HL Deb 09 July 1959 vol 217 cc989-1008

5.53 p.m.

Report stage resumed.

LORD COHEN OF BIRKENHEAD

My Lords, if your Lordships will agree, I might develop, just for two or three minutes, the latter part of the argument which I wished to develop in relation to this Amendment. It is simply to stress that in many cases in which there is overt psychopathic behaviour there is not infrequently underlying organic brain disease. There may be a tumour of the frontal area; there may be inflammation of the brain; there may indeed he some curious defect of metabolism which because of a small pancreatic tumour considerably lowers the blood sugar and so the brain is deprived of its proper nutrition. Those of us who recall the epidemic of sleeping sickness—encephalitic lethargica—in 1918 to 1922 or there-abouts, know that many of the victims were first recognised in the juvenile courts because they appeared as delinquents. Much the same may happen now. I hope that under the amended definition of "psychopathic disorder" it will become clear that we are in fact dealing with a mental disorder and not with a pure disorder of conduct which the noble Lord, Lord Taylor, and the noble Baroness referred to on the Committee stage.

I think the whole point of avoiding the justice of the peace in this type of procedure is that we should not introduce into what is essentially a medical decision a judicial procedure, which is limited to a certain type of patient. As I see it, these psychopathic children and young adults will be admitted to hospital; they will be investigated thoroughly for the presence of organic disease; they will then be assessed and it will be determined whether they do require or are susceptible to treatment. When that is done, then comes the question whether they shall or shall not be discharged from hospital or admitted for treatment, and not until then is there likely to be any difficulty, when I believe the difficulty would be resolved by the Mental Health Review Tribunal.

I have spoken for a little longer than I had anticipated. I should like to say this—because what I said during the Committee stage might well have been misinterpreted, particularly by the remarks of the noble Lord, Lord Douglas of Barloch. I yield to none in my admiration for the work of justices of the peace. In their proper judicial and administrative functions they have a real place in this country. But I believe that to accept this Amendment would be to introduce a procedure which not only fails completely in its intended purpose—or what I thought was its intended purpose, which was to guard the rights and privileges of the individual, to guard the freedom of the subject, and not solely, as the noble Lord, Lord Taylor, tells us is his view, to cover the doctor—but also violates the fundamental concept of the unity of disease, both physical and mental. I am not prepared to concede to the noble Baroness that that is a romantic fiction; it is a real problem. I hope we shall not add something to the machinery of this Bill which, as I say, completely fails in the purpose for which it is intended.

6.2 p.m.

THE LORD CHANCELLOR

My Lords, you will find that I have already had the honour of addressing your Lordships three times on the general question raised—namely, the introduction of a lay person—and therefore I do not intend (and I am sure your Lordships will not take it amiss) to repeat my arguments on the general issue. But I am not sure that those who are supporting the Amendment gave sufficient weight to one important fact which experience has shown to be true—although the noble Lord, Lord Taylor, of course mentioned it with the candour that one would expect—namely, that a considerable number of patients who fall into the psychopathic group under the Bill are at present certified and dealt with under the Mental Deficiency Acts as feeble-minded persons or moral defectives, and that we have considerable experience of treating and training them in mental deficiency hospitals, particularly in the two State institutions, Rampton and Moss Side. There are also some special units for psychopathic patients in mental and neurosis hospitals.

As I think I have stated in earlier debates, my right honourable and learned friend the Minister and the Regional Hospital Boards are at present considering what further or different provision will be possible under the Bill, as it abolishes the present system of separate designation of hospitals for patients dealt with as mental defectives and those dealt with as mentally ill. I do not want the noble Lord, Lord Taylor, to detect from what I have said any complacency; that is the last thing that I intend to convey. I entirely agree that medical knowledge of the causes of psychopathy, and of methods of treatment, is very far from complete. I do not know whether terms such as "being in its infancy" are really fair, but let us say at any rate that it is very far from complete. On the other hand, I should not like anyone to take from your Lordships' debates that it is entirely and completely a new problem. There is a considerable body of experience of many different medical approaches to training and to treatment.

