HC Deb 20 December 2000 vol 360 cc361-75 3.33 pm
The Secretary of State for Health (Mr. Alan Milburn)

With permission, Mr. Speaker, I wish to make a statement on the Government's plans for new mental health legislation, set out in the White Paper "Reforming the Mental Health Act", which my right hon. Friend the Home Secretary and I are publishing today. It includes our plans for managing patients who are dangerous and have severe personality disorders.

Millions of people—perhaps as many as one in six of the population—face mental illness at some point in their lives. About 630,000 patients with serious mental health problems are being cared for by specialist mental health services across England and Wales at any one time; and for every individual with serious mental health problems, there are many others—families, carers, friends and, indeed, members of the wider public—who are affected, sometimes with tragic consequences. It is for those reasons that the Government have made improving mental health services a key clinical priority for the national health service.

First, we have made investment a priority. For the first time, ring-fenced funding is expanding what have for too long been Cinderella services, especially for those who are most seriously ill. By April next year there will be almost 500 extra secure beds, at least 320 extra beds staffed 24 hours a day, and 170 assertive outreach teams. Every patient with complex health needs will have access to services 24 hours a day, seven days a week

We have already recruited 3,000 new staff in mental health services. The NHS plan that we published in July announced a further £330 million investment in those services over the next three years. There will be further substantial increases in staff and new investment in specialist community health services and improved primary care services for all people with mental health problems. That investment will help to ensure public safety and will improve patient care.

Secondly, we have made reform a priority for mental health services. Last year, we published "Mental Health National Service Framework", to give local health and social services for the first time, clear national standards against which to operate. That will help to tackle the lottery in care which means that some patients in some areas miss out on services and treatments that others receive as of right. It provides a clear statement for patients and their carers about what services they can expect, wherever they live. It has been widely welcomed by patients, carers, clinicians and managers.

The White Paper that we are publishing today will now underpin those improvements in mental health services with reforms to mental health laws. Good quality care and treatment are the key to making sure that most people with mental health problems never need to fall within the scope of mental health legislation. Despite public perceptions to the contrary, the overwhelming majority of people with mental illness are a threat to no one. Indeed, many mentally ill patients are among the most vulnerable in the community.

Reducing the stigma which attaches to people with mental illness should be a priority for any caring, civilised society. There will always be some people with a serious mental disorder, however, who do not seek care and treatment when they need them. Sometimes, they do not recognise how ill they are; sometimes, they are so disabled by their mental illness that they are not able to seek help; and sometimes, they choose not to seek help. In some cases, that means that people with serious mental disorder will pose a significant risk to other people in their family or in the community, as well as to themselves.

In those circumstances, the Government have a duty to protect both individual patients and the wider public, when a person poses such risks. Mental health legislation should help us to do just that. The Mental Health Act 1983 is largely based on the last major review of the mental health legal framework, which took place in the 1950s. Since then, the way in which services are provided has dramatically changed. More seriously, the current laws have failed properly to protect the public, patients and, indeed, staff. Under existing mental health law, the powers compulsorily to treat patients are only available if they are in hospital. However, the majority of patients today are treated in the community. Public confidence in care in the community has been undermined by failures in services and failures in the law.

The policy lost public confidence because, in too many cases, neither services nor the law properly protected either patients or the public. There have been no requirements for local health and social services to exchange relevant information about patients. Services have too often worked in isolation from one another. Too often, severely ill patients have been allowed to drift out of contact with mental health services altogether. Many patients have failed to comply with treatment. Clinicians have been in the absurd position of having to wait until patients in the community become ill enough to require admission to hospital. That prevented early intervention to reduce the risks to both patients and the public. In particular, existing legislation has failed to provide adequate public protection from those whose risk to others stems from a severe personality disorder.

As a result, patients and the public alike have been put at risk. They have been denied the protection that they need. The tragic toll of over 1,000 suicides and 40 homicides every year involving patients who have been in touch with mental health services in the previous 12 months graphically illustrates the failure of the old legal framework. It is outdated; it is in desperate need of reform.

Our proposals today clarify the circumstances in which care and treatment should be provided without the consent of people with mental disorder, either in their own interests or in the wider interests of public safety. They introduce new safeguards to protect patients' rights when care and treatment is given without their consent.

We have consulted widely over the past year on our plans for reform. They will mean major changes in four key areas. First, safeguards will be improved for patients. Removing an individual's liberty against his will is a very serious step to take and must be balanced by suitable safeguards that are fully consistent with the Human Rights Act 1998.

