§ Mr. GREENWOOD
I beg to move,That the Mental Treatment Rules, 1930 (Statutory Rules and Orders, 1930, No. 1812 1,083), dated 30th December, 1930, and made by the Board of Control, with the approval of the Lord Chancellor, under Subsection (1) of Section 338 of the Lunacy Act, 1890, as extended by Sub-section (1) of Section 15 of the Mental Treatment Act, 1930, which were presented on the 20th day of January, 1931, be approved so far as they modify or adapt any of the provisions of the Lunacy Act, 1890.The Motion I have to move will not keep the House very long. These Rules are to be laid on the Table of the House. They are made under an Act of Parliament. We have taken the opportunity to consolidate the existing provisions as far as possible. The Act required that in any modification of the existing law we should take the opportunity to consult interests concerned in reference to the matter as far as possible. We have, therefore, consulted with the local authorities, the medical profession, the Mental Hospitals' Association and similar bodies. Since the discussion took place the Rules were modified and published, and I think it has been shown that a measure of agreement has been reached, for no representation has been made against them. In these circumstances, I think the House may feel that the Motion may well be passed.
§ Sir KINGSLEY WOOD
Although the hour is late, it is due to the importance of this matter that some comment should be made upon these Rules, and that questions should be asked. The Rules are made under the Mental Treatment Act, 1930, which was passed with the general assent of most of those in the House. Nevertheless, the Rules affect to a very considerable extent the liberty of the subject, and, therefore, should be closely scrutinised before they are passed. It would be quite easy to say, in the middle of the excitement which has followed the Vote which the Committee has just given, that we should allow these Rules to go without any comment or scrutiny, but there are, undoubtedly, a large number of people up and down the country who are considerably concerned with them. I remember very well it was the main subject of criticism when the Act was passed that Rules and Regulations 1813 would be made by the Minister of Health which might very well affect the liberty of the subject to a very considerable degree. It is from that aspect that I have read these Rules, and would like the Minister of Health to give an explanation on one or two points. Rule 5 is entitled:Absence of temporary patients on trial or for health.It says:Subject to the provisions of Section 5 of the Act of 1930, the person in charge of an institution, hospital or nursing home may permit a temporary patient to be absent on trial or for the benefit of his health for such period as the person in charge thinks fit.That particular phrase "for such period" is perhaps subject to some statutory modification, and the right hon. Gentleman will no doubt state if that is so or not, because otherwise it does seem a very considerable degree of latitude to give to the person in charge. Then, on page 4, Subsection (2) of Rule 8, which deals with the removal of patients, suggests that, upon the death of a person having charge of a temporary single patient, the board may discharge the patient, or, if he does not apply within seven days after the death, may direct the patient to be removed into the charge of the person named in the Order. I should like the right hon. Gentleman to state under whose jurisdiction or authority that is. When the death occurs of the person responsible for a patient who is being treated in this way, apparently a period of seven days is to elapse before this particular Section can be put into operation, and it does appear to me that the period ought to be in some way limited or otherwise dealt with, because otherwise there may be no person who is responsible for the patient who is receiving treatment at that time.
I should like to ask a question with regard to Regulation No. 15, which is entitled "Weekly Expenses." This Regulation lays down that the visiting committee in regard to each institution maintained by a local authority shall fix a weekly sum for the expenses of maintaining patients. I take it that the amount of the weekly sum is to be entirely in the discretion of the local authority itself, and I should like to ask if there is any limit, or whether they are in any way subject to the jurisdiction of the Ministry in regard to the amount of 1814 expenses which they can charge in these cases, and whether there is any suggestion of any uniform sum being fixed in that respect.
