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Baroness Royall of Blaisdon: My Lords, as the noble Baroness will be aware, the Government are absolutely firm regarding other Governments who will, I am confident, sign up to the renewed travel ban. If they are perceived to be, as it were, a bit

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wobbly then perhaps partner civil society organisations in other member states could lobby their own Governments to ensure that they do indeed remain firm.

Baroness Park of Monmouth: My Lords, the need for support from civil society is an important dimension. In a letter to EU Commissioners before Christmas, John Monks, general secretary of the European Trade Union Confederation, and Guy Ryder, general secretary of the International Trade Union Confederation, wrote:

They went on to point out that whether the sanctions should be revoked or renewed ought to be determined by measuring Zimbabwe’s progress toward the benchmark originally set by the EU under the EU-ACP Cotonou convention. Will Her Majesty’s Government ensure, as I hope they will, that these representations by the international trade union movement are circulated to all members of the Council of Ministers and that we ensure proper consideration is given to their concern?

Baroness Royall of Blaisdon: My Lords, the Government welcome the strong statement by John Monks and Guy Ryder on behalf of the International Trade Union Confederation. I see no problem in ensuring that each member state receives a copy to ensure that they remain firm on the issue of sanctions.

Baroness Whitaker: My Lords, in view of the fact that the EU sends the lion’s share of the international community’s $250 million aid to Zimbabwe, most of which goes on emergency feeding programmes, would it not be irresponsible to expect the people of the EU to continue to provide aid at that level and yet lift restrictions on those who engineered the disasters that that aid is meant to respond to? Will my noble friend and the other members of the Government remind our more reluctant EU allies of the huge amount of humanitarian aid needed as a result of the Zimbabwean regime’s wanton destruction of housing, industry and agriculture?

Baroness Royall of Blaisdon: Yes, my Lords, it would indeed be irresponsible if the European Union were to renege on its sanctions now. I am confident that it will not, but I am sure that Her Majesty’s Government will continue to make the very strong case in favour of sanctions. In respect of aid being given to Zimbabwe, of course we must maintain that aid, but it should be balanced by sanctions, and we must ensure that the people of Zimbabwe are not harmed in any way.

Lord Alton of Liverpool: My Lords, will the noble Baroness ensure that in discussions with our European Union colleagues the depredations of the regime are not lost sight of, not least the reduction in life expectancy in Zimbabwe, especially among women, and the levels of child mortality and malnutrition in the country? Will she ensure that the remarks of the Archbishop of Bulawayo, who spoke to Members of both Houses just before Christmas,

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are drawn to their attention? He said that while the regime continues its depredations against the people of Zimbabwe then the targeted restrictions should continue.

Baroness Royall of Blaisdon: Yes, my Lords, it is indeed deplorable that life expectancy in Zimbabwe is the lowest in the world at present. I believe it is 34 years for women and 37 years for men, which is quite extraordinary. It is incumbent on us in the European Union to make those abominable facts known to the widest possible community and to ensure that sanctions are maintained. We keep repeating that in our discussions with our European partners.

Baroness Williams of Crosby: My Lords, will Her Majesty’s Government ensure that those who have been involved in political activity in Zimbabwe will not be returned or deported to Zimbabwe if they are very likely to be persecuted by the Government of Zimbabwe? Does she recognise the extraordinary courage that many of those men and women have shown and how unfortunate it would be for our appearance in the world if we were to deport people who had been involved in that way in the battle for democracy?

Baroness Royall of Blaisdon: My Lords, I certainly pay tribute to the extraordinary courage of those men and women. Of course, the UK must be allowed to operate a robust and fair asylum system, but it must be fair, and we strive to ensure that our asylum system is fair in every way. I am sure that all noble Lords agree that it is right that we provide protection to those in genuine fear of persecution.

Lord Elton: My Lords, under the sanctions as they have operated in the past, we have become accustomed to hearing of people on the stop list being in other European countries and their presence being explained by the fact that they are attending some exempt conference or other. When the sanctions are rolled over, can the Minister undertake that the Government will attempt to close as many of the loopholes as possible, to prevent the ludicrous situation suggested by the noble Lord, Lord Kinnock, just a moment ago, developing?