There is a considerable practical difficulty with regard to the position of the justice. If it is intended only that the justice of the peace should scrutinise the documents (and that was rather suggested by some of the speeches when we last discussed the matter), it is difficult to imagine what useful function a justice could perform in doing this. He would not be required himself to examine and diagnose the patient—we all agree that he is not qualified to do so—but he would be required, apparently, to judge whether the diagnosis is correct from reading such description of the symptoms as the doctor might record in the medical recommendation in support of his diagnosis.

It is a matter of fact that the present system of scrutinising documents by the Board of Control was strongly criticised by the Royal Commission on the grounds that scrutiny by persons who do not themselves see the patient is of limited value as a safeguard to the patient and merely ensures that the detaining hospital have documents which provide prima facie good authority for detention. But even under that much-criticised system, the scrutiny was undertaken by experts. I should have thought that the system which is suggested here is inferior to that, because, after all, the majority of the Commissioners of the Board are themselves medically qualified, and legal or lay Commissioners have the advice of their medical colleagues always to hand. Under the Bill the task of scrutinising documents will in practice fall on the managers of the hospitals and will be carried out on their behalf (so far as the sufficiency of the medical recommendations is concerned) by their medical staff, who will also have the advantage of personal access to the patient.

Although, as I have said, I have the greatest admiration for the work of the justices of the peace, I think it is unreasonable to suggest that a non-medical justice of the peace should be asked to say that the doctor's diagnosis, recorded on paper and supported by such supporting particulars as may be required by regulations, provides or does not provide evidence that the patient is suffering from a disorder or disability of mind and that that disorder requires or is susceptible to treatment. As I said before, a non-medical justice could assess only the description of the behaviour as "abnormally aggressive or seriously irresponsible"; he could not relate that behaviour to a medical cause or assess the prospects of benefit from treatment; and therefore he could form an opinion on only one of the three elements in the definition in Clause 4 (4). I appreciate that the noble Lord and the noble Baroness have felt very strongly on this point. I can only say that I have listened with great pleasure to their deploying of their views on these four occasions; but I am sorry that for once, and I think in almost the only one of the general fields of the Bill, I have not been able to advance in their direction.

6.10 p.m.

LORD TAYLOR

My Lords, we did not really expect that the noble and learned Viscount the Lord Chancellor would be able to advance in our direction, though we hoped he might. My noble friend Lord Cohen of Birkenhead suggested that a number of cases of psychopathy are due to organic nervous diseases; and, of course, he is absolutely right when he says that that is so. But unfortunately—in one sense, at any rate—only in a minority of such cases are these organic nervous diseases to be detected. I say "unfortunately" because when an organic cause is found, organic treatment can be deployed, and there is greater hope of medical cure. May I say at once that we are not going to press this Amendment, because we want this Bill to work. Our fear is that this particular little portion of it may not work as the Government hope it will. If we are proved wrong by experience, good and well; no one will be more pleased than we ourselves. But if, as we fear, it does not work, then an amending Act may become necessary.

We are not by any means convinced that doctors are always right. Doctors do make mistakes sometimes, and one of the ways in which doctors make mistakes is when they do not express them- selves precisely and clearly—and particularly is this so when what they have to express are social facts. We were concerned to force the doctors to express these social facts (because those are the facts on which the diagnosis of psychopathy is made) in common-sense English, and we wanted some means of making doctors express the description of the behaviour of a patient in ordinary language and ordinary terms—much as a jury in a court of law has to make an assessment of diminished responsibility. That is what we were hoping would be the function which the J.P. would perform. However, we are not going to press it, and we wish the Bill in this respect, and in all respects, the best of success. With your Lordships' permission, I will now withdraw the Amendment.

Amendment, by leave, withdrawn.

Clause 31 [Effect of application for admission]:

6.13 p.m.

