Previous Section Back to Table of Contents Lords Hansard Home Page

Lord Mottistone: My Lords, I thank my noble friend for explaining her point of view clearly. I am delighted to hear that my amendment has set her and her officials thinking. However, she does not appear to be thinking along the same lines as I am. I wish to try to detach the thinking from the explanation that, because some things happen in Scotland, the provision that appropriate people are released into the community only when the facilities exist for them should not have the underpinning for which I asked. That is quite apart from what happens to sheriffs in Scotland, which is nothing to do with the argument at all. Perhaps we can detach our minds from that.

My noble friend said that there might be a gap as a result of a delay in making a supervision order. It is those very gaps that worry us because it is then that some people climb into lions' cages. My noble friend also said that the person having been consulted about the kind of services that are required for him will possibly be only too happy to stay as a voluntary patient. Perhaps that will occur in many cases, but one wants to be sure once the procedure is set in motion.

There is a further approach but perhaps it is too late to deal with it at Third Reading in this place. However, Members of another place might consider it. It is a

1 May 1995 : Column 1226

provision requiring the responsible medical officer to begin the process good and early before the end of the patient's time in hospital so that there is at least nine months to plan what is to be done with him. I am not sure that that suggestion is practicable because some people will not be exactly the same nine months later. Therefore, on one occasion one may set the process in motion and it will not be necessary; on another occasion one may not begin the process and it will be necessary. In that case, I am wedded to my amendment.

However, my noble friend has generously said that she is thinking about the subject, even though her solution may be different, with a view to proposing an amendment when the Bill reaches another place. With that in mind, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendment No. 9 not moved.]

Baroness Jay of Paddington moved Amendment No. 10:

Page 2, line 29, at end insert ("in writing").

The noble Baroness said: My Lords, in moving Amendment No. 10 I shall speak also to Amendments Nos. 11, 12, 27, 41, 42, 44, 46, 48, 51, 53, 55 and 56. All the amendments deal with the crucial question of the way in which a patient who is to be made subject to a supervision discharge order is informed of its conditions and of his right to apply to a mental health review tribunal. We discussed the matter in Committee. Of the amendments in the group, only Amendments Nos. 10 and 12 stand in my name; the rest stand in the name of the noble Baroness, Lady Cumberlege. Your Lordships will therefore understand that we have reached almost total agreement on the subject, about which I am delighted.

However, before the Minister explains the Government's thinking behind this long list of amendments I wish to ask her about one small matter. In Committee we asked that when those in the health authority inform the patient, both orally and in writing, of his right to apply to the mental health review tribunal it should also be explained that he should be legally represented at the tribunal hearing. That provision appears in Amendment No. 12.

Is it possible for that additional provision to be contained in the Minister's amendments? She will remember that in Committee there was some discussion about the matter and it was not totally understood whether there was the ability to be legally represented at a mental health review tribunal. In fact, the noble Earl, Lord Balfour, said that he thought that it was not possible. After some discussion, the Minister corrected us and said that it was indeed possible.

Given that there was such a degree of confusion about the matter, even in your Lordships' learned House, it may be appropriate to put the provision on the face of the Bill. That would make it clear to patients and to those looking after them that the right is included in the Bill.

I am extremely grateful to the Minister for accepting and developing the amendments. As was said in Committee by my noble friend Lord Carter, it would be difficult to improve on the limpid clarity of "in writing",

1 May 1995 : Column 1227

which is included in Amendment No. 10, but the Department of Health appears to have done so. I beg to move.

4.30 p.m.

Baroness Cumberlege: My Lords, I am very grateful to the noble Baroness for that introduction of the amendments. Perhaps I may say that in Committee we agreed to the two amendments moved by the noble Lord, Lord Carter.

These amendments have again been tabled by the noble Baroness, Lady Jay, and the noble Lord, Lord Rea. The effect is to require the patient to be informed in writing of the acceptance of the application, and at the same time told both orally and in writing of his rights to a mental health review tribunal and to be legally represented there.

We accept the spirit of these amendments but have considered that this principle needs to be applied more broadly. We believe that there should be a duty to inform the patient both orally and in writing at each stage of the process: on making the application, when it is accepted, if the aftercare services to be provided or the requirements upon the patient are modified, if the power is renewed and when it is terminated.

The patient also needs to be told formally of his rights to a mental health review tribunal not only when the application has been accepted but when it is renewed. In practice, we envisage a leaflet setting out those rights. That would include reference to the free legal representation which is available to all those who appeal to a tribunal.

In considering the duty to provide information we also think that it would be right for the nearest relative to be informed in writing, where it is practicable to do so and where the patient does not object. Informing the nearest relative in writing will enable him or her to exercise the right to appeal to a mental health review tribunal.

Informing the nearest relative in writing ties in with existing provisions of the 1983 Act. We have not amended the references to the informal carer who does not at present feature in the Act. We think there should be flexibility in the way they are informed. In many cases the informal carer may be the nearest relative as well, so would be informed in writing anyway. The Government's amendments will be in the interests of the patient and I trust will be welcomed by your Lordships.

Baroness Jay of Paddington: My Lords, I am extremely grateful to the Minister for that extensive explanation. I am being extremely stupid because I have not yet found the reference in relation to legal representation but I am grateful to hear that it exists. Perhaps the Minister will tell me at a later stage in which of the Government's amendments that appears. I am satisfied by the Minister's explanation. We have covered a great deal of ground which we discussed at length in Committee and that has had a very satisfactory outcome. I beg leave to withdraw the amendment.

1 May 1995 : Column 1228

Amendment, by leave, withdrawn.

Baroness Cumberlege moved Amendment No. 11:

Page 2, leave out lines 30 to 37 and insert ("both orally and in writing—
(i) that the supervision application has been accepted; and
(ii) of the effect in his case of the provisions of this Act relating to a patient subject to after-care under supervision (including, in particular, what rights of applying to a Mental Health Review Tribunal are available);
(b) inform any person whose name is stated in the supervision application in accordance with sub-paragraph (i) of paragraph (e) of section 25B(4) below that the supervision application has been accepted; and
(c) inform in writing any person whose name is so stated in accordance with sub-paragraph (ii) of that paragraph that the supervision application has been accepted.").

On Question, amendment agreed to.

[Amendment No. 12 not moved.]

Baroness Cumberlege moved Amendment No. 13:

Page 2, line 37, at end insert:
("(9) Where a patient in respect of whom a supervision application is made is granted leave of absence from a hospital under section 17 above (whether before or after the supervision application is made), references in—
(a) this section and the following provisions of this Part of this Act; and
(b) Part V of this Act,
to his leaving hospital shall be construed as references to his period of leave expiring (otherwise than on his return to the hospital or transfer to another hospital).").

The noble Baroness said: My Lords, this amendment puts beyond doubt that a supervision application can be made for patients who have been granted leave of absence from hospital and who may be made subject to aftercare under supervision without having first to return to hospital, once their period of liability to detention comes to an end. That has always been our policy intention.

Under the existing Act patients who are on leave of absence are entitled to Section 117 aftercare, but remain liable to recall to hospital and are subject to the consent to treatment provisions in the Act. This means medication can be administered without their consent, although that would usually be given in hospital. When their period of detention ends, we foresee that some patients who are on their way to successful rehabilitation at the end of their period of liability to detention, but who still require supervision, could be made subject to the new power at that stage. Such aftercare services would then have to be provided under supervision. The patient would have the right to appeal against the decision to a mental health review tribunal in the same way as any patient for whom a supervision application has been accepted. I beg to move.

On Question, amendment agreed to.

Next Section Back to Table of Contents Lords Hansard Home Page