HL Deb 11 May 1995 vol 564 cc171-95

3.21 p.m.

Read a third time.

Clause 1 [After-care under supervision]:

Baroness Cumberlege moved Amendment No. 1:

Page 10, line 1, leave out ("section 25H") and insert ("sections 25H and 251").

The noble Baroness said: My Lords, in moving this amendment I shall speak also to Amendment No. 2. These amendments introduce a new Section 251 into Clause 1 of the Bill. This changes the provisions for patients subject to supervised aftercare who are sentenced to imprisonment or committed or remanded to custody. The effect is that for those on remand or serving sentences of six months or less, aftercare under supervision would remain in force although the conditions would be suspended until the person was released. If supervision was due to expire while the person was in custody, or within 28 days of the person's release, it would be extended and deemed to expire 28 days from the date of release. The power would have to be renewed within 28 days of release subject to the prior consultation procedures which are already in the Bill.

The amendment does not apply to those sentenced to longer periods in custody essentially because if someone has been out of touch with the specialist services for a long period, the presumption that he or she is still suffering from the conditions which led to aftercare under supervision being arranged becomes hard to sustain. However, if the sentence was more than six months but less than a year and supervision had not expired while the person was in custody, it would still he reactivated when he or she left prison.

We think that the number of cases in which supervision arrangements expire during a period in prison is likely to be very small. Indeed, it is very likely that the patient would have been transferred from prison to hospital under the existing Mental Health Act power enabling a fresh supervision application when he or she was eventually discharged. Nevertheless, we think it important to minimise the possibility of even a few patients slipping through the net of care in this way. I beg to move.

On Question, amendment agreed to.

Baroness Cumberlege moved Amendment No. 2:

Page 13, leave out lines 6 to 15 and insert:

Special provisions as to patients sentenced to imprisonment etc

("251.—(1) This section applies where a patient who is subject to after-care under supervision is detained in custody in pursuance of any sentence or order passed or made by a court in the United Kingdom (including an order committing or remanding him in custody).

(2) At any time when the patient is so detained he is not required—

  1. (a) to receive any after-care services provided for him under section 117 below; or
  2. (b) to comply with any requirements imposed on him under section 25D above.

(3) If the patient is so detained for a period of, or successive periods amounting in the aggregate to, six months or less and, apart from this subsection, he—

  1. (a) would have ceased to be subject to after-care under supervision during the period for which he is so detained; or
  2. (b) would cease to be so subject during the period of 28 days beginning with the day on which he ceases to be so detained,
he shall be deemed not to have ceased, and shall not cease, to be so subject until the end of that period of 28 days.

(4) Where the period for which the patient is subject to after-care under supervision is extended by subsection (3) above, any examination and report to be made and furnished in respect of the patient under section 25G(3) above may be made and furnished within the period as so extended.

(5) Where, by virtue of subsection (4) above, the patient is made subject to after-care under supervision for a further period after the day on which (apart from subsection (3) above) he would have ceased to be so subject, the further period shall be deemed to have commenced with that day.").

On Question, amendment agreed to.

Baroness Cumberlege moved Amendment No. 3:

Page 13, line 15, at end insert:

Patients moving from Scotland to England and Wales

25J.—(1) A supervision application may be made in respect of a patient who is subject to a community care order under the Mental Health (Scotland) Act 1984 and who intends to leave Scotland in order to reside in England and Wales.

(2) Sections 25A to 25I above, section 117 below and any other provision of this Act relating to supervision applications or patients subject to after-care under supervision shall apply in relation to a patient in respect of whom a supervision application is or is to be made by virtue of this section subject to such modifications as the Secretary of State may by regulations prescribe.").

The noble Baroness said: My Lords, the question of patients who move from England to Scotland, or vice versa, has been raised on a number of occasions during our debates on the Bill. I said on Report that we would be introducing amendments to deal with this, and the present amendment is one of them. It covers the movement of patients from Scotland to England and is complemented by the amendment my noble friend Lord Lindsay will be moving shortly covering movement in the opposite direction.

The amendment introduces a new provision into Clause 1 under which an application for aftercare under supervision may be made in respect of a patient subject to a community care order. The modifications which need to be made to the procedure to cover the fact that the patient is moving, not from being detained in hospital, but from being subject to a Scottish community care order, will be prescribed in the regulations. In practice we see this working as follows. If the care team in Scotland believes it is in the patient's best interest to move to England or Wales, it will make contact with a Section 12 approved doctor south of the Border. This is likely to be the same person who will eventually be the patient's community RMO after the transfer has taken place. This doctor will then make the application to the health authority, which will have to be supported by two recommendations, one from an approved social worker and the other from a registered medical practitioner who has knowledge of the patient's history.

The significant difference from the general arrangement in Clause 1 of the Bill is that the application is made not by a doctor who has been looking after the patient in hospital, but by one who is likely to be his or her responsible medical officer in the community. So far as the supporting medical recommendation is concerned, it would obviously make sense for this to be given by the special medical officer who is the Scottish equivalent of the community RMO and that is what we expect to happen in the ordinary way. There would have to be full consultation on both sides of the Border and the transfer would take place when all concerned were ready for it to go ahead. The patient would become subject to aftercare under supervision upon taking up residence in England or Wales. He or she would have an immediate right to a mental health review tribunal.

It would only be practicable to apply these provisions to patients who agree to the transfer. The new powers rely on the sanction of the patient's possible return to hospital rather than any more direct form of compulsion, so it is not feasible to legislate for patients who abscond.

Although the number of patients who are likely to be affected by such transfers is probably very small, we feel that we need this new provision to ensure that a patient does not lose the support and supervision he or she may need simply as a result of moving to the other side of the Border. I beg to move.

On Question, amendment agreed to.

Clause 2 [Absence without leave]:

Baroness Cumberlege moved Amendment No. 4:

Page 16, line 21, at end insert: ("(2A) In section 22 of that Act (special provisions as to patients sentenced to imprisonment etc.)—

  1. (a) in subsection (2) (detained patient in whose case application for admission for treatment or guardianship application does not cease to have effect), for the words "and 21" there shall be substituted ". 21 and 21A"; and
  2. (b) after that subsection there shall be inserted the following subsection—
(3) In its application by virtue of subsection (2) above section 18(4) above shall have effect with the substitution of the words "end of the period of 28 days beginning with the first day of his absence without leave." for the words from "later of" onwards."").

The noble Baroness said: My Lords, this amendment serves to correct an oversight in the current provisions relating to detained patients who are sentenced to imprisonment. It was brought to our attention as a result of our consideration of the earlier government amendments on this issue.

At present, Section 22 of the Mental Health Act 1983 states that when a patient who has been subject to imprisonment is released, he should be treated as though he were absent without leave under Section 18 of the 1983 Act. This is a legal device to provide a period of 28 days in which such patients could be returned to detention in hospital. However, as your Lordships know, Clause 2 of this Bill extends the period of time in which an absconding patient can be returned to hospital from 28 days to at least six months. An unintentional consequence of this is to extend the period of time within which a released prisoner could be returned to detention under the 1983 Act. I am sure your Lordships will agree that this is undesirable, both in its own right, and because it would be inconsistent with the provisions laid out in the earlier amendments relating to prisoners subject to supervision applications. The effect of the amendment, therefore, is to retain for the purposes of Section 22 the period of 28 days within which a person who has been released from prison may be returned to hospital. This is followed by a period of seven days during which the responsible medical officer must examine the patient and determine whether his liability to detention should be renewed. I beg to move.

