§ Amendment made: In page 3, line 1, leave out "Board" and insert "Commission".—[Mr. Maclay.]
§ 4.45 p.m.
§ Mr. Deputy-Speaker (Sir Gordon Touche)
I suggest that it would be convenient to discuss with this Amendment the following one, in line 2, after "exercise", to insert "general".
§ Miss Herbison
Yes, Mr. Deputy-Speaker.
This was an Amendment which I expected to be tabled by the Govern 702 ment. It is a matter that was raised by my hon. Friend the Member for Greenock (Dr. Dickson Mabon) in Committee, when the Government did not find it possible to accept our Amendment, although, when we suggested that "general" should be inserted, there seemed to be general agreement from the Government side. I wonder whether they are now ready to accept our suggestion.
§ The Lord Advocate (Mr. William Grant)
I do not think that there is any dispute between the two sides of the House on what we are trying to achieve. The only dispute concerns how to do it. Both sides are agreed, first, that the protective functions of the Commission should cover as wide a field as possible and, secondly, that within that field the Commission should have power to deal not only with general matters, but also with particular cases and with the particular details of them.
A slightly parallel example may be found in those cases where a Minister has power to give a general direction but it is found, sometimes to our intense dislike, that he cannot give a specific direction. We want the Commission to have power to deal with the specific cases as well as with the general. The question is how we are to do it.
To refer to the hon. Lady's second Amendment, I believe that the object can be achieved by our own following Amendment, in line 9, to leave out "general" and I will briefly explain why. If we used the phrase "general protective functions" in line 2, it could be read as limiting the protective functions merely to general matters as against particular and specific cases. With that in mind, we prefer not to insert "general" and, equally, to take out the word "general" where it appears in line 9. That will leave the Commission with a wide field and without any generality attached to its functions which might be thought to take away from its specific powers.
It is for that reason that I would resist the two Amendments and not because I am not in agreement with what the hon. Lady has in mind. It is because 703 I feel that the proper way to do this is to delete the word "general" and not to insert it in line 2. The hon. Lady may say that we are leaving the word "generally" at the beginning of line 2, but that is to emphasise that the functions cover a wide sphere of activity. To achieve the object which we all have in mind we should reject these two Amendments and, instead, accept the Government Amendment to page 3. line 9.
§ Amendment negatived.
§ Amendments made: In page 3, line 9, leave out "general".
§ In line 10, leave out "Board" and insert "Commission".—[Mr. Maclay.]
§ Mr. Maclay
I beg to move, in page 3. line 17, to leave out "at such intervals" and to insert:regularly and as often".Perhaps it would be convenient also to discuss the Opposition amendments in page 3, line 17, at the end to insert:but not less than twice in each yearand vote on the Amendments separately.
§ Mr. Maclay
The effect of the Amendment is to require the Mental Welfare Commission to visit patients who are liable to be detained in hospital or subject to guardianship at regular intervals in addition to visiting them as often as the Commission thinks appropriate to make specific inquiries or for some other specific purpose. In Committee, an Amendment was moved to make the Commission visit the patients not less than twice a year when they were subject to guardianship. It was suggested that there was no requirement to visit regularly and that the Commission would visit only when it received complaints. We undertook to consider the possibility of arranging for these visits and the Amendment is an attempt to meet that undertaking, but I understand from the Opposition Amendment on the Notice Paper that our Amendment does not satisfy hon. Members opposite.
Our Amendment does not specify the visits which should take place. We do not think it right to lay down a specific requirement that all patients must be 704 visited twice yearly. Once the Commission has had the duty of regular visitations placed upon it, so that the need to keep in touch with all patients is beyond doubt, we feel that the Commission should be free to fix how frequent the visits should be. The Commission might decide in the light of experience that one class of patients requires more frequent visits than another and a body of this kind should be free to use its resources accordingly.
Boarded-out patients may be living with relatives and everything may be going well, and there may be much more need for more frequent visitation if they are not living with relatives. It seems wrong to make an absolute requirement of so many visits a year, regardless of the condition of the patient. I hope that the Amendment, as an attempt to meet the major part of the point made by the Opposition, will be acceptable. We feel that the Commission is a responsible body and should be free to use its time as it thinks best without being tied too arbitrarily to a timetable which might compel it to make formal visits when these were not necessary and there were other matters to which the Commission might more rightly devote its time.
