MENTAL HOSPITAL PATIENTS (VISITS) (Hansard, 10 May 1957)

§ Mr. Norman Dodds (Erith and Cray-ford)
This debate arises from the many unsatisfactory replies that I have received to the many requests which I have made to be allowed to visit a patient in a mental hospital in accordance with the wishes of that patient and the foster parents of that patient. In this debate I am not dealing with the case of the patient but with the attitude of the Minister and officials to my request to visit the patient, which, I submit, reveals a disturbing state of affairs suggesting a deterioration in the safeguards affecting the liberty of the individual under our mental laws.
Early in February I wrote to the Minister of Health asking for permission to. visit a patient in a mental hospital, and he replied stating that he had no power to grant me permission and suggesting that I should write to the medical superintendent. I accept that the Minister has no authority to give me permission, but I feel that his attitude could have been more helpful. What I contest, and what surprises me, is the Minister's suggestion in his reply that I should write to the medical superintendent of the hospital and put forward my request to him. In all my experience here this is the first time I have known a Minister of Health, whether in a Labour or a Tory Government, to refer a Member of this House to an official of a hospital and to suggest that the Member should write to an official upon a matter.
However, I followed the advice, only to get a very curt reply. It was fairly evident from the nature of that reply that I should not make any progress there. Therefore, I had no alternative to taking up the matter by means of Questions in the House. Time after time I was told that the final decision rested with the medical superintendent. That, I submit, is completely wrong under the Regulations laid down by Parliament and quoted by the Minister in his replies to me. I cannot claim the credit for finding this out. It 1440 was brought to my notice by several experts in this law. I can assure whoever is to reply for the Government today that this time the official attitude will be on trial. At Question Time it may on occasion be difficult, in answering supplementary questions, to give a correct answer, but on this occasion notice has been given that this matter will be raised.
I refer now to that Answer which has resulted in this debate. It was in reply to Question No. 42 on 15th April, in which I asked the Minister of Health under which of the Mental Deficiency Regulations, 1943, it is laid down that the decision as to who can visit a patient apart from the special rights of adult relatives or guardians rests with the medical superintendent. The Parliamentary Secretary replied: Regulation 47 (1) provides that visits may be paid at such times as the superintendent may direct."—[OFFICIAL REPORT, 15th April, 1957; Vol. 568, c. 1552.] That is correct only up to a point.
One of the Regulations, which was quoted by the Parliamentary Secretary, reads as follows: Subject to the provisions of Section 18 of the Act, visits to a patient may be paid at such times as the superintendent may direct, but the interval between any two visits by the nearest adult relative or guardian of a patient shall not be fixed at more than one month, and the special consent of the superintendent shall be obtained before any patient is visited by any person in connection with business transactions. That is what the Parliamentary Secretary quoted but there is paragraph (2) which says: If there is reasonable ground for suspecting that any person visiting a patient is exercising a bad influence on him or encouraging him to break the rules or any special directions given by the superintendent he may be removed from the premises. The superintendent may report the circumstances of any such removal to the Board, and if the Board on any such report consider that further visits by the person so removed would be contrary to the interests of the patient they may suspend the person's right to visit the patient. But I also asked, in Question No. 36, on 15th April, whether the medical superintendent of the St. Margaret's Mental Hospital, Birmingham, has yet approved the application by the hon. Member for Erith and Crayford to visit a patient… I followed that line because of what the Minister had told me, namely, that the final decision was with the medical superintendent. The Parliamentary Secretary 1441 replied that he did not know. I suggest that that was a strange Answer to give, because it was up to the Minister at least to find out what was the answer, as has been done so many times by his predecessors. I have paid tribute to the Minister's predecessor for the way in which he dealt with difficult matters of this kind.
The Parliamentary Secretary then quoted Regulation 48 (1), which is one of the two Regulations dealing with visits by the public. It says: The Board may at any time grant permission in writing for the admission of any person to visit a patient either on a single occasion or for a limited number of times or generally at all reasonable times and with or without restriction as to the presence of an attendant or otherwise. That is the Board of Control.
Then there is the important part of the Regulation which says: (2) If the superintendent refuses,"— that is the medical superintendent— prevents, or obstructs the admission of any person duly authorised by the Board to visit a patient he shall for every offence be liable to a fine not exceeding £20. I suggest that if there is an authority to whom a Member or a Minister can go, it is the Board of Control. That Board, if it so desires, can give an instruction that a person is allowed to pay a visit and if the superintendent then refuses to agree he can be fined £20.
To show that for some period I was not getting what I should have expected under the Regulations, I have to say that, having learned that the Board of Control could be brought into the picture, after weeks of asking questions, I put a Question down for Written Answer on 2nd May, in which I asked that the matter be raised with the Board of Control. I received the answer that I expected, which leads me to another facet of these slapdash mental laws about which I have complained on so many occasions.
The Answer, in part, reads: The Board has informed my right hon. Friend that very careful consideration has been given to the case, but, in view of the opinion of the medical superintendent in charge of the case that a visit at the present time would not be in the patient's interest, the Board feels unable to grant permission… "—(OFFICIAL REPORT, 2nd May, 1957; Vol. 569, c. 27.] 1442 Why was I not informed earlier that the Board of Control had an interest in this matter?
That leads me to another very important aspect. I said at the beginning of my speech that all this indicates that there has been a deterioration in the safeguards for the liberty of the individual. I wonder why I have had not hitherto been informed that in the last few years, for reasons that need to be explained, the Board of Control has ceased to be the instrument, which it was intended to be when it was set up, for safeguarding the liberty of the individual.
I am greatly indebted, in this matter, to evidence put before the Royal Commission on the Law Relating to Mental Illness and Mental Deficiency, and I want to quote from the evidence of the Ministry of Health and the Board of Control, given in page 9: The Chairman of the Board is appointed by the Minister of Health. At present the members of the Board also hold appointments on the staff of the Ministry of Health. The hon. Gentleman the Member for Carlisle (Dr. D. Johnson) and I have complained previously that the Board of Control has ceased to be the instrument which it was set up to be, namely, to safeguard the liberty of the individual. We have complained that the Board of Control has not only moved into the Ministry of Health building but, as the report states, its members hold appointments on the staff of the Ministry of Health. It also stated: The National Health Service Act, 1946, rearranged the functions of the Minister and the Board so as to provide that broadly speaking the administration of hospitals, responsibility for the care and treatment given therein, and supervision of the work of the local health authorities should rest with the Ministry of Health, and the functions of the Board of Control should fee broadly concerned with matters relating to the liberty of the subject, i.e. safeguards against ill-treatment or wrongful detention; Those are thrown overboard according to the evidence given by the Institute of Hospital Administrators: We regret the tendency in recent years for the Board of Control to become much more closely identified with the Ministry of Health so that the mental health division of the Ministry and the Board of Control are virtually indistinguishable. We consider the Board should be independent of the Ministry and that the Commissioners, Inspectors and secretariat should be exclusively concerned with the work of the Board. Because of the Board's proper concern that the liberty of the subject 1443 and the confidence its oversight of the conduct of mental hospitals and mental deficiency institutions affords, we should be very sorry if any suggestion to cease the appointment of Legal Commissioners were adopted. Finally, as regards the work of the Board. we think that the old system of visits to hospitals and institutions without prior notice is preferable and should be restored. If I had the time, I could give other evidence, but I want to sit down at a quarter-past four so that on this occasion the Minister will not think that I have taken more than my fair share of time for the Adjournment debate. However, there is the evidence of Dr. Walk, of the Royal Medico-Psychological Association, which in part states: … from the patients' point of view certain of them feel now that they have no appeal to anybody other than the person running the hospital. That leads me to the question, should there be an independent body? I submit that there should be. I wish I had time to quote more from the evidence given before the Royal Commission because it includes evidence, which if challenged I will give, to show that there are many people retained in mental institutions for no other reason than that their labour is vital to the running of the institutions. As regards any payment to these people, the top rate is about 6s. a week or 2 oz. of tobacco.
I should have liked to quote from the evidence given by the municipal corporations and by the Magistrates' Association, but I will read only the last few words: There is evidence to support that. The patients are really there for keeps, and the better their behaviour, the harder they work, the quieter they are and the less trouble they give, then the more likelihood there is that they stay put. Finally, I say how much most of us are looking forward to the Report of the Royal Commission, which we hope will be out soon. I believe that that Report will justify some of the things which have been said. I forecast that the Commission will make it crystal clear that thousands—not hundreds, but thousands—of people now in mental institutions should not be there at all.