For the first time, all decisions to apply compulsory powers to treat a patient for more than 28 days will be subject to independent scrutiny by a judicial body—the new mental health tribunal. The tribunal, which will be chaired by a senior lawyer, will consider the care and treatment plan proposed by the clinical team. It will take independent advice from medical and other experts and from patients or their representatives. Its decisions will be binding on the NHS and will be regularly reviewed. Patients who are subject to compulsory powers will, as now, have the right to free legal advice. They will also, for the first time, have a right to help from a specialist independent advocacy service.

A new Commission for Mental Health will also be established with a clear remit to monitor the quality of decision making and whether the powers in new legislation are being used in a way that is consistent with the key principles that underpin it. The commission will provide new safeguards to protect the rights of people with long-term mental incapacity who are in need of specialist treatment for mental disorder, but who are not able to participate fully in decisions about how that care is provided. The commission will be fully independent and will report annually.

Secondly, there will be new safeguards to protect patient and public safety by extending compulsory treatment powers from the hospital ward into the community. The complexity of current laws which mean that there are several routes to compulsory treatment will be simplified. In future, there will be a single entry point to compulsory treatment based on a full and fair assessment of each individual's care and treatment needs.

New care and treatment orders will mean that patients subject to compulsory treatment, whether in hospital or in the community, will have to comply with the terms of their treatment programme. Refusal to do so could result in the patient being readmitted to hospital. Care plans will take into account a patient's best interests and any risk that they pose to other people. Compliance with treatment and contact with services will both be enforced under the new legislation in a way that was never possible under the 1983 Act.

Care and treatment orders in the community will allow clinical teams to intervene earlier to prevent a patient's condition from deteriorating. The risk that patients may pose to themselves or to others should be reduced as a result.

Thirdly, public protection will be further strengthened by introducing new duties, backed up by robust safeguards, to cover the disclosure of information about patients suffering from mental disorder. Inquiry after inquiry has demonstrated that a breakdown of communication between local services responsible for a patient's care has been a significant factor in many of the homicides and suicides committed by severely mentally ill people. This situation cannot be allowed to continue.

There will be new powers to exchange information between statutory agencies to parallel the other steps that the Government are taking to improve co-ordination between health and other local services.

The Government are also committed to improving the level of service provided to victims generally and giving proper recognition to the needs of victims of mentally disordered offenders in particular. The new legislation will allow victims of mentally disordered offenders to be given appropriate information about the offender's discharge as well as his detention. We also aim to enable victims to make representations to the mental health tribunal when it considers discharging the offender from hospital.

Fourthly, there will be new criteria giving clear authority for the detention of patients who pose a significant risk of serious harm to others as a result of a mental disorder. They will include the detention of dangerous people with a severe personality disorder. The Government are determined to deal with the challenge to public protection posed by that small group of people.

Our proposals have been the subject of extensive consultation following publication of the joint Home Office and Department of Health document in July 1999. Neither the law nor services are currently geared to cope with the risks posed by dangerous people with a severe personality disorder. Many cannot be compulsorily detained in hospital because they can be defined as untreatable under the current law. Many are sent to prison after committing a serious crime and are a danger to the public upon release. As a consequence, there has been a gap in the protection that mental health laws should afford the public—a gap that we will now close.

In place of the flawed concept of treatability, new criteria will separate those who need treatment primarily in their own best interests from those who need treatment because of the risk that they pose to others. In cases that involve those who present a high risk of harm to other people, the use of compulsory powers will be linked to a care and treatment plan, which describes how to treat the underlying mental disorder and manage behaviours that arise from it. Compulsory treatment can go ahead only after a full assessment by doctors and with the agreement of the independent mental health tribunal. High-risk people who are before the courts for an offence will be able to be remanded for assessment and treatment.

Similarly, my right hon. Friend the Home Secretary will have powers to direct those already serving a prison sentence to be sent for assessment and treatment. Subject to the new mental health tribunal, dangerous people with a severe personality disorder will be able to be detained for as long as they continue to present a high risk to others—indefinitely, if necessary. It should go without saying that the full range of safeguards that I outlined earlier to the House will apply to that group of people.

