Lords Sitting of 1 December 1981

Preamble
The House met at half-past two of the clock: The LORD CHANCELLOR on the Woolsack.
Prayers—Read by the Lord Bishop of Norwich.

British Experts Overseas: Salary Supplements
Lord Hatch of Lusby: My Lords, I beg leave to ask the first Question which stands in my name on the Order Paper.
The Question was as follows:
To ask Her Majesty's Government what changes they have made since 1979 in the supplementation schemes for British personnel serving in overseas countries and whether they intend to make further changes.
Lord Skelmersdale: My Lords, rates of supplement have been reviewed annually. In certain countries for which recruitment and retention of staff present little difficulty the payment of an inducement as part of a supplement for serving overseas has been discontinued or reduced for new contracts. Regulations on advance of salaries at the beginning of new contracts have been relaxed to some extent. No major changes are planned.
Lord Hatch of Lusby: My Lords, while thanking the noble Lord for that Answer, may I ask him whether he is aware that the supplements now being paid to British citizens serving overseas have been drastically reduced since the last general election? Is he further aware that in Zambia, which is the country I am mainly interested in at the moment, it is planned that the total number of recipients of supplements is to fall from 883 to under 700 by the beginning of 1983; and can he equate this with the pledge that the Government have made on a number of occasions to further the cause of the transfer of technology from the rich world to the poor?
Lord Skelmersdale: My Lords, as I said in my original Answer, the reason for the payment of supplements is that they should act, in part, as an inducement, to persuade people to serve in countries overseas. What I did not say, however, was that these supplements are based on what are called analogues, the object of which is to bring the level of pay in the country to which they are going up to the corresponding level of pay in this country, assuming that the aid would be payable in some form for the job anyway. The noble Lord referred, particularly in the case of Zambia, to the reduction in supplementation schemes. This is likely to happen anyway wherever in the world they are paid, because the whole object of the exercise is to get the local people in the host countries to fill the jobs.
Lord Hatch of Lusby: My Lords, I am afraid I cannot accept that explanation and I should like to ask the noble Lord whether he is aware that, in order to get local people trained to do the technical and the academic jobs which British and other foreign experts are doing now, it is essential to have the experts there to do the training? Is he not aware that in many cases—in the universities, in the schools and in technical occupations—the performance of that operation is being run down because of the lack of foreign experts? Is this not completely contrary to the communiqués which have been regularly signed by members of the present Government promising to further the transfer of technologists? Is it not the case that more British young people, in particular, are needed in the developing world in order to help the developing people themselves to become trained so that they can do the job?
Lord Skelmersdale: My Lords, of course I appreciate the need for experts, but, as I was saying just now, as the experts fulfil their role and create local experts the need for foreign experts must of its very nature be reduced. However, the increasingly specialised nature of many remaining posts will ensure that there is a need for external assistance of this kind for a number of years, and, to that extent, I would agree with the noble Lord.

Zambia: Aid for Transport Costs
2.42 p.m.
Lord Hatch of Lusby: My Lords, I beg leave to ask the second Question which stands in my name on the Order Paper.
The Question was as follows:
To ask Her Majesty's Government whether they are prepared to offer any assistance towards the transport problems of Central Africa and, in particular, of Zambia.
Lord Skelmersdale: My Lords, we already provide a lot of assistance to Central Africa in the transport field. In the specific case of Zambia, we part fund the costs of some 60 British experts who work for the Government of Zambia in the transport sector, and are considering meeting the capital costs of a rail bridge over the Kafue River.
Lord Hatch of Lusby: My Lords, is the noble Lord aware that as a result of the actions taken by the illegal régime in Rhodesia during the Rhodesian war there are still bridges and roads destroyed, which are handicapping the development of the transport system of the whole of Central Africa? Is he further aware that the Zambian people themselves have taxed themselves specifically to assist in the repair of this infrastructure? Would he agree that the British Government have a very special responsibility, in view of their responsibilities in Rhodesia at that time, to assist in the restoration of what was destroyed by the illegal régime?
Lord Skelmersdale: My Lords, I appreciate that

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there are tremendous transport difficulties in Zambia as, indeed, there are in southern Africa as a whole—which is why we welcomed the southern African development co-ordination conference and why we have pledged money in this direction; but I am not convinced that the extra pressure is put upon us as a result of the illegality of the former régime in Zimbabwe.
Lord Paget of Northampton: My Lords, were we not informed during the days of the illegal régime that all the problems of Zambia's transport were going to be solved by the benevolence of the communists who were building a splendid road, bridges and a railway from Dar-es-Salaam? What has happened to it?
Lord Skelmersdale: My Lords, I do not think that we were told quite as much as the noble Lord would lead us to expect from his supplementary question. However, it is true that the Chinese offered tremendous aid and assistance, both technical and monetary, in building a railway between Tanzania and Zimbabwe. I know that both these countries have managed to reschedule their debts in this connection, but I cannot tell the noble Lord the details of such.
Baroness Llewelyn-Davies of Hastoe: My Lords, is the noble Lord aware that many of the donor countries even from the EEC have not yet fulfilled the pledges that they made about aiding transport in Central Africa? Is he further aware that this is short-sighted since we need the minerals, if nothing else, from Central Africa, and without transport we shall not get them?
Lord Skelmersdale: Yes, my Lords, I was aware of that. This is something which is currently under discussion during our presidency of the EEC. The point that is sometimes missed in all this is that, although as the noble Baroness has said the aid was promised, quite a lot of this is rescheduling of existing bilateral aid.
Lord Balfour of Inchrye: My Lords, would the Minister say whether the help that we are giving in transport to Zimbabwe covers also the development of internal civil aviation in that country?
Lord Skelmersdale: My Lord, I regret that I shall have to write on that subject to the noble Lord. I have no information on that point.
Lord Hawke: My Lords, as there is a great shortage of rolling stock in southern Africa generally and in this country we are desperately short of jobs using steel, would Her Majesty's Government consider priming the pump by placing orders for locomotives in this country and hiring them out to those other countries, basing the rent on the price of copper?
Lord Skelmersdale: My Lords, this is something that we could look at; but I do not think that it is practicable under current legislation because aid, by the direction of Parliament, must be given directly to the Governments concerned.
Lord Taylor of Gryfe: My Lords, is the noble Lord aware that there have been excellent crops in Zimbabwe this year, particularly of maize, but they are unable to transport these food supplies to other parts of Africa because of the collapse of the transport system? Would he regard efficient transport in the area as a top priority in any aid programme he proposes to support?
Lord Skelmersdale: Yes, my Lords. Eleven years ago I was a volunteer in Zambia where I was advising on the growing of tropical fruit and vegetables. Transport was then one of the major problems and I understand from my advisers that it is so still; and it is one of the things which gets priority.
Lord Brockway: My Lords, while welcoming what the noble Lord has said regarding the co-ordination committee of central African and African countries in southern Africa, may I ask whether an essential priority in securing that economic co-operation is aid to the transport system? Further, in view of the fact that bridges and roads were destroyed by the illegal Government in rebellion against our Government, have not we a special responsibility to rehabilitate the transport system there?
Lord Skelmersdale: No, my Lords. I have already tried to explain that I do not hold that view.
Lord Hatch of Lusby: My Lords, may I ask the noble Lord whether he will consider a practical suggestion which follows on the point regarding locomotives made by the noble Lord opposite? Would he consider not building new locomotives but providing the technical expertise to repair the steam locomotives which are still there in Zambia? Their use could drastically and constructively cut the oil bill if they were substituted for the present diesel engines. The locomotives are there—
Noble Lords: Order!
The Chancellor of the Duchy of Lancaster (Baroness Young): My Lords, the House has been very patient with the noble Lord. I should be glad if he would ask his question briefly and not put in so many supplementaries.
Lord Hatch of Lusby: My Lords, I am trying to explain the background of my question. The steam locomotives are there. They were made in Doncaster and Manchester—
Noble Lords: Order!
Lord Hatch of Lusby: My Lords, will the noble Lord consider the possibility of making a contribution by sending experts from this country in order to put these locomotives back into use?
Lord Skelmersdale: My Lords, as always, the Foreign and Commonwealth Office will consider any suggestion which comes from your Lordships' House.

The Emergency Services
2.51 p.m.
Lord Molloy: My Lords, I beg leave to ask the Question which stands in my name on the Order Paper.
The Question was as follows:
To ask Her Majesty's Government whether they will consider taking steps to reorganise the emergency services into a single unit comprising the police, firemen, and ambulancemen.
The Parliamentary Under-Secretary of State, Home Office (Lord Belstead): My Lords, responding to an emergency call is a vital part of the role of the police, fire and ambulance services. The Government have the highest regard for the work that they do. But the demands made of each service in responding to emergencies and to their other responsibilities are quite different and call for different professional skills in which each service is trained. The important thing is that these services should work together wherever necessary and the Government are satisfied that there is close co-operation between them.
Lord Molloy: My Lords, I am grateful to the noble Lord for his reply. May I ask him whether he is aware that under the heading of what we understand as an emergency, a riot, a fire, civil disobedience sometimes resulting in the need for the use of the police, the fire services and the ambulances, the situation has changed? Expertise has been increased among all three arms, and ought there not now to be consideration in view of the changes I have adumbrated over the past few years of more co-ordination among the three arms of this very vital service? This would show that we care for the magnificent work that the noble Lord has said that they are doing. I approve of this and give full praise. I hope that I can do something to help them in their request for further co-ordination.
Lord Belstead: My Lords, in the case of the types of emergencies that the noble Lord mentioned in his supplementary question, the police would be responsible for initial co-ordination. The fire service, in addition to its fire-fighting and fire prevention responsibilities, undertakes what is called special services, and ambulancemen are an essential part of the emergency services, although their work is part of the work of the National Health Service. Thus I agree with the noble Lord that the work of these three services is interrelated on many occasions, although they remain under separate organisation.
Lord Shinwell: My Lords, may I ask the noble Lord whether something like this is already being done in connection with civil defence? If that is so, what is the difficulty in organising it?
Lord Belstead: My Lords, there is indeed initial co-ordination in civil defence in the way that the noble Lord, Lord Shinwell, suggests. But still the services remain separately organised with separate skills and separate functions.
Lord Molloy: My Lords, may I ask the noble Lord this? In so far as he has acknowledged the work of these three arms of the emergency services—and I am most grateful that he has done so—would he be prepared, please, to ask the Government whether they would now consider one element that is causing some form of irritation; namely, that the ambulance staffs fall behind their colleagues in the police and fire services with regard to remuneration?
Lord Belstead: My Lords, with the best will in the world towards the ambulancemen, it is part of the separate organisations that matters of pay and conditions of service are also separately negotiated.
Lord Inglewood: My Lords, could my noble friend confirm that he disagrees wholeheartedly with the efforts of many of the political friends of the noble Lord opposite who has asked the Question that civil defence expenditure and effort should be run down?
Lord Belstead: My Lords, the expenditure on civil defence has been increased by the present Government. I believe very deeply that that is the right policy.
Lord Inglewood: It has been reduced in some counties!
Baroness Robson of Kiddington: My Lords, may I ask whether the Minister would consider suggesting to Her Majesty the Queen that we should institute an ambulance medal on the same lines as a police medal for long, meritorious service?
Lord Belstead: My Lords, I think that that interesting suggestion from the noble Baroness goes a little wide of the original Question.

UK Continental Shelf Exploration Wells
2.55 p.m.
The Earl of Lauderdale: My Lords, I beg leave to ask the Question which stands in my name on the Order Paper.
The Question was as follows:
To ask Her Majesty's Government how many exploration wells have been drilled on the United Kingdom continental shelf this year, and are now being drilled.
Lord Skelmersdale: My Lords, 33 exploration wells have been drilled this year. In addition, seven exploration wells were being drilled as at 12th November 1981, the last date for which there are figures.
The Earl of Lauderdale: My Lords, I thank my noble friend for that information. Could he tell us how that figure, a total of 40, compares with the figures for the last several years?
Lord Skelmersdale: Yes, my Lords. As I said, 40 to-date this year; 32 in 1980; and 33 in 1979.
Lord Strabolgi: My Lords, despite that situation, are the Government aware that the present excessive tax régime is a positive disincentive to exploration in the North Sea?
Lord Skelmersdale: No, my Lords, I do not think that we are aware of that at all. The indications are that, far from slowing down the number of exploration wells being drilled, they are increasing, as I said in my original Answer to my noble friend. We therefore have no reason at all to believe that the introduction of any new fiscal arrangements is having any significant effect.
The Earl of Lauderdale: My Lords, is my noble friend aware, in the light of his answer to the noble Lord's supplementary question, that the oil industry has made a submission to the Government—a united submission—and has said: "For heaven's sake, do not do any new licensing until we have got through the budget and see what conditions are"? Is he not aware that a whole number of companies have delayed their proposed developments and, in certain cases, are threatening to abandon them altogether?
Lord Skelmersdale: My Lords, I am very much aware that there are two submissions from the oil companies currently being examined in Whitehall, both by my own department and by the Treasury. These are the UKOOA ones, which I think my noble friend has in mind in asking his supplementary question, and also the BRINDEX one. I rather think that this goes a little wide of the Question on the Order Paper which refers to exploration wells rather than production or any other form of well.
The Earl of Halsbury: My Lords, is the noble Lord able to give us a breakdown of the wells drilled for exploration as between oil and gas? How many were drilled in the expectation of oil and how many in the expectation of gas?
Lord Skelmersdale: My Lords, I am afraid that I cannot give that breakdown. But of course, as the House will know, one is never quite sure which one will find, or indeed whether one will find both together.
Lord Taylor of Gryfe: My Lords, will the noble Lord comment as to whether the proposals for the sell-off of BNOC assets in the North Sea is a disincentive to new developments and new investment in that area?
Lord Skelmersdale: My Lords, I do not think that the admission of private capital into BNOC makes any difference at all. Each petroleum production licence granted carries an agreed work programme stipulating the minimum number of wells to be drilled in the initial term of the licence. We believe that the removal of BNOC privileges has helped to stimulate drilling activity, which we expect to see further encouraged by privatisation.
The Earl of Lauderdale: My Lords, is my noble friend aware that in fact the chairman of BNOC has welcomed the proposal to introduce private capital
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into that organisation and the corresponding relief from Treasury interference that will come? Can he also tell us this: Arising out of another exploration well drilled, is it the case—as has been widely rumoured—that the offshore supplies office has had very little opportunity this year to generate new North Sea jobs just because of the slowdown in drilling?
Lord Skelmersdale: Yes, my Lords, I am certainly aware of the views of the chairman of the BNOC in this connection. I must say I agree with him, and I would hope that other nationalised concerns saw the situation in the same light as he does. As far as employment prospects in offshore supplies are concerned, there are really two different points here which perhaps I ought to make. There is currently a shortage of rigs in the North Sea, meaning that foreign rigs may well come in. That might mean a decline in the United Kingdom's share of those rigs but not a decline in employment, since those people currently working will remain and, depending on the origin of foreign rigs, this could well mean an increase in employment of our own labour.
Lord Strabolgi: My Lords, when considering the representations made by the oil industry about the excessive tax régime, will the Government also bear in mind the question of the short-term fields?
Lord Skelmersdale: Yes, my Lords, I am sure that this will be considered.

Business
Lord Denham: My Lords, at a convenient moment after 3.30 this afternoon my noble friend Lord Belstead, with the leave of the House, will repeat a Statement that is to be made in another place on television licence fees. He will be followed by my noble friend Lord Bellwin, who will repeat a Statement on lorries, people and the environment.

Fire Service College Board (Abolition) Bill [H.L.]
Lord Denham: My Lords, on behalf of my noble friend Lord Belstead, I beg to introduce a Bill to repeal Section 23(2) of the Fire Services Act 1947, to abolish the Fire Service College Board established there under and for connected purposes. I beg to move that this Bill be read a first time.
On Question, Bill read 1a, and to be printed.

Agricultural Training Board Bill [H.L.]
3.2 p.m.
The Lord Chancellor (Lord Hailsham of Saint Marylebone): My Lords, I rise to move that this Bill be now read a second time. The House will have seen that there are two consolidation Bills in my name for this afternoon and although I will move them separately they happen to be connected with one another. So,

933
with the leave of the House, I will speak to them together.
Both are pure consolidation, consolidating the law relating to industrial training boards. The law relating to the Agricultural Training Board has developed separately from the rest and so it has been thought easier to consolidate in two separate Bills, the first dealing exclusively with the Agricultural Board, and the Industrial Training Bill dealing with all the rest. Unless any noble Lord objects, the Bills will, in the ordinary way, be referred to the Joint Committee on Consolidation Bills. I beg to move that the Agricultural Training Board Bill be now read a second time.
Moved, That the Bill be now read 2a.—(The Lord Chancellor.)
On Question, Bill read 2a, and referred to the Joint Committee on Consolidation Bills.

Industrial Training Bill [H.L.]
The Lord Chancellor: My Lords, I beg to move that this Bill be now read a second time.
Moved, That the Bill be now read 2a.—(The Lord Chancellor.)
On Question, Bill read 2a, and referred to the Joint Committee on Consolidation Bills.

Hops Marketing Bill [H.L.]
The Minister of State, Ministry of Agriculture, Fisheries and Food (Earl Ferrers): My Lords, I understand that no amendments have been set down to this Bill and that no noble Lord has indicated a wish to move a manuscript amendment or to speak in Committee. Therefore, unless any noble Lord objects, I beg to move that the Order of Commitment be discharged.
Moved, That the Order of Commitment be discharged.—(Earl Ferrers.)
On Question, Motion agreed to.

Mental Health (Amendment) Bill [H.L.]
3.5 p.m.
The Parliamentary Under-Secretary of State, Department of Health and Social Security (Lord Elton): My Lords, I beg to move that this Bill be now read a second time. The Mental Health Act 1959 was a landmark in the development of care for the mentally disordered. It established many important principles. Among them are those which require that where care and treatment in hospital are needed, they are given upon a voluntary basis wherever that is possible and that, in those few cases where compulsion does prove necessary, it must be subject to strict controls. I doubt whether anyone would challenge those principles today; this Bill seeks to amend the 1959 Act but it does not challenge those principles. On the contrary, it seeks to ensure that they are more perfectly implemented. The Government still see the 1959 Act as the foundation of modern practice in providing for
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those few mentally disordered people for whom compulsory powers are needed. Some of those patients are offenders, detained as a result of court proceedings; others have been convicted of no offence but are admitted to hospital and there detained under applications made by those empowered to do so under the Act. These people comprise only a fraction of the mentally disordered in hospital. As for the number under guardianship at any one time, it is likely to be only about 130.
The numbers may seem small, but the importance of this Bill should not be judged solely upon the number of people it affects. It touches upon principles of profound importance affecting the liberties and rights of those of our fellow citizens who are, perhaps, least able of all to look out for themselves. The workings of this part of the 1959 Act have been under scrutiny in one way and another for a considerable time. If I go back no further than 1975, your Lordships will immediately recall the report of the Committee on Mentally Abnormal Offenders. This committee was chaired by my noble friend Lord Butler and I deeply regret, as I know will all Members of this House, that he is unable to be with us today. I hope it will not be long before we see him in full health in this House again. However, my noble friend was kind enough to write to me last week and in part of his letter he said:
"I would be perfectly happy if you would tell noble Lords that I support the Bill in its various aspects, including those referring to my own Report".
In the same letter he expressed in general terms a wish that we could go further in implementing the changes suggested in his report or in the Blue Book on the Mental Health Act 1959. I know that other noble Lords share that wish. Let me say at this stage that the Government's mind is not closed to any reasonable proposals. We are not bound to party lines on this legislation. There are none. This is a non-political Bill. There are, however, two considerations that will bind the Government. They are the interests of the people affected by the legislation and the question of practicability. Much of this ground will, I think, be suitably tested at Committee stage, but may I draw to your Lordships' attention one important consideration. The instrument that lies to our hand and for which parliamentary time is available is a Bill to amend the Mental Health Act 1959. Much of what some noble Lords wish to achieve can only properly be accomplished by the amendment of other statutes. Thirty-four of the recommendations made in the Butler Report relate, for instance, to the Criminal Procedure (Insanity) Act 1964. This Bill is not an appropriate instrument for that purpose and a separate Bill would be needed to accomplish it.
On the other hand, I am glad to draw your Lordships' attention to our provisions, for instance, for remands to hospitals and for interim hospital orders. These arise directly from the Butler Report and are already in the Bill. There are others, such as the proposals on the treatment of patients without their consent, which have come into the Bill from Butler via the 1978 White Paper. By one route or another 17 of my noble friend's recommendations which require legislation have reached this Bill. It is also the Government's intention to implement a further 10 recommendations

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relating to admission to and discharge from hospital of offenders; but legislation is not necessary for these. It will be done by the issue of official guidance.
If I were asked to list briefly the most important and beneficial provisions in this Bill, they would be: the requirement that, except in particular circumstances, people should not be admitted to detention for treatment in hospital if their condition is not treatable; the provision of much more frequent access to mental health review tribunals; the more stringent regulation of the use of treatment without the consent of the patient; the institution of a special health authority, with particular responsibility to oversee the powers to detain and treat patients under the Act; the institution of interim hospital orders; the power to remand to hospital for assessment; and, I think, the limitation of the powers of a guardian to apply only to people over 16 years of age and their curtailment to what is strictly necesssry.
Legislation by amendment is never a simple matter, and the 51 clauses of this Bill provide no exception. For that reason, we published together with the Bill a White Paper which I hope your Lordships will have found, or will find, a useful aid to interpreting its provisions. That White Paper does not follow the sequence of clauses in the Bill. For the sake of clarity, it picks up a series of central concepts and draws to each the relevant provisions wherever they appear in it. In Committee, of course, we have to follow a different convention. We have to follow the sequence of clauses, and I will now try to summarise them briefly for your Lordships in preparation for the next stage. As there are 51 of them, however, and as the White Paper is available, I hope I may be forgiven if I by-pass a few and lump some of the others together.
Part I of the Bill contains two clauses and deals with definitions. Your Lordships will note that the term "mental handicap" is to replace the more familiar and the more pejorative term of "subnormality". I think I should, at this point, mention to your Lordships that I am aware of a body of opinion forcefully held by distinguished people that mentally handicapped people ought not ever to have been included in the principal Act and that one purpose of this Bill should be not to change the nomenclature but to take them out of the Act altogether. I certainly appreciate the strength of the conviction with which this view is held.
I know that it is held by my noble friend Lord Renton and that he has the very weighty support of MENCAP, of which he is the distinguished chairman. His views carry for us an extra interest and an extra weight, because he was himself Parliamentary Under-Secretary of State at the Home Office when the 1959 Act was passing into law. Indeed, I believe that he was actually responsible for the whole of Part V. I think that this concern springs from a desire, which I share, to make clear in the minds of all—particularly of those who administer justice and who keep the peace—that mental handicap is an unalterable condition, usually acquired before birth, whereas mental illness is a treatable condition acquired at any age. The conditions are not the same and to have them lumped together in one Act of Parliament obscures the difference.
Being aware of this view and of the strength with which it is held, I have tried to see what can be done,
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and it is not as much as my noble friend would wish. At present, to separate the two conditions within one Act of Parliament is practicable; to separate them into two different Acts of Parliament is not. We can make the distinction that many people want by consolidation. The rest of the 1959 Act has been much amended, and consolidation will, in any case, follow close on the heels of this Bill. Consolidation takes very little parliamentary time, but legislation takes a great deal; and time for two Bills on such closely related subjects is not in any sort of prospect. I earnestly hope that we can keep some such end in view, but we should not delay the passing of this Bill, which embraces so many objects which all of us want to see accomplished, by trying to use it for a purpose to which it is not suited.
It may, of course, be argued—though I hope it will not—that the provisions in the Act that we are now amending for the mentally handicapped and the severely mentally handicapped are unnecessary; that they can simply be deleted, rather than being transferred into a separate statute. I wish that were so, but it is not. Nor do I think that it would be in the interests of the people concerned if it were. Mental handicap leaves some people with the biological drives of adults and the minds of children which cannot dependably control them.
It simply is not the case that they can always be cared for in the community. Mentally handicapped people differ from one another very much. Some make very agreeable friends and delightful members of the family. Others are best cared for away from home and some are very much in need of detention and can, in fact, be very violent. I have a catalogue of cases which I may have to deploy in Committee, but which I shall not draw upon now. Suffice it to say that every case shows a person with no classifiable mental disorder other than mental handicap who should never go to prison. There are cases among them of such people eventually emerging from the stabilising influence of hospital to return and live in the community.
It may be argued by some that, when a mentally handicapped person becomes violent, he is suffering not only from mental handicap but also from some form of mental illness. I am not a doctor, but I can only say that the people who have made the diagnosis in the catalogue of cases that I have read were doctors, and they were convinced that the patients' condition amounted to mental handicap only and that they were not mentally ill.
There are, again, some who would say that it is axiomatic that no person suffering only from mental handicap can need to be detained in hospital, either for his own safety or for anyone else's, and that, therefore, the diagnoses must ipso facto be wrong. To test this axiom, I have to turn to a more expert authority than my own. The weightiest opinion that I can find is that of the Royal College of Psychiatrists. That is the professional body for trained psychiatrists and comprises a vast body of clinical experience. It is their expressed opinion that there is a very small minority of mentally handicapped people without any other mental disorder, who need to be detained in hospital. That opinion may be regretted; it may be questioned. My noble friend Lord Renton has questioned it in another place and I expect him to question it again here today. But the fact remains

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that it is the most authoritative opinion we have available to us and I have to accept it.
If we were to take mental handicap out of the Act, a few—a very few—people suffering from it would be denied the stabilising care which they need. What is more, on the appointed day a considerable number of other patients—some hundreds—would cease to be detainable anywhere and some of them would, I fear, without doubt constitute a considerable threat to the public. That is not an acceptable result.
I return now to the text of the Bill and to Part II, which deals with compulsory admissions to hospital and to guardianship. The power of compulsory admission in an emergency has become the most widely used of all the compulsory powers. In 1979, nearly 8,400 patients were admitted under this power. This frequent use was never intended, and the Bill suggests changes in prodecure to help ensure that the power is used only when there really is an emergency. Clause 3 (3) also restricts the right to make an emergency application to the nearest relative—rather than any relative—and the mental welfare officer. On the subject of mental welfare officers—if I may be forgiven for stepping, for once, out of sequence—the Bill provides in Clause 43 for their replacement by specially designated and specially trained social workers, who will be known as approved social workers.
The power of compulsory admission for 28 days for obversation is a power which has proved useful. However, we want to introduce an important new safeguard for patients subject to it, and Clause 3 provides that, in future, they will be able to make an application within the first 14 days of their detention to a mental health review tribunal.
Clause 4 provides for changes in the grounds for admission to longer-term detention under Section 26 of the Act. These are designed to make sure that this power is used only for the purposes of treatment. The clause makes a new special provision for those suffering from psychopathic disorder or mental handicap. It provides that no such patient may be admitted under this power, unless medical treatment is likely to alleviate or prevent a deterioration of his condition. We have taken to referring to this as the "treatability" test and we shall doubtless use this term in debate. It replaces the existing provision, that patients, other than offenders, suffering from psychopathic disorder or mental handicap may not be detained after they reach the age of 21. We now know that some people over that age and suffering from those conditions can benefit from treatment, while others under that age may not.
Under Clause 12(5), the conditions for renewal of detention are also strengthened. First, the treat-ability test, to which I have just referred, will be applied to all patients. Secondly, the same conditions will be applied as are applied to cases for admission. However, the Bill provides an alternative test for the severely mentally handicapped and the mentally ill, if the treatability test is not met. Such a patient may be detained if he is unlikely to be able to care for himself, to obtain the care he needs or to be able to protect himself from serious exploitation if he is discharged. This recognises the need that some of these severely handicapped people have for the care and support that can be given to them in hospital,
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even though little can be done for them in terms of improving their condition and even though they are not willing to stay there.
The changes we are making in Clause 12 should help to ensure that no one is detained for longer than necessary and that no one can simply be forgotten. For those detained under the longer term powers, the periods of detention are halved. Application for renewal of detention will have to be made at the end of each period and the patient will then be able to apply to the mental health review tribunal. This means that opportunities for access to a tribunal will be doubled. In addition, there will be automatic hearings for patients detained under Section 26. If patients do not themselves apply, hospital managers will have a duty to refer them to a tribunal after the first six months of their detention and, again, three years after any renewal of detention. This will afford protection to anyone who is too disturbed to apply and has no relative or friend to take the initiative for him.
The need to detain patients who are already voluntarily in hospital can cause difficulties. The patient may be in a distressed state and be quite unable to recognise the wisdom of staying in hospital, at least until the crisis passes. The Act already provides that in such cases the doctor responsible for the patient can authorise his detention for up to three days under Section 30. But the doctor may not always be there in an emergency. Clause 6 therefore provides safeguards for staff by stating that another doctor may exercise this power of detention if nominated by the patient's doctor to act in his absence. In addition, certain nurses are given a carefully controlled holding power for up to a maximum of six hours until the doctor can be brought.
The Act increases, in most cases to double, the frequency with which patients have access to mental health review tribunals. The main concern of mental health review tribunals must therefore be with their function of deciding whether or not a particular patient is properly detained within the terms of the Act. But the interests of detained patients go much wider than this, and they need to be carefully protected, too. There is therefore a need for a body entirely independent of those involved in the procedures of admission, detention and renewal to look after these wider interests. Such a body was suggested in the Boynton Report.
The Bill therefore proposes that a new special health authority be set up. It will be called the Mental Health Act Commission. The commission's duties will be delegated to it by the Secretary of State. It will therefore be directly accountable to him and will have his considerable authority. It will be concerned only with mentally disordered patients who are compulsorily detained in hospital under the powers of the Act. It will visit hospitals, examine records and its members will be available both to patients and to staff. It will bring to the attention of hospital managers and, if necessary, of the Secretary of State any case where the proper procedures for detention have not been followed. It will also take up on request any complaint about a patient's treatment which, in the view of the patient, has not been properly dealt with by the hospital managers. The commission will operate as a

