £300. I can tell him that that will be the case. Typically, it will be £300 for 120 guided learning hours, but I should stress that that means that the Government will continue to contribute substantially. For the same course, the Government will pay almost £900 as our contribution to the cost of the course.



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The noble Lord asked about the proportion of existing students who will continue to receive fee remission. We estimate that about 70 per cent of students will continue to receive full fee remission and therefore free ESOL courses. He asked about our estimate of the drop-out rate. I can tell him that the Learning and Skills Council does not anticipate that that will increase due to the changes because, as I said, 70 per cent will continue to get free ESOL courses and priority groups—those most in danger of dropping out—will be fully covered by the fee remission. Also, we do not expect class sizes to rise, not least because they are so large already, because demand is so great, that we do not expect that the providers would want to increase their size, even if they could.

I state clearly that responsibilities in this area do not reside with the Government alone. Employers and recruitment agencies, many of which recruit in large numbers from overseas, have a responsibility to consider the language needs of prospective employees as part of their recruitment costs and planning. Noble Lords mentioned the report last week of the Commission on Integration and Cohesion. The report stressed the role that employers should be playing in ensuring effective ESOL tuition for their employees. Paragraph 37 states:

Employers have clear responsibilities in this area, and I am glad to say that some companies have already developed their own training programmes for staff, which have proved to be highly cost-effective. For example, the bus company First Bus, which was the Skills for Life award winner last year, has already hired more than 1,100 drivers from eastern Europe. The company assesses their language skills and provides training before they arrive in the UK, which the report by the Commission on Integration and Cohesion also mentions. The investment by First Bus in this approach, which includes its own dedicated language school, stands at around £1 million. As a result, the turnover rate among its staff of drivers has dropped considerably.

It is obviously right, however, that lower-income adults should receive priority for fully subsidised courses. As I have stressed, this will continue as of right. The Government appreciate that such training for these individuals is a lifeline, particularly for those who are out of work, as it prepares them to re-enter the job market with extra skills and increased self-confidence. In a survey conducted by the Department for Work and Pensions, a significant proportion of respondents from ethnic minority backgrounds cited poor language skills as a key impediment to employment.

Furthermore, from April, Jobcentre Plus advisers have been instructed to raise the issue of language learning with any jobseekers who are clearly struggling to make themselves understood. Advisers will seek to agree a programme of action with these individuals so that any language problems are effectively addressed. In addition, we are developing, with the support of the Learning and Skills Council, a new £23 million basic skills and employability

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programme for Jobcentre Plus clients, which includes support for ESOL learners.

We regard this issue as immensely important. I am sorry that I have not been able to respond to all the points that have been made, but I will correspond with noble Lords further to take up points that I have not been able to address tonight. I thank the noble Lord, Lord Greaves, for raising this important issue this evening.

Mental Health Bill [HL]

8.31 pm

Further consideration of amendments on Report resumed.

Clause 28 [Consent to treatment]:

The Minister of State, Department of Health (Lord Hunt of Kings Heath) moved Amendment No. 55:

The noble Lord said: My Lords, I shall also speak to Amendment No. 56. This is a technical amendment that rectifies an anomaly that the Bill would otherwise have created in respect of the duty of approved clinicians to report to the Mental Health Act Commission. Section 61(1) of the Act currently requires reports to be made to the commission when a patient’s detention is renewed, if the patient has been treated without consent in the previous period of detention under a certificate given by a SOAD under Part 4 of the Act. Clause 28, as currently drafted, would have imposed that duty in respect of recalled community patients, even if a certificate was not needed for their treatment. It is not necessary to impose a requirement to report in those circumstances. To do so would be out of kilter with the requirements applying to detained patients, and would impose a small but unnecessary additional burden on clinicians and the Mental Health Act Commission. The amendment will ensure that Section 61 of the Act remains properly targeted on treatment authorised by SOADs appointed by the commission. I beg to move.

Lord Patel of Blackburn: My Lords, Amendments Nos. 56A and 58A relate to the authority for treating patients who are made subject to community treatment orders or returned to hospital under such an order. They would replace Clauses 28 and 29, which establish the Government’s proposals on these matters. My main concern about those proposals is illustrated by the professional slang that has started to be used to refer to second-opinion appointed doctors—commonly known as SOADs—in the context of their proposed role in relation to community patients. The new term is “super-SOADs”, from which we can infer that we are talking about a SOAD with special powers. The special powers in question are indeed remarkable, and include the ability to see into the future.

Under the Bill, at some point during an initial period of at least one month, a community patient will receive a visit from a SOAD. The SOAD will

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examine the patient and authorise whatever treatment he or she thinks is appropriate at the time according to criteria set out in the Act, but he will also be able to anticipate and authorise the treatments to be imposed on the patient should he or she be recalled to hospital. This, I suggest, is where the Bill requires a SOAD to be not only a psychiatrist but also a person with paranormal powers.

