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Session 2006 - 07 Publications on the internet General Committee Debates Mental Health Bill [Lords] |
Mental Health Bill [Lords] |
The Committee consisted of the following Members:John
Benger, Committee
Clerk
†
attended the Committee
Public Bill CommitteeTuesday 1 May 2007(Morning)[Frank Cook in the Chair]Mental Health Bill [Lords]Further written evidence to be reported to the House:MH 53 Pat
Cull
MH 54 Royal
College of Nursing
MH
56 King’s
Fund
MH 57 Penny
Stafford
MH 58 Dr.
Philip
Howard
Clause 5Replacement
of “treatability” and “care” tests with
appropriate treatment
test
Amendment
proposed [26 April]: No. 17, in clause 5, page 3,
line 13, leave out from ‘is’ to end of line 14 and
insert
‘appropriate in
his case, taking into account the nature and degree of the mental
disorder and all other circumstances of his
case.’”.
No. 59, in clause 5, page 3,
line 13, leave out ‘likely’ and insert
‘intended’.
Government
amendments Nos. 19 and 20.
10.30
am
Question
again proposed, That the amendment be
made.
Dr.
John Pugh (Southport) (LD):
I thought
over the weekend that we could perhaps rename the Bill “Mental
Health (Fear of Psychiatrists) Bill”, because amendment No. 59
is largely about what we fear psychiatrists might do, and what
psychiatrists fear that other psychiatrists might do, which is to
incarcerate individuals to vex and/or neglect them under the loosely
worded phrase “appropriate treatment”. The question
whether the fear of psychiatrists is a diagnosable phobia or a rational
suspicion also crossed my mind.
However, the Lords’
proposed amendment to the Mental Health Act 1983 would not strike out
“appropriate treatment”, it would define it as treatment
that is
“likely to
alleviate or prevent a
deterioration”
of a
condition. “Appropriate treatment” is seen simply as a
wider category; the proposed amendment seeks to narrow it
down.
From what I
have been able to gather, simple “appropriate treatment”
and treatment that is
“likely to alleviate or prevent a
deterioration in”
a condition are seen as different by those
on the two sides of the argument. Most accept that any treatment that
alleviates is appropriate, but that the converse does not follow. There
are two main reasons for that. First, “appropriate
treatment” may fall short of “alleviating
treatment” or treatment that prevents the worsening of a
condition; secondly, the reservation on the other side of the argument
is that “appropriate treatment” cannot always be
guaranteed to alleviate. The Mental Health Alliance argues that if
appropriate treatment falls short of being alleviating treatment, it
will lead to detention without therapy, medical purpose and, therefore,
justification. That is a strong and robust argument.
The Department of Health,
citing various examples, argues that if guaranteed treatment cannot be
offered, no treatment can be offered to those who otherwise meet the
criteria for compulsory treatment. I can cite one example myself. There
is a lad in my constituency who was knocked down by a police car that
was travelling at 70 mph. He would normally have died. He recovered,
but with significant brain impairment that left him without any real
sense of responsibility. There is effectively no treatment available to
him—nothing that anyone can identify as a cure. The
manifestations of the impairment in his behaviour so far are that he
has endeavoured to set his family home on fire, exposed himself on a
train, jumped out of a top floor window and a range of other
things.
I have
personally written to all of the agencies concerned with his care,
including the probation service, to ask what can conceivably be done.
They have responded by holding various case conferences, but it is not
obvious that anything can be done. I have had to say as much to his
father, and to write to everybody concerned to say that if something
happens, it will be of a severe nature and that I suspect that the
forces of law and order will necessarily and unfortunately be involved.
Cases such as that have to be addressed by those on both sides of the
debate.
Both sides
have made strong and seemingly opposite cases. The Lords’
amendment is effectively in line with the 1983 Act and the treatability
test, although I accept that some would like to see that strengthened
substantially. On the other hand, the Department of Health argues that
untreatable patients are refused treatment not because they are
untreatable, but because they are treated as untreatable. That is one
of the arguments that the Department gives for its position, but it is
a slightly weak argument, because it is not against the test itself; it
is an argument against the application and interpretation of the test
and for better-trained psychiatrists, and it illustrates once more the
general fear of psychiatrists.