There is a very important regulation which I think requires a little explanation from the Minister. It is Regulation No. 26, on page 8, entitled "Application of Temporary Patient's Property." This is a very important regulation, because it says this:If it appears to any justice that a rate-aided temporary patient has any real or personal property more than sufficient to maintain his family, if any, such justice may by order direct a relieving officer, treasurer, or some other officer of the council of the county or county borough to which the patient is chargeable to seize so much of any money, and to seize and sell so much of any other personal property of the patient and to receive so much of the rents of any land of the patient as the Justice may think sufficient to pay for the expenses of maintenance.…That may undoubtedly be necessary, but, of course, it is very drastic to give power to any justice of the peace or local authority to seize the property of any individual who may be a temporary patient, and, apparently, without notice to the patient's friends, or relations, or next-of-kin, or guardian, come down and take this property and sell it for the purposes of maintenance. I do not say that such a regulation may not be necessary, but I do think that some further explanation is required from the Minister, particularly as to whether the patient's friends are first to be informed of any step that is going to be taken in that connection. On page 9, Rule 30, there is a very important regulation which deals with the ill-treatment of patients. It states that if a person ill-treats or neglects a patient, he shall be guilty of a misdemeanour and on conviction shall be liable to a fine or imprisonment. I should like the right hon. Gentleman to state whether it is open to the court to inflict the penalty that they may think just and proper in such a case. We have to be careful to stamp out at once any suggestion of ill-treatment of patients. Rule 33, which deals with correspondence states, as is proper, that where a patient addresses a letter to the Lord Chancellor or other person specified in the Regulations, those letters must be forwarded without being 1815 opened. In Sub-section 2 it says that, if any person in charge of an institution defaults in complying with the obligation imposed upon him by this Rule, he shall for such offence be liable to a penalty not exceeding £20. It appears to me that there ought to be some provision made, in the case of an officer wilfully breaking that Regulation on more than one occasion, that the penalty should be increased.
I suppose the Minister has carefully considered the Regulation on page 12, that, if a temporary patient escapes and is retaken within 14 days, the person in charge shall take him back again to the institution. We have had the extraordinary spectacle more than once of a man or woman who has escaped and avoided capture for more than 14 days not having to go again through the process of being certified. If he is captured within 14 days, he is immediately taken back without any right of examination. I suppose it follows the rule of procedure, but it is certainly a very serious provision?
§ Sir K. WOOD
I think it has applied for some considerable time, but for the first time the Minister is making it apply to temporary patients.
Rule 49 says that rules and regulations may be made by the visiting committee of an institution, and then submitted to the board before they are finally approved. There does not seem to be any provision as to what should happen in the event of disagreement between the local authority and the Board of Control. I should like the right hon. Gentleman to make some observation on that point. On page 16, regulations are made as to visitation and inspection by the commissioners of people in these institutions receiving treatment. In 51, 53 and 57 it is provided that the commissioners need only of necessity once during the year visit a hospital, a nursing home or a house in which voluntary or temporary patients reside. The House of Commons should consider whether it is sufficient that there should be only one visit a year by the commissioners in the particular cases I have enumerated. I can conceive a case 1816 where there ought to be, and I hope that there will be, under those regulations, a visit by the commissioner to a private home more than once a year. Under the regulations as approved by the Minister, there is only an obligation on the commissioners to visit those particular institutions, homes and houses once a year. I hope that the Minister will be able to give an explanation of the various points I have raised.
§ Dr. MORRIS-JONES
When the Bill was before the House, there was very considerable perturbation in the minds of Members generally in regard to whether the liberty of the subject was being properly safeguarded. I think that these Rules and Regulations are sufficient with regard to that particular matter. I have very considerable sympathy with medical officers throughout all institutions, whether private or public, who will have to work under the Act. When I look at the Schedules at the back of the Statutory Rules and Orders and see their complexity and number and variety, I begin to wonder how a medical man in charge of cases is going to have time to look after the cases at all. I am not sure whether this is not another tendency of the State to burden the medical profession with far more clerical work than they have the facilities to carry out, feel sure there can be no suggestion whatever that the liberty of the subject is being infringed under this Act. On the contrary, it is very sufficiently safeguarded. I had hoped that the right hon. Gentleman might have found his way to simplify some of these Regulations, which are sure to be a very great burden upon those who will have the very serious responsibility of looking after the mentally affected.
§ Sir DENNIS HERBERT
I apologise to the right hon. Gentleman if he has already answered any of the questions which I want to ask. I found it a little difficult to hear him, but. I think the House ought to pay attention to the fact that the document which we are asked to approve contains 133 Rules, occupying 37 closely printed pages, and another 32 pages of Schedules. The reason why this Motion is on the Order Paper to-night is that under the Mental Treatment Act these Rules are not to be effective in so far as they modify or adapt any existing 1817 enactments until they have been expressly approved by this House. I could not hear all the Minister said, but I think I am right in saying that he did not point out to the House in what various ways and in what different sections these Rules modify existing enactments. It is a great farce that the House should retain in its hands the power that these Rules are not to have force unless they are approved by this House, if we get a great document like this brought before us without any explanation from the Minister as to what are the portions of this document for which approval is required or, in other words, what are the portions of the document which modify existing enactments.