On Question, amendment agreed to.

3.30 p.m.

Clause 4 [Community care orders]:

Lord Carmichael of Kelvingrove moved Amendment No. 5:

Page 18, line 12, after ("appropriate") insert ("to ensure that the patient receives such medical treatment and after-care services").

The noble Lord said: My Lords, in moving this amendment, it may be for the convenience of the House if I speak also to Amendment No. 9. The purpose of Amendment No. 5 is to ensure that any order that the sheriff gives under these provisions should not impose conditions in the community care order which are not relevant to the main aims of the order. We believe that if this wording is not inserted, the sheriff's powers could be too wide and that would defeat the purpose of treatment of the patient. I beg to move.

The Earl of Lindsay

My Lords, as the noble Lord, Lord Carmichael, explained, these amendments seek to clarify the position when a sheriff amends or adds to the conditions proposed in an application, or if the sheriff varies the conditions following the refusal of an appeal against the order. The amendment seeks to specify that the conditions must be: to ensure that the patient receives such medical treatment and after-care services". The general objective of making a community care order is so that a patient can receive the medical treatment and aftercare services that he needs to support him in the community. We believe that it is unnecessary to add qualifications to the sheriff's power to impose conditions or vary conditions following the refusal of an appeal against an order. Any condition of an order or variation thereof would have to continue to relate to the need for conditions; that is, that they be with a view to ensuring that the patient receives medical treatment and aftercare services.

The sheriff will decide whether a condition which he is imposing or varying relates to those aims. We believe that the example that I gave in Committee was a valid one. However, we accept that it is likely that conditions of this nature would more usually be the exception than the rule. More usual conditions might include attendance at various places for the purposes of education or training, and a required place of residence. In addition, we believe that the discretion of the sheriff to vary the conditions, which must be exercised reasonably, must be preserved to allow him to take account of relevant points put forward on appeal.

After that explanation, I hope that the noble Lord will be prepared to withdraw this amendment.

Lord Carmichael of Kelvingrove

My Lords, the Minister has been very flexible, particularly in the Scottish part of the Bill. I read carefully his reply to the amendment moved earlier which corresponded to this one. I was not totally convinced, but I hope that there will be a chance perhaps in the other place to deal with this matter. I am grateful to him for the time that he has taken over it. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

The Earl of Mar and Kellie moved Amendment No, 6:

Page 19, line 15, at end insert ("and the consequences of non-compliance;").

The noble Earl said: My Lords, the purpose of this amendment is to ensure that the patient is fully briefed on his situation as soon as he has been made the subject of a community care order.

The patient is not required to be present when the community care application is being heard by the sheriff and the order granted. The amendment places an explicit duty on the aftercare officer—the social worker—to ensure that the patient fully understands his new situation: not only the purpose, effect and conditions of the order, his right of appeal to the sheriff on renewal of the order and his opportunity to make representations to the Mental Welfare Commission for Scotland, but also the consequences upon the patient for non-compliance with the conditions of the order.

Non-compliance comes broadly in two forms. First, the failure to take medicine or other treatment will probably lead to renewed mental illness and admission to hospital for reassessment under Section 35G. Secondly, failure to co-operate with the conditions of the order must also have consequences—for this is a compulsory measure of care. Here I have in mind, for example, a refusal to meet with the care team or moving address without prior agreement or not attending workshop or leisure programmes or day centres.

That may seem to be a rather negative approach to the fundamentally beneficial mental health measure of the community care order. But I am keen to point out that, although the community care order gives the patient priority access to services, it is still a compulsory measure of care imposed on a citizen by the state. I suspect that the compulsory nature of the order may often lie more heavily on a patient's mind than the benefit of priority access to services.

Therefore, I hope that the noble Earl will see the merit of this amendment and be able to accept it. It clarifies the aftercare officer's immediate task and ensures that the patient's immediate future is fully understood. I beg to move.

The Earl of Lindsay

My Lords, as I understand it, the noble Earl, Lord Mar and Kellie, seeks further clarification about what might happen if a person subject to a community care order did not go along with the conditions specified in the order.

Let me say at the outset that, although the patient may not be present at the hearing when the community care order is decided, the explanation of the community care order will be given to him both orally and in writing. The effect of any failure to comply with conditions depends on the nature of that failure. We do not see how it can be predicted and explained to the patient in advance. It will depend on which of the conditions he fails to comply with.

We discussed this matter in some detail at Report stage. I noted that the noble Earl then drew comparisons between community care orders and probation orders. We do not believe that that is appropriate, given that probation orders are a penal disposal included in the criminal justice system, whereas community care orders are a care and treatment option included within the mental health system. We do not believe that it would serve any useful purpose to bring before the sheriff a person subject to a community care order who did not keep to the conditions of his order. We feel that, although that may be appropriate in the case of probationers where the sheriff is enforcing an order made by the court following a criminal act, it is totally out of keeping with the role of the sheriff in the community care order process.

The community care order proposals provide a framework within which care and treatment can be provided. If a patient fails to meet the conditions in his order, that will clearly be of concern to the care team. But it must be addressed administratively. The care team will have to decide whether the conditions remain appropriate or whether a reassessment in hospital might be necessary because of a deterioration in the patient's mental health. If the patient met the criteria for reassessment, he could be returned to hospital for that purpose, as the noble Earl pointed out.

With that explanation to the background of the amendment, I hope that the noble Earl will feel able to withdraw the amendment at this stage.

The Earl of Mar and Kellie

My Lords, I thank the noble Earl for explaining the Government's thinking on this matter. I am certainly quite pleased with the liberal approach that has been taken within the context of a compulsory measure of care. We discussed this matter at Report and continue to do so. I shall accede to his request to withdraw the amendment in the hope that he will continue to have discussions on this subject with his ministerial colleagues and possibly come back with something along these lines in another place. Meanwhile, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

The Earl of Lindsay moved Amendment No. 7:

Page 21, line 45, leave out from beginning to ("have") in line 46 and insert ("Subject to section 35J of this Act and the following provisions of this section, a community care order shall").

The noble Earl said: My Lords, in moving this amendment, it may be for the convenience of the House if I speak also to Amendment No. 12.

As my noble friend the Minister explained a few minutes ago when she spoke about the provisions for England and Wales, and as I mentioned at Report stage, we have reconsidered the position of those who are subject to community supervision and are subsequently imprisoned. I am grateful to the noble Earl, Lord Mar and Kellie, for bringing this matter to our attention in Committee (as recorded as col. 356 of the Official Report of 6th April).

We have concluded that what we had previously provided should remain; that is, that if a person who is subject to a community care order is imprisoned and the community care order expires while he is in prison, the conditions are suspended while he is in prison. If the community care order is still in force when he is released, the conditions re-enter into force.

However, as I understand it, the noble Earl raised the question of a patient whose community care order expired while he was in prison and the steps which might be taken to revitalise the order when he was released. We take the view that in order to maintain a feasible causal link with the making of the community care order, such a revitalisation should only be possible in cases where the period served in prison was six months or less.