The Government recognise that new powers to deal with those who pose the greatest risk to the public will not by themselves be enough to safeguard the public. New specialist services are also needed. In the recent spending review, £126 million has been allocated across the Department of Health, the Prison Service and the Home Office to develop assessment and treatment services for that high-risk group.

The extra resources will allow extra staff to be employed and will provide 320 new specialist places in high-security settings in the Prison Service and the health service, as well as 75 specialist hostel places. New approaches to the assessment of the group are currently being piloted in both the Prison Service and the NHS. Treatment pilots will begin next year. The evidence will be used to inform future decisions about how new services should best be structured.

The changes amount to the biggest shake-up in mental health laws in four decades. They will strengthen the current law, introduce new safeguards for patients, and improve protection for the wider community. Taken with the major investment and reforms that are now occurring in our mental health services, the proposals will enhance the safety both of patients and the public. I commend them to the House.

Dr. Liam Fox (Woodspring)

I thank the Secretary of State for his statement and for his courtesy in making a copy available an hour before he delivered it—that was extremely helpful to the Opposition.

It is not surprising that all parties will agree with a great deal in the statement. Perhaps the most important aspect is the need to reduce the stigma that is attached to mental illness and encourage a new culture that is far more understanding of the problems for affected individuals and their families.

I welcome the move to more care in the most appropriate setting, which must lead to better clinical outcomes. I welcome the move towards compulsion in community settings, which brings the law more into line with current practice. I also welcome the establishment of the tribunals and the commission, which will create a better balance in the system.

Although there is a place for compulsion, it would be unfortunate if it dominated our debate about mental illness and our discussion was perceived to apply only to a small number of people when many other more pastoral issues need to be addressed.

The Secretary of State's rhetoric is not matched by the Government's priorities. He spoke of the desperate need for reform and said that that was a key priority. Yet the Queen's Speech could have provided for legislation on the subject—the Opposition would have supported that. If the public are at such risk, they might want to ask the Government why they make time available for banning fox hunting or considering the plant varieties legislation, but not for much-needed mental health legislation.

There are a number of specific matters on which I would like the Secretary of State to explain the Government's thinking. The first is severe personality disorder. What is the Government's estimate of the number of people who fall into that category, both inside and outside the criminal justice system? Will the right hon. Gentleman give a guarantee to the House that those patients will not find their way on to already overstretched acute psychiatric wards? He rightly referred to vulnerability. Patients who are recovering from severe depression or are tackling schizophrenia find things difficult enough without the disruption caused by potentially dangerous patients on the same ward. We must be given an absolute guarantee that such disruption will not occur.

I was confused by one of the right hon. Gentleman's remarks. He said that, in place of the flawed concept of treatability, new criteria would separate those who need treatment for different reasons. However, the whole point about personality disorder is that it cannot be treated. The right hon. Gentlaman then said that the use of compulsory powers would be linked to a care and treatment plan. What treatment? The assumption seems to be that a large number of personality disorders are based on an underlying condition that can be treated, but, as the right hon. Gentleman knows, that will apply only to a small group of people. Was he speaking about treatment or management? The terms must be clearly delineated.

I have three specific points for the right hon. Gentleman. He spoke about the single point of entry to compulsory treatment. Does that mean reducing the number of sectioning mechanisms that currently exist, and that the single entry point, as he put it, would consist of sectioning with the signatures of two doctors and a psychiatrically qualified social worker? If that is the case, flexibility will be dramatically reduced, which would be a problem in many rural areas. I hope that he will take that practical point into account when he deals with the matter in more detail.

How will the proposals specifically address the Bournewood judgment, which relates to patients who lack the capacity to give consent? I was sorry that when the right hon. Gentleman spoke about the much-needed balance for victims of mentally disordered offenders, he did not say anything about mentally disordered offenders themselves. I am sure that hon. Members on both sides of the House feel strongly about the fact that people under the care of the Prison Service who suffer from mental illness are less likely to be diagnosed and treated, and are consequently at far higher risk of suicide.

The Opposition will support the Secretary of State if, when he puts legislation before the House, he proposes to dismantle the prison health service and bring it into the national health service. That would give to mentally ill offenders the same access to care and quality of care that is enjoyed by everybody else. If we want to provide the appropriate treatment for individuals in the appropriate setting, it would make sense to introduce a far more seamless change in the way in which such patients are dealt with.

There is a great deal with which the Opposition agree, some things that we do not believe have been adequately explained, and areas that we would like to explore. The proposals are a start and we will support the Government where we think that they are sensible, but we would like to see far more detail and want the Secretary of State to consider some areas that he does not seem to have considered so far.

