HC Deb 11 April 1986 vol 95 cc503-19
'(1) The Secretary of State shall annually lay before Parliament a report containing the following information namely—
(a) such information as the Secretary of State considers appropriate with respect to the development of health and social services in the community for persons suffering from mental illness or mental handicap who are not resident in hospitals;
(b) information with respect to—
(i) the number of persons receiving treatment for mental illness as in-patients in health service hospitals, and
(ii) the number of persons receiving treatment for mental handicap as in-patients in such hospitals,
in each case analysed by reference to age and length of stay; and
(c) such other information (if any) as the Secretary of State considers appropriate to be included in the report.
(2) In this section—
"health service hospital"—
(a) in relation to England and Wales, has the same meaning as in the 1977 Act except that it does not include a special hospital within the meaning of that Act, and
(b) in relation to Scotland, has the same meaning as in the 1978 Act, except that it does not include a State hospital within the meaning of the 1984 Act;
"hospital" has the meaning given by section (Persons discharged from hospital)
(4)) above; and
"mental handicap" has, in relation to England and Wales, the same meaning as in Group D in Schedule 1 to the Juries Act 1974.'.—[Mr. Hayhoe.]

Brought up, and read the First time.

Mr. Hayhoe

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

Mr. Deputy Speaker

With this it will be convenient to take the following:

Amendment (a), in line 11, after 'stay', insert 'and diagnostic classes'.

Amendment (b), in line 11, leave out 'and' and insert—

'(bb) information with respect to the numbers of persons under treatment for mental illness or disorder and mental handicap discharged from hospital and the arrangements for the care of those persons outside hospital in each case analysed by reference to age, length of stay and diagnostic classes; and'. Amendment No. 12.

Mr. Hayhoe

Clause 12 as drafted would require the Secretary of State to identify and report to Parliament annually on the number and ages of children resident in mental handicap hospitals for a period totalling at least six months in the preceding year; on similar details for adults in mental handicap or psychiatric hospitals; and on the numbers in each category who have moved out of each hospital since the previous report and the provision that has been made for them in the community.

The Government have proposed the change not because they had any objection to the intentions behind clause 12, but, having looked at the matter carefully, they found that it is not possible to give information about the numbers of

would be fully applied to Scotland. That has been done in so far as one has been able to do so, but some further changes will probably be necessary in the other place, as has been said by my hon. Friend the Parliamentary under-Secretary of State for Scotland, as a result of the new clauses that we are adopting today. Otherwise, we have sought to achieve what was undertaken in Committee. Action will be needed in another place. Clause 9 as it stands is redundant. I hope that, at the appropriate time, the House will agree to its deletion.

Question put and agreed to.

Clause read a Second time, and added to the Bill.

individual patients dischared or provision made in the community specifically for them. Information could be provided in a more relevant and helpful form to that required in clause 12 because as clause 12 stands information would include those who had been in-patients for frequent short-stay periods, which would mask the number of long-stay patients.

Therefore, new clause 5 would require the Secretary of State to make an annual report to Parliament giving information on the development of health and social services in the community for mentally ill and mentally handicapped people, as he considers appropriate; a breakdown of the numbers, by age and length of stay, of patients in National Health Service, mental handicap and mental illness hospitals; and such other information, if any, as he considers appropriate. It would enable the commitment that I gave in Committee to provide information on small units with four beds or under to be met. With the change in the arrangements for dealing with mental handicap and mental illness, it is proper that that should be included.

Therefore, I commend new clause 5 to the House and hope that, at the appropriate time, hon. Members will agree to the deletion of clause 12.

Mr. Galley

My amendment (b) to new clause 5 reinserts in the Bill provisions relating to information on discharge from hospital. I note carefully what my right hon. Friend the Minister said about the difficulties of obtaining that information, and that that is why the Government have sought to amend the Bill. However, I believe that it is extraordinarily important that, if we are to have meaningful information in the report to Parliament, we know what happens to people on discharge.

The new clause specifies information about the number of people in hospital, but says nothing about the arrangements for people being discharged. If we know how many are in hospital and how many are being treated, I cannot see the difficulty in providing at least some information on what happens to people on discharge. We need to know about the numbers discharged and the arrangements made for them, otherwise how are we to monitor the progress, success and problems of our community care policies?

Although amendment (b) does not specify this too closely—that is deliberately so, because I do not wish to tie down the Secretary of State too much—I hope that reports giving the numbers of those discharged, and how many of them may have moved back to their families or into hostel type accommodation or unstaffed homes with some community support will be published. That would allow us to build up a data bank to determine the success of the policy and also of good practice in ensuring that community care ideas come to fruition.