Baroness Royall of Blaisdon: Yes, my Lords, I can ensure that the Government will do their utmost to minimise the loopholes. It is extraordinary that such loopholes exist, but they do. The EU Zimbabwe travel ban contains standard exemptions that enable travel to the EU by banned Zimbabweans in a few, narrowly defined cases. We do our utmost to ensure that they are narrowly defined, because to see people such as Grace Mugabe stomping up and down the streets of the Côte d’Azur is an affront to humanity.

Lord Howell of Guildford: My Lords, is it not clear from this valuable discussion that, while we must be consistent and keep up the pressure, the so-called targeted sanctions are not very effective in hitting the

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right target? It appears on the contrary that, while the ruling tyranny in Zimbabwe is maintaining its position and even strengthening it, more women and children are dying, there is more starvation, more and more other horrors and atrocities are being committed, the country’s economy is less than half the size it was a few years ago, and a great deal of suffering is going on? As we renew pressure on Zimbabwe, should we not look at the other, shadow sanctions which are hurting the poorest people, particularly the withholding of some loans from international institutions and development banks and other investment? Should we not try to refocus the whole of our operation vis- -vis Zimbabwe in ways which hit the criminals who are ruling the country and do not hit the poor people who are starving in very large numbers and longing for greater help, as the noble Baroness, Lady Whitaker, and the noble Lord, Lord Alton, rightly identified?

Baroness Royall of Blaisdon: My Lords, the noble Lord is absolutely right that the sanctions must hit the regime and not the poor people of Zimbabwe, who have to suffer continual atrocities. However, the EU sanctions put real pressure on the regime. They ensure that Mugabe remains isolated—hence his attempts to seek financial lifelines from China and Iran to buy time. It is important to point out that the targeted sanctions have the support of the democratic opposition and the NGO community in Zimbabwe. Mugabe and his regime detest the restrictions on their movement. Therefore, they can be only a good thing. However, I hear what the noble Lord says, and I shall take back his comments to the Foreign Office.

Corporate Manslaughter and Corporate Homicide Bill

3.07 pm

Lord Bassam of Brighton: My Lords, I beg to move the Motion standing in the name of my noble friend Lady Scotland of Asthal on the Order Paper.

Moved, That it be an instruction to the Grand Committee to which the Corporate Manslaughter and Corporate Homicide Bill has been committed that they consider the Bill in the following order:

Clause 1,

Schedule 1,Clauses 2 to 20,Schedule 2,Clauses 21 to 23.—(Lord Bassam of Brighton.)

On Question, Motion agreed to.

Mental Health Bill [HL]

3.08 pm

The Minister of State, Department of Health (Lord Hunt of Kings Heath): My Lords, I beg to move that the House do now resolve itself into Committee on this Bill.



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Moved accordingly, and, on Question, Motion agreed to.

House in Committee accordingly.

[The LORD SPEAKER in the Chair.]

Earl Howe moved Amendment No. 1:

“Guiding principles(a) the importance of the patient participating as fully as is possible in the discharge of the function;(b) the importance of providing such information and support to the patient as is necessary to enable the patient to participate in accordance with paragraph (a) above;(c) the present and past wishes and feelings of the patient which are relevant to the discharge of the function;(d) the views of any carer of the patient, or other person who is involved in a professional capacity, and which are relevant to the discharge of the function;(e) the full range of options which are available in the patient’s case;(f) the need to ensure that, unless it is justified in the circumstances, the patient is not treated in any way that is less favourable than the way in which a person who is not a patient might be treated in a comparable situation;(g) the need to ensure that patients are not discriminated against, either directly or indirectly, on the grounds of age, gender, sexual orientation, race, colour, disability, language, religion or national, ethnic or social origin;(h) the importance of maximising the benefit to the patient from the discharge of the function;(i) the need to ensure that when either informal or compulsory care and treatment of a child aged under 18 years is considered, the welfare of the child is the paramount consideration; and(j) the need to ensure that compulsory treatment or detention of a patient under this Act should be matched by a reciprocal duty to provide treatment and support of a likely health benefit to that patient.