Mr. Milburn

I am grateful to the hon. Gentleman for his overall welcome for our proposals. There is clear agreement on the first three points that he made. First, those of us who care about the national health service and about the needs of people with mental illness must do all that we can to reduce stigma. My Department is making efforts to do that, alongside other Departments. I know that the matter has been the subject of genuine concern among hon. Members from all parties and especially those who serve on the Select Committee on Health. We need to up our efforts.

Secondly, we must ensure that patients are cared for in the most appropriate setting. My view is that we must ensure that people with serious mental illness are provided with care in the least restrictive environment that is consistent with their needs and safety, as well as the safety of the wider community and the public. Thirdly, although tomorrow's newspapers will inevitably be full of headlines about the proposals for dangerous people with severe personality disorders—or SPD—the hon. Gentleman was right to say that the White Paper extends much more widely. Indeed, we published it in two parts to try to make it clear that a legal framework exists, that it should apply to all patients, and that specific measures must be taken for the small minority of patients and others who are a high risk to other people. I think that that gets the balance right.

It is difficult to estimate of the number of dangerous people with a severe personality disorder. We are breaking new ground in trying to estimate the numbers and in trying to provide new services for the people concerned. Our best estimate is that there are about 2,200 such people in the community and in the prison population, although largely in the prison population.

On the subject of overcrowded wards and the pressures that are placed on staff, there are undoubtedly, real pressures on psychiatrists, nurses, social workers and others. Investment is going in to the hospitals and to the community services to help ease those pressures. Arguably, that investment should have gone in many years, or even many decades, ago. We are talking about providing a whole range of new, specialist services for dangerous people with a severe personality disorder, on top of the mainstream mental health services that we are already expanding and reforming.

The hon. Gentleman referred to the inability to treat those with a severe personality disorder. However, there are real differences of clinical opinion on that. Some clinicians say that such people are impossible to treat; others say that they can be treated. We take the view that current legislation provides a lottery, because some dangerous people with a severe personality disorder get treatment and services and others do not. The people who do not are a risk not only to the wider community—and, especially to their families, who inevitably bear the brunt when things go wrong—but to themselves. If it is good enough to provide specialist mental health services for one person in this group, it should be good enough to provide them for all.

Countries such as Holland and Germany have had some success in piloting new therapeutic interventions to manage the behaviours that arise from these mental disorders. We are undertaking further piloting, both in Whitemoor prison and in Rampton, to roll out the appropriate model of care.

The hon. Gentleman was right to raise the Bournewood judgment, which is important for those with a long-term mental incapacity, including those with learning disabilities. The White Paper provides safeguards—particularly for that group of patients—partly as a response to the Bournewood judgment. That group of patients will be brought under the umbrella of the new Commission for Mental Health. I hope that that will help to deal with some of the concerns that have been expressed on the issue.

I agree that prison mental health services need improvement. My right hon. Friend the Home Secretary and I are working closely to ensure far closer integration between mental health services provided in the national health service and those provided in the Prison Service.

My final point is about the time that it takes to make the changes. The hon. Member for Woodspring (Dr. Fox) was a Minister in the previous Government, who were in power for 18 years. They had the opportunity to put right the deficiencies in the law and in services, but they failed to do so. This Government are getting on with the job, modernising the services and putting in the investment. It would be good to hear from the hon. Gentleman that he supports the investment being made, and that his party would match it.

Several hon. Members


Mr. Speaker

Order. I remind hon. Members that one question only is to be put to the Secretary of State. Any hon. Members who have three questions will have to decide which one is the most important.

Mr. David Hinchliffe (Wakefield)

I broadly welcome my right hon. Friend's statement. I have two points, rather than two questions, that I should like him to clarify.

First, there were distinctions between the recommendations of the expert committee on the reform of mental health law, and the contents of the Green Paper. Do those distinctions remain and, if so, why?

Secondly, will the Secretary of State expand on his point about the impact of human rights legislation on mental health law? I make this point because of the concern expressed by the Select Committee, when its members visited the special hospitals. We were told that 30 per cent. of the patients in Ashworth hospital could have been contained in lower-security institutions and, in some instances, in the community. We were also told that 60 per cent. of the women patients at Broadmoor could have been contained in the community under assertive outreach.