939
multi-disciplinary body from various centres across the country. It will be composed of about 70 people, including lawyers, doctors, nurses, social workers, psychologists and lay people. It will have important functions relating to the giving of treatment without a patient's consent.
The Bill provides in this matter that some sorts of treatment shall never be given without the patient's consent and that that consent must be supported by a second medical opinion. These drastic treatments, such as psycho-surgery, will be listed in regulations or in a code of practice. Other items of treatment which do not give rise to such special concern but which do involve physical intervention, such as medication or electro-convulsive therapy, may be given without the patient's consent but not without the support of a second opinion given to the decision of the responsible medical officer. The remaining forms of treatment, such as general medical and nursing care, may be given without the patient's consent, if that is possible, but only by or under the direction of his responsible medical officer. And often, of course, they cannot be given without the co-operation of the patient.
The second opinion to which I have referred in each case can only be given by a doctor appointed by the commission. Very often he will himself be a member of the commission. I have already emphasised the multi-disciplinary character of the commission. It is our intention to secure that there is a constant exchange of views between these doctors and the rest of the commission about the cases with which they deal. This will ensure that non-medical opinion is fully involved in establishing the principles and the criteria to be observed in the sanctioning or, let me emphasise, in the refusal to sanction treatment without the patient's consent. This is another area in which I expect penetrating debate at the Committee stage.
The commission will itself consider what treatments should be listed in the regulations as giving rise to special concern, and will advise Ministers accordingly. For other items, it will draw up a code of practice and keep it up to date. The commission will also monitor the procedures applied where patients do give their consent to treatment. This will be part of its protective function towards detained patients when its members visit hospitals and interview patients and staff.
The commission will be a separate body, independent of management, and I believe it will build up a body of knowledge and experience which can be applied effectively to help detained patients, and those who care for them, and to throw light on the whole field of mental health.
I turn now to the provisions in the Bill which deal specifically with patients who, before their admission to hospital, have been the subject of proceedings in the criminal courts. Part III of the Bill amends sections of the 1959 Act which give powers to the courts to order the detention in hospital of persons convicted of criminal offences and which give to the Home Secretary powers to transfer mentally disordered persons to hospital.
Clause 18(4) provides that the treatability test must be applied by the court before it can make a hospital order on any person who is suffering from a psychopathic disorder or who is mentally handicapped. The
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Home Secretary will have to apply the same test before he can transfer a prisoner who falls into either of these categories from prison to hospital. Both sorts of patient will benefit from the increased access to tribunals.
Clause 26 amends the criteria for the making of a restriction order so as to make it clear that such an order should be made only when it is necessary to protect the public from "serious harm". This is one of the changes recommended, again, by the Butler Committee. The most important provisions in the Bill as it affects offender patients are contained in Clauses 27 to 29. They provide that, if a person is suspected by the court of suffering from a mental disorder, he may be remanded to hospital for a report upon his mental condition. The court may also remand him to hospital rather than to prison if his condition warrants detention in hospital for treatment. A court may be in doubt as to whether a convicted offender's mental disorder is in fact such as to warrant detention in hospital for treatment. In that case, it can make an interim hospital order—again a new provision—and await the results of a period under hospital detention before deciding whether hospital or prison is the place for him to go.
The availability of a new power to make an interim hospital order will cause some small increase in the demand for hospital places. The creation of a new power for a court to make a remand to hospital will have a much more substantial effect on the demand for National Health Service resources. The service cannot be expected to meet this demand instantly. Additional facilities and more staff could well be required. The Government's intention is therefore that the operation of these two new provisions should be phased in gradually over a two- or three-year period after the main provisions of the Bill are brought into effect.
I must now refer very briefly to something which does not yet appear in the Bill. There is under the present legislation a small class of patients who cannot be discharged by any authority save that of the Home Secretary alone. In all other cases, the patient can have his case considered by the mental health review tribunal and the tribunal is free to order a discharge, if it thinks fit. Offender patients restricted under Section 65 of the Act may also have their cases considered by the tribunal, but the tribunal in this case cannot order discharge. It can only recommend discharge to the Home Secretary, who may or may not accept its advice.
Your Lordships may know that in a recent judgment in the European Court of Human Rights it was noted that restricted patients also should have access to a body of a judicial character with power to order discharge. I hope, therefore, to bring amendments before your Lordships to achieve this reform at Committee stage. Their terms are not yet finally decided, but I expect them to seek to give to mental health review tribunals a power to discharge in the case of restricted patients as well as others. As many of them will have committed very serious crimes, it is our intention to ensure that each tribunal panel shall include an experienced lawyer with experience at recorder level. There will be full opportunity for the House to consider the details of the new arrangements when the

941
necessary amendments to the Bill are put before your Lordships.
I have dealt so far with patients detained in hospital. I turn finally to the small number of mentally disordered people who are received into guardianship in the community because they need a degree of supervision or control. Until now a guardian has had the same powers as a father has over a child of less than 14 years. The Bill proposes that the powers should be reduced to what is essential. They will consist of the power to require a patient to live at a certain place, to attend for training, treatment or occupation and to give access to doctors, social workers or otherwise specified persons. It will no longer be possible for patients under 16 to be received into guardianship. We feel that the children's legislation is much more appropriate for them. As with powers to detain in hospital, the duration of guardianship powers will be halved, and therefore applications to the tribunal will be more frequent.
Finally, there is implementation. The Bill specifies that all but three of its provisions should be implemented on 30th September 1983. We hope for Royal Assent by the summer of next year; thereafter we need to consolidate these and other amendments to turn the Act into a form in which it can easily be used. That opportunity may also be used, if your Lordships so wish, to separate the provisions which affect the mentally handicapped from those which affect the mentally ill.
The time before implementation will be needed also to draw up the regulations, to set up the Mental Health Act Commission, to strengthen the mental health review tribunals, to publish guidance and to make other administrative arrangements. Those will include arrangements to phase in gradually the provisions for automatic reviews by mental health tribunals of patients who have not recently been before the tribunal. We shall begin with those patients who have had the longest wait, and we want to do that as quickly as possible so that there will not be a monstrous backlog to be dealt with when the Bill comes into force.
This is a good Bill. I regret that because of the Second Reading procedure I have had to speak to it in such an analytical and dry manner, because it is a Bill in which I think we can all put our hearts. It is a good Bill, but it is a Bill which almost everyone here will have their own ideas about how they can make it better. I hope your Lordships will agree with me that it is a good Bill and that you will accept that the Government intend to make it better if that is practicable and in the people's interests. To that end I and my noble friend Lord Cullen of Ashbourne, who is to reply to this debate, will listen with the closest interest to noble Lords who have listened with such patience and such courtesy to me. I beg to move.
Moved, That the Bill be now read 2a.—(Lord Elton.)
3.34 p.m.
Lord Wallace of Coslany: My Lords, may I first extend a welcome to the noble Lord, Lord Elton, who is dealing, I believe, with his first Bill on his appointment to ministerial responsibility. The noble Lord has indeed taken on a tough task in following the noble Baroness, Lady Young, who set such a high standard and was a formidable opponent, but nevertheless was
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approachable, seeking a degree of co-operation. The noble Lord, Lord Elton, has already extended courtesy and co-operation towards me, and although tough exchanges lie ahead, particularly in the field of social security, I am sure that the atmosphere of reasonable co-operation will continue.
The noble Lord has outlined with clear detail the provisions of this very important Bill. It is a Bill of general appeal which is completely devoid of party political divisions, following in many respects the conclusions of the 1978 White Paper initiated by my right honourable friend David Ennals and debated in another place on 22nd February 1979, with unfortunately the probability of legislation being thwarted by the general election a couple of months later. I refrain from making political capital on that point, my Lords.
The Bill now before us differs to a major extent in the proposal to set up a Mental Health Act Commission and I will refer to this later. In addition, the Bill before us does not include the 1978 White Paper proposals to give patients information of their rights on entering a hospital, or to inform patients within 24 hours if their status is changed from formal to informal or vice versa. As patients' rights is almost the theme of this Bill it seems to me to be a regrettable oversight, but I am sure it will be capable of adjustment during the Committee and Report stages. The Government and the noble Lord, Lord Elton, have indicated the possibility of accepting or bringing forward amendments during the various stages before Royal Assent. This is a welcome change, may I say in passing, from our experiences of other legislation brought forward by the Government, who introduce their own amendments but steadfastly refuse to accept others.
The change indicated in Clause 1, to amend the 1959 Act by the replacement of "subnormality" by "mental handicap", is very confusing indeed. There is a considerable difference between mental handicap and mental illness. The all-embracing phrase "mental handicap" is completely misleading. The definition of "mental disorder" remains as in Section 4 of the 1959 Act, which includes the phrase:
"and any other disorder or disability of mind".
This remains an unsatisfactory and vague definition, which could bring into eligibility for detention on a compulsory basis many classes of people who could not be classified as "mentally ill" but who need care and treatment outside mental hospitals. A clearer definition of mental disorder is needed, but this is a complex and difficult matter. Perhaps it would be more direct and simple to delete the phrase:
"any other disorder or disability of mind".
I should like to repeat what I mentioned some years ago in another place, concerning an incident in which I was involved before the 1959 Act became law. During the 1945–50 Parliament a constituent who was a Justice of the peace had been called in to certify a young woman for admission to a mental hospital. The justice of the peace was not happy about the case but was persuaded to give consent and then went home and told his wife. She was a determined but motherly lady and was not at all satisfied and said: "That girl is crossed in love. Go and get her and bring her to

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me and I will look after her". The justice of the peace did as his wife told him; and then of course he was in serious trouble and came to me for help. Eventually I was able to persuade the authorities to let things stand and the young woman remained in the J.P.'s home in the care of his wife, where I am glad to say she fully recovered.
Because of that, my Lords, and other experiences, I have often felt, and still feel, that there are many people detained in mental hospitals who need not be there if adequate facilities for residential and day care were available. It is true that there have been welcome improvements over the years, but such facilities are still far from adequate and in some cases have been reduced because of financial restraints.
I accept, of course, that the situation goes outside the comparatively narrow scope of this Bill, but, on the other hand, if the Mental Health Act Commission does its job (and indeed I wish it well) then the demand for greater facilities such as those I have mentioned will increase. And there is of course the problem of discharge after care. Many patients who may be discharged, particularly when the commission gets to work, will in fact face discharge after some periods of detention in a mental hospital, and as such will face great problems in acclimatising themselves to the great world outside which has changed considerably since they went in. It is a problem we have to face as a result of this Act.
I can only quote an experience I had when I was the Member for Norwich, North—and the right reverend Prelate the Bishop of Norwich may know this particular facility. A street of old houses had been taken over by a trust and converted to modern standards, and two of them were devoted to the use of people discharged from the nearest local mental hospitals in order to acclimatise them to the great world outside. They were supervised by an ex-nurse from the hospital. I had tea with them and they were very happy people. This is a problem which is bound to arise as soon as the commission gets to work; there will be people discharged who will have to face rehabilitation in the world outside, and rehabilitation of course would not be able to be achieved within the mental hospital.
There is a very big difference between mental handicap and mental illness. This is a field where I am sure the noble Lord, Lord Renton, will later speak with the authority and experience that he undoubtedly possesses, as indeed he did in another place during the debate on the 1978 White Paper. For those noble Lords who would like to read that speech, it is in columns 680 to 685 of the Official Report for 22nd February 1979. I will not draw any commission for that advertisement!
The position of the mentally handicapped is not dealt with within this Bill, but the Government have given a clear and definite undertaking to deal with this when they bring in a consolidation of mental health legislation very soon. Even on this point no one will accept that in this field the provision and services are at all satisfactory. Financial restraint has restricted or reduced facilities at a time when there is a need for expansion. Before I go any further I would draw attention to the fact that a number of
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complex legal points arise from the Bill, particularly dealing with appeals in mental health tribunals, access to the courts, and some others. I do not presume to attempt to deal with these, but my noble friend Lord Elystan-Morgan will be winding up the debate from these Benches and he undoubtedly will extend to the House his experience and professional expertise in dealing with them.
On compulsory admission procedures, Section 29 of the 1959 Act is retained, but Clause 6 of the new Bill defines the emergency period as 72 hours for detention and determination. This, I feel, is too long. It is reasonable to expect that a hospital could obtain a second medical opinion within 24 hours, even at weekends when medical staffs—let us face it—are on a standby rota. In addition, there is a divergence from the 1978 White Paper, which proposes removal to a place of assessment in the community should emergency detention he necessary. As things stand under this Bill patients can only be detained in hospital, with, I may say, the prospect of probably a long stay. There is a view, shared by the British Association for Welfare Workers and MIND, that the provision on a wide scale of crisis intervention centres would reduce the need for emergency admission to hospital. I accept that it is perhaps too much to expect an acceptance of this view at this stage, but I must emphasise that this is a reform which must be given more detailed consideration in the future—and, may I add, the not too distant future at that.
Social workers have, particularly in recent months, been placed in some difficulty and sometimes subjected to criticism of the part they play in the mental health sphere of their work. The proposal is that the role now undertaken by mental welfare officers, which in effect is all social workers, should after two years after the coming into operation of this Bill be taken over by "approved social workers" specially trained in mental health matters. Such approved workers will have to interview any patient prior to admission to hospital in order to ensure that hospital is an appropriate form of disposal. This is indeed a welcome reform, but it raises a number of very criticial questions.
First, such social workers before reaching the status of "approved" will have to undergo a fairly lengthy period of training into all aspects of mental health legislation and all that follows from it. With all the high degree of responsibility that the new post entails, it follows that the test of approval of the candidates must be rigorous and searching indeed. Secondly, in consequence of the nature of the post, there will have to be an attractive salary scale if staffing levels are to be adequate. Thirdly—and this is a vitally important point—it is assumed that the training and provision of such workers will continue to be the responsibility of local authorities. This will be an added financial burden to local authorities at a time when they are enduring demands for severe financial restraint, and in some cases are reducing the number of social workers employed already. Detachment of selected social workers under such circumstances will not only add to the problem but will in fact reduce staff available for other social work.
Will the Government face up to this problem and grant additional finance to local authorities for the purpose? I can only say that failure to do this will

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reduce this desired reform to the status of pie in the sky. Certainly the two Secretaries of State and the departments involved must get together. Social workers apart, local authorities are involved in other important spheres in the field of mental health. It is no good introducing reforms on paper which are obstructed by financial considerations elsewhere.
There will be, I am sure, a mild welcome for the fact that the Bill clarifies the question of consent to treatment. This involves in the majority of cases the patient's consent and agreement of an independent doctor, or—and not all patients are capable of understanding this—giving consent on the advice of a doctor, backed by a second opinion of another doctor selected from a panel provided by the Mental Health Act Commission. This is a difficult and complex area where strong differences of opinion exist and where there is much public concern over some of the methods of treatment carried out. As the Bill stands the second opinion is medical, but there is a wide measure of feeling that a second opinion should not be medical alone, but what is required is a lay, social and commonsense judgment, for, after all, it is a question of imposing treatment on an adult against his will, or because of his lack of ability to give consent. The 1978 White Paper accepted that a second opinion should be multidisciplinary and not medical. This is a vital and complex matter probably best decided by the Mental Health Act Commission.
I come to the Mental Health Act Commission. The broad based membership of the proposed commission is welcome. The appointment of its 70 members is the responsibility of the Minister, who, I assume, will seek advice before making a final decision.
The responsibilities and powers of the commission, although not clearly defined in detail in the Bill, are on the surface an immense job for 70 part-timers. Apart from one or two visits a year to 300 or so local hospitals they have also the duty to visit four special hospitals at least every month, interview patients—and that can be a time-consuming process—study records and deal with complaints. But apart from that they have important duties regarding consent to treatment and drawing up a code of practice on treatment with regular revision and also to keep a watch on other regulations. My mind boggles. Even with a support staff of 14 this is a colossal job for part-timers to undertake, and indeed one wonders whether the professionals, the doctors and nurses et cetera, will find time even to carry out their normal professional duties.
I ask—because it is only implied in the Bill—whether there is a salary involved or an expense allowance because some of these professionals will be losing valuable time from their professional work and the right sort of people will not be obtained if they are to be financially penalised. We need the best and we must have the best and to get the best we must pay for the best. There is no argument about that whatever.
There are many other aspects of the Bill that I could deal with, but with so many experienced noble Baronesses and noble Lords to speak—and I am very much aware of that—I am sure that the points which I have mentioned and others will be well taken care of. This is an important debate with far-reaching consequences. The Bill, although welcome, only just touches the fringe of the problem of prevention, cure
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and treatment of mental illness. Mental handicap in the accepted sense is put to one side for the time being.
Let us look at the background. Despite valiant efforts mainly by voluntary bodies to brighten interiors and surroundings, many mental hospitals are old, institutional and decaying monuments, but staffed, let me add, by dedicated people whether they be doctors, nurses, ancillary workers or visiting, caring volunteers all of whom deserve and earn the highest praise.
An immense amount of effort must be made by the Government and people to eradicate those social evils which so frequently give rise to mental strain—unemployment, bad housing, loneliness among the aged and the young, the unremitting battle by the mother against poverty. All this and much else can upset the balance of the mind leading to mental illness. The Bill is a step forward and welcome, but much more needs to be done.

Television Licence Fees
3.54 p.m.
Lord Belstead: My Lords, with the leave of the House I shall now repeat a Statement being made in another place by my right honourable friend the Home Secretary. The Statement is as follows:
"Mr. Speaker, I will with permission make a Statement about the television licence fees. As honourable and right honourable Members will be aware, the BBC has made an application for an increase in the colour licence fee to about £50 to last for three years. In considering that application it is my duty to ensure that the corporation's home services are adequately funded, and at the same time to have regard to what is fair to the licence fee payer.
"I have therefore decided, and have today laid the necessary regulations, to increase the fee for a colour television licence from £34 to £46 and for a monochrome licence from £12 to £15. The new fees come into effect at midnight tonight. It is my intention that this level of fees should last for at least three years and I shall he making it clear to the BBC that I shall expect it to pay off its current deficit and live within the revenue which these new levels of fees will produce until the end of the 1984–85 financial year.
"My purpose in deciding on an increase to last for at least three years is to make the licence fee system work as it should.
"It is also my aim to fix the level of fees for a period which will enable the corporation to plan ahead more effectively. A three-year increase will require considerable financial discipline on the part of the corporation; and the extent to which it will be able to pursue its plans for new or improved services will depend crucially on its ability to keep down its costs, particularly labour costs.
"In this context the board of governors has announced that it has commissioned a wide-ranging review of the systems by which the BBC monitors its efficiency. I welcome this decision, which indicates how seriously the board of governors takes its responsibility for ensuring that the licence fee paying public get an efficient service and value for money.

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"I recognise that it is not easy for some people to find the licence fee in a single lump sum each year. I therefore intend to provide a range of means to enable members of the public who wish to do so, to spread the cost of the licence fee over the year. To supplement the successful and widely-used television saving stamps scheme. I have approved plans for the introduction of payments by instalments. We propose in the course of next summer to start accepting monthly instalments towards the following year's licence fee by means of direct debit from bank accounts, and to introduce at least a pilot scheme for payment by credit cards. This will be followed, I hope by the summer of 1983, by a scheme for the payment of monthly cash instalments over post office counters towards the following year's fee.
"Mr. Speaker, I believe that the three-year increases which I have today announced, coupled with greater flexibility in the methods of payment, will do much to strengthen the licence fee system and preserve the independence of the BBC".
My Lords, that concludes the Statement.
3.58 p.m.
Lord Ponsonby of Shulbrede: My Lords, I thank the noble Lord for repeating the Statement. We on this side on the House believe that the BBC should be financed by a proper licence fee to ensure its independence and maintenance of proper standards. However, we are also concerned that the licence fees should be raised and that proper provision should be made for those who find television indispensable to any enjoyment of life, as indeed the Minister recognises in his Statement. We are particularly concerned about the old and the disabled. The increase of approximately 35 per cent. over a three-year period suggests that the Government do not see inflation falling into single figures during the remainder of their period of office. The increase will not reflect itself in the retail price index, on which old-age pensions are based, until next year's increase. So old-age pensioners will immediately find themselves in difficulty in finding the full amount of the new licence fee.
The Government's proposals for the payment of fees by instalments are inadequate. Both of the schemes outlined—the existing television savings stamp scheme and the proposed instalments scheme—involve paying money in advance for the licence and no interest or concession is proposed to be made for this money which the Government will hold in their kitty prior to the payment of the fee. Equally, the holder of the licence will not receive any discount for making payment earlier. I wonder whether the Government could consider a scheme for paying licence fees in arrears, as, of course, we currently enjoy with regard to the payment of rates. I should have thought that a deferred payment scheme would be of great benefit. As to the proposal for payment of the licence fee by credit cards, I shall leave others to comment on that.
The other matter at which I think the Government should take a look is the unfairness in the current scheme in that at present the same licence fee is paid by a large hotel, with 500 or maybe more television sets throughout the hotel, as is paid by an individual
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for a single set. I should have thought that this was an area at which the Government should look; indeed, if they could find a way of raising additional revenue in this direction, it might be possible, with the extra income generated, to give some concessions to old-age pensioners.
Until these matters can be resolved, we must oppose the increase in the licence fees. However, we should like to welcome the review instigated by the board of governers. Any large organisation needs to review its activities periodically and we welcome the fact that the governors have set this in motion.
4.2 p.m.
Lord Winstanley: My Lords, I join with the noble Lord, Lord Ponsonby of Shulbrede, in thanking the Minister for repeating this important Statement. Arising from it I should like to ask the noble Lord, Lord Belstead, two questions, one specific and one more general. First, will he look again at the quite extraordinary anomalies which arise from the 5p concessionary television licence fee arrangement for certain elderly people, though not for a great many other elderly people? Secondly, and more generally, does the noble Lord agree that the whole purpose of the BBC Charter was to put the control of public broadcasting at a distance from Parliament? Does the noble Lord agree that for the BBC to have to come, cap in hand, to Parliament for an increase in the licence fee every three years really makes the BBC dangerously dependent on the Government of the day?
Is it recollected that when I raised this matter before in your Lordships' House, on 11th June 1980 (in the course of a brief debate initiated by the noble Lord, Lord Hill of Luton), the noble Lord, Lord Belstead, told us that discussions were taking place between the Home Office and the BBC on alternative methods for the future financing of public service broadcasting? Does this Statement mean that those discussions have borne fruit, or are those discussions continuing?
4.4 p.m.
Lord Belstead: My Lords, I am grateful to both noble Lords for their questions and replies. Although I recognise absolutely that the noble Lord, Lord Ponsonby, accurately put his finger on many of the difficulties which are attendant in fixing a licence fee which is both fair to the licence fee payer and also meets the needs of the BBC—the two main factors which my right honourable friend the Home Secretary has to decide upon—he was a little short on ideas as to how to help the old and the disabled, the first two sets of people whom he identified. The difficulty is that if those people were to be given absolute exemption, or even a considerable exemption, from the licence fee—something which no doubt in our hearts we should all like to see—it would immediately mean that for everyone else, whatever their needs, there would be a very much increased licence fee. If, for instance, there were a completely free retirement pension licence at the moment, it would immediately mean a £70 colour licence fee, so we assess, and a £25 monochrome licence fee. The only other alternative to bring such help to the people whom the noble Lord identifies is, of course, to raise the money

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by taxation. The difficulty there is that you undermine the independence which, in fact, the licence fee brings to the BBC.
To answer the last point made by the noble Lord, Lord Winstanley, at this moment I think that the introduction of a three-year licence fee will bring to the corporation a certainty which the governors will, I hope, recognise, and which I believe they will welcome. The noble Lord, Lord Ponsonby, spoke about the uprating of pensions, Of course, the Government are committed to compensate pensioners for price increases over the lifetime of this Parliament, and since November 1978 pensions have kept up with the retail price index. Therefore, the Government have honoured their commitment. The increase in the licence fee goes into the retail price index and any shortfall on last month's uprating will be made good next year.
The noble Lord felt that the part of the Statement about instalments was inadequate. I should just point out to the House that the best known—in fact, at the moment the only—instalment system, which is the 50p savings stamp, astonishingly accounts now for one-fifth of all the licence fee revenue received each year. I do not think that the people who are buying savings stamps would agree with the noble Lord, Lord Ponsonby, that that is an inadequate system. Again, I hope and believe that when people read and think about the Statement they will agree that my right honourable friend is making sensible and compassionate provision for the future in the other measures which he has said he will bring forward.
The noble Lord mentioned the specific subject of hotels. The Administration of the Broadcasting Receiving Licence Working Party, which of course comprises both the BBC and the Home Office, has advised my right honourable friend that it is technically feasible for hotels to be licensed in respect of each guest room in which a television set is installed. My right honourable friend accepts that there are anomalies in the present arrangement, but he is still considering whether it will prove practical or desirable to implement any changes.
Finally, I come to the specific point which the noble Lord, Lord Winstanley, put to me about the 5p licence for old peoples' homes. My right honourable friend accepts that there is indeed an anomaly here. The Annan Committee recommended that it was a form of concession which ought to be phased out. My right honourable friend would not he prepared to extend the anomaly, but he believes that it would be harsh to withdraw it.

Lorries, People and the Environment
4.8 p.m.
The Parliamentary Under-Secretary of State, Department of the Environment (Lord Bellwin): My Lords, with the leave of the House, I shall now repeat a Statement being made in another place by my right honourable friend the Secretary of State for Transport. The Statement is as follows:
"Heavy lorries have been the subject of continuing debate and controversy for over 10 years. The problems are complex and intractable, but decisions have to be taken. We need above all to end the
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present uncertainty about future lorry weights which is currently placing a handicap on investment in the commercial vehicle industry.
"To clarify the issues, the Government appointed Sir Arthur Armitage in July 1979 to conduct an independent inquiry into the whole problem of lorries and their effects on people and the environment. Sir Arthur and his four independent assessors took evidence very widely, and reported in December 1980. The Government are very grateful to them for their wide-ranging report. It has aroused great interest. A large number of people and organisations have put their views to me and there have been two debates in this House. The Government thought it right to take time to consider fully the many points that have been raised.
"The effect of big lorries on people and communities is a matter of deep concern. The lorry is an offensive element in the environment, and it will make the environment progressively worse unless we take decisions now which will change the trend over the coming years. Our aim is to ensure a more civilised development of freight transport in the future, which will mean a better environment as well as a healthier economy.
"The measures the Government will be taking to achieve this objective are outlined in a White Paper published today. These measures are directed to keeping lorries away from the places where people live, through the provision of more by-passes; to making the vehicles quieter and cleaner; and, in particular, to keeping their numbers down.
"However, to keep costs down, road transport must be efficient and economic. Our present maximum weight limits on lorries place an economic handicap on much of our industry. Our regulations prevent many existing lorries from being loaded to their full technical weight-carrying capacity. This is wasteful. It makes transport costs higher than they need be, which in turn feeds through into prices and makes our exports less competitive.
"The Government agree with Armitage's rejection of the heavier axle weights proposed by the European Commission. We have also announced our rejection of a maximum weight as high as 44 tonnes, which was the heaviest vehicle recommended in the Armitage Report. All the safeguards suggested in the report have been considered very carefully, and the Government are now convinced that maximum lorry weights can safely be raised to 34 tonnes for four-axled vehicles, and 40 tonnes on five axles. These changes are set out in draft amending regulations which are being circulated today by my department for consultation. Copies are being placed in the [Printed Paper Office].
"The proposals outlined in the White Paper will apply to Northern Ireland and, where appropriate, will be given effect to through separate action under the relevant Northern Ireland legislation.
"As well as bringing economic benefits to industry and ultimately to the consumers, through savings in industry's transport costs of around £150 million a year, there will be benefits to the environment. The heavier vehicles will be no bigger than the biggest vehicles on the roads today. Their higher load capacity will enable industry to meet demands for

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freight services with fewer vehicles than would otherwise be needed. There will be safeguards in the regulations on the design of the heavier vehicles to protect roads, bridges and underground services.
"Mr. Speaker, we cannot afford delay. To do nothing would help neither the environment nor the economy. Freight users, vehicle operators and manufacturers are unable to plan ahead whilst the present uncertainty lasts. It is through the decisions taken now, and the actions initiated, that we can achieve over the years ahead the improvements we are seeking."
My Lords, that is the Statement.
4.14 p.m.
Lord Underhill: My Lords, your Lordships will be extremely grateful for the Statement repeated by the noble Lord today. Reference is made in the Statement to the fact that two debates took place in the other place. I must remind your Lordships that we have had no debate whatever in this House on the Armitage Report. We also on this side of the House give full praise and thanks to Sir Richard Armitage and his assessors for the valuable contribution made to this subject by their report. There are some excellent recommendations, but there are some questions left in doubt. I must draw attention to the fact that there are 58 recommendations in all, 159 pages of the report, that no fewer than 871 organisations sent written evidence and 963 members of the public also gave evidence. But your Lordships have had no opportunity whatever to debate this important report prior to the Statement being made today.
We are very pleased that the EEC proposals were rejected by the report and that the Government have now rejected the 44-tonnes maximum lorry as proposed in the Armitage Report. But you will note that the Government propose that the maximum shall rise from 32½ tonnes up to a maximum of 40 tonnes. In another place in January the former Secretary of State posed the point: Can the benefits—and the Statement says that the benefit to the industry will be £150 million a year—be received without paying an environmental price which the public would regard as too high? That is the important question which faces us in this Statement made today: What will be the costs to the environment?
The Government have stated that proposals are included in a White Paper issued today. Obviously, neither your Lordships nor I have yet seen that White Paper. But the Statement refers to proposals for the protection of roads, bridges and underground services. I must draw attention to a few points contained in the report. Time will permit these to be given only in shorthand. We find in paragraph 58 that the lorry traffic adds 15 per cent. to the costs of new construction and improvement of our roads. Paragraph 59 says that lorries account for over 90 per cent. of the damage on our roads. Attention is drawn to the fact that major motorway reconstruction has had to come much sooner than was anticipated when the motorways were built.
In paragraph 382 there is an important point:
"There is still much uncertainty as to how axles damage roads"
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Reference is also made in the report to the damage to pipes and installations under, or adjacent to, roads. Paragraph 60 says that there is no evidence that lorries are the main cause of damage. But I find in paragraph 390 of the report that little is known about the effects of lorries on underground pipes, and it is difficult to say precisely what would be the effects of heavier lorries. This is one of the anomalies in the report, and clearly far more research is needed before a definitive decision can be made.
It is clear that more research is needed on the question of the vibration effect on buildings and persons as a result of the passing of heavy lorries. This is not clear in the report. The report also deals at length with the damaging effects on bridges. It stressed that if the EEC proposals were carried through the greater effect would have been on bridges built before 1922. It states that the work to strengthen all the bridges to cope with the heavier lorries would cost £1,200 million. I should like to ask the Minister: What is the proposed cost, or the estimated cost, for the vehicles of 40 tonnes as opposed to the original proposals in the EEC draft directive?
The question of noise is to be dealt with, but the report states that the Noise Abatement Council estimate that £1·6 billion would be needed to insulate against noise for all traffic noise over an accepted level criterion. We all know the general complaint from the public about noise of lorry traffic. There appears to be doubt in the report also about the effect on pavements, verges, et cetera, when lorries leave the motorway. Noble Lords who drive will frequently see hopeless messes alongside the road where lorries have gone off a motorway. We do not know the effect on underground pipes, and so on. Far more research is needed, including the question of cost.
What will be the possible effect on rail freight? History shows that whenever heavier lorries have been introduced so rail freight tends to fall. This decision on behalf of the Government would appear to indicate the need for more integration and co-ordination between road and rail freight traffic. I make it clear from these Benches that we recognise the great importance of road haulage and road freight traffic to our economy. Therefore, we are not being critical on the question of road haulage.
I should like to know whether the Government are able to say how much further help will be given under Section 8 proposals to provide more freight terminals for British Rail, as is applicable in Germany, and thereby assisting in the task of taking off the roads and on to the rail a greater amount of traffic. The TRRL Report SR/572 published in 1980 stated that the average load factor fell from ·65 in 1967 to ·5 in 1976. What is the present position today about the average loads being carried by lorries?
Reference is made in the Statement to more by-passes. It has been estimated that by 1990 only one-half of the towns with populations of 10,000 or more will have by-passes, and I understand that about 100 important schemes are held up, that some will not be started until after 1984 and that others have been shelved. What actually is the programme on by-passes? Obviously this must have some bearing on the Statement. How many of the 58 recommendations in the Armitage Report are to be carried out?
Lord Denham: I suggest that we are slightly in danger of getting into a debate on this subject, my Lords. Could the noble Lord be a little briefer and more questioning on the Statement rather than on the report?
Lord Underhill: I apologise to the House, my Lords, but it will be appreciated that we have not debated Armitage and that the Statement really arises from Armitage. However, in deference to the Government Chief Whip I will draw my remarks to a close. How many of the proposals in the Armitage Report will be implemented? When is it proposed that the new limits will come into effect? Do the Government accept in particular Recommendation No. 50, by which additional powers and finance are proposed for local authorities in lorry action areas? If so, how much will be covered by that? Finally, as we have not had a chance to debate the Armitage Report, on which the Statement is based, will there be opportunity for the House to debate the White Paper?
4.22 p.m.
Viscount Thurso: My Lords, on behalf of my colleagues on these Benches, I wish to thank the Minister for repeating the Statement made in another place. Like the noble Lord, Lord Underhill, I regret that we have not had an opportunity to debate Armitage, but I do not propose to do so today. I shall however ask a few questions and make a few brief comments.
I note that the Government aim to ensure the more civilised development of freight transport in the future. I hope they will let us know what their intentions are with regard to rail because many of us clearly believe that more of our heavy freight should go by rail rather than in ever-heavier lorries. We welcome the measure to keep lorries away from places where people live and the provision of more bypasses, but wonder in these stringent financial times what provision will be made for these bypasses and whether we shall have the lorries before the bypasses instead of the bypasses before the lorries.
We welcome the dropping of axle weights to approximately eight tons, rather than the raising of them to the higher figure proposed by the EEC Commission, but we wonder about the enforcement of regulations. We know that overloading, lack of adherence to drivers' hours and the ignoring of speed limits are all widespread and we wonder what the Government propose to do to make certain that these heavier lorries do not continue to break speed limits, overload and commit the various offences which it is known that heavy freight commits on the roads.
We should like more information about the contribution to road costs. We feel that heavy lorries are contributing very little to the costs which they incur and we should like more information about how these costs will be recovered. We should like to know more about what is to be done to help protect bridges, roads and underground services both in the provision of funds to local authorities and in the new regulations and design.
Lord Bellwin: I am grateful to the noble Lord, Lord Underhill, and the noble Viscount, Lord Thurso, for commenting on the Statement and I shall try to answer their remarks. First, the issue of there not
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having been a debate and when will there be a chance for one. As for when there will be a chance, obviously a resolution will have to go through this House as well as the other place, and clearly there will then be an opportunity to debate more than, as it were, just the philosophy but the nuts and bolts as well, and I should have thought that was the best kind of debate to have, and that will come. It is a White Paper and it is there for consultation, and therefore that debate will be all the more informed because presumably it will be conclusive. Perhaps I should add, however, that I am told that there has been a Motion down for debate for most of the last Session which was not taken up through the usual channels. So, although I entirely take the point made by both noble Lords, I suggest that it should be a matter not so much of criticism but more of comment.
The noble Lord, Lord Underhill, asked what the cost would be to the environment. Clearly he needs the opportunity, as does the noble Viscount and others, to read the White Paper. When the noble Lord has done that I think he will be encouraged, as I was when I read it, because, for example, in terms of damage, it is estimated that the damage to the roads will be some 5 per cent. less than at the present time for the same freight carried. One needs to know exactly how and why that is, and that is explained by the way in which the weight is distributed in vehicles with the extra axle.
That picks up a point made by the noble Viscount when he referred to overloading. The problem with lorries today is that because of their construction, vehicles have to carry less than the full load that they are permitted to carry because they cannot load them in such a way as to enable the vehicle to take it. That will come out more clearly when the White Paper and other literature is available because that will illustrate the point clearly.
I know the noise factor concerns most people. There will be lower noise limits in 1983 and it is the intention to move, by research and other methods, so that perhaps by the end of the decade these heavy vehicles will be no noisier than are motor cars at the present time. That clearly requires some research, but emphasis is being put on that and I am sure the whole House will agree that that is a desirable objective towards which to aim. I am told that the effect on rail freight need not be adverse. Quite the contrary, because in the case of the freightliner, for example, the problem for the railways has been that they could always carry heavier weights, but the size of the containers has been a problem for them. British Rail have said they are not against the proposals we are bringing forward. I was asked when the new limits would come into effect. That depends on the consultation, and I think we are talking about March/ April time, but we shall have to see how that goes.
The noble Lord, Lord Underhill, in particular mentioned Recommendation No. 50. That, he will see, is referred to in the White Paper, which says:
"The Armitage Report suggested that some of the worst of these places could be designated as lorry action areas in which special steps would be taken to alleviate the effects of lorries. The Government considers that this proposal is well worth further study and will be inviting the co-operation of the local authorities and others concerned in studying it further".