If a person is imprisoned for such a period, or successive periods which amount in the aggregate to six months or less, and his community care order expires while he is in prison or within 28 days of his release from prison, then it will be artificially extended and deemed to expire 28 days after his release from prison. We believe that that will allow adequate time for a renewal of the community care order under new Section 35C if that is considered necessary and allow time for the necessary consultation and a proper assessment of the patient in a community rather than a prison setting.

I hope that those provisions meet fully the concerns expressed in Committee by the noble Earl. I beg to move.

The Earl of Mar and Kellie

My Lords, I am grateful to the Minister for bringing forward the amendments. The few vulnerable prisoners who are subject also to community care orders will benefit from the fact that there will be a 28-day guaranteed resettlement period. Social workers and probation officers working in prisons in England and Wales will find it helpful to know that there is a community care team outside the prison waiting to receive the ex-prisoner who will once again be their patient.

On Question, amendment agreed to.

The Earl of Lindsay moved Amendment No. 8:

Page 25, line 28, at end insert: ("( ) An appeal under subsection (1) above shall be by way of summary application and shall be made to the sheriff of the sheriffdom within which the patient is resident.").

The noble Earl said: My Lords, I mentioned on Report, as recorded at col. 1304 of the Official Report, that we were considering this matter.

This is a technical amendment. It ensures that appeals to the sheriff against a community care order are in line with other appeals under the Mental Health (Scotland) Act 1984—that is, that they are by summary application to the sheriff of the sheriffdom within which the patient is resident. I beg to move.

On Question, amendment agreed to.

[Amendment No. 9 not moved.]

Lord Carmichael of Kelvingrove moved Amendment No. 10:

Page 27, line 22, at end insert: ("( ) This section is without prejudice to the emergency admission provisions of section 24 of this Act and in the event that a patient under a community care order is admitted to hospital under section 24 of this Act, his community care order will cease to have effect.").

The noble Lord said: My Lords, I put down the amendment in order to ask the Minister whether he had finished his consultation. He was helpful during earlier stages of the Bill and said that he would take away this section and look at it. The amendment is designed merely to give him the opportunity to report to the House and to say what his thoughts now are. I beg to move.

The Earl of Lindsay

My Lords, we agreed to consider whether an amendment was required to make clear the effect of an emergency admission on a community care order. Our consideration is continuing. But there is no doubt that emergency detention under Section 24 would be available in respect of a patient detained under a community care order. I hope that with that assurance the noble Lord will feel able to withdraw the amendment.

Lord Carmichael of Kelvingrove

My Lords, as before, the Minister has been helpful, and I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Lord Carmichael of Kelvingrove moved Amendment No. 11:

Page 27, line 22, at end insert: ("( ) A patient who is detained in hospital under this section shall have the right to appeal to the sheriff for his discharge from detention.

(2) Unless the sheriff is satisfied that—

  1. (i) the patient is suffering from mental disorder of a nature or degree which makes it appropriate for him to be detained in a hospital for assessment, or for assessment followed by medical treatment for at least a limited period; and
  2. (ii) he ought to be so admitted and detained in the interests of his own health or safety or with a view to the protection of others persons,
he shall order that the patient be discharged from hospital and he may revoke the community care order.").

The noble Lord said: My Lords, the amendment gives a patient detained in hospital the right to appeal against that detention. If the amendment were carried, the sheriff would have to stop the detention if he was not satisfied that the case for it had been made out, and he may also revoke the community care order.

While a patient on a community care order generally has the right to appeal against it, he does not have that right during the first six months of the making of the order. So new Section 35F(1) allows for appeal only after the first renewal of the order—Section 35F being the appeal provisions in relation to detention in hospital.

Deprivation of a patient's liberty without the right of appeal to a judicial forum may be in breach of the European Convention on Human Rights. We raised that issue before, and I hope the Minister has been able to check and double check. He said that he thought they were safe enough with regard to the terms of the Convention on Human Rights. I hope that the Minister will accept the amendment or give us an assurance that there is no conflict. I beg to move.

3.45 p.m.

The Earl of Balfour

My Lords, before my noble friend the Minister replies, I should like to point out from a practical point of view that when mentally disturbed people are first taken into hospital they are often unhappy and distressed because they are in a different environment. After about a month or eight weeks—they would need that time even to be able to appeal—they have usually settled down. While I sympathise with the noble Lord, Lord Carmichael of Kelvingrove, in moving the amendment, when someone is taken into hospital they need to be held there for some time, partly to allow the medical people to carry out research to their satisfaction. Although I sympathise with the idea of an appeal, I do not believe that an appeal should be permitted at too early a stage.

The Earl of Lindsay

My Lords, the amendment seeks to introduce a right of appeal to the sheriff by the patient against reassessment in hospital.

The detention in hospital under new Section 35G is for the purposes of reassessment, or reassessment followed by medical treatment. The procedure prior to admission under new Section 35G requires much consultation. The reports are also copied widely, including to the Mental Welfare Commission. We do not, therefore, think that a right of appeal is necessary at this point.

The proposed reassessment period is for a maximum of seven days and is drawn from an existing provision in Section 2 of the Mental Health Act 1983. At the end of the seven days the patient will have returned to the community on his community care order (with its existing rights of appeal); or the community care order will have been revoked (when no appeal is necessary); or an application will have been made to a sheriff for the patient's detention in hospital. That may answer the point made by my noble friend Lord Balfour. If seven days is too short to make a proper reassessment, there is always the option to apply for a Section 18 order for that patient.

We are convinced, having looked carefully at this matter—it having been pointed to by the noble Lord, Lord Carmichael of Kelvingrove, at an earlier stage of the Bill—that the existing provisions are sufficient. We are also advised—I stress this—that this provision does not fall foul of the UK's obligations under the European Convention on Human Rights. With those reassurances, I hope that the noble Lord will feel able to withdraw the amendment.

Lord Carmichael of Kelvingrove

My Lords, I am grateful to the Minister for the trouble that he has gone to. I am grateful also to the noble Earl, Lord Balfour, for his intervention. I accept the point that a patient may need a certain amount of time to become acclimatised to a hospital regime and to find his way around. But I was worried that the six months may be too long. The Minister's reassurances and the possibility of a review in any case, without one being demanded, are such that I feel satisfied and beg leave to withdraw the amendment.

Amendment, by leave, withdrawn

The Earl of Lindsay moved Amendment No. 12:

Page 29, leave out lines 17 to 24 and insert:

("Special provisions as to patients sentenced to imprisonment etc.:

community care orders.

35J.—(1) This section applies where a patient who is subject to a community care order is detained in custody in pursuance of any sentence or order passed or made by a court in the United Kingdom (including an order committing or remanding him in custody).

(2) For so long as the patient is so detained the period for which, under section 35C of this Act, the community care order has effect shall continue to run but the conditions to which he is subject under that order shall not apply in relation to him.

(3) If the patient is so detained for a period of, or successive periods amounting in the aggregate to, 6 months or less and, apart from this subsection, the community care order—

  1. (a) would have ceased to have effect during the period for which he is so detained; or
  2. (b) would cease to have effect during the period of 28 days beginning with the day on which he ceases to be so detained,
the order shall be deemed not to have ceased, and shall not cease, to have effect until the end of that period of 28 days.

