HC Deb 05 May 1959 vol 605 cc305-15

7.45 p.m.

Dr. Summerskill

I beg to move, in page 46, line 23, at the end to insert: (3) The Secretary of State shall require the responsible medical officer and the managers to review the case of any patient subject to an order restricting discharge twelve months after the admission of the patient to hospital and thereafter at intervals of twelve months, and to make a report to him on each occasion stating whether or not in their opinion compulsory detention of the patient is still necessary. This is a subject which we discussed at length in Committee when we had put down a similar Amendment. I hope that the Minister will be sympathetic towards it. There is a tendency to reiterate that the machine as it functions now will look after this category of patient, who is subject to an order restricting discharge. I emphasise that here we have a category of individuals who must be regarded as social outcasts. Not only have they a mental disorder but they have committed an offence. Consider the case of the psychopath who has been given one chance after another by his family and finally has committed an offence for which not even his mother will forgive him. This category must have special attention.

In the Amendment we are asking only that a report should be made on these people every year. After all, it is easy to forget them. To some extent they antagonise the people who are looking after them. They can be extremely offensive, and whereas those who are closest to them may at the beginning of their confinement feel sympathy towards them, after a time their behaviour is such that even those closest to them feel a little antagonistic. Surely they should therefore be given a special kind of observation.

I want to know why it is impossible for this report to be made. Surely there are plenty of people who could report on them. It seems to me that any difficulty would be only a clerical difficulty, especially as the number is limited. There is not such a vast number subject to restrictions that I could be told that it is administratively impossible.

We have tried to be reasonable in the Amendment. At least the Minister should tell us that this point will be reconsidered in another place. I hope that he will tell me precisely why, from an administrative point of view, there are difficulties. I hope that he will meet the point which I have mentioned time after time that if we are to discharge our responsibilities properly we must recognise that special care and vigilance should be exercised in these cases.

Mr. Renton

We accept that the right hon. Lady is being reasonable in her motives for the Amendment. The question is whether the machinery which she suggests is necessary, bearing in mind the other provisions of the Bill and the arrangements which my right hon. and learned Friend proposes to make in order to give these people the opportunity of having the question of their discharge reviewed.

The people concerned are of three kinds. First, there are those whom the courts have had before them and, after conviction, have made against them a hospital order with restriction on discharge; secondly, there are those whom the Secretary of State has transferred from prison with a direction restricting discharge; thirdly, there are Queen's Pleasure patients. There are technical drafting reasons why the last two categories come within the ambit of the Amendment as well as the first category to which the Clause particularly refers.

There are four separate sets of arrangements which will enable these cases to be reviewed and perhaps if I describe them the right hon. Lady will feel that it is unnecessary also to have the annual reports which her Amendment requires. First, there will be continuing responsibility on the part of the responsible medical officers. It will be their normal duty to keep constantly under review the question of the patient's fitness for discharge and to recommend discharge as soon as they think that the patient is ready for it. It is open to the patient to ask the doctor or the hospital managers for a discharge at any time.

That applies to patients subject to restriction on discharge just as much as it applies to patients under Part IV of the Act, that is ordinary patients who have not been before the courts. The only difference is that the doctor or the hospital managers must obtain the Home Secretary's consent before patients who have come through the courts or from the Secretary of State can be discharged. The first procedure is the continuing responsibility of the responsible medical officer.

Secondly, the patient, his relatives, a member of Parliament or any one else, may at any time write to the Home Secretary asking him to consider discharge. The Home Secretary will then obtain reports from the hospital and, if he thinks necessary, refer the case to the tribunal for advice before deciding whether to discharge.

Thirdly, there are to be periodical reports under administrative arrangements which I mentioned in Committee in relation to these patients and which my right hon. and learned Friend also mentioned in relation to Part IV patients. There are to be administrative arrangements whereby my right hon. and learned Friend intends to arrange that reports, similar to those which will be made on other patients under Clause 43, should be made by the responsible doctor to the managers on those patients who are subject to restriction on discharge and the other categories which I mentioned. Those reports will be made at the same intervals as those now laid down under Clause 43 for other patients. Only within the last hour my right hon. and learned Friend accepted an Amendment, the effect of which is that such reports will be made not less frequently than every two years. It was originally three years. It is now to be two years.

Fourthly, under an Amendment which we shall next come to and which I hope that I may have leave to refer to and which perhaps the right hon. Lady has already seen the patient will be able to require the Home Secretary to refer the case to a tribunal. The Home Secretary will be able to discharge the patient, if he thinks fit, after considering the views of the hospital authorities and of the tribunal after the case has been so referred by him to the tribunal for advice.

Bearing in mind those four procedures, each of which is likely to be very helpful and a very good safeguard for patients, the question is whether we should also oblige medical officers and hospital authorities to have these annual reports. I point out that requiring them to do so would have the rather strange effect that there would be more frequent compulsory reports on patients who have come through the courts or as a result of the criminal law than on ordinary patients. I am not sure that that is a result which the right hon. Lady would wish to achieve. One has to bear in mind also that in the case of the transferred patients there is no question of the patient's liberty being at stake. It is a question of whether they shall be detained in a hospital as a result of a transfer order, with a restriction on discharge, or sent back to prison.

I am sure that on reflection the right hon. Lady will realise that, if we had these compulsory annual reports on these cases, who will for the most part be the bad cases, it will result in a great many of what we used to call in the Army nil returns or purely negative reports. All of us, exercising our judgment, have to consider whether it is necessary to impose that administrative procedure on the very busy doctors who, in any event, have these patients under their care all the time.

We have considered this and our advice to the House is that it is better to stick to the four procedures which I have mentioned. For that reason, I am afraid that we are not able to accept the right hon. Lady's Amendment. 1 hope that with the explanation which I have given she will now feel the same way as we do. We have considered it very carefully.

