HL Deb 13 July 1959 vol 217 cc1091-120

6.53 p.m.

Further considered on Report (according to Order).

Clause 54 [Duty of mental welfare officer to make application for admission or guardianship]:

LORD STONHAM moved in subsection (1), to leave out "regard to any wishes expressed by" and insert: taken all reasonably practicable steps to ascertain the wishes of the". The noble Lord said: My Lords, under the clause as it now stands it would be possible for a patient to be compulsorily admitted on the application of the welfare officer and without the knowledge of the nearest relative, because in the present words of the clause there is no obligation on the officer to take stops to inform the relative, nor is he obliged to ascertain the relative's wishes. The only duty which is laid on the officer in this regard is in the general provisions in Clause 27, but that duty, I submit, is a negative one, because the onus is laid on the relative. The relative is obliged, under that clause, to make his wishes known to the officer. I submit that this is wholly wrong. We all know the circumstances in which mentally retarded or mentally afflicted people may come under the notice of the officer, and we know that in many cases the relatives are not in any way sure of their rights, or of how to express them, or to whom they should go for advice—and, indeed, in many cases the patient will not be living with his or her relatives. Therefore, under the clause as it now stands it is not merely possible but is very likely that an application will be made by a welfare officer and the patient will be in hospital and the relatives not know anything about it.

It must be borne in mind also that in many cases the patient cannot, for various reasons, inform his relatives himself of what is likely to take place. I would submit that this will give rise unquestionably to some of the evils that we are trying to avoid, some of the things that have happened in the past and which we are trying expressly by this Bill to avoid happening in the future. In my Amendment I am suggesting the employment of the words "reasonably practicable"—that is to say, that the welfare officer is to take such steps as are reasonably practicable to inform the relatives. Those words are exactly the same words as are used in Clause 27, and I would submit that they are surely applicable here.

In Committee, the noble and learned Viscount who sits on the Woolsack admitted on this point that this subsection assumed that the relatives had already expressed a view; that they knew about it; that they had already been informed. But he will agree that many cases must arise where they have had no opportunity to express a view because they have not known anything about it. I appreciate the concern that is felt with regard to emergency cases, and that it is necessary to protect the position of the welfare officer when emergency cases arise, because he must act quickly: but I submit that the wording that I suggest will protect him. It will not stop him from taking action in emergency cases, because it would be reasonable for him to take action to make the application in an emergency without consulting the relatives if they were not accessible, or were not reasonably accessible. But I think we must, nevertheless, impose on the welfare officer the duty of consulting relatives whenever it is reasonably practicable for him to do so. I beg to move.

Amendment moved— Page 38, line 46, leave out ("regard to any wishes expressed by") and insert ("taken all reasonably practicable steps to ascertain the wishes of the").—(Lord Stonham.)


My Lords, I think that this Amendment to Clause 54 arises from a slight confusion as to what is done under Clause 27 and under this clause. I am sorry if I shall take up a little time, but it is very important that the point should be made clear. The circumstances in which applications may be made, and the persons who may make them, are governed by Clauses 25 to 29 and, for guardianship, Clause 33. Clauses 25, 26, 29 and 33 allow applications to be made either by a mental welfare officer or by the patient's nearest relative—or, in emergency cases under Clause 29, by any relative.

Consultation between the mental welfare officer and the nearest relative in cases where the mental welfare officer proposes to make an application is dealt with in Clause 27. Subsection (2) of that clause provides that a mental welfare officer may not make an application for admission for treatment under Clause 26 if the nearest relative has notified him, or the local authority by whom he is appointed, that he, the nearest relative, objects to the application being made. It also lays on the mental welfare officer a duty to consult the nearest relative before making an application unless the officer considers that such consultation is not reasonably practicable or would involve unreasonable delay. All this applies to applications to be made under Clause 26 and also, by virtue of Clause 33 (5), to applications for guardianship. It does not apply to applications for admission for observation under Clause 25 or to emergency applications for observation under Clause 29. Therefore it is Clause 27 which deals with the extent of the mental welfare officer's duty to ascertain the views of the nearest relative on the question whether the patient should be admitted or not.

Clause 54 deals with a different point. The Bill as originally introduced was criticised on the grounds that the power to make applications given by Clauses 25 to 29 and 33 to the mental welfare officer and the nearest relative was permissive only. No duty was laid on the mental welfare officer to make an application even in cases where the officer is satisfied that an application ought to be made. Such a duty exists under the present law. It was therefore agreed, while the Bill was in another place, that a similar duty should be imposed by the Bill, and Clause 54 was therefore inserted.

If the noble Lord will look at subsection (1) of Clause 54 he will see that it describes the circumstances in which the duty is imposed. First, the mental welfare officer must be satisfied that such an application ought to be made—that is, he must be satisfied that all the conditions laid down under Clauses 25 to 29 or 33 are fulfilled. This, of course, includes his being satisfied that the conditions laid down in Clause 27 have been fulfilled. Subsection (2) of Clause 54 specifically refers to the duty laid on him by Clause 27 (2) to consult the nearest relative when an application under Clause 26 or 33 is proposed and which precludes him from making such an application against the known wishes of the nearest relative. Clause 54, therefore, neither adds to nor detracts from the duty of consultation 'imposed by Clause 27. Secondly, the last three lines of Clause 54 (1) limit the duty on the mental welfare officer to make the application to cases where, having been satisfied that the application ought to be made, he is also of the opinion that it is necessary or proper for the application to be made by him rather than by the nearest relative, or under Clause 29 by any relative.


My Lords, if the noble and learned Viscount will allow me to interrupt, may I say that I do not think that there is much point of difference between us. I know that the duty is laid on the mental welfare officer to satisfy himself that an application should be made, that he must consult the relatives and that, if they oppose, unless the opposition is unreasonable, he cannot then apply for an order. I cannot see anything in Clause 27 or in Clause 54 which indicates that if the relatives are unaware of the position then the mental welfare officer has to take reasonable steps to consult them.


