§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Sainsbury.]11.46 pm
§ Mr. Stan Thorne (Preston)
I am indebted to Mr. Speaker for being given the opportunity to raise an issue which, although not earth-shattering, is of considerable importance following the passage of the Mental Health Act 1983 which set up the Mental Health Commission.
The Minister and I sat on the Committee that considered that measure. Various discussions, which are not connected with the work of the secretariat, took place, although much of what we determined in that Committee gave life to the secretariat.
The secretariat's main function is to protect the rights of formally detained psychiatric patients by investigating complaints by such patients and by visiting hospitals where they are detained.
The commissioners are either professionals associated with psychiatry or interested and involved lay people. Its organisation is split into three regions—the north-west, the north-east and the south. Each region is serviced by its own secretariat, with support staff, totalling only about 15.
My debate is about the proposed centralisation of that secretariat. Before dealing with that, I shall deal with a misleading answer given to me by the Minister. He said that commissioners do not receive fees. Different classes of commissioners exist. The retired, the self-employed and those employed by private organisations, in addition to their expenses, receive fees at a rate of a little more than £70 per day. The employers of those employed by public bodies other than the Health Service are remunerated for loss of their employees' time.
I regret that, unfairly, where commissioners are Health Service employees, neither their employers—the district health authorities—nor the commissioners receive any financial consideration for their loss of working time on commission business that may involve several days per week, evenings and even weekend work. NHS-employed commissioners must be struggling to maintain an adequate input to keep their jobs going. Their hard-pressed district health authorities, with their manpower targets and cash limits to meet, must regret releasing their staff without compensation.
Many of the staff are highly experienced and valuable. After all, presumably that is why they were appointed by the Secretary of State. Many of their jobs involve direct patient services. I suggest that the discrimination against the Health Service appointees is likely to present a powerful disincentive to health authorities supporting their employees' appointment to the commission and to such employees to accept appointments in future. I urge the Secretary of State to regularise the position of Health Service-employed commissioners at an early date.
The commission consists of part-time commissioners — some of whom are in an anomolous position in respect of fees-serviced by a full-time but small secretariat organised on a regional basis. It has been in existence for just over one year. As the Minister has acknowledged, its achievements are impressive, yet already it is proposed radically to alter its organisational structure. That was admitted by a DHSS Minister in answer to my recent parliamentary question.
135 The proposal is no longer to have separate secretariats in the three regions, but to centralise them in the south-east, in London. I maintain that one reason why the commission has been able to establish credibility so quickly is that it is decentralised and regionalised. Thus, in the north-west, the commission covers two special hospitals—Moss Side and Park Lane. Much of the work of the commission is very much concerned with those institutions.
The patients in the hospitals have been able to relate to a commission which, for them, is almost just down the road. More importantly, it stands a chance of being seen as independent of "them" — the DHSS and the Home Office in London.
The commissioners have been able to establish good working relationships with the present secretariat, so that, as has been acknowledged, a commission that is part-time and largely unpaid has become an efficient, practical and working body. Yet, already, it is proposed to destroy the working relationships and replace them with what will inevitably mean more faceless relationships with more anonymous civil servants in London.
From both points of view—that of the patients served by the commission, and the efficiency and good working relationship within the commission — the proposed change cannot make good sense, especially coming, as it does, so soon after the inception of the commission. More general considerations concern me as well. The proposal represents yet another, albeit small, example of the drift of jobs away from the north-west and north-east, for example, into the south-east and London. It seems to represent yet another imposition of a doctrinaire policy of centralisation against the wishes of those concerned.
I understand that of the two commission regions concerned, the commissioners in the north-west were unanimous in their objection to the proposed centralisation, as were many of the commissioners in the north-east.
Worse than this, a centralised secretariat of civil servants in central London, dealing sometimes with highly sensitive complaints involving the DHSS, starts to sound like the beginning of the end of the independence of the commission. I consider that independence —I thought that the Minister did too—to be essential. It will no doubt be seized upon by patients' rights groups, which will perceive this, rightly or wrongly, as the first nail in the coffin for a body for which they had high hopes.
