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'(1) Where a court is minded to make a hospital order or interim hospital order in respect of any person it may request—
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(2) In its application to Wales subsection (1) above shall have effect as if for any reference to any such Authority as is mentioned in paragraph(a)or(b)of that subsection there were substituted a reference to the Secretary of State, and as if for the words "in its region or elsewhere" there were substituted the words "in Wales".'.[Mr. Kenneth Clarke.]
§ Brought up, and read the First time.
4.17 pm§ The Minister for Health (Mr. Kenneth Clarke)I beg to move, That the clause be read a Second time.
§ Mr. SpeakerWith this it will be convenient to take Government amendment No. 71.
§ Mr. ClarkeThis first debate touches upon the extremely important question of the problems that are sometimes encountered by the law courts in finding hospital places for mentally disordered people who appear before them. This problem has caused concern over the years both to those who practise in the courts and those who follow these matters in the House. Governments of both complexions have tried to improve matters over the years and it was a question that exercised hon. Members on both sides of the Standing Committee that considered the Bill.
New clause 3 is an attempt to introduce a useful new element that should reduce the difficulties in future and, I hope, also pave the way for other proposals in an attempt to get round the appalling problems that can arise when someone appears before a court, charged with a criminal offence, when it is plain that he is suffering from some form of mental illness or acute mental handicap rather than deserving of punishment. Great difficulties then arise in finding a hospital place for that patient.
Over the years a number of suggestions have been made about how the difficulties that are sometimes experienced by the courts might be quickly overcome. One of the most frequent and popular suggestions, at first sight, has been that the courts should be empowered to direct an offender's admission to a particular hospital or direct a health authority to provide a bed for him.
At first sight it seems attractive that a judge, or a bench of magistrates, should be empowered to order that a hospital opens its doors to an offender who should be treated as a patient. All those who have considered the issue in greater depth have decided against giving the courts the power of direction. The report produced by the late Lord Butler and the White Paper that was produced when the previous Labour Government were in office, when the right hon. Member for Norwich, North (Mr. 37 Ennals) was Secretary of State for Social Services, both concluded that such power of direction would be unworkable. In modern mental hospital practice we insist that those who are in hospital are patients who are treatable and who might benefit from treatment. To force mental hospitals to take patients who, in their opinion, are not amenable to their regimes or to the treatment that they might receive would not be in the best interests of anyone.
We cannot ask professional staff to treat patients to whom they feel that they cannot offer any useful treatment, because their hospitals lack facilities or because of their assessment of the patient's condition. I agree, as have all my predecessors, with those who have said that the courts cannot be given powers of direction. However, I believe that the courts should not be left in the position in which they can find themselves occasionally when dealing with the worst and most difficult cases. That is the position of having to tout around all the hospitals that they can find to ascertain whether a bed can be made available in one of them. This happens rarely because in the majority of cases those who have been concerned with the offender have made arrangements for his admission to hospital, subject to the court's decision, before the case is even heard. It is often the prison medical officer who makes the arrangement. When for some reason the prison medical officer, the defendant's own solicitor or the court authorities are not able to make arrangements straightforwardly, it is the Government's opinion that the court will need advice and assistance when considering what suitable places are available. The new clause provides that that advice and assistance is properly for the regional authorities to provide. It is only the regional authorities that will have the comprehensive knowledge of all that is available within the regional boundaries. Sometimes a regional authority will be able to make arrangements with other regions if its own facilities are lacking.
The new clause provides that whenever a court is minded to make a hospital order, or an interim hospital order, it may, if it chooses, ask the appropriate regional health authority to provide information on the availability of suitable hospital places. The appropriate regional health authority will normally be where the offender presently lives or last lived. Where he does not have a fixed home base, the court will decide which regional authority should be called upon.
The position in Wales is different as there are no regional health authorities within the Principality. In Wales the formal duty to supply information will rest with my right hon. Friend the Secretary of State for Wales. In practice, he will normally exercise this function by directing that an official of the relevant district health authority, or authorities, should give evidence on his behalf. The health authority will supply the information in whatever manner the court requests. Often a straightforward informal letter to the court will suffice. However, on occasions, I am sure that a court will find it helpful to hear in person from a representative of the health authority what facilities might be made available.
As I have explained, in the majority of cases the problem with which we are concerned does not arise and there is no need for the courts to seek information. However, I believe that we are making an important change in the regional health authorities' duties and an important change in the assistance that is open to a court when faced with problems of the harrowing kind that can occur in some of the more difficult cases. Anyone who has 38 practised in the courts, as I have for many years, has encountered cases where it is plain that the person before the court needs help and treatment rather than punishment. In a majority of cases it proves exasperatingly difficult to find that treatment, with the dangerous consequence that prison is the only alternative to which the court will have to resort. I hope that the clause will provide an improvement.
§ Mr. Arthur Palmer (Bristol, North-East)Is the hon. and learned Gentleman aware that I have a case, details of which are in front of him, in which the prisoner has been convicted of arson and found to be mentally unstable? He is still being held in prison after three months of negotiations with health authorities.
§ Mr. ClarkeThe new provisions will be of some assistance in just that sort of case. I am sure that the health authority concerned is trying to give such assistance as it can. If the House accepts the new clause, the regional health authority will be obliged to give assistance and will be ready to do so when the Bill is enacted. I hope that the patient is not awaiting admission because of industrial action taken by the staff in the course of the present dispute. At least one case of that sort occurred recently In London but fortunately not many have occurred so far.