(4) Where the period for which the patient is subject to a community care order is extended by subsection (3) above, any examination and report to be made and furnished in respect of the patient under section 35C(3) and (4) of this Act may be made and furnished within the period as so extended.

(5) Where, by virtue of subsection (4) above, a community care order is renewed for a further period after the day on which (apart from subsection (3) above) the order would have ceased to have effect, the further period shall be deemed to have commenced with that day.").

The noble Earl said: My Lords, I spoke to the amendment when I moved Amendment No. 7. I beg to move.

On Question, amendment agreed to.

The Earl of Lindsay moved Amendment No. 13:

Page 29, line 24, at end insert:

("Patients moving from England and Wales to Scotland.

35K.—(1) A community care application may be made in respect of a patient who is subject to after-care under supervision under the Mental Health Act 1983 and who intends to leave England and Wales in order to reside in Scotland.

(2) Sections 35A to 35J of this Act shall apply in relation to a patient in respect of whom a community care application is or is to be made by virtue of this section subject to such modifications as may be prescribed.").

The noble Earl said: My Lords, my noble friend the Minister introduced a similar amendment to cover arrangements in the provisions for England and Wales.

The amendment will allow an application for a community care order to be made for people subject to aftercare under supervision in England and Wales who intend to move to Scotland. It is vital that people who require their care to be provided within such a legal framework continue to receive that care when they move from one area to another, if that is considered necessary.

The most straightforward way for that to occur in this case is to allow applications for community care orders to be made available in such cases. However, it will be necessary for the new provisions contained in the Bill to be modified slightly for that to occur. That modification is to be by way of regulations made by the Secretary of State.

It may be helpful if I reassure the House that the regulations will not produce a "fast-track" procedure by which a community care order can be made. The sheriff will continue to be involved, and we envisage that the application will require to be made by a medical practitioner approved for the purposes of Section 20 of the 1984 Act. We also envisage that the care team in England or Wales will wish to discuss the proposed transfer with those likely to be concerned with the patient in Scotland some time prior to the making of the application and that there will be the appropriate full consultation about the application.

We believe that these provisions are adequate. I beg to move.

On Question, amendment agreed to.

Clause 5 [Absence without leave]:

The Earl of Lindsay moved Amendment No. 14:

Page 31, line 49, at end insert: ("(3A) In section 32 of that Act (special provisions as to patients sentenced to imprisonment etc.: hospital)—

  1. (a) in subsection (2) (detained person in whose case application for admission does not cease to have effect), for the words "and 31" there shall be substituted ", 31 and 31A"; and
  2. (b) after that subsection there shall be inserted the following subsection—
(3) In its application by virtue of subsection (2) above section 28(3) of this Act shall have effect with the substitution of the words "end of the period of 28 days beginning with the first day of his absence without leave." for the words from "later of" onwards.".").

The noble Earl said: My Lords, it may be for the convenience of the House if I speak also to Amendment No. 15. In a similar vein to Amendment No. 4 to the England and Wales provisions, these technical amendments seek to rectify an unintentional effect of the new provisions for those absent without leave. They amend Sections 32 and 49 of the 1984 Act.

They ensure that where a person is imprisoned for six months or less and his liability to detention in hospital or guardianship expires while he is in prison, then on release he is for a period of 28 days liable to be taken into custody to establish whether a renewal is necessary. It was never our intention for that period to be six months for such a person. I beg to move.

On Question, amendment agreed to.

The Earl of Lindsay moved Amendment No. 15:

Page 34, line 24, at end insert: ("(6A) In section 49 of that Act (special provisions as to patients sentenced to imprisonment etc.: guardianship)—

  1. (a) in subsection (2) (detained person in whose case guardianship application does not cease to have effect), for the words "and 48" there shall be substituted ", 48 and 48A"; and
  2. (b) after that subsection there shall be inserted the following subsection—
(3) In its application by virtue of subsection (2) above section 44(2) of this Act shall have effect with the substitution of the words "end of the period of 28 days beginning with the first day of his absence without leave." for the words from "later of" onwards.".").

On Question, amendment agreed to.

Schedule 1 [After-care under supervision: supplementary]:

Lord Jenkin of Roding moved Amendment No. 16:

Page 36, line 34, after ("treatment") insert ("as defined in paragraph 15.4 of the Code of Practice").

The noble Lord said: My Lords, Amendments Nos. 16 and 17 and probing amendments. It may seem slightly odd to move probing amendments at this stage of the Bill. However, noble Lords who were in the Chamber at the end of the Report stage will remember that I was badly bitten by a gremlin which leapt out at me and prevented me moving the amendments then, which may have been a more appropriate occasion. I can deal with the matter shortly.

On Report I moved a number of amendments and made the general point that it would be desirable if draftsmen of such legislation could be prevailed upon to use language which has been used in previous legislation, and with which many practitioners in the field are familiar, and not try to invent a new language. If people have been working a system for a number of years and have been used to a particular definition it is important that if a word appears in later legislation they know that the same definition applies. Paragraph 4 of Schedule 1 defines the community responsible medical officer and refers to a person who: is in charge of medical treatment provided for him".

My amendment refers to the code of practice, which defines medical treatment as being provided not only by doctors. It includes, for instance, nursing, care, habilitation and rehabilitation under supervision. That is a broad range of activities aimed at anticipating or preventing a deterioration of the patient's mental disorder. Of course, it includes physical treatment such as ECT or the administration of drugs and it includes psychotherapy.

The same point arises in new Section 2A, which is added to Section 117 of the 1983 Act. It states: It shall be the duty of the Health Authority to secure that at all times while a patient is subject to after-care under supervision… a person who is a registered medical practitioner … is in charge of the medical treatment".

That appears to suggest that the use of the term "medical treatment" is confined to the kind of treatment that only doctors can give. However, everyone recognises that when one is dealing with mental patients in circumstances provided for by the Bill medical treatment goes much wider. Therefore, is it not necessary to include as part of the definition of "the community responsible medical officer" the words which appear in my amendment? It refers to paragraph 15.4 of the code of practice, which ensures that the phrase is defined in the widest possible terms.

The point has been raised by people who are concerned with the provisions. For instance, it has been raised by the chief executive of an NHS trust who believed that it was likely to give rise to confusion and uncertainty. I do not say that my words are correct but it may be necessary to add such words in order to clarify the position. I beg to move.

Baroness Jay of Paddington

My Lords, I support the amendment. Throughout the passage of the Bill we have tried to obtain precise definitions about the qualifications and responsibilities of the various officers involved. As noble Lords will know, we have succeeded in obtaining a definition of the precise professional qualifications of the community responsible medical officer. The amendment would help to define that even more clearly.

Baroness Cumberlege

My Lords, I recognise the purpose of my noble friend's amendment but we believe that the objectives are already met. The term "medical treatment", which occurs throughout the Act, is defined in Section 145(1). It includes nursing and also care, habilitation and rehabilitation under medical supervision. The meaning would be the same here. The code of practice does not add to or extend the meaning of "medical treatment" but merely explains it more fully.

