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Baroness Cumberlege: My Lords, the amendment suggests that where place of residence is among the requirements—if any—placed upon a patient, special arrangements for moving him or her to another area covered by another health and local authority would be necessary. I hope I can explain that, while the arrangements will indeed be necessary, the amendment itself is not. The power of supervised discharge aims to ensure that a discharged patient receives the services which must be provided under Section 117 of the Mental Health Act. This latter provision has been in existence since 1983 and allows—without specifying the detailed arrangements and consultations which must take place as a matter of good practice—a patient to move from one area to another without losing the care in the community and support he or she needs. Section 117 simply says that it is the duty of the authorities in

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which the patient is resident (or to which he or she is discharged) to provide those services, regardless of whether the authorities change because of where the patient subsequently moves to. Therefore, if a patient wishes to move to a different area and it is considered to be in his or her best interests, then arrangements can be made regardless of whether his or her actual place of residence is a requirement under supervised discharge. Such a change could be accommodated by the review of requirements provisions already in the Bill and by the flexibility which Section 117 already allows. A change of community responsible medical officer or supervisor, whether because of a change of location or any other reason, is allowed for in the Bill as drafted.

The transfer to Scotland is, as your Lordships have identified, a slightly different matter, as would be a transfer in the opposite direction. We are looking at this at present and I intend to put proposals to the House on Third Reading. In the meantime, in the light of that explanation, I hope that the noble Baroness will withdraw the amendment.

Baroness Jay of Paddington: My Lords, I am grateful to the Minister for that explanation and in particular for her remarks that she will be tabling proposals relating to cross-border transfers, or whatever one may call them—drifting perhaps rather than transfers —at a later stage of the Bill. On that basis, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Baroness Cumberlege moved Amendment No. 46:


Page 9, line 26, 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. 47:


Page 9, line 27, 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 Amendments Nos. 48 to 56:


Page 9, line 28, after ("inform") insert ("in writing").
Page 9, leave out line 31 and insert ("that the report has been furnished.").
Page 10, line 25, leave out from ("whether") to end of line 43 and insert ("the conditions set out in subsection (4) above are complied with unless—
(a) the following persons have been consulted—
(i) the patient;
(ii) the supervisor;
(iii) unless no-one other than the community responsible medical officer is professionally concerned with the patient's medical treatment, one or more persons who are so concerned;
(iv) one or more persons who are professionally concerned with the after-care services (other than medical treatment) provided for the patient under section 117 below; and

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(v) any person who the community responsible medical officer believes plays a substantial part in the care of the patient but is not professionally concerned with the after-care services so provided;
(b) except where 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; and
(c) the community responsible medical officer has taken into account any relevant views expressed by the persons consulted.").
Page 11, leave out lines 4 to 13 and insert ("both orally and in writing—
(i) that the report has been furnished; and
(ii) of the effect in his case of the provisions of this Act relating to making a patient subject to after-care under supervision for a further period (including, in particular, what rights of applying to a Mental Health Review Tribunal are available);
(b) inform any person who has been consulted under paragraph (a) (v) of subsection (6) above that the report has been furnished; and
(c) inform in writing any person who has been consulted under paragraph (b) of that subsection that the report has been furnished.").
Page 11, line 27, leave out from ("unless") to end of line 45 and insert ("subsection (3) below is complied with.
(3) This subsection is complied with if—
(a) the following persons have been consulted about the giving of the direction—
(i) the patient;
(ii) the supervisor;
(iii) unless no-one other than the community responsible medical officer is professionally concerned with the patient's medical treatment, one or more persons who are so concerned;
(iv) one or more persons who are professionally concerned with the after-care services (other than medical treatment) provided for the patient under section 117 below; and
(v) any person who the community responsible medical officer believes plays a substantial part in the care of the patient but is not professionally concerned with the after-care services so provided;
(b) 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 giving of the direction; and
(c) the community responsible medical officer has taken into account any views expressed by the persons consulted.").
Page 12, line 7, after ("patient") insert ("both orally and in writing").
Page 12, line 13, leave out ("except where") and insert ("unless").
Page 12, line 14, after ("inform") insert ("in writing").
Page 12, line 17, leave out ("of his ceasing") and insert ("that the patient has ceased").

On Question, amendments agreed to.

[Amendments Nos. 57 and 58 not moved.]

Baroness Cumberlege moved Amendment No. 59:


Page 12, line 30, leave out subsection (3).

The noble Baroness said: My Lords, I shall speak also to Amendment No. 128. The amendments change the commencement date of the Bill from 1st January 1996 to 1st April 1996. We have taken stock of the Bill's progress through Parliament and considered the need for consequential amendments and secondary legislation. We believe that once the legislation has been passed

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there must be sufficient time for guidance to be issued and read and fully understood by those who are to operate the new powers both in England and Wales and in Scotland. During Committee we also took note of the points made about local government reorganisation in Scotland, and the Government consider that a 1st April start date would be a more suitable date for this reason. I beg to move.

On Question, amendment agreed to.

6.30 p.m.

Baroness Jay of Paddington moved Amendment No. 60:


After Clause 1, insert the following new clause:

("Guardianship

. In section 7(5) of the Mental Health Act 1983 after the words "the local social services authority" in each place they occur, there shall be inserted the words "or relevant health authority".").

The noble Baroness said: My Lords, in moving Amendment No. 60 I shall speak also to Amendment No. 61. They would place on the face of the Bill the amendments to the Mental Health Act 1983 which would make guardianship a statutory alternative and with the same terms as a supervised discharge order. That would thus make the two provisions interchangeable.

On Second Reading we discussed the general advantages of guardianship. I suggested that if the guardianship orders in the Mental Health Act 1983 were amended as we now propose, the new supervision order could be made redundant. However, in Committee I proposed an amendment to ensure that guardianship was considered before a supervised discharge order was made. In reply, the Minister said that she was sure that in practice that would happen. However, she also said that, as the guardianship order was seen as a social services provision and the new order is to be health authority driven, and as there is no power to take and convey in guardianship as it now stands, it was unlikely that guardianship would often be used for this particular group of patients.

The new clause seeks to amend the 1983 Act so that guardianship may in future be the responsibility of a health authority as an alternative to a social services authority. It also adds to Section 8 of the Mental Health Act the additional power to take and convey. I remind your Lordships that that additional power as regards guardianship was suggested by the Law Commission report on mental incapacity. It was published earlier this year but after publication of the Bill. Those consulted by the Law Commission were unanimous in supporting the additional power and said that the fact that it was not in the present guardianship arrangements was a serious omission.

We know that guardianship is growing in practice, although at one stage it was not often used by local social services. There were 66 orders in 1983-84 and 326 in 1993-94. I believe that if the practice is becoming acceptable to patients and to doctors and social workers, who understand the implications of the guardianship law and have practice in using it, the simple addition of taking and conveying to make it consistent with the new

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Bill and to amend the 1983 Act in the way that I have suggested would make it even more useful. I beg to move.


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