11.30 am
Mr. Greg Knight (Derby, North)

Does my hon. Friend intend that the information given will relate to those persons discharged from hospital in the year for which the Minister gives his report, or will it be given about those discharged from hospital but who are still receiving treatment?

Mr. Galley

That would be consistent with the new clause. My interpretation of my amendment is that such information would be on the same lines as other statistics produced annually in the NHS in that it would be about the numbers discharged during the course of the 12 months to which the NHS annual report refers, and about what has happened to those people. We need some information about trends of people discharged, their community locations and treatment. If we are to plan sensible services, that is as important, if not more important, as how many people are in hospital on an in-patient basis.

Amendments (a) and (b) refer not only to age and length of stay but to diagnostic classes. It is important that we know how many people are in hospital or being discharged under certain diagnostic headings. We need to know how many of them have long-term serious mental illness, and how many have short-term, rather less serious mental illness. That is the key to planning sensibly the required services.

There should not be any great difficulty of acquiring such information. Figures on admissions to hospital by diagnostic classes are already available in the annual NHS statistics, and it would be fairly easy for a requirement for such information to be included in the new clause. One can understand the difficulties to which my hon. Friend the Minister refers. I hope that he understands the worry of many in the House and elsewhere about not having full, accurate, up-to-date and sensible data. One cannot plan appropriate services for those discharged without such information, and I hope that my hon. Friend will indertake to give rather more sympathetic consideration to these small measures.

Mr. Thurnham

My hon. Friend the Minister said that the report would cover the ages and numbers of children. Will it also relate to the local authority which will be responsible for the child on discharge, because sometimes there can be a great deal of confusion? A child may be in hospital for many years, the parents may have moved from the place where the child was when it first came into care, and there may be no contact with any local authorities. One of the reasons why so many children are still in hospital is that no local authority accepts responsibility for them. I have not tabled an amendment, but if my hon. Friend the Minister could make this clear it would be helpful.

Mr. Peter Lilley (St. Albans)

I welcome the new clause, especially the requirements for information to be published on the development of health and social services in the community for persons suffering from mental illness or mental handicaps, and for figures of how many people need such provision. I support the publication of such information, because the move towards such provision in the community is being threatened by an unholy alliance that is developing between three groups. One is prejudiced against the mentally ill and mentally handicapped and does not want to see them moved into the community. The second group is seeking to denigrate the Government's achievements in the NHS, and the third group has a vested interest in retaining existing forms of provision—large, old-fashioned institutions.

The unholy alliance that has built up beween these three groups could be overcome if we published more information about what is being done and what needs to be done. I do not deny that many people are genuinely concerned that not enough is being done to make adequate provision in the community, and they too will benefit if more information is published.

Mr. Forth

Does my hon. Friend accept the logic of his position and his points—that the provision of such information in the suggested form may lead to yet further demands for policy developments that could have important resource implications?

Mr. Galley

That is true, but, if new policies are developed on a basis of fact rather than ignorance, we should not stand in their way, and I would welcome such a development.

In Victorian times, the policy towards the mentally ill and handicapped was to get rid of them and put them in large institutions a long way from the centres of population because they were embarrassing and frightening. There are several large institutions around my constituency that were originally far from areas of habitation for precisely that reason.

Nowadays, people are just as prejudiced, but the prejudice takes a more hypocritical and sophisticated form. Frequently, this expresses itself not in terms of, "Let us not have a mentally ill or mentally handicapped person living next door" but, "Is there really adequate provision in the community for these people, should we leave them in institutions, and should we not delay any attempts to close such large institutions and replace them by smaller-scale community care?"

Mr. Deputy Speaker

Order. I am trying to be flexible and tolerant, but the hon. Gentleman seems to be getting well away from the new clause that the House is debating.

Mr. Lilley

The new clause emphasises the duty of the Secretary of State to publish information on these matters. The problem that I have outlined, which I see in my constituency, would be eased if such information were published. I hope that my right hon. Friend the Secretary of State will not just limit himself to publishing information about national statistics, as the clause implies, but that each area health authority will publish similar information to that asked for in the clause.

I support my hon. Friend the Member for Halifax (Mr. Galley) in his amendment (b), which would make clear to the general public the number and type of people in such institutions who will need community care. It would be beneficial if that were spelt out more clearly in the clause. I hope that my hon. Friend's amendment will be accepted.

Widespread ignorance can be overcome only by telling the truth, publishing the facts and letting people know what provision is already being made and how many people need such provision in future. I welcome the new clause and hope that it will be incorporated in the Bill.