There are one or two other steps that we propose to take to supplement the new clause and to try to reduce the number of cases in Bristol or anywhere else where these problems arise.
We continue to have meetings and discussions with representatives of health authorities to try to reduce the problems. We have recently held a meeting with representatives of the Trent regional health authority to discuss the problem in its area. We are holding a series of meetings with other authorities to discuss the same problem. We shall be issuing guidance notes to health authorities and professional staff when the new legislation is on the statute book about the overall effects of the new legislation. Part of that guidance will deal specifically with the problem that we are now discussing.
We shall be suggesting possible mechanisms for tackling the problem such as the idea that is known loosely as the "clearing house". It is an approach that was urged in Committee by my hon. Friend the Member for Basildon (Mr. Proctor), in particular. We shall want to clarify the "clearing house" approach before we put it in any detail to health authorities. We have in mind the possibility of setting up a panel of experienced and knowledgeable professional staff in each region who will try to ensure that the appropriate place is found for individuals in cases of difficulty.
Ministers in my Department propose to raise the problem of finding places for difficult-to-place offenders in mental hospitals as part of the process of regional review which we have set up in the Department. Regular meetings are now held between Ministers and the regions to discuss priority policies for the regions. It is one of the issues that we shall be raising during the regional reviews. I hope that the Mental Health Act Commission, which the Bill is establishing, will be able to assist with the problem. The commission will be able to help in cases where the courts have sentenced people to prison and where a situation has arisen that makes it necessary for them to be transferred to hospital. I shall not speak at greater length about that problem because it is the subject matter of new clause 4, 39 which will be introduced by my hon. and learned Friend the Minister of State, Home Office, within whose responsibilities it lies. It is a similar and related problem.
I hope that the House will agree that the clause will be a useful addition to the help that is available to the courts. I hope also that I have satisfied the House that the Government are taking the problem seriously and will take whatever steps are open to them very much to reduce the worrying number of cases where the courts find themselves unable to place someone who needs the care and treatment of a mental hospital.
§ Mr. Terry Davis (Birmingham, Stechford)It is good to begin our consideration of the Bill on Report on a note of agreement. On behalf of the Opposition, I give a sincere welcome to the new clause. In Committee I tabled several amendements that were designed to deal with the worrying problem that we are now considering. It is fair to say that the Minister has adopted the tenor of one of those amendments. It is also fair to say that the new clause represents the least that we can do to deal with the problem. However, I do not wish to derogate my appreciation of the Minister's action in introducing the new clause.
In Committee I referred to a number of cases where the courts had had great difficulty in obtaining appropriate facilities for those who should receive medical treatment rather than imprisonment. There was one extremely worrying case in the West Midlands which I referred to as the case of Julie—a young woman who had been waiting for months without being admitted to a hospital. She had been kept in a remand centre and had been backwards and forwards to the court where the judge was trying desperately to obtain admission for her to a mental hospital. He had before him a series of psychiatrists, all of whom told him that it was impossible for them to give the treatment that the young woman needed.
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There was another extremely worrying case in Wakefield, which had been brought to my attention by my right hon. Friend the Member for Wakefield (Mr. Harrison). It involved a young man named Paul, who was brought before the court, having been released on one occasion because the court could not obtain admission to any facility for him. The young man had been considered for admission to an ordinary mental hospital, a special hospital and a regional secure unit without being offered a place at any of those institutions. The new clause will be of great assistance to the courts in dealing with such problems. The court will approach the regional health authority for advice on the most appropriate institution for a person.
We welcome the new clause. The problem was raised in Committee as a result of representations by the Justices' Clerks' Society, which considered that this was a growing problem. In its experience, there have been an increasing number of cases where magistrates' courts, as well as Crown courts, have been unable to obtain admission for people to hospitals appropriate for their treatment.
I give an unreserved welcome to the new clause. I am grateful to the Minister for having acted on the suggestions that we made in Committee. He has chosen the lowest option, but we are still grateful. If the provisions of the new clause do not work out in practice, a future 40 Government, of whatever persuasion, will need to return to the problem. They may need to consider providing a court with the power to insist that people are admitted to hospitals. However, let us all hope that the new clause will make such powers unnecessary and that it will work in the interests of everyone, not least those who need treatment in hospitals rather than incarceration in prison. I give a genuine and sincere welcome to the new clause. We appreciate the Minister's willingness to act on this point.
§ Mr. Mike Thomas (Newcastle upon Tyne, East)I associate the unofficial Opposition with the remarks made by the hon. Member for Birmingham, Stechford (Mr. Davis). We should note at the beginning of the final proceedings on the Bill that the Special Standing Committee procedure worked. We received evidence, saw witnesses and took a variety of views in the open rather than within the closed walls of the Whitehall nexus, and that has resulted in producing a better Bill. The new clause is an example of the way in which that process continued to work after the completion of the Committee stage.
I, too, unreservedly welcome the new clause. Great scandal sometimes arises in that area. We want people who need to be in hospital to be in hospital. I hope that the new clause will assist. I know that that is the spirit in which the Minister for Health brought it forward. The Social Democratic Party welcomes it very much. As we are likely to sit late this evening, I shall not trouble the House further.
§ Question put and agreed to.
§ Clause read a Second time, and added to the Bill.