My Lords, the point I was making is that this is really a matter to be dealt with under Clause 27. The difficulty is that under Clause 54 he should make the application himself. In forming this opinion, he is required to have regard to any wishes expressed by the patient's relatives or any other relevant circumstances. These "wishes expressed by relatives" relate only to the question of who should make the application. They do not deal with the question of whether the application ought to be made at all, as this is covered by Clause 27. The purpose of this reference to the relatives' wishes in Clause 54 is to make sure that the mental welfare officer is not to be obliged to make the application in cases where the nearest relative would prefer to make it himself. In many, if not most, cases the relative is likely to prefer the welfare officer to sign the application.

The Bill as brought from another place used the expression in Clause 54 "having regard to the wishes of any relatives of the patient". It was felt that these words might be interpreted as laying on the mental welfare officer a duty to consult the nearest relative over and above that already imposed by Clause 27, and that it might be held that such consultation was required in all cases, even in emergency cases under Clause 29. It was for this reason that I moved my Amendment in Committee to change the words to "any wishes expressed by relatives" and to add the words in lines 7 and 8 on page 39 after the word "Act".

I am very conscious that I did not give this explanation on Committee stage. I hope that the noble Lord, Lord Stonham, will forgive me. I said a great many other things on Committee stage; but I did not really have the history of this matter in my mind. The noble Lord will appreciate that, whether he thinks Clause 27 ought to have gone further or not, this is really an independent point which comes up in a separate form, and I have not been cutting into the point in the noble Lord's Amendment by dealing with the question of who should make the application. When the noble Lord has read what I have had to say—because it is bound to be technical—I hope he will be satisfied: if not, I shall be pleased to deal with it again, if he will send me a letter.


My Lords, I am grateful to the noble and learned Viscount the Lord Chancellor for his explanation and for the detailed manner in which he has dealt with the question. The crux of the matter so far as I am concerned is that Clause 27 apparently lays the duty on the mental welfare officer, and Clause 54 determines by whom the application shall be made. I most certainly accept the noble and learned Viscount's invitation to study his remarks. I am quite sure that they will cover my point, but if not I will write to him. Meanwhile, I beg your Lordships' permission to withdraw the Amendment.

Amendment, by leave, withdrawn.

Clause 56 [Regulations for purposes of Part IV]:


My Lords, Amendment No. 25A is a drafting Amendment consequential on earlier Amendments to this Clause. No. 25B is also drafting and enables a juvenile court to make a hospital or guardianship order in respect of a child or young person in certain circumstances. Nos. 25BA and 25BB are also drafting. No. 25BBA deals with a point which is also dealt with by other Amendments to Clauses 71, 72, 74, 79 and 80. Which are designed to clarify the provisions for equating the Secretary of State's directions removing persons into hospital or guardianship with hospital orders or guardianships orders as the case may be, and his directions restricting discharge with orders restricting discharge. Nos. 25BC, 25BCA, 25BCB and 25BCC are all drafting. I think that I should say a word about 25C when I come to it. Unless your Lordships have any difficulty in the matter, I think perhaps we might in the interests of economy of time put Amendments 25A to 25BCC together I beg to move.

Amendments moved—

Page 40, line 13, leave out from ("any") to ("this") in line 14 and insert ("application, notice or report the service of which is regulated under paragraph (b) of")

Clause 61, page 44, line 4, after ("are") insert ("so far as applicable")

Clause 62, page 44, line 33, leave out from ("practitioner") to ("may") in line 34.

Clause 63, page 45, line 21, after ("directed") insert ("to do so")

Clause 63, page 46, line 20, leave out from ("application") to ("by") in line 21 and insert ("hospital order or guardianship order")

Clause 66, page 49, line 1, leave out from ("shall") to ("is") in line 2 and insert ("not in any event expire until the patient returns to the hospital or")

Clause 68, page 51, line 20, leave out ("Sections sixty-three and") and insert ("Subsection (1) of section sixty-three and section")

Clause 68, line 23, leave out from ("in) to ("were") in line 24 and insert ("the said subsection (1)")

Clause 68, line 28, leave out from beginning to end of line 30.—(The Lord Chancellor.)

On Question, Amendments agreed to.

Clause 70 [Appeals from magistrates' courts]:

THE LORD CHANCELLOR moved to add to the clause:

Page 52, line 30, at end insert— ("(4) Section two of the Summary Jurisdiction (Appeals) Act, 1933 (which relates to legal aid) shall with the necessary modifications apply in relation to an appeal against a hospital order or guardianship order made by a magistrates' court (whether or not brought under this section) as it applies in relation to an appeal against sentence.")

The noble and learned Viscount said: My Lords, I mention this Amendment particularly because its object is to make clear that the provisions relating to legal aid for persons who appeal to quarter sessions against sentence imposed by a magistrates' court apply also to people who appeal against a hospital order or a guardianship order. I beg to move.

Amendment moved—

Page 52, line 30, at end insert the said subseetion.—(The Lord Chancellor.)

On Question, Amendment agreed to.

Clause 71 [Persons ordered to be kept in custody during Her Majesty's pleasure]:

THE LORD CHANCELLOR moved, at the beginning of subsection (1) to insert Where under any enactment to which this subsection applies any person is ordered to be kept in custody during Her Majesty's pleasure, that person shall, until detained in pursuance of any directions under subsection (2) of this section, be detained in such place of safety as the court may order, and the order shall be sufficient authority for his conveyance to that place. (2)".

The noble and learned Viscount said: My Lords, this Amendment and the following Amendments, 25E, 25F, 25G, 25H, 251, 25J, are related. Clause 71 deals with the Secretary of State's power to make a direction authorising removal to and detention in a hospital in a case in which a person has been ordered to be detained during Her Majesty's pleasure, having been found guilty but insane or insane on arraignment.

The Amendments are designed to meet a point recently raised by my noble and learned friend Lord Denning. Lord Denning drew attention to a case in which a man who was a patient on licence from an institution for mental defectives was charged with an offence and subsequently found by the court to be insane on arraignment. It was extremely likely that the Secretary of State would order that the defective be sent back to the hospital in which he had previously been a patient and to which he had been recalled to await trial, and the court considered it unfortunate that, as a result of being found unfit to plead and being ordered to be detained until Her Majesty's pleasure be known, the defective should have to await the Secretary of State's decision in prison instead of being returned direct from the court to the hospital. When my noble and learned friend brought that point to my attention I thought it was one I ought to deal with, and I put down the series of Amendments which I have mentioned in order to deal with it. I beg to move.