§ The Parliamentary Secretary to the Ministry of Health (Mr. J. K. Vaughan-Morgan)
The hon. Member for Erith and Crayford (Mr. Dodds) has 1444 been very courteous in giving me notice of the points that he would raise. The subject of the Adjournment debate is really, I understand, the legal rights of the authorities concerned with regard to an individual visiting a patient in a mental hospital.
I do not propose to follow the hon. Member or to argue or discuss with him whether or not in its years of existence the Board of Control has done its job rightly and well. As the hon. Gentleman said, we have not very long to wait for the Report of the Royal Commission, and I think that at this late stage it would be better to reserve further comments of the nature of those of the hon. Member until we see what the Report has to say.
What I want to do is to set out the legal position as it exists today. As the hon. Member was, or should have been, aware, I am not in a position, because of the nature of the debate, to hint at any change that might be possible. The hon. Member is not a lawyer and neither am I. I will not say that it is quite a case of the blind leading the blind, but he will have to excuse occasionally a rather amateurish way of interpreting the law.
The position, very simply, is that the Board of Control still retains the duties that were originally held by the Board of Control and by the Commissioners in Lunacy in respect of the liberty of the subject. The Board is an independent body constituted by the Mental Deficiency Act, 1913. It was reorganised in 1930, and in 1948 certain functions were taken from it, but it retained the residual duties that it previously had.
Apart from the power to make statutory regulations under Section 25 (1) of the 1913 Act, which is the administrative part, and the power to direct the Chairman of the Board as to the arrangements for the administrative business of the Board, there is no statutory provision whatever which gives the Minister power in any way to control the Board in the performance of its statutory duties. Therefore, let me make clear at once that, even if the Board is in the same office, my right hon. Friend has no right to direct it in any way to do anything that he may think fit.
With regard to the relationship between my right hon. Friend and the medical 1445 superintendent, the position is that the medical superintendent is employed by the regional hospital board. I suppose that under the terms of the National Health Service Act my right hon. Friend could indirectly via the Board issue a direction to him on any subject, but— I must be quite frank about this point —I really do not think that, whatever the legal position may be, any Minister would for a moment consider directing a medical superintendent on any matter such as this when that medical superintendent was primarily responsible for the health and welfare of a patient. I believe that such a precedent would, very rightly, meet wide objection.
With regard to visits to patients detained in mental deficiency hospitals, these are dealt with in the rather complicated provisions of the Regulations of 1948. The point there is that, subject to the provisions of Section 18 of the Act, a visit to a patient may be paid at such times as the superintendent may direct. The point where the hon. Member has not interpreted the rules quite correctly is that if the superintendent does not direct, no visit can be paid. In other words, it is entirely his responsibility, but there are separate powers as regards visits by the parents and the nearest adult relation.
Then there are the further powers, to which the hon. Member has referred, by which the Board of Control can overrule the superintendent.

