REPEAL OF SECTION 4 (3) OF THE ACT OF 1949 (Hansard, 18 December 1968)

§ Mr. Lubbock
I beg to move, That the Clause be read a Second time.
This pursues a matter I raised in Committee about the position of patients in psychiatric hospitals. This Clause is slightly wider than the Amendment put forward in Committee because it deals not only with those who are called "informal" under the Mental Health Act, 1959, but with all patients in psychiatric hospitals under Sections of the Mental Health Act excluded by previous Amendments.
Since we discussed this matter in Committee I have been in touch with the National Association for Mental Health and have made inquiries about the number of patients who might have been affected by the previous Amendment. The numbers are quite substantial, as a letter I received from the Association on 13th December will show. In a hospital in Cambridge where the total number of patients is 700, there are 200 who are short-term patients still registered for voting at their home addresses, and a further 150 patients who have no other address than the hospital at which they might be able to register.
This brings me to the crux of the difficulty. The Home Office has wisely issued advice to registration officers that where a patient in such a hospital has a relative at whose address he or she can register the patient is to be included as normally registered at that address, but, if the patient has no relative or friends with whom he normally stays and is a long-stay patient at the hospital, he is registered at the hospital itself. Under Section 4 (3) of the Representation of the People Act, 1949, he cannot do so because that subsection specifically debars the hospital being used as the qualifying address.
Informal patients are patients who enter hospitals voluntarily under the Mental Health Act, 1959. We have had some discussions with the National Association of Mental Health, not only about the number of patients affected but also on the question of whether it is right to make this distinction between informal patients and those who are "detained" under one or other of the Sections of the Mental Health Act, 1959. Contrary to what may be popularly supposed, it is not that detained patients are less able to exercise 1436 a franchise than informal patients. That is why I propose this Clause.
It would mean that any person who is a patient in such an institution is able to register at that address and to exercise his vote if he is fit to do so. There is the ultimate safeguard that the presiding officer in the polling station may stop a person voting unless he is able to answer a simple question or if he is disorderly in any way. Matrons and medical attendants responsible for the health of patients who may be enfranchised by this proposal would be very careful to see that those patients were medically fit to go to a polling station and exercise the vote in a proper manner.

§ Mr. Onslow
This seems to be the crucial part of the hon. Member's argument. Is he suggesting that a duty should be laid on the medical staff to satisfy themselves that patients are fit before they go out to vote and that there should also be some indication to the presiding officer that it would be appropriate for him to ask a question to establish their fitness? How could this be done when there might be as many as 500 such people on one voting register?

§ Mr. Lubbock
One would not of course put such duties on a presiding officer other than those under the Representation of the People Act, 1949, which requires them to make sure that the person on the electoral register can answer that test. That is a safeguard against anyone who is totally incapable being allowed to go into a polling station to cast a vote. It is not that the matron or medical staff should be made in any way responsible for matters which are the concern of the registration officer or the presiding officer at the polling station.
The situation is rather analogous to that of patients in geriatric homes in Part III accommodation, many of whom may not be fit to vote. We have not found any practical difficulty there. I do not think there would be more difficulty in the case of psychiatric hospitals. This matter is rather more complicated than we envisaged it when it was first raised in Committee. The hon. Gentleman who is to reply to this debate has been making inquiries and I have been in touch with him since the Committee stage. I hope 1437 that he will give an assurance that this matter will be fully considered before the Bill reaches another place and that the difficulty will be resolved.