I hope that the Opposition will not feel that there should be a more rigid adherence to a timetable.
§ Miss Herbison
The right hon. Gentleman has gone some way to meet the points which we made in Committee. Perhaps I would have been more willing to accept the Amendment which the right hon. Gentleman has tabled and to forgo the further Amendments which we have put dawn had we been more successful in persuading him to accept the last Opposition Amendment that we have just discussed. The Secretary of State has told us that those who are members of the Commission will be responsible people, but if sometimes the Commission takes on three part-time doctors and not one full-time, those doctors might find that they did so much outside work apart from the Commission's work that what they would consider to be regular visitations would not be considered by other people to be regular enough.
At this stage, it is of the greatest importance that there should be at least a visitation twice a year. We on this side 705 of the House feel strongly that the Secretary of State has not given us reasons to convince us that we can leave the matter completely to the Commission, particularly since he has not given us the assurance that full-time doctors will be employed. I ask the right hon. Gentleman to give further consideration to this matter while the debate continues.
§ Dr. Dickson Mabon
There is a very reasonable point here. The Secretary of State said in a debate on a previous Amendment that he could not commit any of his successors in office. He has now made a statement on this Amendment to which, again, he cannot commit his successors, and it could be read to mean that visitations can be as few as possible. The right hon. Gentleman, earlier in the debate, managed to have one of the full-time men working only four-fifths of the time for the Commission and working the remaining fifth making money.
These full-time commissioners seem to be meeting the finest clinical material, in the medical sense, in the course of their work and I cannot see why they should want to take on any outside task. It is true that that is another point, but it only reinforces the argument about the frequency with which visitations are carried out. I do not think that the impression should be created that the Commission will not work at the pressure that we think is desirable.
Many of these cases, and particularly the mental deficients and the more advanced psychotics, tend to be hopeless in appearance when met de novo even by an experienced practitioner, and there is frequently a long case history which tells against the patient. There is nothing more distressing than encountering a huge case history and feeling that one has to go through the whole thing to get the patient's antecedents.
It is very difficult not to tend to say to oneself, if one is a busy man, "This is rather a sad case, and that is that". We do not want that to happen, and I am sure that the Government do not want it. We want the Commission not only to do its routine work, but also to act with drive and energy to try to find out apparently irrecoverable oases. There is also the argument about public expense in keeping persons in hospital 706 who should have been discharged. During the Second Reading debate, the hon. Member for Ayr (Sir T. Moore) made the assertion—and it was a very proper one—that many people have been kept much longer in hospital than they should have been.
To a large extent, this ennui of neglect passes over almost everybody, even those well disposed to the patient concerned. They tend to think, "This is a hopeless case." The men to whom we turn to start the first inquiry into these patients are the commissioners. Admittedly, they may have medical staff, but we turn to them because they are supposed to be men of high calibre who are taking on the most difficult patients. Why cannot we have a definite period set down?
The Secretary of State has argued that "regularly" could mean three or four or more times a year. But it could also mean the reverse. It could mean once in two years. The detained person can receive better service from the Mental Welfare Commission by the Secretary of State's Amendment than if he is a voluntary patient. Yet the Bill is designed to be biased in favour of voluntary patients entering hospital for treatment and against there being an extension of detention. Under the Bill's provisions a patient who is in detention receives a visit, an inspection—in fact, "the works"—including the judicial process, if necessary, once a year. Yet a voluntary patient, under the Secretary of State's Amendment, could be neglected, or seen once every two or three years. In fact, there is no limit.
There is, however, substance in our Amendment. We are specifically suggesting a minimum of at least twice a year for visits. The Secretary of State's Amendment says that these should be "regularly, and as often" as possible. How much more effective his words could be. The right hon. Gentleman leads us to believe that the Commissioners, who will have much work to do, will visit these patients as often as possible. It is a balance of argument. It is not unreasonable to argue that he has taken a step towards us, and we appreciate that. We are not ungrateful that our arguments have received a response. But now we want to carry him a step further.
