§ Lords amendment: No. 34, in page 7, line 25, leave out "a".
§ Mr. Tom ClarkeI beg to move, That this House doth agree with the Lords in the said amendment.
§ Mr. Deputy Speaker (Sir Paul Dean)With this it will be convenient to take the following Lords amendments: No. 35, in page 7, line 27, leave out from "discharged" to end of line 35 and insert—
the managers of the hospital shall give written notification of that date—
- (a) to the health authority in whose district or area it appears to the managers that that person is likely to reside after his discharge (unless the managers are that authority),
(aa) to the local authority in whose area it appears to them that that person is likely then to reside, andNo. 36, in page 7, line 36, leave out—where that person will beand insert—in the case of a person".No. 37, in page 7, line 36, leave out "the age of 19" and insert "the relevant age".No. 38, in page 7, line 37, after "date," insert "to".
No. 39, in page 7, line 37, at end insert—
as soon as is reasonably practicable after that date is known to the managers.No. 40, in page 7, line 42, at end insert—the Mental Welfare Commission for Scotland or by".No. 41, in page 8, line 2, leave out "in a hospital".No. 42, in page 8, line 5, leave out from beginning to "subsection" in line 7 and insert—
the managers of the hospital shall give written notification of that person's discharge in accordance with paragraphs (a), (aa) and (b) of".No. 43, in page 8, line 8, at end insert—(2A) Where—that authority shall (subject to subsection (3)) make arrangements for an assessment of the needs of that person with respect to the provision of any services under the 1977 Act or 1978 Act which the Secretary of State is under a duty to provide; and in making any such arrangements a health authority falling within paragraph (a) above shall consult the managers of the hospital in question.
- (a) a health authority receive a notification given with respect to a person under subsection (1) or (2), or
- (b) the managers of a hospital from which a person is to be, or is, discharged as mentioned in subsection (1) or (2) are the health authority referred to in subsection (1)(a),
(2B) Where a local authority receive a notification given with respect to a person under subsection (1) or (2), the authority shall (subject to subsection (3)) make arrangements for an assessment of the needs of that person with respect to the provision of any services under any of the welfare enactments.(2C) A health authority and a local authority who are by virtue of subsections (2A) and (2B) each required to make arrangements for an assessment of the needs of a particular person shall co-operate with each other in the making of those arrangements.(2D) Any assessment for which arrangements are required to be made by virtue of subsection (2A) or (2B) shall be carried out—No. 44 in page 8, line 9, leave out subsection (3) and insert— 1335
- (a) where the notification in question was given under subsection (1), not later than the date mentioned in that subsection, or
- (b) where the notification in question was given under subsection (2), as soon as is reasonably practicable after receipt of the notification."
(3) A health authority or a local authority shall not be required to make arrangements for an assessment of the needs of a person by virtue of subsection (2A) or (2B) if that person has requested them not to make any such arrangements.(3A) Nothing in this section shall apply in relation to a person who is being discharged from a hospital for the purpose of being transferred to another hospital in which he will be an in-patient (whether or not he will be receiving medical treatment for mental disorder); but any reference in subsection (1) or (2) to a person's having received medical treatment for mental disorder as an in-patient for the period mentioned in that subsection is a reference to his having received such treatment for that period as an in-patient in one or more hospitals (any interruption of that period attributable to his being transferred between hospials being disregarded).No. 45, in page 8, line 16, leave out "is" and insert "are".No. 46, in page 8, line 16, after "authority" insert "or, in Scotland an education authority".
No. 47, in page 8, line 17, leave out "its" and insert "their".
No. 48, in page 8, line 18, after "authority" insert "or (as the case may be) education authority".
No. 49, in page 8, line 20, after "where" insert ", in England and Wales,"
No. 50, in page 8, line 20, leave out "is" and insert "are"
No. 51, in page 8, line 22, at end insert—
health authority"—No. 52, in page 8, leave out lines 23 to 33.
- (a) in relation to England and Wales, means a District Health Authority, and
- (b) in realation to Scotland, means a Health Board;"
No. 53, in page 9, line 3, leave out
within the meaning of the 1978 ActNo. 54, in page 9, line 19, at end insertand "the relevant age"—No. 55, in page 9, leave out lines 20 to 23.
- (a) in relation to England and Wales, means the age of 19; and
- (b) in relation to Scotland, means the age of 18"
§ Mr. ClarkeClause 4 has perhaps seen more changes of substance, as opposed to drafting, than any other clause in the Bill, so I shall spend rather more time explaining individual amendments than I have on other clauses. I should first, however, like to remind the House of the changes to the clause during its passage through this House. In the original Bill the requirement was for hospital managers to inform the social services 28 days before anyone was discharged who had
been receiving medical treatment for mental disorder as an in-patient for a period of, or periods totalling not less than, six months in the preceding twelve months.The social services were then required to make assessment of their needs within 28 days.On Report the Government produced a clause which simply required notification of discharge by hosptial to social services — a procedure described by the Association of Metropolitan Authorities as a waste of paper. I had already reluctantly agreed to drop the totalling of short periods and tabled a new clause which required hospital managers to arrange an assessment before a person was discharged. It had been agreed in discussions with the associations that the initiative should be taken by the hospital. My new clause was accepted by the Government and the House.