Mr. Hayhoe

I shall reply to some of the points raised in the debate. My hon. Friend the Member for Bolton, North-East (Mr. Thurnham) asked what additional information would be incorporated in the reports that would be required as a result of new clause 5. I noted his comments about what would be appropriate, but I hope that he will accept that I cannot give a definitive answer today. Instead of giving a speculative answer, I should be happy to write to him as the matter requires further consideration by the Department in order to see what is appropriate.

Amendment (a) provides that information on the numbers of people receiving treatment for mental illness and mental handicap, as set out in new clause 5(1)(b), would have to be analysed by a diagnostic class as well as by age and length of stay. Amendment (b) requires follow-up information to be obtained on persons discharged from hospital who have received treatment for mental illness, disorder or mental handicap, and for it to be obtained on the arrangements that have been made for their further care. The information published is to be analysed by reference to age, length of stay and diagnostic class.

Information in respect of both of those amendments is not collected. As has been said, it exists in certain places, but the coverage is patchy. The Korner recommendations—the information technology recommendations—are being implemented, but once they have been fully implemented by April 1987 it may well be possible to provide more information on the number of in-patients who have been in hospital for more than 12 months and

New Clause 8
'(1) A local authority shall permit the authorised representative of a disabled person, if so requested by the disabled person—
(a) to act as the representative of the disabled person in connection with the provision by the authority of any services for him in the exercise of any of their functions under the welfare enactments, or
(b) to accompany the disabled person (otherwise than as his representative) to any meeting or interview held by or on behalf of the authority in connection with the provision by them of any such services.

who are receiving treatment for mental disorder. That information is likely to become available during the summer of 1988.

However, there is no proposal to collect information in the form required in amendment (b), as it would need to be collected from both the Health Service an the local authority's social services department.

Thus, I hope that my hon. Friend the Member for Halifax (Mr. Galley) will not press his amendments today, as the information is not available. If it was collected, there would be a significant resource implication for the Department and for the health and local authorities.

Mr. Galley

How difficult and costly would it be to obtain the information? After all, it is important for sensible planning. If the spirit of my new clause 14 which would put the onus on the responsible medical officer was accepted, there would be one collating point, and one would not need two or three different sources.

Mr. Hayhoe

I understand that the Korner information initiative will make it easier to obtain the sort of information that my hon. Friend has in mind through the health authorities. However, the problem of cross-batching with the local authorities would remain. Nevertheless, I give my hon. Friend the assurance that we will try to include in the report to Parliament as much information as possible about long-stay patients receiving treatment for mental disorders, as analysed by diagnostic class. Indeed, I gladly give that assurance.

Once the Korner information becomes available, everything will be put into perspective. If there was a legislative requirement to collect that information and to report to Parliament, as the amendments demand, I would have to take advice on the overall cost. However, I have given the assurance that we shall try to provide such information. The Government's record on providing such information and statistics for the Health Service is pretty good. Indeed, the number of statistics on my desk is very considerable, and the answers that I have given to the Opposition spokesman on health fill up pages of Hansard. I make no complaint about that, as it is wholly proper that such information should be provided. But it shows that I am a willing provider of such information, and so I hope that my hon. Friend the Member for Halifax will not press his amendments. We shall do the best we can with regard to reports along the lines that he has implied would be of significance to him and his colleagues.

Question put and agreed to.

Mr. Deputy Speaker (Mr. Harold Walker)

Does the hon. Member for Halifax (Mr. Galley) wish to move his amendments formally?

Mr. Galley

In view of the helpful assurances given by my right hon. Friend the Minister, and my wish not to impede progress, I shall not press them.

Clause read a Second time, and added to the Bill.