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I think I have covered most of the points that were raised. I appreciate it is hard for your Lordships to deal with the details without having had sight of the documents and the time to study them, but I hope we shall have a good debate on this very important matter in due course.
Lord Walston: My Lords, I should like to put two questions to the noble Lord. The first follows the point raised by the noble Viscount, Lord Thurso, about by-passes. Clearly it will not be possible to build sufficient by-passes before the regulations come in, but will the Government be prepared, and be able, to take steps to prohibit to an increasing extent the heavier lorries from passing through particularly narrow streets of our small towns and villages, forcing them perhaps to make rather longer detours in order to preserve the environment and the amenities of these places? Secondly, the statement refers to the saving of £160 million. Can the Minister tell us what is the likely destination of that £160 million? Will it go to increase the profits of the hauliers, or will it be passed on to the ultimate consumer, whether in the form of cheaper exports or cheaper prices at home?
Lord Bellwin: My Lords, with regard to the question of by-passes, I think that the noble Lord, Lord Walston, will obtain some useful information when he has a chance to look at the White Paper itself. Perhaps I ought to state for the record that already this year 38 new starts are being made on by-passes. In addition, the White Paper announces four more new by-passes, and it announces also the bringing forward of yet more from the previous programme; in other words, a phasing forward. I think that that would illustrate that, in so far as is at all possible, the Government are concerned to step up work of this kind within the resources available. I think that it indicates that priority is being given to the point that the noble Lord makes, and I hope that he will be pleased about that.
It is hard to break down the figure of £150 million—it was not £160 million—but perhaps I can give a very approximate indication. In the main the benefits will go not so much to road haulage operators as to the users of road haulage. In turn they will be enabled to be more competitive in what they are providing by way of goods, where they are delivered, or products, where they are sold. I am sure that the noble Lord will appreciate that those who will benefit most will be those who are farthest away from the ports to which they have to go to reach the EEC and the like. Anything that can be done to help in terms of costs can only be beneficial all round. But I should add that part of the saving will also be in general maintenance, too. So the savings are somwehat spread and it is difficult to give an exact sum, but the thrust of the savings will be made where I have indicated.
Lord Glenkinglas: My Lords, if I heard correctly, my noble friend said to the House that the new, heavier lorries would be no bigger than the biggest lorries at present in existence, but would he not agree that the biggest lorries in existence at the moment are already far too big for a great many of the roads which they are using? In my part of Scotland they are creating very
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real problems indeed. It is not a question of by-passes, but rather the fact that the lorries are too big for the roads.
Lord Bellwin: My Lords, I hear what my noble friend Lord Glenkinglas says about that point, and I think that it only illustrates the difficulty facing anyone who is trying to take on board all the problems mentioned in the Statement. There are complex and intractable problems in trying to find a balance, a way through. I am sure that there is much sympathy for what my noble friend says. However. I hope that he will find helpful what we are proposing. It is not intended to increase at all the size of the lorries as such, but rather to find a way to achieve greater capacity within vehicles of the same size without damaging road surfaces and foundations. Perhaps that will not completely satisfy my noble friend, since he might like to see more by-passes and other solutions to the problem of narrow roads. If he has any suggestions, I would point out that the White Paper is intended for consultation, and we should be very glad to hear them.
Baroness Masham of Ilton: My Lords, may I ask the noble Lord whether the Government intended to keep down the speed of the heavier lorries?
Lord Bellwin: My Lords, I believe that the intention—and clearly this, too, is part of the discussion that must go forward—is to keep down speeds. I understand that a particular speed limit, is at present being considered. I do not have details of it, but I will gladly write to the noble Baroness with that information.
Lord Somers: My Lords, I should like to ask the noble Lord whether due attention has been given to the fact that very heavy lorries are liable to cause damage not only to the roads, but perhaps to the valuable architecture by the side of the roads? In view of that fact, would it not be possible to prohibit lorries in the highest weight range from using roads alongside which there is such architecture?
Lord Bellwin: My Lords, I had hoped that what was said in the Statement, and what the White Paper brings out, would indicate that we are very conscious of the point that the noble Lord makes, as indeed we are of what I may call all the other environmental aspects of the matter. I ask your Lordships to await the details as to how the objective will be achieved through having greater capacity without the vehicles having to be bigger or being likely to cause more vibration. Indeed they will be less so, due to the fact that the lorries will be constructed with an extra axle, as suggested. I think that the noble Lord will be satisfied on that point. In view of the questions that are coming from different parts of your Lordships' House, I feel that there is a need to look at the matter in more detail to see exactly how it is proposed we should move in the desired direction.
Lord Swinfen: My Lords, bearing in mind that a number of lorries are already very much overloaded, can the Minister assure the House that adequate steps

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will be taken to see that the new, heavier lorries are not overloaded to the same extent?
Lord Bellwin: My Lords, I thought I had made the point that one of the great complaints from the industry is not that they have to overload, but that they have to underload, if I may use the term. I am assured that one of the objects of the exercise—through increasing in terms of tonnes the weight that vehicles will carry, using an extra axle, yet without the vehicles being larger than at present—is to carry an additional amount, thus resulting in extra efficiency and economy, without the necessity for vehicles to be of the heavier type that was previously considered. It is interesting to note that the EEC, which previously had a limit of 44 tonnes, is now coming down to the 40 tonnes limit that we are proposing in the White Paper. If my noble friend Lord Swinfen wishes to pursue further that particular point with me, I should be glad to do so with him outside the House.

Mental Health (Amendment) Bill [H.L.]
Second Reading debate resumed.
4.38 p.m.
Baroness Robson of Kiddington: My Lords, I wish to join with the noble Lord, Lord Wallace of Coslany, in welcoming the Minister upon introducing his first Bill to the House following his new appointment. He and I have met on I think at least one occasion in our different capacities at the Department of Health and Social Security, and I join him in regretting that the noble Lord, Lord Butler, is not here today. From these Benches we, too, very much welcome the Government's introduction of the Bill, as well as the time that they have seen fit to set aside for it in the House. It shows a recognition of the great need to increase the rights of detained patients in our mental institutions. As the noble Lord, Lord Elton, said, a large proportion of the recommendations are in fact proposals that were contained in the Butler Committee Report and in the White Paper of 1978, and as such I believe deserve the support of all Members of this House.
I shall not speak on every point regarding the Bill, since we have a large number of expert speakers, but there are one or two points that I should like to pick out in particular. We particularly welcome the safeguard introduced in relation to Section 29, that a time limit of 24 hours be introduced for both examination and admittance; and we do not object, I would have thought, to the extension to 72 hours in the case of emergency admissions under Sections 29, 30 and 136. I think it is perfectly reasonable that in the case of an emergency admission of that kind a longer time should be taken and should be given. I do not believe it is purely a question of having hospital staff ready to undertake the examination: it is the greater difficulty of deciding the case on an emergency examination. I therefore believe that the 72 hours under this particular heading is the correct time.
All of us, I am sure, welcome the more frequent recourse to the Mental Health Review Tribunal that will be available to patients, and the fact that the
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waiting time is cut in half. But there is in society a great cry for recourse to the courts in the final instance. One can see that there is concern among people that this should be possible, but I wonder whether we could not look at it in a different way and see whether the patient could be legally represented before the Mental Health Review Tribunal. That, I believe, would help to allay much of the concern that exists in society over that problem.
Another point which I think is particularly welcome—and this comes from someone who has a large number of psychiatric hospitals in her region—is the right that nurses have, as has been recognised in this Bill, to detain a patient for a period of 6 hours. This was essential, because nurses in hospitals have had this great problem of never having had their rights laid down, and they had always suffered from the fear that they were overstepping their jurisdiction. I believe it is a very good thing that this problem has been finally cleared up.
The question of consent to treatment and the clarification that the Bill offers are very important matters and are fully in line with the Butler Committee recommendations; but there is a widespread concern that the second opinion is purely medical. Anyone who has knowledge of, or has worked in, a psychiatric hospital realises that the treatment of a patient in such a hospital is a complete multi-disciplinary treatment, and that it is necessary to have the opinion of nurses, psychologists and social workers, all of whom put an enormous amount into the treatment of the patient. You have only to talk with some psychiatrists and they will freely admit that on many occasions the ideas that have broken through with a patient have come from the nurses, and not necessarily from the psychiatrist. So there is concern that the second opinion is purely medical.
In the Mental Health Review Tribunal we have a multi-disciplinary body capable of giving that multi-disciplinary second opinion and we recommend that their terms of reference be altered to enable them to take on this additional service. I realise that the proposed Mental Health Act Commission is a multi-disciplinary body, but under the Bill they are proposing to appoint a doctor to give the second opinion. I do not believe this is the right way to go about it, and I believe that, as we have the mental health review tribunal, which is multi-disciplinary, we should ask that body whether it can undertake these additional duties.
When it comes to the Mental Health Act Commission itself, the principle behind the commission appeals very much. What is aimed at by the Government in their statements, particularly in their White Paper, and what the commission is supposed to do, needs to be done; but we already have overlapping jurisdictions and bodies working in the psychiatric field. We have the mental health review tribunal, we have the health advisory service and we have the national development teams, all of which overlap somewhat and all of which have slightly different attitudes from which they are looking at this matter within the service itself. Is it not possible to streamline some of these organisations, change their terms of reference and make one or other of them take on the responsibilities that the Government want to place on the Mental Health

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Act Commission? I thought this Government were the ones which were absolutely against setting up any more bodies—more Quangos, if you like. I am not saying that the Mental Health Act Commission would be a Quango—it would probably perform marvellously well—but I do not believe it is necessary. I believe we can use the organisations we already have, and perhaps get a better result.
I very much welcome, in reading the Government's White Paper and also in what the noble Lord, Lord Elton, said, the increased responsibilities being placed on the National Health Service under the 28-day admission for observation. This will inevitably increase expenditure in the NHS, and it will also create some problems. Over the past 10 years or more in the psychiatric field we have been working on the open-door policy. We have also proceeded along the line of creating assessment units in district general hospitals. We would not want to jeopardise the open-door policy of the psychiatric hospitals. On the other hand, the assessment units in district general hospitals would not always be suitable for particularly difficult patients.
The Butler Committee's recommendation in 1975 for the creation of the regional secure units would provide the perfect place for a lot of these assessments to take place. The Butler Committee recommended this in, I believe, 1974, and the Government of the day decided to set aside special funds for the creation of regional secure units. Let me give the example of what happened in my own region, because I think it is illuminating. It is not so easy to set up a regional secure unit. I believe there is one fully functioning and two or three in the pipeline in the whole of the country. We set about it in the South-West Thames Region, and we produced a detailed report and a complete scheme for building the unit in the grounds of the Royal Earlswood Hospital, which has grounds of 150 acres. It was to be at one side of the grounds, and would be properly secure, with a secure wall. There was enough local opposition—and we were not helped by the fact that local MPs also joined that opposition—for us not to get permission from the Secretary of State to go ahead with this scheme.
We therefore looked round, and we put forward another hospital. We asked the Department of Health, "Will you give us agreement as to the siting of this place, before we do all the planning?" After a few months we received the aswer, "No; you must come forward with your scheme in a bit more detail—not just on a question of siting". That took some months, and we completed the submission in about July 1980. We finally got an agreement to go ahead in July 1981, which means that that unit might be ready by 1985. I am not blaming anybody; I am just relating this story because it shows how difficult it is to implement these proposals. It is all very well; everybody feels that we should have these places—the courts feel it, the probation service feels it, society in general feels that we should have them—"so long as they are not in my particular patch".
I would recommend that Members of Parliament and Members of this House should themselves go out and actively try to influence people to the view that it is not a danger to society; that, on the contrary, it is much more of a danger to society in many cases to have some
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of these patients in open-door psychiatric hospitals. We must do all we can to convince people that it is the right way to go forward. Unless we do that, the whole of this Bill, if it becomes an Act, will not function any more than the secure units have functioned in the past. We have an enormous job of persuasion to do.
The noble Lord, Lord Elton, mentioned—and I was going to finish up with my regret at it—that the mentally handicapped had not been removed from the Bill. I understand his problem and understand that it would necessitate a second piece of legislation but, in view of the fact that we have had time for this Bill, I believe that as we have done nothing about the poor mentally handicapped within the Mental Health Act 1959 since 1959, we should have found the time to deal with them on this occasion. I know that the Government have promised a consolidation Bill which will put all this right; but the mentally handicapped people and their relatives have had promises. It has been a case of "This year, next year, some time, never!" I believe that they, and particularly their relatives, are getting very tired of being promised something in the future. I much regret that it was not thought possible by the Government to include that alteration to the Mental Health Act on this occasion.
4.52 p.m.
The Lord Bishop of Norwich: My Lords, with the noble Baroness, Lady Robson, I should like to congratulate the noble Lord, Lord Elton, on the way he steered us through. He called his opening speech analytical but it was so full of facts that, in reading, I believe it will help us very much. This Second Reading has attracted so much attention, publicly and in the press, and with this long list of 23 Members of your Lordships' House wanting to speak it will probably produce an opportunity to clear our minds within the thickets of the whole problem of mental disability, which, I think, is at a very liberalising point. believe that underlying this Bill there is an emphasis upon opening tip society again more understandingly to welcome people of mental disability.
I give one instance which opened my eyes. In Lowestoft, in my part of the world, we hold mini-Olympics for those who are mentally disabled. To go there, as I did, on the closing day and to help give out the medals, with 800 to 900 people with mental disability from all over the country, many from adult training centres, and to see their enthusiasm and the way in which they work to the limit of their abilities—even at dressage at that mental disability Olympics—was to see how the work being done in this country to welcome into society in the fullest way we can those who suffer from mental disability is moving in the right direction.
I recognise that this Bill is a sincere and determined attempt to look closely at the 1959 Act and to see how it can be amended with improvements. Following what the noble Baroness, Lady Robson, has said, I am sure that we are right to work towards the end of a consolidation Bill; but it may be that, because there is so much work to be done here, to advance immediately on a narrow front within the very strict time limit that the noble Lord the Minister told us about in the aim to get this legislation through by September of

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next year, is the right step forward and this would open up the wider areas.
Lord Elton: My Lords, it is implementation—which I think is what the right reverend Prelate meant by getting through—by September 1983; Royal Assent in 1982; consolidation shortly afterwards. That gets us in a position for implementation with a consolidated Act, which is something you can hold in your hand, read through and work upon, instead of the jigsaw that we are producing at the moment. I did not want that to go unmentioned in case I had earlier misled the House.
The Lord Bishop of Norwich: My Lords, the noble Lord did not mislead the House. I did not write down what he said; I held it in my mind, but bishops' minds are not always as clear as they ought to be. We were all moved by the letter from Brian Rix in The Times this morning making the point that mental illness and mental handicap are different. The heading:
"Why call my daughter sick when she is sane?"
has something to say to us for the future. He was able to say that the Government share the concern over this confusion and for the needs of the two groups to be recognised. We are moving in that direction.
I see this Second Reading as partly a matter of general public education for all of us for whom these areas may be new in terms of detail. We have had the whole question of the Down's syndrome issue before us and it is not unconnected with the wider issues concerning mental disability. Time has shown us that mongol children are basically happy, and, given parental love and security, do well in life.
I want to make one point about that from these Benches for two reasons. I find that mongol children, as they grow up, are very spiritually perceptive. Noble Lords will have read that letter from a Member of this House about his little mongol son. When I read that some weeks ago, my mind went back to a comparatively short time ago when I confirmed that little boy in a Norfolk village church. As he came forward and knelt before me and put his two hands together and rested them on my knee it was almost like a child from the Victorian age taught to kneel at his mother's knee to say his prayers. It was a moving moment for me. When later, with other candidates, he received the sacrament, he received it with a quiet and simple joy and a gentle reverence that made me feel that anything we can do to liberate people who are mentally disabled, through the law, through this Bill, through the interest aroused in it, is something well worth while.
The second reason why I tell that story is that in the Green Paper Care in the Community: a consultative document on moving resources for care in England, from the DHSS, of July 1981, noble Lords will remember that in Annexe "A" paragraph 4, we read:
"NHS Act 1977 Section 26 requires the Secretary of State to make services, facilities and staff available to local authorities so far as is reasonably necessary and practicable to enable them to discharge their functions relating to social services, education and public health".
But it does not say "concerning spiritual care". Noble Lords will remember the exact date of the NHS Act—5th July 1948. I remember it because it
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was three days before my eldest son was born on the 8th July, so it is an easy date for me to remember. Since that date the work of chaplains in hospitals—chaplains of all denominations who are now working closely together in a very warm, ecumenical way—has shown the tremendous importance of the chaplaincy work within the regular health service.
My plea simply at this point is this. We should not forget that if we are seeking to move people out into the community again who have themselves been tremendously helped by the administration of chaplains within hospitals and chaplains who have learned over the years, with considerable expertise, how to minister to those who are ill and mentally ill and suffer from both mental handicap and psychiatric illness, then when they come out of hospital it would be good if in some way provision could be made for chaplaincy help. It is true that not every parochial clergyman is expert in this particular task. Statutory workers, whether hostel staff or social workers, will need to initiate links with local churches. If some provision could be made for the short training of Ministers of all denominations in this work, I believe that great things could come from this.
As I see it, as was already made clear in the opening speeches, this Bill is an amending Bill to the main 1959 Bill. The Church—if I may speak from these Benches—welcomes very warmly its general thrust. It seems to me that its main provisions are ones which, as the noble Lord, Lord Elton, said, are very nonpolitical and are general, that hospitals should in future be more places of treatment and no longer so much of confinement and that patients will have many more chances to go before mental health review tribunals to seek release. I particularly liked the word that the noble Lord, Lord Elton, used when he said that no patient will ever be forgotten again because, with the review at least every three years, this will be done.
If I may descend to the realms of party politics for a brief moment—only to ascend—if we have to have Quangos (I do not quite understand who likes them and who does not) a Mental Health Act Commission is probably a very good, whitewashed, suitable and blessed-by-the-Church type of Quango. I hope therefore that the Mental Health Act Commission will receive the widest possible support.
I arise again after that above the level of party politics. I am so glad that the appointment of approved social workers is going ahead. This I believe will give chances for people who are enthusiastic amateurs to be trained in this particular and difficult area. Even such a small matter—apparently small to us in this House—of relaxation of censorship of detained patients' mail is I am sure a step in the right direction.
We seem so often to speak of the patients and not of the staff; but I believe that we ought to recognise that this Bill is going to do a lot to help the staff of our hospitals. It is so easy for them to be criticised and so difficult for them to do their work well. As I see it, there is here a balance between both freedom and control with some delicacy, particularly of course in the area of treatment without consent which no doubt will come in very much in the Committee stage when we talk in greater detail. I believe that the staff of our special hospitals deserve our support.

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I hope that the definitions in this Bill will help them to see what they can do and what they should do, and how they can do it.
I have a quotation from Martin Luther King which I will inflict upon your Lordships. I prepared it to give at the Cambridge Union a fortnight ago in a Homeric struggle between Mary Whitehouse on the one hand and Victor Lownes, ex- the Playboy show on the other. I was the supporting middleweight round with a famous poet who had produced the Penguin Book of Sick Verse. They had a bishop there to make for respectability. I was there behind the scenes as a type of No. 2 standing in on that Homeric struggle.
I had worked out for that the following quotation from Martin Luther King:
"Law cannot change the heart; but law can restrain the heartless".
Unfortunately, I lost it in the excitement of working among the young ladies and gentlemen of Cambridge. For the sake of your Lordships who do not follow these things, we won by 350 votes to 190 votes. I will tell noble Lords afterwards who "we" were. It was an exciting time.
I used it as a quotation simply to say that of course we cannot deal with all the problems that crop up within a confined community and with tremendous pressures on staff. But what we can do I believe—and I hope that in the Committee stage we shall do it in detail—is set the parameters within which staff work, to set the parameters within which patients can have as much freedom as possible and so to help those staff do their work carefully and well and patients to receive the very best treatment that is possible for them.
Therefore, without spending further time on that, may I simply say that we from these Benches warmly support the whole thrust of this Bill. I have to say to your Lordships that diocesan business unfortunately at 9 o'clock tomorrow morning means that I cannot stay through until midnight when the rest of you look forward to hearing the noble Lord, Lord Cullen, sum up after what will be a very good debate.
5.7 p.m.
Lord Allen of Abbeydale: My Lords, in view of the long list of speakers, I am proposing to limit myself to two points only. In particular, I am resisting the temptation at this stage to follow the noble Lord, Lord Elton, in discussing the recent judgment of the European Court of Human Rights and the noble Baroness in what she said about mental handicap. I would just make the point that I think it is risky to place too much confidence in the prospect of consolidation. Consolidation cannot make fundamental changes in the law. I fear that it is basically cosmetic, but there will be other opportunities to discuss that in due course.
When a Bill of this kind appears, I suppose all of us look at it from the point of view of our particular interest. I confess that for my part I went through it to see whether there was any prospect of its providing an additional measure of relief to our overcrowded prisons by enabling rather more persons suffering from mental disorder to be treated in hospital rather than to remain incarcerated in gaol. The desirability of moving in this direction is a long and familiar story.
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We were reminded of it only just a week ago by the noble Lord, Lord Mishcon, in the debate on prisons, and earlier by the May Committee which had a particularly eloquent passage on this point.
I have been looking at the figures in the White Paper—in particular, Table 1.4. I have done my best to bring the figures up to date. I understand that in 1980 the numbers committed by the courts under Section 60 of the 1949 Act, with restrictions under Section 65, totalled only a little over 100. Ten years before the total had been nearly three times this, although there were then many fewer people appearing before the courts. Again in 1980 rather fewer than 100 prisoners were removed to hospital under Sections 72 and 73, with restrictions under Section 74. I am sorry if I sound a little technical on this but I suppose it is better to try and be accurate.
There must be a number of reasons for these rather small figures, but I suppose, given the frustration expressed from time to time by the judges in individual cases, one reason has been the problem of finding hospital accommodation with some suitable degree of security. That is a problem which for various reasons has got worse rather than better in recent years and it is one explanation of why so many of us have been gravely disappointed in the delay in setting up the regional secure units to which reference has been made, which it must be recalled were recommended as a matter of urgency by the Butler Committee well over seven years ago, following up an even earlier working party which had made a similar recommendation some years before that. The noble Baroness has explained some of the problems and difficulties involved in pressing on with these new establishments, and no one will underrate the difficulties. Nevertheless, the story has not been a very good one and I do not think so far that anyone can feel particularly proud about it.
Looking at the likely impact of the present Bill in the context I have been discussing, I take the point, as the noble Lord, Lord Elton, explained, that tinder the Bill courts will not be able to make a hospital order in respect of a person suffering from a psychopathic disorder or mental handicap unless there is evidence that treatment in hospital is likely to benefit the individual. I cannot persuade myself that this provision of itself is likely to swell the number of those who go to hospital rather than to prison; but, in view of what has been happening in the last few years and of what has now in effect become accepted doctrine in the handling of psychopaths, I wonder whether it will have all that much practical effect.
Somewhat disturbing, to my mind, is what the White Paper says about the implementation of the Bill. I am afraid that the remarks made by the noble Lord the Minister have not altogether removed my feelings of anxiety. I particularly welcome Clause 27 of the Bill, giving Crown Courts and magistrates' courts the power to remand to a hospital for a medical report, and Clause 28, which gives the Crown Court the power to remand an accused person to a hospital for treatment, even though it is just a trifle obscure what happens if the treatment is of a nature requiring the individual's consent and he refuses to give it. Then there is another clause which gives the Crown Courts and magistrates' courts the power to make interim hospital orders. As has been explained, these are provisions

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implementing the Butler recommendations, and I take the point that quite a lot of what the Butler Report recommended would involve altering other Acts and not just the 1959 Act. I do hope, though, that these clauses are precursors of legislation implementing other Butler recommendations, and I will study with great care what the noble Lord the Minister said on this particular point.
Going back to Clauses 27 to 29, reading them in the Bill does buoy up one's hopes, but the White Paper then goes on to dash those hopes by explaining that they are likely to be brought into effect only during two or three years after the Bill is passed. Painful experience suggests that that estimate is not likely to exaggerate the length of the waiting period. But I hope the White Paper means what it says when it refers to two or three years after the Bill is passed because, as I understand it from what has been said, the Bill as a whole is not likely to be implemented until well into 1983, which is getting on for two years from now.
I suppose the additional hold-up contemplated for the particular clauses I have referred to must arise in part from the delays in setting up the Butler units, and relieving the overcrowding in the special hospitals. However, it looks as if there may be other factors, too. I am just a little puzzled by this because I would have thought that the provisions in the Bill, extending the opportunities for individuals to go to the mental health review tribunal, should mean that some of them would be released, whereas under the old regime they would have stayed in hospital—or, if not, I am not quite sure what we are discussing. If that were so, some of the resources in the hospitals ought to be made available for these new demands. Anyway, this is a very important topic which is dealt with a little cursorily in the White Paper. I hope that when the noble Lord comes to wind up he may be able to say a little more about the implementation of this part of the Bill.
Now I come to my much shorter second point. Here I suppose I must declare an interest, although certainly not a financial one, in that I am president of the Friends of Broadmoor Hospital. When the noble Baroness the Leader of the House announced on 11th November 1980—I have a note to say that the Hansard column number is 1291, but I would not guarantee that—that the Government accepted the Boynton recommendation to set up a hospital review board for Rampton and explained what arrangements were in force at Moss Side and the remarkably named Park Lane, she said the Government were looking at what suitable arrangements might be made at Broadmoor for bringing in some outside interests. Nothing more has been heard of these arrangements, so far as I am aware, and I should like to ask whether the new Mental Health Act Commission is intended somehow to fill this gap as regards Broadmoor. If it is, the consequential question arises as to how the new body will fit in with the Rampton board, which is already in existence and, I believe, working satisfactorily. On the other hand, if this new body is not intended to meet the special circumstances of Broadmoor, as I suspect it is not, I wonder whether we could be told what the prospects are now of our hearing about possible arrangements at Broadmoor. If the Minister
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cannot let us know when winding up tonight, perhaps he would be good enough to write to me about it.
In conclusion, could I say that I do greatly welcome this Bill, which cuts right across party lines and is intended to improve the lot of one of the least favoured sections of our community? We are grateful to the noble Lord the Minister for his clear exposition of the Bill, and I think it is remarkably appropriate that the Bill should be introduced and gone over in detail in your Lordships' House.
5.19 p.m.
Lord Kilmarnock: My Lords, we on this Bench are glad to be able to extend a welcome, albeit with important qualifications, to a Bill which will be the first major revision of the law on this subject since the Mental Health Act 1959.
The history of the Bill is well known to your Lordships and was outlined by the noble Lord, Lord Elton. It deals with a subject that has been the concern of both major parties—I should say now of all parties in the political spectrum. The Butler Report on mentally abnormal offenders was published in October 1975 and the same month saw the appearance of Mrs. Castle's White Paper, Better Services for the Mentally Ill. Those were followed by the last Government's White Paper, A Review of the Mental Health Act 1959, which was published in September 1978 (a very valuable document), and by the present Government's White Paper which was published last month and on which the present Bill is largely based.
The Government's White Paper refers to the proposals made by the Rampton hospital review team, chaired by Sir John Boynton, for the establishment of an entirely new body to inspect and monitor closed institutions such as Rampton, and to oversee the very sensitive and difficult area of the treatment of certain patients detained without their consent. Paragraphs 29 to 40 of the latest White Paper set out the Government's view of the role and scope of this new body, which they will call the Mental Health Act Commission, and which constitutes one of the major innovations of the Bill which is before your Lordships' House. But before looking at this new body in any greater detail, I should like to point briefly to those provisions which, it seems to us, constitute improvements to the principal Act.
First, with due respect to the noble Lord, Lord Wallace of Coslany, we find perfectly acceptable the changes in terminology. The replacement of the term "subnormality" by "mental handicap" may be little more than cosmetic, but it is in keeping with current concern for all those who are disadvantaged in our society; though I am inclined to agree with the noble Baroness, Lady Robson, and others, that the handicapped should not ideally be lumped together with the mentally ill in the same legislation. The replacement of the word "observation" by "assessment" is a distinct improvment, with its more positive implication of a first step towards diagnosis and, where appropriate, treatment.
Then, more importantly, come those measures whose general thrust is in the direction of better safeguards for patients. It seems to be right that a

