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That concern is shared by many people who work daily with the mentally ill. It is ridiculous for the Government to seek to improve the provision of care for the mentally ill without heeding the advice of the professionals who daily provide that care.The Bill fails to address the concerns of the caring professions, who are anxious that treatment for the mentally ill should be properly addressed and funded. The Bill's provisions do not address long-term issues but are a quick fix aimed at mending public opinion rather than mending an outmoded and underfunded system.
I hope that the Government have noted past debates and those today, will listen to health professions, and will accept the amendments, so that we may all be united in getting behind better services for the mentally ill.
Mr. David Nicholson (Taunton): I hope that I have the support of my hon. Friend the Member for Bournemouth, East (Mr. Atkinson) in asking my hon. Friend the Minister to resist the amendments. It is important that this difficult and sensitive subject should be explored at this stage of the Bill and the speeches have been helpful, but my hon. Friend will be aware that the National Schizophrenia Fellowship has briefed us to resist the amendments. The fellowship is not concerned about this particular power. In fact, the NSF thinks that it is sometimes necessary to use that power. Patients found wandering in the streets need to be returned to their accommodation. When offered transport by authorised staff, they are willing to accept it.
In addition to the NSF's representations, I and other hon. Members are aware of individual episodes in our constituencies. Such a safeguard is necessary for people to accept and support the care in the community measures that the Government have introduced, with widespread support, in recent years. I look forward to hearing from my hon. Friend that he resists the amendments.
Mr. Bowis: The hon. Member for Newcastle upon Tyne, East (Mr. Brown) invited me to join him on the high wire. Although we paled at the thought of the impact on the Chamber, that summed up the balance that we are seeking to achieve. That was evident even on the other side of the House. The hon. Member for Dulwich (Ms Jowell) said that the 1983 Act was adequate, while the hon. Member for Doncaster, North (Mr. Hughes) said that the system was outmoded. Somewhere in the middle is the need to improve the system all the time, for the benefit of patients and the whole community.
When the Law Commission's report on mentally incapacitated adults was published, it looked to extend the power to convey to guardianship, which the commission said was the unanimous view of everyone that it consulted. We heard a quote from the Royal College of Psychiatrists, but I could quote another report that states exactly the opposite--that the Government are not going far enough. That message has also come from the British Medical Association, and the view of the National Schizophrenia Fellowship suggested that the amendment should be resisted.
The Labour party must look at its own policy. In the other place, Labour thought that the power to convey was so good that it should be extended to guardianship, yet Labour Members here believe that that power should not apply to anyone. They must explain to the public why that
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strengthening of care and support for severely mentally ill people and protection for the community is not something that they are prepared to accept. I believe that the public support our proposal, which is in the interests of patients.4.45 pm
I will seek to reunite the hon. Members for Doncaster, North and for Dulwich. We have made it clear that supervised discharge will work largely on the basis of co-operation between all concerned. We therefore see the power to convey a patient being used only rarely--for example, when he or she is temporarily unco-operative, which point was forcefully made by my hon. Friend and the NSF. The principle of a power to convey is already present in the Mental Health Act 1983 when a patient has to be taken to hospital for treatment or assessment. That may be valuable in helping to resolve a temporary crisis. It is limited in nature and provides a halfway house before return to hospital is considered. If there were no power to convey, the care team would be in the position of needing to consider readmission to hospital on every occasion that a patient was unwilling to co-operate with the arrangements for his or her aftercare.
The starting point for the Bill is that for this particular group of patients, the care programme approach is not enough and needs a degree of legal underpinning to make it effective. It is a matter of balance, and I believe that the Bill has the overall balance right. The argument that the power to convey in some way contravenes basic human rights ignores the point that in the absence of supervised discharge, the patient might have had to continue being detained in hospital. In that case, the overall effect of supervised discharge is to enable someone to enjoy a greater measure of freedom--even though subject to some constraints--than would have been possible in its absence.
