HL Deb 27 October 1982 vol 435 cc492-8

[References are to Bill [83] as first printed for the Commons]

1 Clause 5, page 4, line 25, leave out paragraph (a) and insert— '(a) compliance with that subsection would result in delay involving serious risk to the health or safety of the patient; and'

2 Clause 5, page 4, line 32, leave out 'at the hospital' and insert '(whether at the hospital or elsewhere)'.

3 Clause 6, page 4, line 44, leave out paragraph (a).

4 Clause 6, page 5, line 11, at beginning insert— '() The medical practitioner in charge of the treatment of a patient in a hospital may nominate one (but not more than one) other medical practitioner on the staff of that hospital to act for him under subsection (2) of this section in his absence.'.

5 Clause 6, page 5, line 37, leave out from 'section' to 'prescribed' in line 44 and insert ' "prescribed" means'.

6 Clause 9, page 6, line 42, after first 'the' insert 'detention or'.

7 Clause 10, page 7, line 22 at end insert— '(1B) Before furnishing a report under subsection (1) of this section the responsible medical officer shall consult one or more other persons who have been professionally concerned with the patient's medical treatment.'.

8 Clause 12, page 9, line 2, at end insert— ' (3B) Before furnishing a report under subsection (3) of this section the responsible medical officer shall consult one or more other persons who have been professionally concerned with the patient's medical treatment.'.

9 Clause 14, page 10, line 12, after 'last' insert 'ordinary'.

10 Clause 14, page 10, line 24, at end insert— '(5) After subsection (6) there shall be inserted— (7) A person, other than a relative, with whom the patient ordinarily resides (or, if the patient is for the time being an in-patient in a hospital, last ordinarily resided before he was admitted), and with whom he has or had been ordinarily residing for a period of not less than five years, shall be treated for the purposes of this Part of this Act as if he were a relative but—

  1. (a) shall be treated for the purposes of subsection (3) of this section as if mentioned last in subsection (1) of this section; and
  2. (b) shall not be treated by virtue of this subsection as the nearest relative of a married patient unless the husband or wife of the patient is disregarded by virtue of paragraph (b) of subsection (4) of this section.".'.

11 Clause 16, page 10, line 37, leave out from beginning to 'there' in line 38 and insert— '(1) Section 54 of the principal Act (duty of mental welfare officer to make applications) shall be amended as follows. (2) In subsection (1) for the words "the local authority" there shall be substituted the words "the local social services authority". (3) After subsection (1)'.

12 Clause 16, page 10, line 41, after 'patient' insert 'in a suitable manner'.

13 Clause 16, page 11, line 6, at end insert— '(1C) It shall be the duty of a local social services authority, if so required by the nearest relative of a patient residing in their area, to direct a mental welfare officer as soon as practicable to take the patient's case into consideration under subsection (1) of this section with a view to making application for his admission to hospital: and if in any case that officer decides not to make an application he shall inform the nearest relative of his reasons in writing."'.

14 After Clause 16, insert the following new clause:

Social report

'Where a patient is admitted to a hospital in pursuance of an application (other than an emergency application) made under Part IV of the Principal Act by his nearest relative, the managers of the hospital shall as soon as practicable give notice of that fact to the local social services authority for the area in which the patient resided immediately before his admission; and that authority shall as soon as practicable arrange for a social worker of their social services department to interview the patient and provide the managers with a report on his social circumstances.'.

15 Clause 17, page 11, line 11, leave out 'as to the condition of a patient'.

16 Clause 17, page 11, line 16, after first 'the' insert 'detention or'.

Lord Trefgarne

My Lords, with your Lordships' permission, I should like to speak to Amendments Nos. 1 to 16 inclusive, and then to move the remainder formally as we reach them. I beg to move that this House doth agree with the Commons in their Amendments Nos. 1 to 16. These amendments concern compulsory admission to hospital and guardianship. Several of the amendments—Amendments Nos. 5, 6, 9, 11, 15 and 16-are purely technical, and I shall not detain your Lordships with a complicated explanation, unless there is a particular point which a noble Lord should like me to clarify.

Several of the other amendments-Nos. 1 to 4—tighten the safeguards on the admission procedures. Amendment No. 1, for example, strengthens an amendment made by your Lordships at Report, when we said that two recommendations might come from doctors at the same hospital only if there would otherwise be "undesirable delay". The other place has replaced that term by the condition that there would otherwise be, delay involving serious risk to the health or safety of the patient". Two other amendments. Nos. 7 and 8, introduce a theme to which I shall return when we come to the new Part on consent to treatment—the theme of multidisciplinary consultation. These amendments require the patient's responsible medical officer to consult at least one other person who has been professionally concerned with the patient's treatment before he makes a statutory report to reclassify the patient's mental disorder, or to renew his detention.