Mr. Milburn

My hon. Friend has been in politics for far too long; he knows the old trick of putting one item on the agenda with two more arising from it—we have all done that.

I am grateful to my hon. Friend for his broad welcome. On the Richardson committee, when he has an opportunity to study the proposals in the White Paper—I know that he will do so carefully—he will find that they are largely based on the committee's recommendations. I can give him that assurance.

On compliance with the European convention on human rights, my hon. Friend will be aware that the convention makes it clear that there is a right to liberty but that it is subject to express exceptions—one of which, in article 5(1)(e), is the lawful detention of persons of unsound mind. That is why we are convinced that the proposals are wholly compliant with the convention and with the Human Rights Act 1998.

My hon. Friend makes a good point about patients detained in special hospitals. Our estimate is rather lower than his; we think that about 60 patients are currently contained in the three special hospitals; they have gone through all the hoops with the Home Office and so on and could be released to a lesser form of secure intervention. We need to make more progress on that matter; we certainly need to make more progress for women patients in the hospitals. The additional investment that we are making in secure beds and other facilities will help us to do just that.

Mr. Nick Harvey (North Devon)

I, too, welcome the statement and the Government's plans to amend the law. I also welcome the fact that, from a civil liberties point of view, some of the objections to the earlier proposals seem to have been met. Certainly, the wide entitlement to go to tribunal and the provision of independent advocacy should be a significant improvement.

We have not heard much about resources, however. The Secretary of State acknowledged in his statement that mental health services have been the Cinderella of the health service. He pointed out that some progress is being made in that regard, but is not there still a serious shortage both of psychiatrists and psychiatric nurses? If the improvements in the service envisaged in the White Paper both in secure settings and in the community are to come about, further progress will be needed—in particular, much more recruitment will be needed.

On severe personality disorders, what criteria will be used to have people considered in the first place? Will such consideration be based on a pattern of previous behaviour, or is that not to be taken into account? The Royal College of Psychiatrists points out: The link between severe personality disorder and dangerousness is extremely tenuous and poorly researched. We will find that most people with a severe personality disorder are not dangerous and most people who are dangerous in the Government sense will not have a severe personality disorder. What is the Secretary of State's response to that point? What approach will be taken towards people who have no previous record or pattern of behaviour, but may nevertheless fit the criteria that the Government are considering?

Mr. Milburn

I am grateful to the hon. Gentleman for his broad welcome for the proposals. He is right to point out that there are significant safeguards to deal with some of the reasonable civil liberties arguments. As I said in my statement, to take away someone's civil liberties without consent is a serious step, so it is important that safeguards are in place. The tribunal and the fact that it will regularly review the compulsory treatment order will be extremely important.

For the information of the House, I shall explain how that will work. The assessment period for someone who could be subject to compulsory treatment will take up to 28 days. After 28 days, the tribunal will meet and will take evidence from various parties—including the patient's clinical team, but also external second opinions. It will be able to make an order, in the first instance, for up to six months; then for a second period of up to six months; and after that, for periods of up to 12 months. In each of those periods, patients and their representative will be able to call for a review of that decision and they will receive a fair hearing. Those are significant safeguards to deal with the issues.

On staffing—yes, there are shortages of psychiatrists, community psychiatric nurses and other nurses in the psychiatric profession. We are making progress, however. Over the past couple of years, an extra 350 consultant psychiatrists have been working in the NHS; and 2,000 more nurses are working in mental health services in the NHS. By 2005, I expect that—from the position that we inherited—there will be a 60 per cent. increase in the number of consultant psychiatrists working in the NHS, because of the extra training places and the resources that we are making available.

As for admitting someone with a severe personality disorder, the best test of dangerousness is likely to be offending behaviour and a pattern of offending behaviour. However, there will need to be other tests, too, because we know from our constituency experiences that although there will be people out there who have offended in the past, they may not have come to the official notice of the criminal justice organisations. We must have the means of properly and precisely assessing those people for their dangerousness and for the risks that they pose to others in society.

Mr. Robin Corbett (Birmingham, Erdington)

In welcoming my right I hon. Friend's proposals, I thank him for the attention that he has paid to the Home Affairs Committee report on the issue of dangerous people with a severe personality disorder. Will he please clarify that when people are assessed, they will be held in specially built separate units?