LORD DOUGLAS OF BARLOCH moved, in subsection (4) after "treatment" to insert: shall forthwith be informed of his right to apply to a Mental Health Review Tribunal and". The noble Lord said: My Lords, under subsection (4) of Clause 31 a patient who is admitted to hospital for treatment is entitled within six months to apply to a Mental Health Review Tribunal. This is the substitute, under the new procedure of this Bill, for the old form of safeguard which was given to the patient in the shape of the certification by the justice of the peace. Now, instead of having some protection before he is detained compulsorily, he is given the opportunity of applying to a Mental Health Review Tribunal to have his case considered. Unfortunately, there is nothing in the procedure laid down in the Bill by which the patient is informed that he is being subjected to compulsory detention in a hospital, or that he has a right to have his case reviewed; and, unless that information is communicated to the patient, his right to apply to the Mental Health Review Tribunal is completely nugatory. In the beginning, he does not even know that he has been compulsorily detained. The procedure does not require any notice or reference to be given to him. It is done on the application of one of his next of kin, or by an official supported by the certificates of two doctors—and some of us have not the touching faith in the infallibility of doctors that the noble Lord, Lord Cohen of Birkenhead, has shown this afternoon. In any case, we believe that the liberty of the subject is a sacred principle which must be protected in some way or other.

Many of us would have preferred, though we have not succeeded in getting it, some kind of independent or judicial process which could be brought into operation before the patient was subjected to compulsory detention. We take the view that that should not be done merely upon the certification of medical experts. We have failed in our efforts to secure an amendment of the Bill in that direction, and therefore I hope that the noble and learned Viscount will be prepared to consider at any rate this safeguard: that the patient shall have a statutory right to be informed of his position, so enabling him, if he pleases, to apply to the Mental Health Review Tribunal. That is the purpose of this Amendment. I beg to move.

Amendment moved— Page 20, line 6, after ("treatment") insert ("shall forthwith be informed of his right to apply to a Mental Health Review Tribunal and").—(Lord Douglas of Barloch.)

THE LORD CHANCELLOR

My Lords, this point which has been brought forward by the noble Lord, Lord Douglas of Barloch, raises one of the real difficulties in Government—that is, that on the one side one always wants to see any provision which could be used in a Bill for the protection of the freedom of the individual; while on the other side one wants to keep a certain field of the action of Government flexible and able to meet all problems that arise. I take the view, first of all, that a patient ought to know all about his rights; but I should have thought that this was essentially something which should be done by administrative methods, so long as they are supported by statutory powers—and the statutory powers here, of course, are contained in paragraph 2 (c) of Clause 56, which empowers the Minister to make regulations requiring the managers of hospitals and local health authorities to furnish or make available to patients and their relatives such written statements of their rights and powers under the Bill as may be prescribed.

Now I want to make my point that this is a case for the more flexible procedure. The Amendment which the noble Lord has put down would deal only with the initial right of application to the Tribunal by a patient admitted to hospital under Part 1V of the Bill. Just on this Amendment. I can think of a number of other occasions on which patients may apply to a Tribunal—for example on admission to guardianship under Clause 34; on any renewal of the authority for detention; and on admission under Part V of the Bill, to name only a few. There are also other rights under the Bill of which the patient should be informed—for example, the powers of discharge.

The Amendment does not provide for informing relatives of their rights, which are also important. It does not say who shall inform the patient, or how, or what is to happen if at the time of admission the patient is not capable of understanding the information given to him. In general, it is necessary, if the patient is to be properly informed, to go into greater detail and have greater flexibility than can be provided for in a provision of the Bill itself. It will be more effective to deal with the matter, first, through administrative means, and secondly, by regulations. After all, if the regulations are not made or are defective, then it will be possible for the matter to be discussed either in your Lordships' House or in another place.