I understand that the secretariat shares the same in-line management structures as the managers of special hospitals. Centralisation into London is bound to lead to concern, justified or otherwise, that the vital and necessary independence of the commission and its secretariat will be eroded within these management structures.
The Minister may wish to claim that the proposed centralisation is necessary on cost and efficiency grounds. I dispute that. The commission has a modest budget which should not be made so modest that it cannot carry out its functions. It has a small support staff. In the three regional secretariats there is a total staff of about 15, including typists, and they have the job of organising the part-time commissioners, who are scattered throughout the country, to visit every establishment where there are detained patients at least once a year, and once a month to special hospitals. They deal with many complaints and organise second opinions for compulsory treatments within days of 136 the request coming from hospitals, including all the paperwork and documentation that must be involved. Against that background, a staff of 15 can be considered only as minimal.
As I understand it, the proposed reorganisation will do nothing to reduce the number of secretariat staff. The proposed centralisation will lead almost certainly to more expenditure on incidentals such as travelling, telephone and office rental costs. Given the nature of the work that I have outlined, it is difficult to see how greater efficiency can ensue.
Another claim that the Minister may wish to make in justification of the proposal is that the central policy committee within the commission has agreed to the proposal. Far from being a justification, I would submit that that agreement raises other concerns. I know that some of the commissioners are concerned about the work and role of the committee, which is appointed by the Secretary of State. They consider it to be out of touch with the regions, in that it has agreed with the proposal against the wishes of the regional commissions.
The proposal to centralise the secretariat has met with considerable opposition from commissioners. It will decrease markedly the credibility of the commissioners as an independent body seeking to protect the rights of formally detained patients. The proposal represents yet another centralising drift of jobs and influence from the regions to London.
The new commission has a difficult job, and our efforts must be directed towards supporting, not undermining, it. This country's recent record on human rights has been somewhat tarnished in the eyes of the rest of the developed world. We have set up a body to safeguard civil rights and guarantee minimum standards of care and treatment to a vulnerable section of our community which, sadly, until recently as a society we preferred to lock up as far away from us as possible and forget. We must not demean our advances by petty-minded and premature bureaucratic blinkering or efforts at minuscule financial savings.
I should like the Minister of Health to give the House certain assurances. Will the right hon. and learned Gentleman reconsider his decision to centralise the commission's secretariat and instead follow the opinion of the majority of the commissioners affected and ensure adequately staffed regional secretariats? If the right hon. and learned Gentleman has not yet made a decision to centralise — I must admit that an earlier reply to a parliamentary question seemed to suggest that the final decision had not been taken—will he reject the advice of his civil servants, accept the unanimous view of the north-west commissioners and at least ensure an adequately staffed regional secretariat within the north-west? If the right hon. and learned Gentleman feels unable to depart from the concept of a centralised secretariat, will he consider carefully whether it must be centralised into London? I understand that there is more than adequate office space next to the offices of the north-west secretariat and within the same building to house the whole centralised secretariat. There seems little good reason—other than dogma — why London should always be chosen as the site for the centralised secretariat, when adequate and arguably more suitable accommodation exists elsewhere.
Could the Minister leave the north-west on its own if he is determined to centralise and take in the north-east with London? The right hon. and learned Gentleman will 137 be aware that the National Health Advisory Service consists of people who are seconded from their employing authority. Why cannot the same be done with the mental health commissioners? Whatever the decision the Minister eventually reaches, I hope that he can say that there will be no enforced redundancies among the staff of the existing secretariat.
§ 12.3 am
§ The Minister for Health (Mr. Kenneth Clarke)
I thank the hon. Member for Preston (Mr. Thorne) for raising this matter on the Adjournment. As he said, the subject matter is hardly earth-shattering, but I agree with him about its importance. We served on the Standing Committee on the Bill which eventually became an Act and paved the way for the creation of the Mental Health Act Commission. During the Committee's proceedings we agreed on rather more occasions than we are accustomed to do when considering more general political issues in the House. We both share and support the broad objectives of the legislation and support the work of the new commission. We wish to defend its independence, which was a matter which the hon. Member mentioned. I am sure that we both congratulate it on its work so far.