We do not believe that quoting the code of practice explanation of the meaning of "medical treatment" will add anything here. We believe that its meaning in the Act is unambiguous. Apart from that, the Mental Health Act provides for the code to be made and it would be circular for the Act to rely on definitions in the code.

I understand that Amendments Nos. 16 and 17 are probing amendments and I am pleased that on this occasion my noble friend has slain the gremlin and been able to put them forward. However, although he may not have found my explanation entirely satisfactory I hope that he found it explanatory.

Lord Jenkin of Roding

My Lords, I am grateful to my noble friend. It will be helpful to have that explanation on the record and therefore I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Lord Jenkin of Roding moved Amendment No. 17:

Page 39, line 17, after ("authority") insert ("in conjunction with the local social services authority").

The noble Lord said: My Lords, there appears to be a departure from the standard terms of the 1983 Act and it has given rise to a query. Are we talking only about health authorities or are we also talking about local authority social services? It is well understood that the type of treatment that a patient will receive in the circumstances envisaged by the Bill is bound to involve at least those two statutory authorities and may well involve voluntary bodies.

Section 117 of the 1983 Act refers to aftercare. Subsection (2) states: It shall be the duty of the District Health Authority and of the local social services authority to provide, in co-operation with relevant voluntary agencies, after-care services for any person to whom this section applies". However, the new community supervision order that we are adding refers only to the health authority. Why does it not refer to the local authority social services? Such provisions raise doubts in people's minds. Is it intended to mean something different or is there somewhere tucked away a form of words which says that it means the same thing? It is quite clear that the Bill will not work unless the local authorities are involved, as has been discussed throughout the passage of the Bill. This is a matter of drafting. I hope that my noble friend will be able to set our minds at rest. I beg to move.

4 p.m.

Baroness Farrington of Ribbleton

My Lords, I support Amendment No. 17. It is quite clear and it was agreed by the Minister during the earlier stages of the Bill that this legislation can work only when a complementary approach is adopted by the appropriate social services and health authorities. I hope that the Minister will accept the amendment.

Baroness Cumberlege

My Lords, as my noble friend said, the amendment would place a shared duty on the health and local social services authorities to ensure that there are always a suitably qualified medical officer and supervisor in place throughout the period of supervision. The Bill as it stands makes this the duty of the health authority alone.

We believe it is important that the duty to see that a patient has a community RMO and a supervisor at all times should be vested in a single agency. We have made it clear that the new power is health led but with a firm requirement for the social services to be fully consulted and involved. It is the health authority which accepts the application but it does not act in isolation. Before accepting the application, the health authority will need to be satisfied that the requirements of the Bill have been fully met. As a double check on that, the health authority is also required to consult the local social services authority. That will ensure that there has been full consultation with the care team in the community and anyone else directly involved with the patient's care. A doctor must have been identified for the purposes of being a community responsible medical officer. One of the professionals in the care team in the community must have agreed to act as supervisor. When the health authority accepts the application it also accepts the responsibility of ensuring that there are always professionals in place to fulfil these roles.

Section 117 of the Mental Health Act 1983 already makes clear that the provision of aftercare is a joint health and local authority responsibility. The imposition of any requirements on the patient in the community is also a joint health and local authority responsibility, as is keeping the aftercare services under review. Those provisions should avoid any risk of a health authority going ahead independently of the local social services authority and we shall also be emphasising the need for full consultation in our guidance on the operation of the new powers. With those assurances, I hope that I have set my noble friend's mind at rest.

Lord Jenkin of Roding

My Lords, my noble friend has gone a very long way towards achieving that. However, I am not sure that in the eyes of those who have been advising me, she has fully met their concerns. They will need to read what my noble friend said. It may be that this matter will need to be looked at again at a later stage in another place. I am grateful for the support I have received for the amendment from the Benches opposite but it would not be right to press the matter further at this stage. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Baroness Jay of Paddington moved Amendment No. 18:

Page 39, line 32, at end insert:

("Mental Health Act Commission

—In section 121 of the Mental Health Act 1983, in subsection (4) leave out from ("review") to ("Act") and insert—

  1. (a) the exercise of the powers and the discharge of the duties conferred or imposed by this Act so far as relating to patients received into guardianship or after-care under supervision under this Act; and
  2. (b) the care and treatment, or any aspect of the care and treatment in hospitals and mental nursing homes of patients who are not liable to be detained").

The noble Baroness said: My Lords, the purpose of this amendment is to make one final attempt to persuade the Government of the important role the Mental Health Act Commission should play in the working of the new supervised discharge system.

As noble Lords will remember, the Mental Health Act Commission is a special health authority which, since the implementation of the Mental Health Act 1983, has monitored the care and treatment of patients detained in hospitals. Commissioners visit at least once a year all the residential hospitals and nursing homes which care for legally detained patients. The commission also deals with about 500 complaints per year through its statutory complaints procedure.

In Committee the Minister said that the commission admirably fulfils its function. Amendment No. 18 simply seeks to extend that function to include patients living in the community under legally enforceable supervised discharge orders. That is something that could be achieved easily by amending the 1983 Act.

Noble Lords who are familiar with the Act will know that Section 121 deals with the Mental Health Act Commission and Section 121(4) makes provision for the Secretary of State to extend the remit of the commission lo include residential patients who are being treated voluntarily; that is, they are not formally detained.

The subsection as it now stands in the Act reads: The Secretary of State may, at the request of or after consultation with the Commission and after consulting such other bodies as appear to him to be concerned, direct the Commission to keep under review the care and treatment, or any aspect of the care and treatment, in hospitals and mental nursing homes of patients who are not liable to be detained under this Act".

Amendment No. 18 would extend the power of the Secretary of State to direct the commission to include patients living in the community who are subject to guardianship or aftercare under supervision.

The House will have noticed that the central existing provision in the 1983 Act from which I quoted refers to a request by the commission to alter the scope of its authority and to consultation with the commission. On Report, in response to a similar amendment, the Minister said: We consulted with the commission over our proposals"— those proposals are the ones in the existing Bill— and listened carefully to what it said". But the Minister went on to reject the amendment.

It is extremely difficult to believe that the Government listened carefully to the commission because very recently, during our consideration of the Bill, the commission published its own position paper on supervised discharge orders which seems to support the extension of its remit which is the subject of the Amendment No. 18.

I make no apology for once more quoting directly from section 3 of the commission's published paper which states: The Commission notes that the independence given to it by the Secretary of State is an important realisation of the principle that where individuals' rights are or can be abridged there must be adequate safeguards". It goes on: The powers of control and compulsion included in the Bill… in the Commission's opinion warrant consideration being given to the extension of its remit to patients under supervised after-care so as to enable it to ensure (so far as possible) that the new powers are correctly exercised and applied in strict accordance with the statutory requirements, and that, by a process of observation and monitoring over the years, the use of the powers is of benefit to the patients involved and to the community into which the patients have been discharged". Those are extremely important principles which, in our opinion, should always be included in legislation dealing with the compulsory care of the mentally ill. However, on Report, the Minister seemed more concerned with the practical problems which the commission might have in extending its responsibilities. The Minister said in the same reply to which I referred earlier that, bearing in mind the commission is undergoing a major structural change later this year, we do not propose to divert it from its central task of safeguarding the interests of detained patients".—[Official Report, 1/5/95; col. 1314.]