707 The right hon. Gentleman may not wish to accept our suggestion that the visits should be at least twice a year. Perhaps he would prefer once a year. He should, however, definitely state a minimum. We believe that the voluntary patient deserves to be visited at least twice a year. He is neglecting the voluntary patients, who are the majority of those in mental hospitals. He is missing an opportunity of making the Commission not only a guiding protective body in the background, but a body actually taking an active part in the rehabilitation of patients.
Is it to be a passive Commission, to be called in in times of emergency? Or is it to be an active Commission, taking a helpful part in bringing patients back to sanity and a proper mental status? That, I believe, is the choice. I do not wish to build too much on our Amendment, but I think that there is an appreciable difference between the two sides. I invite the Secretary of State to think again, in the hope that he may meet us on this point.
§ Mr. Willis
I can see that the Secretary of State, while he might not yet have taken the step to meet us on this, has his foot lifted in readiness to do so. I have risen to enable him to give a little more consideration to the very cogent arguments of my hon. Friend the Member for Greenock (Dr. Dickson Mabon), because I feel that if he does give such consideration he will accept our Amendment. We are proposing something quite reasonable. If our Amendment were accepted this subsection would read:…it shall be the duty of the Mental Welfare Commission… to visit at such intervals as they may think appropriate, but not less than twice in each year, patients who are liable to be detained in a hospital…As my hon. Friend the Member for Greenock pointed out, as the subsection stands at present, and as amended by the Secretary of State, there is no guarantee that there will not be long periods between visits, but the subsection would go on to read, if our Amendment were accepted:…but not less than twice in each year, patients who are liable to be detained in a hospital or who are subject to guardianship, and on any such visit to afford an opportunity, on request, for private interview to any such patient as aforesaid…708 The voluntary patient should surely have the opportunity to have this interview if he wants it, certainly at least once a year, as my hon. Friend the Member for Greenock suggested, or perhaps every six months. If the Commission does not visit him, then he is denied this opportunity of an interview. The subsection goes on:…or, where the patient is in a hospital, to any other patient in that hospital;If we have several patients in a hospital whom the Commission does not seem to think it should visit for eighteen months, or perhaps two years, what happens to that provision? How are these rights of the patient to be made effective? To enable the intention of that subsection to be carried out, and made effective, the Secretary of State ought to lay down a period which he thinks appropriate. We should state which period we think is appropriate. There is, after all, no great difference of opinion about this. What is wrong with saying six months?
It may be true that a patient need not be visited every six months or every year, but we should be denying these people certain rights if we did not lay down a period of time for such visitations. I hope that the right hon. Gentleman will look more kindly upon our Amendment than he has done so far. Having listened to the argument, I am rather suspicious of the right hon. Gentleman's Amendment. If we are to have part-time commissioners they might turn out to be only half-time commissioners. There may be great pressure of work, for there are 20,000 patients at present, with 6,000 awaiting admission, while there will be a large increase in the number of people coming within the scope of this Bill.
No doubt, given the present affluent society and the Tory Government, there is quite a good prospect that the number will increase even more. It is increasing every year under a Tory Government and I cannot see why it should not increase even more, particularly in this affluent society when a person is subject to all the pressures of hire purchase and the worries connected with it.
§ Mr. Willis
The point is, of course, that if great pressure should be put upon the commissioners—and there is no guarantee that there will not be, because we are now told that they need not be full-time, but half-time—surely that would create conditions in which the commissioners would say, "We think it appropriate if we visit these people every eighteen months." We must avoid that sort of situation. I would not necessarily blame the commissioners if they said that, but there is a responsibility upon the Government to avoid that, and that responsibility can only be accepted if the Government put something specific into the Bill.
The other point made by my hon. Friend was why there should be this difference of treatment between voluntary patients and detainees. I cannot understand why we should lay it down in one case and not in the other. The right hon. Gentleman gave no reasons for that at all. He did not say why there should be this differentiation, and I think that he must reply to that point.
I hope that my hon. Friends will vote on the matter unless we get a much more satisfactory explanation than we have had so far from the right hon. Gentleman.
I do not want to detain the Committee for very long, but I agree entirely with my hon. Friend the Member for Edinburgh, East (Mr. Willis) without advancing further the arguments that have already been put. I would like the right hon. Gentleman to look at the wording of his Amendment and to ask himself what exactly it means. If the Amendment were accepted the subsection would read:to visit, regularly and as often as they may think appropriate…What exactly does that mean? It does not carry us one iota further.