Both of us are fairly defiantly provincial, which is an interest we share, and, as the hon. Gentleman said, the present secretariat is divided, with five people in London, four in Liverpool and four in Nottingham. I have no doubt that the hon. Gentleman speaks with an interest in Liverpool, but I represent part of the county of Nottingham and assure him that I have no innate desire to see the secretariat of this or any other body situated in central London if there are compelling reasons to the contrary.
I agree with the hon. Gentleman in supporting the work of the commission. It was established in 1983 under an order and regulations following the powers contained in the Mental Health Act 1983. Its work began on 30 September 1983. I am pleased to join in the tribute which, by implication, the hon. Member paid to the work of the chairman, my noble Friend Lord Colville, and his fellow commissioners, who have made impressive progress.
The principal purpose of the Act and the commission's work is to look after the interests of patients who are suffering from mental illness. The commission must protect the interests of those patients whose mental disorder takes such a serious form that they must, in their interests and for the protection of others, be compulsorily detained.
People in such a position suffer a double disadvantage. They suffer a serious mental disorder and they lose the freedom of movement, which is such a valued possession of all in a society such as ours. The law therefore has to make special provision to protect the interests of detained patients. The Act was intended to make radical changes to the law to bring it up to date and to add to the protection of patients.
The commission was set up to look after the legal and more general rights of those patients. It has four main functions. First, members of the commission pay regular visits to hospitals where patients are detained to monitor the standards of care and treatment provided and to ensure that the various requirements of the Act are being satisfied.
Secondly, the commission's members operate the statutory provisions relating to consent to treatment. In some limited circumstances, those provisions affect informal patients also. At the moment, the commission is 138 interested mainly in the consent to treatment of detained patients. Some of the medical members of the commission undertake second-opinion visits in connection with consent to treatment. The commission also provides the doctors to carry out that work.
Thirdly, the commissioners receive and act on complaints or other representations made by or on behalf of detained patients. Fourthly, the members of the commission are preparing a draft code of practice which will contain guidance on compulsory admissions to hospitals or nursing homes and guidance on the treatment of patients suffering from mental disorder.
The purpose of the code of practice is to promote good practice generally throughout the service. After we have undertaken the required consultations, we shall table the code for Parliament to consider. That is a wide range of work, which the commission is undertaking with vigour and enthusiasm. The commissioners, in the first year of operation, as part of the regular visiting programme already have paid one or more visits to hospitals where there are detained patients throughout England and Wales. They are also dealing with a considerable number of complaints from patients and their friends and relatives.
The commission is a large body. It must he, to undertake all this work across the country. There are 90 members. By discipline, the largest group is doctors. The other main disciplines represented are nurses, social workers, psychologists and lawyers. There are also lay members, and one or two members with a special knowledge of mental health services. The members are drawn from all parts of England and Wales.
While individual members bring their experience and specialist knowledge to the commission's work, one of the impressive features of the first year's work is the way in which members have seen themselves as commissioners first and not as representatives of specialist interests. A strong corporate team spirit has been forged.
The hon. Gentleman mentioned the fees paid to the commission's members and suggested that we were in some way making divisions between them according to classes and not dealing with them fairly. It is true that we pay some compensation for loss of earnings to those in private employment, and we also make arrangements to pay the travelling expenses of all commissioners. There are some special arrangements to pay for additional work done by doctors who give up parts of their practice to serve on the commission but do extra sessions to provide a service to patients in their localities. Otherwise, in drawing up the statement of compensation for members of the commission, we try to act fairly between them all.
I shall write to the hon. Gentleman setting out fully and clearly the precise arrangements, in order to try to answer his fears that we are being unfair as between one category and another. He was, however, particularly concerned about those who worked for health authorities and thought that we might be deterring the authorities as employers, or the employees themselves, by not providing either with compensation for loss of earnings.