I understand that the internal changes at the commission will be completed by this autumn and, as the House knows, this Bill will not come into force until April 1996. Surely, if the commission, which is a responsible statutory body, proposes to take on that new function it must be confident of its ability to do so.

We are discussing new and untried powers which will be exercised over the lives of some of the most vulnerable and probably the most difficult members of our society. The legislation seeks to protect them and the communities in which they live. It is a complex area where the problems of practical health and social care are combined with anxieties about civil rights. We must have national monitoring and we must be able to evaluate the effectiveness of those significant changes. We should also have a nationwide system responsible for the well-being of patients.

The Mental Health Act Commission is the one statutory body that we have which can assume those tasks. The commission has proved its very great value in its work with detained patients. It now wishes to extend its authority to include patients on supervised discharge orders. That is the purpose of Amendment No. 18.1 beg to move.

Lord Thurlow

My Lords, I should like briefly to express my support for the amendment. The noble Baroness explained very clearly its substance. I believe that it is universally agreed that in the operation of the powers of the Bill, especially the power to convey, great sensitivity should be exercised by those concerned. It seems to me that it would do nothing but good for those concerned to know that there was an authority which was able to keep an eye on the way that the powers were being exercised. I support the amendment.

Baroness Cumberlege

My Lords, as your Lordships are aware, the noble Baroness moved amendments at both the Committee and Report stages of the Bill to extend the Mental Health Act Commission's remit to include patients subject to aftercare under supervision. As I explained then in responding to the earlier amendments, we have reservations about this on two counts. The first is the question of priorities for the allocation of the finite resources at the commission's command. It seems to us that detained patients, having been deprived of their liberty, have a uniquely powerful claim on the commission's protection and that any extension of its remit to other groups certainly ought not to be at their expense. The second reservation has to do with timing. The commission is at present undergoing a major reorganisation of its structure and we think that that needs to be allowed to settle down before any widening of its remit could be considered.

That does not mean that the commission will have no locus at all in reviewing the use of the new power. Given its general responsibility to protect the rights of patients liable to be detained, it will be able to review the procedures for making a supervision application since the patient at that point must be liable to be detained. The commission's involvement will be similar to its monitoring of Section 117 aftercare procedures prior to a patient's discharge. But its remit does not at present extend to the services provided in the community once a patient has left hospital.

I can also assure your Lordships that the department will be keeping the use of the new power under review. It will form part of the NHS Executive's routine monitoring of health authorities and the Social Services Inspectorate will be keeping in touch with local authorities about their involvement in providing aftercare under supervision. The rights which all patients will have to appeal to a mental health review tribunal are also an important guarantee of their civil liberties.

I recognise of course that the amendment adopts a different approach from those which were moved in Committee and on Report in that it would not directly extend the commission's remit to include patients subject to aftercare under supervision but would instead give my right honourable friend the Secretary of State discretion to extend it to them and also to those received into guardianship. It would be very tempting to agree to that proposal on the basis that it would not actually commit us to an extension of the remit but would only give my right honourable friend the option of extending it at some later date when we were satisfied that the circumstances were right. I am afraid, however, that it is a temptation that I must resist. Although there is certainly a case for saying that those patients should fall within the commission's jurisdiction, the question of extending its remit beyond those who are detained in hospital raises an important point of principle. We think that it would be wrong to amend the primary legislation in that way without that point having been fully considered. It is certainly something that will need to be looked at as part of the more fundamental review of the Act which is likely to be needed before too long. By that time, we shall have some practical experience of the operation of aftercare under supervision on which to draw. Meanwhile, I ask the noble Baroness and the noble Lord not to press the amendment.

Baroness Jay of Paddington

My Lords, I thank the Minister for her reply, although I must confess that I am not entirely convinced by her arguments. Nevertheless, I am pleased to hear that the noble Baroness was tempted into accepting my arguments. I hope that the suggested provision will be introduced at another stage in another place and that the temptation then will be even greater and perhaps irresistible. I hear what the Minister says about the need to consider the role of the Mental Health Act Commission in the context of a wider review of the Mental Health Act 1983. As the noble Baroness will know from our previous debates on the Bill, I hope that that review will take place very soon. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Schedule 2 [Community care orders: supplementary]:

[Amendment No. 19 not moved.]

An amendment (privilege) made.

4.15 p.m.

Baroness Cumberlege

My Lords, I beg to move that the Bill do now pass.

I am most grateful for the careful thought and attention that your Lordships have given to the Bill. A number of excellent amendments have been moved. I am very pleased that we have been able to accept the spirit of some of them. Even those which have been unacceptable to us or those which have been probing amendments have almost invariably be invaluable in stimulating thought and debate. I can say without hesitation, and I hope without much fear of contradiction, that your Lordships have significantly improved what, of course, I believe was already a good Bill.

I have no doubt that the measures that we have passed in the Bill mark a significant advance in the care of some of the most vulnerable patients. As your Lordships know only too well, the background to our debates has been the cases of high risk patients who have become lost to care with tragic consequences. Those cases were very effectively highlighted by the noble Baroness, Lady Jay. My noble friends Lord Campbell of Croy, Lord Haig and Lord Balfour also spoke very movingly from their personal experiences with relatives who have suffered from severe mental illness.

The Bill aims to give the essential underpinning to help avoid tragedies in the future. But in doing so it maintains the key elements of the care programme approach which apply to all patients receiving specialised psychiatric care in the community. The central principle of the Bill is that supervision cannot be separated from the aftercare services which it exists to support. Many of your Lordships, in particular the noble Earl, Lord Russell, and the noble Baroness, Lady Farrington, raised the question of resources. As I said during the course of the Bill, the background to that is that the Government have increased very substantially the resources devoted to the care of mentally ill people. Your Lordships can rest assured that there is no question of compulsion being substituted for care.

I should also like to offer a special word of thanks to those of your Lordships who have made suggestions for amending the Bill and, as I said, have helped us significantly in sharpening its provisions and ensuring that the essential interests of patients and their relatives are properly reflected.

In his unfailingly courteous but effective way, my noble friend Lord Mottistone persuaded us by the force of his argument of the importance of consulting the patient's nearest relative. He was joined by my noble friend Lord Haig and the noble Baroness, Lady Jay, in arguing the case for the community responsible medical officer to be someone approved by my right honourable friend the Secretary of State. The noble Lords, Lord Carter and Lord Rea, put forward a persuasive case for requiring information, including that about mental health review tribunal rights, to be given to patients both orally and in writing. I confess that I enjoyed being able to surprise your Lordships just a little by going even further than we had been asked to do.

We also had important contributions to our debates from the noble Earl, Lord Longford, the noble Lord, Lord Thurlow, the noble Baroness, Lady Robson, and my noble friend Lord Jenkin of Roding. They brought to our considerations that blend of wisdom and experience which people expect from your Lordships' House. Of course, their contributions have not been the only ones. I hope that your Lordships will excuse me for not mentioning by name all those who have spoken.

