HC Deb 18 October 1982 vol 29 cc77-87

'Sections 41, 43 and 44 of this Act shall apply to any patient who is not liable to be detained under the principal Act or this Act.'.—[ Mr. Terry Davis.] Brought up, and read the First time.

Mr. Terry Davis

I beg to move, That the clause be read a Second time.

New clause 7 is principally concerned with the effect of clause 41. As the Minister said, this part of the Bill about consent to treatment was completely revised in the Special Standing Committee. Although we have some reservations about parts of those provisions, we are not seeking to oppose them. In particular, we have reservations about the three months grace that is given to a psychiatrist enabling him to administer medicine during that period without the consent of a patient able to give that consent and without a second opinion. We do not like that provision, but our amendments have not been selected. Therefore, we shall not be able to debate that point.

In Committee, we were concerned with the arrangements for consent to treatment of detained patients. Indeed, all our considerations about this part of the Bill were concerned with detained patients. At several points the Committee extended the provisions of the Bill to cover voluntary mental patients as well as detained patients. I am thinking particularly of the responsibilities of the Mental Health Act Commission, but there were several other points. For example, we were concerned with the rights and protection of voluntary mental patients. However, the part of the Bill concerning consent to treatment is concerned only with detained patients.

Clause 41 is perhaps the most important as regards consent to treatment, because it provides for both consent and a second opinion for certain treatments. Specifically, it will be necessa-y to have a detained patient's consent and a second opinion from another doctor for psychosurgery and other treatments which will be specified by the Secretary of State. Those treatments were described by the Under-Secretary of State for Health and Social Security as the most serious treatments. That is a fair description.

Clause 41 makes it necessary for six people to be involved in the decision about such treatment being given. Indeed, there will be seven people if we include the patient. First, there would be the psychiatrist and the patient. The patient would have to consent to the psychiatrist's proposed treatment. If the patient were not able to consent, it would riot go any further. In such instances, it is essential that a patient consent to a treatment proposed by the psychiatrist.

However, the matter is not left there. Those treatments are regarded as being so serious that the clause provides for another three people to be involved. Only one of those three people can be a doctor. Their function is to confirm that consent has been given. That confirmation would include a certificate that the patient is capable of understanding the nature, purpose and likely effects of the treatment. The second doctor, who is one of that trio, must certify that the treatment should be given having regard to the likelihood of it alleviating or preventing a deterioration of a patient's condition. Therefore, we have the patient and his psychiatrist and three other people who will have to certify that conse at is meaningful in that it is based upon the patient's proper understanding of what will happen.

The doctor amongst those three people would then, under amendment No. 27 which has been tabled by the Government, consult two other people who have been professionally concerned with the patient's medical treatment. That amendment, to which we shall come later, resulted from a similar amendment which I tabled in Committee. Indeed.. I think it was identically worded. It means that the second doctor would talk to other people who have been professionally concerned with the patient in order to ensure tiat the treatment should be given.

There is a high level of protection. The patient must consent to the treatment proposed by the psychiatrist. Three other people must decide and confirm that the patient has given meaningful consent and understands what will happen, and two other people must be consulted to ensure that the treatment is appropriate and necessary and in the patient's interest. That adds up to seven people., including the patient: and the original psychiatrist.

That high level of protection is justified because we are talking about the most serious treatments, which will include psychosurgery as specified in one of the amendments tabled by the Government tonight, again in response to a request in Committee. Those treatments will include not only psychosurgery, but other treatments which will be specified by the Secretary of State who will act on the advice of the Mental Health Act Commission. Therefore, a high level of protection will be provided for psychosurgery and other treatments.

This part of the Bill is concerned only with detained patients. That is mainly because in Committee we were concerned with the need to protect detained patients, especially those who do not consent to some treatment which the psychiatrist wishes to impose. It was felt—and I think that it is widely accepted—that a voluntary patient can look after his own interests. It was thought that a voluntary patient would simply refuse to give consent and, as nothing could be done without consent, the voluntary patient did not need any protection.

That position appertains to treatments covered by clause 42—the serious but less serious treatments where it is necessary to have the patient's consent, or a second opinion if consent is not forthcoming, for treatment to be given to a detained patient. In that context we are happy that a voluntary patient can refuse to give consent, so that a psychiatrist could not impose the treatment.