Amendments 46 and 47 would require the supervisor to make a "conveyance application" to the health authority before the power was used but the whole point about the provision is that it is likely to be needed in an emergency, to enable a patient to be removed urgently from a situation that may present a danger to him or herself or to other people--for example, as a result of drinking. The supervisor, or someone that he or she has authorised, needs the power to ensure that effective action can be taken in such a case. Requiring the supervisor to apply to the health authority would defeat the purpose of the provision.
This reserve power is designed to help ensure that the patient will receive and participate in the aftercare services that he or she needs. As the NSF said, it could defuse a crisis and persuade previously resisting patients that it would make sense if they agreed to go back home or to see a doctor or psychiatric nurse. It clearly involves less restriction of a patient than the alternative of considering readmission to hospital when the patient ceases to co-operate in the delivery of aftercare services. In that spirit, I hope that the hon. Member for Dulwich will withdraw her amendment.
Ms Jowell: I want to make it clear that there is no dispute between myself and my hon. Friend the Member for Doncaster, North (Mr. Hughes). My point was that existing powers are adequate to cover take-and-convey as the Minister intends. I was not making the point that
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existing legislation is adequate. There is increasingly urgent need for a review of the 1983 Act, to address properly the dramatic and correct shift in the last 12 years in the care and treatment of people suffering from mental illness, from hospitals to the community.The Minister attempted to confuse events in the other place. My noble Friends were seeking to draw out the distinction between the power to take and convey and the power of guardianship. They appear almost identical, apart from the use of coercion--guardianship is not a coercive power.
The Minister described the provision as a reserve power that will be used only rarely. The power might be helpful where a seriously ill individual has stopped taking his or her medication and begins to deteriorate-- becoming disturbed and disruptive and causing concern to their family, people around them and professionals. If the Minister envisages take-and- convey being used in such circumstances, I would insist that adequate powers are already available in the 1983 Act. Indeed, the circumstances in which the reserve power is likely to be needed are precisely those in which the individual is likely to need to be taken to hospital for assessment and, possibly, treatment. We are not talking about a draconian and coercive power to take someone to a day centre, simply because they choose not to go; at any rate, I sincerely hope that that is not what is being proposed.
Although I am naturally disappointed that the Minister is not prepared to accept even the compromise proposals, we shall not press the amendment to a vote. We believe that the House will wish to return to these matters at a future date, when a Labour Government will conduct a thoroughgoing review of the Mental Health Act 1983. I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Amendments made: No. 15, in page 8, line 7, after `patient' insert
`who is (or is to be)'.
No. 16, in page 8, line 21, leave out
`unless the patient has otherwise requested,'.
No. 17, in page 8, line 27, at end insert--
`(6A) Where the patient has requested that paragraph (c) of subsection (6) above should not apply, that paragraph shall not apply unless--
(a) the patient has a propensity to violent or dangerous behaviour towards others, and
(b) the community responsible medical officer (or the person who is to be the community responsible medical officer) considers that it is appropriate for steps such as are mentioned in that paragraph to be taken.'.
No. 18, in page 8, line 28, leave out `, after such consultation, '.
No. 19, in page 11, line 12, leave out
`except where the patient has otherwise requested,'.
No. 20, in page 11, line 18, at end insert--
`(5A) Where the patient has requested that paragraph (b) of subsection (5) above should not apply, that paragraph shall not apply unless--
(a) the patient has a propensity to violent or dangerous behaviour towards others, and
(b) the community responsible medical officer considers that it is appropriate for steps such as are mentioned in that paragraph to be taken.'.
No. 21, in page 12, line 22, leave out
`unless the patient has otherwise requested,'.
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No. 22, in page 12, line 29, at end insert- -`(3A) Where the patient has requested that paragraph (b) of subsection (3) above should not apply, that paragraph shall not apply unless--
(a) the patient has a propensity to violent or dangerous behaviour towards others, and
(b) the community responsible medical officer considers that it is appropriate for steps such as are mentioned in that paragraph to be taken.'.
No. 23, in page 12, line 44, leave out
`unless the patient otherwise requests,'.