Amendment moved—

Page 52, line 31, at beginning insert the said subsection.—(The Lord Chancellor.)


My Lords, I should like to ask one question. Does it apply also to insane as well as to mental defectives?


Yes, I understand that is so. If the noble Lord will look at the Amendment he will see the words …under any enactment to which this subsection applies any person ordered to be kept in custody during Her Majesty's pleasure, that person shall… I certainly thought it was general, but I will verify that for the noble Lord and let him know.


It is a very substantial advance if it is general. I greatly welcome this change because it will be an excellent thing that these patients are not sent to prison.


The noble Lord may have noticed that by a kind of telepathy I am confirmed in my view that it is general. If there are any second thoughts I will write to him but it is extremely unlikely.

On Question, Amendment agreed to.

Amendments moved—

Page 52, line 32, leave out ("section") and insert ("subsection")

Page 52, line 35, leave out ("removed to and")

Page 52, line 36, at end insert ("and where that person is not already detained in the hospital give directions for his removal there")

Page 52, line 37, after ("which") insert ("subsection (1) of")

Page 52, line 39, after ("1883") insert ("and")

Page 52, line 40, after ("1907") insert ("and the enactments to which subsection (2) of this section applies are the aforementioned enactments and")—(The Lord Chancellor.)

On Question, Amendments agreed to.

7.16 p.m.


My Lords, this is a drafting Amendment consequential on the Amendments to Clause 71; and Amendments 25K to 25L deal with another point which is little more than drafting. The object of the Amendments is to make it clear that when the Secretary of State remits a patient to prison or remand centre under this clause the original direction under which he was sent to hospital is spent and so ceases to have effect. Amendments 25KA and KB are also consequential drafting. 25M is also drafting as are Amendments 25N, 25O, 25P, 25Q, 25QA, 25R and 25RA. If your Lordships will allow me, I will move that the other Amendments under the letters and numbers 25 be now agreed to.

Amendments moved—

Page 53, line 3, leave out from ("and") to end of line 7 and insert ("where such a direction is given in respect of a person while he is in the hospital, he shall be deemed to be admitted in pursuance of and on the date of the direction")

Page 53, line 16, at end add ("and on his arrival at the prison or remand centre the direction under this section shall cease to have effect")

Clause 72, page 53, line 40, leave out from ("case") to end of line 44.

Clause 74, page 55, line 34, leave out from ("sixty-five") to end of line 45.

Clause 76, page 57, line 14, at end insert ("and on his arrival at the place to which he is so remitted the transfer direction shall cease to have effect")

Clause 76, page 57, line 15, leave out ("such direction having been given") and insert ("direction having been given under paragraph (a) of this subsection")

Clause 77, page 58, line 21, leave out from ("Act") to ("and") in line 23.

Clause 77, page 58, line 23, leave out ("the said Part IV") and insert ("this Act")

Clause 78, page 58, line 35, leave out from ("Act") to ("and") in line 37.

Clause 78, page 58, line 37, leave out ("the said Part IV") and insert ("this Act")

Clause 79, page 59, line 16, leave out from ("case") to end of line 18.

Clause 80, page 60, line 9, at end insert— ("(3) Where a patient who is liable to be detained in a hospital in pursuance of an order or direction under this Part of this Act is treated by virtue of any provision of this Part of this Act as if he had been admitted to the hospital in pursuance of a subsequent order or direction under this Part of this Act or a subsequent application for admission for treatment under Part IV thereof, he shall be treated as if the subsequent order, direction or application had described him as suffering from the form or forms of mental disorder specified in the earlier order or direction")

Clause 80, page 60, line 9, at end insert— ("(3) In the following provisions of this Part of this Act, that is to say—

any reference to a hospital order, a guardianship order or an order restricting the discharge of a patient subject to a hospital order shall be construed as including a reference to any order or direction under this Part of this Act having the like effect as the first-mentioned order; and the exceptions and modifications set out in the Third Schedule to this Act in respect of the provisions of Part IV of this Act described in that Schedule accordingly include those which are consequential on the provisions of this subsection")—(The Lord Chancellor.)

On Question, Amendments agreed to.


My Lords, this is a drafting Amendment consequential on Amendments to Clause 46 made in Committee. Amendment 26A is also drafting. I beg to move these Amendments.

Amendments moved—

Clause 93, page 69, line 40, after ("Act") insert ("or under the said section forty as applied by section forty-six of this Act")

Clause 96, page 70, line 44, at end insert— ("2) Where a patient is treated by virtue of this Part of this Act as if he had been removed to a hospital in England and Wales in pursuance of a direction under Part V of this Act, that direction shall be deemed to have been given on the date of his reception into the hospital.")—(The Lord Chancellor.)

On Question, Amendments agreed to.

Clause 103 [Particular powers as to patient's property and affairs]:

THE LORD CHANCELLOR moved in subsection (4) after the second "made" to insert: "or that there has been any substantial change in circumstances". The noble and learned Viscount said: My Lords, this Amendment is designed to ensure that the court's power to vary a settlement shall continue to be as wide as it is now under Section 171 (7) of the Law of Property Act, 1925—namely, that a settlement made under that section may be varied where the court is satisfied either that any material fact was not disclosed at the time that the settlement was made or on account of any substantial change in circumstances.

Your Lordships will appreciate that Section 171 will be repealed by the Bill in toto; and it was thought when the Bill was prepared that in justice to interested third parties the power to vary sentence should be kept as narrow as possible, with the result that subsection (4) of Clause 103 of the Bill as it now stands limits the power to vary to cases where there has been non-disclosure of a material fact. On consideration, however, we thought that we ought to take a different course. We thought originally that the court would write into the settlement the appropriate provision for variation, if any were likely to be needed, but it now appears to me that a number of settlements made by the Judges in Lunacy under Section 171 have con- tained no express power to vary in reliance on the court's statutory power. They relied on Section 171 being there; they did not put in a power to vary. Obviously there will be some settlements where it is necessary to have the power to vary on the grounds that I have mentioned, and I think it is fairer on the people who own the property that that provision should be there. I beg to move.