It is difficult to know how to draw a line, because on one side there is the declaration of the Statute, and, on the other, its rigidity. I have always tried to draw the line in this way: I have said that I will not use subsidiary legislation for something that is really a change in the law of the land and a truly legislative act, because I do not believe in subsidiary legislation supplanting discussion in Parliament; but when we want to provide for methods of application, which I hope to Heaven will improve and can be altered when one realises the defects of one's first shot, then I think that that is a legitimate sphere for subsidiary legislation and that we are clogging the flexibility of action of Parliament if we do not use it. That is why have given careful consideration to the noble Lord's point, with which I have great sympathy. I hope that, in the interests of the good application of this Bill, he will not press this Amendment to-day.

LORD DOUGLAS OF BARLOCH

My Lords, I should certainly not feel at all happy if this matter were left to be dealt with by administrative action only. I think it would be a deplorable state of affairs if there were no statutory safeguard of any kind, either in this Bill or in the regulations which may be made. This afternoon the noble Viscount, Lord Astor, said something about Ministerial circulars, and I certainly should be deeply alarmed if I thought that a fundamental right of a mental patient was going to depend on that kind of thing. If the noble and learned Viscount will assure me that regulations which will be made will meet this point of ensuring that the patient and his relatives—I agree that that is also important—are informed of those rights, so that an application can be made, if desired, to a mental health tribunal, then I should certainly feel happier about it. I may say that there is nothing in the Amendment which I moved which would prevent regulations from being made in order to amplify and provide details of procedure, but if I have an assurance that this whole matter will be dealt with by regulations, then I should certainly be happy to withdraw the Amendment.

THE LORD CHANCELLOR

My Lords, I should like to leave my right honourable friend this freedom of action: that this should first of all be introduced administratively so that he can then see how the administration works and subsequently use regulations to ensure that what he thinks are the most desirable methods are given statutory force. I do not want to force the making of regulations before the matter has been sufficiently explored. I think that that is reasonable and I am prepared to go so far as that.

LORD DOUGLAS OF BARLOCH

My Lords, may I have leave of the House to speak again? I can see that there may be a case for a certain amount of experiment, and it may well be that the procedure which would be adopted first of all would require to be altered and improved in the light of experience. That is an argument which, out of a respectable experience, I can appreciate. But I am still disturbed that it should be posed that this should depend entirety on administrative action, because the consequence of that is that a person who is aggrieved by the failure of administrative action has no remedy for that failure. A person who is aggrieved by failure to comply with a statutory regulation no doubt has a legal remedy, but failure of administrative action leaves him in a very difficult position and that failure may have serious consequences.

I can understand that administrators dislike being subjected to statutory regulations. They always wish to be as free as possible. But I do think that in a matter of such vital importance, which affects the liberty of a human being, every possible step ought to be taken to ensure that that person and his relatives know what is being done and what remedy is available to them if they are dissatisfied. I am sorry, but I do not feel that this assurance is entirely satisfactory. I understand all the arguments which have been raised in favour of having a new procedure entirely different from that which has taken place in the past, but whatever may be the validity of all these arguments towards assimilating the treatment of mental illness with the treatment of other illnesses, we have here reached a point where we are not dealing with that but with something entirely different, and that is whether a person shall be subjected to compulsory detention or not and what remedy he can have for it.

THE LORD CHANCELLOR

Is the noble Lord pressing his Amendment?

LORD DOUGLAS OF BARLOCH

It can be negatived but I will not withdraw it.

On Question, Amendment negatived.

Clause 36 [Correspondence of patients]:

LORD TAYLOR

My Lords, there is a series of Amendments dealing with correspondence. The noble and learned Viscount on the Woolsack has, I think, come a long way to meet us in subsequent Amendments and unless he very much wants us to press the Amendment which we have put down I propose not to move it.

6.32 p.m.

