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Page 22, line 42, at end insert:

Change of special medical officer or after-care officer

("35DA.—(1) This subsection applies where a patient's special medical officer, after consulting the persons mentioned in subsection (3) below, agrees with another medical practitioner ("the new special medical officer"), who shall be a practitioner approved for the purposes of section 20 of this Act by a Health Board as having special experience in the diagnosis or treatment of mental disorder, that the new special medical officer should, from a date so agreed, assume principal responsibility for the patient's medical treatment while the community care order is in force.
(2) This subsection applies where a patient's after-care officer, after consulting the persons mentioned in subsection (4) below, agrees with another person ("the new after-care officer"), who shall be a mental health officer of the local authority which is providing (or, if different, the local authority which is to provide) the after-care services to be provided for the patient under section 8 of this Act while the community care order is in force, that the new after-care officer should, from a date so agreed, assume responsibility for co-ordinating the provision of the after-care services to be so provided.
(3) The persons referred to in subsection (1) above are—
(a) the patient and, if practicable and the patient does not object, his nearest relative;
(b) the other persons concerned or to be concerned with the patient's medical treatment (including the new special medical officer);
(c) the patient's after-care officer;
(d) the other persons professionally concerned or to be so concerned with any aspect of the after-care services provided or to be provided for the patient under section 8 of this Act; and
(e) any person who the special medical officer believes plays or is to play a substantial part in the care of the patient but is not, and will not be, professionally concerned with the after-care services so provided or to be so provided.
(4) The persons referred to in subsection (2) above are—
(a) the patient and, if practicable and the patient does not object, his nearest relative;
(b) the patient's special medical officer;
(c) the other persons concerned or to be concerned with the patient's medical treatment;
(d) the other persons professionally concerned or to be so concerned with any aspect of the after-care services provided or to be provided for the patient under section 8 of this Act (including the new after-care officer); and
(e) any person who the after-care officer believes plays or is to play a substantial part in the care of the patient but is not, and will not be, professionally concerned with the after-care services so provided or to be so provided.
(5) Where subsection (1) or (2) above applies the new special medical officer or, as the case may be, the new after-care officer shall, from the agreed date, assume responsibility as mentioned in that subsection and shall within seven days of that date intimate the change, in the prescribed form, to—
(a) the patient and any other person who has been consulted under paragraph (a) of subsection (3) or, as the case may be, (4) above;
(b) the Mental Welfare Commission; and
(c) the patient's after-care officer or, as the case may be, special medical officer.
(6) On a change of special medical officer or after-care officer by virtue of this section, the community care order shall have effect in respect of the patient as if the new special medical officer or, as the

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case may be, the new after-care officer had been the special medical officer or after-care officer specified in the community care order by virtue of section 35A(4) of this Act.").

The noble Earl said:

My Lords, the way in which a change of special medical officer or aftercare officer might take place was a subject raised in Committee by the noble Earl, Lord Mar and Kellie. I indicated then that we were considering the way in which this might take place. This amendment contains our proposals.

If I can take the example of a change of special medical officer, the change could only take place after consultation with the patient and, where practicable and if the patient did not object, his nearest relative, and with those involved, or to be involved, in the care and treatment of the patient. There would be an agreement between the special medical officer and the proposed new special medial officer that, from an agreed date, the new special medical officer should assume principal responsibility for the patient's medical treatment while the order was in force.

Within seven days of assuming responsibility, the new special medical officer would have to inform the patient, the nearest relative, if the nearest relative had been consulted, along with the Mental Welfare Commission and the aftercare officer. A change of aftercare officer would operate in a similar way, with the aftercare officer and the new aftercare officer taking the leading roles, and the special medical officer being consulted. We believe this provision would offer a means of changing the special medical officer and aftercare officer which is in keeping with the spirit of consultation in the Bill. I hope it meets the concerns raised by the noble Earl in Committee. I beg to move.

The Earl of Mar and Kellie: My Lords, I certainly think the amendment that the noble Earl has proposed meets the concerns I expressed in Committee.

On Question, amendment agreed to.

Lord Carmichael of Kelvingrove moved Amendment No. 113:


Page 22, line 46, at end insert ("or for a variation of the conditions of the order").

The noble Lord said: My Lords, the purpose of the amendment is to clarify the point that while the doctors and social workers have the right to apply to the sheriff to vary the conditions of the community care order, there is no such right given to the patient who is having to live with the conditions on a day-to-day basis. We think this is wrong. The amendment gives the patient the right to require the sheriff to reconsider his case. Having reread the amendment, I realise that there are flaws in it. For instance, there is no time factor involved. There is no indication as to how often a patient can ask for a variation. We know that in certain cases, perhaps because of a loss of memory, there may be almost daily applications. Therefore, the provision would need to be tightened up in that regard. However, the sentiment behind the amendment is that someone other than the doctors or the

1 May 1995 : Column 1304

social workers should be able to ask for a variation. We are seeking a safeguard that the patient should have some rights in this matter. I beg to move.

The Earl of Lindsay: My Lords, as the noble Lord explained, this amendment seeks to extend the right of appeal by a patient to the sheriff to include an appeal against a variation of conditions. The noble Lord may be less enchanted with some of the detail of the amendment but we feel that the substance of the amendment, which I now concentrate upon, is unnecessary.

The Bill as drafted includes in new Section 35D(3) a right for the patient to object to, or make representations concerning, the proposed variation, and, if he does so, the sheriff shall not approve the variation without hearing the patient's case. We therefore believe that the right to be heard which we propose is adequate.

I should mention in passing that we are considering a technical amendment to ensure that the appeal against the community care order is by summary application to the sheriff of the sheriffdom in which the patient resides. I would ask the noble Lord on this basis to withdraw his amendment.

Lord Carmichael of Kelvingrove: My Lords, that is quite reassuring. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendment No. 114 not moved.]

The Deputy Speaker: My Lords, before calling the next amendment I should inform your Lordships that there is a printing error on the Marshalled List. This amendment should read,


    "Page 23, line 20, leave out from first ("The")".

Lord Carmichael of Kelvingrove moved Amendment No. 115:


Page 23, line 20, leave out from ("The") to first ("of") in line 21 and insert ("person applying for the variation of the community care order shall promptly notify the patient, and if practicable and if the patient does not object, the patient's nearest relative, and the after-care officer or the special medical officer, as the case may be").

The noble Lord said: My Lords, the purpose of this amendment is to provide that the person making the application must notify the patient, his nearest relative and the aftercare officer or the special medical officer not involved in the application for variation. The notification should, of course, be given promptly. If the amendment is accepted, then either the special medical officer or the aftercare officer may apply for a variation and either will have to notify the others. It is essential that the patient and his nearest relative be informed and that that is done promptly. This seems fairly straightforward to me. I beg to move.


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