Amendment moved—

Page 74, line 33, after ("made") insert the said words.—(The Lord Chancellor.)

On Question, Amendment agreed to.

Clause 124 [Rules as to procedure]:

LORD STONHAM moved, in subsection (1), after "may" to insert "from time to time". The noble Lord said:

My Lords, my noble friend Lord Silkin has had to leave and has asked me if I would move the Amendment which stands in his name and my name on the Marshalled List. I would suggest to the noble and learned Viscount on the Woolsack, if he does not think it presumptuous on my part, that in the interests of economy of time it might be convenient if we discussed Amendments Nos. 28 down to 29F in one discussion, which, so far as I am concerned, will be quite short.




We seek to insert here the words "from time to time" because we feel that it would be necessary for these regulations——


Perhaps I can interrupt the noble Lord to say this. Under Section 32 (1) of the Interpretation Act, 1889, it is provided that: Where an Act …confers a power or imposes a duty, then, unless the contrary intention appears, the power may be exercised and the duty shall be performed from time to time as occasion requires The contrary does not appear here. I am glad the noble Lord has raised this point, because it enables me to give that assurance that I will keep the working of the Tribunals under review and make any amendments and additions to the rules as prove necessary, and they will go to the Council of Tribunals. So I shall have the advantage of my noble friend Lord Reading and his Council, who will not only make their own suggestions but will pass on any complaints that come from the people who have found the Tribunals not working. I thought the noble Lord would not mind my interrupting, as it is a point that is covered by an obscure Victorian statutory provision.


I am grateful to the Lord Chancellor. I was going to suggest that he should interrupt, and I am now going to suggest that after a few more sentences he may think it right to interrupt me again. He will remember that in Committee I pointed out that Clause 62 (3) provided that when an accused person is brought before the court a copy of the medical report is to be handed to his solicitor or to the accused person or his parent or guardian; also, that the doctor can be required to give oral evidence, and that evidence on behalf of the accused may be given in rebuttal. I ventured to suggest then that these rights which were accorded to an accused person ought to be similarly enjoyed by a person against whom no offence is charged. My question now—and I hope the noble and learned Viscount will interrupt me if it is not right—is: Is it the view of the Lord Chancellor that his Amendment, No 29B, would confer those rights on a person who was not an accused person?




I am obliged. That covers that point. There is one remaining point that I have, and that is the Amendment at page 84, line 26, to leave out "if not desiring to appear in person". It will be recalled that when I raised this point in Committee it was because the original wording made it appear to me that the applicant had the alternative either of appearing himself and conducting his own defence or of not appearing himself but allowing someone else to conduct his case on his behalf. I therefore propose to delete these words, "if not desiring to appear in person", so as to make it absolutely clear that an applicant can have a third alternative of appearing with a relative or friend who will help him to present his case to the tribunal—that is, that two of them can appear together. This, as I say, would give three opportunities: first, for the applicant to appear in person alone; secondly, for the applicant not to appear but to be represented by someone else, a solicitor or counsel; and thirdly, to appear but also to have a friend or relative with him.

That last practice is exactly in accord with what happens before the pensions appeal tribunals, which, incidentally, deal with many cases of pensionable neurosis or applications for pensions on that ground and which, in my submission, have proved eminently satisfactory. We do not want anything approaching a court of law, but I should be happy if I could feel that we were to have something like the pensions tribunals, which means that a friend or relative can go with the applicant. All the papers will have been seen beforehand, and it is likely to excite less fear and less apprehension in the mind of the patient than almost any other method of which I can think. If that is what the Lord Chancellor's Amendment No. 29A means and is intended to provide, then I am quite happy. I beg to move.

Amendment moved—

Page 84, line 1, after ("may") insert the said words.—(Lord Stonham)


My Lords, I have tried to meet the point that the noble Lord, Lord Stonham, raised. As he will remember, there was some slight difficulty about the words "appearing in person" and "being represented" in the technical senses in which they are normally used, and we could not provide for both the applicant and his representative to conduct the case. But we think it will help to meet the point if the words "conduct their own case" are substituted for "appear in person". That was to try to meet the noble Lord, Lord Stonham, in order to make clear what is intended. But the point the noble Lord has raised to-day, that the applicant who appears in person might want to be assisted informally by a friend, can be done no doubt by the rules. I have every sympathy with this. Like the noble Lord, Lord Stonham, I have had a certain amount of experience of the tribunals mentioned—not only in my present office, but in my early days at the Bar and as President of a branch of the British Legion—and I am in full sympathy with the point. I assure him that it can be done, and I shall provide for it myself.

I think I have tried to meet the point; at any rate I do not think that anything fell from the noble Lord, Lord Stonham, with which I had any reason to disagree. The Amendments I have put down, Nos. 29A to 29F, deal with the points which either the noble Lord, Lord Stonham, or the noble Lord, Lord Silkin, raised on the Committee stage. I have tried to advance in the direction wished for by Lord Stonham and I hope he will feel that his points have been met. Perhaps it will be convenient for him to indicate that he will not press his Amendment, and I will move mine.


My Lords, I am completely satisfied with the answer given by the Lord Chancellor, and I am most grateful to him. I beg leave to withdraw the Amendment.

Amendment, by leave, withdrawn.


My Lords, I shall not repeat the explanation I have given, but with your Lordships' permission I will move Amendments Nos. 28A, 29A, 29B, 29C, 29D, 29E and 29F. I understand that the noble Lord, Lord Stonham, will not move Amendment No. 29. I beg to move.

Amendments moved—

Page 84, line 18, at the end insert— ("(c) for enabling a tribunal to dispose of an application without a formal hearing where such a hearing is not requested by the applicant or it appears to the tribunal that such a hearing would be detrimental to the health of the patient;")

Page 84, line 27, leave out from ("to") to end of line 28 and insert ("conduct their own case, be represented for the purposes of those applications;")

Page 84, line 29, at beginning insert ("for regulating the methods by which information relevant to an application may be obtained by or furnished to the tribunal, and in particular")

Page 84, line 31, leave out ("to the tribunal")

Page 84, line 35, leave out from ("of") to ("except") in line 36 and insert ("any documents obtained by or furnished to the tribunal in connection with the application, and a statement of the substance of any oral information so obtained or furnished")

Page 84, line 39, after ("tribunal") insert ("if so requested in accordance with the rules")

Page 85, line 1, transfer paragraph (h) to page 84, line 15 as paragraph (b).—(The Lord Chancellor.)