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person making an application under Section 29 of the Act, to have a patient detained under the emergency procedure, should have to have seen that patient within the previous 24 hours, rather than three days as at present. The period within which the patient must be admitted is likewise reduced to 24 hours and the application is restricted to the person's closest relative or mental welfare officer, rather than left open to any relative. Obviously these provisions should only be used in cases where speed is of the essence and the proposals in the Bill, which derive from paragraph 16 of the White Paper, can therefore be welcomed.
Next, the general shift in the patient's favour of the whole appeal and review procedure is also to be welcomed. Paragraph 28 of the White Paper shows in tabular form the improved frequency of the right of application to the mental health review tribunals. These revised arrangements may be seen, in fact, as providing additional safeguards not only for patients, but also for staff. Long-term cases tend to get overlooked and to become resigned to their characterisation by the hospital staff, and from now on, or from the passing of this Bill if it becomes an Act, patients will be less likely to get stuck in this kind of rut. In effect, Clause 12, by halving the duration of authority for detention, doubles the opportunity for review by the tribunal.
I turn next to the Bill's main proposals concerning offender patients, which are contained in Clauses 18 to 30. This part of the Bill offers some modest but useful reforms, of which those contained in Clauses 26, 27 and 28, which were mentioned by the noble Lord, Lord Allen of Abbeydale, are the most important. On restriction orders, the Bill echoes the proposals of the Butler Committee, which recommended that such orders should only be imposed to protect the public from "serious harm", which is the phrase used in Section 26 of the Bill. There is little doubt that these orders were sometimes imposed in cases where their severity was inappropriate; for example, in cases of frequenting, soliciting, disorderly behaviour, petty theft and drunkenness. Their exclusive use for cases in which serious harm may be inflicted on the community is to be welcomed.
Clauses 27 and 28, on remands to hospital, also seem to be steps in the right direction. Hitherto the only possible forms of remand have been remand on bail or remand in custody. As remands in custody for medical reports are notoriously unsatisfactory, the new category is an improvement. But we have some reservations here. It would be preferable if two medical practitioners, rather than just one, had to advise the court under Clause 27(3)(a). Then, under both Clause 27(7) and Clause 28(7), 28 days seems an adequate time for an assessment and we question whether the 12-week maximum is excessive. In both these clauses, our concern is that safeguards should be stronger than the Bill provides, in order to prevent accused people from being remanded to hospital for longer than is absolutely necessary, and we shall want to look at this at Committee stage.
I come now to the proposed Mental Health Act Commission and the areas of the Bill where our serious disagreements begin. There is certainly a good case for arguing that very closed institutions, such as Rampton,
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would benefit from the scrutiny function which is to be exercised by the new body. However—here is our first caveat—what provisions will there be to ensure that it is properly and publicly accountable? And what about its composition? The Bill is rather coy about the composition of the commission. The White Paper speaks in paragraph 31 of,
"an independent body with members who will be eminent in their different fields; it will really be a safeguard to patients when they are detained".
So far, so good. But then in paragraph 32 we are told that,
"The Government intends that members of the proposed MHAC will be lawyers, doctors, nurses, psychologists, social workers and laymen".
But it does not tell us in what proportions. And the Bill is even less explicit than the White Paper. Clause 42 simply tells us a little about the commission's functions and remuneration, but there is nothing about its composition. The noble Lord, Lord Elton, has simply told us that he envisages about 70 part-time members.
Then in subsection (3) of Clause 42 we learn—as it were, in an aside—that medical practitioners, empowered to act under the very important Clauses 38 and 39, may include members of the commission. Here I really must voice a sense of disquiet. We seem to be asked to accept a commission appointed by the Secretary of State, which may in turn appoint its own medical members to give the second statutory opinion specified in the Bill. Here I very much agree with what the noble Baroness, Lady Robson, said about the desirability of a multi-disciplinary second opinion.
I would question very seriously whether, in a free country, the Government of the day should ever be given power to decide, through their own appointees, whether someone should be treated who does not want to be treated—even though the White Paper states in paragraph 39 that these appointees,
"will take account of wider social and ethical"
matters. But these are areas in which they are surely no better qualified than anybody else. The whole question of the balance and composition of the commission, and, in particular, of the lay membership, is of the utmost importance, and I hope that the noble Lord, Lord Cullen, will be able to enlighten us more on this when he comes to wind up.
I want to say just a few words on Clause 38, which is by far and away the most controversial in the Bill. However good its intentions, it undoubtedly introduces a new principle into English law and triggers off, in me, at any rate, a whole battery of alarm bells. The tricky issue of consent to treatment by detained patients is very thoroughly discussed in the last Government's White Paper of September 1978, which was called Review of the Mental Health Act 1959—a most excellent document, in my view.
The first and most important point to grasp is that the 1959 Act, as it stands, confers no statutory right on a medical practitioner to treat a patient without his consent. The most that can be read into it is an implied authority in certain exceptional cases. And even this view—which, incidentally, has never been tested in the courts—has recently been increasingly questioned by bodies such as MIND and others. Because of these doubts, it was the last Government's opinion—and is, apparently, that of the present

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Government—that the power to impose treatment in certain circumstances needs to be made specific, rather than simply left implied as at present. But this immediately raises almost more difficulties than those its sets out to solve. As was admitted in the 1978 White Paper, in chapter 6, paragraph 17,
"… it is by no means easy to formulate proposals which will both provide safeguards for patients and sufficient flexibility to enable staff to deal with the variety of difficult situations which confront them".
How have the Government gone about it? They have, in broad terms, lifted the proposals made in the 1975 report of the noble Lord, Lord Butler, out of their original context—because it should be remembered that the Butler Committee was only concerned with offender patients—and are attempting here to incorporate them, with their safeguards, into the statute law of the land. The safeguards are, of course, important and they appear in subsection (7) of Clause 38. But they are hardly foolproof.
For example, subsection (7)(b) permits involuntary treatment,
"which (not being irreversible) is immediately necessary to prevent a serious deterioration of his condition".
But some would argue that this is open to such wide interpretation as to be either dangerously loose or almost meaningless, or, perhaps, both at once. Be that as it may, there is, without any doubt, one paramount respect in which the Bill, through this clause, makes a revolutionary impact on our law. At present, treatment without consent is both a civil and a criminal assault. The Government have set this important principle on one side, for in order to give their safeguards some validity they have had to come up with something to safeguard against. And this they have done in no uncertain or mealy-mouthed fashion by announcing in the very first lines of the clause that:
"Subject to the provisions of this section, the consent of a patient detained under the principal Act or this Act shall not be required for any medical treatment given to him for the mental disorder from which he is suffering if the treatment is given by or under the direction of the responsible medical officer".
Those are the words at the beginning of Clause 38. There it is in black and white, for the first time ever, subject of course to certain provisions.
But are these provisions going to be adequate? Once you have got the principle down in black and white, from which of course the safeguards are merely derogations, can one be certain that the safeguards may not be progressively whittled away or arbitrarily interpreted? And it is not only Clause 38 but the clause in conjunction with the proposed body for monitoring its application which gives rise to some alarm. We must be very vigilant, I suggest, in ensuring that something introduced, no doubt with the best of intentions, does not become the tool of future abuse. I shall not pursue this question any further in the present debate. I am simply putting down a marker for a later stage when, among other things, we shall also want to look very hard at the definition of "consent" which nowhere appears in this clause.
Another thing that is missing is any requirement for a detailed written record of the procedures leading up to and accompanying treatment. It is surely of the greatest importance that, if the state is to extend its power of administering medical treatment to its citizens without their consent and even, as is provided in
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Clause 38(2)(b), against their will, the most meticulous records should be kept and be accessible to independent scrutiny. I think I have now said enough to indicate that this clause gives rise, among us, to some very grave misgivings.
There are some other shortcomings in the Bill. It does not provide for any change in the eixsting restrictions on legal aid, to which the noble Baroness, Lady Robson of Kiddington, referred, which prevent a patient who wants to be legally represented at a hearing of the mental health review tribunal from applying for legal aid. Without this reform, will not much of the benefit of increasing patients' access to the tribunal be undermined? We are also less than happy with paragraph 62 of the White Paper dealing with the position of restricted patients' access to court review of their detention. We feel that the necessary amendments to meet the strictures of the European Court of Human Rights should be incorporated in the Bill. I was glad to hear the noble Lord, Lord Elton, refer to this and tell us that the Government are proposing to bring forward some amendments on this point. And there is finally the question of the deprivation of 124,000 informal patients of the right to vote. How many of these are in fact unfairly deprived? This important matter is not touched on.
I said at the beginning that we give a qualified welcome to the Bill, and that remains the case, but the qualifications are very important ones and the more I think about them the larger they loom in my mind. I have said nothing about the financial effects of the Bill, referred to in the Explanatory and Financial Memorandum, but I think it is worth remarking that the cost appears to be in the region of £6.1 million in any one year. While applauding the Government's intention to spend such a sum in the area of health and social policy, for which their administration has, frankly, not been remarkable, I am sure they will agree that we must be very careful to get the Bill right if such a sum is to be warranted. I hope, therefore, that we shall have a constructive Committee stage and that the Government will accept that those of us who bring forward amendments will not be trying to wreck the Bill but to make sure that it goes to another place with significant improvements.
5.34 p.m.
Lord Renton: My Lords, I am glad to know that the noble Lord, Lord Kilmarnock, joins the growing number of your Lordships who do not want the mentally handicapped and the mentally ill to be lumped together. My noble friend Lord Elton in his open-minded opening speech said that this Bill was a non-party measure. The noble Lord, Lord Wallace of Coslany, endorsed that. I think that this is a splendid way for us to approach this, from both sides of the House. I am so grateful to both noble Lords for the favourable advance notice that they gave of what I might now say. I must try not to disappoint your Lordships.
In the last session the Government did a splendid job, with the help of both sides of both Houses, in improving the Education Bill which we in the Royal Society for the Mentally Handicapped welcomed so much in its final outcome. I hope that the present Bill, in the capable hands of my noble friend Lord

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Elton, will receive similarly favourable treatment, as he said it might, for although it contains useful and welcome provisions it is not acceptable in its present form so far as the mentally handicapped are concerned—as I shall explain.
My noble friend mentioned that 21 years ago when I was Under-Secretary at the Home Office under my noble friend Lord Butler, who was then Home Secretary and whose absence we greatly regret today because his report was so valuable so far as mentally disordered offenders were concerned, I had the responsibility of piloting the criminal justice provisions through another place. My right honourable and learned friend Sir Derek Walker-Smith was the Minister of Health in charge of the Bill. Those criminal justice provisions are in Part V of the 1959 Act. In Part III of this Act they are improved in various useful but relatively minor—not unimportant but relatively minor ways. At the time, the 1959 Act was regarded as a progressive measure but the advance of medical knowledge and the experience gained both within the hospital system and within the prison system, and generally, of the way that that Act has worked have revealed that we made a serious mistake in lumping together the mentally handicapped and the mentally ill. They are now seen to be radically different. After all this time we should surely deal with them differently and if possible separately.
Even today, alas! it is not always understood by the police, by magistrates, by judges (even High Court judges), and by court officials that mental handicap differs fundamentally from all other forms of mental disorder. In trying to understand why this is so—I have asked many members of my own profession and those who still practise in the criminal courts—the nearest I can get is that in the 1959 Act definitions they are all lumped together. Such distinction as is made in the definitions is not clear enough to show their different condition. As it is possible that some others still do not understand the difference, I wonder whether I might very briefly amplify it.
Mental handicap is nearly always something with which people are born, just as some other people are born with a club foot, a withered arm, a cleft palate or some other physical disability. Mental handicap is mostly due to genetic factors, but not hereditary genetic factors. Indeed, so far as present knowledge shows, it is scarcely ever hereditary. But it can also be caused by brain damage either at birth or through an accident in later life. The main point about mental handicap is that it is incurable, with one very small, unpronounceable exception, and that has to be dealt with within a few days or weeks of birth. I shall not try to pronounce it but it is familiar to those who have some medical knowledge.
It is on this point of the incurability of mental handicap that I say with respect that the Bill goes wrong. In Parts II and III it assumes that mental handicap is curable. But it is not. Mental illness, on the other hand, can happen to any of us at any time. It is generally curable to a greater or less extent, with or without admission to hospital. So there is a real difference between those two conditions. Now there are cases in which mentally handicapped people become mentally or physically ill as well as having
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their mental handicap, and I suggest to your Lordships that that is the only time when there is any justification for sending the mentally handicapped to hospital. whether under the compulsion of a court order or under any other kind of persuasion.
This difference between mental handicap and mental illness was acknowledged in the report of Lord Butler's Committee on page 5, where it is said:
"Severe subnormality and subnormality, together generally referred to as mental handicap, are permanent disabilities. Care and training may, over a long period of time, to some extent improve the patient's level of performance but the disabilities are not, in the present state of medical knowledge, susceptible to cure".
If we send mentally handicapped people to hospital when there is nothing else wrong with them it is a sheer waste of time, effort, money and resources within the National Health Service. But, worse than that, if we shut them up in hospital, when they have been accustomed to living in the community, either in their own families or in a hostel or elsewhere in the community, we cause them frustration and unhappiness which can have a bad psychological effect upon them.
As has been mentioned, in September 1978 the Labour Government produced a departmental report, Review of the Mental Health Act, 1978 and that went only part of the way towards acknowledging this difference between mental handicap and mental illness. It is significant that when it was debated in another place in February 1979 every Member except two (who shall remain nameless) who spoke in that full day's debate, said that there should be separate provisions and indeed separate legislation for the two types of mental disorder. Since then the DHSS and the Home Office (in which I was proud to serve for 4½ years) have had nearly three years to get this right; it could be said that they have had longer. I was looking forward to this Bill in the hope that they would do so, but I must confess that I am disappointed. No change of real substance has been made in the stringent powers affecting the mentally handicapped. They can still even be sent to prison in exceptional circumstances. I hope they never will, but they can be sent to prison. I wonder whether my noble friend who is to wind up the debate can tell us how many people suffering only from mental handicap are in prison today? I hope the answer is, nil, but if it is two, it is pretty bad.
Lord Donaldson of Kingsbridge: My Lords, before the noble Lord leaves that point, I was listening to him with the greatest attention in his most interesting speech and there is one point which I think we shall agree with but that I want to have cleared up absolutely in my mind. It is the question of sending the mentally handicapped to hospital. Surely in the case of mentally handicapped children beyond a certain level the normal practice is to send them to an institution which is a branch of a hospital. I only wish there to be no confusion. I have been a governor of a hospital and we had a very fine institution for purely incurable mentally handicapped children. I think it should be made clear in what the noble Lord has said that he is not speaking against that practice.
Lord Renton: My Lords, I am grateful to the noble Lord for inviting me to amplify and clarify the position.

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I was coming to that, but as he has mentioned it I think I should tell your Lordships of the lamentable fact that there are no fewer than 2,000 children in large hospital institutions who are suffering from nothing but mental handicap and I am glad to say that it is the policy of the present Government to help the voluntary societies to provide alternative ways of life within the community for those 2,000 children. Only this week I am glad that my right honourable friend the Secretary of State was able to announce a pound-for-pound scheme whereby the Government will provide, over a period, a million pounds on the basis of a pound for pound spent by voluntary societies. That is partly the answer to the noble Lord, but I shall come to a further answer in a moment if he will be so good as to follow me.
The Bill makes no change of real substance in the stringent powers affecting the mentally handicapped. I have dealt with prison. There can still be compulsory hospital orders. It would help to know how many mentally handicapped offenders are compulsorily kept in hospitals of one kind or another. I think they are all in what are known as special hospital—anyway those who come through the courts are—and I understand that the number is about 600 or 700 of those just in special hospitals who have been sent there under Part V of the Act. That is in addition to the 2,000 that I mentioned just now. But surely we can do better than that, bearing in mind some of the cases—I will not give details now; I shall hope to do so at Committee stage—of children who should never have been sent to hospital. Trivial offences simply because the court did not know better and was not given better advice or opportunities.
The Bill merely substitutes a welcome change of name from "subnormality" to "mental handicap", and it redefines "treatment" and "treatability", but it does so in ways which are irrelevant and out-of-date so far as the mentally handicapped are concerned.
I was very surprised—and I must be frank with him and tell him that I was shocked—to hear my noble friend Lord Elton relying upon the report of a committee of the Royal College of Psychiatrists in about the New Year of 1979—a report which was discredited by many other psychiatrists as soon as it had been published. Indeed, I do not know of anyone outside the Government departments who now supports its conclusions, and it was even more reactionary in one important way than the DHSS because it said that there should be no change from the expression "subnormality" to "mental handicap", and I hope that in further discussion we shall not have this now discredited report foisted upon us.
In order to placate those many people inside and outside Parliament who want a separate and distinctive set of legislative provisions for the mentally handicapped, the White Paper (as has been mentioned) promised separation on consolidation, but as the noble Lord, Lord Allen of Abbeydale, with all his experience of the Government service so wisely pointed out, that would make no difference because on consolidation the law cannot be changed.
I do not blame my noble friend Lord Elton for the situation in which he finds himself. A few weeks ago when this Bill, which had not then seen the light of day, was placed on his table years of work had been
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done on it. It was all crystalised, I would think, not months before but probably two years before he was appointed. I suspect that in both the DHSS and the Home Office it was crystalised in September 1978 at official level—and it was an official's report in 1978—and they, for reasons perhaps of pride or sincere conviction or what have you, have committed themselves to this wrong attitude and have declined to pay heed to informed opinion in and out of Parliament since then. Administratively, of course, it is easy and convenient to leave things more or less as they are, always, especially if change involves some complication, especially in legislation. As the White Paper says in paragraph 9, only a very small minority are involved. But they are among the saddest of our people. They cannot speak for themselves. We must speak for them. The Government must get it right, with our help.
It is not only a question of further amending the Bill; it is a question of amending the 1959 Act as well. May I say that I agree with those noble Lords who have said it does not matter very much whether we have a separate Bill or not. If we had a separate part confined to the mentally handicapped in this Bill at the end of the day, honour would be satisfied. I come further to the point of the noble Lord, Lord Donaldson. If some few mentally handicapped people must unavoidably be detained, let it be with those of their own kind. I know from experience that they always get on better with each other than if they are pushed in with psychopaths, people suffering from various kinds of mental illness, or indeed with normal people. It is rather wonderful how they do. Bearing in mind that the numbers are not great, I would have thought it would not be beyond the wit of the DHSS and the Home Office to find some way of providing more or less secure accommodation, perhaps on the lines recommended by Lord Butler's committee in their interim report in 1974, which has never been acted upon, when they suggested that there should be in each region a secure psychiatric unit. This could be an annex to the psychiatric unit, but separate from it. As I say, the numbers are not great. Perhaps that should be considered.
I hope, when my noble friend, Lord Elton professes an open mind on the part of the Government, and when your Lordships volunteer that they think that the treatment of the mentally handicapped should be different from what it has been under the 1959 Act, that we shall as a result of a combined team effort somehow get this right; but it is going to need the co-operation of the Home Office as well.
5.54 p.m.
Lord Wells-Pestell: My Lords, having listened to the seven previous speakers in detail, it is quite clear that two things have emerged from the discussion that we have had so far. One is that there is a general opinion that the Bill is a good one and it has no party political implications at all; and, secondly. that there are a number of things which need to be done. I would subscribe to that, but, bearing in mind that there are still 15 speakers to go—and think it is fair to say that all that can be said about this Bill has already been said by the seven previous speakers—I do not intend to monopolise much of your Lordships' time. But I do want to make one or two comments.

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It is perfectly true that basically the Bill is a good one, but it is equally true that it has got to undergo a very real reappraisal, and obviously this is a matter for Committee. The Bill, as we all know, covers a very wide field, but perhaps it does not go far enough, and I hope the Government will be prepared to keep an open mind on this. If I may say so without giving offence, I think the most important thing that has been said today is the statement made by the noble Lord, Lord Elton, that the Government's mind is not closed—something new for this House, if I may say so; something quite new. We on this side of the House know that in the last two years, when we have had to fight a whole series of complicated Bills, not only was it closed but sometimes we wondered whether it existed at all. So I do ask, quite sincerely and without being too disagreeable about it, that the noble Lord will come to the House, not only at Committee stage but at Report stage, with an open mind, because it is of supreme importance that we get this Bill right, seeing that generally speaking we are in complete agreement with it.
The Government's willingness to consider amendments is very important indeed. I find myself in some sympathy with the noble Lord, Lord Renton. I can remember being in the same place as the noble Lord, Lord Elton, when I had to introduce into your Lordships' House the Medical Act 1978, and being told in no uncertain manner that there were certain things that could not be included and in no circumstances was I to give way. The noble Lord, Lord Hunt of Fawley, came forward with a whole series of amendments, and I had to tell him, "No part of the Bill at all; no resemblance to the Bill; I could not accept them". He accepted that. They came up again on Report stage, and I was told. "You must not accept them; you must not give way". And, of course, being the lowest form of ministerial life in the department, I did as I was told. But the noble Lord, Lord Hunt of Fawley, had consulted a very eminent medical body, who established beyond all reasonable doubt that it could be done. So at Third Reading he put the amendments down again and we had to accept them—the first time. I believe, in the history of your Lordships' House that an Opposition Member had got everything he wanted.
I say to the noble Lord, Lord Elton—and I want to be perfectly serious about this now—that I hope he will not be intransigent. I understand the position he is in; I understand the difficulties. But I hope that he and his friends will not be intransigent about this Bill; that they will read first what the noble Lord, Lord Renton, said, will look at it and find ways and means of seeing whether it can be done. Many of us believe it can be done.
Lord Elton: My Lords, I only wanted to say to the noble Lord that, while I accept his description of myself as the lowest form of ministerial life, I would not accept it for him, particularly in view of what he has just said. I endorse that my mind will be open. Perhaps I might take this opportunity to say that the earlier amendments come to us the easier it is to discover ways to accommodate rather than reject them.
Lord Wells-Pestell: My Lords, I am much obliged
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to the noble Lord I do not know whether he and or his friends have had any discussions with the noble Lord, Lord Renton. I imagine that perhaps they have. I hope that they will pursue this point because I think the noble Lord, Lord Renton, has raised an important point.
I wish to comment on two other matters. First, concerning the Mental Health Commission, I believe that the noble Lord, Lord Elton, said that it would consist of 70 people. There is certainly no mention of that in the Bill. I cannot find the figure "70" in the Bill. I wonder whether this is a figure that they are aiming at, or whether in fact it is a decision that has been taken. The noble Lord mentioned the various classes of people in our society who would go to make up the 70, and he used the word "laymen". This is the first time that I have seen it used in any document that has been published on this matter. I hope, in point of fact, that it will not be left entirely or exclusively to representatives of the few professions which are usually involved in medical matters. I hope that there will be one, two or three balanced ordinary people who, perhaps cannot subscribe to the great heights that other members might be able to subscribe to, but who can bring an everyday common sense view to the matter. I think that it would be a great mistake if the commission were, in fact, bounded by professionalism in the academic sense.
I should like to ask at some stage how the commission will work. If there are to be 70 people, then presumably England must be divided up into areas. Does it mean that a certain number of the 70 will be appointed to each area and then there will be a kind of sub-committee of the commission? I cannot visualise the structure. I think it is important that, if we are to agree in principle to these matters, we ought to be able to see clearly the structure that the Government envisage. I should be grateful if at some stage the House could be given some indication as to how the 70 will work. They cannot all be running all over England. They must put down their roots deeply in a defined area or areas somewhere. But I cannot see how they will work, and so I should like to ask about that.
The other matter relates to the social services. Clause 43 on page 30 of the Bill says:
"After the expiration of the period of two years beginning with the day on which this Act is passed the functions conferred by the principal Act on mental welfare officers shall be discharged by officers of local social services authorities to be known as approved social workers".
I should not have thought that there was a possible chance of that coming into being in the next two years or the next three years.
Whatever we do, let us be realistic. If the noble Lord were to say that if we do not put this in the whole matter will drag on, then I could understand it. I think that it is desirable to express in an Act what we intend to do. But if we are going to say that it has got to be at the end of two years then a great deal must happen. Presumably the mental welfare officers will be transferred to the local authority social services, otherwise they may not have a sufficient number of qualified people to undertake the task. If they have to use approved social workers then the word "approved" in this case surely means qualified. It

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cannot mean anything other than qualified. There will not be that number of qualified social workers to deal with the mentally ill. I am sorry to keep on saying this to your Lordships, but more than half the social workers in the employ of the local authority social work services that we let loose on the public are themselves untrained. It is not their fault; they are willing to be trained, but the places are not there and the money is not there.
So I say to the Government that if they are seriously minded to do something about this, then I should like them to come to the House and to say what their plans are for training people within the next two years to undertake this very difficult task—and let us make no mistake about the difficulty—of dealing with the mentally ill. Some of your Lordships who have had experience in this field will know that it is a supremely difficult job. Therefore, again at the risk of repeating myself—and that is precisely what I am doing—I want to ask the noble Lord to give the House some assurance that the means will be found, and that they will really start on the day that the Act is passed, so that the mental welfare officers can be transferred at the earliest possible moment to the local authority social work service, and, what is more important, that each local authority social work service will have the means and the money to train social workers within the service to become mental welfare officers, albeit that they will be called "approved social workers". Do not let us use words which have specific meanings as the word "approved" does—it implies a trained person—if in point of fact, when the time comes, we are not in the position to do it. I can think of nothing worse than having somebody who is untrained trying to deal with the problems of the mentally ill.
I do not necessarily expect answers to these questions tonight, but I think that the House ought to know at the earliest opportunity what the Government's thinking is on these particular matters, because it will be very difficult to put down amendments unless we know the Government's intentions. I hope that the House will be informed even if it is only by letter, or perhaps by somebody being invited to put down a Question for Written Answer.
6.7 p.m.
Baroness Vickers: My Lords, first may I thank my noble friend Lord Elton for the way in which he has presented the Bill and wish him every success in his new office. I feel that I must say a few words on this matter—although I suppose that I am the first amateur to speak tonight—because I was on the committee which dealt with the 1959 Bill. I should like to pay a tribute to a woman in the other House at that time—Bessie Braddock—because I think that she did a great deal to help these people; and, although she was in Opposition at the time, she worked very well with us and I think she would be very sad to see Liverpool at present. However, I think that we owe her some thanks tonight because she worked so well.
I personally think that the 1959 Act has worked well in view of the general progress of medicine and the better understanding, which is so important, of the general public in regard to mentally ill persons. Therefore, I hope that with the passing of this Bill more understanding will come in the community and more
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people will be able to receive care in the community, which I think is something we all want, and there will be less posssibility of detained patients. I notice in the appendix, Table 3.1 of the White Paper, that since 1974 the number of compulsorily detained patients has averaged every year about the same—7,000-plus. I think that we ought to look into this matter to see whether any action can be taken.
With reference to what the noble Lord, Lord Renton, has said as regards the mentally handicapped, he may be pleased to know that on Saturday I was in Plymouth, where we have just opened two special houses for these people and we now have an assessment centre with a fully qualified woman in charge. That may give him a little encouragement and I should like to add that I totally agree with many of the things that the noble Lord said. I think that it may be a little difficult to do all that he wants done in this Bill, but I am sure that he will get the support he needs.
As I understand it, when the 1959 Act was passed it was thought that it would provide new types of psychiatric treatment and research, and that the public would accept—as I think it has—psychiatric treatment, the use of ECT and tranquillisers; and it was hoped that every patient would have the right to refuse this type of treatment. Like the Nationality Act, which does not define "nationality", the Bill does not define "mental disorders". I hope that before we complete this Bill we shall be able to get some more definite understanding of what this implies.
I shall cut out many of the points that. I would have raised because they have already been spoken to. However, I should like consideration to be given to the appointment of a medical director or medical superintendent in each hospital. Before the 1959 Act there was the post of medical superintendent. It is absolutely essential that we have some officer to co-ordinate the work in these hospitals. A hospital may have as many as eight or nine consultants and, therefore, i think it is essential to have someone who can co-ordinate their work, to whom the patients can turn (if they wish) with their particular problems—not their medical problems, but their personal fears—and who can offer advice to the staff, which is very lacking at the present time. We used to have a medical superintendent and a matron in our hospitals. I personally think that they are very much missed both by the patients and by the staff.
Patients' friends sometimes have to travel a long way to visit them in these hospitals. Therefore, when relations ring up or come to see the consultant, he may not be present and they also sometimes cannot get the information that they desire.
I should like to turn to social workers. Are they to have any other work, or will they be simply approved entirely for this type of work? In 1959 I was very interested in a recommendation of the Younghusband Report for a generic social worker—a social worker rather on the lines of the French system. I have now changed my mind, especially in regard to the appointment of social workers who need special qualifications, because I think that they have far too much work to do and have to turn their minds to far too many different problems. If they are to do this type of work, I understand that they need to visit the hospitals and to see the patients, which will be a full-time job.