Mr. Milburn

Yes. As the Chairman of the Home Affairs Committee, I think that my hon. Friend will be pleased with the White Paper because, in large part, it reflects what his Select Committee said—I believe unanimously—about the issue of dangerous people with a severe personality disorder. I can confirm to him absolutely that we will ensure that people with severe personality disorders will be treated and cared for in specialist units in precisely the way that he describes.

Mrs. Virginia Bottomley (South-West Surrey)

May I congratulate the right hon. Gentleman on a very much more enlightened policy than that advocated by his predecessor and the Home Secretary when they last spoke in a really shockingly authoritarian manner on these matters? May I also commend Genevra Richardson again for her extremely impressive report?

In the light of the endless examples of relatives, parents and carers who feel that their calls were not heard when they knew that their close relatives were deteriorating and that professionals would not heed their advice, will the right hon. Gentleman repeat what more he will do to ensure that those people have a voice? In that light, has he recently spoken to Marjorie Wallace? At SANE, she has been a constant thorn in the flesh of Ministers of all political parties, but the funding for SANELINE is seriously at risk, as I understand it, and it would be a great tragedy if that service could not continue.

Mr. Milburn

As I understand it, we have recently made available £300,000 to SANE and we are looking at future funding. Yes, Marjorie Wallace does an extremely good job for that organisation and she has a very warm relationship with both the Minister of State, Department of Health, my hon. Friend the Member for Barrow and Furness (Mr. Hutton), and the Minister of State, Home Office, my right hon. Friend the Member for Brent, South (Mr. Boateng).

I do not know whether the right hon. Lady was trying to be helpful when she described me as less authoritarian than the Home Secretary; I shall have to think about that.

As for the serious is point about carers, the right hon. Lady knows, as does the whole House, that carers do a brilliant job in very difficult circumstances indeed, particularly when caring for those with a severe mental illness. They are often on the receiving end of a great deal of stick from their charges, who are not easy people. Those carers do a first-class job. The White Paper contains a number of provisions to make their lives easier, I hope. In particular, I hope that the right hon. Lady will be pleased that we are now proposing that when a carer of a person with a mental illness is worried, he or she will be able to refer his or her charge to the mental health trust for assessment. I very much hope that that will help relieve some of the burdens that carers face day in, day out in every community.

Dr. Lynne Jones (Birmingham, Selly Oak)

I thank my right hon. Friend for the high priority that is being given to mental health services. Does he agree that the sooner people with signs of mental illness seek help, the better the outcome; and that a measure of the success of the Government policies is a reduction in delays in people's seeking that help? What measures in the White Paper does he consider will assist in achieving that aim?

Mr. Milburn

My hon. Friend is absolutely right. Clearly, the sooner the health service can assess those who might have a mental illness and get on with treating them, the better. I am afraid that, as she knows, the deficiencies in the Mental Health Act 1983 have in some cases prevented clinicians from doing their jobs. They have often faced the dreadful problem of treating patients in hospital, discharging them into the community and finding that they then disappear altogether from the services' attention. They know full well that those patients are causing disturbance and nuisance to others and are very possibly a danger to themselves and others, yet those clinicians can do nothing about it, other than wait for the patients' readmission into hospital. Such a pattern has not been good for clinicians and it certainly has not been good for patients or the wider community.

The reforms that we are introducing to expand the services and get crisis intervention teams and outreach teams out of the hospitals and into the community will make a real difference to many patients.

Dr. Julian Lewis (New Forest, East)

Does the Secretary of State accept that there is a continuing risk to female in-patients in psychiatric institutions from assaults arising from the continuation of mixed-sex wards? Is he aware that, in December 1997, when the Government talked out my private Member's Bill, by which I sought to address the issue, the right hon. Member for Brent, South, then Under-Secretary of State, Department of Health, who had responsibility for such matters, assured me: A central monitoring system is being developed which will provide further regular information on authorities' performance against those objectives—[Official Report, 12 December 1997; Vol. 302, c. 1331.] Can the Secretary of State therefore explain why, when I tabled a written question on 25 October to ask if he would list the hospitals that have eliminated mixed-sex wards since May 1997, I received a reply that stated: At the moment, information on which hospitals in England have eliminated mixed sex accommodation is not available, as data are collected on a health authority basis.—[0fficial Report, 30 October 2000; Vol. 355, c. 248W.] What progress has been made during the long period since my Bill was talked out in achieving an objective which, before being elected, the Government boasted they would make a top priority?