(2) For the purpose of assisting the authorised representative of a disabled person to do any of the things mentioned in subsection (1)(a) and (b) a local authority shall, if so requested by the disabled person—
(a) supply to the authorised representative any information, and
(b) make available for his inspection any documents,
that the disabled person would be entitled to require the authority to supply to him or (as the case may be) to make available for his inspection.
(3) A local authority shall not be required by virtue of subsection (1) or (2)—
(a) to permit an authorised representative to be present at any meeting or interview or part of a meeting or interview, or
(b) to supply any information to an authorised representative or to make any documents available for the inspection of an authorised representative;
if the authority are satisfied that to do so would be likely to be harmful to the interests of the disabled person by or on whose behalf the representative has been appointed; and in determining that matter the authority shall have regard to any wishes expressed by the disabled person.
(4) Where a disabled person is residing—
(a) in accommodation provided by a local authority under Part III of the 1948 Act or Schedule 8 to the 1977 Act or, in Scotland, under Part IV of the 1968 Act or section 7 of the 1984 Act, or
(b) in accommodation provided by a viluntary organisation in accordance with arrangements made by a local authority under section 26 of the 1948 Act or, in Scotland, provided by a voluntary organisation or other persons in accordance with arrangements made by a local authority under section 59(2)(c) of the 1968 Act, or
(c) in a residential care home within the meaning of Part I of the Registered Homes Act 1984 or, in Scotland, in an establishment (other than accommodation falling within paragraph (b) above) registered under section 61 of the 1968 Act, or
(d) at any place specified by a person having the guardianship of the disabled person under Part II of the 1983 Act or Part V of the 1984 Act,
the disabled person's authorised representative may at any reasonable time visit him there and interview him in private.
(5) In this Act "authorised representative", in relation to a disabled person, means a person for the time being appointed by or on behalf of that disabled person (in accordance with regulations made under subsection (6)) to act as his authorised representative for the purposes of this Act.
(6) The Secretary of State may by regulations provide—
(a) for the manner in which the appointment of a person as an authorised representative is to be made or terminated;
(b) for any such appointment, and any termination of such an appointment, to be notified to the relevant local authority as defined in the regulations;
and any such regulations may provide for the parent or guardian of a disabled peron under the age of 16 to appoint himself or some other person as the authorised representative of the disabled person, and to terminate any such appointment (but shall not permit a person under that age himself to appoint a person as his authorised representative).
(7) Any such regulations may also make special provision for cases where ther disabled person is unable to appoint, or to terminate the appointment of, an authorised representative by reason of anymental or physical incapacity; and subsection (1) and (2) shall have effect in relation to a person whose authorised representative is appointed by virtue of any such provision as if the words "if so requested by the disabled person" were omitted.
(8) It is hereby declared that any person exercising under Part II of the 1983 Act or Part V of the 1984 Act—
(a) the functions of the nearest relative of a disabled person, or
(b) the functions of the guardian of a disabled person received into guardianship under that Part of that Act,
may, if appointed as such in accordance with this section, also act as that person's authorised representative.
(9) The Secretary of State may, after consulting such bodies representing health authorities or local authorities as appear to him to be appropriate, provide by order for any of the preceding provisions of this section to have effect (with such modifications as may be prescribed by the order) in relation to—
(a) the provision of services by health authorities in the exercise of such of their functions under the 1977 Act or the 1978 Act as may be prescribed by the order, or
(b) the provision of services by local authorities in the exercise of such of their functions as may be so prescribed.
(10) In subsection (9)—
"health authority"—
(a) in relation to England and Wales, has the meaning given by section 128(1) of the 1977 Act, and
(b) in relation to Scotland, means a Health Board within the meaning of the 1978 Act; and
"local authority"—
(a) in relation to England and Wales, has the meaning given by section 270(1) of the Local Government Act 1972; and
(b) in relation to Scotland, means a regional, islands or district council.'.—[Mr. Hayhoe.]

Brought up, and read the First time.

Mr. Hayhoe

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

Mr. Deputy Speaker

With this, it will be convenient to discuss the following: amendment (a) to new clause 8, line 44, at end insert— '(5A) The person appointed by or on behalf of a disabled person as an authorised representative shall be—

  1. (a) the person exercising the functions set out in subsection (8) below; or
  2. (b) if that is not applicable or where that is not, in the relevant circumstances, reasonable, another person related by blood or marriage to that disabled person; or
  3. (c) where in the relevant circumstances, it would be unreasonable to appoint a person as defined in paragraphs (a) and (b) above, another suitable person who otherwise falls within the terms of this section.'.—[Mr. Roy Galley.]

Amendments Nos. 1, 16 and 17.

11.45 am
Mr. Hayhoe

The new clause involves the representation of disabled people and is obviously an important and significant provision. Clause 1 of the original Bill would enable a disabled person to appoint a representative to attend on his behalf, or accompany him to any meetings of a local authority or health authority at which the provision of services for the disabled person was to be discussed and to provide him with any necessary assistance in connection with the provision of those services or otherwise.

The Government fully recognise that it would be a valuable step forward to provide a right of representation for disabled people. But we are concerned about the practical difficulties of applying the representation provisions to services provided by health authorities as well as social services departments. I certainly recognise the strength of support for such an extension, which emerged from the consultation exercise. Accordingly, the Government are prepared to consider the matter further, in consultation with the health authorities. In Committee, I explained some of the problems that could arise, and we need to discuss further to see how they could be overcome. Consequently, I shall in a moment explain how we propose to deal with the issue.

Mr. Ashley

Before going into the practical difficulties, will the Minister say what practical difficulties arise for the health authorities that do not arise in the area in which he is prepared to accept representation?