No. 24, in page 12, line 48, at end insert--
`(6) Where the patient has requested that paragraph (c) of subsection (5) above should not apply, that paragraph shall not apply unless subsection (3)(b) above applied in his case by virtue of subsection (3A) above.'.-- [Mr. Dorrell.]
Clause 4
Community care orders
Mr. John McAllion (Dundee, East): I beg to move amendment No. 2, in page 18, line 26, leave out from `35A.--(1)' to `the' in line 28 and insert
`Where a patient has attained the age of 16 years'.
Mr. Deputy Speaker: With this, it will be convenient to discuss the following amendments: No. 3, in page 18, line 39, at end insert `and
(c) a community care assessment under section 12A of the Social Work (Scotland) Act 1968 (in this Act referred to as a "community care assessment").'.
No. 4, in page 19, line 2, after `appropriate', insert
`to ensure that a patient receives such medical treatment, after-care services and a community care assessment'.
No. 5, in page 19, line 22, after `until', insert
`a community care assessment of the patient has been carried out and'.
No. 8, in page 21, line 7, at end add `;and
(c) the community care assessment of the patient.'.
No. 11, in page 22, line 14, after `circumstances', insert `and his community care assessment'.
Mr. McAllion: The amendments were inspired by the Law Society of Scotland and cover a range of issues connected with the Bill's Scottish clauses.
Amendment No. 2 would ensure that only people over the age of 16 could be subject to community care orders. Let me explain why we consider that limitation necessary. The English and Welsh clauses limit supervised discharge to young people who have attained the age of 16, because it is felt that young people would be more appropriately dealt with under the Children Act 1989. If that is the Government's view in respect of young people in England and Wales, surely they should take the same attitude to young people in Scotland.
The Minister will know that a young person can be subject to compulsory detention under the Mental Health (Scotland) Act 1984, which does not set an age limit. Although it is fairly rare for a young person to be compulsorily detained in hospital, it does occasionally happen in Scotland. The amendment simply covers circumstances in which a young person is discharged from hospital to live in the community.
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It is suggested that, if further powers are to be taken to control the young person's life in the community, doctors should involve the expertise of the reporter and the children's panel in Scotland, as they would more appropriately control and supervise the lives of such young people. They certainly have the experience and the procedures to consider young people's needs. Surely it is better to involve them than to use the sheriff court procedure.As the Minister will know, the Children (Scotland) Act 1995 provides that those responsible for a young person's welfare may apply to the sheriff for a supervision order for a child in need of extra care. Among the conditions that can then be imposed are conditions relating to residence and medical treatment. Those are precisely the kind of matters that might be included in a community care order; however, it would be preferable to use a supervision order, because that too involves the expertise of the reporter and the children's panel.
On an allied matter, may I remind the Minister of an incident that took place in Glasgow in 1994 and led to the death of a police constable? Philip McFadden was subsequently committed to the State hospital in Carstairs. The Minister will be aware that the Mental Welfare Commission for Scotland had conducted an inquiry into the care and treatment of Philip McFadden before the incident took place. Has there been any progress with that inquiry?
Amendment No. 3 is intended to provide for a person who is subject to a community care order to have a full community care assessment under the National Health Service and Community Care Act 1990. It would ensure that such a person received the benefits of the new community care system of assessment and care management under the care programme approach, and would make it clear that such an assessment should be carried out before the granting of the community care order. We believe that the sheriff should have the benefit of seeing the full assessment before granting such an order. Amendment No. 4 attempts to ensure that the sheriff does not impose conditions on the community care order that are not relevant to the main aims of that order. The Minister will be aware that the provisions in clause 4 which apply to Scotland are very different from those that apply to the supervised discharge procedures proposed for England. Under the English procedures, the special medical officer has the power to say where the patient should reside, what day facilities he or she should use and whether access to medical and social work personnel will be necessary. Those procedures also include the controversial power to convey the patient to treatment, which was mentioned when we discussed the earlier group of amendments.