Another theme in this group of amendments is the increasing involvement of social workers in every case, either before or after admission. Amendment No. 13 provides that a relative can ask a local authority to send an approved social worker to investigate whether an application for compulsory admission should be made. I am sure that local authorities already meet requests such as that, but it does no harm to have a clear statutory duty. That enables the nearest relative to have the benefit of the social worker's advice before an admission is made. Amendment No. 14 involves a social worker after an admission under Sections 25 or 26 for 28 days or more, where the application was made by the nearest relative.

I hope that your Lordships will agree that somewhat cryptic description of the amendments is appropriate in the circumstances, and that you will see fit to agree that they should be incorporated in the Bill. I beg to move.

Moved, That this House doth agree with the Commons in the said amendments.—(Lord Trefgarne.)

Lord Renton

My Lords, I wish to say a few words very briefly about Amendments Nos. 7 and 8 on the reclassification and duration of authority for detention and guardianship, respectively. The amendments place a fresh duty on the responsible medical officer to consult other professionals concerned with the patient's treatment. This is a welcome extension of wider consultations, which MENCAP and others have advocated all along. I believe that the Government have got this right, and we are grateful.

Lord Mottistone

My Lords, I should like to ask my noble friend a brief question in relation to Amendment No. 4. What happens in an emergency if the medical practitioner in charge of treatment and his nominated alternative are both away? Can the medical practitioner nominate somebody else—over the telephone, say—so that an emergency sitution can be dealt with? Or have the Government in mind that there would always be a duty officer, or somebody of that nature? Perhaps my noble friend could clarify that for me.

Lord Kilmarnock

My Lords, I should simply like to refer to Amendment No. 14. We supported this Opposition amendment in another place, but one rather wonders why emergency applications under Section 29 are excluded. Speed may be of the essence in such cases, and there is no reason why a social worker should have a veto over a psychiatrist. But a subsequent interview with a social worker who may know the family background could be of considerable assistance to the doctor after an emergency admission. I should be grateful for some clarification upon this point.

Baroness Robson of Kiddington: My Lords, may I refer to Amendment No. 12, where, after the word "patient", the words "in a suitable manner" are being inserted? If my memory does not fail me, when we had our Committee stage on this Bill there were a number of amendments put forward by my noble friends on these Benches and from every side of the Committee which were turned down by the Government because they were not sufficiently clear or specific enough. I should like to know what "in a suitable manner" means, and whether the phrase can really be interpreted when it appears in an Act of Parliament.

Baroness Lane-Fox

My Lords, I fear very much that some of these amendments are going to place undue restraints on psychiatrists, who have such an important part to play in getting people back into ordinary life from the agony of a special hospital. I fear that in many ways it is going to restrain them from doing what they believe to be the right thing, and at the right time, if these amendments are carried through.

Lord Wallace of Coslany

My Lords, I am afraid that I cannot agree with the noble Baroness. Generally speaking, I welcome these amendments. Indeed, with one exception I welcome most of them. Apart from that, I am very pleased indeed to see Amendment No. 14, and also Amendment No. 10. In the early stages we tried to move such amendments; but the Government have had reconsiderations elsewhere, which is acceptable to us.

Lord Winstanley

My Lords, I rise briefly to indicate the consent of my noble friends on these Benches to this block of amendments. I should like to do two other things, but briefly. First, I certainly join with the noble Lord, Lord Renton, in what he said about Amendments Nos. 7 and 8. I, too, warmly welcome these. I agree with him wholeheartedly that they make an immense improvement on the procedures which we have had hitherto, and I think they are warmly to be welcomed. I should also like to endorse what has been said by my noble friend Lady Robson in asking for some clarification of the words "in a suitable manner" in Amendment 12. I am not saying here that I do not necessarily accept this amendment, but it would be interesting to hear precisely what the Government have in mind in this regard.

May I say just one thing further, and then it will not be necessary for me to say it on any other amendment. If the noble Lord will forgive me for introducing a faint note of criticism into these proceedings—perhaps not criticism, but of regret—in general terms it is this. Noble Lords will remember that we spent four months on this Bill. We were very grateful indeed that this Bill was introduced in your Lordships' House—a House in which a great many noble Lords in all parts of the Chamber have vast experience and expertise; people who have worked in this field for the whole of their professional lives.

I think it was very valuable that your Lordships' House had the opportunity of moulding this Bill initially; and in those four months—and it was four months from Second Reading until we had finally finished with it—I think there were noble Lords in this House who gained a great understanding and expertise in the matter of this Bill as a whole. I therefore merely say that, to me, it seems a matter of faint regret that we should now get the Bill back at the eleventh hour, as it were, in such a form that it is quite impossible for us to make any changes without perhaps imperilling the Bill as a whole.