We are still left with a voluntary patient for whom the psychiatrist proposes one of the most serious treatments. As the Bill stands, that treatment would be given if the voluntary patient consented. There would not be the additional protection that would be given to detained patients to ensure that the consent is meaningful and that the treatment should be given in the best interests of the patient in the opinion of a second doctor after consulting two other people who have been professionally concerned with the patient's treatment.

It was unanimously agreed that some treatments are so serious that, even if a detained patient gives consent, that is not enough. It was accepted by the psychiatrist who came to the Committee—and I believe that it is accepted unanimously in the country—that treatment cannot be given unless there are those other safeguards. Consent is not enough. If some treatments are so serious that consent is not enough for a detained patient, should consent be enough for those most serious treatments to be given to a voluntary patient? I question whether the consent given to the psychiatrist alone, with no confirmation of that consent from anyone else, is adequate. I also question whether there should not also be confirmation from another doctor, after consultation with two other people, that treatment should be given and is in the patient's interest. That is the purpose of the new clause. It will extend the protection of clause 41 to voluntary patients in relation to the most serious treatments.

I understand that there may be a drafting inexactitude in the new clause as tabled. I have referred not only to clause 41, but to clauses 43 and 44, which concern how the various aspects of the procedure are followed by those responsible. However, I did not refer to clause 45, because clause 44 refers to it and I thought that that was adequate to ensure that the whole package existed for the protection of voluntary patients. I have now been advised that that is incorrect. Indeed, I am grateful to the Minister for consulting me and for giving me the benefit of his advice. Therefore, my hon. Friend the Member for Penistone (Mr. McKay) will formally move a manuscript amendment which, I understand, is acceptable to the Chair. He will move that the words "and 45" should be added at the appropriate place in the new clause. It is a technical point which will ensure that the Bill is correct.

Mr. Deputy Speaker (Mr. Paul Dean)

I can confirm that Mr. Speaker has indicated that he is prepared to select an amendment on those lines.

Mr. Davis

I am grateful to Mr. Speaker for being willing to accept a manuscript amendment on that detailed point, because it will allow the Government to accept the new clause. The new clause should be welcomed by hon. Members on both sides because it extends the protection given by clause 41 to voluntary as well as detained patients.

The kernel of the argument is that if consent is not enough for a detained patient to be given these treatments, consent by a voluntary patient alone should not be enough for him to be given those treatments.

7.45 pm
Mr. Kenneth Clarke

I accept what has just been described by the hon. Member for Birmingham, Stechford (Mr. Davis) as the kernal of the argument. The manuscript amendment is essential if the new clause is to have the effect that he intends. However, I must make it clear that in some ways we are taking a fairly drastic step. As the hon. Gentleman said, throughout the Committee's discussions on part VI, which is most important and which concerns consent for treatment, this part of the measure applied only to detained patients. The whole basis of the argument was that patients subject to detention who had lost their civil liberties needed some additional protection, but that because they were detained there were circumstances in which they should be given treatment without their consent, because the treatment might enable them to regain their liberty despite the fact that they lacked the insight to appreciate that when admitted to the hospital. Most of the provisions in part VI were designed to enable some treatment to be given without the patient's consent but subject to important safeguards.

The Committee worked on those safeguards and by and large we are happy that we have got them right. If it had been suggested at this late stage that we should extend all the provisions of part VI to non-detained patients, the Government would have resisted that strongly. Suddenly, a closely defined statutory regulation concerning courses of treatment in mental hospitals would extend to the generality of psychiatric patients and change the nature of the legislation. However, I agree with the hon. Member for Stechford that clause 41 is a special case. It is designed to apply to the most serious treatments, including psychosurgery. It will also apply to the most serious treatments that are irreversible or drastic, such as certain hormone treatments.

In the case of clause 41, medical witnesses gave their general approval to the proposition that such treatments could not be given without the consent of the patient. Not only should the patient give his whole hearted consent, but an independent second opinion should be required confirming it. That second opinion will be hedged about with such things as a duty to consult. The medical practitioner will be accompanied by two other persons and will have to consult those responsible for the patient's treatment. Indeed, the hon. Member for Stechford accurately described the careful safeguards involved.

