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House of Lords

Friday, 27th March 1998.

The House met at eleven of the clock: The LORD CHANCELLOR on the Woolsack.

Prayers--Read by the Lord Bishop of Norwich.

The Lord Chancellor: Leave of Absence

The Lord Chancellor (Lord Irvine of Lairg): My Lords, before the commencement of business I take the opportunity to inform the House that I am to host a welcome luncheon for the Prime Minister of China on behalf of Her Majesty's Government on Wednesday, 1st April. Accordingly, I trust that the House will grant me leave of absence on that day.

Prime Minister (Ecclesiastical Functions) Bill [H.L.]

11.6 a.m.

Lord Alderdice: My Lords, I beg to introduce a Bill to make provision for the alternative exercise of the ecclesiastical functions of the Prime Minister when that office is held by a person who is not a member of the Church of England. I beg to move that this Bill be now read a first time.

Moved, That the Bill be now read a first time.--(Lord Alderdice.)

On Question, Bill read a first time, and to be printed.

Electricity Generation Bill [H.L.]

Baroness Maddock: My Lords, on behalf of my noble friend Lord Ezra, I understand that no amendments have been set down to this Bill and that no noble Lord has indicated a wish to move a manuscript amendment or to speak in Committee. Therefore, unless any noble Lord objects, I beg to move that the order of commitment be discharged.

Moved, That the order of commitment be discharged.--(Baroness Maddock.)

On Question, Motion agreed to.

Mental Health (Amendment) (No. 2) Bill [H.L.]

11.8 a.m.

Lord Rowallan: My Lords, I beg to move that the House do now resolve itself into Committee on this Bill.

Moved, That the House do now resolve itself into Committee.--(Lord Rowallan.)

On Question, Motion agreed to.

House in Committee accordingly.

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Clause 1 [Strategies for the provision of in-patient facilities in psychiatric units]:

Lord Rowallan moved Amendment No. 1:

Page 1, line 8, at end insert ("and other 24-hour nursed bed").

The noble Lord said: This amendment came about as a result of the Second Reading of this Bill and provides for 24-hour nursed beds to be available in each health authority. Both Sane and the National Schizophrenia Fellowship support this amendment. I am pleased to say that the Mental After Care Association also supports it. Mind, which has not liked Clause 1 of this Bill up to now, accepts it is a good idea for area authorities to have an appropriate strategy both in the context of in-patients, who are well catered for in this Bill, and those needing care in the community.

This Bill does not deal with out-patient care at all. But I give Mind and all the other charities concerned a firm commitment that in the absence of a new mental health Act being revealed shortly, I shall tackle the issue of out-patients and care in the community soon. To this end I look forward to the proposed Green Paper on mental health reform which is due at the beginning of April but which I gather has now been delayed. I ask the noble Baroness, Lady Ramsay of Cartvale, to inform this Chamber when she now expects it to be published.

It has to be significant that all the psychiatrists I have spoken to--after all, they are in the front line of mental healthcare--support this clause and its amendment. We should remember that there is a one in 10 chance of someone contracting the dreadful illness of schizophrenia. It does not respect wealth, colour, creed or geography as the statistics are the same the world over. Schizophrenics who either do not respond to, or comply with, medication pose particular problems to mental health services. For these people 24-hour care and nursing support within a safe, therapeutic environment is a necessary and important stage of this care.

This amendment has become even more important as a result of the recent Bournewood ruling in the courts stipulating that any patient unable to give informed consent must be detained on a section of the Mental Health Act. This of course dramatically increases the number of patients because it now takes into account all those with Alzheimer's, learning difficulties, etc., who need 24-hour care as they will be detained by law. I beg to move.

Lord Thurlow: I support this amendment. If the Bill were to become law it is manifestly important that it should cover the whole range of beds, including those in 24-hour nursed units. In that connection, it would be helpful if the Minister could give us an indication of what progress has been made with the creation of 24-hour nursed units for which we had high hopes two years ago when the previous government introduced the measure. However, we realised that there were difficult problems with regard to resources.

The noble Baroness in her forceful statement on Second Reading--I regret I was unable to be present--made it clear that it was not strictly necessary to

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introduce primary legislation at this stage to achieve the specific object of the Bill, and that under existing law the authorities are under an obligation to make strategic reviews and plans. Equally, there are obvious disadvantages in tackling this particular area piecemeal when we hope and believe that the Government are on the point of addressing the wide range of urgent and necessary issues. I accept that we cannot expect this Bill to reach the statute book, but that does not make the debate any less useful. It is a long time since we had a general debate of any kind on this urgent social question on which Parliament and the public have been for so long, and are still, exercised.