Mr. Hayhoe

It might be better for the right hon. Gentleman to wait until I say how I propose to deal with the matter. I hope that he will find that my remarks are not unacceptable to him. As it stands, the clause is of concern to the Government because there are no lower age limits. In the Government's view, it would be undesirable for children under 16 to appoint representatives. However, their parents may find it helpful to do so. Moreover, as it stands, the clause does not make it clear whether a representative would hav only the same rights to attend meetings, or would have access to information that the disabled person would have. There is no provision for a statutory authority to bar a representative from attending a meeting, or from having access to information, if very sensitive personal matters are at issue.

The effect of the Government's amendment, which is to replace clause 1 of the Bill with new clause 8, would be to place a duty on a local authority to allow an authorised representative to act on behalf of a disabled person or accompany him or her to meetings to discuss the provision of social services and to make available to the representative information that the disabled person is entitled to receive. This duty would apply only if the disabled person requested that it should. The local authority could bar the representative from being involved on a particular occasion if the authority thought it would be harmful to the disabled person's interest, although in deciding on that it would have to have regard to any wishes expressed by the disabled person.

Mr. Wigley

Can the Minister clarify what he said about disabled persons giving their consent? How can we solve the problem that a disabled person who is so severely handicapped that he cannot meaningfully consent should not miss out on representation?

Mr. Hayhoe

The hon. Gentleman is pre-empting what I will shortly say. The proposed new clause would also empower the Secretary of State to provide by regulation for appointing representatives by parents appointing themselves or others as representatives for children under 16 and for representatives to be appointed—arid I now come to the point the hon. Gentleman the Member for Caernarfon (Mr. Wigley) was raising—for those who by reason of mental disorder are themselves unable to appoint representatives. The details of this provision need further consideration.

The hon. Gentleman will remember that we discussed this matter in Committee and, of all the various possibilities, none commanded widespread support. There were difficulties with the various proposals made. Thus, I propose that we go into further consultation on that matter in the hope that additional amendments might, if they were required to deal with the matter, be introduced in another place. I do not believe that on this point there is any difference in principle between me and the hon. Gentleman. We both recognise this as a problem and want to find a solution that is fair and reasonable to all concerned and that works in practice.

Mr. Forth

Could my right hon. Friend also include in such consultation the consideration of any difficulty that might arise as a result of someone with a hearing impairment, who is deaf, and who might need help in interpretation in dealing with the authorities, having access to someone with those skills? Will he consider building into the provisions that will be examined some way of providing assistance to people with the kind of problem to which I have referred?

Mr. Hayhoe

In the context of the Bill, we have certainly been considering the question of interpretation as relevant to dealing with problems of communication arising from disability, not the problems of interpretation arising from different languages in the case of people coming from abroad, and so on. I accept that, in considering these matters, we must take into account the case raised.

The new clause I propose would also provide that representatives should have access at all reasonable times to disabled people whom they represent. The proposal would give the Secretary of State the power to extend, by order, the scope of the representation provisions to the provision of health services and other local authority services. That would mean that consultation could take place. We could see whether we could overcome these difficulties. How will health authorities, in this context, distinguish a disabled person who has an entitlement to a representative from another patient who might well be in the bed alongside, or certainly in the same ward, and who would not have that right? There could be difficulties in that respect.

Would representatives of the disabled person have the right in hospital to be present at clinical examinations? There could be problems there. It will also be recalled that in Committee, when this matter was discussed, reference was made to ethical problems of the medical profession about confidentiality. That matter would need to be taken into account. There is a raft of problems involved, and I hope that in further consultation we can solve them. As I have indicated, the Government have accepted the strength of view expressed during the consultation process in favour of extending the right of representation to health authorities as well as to local authorities.

In the context of this clause I will say something about the implications for resources. The provisions for the appointment of representatives will, as is widely acknowledged, have resource implications. Further, there are the practical difficulties of the health authorities and the need to provide arrangements for the appointment of representatives for those disabled people who are unable to appoint someone themselves—the point I have just been discussing with the hon. Gentleman the Member for Caernarfon. Both of these factors mean that the Government are not able to indicate at this stage when we believe the clause can begin to operate. It would depend on how we are able to overcome the practical difficulties of appointing representatives and on when resources can be made available. I have already made that point in conversation with the hon. Member for Monklands, West (Mr. Clarke), but it should be made in the House.

Mr. Clarke

I am slightly concerned about the time factor in this debate. I hope that on Third Reading we shall have the opportunity to deal with the important matter about which the Minister has been speaking.

Mr. Hayhoe

Subject to the decision of the Chair, we can always deal with the point on Third reading. I am sure that for anything else to happen would be out of context with the harmonious attitudes that have pervaded the whole of the discussions on the matter today. I commend new clause 8 and hope that the House will, at the appropriate time, agree to delete clause 1.