THE LORD CHANCELLOR moved, at the start of subsection (2) to insert: "Subject to the provisions of this section". The noble and learned Viscount said: My Lords, as the noble Lord, Lord Taylor, has said, I have put down a series of Amendments to try to meet the views which were expressed with regard to correspondence. These are Amendments Nos. 15, 16, 18 and 20, the first three being paving Amendments for the fourth, which is designed to meet two of the main points raised in Committee on the clause about patients' correspondence. The first object of Amendment No. 20 is to give the Minister power to make regulations adding to the list of persons from whom patients' letters may not be withheld in any circumstances. As I explained during the Committee stage, it will be possible in this way to meet the point of the noble Lord, Lord Silkin, about letters to the patient's solicitor, and perhaps also to make some provision about patients' agents and ministers of religion.

In dealing with solicitors, my right honourable friend would propose to provide in the regulations for the clause not to apply to letters addressed to any person who the patient has informed the hospital authorities is acting as his solicitor. If letters are to be forwarded unopened it will be necessary for the hospital authorities to be notified in this way, since the solicitor may not be identifiable from the address on the envelope. For this reason it would not be enough to add to the persons at present listed in the clause the words "the patient's solicitor", as Lord Silkin's Amendment No. 19 proposes. With regard to "agents", I invited the noble Lord, Lord Silkin, to let me know what types of agent he has in mind. If he makes any suggestions, the Minister will do his utmost to see if words can be found to deal with the point in the regulations. He will also consider the question of letters to ministers of religion, which my noble friend Lord Craigmyle had very much in mind.

The second object of Amendment No. 20 is to give effect to a helpful suggestion made by the noble Lord, Lord Silkin, in Committee. It introduces a new subsection (3) which will, in effect, limit the power to open and examine outgoing letters to cases where the responsible medical officer has reason to think that the patient is likely to send the type of letter which subsection (2) allows to be withheld. This will make it impossible for hospitals to conduct routine censorship of correspondence in other cases. We hope that this will go a long way to meet Lord Silkin's criticisms of this clause, and also of Clause 133 to which the same limitations will automatically apply, as Clause 133 merely applies the provisions of Clause 36. I hope that those who have been interested in the Bill will believe that we have seriously considered their points and, as I believe, have come a considerable way to meet them. I beg to move the first Amendment.

Amendment moved— Page 23, line 37, at beginning insert the said words.—(The Lord Chancellor.)

LORD TAYLOR

My Lords, we thank the Lord Chancellor for the generous way in which he has met us over these Amendments. There is, however, one small point which my noble friend Lord Stonham has asked me to raise. Some six months ago I was invited to address the students at Guy's Hospital, and by a little guile I suggested that my noble friend Lord Stonham might go instead; and he accepted. Now he has gone to Guy's Hospital to address the students and has left me with his Amendments and the points he wished to make. He has noticed, and asked me to draw to your Lordships' attention, the last portion of Amendment No. 20. Would it be in order if I refer to it?

THE LORD CHANCELLOR

Yes.

LORD TAYLOR

It is subsection (3) which says: Nothing in paragraph (b) of subsection (2) of this section shall be construed.… and so on. As my noble friend reads it, and, I must say, as I read it, too, paragraph (b) of subsection (2) consists of the words: to any Member of the Commons House of Parliament, It reads literally as if a patient must be suffering from a mental disorder if he wants to write to his Member of Parliament, because this is the only class singled out. "Either these words admit of this interpretation", says my noble friend, "or they are meaningless. Who wants them? Surely not M.P.s. They appear to me to be offensive, and I hope that we shall not send that subsection back to another place unaltered."

LORD DOUGLAS OF BARLOCH

My Lords, the noble and learned Viscount has gone a long way to meet the difficulties which we saw in the Bill as it was originally drafted. There is one small point to which I should like to refer, arising out of the statement he has made that the regulation will provide for letters to be sent to a solicitor whom the patient has notified to be his solicitor. Not all persons are in the position of already having a solicitor whom they can describe as being their solicitor; and some may know of a solicitor whom they wish to act for them. The regulations ought to be wide enough, I think, to cover the case in which the patient says that he is writing to somebody asking him to act as his solicitor.