The
Department of Health also argues that not all appropriate treatments
immediately alleviate or prevent the worsening of a condition; that
when a person is sectioned, they may deteriorate rather than improve.
That is also a weak argument. Many physical treatments have exactly
similar effects. Chemotherapy, for example, does not produce immediate
improvements—treatments should be judged over the long
term.
The
supporters of the amendment have suggested that the Government’s
definition of appropriate treatment includes things such as nursing
care, rehabilitation, symptom mitigation and so on, which apparently
fall short of the expected standard. However, in other fields
such treatments are all that is available for chronic conditions. In
physical medicine, palliative treatment is a defensible medical
activity in all circumstances. Fundamentally, do we not all have a
difficulty in describing a treatment that is not likely to alleviate or
prevent a condition worsening as medical care? What would that sort of
medical care look like? It is not obvious that it would be medical care
at all and would, therefore, not pass muster as far as the Government
are concerned. My guess is that the two sides are not as far apart as
it seems, although they differ markedly in how they feel psychiatrists
would use the legislation and the alternative
wordings.
There
are two further considerations that slightly muddy the water. The
Mental Health Act 1983, which we have lived with for 24 years, contains
different concepts of treatment. For urgent treatment, the standard is
reduced to what is acceptable. The Scottish legislation, which is
praised by the Royal College of Psychiatrists, allows treatment to deal
with the effects of a disorder. That is a very broad categorisation.
The narrowness of the gap between the two sides, together with the
variations in the discussion of treatment, suggests that one could, and
possibly should, believe that an acceptable compromise can be
reached.
Mr.
Tim Boswell (Daventry) (Con): I am following the hon.
Gentleman’s argument with great interest and care. Does he agree
that one of the difficulties—which may be suppressed and not
always made explicit in the argument—is that different
professionals may have a view on the treatability of an individual, but
feel that their professional reputation would be at risk if they sought
to treat, or claimed to be treating somebody, and there was no
improvement in that person’s condition? Does that not further
complicate the
issue?
Dr.
Pugh:
I agree, if that is empirically the case. The
interesting thing about the debate that we had on impairment is that we
all believed, and the psychiatrist said, that when applying the concept
of impairment to an individual, the same conclusion would be reached by
everybody. It is not obvious to me that they should not equally come up
with the same conclusions when applying a concept of treatability. Why
would they come up with different conclusions in the one case and not
the other?
Given my
belief that there is scope for some kind of dialogue, as opposed to
mutual campaigning against each other, I found the amendment tabled by
the hon. Member for Rhondda fairly helpful. I did not agree with it
wholeheartedly, but he tried to define legitimate
treatment—treatment that is the basis for some degree of
coercion— as having the intention of alleviating rather than
being “likely to alleviate”.
Unfortunately
he is not here, but he was endeavouring to lower the bar as to the
treatments that are permissible, while seeking to outlaw anything that
cannot reasonably be expected to be efficacious. He was challenged by
my very acute colleague, my hon. Friend the Member for Romsey, on
precisely that point. He said
that
“intention
must always include an element of likelihood, although likelihood is
not predominant... There is always an element of likelihood in any
degree of intention”.——[Official Report,
Mental Health Public Bill Committee, 26 April 2007; c.
133.]
I guess he was saying that one cannot
honestly intend something that one has no reason to expect. The Liberal
Democrats, of course, intend to form a Government soon, which implies
that we have a reasonable expectation of doing so. To be wholly
acceptable to anybody, his amendment must explicitly incorporate the
concept of reasonable
expectation.
Another
change that would help to move things forward in a positive way is to
incorporate a care plan, and a review of it, for anybody who is subject
to coercive treatment, as found in the Mental Health (Care and
Treatment) (Scotland) Act 2003. That would spell out what was to be
done and how it was to be monitored and evaluated, and could be the
basis for an appeal. There is further debate to be had—this is a
big
issue.
Mr.
David Kidney (Stafford) (Lab): In a genuine spirit of
considering the hon. Gentleman’s point about whether there is a
middle ground, I note that in the Mental Health Act 1983 treatability
is a test for two conditions, but not for two others. If we were to
return to focusing on benefit to the patient as the overriding aim,
rather than treatment that alleviates or prevents a deterioration in a
condition, might that be a potential way to reach the sort of
compromise about which the hon. Gentleman is
talking?