On Question, Amendments agreed to.

Clause 129 [Assisting patients to absent themselves without leave, etc.]:


My Lords, this again is a consequential drafting Amendment. I beg to move.

Amendment moved—

Page 88, line 18, leave out subsection (4)—(The Lord Chancellor.)

On Question, Amendment agreed to.

THE LORD CHANCELLOR moved, after Clause 131 to insert the following new clause:

Notification of hospitals having arrangements for reception of urgent cases

". It shall be the duty of every Regional Hospital Board to give notice to every local health authority for an area wholly or partly comprised within the area of the Board specifying the hospital or hospitals administered by the Board in which arrangements are from time to time in force for the reception, in case of special urgency, of patients requiring treatment for mental disorder."

The noble and learned Viscount said: My Lords, this Amendment is the best solution which we could find to the point raised in Committee by Amendments to Part IV of the Bill, tabled by my noble friend Lord Milverton and the noble Lords, Lord Taylor and Lord Stonham. This Amendment will ensure that local health authorities know which hospitals in their area are prepared to accept patients at short notice, or even without notice in cases of acute emergency. That was the point which was stressed by my noble friend Lord Milverton, and also by the noble Lord, Lord Burden, as your Lordships will find in the OFFICIAL REPORT for June 29, cols 402 to 407.

The Amendment will in effect require Regional Hospital Boards to notify local health authorities which hospitals have what one might call "psychiatric casualty beds" ready to admit any patient in a real emergency of the sort described by the noble Lords, Lord Milverton and Lord Burden. The information will of course also be given to general practitioners who may arrange an emergency admission, with the agreement of the relatives, without calling in a mental welfare officer. I discussed these points on the Committee stage, and I do not want to go into them again. We have considered this matter very carefully, and I assure noble Lords that we have gone as far as we think we can go. I beg to move.

Amendment moved—

Page 89, line 1, at end insert the said clause.—(The Lord Chancellor.)


My Lords, in welcoming this Amendment I should like to take this opportunity of expressing our gratitude to the noble and learned Viscount for the courtesy and consideration which he gave to the proposals we made and the point we tried to make. As he has very generously given us the essence of what we have required, I quite appreciate the reasons why he finds it undesirable to go any further. I take this opportunity of saying how grateful we are.


My Lords, may I also welcome this Amendment? There is one very small point arising on it. The Lord Chancellor said that general practitioners would be notified of the hospitals having these emergency beds. One wonders whether the words, "and the local executive council" after the words "local health officer" in line 2, might possibly have been considered, because the local executive councils are frequently in touch with the general practitioners. They are the bodies who employ general practitioners. Would it be appropriate to notify them as well as the local authority, so that they in turn would automatically inform general practitioners? So long as general practitioners get the information, that is all that matters.


They will certainly get the information, but I should like to look into that point. I must say frankly that I have not considered it, but if it is of great importance I am sure the House would allow me to put down an Amendment. The noble Lord may take it that general practitioners will in any case be informed.

On Question, Amendment agreed to.


My Lords, Amendments Nos. 32 to 35 inclusive are all consequential drafting and, therefore, with your Lordships' permission, I will move them all together. I beg to move.

Amendments moved—

Clause 132, page 89, line 13, leave out from beginning to end of line 14 and insert ("In the application of this section to Scotland").

Clause 137, page 92, leave out line 36.

Clause 138, page 93, line 9, leave out subsection (4).

Clause 140, page 94, line 39, leave out from beginning to ("references") in line 1 on page 95 and insert ("In this section").—(The Lord Chancellor.)

On Question, Amendments agreed to.

7.35 p.m.

LORD TAYLOR moved, after Clause 143 to insert the following new clause:


". The Minister may undertake, or cause to be undertaken, research into the nature, causes and treatment of mental disorder, as defined in this Act."

The noble Lord said: My Lords, I beg to move the new clause standing in my name and the name of my noble friend Lord Pakenham. It will be seen that this is an abbreviated version of the clause which my noble friend and I moved in Committee. My noble friend then said that he hoped the Lord Chancellor would see no objection to our returning to the subject quite briefly on Report. On the previous occasion, the Lord Chancellor properly pointed out to me that the point of the clause is, in fact, covered by the Schedules to the Bill, and I move the Amendment only to emphasise our great interest in the encouragement of research in mental health, and to spur the Government on to do even better than they are already starting to do well.

May I speak for one moment about money? Between 1956 and 1958 the Medical Research Council spent approximately £7 million on medical research. Of this, less than one-sixtieth was spent on research into mental disorders. A few years before this the situation was so bad that a group of public-spirited individuals and a number of research psychiatrists set up a body of which the noble Earl, Lord Feversham, is, I think, the senior patron—the Mental Health Research Fund—and I have the honour to serve on its Research Committee. In the four years 1954 to 1958, the Mental Health Research Fund expended as a voluntary body nearly as much on psychiatric research as the Medical Research Council. By contrast, in America the National Institute of Mental Health is now spending 14 million dollars a year on research into mental disorders, and their total research budget in this area, including both Federal and State, is of the order of £10 million a year. It is not surprising that there has been some flow of research workers from this country to the United States.

We are indeed pleased to note that there has been a change of heart on the part of the Government and on the part of the Medical Research Council. Two new research committees, one under Sir George Pickering and the other under Dr. Aubrey Lewis, have recently been set up and, even more important, two new research units, one under Dr. Slater and the other under Dr. Morris Carstairs, dealing with genetics, psychiatry and epidemiology have recently been started. I greatly welcome this step. I cannot think of better people who could have been chosen. The expenditure will be of the order of £20,000 a year. That is about what the Medical Research Council spends on each of its research units. I would say that the total expenditure on psychiatric research is still grossly under 1 per cent. of the expenditure on mental hospital care of patients—possibly only about 1 of one per cent.