I accept the argument that if a course of treatment is so drastic that a detained patient's consent alone should not justify it and that there should be further safeguards, it is difficult to see why the same provisions should not apply to an informal patient. However, one could point out that a voluntary patient is free to leave. He can not only withhold his consent, but leave the hospital. Therefore, he is free to go and get whatever second opinion he thinks necessary. He is free to look to whatever other safeguards he thinks necessary. However, although that may apply to many voluntary patients, who have far greater insight into their condition than is usual among detained patients, I am sure that the House will accept that that does not apply to all voluntary patients.

In Committee we discussed the role of the Mental Health Act Commission in giving guidance on courses of treatment. The Committee was not disposed to confine that to detained patients and wished to have that advice and guidance extended across the generality of patients as far as treatment was concerned. The same arguments apply now. If it is thought necessary for a detained patient to have such safeguards in relation to the drastic and serious treatments involved in clause 41, the House will want to give the same safeguards to informal patients. Of course, some informal patients are fully capable of managing their affairs, have great insight into their condition and know that they need help. However, some informal voluntary patients are, in practice, near the borderline. Indeed, when evidence was given to the Committee frequent reference was made to informal voluntary patients who would almost certainly be sectioned if they showed any inclination to leave the hospital and to try to care for themselves in the outside world. There may be many patients in that category and they are entitled to the same protection as that given in clause 41 to detained patients.

On that basis, I accept the new clause. I am glad that the hon. Member for Penistone (Mr. McKay) intends to move a manuscript amendment, because it would be a drafting error to leave out the reference to section 45. This important new element in the Bill has emerged at a late stage in our proceedings. As a result, we have not had the wide consultations or the direct evidence that we have had on some of the other provisions. My impression of our debates in Committee is that the new clause very much matches the views expressed by hon Members and it is on all fours with the arguments that we heard. I think that the hon. Member for Stechford and I would agree that a large body of medical opinion would probably agree that, as long as it is clearly understood that the provision applies only to the most serious treatments, the principle is also admissible for voluntary patients. However, if there is a little consternation in the outside world about the lack of consultation and the short time left in which to deal with the matter, I trust that the official Opposition and the hon. Member for Stechford will take their fair share of the criticism—along with the Government and me—from those who complain about the lateness of the measure.

However, given that it has taken about 23 years to amend the law, it might be some time before such a step could be taken again if we let this opportunity pass. As we agree with it, it should be taken.

Mr. Ennals

The Labour Party appreciates the way in which the Minister has accepted the amendment, in the spirit of our debates about detained patients.

My clear impression is that a substantial number of patients in our mental hospitals do not actually know, and have not asked themselves, whether they are detained or voluntary patients. It is good that we are establishing this point in the amendment, and it will help to bring home to patients that there are two categories. I agree with the Minister that a voluntary patient may become an involuntary patient according to the nature of his conduct and so on.

I greatly appreciate the Minister's willingness, even at this late stage, to accept the amendment. My hon. Friend the Member for Birmingham, Stechford (Mr. Davis) and all Labour Members will take our share of any criticisms.

Mr. Charles Irving

I am sorry, at this late hour, to have to bring in one or two notes of slight discord. First, however, I join the right hon. Member for Norwich, North (Mr. Ennals) in congratulating the Government and all those on the Committee who obviously went painstakingly into these vital issues which are of such importance to patients who suffer from the great problems about which we have heard so much over many years. It is significant, and therefore even more important, that we should get it as near right as possible, when one bears in mind that it has taken 23 years for a Conservative Government to come back with far-reaching and radical proposals that will be of immense benefit, help and protection to those who are suffering from mental health problems and who are detained in hospital. Nothing that I say is meant to denigrate the efforts of the Minister and his colleagues to be receptive to suggestions. I thank the Minister for the courtesy of his letter to me on a number of matters with which I shall not now have to weary the House.

The Bill is undoubtedly a great advance in providing much more protection for patients in psychiatric hospitals. Part VI of the Bill is a most important group of provisions. While there are many other matters of consequence to discuss, I cannot, as chairman of the all-party mental health group, allow this opportunity to pass by without making some comment upon it. There is no doubt that great efforts have been made in Committee to improve the complex provisions covering the difficult problem of consent to treatment. What has emerged is a sort of compromise between those who regard providing treatment for a patient as paramount and those who are concerned about the rights of detained patients. I do not feel that these positions are necessarily incompatible.

