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Baroness Jay of Paddington: My Lords, I thank the Minister for her reply, although I must confess that I am not entirely convinced by her arguments. Nevertheless, I am pleased to hear that the noble Baroness was tempted into accepting my arguments. I hope that the suggested provision will be introduced at another stage in another place and that the temptation then will be even greater and perhaps irresistible. I hear what the Minister says about the need to consider the role of the Mental Health Act Commission in the context of a wider review of the Mental Health Act 1983. As the noble Baroness will know from our previous debates on the Bill, I hope that that review will take place very soon. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Schedule 2 [Community care orders: supplementary]:

[Amendment No. 19 not moved.]

An amendment (privilege) made.

4.15 p.m.

Baroness Cumberlege: My Lords, I beg to move that the Bill do now pass.

I am most grateful for the careful thought and attention that your Lordships have given to the Bill. A number of excellent amendments have been moved. I am very pleased that we have been able to accept the spirit of some of them. Even those which have been unacceptable to us or those which have been probing amendments have almost invariably be invaluable in stimulating thought and debate. I can say without hesitation, and I hope without much fear of contradiction, that your Lordships have significantly improved what, of course, I believe was already a good Bill.

I have no doubt that the measures that we have passed in the Bill mark a significant advance in the care of some of the most vulnerable patients. As your Lordships know only too well, the background to our debates has been the cases of high risk patients who have become lost to care with tragic consequences. Those cases were very effectively highlighted by the noble Baroness, Lady Jay. My noble friends Lord Campbell of Croy, Lord Haig and Lord Balfour also spoke very movingly from their personal experiences with relatives who have suffered from severe mental illness.

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The Bill aims to give the essential underpinning to help avoid tragedies in the future. But in doing so it maintains the key elements of the care programme approach which apply to all patients receiving specialised psychiatric care in the community. The central principle of the Bill is that supervision cannot be separated from the aftercare services which it exists to support. Many of your Lordships, in particular the noble Earl, Lord Russell, and the noble Baroness, Lady Farrington, raised the question of resources. As I said during the course of the Bill, the background to that is that the Government have increased very substantially the resources devoted to the care of mentally ill people. Your Lordships can rest assured that there is no question of compulsion being substituted for care.

I should also like to offer a special word of thanks to those of your Lordships who have made suggestions for amending the Bill and, as I said, have helped us significantly in sharpening its provisions and ensuring that the essential interests of patients and their relatives are properly reflected.

In his unfailingly courteous but effective way, my noble friend Lord Mottistone persuaded us by the force of his argument of the importance of consulting the patient's nearest relative. He was joined by my noble friend Lord Haig and the noble Baroness, Lady Jay, in arguing the case for the community responsible medical officer to be someone approved by my right honourable friend the Secretary of State. The noble Lords, Lord Carter and Lord Rea, put forward a persuasive case for requiring information, including that about mental health review tribunal rights, to be given to patients both orally and in writing. I confess that I enjoyed being able to surprise your Lordships just a little by going even further than we had been asked to do.

We also had important contributions to our debates from the noble Earl, Lord Longford, the noble Lord, Lord Thurlow, the noble Baroness, Lady Robson, and my noble friend Lord Jenkin of Roding. They brought to our considerations that blend of wisdom and experience which people expect from your Lordships' House. Of course, their contributions have not been the only ones. I hope that your Lordships will excuse me for not mentioning by name all those who have spoken.

Perhaps I may just add that I am very sorry that, because of his illness, the noble Lord, Lord Ennals, was not able to be with us after the Second Reading of the Bill. I have referred to the high quality of our debates, but I am sure that, with his long-term interest and knowledge in the field, the noble Lord would have enriched them even further. I am sure that all noble Lords will want to join me in wishing the noble Lord a speedy recovery.

In relation to the Scottish provisions of the Bill, we are grateful to the noble Lord, Lord Carmichael of Kelvingrove, for his intervention on the subject of the immediate re-use of the period of reassessment in hospital. We have now made it clear on the face of the Bill that rolling periods of reassessment in hospital are not to be permitted. We are also very grateful to the noble Earl, Lord Mar and Kellie, for bringing to the debates knowledge gained from his experience in the field.

We are particularly grateful for the noble Earl's intervention on the subject of those community care order patients whose order expires when they are in prison. As

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a result, we have now addressed that group of people not only in Scotland but also in England and Wales. The noble Earl's interventions have also allowed my noble friend to explain quite clearly, and in some detail, the client group in respect of whom applications for community care orders may be made. We are grateful to have had that opportunity.

Finally, it is my very pleasant duty to thank my ministerial colleagues who have helped me take the Bill through your Lordships' House. As your Lordships will have recognised, it has been a textbook example of Anglo-Scottish co-operation. It has been salutary to have been told on occasions how much better the Scottish provisions are. My noble and learned friend Lord Fraser and my noble friend Lord Lindsay have taken the Scottish clauses through with skill and flair. I am also most grateful to the noble friend Lady Miller for sharing the burden of the English clauses and for being such a stalwart ally by my side. I think we have done good work on this Bill and I look forward to seeing it progress smoothly through the other place and on to the statute book.