Mr. Milburn

We cannot publish information that we do not have, and the last thing that the hon. Gentleman would want us to do is to make up the data.

Dr. Lewis

The Government ought to have it.

Mr. Milburn

We will get it, and when we do so, we will make it available. This Government, unlike the previous Government, are determined to eliminate mixed-sex accommodation.

Mr. Tom Clarke (Coatbridge and Chryston)

May I welcome one of the most comprehensive and profound statements on an important issue that we have heard for a very long time? May I press my right hon. Friend on advocacy? Will the Government implement or adapt existing legislation—for example, the Disabled Persons (Services, Consultation and Representation) Act 1986? Will he accept that, when people leave long-stay hospitals, advocacy would be helpful in preparing proper assessments, involving advocates, social services and so on? I very much welcome the new thinking on prisons, but many people take the view that, in Britain, we send many mentally ill people to prison unnecessarily and that that may well apply to people with learning disabilities.

Mr. Milburn

I am grateful to my right hon. Friend, as is the House, for the work that he did on behalf of those with disabilities, especially in the 1986 Act, in which I suspect he has more than a vested interest. Advocacy services are very important because we are talking about a very vulnerable group of people and their reintegration into the community is not easy, especially if they have spent time in prison or in specialist mental health services. They need more information on how to contact services, on their legal rights and so on. Although decent advocacy services exist in some parts of the country, their availability is patchy. We propose that people, especially those detained under compulsory powers in our proposed new mental health legislation, should have access to specialist advocacy services. We are consulting on the best way to do that, and we expect to publish the results of that consultation in the spring.

Mr. Dafydd Wigley (Caernarfon)

May I press further the point on advocacy that was made by the right hon. Member for Coatbridge and Chryston (Mr. Clarke)? The Secretary of State said that compulsory treatment can go ahead only after a full assessment by doctors and with the agreement of the independent mental health tribunal. Will a professional advocate also be available and will the Secretary of State ensure that resources are available for that purpose?

Mr. Milburn

Yes. I assure the right hon. Gentleman that that is precisely one of the safeguards that we seek to put in place. Every patient should have access to the specialist advocacy services for which he has argued for many years.

Ms Bridget Prentice (Lewisham, East)

My right hon. Friend may be aware that, in April 1999, I introduced a ten-minute Bill on protection and restraining orders, and it covered the very people referred to in the White Paper. The issue of treatability was one of the problems that I faced, so I very much welcome the fact that he has said that that issue will be examined. Will he go further and tell me that the White Paper will make provision for people with severe personality disorders who recognise that they are a danger either to themselves or to others? What opportunity will such people have to refer themselves, and to whom will they go?

Mr. Milburn

My hon. Friend makes an extremely good point that relates to one of the gaping holes in the existing legislation. Not only have people out there been dangerous, but people in prison who have been dangerous and who have a severe personality disorder have warned prison officers, on their discharge, that they are danger to others. None the less, they have been discharged. That has got to change for the protection of the individuals concerned, their families and the wider community. In future, as we roll out the new specialist services for those with a severe personality disorder, we shall provide precisely the help, treatment and care that they need.

Mr. Andrew Rowe (Faversham and Mid-Kent)

Does the Secretary of State share my perception that even the best-intentioned members of the public have no idea how to respond to someone displaying clear signs of personality disorder? Does the taskforce considering the removal of stigma intend to consider public education in that respect?

Mr. Milburn

Yes, and that is one of the jobs that we must do. The hon. Gentleman knows that we spend a certain sum of money each year trying to educate and inform the public about what mental illness means. Although, today, we are concentrating primarily on those with the most severe mental illnesses—they are sometimes the greatest threat to themselves and to others—overwhelmingly those with mental health problems do not fall into that category. We must continue to make and reinforce that point, so that the public get the right idea and not the wrong one.

Laura Moffatt (Crawley)

I very much welcome today's announcement. Does my right hon. Friend not agree that one of the saddest experiences is to watch someone daily losing touch with reality when the professionals are not able to intervene? [Interruption.] I knew that that was coming, but this is a serious subject. Sometimes health teams cannot intervene and take part in active treatment.

The proposals announced will allow for the compulsory administration of drugs through the community health teams. Does my right hon. Friend not agree that those teams will need much help and advice when taking part in such work in conjunction with the acute services? The sensitive relationship that they have with patients might become slightly different, so we should consult those teams on how we carry out the new arrangements.