The smallness of Government expenditure on psychiatric research appears to arise from three reasons: first, the fundamental philosophy of the Medical Research Council. That philosophy has been always to back men rather than projects. There is much to be said for this view. They pick a good man, build a research unit round him and tell him to get on with it. But that is only half the story. In industry and in atomic research things usually go the other way round. The project is decided upon and the men sought to run it. That is precisely what the Americans are doing in the sphere of medical research, and particularly in the sphere of biochemical and electrical psychiatry. It is increasingly being found that the technique of finding a project and financing it and then finding the workers is, in fact, successful. Demand for scientists creates supply. We want the Medical Research Council and those who have charge of money for research to start thinking much more on those lines.

The second factor is the great difficulty which the psychiatric research worker who has done, say, three years on research usually finds in getting a permanent or career post. It is easy enough to get finance for the initial period of research; one can get a grant of £1,200 or £1,500 a year for two or three years and start off a project, but at the end of that time there is a blank wall: there are no further vacancies in the research world, or very rarely, and the result is that excellent young psychiatric research workers have to go to America or become clinical psychiatrists in the National Health Service. They earn a good income and keep their families all right, but they have no time whatever for research. Even our teaching professors now spend much of their time on routine clinical out-patient psychiatry because they cannot get senior research posts from the University Grants Committee or the Medical Research Council. There seems to be unwillingness on the part of the Medical Research Council to finance what in America are called "Associate Professorships" to work alongside, and with similar salaries to, clinical teacher professors, but devoting their whole time to research. The official answer is that the Medical Research Council sets up its units. It is doing so, but there are far too few, and often they are too late.

The final thing that inhibits psychiatric research in this country is that the research workers on the Medical Research Council are de factocivil servants. Doctors working for Regional Boards and local executive councils are under the Third and Fifth Schedules to the National Health Service Act allowed to sit and vote in the House of Commons. This greatest civil liberty is preserved for members of the great profession which has been virtually socialised. This right is actually exercised by one consulting psychiatrist who sits on the Conservative Benches in another place. My noble friend Lord Amulree is a consultant employed by Regional Hospital Boards. He is not in the least inhibited from discussing his own particular subject, geriatrics, or any aspect of the National Health Service in this House. But were I a research worker I doubt whether I should be able to make this particular speech, any more than I am able to make a speech on the new towns. Recently a member of a research unit of the Medical Research Council desired to become a J.P., particularly as he was a worker in a sphere closely touching the social aspects of medicine; but he had to go cap in hand to a Civil Service official of the Medical Research Council and was cross-examined on his political affiliations to get permission before he could do this. This is unthinkable with any clinician employed in medicine, and it is entirely wrong. It is not a matter of evil intent but something which has grown up over the years, something which we very much hope will be speedily put right, so that the research workers in the Medical Research Council may in fact enjoy full civil liberties.

I will say very little more about this. Mental health research is immensely difficult. The mind and brain are far the hardest organs to study. We have to use very inferential techniques, very difficult histological biochemical techniques. The sphere where I work, social psychiatry, is the easiest of all, using techniques of sampling and field investigation. But even here there are many difficulties. We are eager to press on, but we desperately need more research workers. The people are there; the men and women are waiting. But there is no money to employ them. Our achievement will be precisely proportional to the Government's generosity. We ask for help not only in the name of folk suffering from mental illness of all kinds, but because the Government should also bear in mind that any help given to psychiatric research will bear dividends, we hope, in the short and long term reduction in the amount of cost of the National Health Service in caring for the mentally ill. I beg to move.

Amendment moved—

After Clause 143 insert the said new clause.—(Lord Taylor.)

7.47 p.m.


My Lords, I feel that I must support the noble Lord, Lord Taylor, who has moved this Amendment which stands in my name as well as the name of the noble Lord, Lord Pakenham. Your Lordships' House will remember that when we reached this Amendment on the Committee stage the noble and learned Viscount the Lord Chancellor suggested that at a later stage we might have a fuller discussion of this Amendment, in view of the fact that such a discussion would provide paving stones for my right honourable friend the Minister of Health and, indeed, the Lord President of the Council in consideration of the importance of research and of some of the arguments that have so lucidly been put forward by the noble Lord, Lord Taylor. I could not agree more with Lord Taylor's view that we regard this matter of research as most important. I put that forward as my excuse for detaining your Lordships longer than I would otherwise intend to do.

I think that all will agree that one of the most impressive conclusions that may be drawn from the debates on this Bill is that mental disorder is probably the most tremendous scourge in the country to-day. One could well assume that the biggest single cause of illness would in this country, as elsewhere, command the largest resources both in money and manpower. But, as the noble Lord, Lord Taylor, has pointed out, neither is the case. I think it is necessary, if this matter is going to be reviewed in the light in which it should be reviewed, to remind your Lordships that the Younghusband Committee quoted an estimate that 2 million mentally disordered patients are cared for by general practitioners. Eighty million man-days are lost to industry every year through absenteeism caused by psycho-neurosis. I think the interesting point about that estimate is that on average this is twenty times more than the man-days lost to industry through strikes.

Another major point is that hospital care for the mentally disordered, sickness benefits and the loss of production are estimated to cost together some £200 million a year. The biggest single cause of illness and, I think, of unhappiness and disruption is undoubtedly due to mental disorder, and I doubt whether there is to-day anything that we know so little about. Yet how much do we spend on research? The noble Lord, Lord Taylor, has already given us some figures which largely correspond to my own. We know that in 1958 the Medical Research Council spent £63,000 on mental health, and from the Exchequer the Medical Research Council spent last year £130,000, which is another way of putting Lord Taylor's figure of 4 to 4½ per cent. of their total grant.

How do the Research Council spend this £130,000? I have here the projects sponsored by the Medical Research Council in the sphere of mental health. They make a formidable and lengthy list, and I have no intention of going through them. They were provided by my right honourable friend the Minister of Health in another place. It is an impressive list comprising many diverse and vital investigations. These projects number 31, and when that total is divided into the Exchequer grant spent by the Research Council, the answer is that the Council who sponsor these projects are spending on an average on each of them less than £4,000. I share the view of the noble Lord, Lord Taylor, that the new units which the noble and learned Viscount announced previously—one on the epidemiology of mental disorders and the other on psychiatric genetics—are a most valuable new addition. But I should like to ask the noble and learned Viscount whether they also will share the total that I have mentioned or will be given a separate or additional grant of funds.

