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Lord Rea: My Lords, I thank the Minister for that reply. We still feel that this is a special group of patients who should be able to cope, with help, in the community. We feel that rather more searching scrutiny should be made of the reasons for their readmission and that consideration should be given to the question of whether their readmission or detention in hospital is necessary. However, I do not intend to press the amendment and I beg leave to withdraw it.

Amendment, by leave, withdrawn.

Baroness Cumberlege moved Amendment No. 38:


Page 7, line 36, leave out from beginning to ("under") in line 37 and insert:
("(5) The responsible after-care bodies shall not modify—
(a) the after-care services provided (or to be provided)").

The noble Baroness said: My Lords, in speaking to Amendment No. 38, I should like to speak also to Amendments Nos. 39 and 40. This group of amendments tidies up the existing provisions in new Section 25E. These all relate to the modification of the aftercare services; in other words, changes to the agreed care plan.

As currently drafted, the Bill would not allow for a change to the care plan to be made before the patient left hospital. In the great majority of cases the sequence of events will be, broadly, that the care plan will have been drawn up and agreed, the supervision application made and then accepted by the health authority, and the patient leaves hospital and returns to the community

1 May 1995 : Column 1257

where he will be subject to aftercare under supervision. However, it is possible that the care plan may need to be revised before discharge from hospital—perhaps a hostel place has fallen through, or the care team has to change. It therefore seems sensible to build in the possibility that the aftercare services could be modified before the patient leaves hospital. Changes as needed could also be made to the requirements in new Section 25D. Any other approach would mean that the original care plan and requirements would take effect when the patient leaves hospital and would then need immediate review and change.

The responsible aftercare bodies must not modify the aftercare services which are actually being provided or will be provided when the patient leaves hospital, unless they consult the patient, informal carer and nearest relative (where practicable unless the patient has objected) about the modifications. Again, as currently drafted, the Bill places the duty to undertake the consultation upon the responsible aftercare bodies; that is, the health authority and the local authority with the duty under Section 117 to provide aftercare. The amendments are intended to add flexibility to the system by leaving open who actually undertakes the consultation. In practice, we envisage that when the patient is subject to aftercare under supervision it will fall to the supervisor. The amended new Section 25E(6), however, makes it incumbent upon the responsible aftercare bodies that they must take into account the views expressed by those who have been consulted. I beg to move.

On Question, amendment agreed to.

Baroness Cumberlege moved Amendment No. 39:


Page 7, line 42, leave out from beginning to end of line 7 on page 8 and insert ("unless subsection (6) below is complied with.
(6) This subsection is complied with if—
(a) the patient has been consulted about the modifications;
(b) any person who the responsible after-care bodies believe plays (or will play) a substantial part in the care of the patient but is not (or will not be) professionally concerned with the after-care services provided for the patient under section 117 below has been consulted about the modifications;
(c) unless the patient has otherwise requested, such steps as are practicable have been taken to consult the person (if any) appearing to be the nearest relative of the patient about the modifications; and
(d) the responsible after-care bodies have taken into account any views expressed by the persons consulted.").

On Question, amendment agreed to.

Baroness Cumberlege moved Amendment No. 40:


Page 8, line 9, after ("provided") insert ("(or to be provided)").

On Question, amendment agreed to.

Baroness Cumberlege moved Amendment No. 41:


Page 8, leave out lines 13 to 21 and insert ("both orally and in writing;
(b) inform any person who has been consulted under paragraph (b) of subsection (6) above; and
(c) inform in writing any person who has been consulted under paragraph (c) of that subsection,
that the modifications have been made.").

1 May 1995 : Column 1258

The noble Baroness said: My Lords, I spoke to the amendment with Amendment No. 10. I beg to move.

On Question, amendment agreed to.

Baroness Cumberlege moved Amendment No. 42:


Page 8, line 44, after ("patient") insert ("both orally and in writing").

The noble Baroness said: My Lords, I spoke to this amendment with Amendment No. 10. I beg to move.

On Question, amendment agreed to.

Baroness Cumberlege moved Amendment No. 43:


Page 9, line 1, leave out ("except where") and insert ("unless").

The noble Baroness said: My Lords, I spoke to this amendment with Amendment No. 15. I beg to move.

On Question, amendment agreed to.

Baroness Cumberlege moved Amendment No. 44:


Page 9, line 2, after ("inform") insert ("in writing").

On Question, amendment agreed to.

The Deputy Speaker (Lord Elliott of Morpeth): My Lords, I understand that there is a misprint on the Marshalled List, and that Amendment No. 45 should be in the name of the noble Baroness, Lady Jay of Paddington.

Baroness Jay of Paddington moved Amendment No. 45:


Page 9, line 6, at end insert:

("Regulations as to transfer of patients.

(1) This section applies when a patient decides to move from the original place of residence decided under section 25(d) above and this move involves a change of responsible Health Authority or Social Services Authority.
(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 areas 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 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.").

1 May 1995 : Column 1259

The noble Baroness said: My Lords, I am sorry that the amendment does not stand in the Minister's name. It is, however, similar to an amendment introduced in Committee by the noble Earl, Lord Haig, and it is with his permission that I am introducing it. The amendment allows for flexibility and continuity in the aftercare arrangements if a patient on a supervised discharge order moves from one health or local authority area to another. That will obviously be an issue where patients live in a large city such as London and by inadvertence move out of one local authority or health authority's area into another.

The noble Earl asked what would happen to patients who may move between Scotland and England where, as we know, the jurisdictions and care programme arrangements are different. The community supervision arrangements proposed in the Bill are dissimilar. We have been made aware that many patients are inclined to drift from one place to another. We have experienced such examples, and reports of difficult cases have been mentioned several times today.

Responding to the noble Earl's amendment in Committee, the Minister said that continuity of care was assured under the Section 117 duties on health authorities and social services which are transferable. That is fine in theory and in statute: it may not be so good in practice. It does not always work. Patients sometimes become the only source of information about their circumstances and diagnoses when they turn up in another jurisdiction and appear before another set of doctors and social services staff.

There is a strong case for revising the powers of the Mental Health Act Commission, something that we shall discuss under Amendment No. 141. In any case, there is an argument for being more precise on the face of the Bill about the need for cross-boundary consultation. That, as I say, will be especially important across the national border between England and Scotland. In Committee, in reply to that point, the Minister said:


    "We are looking carefully at what might be done to address this and we hope to bring forward our proposals soon".—[Official Report, 4/4/95; col. 163.]

When I saw the Marshalled List before the misprint came to light, I thought that that might have been what had happened. I have been disabused of that optimism. I beg to move.


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