THE LORD CHANCELLOR

My Lords, I think the answer to the point raised by the noble Lord, Lord Taylor, is that the reference to paragraph (b) of subsection (2) is to the paragraph (b) created by Amendment No. 16. The noble Lord will see that that is at page 23, line 39, where we leave out from "Office" to "officer" and insert the words which appear in Amendment No. 16. I think it is all right, but I will make quite sure, I will certainly convey to my right honourable friend the Minister the important point which the noble Lord, Lord Douglas of Barloch, has raised. That is a matter which he ought to have in mind in making the regulations.

On Question, Amendment agreed to.

THE LORD CHANCELLOR

My Lords, this is part of the same corpus of Amendments. I beg to move.

Amendment moved—

Page 23, line 39, leave out from ("Office") to ("officer") and insert—

  1. ("(a) if the addressee has given notice in writing to the managers of the hospital or to the responsible medical officer requesting that communications addressed to him by the patient should be withheld; or
  2. (b) if it appears to that").—(The Lord Chancellor.)

On Question, Amendment agreed to.

THE LORD CHANCELLOR

My Lords, this is also part of the same series of Amendments. I beg to move.

Amendment moved—

Page 23, line 43, leave out from ("patient") to ("this") in line 46 and insert— ("Provided that").—(The Lord Chancellor.)

On Question, Amendment agreed to.

LORD SILKIN

My Lords, I think this Amendment has been covered by previous discussion, but perhaps I had better move it formally in order that some of my noble friends may say whether I need to pursue the matter. I beg to move.

Amendment moved—

Page 24, line 8, at end insert—

  1. ("(g) to his solicitor;
  2. (h) to a person of any class or description designated by the Minister").—(Lord Silkin.)

LORD TAYLOR

My Lords, I think it would be fair to say, in view of the previous discussions, that the Lord Chancellor has in fact covered the points raised in this Amendment.

LORD SILKIN

My Lords, I beg leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

THE LORD CHANCELLOR

My Lords, this is the final Amendment of the body that I have just mentioned. I beg to move.

Amendment moved—

Page 24, line 8, at end insert— ("and regulations made by the Minister may except from this subsection, subject to such conditions or limitations (if any) as may be prescribed by the regulations, postal packets addressed to such other classes of person as may be so prescribed. (3) Nothing in paragraph (b) of subsection (2) of this section shall be construed as authorising a responsible medical officer to open or examine the contents of any postal packet unless he is of opinion that the patient is suffering from mental disorder of a kind calculated to lead him to send such communications as are referred to in that paragraph. ".—(The Lord Chancellor.)

On Question, Amendment agreed to.

THE LORD CHANCELLOR

My Lords, I am happy to inform your Lordships that this is merely a drafting Amendment. I beg to move.

Amendment moved— Page 24, line 13, after first ("by") insert ("such").—(The Lord Chancellor.)

On Question, Amendment agreed to.

Clause 39 [Leave of absence from hospital]:

LORD TAYLOR

My Lords, this Amendment seeks to increase the time in which it is possible for a mentally defective patient to be recalled when he is out on licence, from six months to twelve months. This was discussed on a previous occasion. It is designed to encourage medical superintendents to discharge patients early, knowing that they can get them back if things go wrong. On the Committee stage there was considerable discussion about the risks which were run, particularly with young girls who were early discharged, and a number of your Lordships felt that something might be done about this. It is not a matter to which I personally attach immense importance, but I think it would be an improvement if the figures were altered as my noble friend Lord Stonham suggested. It would enable medical superintendents to do their job rather better than they can do it at present or will be able to under the Bill. It is nothing like the present power of recall. I beg to move.

Amendment moved— Page 26, line 22, leave out ("six") and insert ("twelve").—(Lord Taylor.)