I am pursuing this matter in some detail because I was not at all satisfied with the reply (admittedly it was not a full reply) of the noble and learned Viscount. If we add those together, the Mental Health Research Council grant to the £130,000, the £55,000 spent by the Regional Hospital Boards, the £15,000 in other odd items, we get a total of £200,000 spent out of public funds. The noble Lord, Lord Taylor has given your Lordships the expenditure by the United States Federal Government—and I, too, have the figures here—and I think that any comparison between what this country does and what the United States does casts a very poor reflection upon us. It may be said that the results of the research of the United States will eventually become known to us, but I suggest that that is no reason why this country should be so complacent at its own efforts and at the spending of only this negligible sum.

It may also be said—indeed, it has been said—that powers exist under other Acts for the promotion of research. Whatever powers there have been in other Acts, the figure that I have quoted, and which the noble Lord who moved this Amendment has referred to, shows conclusively, I think, how unsuccessful this method has proved so far. We cannot be complacent when we hear that in Washington the Institute to which the noble Lord referred, The National Institute of Mental Health, spends 5 million dollars in research into one illness, schizophrenia. Our own Research Council has a total grant of only £3 million for physical and mental research for which they are responsible. It is not surprising that we know virtually nothing about the many aspects of mental illness. Several treatments which since the war have proved to be very successful are little more than empirical, in that of course we do not know why they produce the results they do.

Almost every book or paper that one reads in relation to mental health says the same thing—that the crying need today is for research. Recently there has been a comprehensive survey of mental deficiency which in every chapter says the same thing: that the main project now seems to be to investigate experimentally the mechanisms involved, both in environmental (reduced retardation and recovery from the effects of deprivation) and in genetic influences, which are no less important. Elsewhere in this book very much the same thing is said.

I do not wish to detain your Lordships further on this subject, but in spite of the extreme courtesy and capable manner, to which we have grown accustomed, of the noble and learned Viscount, when giving answers in regard to any Bill that comes before your Lordships' House, I cannot quite accept that the reply given in respect of this matter was the reply he would have given had he been in the office of my right honourable friend the Minister of Health, or, indeed, that of the Lord President, who is responsible for research. It appears that the responsibility for research does not fall primarily upon the Minister of Health; it falls primarily upon the Lord President. The sort of reply of a degree of complacency that has been apt to be trotted out when this question arises, emanates from those who are neither trained nor expected by the public at large to be responsible in regard to the wide concern that I think many of your Lordships share concerning the need for research.


My Lords, may I interrupt the noble Earl? He is telling us—I think it is most important if it is so—that the responsibility for research into mental health falls on the Lord President and not in any way on the Minister. I am only asking for information.


The authorised and responsible Minister, as I understand it, for the Medical Research Council is the Lord President of the Council and not the Minister of Health. It was Mr. Walter Elliot who said in another place—and I think he was so right in saying it—that no ambitious student starts research in this country which may lead him into an investigation of mental processes, because there is no future to it. We in this country are not tackling research with sufficient realism for young doctors to give it a future. That is perhaps the reason why a number of eminent people in this field have gone abroad to pursue their studies. I personally have known three doctors who have done that, and who are now in America: Professor Finney, who was formerly Professor at the Maudsley and Bethlem Royal Hospital; Professor Elkin, formerly Senior Lecturer in Pharmacology at the University of Birmingham and Doctor Mainwaring, who was Director of Research at the Romford Hospital in Essex. They have all left this country because of lack of opportunity in this field. That, I think, is a serious indictment of the way we regard openings for young men to train.

As I was saying, it was Mr. Walter Elliot who brought to the attention of another place that there is a shortage of manpower in psychiatric work. And if this problem were tackled by the Government, if the Government would say in indisputable terms that the status of research in this field is going to be on the highest plane, if it were known that research was to be given a high priority, I am convinced, as the noble Lord, Lord Taylor, is, that many competent men might be encouraged to take up psychiatry. Quite clearly, the supply of ideas for research also might be similarly encouraged. That is the experience we have had in the body with which I am closely connected and to which the noble Lord, Lord Taylor, referred.

As to this Amendment, I know what the answer of the noble and learned Viscount will be as to the inappropriateness of including these words in this Statute because they are included already in a previous Statute and named in a Schedule. Therefore, it seems unnecessary to press the Amendment. But I hope that the noble and learned Viscount will pass on to those who are responsible the essential features and factors underlying the purpose of the noble Lord in putting down this Amendment. We are sitting late this evening, as time is reckoned in your Lordships' House, due to the fact that we have listened to a debate for many hours on foreign affairs, dealing with the deterrent of the H-bomb and methods to prevent humanity from blowing man off the face of the earth. I do not think it is beyond the terms of practical expression to say that if there were greater concentration upon, and a greater sense of value applied to, research into the motives of man, and why he acts as he does, some of the problems with which your Lordships' House was engaged today under the heading of foreign affairs might possibly be easier to solve than we can see at the present moment. I therefore feel, without elaborating or developing that argument, which one might well do, that this subject is of paramount importance to the wellbeing of the Bill.

8.2 p.m.


My Lords, I should like, very shortly, to support this Amendment, particularly underlining the word "treatment". A lot of research has been going on and I understand that a good deal of the research into treatment and rehabilitation of mental patients has been due over the years to unofficial bodies, supported by appeals for public funds or sometimes by local authorities. One such institution is the Institute of Social Psychiatry. They have pioneered a number of projects in the field of treatment and the returning of mental patients to normal life, which seems to me very deserving of support. They were, I believe, the pioneers of the day hospital, which was designed to enable patients to live with their families and to restore them by degrees to normal life. Then there are therapeutic clubs which have been started, of which a number exist in London now, providing a setting in which people returning from treatment in mental hospitals may learn to get on with one another and eventually become adjusted to living normal lives. Finally, there is the rehabilitation centre, which again is for patients who are convalescing from mental disorder and who by this means are enabled to take their place gradually in normal society.

