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Lord Jenkin of Roding moved Amendment No. 26:


Page 4, line 24, after ("requirements") insert ("which will be set out in the care programme approach").

The noble Lord said: My Lords, with this amendment, we shall also take Amendment No. 135. Perhaps I may deal with the two points in turn.

Subsection (8) of what is now to be Section 25B of the Mental Health Act requires the application for a supervision order to be accompanied by four requirements: first, a statement from the proposed community responsible medical officer that he will be in charge; secondly, a statement by the supervisor that he will supervise the patient—we have just discussed the professional qualifications of such a person, and I shall return to that a little later; thirdly, the details of the aftercare services to be provided under Section 117 of the 1983 Act; and fourthly, details of the requirements to be placed on the patient for the purpose of securing that he receives those services. It is the last of those requirements to which my Amendment No. 26 is directed.

Noble Lords will remember that at the start of today's proceedings I expressed the view that it is crucial that this legislation should be readily understandable to those who will have to operate it. Few areas of health legislation require such continuous, precise and meticulous observance of the ipsissima verba of the statutes as the care and treatment of the mentally ill. It is therefore very helpful if the amending legislation can deploy language with which practitioners will be readily familiar. The phrase "care programme approach" is now widely used. Indeed, it is used in the Notes on Clauses with which we have been provided and was used in an amendment moved earlier by the noble Baroness, Lady Jay.

It is simply not clear what the "requirements" are, of which details need to be given under subsection (8) (d). However, practitioners would understand the words in my amendment,


That is perfectly clear. It is language with which they are familiar, and they would know precisely what has to be included. I commend that form of words to my noble friend.

Somewhat similar considerations apply to Amendment No. 135, which relates to page 35 of the Bill. It is to be found on page 19 of the Marshalled List. Paragraph 4 of Schedule 1 to the Bill amends Section 34 of the 1983 Act by adding two new definitions: one is the community responsible medical officer, and the other—we come back to our old friend—the supervisor.

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Amendment No. 135 would add some words at the end of that definition, again to give, I hope, familiarity to those who will have to operate the legislation. The additional words suggested are,


    "and will normally be the person who is the key worker for the purposes of the patient's care programme".

The phrase "the key worker" is one that is widely used and understood, and everybody will know what is meant. In other words, it is the front line person in charge.

I really must ask again: why is it that the draftsman will not use this phrase? It is widely understood in the professions. Why is it not possible to bring these sorts of commonly used expressions into legislation? Why is it that the draftsman always turns his back on words that ordinary people use and imports his own language, which simply gives everybody another task of trying to understand. They will say finally, "Oh, what you mean is the key worker", and, "Yes, that is who we mean, the key worker". Why can that not be in the Bill? This will apply again when we come to Amendment No. 135, although I shall probably not move it. The draftsman dealing with this kind of matter seems to live in a world of his own, remote from the people who deal with these matters. They have to deal through my noble friend's department, which is itself, with the best will in the world, somewhat removed from the health authorities, the trusts and local authorities where the people who operate the legislation are employed. The result is that thoroughly familiar expressions get lost. We have two such expressions here, and there is no reason why they should not be written into the Bill. They would make the legislation clearer and easier to understand for the people who will operate it. I beg to move.

Baroness Jay of Paddington: My Lords, I support the noble Lord, Lord Jenkin of Roding. He explained to me why Amendment No. 24 was not accepted; namely, because the words "community psychiatric nurse" and "approved social worker" are obviously not suitable for the draftsman either.

Baroness Cumberlege: My Lords, our objections in that regard go a little deeper.

As I understand my noble friend's amendments, they refer to the care programme approach which lies at the heart of all our initiatives to improve the care provided for mentally ill people. This approach provides for a personal key worker (to use my noble friend's words) and systematic arrangements for the assessment of aftercare and accommodation needs to ensure that those with a mental illness get the health and social care they need in the community.