The noble Earl said: It is a pleasure for me to begin these Committee proceedings by issuing a very warm welcome to the noble Lord, Lord Hunt of Kings Heath, whom I congratulate on behalf of all noble Lords on his appointment as Minister of State at the Department of Health. We wish him well there—it is familiar territory to him—and I am sure that it will not take him long to make his mark there once again. For us on this side of the Committee, it suddenly feels like old times.

We begin our Committee debates with an extremely important amendment which, I venture to suggest, will come as no surprise to the Minister. It

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would insert a set of key principles into the Mental Health Act 1983. Why this idea is so important can be explained very simply. The Mental Health Act and this amending Bill are not in any sense run-of-the-mill measures. They have two features about them which place them in a class apart from most other legislation: the powers granted to the state and its employees to coerce individuals who are not criminals into being detained and treated, and the fact that those individuals are, almost by definition, some of the most vulnerable of our citizens. The ethical standards governing that key interaction, between state and individual, are not some sort of subsidiary add-on; they are integral to the basic acceptability of the legislation. The principles defining those ethical standards deserve a place at the heart of the Act because it is only in that way that Parliament can signal to practitioners, patients and the legal profession how it wants the Act to be interpreted and implemented. Interpretation and implementation need to be in all our minds from the outset.

The Bill is full of tensions. We will deal with those tensions, I am sure, repeatedly. The most glaring tension is that between patient autonomy on the one hand and public safety on the other, but there is another tension pulling in a third direction: the need to make certain that mental health services remain trusted by service users. To achieve that, we have to ensure not just that coercive powers are used only as a last resort, but also that the ways in which those powers are used are not excessive in any given set of circumstances. By placing these very sensitive measures within a framework of overarching principles, the Bill will be more effective in protecting patients and the public. Why? Because if you make it crystal clear to everybody that the rules of compulsion are underpinned by values, and that because of those values there are times when compulsion is appropriate and times when it is not, you will have legislation that is much clearer and much more likely to command universal respect.

During the past few years of discussion on the two draft Bills there has been much debate about the relationship between the Mental Health Act and the European Convention on Human Rights, not least Article 5(1) which deals with the deprivation of liberty. Since the Human Rights Act was passed in 1998, there has been a succession of legal challenges to the Mental Health Act. It is argued by many people that the absence of a set of principles on the face of the Mental Health Act leaves it wide open to such challenges. I believe that that view is right and that we have a golden opportunity to remedy the lacuna now.

So what principles should the Act enshrine? None of them is unfamiliar but all, I suggest, are crucial. If we look at healthcare more generally, the importance of involving service users as far as possible in their own care is perhaps the most obvious way in which the practice of medicine has evolved over the past 10 or 20 years. It should apply in mental healthcare as it does anywhere else. Indeed it should apply with particular emphasis because when the context of care is one in which compulsory powers may at some point be used, it is all the more important that service users

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should be involved with their own assessment and care. It is only by doing that that users are likely to have confidence in those looking after them. The patient voice is a key plank of the Mental Capacity Act, and so it should be here. We need to promote the idea of patient empowerment. Patients are empowered by being given information and the freedom to make choices for themselves which those around them will respect. That is so even when a patient is subject to compulsion. There is no reason why he should not retain as much autonomy as possible, consistent with his own safety and that of others. Service users should be able to express their views and say what they want and not be criticised for doing so.

3.15 pm

The amendment speaks of the respectful treatment of carers and of patients; it speaks of equal treatment of all groups in society. Here, not surprisingly, individuals from black and ethnic-minority communities are uppermost in my mind. I am sorry to say that respect and equal treatment are not commodities in abundant supply in mental healthcare. Others in this debate will, I am sure, speak with particular authority on that issue, but if we allow ourselves not to address it with absolute seriousness in the context of the Bill, we shall be guilty of failing to get to grips with the stigma and discrimination which hang around mental illness like a yoke. The inclusion of principles in the legislation is a visible recognition by Parliament that stigma, discrimination and racial stereotyping need to be banished. I believe that the amendment will help promote, in their place, a culture of respect and confidence; very importantly, it will also guide the courts.

