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Madam Speaker: The hon. Gentleman rightly said when he began his point of order that I have no responsibility for Ministers' answers and comments. The hon. Gentleman did not give me notice of his question and I have not seen the question and written answer, but I should like to look at them. However, I am sure that what he has said has been noted this afternoon.
Electro-convulsive Therapy (Restrictions on Use)
5.41 pm
Mr. John Gunnell (Morley and Rothwell): I beg to move,
- That leave be given to bring in a Bill to amend the Mental Health Act 1983 to prescribe the circumstances in which electro-convulsive therapy may be used without the patient's consent; to establish who may administer it; to lay down requirements governing the apparatus with which it is administered; and for related purposes.
ECT is given to patients suffering severe depressive illness. The increased effectiveness of anti-depressant drugs has resulted in a reduced use of ECT, but its present level of use is not known because the previous Government stopped collecting data centrally.
In January this year, the Royal College of Psychiatrists completed its as yet unpublished third audit of ECT clinics in England and Wales. It revealed that 45 per cent. of junior doctors
In other words, in our hospital system, ECT treatment may be carried out with or without the patient's consent on equipment that is out of date and is administered by doctors who often do not have adequate training.
I submit that if that had happened in any other field of medicine, public opinion would have focused on it and found it wholly unacceptable. ECT continues, however, without any legal mechanism for improving the circumstances in which it is prescribed and carried out--perhaps because of the stigma attached to the mentally ill.
Data on ECT may be collected, but they are not held centrally. Inquiries to a specific trust or unit may be answered, but it is impossible to get a sense of the national picture. My Bill would establish a legal obligation on all hospitals to supply the Department of Health with detailed information on every patient in receipt of ECT and on the Department to publish an annual record, broken down according to gender, age and race, with an assessment of outcome.
The Royal College of Psychiatrists "ECT Handbook" publishes a suggested treatment record form for clinics to use. It includes space for an assessment of outcome to be
completed by both the patient and the responsible medical officer. My Bill would make the reporting, collating and central publication of such information compulsory.
There is a need for a change in practice. The Royal College of Psychiatrists, following its audits during the past 17 years, has given some clinics a yellow card--even a repeated yellow card--but there is no statutory means of giving a red card. Without that sanction, how effective can a warning be?
Should ECT be used at all? Some may have reservations about my Bill because it does not ban ECT, as has been done in some countries, such as Germany and Holland. It is commonly accepted in Britain today that, where possible, medicine should be evidence based. Enough examples are reported of patients who believe that their lives have been irreparably damaged by ECT. I have received a number of such letters and reports, and they are harrowing.
Such evidence is, of course, anecdotal, but there are enough anecdotes at least to raise serious questions. The wording of the Mental Health Act 1983 suggests that ECT would not be legal at all under emergency procedures if the changes to the patient it brings about are found to be irreversible. Some hard evidence is required.
For its part, the Royal College of Psychiatrists claims "rock solid" evidence that ECT works. It also argues that claims of side effects such as memory loss are attributable to the patient's depressive disorder. I note that the Royal College of Psychiatrists cites as the "best evidence to date" of ECT's success in treating severe depressive illness a 15-year-old piece of research it conceives can be criticised. With proper data collection and measurement of individual outcomes, my Bill would help to ascertain ECT's effectiveness and whether its effects are reversible.
My Bill proposes some limitation on the relative ease with which ECT can be given. At present, if a patient consents, ECT can be given without the agreement of a second opinion appointed doctor. The consent principle in the Mental Health Act 1983 can also be overridden by detaining the patient and treating them under the patient's best interest principle. While a risk of suicide, self harm or danger to others understandably requires the putting to one side of the consent principle, it is disturbing that that can occur simply because it is thought that the patient's health may improve if they are given ECT.
At the time of the debate on what became the Mental Health Act 1983, the right hon. and learned Member for Rushcliffe (Mr. Clarke), then the Secretary of State for Health, said that he had decided not to include ECT under treatments requiring both consent and a second opinion
Question put and agreed to.
Bill ordered to be brought in by Mr. John Gunnell, Mr. David Hinchliffe, Mr. Andrew Rowe, Audrey Wise, Mr. Paul Burstow, Mr. Peter Bradley, Mr. John Austin, Miss Melanie Johnson, Mr. John McAllion, Mr. Gordon Marsden, Mr. Ken Purchase and Mr. Neil Gerrard.
