HC Deb 05 May 1959 vol 605 cc259-65
Mr. Walker-Smith

I beg to move, in page 10, line 30 at the beginning to insert: Subject to the provisions of this section". This and the next Amendment are paving Amendments for the Amendment, in page 11, line 12, and with your permission, Mr. Deputy-Speaker, I think it would be for the convenience of the House if we dealt with all three together.

The pattern of this Clause is broadly that subsection (1) empowers any person authorised by the Minister or by the registration authority to enter and inspect mental nursing homes. A registration authority, of course, is defined in Clause 14 as a borough or county borough council. Subsection (2) provides that regulations made by the Minister under Clause 16 (1) may include regulations about the authorisation of visits of inspection on behalf of the registration authority.

Subsection (3) empowers persons who are authorised to inspect to interview and examine a patient.

That is the broad pattern of the Clause and there was no dissent from it in general or in principle in the Standing Committee, but there was a good deal of comment and criticism on one specific point. That was in relation to its application to the four registered hospitals which, as the House knows, are of considerable repute and long standing—The Retreat at York, Cheadle Royal near Manchester, Barnwood House at Gloucester, and St. Andrews at Northampton. The suggestion was made that these hospitals should be exempt from local authority inspection and should be inspected from the centre as they are now by the Board of Control. I gave an undertaking in this regard as reported in column 206 of the OFFICIAL REPORT, in which I said: We are on the narrower question of these four registered hospitals. I can see the point in regard to them and I will consider it further between now and the Report stage and see whether there is any possibility of working out a special provision for these four hospitals without detriment to the general pattern."—[OFFICIAL REPORT, Standing Committee E, 24th February, 1959; c. 206] I have sought to give effect to this undertaking in the third of the Amendments which introduces a new subsection (3) incorporating the existing subsection (2) but, in addition, enabling the Minister to make special provision in regulations under Clause 16 in respect of the present registered hospitals. Under this he is to be able to impose conditions or restrictions on the exercise of the registration authority's powers in relation both to the inspection and visiting of patients in these hospitals.

My intention is to use this regulation-making power in order to arrange that persons authorised by the Minister should take part in all the periodic inspections of the hospitals, but that, albeit the van would be taken by the Minister's inspectors, they should be accompanied by persons authorised by the registration authority in order keep that authority in the picture.

I should draw attention to other points. This will not apply to ad hoc visits under Clause 17 (3), which are in response to a complaint. One hopes that this is a remote possibility as these registered hospitals are of high repute, but if the occasion arose it would be more appropriate for it to be dealt with by the registration authority, because it is the registration authority.

I should also draw attention to the rearrangement involved in these Amendments. Since the new subsection governs both inspection and visits, it is to be inserted as subsection (3), and the existing subsection (3), which relates only to the interviewing of patients will be renumbered subsection (2).

It is our intention that the arrangement for inspection and for the investigation of complaints should be equally as effective in these hospitals as in other mental nursing homes, but that it should be appropriate to the special circumstances of these hospitals. In Committee I drew attention to the fact that we must make it clear, for the reassurance of the public, that we attach importance to inspection in the case of all. I think that we have the right solution in the Amendment.

Mr. K. Robinson

I am glad that the Minister has managed to find a way of exempting these four registered hospitals from the normal provisions of local authority inspection. When discussing the Amendment which I tabled in Committee we said that these hospitals had no objection to being registered but that it was felt that, with the very long and distinguished record which each had, it was a little invidious to make them alone of the existing mental hospitals subject to local health authority inspection. Not that there is anything in itself derogatory in local health authority inspection, but we pointed out that we did not think that the normal staffs of local health authorities would be appropriate to carry out the kind of inspection needed of such a large hospital.

I am a little disappointed that the Minister has found it necessary to make the one exclusion. He says that he naturally wants to keep the registration authority in the picture, and representatives of that authority may accompany the officials of his Department when they carry out their inspections from the centre. That is all right, but why is it necessary to exclude the powers of visiting under subsection (3), which are for the purpose of investigating any complaints or where there is reasonable cause to believe that the patient is not receiving proper care? Why is it necessary for those investigations or inspections to be carried out by the registration authority? The same objections hold good there, in that normally the staff who are inspecting a mental nursing home would hardly be appropriate for this purpose. Why should these four hospitals be placed in any different position from all the other hospitals where inspection is made from the centre and for whose inspection the Minister is responsible?

5.30 p.m.

By and large I think that we welcome this set of Amendments. I wonder whether the Minister will between now and the Bill going to another place think again about whether it is necessary to make this exclusion and whether the whole of the powers of inspection conferred under Clause l7 in respect of these four hospitals could not be exercised from the centre rather than by the local health authority, whilst at the same time keeping it in the picture as the registration authority, about which there will be no objections?

Mr. Walker-Smith

I am always very ready to think again on these problems, especially when asked to do so by hon. Members with the degree of expertise and attention to these subjects which the hon. Member for St. Pancras, North (Mr. K. Robinson) has.