In short, it anticipates that a SOAD, whose role should be to safeguard against unnecessary or unsafe compulsory treatment, will authorise the forced application of medication in circumstances that he or she cannot foresee at some unpredictable point in the future. The SOAD can have no way of anticipating the circumstances whereby a community patient might be recalled to hospital or what physical or indeed mental condition that patient would be in upon such a recall. A patient who has developed dangerous and possibly irreversible side effects might have them worsened by the further imposition of medication on the authority of the SOAD. A patient with a heart condition might be killed by the imposition of medication authorised in good faith by the SOAD. Alternatively, the patient may have become pregnant, in which case some medications might be dangerous to her or her unborn child.

The Minister may argue that I am ignoring the obvious fact that the responsible clinician or whoever is involved in actually giving the treatment to the recalled patient will of course have a duty of care and will not endanger their health or life recklessly in these ways. But if the only safeguard against a SOAD’s authorisation being used recklessly in a context other than that in which it was given is the professional judgment of the treating doctor, or even nurse, we have negated the point of the SOAD role. It is important to preserve the role of the SOAD in considering what treatment should be given on the basis of the actual presentation of the patient at the time of their examination. This is the protection that SOADs can offer patients. The Minister may also argue that SOADs already authorise some treatments in advance of their being given, which of course is true, particularly with medication that is authorised on a ‘PRN’ or as-required basis; but they do so on the basis of the patient’s presentation and situation at the time of their visit, having examined the patient and consulted two other members of staff who have professional involvement with the patient’s care. The SOAD is not acting as if he or she can predict the future.

I should make it clear that I have an interest as chairman of the Mental Health Act Commission, which is responsible for the administration of second opinions. One of the commission’s roles is to appoint and train SOADs, and this means that it must provide advice on second-opinion procedure. The Mental Health Act Commission will be likely to advise SOADs to be extremely cautious when considering whether or not to authorise treatments to be given in an unforeseeable situation at an unidentified point in the future. Indeed, even putting the issue in this way makes me wonder whether the discretion that the Bill allows SOADs in this respect will actually be taken up by this body of responsible psychiatrists. I have to say that I hope it will not.



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The Bill’s proposals for SOADs raise another ethical issue. According to the Bill and the draft code of practice, a SOAD who certifies that a community patient consents to treatment would also be enabled to certify what treatments can be imposed on the patient if he or she withdraws consent and is recalled to hospital. I realise that the possibility of coercion hangs over the heads of many psychiatric patients, but this truly is a sword of Damocles. At the very least it would appear to breach the principle underlying true consent as set out in the Mental Health Act code of practice, which at paragraph 15.13 states:

This brings me to my alternative model, set out in these amendments. The key difference between my model and the Bill is that any certification of the treatment of a community patient cannot authorise treatment upon recall. This means that the forcible imposition of treatment to a recalled community patient would find authority only in the urgent treatment provisions set out in Section 62 unless and until a further second opinion is requested to consider treatment in the new context of detention.

The amendment would not extend the three-month rule. Under the Bill, the requirement for a certificate authorising treatment takes effect only after the CTO has been in place for at least one month, and may be longer. A patient discharged to a CTO during his three-month period as an in-patient would have to wait until all of the unspent part of the three months had run its course before having the safeguard of a second opinion. Indeed, when an in-patient’s three-month period is but a distant memory, if that patient is discharged on to a CTO he or she will be subject to a new one-month period where the safeguards over his or her treatment as an in-patient will be suspended. I think patients will perceive that to be simply unjust.

My alternative proposal, where the three-month period still has some time left to run when the CTO is made, is to require certification no later than one month from the start of that order. Therefore, if the three-month period had expired within the first month, it would not be extended at all. If it were extended for more than one month from the start of the CTO, it would expire exactly one month from the start of that order. For in-patients whose three-month period has expired at the point when a community treatment order is made, I would require certification from the start of the order. Let us remember that drug treatment in the community is inherently less safe than such treatment under 24-hour medical care in hospital. We should be increasing the safeguards for community patients, not lessening them.

To enable the certification from the start of CTOs, part of the preparation for discharging a patient on to a CTO would be for incapable patients to be visited by a SOAD, and for a capable patient to have a consent discussion with a clinician responsible for the treatment. It would be permissible to complete certificates prior to the patient’s discharge that would only take effect once they become a community patient. There is a precedent for that in the fact that all detained patients who are currently coming to the end of their three-month

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period will have Section 58 certificates completed for them, with such certificates taking effect only when the period has actually expired.

Such an approach seems to be both more of a safeguard for patients and more practical for the administration of the SOAD system. One of the great unknowns in the Government’s proposals is how the second-opinion system might work with community-based patients. My proposals would allow for many SOAD visits in relation to the new powers to be undertaken before the patient ceases to be resident in hospital. At the very least, such a system would ensure that we knew where the patients were when they were due to be examined by a SOAD. I have some concerns that under the Government’s proposals a great many clinicians would be faced with the dilemma of whether to recall a patient to hospital simply because they do not attend appointments to meet a SOAD.


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