As the Minister for Health said, there were certain illogical aspects in the drafting, although the purpose was clear. In particular, the clause as it stood required the 1336 hospitals to arrange an assessment of a person's social services needs, but there was no duty on the social services to co-operate.
It would, perhaps, have been easy for the Minister to have taken a minimalist approach; but I am delighted to say he did not do so. Encouraged by the associations—the Association of County Councils, the Association of Metropolitan Authorities and the National Association of Health Authorities — who clearly wanted an effective clause, agreement was reached on the amendments which we are considering.
Amendments Nos. 34, 35, 38 and 39 require the hospital managers to send written notification of the date of discharge to the local authority of the area in which the patient is to live and also to the district health authority and the local education authority if the patient is under 19. I should say in explanation that in most cases the "hospital managers" will be a district health authority and there are exclusions throughout the clause to prevent them informing themselves or consulting themselves if the same DHA will continue to be responsible for the patient.
Following notification, amendment No. 43 ensures that each authority will be required to take action as follows. Under subsection (2A) the district health authority must assess the patient's need for services under the National Health Service Act 1977 in consultation with the hospital managers. Under subsection (2B) the social services department must assess the need for services under the "welfare enactments" and, of course, in this case clause 2 will also apply.
Subsection (2C) also places the additional duty on each of these authorities to co-operate with one another in making the arrangements for assessments. In many cases authorities may wish to undertake joint assessments; but it was not felt right to tie their hands in primary legislation and tie the practical arrangements to a precise formula which may not be credible or operable in all circumstances.
Subsection (2D) requires both these assessments to be undertaken before the discharge, or as soon as possible after discharge, following the order of a mental health review tribunal or, in Scotland, the Mental Welfare Commission or the sheriff. Where a discharge is properly planned there should be no fear of it being held up by this clause. As the Mental Health Act Commission asserted in its first biennial report in 1985:
Discharge should be a process, not an event.Where the temptation might be to make an overnight decision to discharge someone, the clause will ensure adequate planning for that person. In any event, subsection (3) in amendment No. 44 allows patients to waive their right to an assessment.The duty on the local education authority is not so clear. I understand that if the patient is under 16 the procedures under the Education Act 1981 will apply. The LEA will either initiate an assessment of the child's special educational needs or amend an existing statement. What will happen if the patient is over 16 but under 19 is less clear, but perhaps the Minister can clarify this in his speech.
Subsection (3A) in amendment No. 44 is a technical amendment to stop assessments being triggered by transfers between hospitals and also to confirm that time spent in different hospitals will be added together for the purpose of the six months mentioned in subsection (1).
1337 The remainder of the amendments are either technical or are necessary for the application of the clause to Scotland.
The clause introduces significant new duties to make assessments and in view of the dearth of provisions for people who are mentally ill in many parts of the country there will — rightly—be a knock-on effect on services and some authorities will need to incur substantial expenditure. Nevertheless, I am sceptical about some of the estimates that I have seen which seem to involve building new mini-institutions for people with mental illness. I say again in connection with this clause that there will be dismay around the country if excuses are made for delaying its implementation, since the principle has now been accepted.
Assessment is fundamental to the successful discharge of long-stay patients into the community. The clause is needed immediately; indeed, it is long overdue.
§ Mr. Alfred MorrisWe owe a special debt of gratitude to another place for its work on this part of the Bill. I know that my hon. Friend the Member for Monklands, West (Mr. Clarke) will join me in that tribute.
We are dealing with an extremely important provision. If there is a failure properly to assess a disabled person leaving hospital, he or she is all too likely to end up back in hospital rather than in the community. I know that the Minister will appreciate the importance of this part of the Bill and will do all that he can to ensure its implementation at the earliest possible date.
There has been repeated emphasis on the two vexed issues of implementation and resources. We shall return time and again to those issues to make absolutely certain that this extremely important Bill is implemented fully at the earliest possible date.
§ Mr. NewtonAs the hon. Member for Monklands, West (Mr. Clarke) has explained, following our extensive debate on the clause on Report, another place has helped us to get the provisions into what is generally accepted to be a satisfactory form. I am particularly grateful for the hon. Gentleman's warm acknowledgement of the fact that we have all sought to get the provisions into an acceptable form and have not adopted what he calls a minimalist approach. I should certainly not wish to see such an approach.
Health authorities and social services departments are to be required to make arrangements for an assessment of the needs of a disabled person for their respective services. When they receive notification that a long-stay patient is to be discharged, the authorities and departments will be required to co-operate with each other in making the arrangements.
The hon. Member for Monklands, West asked about the duties of local education authorities if they are notified under clause 4(1)(b) of the discharge from hospital of a child or a young person aged under 19. The general purpose of the subsection is to ensure that local education authorities are in a position to discharge their responsibilities either under the Education Act 1981 or clause 3 of the Bill.