The day hospital has been taken over as part of the Health Service. These other efforts are supported to some extent by local authorities, but otherwise by purely voluntary means. I would emphasise that the object and the effect of all these efforts is to reduce the demand on beds, on in-patient accommodation for mental patients; therefore I suggest that it is in the interests of the service and of Her Majesty's Government to support this work in every way possible.


My Lords, I was anxious, as I am sure the House was, that we should hear in the limited time available from the acknowledged experts who have already spoken in favour of this Amendment. I should like to support all they have said and what has just fallen from my noble friend the Earl of Lucan, and in particular what he has said about treatment. I would only say this: that the National Society for Mentally Handicapped Children, of which I had the honour to be chairman, is overwhelmingly impressed—one might say obsessed—with the importance of research and I should not like anyone to suppose otherwise. The noble Lord, Lord Grenfell, who is a joint honorary treasurer, was to have spoken to-night on certain detailed aspects, but he has, unfortunately, been called away. Therefore I rise to say that when we look to the ultimate benefit to the community, it is perhaps in the field of research, even more than in the other fields we are discussing under this Bill, that the great hope for the future lies. Therefore I should like to support all that has fallen from the previous speakers.

8.8 p.m.


My Lords, I should like to say for myself that I have seldom been more impressed than I have by the speeches that I have heard on this Amendment. I am sorry if I gave my noble friend Lord Feversham the impression of complacency in my earlier statements. I know exactly what he means. When a Minister is dealing with a Bill from another Department he cannot have the specialised knowledge involved, and when he retails information that he is very properly and fully given it perhaps sounds as if he were more satisfied with it than any Minister should ever be satisfied about anything. If I did so I am sorry, but I should like to make it quite clear that my right honourable friend is not in the least complacent on this matter and he will certainly take into account the most striking facts that have been put before your Lordships' House as to the importance of the matter, and also the various methods of approach of the various societies.

I am extremely glad about one thing. My noble friend Lord Feversham asked me one specific question. That was whether the new units—one on the epidemiology of mental disorder and the other on psychiatric genetics—would be taken out of the present amount. I am glad to be able to inform him from the information that has been given me—and I give him the exact words—that this will inevitably involve considerable additional expenditure. So on that specific point I am glad to be able to reassure my noble friend.

I would willingly go through again the account of the research which I have already given to your Lordships twice—because my noble friend Lord Feversham will remember that I did give that general account when he introduced this matter a year ago, and I gave a shorter account on Second Reading—but I do not think that that is what my noble friend Lord Fevers ham wants, or what any other noble Lord wants. That might give the impression to those who have not been here that I was satisfied and that my right honourable friend was satisfied by what has been done. He is not; he wants the research to increase. He wants it to go forward and be improved—of course in a steady and orderly manner, but constantly to be improved.

One or two noble Lords mentioned the statutory background. As I explained to the noble Lord, Lord Taylor, the effect of the Amendment is to include this in the powers under Section 16 of the 1946 Act. Now it might occur to noble Lords: Why was that put into the 1946 Act if it was in the 1919 Act? I thought it might interest them to know the answer. It is that Section 16 did two things: it replaced certain powers previously held by local authorities—under the Mental Treatment Act, 1930, for example; and it also extended my right honourable friend's powers beyond those contained in the 1919 Act. His powers under the 1919 Act were not precise or clear, particularly having regard to the point the noble Earl mentioned—namely, the powers given by the same Act to the Medical Research Council. They did not explicitly include power for the Minister himself to conduct research or to make financial grants towards the conduct of research; and Section 16 of the 1946 Act put his power to do this beyond doubt. I explain that only because I know your Lordships have been making inquiries into it.

My Lords, I think that really the best answer that I can make is threefold: one, that I myself entirely agree with the importance that has been attached to this subject by everyone who has spoken. I mentioned Lord Taylor and Lord Feversham, but I of course listened to and will read carefully again what the noble Earl, Lord Lucan, said, and what the noble Lord, Lord Pakenham, said about the organisation in which he is specially interested, apart from his general words. That is the first point: that my own interest has been increased a little (I think I can claim) by what has been said to-night. I shall convey that to my right honourable friend personally, and he will, I know, examine most carefully everything that has been said with a view to increasing and improving the amount and quality of research. If I am to say anything about comparative statistics I know that I shall again fall into a trap, to the annoyance of my noble friend Lord Feversham, because comparative statistics always depend on what particular figure you start from: and someone like Lord Feversham, who knows the original figure, is not impressed by arithmetical comparisons. So I simply say to him, frankly, that there will be an increase. I cannot say how much, but there will be an increase. However, we are certainly alive to the problem which has been put so graphically in front of us.

Having said that, may I be flippant for one moment? It has nothing to do with the Amendment; but the noble Lord, Lord Taylor, mentioned that there was a consultant psychiatrist in the House of Commons. I leave your Lord- ships to draw your own conclusions from the fact that he was my Parliamentary Private Secretary. I hope your Lordships will not take that as any diminution of the seriousness with which I approach the rest of the subject. Perhaps the noble Lord, Lord Taylor, will not press his Amendment now.


My Lords, I thank the noble and learned Viscount the Lord Chancellor for his kind remarks. By a strange coincidence, I was Parliamentary Private Secretary to a Lord President of the Council when I was also practising psychiatry, so perhaps it is the habit of Parliamentary Private Secretaries to become psychiatrists. I should like to apologise, if I might, to the noble Lord, Lord Feversham, for failing to mention his name when I moved the Amendment. It was very rude of me, but it was due to relying on too early a copy of the Marshalled List. We know how the noble and learned Viscount always follows up our points; and, with the assurance that he has given that he will follow them up with the Lord President, I know we feel fairly satisfied and very pleased. I therefore beg leave to withdraw my Amendment.

Amendment, by leave, withdrawn.


My Lords, it has been intimated to me that this would be a convenient moment at which to stop to-night. May I say to your Lordships, from the point of view of convenience in making arrangements for to-morrow, that the noble Lord, Lord Stonham, has an Amendment No. 37 and also an Amendment No. 45. The rest of the Amendments are purely consequential and drafting; and the noble Lord, Lord Stonham, alone knows how long those two Amendments will take. I wanted merely to tell your Lordships that there is nothing in the other Amendments.