The Bill as now drafted says that they shall…visit, at such intervals as they may think appropriate…In other words, it is entirely up to the commissioners to decide when they shall visit. The words which the right hon. Gentleman seeks to insert carry that power no further. It would still be within the province of the commissioners to decide how regular is 710 "regularly." The Amendment is the vaguest of all vagueness.
If the right hon. Gentleman wants to meet the wishes of this side of the House and to make progress with the Bill, I cannot understand why he is not more specific in his language. He told us on the earlier Amendment that was rejected on a Division that he had taken opinion and thought about the matter very deeply. If this Amendment is the result of similar thought, then the sooner the right hon. Gentleman stops thinking the better, because I cannot think of any more vague and useless language than that of the Amendment.
§ Mr. William Hannan (Glasgow, Maryhill)
I wish to follow up the remarks of my hon. Friend the Member for Edinburgh, East (Mr. Willis) by saying that I think that the matter goes very much further than he said. In urging this specific Amendment upon the right hon. Gentleman, my hon. Friend referred, of course, to paragraph (b).
What are the purposes of these limits? According to paragraph (a), they are to remedy any deficiency in the patient's care and treatment. Another purpose is to terminate improper detention if that should be happening or to prevent or redress loss or damage of the patient's property.
I should have thought that any one of those three purposes was sufficient to demand the specific attendance of the members of the welfare commission at hospitals. If it is really the care of the patient that we are concerned about, then what is proposed is not sufficient. I urge the right hon. Gentleman to pay attention to these points. They are important. Merely to leave the matter in this vague fashion and to leave the commissioners to determine when they will make the visits is not sufficient if their duties are to be properly carried out.
I should have thought that if there is a deficiency in the treatment of a patient, or if there is something lacking as regards his welfare, it would be too long to leave the matter for a year or eighteen months. Being specific and saying that a patient should be visited at least twice a year would give certain safeguards and would avoid some of the things which caused the inquiry into the 711 allegations of mistreatment, improper detention and all the rest of the complaints which this Bill happily deals with. There is real cause for the right hon. Gentleman to give an affirmative answer now by accepting our Amendment.
§ 5.15 p.m.
§ Mr. Maclay
Hon. Members have argued, as usual, with great persuasion and energy. But my foot, which was poised—I was interested to see how it was moving—did not move in the direction which they wanted, and I do not think that I can accept what they have said.
I will try to clear up certain points. This body is a responsible one and I do not think that it would be right to tie its members down to treating every single person in the same way. It would not be necessary to visit some patients twice a year, and I think that it is much wiser to leave the commissioners flexibility to visit patients as that seems desirable. One must accept that the body, if it is to function properly, would have to be a responsible body, as otherwise it would not be fulfilling any of its functions under the Act. One must leave it to decide for itself.
As for the wording which I have used in my Amendment, I would point out that it is always difficult to say precisely what difference it makes in a Statute when one uses a rather more specific phrase which does not lay down an absolutely rigid timetable and to see whether there is any difference from that of the previous wording. In this case, there is a difference, and an important difference. It conveys a different meaning to me. It has a different meaning from the words originally in the Statute.
The Amendment is certainly an attempt to meet the point without going to a degree of rigidity which I do not think it would be right to impose on a responsible body. I have heard no complaints through the years of a failure to visit owing to the wording used in the past, and I cannot think that there would be any likelihood of any complaint in the future.
This is an important point. Of course, quite apart from regular visits, a patient who wants to see a commissioner can 712 always ask to see him. He may be seen without waiting for any specific visit, and if a commissioner is visiting a certain patient in a hospital any other patient can ask to see him while he is there.
§ Miss Herbison
The Secretary of State says that if a patient wishes to see a commissioner he may write to him. But the right hon. Gentleman must realise that we are here dealing with mentally ill people. Not every patient who is most desperately in need of being seen by a commissioner will know his or her rights. Even if they have some knowledge of those rights, they might not be in a position to write to the commissioner. Therefore, we could not possibly accept that argument.