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One of the difficulties—and I hope that my noble friend Lady Faithfull will not mind my saying this—about child care is that too many burdens have been placed on social worker officers. Clause 16 of the Bill will put too heavy a burden on the approved social worker unless we make special conditions.
There is also a need to place a mandatory duty on local authorities to provide housing, care and support in their areas. Resources will be needed if we are to get people out of hospitals, either when they are cured of their mental breakdowns or the mentally handicapped, as previously mentioned. If people could be put in the care of local authorities, it would he very much cheaper than keeping them in hospital and would also give them a freer, individual life. I suggest that it would be possible to transfer some of the money from the National Health Service to local authorities to perform these duties. Regrettably, there are too many geriatric women in these hospitals. In one hospital I know there are about 50 or 70 of these old ladies. They should not be kept in such a place. In looking at this Bill, perhaps we could consider what else can be done for them.
I should like to know whether there will be a general practitioner on the commission. I think that general practitioners should be brought in much more than I anticipate, from the Bill, will be the case, because they know their patients. As regards abnormal offenders, Cmnd. 6244 says that the courts may remand an accused person to hospital for medical reports and treatment in cases of mental illness or severe mental handicap. That is why I should like general practitioners to be on the commission, because in all probability he has known his patient for many years and should have a real say in that person's future.
I should like to pay a tribute to the League of Friends, which has done so much in particular for the mentally handicapped. On Saturday, when I was in Plymouth, they were there collecting £10,000 for a new roof on a hostel (which they have already bought) for the adult mentally-handicapped whose parents do not know what will happen to them when they themselves unfortunately die. I have not gone into the details of the Bill, and I intend to study the Bill and consider amendments very carefully, but I hope that it will provide future happiness for many people. This is what we are all striving at in dealing with this Bill today.
6.15 p.m.
Lord Campbell of Croy: My Lords, I, too, should like to thank my noble friend Lord Elton for having introduced this Bill and explaining it so clearly today. The Bill aims at reforming the law in England and Wales applying to mentally disordered people who need special protection and control. I welcome these proposals to improve safeguards for those people; for example, to provide greater opportunity to appeal against continued detention. That is an area where there has been some public concern. I also hope that in future it will be more clearly visible that opportunities are available. I also commend the drawing up of a code of practice concerning special treatment; for example. electro-convulsive therapy—ECT as it is known, the electric shock treatment. That code
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would be a guide to individual doctors. Again, this should improve confidence where some sections of the public have had doubts about what is known as "hazardous" treatment.
One reason why I am taking part today is that most, if not all, of these mentally disordered people have a mental disability. They are some of the disabled for whom 1981 is the International Year and, as some of your Lordships know, I am the chairman for the Year in Scotland. Indeed, I flew from Scotland this morning, having taken part in two of the substantial events there in the year, in Inverness on Saturday and in Glasgow yesterday. The other three chairmen for the other three parts of the United Kingdom—England, Wales and Northern Ireland—are not in Parliament. I do not seek to speak for them; nonetheless I am sure that they would join me in expressing pleasure that this Bill has been introduced during the International Year.
Where we consider disabling mental illness we must recognise that prodigious progress has been made in medical science and treatment during the past 30 years. As a result, many more disabled people are, fortunately, able to live outside hospitals and institutions. Often this can be done with a régime of drugs and medical supervision. In some cases a protected environment is also required so that the disabled person does not need to be subjected to the hurly-burly of ordinary life. I suggest that this is all to be encouraged. It coincides with the similar aim that physically disabled people should, if possible, live outside hospitals and institutions.
In future this means that more severely disabled people, with various kinds of handicap, will be in circulation in the community. This is to be applauded and encouraged for several reasons. In almost all cases this is what they, the disabled people, want. They wish to be as independent as possible. It is also good for their condition, psychologically; and it is also the best use of the taxpayers' resources. It relieves burdens upon the Treasury rather than adding to them.
One can do more with the same money. Living in the community costs less, with a sensible range of allowances, benefits, and services, than occupying a place in a hospital or institution. So it is not necessarily a matter of asking for more public expenditure but of asking for imagination and flexibility in the ways in which the resources are used. In the case of mental disability it also relieves pressure on our scarce resources of mental nurses—and mental nurses who are qualified.
Many mentally disordered people 30 or more years ago were simply locked up or put in an institution for their own good, or for the good of the public. Now drugs can enable them to live ordinary lives. This means that there must be procedures for handling quickly situations which can arise from a relapse or failure to take the prescribed drugs. I am glad to note the new arrangements in the Bill which include a six-hour holding power for certain staff. In general, the clarification of duties of hospital staff in these matters will be helpful.
The fact that many more mentally disabled are now living in the community, and we hope that more will in future, requires a matching increase in knowledge and understanding on the part of the general public. This is especially so of those disabled people who are

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not obvious to strangers. For example, the deaf and dumb, as well as those suffering from a mental illness.
There is still a lot to be done in spreading knowledge about mental disability. May I give one example. There is a serious and disabling illness, schizophrenia, for which the cause and cure are still being sought. But it is widely thought by many of the public simply to be a Jekyll-and-Hyde phenomenon. The name of the illness is misused and does not evoke the care, sympathy and consideration which it should. Some parliamentarians are to blame. A number of achievements have already been obtained in this international year. Another which I should dearly like to see would be that Members of both Houses of Parliament should refrain from applying the word, "schizophrenia" when they are being derogatory about the behaviour of their political opponents. Such self-imposed restraint would be a very useful advance during 1981.
Mentally disabled, like the deaf and dumb, hope for improvement in public awareness. Most are not immediately recognisable to strangers. All of us hope that members of the public will be more ready to assume that someone who does not reply immediately or sensibly to a question or a remark may be disabled mentally. Then there will be fewer incidents where mentally disabled people are misunderstood or shouted at on the pavement or on public transport.
I should like to make comments on two points in particular in the Bill. First the commission to be set up under Clause 42 for England and Wales, and to be known as the Mental Health Act Commission. This is clearly part of a new system to improve the safeguards, which I welcome. There is already such a commission in Scotland. It is known as the Mental Welfare Commission. The 1978 White Paper referred to it on page 77, and suggested then that there should be a commission on similar lines established for England and Wales. That was discarded by the Government at that time, but it has now been accepted by the present Government and is in the Bill.
I would just contribute this, if I may, to your Lordships' House. It is generally agreed that the commission which has been operating in Scotland has been working well. I hope I can say this with appropriate modesty as someone who has been concerned with it over the years as a Minister and a Member of the other place. That commission was established in 1960 by the Mental Health (Scotland) Act, which was of course the counterpart of the 1959 Act for England and Wales, which has been referred to many times in this debate. From experience of the Scottish Welfare Commission I have high hopes that the new commission now proposed for England and Wales will contribute to safeguards and also contribute to confidence, which is so important in these matters.
The second point to which I should like to refer is the question of hazardous treatment, with or without the permission of the patient, and I would add also the question of such treatment for children when the parents have to give permission, or are consulted. I should like in particular to refer to the electric shock treatment, ECT. This is normally given under an anaesthetic. It can affect, and usually does, the memory of the patient for several weeks. Clearly people will also worry about other possible effects. But someone who is thoroughly disturbed, wildly
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suicidal, or in a very distressed and distressing state can be brought to a normal state, and this is often later accepted, I understand, by the patients themselves. They find that the burdens which had oppressed them mentally have either been removed or greatly lightened. But these are difficult decisions to be taken, especially for parents who find themselves facing this for the first time. The code of practice which the Bill proposes should be helpful and should reassure.
In supporting the principles in the Bill, I see them as trying to achieve a proper balance between the freedom of the individual to live a normal life and powers to detain, or control, someone in the interests of his treatment and safety. At the same time the Bill should be buttressing confidence in a revised system and its procedures.
6.27 p.m.
Lady Kinloss: My Lords, if I do not follow other speakers but confine myself to a few remarks I hope I may be forgiven, as I have rather severe catarrh and find it hard to speak clearly. My noble friend Lady Loudoun also regrets that she is unable to be here today to speak in this debate.
Of course there is very much to praise in this Bill. I am a member of the all-party Parliamentary Mental Health Group, and the National Association for Mental Health, MIND, have always been most helpful in keeping one up to date and informed on mental health matters. MIND applauds the Government's decision to devote parliamentary time to the subject of the mentally ill and the mentally handicapped, and warmly supports the recognition accorded in the Bill to the need for increasing the rights of the detained person.
I still think that the confusion caused by the 1959 Act needs clearing up. That Act tried to deal in a portmanteau fashion with both mental handicap and mental illness at the same time, as if these two things were the same. Mental handicap cannot be cured and therefore medical treatment does not arise, but on the other hand a mentally handicapped person can be helped to gain a certain independence where possible. Mental illness is an illness, like any other, and can be treated medically, which often results in a complete cure.
In answer to a Written Question in another place, in the Official Report of 19th November 1981, col. 50, the Government replied that they recognised,
"the need to distinguish between mental handicap and mental illness and intend to provide for the legal powers affecting mentally handicapped patients to be grouped separately in a consolidation Bill, to be introduced as soon as possible after the passage of the Mental Health (Amendment) Bill".
I wonder why mental handicap cannot be removed from this Bill now? Would it not save time and money? MENCAP has collected evidence that psychiatrists and psychologists have recognised the vast difference between mental handicap and mental illness. It is clearly a mistake to lump the two together, as they have only the word "mental" in common.
Last Friday I was able to visit Yearsley Bridge, an adult training centre in York for mentally handicapped people of all ages. I noted that many of those concerned were eager that mental handicap and mental illness should not be legislated for in the same Bill. In that centre, as I am sure in others, they are very con-

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cerned with their role of helping their trainees, as they are called, to reach the full potential of such talents as they have. They are determined to make them as independent as possible so that eventually they can live in sheltered hostels; that is, so that those who are able should stand on their own feet as far as possible. I cannot praise too highly the patience and dedication of the staff, and I should like to thank the manager and staff for their kindness to me. I wish your Lordships could have seen the joy and happiness of those persons of limited capacity in the achievements they are able to reach. One trainee took me round and introduced me to each group and the staff. He was kind and helpful and waited patiently while I was shown round the various groups. He was clearly not to be placed in the same category as a person who was mentally ill.
There are very many in hospital who need not be there, although there will always be a few who will need special care and attention. The DHSS has produced an estimate of the numbers who could be transferred from hospital to the community if there were sufficient hostels or some other form of sheltered accommodation for them, and adequate supportive help in the community. I hope very much that when we see the consolidated Bill it will show that steps have been taken in that direction. In the meantime, I wish this Bill a speedy and happy passage through your Lordships' House.
6.32 p.m.
Baroness Faithfull: My Lords, with others, I support this amending Bill to the successful Mental Health Act 1959. I am the twelfth speaker and all the points have been covered. However, not having the generous nature of the noble Lord, Lord Wells-Pestell, I propose not only to pursue my speech but to add briefly to it, and I hope I shall have the indulgence of the House.
Before coming to the four questions which I have to ask the Minister, I wish to take up the point of the separation of mental handicap from mental illness. In principle I agree with that, but there are difficulties over it. I see that my noble friend Lord Renton is not in his place, so I shall ask him about this at a later stage. While I see that mental illness and mental handicap are different, nevertheless the services are the same, but the point needs thinking about to appreciate it. I speak as an ex-director of social services. I look back and think of our services to the mentally handicapped and mentally ill. The same social workers dealt with the two groups of people. We did not, in certain degrees of mental handicap and mental illness, separate them, and the day centres which we ran accommodated all sorts of conditions of men; our day centres were not only for the mentally handicapped, mentally ill or physically handicapped or normal lonely people, but they were for everybody. That brought great wealth both to the mentally handicapped and to the mentally ill, in that they were at a centre where there were all sorts of conditions of people, and I should be sorry, so far as the services are concerned, if they were divided, giving a separate service of one group of people from another. Therefore, while in principle the point made by my noble friend Lord Renton is accepted, in practice when it comes to giving a service by a social services department and
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by voluntary organisations, I should be sorry to see the two sides separated. Indeed, I am not at all sure that we could afford it.
My first question concerns social workers (Clause 43). This aspect was dealt with by the noble Lord, Lord Wells-Pestell, and my noble friend Lady Vickers. Perhaps your Lordships will allow me to go into the history of this matter. In 1970, the Local Authority Social Services Act was passed, amalgamating the mental health department of the local authority, the welfare services department of the local authority dealing with the elderly and handicapped and the children's departments. At that time, when they were amalgamated—it was based on the Seebohm Committee Report—we all agreed with that amalgamation, setting up local authority social services departments, and I still agree with that law that was passed at that time.
As my noble friend Lady Vickers said, there was a move towards generic social workers which we have now recognised is simply an impossibility. However, I wish to speak briefly about the training. Before the passing of the Local Authority Social Services Act 1970 there were two forms of training for social workers. There were the Younghusband courses which trained for working with the handicapped and the elderly, and the mental health officers, and that was a two-year training. There was also, separately, two-year training for childcare staff and children's departments.
An extraordinary thing happened in 1970. Social workers were given a two-year course, but it combined all the departments so that they had to cram into two years what before had been done in two years separately. That really meant that the basic training of social workers has been very unfair on the social workers, very hard for the tutors and, I would add, unjust on our clients. I think it is now fully recognised, and thus my first point is that the basic training of social workers should be longer, even if we must train fewer of them. I would rather have fewer well trained social workers than a number of them thought to be trained but not well trained. I therefore believe that the Minister will be in a real dilemma because the approved social workers in mental health under this Bill will receive extra training on top of the basic social workers' training.
There are two points here: first, where will he find throughout the country enough social workers who have had the basic training? Secondly, would my noble friend Lord Cullen say what training it is proposed to give the approved social workers in the mental health field? Will it be in-service training or additional training? Inevitably one must ask: From whence are the resources coming? Quite definitely they will not come from the local authority. I think that is definite with the position as it is today.
In fairness to the other branches of social work, children's work, the work with the elderly and the work with the handicapped, it is fair to say that social workers in these fields must be trained also, and there are not enough trained social workers for all sides of the work of social services departments.
I look back on my own training long ago. I trained to be a social worker. I did not train to be anything else—a welfare rights officer or whatever else is sometimes done in social work departments. It was a

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disciplined training. For instance, I am bound to mention, particularly in the light of the Bill, that we had throughout my two year course at Birmingham University a lecture on law from a barrister brought from London, and we had a paper to write every week for two years. Nowadays social workers are fortunate if they have three lectures in two years on the law, and I believe that it greatly behoves us all to look at the quality of training that is being given at the moment, in fairness to everyone all round.
I should add that at the moment the Barclay Committee is sitting, looking into the role of social workers in social services departments. I very much hope that following the publication of the report of the committee we shall look into the training of social workers and this time get it right. But I must say that I believe my noble friend the Minister will have some problems over the training of approved social workers to administer the Bill when it becomes an Act.
My next point concerns Clause 43(3), which states that social services authorities,
"shall have regard to such matters as the Secretary of State may direct".
I wonder what that means. I should like to think it means that there should be a code for the structure of management. At the moment some mental hospitals have their own social workers based on hospitals. In those cases there is a relationship between the mental hospital staff, both nurses and doctors and the social workers. Work of this nature cannot be done well without a good relationship and understanding between the staff. But when it comes to night duty and to dealing with the different sections, in particular Section 29, the rota is such that social workers who have to deal with sections are not always those who work in the hospitals. Therefore, doctors find themselves sectioning a case, perhaps at two o'clock or three o'clock in the morning, with a social worker whom they do not know and with whom they do not have a relationship. I have done section work and I know what it is like to deal with a case which one does not know and to work with a doctor whom one has never previously met, in a hospital which one has not previously been in. Therefore, I very much hope that under the provision guidance will be given to local authorities, asking them to look at their structures.
My next point concerns the Mental Health Act Commission. I have kept a tally and I see that three noble Lords have spoken for the commission, two noble Lords have spoken against it, and the noble Lord, Lord Allen of Abbeydale, has asked questions about it. I have to ask: Will the setting up of yet another structure really solve a problem? I understand from the noble Lord, Lord Campbell of Croy, that this has helped in Scotland, and therefore perhaps I am wrong, but consider—
Lord Campbell of Croy: My Lords, I apologise for intervening and I am grateful to my noble friend for giving way. Perhaps I should have added a little more when I spoke earlier, to say that conditions and the system in Scotland are different and that there could be overlapping in England and Wales because there are more organisations already working in the field South of the Border. But what I wanted to
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say was that, on the whole, the commission has been regarded as doing a good job in Scottish conditions.
Baroness Faithfull: My Lords, I could not be more grateful to my noble friend Lord Campbell of Croy for intervening because I was going to come on to the point about overlapping, to which the noble Baroness, Lady Robson of Kiddington, referred. Consider, my Lords, the number of people with whom psychiatrists will have to deal. Are they ever going to be able to work? There will be the Mental Health Review Tribunal. There are the area, region and district health authorities and the hospital advisory service. Will there not be serious overlapping? Therefore, despite the Boynton Report, I question the setting up of the commission as another structure. I would rather see us get the grass roots work properly organised. I shall perhaps put down an amendment at the next stage of the Bill suggesting that the commission be set up for five years only, to be reviewed at the end of that priod; but I have yet to consider that.
My final point concerns mentally handicapped children in hospital. The noble Lord, Lord Renton, and the noble Baroness, Lady Vickers have already referred to these children. The deepest concern for these mentally handicapped children is that they are permanently being brought up in hospitals and this is less than worthy of our caring society. The children perforce suffer in silence. They cannot strike to make known their rights to a normal life. They cannot riot to make known their needs and because they cannot protest, our society acquiesces and allows them to be brought up in a hospital, away from a community setting, and very often away from emotional relationships so necessary to the development of personality.
That is not to say that the nurses who look after them do not look after them well but, judging from my experience and knowledge, the children cannot possibly lead a normal life. Many children who are mentally handicapped can make a great contribution to life, as was said by the right reverend Prelate. I would add that this point has been looked at by the King's Fund, and I would commend to your Lordships' House the project paper which gives all the details of the position of mentally handicapped children being brought up for many years in hospitals, when they could as well, as happily and more profitably be brought up in the community.
I am privileged to be the vice-chairman of the council of Barnado's. I am also a vice-president of the British Agencies for Adoption and Fostering and I serve on the Committee of Parents for Children. I have worked in a social services department. I would suggest that with a partnership between the voluntary sector and the statutory sector it should be possible to get children out of hospitals, perhaps by adoption. Your Lordships would be astonished if you knew the number of people who in the last two years have adopted mentally handicapped children. It is possible happily to foster the children. It is possible for the children to be looked after in an integrated children's home, and it is possible, as is being done by Barnado's at the moment, to run community-based centres for the mentally handicapped. I ask the Minister, the noble Lord, Lord Cullen of Ashbourne, whether, in order to deal with this position, we should

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set a time limit, and say that within two years every mentally handicapped child who is fit and healthy should be brought out of mental hospitals.
I would ask: what is the status of treatability? We heard earlier the noble Lord, Lord Elton, say that one of the principles of the Bill was that no one should remain in hospital, except under the status of treatability. Fit, healthy mentally handicapped children do not need treatment. Therefore, under the Bill would it not be illegal for children to remain in hospital and be brought up in such conditions? If the Bill means that many children at present being brought up in mental hospitals are moved into the community, to a richer life, where they can work, and live and have training and education, then indeed it will have been a great success.
6.50 p.m.
Lord Auckland: My Lords, a longstanding engagement at New Zealand House will mean my leaving your Lordships' Chamber almost immediately after I have spoken, but I shall try my utmost to return for the final speeches. I should like to add to the congratulations extended to my noble friend Lord Elton on his appointment to this important if relatively lowly office—an office which I think he will fulfil with distinction. It is certainly not going to be an easy passage for him; and, having been involved in a very small way with mental health legislation in your Lordships' House over a number of years, I cannot see this Bill presenting any less problems than any other Bill on the same subject, notably that which became the very important 1959 Act, which of course this Bill largely consolidates. Indeed, I remember that after my speech on the 1959 Bill—and I had been in your Lordships' House for only a short time—I was summoned to the Woolsack by the late Lord Kilmuir. I wondered what transgression I had committed. He said to me, "I enjoyed your speech very much, but would you please speak up in future?"
Since those days there has been a good deal of progress in the field of mental health. But, of course, one of the main problems is that there is still a great lack of knowledge, even among those who are really interested in mental health, as to the real difference between mental illness and mental health; in other words, the various degrees of severity among those who are severely handicapped and those who merely enter hospital for a short time, possibly for a nervous breakdown. Therefore, I think the amendment of the term "subnormality" to replace "mental handicap" may well be a good move. At least, this is the view of some members of the medical profession.
On Sunday night my wife and I spent some four hours with the chief nursing officer and administrator of one of the seven mental hospitals near the town where I live in Surrey. We went through this Bill (it was on a Sunday night, when one's brain is not as active as it might be) as far as we could. As a result there are a few points that I should like to make at this stage, because this a is Second Reading—an occasion for short speeches. When we come to Committee stage, bearing in mind that this Bill, laudably, is starting in your Lordships' House, we shall have some very detailed examination to do because there is much
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definition to confirm and a great deal of information which we shall need to know.
We shall need to know who does what and, above all, where the staff is going to come from and where the money is going to come from; because many of the schemes provided for in the Bill are in themselves totally praiseworthy but they are going to lead to expenditure; and it is my contention, and I think the contention of most of your Lordships, that even in these austere times there must be expenditure upon these people, or at least an improvement in their conditions. Because, my Lords, we are talking about people; we are not talking about inanimate objects. We are talking about people who, through no fault of their own, are mentally handicapped or mentally ill, whatever the case may be, some with Down's syndrome, another very distressing condition, and others who are able to speak and to work, albeit to a limited extent.
Clause 16 of the Bill has been discussed a great deal, and I think the question one must put to the Government is this. As I understand it, the mental welfare officer has to interview the patient to satisfy himself that detention in hospital is appropriate. But how many doctors, psychiatrists or other experts on the therapeutical side of mental health are going to be needed to confirm (or otherwise) this situation? I speak hearing in mind particularly an area such as where I live, where we have seven mental hospitals; and another such area is the St. Alban's-Watford area, where there are another seven mental hospitals. In some cases there is overcrowding and in some cases there may not be so much overcrowding but there are a very large number of patients who may have to be seen. One wonders just how many qualified people there will be to see these people in a reasonably short time, without intolerable delays.
Here we obviously have to come to a decision as to not only how far the Bill should serve the rights of patients—and, of course, this is the main object of the Bill, and an admirable object it is, too—but also how far it is to ensure that in the case of those patients who are not able to decide for themselves and who have no parents or relatives to decide for them, their rights are going to be protected. Not being a social worker myself or a magistrate, or any expert of that kind, I shall not, certainly at this hour of the evening, try to adumbrate upon that. But one thing is quite certain, it seems, from a number of the clauses in this Bill: the work which the courts face is going to be tremendous. Some very difficult decisions are going to have to be taken by magistrates—and here I declare an interest (a completely non-financial interest) because my wife is a magistrate and serves on a bench which, naturally, from time to time has to deal with cases which involve people from hospitals of this kind—and this is an important point to remember.
The other point we have to remember, I think, is that the mental handicap services remain the Cinderella services in 1981. In so many of these hospitals, still, not only is there a desperate shortage of staff to look after patients, some of them very severely handicapped, but salaries are often inadequate. This Bill does not deal with that specifically; that is a matter for negotiation. I completely accept that point; but we do have, perhaps, a cart-before-the-horse situation here, because

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unless and until we have really first-class staff and a sufficient staff, all these recommendations are going to be in danger of falling by the wayside.
One suggestion which I should like to put forward and perhaps develop in Committee stage is this. Many of these long-stay hospitals do not have such relative luxuries as a minibus, by which patients can be taken to the seaside or other places of entertainment and beauty or a swimming pool for therapeutic purposes. Many of these patients have funds of their own, but in many cases they are not able to administer them. I am not advocating the setting up of another Quango but there could, surely, be a committee set up to look at a situation where one or more of these amenities were needed, perhaps having a representative of the DHSS acting as chairman and representatives of the League of Friends. I would associate myself with all the tributes paid to the League of Friends who have contributed so much to the schemes; but in inflationary days even the League of Friends are not able to be as generous as they would like. This is an idea which the Government might think about. Funds could be raised without the taxpayer's pocket being hit too hard to provide amenities for these patients, particularly in hospitals in the greyer areas where they do not have minibuses, swimming pools and other things which are helpful therapeutically, not only for those who are what I might call high-grade but for those who are very much less fortunate.
My Lords, inevitably, the Second Reading of a Bill of this kind is an opportunity for discussing a large number of points. I have thrown a few, to so speak, to the House; but I submit that the value of your Lordships' House at the Committee stage of this vital Bill will be very substantial.
7.2 p.m.
Baroness Masham of Ilton: My Lords, I should like to contratulate the Government on bringing in this amending Bill. I should like also to add that I hope that your Lordships may be able to improve the Bill during its passage through this House. I was pleased to hear the noble Lord, Lord Elton, say that he was open to suggestions. I was moved some years ago while watching the remarkable film, "One flew over the Cuckoo's Nest". This was a film which showed how attitudes of staff in a hospital for mental patients can become so orientated to automatic treatment of patients not for their individual well-being but for the convenience of the staff and the system. Also, while visiting hospitals for the mentally ill and handicapped I have been made aware by patients who have called out my name; and I have realised that they need friendship and individual recognition. There are many desperately lonely people in our society.
The subject of this Bill is not easy. I hope that we can help to open up the real fear that often is connected with hospitals which detain patients. I know, too, that sometimes ill patients who might benefit from being in-patients for a time in hospitals refuse to go for fear that things will be done to them against their wishes. Some of the recent television programmes on this subject have been very revealing. The lack of privacy and being deprived of personal effects has always worried me when I have visited some hospitals, and also the mixing of ages and illnesses. Parliament
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now has before it a Bill which we have the great responsibility of being able to change and thus to help some unfortunate people who are not able to help themselves.
There are questions which I should like to ask the Minister. I have given advance warning of some of them to the noble Lord, Lord Elton. Because there is a lack of hospital secure places, I believe that some patients have been sent to prisons. Are these patients then classed as patients or prisoners? Under this Bill, when it becomes an Act will they have the same benefits as patients in hospital? Do they come under the care of the Department of Health and Social Security or of the Home Office?
I am going to visit a secure unit in Middlesbrough in two weeks' time. I believe this is the first such unit in the country. I believe that the North of England is further advanced than the South in building these units. Is it going to be possible to send patients from the South to the North if they need treatment in a secure hospital unit?—which might be better for them than the holding process and drugs which may be the only facilities that the prison can offer.
I should like to hear from the Minister on the matter concerning the mobility allowance which is paid to some patients in mental hospitals. I brought this up some time ago, and I believe Sir George Young is looking into the matter. Apparently some patients are not able to make use of this money and it mounts up in their accounts. As the law stands now, when they die it goes to whoever is their nearest relative. This may be someone who has never been near them or even visited them in hospital. I think this is a monstrous waste of public money. I gather that the total sum now accumulated is in excess of £25 million. It seems to me that if the money is not used to benefit the individual concerned, then if it were to be paid into a patient's "No. 2 Special Mobility Account" so that it would not be muddled up with any other money the patient might have, then, if the mobility money was not used by a certain time—and certainly when they die—the DHSS might claim back the money.
The DHSS keep on saying that they are short of money and yet the Government allow £25 million to lie idle and then not be used for its original purpose. I am sure that many of the hospitals dealing with mental illness or handicap could benefit from more money. When visiting one hospital I found the last meal of the day was sent to the wards at 3.30 in the afternoon. I do think that the quality of life could be greatly improved in many hospitals, even though great efforts in some hospitals have been made in the last few years. I was delighted this year to receive a cheque for £5,000 on behalf of one hospital. The money had been raised for upgrading a psycho-geriatric ward by the efforts of a police college. I think that the community often does care but, in many instances, raising money is the only way it knows how to help.
It has been found by research in America that many patients admitted for psychiatric treatment have been suffering from undiagnosed physical illness. This could well be found to be the same in Britain. Therefore, I think it seems wise and necessary that all patients detained under Section 25 should have a full

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physical examination by a consultant physician during the first three days. What is stated on page 6, paragraph 18, of Reform of Mental Health Legislation, (Cmnd 8405) is vague and inadequate.
When we are dealing with such a serious matter I will be very surprised if the Government do not agree with this suggestion and I would ask the Minister, the noble Lord, Lord Elton, to look into this carefully. I have met serveral psychiatrists from time to time and I have found some to be most excellent doctors; but on occasions I have seen some who were so tired, over-worked and drained of energy that they could easily miss some vital clue through their own exhaustion and not looking for what a general physician would look for in their complementary assessment.
Undiagnosed physical illness may cause or exacerbate patients' psychiatric symptoms. I think many people will welcome the provisions in the Bill by which patients have increased access and opportunities to be heard by mental health review tribunals. I think that these provisions should be improved upon. May I ask the noble Lord the Minister: Who will represent the patient? It may be very difficult or impossible for him to represent himself. Will the patient be able to have the benefit of legalaid?
I believe that the mental health review tribunals have the power to recommend either continued detention or discharge. People who serve on these tribunals have told me that it is an impossible choice. In many cases they do not want to detain the patient but the facilities for him to cope in the community are non-existent. The tribunal should have a third choice so they could indicate the type of resources the patient would need outside the hospital. For example, hostel accommodation, sheltered workshop, social worker support or day centre facilities. Mental health tribunals will then be able to pinpoint the lack of facilities and something may be done about improving the areas which are now inadequate.
There is considerable worry about Clause 38 which contains provisions for the involuntary treatment of patients. With the doing away of forced feeding in prisons is it not time that we did away with the indignity of patients being forced to have treatment that they do not wish to have and which may not benefit them? Many of the treatments such as psycho-surgery, ECT and heavy psychotropic drug treatments can be hazardous, experimental and irreversible. On a recent television programme that I saw it was said that patients now having electro-convulsive therapy (ECT) do so under a general anaesthetic. I should like to ask the Minister: Who signs the consent form for the patients who are having this treatment and other operations against their will?
I hope that we will have our questions answered if not at the end of this debate, before the Committee stage. I end by saying that many community health council members, when discussing the Mental Health Act, felt that mentally handicapped people should not come within the scope of the Act as they do not at present and that it should be concerned solely with mental health. No doubt there are grey areas where the two merge and some mentally handicapped people may be mentally ill, but this could apply to any of us at any time.
7.15 p.m.
Lord Hooson: My Lords, the Mental Health Act 1959 was in its day regarded as a thoroughly enlightened piece of social legislation. Its greatest achievement was to remove needless formalities in the admission process. But as the years have passed—as the noble Lord, Lord Renton, has mentioned already—its reputation for far-sightedness and liberalism has become to look a little exaggerated. It did not, after all, actually cause the fall in the use of compulsion; that trend was well under way in the years preceding it. Although it established mental health review tribunals, which at their best provide an admirable review, only those patients detained under the longer-term powers could apply to them. The very large number of patients detained for 28-day periods have had no remedy.
In so far as this Bill remedies that situation, it is very much to be welcomed. I extend the welcome which has been given to the Bill generally. It is high time that the 1959 Act was amended. Having said that, I want to come to a most important reservation that I have about it. It has already been touched upon by the noble Baroness who has just spoken and by the noble Lord, Lord Kilmarnock, in an earlier speech. The most worrying part of the Bill is its proposed scheme for the imposition of treatment on unwilling or non-consenting patients. It introduces an entirely new principle into our law.
This aspect of mental health law is clearly ripe for reform. At the moment doctors, nurses and patients are quite unable to obtain any authoritative legal guidance on their legal rights. On the crucial issue of whether a psychiatrist can impose treatment on a detained patient, practitioners have been forced to rely upon counsels' opinions. But opinions differ and those obtained by, COHSE and the Royal College of Psychiatrists have conflicted. Indeed, my information is that the two medical protection societies were also given conflicting counsels' opinions. Parliament must therefore accept its duty to enact clear principles into law in this amending Bill.
But the provisions set out in the Bill are inadequate, misguided and unbalanced. I do not think that Parliament should allow them to go through unamended. I freely accept that most psychiatrists dislike resorting to force majeure and would far prefer to have their patients' agreement to any treatment. It is probably quite rare for treatment to be given to a patient in the face of his or her implacable opposition and physical resistance. Of course, there are circumstances in which it is justified; that is not in dispute. In genuine emergencies there may be no other compassionate alternative.
However, if no emergency has arisen, the views of the detained patient should be respected if he or she is capable of understanding what is involved. That principle is vitally important; but the truth is that this Bill casually ignores it in Clause 38. That would allow a competent detained patient to be treated against his will—subject only to one qualification; a second psychiatric opinion—by ECT or long-acting phenothiazines or any other treatments likely to be listed in the code of practice. It ignores the principle of no treatment to the non-consenting despite the clear recommendation of the Butler Committee on Mentally