Mr. Ashley

It is wrong to exclude health services from representation because, if it is possible to have representation of social services, the same kind of representation should be given in health services. It is significant that major decisions are made for disabled people in health services. If those decisions are thus made, there is little point in giving representation in social services after the damage has been done. I warmly welcome the Minister's assurances that he will enter into consultation; that is a big step forward. I look forward to the consultations and to the fact that the cart-before-the-horse situation I have just mentioned will be considered.

Mr. Galley

I wish to make a few remarks about my amendment (a) to new clause 8. The essence of the amendment is that, wherever possible, there should be a presumption that a disabled person's authorized representative should be a relative by blood or marriage. The drafting of the amendment has caused me some anxiety, but I have had the advantage of the most expert advice available, so I hope that it achieves my objective.

The amendment stems from a concern I expressed on Second Reading that an open-endedness about authorised representatives may allow some disabled people to be manipulated. That concern is shared by the National Schizophrenia Fellowship. We are genuinely worried about the possibility of conflicts of view and interest between the relatives of a disabled person and an authorised repesentative from outside the family. It is important that families are fully involved in the caring process of disabled people.

Mr. Greg Knight

Does my hon. Friend agree that his point cuts both ways, and that there may be a conflict between a disabled person and members of his family?

12 noon

Mr. Galley

My hon. Friend is right, and I shall deal with that point in a moment.

As the new clause stands, relatives and families are deliberately excluded from the representational arrangements and the discussions about care, and I am worried about that. It is presumed that, generally, relatives will be caring and sympathetic, and, indeed, that is normally the case. However, if the problem to which my hon. Friend the Member for Derby, North (Mr. Knight) referred arises, the amendment would introduce a test of reasonableness, relating to the appointment of someone other than the relative by blood or marriage. That test of reasonableness would apply if it were considered that a relative was not sympathetic to a disabled person and would not act in his best interests.

Mr. Forth

Will my hon. Friend clarify the point that I made earlier? If a particular expertise were required, such as lip reading or sign language for the deaf, would the test of reasonableness apply? In other words, if a member of the family could not provide the necessary service, could another representative be appointed to cover that requirement under his amendment?

Mr. Galley

My interpretation of the amendment is that that would be possible. In all these circumstances one hopes that there will be a co-operative element, and that the representative and others with expertise will work together. However, one needs to take particular care in circumstances where there may be disagreements about how care should be delivered.

There is some support for that view in the submission made by the ACC. It states that disabled people are vulnerable, and that it is not unknown for individuals and organisations to represent such people in an exploitative manner which has little to do with the needs of the disabled as an individual. I do not wish to over-emphasise that point, but it can occur in certain circumstances. People and organisations who seek to be representatives may have some philosophical or ulterior motive. In most instances where acknowledged experts and established, respected voluntary bodies act as representatives, there will be no difficulty. However, there is a danger of fringe organisations making advocacy almost into a business, without necessarily having the interests of the disabled person at heart. The best way out of the problem is to presume that a relative will do the job, unless it is unreasonable or inappropriate.

In general terms the concept of advocacy is in its infancy. A number of pilot projects are under way, but they have not yet been evaluated. Before we fully implement the provisions on representation we should ensure that a careful evaluation of those advocacy schemes takes place. That is the burden of my case.

There may be difficulties with the amendment as it is drafted. My right hon. Friend the Minister and the hon. Member for Monklands, West (Mr. Clarke) may not wish to accept it today, but I hope that my points will receive sympathetic consideration, so that when the regulations relating to the authorisation of representatives are eventually drawn up, the needs, duties and responsibilities of families will be fully taken into account. On that basis, I do not wish to press my amendment to a vote. I know that the hon. Gentleman is not entirely happy with it, and there may be some practical difficulties for my right hon. Friend.

Mr. Alfred Morris

As the Minister may have heard, our estimate is that new clause 8 gives 80 per cent. of clause 1 of the Bill as now drafted. The Minister is an engineer and thus knows more than most about mathematics. I think that 80 per cent. is right, and we are prepared to take four-fifths of the loaf that we were seeking. So we accept the new clause.

This part of the Bill puts representation into rehabilitation. That is extremely important to disabled people and their families. Successful rehabilitation can be defined as giving the disabled person the right help, in the right place and at the right time. To allow representation where required is to make that objective more attainable. That is why we want to see adequate representation for disabled people wherever it is called for.

We have some important reservations about the amendment of the hon. Member for Halifax (Mr. Galley). I know he understands them and we are grateful to him for agreeing not to press it at this stage. There will no doubt be detailed consideration of this matter in the other place. It is our view, and he no doubt agrees with us, that the other place will have a role in considering anew this important part of the Bill.