The hon. Member may be under some misapprehension in regard to the intended operation of subsection (3). It is true that on the drafting the person authorised under subsection (1) to inspect is the same as the person who is authorised to visit and interview under subsection (3). He may be either the emissary of the registration authority or of the Minister. The subsection (3) procedure is the procedure, broadly, in response to complaint. Though there is a permissive power whereby either can do it, I visualise that this will normally be the function of the registration authority. I have only reserved power for a representative of the Minister in order to take account of the exceptional case.

The reason why I do it in that way is this. This procedure is closely associated with the registration function. The mental nursing home is registered. Then, if there are complaints, it is a matter for the registration authority to inform itself about them. I envisage the subsection (3) procedure as being normally one for the registration authority.

Mr. Ede

The right hon. and learned Gentleman says "subsection (3)". Does he mean the old subsection (3) or the new one?

Mr. Walker-Smith

I am speaking of the old one. I mean the one giving the power of examination.

Mr. Ede

It will become subsection (2) as a result of the Amendments.

Mr. Walker-Smith

That is so, and I indicated that in moving the Amendment. I am sorry if there has been any confusion about that.

That is the way I see it. I will certainly think about it further, but I think that the balance is now right. In the exceptional case the Minister may do it. In the ordinary case the registration authority will do it. On the subsection (2) aspect of it, it would probably be better to leave the registered hospital in the same general pattern as the rest.

Dr. Summerskill

I hope that my hon. Friend the Member for St. Pancras, North (Mr. K. Robinson) will not mind me saying this, but I have not been so sympathetic about this as other hon. Members. I see all kinds of difficulties ahead. Once we start making these exceptions, other people will come along and ask that they should be regarded as exceptional cases. How does the Minister define an "exceptional case"?

Mr. Walker-Smith

One cannot define an "exceptional case" until the case arises, because that is what an exceptional case is. An exceptional case is something which when it arises is found not to fit into the normal and predictable pattern.

Mr. Ede

Following upon what my right hon. Friend the Member for Warrington (Dr. Summerskill) said, as I understand it there are only four hospitals, which the right hon. and learned Gentleman named. They are defined in the Amendment as being hospitals registered as mentioned in subsection (9) of section two hundred and thirty-one of the Lunacy Act, 1890. I take it that there can be no more in the future, because the Lunacy Act, 1890 is completely repealed by the Eighth Schedule. Therefore, as from the passing of the Bill, the Lunacy Act, 1890 will disappear and it will not be possible for a fifth, sixth, seventh or any other hospital to be brought in, unless such hospitals rush in now very quickly and become registered before the Bill becomes law.

Would it not be better to put the names of these hospitals in the Bill so as to make clear that this is the limited range to which the exception applies? In the distant future copies of the Lunacy Act, 1890 will become exceedingly rare and, even if an hon. Member goes into the Division Lobbies to get the Statutes Revised, the Lunacy Act, 1890 will not appear. There may be difficulties in identifying these hospitals for people trying to think up if somehow or other they were registered under that Act, unless the four hospitals are named in the Bill so that there is no doubt as to the limited range to which the exception applies.

Mr. Walker-Smith

I am grateful to the right hon. Member for South Shields (Mr. Ede) for that suggestion. Where there are only four such hospitals and where, as the right hon. Gentleman rightly says, there cannot be another such hospital because of the repeal of the Act under which those hospitals are registered, it might seem attractive to legislate eo nomine rather than by reference in this way. However, the right hon. Gentleman will know from his very long experience of these matters that it is difficult so to do, and indeed I think that there might be some danger that it would hybridise the Bill. I think that the word is right, but the right hon. Gentleman is more familiar than I am with these constitutional matters.

I am sure that the right hon. Gentleman would not wish us to court that risk, and perhaps therefore it would be better to leave it as it is, knowing that the counter risk to which he draws attention is slender. There will always be copies of the Lunacy Act, 1890, available, if not in the unexpurgated statutes, at any rate in the older editions of Matthews. It is very well known at present that the four hospitals are the four in question. I do not think that we are running any practical risk by leaving it as it is.

Amendment agreed to.

Further Amendments made: In page 10, line 39, leave out subsection (2).

In page 11, line 12, at end insert: (3) Regulations under subsection (1) of section sixteen of this Act may make provision with respect to the exercise on behalf of registration authorities of the powers conferred by this section; and such regulations may in particular provide—

  1. (a) for imposing conditions or restrictions with respect to the exercise of those powers in relation to mental nursing homes which, immediately before the commencement of this Act, were registered hospitals; and
  2. (b) subject as aforesaid, for requiring the inspection of mental nursing homes under subsection (1) of this section to be carried out on such occasions, or at such intervals, as may be prescribed by the regulations.
(4) In this section "registered hospital" means a hospital registered as mentioned in subsection (9) of section two hundred and thirty-one of the Lunacy Act, 1890.—[Mr. Walker-Smith.]