On Second Reading, as chairman of the all-party group, I said that we were concerned at the use of such treatment as ECT, especially in the high security hospitals. I am even more concerned because of the reports that I have received in the last few months on the use of potent drugs. This is not because I do not think that they should be prescribed. However, if they are given against the patient's wishes, perhaps because of fear of unpleasant side effects, the law must provide full and proper safeguards. Heavy drugging should not be used solely to silence the difficult.

There are many aspects of the consent provisions in the Bill that I applaud. The requirement for a patients consent, plus a multi-disciplinary confirmation of that patient's consent, to treatment that gives rise to special concern must be welcome. It should not be forgotten, however, that the number of psychosurgical operations, which is the treatment specifically named in this provision, on detained patients between 1979 and 1982 were minimal. As I understand it—I am sure the Minister will correct me if I am wrong—it is more or less policy not to carry out any more of these operations on detained patients. I am concerned with clause 42 dealing with those treatments requiring consent or a second opinion.

It is worth restating that part VI of the Bill, which deals with this matter, is the first time in English law that it has been specifically stated that a patient who is competent can still have treatment administered without his consent. The Mental Health Act 1959 never faced this issue and although section 26 is labelled "Admission for treatment" and treatment without consent is given as a matter of routine under it, there are two diametrically opposed legal views as to whether this is lawful.

I cannot imagine why a person who understands the nature and purpose of a treatment and refuses it should have treatment imposed upon him against his will. The Committee felt unable to accept this view, which makes it doubly important to re-examine the safeguards available for the objecting patient. The principal safeguard is a second medical opinion, to be appointed by the Mental Health Act Commission. I am pleased that he will be obliged to consult two members of the patient's caring team, neither of whom must be the doctor and one of whom must be a nurse. However, there is still professional self-regulation, which I fear may not gain the confidence of the public. Therefore, it is essential that the second medical opinion should be wholly independent of the hospital where the patient is being treated. I hope that this is the intention of the Government, and should welcome reassurance about this.

This subject became even more important to me after I read an article inThe Guardianon 9 September which reported moves by the East Berkshire health authority to discipline a senior nursing officer who was suspended by the Wexham Park hospital purely because he refused to order his nursing staff to hold down or sit on a patient to inject treatment she had refused, and was competent to refuse.

Mr. Walsh, the senior nursing officer concerned, was undoubtedly a thorn in the orthodox and cavalier set-up at Wexham, which has now closed the psychiatric unit, losing the use of 80 beds in this important type of medical treatment. However, Mr. Walsh had the full support of 50 of his own nurses. In a recent report commissioned by the Oxford regional health authority the East Berkshire authority admitted serious shortcomings at the hospital, which TheGuardianarticle outlined in full. The shortcomings are a disgraceful and shameful catalogue in medical history. The thanks that the senior nursing officer received for respecting his patient's wishes was to be sacked.

Mr. Walsh had nothing to gain and everything to lose. I and other members of the all-party group, have been, and are still, greatly concerned at the horrific power of the consultants and medics over the senior nursing staff who, because of their training and their ability to take on responsibility of a senior job of this kind, should at least have some say in the patient's welfare. Their knowledge of the patient's condition is often greater than that of the consultant or medic who may see the patient for a very few moments, as compared to the many hours that the nursing staff spend with the patient.

I cannot forget the outrageous case of the man who apparently, and, I expect, with considerable help, kicked himself to death. Yet at the end of the day the truth of Barry Prosser's fatal and vicious injuries have never been satisfactorily resolved. 8 pm

Furthermore, I cannot see why it is necessary for a patient who is objecting to the administration of a particular medicine to have to wait three months before he can demand a second opinion. In the Standing Committee, the Under-Secretary of State said that three months seemed to fit best with clinical experience and practice and that anything less would not allow the psychiatrist to assess the patient's condition and prescribe a long-term course of treatment.

I respect the Minister's views. Is it really necessary, however, to wait three months before a safeguard that is obviously deemed essential becomes operational? Now that treatment is specifically extended to those detained under section 25, they will have no effective opportunity to object to medicine that is given to them. Surely the core of this Bill is the recognition that patients who are to be treated against their will shall have truly effective safeguards. I can understand allowing one month's grace for those detained under section 26 but I am unable to see the reason for a longer period.