The hon. Member rightly said that in the case of a child who is at school the local education authority will be required to consider whether amendments are needed to the terms of any existing statement of special educational 1338 needs or, if no such statement exists, to consider whether the child's education needs should be assessed with a view to making a statement.
The hon. Gentleman asked me to say a little more about those over school leaving age. In the case of a child over 16 who is already subject to a statement and transfers to a full-time course of further education, the local education authority is no longer obliged under the Education Act to maintain the statement, but it will be under a duty, under clause 3, to inform the social services department in due course of the child's leaving date.
In the comparatively rare cases of children who are subject neither to the Education Act 1981 nor to clause 3—children who are not, or have not been, subject to a statement and who either transfer to further education or cease full-time education — it will be for the social services department, under clause 4, to assess their needs.
I know that this is a slightly complex issue, but I hope that my explanation will help hon. Members and those outside the House who are following our proceedings carefully.
Predictably and understandably — I make no complaint about it—the hon. Member for Monklands, West and the right hon. Member for Manchester, Wythenshawe (Mr. Morris) returned again to the implementation of an important clause which I am pleased to see in the Bill.
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On Report, the hon. Member for Monklands, West said that he was prepared for the implementation of this clause to be delayed slightly longer than other clauses in the Bill—although I realise that he would not expect that to be a long time — in order to allow adequate preparation. He said that he hoped that the target date would be set no later than 1988–89. 1 regret that, once again, I must be a little less forthcoming than I have been on one or two other clauses that we have discussed recently. As always, we are once again back in an area where resources are an important factor.
As yet, we have not come to a common view with the local authority and health authority associations on how, if at all, changes introduced to the Bill on Report, as subsequently refined in another place, will affect the overall costings. In other words, there is still a good deal of uncertainty about costings in this area and it inescapably follows from that that it is impossible for me to make any useful comments at this precise point in time about when the clause will be implemented.
However, we shall continue discussions to try to make sure that we obtain the best and most reliable estimates of what is involved as soon as possible. Then, as I have already said, we shall be looking for ways forward to achieve the speediest possible implementation, subject always to the availability of the money—in other words, finding the resources to make sure that local authorities and health authorities have them.
§ Mr. Alfred MorrisThe Minister talked of the Bill costing an estimated £100 million. He talks about costs; we talk about net costs. Clearly, there will be savings on this part of the Bill if the right action is taken at the right time. If a person leaving hospital is not properly assessed, he or she is likely to return to hospital at far greater cost to the taxpayer than if adequate help is provided in the 1339 community. Can we be assured that full consideration will be given to the savings that will accrue if disabled people are given the right help in the right place at the right time?
§ Mr. NewtonThe right hon. Gentleman makes an entirely legitimate point about the potential savings that might arise from some forms of expenditure under the clause. But, in doing so, he will, as I hope he will acknowledge, have to bear in mind some of the difficulties in achieving a good estimate of the cost of such provisions. Making estimates of the kind which he implies are required is a difficult and complex matter. I cannot add to what I have said. The Government are approaching the matter in the spirit of wishing to make progress as soon as possible, but I am unable to give a precise implementation date at this stage. We shall do what we can to get into a position to make a better assessment of the costs as soon as possible, which, in turn, will enable us to make a better assessment of when we may be able to make a commencement order.
§ Mr. WigleyMay I press the Minister a little on this because it is obviously important? I do not want any delay in the introduction of the clause to be a reason for not pressing ahead with the integration of people from long-stay hospitals into the community. There may be some who believe that it would be preferable to wait until better safeguards are available but that would be detrimental. The Under-Secretary of State wrote to me last month telling me that the average cost in England for a stay in hospital for mentally handicapped people is £227 a week and for mentally ill people, £255 a week. That shows the fairly considerable costs that there are and I should have thought that, following what the right hon. Member for Manchester, Wythenshawe (Mr. Morris) said a few moments ago about achieving a balance between the figures, we should try to make rapid progress in this matter.
§ Mr. NewtonI understand what the hon. Gentleman is saying and I can assure him that the Government are not looking for ways to diminish progress towards care in the community in the sense that he is talking about. Indeed, I think that it is fair to claim that that has advanced rapidly under the Government, especially in relation to those who were formerly in long-stay hospitals for the mentally handicapped, and, not least, in respect of children in such hospitals, where the drop in numbers has been dramatic during the past few years. We are all anxious to see that momentum sustained.
One of the other complicating factors is that much of this assessment work already goes on. It is not the practice suddenly to decant children, or indeed adults, from long-stay hospitals for the mentally handicapped without taking a look at what their needs will be in the community, and making provision for them.
Thus it is quite a complex business to assess what additional resources will be involved in implementing the clause. However, we shall be doing so as soon, and as effectively as possible. But I think that the hon. Member for Monklands, West will recognise that the task is complex. We shall not drag our feet, but I am not in a position to be more specific today.
§ Questions put and agreed to.
§ Subsequent Lords amendments agreed to [one with Special Entry.]