We look forward to the report to the Minister of the independent reference group and the Government's Statement. There has been considerable confusion arising from conflicting reports of the Government's immediate intention to close the big hospitals. We need clarification. It is not the fault of the present Government that they are landed with an immensely difficult, almost insoluble, problem of the discrepancy between resource and requirements. Nonetheless that makes it necessary to get on with the most urgent issues. I submit that all sides of the House have indicated that the issue of the closure of beds is perhaps the most urgent.

Lord Alderdice: The Bill results from the dismay felt by the noble Lord, Lord Rowallan, when it became apparent to him that there was great difficulty in acute in-patient psychiatric facilities. It has occurred over a period of time as we have attempted to move from the widespread treatment of patients in acute in-patient beds to care in the community. That in itself is a laudable and welcome development.

However, the resources left behind in the acute hospitals, and the concentration of disturbed people there, have led to considerable difficulties in the management of acute in-patient beds. The concern of the noble Lord is shared widely by those who work with people in acute in-patient facilities in psychiatric hospitals throughout the country as they become increasingly worried that the experience of in-patient care is much less therapeutic and more custodial--something we hoped we had left behind a long time ago.

However, there are other reasons why acute in-patient beds have become blocked. This became apparent as we looked into the matter. It is particularly apparent in the review paper published in the British Medical Journal some time ago by Shepherd and his colleagues. It is pointed out that one of the reasons why many people stayed in acute facilities is not that other facilities in the community were not readily available but because other residential facilities, properly manned by specialised care workers, were not available. That is why the Royal College of Psychiatrists has begun increasingly to talk about 24-hour nursed bed units in the community. Those are not a half-way house between acute psychiatric care and community care but facilities which provide the necessary expertise and containment appropriate for people in that setting.

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That is why, in the light of further exploration and concerns expressed that the Bill would point people back into acute psychiatric facilities rather than out into the community, the noble Lord, Lord Rowallan, has brought forward the amendment. I heartily support it. I believe that it has increased overall support for the Bill. I beg noble Lords heartily to support the amendment.

11.15 a.m.

Earl Howe: I, too, support the amendment. My noble friend and the noble Lord, Lord Alderdice, have set out the arguments for it most ably. I wish only to reinforce and develop one or two key points.

The main criticism of Clause 1--it was rehearsed by some noble Lords at Second Reading--is that by focusing on the requirement to provide in-patient facilities it unhelpfully skews the emphasis of patient care away from community provision and towards in-patient beds. In other words, by singling out one aspect of the continuum of care for mental patients one is somehow damaging the balance of care available to such patients and distorting the overall allocation of resources.

There are two answers to that point. First, one of the main reasons that my noble friend felt moved to introduce this Bill is that there is a clear need to right what is already an imbalance in the system. As the noble Lord, Lord Alderdice, emphasised with tremendous authority at Second Reading and again today, many people in need of in-patient care are not receiving it. Often they are not receiving it because available resources are being over concentrated on community provision. No one is arguing, least of all my noble friend, I am sure, against the principle of community care. Community care--thank goodness--is here to stay and we must do all we can to foster and support it to ensure that it works well. But if we believe, as I do, that community care is not the whole answer and that there are those who need looking after either short or long term in surroundings where professional help is continuously to hand, we need to focus more on how current shortcomings in that area can be addressed.

The second rebuttal to the criticism of Clause 1 is surely this. The clause speaks of the requirement for health authorities to prepare a strategy for in-patient care. I do not believe that that formulation allows one to argue that health authorities are thereby being discouraged from preparing strategies for other services. On the contrary, the provision of a strategy for in-patient beds should relate directly to a local needs assessment and be part of the much wider planning process which predicts and meets demand for mental health services and for support services generally, including housing and primary care.

The amendment seeks to insert a specific mention of 24-hour nursed beds into the definition of the facilities for which health authorities have a duty to plan. The need for 24-hour nursed beds relates particularly to those people with schizophrenia and other severe mental illness who either do not respond to, or perhaps more frequently do not comply with, their prescribed

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medication. Those patients represent a serious problem to the health service. For them quick access to a safe and secure environment in a hospital bed, or its equivalent--so long as it has 24-hour nursing support--is a vital part of treatment. The amendment strengthens Clause 1, and I support it.

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