My fear about these provisions is that they are so complex that they come perilously close to the old legislation that was consigned to the dustbin in 1959. I wish to refer to a recent case that illustrates the shortcomings in the present position especially in relation to drugs. I do not wish to go into details but the patient objected to the proposed drug treatment. The only reason that she did not receive it was that the nursing staff, partly on the basis of their union's legal advice on imposing treatment under the 1959 Act, refused to administer it. The patient was subsequently discharged by a tribunal which seems to suggest that her objection to treatment had some validity. What will be the position of this lady under the new Bill? So far as I can see, there will be no way that she could object to any drug treatment until three months have passed. I find that unacceptable.

Mr. Peter Bottomley (Woolwich, West)

The Brook hospital in my constituency has a neurosurgical unit. The whole issue of psychosurgery at the hospital has come up twice during my time as an hon. Member. I have been impressed by the manner in which the doctors have opened up the unit to interested observers, those critical of procedures and those, like myself, who are waiting to be convinced that safeguards were already in effect. I support the amendment and the welcome given to it by the Minister.

Although there has not been much time for consultation on extending the provision, it will be generally welcomed. Those involved have little to fear by making sure that there is informed consent by the patients themselves or those about them. I believe that the hospital would not want this opportunity to pass without my thanking the Minister for his intervention over the cardiac unit at the hospital and passing on our thanks.

Mr. Kenneth Clarke

I am grateful to my hon. Friend the Member for Woolwich, West (Mr. Bottomley) for his remarks. I rise, however, not to reply to my hon. Friend or to the hon. Member for Birmingham, Stechford (Mr. Davis) with whom Ministers are in broad agreement, but to reply to some of the points made by my hon. Friend the Member for Cheltenham (Mr. Irving). I would have expected a fairly major contribution to be made by the chairman of the all-party mental health committee. Indeed, my hon. Friend has made a fairly weighty contribution covering the whole of part VI on consent to treatment. I accept the strictures, because my hon. Friend is not opposing the policy of the Bill. He has been kind enough to say that he regards the Bill as now drafted as a substantial improvement on the 1959 Act and the existing situation. I believe that is correct.

My hon. Friend wonders whether we have gone far enough and whether the safeguards as they now stand are sufficient. My hon. Friend's starting point is that the existing law allows patients to be admitted to hospital under the 1959 Act, and detained. It is widely assumed or argued that because, under section 26, they are admitted for treatment, this entitles the medical staff to give treatment without the patient's consent where this is in the patient's own interest. That has always been a somewhat arguable proposition. It has given rise to difficulties. Indeed, that uncertainty about the law probably lies at the root of some of the recent scandals, or controversies, to which my hon. Friend referred.

The point of part VI is to remove all those doubts for doctors, nurses, patients and for patients' relatives and friends about what is lawful and what is not lawful. I believe that part VI as a whole provides clear codification of the law. It makes clear what can be done without consent and what cannot be done except with consent. We have produced a code with the facility to make regulations and to provide that the continued role of the Mental Health Act Commission can be updated and revised to match good practice and its continuing evolution in this difficult field.

My hon. Friend the Member for Cheltenham is among those who are more than half inclined to argue that no patient should be given any treatment unless he has consented to it. As a general proposition, across the broad field of medicine and most of mental health, no one would dream of arguing against the approach in a free society that no patient should be obliged to accept treatment without his consent. But there are difficulties. Like the Government, the Standing Committee was persuaded that there are exceptions in the case of those patients who are so seriously mentally disordered or handicapped that they come within the kind of provisions that we regard as applying to detained mental patients.

I have explained earlier that an individual can be so ill that he has no real insight into his own condition. Sometimes the distress that he suffers as a result of his mental illness may have a physical cause. If there were no provision for any treatment without consent, doctors, nurses and other professional staff would have to set about locking up the patient and making sure that he did nothing to injure himself or other people when they knew perfectly well that they could put right the root of the problem. However, restrained by a law that had such regard for his civil liberties, the patient would be left free to inflict misery on himself by not consenting to treatment he could not understand.

Mr. Charles Irving

I am grateful to the Minister. I may perhaps not have made clear that I was referring to competent patients. It is accepted that some patients are in exactly the position the Minister has stated. We must be careful that competent patients are protected. I want that protection strengthened.