I am not saying that there are very many changes that we should like to make, but since we have acquired such expertise in this particular matter I think it is a pity that noble Lords will not have an opportunity to make minor improvements which perhaps they could have made had we had the Bill returned to us at a slightly earlier stage, instead of a matter of minutes before Prorogation.

Lord Trefgarne

My Lords, let me say straightaway that I have a great deal of sympathy with what the noble Lord, Lord Winstanley, has said, but I can assure him that the timetable for the Bill has not been arranged in such a way as deliberately to deny your Lordships an opportunity to amend the Commons amendments. I of course appreciate that the Bill is one which began its life in your Lordships' House and was the subject of considerable and important debate here, under the guidance of my noble friend Lord Elton. But I think it would be right to say that the vast majority of the Commons amendments which are before us' today would in general be welcomed by your Lordships. Many of them were certainly taken up in another place in response to points made here in your Lordships' House.

I appreciate that the end of the Session is now very nearly upon us, but it is only fair to say that the position we find ourselves in today is not unique. It has happened before on many occasions under many different Governments, I fear. It would not be right for me to comment on the timetable in another place, although I would personally have preferred a little more time for your Lordships to consider these amendments. Having said that, in fairness to another place I should say that in the last few days they have been able to consider amendments made by your Lordships to the Criminal Justice Bill, the Transport Bill and the Employment Bill with even less notice than we have had today. I have certainly taken note of the view of the noble Lord, Lord Winstanley, which is undoubtedly shared by other noble Lords, and I am certain that the point will be taken on board by my noble friend the Chief Whip; but I hope your Lordships will agree that we should now proceed to consider these amendments.

Perhaps I may go straightaway to the specific point made by the noble Lord, Lord Winstanley, which I think echoed the point made by the noble Baroness, Lady Robson, about the words "in a suitable manner" referred to in Amendment 12. That amendment provides, as the noble Baroness says, that the mental welfare officer must use "a suitable manner" when interviewing a patient with a view to making an application for admission. We have in mind here the special needs of, for example, deaf people and other people with communication problems, and that was why those particular words were included. I can assure the noble Baroness and the noble Lord that there was no ulterior motive.

May I turn now to the point made by my noble friend Lord Mottistone on Amendment No. 4. Let us suppose that the first doctor is out of the country and that his nominated deputy dies. You then have to ascertain who in fact is the doctor in charge of the patient's treatment. The medical executive committee of the hospital would want to make sure that someone was responsible for the patient's care, medication and so on, and might appoint another doctor to take charge pro tem. It seems to me that in those circumstances the third doctor would then have the power to make a Section 30 report.

The other way out of all this would he to use Sections 25 or 26, or even 29, if it was urgently necessary to detain the patient. I suspect that if we start imagining a long chapter of accidents or disasters, or let our imagination run wild in these circumstances, we might really get ourselves into difficulties. I really do not believe that there will be any difficulty of the kind that my noble friend describes.

Lord Mottistone

My Lords, before my noble friend moves on from that, he did not really take my point about an emergency. I was not thinking of people out of the country and dying, where arrangements could be made more of less in slow time; but if a patient really does require medical treatment in a hurry and there is no doctor in the hospital, what is to be done? Under Amendment No. 4, which we are considering, it seems that only one person is to be nominated as alternative to the other person. If they are both not available, is it conceived by the Government that it should be possible to further nominate to deal with an immediate problem, not the sort of longish-term situation my noble friend was describing?

Lord Trefgarne

My Lords, I am not sure that I was discussing a longish-term situation, as my noble friend put it. I believe that it will be possible for hospitals to obtain the services of the medical officer who is the appropriate medical officer in this case, and if a genuine difficulty arose I have no doubt that they would re-nominate someone if that is what is necessary. I really think that my noble friend is exaggerating the difficulties in the situation that may occur. I hope that, on reflection, he will be persuaded along those lines.

May I turn now to the point raised by the noble Lord, Lord Kilmarnock, and in particular to the question about the Section 29 arrangements in Amendment No. 14. We excluded them because of the great practical difficulties. The maximum period for which a patient can be detained in hospital under an emergency application is 72 hours. It will be very difficult for all the steps in the new clause to be completed within 72 hours and for the social worker to make a satisfactory, full report within that time. It would not be right to make provision in law for something which in many cases could not be fulfilled. The difficulty therefore is a practical one in the way of the proposal which the noble Lord puts forward and I hope that he will agree that it is a real one.

Baroness Masham of Ilton

My Lords, may I ask the noble Lord whether he will answer the question put by the noble Baroness, Lady Robson, and explain what is "in a suitable manner"?

Lord Trefgarne

My Lords, I have already done so.

On Question, Motion agreed to.

3.32 p.m.