When a patient is treated, it should be after consideration of a full range of options for that treatment, and after a conscious decision that treating him will be better than not treating him—the first “do no harm” principle. We need to make a statement about child welfare in the context of treatment for mental illness. The Minister may argue that the paramountcy principle is already enshrined in the Children Act 2004, but I firmly believe that we should be explicit about it here. The needs of children are very specific. The provisions on children are dealt with separately under the Act. When we come to debate community treatment orders, we will see that separate provisions for children are included.

We then come to the principle of reciprocity. Where society imposes an obligation on an individual to comply with a programme of treatment and care, it should impose a parallel obligation on health and social care authorities to provide appropriate services. The mental health community feels very strongly about that principle, and I share its view.

The final part of the amendment covers the key issue I referred to earlier: that compulsory treatment should apply only after all alternatives have been exhausted or ruled out. We must never forget what coercion feels like for the person subjected to it. It is deeply traumatic and humiliating, and frequently serves to engender terror of mental health services

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from that moment on. It also, almost inevitably, results in severe social disadvantages, not the least of which are employment and housing. Nobody should belittle the magnitude of what is done in the name of the state to administer compulsory detention and treatment to an individual. That is why the principle of least restriction needs to be articulated with absolute clarity.

I like to hope that the Minister will not be unsympathetic to the amendment. If he is in any way hesitant, I put it to him that a clause of this nature, setting the scene on a Bill, is not without precedent in recent legislation. It is worth reminding ourselves of one other thing: while we all agree that our mental health services need to deal fairly and effectively with those who pose a danger to themselves or others, this Bill will affect very many thousands of people who will never harm anyone. We owe it to those people, as much as to any others, to frame the Mental Health Act within a set of clear standards and values. Only in that way will we have an Act that achieves what the Government themselves aspire to: to give all patients, whatever the nature of their illness, the treatment they need. I beg to move.

Baroness Barker: I declare an interest as an employee of Age Concern England. I also take the opportunity to welcome the noble Lord, Lord Hunt, back to his former position as Minister for Health. I can think of nobody better to be in that position, not least because we have the tantalising prospect of discussing patient involvement and patient forums in the near future. I know that those are subjects very close to the noble Lord’s heart.

Before following up on a number of the points made by the noble Earl, Lord Howe, about why we should have principles on the face of this Bill, it is important to address one other, more fundamental, question. What is the purpose of mental health legislation? I ask because just before Christmas the noble Baroness, Lady Royall of Blaisdon, kindly arranged for noble Lords who are interested in this Bill to meet some of the people responsible for its drafting. One of those people made a quite extraordinary statement. He said that the purpose of mental health legislation was to give practitioners the tools that they need to make people better. That is a partial truth and, because it is a very partial truth, quite a dangerous statement.

As the noble Earl, Lord Howe, pointed out, this is a subject with a long-standing history of sensitivity around such matters as compulsory treatment and the detention of individuals. The purpose of mental health legislation is to set the ethical framework and agreed standards, held by society to be true, for people who are perhaps among the most vulnerable of its number. As such, it entails questions of autonomy, safety, liberty, the role of the state, science and clinical judgment. The role of mental health legislation is to provide the framework by which clinicians and their activities are judged. Given that the architects of the Bill have chosen to project it in such a limited and partial way, it is our view on these Benches that there is, perhaps, a greater need than ever to have

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on the face of the Bill a statement of principles that encapsulate the framework within which practitioners, patients and other individuals will seek to make what we all recognise to be extremely difficult judgments on a daily basis.

The noble Earl, Lord Howe, has talked about the importance of Article 5 of the European Convention on Human Rights—the right to liberty and security of the person—as the key piece of European legislation into which ours must fit. Ever since 1999, the Government have received advice about the ethical nature of any future mental health Act. In 1999, the Richardson committee stated that any new Act should be based on principles of autonomy and non-discrimination. Importantly, that report was accepted by the Health Select Committee.


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