§ Mr. Maclay
I realise all that. I am pointing out that the commissioners will realise that that type of person is in a particular place and will visit him or her regularly. That is the whole point. We would not want to limit the commissioners to visit people boarded out, people with a known state of health and who are known to be living happily with parents who are happy to have them with them. We would not want the same regularity of visiting there as in the case of the person to whom the hon. Lady has referred. It would be a mistake, I think, to tie down the commissioners as tightly as that.
The hon. Member for Edinburgh, East asked about the difference between detained and voluntary patients. The point is that one of the jobs of the commissioners will be to see that the people who are detained ought to be detained. That is why there is a difference in the way in which their duties are set out in relation to patients compulsorily detained, on the one hand, and voluntary patients, on the other, the latter, of course, being able to leave hospital at any time. I hope that the House will accept what I have said.
§ Mr. Willis
Before the right hon. Gentleman concludes, may I remind him that he did not answer another point which was put during the discussion? Let us suppose that the period was one year—
§ Mr. Willis
I did say, Mr. Deputy-Speaker, that before the right hon. Gentleman sat down he ought to reply to a point to which he had not yet replied. It was a point made by my hon. Friend the Member for Greenock (Dr. Dickson Mabon) about changing the period to once a year. Does he envisage patients who should not be visited for periods longer than one year, and would the commissioners have freedom to make their own arrangements under that period?
§ Mr. Maclay
I would not like to give a specific answer on that, because it must be up to the commissioners to decide what is right in relation to the individuals with whom they are dealing. I am sure that that is the right way to leave it.
§ Amendment agreed to.
Amendment proposed: In page 3, line 17, at end insert:
but not less than twice in each year".— [Miss Herbison.]
§ Question, That those words be there inserted in the Bill, put and negatived.
§ Amendments made: In page 3, line 26, leave out "Board" and insert "Commission".
§ In line 37, leave out "Board" and insert "Commission".
§ In line 40, leave out "Board" and insert "Commission".—[Mr. Galbraith.]
§ Mr. Galbraith
I beg to move, in page 3. line 40, at the end to insert:(4) For the purposes of subsection (2) of this section, the Mental Welfare Commission may interview, and a medical commissioner or a medical officer of the Commission may examine any patient in private.(5) A medical commissioner or a medical officer of the Mental Welfare Commission may call for the medical records of any patient.The effect of the Amendment is to make plain, first, that the commissioners of the Mental Welfare Commission may visit any patient in private; secondly, that medical commissioners or medical officers may examine any patient in private; and, thirdly, that medical commissioners or medical officers may call for medical reports and records in respect of any patient.
This meets an undertaking which I gave in Committee, and I hope that the House will feel that the points raised have been adequately covered.
§ Miss Herbison
We are glad that this Amendment has been put down by the Government, because it gives a greater safeguard to the patient than was given by the Bill as originally drawn.
§ Amendment agreed to.
§ Further Amendment made: In page 3, line 41, leave out "Board" and insert "Commission".—[Mr. Galbraith.]
§ Mr. Galbraith
I beg to move, in page 3, line 43, at the end to insert:and to bring to his attention any such matter of which, in the opinion of the Commission, he ought to be apprised".The effect of the Amendment is to make it plain that the Mental Welfare Commission may at any time bring to the attention of my right hon. Friend any matter arising out of the Bill of which they think he ought to know. In Committee, the Opposition were doubtful about this, and the Amendment meets an undertaking which I then gave to try to meet their fears.
§ Dr. Dickson Mabon
The undertaking which was, I think, given by the Solicitor-General for Scotland, the Joint Under-Secretary concurring with it, was a very generous one, so generous, indeed, that the new wording now shows that he has become an enthusiastic convert to our point of view. We modestly wanted only to cover matters arising out of the Bill. As it now stands, it is much better because it means almost anything at all. This is an admirable point of view, and we are delighted to welcome the Amendment.
§ Amendment agreed to.
§ Further Amendments made: In page 4, line 2, leave out "Board" and insert "Commission".
§ In line 4, leave out "Board" and insert "Commission".
§ In line 6, leave out "Board" and insert "Commission".
§ In line 11, leave out "Board" and insert "Commission".—[Mr. Galbraith.]