State Hospitals (Scotland) Bill [H.L.] (Hansard, 30 March 1994)

§ The Marquess of Huntly
My Lords, I beg to move that this Bill be now read a second time.
I must first apologise to the House that I was not able to move the First Reading of this Bill. I am grateful to my noble friend Lord Lyell for doing that on my behalf.
The Bill brings all powers for the provision, control and management of state hospitals in Scotland in to the National Health Service (Scotland) Act 1978 and will enable the Secretary of State for Scotland to set up a special health board under Section 2 of that Act to provide for the care and treatment of patients within such hospitals.
Granting special health board status will, I assure your Lordships, be welcomed by the general public, the Carstairs staff and the wider National Health Service as the final step in fulfilling the Government's long-standing commitment to do all they can to change lingering perceptions of the State Hospital, Carstairs, as an extension of the prison system and instead complete the conditions in which it can come to be properly regarded as a health facility.
At present the provisions for the control and management of the State Hospital are set out in the Mental Health (Scotland) Act 1984, whereas the Secretary of State's power to constitute health boards is set up under the National Health Service (Scotland) Act 1978. As there is no statutory link between the two 1159 pieces of legislation, this Bill is intended to bridge that gap and create the conditions in which the Secretary of State for Scotland can apply special health board status to Carstairs hospital.
The National Health Service and Community Care Act 1990 created powers within the 1978 Act for the Secretary of State for Scotland to create and transfer functions to special health boards. Quite properly, of course, only those functions that are set out within the 1978 Act can be transferred. In order to transfer the full range of provisions attaching to the state hospital service to the special health board that is to be created, it is necessary to transfer the legislative provisions covering the control and management of the State Hospital, Carstairs, from the Mental Health (Scotland) Act 1984 to the 1978 Act.
Your Lordships may be interested in some background to the state hospital service in Scotland. The State Hospital at Carstairs is a secure hospital which is administered for the Secretary of State for Scotland by an appointed management committee. Carstairs is the only state hospital in Scotland. It serves as a special hospital and regional secure unit for Scotland and Northern Ireland. The hospital cares for an average of 220 or so patients who are admitted under requirements of the Mental Health (Scotland) Act 1984 and related legislation, including in particular the Criminal Procedure (Scotland) Act 1975, because of their dangerous, violent or criminal propensities.
The hospital treats patients admitted suffering from a range of mental disorders. The staff expertise is held in high regard by all who make use of the hospital's services. They are expert in dealing with potentially dangerous people suffering from mental disorders or indeed patients who have proved themselves very difficult to manage elsewhere in the National Health Service. The facilities at the hospital are designed to allow people to be cared for in secure conditions and to minimise the potential danger to themselves, to staff and, of course, most importantly, to the general public. Like all hospitals in the National Health Service, at Carstairs the patients' needs must come first.
The patients fall into two categories: the Secretary of State patients—that is, those admitted from the courts under a restriction order and who may be discharged only with the approval of the Secretary of State for Scotland—and the non-Secretary of State patients—that is, those admitted either from the courts but without a restriction order or as ordinary detained hospital patients, usually on transfer from National Health Service hospitals, who may be discharged or transferred with the agreement of the Carstairs management committee. There are also patients in both categories who are transferred from prison for treatment at Carstairs.
I have already mentioned that the granting of special health board status will fulfil a long-standing commitment and your Lordships will be interested to know that over the past three years all other available steps have been taken towards the creation of health board status for Carstairs. For example, the State Hospital management committee has been restructured 1160 along health board lines. Her Majesty's Treasury has agreed to the approach made that from 1st April 1992 the hospital should no longer have its own Vote but should be part of the main Health Service Vote and be subject to the same financial regimes as apply for all other health boards in Scotland. Also, the State Hospital has developed its own strategic objectives and is subject to he same accountability review process as the other health boards in Scotland.
Much progress has therefore been made. For instance, I can give two tangible examples of the significant change and improvements made so far at Carstairs in response to the initiative to transform the state hospital service from its custodial and punitive past into a hospital where the emphasis is properly on care therapy and rehabilitation.
More recently, in fact in February this year, the British Standards Institution awarded the hospital its British Standard BS5750 certificate in recognition of the commitment to quality at Carstairs. The State Hospital, Carstairs, was the first National Health Service hospital in the UK to achieve certification by the British Standards Institution for its entire operation, which is no small achievement and an indication of the progress made by the staff for the benefit of patients and their relatives.
As I have explained, this Bill brings all the Secretary of State's powers for the provision, control and management of state hospitals in Scotland into the National Health Service (Scotland) Act 1978. This is a technical Bill, running to just three clauses. Clause 1 re-enacts in an extended form Section 102 of the National Health Service (Scotland) Act 1978 to include the provisions dealing with the control and management of state hospitals in Scotland currently provided in the Mental Health (Scotland) Act 1984. Clause 2 deals with consequential amendments and repeals. Clause 3 gives the powers to make an order which will commence the provisions of the Bill. The Bill has no financial effects, no effect on public sector manpower and no compliance cost implications for business. I commend the Bill to the House.