THE LORD CHANCELLOR

My Lords, since the Committee stage we have given much consideration to the points that were raised. Your Lordships will remember that my main answer was that Clause 39 does not deal with arrangements for care and after-care, but only with the power of arbitrary recall to hospital. There were certain points raised in the debate to which I gave some reply, but they seemed to me important and I should like to say a word about them. In the OFFICIAL REPORT of Monday, June 29, at column 431, the noble Lord, Lord Stonham, said: If they send such patients"— I think one must put in "subnormal patients"— out on licence at 20½ or 21 and they cannot be recalled after six months, I think they are much more likely not to take the risk and to keep the patients in until the age of 25… I said that within the six months the patient could, of course, be transferred to guardianship and, if necessary, transferred back to hospital later. Such transfers are permissible under the Bill for subnormal and psychopathic patients between the ages of 21 and 25. It is only if the patient is completely discharged from the authority for detention or guardianship that compulsory readmission over the age of 21 is not permitted under Clause 26. Informal admission is, of course, permissible at all ages.

The noble Lord, Lord Taylor, at column 434 said: They are much more likely to get into trouble and to be led astray in this early period of discharge. My noble friend Lord Iddesleigh said in the same column: These people are in considerable moral danger…". The noble Lord, Lord Stonham, said at column 435: …guardianship is no possible substitute for the kind of relationship which has existed between medical superintendents and their patients; it is almost a fatherly relationship. I think it is fair to say that these speakers seem to assume that a patient on leave is under stricter supervision than a patient under guardianship. I am told this is not so. The form of control is very similar. In the case of leave, the hospital, and in the case of guardianship, the guardian (who may be the local health authority) can control where the patient is to live and work and can arrange for him to have the help and advice of social workers. In both cases also the patient can be quickly readmitted to hospital if this becomes necessary. The only difference is that there is no appeal of any sort against recall from leave, whereas transfer from guardianship to hospital carries with it a right of application to a Mental Health Review Tribunal. The hospital authorities are in a no better position than the guardian to protect the patient against getting into trouble, nor to see the first signs of trouble arising which might make return to hospital desirable. On the contrary, unless the patient happens to be living quite near the hospital, in most cases the local authority staff who supervise all patients under guardianship will be nearer to him and from that point of view better placed to help him.

Both the noble Lords, Lord Stonham and Lord Taylor, prayed in aid the authority and support of two medical superintendents. The last thing in the world that I would denigrate, as the noble Lord, Lord Taylor, knows, is in any way their great experience. He knows that they have circularised all Members of Parliament. My right honourable friend has dealt with the arguments in their letters, and they have been replied to in detail. I say only this: that the provisions in the clause follow the recommendations of the Royal Commission, which included one medical superintendent of a mental deficiency hospital and other members with direct experience of the administration of the mental deficiency services both by hospitals and by local authorities. So if we appeal away from argument to authority I have some authority on my side. As the noble Lord sees, I have considered what has been put, because I have quoted what seemed to me the most important points. I am sorry to have to tell him that the arguments the other way appealed to me more, and I thought in fairness I ought to tell him why.

6.51 p.m.

LORD SILKIN

My Lords, I am myself not finally convinced that twelve months is better than six. Indeed, on the argument I suppose that two years would be better than twelve months. But I do not think that the noble and learned Viscount, with all respect, has really addressed himself to the argument. The argument is that a patient may be released unconditionally; he may be released subject to such conditions as the medical officer may make, but he may be released unconditionally, not under guardianship at all. As the Bill stands, whatever may happen to the patient subsequently at the end of six months, that patient cannot be recalled. There is a view that it ought to be possible for the medical officer to recall the patient within twelve months. I should be grateful if the noble and learned Viscount would address himself to that. What is the objection to giving a medical officer the right to recall a patient of the type we are dealing with within twelve months of the patient's being released provisionally? There may be a good argument. I tried to follow the noble and learned Viscount, but I did not understand that he was really addressing himself to that very narrow point.