Perhaps I may just add that I am very sorry that, because of his illness, the noble Lord, Lord Ennals, was not able to be with us after the Second Reading of the Bill. I have referred to the high quality of our debates, but I am sure that, with his long-term interest and knowledge in the field, the noble Lord would have enriched them even further. I am sure that all noble Lords will want to join me in wishing the noble Lord a speedy recovery.

In relation to the Scottish provisions of the Bill, we are grateful to the noble Lord, Lord Carmichael of Kelvingrove, for his intervention on the subject of the immediate re-use of the period of reassessment in hospital. We have now made it clear on the face of the Bill that rolling periods of reassessment in hospital are not to be permitted. We are also very grateful to the noble Earl, Lord Mar and Kellie, for bringing to the debates knowledge gained from his experience in the field.

We are particularly grateful for the noble Earl's intervention on the subject of those community care order patients whose order expires when they are in prison. As a result, we have now addressed that group of people not only in Scotland but also in England and Wales. The noble Earl's interventions have also allowed my noble friend to explain quite clearly, and in some detail, the client group in respect of whom applications for community care orders may be made. We are grateful to have had that opportunity.

Finally, it is my very pleasant duty to thank my ministerial colleagues who have helped me take the Bill through your Lordships' House. As your Lordships will have recognised, it has been a textbook example of Anglo-Scottish co-operation. It has been salutary to have been told on occasions how much better the Scottish provisions are. My noble and learned friend Lord Fraser and my noble friend Lord Lindsay have taken the Scottish clauses through with skill and flair. I am also most grateful to the noble friend Lady Miller for sharing the burden of the English clauses and for being such a stalwart ally by my side. I think we have done good work on this Bill and I look forward to seeing it progress smoothly through the other place and on to the statute book.

Moved, That the Bill do now pass—(Baroness Cumberlege.)

Baroness Jay of Paddington

My Lords, this is a difficult Bill about a difficult subject. Community care for the growing numbers of mentally ill people in this country is causing great anxiety to the professional and informal carers who try to look after them; anxiety to ordinary citizens who are disturbed and sometimes threatened by the presence of seriously ill people in their midst and, above all, anxiety to the patients themselves who often feel isolated and bereft of support and treatment.

The problem arises from a failure to develop proper community care services which substitute for the old-fashioned, long stay residential institutions. The Government have introduced this Bill in the hope that additional legal powers over patients living in the community will alleviate anxiety. But we on these Benches have argued from the beginning that the fundamental issue is inadequate services, not inadequate laws. However, as I said at Second Reading, many of those involved in the care of seriously ill patients reluctantly accept that in a limited number of cases the kind of community supervision proposed in this Bill may be useful.

The fundamental questions we have raised about supervised discharge concern achieving an appropriate balance between an effective statute which must limit a patient's liberty, and the patient's own civil rights. We have also questioned the necessity of introducing this new, somewhat draconian order when the less onerous system of guardianship already exists. Guardianship provides almost identical powers to those in the new order, and I am glad that at Report stage the noble Baroness, Lady Miller, said that the Government were reviewing this power again and may extend it.

The most important protective agency looking after detained patients is the Mental Health Act Commission which also provides a national monitoring and evaluation of residential services. Throughout the discussions on the Bill we have introduced amendments to extend the remit of the Mental Health Act Commission to include the patients covered in this Bill, and/or those on guardianship orders. This is an additional responsibility which, as I have already discussed this afternoon, the Mental Health Act Commission itself has suggested. But the Government have rejected this proposal although we still feel strongly that the commission could provide the necessary safeguard both as regards the effective operation of the new orders and as regards the well-being of the patients concerned. I am sure that my right honourable and honourable friends in another place will return to this issue.

But, on the whole, as the Minister said, we on these Benches, and noble Lords around the House, are satisfied with the changes in the Bill for which we have argued, and which the Government have now accepted. I am pleased, for example, that at Report stage the Government moved amendments to formalise the arrangements for consulting and informing patients about the procedures for supervised discharge and their legal rights. I am also glad that they have extended the involvement of relatives which, as the Minister mentioned, was something of particular concern to the noble Lord, Lord Mottistone. The noble Lord, Lord Mottistone, my noble friend Lord Longford and others were also concerned about the professional qualifications of the community responsible medical officer—a new post—and that, too, has been made explicit on the face of the Bill, as has the professional qualification of the person who will hold the responsible position of the community supervisor. The noble Earl, Lord Haig, moved amendments in Committee—which we on these Benches followed at Report—to clarify the position of patients who move between England, Wales and Scotland. That, too, has been satisfactorily resolved by government Amendments Nos. 3 and 13 this afternoon.

I thank the Minister for responding so positively to these concerns. I also thank her and the noble Baroness, Lady Miller, for their courteous and usually helpful replies to many other amendments. The noble Earl, Lord Lindsay, seemed even more amenable to proposals from my noble friend Lord Carmichael of Kelvingrove on the Scottish provisions. No doubt this was due to the superior forensic skills of my noble friend to whom I am most grateful for shouldering responsibility for the second part of the Bill. As the Scottish arrangements are so different from those in England and Wales, it really amounts to two Bills. There were several occasions when noble Lords from south of the Border cast envious eyes at Scotland's community care orders which seem to be more flexible and realistic than our supervised discharge orders. As my noble friend Lord Carter said in Committee, there was a clear case here for devolution in reverse.

The noble Lord, Lord Carter, who unfortunately cannot be with us this afternoon, has been, as always, a tower of strength during the passage of the Bill. I thank him and my noble friend Lord Rea for tackling the whole range of complex health, social and legal issues included in this legislation. My noble friend Lord Rea has, of course, longstanding personal experience of working on the front line with mentally ill patients in the community and this has lent his contributions special authority.

The longstanding personal experience of my noble friend Lady Farrington in local government was particularly valuable when she pressed the Government to tighten the arrangements for providing community services. I am grateful to her for emphasising in her amendments the importance of jointly planned, properly resourced care programmes if supervised discharge orders are to be of any use. Adequate resources have also been a major concern of the many professional and voluntary organisations working in this field. I must thank them for their comprehensive briefing and careful help on the detail of the Bill. I am particularly glad that representatives of several outside bodies were able to take part in the special meeting we had with Ministers and officials before the Committee stage began. I echo the words of the Minister in regretting the absence of my noble friend Lord Ennals who was so helpful at the beginning of the Bill and whose illness we greatly regret. We wish him a speedy recovery.

We have made considerable progress on the detail of this Bill, but my concern remains that it seeks to solve a serious problem from the wrong direction. I repeat that the primary need in this area is for more services, not for more laws. The fundamental flaw of the Bill is in the introductory financial memorandum which states that the new measures will give rise to no new additional costs. If any new form of community care is not properly funded, it will fail. I am sure that that central issue will be addressed by honourable Members in another place and I look forward to their further consideration of this Bill.

Lord Jenkin of Roding

My Lords, I will not detain the House more than a moment. However, one or two of the remarks made by the noble Baroness, Lady Jay, require some answer. The NHS trust which I have the honour to chair is in the process of closing one of the south's major mental hospitals, Claybury Hospital in north-east London, and providing those services elsewhere. I have not the slightest doubt that the provisions of this Bill will be extremely helpful to the professionals who are engaged in finding—if I may use the words which I used as chairman—a place and a plan for every single one of those patients who is to be moved into the community.