Mr. John Gunnell accordingly presented a Bill to amend the Mental Health Act 1983 to prescribe the circumstances in which electro-convulsive therapy may be used without the patient's consent; to establish who may administer it; to lay down requirements governing the apparatus with which it is administered; and for related purposes: And the same was read the First time; and ordered to be read a Second time on Friday 30 January, and to be printed [Bill 94].
Question again proposed, That the amendment be made.
The Chairman of Ways and Means (Sir Alan Haselhurst):
I remind the Committee that with this we are taking the following:Amendment No. 4, in page 1, line 13, after '9', insert
Amendment No. 59, in page 1, line 13, at end insert 'except Article 2(3)(c)'.
Amendment No. 34, in page 1, line 13, at end insert
Amendment No. 36, in page 1, line 13, at end insert
New clause 21--Appointments to Employment Committee--
New clause 27--Social Chapter: Report to Parliament--
Mr. Mike Gapes (Ilford, South):
When we were discussing the Bill yesterday, I was trying to explain to the Committee and to Conservative Members my view that the proposals in the social chapter were an important contribution to the success of building harmony and a social partnership between employers and employees throughout the European Union. Today, I start by emphasising the fact that there are in this country many companies that were already implementing the provisions of the European directive concerning works councils before our Government signed up to the social chapter.
The European directive on works councils covers undertakings or groups of undertakings with at least 1,000 employees in 14 European Union states and the three European Economic Area states and at least one establishment employing a minimum of 150 workers in two of those member states. It therefore applies in 17 countries to multinational companies with their headquarters in the
United Kingdom, or anywhere else in the world, which operate on that basis. Although employees in the United Kingdom or any other country outside the European Economic Area do not count towards the 1,000 and 150 thresholds, they were considered within the overall picture if the companies that employed them were based in the requisite number of European Union states.
The Library has produced an interesting research paper, which includes the following statement:
"lack knowledge about one or more basic issue related to effective administration of ECT."
The audit's authors say that for
"maximum efficacy and minimal side-effects"
those administering ECT should fully understand such issues and have
"access to, and training in the use of, appropriate equipment."
Although all mental services now have a named consultant psychiatrist responsible for the ECT clinic, routine ECT treatment will usually be given by junior doctors. According to a Royal College of Psychiatrists press release, the third audit found that a majority of ECT machines met what was the then college standard, but in August this year one of the audit's co-authors told me that a more recently completed survey had revealed that 53 per cent. of ECT machines were obsolete.
"but as experience is acquired, and if opinion changes, we shall be able to move it into the more serious . . . category."--[Official Report, 18 October 1982; Vol. 29, c. 86.]
My Bill would take us to the situation that the right hon. and learned Gentleman envisaged might be necessary. It would also ensure that ECT is carried out in safe circumstances and that the patient can be given ECT only if he or she has given informed consent and if a second opinion appointed doctor agrees, unless urgent treatment is judged necessary by the responsible medical officer.
'(except Article 2 paragraph 22)'.
'other than in Article 2, paragraph 19)'.
'other than in Article 2, paragraph 22)'.
'.--Pursuant to Article 2 of the Treaty of Amsterdam, Paragraph 19 (Cmd. 3780, page 31), Her Majesty's Government shall make appointments to the Employment Committee in consultation with employers' and workers' organisations.'.
'.--Her Majesty's Government shall make a half-yearly report to Parliament on the implementation of Article 2, paragraph 22 of the Treaty setting out the United Kingdom legislation and employment implications arising from the new Employment Chapter and Social Chapter as agreed in the Amsterdam Treaty which shall be subject to resolution by each House of Parliament.'.
"It is estimated that, regardless of whether we are in or out of the Social Chapter, 113 UK-based companies will have to set up European Works Councils or other procedures under the Directive because of the number of their employees in other"
European Community or European Economic Area
"Member States. It is likely that most of these companies will choose not to exclude their UK workforce from any arrangements they make. Some 57"
European works council
"agreements have already been reached in UK companies and all include UK employees. All but 6 are in companies covered by the Directive."
A publication called "Bargaining Report", issue No. 167, published in December 1996, on European works councils, gives a helpful list of those 57 agreements. I shall not quote the entire list, but it starts with Albert Fisher group, Allied Domecq and APV and continues through British Airways, British Steel, British Telecom and Coats Viyella to Hanson Brick and Hanson Electrical--which is interesting, given the association of the latter two with a member of the other place--Imperial Chemical Industries, Imperial Tobacco, Laporte, Lloyd's Register and Marks and Spencer. The list continues through Reckitt and Colman, Reuters, Scottish and Newcastle and Securicor and ends with United Biscuits and Zeneca.
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