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Abnormal Offenders, which recognised that mentally abnormal offenders detained under the Mental Health Act were not necessarily unable to appreciate what a treatment involves.
What is true for patients detained under Part V of the Act (which provides the legal powers in respect of offenders) is just as true for patients detained under the civil powers contained in the Act. The Butler Report (in paragraph 3.54) quite rightly did not countenance the imposition of treatment on a competent patient except in emergencies.
A major defect of the proposed scheme is therefore that it fails to uncouple two concepts: the concept of detainability on one side and on the other competency to decide on treatment. Among the 7,000 patients who at any one time are detained under the Act there are many—a great many—whose faculties of reasoning and understanding are quite sufficient to comprehend a treatment proposal. For example, the diagnosis of psychopathy does not depend upon the observation of any intellectual defect—it is regarded as a moral or emotional defect—and the White Paper recently published shows that nearly 10 per cent. of detained patients are classified as suffering from psychopathic disorder.
Among the much larger number of patients diagnosed as being mentally ill (nearly three-quarters of all detained patients) there are undoubtedly many with quite adequate capacity to decide on treatment for themselves. Mental illness, after all, is manifested in almost every shade or gradation of insight. The fact that a person is properly diagnosed as mentally ill does not mean that he or she is disabled in all his or her powers of judgment. And, of course, detention may cover periods when a mental illness has gone substantially into remission. The Percy Commission, which reported in 1957, which was of course before the 1959 Act, recognised this fact when they said:
"We do not think it right that it should be assumed in law or in administrative practice that mentally disordered patients who are admitted to hospital under compulsory powers are necessarily incapable of managing their financial affairs".
What is true about a patient's ability to make financial decisions is just as true about treatment. Indeed, we should be more concerned about overriding a patient's wishes on treatment since it touches the core and essence of a person's right to be regarded as a self-determining human being.
The White Paper entitled The Review of the Mental Health Act 1959 (Cmnd. 7320) which the last Government put out in September 1978, accepted the Butler Committee's view which I previously quoted. It specifically noted that it had the advantage that—I quote:
"it distinguishes between patients who can appreciate what is involved and those who cannot".
Why, then, have this Government thrown this important principle overboard? I think the White Paper which has been published alongside the present Bill certainly does not provide any answer. I recognise of course, as the Butler Committee and the last Government must have done, that if a detained patient who is competent to understand chooses to refuse treatment he may suffer continuing detention without receiving the treatment which his doctor believes in. The decision to invoke compulsory detention under
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Sections 26 or 60 of the 1959 Act is made on the basis that the patient's condition warrants treatment; but this is now to be very broadly defined and will include nursing care or care, habilitation and rehabilitation under medical supervision.
Just because a person has been detained it does not follow he should be unable to refuse a particular treatment on a subsequent occasion when circumstances, including his own state of mind, may have changed. And it certainly should not mean that he has lost his right to refuse treatments which would constitute assaults at common law in the absence of consent. For better or worse, it is the patient's right to choose if he is capable of choosing. That seems to me to be a fundamental principle and we are faced with its abrogation in this Bill. I would therefore hope that the Government will be receptive to amendments to Clause 38 which would restore the position of the competent patient to that which the Butler Report and the last Government in their White Paper proposed. As it stands, I believe that this Bill provides unacceptably wide powers over a vulnerable group of people.
In my view, it will not be enough simply to amend the Bill to protect the freedom of choice of the competent detained patient. Inevitably one must ask: who will decide whether a patient is competent or incompetent to make the choice for himself? Is it to be the doctor whose proposal on treatment has been refused? I would hope not, because his judgment would be bound to be coloured by the reaction, and he may think the unreasonable reaction, of the patient concerned. No patient would have confidence in such a system. There must be a second opinion from a multi-disciplinary panel.
The 1978 White Paper discussed in some detail the form that second opinions should take, and noted that there had been considerable support for the idea of a multi-disciplinary panel, and I would entirely agree with that approach. I need not go into it now: I can go into it more at Committee stage. But one is hound to feel that the Government have stood in awe of psychiatric opinion on this issue and have discounted in the end all other views. I hope they will reconsider and that your Lordships' House will make them reconsider. The way in which society adjudges an individual to be in a state of mind justifying his subjugation to medical treatment is significant beyond the walls or the confines of psychiatric hospitals. Doctors alone cannot decide whether an individual is fit to plead to an indictment in court; doctors alone cannot decide whether somebody should be deprived of control of his or her property. The length of detention in mental hospitals is, by virtue of the 1959 Act, subject to review by tribunals and it is going to be subject to even greater review now. I would respectfully submit to your Lordships that the decision to compel treatment is quite as serious and solemn an issue as any of the three I have mentioned and should not be left to doctors alone.
I have already taken up a great deal of your Lordships' time and I will make the other points I wish to make on this Bill at a subsequent stage. Suffice it to say that, with one or two important reservations—and here I would entirely agree with the point made by the noble Lord, Lord Renton, about the clear distinction

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between mental handicap and mental illness, which one would have thought, as it is over 20 years on from the 1959 Act, should now be capable of separate definition and separate treatment—some of which have been dealt with in this debate, I would say that I generally welcome the Bill. But I think that the matter I have raised in relation to Clause 58 goes to the very root of a most important principle enshrined in our law.
7.28 p.m.
Baroness Lane-Fox: My Lords, at this late stage of the debate I put it to your Lordships that in this pressurised existence many of us find ourselves treading the tightrope of mental health, from which tightrope crashing falls too easily occur. What a blessing it is that over the last four decades such real progress has been made in breaking through the awful barrier that formerly surrounded these hazards. Then it really was a case of "them" and "us", where little publicly was done about the lot of, for example, the cerebrally palsied or spastic, except possibly to label them "the village idiot" The only refuge that could be offered to them was the old, gruesome asylum. Society was so patently mistaken about these people, and I am grateful that in this Bill the term "subnormal" is substituted by "mental handicap", for in today's more humane and emancipated climate we could not expect less. It is almost today's climb-down to concede how little we once knew about the troubles of our fellow men.
What worries me is the point which was put so strongly by the chairman of the Royal Society for Mentally Handicapped Children, my noble friend Lord Renton. This is that through the Bill as it stands a small minority of mentally handicapped people will continue to be detained in hospital despite the fact that their handicap cannot be cured. For them, treatment is irrelevant. Certainly forceful detention is of no benefit to them and can lead to serious psychological damage and physical deterioration, we are told. Research in many countries has shown that progress for them can be made through suitable education, social training and psychological support, geared to the specific needs of each mentally handicapped person. This, I am reliably informed, can best be given away from the atmosphere of a hospital ward. No other handicapped person, such as the blind, the deaf or the crippled, can by law be forcibly detained in hospital just because of his or her handicap. To me, it seems obsolete and wrong to hold a person in hospital solely because of his or her intellectual handicap.
This is not the kind of attitude that we look for in this International Year of Disabled People. The IYDP appears to have increased the public's understanding and awareness, not only of the problems of those of us who are so obvious and so easy to identify, with our sticks, crutches and wheelchairs, but also of those who suffer from the large numbers of unseen handicaps, distressing and isolating as they often are. Mental handicap and illness must rank high among these.
I believe that openness and frankness alone can improve the life situation of such cases. Yet even today there is still a bias and prejudice which can so damage the lot of ex-mental patients. For this reason, I want to relate that, pre-1957, I spent two nights on the
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wards of a mental hospital. The cause with me was difficulties and frustrations at work, which had left me sleepless and in a miserable mental muddle. But that short visit certainly taught me the anguish of being incarcerated in a ward, with just one nurse on duty and 14 other mentally disturbed patients. Let me repeat that this took place nearly 25 years ago, and my reason for encroaching on your Lordships' time with my experience is that I believe there should be no more shame attached to such setbacks and disorders than to any other illness.
I now turn to the much discussed Clause 38 in Part VI of the Bill. There is opposition to this, on the grounds that patients and lay people should be allowed more say as to the treatment administered to the mentally ill. I simply cannot go all the way with that view, because I have been in very close contact in the community with people who were so mentally confused that they were utterly incapable of making a sound judgment for themselves. What is more, despite the dramatic connotation of ECT treatment, I have seen those cases quite remarkably and successfully treated by those means.
Far be it for me to suggest what, if any, treatment could suit everybody, but it is my firm belief that decisions on treatment are beyond any doubt a matter for the psychiatric experts. Patients should not be denied this chance of escape from their intense misery, because of judgments made by frightened and unqualified people. My experiences have taught me that, when such advanced forms of treatment are given, there should be a uniformly high standard of equipment, accommodation and immediate after-care, so that cases may derive the fullest benefit.
Finally, the Bill does not deal with that all-important matter of the co-operation of statutory and voluntary bodies in mental after-care. This so much affects the person, the family and the results of the treatment. Perhaps most of all, provision through the voluntary organisations is needed for those unfortunate people who are not lucky enough to have friends and family to care for their welfare. May I hope that my noble friend the Minister will find it possible to include this aspect in the Bill, so that the whole unhappy situation is given the fullest support?
7.34 p.m.
Baroness Fisher of Rednal: My Lords, to those noble Lords who are not aware of the fact, may I say that I am the last speaker before the winding-up, at which some of your Lordships might breathe a sigh of relief. Listening to noble Lords this afternoon, there appears to be an enormous range of local variations in the quality of mental hospital care, and if "care" includes not only nursing and medication, but habilitation and rehabilitation, then there is a need to avoid inconsistency in what is a National Health Service.
I particularly noted the point made by the noble Baroness, Lady Masham, regarding television programmes, two or three of which I have watched and been horrified by, because they bore no comparison with the hospitals that I know near my home, in the environs of the City of Birmingham. I can quite candidly say that I am pleased with the very fine training facilities that there are and especially—I make

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this point because handicapped children have been mentioned so many times—with the excellent schools which are now being set up, or are in operation, and which come under the Act dealing with special schools.
We have to make sure that these inconsistences in the National Health Service are avoided, because only the highest standards are acceptable. Therefore, I should like to pay tribute to Professor Mittler and Dr. Simon on their involvement in the national development group, and on the work which they have been doing in mental hospitals throughout this country. With the encouragement of the Minister and the department, they have tried to lay down a basic national general policy of management and training in mental hospitals. I look upon this Bill as a furtherance of national general policy, but not encroaching upon the work of Professor Mittler or Dr. Simon, whose work has to do with administration and management. But this Bill will mean a furtherance of better services for the mentally handicapped, because it concentrates on the patient as an individual.
In saying that, one has to recognise that the Bill represents significantly new departures from existing procedures. Therefore, the Mental Health Act Commission will carry a very heavy responsibility in safeguarding and protecting the interests of detained patients, and in making quite sure that the spirit and the letter of the law are strictly operated, while recognising, quite clearly, that its responsibility will be to the patients or, as the noble Lord, Lord Auckland, said, to the patients who are people.
Therefore, I am particularly concerned with the composition of the commission, as other noble Lords have been this afternoon. I should like to ask the noble Lord the Minister whether he feels that any difficulties might arise between commission members who are not medically qualified and those who are? Can he foresee an occasion arising when the commission, because it was being guided by medical observations, would not, perhaps, act as impartially as we think desirable?
I have very mixed feelings about the commission, because I am not sure whether it is supposed to be acting as a policeman in the mental hospital, seeing that the law is upheld and protecting the patients' interests, or whether it will be judge and jury and be brought into play if the law is broken. Therefore, the work description will have to be spelled out clearly, because it is not sufficiently clear in the Bill at the moment.
The other point which I want to raise has been mentioned by the noble Lord, Lord Allen, and the noble Baroness, Lady Masham. I should like to take it a little further. While I welcome the safeguards for patients detained in hospitals and their right and opportunity to apply to a tribunal for a review of their case, I am concerned, as are the noble Lord, Lord Allen of Abbeydale, and the noble Baroness, Lady Masham of Ilton, about whether those safeguards will apply equally to mentally sick persons who are placed in prison because there is not available a sufficient number of secure hospitals. Just because there is not a sufficient number of secure hospitals and therefore we cannot classify them as patients, what will be their rights?
A recent newspaper article quoted from the judg-
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ment of Lord Lane in the Court of Appeal concerning a mentally sick person who came before him. According to this press report, the Lord Chief Justice observed:
"We are forced to do what we know to be wrong, put her in prison, because not enough secure hospitals are available".
He went on to say:
"We see this type of case every week and nobody has done anything about it".
Mr. Justice Taylor, sitting with him, is reported to have said that it was a public scandal that this mentally sick person who was before him in the Court of Appeal had to go to prison. I wonder whether noble Lords agree that it would be a public scandal twice over if that type of patient, committed by the courts, who is not allowed to have hospital treatment, whether medical or rehabilitation treatment, because there is no place in hospital for him should have to forgo the privileges, rights and opportunities that he would have if he were a patient in a hospital. The noble Lord, Lord Elton, said that no patient will be forgotten. But if you are a general practitioner, patients who cannot be admitted to hospital are still patients.
All Acts of Parliament are very difficult for the average person to comprehend. They are even difficult for Members of this noble House to comprehend. Therefore, I should like an assurance from the Minister that the patient's nearest relative, who is specified in many clauses of the Bill, will be issued with written information in easy to understand language and not, I beg the indulgence of learned Members of this House, in legal mumbo-jumbo—information that the nearest relative will hold on behalf of the patient which clearly sets out the protection under the Bill. This is most important. We have heard today that patients might not be able to make decisions for themselves. Therefore their nearest relative must know about all their rights and privileges under the Bill.
The noble Lord, Lord Kilmarnock, and the noble Lord, Lord Hooson, illuminated in great detail the concern which I, too, feel regarding consent to treatment. At this late hour I shall not elaborate upon that point. All I would say is that I shall refer to it when the matter is raised in Committee.
It has been said today that the mentally handicapped, those who are mentally ill in society, and mental hospital provision have been the Cinderella of the National Health Service for very many years. For a decade or more there have been conferences, committees, blue papers, white papers, green papers—every-colour-of-the-rainbow papers—and Government reports without end upon this Cinderella service. Therefore I welcome the Bill. If, however, one looks at the White Paper which accompanies the Bill, the "meat in the sandwich" consists of those points which cannot be put into operation for three, four, five or six years. I feel, therefore, that the powers which the Bill will give and the progress made in putting those policies into operation must commence as quickly as possible after the Bill becomes law. There is no need for us to have to consider when to set up courses for approved social workers. One hopes that at the beginning of their next session at college or university a course will be provided for them, which would mean that immediately after their training they could put this into operation.

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I welcome the Bill. It is a non-party issue. Therefore we on this side of the House support the Bill. However, we want there to be more emphasis upon the resource implications in terms of manpower and buildings as well as money.
7.47 p.m.
Lord Elystan-Morgan: My Lords, my first task—indeed, a pleasant task it is—is to join with all those who have extended their sincerest congratulations to the Minister, the noble Lord, Lord Elton, on the distinction with which he introduced his first Bill. It is his legislative baptism. Baptism in adult age is a time undoubtedly for conversion. We shall look forward with very great zeal to many conversions on his account at a later stage of the Bill.
There have been two themes which have totally dominated the debate. Everyone who has contributed has. I believe, endorsed both of those themes. The first, clearly, is the most genuine welcome for this humane and enlightened reform. I confirm what was said a moment ago by the noble Baroness, Lady Fisher of Rednal, that this is in no way a political issue. It will be possible for everyone to commit himself and herself to the speedy passage of the Bill, provided that it is consistent with certain improvements which I believe all Members, to some degree or another, would wish to see brought about. This is the second attitude which has been voiced by many: that the Bill, though good, is most certainly capable of improvement. May I quote in the ancient language of Wales, which will be understood by one or two in this Chamber, an old Welsh proverb:
"Mid dâ Lle Ellir Gwell".
"Nothing is good that is capable of being improved upon"
I am sure that it will be in that spirit that we shall try to achieve for this Bill as speedy a passage as is reasonably consistent with the putting forward of those matters which we believe are utterly vital to its improvement.
I am sure that all Members of the House will agree that in putting forward these proposed improvements they will not be put forward in any spirit of carping or childish motivation but from a sense of the significant opportunity that will be presented to us at Committee and Report stage. It may well be that such an opportunity will not occur again for some decades. It is now almost a quarter of a century since the Mental Health Act 1959 was planned and drafted, and it may well be 25 years hence when again there will be a major review of this basic legislation. It is vital, therefore, that we should not only seek to interpret the progressive views that have developed over the last 25 years, but that we should also to a certain extent seek to anticipate their further development in the future.
I join with so many others in extending the warmest congratulations to all who have been concerned with the bringing about of this legislation: Ministers of the present Government, those who were concerned with the White Paper of 1978, particularly my right honourable friend David Ennals, who in addition to his work in the Department of Health and Social Security was in fact a national official of MIND for many years
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and indeed, if I may also mention Mr. Gostin, the legal director of MIND in his two volumes A Human Condition, which have proven to be an inspiration to many, and indeed of course the report of the noble Lord, Lord Butler of Saffron Walden.
The Bill now presented follows honourably a path that was pioneered a long time ago. It was at the end of the 18th century that Pinel, the head of the Paris asylum for men, horrified his colleagues by removing restraints and shackles from hundreds of patients. His example was soon followed in England by Tuke, who led the Quaker movement in that noble direction. His example was paralleled in America by people like Benjamin Rush.
The weaknesses of the Bill have been dealt with fairly comprehensively by many, including my noble friend Lord Wallace of Coslany. I believe that future generations looking back at our efforts may well say that the most significant weaknesses of the Bill at this stage were weaknesses that were attributable to the Bill seeking to fly in the face of its own philosophies and to defy the conclusions of its own logic.
May I say that, like all other noble Lords, I greatly welcome the fact that Her Majesty's Government were so thoughtful as to publish concurrently a White Paper that has been most helpful in understanding all parts of the Bill. The White Paper stresses as one of its main themes, that of treatability; that mental hospitals are there to cater for people who can be treated or who can reasonably be expected to be treated by them for their sickness. It is on that basis therefore that, on the face of it, there must appear to be the severest condemnation for the inclusion of the mentally handicapped in mental health legislation.
In 1959, as the noble Lord, Lord Renton, has said, it was not thought incongruous to include the mentally handicapped in that legislation. He need not chastise himself. No doubt those decisions were made in the light of the medical knowledge then prevailing in relation not only to mental handicap but to mental illness as well. A great deal of progress has been made in the last two decades.
Now, with the benefit of hindsight—and we should all be Solomons of good judgment if we were always able to judge everything from that perspective—we can say that it is unfortunate that it should have been so included. In a debate in another place on the 16th November 1979—a debate which has already been referred to—it is noteworthy that two honourable Members of that other place, Dr. Gerard Vaughan and Mrs. Chalker, who since have suffered a sea change to be Ministers in Her Majesty's Government, and indeed in the Department of Health and Social Services—spoke very strongly for excluding those who suffered from mental handicap from the provisions of the Act of 1959.
In reply to a question by an honourable Member in another place a Minister, Mr. Geoffrey Finsberg, said these words in relation to mental handicap:
"I think that question in fact was answered a few months ago. The needs of the mentally handicapped cannot be served by the Mental Health Act 1959";
and he then went on to say that the Government proposed in a shortly forthcoming Consolidation Bill to remove mental handicap from mental health legisla-

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tion and to deal with it separately. That of course is not done in this Bill. Although there will be superficial cosmetic changes it will still remain part and parcel of that fundamental legislation.
I do not think that I need say anything at all to add to the arguments that have already been so splendidly put forward by so many, particularly by the noble Lord, Lord Renton, whose efforts in this whole field are the subject of admiration in this House as they were in another place; and indeed no one who read that powerful cri de coeur by Mr. Brian Rix in The Times of today can fail to be moved, not only by his own experience but, it seems to me, by the overwhelming and unremitting logic of his argument. It seems to me there is no earthly reason why a child or young person or older person suffering from mental handicap should be dealt with in any way in law that is different from a condition of blindness or deafness or the stunted growth of a limb. I accept totally what the Minister has said about the Government having an open mind on this matter, and I am sure that the Government will be prepared to give urgent reconsideration to this most vital part of the Bill.
Another dominant objective on the part of the Government was of course the protection of mental patients and to see to it that that protection should be real and that, above all, so far as the public is concerned, that it should be manifestly seen to be effective. It is in the light of such a principle that we look at the Mental Health Act Commission, and if I may at this late hour I will confine my remarks purely to its function in relation to non-consented treatment.
On the face of it, the case here seems to be a very clear one in favour of a decision being made by a multi-disciplinary body. Almost all the institutions and bodies that have been canvassed in this matter, I understand—and I am sure that the noble Lord who is to wind up the debate will correct me if I am wrong—have been unanimous in their view that it should be decided by such a body. The 1978 White Paper was strong on the question that the second opinion should be a multi-disciplinary one. It appears that the only dissentient voice of note was the Royal College of Psychiatrists, and they appear, at the moment at any rate, to have got their way. That, I suggest, is totally unacceptable.
The noble Lord, Lord Hooson, made a very pertinent point, that in many cases persons who are detained in mental hospitals will indeed still be able to exercise a balanced view in relation perhaps to financial affairs. I would not pose as an expert on probate—far from it—but I believe I am right in saying that the test whether a person has testamentary capacity or not is whether he is able to know who his family are, what his duties are, and what the effect of certain dispositions might be. So there may well be thousands of people under restraint who have testamentary capacity, the capacity to dispose of tens or thousands of pounds, but have not the capacity to make the decision as to whether they shall be subjected to certain treatment or not. That irony in itself, I believe, is a very crushing phenomenon in this particular connection.
This is not the way to gain confidence, the confidence that is utterly necessary for the success of the system. This is not the way to gain confidence from patients
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and from the public at large. If one may faintly parody the words of Clemenceau, "Medical treatment on certain occasions is too important to leave to the medics alone".
The decisions that would have to be made by the multi-disciplinary body, as the noble Lord, Lord Hooson, has pointed out, will not be different from decisions that have to be made by juries in relation to medical evidence, by judges in relation to medical evidence, day in and day out in our courts. And indeed the decisions that are made now in relation to treatment, in relation to the disposal of patients, are not confined to the medical profession but are made upon a multi-disciplinary basis. One does not challenge the integrity of psychiatrists, but on the other hand this House can never be blind to the fact that the community of psychiatrists is a very narrow and a very select and a very distinguished family. Most of them know each other well. That in no way affects their independent judgment, but it is asking a great deal to expect that a decision made or ratified by a so-called independent doctor in the context of Clause 38 will be manifestly seen by the public at large to be independent.
Lord Elton: My Lords, if the noble Lord would be kind enough to allow me, I do not want to anticipate the Committee debate, but equally there is a point which seems to be eluding us, or eluding me, every time this matter is raised. A second opinion to be multi-disciplinary presumably must embrace more than one person, and I envisage that the occasions when a second opinion is needed will very frequently be occasions of considerable emergency. I hope, therefore, that when the noble Lord comes to the Committee with an amendment, where we can thrash this matter out, he will consider the difficulty, if there is one, of getting together a multi-disciplinary second opinion—and how multi it will be remains to be seen—in the sort of circumstances where it will be urgently needed. That is the only point I wanted to intervene on.
Lord Elystan-Morgan: My Lords, the point made by the noble Lord is a fair one. It is, however, qualified to some extent by the fact that there is already provision in the Bill to deal with situations where the patient's life is in danger. There are many situations covered in the Bill—I will not seek to quote them now at this late hour—where it is obvious that the commission, to do the work that the Bill requires it to do, will have to act within a fairly confined space of time; two, three or four days at the most. It is a point; but, with the greatest respect, I do not believe that it is a point that undermines the basic principle that concerns noble Lords in every part of the House. It may well be that the body that should exercise that multi-disciplinary decision should not be a body such as the commission itself. I know not; I am very prepared to be swayed by argument.
It may be that a body such as the present review tribunals would be more appropriate and avoid certain clashes and certain difficult areas of distinction. But of one thing I am certain, and it was very strongly put by the noble Baroness, Lady Masham; it is vitally necessary that there should be proper representation before these bodies. If the only way that basic human

1003
rights can be preserved is by an articulate presentation of a case, that case must be so articulated, and any funds required for payment must be provided out of public resources. One remembers the famous words of Mr. Justice Darling when he said: "The courts of our land are open to everybody, exactly the same as the Ritz Hotel". There is no point in saying that the tribunals which will have to decide will be open to everybody, unless there is provision for representation to present a case on its merits.
There are a number of other matters I would have wished to deal with—the treatment of offenders, questions arising out of the most informative speech, as one would expect of course, of the noble Lord, Lord Allen of Abbeydale, who comes to this House with a wealth of distinguished experience in the Home Office. May I quote what the noble Lord, Lord Butler of Saffron Walden, said in this House on 22nd March 1978 in a debate which touched upon the condition of affairs, among other things, in Broadmoor:
"The situation concerning bed room, sanitation, and health is probably the most intolerable in the world. It is intolerable that this should be going on and on".
I ask the question, though I know what the answer will be, how better is the situation at the present moment, how much progress—this is not a political point for I well appreciate the difficulties spelled out by many who have taken part in this debate—has been made with the secure wings to be built in local hospitals, a plan that has now been in train for many years?
There are so many other matters that will have to be left to the Committee stage, and I know that every Member of this House looks forward immensely to that, for it will undoubtedly be a Committee stage that will bring out the very best from all parts of this House. Since this Bill is about the legal status and position of patients under mental health legislation, its terms do not allow us to discuss wider issues. Many of us would have welcomed the opportunity to look in some detail at such profoundly important matters as the massive needs of mental patients in general, whose number represents a high percentage of National Health Service beds but who receive a disproportionately meagre share of the revenue and capital resources. This is not a matter of political issue but stems rather from the condition of ignorance and complacency which has surrounded mental health in Britain like a fog for so long. The humane and enlightened proposals of this Bill, which the House will undoubtedly wish to improve upon, in addition to bringing about many changes that are much needed, will, I trust, also serve to quicken the conscience of the whole community and thus lead to the greater spiritual and material commitment that is demanded of it in this most deserving field.
8.10 p.m.
Lord Cullen of Ashbourne: My Lords, as the noble Lord, Lord Elystan-Morgan, said just now, we seldom get the opportunity to debate this subject and it is very important that between us all we should get it as right as we possibly can. I am most grateful to the many noble Lords who have welcomed this Bill. It is, as many have emphasised, not a party political subject and I
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look forward to the opportunity for further and more detailed discussion and for working together to make this legislation as sound as it can be. From my own point of view it is rather refreshing to be involved in a non-political Bill of this kind after some of the social security Bills that we have had in the last two or three years.
We have heard from the widest possible range of expert opinions—from an ex-Minister, a former senior civil servant in the Home Office, and also from the chairman of the League of Friends of a special hospital to those who have administered such hospitals, those who care for the chaplaincy in them and a former patient. All agree that the Bill is a step, whatever its size, in the right direction. Even with a list of speakers impoverished by the departure of three of our number, a wealth of questions in matters raised by 16 noble Lords is before me. I can only, I fear, address myself to the larger issues and on the others I shall write to noble Lords as soon as possible.
Perhaps the principal issue raised today has been that of the feasibility of separating mental illness and mental handicap in legislation. My noble friend Lord Elton and I will read with the greatest attention and care everything that has been said by noble Lords and noble Baronesses on the subject. This is a matter of considerable difficulty, not for want of goodwill but for reasons of legislative complexity. The Act that we are amending itself places the various conditions of mental illness and the condition of mental subnormality—as it is there described—together and does so throughout. That naturally imposes a certain pattern on the Bill that amends it. However, in view of the opinions already expressed, so strongly, so carefully and so well on this subject, we shall examine very carefully whether we can break out of this situation. We stand by our undertaking not to close our minds to what is difficult; only to exclude what is not practicable. My noble friend has our goodwill, and our efforts to find a way forward will be genuine and urgent. How far we can go I cannot yet foretell.
A very wide range of points has been raised by the many noble Lords who have spoken and I cannot hope to deal with them all tonight. Much has been said about the details of the proposed Mental Health Act Commission—which has also been given the blessing of the Church—and about the thorny issue of consent to treatment. The amendments to the emergency powers in the Act and the introduction of the nurses' holding power have been welcomed, as has the increase in opportunities to apply to mental health review tribunals. Many of the points which have been raised will be more readily answered in Committee, but I shall try to answer some of them now.
The noble Lord, Lord Wells-Pestell, asked about the content of the code of practice to be drawn up by the Mental Health Act Commission and the membership of the commission. The code will set out certain treatments which in the commission's view give rise to special concern and which should, therefore, not be given without both the patient's consent and a concurring second opinion. The code will also provide a source of advice and guidance for staff on the complex ethical and other issues which arise in the care and treatment of detained patients.
The noble Lord, Lord Wallace of Coslany, also