Dr. Summerskill

I am very sorry that the Joint Under-Secretary of State has adopted this attitude. I find it awfully difficult to accept his reasoning that there would he an anomaly, though I agree.

if he accepts one year, whereas on a previous Amendment he accepted two years for other patients, this would be so. He will recall that in the first place in Committee we mentioned that it should be one year for both categories of patients. Therefore, it is not our fault that this anomaly would occur. That is not any reason for withdrawing the Amendment.

The other things which the hon. and learned Gentleman said are a repetition of what we have already heard. I am afraid that he has not convinced me, and I will ask my hon. Friends to support the Amendment.

Question put, That those words be there inserted in the Bill:—

The House divided: Ayes 162, Noes 174.

Mr. Renton

I beg to move, in page 47, line 13, at the end to insert: and, where so requested in writing in accordance with the following provisions of this section by such a patient who is detained in hospital, shall do so within the period of two months beginning with the receipt of the request unless during that period the patient is discharged absolutely or conditionally under subsection (2) of this section or the order restricting his discharge ceases to have effect. (7) A patient shall not be entitled to make a request to the Secretary of State under the last foregoing subsection before the expiration of the period of one year beginning with the date of the relevant hospital order, but subject as aforesaid may make one such request during each period during which he could have made an application to a Mental Health Review Tribunal if he had been subject to a hospital order without an order restricting his discharge and the authority for his detention had been renewed at the requisite intervals. (8) Where a patient subject to an order restricting his discharge has been conditionally discharged under subsection (2) of this section and subsequently recalled to hospital, the last foregoing subsection shall apply as if the relevant hospital order had been made on the day on which he returns or is returned to hospital, but he may also make one such request as aforesaid between the expiration of the period of six months and the expiration of the period of one year beginning with that day ". This Amendment gives effect to an undertaking that I gave in Committee to consider the possibility of giving patients who are subject to restriction orders the right to initiate consideration of their case by the mental health tribunal, with a view to that tribunal tendering advice to the Home Secretary about discharge. It gives the patient who is detained in hospital, and subject to an order or direction restricting discharge, or who is a Queen's Pleasure patient, the right to initiate consideration of his case when a period of twelve months has elapsed since the making of the order or direction restricting the discharge.

He wi11 also be able to exercise this right once during his second year, once during the third and fourth years, and once during every successive period of two years. This corresponds with the right to apply to the tribunal which the patient would have had if the authority for his detention were subject to periodic review and was renewed at those intervals.

The procedure proposed is that the patient will ask the Home Secretary, in writing—or have it made in writing on his behalf—to refer his case to the tribunal for its advice. If the patient makes such a request and is at that time entitled to have his case referred to the tribunal the Home Secretary will be under a duty to refer it within two months, unless the patient is discharged meanwhile.

The object of having that two-month period of grace, if I may so call it, is to avoid the Home Secretary being obliged to refer to the tribunal a case in which he may propose, after seeing the latest reports, to discharge the patient either absolutely or conditionally, or agree to his discharge by the hospital authority. The two months' period may be required before a decision can be taken because it will be necessary to obtain reports from the hospital; but it will also be necessary to ascertain that if the patient is discharged he has a suitable home and job to go to. It may also be necessary—indeed, it may be a statutory obligation —to make arrangements for the patient's after care. I think, therefore, that for all these arrangements and reports to be made, a period of two months is not unreasonable

I should draw attention to the new subsection (8), which makes special provision for a patient who, having already been conditionally discharged, is later recalled to hospital. When that happens, he will have the same right to initiate consideration of his case by a tribunal as he had when originally admitted or transferred to a hospital with an order restricting his discharge. He will also have that additional right if so recalled during the last half of his first year of recall.

If I may say so, this Amendment represents a fairly broad concession, as it refers to the three categories of case that I mentioned in our discussion on the previous Amendment. I hope, therefore, that it will commend itself to the House.

Mr. K. Robinson

As the hon. and learned Gentleman suggested in his closing remarks, I readily concede that this is a considerable concession. I think that probably it is the greatest change in the Bill that has taken place since it was presented on Second Reading. We on this side of the House are grateful to the hon. and learned Gentleman for listening so carefully and so generously to the remarks made in Committee on this matter.

At the moment, we are dealing with a separate category of patient—patients who are under hospital orders with restrictions on their discharge. They are patients whose discharge originally could be effected only by the Secretary of State for the Home Department. It is for that reason that we have been seeking ways and means of giving these patients—who, although they are offenders, are primarily patients and must be regarded under the Bill as patients—additional safeguards against the possibly arbitrary exercise of this individual and solitary power which the Home Secretary has. The access which they will now have to a mental health review tribunal is probably the most satisfactory way of dealing with the matter, although it does not quite meet some of the points which I made earlier in which I said that the decision governing discharge should be primarily a medical one. The review tribunals are not exclusively medical, but at least they will have the benefit of much medical advice.

The hon. and learned Gentleman said that the decision of the tribunal will be an advisory one. It will not strictly be a decision; it will be advice tendered to the Home Secretary. However, I think that it will be very powerful advice and I do not want to press our luck too far, but I would have thought that the effect of a decision of a tribunal in one of these cases would not be substantially different from the effect of a case under the other Clauses. If a tribunal thought that discharge of a patient was appropriate, I have a shrewd idea that the discharge will follow in this case also.

We on this side warmly welcome the concession made in giving special restriction patients access to mental health review tribunal in the same way as if they were not subject to special restriction and with the same frequency available to other patients. We think that this is a substantial improvement on the Bill as originally drafted.

A tnendment agreed to.