Mr. Milburn

I very much agree with my hon. Friend, who is an expert on this subject, and I assure her that there will be the comprehensive training that she seeks. It will be necessary, because there will be a big change in the law and, therefore, big changes to services and the way in which clinicians relate to patients. Overwhelmingly, clinicians will conclude that we are taking the right approach, because they are as frustrated as anyone else about their inability to get the right care and treatment, including medication, to those who need it most.

Dr. Evan Harris (Oxford, West and Abingdon)

Does the Secretary of State accept that, although many of his proposals are welcome, there will be concerns about the tendency to seek to minimise risk to the public to such an extent that it impedes civil liberties? In particular, I refer to the redefinition of the term "treatability". When unfortunate and tragic incidents occur, there is always an inquiry and Ministers have to appear on "Newsnight" for an inquisition and the press and the public think that there is a higher risk than actually exists. Is the Secretary of State aware that there will be some concern about his proposals on the basis of the balance between civil liberties and the reduction of risk?

Mr. Milburn

No one is saying—and no one should say—that we can remove every risk: we cannot, but we can do a lot better. The 1,000 suicides and 40 homicides a year involving people who have been in contact with mental health services in the previous 12 months is hardly a catalogue of success. Indeed, it is a catalogue of failure for them, their families and the broader community.

We have a choice. Either we can stand back and do nothing, which is what the 1983 Act provides for, or we can take appropriate action. Of course we must get the balance right between protecting the patient and protecting the public, but we must get away from the idea that one necessarily runs counter to the other. The debate is not about that. The best solution is to offer the patient enhanced protection by introducing more safeguards and, at the same time, to better protect the public.

Mr. Jonathan Shaw (Chatham and Aylesford)

I welcome the announcement, but will the measures cover child and adolescent mental health services? In particular, will they address the tragedies that occur in young offenders institutions where so many young people have lost or taken their lives?

Mr. Milburn

My hon. Friend will be aware that suicide is a major cause of death among young men. We need to take more action to improve our child and adolescent mental health services. We have begun to do that and we will do more in future. I can confirm that there are provisions to help safeguard the interests of children in the mental health services.

Mr. Roger Gale (North Thanet)

I have a constituent in Holloway prison who, according to a ministerial reply today, is due for release on 28 December. Her father is desperately worried because she is a sick woman. She is a danger to herself and the public and could well cause injury or death to herself or someone else. There is no provision for her and she will be back on the streets of Thanet by the end of the year.

With respect to the Secretary of State, we do not need lectures on what has or has not been done in the past. The Government have been in power for three years and talked out a Bill that was promoted by my hon. Friend the Member for New Forest, East (Dr. Lewis) three years ago. Can the Secretary of State give us a sense of the Government's priority and tell us when the legislation, which I welcome, will be introduced?

Mr. Milburn

If the hon. Gentleman were in fairer mood he would concede that we are making progress on mental health services. He knows that when I became Secretary of State. I declared three clinical priorities—cancer, coronary heart disease and mental health services. I included mental health services because they deal with so many people and because there were so many gaps in provision when we came to office. The case that he describes justifies the measures announced today. People who revolve in and out of the criminal justice or the hospital system sometimes receive inadequate care and treatment. Frankly, we do not have the legal powers to ensure that the decent care and treatment that they need are provided. Legislation will be introduced as soon as there is parliamentary time.

Fiona Mactaggart (Slough)

Like other hon. Members. I welcome the statement. However, I want to ensure that it is delivered properly. This morning, I had a meeting with SHOC—Slough Homelessness Our Concern—which works with homeless people in my constituency, especially those who have had a dual diagnosis. Those people are anti-social and will not use most care services because they find them difficult to relate to. Will my right hon. Friend assure the House that voluntary organisations such as SHOC, will be given a key role in delivering the strategy; otherwise, we will not be able to reach the parts that we need to reach?

Mr. Milburn

I agree with my hon. Friend. Mental health services are not the exclusive preserve of the national health service. They also involve social services, housing agencies and the criminal justice system. In addition, many voluntary and community organisations have an important role to play in every constituency, including mine and that of my hon. Friend. The strategy in the national service framework and today's White Paper is an all-inclusive approach that involves the voluntary and statutory sectors. Unless we get such organisations working more as one, the gaps in provision that hon. Members on both sides of the House have highlighted, will continue.

Several hon. Members


Mr. Speaker

Order. I am afraid that we must move on.