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asked about the commission's membership. They will, as my noble friend Lord Elton explained, be from many disciplines. The membership will not, I recognise, be large, but then there are only some 7,000 detained patients in England and Wales. However, we agree that sufficient members should be appointed to enable the commission to work effectively. The Bill provides for remuneration for members of the commission—
Baroness Jeger: My Lords, I hope that the noble Lord will forgive me for intervening but he just said—I think I heard him correctly—that the membership would not be large. At an earlier stage of the debate it was suggested that there might be 70 members. Can the noble Lord confirm that?
Lord Cullen of Ashbourne: Yes, my Lords, there will be 70 members for the whole country. The intention is that they should be split into five groups around the country. We can go into any detail on this matter in Committee. If I have in any way misled the House I shall certainly ensure that I clear the matter up before I sit down.
I was saying that the Bill provides for remuneration for members of the commission as well as for expenses and other allowances. The noble Lord, Lord Wallace, also referred to the need for patients to be fully informed of their rights and legal position. That is a matter of crucial importance, but is not one which can readily be dealt with in legislation. We shall, however, be making clear to hospital managers and staff their responsibility to ensure that detained patients are given all the information and help which they need.
The noble Lord, Lord Wallace, also asked about the provision of resources for the training of approved social workers. The basic principle is that details of training schemes and approval procedures should be determined locally over the next two years in the light of authorities' own assessments of the number of social workers requiring to be approved and the additional training which individual social workers may need in order effectively to discharge their legal responsibilities.
Lord Wallace of Coslany: My Lords, I am sorry to interrupt the noble Lord, but there is a very important point here. Where is the money coming from? Are the local authorities to get additional grants?
Lord Cullen of Ashbourne: My Lords, I am afraid that I do not know the answer to that question. It is something that we shall have to go into during the later stages.
The noble Lord, Lord Allen of Abbeydale, referred to the problem of finding hospital places for offender patients. We fully accept that it is wrong that any mentally disordered person should be imprisoned when his condition permits his detention in hospital under the Mental Health Act. But there is a good deal of misunderstanding on this subject. The noble Lord, Lord Allen, explained that the number of hospital orders made by the courts had fallen in the last 10 years, but this fall is no greater than the fall in the use of the powers of the Act as a whole. It is almost wholly attributable to the drop in hospital orders in respect of the mentally handicapped, reflecting the view of
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the professionals who care for them that, with few exceptions, mentally handicapped people are inappropriately placed in hospital. This view has been echoed by many in this debate today.
The noble Lord referred to the drop in the numbers of prisoners transferred to hospital under the provisions of Section 72 of the Act. Again, this is part of the picture of reduction in the use of the powers of the Act overall, and it is, too, a reflection of the fact that on 30th June 1981 prison medical officers took the view that only 94 sentenced mentally ill prisoners needed transfer to hospital under Section 72 as compared with 201 on 31st December 1977.
I suggest that all of this must be seen in the context of the fact that over 2,000 of those in our hospitals at any one time have come there by way of the courts or prisons. As the noble Lord recognised, the provisions in Clauses 27 to 29 of the Bill will be of some help here, but we must allow time for the National Health Service to provide the facilities which will be required.
The noble Lord, Lord Allen, and the noble Baroness, Lady Robson, referred to regional secure units. The much speedier progress which we are now making in establishing regional secure units will help to expand the range of provisions available for the mentally disordered. The noble Baroness described, most helpfully, the difficulties which can arise in establishing regional secure units, but, happily, the programme is now well under way. She also referred to the question of legal representation for those appearing before mental health review tribunals. The noble Lord, Lord Elystan-Morgan, touched on many of the points which have attracted particular attention in our debate today. I have already referred to the position on mental handicap and consent to treatment, and what he has said makes it clear that we shall have a full consideration of these matters in Committee.
My noble friend Lady Faithfull and the noble Lord, Lord Wells-Pestell, referred to the training of social workers. The draft guidance which the department is preparing on the training needs of approved social workers is very nearly ready. It will be issued early in 1982 for consultation with professional bodies, local authorities and interested individuals. I hope that the draft will stimulate much interest and many comments. My noble friend will be most welcome to contribute her comments then and, indeed, I cordially invite her to do so.
My noble friend Lady Faithfull also asked whether resources would be available for the training of approved social workers. The basic principle is that details of training schemes and approval procedures should be determined locally over the next two years in the light of authorities' own assessments of the numbers of social workers requiring to be approved and the additional training which individual social workers may need in order, effectively, to discharge their legal responsibilities.
Noble Lords have referred to the Mental Health Act Commission and as to whether the Health Advisory Service could fulfil that role. There are certainly a number of bodies—for example, the Health Advisory Service, the Development Team for the Mentally Handicapped, community health councils and, of course, the ombudsman—which do valuable work in protecting patients and advising them. However, the

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Mental Health Act Commission will have a role which is quite distinct from these bodies. It will be a highly specialised body and will be able to build up a fund of knowledge and experience of considerable weight about mentally disordered detained patients. It will be able to attend to all detained patients. For example, a community health council meets only very few such patients at any one time and is not, therefore, able to build up a depth of experience in this specialised area. The MHAC will also be able to deal with all categories of mentally disordered detained patients. Other bodies, such as the Health Advisory Service, whose remit covers only the mentally ill or geriatric, or the development team, which is concerned only with the mentally handicapped, are not able to build up the same breadth of specialised experience and knowledge in this narrow area.
Another feature of the Mental Health Act Commission is that its organisation into regional panels will enable it to visit regularly and frequently all hospitals where patients are detained. Other bodies which visit patient in hospitals have to do so on a longer cycle, with bigger gaps between visits. The commission is not intended to usurp the role of existing bodies which have various advisory and executive responsibilities towards patients. Rather, it is intended to devote attention in depth to a small group of patients who are particularly vulnerable, and hence in need of a body like the commission to take a continued and informed interest in them.
I should like to add a few words to what I said previously about regional secure units. Sir George Young opened the first permanent unit at St. Luke's Hospital in Middlesbrough last November. Of the 14 RHAs in England, only one has yet to submit formal plans for an RSU. Four RSUs, providing 160 places, are already under construction and another two, providing a further 140 places, should be by the end of the year. By 1985 there are expected to be over 500 permanent places available. There are also increasing numbers of places in interim secure facilities which RHAs were asked to make available until permanent RSUs were available. I think that I have probably gone as far as I should at this stage. I shall certainly write to noble Lords on any points with which I have been unable to deal.
Lord Renton: My Lords, before my noble friend sits down, may I say how much we welcome his statement that the Government will consider how far they can go in having the mentally handicapped dealt with separately. In the event of the Government deciding how far they can go, can he say whether they will then table the necessary amendments?—because they will have all the expertise at their command and it would make for better progress if that were done. Then, if we want to carry the Government a stage further, we can see what we have to build on.
Lord Cullen of Ashbourne: My Lords, I am sure that that is exactly what we should like to do if we were able to, but, of course, we shall have to have discussions with my right honourable friend and go into this matter. No doubt the noble Lord will join us in discussions after this debate.
On Question, Bill read 2a, and committed to a Committee of the Whole House.

Asbestos: Methods of Monitoring
8.30 p.m.
The Earl of Gosford The Earl of Gosford rose to ask Her Majesty's Government whether they are satisfied with the methods of monitoring asbestos that are currently in general use and with the progress made in developing alternatives for asbestos.
The noble Earl said: My Lords, I am sorry that this Question has come on so late, but I am consoled by the fact that it is not as late as we had anticipated earlier, as there are a few who have left. I should like to thank those who have stayed to speak on this Question. The reason for the first part of my Question is to draw your Lordships' attention to some evidence concerning asbestos that unaccountably failed to reach the Select Committee on the European Communities Sub-Committee G, and so does not appear in the Committee's 17th Report published on 17th March 1981, and therefore was not debated when the 17th Report was presented to your Lordships' House on 14th May.
The evidence I refer to is that of the Society for the Prevention of Asbestosis and Industrial Diseases, SPAID for short. I understand that Her Majesty's Government have been informed about SPAID's evidence, and I am sure when your Lordships have heard of its content you will join with me in asking the Minister not only to place a copy in the Library but also to bring it to the attention of the European Commission to be taken notice of in any further discussions which I believe will begin in early 1982. I should like to ask the noble Lord, Lord Lyell, whether he can confirm dates in relation to the Commission.
I should also like to ask him whether there is any way of adding SPAID's material as an appendix to the 17th Report. If I may remind your Lordships, the 17th Report is the response to the two EEC draft directives, the first restricting the marketing and use of asbestos, and the second concerning the protection of workers from risks due to exposure to asbestos. The nub of the argument brought out by the draft directive, and also the United Kingdom Government's policy, is that the amphibole group of asbestos containing, among others, crocidolite, known as blue asbestos, and amosite, known as brown asbestos, are more dangerous than chrysotile, known as white asbestos, which is of the serpentine group of minerals. That the import of blue should be banned altogether in the raw state, but may be used in certain products especially on the Continent. That if the United Kingdom goes ahead with more stringent regulations as advanced by the final report of the Advisory Committee on Asbestos, chaired by Mr. Simpson, which reported to the Health and Safety Executive and the Minister in 1979, and if it goes further than some other EEC countries are prepared to go, then there will be an industrial competition problem which may result in jobs lost in this country. That therefore white asbestos and brown can be used under controlled conditions until substitutes can be found.
This sounds like a simple solution. But simple for whom? I will leave aside the blue asbestos for a

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moment which I shall bring up under mining, and concentrate on all the others, especially the white. Nancy Tait, the Secretary of SPAID, has been single-mindedly pursuing and collecting evidence for a number of years, and all those involved must be indebted to her. The DHSS social workers, and chest consultants, refer people to SPAID to get advice on benefits, et cetera, as it is too complicated for the hospitals to deal with. The noble Lord, Lord Avebury, will be enlarging on this aspect. The nub of SPAID's evidence—and I shall not go into detail, which can be found in their report along with extensive back-up material—is that the dangers of mesothelioma, cancer of the lung, and other cancers due to inhalation of asbestos fibres, have been underestimated, and unrecognised as being caused by the white asbestos, chrysotile, the most widely used asbestos.
SPAID maintains that the pneumoconiosis medical panels are failing to recognise that their methods of diagnosing asbestos diseases are out of date. The panels rely on the optical microscope to determine the levels of fibres in lung tissue, which readily show the larger blue crocidolite fibres but fail to see the fine white fibres. For instance, one of SPAID's cases shows one asbestos fibre was seen by this method, and using the electron microscope 8,600,000 fibres of asbestos of all kinds were found in one gram of dried lung tissue. In cases when blue and white fibres are present in roughly the same numbers and sizes, how can it be argued that the blue fibre was the culprit and the white was not?
SPAID believes that without the commitment to ban, both by the Government and by the EEC, things will continue to slide. After all, it was in 1898 that asbestosis was first noted by the Factory Inspectorate, and it was known in 1935 that lung cancer was caused by the exposure to asbestos dust, and as the Work Hazards Group of the British Society for Social Responsibility in Science states:
"Each year more is mined and used than in all the years before 1930".
SPAID believes that the weakness lies in the fact that industry plays a dominant role not only in the development of automatic systems which it is hoped will ensure uniformity in optical microscope observations in the counting of fibres on membrane filters when dust levels are sampled in the workplace, but also in the setting up, and running of, the Central Reference Laboratory in the United Kingdom. The proposed one fibre control limit by the old optical techniques will leave workers still exposed to these fine fibres that are found in the lung tissues of those dying now, and as these diseases take years to develop they will he causing cancer well on into the future.
The unions, and workers, in the industry have a right to know when they will get added protection from the introduction by the Government of regulations arising out of the recommendations of the Simpson Report of 1979. Simpson asked for tighter controls to be introduced by December 1980. As the unions rightly point out, it is hard enough to prosecute employers, and impossible if men and women on the shop floor, docks, demolition sites, decorators, carpenters, electricians and especially laggers, to name but a few, do not have hard legislation to protect them.
I have read with interest the opening speech, and reply, made by the Minister, the right honourable David Waddington, in another place, in the debate on these two directives on asbestos on 22nd October, and too his mention of the two explanatory memoranda of 15th October, which I believe the noble Earl, Lord Cranbrook, will refer to, and it seemed to me that he was not acquainted with the latest information, and may I ask him whether he has seen SPAID's evidence? He said he would review matters if further evidence showed dangers, and I believe SPAID's evidence does just this.
SPAID's researches when producing evidence for the Department of the Enviroment inquiry into industry's appeal against the decision of the Langbraugh Council, Cleveland, 28th April 1981, that planning permission should be refused for applications specifying the use of asbestos, has brought to light a lot of new information not available at the time of the Simpson Report in 1979, and I believe my noble friend Lord Plant will be mentioning something of this later.
All the new SPAID evidence directly contradicts what the Minister said in another place on 22nd October. Take, for example, the Minister's assertion concerning the handling of ready-cut sheets on a building site by building workers for a small time in part of a week, and that they would no longer be in danger, which highlights the assumption that small doses of exposure cannot kill. There is much evidence from home and abroad that this is not the case. Cases of disease following slight exposures highlight the serious dangers to the public from asbestos dust. Industry claims that fibres are locked into asbestos cement, but even this is disputed. Sheeting, even if it is produced using the wet process, will flake during the years, releasing fibres. The cases of men, women and children who have died due to slight contact with asbestos is growing, like the case of a man building an asbestos sheet garage in a couple of days, a bank manager warming his clothes overnight on his asbestos-cladded water heater or wives and children of workers in the asbestos industry who come in contact with fibres on clothing.
The problem is that because of former assumptions, post-mortems looking for asbestos have been carried out only on those who have had long histories of heavy exposure to asbestos, so these cases in the general public are only now being collected by SPAID. A particular revealing survey done by Nancy Tait on the voluntary labelling of the dangers of asbestos on cooking pads showed that many had no labels, and where one was stamped on, the asbestos did not hold the print. An article in the Hardware Review for August 1981 stated:
"It was a bit of a surprise to hear the sales manager of a company making ironing boards, say that since the asbestos scare had now been forgotten, his company has reintroduced ironing boards with asbestos iron rests".
It is not insignificant that the Department of Trade wrote to shipbuilders in September 1980 saying that asbestos as a fire preventive material would no longer be acceptable in United Kingdom-registered ships.
If it were possible to safeguard against the dangers of asbestos we would have no problem. For instance, even if foolproof controlled conditions could be guaranteed in manufacturing to safeguard the work-

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force, the deterioration and disintegration of asbestos materials and the release of fibres in the atmosphere from those products cannot be prevented. This is acknowledged by the Health and Safety Executive, and we must accept that we are dealing with a lethal component, a component which is most probably found within and around most households in the country. May I ask what steps the Government would be prepared to take for an advertising campaign pointing out the dangers not only of asbestos such as sheds, ironing pads and so on, but also of working with asbestos sheeting and the removal of old asbestos? I urge the Government, along with SPAID and others, that the warning label should specifically state the dangers of cancer.
The United Kingdom and the other European countries have a wider responsibility than to themselves. The bulk of asbestos used by the EEC is imported—in the region of 800,000 tonnes. Countries such as South Africa and Canada knowlingly expose their workforces to high risk during mining. Your Lordships may recently have seen the ITV World in Action programme "Dust to Dust" on South African mines, some of them United Kingdom owned. Concerning one, 900 deaths have occurred, from mesothelioma. The latest cancer death was that of a white woman of 45 who lived near the mine but had never worked with asbestos, and she contracted the disease from environmental exposure. In both Canada and South Africa the slag heaps rise from the ground like our coal tips, with asbestos floating about everywhere.
One South African company makes bricks for the black workers houses out of blue asbestos waste. In Quebec Province, Canada, when researchers began to take interest in the incidence of cancer in the area, the Quebec Government introduced a form of death certificate which ensured that only Government officers knew the cause of death. McGill University confirmed that in 1979 their researchers could not get information on cause of death. SPAID conclude that information on even major risks is not reaching those to whom this information is vital and that the
"strict control of all use of asbestos during a planned, phased changeover to alternative materials is the only sensible approach to the problem".
I have left little time for the second part of my Question, alternatives. This is because the facts are straightforward. With a substantial case for the dangers of asbestos, the alternatives must be a foregone conclusion. In the circumstances, it is a pity that it has been left to Holland to develop the material pioneered by the University of Surrey. The Dutch expect that the products can be marketed at prices that do not differ substantially from the current prices of asbestos cement products. Polypropylene is the substance used by Surrey University. The glass fibre product Cemfil is on the market and is being further developed in this country, and cellulose is being looked into. Can the Minister say how far it is known whether any of these alternatives could also be a health hazard? The World Health Organisation will hold a conference in Copenhagen from 20th to 22nd April 1982 to try to find out the answer to this question. It will be most interesting to hear the findings of that conference.
8.47 p.m.
Lord Avebury: My Lords, the noble Earl has done the House a service in raising this Question and enabling us, I hope, to extract some information from the Minister when he replies about the improvements in the methods of monitoring asbestos and the alternative materials that have been developed. In 1976 I first realised the full extent of the morbidity and mortality arising from the industrial uses of asbestos when I was concerned with the publication of a document entitled Asbestos Kills, the author of which was Mrs. Nancy Tait, whose name has already been mentioned, the distinguished secretary of the Society for the Prevention of Asbestosis and Industrial Diseases, and I declare my interest as a trustee of that organisation. I wish to take this opportunity of paying my tribute to Mrs. Nancy Tait for the immense amount of work she has done in the past five years to draw the public's attention to the risks of asbestos and to fight for the rights of workers and their families who have fallen victim to the diseases which the noble Earl mentioned.
The original paper published by Mrs. Tait dealt in two places with the use of the electron microscope to identify asbestos in lung tissue, and in the second edition, which appeared in 1977, Mrs. Tait referred to American and French research which used the electron microscope to see fibrils of chrysotile, one of the substances mentioned by the noble Earl, which had migrated to all organs of the body. So as long ago as 1977 the electron microscope was already seen as a very important aid to the diagnosis of asbestos-related diseases.
Undoubtedly as methods of monitoring asbestos in biopsies and autopsies have improved, so the extent of asbestos-related diseases has been found to be much greater than formerly had been imagined. But as these new techniques have been developed, so have the complexities of establishing claims for compensation in respect of disablement and death arising from exposure to asbestos, and it is to these problems that I now turn, as foreshadowed by the noble Earl, and I shall illustrate the difficulties by referring to some of the cases I have taken up at the request of Mrs. Tait and SPAID.
The first case is that of Mr. B, who died of mesothelioma on 24th July 1977. Both the death certificate and the coroner's report gave that disease as the cause of death, but the insurance officer refused the widow of Mr. B industrial death benefit on the grounds that there had been no occupational exposure to asbestos. When it was proved that the deceased had been so exposed, it appeared to Mrs. Tait, and certainly to me when I first took up the case, that the insurance officer changed his ground and queried the diagnosis of mesothelioma.
What actually happened, as it emerged later, was that the insurance tribunal had first to be satisfied that there had been a history of exposure before it could even look at the question of diagnosis, and because Mr. B had a very complicated work history, including spells in the Royal Navy, sometimes overseas (I think in New Zealand), and in self-employment, it was not until June 1980 that the evidence could be produced and the tribunal satisfied that Mr. B had worked in an occupation in respect of which mesothe-

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iloma was prescribed, and it accordingly allowed the appeal.
The first suggestion that I want to make to the Minister is that where mesothelioma or asbestosis are diagnosed the claimant should not have to prove a history of exposure. In many cases this would be extremely difficult, if not impossible, and yet these particular diseases can be caused only by exposure to asbestos. It is conceivable that some people would benefit when their exposure resulted from work in self-employment, or even in do-it-yourself activities, but I think that that would be preferable to denying benefit to persons with a legitimate claim that they cannot establish.
Returning to the case of Mr. B, after the first appeal was allowed the matter was referred to the Pneumoconiosis Medical Panel, which disagreed with the coroner's finding, though it did not suggest any alternative diagnosis. The tribunal had adjourned in the meanwhile, and the widow had the right of appeal to a medical appeal tribunal against its finding. It is very hard to say how a widow with young children to support can be expected to cope with these complex technical issues on which the experts themselves disagree. Dr. Elmes of the MRC Pnuemoconiosis Research Unit at Penarth has said that no infallible method of diagnosing mesothelioma exists, and therefore one would have thought that a diagnosis by the coroner's pathologist in favour of the claimant should be treated as conclusive. The second point that I should like to put to the noble Lord the Minister is that in a case where the coroner's pathologist has diagnosed this particular disease, it should not then be open to review and negatived by the Pneumoconiosis Medical Panel.
The second example that I want to give is that of Mr. C, who was given an x-ray examination by his employer's medical adviser in July 1978 and was informed, by means of a notice which appeared on the company's notice board, that in common with all the other employees screened he was clear. Two year's later, however, Mr. C received a letter from his own GP stating that the x-ray—which was referred to in the letter as "recent"—gave a suggestion of pneumoconiosis. Mr. C asked the company for an explanation, and the works manager apologised, saying that in future they would take more care to check the records.
Mr. C then claimed industrial injuries benefit for damage to his lungs caused as a result of his employment with the company, but the Pneumoconiosis Medical Board decided that he was not suffering from asbestos-related disease. In notifying him of the decision, the DHSS local office in Lichfield, Staffordshire, told him that he could appeal against it only if he had been examined by the board on at least four occasions. That was wrong. Since April 1979 the claimant has a right of appeal if there have been two refusals with a year in between them. The Secretary of State, Mr. Patrick Jenkin, apologised for the local office and said that although the DHSS does try hard to see that correct and up-to-date information is given, sometimes the effect of recent changes in the rules is overlooked. He also apologised, incidentally, for the illegible signature which appeared on the wrong letter, and said that normally the sender is identifiable by his or her printed name. I think that it ought to be
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an absolute rule—and I hope that the noble Lord the Minister will agree with this—that no letter is sent out by any office of any Government department without proper identification of the sender, as you would expect in any businesslike organisation. At this stage I should like to say that the Minister, Mr. Patrick Jenkin, was invariably extremely helpful when raised these questions with him. I have no complaint whatsoever about the examination which was conducted by the Secretary of State of any cases that were submitted to him.
The next case that I want to quote is that of Mr.H, who was admitted to Fazakerley Hospital in September 1979, and died there on 23rd September of that year of mesothelioma, which the coroner said was of industrial origin. Again in this case it proved extraordinarily difficult to establish the history of exposure. Protracted inquiries had failed to identify any particular employment in which exposure might have occurred, when at the very last moment two former workmates of Mr. H came forward and gave information which enabled the insurance officer to agree the preliminary matter of exposure.
Another aspect which arose in this case was that the hospital where Mr. H died omitted to tell his widow of the possibility of making a claim for industrial death benefit. When he replied to my letter on the subject, the Secretary of State told me that the responsibility for what is said to a patient or the relatives lies with the consultant. But medical social workers do quite often inform the relatives of patients of the possibility of claiming from cancer charities, presumably with the approval of the consultant, and I believe that they could be expected to do the same in regard to social security benefits.
In the case of Mr. J, he was originally refused his claim for benefit for diffuse mesothelioma, a prescribed industrial disease, on the grounds that the employment to which he had been exposed was not employed earner's employment. He had been self-employed from 1952 to 1957, but in the end was able to satisfy the officer that his occupation between 1946 and 1952 did involve exposure to asbestos. This illustrates another problem: that the diseases associated with asbestos might take as long as 20 or more years to develop, so that the burden of proof on the claimant might be very onerous. Mr. J's original claim for injury benefit was made on 2nd April 1980, and the Secretary of State finally wrote to me in November 1980, saying that it had been allowed, backdated to the original date of the claim, and that was reasonably quick as these cases go.
Turning to the case of Mr. P, he was first diagnosed as suffering from asbestos-related disease in April 1980, and a claim had been made for attendance allowance. On his death, which occurred on 23rd October last year, the DHSS Attendance Allowance Unit sent his widow a form letter, with the dead man's name filled in by handwriting, expressing sympathy and notifying her of the disallowance of the claim. By the way this letter, too, was signed illegibly, above the words "For Controller". Apparently some 9,000 letters of this kind go out every year, as I discovered from the Secretary of State.
I suggested that this would be an ideal application for the use of word processors, because that would enable

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the letters to be far more personal than they are at the moment. The Secretary of State mentioned cost, but the amount required would be minimal. A sum of around £2,500 would cover the annual cost of equipment, including maintenance, while the labour costs would he the same as the scruffy form letters that are now sent out. I suggested that this would be an excellent application for the DHSS to introduce as one of its modest contributions to Information Technology Year 1982. One might say that another answer to this problem would be to speed up determination of claims for attendance allowance. It rather shocked me to discover that as many as 9,000 persons who had submitted claims for this allowance in fact died before the claims could be determined.
Following Mr. P's death, his widow made a claim. This still had to go before the medical appeal tribunal, in spite of the diagnosis which had been made during the patient's lifetime and a favourable decision by the Pneumoconiosis Medical Panel in January 1981. It was not until 26th November that the noble Lord, Lord Elton, finally wrote to tell me that the claim had been settled in favour of the widow, with full payment of arrears—well over a year after the patient's death. This enables me to underline yet again the importance of trying to settle these claims far more promptly than they are settled at the moment.
There is one more claim that I would mention. It is that of Mr. S, who originally filled in claim forms in July 1979, after being found unfit for work due to asbestos-related disease in June of that year. He was not called for examination by the board until 18th December, some five months later. When I enquired about this I was told that the average length of time which elapsed between the receipt of a claim and the holding of an examination by the board is about three weeks. So clearly there are some circumstances in which it takes a great deal longer to process a claim, and this is a matter which I hope might be looked into.
On 31st March 1980 the Secretary of State wrote to me saying that the board had completed their examination and had concluded that Mr. S was indeed suffering from asbestosis. They had been unable to reach a decision immediately at their examination on 18th December, but had found it necessary to obtain several biopsy sections from the hospital and to seek reports on them from two pathologists; and it was not until 14th March that they were finally able to decide in favour of Mr. S's claim. It was subsequently maintained that the board did not ask for any additional biopsies to be carried out, in contravention of the advice which is given by the Department of Health in its own booklet of December 1979, which states (and I quote):
"Lung biopsy undertaken solely for the diagnosis of asbestosis for purposes of compensation is never justified",
because, of course, biopsies may aggravate the condition from which the patient is suffering. However, the correspondence shows that that was how the hospital interpreted the request, and I would suggest that proper safeguards should be built into the procedures rather than that reliance should be placed on doctors remembering the contents of the advisory booklet.
Mr. S died on June 6, 1980, three months after his claim was determined. In September his widow
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wrote to me asking whether her solicitors could be helped in extracting a report from the PMP which they needed in connection with an action against his former employer. I wrote to the PMP myself, but received no answer. I think that something should be done to see that prompt and full replies are given in matters of such great importance, where claims remain to be determined.
My Lords, I think I have said enough to show that the matter of submitting claims and of obtaining benefits for asbestos-related disease is indeed, as the noble Earl, Lord Gosford, has said, an extremely complicated and long-winded one. Methods of monitoring asbestos have improved, and more people may be receiving awards than have in the past; but much remains to be done to ensure that disabled persons are properly diagnosed and that claims are processed quickly and efficiently. I think that in this Year of the Disabled vigorous measures should be taken to see that people who contract these fearful diseases are fully and promptly compensated.
9.3 p.m.
The Earl of Cranbrook: My Lords, I am grateful to the noble Earl, Lord Gosford, for raising this matter tonight, and I am glad to take the chance to say a few words, in particular in my position as chairman of Sub-Committee G of the Select Committee on the European Communities in this House. I should like to clear up a little bit the matter of the SPAID evidence which was submitted to Sub-Committee G through the European Legislation Committee of the House of Commons. We received this paper in June 1981. The House of Commons Select Committee in fact reviewed the evidence of SPAID, and they referred to this in the 25th Report, which was published on 10th June 1981, in which, in order to save a little time for my noble friend on the Front Bench. I might as well inform the noble Earl he will see a foonote on page 6 saying that a copy of the SPAID evidence was placed in the Library of the House of Commons and is available to Members there. Since the evidence was directed towards me rather than towards Her Majesty's Government, it is appropriate that I should say here, too, that I am placing a copy of the same evidence in the Library of this House, where it will be available to your Lordships.
I also intend to place in the Library, alongside, SPAID's comments on the two council documents; that is to say, the document relating to the protection of workers, which is identified by the number 9953/80, and the other document, which relates to the restriction on the marketing of asbestos and is identified by the number 6582/80. If they had been received sooner, these papers would undoubtedly have been published with the report of your Lordships' Select Committee on the European Communities under the title Asbestos, which, as the noble Earl has noted, is the 17th for the Session 1980–81. I remind your Lordships that this was in fact published on 17th March 1981 and was debated on the 14th May 1981. On neither occasion did we have the benefit of this extra evidence. I therefore value the chance to draw your Lordships' attention to the SPAID contribution.
This brings further emphasis to bear on issues which had in fact, I think, already been identified and caused

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concern among Members of Sub-Committee G in their scrutiny of the two documents to which I have referred. I do not wish now to repeat at length the debate which we held last May, but I would draw your Lordships' attention to the fact that the Sub-Committee's report stressed the view that there can be no so-called "safe" level established for the exposure to asbestos dust. We also noted that there are differences of opinion on the relative dangers of blue and white asbestos; that further dissemination of knowledge of the hazards of asbestos are an essential part of control, and that the counting methods which are at present in use leave much to be desired.
Since these papers were received, since the debate of 17th May, time has passed. I am very glad to note that during this time there have been some useful and progressive changes in the proposals emanating from the Commission. These changes have been notified in two memoranda which have been circulated by the Department of Employment, as the noble Earl has already noted, on 15th October 1981. I shall place these, also, in the Library so that they will be available for consultation.
In relation to the revisions of the Commission documents which have occurred, I should like to ask my noble friend a number of questions of which I have in fact given him notice. I should like to ask him, first of all, whether he is satisfied on the following points. First, does the current draft of 9953/80 ensure that the United Kingdom will be able to implement in full any recommendations of the Health and Safety Commission based on the study by the Advisory Committee on Asbestos? I should also like to ask him: are the revised requirements for medical examinations and the retention of medical records satisfactory in terms of the benefits and protection they are expected to provide to workers either exposed or likely to be exposed to asbestos?
So far as the document 5682/80 is concerned, may I ask my noble friend whether he supports the addition of the clause stipulating a review of exemptions at the end of five years after the implementation of the directive, and does he agree that the progress in this direction ought to be subject to continuing reviews at similar intervals rather than, as appears at present, to a single review? Arising out of what was said by noble Lords who preceded me this evening, I should like to join the noble Earl, Lord Gosford, in asking the Minister if he is satisfied that the existing scheme for marking products containing asbestos (other than crocidolite; for there is no crocidolite marketing in this country) is working; or whether it is failing as badly as was implied by the noble Earl.
Finally, I should like to draw the attention of the House to the fact that the World Health Organisation proposes to hold a conference on the biological effects of artificial mineral fibres; that is to say, the potential substitutes for asbestos; that this conference will be held in Copenhagen in April 1982 and I should like to ask if it is intended that the Health and Safety Commission should send delegates to the conference and whether the Health and Safety Commission are satisfied that there is adequate progress at present into the research for suitable and safe artificial mineral fibre substitutes for asbestos.
9.9 p.m.
Lord Plant: My Lords, I want to thank the noble Earl, Lord Gosford, for introducing this debate and to thank the previous speakers for having taken part in the debate on what I regard as an important subject. We know now why this debate is taking place. The evidence that was missing was based on the work of SPAID, (the Society for the Prevention of Asbestosis and Industrial Diseases) of which the noble Lord, Lord Avebury, and myself are trustees. I have had a lifelong interest in this subject as a trade unionist and some 25 years as chairman of the Post Office and Civil Service Sanatorium Society whose hospital is at Benenden in Kent.
Looking at the visitors' book the other day, I found that Lord Cranbrook's forbear was present at the opening of the hospital by Princess Helena of Schleswig-Holstein in 1905. I am very glad that his descendants maintain a deep interest in this question of chest diseases. SPAID aims at benefiting the community in two ways. We advise people who become sick and disabled because of their work and often represent them at DHSS medical appeal tribunals or advise their families when there is a coroner's inquest after a death.
In the course of this work, the society gains much information which we make available to doctors, scientists, researchers, administrators, legislators, trade union officials and anyone who is able to put it to good use. Mrs. Nancy Tait has been mentioned. She is a widow, a Churchill scholar. Her husband, a Post Office engineer, died of asbestosis. Since then, Mrs. Tait has devoted her whole life to examining this problem and helping others. She works for nothing. SPAID has no money. We have to go round with the hat; and it is significant that very few coppers get in the hat. Fortunately, recently the national press has been giving some publicity to SPAID. I see that the monthly paper for old people called Yours produced by Help the Aged is now giving a good deal of information about the work of SPAID and I dare say that Mrs. Tait will be inundated by requests for help from some of our senior citizens.
The importance of this work was recognised by Mr. Danby, inspector for the Department of the Environment and Transport, whose report to the Secretary of State for the Environment following the Langburgh inquiry at which SPAID reported its recent findings on asbestos included the words:
"… it is clear to me that developments in the use of the electronic microscope, which post-date the eminent Advisory Committee's Final Report, may call for changes in the recommended methods of handling and working asbestos cement sheets outside the place of manufacture; the pursuit of alternative reinforcements (to asbestos) is also an obvious priority".
So I feel it is important that this House should have the opportunity of considering these new developments reported by SPAID. The chairman of the Health and Safety Commission has written that the considered response to the recommendations of the final report of the Advisory Committee on Asbestos was made in April 1981. This advice has not been made public, but the asbestos industry's public relations body published, also in April 1981, that the Health and Safety Commission's advice to Ministers would include a recommendation that the control limit for amosite—brown asbestos—should be only half as