We cannot conceive that the sheriff would have it in mind to include in the order any additional powers, but we consider it essential for the legislation to make very clear what the Government have in mind. Is it proposed, for example, that the controversial power to convey could be introduced in Scotland under the sheriff court procedure? Could patients in Scotland be conveyed against their will to day-care and medical facilities? Those who work in the field in Scotland are interested to know exactly what the Government intend.
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Amendment No. 5 is designed to ensure that the sheriff has the power to defer making an order until he is satisfied that the patient's community care needs have been assessed. Again, we believe that the sheriff should have the benefit of seeing a full community care assessment of the patient before making an order.Amendment No. 8 is linked to, and consequential on, amendment No. 2. It is simply an attempt to bring the proposed new system into line with community care procedures now current in Scotland. It would ensure that the person considering whether to make a community care order would consider the information about the patient's needs as set out in his formal community care assessment. Amendment No. 11 is simply consequential on amendment No. 2.
Mr. George Foulkes (Carrick, Cumnock and Doon Valley): I am grateful for the opportunity to speak, particularly because the report mentioned by my hon. Friend the Member for Dundee, East (Mr. McAllion)--the report of the inquiry conducted by the Mental Welfare Commission for Scotland into the care and treatment of Philip McFadden--was published by the Scottish Office today. I am grateful to the Under-Secretary of State for sending me a copy of the report earlier this week: I have now had time to read it in some detail. With the permission of the Scottish Office, I sent a copy of the report to the parents of the late Police Constable Lewis Fulton. Lewis and Gette Fulton, who are constituents of mine, bore their tragic and unnecessary loss with great fortitude and dignity. I am happy to place that on record.
As I am sure the Minister would admit, the report is quite worrying. I shall deal with two issues arising from it which relate to today's debate. First, there is the question of media coverage of such incidents. Section 7 of the report, on page 23, is very critical of the coverage by the Daily Record , which featured the headline "Schizo can't be tried for cop killing",
and an article that described Philip McFadden as a madman. The same issue contained the headline
"Teenage schizo can't face trial, but judge orders `Keep this madman in Carstairs'".
I entirely agree with the comment of the Mental Welfare Commission:
"Press coverage is very important, because it forms a basis for the public perception of events. The sort of pejorative language used by the Daily Record is deplorable and does not assist an intelligent debate about the problems of community care." We need, above all, an intelligent debate. This is a very difficult issue, and if newspapers--particularly tabloid newspapers--employ such expressions, we shall not have that intelligent debate.
I shall deal with another section of the report at slightly more length-- although not in extenso, hon. Members will be pleased to hear. It relates to the position when Philip McFadden was discharged from the psychiatric hospital. When he was in the hospital, he had the support and help of a very experienced consultant psychiatrist, Dr. McCabe--who comes out of the report very well--and a range of specialist support. That support was expensive--rightly so--but it was immediately available, and provided excellent support for a very disturbed young man at a very difficult time. When Mr. McFadden moved out into the community--this point relates to community care--the general practitioner was his first line of support.
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We all accept that GPs should be the first line of support. GPs are anxious to remind us that people cannot be referred to consultants, that people cannot get any other kind of medical treatment and that they must go to their GP. They demand the right to be the primary support in medical care, but in so being they have some responsibilities to society and, above all, to their patients. When Philip McFadden's mother was in desperate need of urgent support and assistance she rightly called her GP. The Minister will confirm, however, that for a substantial period that distraught lady could not get past the GP's receptionist. I have heard of many instances where anxious and desperate patients or their relatives have been fobbed off by receptionists. That is what happened in this case.Eventually, after persisting, and with the help of Rosemary Fitch--a psychiatric nurse who comes out very well in the report--she got through but found that not one GP was available in the practice. It is astonishing that this big, busy practice in Glasgow had not one GP available to deal with the mother of a psychiatric patient. By this time, Philip McFadden was wielding a knife and threatening people in the family.