Mr. Tom Clarke

I too welcome the fact that the Government have improved the proposals in the basic recommendations of the earlier consultation document. I particularly welcome the right of representation to all those aged 16-plus and to the parents of disabled children. I wish to put on record some points consistent with those of my right hon. Friend the Member for Manchester, Wythenshawe (Mr. Morris).

The new clause is comprehensive, but a few matters will need to be considered carefully in another place, for example the restrictions in subsection (3) on the rights of representatives, and subsection (4) on access to people in hospital in advance of the implementation of subsection (9), for example to plan a discharge. The clause was introduced after a three-week consultation period. The Government now have far longer to consult health authorities before the Bill leaves the other place. Therefore, I hope and expect that the Minister will seek to complete his consultations before then and will introduce substantive amendments in the other place on Report or Third Reading.

In the first consultation exercise the principal representation received support from 21 of the 26 health bodies which responded by the deadline, including the National Association of Health Authorities, many of the RHAs and the Royal College of Nursing. It also received almost universal support from everyone else. I feel confident that that will be borne in mind in the other place, and that the Minister will consider these points carefully.

Mr. Greg Knight

It has not gone unnoticed by Conservative Members that the hon. Member for Monklands, West (Mr. Clarke) has developed a worried expression. We can see that he is keeping one eye on the clock. I assure him that I support the new clause and the Bill and that I do not wish in any way to impede its passage. I hope that all my colleagues support the principle of the clause—the principle of an authorised representative having the right to present the case of a disabled person. There is a good reason for doing so, because often the presentation of a case is crucial to its outcome. A tribunal or an officer who must examine the circumstances may have his heart in the right place and wish to make the right decisions, but if the facts are not presented to him cogently and intelligibly, the decision may be incorrect and an injustice may result. We should all welcome the principle of allowing an authorised representative, a claimant's friend, to act as advocate.

I agree with the point made by the right hon. Member for Stoke-on-Trent, South (Mr. Ashley). I ask my right hon. Friend the Minister to reconsider in another place extending the provision to the Health Service. I am aware of the potential difficulties that that would create, but it is stretching worries too far to include clinical examinations in that connection. We are seeking to give a right to appoint an advocate to a disabled person. I cannot think of any reason why the advocate would need to be present at a clinical examination.

The Lord Chancellor has said that two heads are better than one, even if they are sheep's heads. Although he made that point in relation to advice given in court cases, the principle applies here. Right may often be on the disabled person's side, but he may not have the ability to present the case properly.

I have several questions which I hope that the Minister will answer before we move to the next new clause. I share the anxiety of the hon. Member for Caernarfon (Mr. Wigley) in connection with subsection (1) and a person who does not have the ability to make the decision that he wishes to be represented. The House must be assured that that person will not thereby be denied the right to have an advocate to speak on his behalf. Subsection (2)(a) and (b) provide that it shall be the duty of a local authority, "To supply to the authorised representative any information, and … make available for his inspection any documents,". At whose expense will that be done? I hope that a local authority will not say, "There is a file that your advocate can see, but we shall require a photocopying charge or a production fee." I hope that in the spirit of this clause, local authorities will not seek to charge for providing such information.

Perhaps I am being overly suspicious, but in subsection (3) I am anxious about the circumstances in which the local authority will decide that it is harmful to the interests of the disabled person for him to be represented. That is like the prosecution telling the defence how to prepare its case. May I be given an example of when the Minister envisages a local authority saying, "It would not be in your interests to be represented by this person"?

I am also concerned about subsection (6). My hon. Friend the Member for Halifax (Mr. Galley) said that he was worried about an advocacy organisation acting without the interests of the disabled person at heart, whereas relatives would have the interests of the disabled person at heart. I do not agree with that argument. It is difficult to imagine a person who is there to act as advocate for the disabled person doing anything other than act in that person's interests, especially if he has no personal involvement in the issue. He is there to do a job and to help the disabled person. I can conceive of many instances in which the relative of a disabled person may have a family axe to grind. There may have been a dispute between brothers and sisters and, therefore, they might not act in the interests of the disabled person. I hope that the House will not accept the amendment of my hon. Friend the Member for Halifax. With those reservations, I welcome the new clause.

Mr. Yeo

I welcome the tone of the Minister's remarks when he introduced the new clause. I listened carefully to his comments outlining some of the problems that he believes could arise from the appointment of representatives in relation to the services provided by health authorities. I appreciate the potential difficulties, but they may be overcome. It is of the utmost importance that they should be overcome because few groups of disabled people are more in need of representatives than the residents of long-stay mental handicap hospitals. Many hon. Members who have experience in this area will know of cases where the lives of individuals have been transformed by the appointment of representatives. I urge my right hon. Friend to make every effort in the coming weeks to overcome the difficulties that he outlined so that that group can also benefit from the appointment of representatives.