We believed that, for those working for health authorities, work for the Mental Health Act Commission would be regarded as part of their ordinary service to the NHS. I have no evidence that anyone has been deterred, and I have no evidence that any health authority has discouraged any of its employees from serving on the commission. I hope that that has not happened, but I shall 139 look into the matter and give the hon. Gentleman a full letter. He can then respond if he feels that our arrangements are in some way unfair and discriminatory.
The hon. Gentleman's main concern is with the organisation of the commission. In drawing up the organisation we followed, but did not exactly match, the organisation of the parallel mental health review tribunals. They are slightly different bodies created under the Mental Health Act 1959. Their members are appointed by my right hon. and learned Friend the Lord Chancellor. They hear appeals against detention by detained patients, and have been working for many years.
The tribunals have found that a large proportion of their hearings arise from patients who are detained in the four special hospitals located in Berkshire, Nottinghamshire and near Liverpool. Because a significant proportion of all tribunal hearings take place at those hospitals, the secretariat offices of the mental health review tribunals are located in London, Nottingham and Liverpool, and from there the tribunals derive the secretarial support that they need.
I mention those because when the Mental Health Act Commission came into existence that pattern was to some extent followed. The commission divided the NHS regions in the country into three groups, one covering the southern half of the country, one the regions on the western side, from the west midlands northwards, and the third the eastern side, from Trent northwards. Each of these three territorial teams has its own chairman and vice-chairman, and organises its own programme of regular work under the various headings which I have described.
Essentially, my noble Friend Lord Colville of Culross is supported by a small central policy committee. When the organisation was first being set up, we rejected the suggestion that it should share the secretariat with the mental health review tribunals, because the two bodies have quite different functions and ought to have separate identities. However, we followed the pattern which I have described, which the tribunals had previously followed, and we now describe our areas within the Mental Health Act Commission as the southern, north-eastern and north-western regions of the commission.
There is a total of 15 staff in the commission's secretariat, all but one being seconded officers from my Department, and almost all of them serving with one of the three regional teams. All those staff have thrown themselves with great enthusiasm into the work of the commission, and their work has been much appreciated by the commissioners.
A little while ago it was decided that as it was now 12 months since the new Act was introduced, and it was time 140 for the Department's staff inspectors to examine the work of the secretariat staff of both the mental health review tribunals and the Mental Health Act Commission. We use staff inspectors regularly inside our Department, just as we do inside every Department of central Government. It is a well-established procedure for looking at the distribution of the work load and making sure that organisational questions are addressed in a way which ensures that work is undertaken in the most efficient and economical manner.
The inspectors in this case interviewed individual staff members and looked at the replies to standard questionaires. After discussion of a draft report with local management, they drew up a final report with their recommendations. It was those staff inspectors who recommended the centralisation of the services.
In due course I can provide the hon. Gentleman with a list of the eight reasons which led the inspectors to recommend the centralisation of the secretariat. They were first drawn in by a request from the regions for more staff, because various problems had arisen in organising the work properly with such comparatively small numbers in each of the centres. It was very difficult to cover for staff absence, holidays or sudden surges of work. It was found that that difficulty had been overcome by a rather heavy use of casual labour. No fewer than 42 man weeks of casual labour had been used in the period 1 October 1983 to 30 June 1984. Therefore, the recommendation was that greater efficiency of operation could be achieved if all staff were located at the London headquarters office of the commission.
I listened to what the hon. Gentleman said. No final decision has been taken, although the central committee, despite some misgivings on the part of some members, has supported the recommendation. I shall put the points made by the hon. Gentleman to my noble Friend Lord Colville of Culross and will look into the matter again to see whether the commission is really satisfied that it needs to centralise its staff. We do not want more staff, but we do want efficient organisation. We do not want unnecessarily to increase costs. We are both agreed that we want to support the work of the commission. There is no point in centralising it if that is not useful to the commission. Therefore, I promise the hon. Member that I shall take his points on board and come back to him in due course with a considered response. I shall hope to amplify the reasons for centralisation if that goes ahead or to come back to the hon. Gentleman with the reasons for its reconsideration if my noble Friend considers that, on balance, this matter is worth reopening.
§ Question put and agreed to.
§ Adjourned accordingly at sixteen minutes past Twelve o' clock.