§ Mr. Dodds
Many people are interested in this subject. The Board may at any time grant permission in writing for the admission of any person to visit a patient.

§ Mr. Vaughan-Morgan
The Board of Control may. The Board of Control can over-ride the medical superintendent about visits to a patient, but my right hon. Friend cannot direct or over-rule the Board of Control. I do not see what the difference between us is.

§ Mr. Dodds
I wrote as a Member of Parliament to the Minister as political head of a Department. If he cannot direct somebody, he can get in touch with the person accorded the powers by Act of Parliament. The Board of Control was not brought in until later, as 1 discovered. That is my complaint.

§ Mr. Vaughan-Morgan
If the hon. Member is complaining only of that, he 1446 is being a little unreasonable. To put it courteously to the hon. Member, it is not my right hon. Friend's function to act as a post office. The hon. Member is very well acquainted with these rules and regulations and has made himself very learned in them. If he did not discover that he has a right, as has any citizen, to write to the Board of Control—

§ Mr. Dodds
I have done this in several cases with the hon. Gentleman's predecessors.

§ Mr. Vaughan-Morgan
—then my right hon. Friend has nothing to answer. There may be a little confusion in the hon. Member's mind, but I do not consider it part of my right hon. Friend's duty to do what the hon. Member has suggested.
I thought that the hon. Member was under the impression that there was a conflict between the original Act and the Regulations. At one time I thought so myself, but there is no conflict. The hon. Member said that no Government would be "barmy" enough—not a very elegant word—to leave this matter entirely to the medical superintendent. In fact, it is very carefully laid down in the 1948 Regulations. I was not a Member of Parliament at the time, but the hon. Member was. I do not necessarily accept his standard of what is in the Regulations.
If the hon. Member feels that he has been hardly done by in this matter and that he has other questions to raise, I shall be only too willing to discuss them with him to see if I can help him in any way. I do not think that he has raised any important administrative point. In the long run, it is a question of legal interpretation, and that must be a matter for the courts. I am always willing to discuss that with the hon. Member and to help him with his questions. I do not necessarily say that he will like the answers, that is not for me to say. However, I do not think that he has today put forward a case which we must seriously answer.

§ Mr. Marcus Lipton (Brixton)
It would help hon. Members in dealing with these cases if the Parliamentary Secretary would answer one or two questions. The Board has the power to permit visit whether the medical superintendent is favour of those visits or not. To 1447 extent is that power exercised by the Board, and in how many cases has the Board granted permission in writing irrespective of the wishes, instructions or advice of the medical superintendent?

§ Mr. Vaughan-Morgan
I am afraid that I really could not answer that question without notice. That is obviously 1448 one of the functions of the Board. I think the hon. Gentleman will agree that it is only reasonable that I should have notice of the question. If he tables it, no doubt the answer will be forthcoming.