12.15 pm
Sir Nicholas Bonsor

I risk incurring your wrath, Mr. Deputy Speaker, by intervening briefly in the debate. Three matters should be emphasised more than they have been. The first is the need of the mentally disabled for representation. As my hon. Friend the Member for Suffolk, South (Mr. Yeo) so ably said, the residents of long-stay mental handicap hospitals are those least able to appoint representatives to help them and those least able to help themselves without representation. Therefore, it is imperative, to get the proper results from the Bill, that a solution is found to the problem of providing them with representation.

The second matter arises from subsection (3). I do not believe that the formula in the Bill is adequate or appropriate. The local authority cannot be let off the hook so easily as it is by the excuse that, in any circumstances, on its judgment alone, it can withdraw documents or information from a representative because it believes that it is not in the interests of the disabled person for it to be provided. All hon. Members will have experience of occasions on which local government managers, harassed and overworked as they are, find it extremely convenient not to give information or co-operate fully with the people who will be affected by their decisions. I am confident that my fears will be justified when I say that if the clause goes ahead as drafted, there will be many instances of authorised representatives not being provided with essential information to enable them properly to carry out their functions.

It is also imperative that the provisions of the new clause are extended to the health authorities. Often, the mentally handicapped desperately need representation in their dealings with health authorities. On Second Reading, I told the House of my experience in my previous constituency. A mental handicap hospital was to be closed and the people living there were to be moved to a much larger and completely unsuitable home in the middle of a large city. Medical evidence showed that at least two of the patients would die if such a move was made. Had it not been for a local councillor and the then Minister of State, those people would have been moved and would have died. I was an intermediary. We saved those people only because of the personal involvement of a local councillor. Although she was not officially appointed as their representative, she took upon herself the duties of such a representative. There must be many other instances where people have not been so fortunate in being allocated care and where the machinery of bureaucracy has used them as pawns, moving them from place to place without adequately considering their needs. It is important for my right hon. Friend the Minister for Health to use his powers under subsection (9) to bring the health authorities within the ambit of the Bill.

Several Hon. Members


Mr. Deputy Speaker

Order. I remind the House that we have a long way to go before we conclude consideration of the Bill.

Mr. Thurnham

I am a little disappointed that we have not been able to pin down details of the provision for the severely mentally handicapped. It is still not clear who should represent them. I again draw the attention of my right hon. Friend the Minister for Health to the case of children so distanced from their parents that the family cannot easily be considered to act as representatives for them.

I was interested in the remarks of my hon. Friend the Member for Halifax (Mr. Galley) about developments in pilot advocacy schemes. If charitable organisations can take this action, that would be one of the most obvious possibilities. I hope that the Government will pay full attention to this matter so that the details can be sorted out and amendments introduced in the other place at an early stage.

Mr. Hayhoe

The proposed amendment of my hon. Friend the Member for Halifax (Mr. Galley) would set out a hierarchy of people through which one would have to work tier by tier to establish the disabled person's choice. That would impose an unnecessary prescription.

These matters must be looked at in the context of regulations. In considering the regulations, I shall take account of the points of my hon. Friend the Member for Halifax who was concerned that the family should not be damaged by these arrangements. I hope that we all agree with that principle.

I welcome the general acceptance of this important major step in giving a new right of representation. I am glad that the changes have been generally accepted. My hon. Friend the Member for Suffolk, South (Mr. Yeo) recognised the difficulties with respect to extending the right of representation to health authorities. Because I believe that those difficulties can be overcome. I have responded to the consultation by including the new power in the new clause. Discussions with the various concerned interests are needed to deal with the problems. The intention is to find a route to follow, and I think that that is in accord with the request of my hon. Friend the Member for Suffolk, South.

My hon. Friend the Member for Derby, North (Mr. Knight) asked when it would be inappropriate to allow a representative to be involved without the disabled person's agreement. There may be occasions in problems of a sexual or related matter when the family's relationship could be damaged if a close relative—perhaps a husband or wife—were included as a representative. Those difficulties arise, but I do not think that I need say more. We are concerned with the interests of disabled individuals.

It has been suggested that subsection (3) may be used by local authorities to get out of their responsibilities because it is not convenient for them to act in a particular way. I am advised that the drafting of that subsection means that local authorities would have to be convinced that something was harmful to the interests of the individual concerned before the powers could be used.

I hope that I have said enough to show that the new clause deserves the support of the House. If necessary, the detailed points can be considered in the other place, although I think that many would be more appropriately dealt with in the regulations which are a consequence of this measure.

Question put and agreed to.

Clause read a Second time, and added to the Bill.

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