Moved, That the Bill do now pass—(Baroness Cumberlege.)

Baroness Jay of Paddington: My Lords, this is a difficult Bill about a difficult subject. Community care for the growing numbers of mentally ill people in this country is causing great anxiety to the professional and informal carers who try to look after them; anxiety to ordinary citizens who are disturbed and sometimes threatened by the presence of seriously ill people in their midst and, above all, anxiety to the patients themselves who often feel isolated and bereft of support and treatment.

The problem arises from a failure to develop proper community care services which substitute for the old-fashioned, long stay residential institutions. The Government have introduced this Bill in the hope that additional legal powers over patients living in the community will alleviate anxiety. But we on these Benches have argued from the beginning that the fundamental issue is inadequate services, not inadequate laws. However, as I said at Second Reading, many of those involved in the care of seriously ill patients reluctantly accept that in a limited number of cases the kind of community supervision proposed in this Bill may be useful.

The fundamental questions we have raised about supervised discharge concern achieving an appropriate balance between an effective statute which must limit a patient's liberty, and the patient's own civil rights. We have also questioned the necessity of introducing this new, somewhat draconian order when the less onerous system of guardianship already exists. Guardianship provides almost identical powers to those in the new order, and I am glad that at Report stage the noble Baroness, Lady Miller, said that the Government were reviewing this power again and may extend it.

The most important protective agency looking after detained patients is the Mental Health Act Commission which also provides a national monitoring and evaluation of residential services. Throughout the discussions on the Bill we have introduced amendments to extend the remit of the Mental Health Act Commission to include the

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patients covered in this Bill, and/or those on guardianship orders. This is an additional responsibility which, as I have already discussed this afternoon, the Mental Health Act Commission itself has suggested. But the Government have rejected this proposal although we still feel strongly that the commission could provide the necessary safeguard both as regards the effective operation of the new orders and as regards the well-being of the patients concerned. I am sure that my right honourable and honourable friends in another place will return to this issue.

But, on the whole, as the Minister said, we on these Benches, and noble Lords around the House, are satisfied with the changes in the Bill for which we have argued, and which the Government have now accepted. I am pleased, for example, that at Report stage the Government moved amendments to formalise the arrangements for consulting and informing patients about the procedures for supervised discharge and their legal rights. I am also glad that they have extended the involvement of relatives which, as the Minister mentioned, was something of particular concern to the noble Lord, Lord Mottistone. The noble Lord, Lord Mottistone, my noble friend Lord Longford and others were also concerned about the professional qualifications of the community responsible medical officer—a new post—and that, too, has been made explicit on the face of the Bill, as has the professional qualification of the person who will hold the responsible position of the community supervisor. The noble Earl, Lord Haig, moved amendments in Committee—which we on these Benches followed at Report—to clarify the position of patients who move between England, Wales and Scotland. That, too, has been satisfactorily resolved by government Amendments Nos. 3 and 13 this afternoon.

I thank the Minister for responding so positively to these concerns. I also thank her and the noble Baroness, Lady Miller, for their courteous and usually helpful replies to many other amendments. The noble Earl, Lord Lindsay, seemed even more amenable to proposals from my noble friend Lord Carmichael of Kelvingrove on the Scottish provisions. No doubt this was due to the superior forensic skills of my noble friend to whom I am most grateful for shouldering responsibility for the second part of the Bill. As the Scottish arrangements are so different from those in England and Wales, it really amounts to two Bills. There were several occasions when noble Lords from south of the Border cast envious eyes at Scotland's community care orders which seem to be more flexible and realistic than our supervised discharge orders. As my noble friend Lord Carter said in Committee, there was a clear case here for devolution in reverse.

The noble Lord, Lord Carter, who unfortunately cannot be with us this afternoon, has been, as always, a tower of strength during the passage of the Bill. I thank him and my noble friend Lord Rea for tackling the whole range of complex health, social and legal issues included in this legislation. My noble friend Lord Rea has, of course, longstanding personal experience of working on the front line with mentally ill patients in the community and this has lent his contributions special authority.

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The longstanding personal experience of my noble friend Lady Farrington in local government was particularly valuable when she pressed the Government to tighten the arrangements for providing community services. I am grateful to her for emphasising in her amendments the importance of jointly planned, properly resourced care programmes if supervised discharge orders are to be of any use. Adequate resources have also been a major concern of the many professional and voluntary organisations working in this field. I must thank them for their comprehensive briefing and careful help on the detail of the Bill. I am particularly glad that representatives of several outside bodies were able to take part in the special meeting we had with Ministers and officials before the Committee stage began. I echo the words of the Minister in regretting the absence of my noble friend Lord Ennals who was so helpful at the beginning of the Bill and whose illness we greatly regret. We wish him a speedy recovery.

We have made considerable progress on the detail of this Bill, but my concern remains that it seeks to solve a serious problem from the wrong direction. I repeat that the primary need in this area is for more services, not for more laws. The fundamental flaw of the Bill is in the introductory financial memorandum which states that the new measures will give rise to no new additional costs. If any new form of community care is not properly funded, it will fail. I am sure that that central issue will be addressed by honourable Members in another place and I look forward to their further consideration of this Bill.


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