§ The Under-Secretary of State for the Home Department (Mr. Merlyn Rees)
I remind the House that this question was considered by Mr. Speaker's Conference. I think that in this case the conference got it wrong. The last time we discussed the matter we discovered something about the general problem of mental health and I think we shall pursue it a little further today. This is an example of discussion leading to more essential truths than one had in the first instance.
As the hon. Member for Orpington (Mr. Lubbock) said, we have discussed this at some length in recent days. The purpose of the new Clause is to pursue the question of registering informal patients in mental hospitals. It goes further than that now, but it started with the attempt to deal with informal patients in mental hospitals and follows an undertaking which I gave on 11th December.
The present situation was put clearly when we last discussed this subject, but it is worth repeating that under Section 4 (3) of the 1949 Act patients in psychiatric hospitals are not able to register there for voting purposes, whereas people in other types of hospital can be registered. If one is in a psychiatric ward of an ordinary hospital one can be registered, but if one is in a psychiatric hospital one cannot be registered. In 1949 one of the reasons given for non-registration was that patients would not want to reveal that they were in mental hospitals. We have come a long way since then in our treatment of mental health and our attitude to mental health.
Informal patients can be registered at their home addresses. Mr. Speaker's Conference and the Home Office dealt with this point for the last registration in advice about Form A. This has led to more registrations of this type. Since that time we have all been making inquiries. The situation is—this information comes from the National Association for Mental Health, which has advised the hon. Gentleman and which has written to me—that about 50 per cent. of all patients in mental hospitals are not registered.
1438 6.0 p.m.
There is little doubt but that we should start from the principle that informed opinion wants to treat all patients in mental hospitals, with exceptions to which I will come, in the same way; and, if possible, in the same way as patients in ordinary hospitals. Mental ill health is not shameful in the way that might have been thought at one time.
On investigation, the distinction between informal patients—Section 5 or Part IV patients—and detained patients—Part V patients—is of little value. Some informal patients may be more mentally ill than those who are detained. To start by trying to draw a distinction between informal and detained would be to go in the wrong direction.
One aspect of mental ill health which is important is the question of lucidity. This is not decided by knowing whether someone is a Part IV patient or a Part V patient, just as lucidity is not, as we find in ordinary life, the distinction between the possession of a university degree and not having one. Lucidity is rather difficult to define. To add to the problem, there are distinctions between types of detained patients which do not make policy decisions easier.
We must start by treating all mental patients in the same way. The Amendment the hon. Gentleman moved in Committee would not have met the point. Nor is the analogy between convicted prisoners and detained patients a very fruitful avenue. We were thinking about that in Committee in the hope that there was some analogy between being a convicted prisoner and being a detained mental patient. The real distinction is that in one case imprisonment is punishment. In the other case, the detention is for treatment.
Before the Bill reaches another place, I should like to consider the effect of registering all patients. I should not like anyone to think that there are not problems in this respect, because there are. There are problems in Statute law and in common law, because historically important decisions have been made. Many years ago we used to crack the joke that the two classes of persons not allowed the vote were lunatics and peers, to use the phraseology of 160 to 170 1439 years ago. I want to look into the legal aspect more deeply.
The question of swamping the electorate should be considered. There is a difference between an ordinary hospital and one in which there are more long-term patients. In an ordinary hospital there may be the chronic sick, but there is a much larger proportion of people who are in for a relatively short period and who are registered at home. The other day, on an Amendment moved by the hon. Member for Cornwall, North (Mr. Pardoe), we discussed the question of the electoral role in Padstow being swamped by people possessing votes because of holiday cottages. If that was a valid point there, I am sure that it becomes a valid point in other constituencies, such as that of the hon. Member for Woking (Mr. Onslow), who has a large number of people who are in hospitals of this type. It is not true of ordinary hospitals.
The hon. Member for Woking raised the question of the difficulty of deciding whether a person is fit to vote. I am advised by the Ministry of Health that there would not be much difficulty about deciding whether a person was capable of voting on the day. If the polling booth were inside the hospital, I presume that a doctor would decide. If the polling booth were outside, as I presume would be more normal, the presiding officer has the right to decide already under electoral law whether someone is fit to vote. If there were a high proportion of people who were mentally ill, given the different attitude we now take to this problem, it could be that we were putting on the local presiding officer a burden which perhaps he should not have to bear. In any event, if a patient is legally detained he would not be allowed out anyway. So the geography of the polling booth would decide it.

§ Dr. M. P. Winstanley (Cheadle)
I am interested in the Minister's explanation. On the point raised by the hon. Member for Woking (Mr. Onslow), there are more mentally disturbed patients, or patients with mental diseases, being treated at home than there are in hospital. It is not as if we would be creating a new problem. This is a problem which already exists outside hospitals and which we cope with satisfactorily. There is no 1440 reason why we could not cope with it satisfactorily within hospitals.

§ Mr. Rees
This is so, but the problem of a largish number being together raises problems.

§ Mr. Onslow
The parties would send their election literature to everybody on the register. It would be in the interests of people who were thought not to be fit to vote that they should not get election literature. It would raise many extremely difficult problems on the administrative side for the hospital staffs concerned.

§ Mr. Rees
This is one of the reasons why, although I am very sympathetic to the hon. Gentleman's objection, I would ask him again to leave the matter with me. We will certainly consider it. We start with the premise that we want to be helpful. However, there must be further investigation. I hope that the hon. Gentleman will withdraw the new Clause.

§ Mr. Lubbock
I am grateful to the Minister for his helpful reply. I realise that he could not solve this complicated problem in a week. I hope that the inquiries he is to conduct between now and when the Bill reaches the Lords will be fruitful. I beg to ask leave to withdraw the Motion.