5 pm
When Philip McFadden's mother eventually got through to the doctor some time later, he refused to attend. I know of incidents in Scotland where GPs have been assaulted, and we have to take account of that, but this was a difficult situation, and the report says that the doctor should have contacted the police and gone with them so that there was medical and police assistance simultaneously. That was not done in this case. Instead, a young police constable went along on his own and was stabbed to death. In my view, it happened because the system, under which GPs give immediate support to people like Philip McFadden's mother, broke down.
That is why I am asking the Minister to review the role and responsibilities of GPs. That is important. More young people will be discharged into the community, which is absolutely right in principle, but the necessary support must be available to ensure their protection and the safety of the general public--in this case, a young policeman.
I hope that the Minister will give an assurance that he will contact the Royal College of General Practitioners and the British Medical Association, both of which provided experts to give evidence to the commission. Dr. Jim Rodger of the Scottish Council of the Royal College of General Practitioners and Dr. John Garner of the Scottish committee of the BMA suggested that there should be some improvements, that GPs need to be available 24 hours a day for such emergencies, for which they need clear rules such as how and when to bring in the police to work alongside them.
This was a tragic death that should never have occurred. In my view, the system broke down. I am not pointing the finger at any individuals, although some are criticised in the report. I hope that the Minister will deal with those criticisms and say how he will respond to them. The Mental Welfare Commission has pointed the finger at certain individuals, but I am more concerned about the system and to ensure that, as far as is humanly possible--it can never be guaranteed--the kind of situation in which Lewis Fulton met his death does not occur again. I know that I am speaking on behalf of his parents and his widow
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when I say that they are anxious to ensure that such a situation does not occur again, and that no other young policeman has to face the same difficulties.The Minister of State, Scottish Office (Lord JamesDouglas-Hamilton): I share the sympathy of the hon. Member for Carrick, Cumnock and Doon Valley (Mr. Foulkes) for the family of police officer Lewis Fulton, and I shall make a full statement on that in a moment.
I shall deal first with the amendments, which seek to achieve two things. First, they would have the effect of making available community care orders to patients who are over 16, whether detained or otherwise. Although the question of detaining a child under 16 in a psychiatric hospital is a disturbing thought--children can become mentally ill--the existing provision recognises that it may be necessary for a child to be detained in hospital. If there is a possibility of a person under 16 being detained in hospital, it is only fair that that person should have the same rehabilitation opportunities as all others so detained, including access to community care orders. For that reason, an age limit of 16 years, in our view, should not be imposed.
The amendments also seek to introduce a statutory requirement that the patient should receive a needs assessment, and propose an associated change to the Bill. We do not need to legislate to do that, as local authorities already have the duty, under section 12(a) of the Social Work (Scotland) Act 1968, to assess people's social care needs. We believe that the duties on authorities to provide aftercare, under section 8 of the 1984 Act, are quite clear, and include, through the Bill, duties to provide aftercare for persons subject to a community care order. We shall also underline in guidance the circumstances in which that duty applies to community care order patients. If there are problems in meeting these duties, they should be addressed administratively, not by primary legislation. With that explanation, I hope that the hon. Member for Dundee, East (Mr. McAllion) will not press the amendments. If there are matters that require the Children Act provision to apply in a case, they can definitely be used, but it is still preferable to have the opportunity to use a community care order if that would help to support a young person on discharge from hospital.
The hon. Member for Carrick, Cumnock and Doon Valley raised the very tragic case of police officer Fulton and inquired into the care and treatment of Mr. Philip McFadden prior to the incident on 17 June 1994. I am grateful to the commission for the comprehensive way in which it has carried out its inquiry. Because of the possibility that Mr. McFadden may yet stand trial, if considered fit to do so in future, the inquiry has necessarily concentrated on the care and treatment that he received before the death of police officer Fulton, to whose family we extend our deepest sympathy.