The Bill will provide the safeguard and the safety net to make sure that when patients are moved into the community there can be a provision whereby they can be properly supervised, and in particular whereby their medication can be properly supervised. If any single message came out of the cases to which my noble friend referred when she moved the Motion, it is the fact that people are lost sight of and as a result they cease taking the medication which keeps their condition under some kind of control and the result is disaster of the worst kind.

In the case of a major hospital closure such as I am engaged in, the question of adequate finance is, of course, crucial. We are close now, in our case, to being able to match the requirements with the resources that are available to meet them. The suggestion that somehow there is still an enormous amount of community care for mentally ill people which is not adequately resourced seems to me to be alarmist and untrue. Of course people always want more, but where one is engaged in a major operation of this kind, and where one is spending millions of pounds in new capital provision for accommodation in the community and on various forms of community care, it falls odd on one's ears to be told that it is not new laws that we need, we just need more money. If I may say so, the noble Baroness has not fully reflected on what most of us feel is the considerable value of this legislation. It will strengthen the hands of everyone who has the interests of patients at heart. I warmly support the Bill.

Baroness Robson of Kiddington

My Lords, I am sorry to rise to speak at this stage of the Bill. I very much regret that I was unable to be present at the Committee and Report stages. I thank my noble friend Lord Russell for so staunchly standing in in my absence.

I read with great interest the proceedings of both the Committee and the Report stages. I am very conscious of the great assistance that both Ministers on the Front Bench have given in response to the anxieties expressed by Members of this House.

In her final remarks, the Minister referred to resources. That is one issue which still worries me deeply. How can one say that the Bill will not give rise to additional costs for health authorities while at the same time the Secretary of State states that those responsible for mental health services must ensure that this particular group of patients is afforded priority in terms of resources, staff time and active monitoring in the community? That cannot be done without increased expenditure. If it is done without increased expenditure, the services for other mentally ill patients who also need the services of the community will be diminished.

I know that the Government have injected another £10 million into mental health services. However, that money was injected, and was badly needed, before the Bill comes into effect. I am convinced that the Bill will be costly if it is implemented in the way that it is intended that it should be implemented. I am concerned that some other mental patients may suffer neglect in the community. Otherwise, I am grateful for and welcome the Government's attitude to the amendments that were introduced.

4.30 p.m.

Lord Mottistone

My Lords, I should like to add my thanks to my noble friend the Minister for her acceptance of several of the amendments that I was, happily, able to put forward, so ably advised by the National Schizophrenia Fellowship.

I am concerned that people are worried as to whether this is the right kind of Bill for the subject in question. I believe it is a very good Bill, which fills a gap that needs to be filled. It provides additional resources in introducing the power to make supervision orders. It is now up to us to make use of the Bill, once it has been agreed by another place. If that turns out to be more expensive than suggested in the introduction to the Bill, as the noble Baroness, Lady Robson, expects, that is unfortunate from the Government's point of view. They have guessed wrong again.

The Bill provides a power that is needed for supervision of people in the community which is at present lacking. In my view, those people who feel that the Bill implies some form of restraint on civil liberties are wrong. As I see it, if and when this Bill is implemented, if the psychiatrists and others who are empowered to apply the legislation make use of it, then we shall find that more people are given the opportunity to live in the community than otherwise would be. Without the possibility of providing for supervision, the authorities might not dare to let patients out into the community.

I believe that the concept of the Bill is most imaginative. Above all, I should like to thank my noble friend the Minister for being so ready to accept good arguments and to introduce amendments of her own to meet points which were made. That is something which, generally speaking, my noble friends on the Front Bench tend not to do. This is a jolly good Bill, and I hope that another place does not spoil it in any way and will hurry it through as quickly as possible.

Baroness Farrington of Ribbleton

My Lords, I too wish to add my support for the principles behind the Bill and the important issues which it seeks to tackle. I had not intended to speak, but, declaring an interest and drawing on my experience as a member of a social services authority in a county council, I feel that the issue of resources needs to be placed firmly on the record at this stage in the passage of the Bill through your Lordships' House.

Inexorably, additional demands for care in the community of a new range, quality and quantity are being added to the existing demands on local authorities providing those services. I say in passing—not as a member of a housing authority—that with a reduced range of properties available for tenants it is increasingly difficult to find property for people who may, through no fault of their own, at times not be good neighbours and who may be difficult to place.

Within the community there are demands to meet the needs for the care of the elderly, chronically sick and mentally ill patients needing care in the community. As hospitals are closed and such people no longer become patients in hospitals, the demands grow. At every stage, every new demand is treated as being small or less than the total resources realistically required to meet those needs.

"Priority must be given" is a phrase the Minister will use. However, at the end of the day the community believes that priority must be given to other groups who are mentally ill: priority must be given to the young who need care within the community; priority must be given to the elderly within the community. When all those priorities are top priorities, priority must be given by the Government to the resources necessary to enact legislation which is basically good legislation, as this will be, but which will be better legislation if in another place the resources are appended to make it fully effective in all places at all times.

The Earl of Mar and Kellie

My Lords, I too wish to thank the noble Baroness and the noble Earl for the way they have presented the Bill and have been prepared to take on board some of the amendments which were moved in Committee and subsequently. I believe that the Bill has been improved as a result and will be more roadworthy for the 150 or so Scottish patients affected when the Bill becomes an Act. I should also like to thank the noble Earl, Lord Lindsay, for his patient and helpful explanations of the Government's thinking about the practical operation of Part II of the Bill.

Finally, I should like to make a comment arising from the Report stage. There seems to be merit in not grouping amendments, for it is then clear to external readers of Hansard exactly what the Government's thinking is on any one aspect.

Earl Russell

My Lords, I shall not repeat what my noble friends have said. The noble Baroness knows that I agree with it in detail. But I shall say, on the basis that all that the noble Baroness was able to introduce was a Bill, that it is rather a good Bill. I can recognise a good government Bill when I see it. It gives me great pleasure to do so and to congratulate the noble Baroness and her team on producing it.

Baroness Cumberlege

My Lords, I am very grateful to noble Lords for their contributions to this final debate and for the, on the whole, warm welcome they have given to the Bill. I am particularly grateful for the words of the noble Earl, whose experience in your Lordships' House is long and distinguished. We believe that the Bill as a whole strikes the right balance. It provides the means of ensuring that mentally ill people who no longer need to be detained in hospital but who still represent a serious potential risk to themselves or other people receive the support they need in the community.

I understand the issues concerning resources, but the level of resources for the care of mentally ill people has increased and is continuing to increase, as the noble Baroness, Lady Jay, acknowledged. Gross expenditure on hospital and community health services for mentally ill people increased by 40 per cent, in real terms between 1979 and 1990 to £1.7 billion. Gross expenditure on local authority social services for the mentally ill increased by 209 per cent, in real terms between 1978 and 1992. So there has been a huge amount of increase. But I think that the new power will help to set priorities for the use of those increasing resources.

As with any new power, it is important that it is properly understood and used. We shall be issuing full guidance before it comes into effect next year.

On Question, Bill passed, and sent to the Commons.