In order to show the House the importance of some of the points which may arise, I want to draw attention to Rule 22 at the bottom of page 9, which reads:Mechanical Restraint.Mechanical means of bodily restraint shall not be applied to any temporary patient unless the restraint is necessary for the purposes of surgical or medical treatment.In regard to "surgical or medical treatment," I think the question arises whether if a person is a temporary patient he puts himself under this Rule in such a position that he can be forced by means of bodily restraint to undergo some surgical operation which, if he had the chance and the choice to decide, he would prefer not to undergo. I think that is rather a serious point, and it is the only one that I want to raise as an example of the importance of this document. I hope the right hon. Gentleman will answer that question and also give us some definite indication which of these Rules modifies existing enactments and makes it necessary to obtain the approval of this House.
§ Mr. CHARLES WILLIAMS
I must join in protestng against the complication of these Rules and I also hope that when the right hon. Gentleman has them printed he will not insist upon printing them upside down. If hon. Members will look at page 40 they will see that they have been so arranged that if you want to read page 43 you have to turn it upside down. Even the Minister will not say that that is a good sort of mental treatment. It is a pity the right hon. Gentleman should 1818 spoil so complicated a document as this by making it absolutely absurd. I hope he will also explain the reference to post-mortems in page 19.
§ Mr. GREENWOOD
With reference to the remarks of the right hon. Gentleman the Member for West Woolwich (Sir K. Wood) the provisions of the principal Act apply to the question of the liberty of the subject. As to the rates to be charged, where the patients are rate-aided, that is a matter for the discretion of the local authority. Where there are private patients the rate charged is fixed by agreement between the parties concerned. On the question of property some discretion has been granted. It is necessary to protect public funds and make a charge upon the patient. It is a very difficult matter of administration. It will depend on the form of the Order. I am circulating a statement to local authorities pointing out that patients ought not to be deprived of the whole of their resources and drawing their attention to an alternative procedure.
§ Mr. GREENWOOD
I think that is so. In regard to second offences, the penalties are laid down in the principal Act and it is not possible to go beyond them. They will not exceed £100, and I imagine that the penalty for a first offence is not so high. As to recapture, that is an application of a Section of the principal Act, and we cannot go outside it.
§ Mr. GREENWOOD
Yes. As to visitations, that is the prescribed minimum, although the commissioners can go oftener if they choose.
§ Sir K. WOOD
With regard to the general Rules of the Board, in the case of disagreement, how is it to be settled?
§ Mr. GREENWOOD
I think the authority of the Board of Control decides. As to the elaborateness of the Schedules, it is true that they are elaborate, but medical officers are accustomed to dealing with these forms, and I do not think they will find them confusing.
§ Mr. GREENWOOD
If my hon. Friend looks, I do not think he will find that they are substantially different. The hon. Member for Watford (Sir D. Herbert) complained about the size of the document. It is a large document. We took the opportunity of consolidating the regulations. Some of the Rules do not require the approval of the House, and a number of others, particularly 8, 10 and 11, are the re-making of the existing Rules.
§ Sir D. HERBERT
Will the right hon. Gentleman answer the question about Rule 32—mechanical restraint?
§ Sir D. HERBERT
That disposes of my point, in that it is a reproduction of what is in the principal Act, and not a new enactment, except in so far as it applies now to a temporary patient. At the same time, it would have been more convenient if the right hon. Gentleman had issued a memorandum showing what were modifications of existing enactments, and what were not.
That the Mental Treatment Rules, 1930 (Statutory Rules and Orders, 1930, No. 1,083), dated 30th December, 1930, and made by the Board of Control, with the approval of the Lord Chancellor, under Subsection (1) of Section 338 of the Lunacy Act, 1890, as extended by Sub-section (1) of Section 15 of the Mental Treatment Act, 1930, which were presented on the 20th day of January, 1931, be approved so far as they modify or adapt any of the provisions of the Lunacy Act, 1890.