The commission's report recommended: first, that the Secretary of State and the Royal College of General Practitioners and other appropriate GP organisations consider the need for further guidance for GPs in dealing with potentially violent, mentally disturbed patients in community care. Secondly, it recommended further discussions between the police and doctors to address the issue of collaboration in respect of crisis situations involving people with mental illness who are potentially violent. Local arrangements should be agreed between GPs, psychiatric services, mental health officers and the
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police to deal with such emergency situations. Thirdly, police training should be appraised to ensure that there is adequate preparation for recognising mental illness and dealing with members of the public who are mentally ill.I am glad to confirm that the Government have accepted those recommendations. As a first step, we have written to the national general practitioner and police organisations, enclosing a copy of the commission's report and asking them to agree with us the action necessary to address the commission's recommendations. I shall also refer the report to the Greater Glasgow health board to consider whether any separate action, bearing on the board's responsibilities, is necessary to address the commission's comments and conclusions in relation either to primary care or hospital settings. As I mentioned to the hon. Gentleman, in relation to GPs' responsibilities, the report has been sent to the Royal College of General Practitioners and the BMA, and we will follow up with them how they can address the commission's recommendations.
I am also sympathetic to the point that it is undesirable for the press to leap to conclusions in cases of this nature. Indeed, the commission's report emphasised that Mr. McFadden received appropriate treatment from the adolescent psychiatry service in Glasgow and dispels any suggestion that he had been inappropriately discharged into the community. It also criticises misleading aspects of the press coverage given to the case, including the suggestion, which was irrelevant, that a shortage of psychiatric admission beds had contributed to the incident.
Mr. Foulkes: Before the Minister concludes, I should like to thank him. The Government have acted properly in all that they have done and I sincerely welcome the Minister's announcement. It shows that when dealing with such sensitive matters party politics need not play a part and that we can sometimes move forward with agreement. I am especially grateful to the Minister.
Lord James Douglas-Hamilton: I thank the hon. Gentleman for his welcome for these measures and our actions on the recommendations. I can now respond specifically to a point made by the hon. Member for Dundee, East. Under the Bill, there is a much more specific provision than a power to convey in Scotland, which requires the return of the person to hospital for reassessment if his mental condition has deteriorated. That can be done by a member of the care team. The direction to attend hospital for reassessment in such cases constitutes sufficient authority to convey a person to hospital, and an additional power to convey as proposed in England and Wales is not considered necessary. In other words, the technicalities may be different but the purpose is the same, and I thought it necessary to mention that.
Of course, the decision to detain a person must be made on the basis of clinical diagnosis and has to be of a nature or degree that warrants detention. Detention can be for a period of six months and can then be renewed at 12-month intervals depending on the mental condition of the patient involved.
Mr. McAllion: I thank the Minister for his prior notification of the publication of the report by the Mental
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Welfare Commission for Scotland and I associate myself with the remarks made by my hon. Friend the Member for Carrick, Cumnock and Doon Valley (Mr. Foulkes) to the effect that the Government have handled the matter properly.I should also like to add my support from the Front Bench to my hon. Friend's criticism of the tabloid coverage of the tragic incident. The use of words such as "schizo" and "madman" was disgraceful and wholly unacceptable. It strikes me that the tabloids in particular increasingly exercise considerable power in our society, but with power should go responsibility. In this case, they have shown no responsibility whatsoever.
I also accept to a certain extent the Minister's explanation about ensuring that people under 16 should have the same rehabilitation opportunities as everyone else. The point is not that they should be denied those rehabilitation opportunities but that their rehabilitation opportunities should be under the supervision of the reporter on the children's panel service. That is the most appropriate way to handle them, as opposed to the sheriff court system in Scotland.
I thank the Minister for his remarks about improvements that the Government are suggesting for better collaboration between the police and general practitioners and for police training, and for referring the report to the Greater Glasgow health board.
Finally, I hope that there is to be no scapegoating in this affair. If there are any lessons to be learnt about weaknesses in the system, I hope that we try to deal with them rather than hold an individual responsible. However, I am grateful to the Minister and I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Lord James Douglas-Hamilton: I beg to move amendment No. 25, in page 19, line 45, after `(3)(a)' insert `or (f) or (3A)'.
Mr. Deputy Speaker: With this, it will be convenient to discuss Government amendments Nos. 26 to 44.
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