§ Lord Carmichael of Kelvingrove
My Lords, we should be grateful to the noble Marquess, Lord Huntly, for introducing the Bill and explaining it so thoroughly. I am grateful also to the Minister of State at the Scottish Office for sending me an explanation of it. We have been waiting for such a Bill for a long time and for the changes that it will introduce.
I know Carstairs reasonably well. Like the noble and learned Lord, Lord Fraser of Carmyllie, I was a constituency Member of Parliament in the area for quite a long time and have visited Carstairs once or twice. I agree with the noble Marquess, Lord Huntly; whenever I visited the staff were extremely attentive. I do not think that that was a show; I think that they were really concerned and interested. Therefore, if we can do anything to take away the old stigma from that hospital, we shall have done a very good job.
1161 I should like to make another point to the Minister in the hope that at some point in the future something can be done about it. I know that there must be a certain amount of security in any institution—prison or hospital —of the nature that Carstairs will become. However, as a member of the Penal Affairs Group in the other place and as a chairman of SACRO for some time, I have visited nearly all the prisons in Scotland and I must tell the Minister that what got me about Carstairs was its fencing. I found it offensive. I know that such things can be expensive to change, but if the opportunity arises, I hope that the Minister will seriously consider it. It must be very depressing for relatives to see that double fencing. I imagine that they would rather see a wall.
Having said that, however, I am delighted that this short Bill has been introduced. I hope that we can proceed with its remaining stages quickly so that the Bill will reach the statute book soon.

§ Baroness Carnegy of Lour
My Lords, I did not put down my name to speak on this Second Reading because I was not sure that I would be present in the House when the Bill was introduced. However, I should like briefly to congratulate my noble friend on introducing the Bill and on the clear way in which he has moved the Second Reading.
Anyone who has been an honorary sheriff in Scotland knows the importance of having the right sort of secure state hospital in our midst. Anyone who follows, as I am sure noble Lords do with interest, the advancing state of medicine and who has an understanding of mental illness will realise how important it is that the status of such hospitals should be seen somewhat differently than has been the case in the past. I believe that the Bill will bring about a change in public perception which will be extremely helpful, above all, to the patients, as well as to the staff and the patients' relatives. That is an important part of my noble friend's purpose. I congratulate him and hope that the House will give the Bill a fair wind.

§ The Minister of State, Scottish Office (Lord Fraser of Carrnyllie)
My Lords, I join the congratulations that have been extended to my noble friend Lord Huntly on the way in which he has simply but eloquently explained the desirability of the Bill that he has just introduced. I am delighted that the noble Lord, Lord Carmichael of Kelvingrove, and my noble friend Lady Carnegy of Lour should have joined in the approval of the Bill.
When introducing the Bill, my noble friend described it as "technical". In some respects he is correct, but he should not underestimate its importance to those who work at Carstairs in what are difficult circumstances from time to time. I have no doubt that it will be a great encouragement to them that my noble friend has introduced this Bill and that every indication has been that your Lordships' House supports it. As my noble friend said, the hospital recently secured the BS5750 1162 certificate. That is very important. I have no doubt that the great improvements that have been made there in recent years will enable that progress to continue.
A further matter of encouragement to the staff and all those who are interested in this matter is that, while my noble friend has introduced the Bill in this House because it is non-controversial and essentially non-political in nature, I understand that the Member of Parliament for Clydesdale, Mr. Jimmy Hood, whose constituency contains Carstairs, is now prepared to take the Bill through the other place if it secures the approval of your Lordships. I have no doubt that that combination will be of further encouragement to the staff.
The only problem raised in this short debate was one mentioned by the noble Lord, Lord Carmichael, with regard to the fencing. Difficult security issues have to be dealt with, not least so far as concerns the local community. I have no doubt that he will be interested to know that, while at present the State Hospital, rather curiously, is located on both sides of a public road, the proposal is that in the near future the site on one side of the road should be abandoned and the hospital should be contained on a single site. I have no doubt that that will not just make security better but in many respects what is in place will look less oppressive to those who work within the hospital and to the local community. It is a great encouragement that the Bill so clearly commands the support of your Lordships. I, too, commend the Bill to the House.

§ The Marquess of Huntly
My Lords, am most grateful for the support that I have received this evening. I am pleased that I have been able to be involved in bringing forward the Bill. I commend it to the House.