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Earl Russell: My Lords, before the noble Baroness sits down I wonder whether she could answer the question

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which the noble Lord, Lord Campbell of Croy, asked. It was whether it would be possible to refuse to be a supervisor. It is an interesting question.

Baroness Cumberlege: My Lords, if someone did not wish to be a supervisor but was appointed then the care plan would not work. It is essential that everyone should agree on how the care plan works, and the supervisor is the key person in that role.

Lord Campbell of Croy: My Lords, I am grateful to my noble friend. I shall ensure that what she said is conveyed to those who are worried about the legal and constitutional side of their responsibilities. I hope that they will be reassured by what she said. These are serious points and that is why I thought it worth raising them in a probing amendment, even at this stage, because they had not been brought to my attention before the Committee stage. I am grateful to the Minister for her reply and beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

5.15 p.m.

Baroness Jay of Paddington moved Amendment No. 24:

Page 3, line 32, after ("supervisor") insert ("who shall be a community psychiatric nurse or an approved social worker").

The noble Baroness said: My Lords, Amendment No. 24 follows precisely the concerns raised by the noble Lord, Lord Campbell, on the previous amendment.

Amendment No. 24 seeks to establish on the face of the Bill who will be the nominated supervisor who will deal with the patient who is on a discharge order and what that person's professional qualifications will be. Noble Lords will remember that at the Committee stage I raised the question in an amendment stipulating that the supervisor should be a community psychiatric nurse. Amendment No. 24 seeks to extend that to include an approved social worker under the meaning of the 1983 Act.

The noble Baroness, Lady Miller, who replied to our discussion at Committee stage, said (at col. 142 of the Official Report for 4th April 1995) that naming one professional discipline was an unnecessary constraint and that flexibility was needed. However, it seems to me that those were exactly the same arguments as were made by the Government at an earlier stage about not professionally defining the qualifications of the community responsible medical officer. As we have heard, the Government themselves rejected those arguments in bringing forward Amendment No. 139, which the House is likely to accept this afternoon. Perhaps I may remind noble Lords who were not in the Chamber that that amendment defines the qualifications for the community responsible medical officer in the way which we seek to do by Amendment No. 24 for the equally crucial role of the supervisor in the community. I hope that the Minister will be able to change her position about it.

As the noble Baroness, Lady Miller, told us in Committee, the supervisor will be the key worker dealing with patients in the community. As I said in earlier debates, the position of supervisor will be a new and extremely responsible one. It therefore seems only

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sensible that they should be appropriately professionally qualified. Both the Royal College of Nursing and the British Association of Social Workers believe that the position must be specified.

Their position is similar to the one raised by the noble Lord, Lord Campbell of Croy, on the previous amendment. They are concerned that their members will feel unable to undertake the responsibilities unless they are given specific professional status within their organisations. Both organisations are anxious that anyone who holds the position must be properly resourced. The Royal College of Nursing, for example, pointed out that only one in five people diagnosed as having schizophrenia currently has access to a CPN. The Royal College of Nursing therefore estimates that the number of CPNs would have to be doubled in England alone if supervised discharges were to work effectively.

At Committee stage, the noble Earl, Lord Russell, and I discussed whether, if professional designation of the supervisor were on the face of the Bill, it might encourage better resourcing of those people who held the posts. If that happened, it would in itself, it seems to me, be a good argument for accepting the amendment.

I also wish to point out that the amendment reflects one of the crucial recommendations made in the Ritchie Report on the Christopher Clunis case which has not yet been accepted by the Government. I thank the Minister very much for writing to me in considerable detail about the Government's present position on the recommendations of the Ritchie Report on Christopher Clunis. I particularly thank her as I raised the question with her only in the middle of last week.

The Minister will undoubtedly recall that in a previous debate which we had on community care on 16th March 1994—over a year ago—she said in reply to her noble friend Lady Cox:

    "My noble friend Lady Cox will be pleased to learn that my right honourable friend the Secretary of State has accepted all the recommendations of the Ritchie Report".—[Official Report, 16/3/94; col. 283.]

I emphasise "all" because, although the Minister was kind enough to write to me explaining the position of the Government on the present state of their approach to the recommendations of the Ritchie Report, this recommendation is crucial. It is that anyone who held the key worker role in relation to supervised discharge—although at that stage the Government were only theoretically considering future legislation—should be either an approved social worker or a CPN, as the amendment suggests. I hope that this afternoon the Minister will stand by that commitment on this important issue and be able to accept the amendment. I beg to move.

Lord Rea: My Lords, I support my noble friend from the point of view of a practising GP. In my practice, many chronic mental patients have been supervised in the community either by CPNs or by social workers. It seems often to be the luck of the draw which member of which profession the patient relates to. In my case the CPNs were often moved more rapidly. The social workers were

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the more stable professionals who related to long-term schizophrenic patients. However, both professions equally can take on the role and do so effectively.

The Earl of Mar and Kellie: My Lords, it is important that for a case at this level of priority only an experienced social worker with specialist training in the mental health field should be allocated to the task and not just any social worker.

Baroness Miller of Hendon: My Lords, your Lordships expressed the view when we last looked at these provisions that a supervisor should always be a community psychiatric nurse. The present amendment broadens that by proposing that, as an alternative to a community psychiatric nurse, the supervisor may be an approved social worker—that is, a social worker approved by the local social services authority under the Mental Health Act as having a special competence for the purpose of making applications for compulsory admission to hospital or guardianship. As I explained previously, we envisage the supervisor being the same person as the key worker under the care programme approach in most cases and, again, in most cases, this will be a community psychiatric nurse. But we do not want to restrict who may be the supervisor in the way that the amendment proposes. In some cases that person might be a social worker rather than a nurse, but in others the patient's doctor might be better placed to perform the role. Nor would we want to exclude other possible but perhaps unusual arrangements such as, for example, a clinical psychologist being nominated.

The Government's Amendment No. 139 to Schedule 1 will, if your Lordships accept it, ensure that the supervisor is someone professionally concerned in the patient's care. We think that this will provide the safeguards necessary without being unduly rigid and prohibiting what, in some unusual cases, may be the most appropriate professional person. In the light of our proposed amendment to Schedule 1, I hope that the mover of this amendment will feel able to withdraw it.

Baroness Jay of Paddington: My Lords, as I said when we discussed the group of amendments that included Amendment No. 139—we accept that particular amendment and we are grateful to the Government for introducing it—I still feel unhappy about leaving this provision quite so baldly as it stands at the moment on the face of the Bill. As I said, there are two particular concerns, one of which is that raised by the noble Lord, Lord Campbell of Croy, about the concerns of professionals over their liability. The second is a more general one. It is the question of concerns about undertakings given on the basis of the Ritchie Report on Christopher Clunis, which made the very specific suggestion about the CPN or the ASW being the person responsible, which appears to have the agreement of all the professional bodies. Perhaps the Government will think about this matter again before Third Reading. In the meantime, I beg leave to withdraw the amendment.

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Amendment, by leave, withdrawn.

Baroness Cumberlege moved Amendment No. 25:

Page 3, line 34, leave out from ("of") to end of line 37 and insert ("—
(i) any person who has been consulted under paragraph (a) (iv) of subsection (2) above; and
(ii) any person who has been consulted under paragraph (b) of that subsection.").

The noble Baroness said: My Lords, I have already spoken to this amendment. I beg to move.

On Question, amendment agreed to.

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