THE LORD CHANCELLOR

My Lords, I did try to make it clear, and I am sorry if have not succeeded, that Clause 39 does not deal with arrange- ments for care or after-care but only with the power of arbitrary recall. The Royal Commission recommended that the time for an arbitrary recall should be six months and that if a longer period is thought desirable it should be subject to the patient's having a right to go to the Tribunal. That is really our answer: that you ought to have a short period completely arbitrary, when you can say "You can come back to-morrow"; but if you are going to allow a patient out for more than six months, then if you are going to take action he ought to have the right to go to the Tribunal. That is the short answer that appealed to me.

LORD TAYLOR

My Lords, I think a real difficulty arises also, besides the matter raised by the noble Lord, Lord Silkin, over the point when the patient proceeds from hospital care to guardianship. The superintendents of mental defective institutions have had very little experience of this kind of guardianship which we hope to see developing under the Bill, and one hopes that as a result of the local authorities doing their job very much better in the future there may not be any difficulty in the transfer from post-hospital care to guardianship care. If that is achieved, then it will not matter greatly whether it is six months or twelve months or what it is. It is a matter of practical working out and one hopes the thing will be successful in practice; it depends on the efforts of the local authorities. In view of what the noble and learned Viscount the Lord Chancellor says, I beg leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

Clause 40 [Return and readmission of patients absent without leave]:

THE LORD CHANCELLOR

My Lords, this is a drafting Amendment, consequential on the Amendments made in the other place. No. 21B is also a drafting Amendment, as is 21C. The revised wording conforms to the wording of other clauses and imports the provisions of Clause 59 (3). Perhaps your Lordships will allow me to deal with these Amendments together.

Amendment moved— Page 27, line 11, leave out from beginning to ("that") in line 13, and insert ("first day of his absence without leave").—(The Lord Chancellor.)

On Question, Amendment agreed to.

THE LORD CHANCELLOR

My Lords, I beg to move.

Amendment moved— Page 27, line 15, after ("years") insert ("on that day").—(The Lord Chancellor.)

On Question, Amendment agreed to.

THE LORD CHANCELLOR

My Lords, I beg to move.

Amendment moved— Page 27, line 18, leave out from ("as") to end of line 19 and insert ("a psychopathic or subnormal patient").—(The Lord Chancellor.)

On Question, Amendment agreed to.

Clause 47 [Discharge of patients]:

THE LORD CHANCELLOR

My Lords, this Amendment is drafting, as also are Amendments Nos. 23, 24 and 24A. I beg to move.

Amendment moved— Page 33, line 9, after ("is") insert ("liable to be").—(The Lord Chancellor.)

On Question, Amendment agreed to.

Clause 49 [Definition of relative and nearest relative]:

THE LORD CHANCELLOR

My Lords. I beg to move.

Amendment moved— Page 35, line 5, at end add ("and 'court' includes a court in Scotland or Northern Ireland").—(The Lord Chancellor.)

On Question, Amendment agreed to.

Clause 50 [Children and young persons in care of local authority]:

THE LORD CHANCELLOR

My Lords, I beg to move.

Amendment moved— Page 35, line 17, leave out from ("authority") to second ("or").—(The Lord Chancellor.)

On Question, Amendment agreed to.

THE LORD CHANCELLOR

I beg to move this Amendment.

Amendment moved— Page 35, line 29, leave out from ("shall") to end of line 30 and insert ("be deemed to be the nearest relative of the patient in preference to any person except the patient's husband or wife (if any) and except, in a case where the said rights and powers are vested in a local authority by virtue of subsection (2) of the said section three, any parent of the patient not being the person on whose account the resolution mentioned in that subsection was passed").—(The Lord Chancellor.)

On Question, Amendment agreed to.

THE LORD CHANCELLOR

My Lords, I beg to move that the debate on the Report stage be adjourned.

Moved, That the debate on the Report stage be adjourned.—(The—Lord Chancellor.)

On Question, Motion agreed to, and debate adjourned accordingly.