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Baroness Cumberlege moved Amendments Nos. 139 and 140:


Page 37, line 20, leave out from ("that") to end of line 25 and insert ("at all times while a patient is subject to after-care under supervision—
(a) a person who is a registered medical practitioner approved for the purposes of section 12 above by the Secretary of State as having special experience in the diagnosis or treatment of mental disorder is in charge of the medical treatment provided for the patient as part of the after-care services provided for him under this section; and
(b) a person professionally concerned with any of the after-care services so provided is supervising him with a view to securing that he receives the after-care services so provided.").
Page 37, leave out lines 28 and 29.

The noble Baroness said: My Lords, I have spoken to both of these amendments. I beg to move.

On Question, amendments agreed to.

Baroness Jay of Paddington moved Amendment No. 141:


Page 37, line 33, at end insert:

("General Protection of Detained Patients

.—(1) Section 120 of that Act (General Protection of Detained Patients) shall be amended in accordance with sub-paragraphs 2 and 3 below.
(2) In subsection (1), for the words "detained under this Act and shall make arrangements" there shall be substituted "detained or received into guardianship or after-care under supervision under this Act".
(3) In subsection (1) (b) (ii), for the words "has been so detained" there shall be substituted "has been detained or liable to be detained or received into guardianship or after-care under supervision".").

The noble Baroness said: My Lords, this amendment seeks to extend the remit of the Mental Health Act Commission to cover those patients placed on supervised

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discharge orders and living in the community. Such patients are the main subject of this Bill. With the leave of the House, I should like to discuss the ancillary issues which arose in relation to Amendment No. 20, which was not discussed earlier in the day. As the noble Lord, Lord Jenkin, discovered, the amendment was pre-empted without notice being given. I understand that I cannot now move Amendment No. 20. However, with the leave of the House I should like to discuss and include some of the issues related directly to Amendment No. 141 which I would have raised in relation to Amendment No. 20 had I spoken to that amendment in its place on the Marshalled List. We discussed these questions briefly in Committee, but I should like to return to them in greater depth now.

I remind noble Lords that the Mental Health Act Commission is a special health authority which, on behalf of the Secretary of State, keeps under review the uses of the Mental Health Act in England and Wales as it relates to patients detained in hospital. The commission now visits at least once a year every hospital and mental nursing home caring for detained patients. I understand that that is currently about 634 units. It deals with approximately 500 complaints each year under its statutory complaints remit. In other words, this is the one national statutory authority which is able to monitor and evaluate both mental health services and mental health patients across the country.

As I said at the Committee stage, if we are to be able in the future to make an accurate nationwide assessment of the success or failure of this new supervision order, it will best be carried out by the Mental Health Act Commission. It is equally important that, if the health and social services are to be able to keep track of patients as they move about the country, it could best be done also by the Mental Health Act Commission. Noble Lords will remember the examples which were quoted extensively in earlier debates. They showed how patients like the schizophrenic, Andrew Robinson, turned up in different places, and doctors and social workers had only his account of his problems and background to go on. At the moment there is no central reference point or central monitoring of mental health patients who are living in the community. I remind your Lordships that the public inquiry into the Robinson case noted that as a serious failure in the existing system.

At the Committee stage the Minister said that these matters would be dealt with by the social services inspectorate or the National Health Service executive. I refer noble Lords to col. 141 of the Official Report dated 4th April. I wonder whether, on reflection, the Minister believes that that is rather unrealistic and impractical. I am afraid that I have to say that I do. Since we had the Committee stage discussion, the Mental Health Act Commission itself last week published a position paper on the Bill. That paper appears to argue in support of Amendment No. 141 and indeed for the earlier Amendment No. 20.

Amendment No. 20, which was not called, asked that the Mental Health Act Commission should be notified when a supervision order was made. Paragraph 2.4 of the commission's paper states:


    "We consider that careful observation and monitoring of the use of these new powers will be necessary, particularly in the early years. Although the commission has no wish to be directly involved in the

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    consultation process itself, which has to be carried out before a particular discharge takes place, it may be considered sensible and desirable for the Bill to include a provision which obliges the applicant RMO to copy the application, whether or not it is successful, to the commission".

It was also noted that the Bill already provides for similar proposals in Scotland. I remind your Lordships that the RMO there shall, within seven days of making a community care order, send a copy to, among others, the Mental Welfare Commission for Scotland. That is found in Clause 4(1). When we debated that matter at an earlier stage, noble Lords around the House raised the question of the inconsistency between the Scottish and the English provisions. We did not have a very satisfactory reply as to why they were different south of the Border. Perhaps the Minister could help us with that point in her reply tonight.

Going further, in Section 3 of its comments on the Bill, the commission discusses the general extension of its statutory remit through amendments to the 1983 Mental Health Act, as proposed by Amendment No. 141. The commission states that the new powers of control and compulsion of patients proposed by the Bill warrant consideration being given to the extension of its remit to patients under supervised aftercare, and to make its new proposed position consistent also to patients discharged under guardianship orders.

The commission argues—I quote directly from its document:


    "This would ensure that the new powers are correctly exercised and applied in strict accordance with the statutory requirements and, by a process of observation and monitoring over the years, the use of the powers is of benefit to the patients involved and to the community into which the patient is being discharged".

I should also add that that was another of the recommendations from Jean Ritchie's report on the Christopher Clunis case, which—despite the general undertakings that we discussed earlier from which it appeared that the Government had undertaken to adopt all the recommendations—has not yet been agreed on. Surely, given those authoritative opinions on the situation related to the Mental Health Act Commission, the Government should accept the amendment, which must safeguard both the effective operation of the new orders and the well-being of the patients concerned. I beg to move.

Baroness Cumberlege: My Lords, the second of these amendments was tabled by the noble Baroness at Committee stage and I explained then our reservations to extend the remit of the Mental Health Act Commission to cover those subject to legislation in the community. I know that the noble Baroness had some sympathy with the arrangements proposed north of the Border. But the Mental Welfare Commission for Scotland has a different statutory function to that of its nearest equivalent in England and Wales.

In keeping with the second amendment, the first would empower the Mental Health Act Commission to keep under review, on the Secretary of State's behalf, the way both guardianship and supervised discharge were being applied in the community. It would enable the commission to investigate complaints accordingly. I

1 May 1995 : Column 1314

understand the case being made; but in terms of priority, the commission must concentrate on the special position of those who are detained in hospital.

We consulted with the commission over our proposals and listened carefully to what it said. At present, and bearing in mind the commission is undergoing a major structural change later this year, we do not propose to divert it from its central task of safeguarding the interests of detained patients. Patients receiving aftercare under supervision will have their rights protected by access to the Mental Health Act review tribunal, as those subject to guardianship do now. We shall be looking at the use and effectiveness of the new power as practitioners become familiar with its application.

I can assure your Lordships therefore that monitoring and evaluation will take place both locally and nationally. Again, I ask the noble Baroness to withdraw the amendment.

Baroness Jay of Paddington: My Lords, I am grateful for that reply, but I am rather disappointed by it. If an effective national evaluation of these new and complicated procedures is to take place, then it should be done by a national body. I simply repeat the Minister's words at Committee stage when she said that the Mental Health Act Commission admirably fulfils its function. I should have thought it would be a necessary extension of that function to include patients in the community.

I should have thought also that if the commission itself argues in its position paper on the Bill that it should take on these new functions, then the Government's anxieties about them having inadequate resources or capacity are ill-founded and the commission's position must be taken at face value. However, I hear what the Minister says. I shall think about the matter again and perhaps return to it later. In the meantime, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.


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