Mr. Kenneth Clarke

That is what we are doing with the voluntary patient and the informal patient, who will still be covered by the general law. It will be unlawful to administer treatment to him without his consent. We are including a new clause moved by the hon. Member for Stechford which would protect the voluntary patient. We are being rather paternalistic in protecting him against himself. We are saying that there are a few treatments so serious that, even where a voluntary patient consents, there should be a second opinion and the safeguards that are set out to make sure not only that he has understood but also that it is the right thing to do in his interests. We are going a long way down the road that my hon. Friend wishes us to travel.

For detained patients, clause 46 will allow medical treatment to be given without a patient's consent, for the reasons that I have given. My hon. Friend mentioned ECT and potent drugs. Both will be included in clause 42 and the detained patient will have to consent, as my hon. Friend wishes, or, if the patient does not consent, treatment will be able to be given only after a genuinely independent second opinion. I confirm, in answer to one of my hon. Friend's questions, that the MHAC will ensure that the doctor who gives a second opinion will not come from the same hospital and will not have any conflict of interest.

Clause 42(1)(b)deals with potent drugs and includes the three-month rule, which my hon. Friend thinks is rather generous. He mentioned on Second Reading the unsatisfactory way in which that was set out in the Bill. The protections on medicine were so severe that it was argued that a patient could not be given a sleeping pill or an aspirin to relieve his headache without a second opinion being obtained. The danger against which everyone wished to protect patients was the continuing course of heavy drug therapy, which has to be resorted to and can be beneficial in some cases. There are different views about that sort of treatment and it was felt that some safeguards were required.

If we start applying safeguards from the moment any drug treatment is embarked upon there will be difficulties. There will be no lime to see whether the treatment s working and the patient may object bitterly, because he does not understand that it will do him good. The conclusion arrived at in clause 42 is that medical practitioners should have the right to continue a treatment for three months, but if the patient still refuses consent at the end of that period a second opinion will have to be obtained.

ECT will be given only if the patient consents or after a second opinion. ECT no longer appears on the face o f the Bill and the reason for that was accepted on both sides of the Committee. The Government intend to put ECT into the category of treatments that require consent or a second opinion. We have not put it on the face of the Bill, because as practice develops a subsequent Secretary of State may wish to promote it or relegate it from one division to another. Those who have doubts about the treatment think that perhaps it should be put into the clause 41 category. The Government have undertaken to put ECT into the clause 42 category, but as experience is acquired, and if opinion changes, we shall be able to move it into the more serious clause 41 category.

The new clause relates to clause 41. Psychosurgery will be on the face of the Bill. The fact that it is a very serious treatment is borne out by the limited numbers who have it. I am told that there were two such operations carried out on detained patients in 1979, one in 1980 and one in 1981. There is no policy not to carry out such operations, but the figures show that psychiatrists who take care of detained patients consider such treatment with great caution and operate in a very limited number of cases. It is irreversible and a difficult treatment to give, and it is right to make sure that if it is to be given an independent second opinion, hedged around with all the advice included in clause 42, is needed for informal and voluntary patients as well as for detained patients.

I am grateful to my hon. Friend the Member for Cheltenham. He may not be wholly satisfied, but I am sure that he accepts that we have moved a long way towards his opinion and that of many like him who have a humane and close interest in the problems of our mental hospitals and who wish to see conditions improved.

8.15 pm

I will not embark on a discussion on the problems of Wexham Park hospital at the moment. My hon. Friend the Member for Beaconsfield (Mr. Smith), in whose constituency the hospital is situated, and the hon. Member for Lewisham, West (Mr. Price) have told me that they are likely to refer to the hospital in the debate on a later new clause. Of course, there are two sides to the argument. My hon. Friend the Member for Cheltenham put one side, but I agree with the other side. I accept that the picture that emerges from the Camps report is worrying and reveals a lot of things that have to be put right as regards medical practice, nursing practice and relations between the professions, but I believe that the East Berkshire health authority has handled the situation well since the report came out and has been fully justified in taking the steps that it has. It has followed all the right disciplinary procedures and its actions have been fully supported by the findings of the Camps report. In the interests of those affected, I felt it right to make those comments on my hon. Friend's remarks about the hospital.

The debate has shown that this is a difficult area. I am grateful to the Opposition for extending the safeguards that we have provided into yet another valuable and significant area.

Question put and agreed to.

Clause read a Second time.

Manuscript amendment made:In line 1, leave out "and

44" and insert "44 and45".—[Mr. Allen McKay.]

Clause, as amended, added to the Bill.

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