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Earl Russell: I thank the noble Baroness for that reply and all those who have spoken on the amendment. It is an important issue. Listening to the noble Baroness about the proposed statutory duty, I was reminded of the comments of local authorities on the subject of Amendment No. 1. There is a resistance to having a statutory duty placed upon them. I can see why. It tends to pass the problem round the circle. But it means of course that the patient gets passed around the circle as well. In the end, the buck has to stop somewhere.

I understand what the noble Baroness said about the responsibility of health authorities. But, in the end, there must be a final duty resting somewhere; or else, as happens with mental illness patients, the patient will be

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passed repeatedly around the country. If the responsibility does not finally stop with the Secretary of State, I do not see where it would stop.

I listened to what the noble Baroness said about what she called the "Epsom cluster" and understood her remarks. I have visited patients who were in that cluster. But, like the noble Baroness, Lady Farrington, I see them now, sleeping in doorways off the Strand. I work in the Strand. I walk down the Strand late at night quite often and have some idea of what goes on there.

Baroness Cumberlege: Before the noble Earl proceeds, perhaps if he will look at the studies that we have done, he will see that the people in the Strand, who are homeless and who are roofless, are not the people who have come from the long-stay institutions, although they may well have a mental illness.

Earl Russell: I accept that a very large number of them are not from such institutions. I am sure that the noble Baroness has heard me speak about the 16 and 17 year-olds often enough for me not to need to go into that subject again. I am equally sure that many are, including some cases whom I happen to know personally. Those people come from a great many different categories. That, I believe, is one of them. The noble Baroness should also bear in mind what the Royal College of Psychiatrists said; namely, that the monitoring does not have the statistical techniques available to it to be quite so certain about those points.

The Government have suffered many times from the Rayner principle: they only collect the statistics which are necessary to them. They keep finding that the statistics which are necessary are those that they did not foresee would be necessary. So the information is not there.

We have not had an answer on the point of the noble and learned Lord the Lord Chief Justice and mental health sufferers in prison. That is an extremely serious point which needs to be taken into account in any full resolution of the issue. I should be grateful if the noble Baroness would perhaps write to both me and my noble friend Lord Harris of Greenwich before we come to that issue on Report. In the meantime, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendments Nos. 44 to 52 not moved.]

Earl Haig moved Amendment No. 53:

Page 9, line 6, at end insert:

("Regulation as to transfer of patients

( ).—(1) This section applies where, for good reason, the patient wishes to reside at a place other than that imposed on him under section 25D above.
(2) Where subsection (1) above applies in relation to a patient, the responsible after-care bodies shall consider whether appropriate after-care services will be available in the area in which the patient wishes to reside, being an area not within that of the responsible Health Authority or local social services authority as specified in section 25A")
(3) Where subsection (1) above applies in relation to a patient, the responsible after-care bodies shall consult the persons referred to in subsection (4) below who will be professionally concerned, in the intended area of residence, with the after-care services to be provided for the patient under

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section 117 below, or shall, if the patient intends to reside in Scotland, make an application to the appropriate sheriff under section 35 below.
(4) The persons referred to in subsection (3) above are—
(a) the responsible medical officer within the area of the Health Authority where the patient intends to reside; and
(b) an approved social worker acting for the local social services authority where the patient intends to reside.
(5) Where a patient is for the time being subject to after-care under supervision of a Health Authority by virtue of an application under section 25A above, that patient may be transferred into the after-care supervision of another Health Authority after such consultation, and in such circumstances and subject to such conditions as may be prescribed by regulations made by the Secretary of State.
(6) Where a patient who is subject to after-care under supervision is transferred in pursuance of regulations under subsection (5) above, to after-care under supervision of another Health Authority, the provisions of this Part of this Act shall apply as if the application were for his reception into the after-care under supervision of that Health Authority and had been accepted at the time when it was originally made.").

The noble Earl said: The purpose of this amendment concerns patients who, for good reason, wish to move between districts when subject to an aftercare supervision order. The inference of the Bill, as currently drafted, is that a patient subject to an aftercare order might only change his place of residence within the same health authority or local social services authority area. That limitation is most likely to prove a problem in major cities where there can be numerous health trusts and local social services authorities within a comparatively small area. Under the current provisions of the Bill, a patient could only have the requirements imposed upon him amended if he refuses or neglects to receive aftercare services or comply with the requirements of the supervision order.

The only options available to the aftercare bodies then are either to cancel the supervision order or to admit him to hospital. Obviously, neither option is appropriate. There should be greater flexibility within the framework of the Bill. In cases where there are better opportunities for housing, employment, or support from relatives, a move should be countenanced without hindrance from unnecessary red tape.

Perhaps I may make a proviso; namely, that a move should only take place with care and consideration and in the certainty that cases will be delivered into safe medical hands. There is always the danger that a patient can escape between one doctor and another and thus forgo the planned medical programme. It is envisaged that the amendment will allow for such transfers between districts in England and Wales and also between England, Wales and Scotland. This amendment has the support of the Royal College of Psychiatrists. I beg to move.

The Earl of Balfour: I do not wish to interrupt the Committee in any way. I believe that one of the most wonderful services provided by the National Health Service is that a patient can be moved from a hospital in London, say, all the way to a hospital in Scotland under the National Health Service provisions. That is marvellous. It happened in the case of my mother who broke her leg falling downstairs in London and was taken to a hospital at home in Scotland. Under these

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provisions, if somebody who required mental care wanted to be moved from, say, England to Scotland, I wonder whether he could go with a qualified person accompanying him on that journey.

Baroness Jay of Paddington: I too should like to ask the Minister whether this amendment would precisely illustrate the great advantages of involving the Mental Health Act Commission (as I suggested in my earlier amendment)? It would focus attention on how and where patients were transferred and on their supervision arrangements when they left a certain place, so that they could be appropriately reinvigorated when they moved to a new place. It would ensure that responsible authorities—as I know has happened in previous tragic circumstances—did not have to rely exclusively on the version of the patient himself as to what his care involved.

Baroness Cumberlege: Though we understand the reasoning behind the amendment, we believe it to be unnecessary. The Bill already allows for a patient to move to another area and for aftercare under supervision to continue. That is not explicit in the Bill, but works because of the link with Section 117. The Section 117 duty is placed on the health authority and the local social services authority for the area in which the patient is resident. That means that the duty transfers when the patient moves and lasts until the two authorities are satisfied that the person no longer needs the services. There is therefore no need for the amendment, and we would not wish to issue regulations covering transfers.

There is however one issue which we are still considering. That is transfers between England or Wales and Scotland or vice versa. This raises some rather difficult issues of converting a power which is based on an application to a health authority and one firmly rooted in the courts, by an application to the sheriff. We are looking carefully at what might be done to address this and we hope to bring forward our proposals soon.

In view of what I have said, I hope that my noble friend will withdraw his amendment.

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