The report of the internal review into the Legal Powers on the Care of Mentally Ill People in the Community which was published in August 1993, and upon which we consulted widely, forms the basis of the new power of aftercare under supervision. In that report we stressed that it was an underlying principle that any new power would reflect the objectives of the care programme approach and be part of a comprehensive multi-disciplinary approach to care. This principle has been incorporated into the Bill.

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These amendments are designed to link aftercare under supervision explicitly with the care programme approach by including it in the reference to requirements which may be imposed on the patient and by requiring the supervisor to be the key worker for the patient's care programme.

I have a lot of sympathy with the views expressed by my noble friend and the plea for plain language. But, as I understand it, our objections are not related to any language problem. It is simply that we do not believe that the amendments would work because they would make the operation of aftercare under supervision rely on the terms used in the care programme approach, which have no statutory basis.

It is certainly true that the Bill seeks to ensure the effectiveness of the care programme approach by giving it a measure of statutory backing. But because the CPA is not itself a statutory arrangement the Bill needs to have its own distinct terminology. The alternative would be to create a comprehensive statutory framework for the CPA and we do not think that that would be justified, given that most of the patients to whom it applies do not need to be subject to statutory supervision. We agree entirely that the supervisor should normally be the patient's key worker and that will be made clear in guidance. But we would not want absolutely to exclude an alternative arrangement if, for example, there were special reasons for the community responsible medical officer acting as the supervisor in a particular case.

My noble friend said that he would not press these amendments. I hope that to some extent I have enlightened him upon our position.

5.30 p.m.

Lord Jenkin of Roding: My Lords, I am grateful to my noble friend for her explanation. I understand the reasons of substance why, in the present framework of the legislation, it may not be possible to encompass words such as "care programme approach" and "key worker" and so on—words which are absolutely in the vernacular of CPNs and those who are involved in this area. I simply ask that when this kind of legislation is being put together it could start from the proposition of what people do and the language that they use —the phrases with which they are familiar—and not simply say, "Well, it is outside the statute and we will have our own special legislation in the statute".

I shall not labour the point. I simply say that I find the whole approach of the draftsman to this kind of legislation increasingly difficult. I hope that perhaps they may take some notice of the protests made from these Benches in this House. I am grateful to the noble Baroness, Lady Jay, for her support. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Baroness Cumberlege moved Amendment No. 27:


Page 4, line 28, leave out lines 29 to 36 and insert ("both orally and in writing;
(b) inform any person who has been consulted under paragraph (a) (iv) of subsection (2) above; and
(c) inform in writing 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.

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On Question, amendment agreed to.

[Amendment No. 28 not moved.]

Lord Rea moved Amendment No. 29:


Page 6, line 27, at end insert:
("( ) The responsible after-care bodies shall not make such requirements specified in subsection (3) below unless they have first heard and considered the views of the patient.").

The noble Lord said: My Lords, as my noble friend and others have pointed out, the Minister has gone a long way in her amendments to meet the points made at Committee stage about consultation with those who might be concerned with aftercare and informing patients of their rights. However, it is still necessary to ensure that the patient himself, who after all is the chief actor on the stage—or chief persona, as he is acted upon—should be brought into the centre of the discussion about his (or her) future management and not merely into the mechanisms of drawing up the application for the supervision order.

It is true that long-stay patients with severe mental illness are still vulnerable people—although, according to the noble Baroness, they are apparently not vulnerable when it comes to deciding whether they should get priority in housing—but when they are about to be discharged, patients will be more settled and rational than when they were admitted. They should be given a full right as a citizen to express their views and preferences.

The amendment is not simply to ensure that a patient has a right to consultation. It is likely to make it much more probable that he will willingly co-operate with any arrangements that are made as a part of that process of consultation. Therefore, this provision will make the package much more likely to be a success rather than have it disintegrate through either misunderstanding or even a form of protest by obstruction, because the patient did not feel that he had played any part in drawing up the care plan or package and did not have a proper voice in it.

I hope that my remarks have made the purpose of the amendments clear. I beg to move.


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