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strict as that recommended by the final report; that is, one fibre per millilitre instead of 0.5 fibres per millilitre; and that the introduction of safer controls for chrysotile and amosite should be delayed until January 1985, when the European Community limits take effect, although the advisory committee recommended that they should be introduced with legal backing by December 1980.
Those engaged in dangerous industries are rapidly becoming better informed by their trade unions and they will not easily forgive legislators if there is continued procrastination on this subject. Even more disturbing is that industry claims that Ministers have been advised that the obligation to consider substitution of asbestos by other materials should now apply only to manufacturers instead of to any person producing specifications or carrying on a process involving the use of asbestos, as recommended in the final report. SPAID's records show that there is more asbestos disease among workers in the asbestos industry than is reported, and even more disease among those using asbestos materials, as distinct from workers manufacturing asbsetos products.
To give some examples: an asbestos cement worker was told for 10 years that he suffered from bronchitis. A medical appeal tribunal accepted evidence that he is suffering from asbestosis, presented on his behalf by SPAID, and, assessing his disability at 50 per cent.. backdated benefits for five years. Yet we are asked to accept that asbestos cement is a safe material to manufacture and to use. This stems from the procedures for diagnosing asbestos disease used by the pneumoconiosis medical panel who rely on counts of asbestos bodies seen with an optical microscope. Yet these bodies rarely form on the white fibres used for asbestos cement and brake-linings, so that in the past, much disease arising from work in these industries has been missed.
When we look at brake linings, we find that Turner and Newall, when reporting in their 1980 Review on a study of workers at Ferodo who had at least 10 years' employment at Chapel en le Frith, claim that
"A preliminary report showed that the proportion of deaths in the factory workforce was no greater than of the general population".
Yet, the TUC Institute of Occupational Health has reported 13 mesothelioma deaths at the factory by the end of 1979. There is a discrepancy here.
Is industry claiming that mesothelioma, the untreatable asbestos cancer, is to be considered a normal cause of death? That their employment played no part in these workers' deaths? SPAID knew another worker at that factory, at Ferodo, who died early in 1980. The coroner's pathologist suggested malignant mesothelioma as a secondary cause of death. Although the pneumoconiosis medical panel's pathologist was able to photograph what was described as an early mesothelioma, the pneumoconiosis medical panel reported that they failed to find asbestos bodies in the 30 micron sections of lung tissue, and they decided that death was unrelated to exposure to asbestos.
SPAID arranged for examination of six lung blocks using the light microscope and the analytical transmission electron microscope. While the pneumoconiosis medical panel report no asbestos bodies, our investiga-
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tions found between 4,200 and 12,400 asbestos bodies per gram of dried lung—this was when the light microscope was used—and between 11 million and 52 million asbestos fibres per gram of dried lung when they used the electron microscope. In how many other cases would panel decisions be found to be wrong if more of their decisions were to be investigated by the methods recommended by SPAID? Mesothelioma deaths have increased almost three-fold over a decade but only one in five has received industrial death benefit from DHSS. Does this mean that the DHSS and their pneumoconiosis medical panels have decided that four out of five mesothelioma deaths are due to environmental exposure to asbestos? Or are they denying claimants money to which they are entitled?
Certainly, cases investigated by SPAID suggest that the general public is at risk as the amount of asbestos accumulates in the air we breathe. The following people have died of mesothelioma; a man who worked with asbestos sheets for two weeks to line a factory's walls and ceiling died 24 years later at the age of 46; a man who demonstrated an asbestos plugging compound for one year. A similar product is still sold for use by the home handyman—and you do not know you are using it—without any adequate warning on the packet. A man died who built one garage of asbestos cement sheeting. The number of carpenters developing this cancer is causing the building industry and the trade union movement a great deal of concern.
In 1973 the Department of Employment recommended the use of less toxic alternative materials in place of asbestos in new construction work. Yet we find that it is only overseas that an excellent alternative to asbestos cement, developed by the University of Guildford by 1978, is going into production. Why has the United Kingdom company which acquired the licence failed to keep pace with Holland. Italy and Australia when there is such a need for this product? Both the TUC and Labour Party conferences in 1980 and 1981 supported recommendations that the use of asbestos should be phased out and the evidence collected by SPAID that disease caused by asbestos has been seriously under-reported in the past makes it clear that asbestos is too dangerous to be used. So much is used and it is used so carelessly. Recent reports by our Medical Research Council concerning incidents in Turkey suggest that mesothelioma can occur where the exposure is only to very low Environmental fibre concentrations; even as low as one-hundredth of those encountered by workers in the asbestos industry today.
There has been much media interest in the 63 mesotheliomas in this Turkish village because the fibres are zeolite, not asbestos and the media like novelty. But about 200 kilometres further north. 122 mesotheliomas are reported, and in this area we find that the fibre is chrysotile and tremolite, otherwise known as white asbestos. Perhaps the Langburgh inspector would have been even more concerned had a recent Lancet article on these Turkish mesotheliomas been published before, rather than after, the Langbaurgh hearing. In this article, researchers report that they cannot explain how such low levels of fibres can be reconciled with mesothelioma rates at least as high as those observed among heavily exposed asbestos workers, and conclude

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by saying that this problem
"… may be relevant to the wider issue of mesothelioma in relation to long-term inhalation of low levels of mineral fibres (typically asbestos) by the urban populations of industrialised countries".
SPAID has been involved with eight DHSS appeals recently. In all but one case the appeal tribunal has agreed with SPAID and awarded benefit previously withheld by DHSS—that is, medical men recognised by the DHSS as eminent in their field are agreeing that SPAID has succeeded in identifying asbestos disease previously undiagnosed by the pneumoconiosis medical panels.
In two cases, both diagnosed as asbestosis by the appeals tribunal, work with asbestos had been intermittent and for short periods only; for example, weighing asbestos for only one day a week for about five years. Asbestosis is not dose-related. It is not only those who have worked with asbestos for years who develop asbestosis and cancer, but until recently there was no right of appeal against decisions of pneumoconiosis medical panels, as mentioned by my noble friend Lord Avebury. So they have been able to impose their own criteria as to what should be recognised as asbestos disease, and were able to stipulate that there must have been heavy exposure to asbestos before a diagnosis of asbestosis could be made.
If exposure had been slight, other names were given to conditions which cannot be distinguished from asbestosis. In one case, a family pet budgerigar was blamed. The panel forms have a list of birds, from racing pigeons to turkeys. It is duly recorded if a claimant has kept them at any time, and then they argue that keeping birds is more likely to cause disease than is work with asbestos. How mean and stupid can we get? I suggest that it is time for investigation and reform of these Pneumoconiosis Medical Panels.
It is argued that workers benefit from the jobs which the asbestos industry provides, but the workers who are required to use asbestos products, often unlabelled—and this has been mentioned as another problem—pay for those jobs with their health, and the manufacture of safer materials would equally provide employment. Alternatives are now known for all uses of asbestos in this country. The change to alternative materials is making better progress overseas. Asbestos-free brake pads are marketed in Australia and asbestos-free braking systems are being developed in the United States. Perhaps their product liability legislation makes them more aware of the need.
In contrast, in the United Kingdom industry has apparently persuaded the Health and Safety Commission to allow the asbestos industry to control the pace at which any change is made in this country. It is necessary to take care that alternatives are not equally dangerous, but, too often, this is argued purely as a delaying ploy and without making any effort to compare or identify possible risks.
Meantime, workers are still working in levels of asbestos dust which the Advisory Committee on Asbestos said should not be allowed to continue after December 1980. The Advisory Committee on Asbestos considered a number of studies before recommending control limits of 0·5 fibres per millilitre for amosite (brown asbestos) and one fibre per millilitre
1022
for chrysotile (white asbestos). One, a study of American asbestos textile and asbestos cement workers using chrysotile, reported one death from mesothelioma. The authors now report 58 mesothelioma deaths associated with that factory: 41 were workers at the factory not included in the original study, and 17 were people not working there but living near the factory. This fully justifies the criticism made by many at the time when the final report was published, that there was no sound scientific basis for the proposed control limit of one fibre; that such a control limit would not protect workers from disease.
It is not surprising that the inspector of the Department of the Environment drew attention to new evidence post-dating the advisory committee's final report, which suggests that asbestos is more dangerous than was thought when the committee reported in 1979. It is surprising that the Health and Safety Commission is content to allow its recommendations to be watered down and shelved, and is content to allow workers to continue to put their health at risk. I hope that my friend, Bill Simpson, will take note of my criticism.
I said earlier that the claimant has been successful in seven of eight cases in which SPAID has given advice, which shows the quality of the work which this society is doing. In the one case refused benefit by the Medical Appeal Tribunal, the reason given was that asbestosis affects the lining of the lung (called the pleura), but not the lung itself, and the DHSS regulations do not recognise this as asbestosis. The Industrial Injuries Advisory Council recommended in 1973 that the regulations should be changed to allow benefit to be paid if a claimant was disabled by asbestosis of the lung or its lining. Researchers have demonstrated that disablement caused by pleural asbestosis can be identified but the regulations still remain unchanged. Again we see the continued procrastination. One pneumoconiosis medical panel doctor told an international conference in 1979 that he agreed with Mrs. Nancy Tait, however, that the rules to which the panels had to work were not all in complete agreement with current scientific opinion. The value of the society's work is recognised by eminent medical men in this country and abroad. It shows clearly that asbestos is even more dangerous than had previously been reported.
I apologise for the time I have taken in making this statement to your Lordships. I am grateful to the noble Earl, Lord Gosford, for asking this question and for drawing attention to this important new evidence on the dangers of the use of asbestos.
9.31 p.m.
Lord Ponsonby of Shulbrede: My Lords, first I should like, as other noble Lords have done, to thank the noble Earl, Lord Gosford, for raising this evening the subject of asbestos. Those who have spoken before me in the debate have gone into a great deal of detail. I do not intend to weary your Lordships by repeating it. However, it has presented your Lordships with a very effective case for the Government taking action.
The noble Earl, Lord Gosford, complained that SPAID's evidence did not get to the EEC Select Committee and should be added to their report. The

1023
noble Earl, Lord Cranbrook, told your Lordships what happened and he has taken immediate action to see that the relevant documents which have been presented to him are placed in the Library. I am sure that your Lordships would like to thank him for taking such speedy action.
The noble Earl, Lord Gosford, pointed out that the new scientific developments to which he referred and which had been referred to the Select Committee have shown that multitudes of small white asbestos fibres which were not previously visible are present in diseased tissues and that the danger of asbestosis is much wider than had been previously suspected. Obviously we must be very concerned at this turn of events—and necessarily. This makes us more concerned as to whether the present methods of monitoring the presence of asbestos are adequate.
Monitoring is a highly technical question. I am sure that your Lordships' desire must be that it should be as effective as possible, consistent with the monitoring system being able to give speedy results. As always on monitoring, one must strike a balance between speed and effectiveness. However, our major concern this evening must be the eradication of these health hazards and whether adequate safety standards are being used—and where this is not possible, that in fact substitutes are brought in.
Asbestos has been widely used as an insulating agent for many years and has been put to many other uses. There is undoubtedly difficulty over a period of time in developing substitutes. Both the noble Earl, Lord Gosford, and the noble Lord, Lord Plant, have spoken about these substitutes, and in particular about the delay in developing them. We must be concerned that the substitues themselves do not involve health hazards. But even so, we must be concerned at the report in The Times yesterday about this delay, which was spoken to my my noble friend Lord Plant. In fact it seems that the delay has gone on rather longer than necessary. I hope on this general point, as opposed to some of the very detailed points which noble Lords have raised, that the noble Lord, Lord Lyell, will be able to give an answer as to why we have not been able to proceed faster with the manufacture of substitutes, as has been indicated.
I think in general your Lordships have shown in this debate this evening that this is an area of great concern. As I have said, the noble Lord, Lord Avebury, detailed individual cases which he had investigated. The noble Lord, Lord Plant, detailed some of this history of the society. I do not intend to add to those details, but my fear is that the Government will be tempted to sit back and do nothing while further tests are made. I feel that the evidence which has been presented to your Lordships this evening from all quarters of the House is important evidence which should lead the Government to take action.
9.37 p.m.
Lord Lyell: My Lords, I believe the whole House will be immensely grateful to the noble Earl, Lord Gosford, for raising this fascinating and very detailed and interesting, and in many cases very tragic, subject in your Lordships' House this evening. Your Lordships will be aware that many different and detailed
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points have been raised and many of those points have contained frank and detailed warning from Members of your Lordships' House who have taken part in the debate. I hope that I shall be able to give satisfactory answers. With regard to some of the other instant questions I shall do my best, and if there are any points that miss I trust that I shall obtain the usual indulgence from your Lordships and be able to write in detail, together with some of the scientific points, to noble Lords who have taken part in the debate. We shall all be conscious that Members of your Lordships' House and of another place have done much valuable work in examining all the developments in legislation on, and the control of, exposure to asbestos in this country, in other member states of the European Community, and indeed further afield.
The noble Earl, Lord Gosford, who asked this Question tonight took part in our previous and more general debate on the two draft European Community proposals which are now under negotiation in Brussels, and I would attempt to build on what my honourable friend said recently in another place, actually on the 22nd October, in replying to the more detailed questions which have now been asked by the noble Earl.
The Health and Safety Commission's Advisory Committee on Asbestos, as the experts in your Lordships' House will be aware, sat between 1976 and 1979 and took a very comprehensive review of the current methods of sampling and indeed of evaluating asbestos dust. In the report on the measurement and monitoring of asbestos in the air, published in 1978, the Advisory Committee concluded that for workplace monitoring there was then no practical alternative to the collection of airborne fibres on what we call a "membrane filter" and then counting these by means of optical phase contrast microscopy—or should it be micro-scoppy?
Baroness Llewelyn-Davies of Hastoe: My Lords, the noble Lord was right the first time.
Lord Lyell: Clearly the noble Baroness is a Great expert, and we look forward to hearing her perhaps on another occasion. Although this committee acknowledged the limitations of this particular method, subsequent research and development has not yet produced a satisfactory replacement, and indeed the membrane filter method continues to be the one on which controls for occupational exposure are based, and which is at present routinely used for the protection in the workplace, for process control, and indeed for assessing legislative compliance by industry both in the factory inspectorate and in epidemiological surveys.
The advisory committee further recognised that there was an important need to devote further effort to reducing the variation which occurred in the evaluation of samples by this method and indeed to develop more sophisticated methods to replace or supplement manual counting. The Health and Safety Executive, in co-operation with industry, and indeed with other countries, have already done a great deal of work to implement these recommendations. The debate which we had in your Lordships' House—I think it was in March this year—looked at some length at research and development of automatic methods of counting and analysing the concentration of airborne fibres in the workplace, and I am happy to say that this work is

1025
continuing in co-operation with the manufacturers of the instruments, and that comparative trials are undertaken regularly to increase the reliability of these instruments which are in day-to-day use.
In addition the Government, as your Lordships will recall, are engaged in discussion of the draft European Community directive on the protection of workers from the risks which are related to exposure to asbestos, and this draft directive contains, among other things, provisions for monitoring asbestos in the air at the workplace; and, certainly from the background of our experience, we are discussing with other member states development of an agreed reference method to encourage more consistent comparisons of the techniques of monitoring this problem throughout the Community.
Various noble Lords who have spoken in the debate have raised the problem of alternatives for asbestos. In this regard the Government encourage the replacement of asbestos in particular uses by other suitable substances so far as is reasonably practicable. But, of course, we have to take account of current knowledge of the respective health risks of these substitutes, and also of the use of the substitutes in production, the effectiveness of the substitutes in the performance in place of asbestos and asbestos fibres, and the costs which are associated with the changeover from asbestos to various forms of substitutes. The Government very greatly welcome the efforts that have been, and indeed still are continuing to be, made by industry, and especially by research institutes, to develop substitutes for asbestos in an ever-widening range of applications.
I would remind your Lordships that, as was said by my honourable friend in another place, the unique combination of properties which has led to the widespread use of asbestos in general has made asbestos difficult to replace. By the same token, if other substances are to be effective substitutes, the very properties that make them suitable can also present potential, possibly as yet undiagnosed, risks to health. Therefore, in this respect the Government would advise prudence in substitutions.
The Earl of Gosford: My Lords, may I just add very quickly that men and women and children are also difficult to replace, and really there is quite an urgency to see that these old materials are now replaced by more modern methods.
Lord Lyell: My Lords, of course the Government agree totally with the noble Earl. But I possibly did not spell it out in my reference to alternative substances that we are operating at the limits of scientific knowledge, as we find it, and as the noble Earl will find later in my reply to a very valid point made by the noble Lord, Lord Avebury, many of these diseases regrettably only become evident 20 to 30 years after the worker or, as the noble Earl points out, the men, women and children, have been exposed to this particular risk. But certainly, the Government take an urgent view of this matter and are doing everything that can be done within the limits of science.
I should like to attempt to reply in detail to the points which have been raised by those noble Lords who have taken part in the debate this evening. The noble Earl, Lord Gosford, began his interesting speech
1026
by mentioning evidence which had been offered by SPAID to, I think, the Select Committee in another place. Certainly I hope that the noble Earl and the House will be satisfied with the very full and valuable answer which was given by my noble friend Lord Cranbrook.
The first major question which was put to me by the noble Earl, Lord Gosford, was about the dates of the consideration by the European Commission. I am advised that further discussions on the draft directives are expected to take place in early 1982. The precise timing of these discussions will, indeed depend upon decisions which will be taken by the new presidency for the first half of 1982, which will be the Belgium presidency, of the European Community. However, we would hope that they would accord these discussions the utmost urgency and I have no doubt that, in view of the very valuable work which is done by your Lordships' European Community committees and, indeed, by my noble friend Lord Cranbrook, the remarks which all Members of your Lordships' House have made in the debate tonight will be very closely studied in the European Commission. That is the way that these things work and your Lordships' House is pre-eminent in its knowledge and I would pay tribute to the valuable work which is done by the European Community committees upstairs. We know that their reports and the debate tonight are taken seriously by the European Commission.
The noble Earl also made a brief reference to electronic microscopy and I thought that I might just turn briefly to this particular problem. As your Lordships will be aware, the Health and Safety Executive is evaluating several what we call automatic counting devices which are available commercially to monitor and check on the problems which we are discussing this evening. There are, I understand, three devices. One is called Magiscan. This is something which is beyond my scientific knowledge so far and it is called an automatic image analyser and this, we are very proud to see, has been developed at the University of Manchester and is manufactured in this country. There is another microscope which goes under the trade name of M88. The third is a fibrous aerosol monitor. I understand that the fibrous aerosol monitor has not proved as satisfactory, at least at present, as we would wish. The M88 microscope has been very fully assessed by the Institute of Occupational Medicine in Edinburgh in co-operation with the manufacturers Vickers Instruments Limited and, above all, with the asbestos industry. From the results which have been obtained, the Health and Safety Executive believes that the device would have very great advantages where samples were of a limited range of types or, indeed, for large numbers of low density samples of one particular type of fibre. But we wonder whether this particular machine would be suitable for routine enforcement.
I come lastly to the machine which is known as Magiscan. We understand that the results which have so far been obtained at levels which correspond to the present hygiene standard are usually well within the spread of the manual results, which use the systematic manual method, but further developments of monitoring methods and instruments are being pursued

1027
with great vigour in co-operation with other countries outside the European Community, and, indeed, with the European Commission.
The noble Earl raised one other point which, indeed, I think was also raised by a number of other Members of your Lordships' House; certainly by the noble Lord, Lord Plant, and my noble friend Lord Cranbrook. This was concerned with the problems of labelling. Following various discussions between the Government and representatives of the asbestos industry, there was a scheme, which we are happy to call the Voluntary Labelling Scheme, which was introduced in 1976 for all manufactured consumer products in the United Kingdom which contain asbestos of a form and of a type which could constitute a possible danger to health through the release of asbestos dust.
More recently the industry has had some success in persuading importers of similar products to participate in this scheme. But since the publication of the final report of the Advisory Committee on Asbestos, a research study has been carried out on behalf of the Department of Trade which shows that although there has been some improvement in the effectiveness of this voluntary scheme since 1976, regrettably it was still not fully observed. But the proposals on labelling, which are now under consideraton in relation to the draft Directive on Marketing and Use, would be based on the design of the United Kingdom label. The scope and wording of any safety instructions unfortunately remain to be agreed. But, if adopted, this directive would make labelling mandatory for all member states. The Government support this proposal in principal as a further means of achieving harmonisation on the use of asbestos throughout the Community, provided that the provisions of this directive are practicable and, indeed, are capable of effective enforcement.
The noble Earl, Lord Gosford, raised a particularly interesting point, as certainly did the noble Lord, Lord Plant, and another noble Lord. It concerned this substitute for asbestos developed with cement, which I understand is the result of work which has been carried out and is still under research at the University of Surrey. We are very much aware of the work which is done at this university towards developing a potential alternative to asbestos cement. This consists of a cement mixture with what I am told are reinforcing layers of stretched polypropylene netting. I am given to understand that an important aspect of cement made by this process is that, unlike asbestos cement, which is manufactured in several layers, the potential substitute at this university under this process is made in one layer during what is called "continuous manufacture". I have not had the opportunity of seeing this being manufactured, but I understand it means that new production machinery has had to be developed, making the product itself more complicated and, Indeed, more costly to produce.
This problem has created a potential difficulty in changing over from the manufacture of asbestos cement to that of this new material. But, of course, in this area of trying to find some particular or suitable substitute for asbestos cement we must take into account that the decision of any company whether or not to manufacture a particular product is for that
1028
company to take, bearing in mind the technical, social, medical and, of course, the economic factors in the case of each substitute and how that substitute will be relevant to the particular company's product.
The noble Earl, Lord Gosford, gave me notice of one other particular point, which he did not necessarily raise this evening, but I would hope that your Lordships would enable me to deal with it briefly. It concerned paints. The noble Earl asked me about asbestos fibres in paint, and especially in paint used for decorative purposes. I am advised that asbestos fibres have not been used in decorative paints for many years, although they were once used as what we call a binding agent in some specialised domestic paints for protection against condensation and indeed corrosion.
I am given to understand that there is still a very small and diminishing use of chrysotile fibres—they are complicated words; I believe this is the white asbestos in what I was told was the spectrum; I see the noble Lord, Lord Stone, nodding, so clearly at least I have the support of one in your Lordships' House—as a minor component of some industrial paints, but I would say that active steps are being taken to replace any form of asbestos fibres in these remaining uses.
The Earl of Gosford: My Lords, I thank the noble Lord for being so conscientious in answering that "silent" question.
Lord Lyell: My Lords, I had hoped your Lordships would bear with me. I have taken one minute, but it certainly was of interest to me and I am sure is of interest to your Lordships' House. The speech of the noble Lord, Lord Avebury, was very interesting indeed, but I would have to say to him, with all the courtesy that I can muster, that many of the cases—and the detailed cases—he raised are to a large extent outwith my brief this evening, and indeed many of the references that the noble Lord made were to my right honourable friend in another place, Mr. Patrick Jenkin, when he was at the Department of Health and Social Security.
I have to advise the noble Lord and the House that I do not have a second selection of notes on these particular detailed problems of claims and compensation. Any of your Lordships who have had to deal with questions and debates on Department of Health and Social Security problems and claims will appreciate that we could be here until very late at night if I, of all people, had to attempt to deal with the claims. May I attempt to answer as many as I can of the questions and the points that were raised by the noble Lord, Lord Avebury. I hope that I shall be able to do so, and I hope that he will hear with me.
One of the first points the noble Lord raised was what I called automatic counting. I hope I have covered that in my earlier comments in reply to the noble Earl, Lord Gosforth. So far as Mr. B, the first case, was concerned—and indeed it was fascinating to hear his complicated life pattern—I am afraid I could not comment on that particular case so far the Question tonight is concerned. Indeed, all these claims and the problems that have been associated with the claims are, I am afraid, outwith the particular Question I am attempting to answer, and this deals particularly with the actual disease, the conditions at the work place and the steps taken to attempt to monitor or, we hope, prevent the disease.

1029
Mr. C was found to have asbestosis. I am afraid the particular details of his claim are outwith any sphere of answer that I could give tonight. So far as the illegible signatures are concerned, first of all the department for which I am speaking this evening would have no special responsibility for signatures from another department, but in general the points that were raised by the noble Lord so far as illegible signatures, or "For Controller", are concerned, will be carefully read, and I hope diagnosed and acted upon in other departments.
So far as Mr. J was concerned in the comments by the noble Lord, Lord Avebury, I noted his lifestyle and how he was self-employed and how he was employed from 1947 to 1952. I would not be able to comment necessarily on the justification or not for his claim or the problem, but the point raised by the noble Lord, Lord Avebury, is of particular relevance to these appalling diseases we have been discussing this evening. Indeed, these diseases were spelt out in graphic detail in the report of the committee of my noble friend Lord Cranbrook.
The noble Lord, Lord Avebury, rightly pointed out that many of these diseases take 20 years or more to manifest themselves. The timespan between when workers—or, as my noble friend Lord Cranbrook pointed out, innocent members of the public—are exposed to risk and one of these diseases manifesting itself by whatever method (by electronic microscopy and so on) can be 20 or 30 years. Of course, technology is advancing all the time, so the point raised by the noble Lord, Lord Avebury, was of exceptional relevance.
As for the other cases the noble Lord raised, of Mr. P and Mr. S, while they are most interesting, I am afraid I could not comment on the settlement or indeed justification of the claims, or the time between examination and the claim being three weeks or five months or whatever. While I could not comment on that tonight, I assure the noble Lord that his comments, and all the others that have been made in this debate by noble Lords, will be carefully read by the departments which have an interest in these diseases, and of course by the department for which I am speaking tonight. Thus, any points with which I am not able to deal will be noted by the relevant departments.
We had a notable contribution from my noble friend Lord Cranbrook. The whole House will be aware of the tremendously valuable work which he as chairman and his committee do, and have done, in examining the two directives, and I hope the House will bear with me when, on behalf of all your Lordships, I thank him and his committee for the expert and valuable work they have done and for their fascinating report, which I and noble Lords who have spoken tonight will have read. I was grateful for my noble friend's replies to the problems of the evidence presented by SPAID, and I hope that also dealt with the first problem raised by the noble Earl, Lord Gosford.
My noble friend raised a point of special reference to the Health and Safety Executive going to Copenhagen in April 1982. I am able to confirm that the executive will be well represented at the World Health Organisation's meeting on the biological effects of man-made mineral fibres to be held in Copenhagen in April 1982. The
1030
HSE representation consists, I am informed, of the factory inspectorate division, the scientific and medical divisions and representatives of policy. I hope that that massive representation demonstrates the great importance which the HSE places on the development of all safe alternatives to asbestos. My noble friend also asked about voluntary labelling, and I hope the answer I gave to the noble Earl, Lord Gosford, will satisfy him on that.
The noble Lord, Lord Plant, made a very interesting speech. However, I fear that much of it was beyond the scope of my reply this evening. The noble Lord asked about the final report from the Asbestos Advisory Committee. I am advised that the Government have generally welcomed the HSE's advice, and the Government have agreed that this advice should form the basis of the approach by the United Kingdom to Community legislation on asbestos and all the problems associated with it. But the development and the implementation of the policy of this country and of this Government on asbestos will need to be co-ordinated henceforward with that of the two draft EEC directives.
The noble Lord, Lord Plant, also raised two other points, one of which related to labelling, and I hope that on that I was able to satisfy him through my reply to the noble Earl, Lord Gosford. The noble Lord, Lord Plant, also raised the problem of the substitute material which is being developed continuously at the University of Surrey, and I hope that my previous remarks will have satisfied him on that particular score.
The noble Lord, Lord Ponsonby of Shulbrede, raised one particular point which related to monitoring, and I shall try to answer this briefly. I understand that the word "monitoring" means maintaining a regular surveillance over something or someone. In regard to what we are dealing with tonight it applies to both the problem of asbestos dust as well as the human beings who are involved, either actively at their place of work, or, as the noble Earl, Lord Gosford, mentioned, as innocent bystanders or people otherwise in the vicinity. I hope that the Government have been able to show that by all kinds of methods, certainly by the electronic microscopy methods, and by attempting to fulfil our obligations under the workplace directive, we are meeting our obligations in this particularly important area.
There is of course another problem, that of the diagnosing of disease. The distinction between diagnosing and monitoring is a fundamental one, and certainly we should not want to blur the boundaries between these two concepts of diagnosis and monitoring.
Lord Davies of Leek: My Lords, I hate to interrupt the noble Lord, but I have had experience of pneumoconiosis, and I am concerned that a person who might have a disease arising from asbestos should have the legal muscle—which sometimes the trade union movement tries to give him—to get his case fought out properly before the tribunals, which overawe many a worker who goes before them.
Lord Lyell: My Lords, I suspect that the noble Lord has experience of providing what he calls the muscle to assist the very unfortunate victims of asbestosis, above all, and the associated diseases. I hope that Government monitoring and diagnosis—

1031
the two concepts—are clearly drawn. Certainly my right honourable friend who is in charge of the Department of Health takes these problems very seriously. The department for which I am speaking this evening is concerned to take very seriously problems connected with prevention rather than hoped-for cure. We take the question of prevention very seriously, and I shall see that the remarks of the noble Lord, Lord Davies, are noted—
Lord Davies of Leek: I did not mean to be aggressive.
Lord Lyell: No, my Lords; I hope that the noble Lord does not think that I am attempting to be in any way aggressive in returning his volley. I shall certainly see that his remarks are noted, particularly in view of his undoubted interest in asbestosis, as well as the other diseases, including pneumoconiosis and byssinosis, which we have also heard about, though not tonight.
I promised to be brief, and I am very near the end in trying to reply to all the very detailed points, but the noble Lord, Lord Ponsonby, and indeed others, asked about the substitution of asbestos. I would have to say that there is no apparent threshold below which any exposure to asbestos entails absolutely no risks to anybody's health. But, of course, there are very clear and obvious advantages in replacing it with alternatives provided that those alternatives are, in their turn, less hazardous. The Advisory Committee on Asbestos recommended that there should be an explicit obligation to consider the replacement of asbestos so far as it is reasonably practicable to do so—and I hope that this will marry in with the remarks that I made earlier—the Government and industry being very much at the limits of technology and science as we have the position today. The Government certainly support this particular view, and also the onward thrust of technology, but for practical reasons we believe that this obligation should be applied particularly and only to manufacturers of products which contain asbestos—and, of course, in the United Kingdom at the moment these are white and brown asbestos. I think that is chrysotile and amosite.
In conclusion, while I hope that I have shown this evening that the Government are by no means complacent about the progress which has been made so far, they believe that in the field of monitoring at the workplace of asbestos and the development of substitutes responsible advances are being made, and we hope that the United Kingdom will continue to play a leading role in seeking their realistic harmonisation with other countries.

British Railways (No. 2) Bill
The Queen's consent signified; Bill reported from the Unopposed Bill Committee with amendments.