Dr.
Pugh:
That certainly demands looking at, and we should
examine the 1983 Act further to see exactly what it says. Many of the
criticisms that I make of the Bill are also criticisms of the 1983
Act.
Mr.
Boswell:
I wish to take up the helpful
suggestion made by the hon. Member for Stafford and draw on the
concepts and principles of the Mental CapacityAct 2005, in
which the best interests principle is paramount, although not
exclusive. I do not wish to muddy the waters further, but the
suggestion that the action taken should be for the benefit of the
patient seems a reasonable filter against unreasonable
action.
Dr.
Pugh:
Well, again, I agree. It is
unfortunate that the Government did not accept statements to that
effect as a preamble to the Act or as a statement of principles. Had
they embodied a statement of principles right at the start, many of the
difficulties that we are now in would have been avoided. It is a big,
complex
issue.
Ann
Coffey (Stockport) (Lab): Does the hon. Gentleman agree
that there is also an element of confusion? When we talk about medical
treatment we have an idea of what it is—basically medication for
illness. That is why a comparison is often drawn between treatment for
a mental disorder and treatment for a physical ailment. However, in the
1983 Act the definition of medical treatment is quite wide and includes
psychological treatment. Further down the line, that will probably
bring us to a debate aboutthe definition of a responsible
clinician, but I imagine that for a certain group of people a
psychological intervention can be more helpful than one based on
medication. The situation adds to the confusion about what the
treatment is designed to alleviate, because we necessarily make a
comparison with physical illnesses.
Dr.
Pugh:
We are unravelling a further level
of complexity that is well worth going into. Part of the problem is
that when people think of treatment for psychiatric patients, they
almost invariably think of medication or, worse still, surgically
invasive techniques of one kind or another. That has by and large been
the history of dealing with the more drastic cases confronting
psychiatrists.
Given
the complexity of the issue, which we have touched on and which has
been widely accepted in the Committee, I do not believe that it will be
resolved simply by the Government’s gainsaying or reversing the
Lords amendments. The reasons that they have given for doing so are not
as persuasive as they ought to be for such a radical
move.
Tim
Loughton (East Worthing and Shoreham) (Con): I welcome you
back to the Committee, Mr. Cook. I congratulate the
Minister, the hon. Member for Watford and their colleagues on their
10th anniversary today. [Hon. Members:
“Ah.”] Wait for it. I fear that I am the only Opposition
member of the Committee from the 1997 intake, but the message of the
1997 election has never been more appropriate—“Things can
only get
better”.
The
clause is one of the most crucial parts of the Bill on
therapeutic benefit, which was the key to the 1983 Act and has been
described as the linchpin of the way in which we apply medical
treatment provisions. When the then Under-Secretary of State for the
Department of Health and Social Security, Lord Elton, introduced the
Bill that became the 1983 Act, he stated that if he were asked to list
briefly the most important and beneficial provisions in the Bill, they
would be the requirement that except in particular
circumstances—by which he was referring to learning
disabilities—people should not be admitted to detention for
treatment in hospital if their condition was not
treatable.
10.45
am
Under section 3
of the Act, reasons for admission for treatment were classed in three
categories:
“He
is suffering from mental illness, severe mental impairment,
psychopathic disorder or mental impairment and his mental disorder is
of a nature or degree which makes it appropriate for him to receive
medical treatment in a hospital;
and
(b) in the case of
psychopathic disorder or mental impairment, such treatment is likely to
alleviate or prevent a deterioration of his condition;
and
(c) it is necessary for the
health or safety of the patient or for the protection of other persons
that he should receive such treatment and it cannot be provided unless
he is detained under this
section.”
[
Interruption.
]
That definition was all-encompassing for the protection of the
individual and for the safety of the public. It is for the Government
to make a case that those treatability criteria are no longer
appropriate. The burden of proof is on the Government to make the case
for changing what was in the 1983 Act, which has served us well in the
past 24
years.
Mr.
Kidney
:
I am sorry to shout at the hon. Gentleman
from a sedentary position. He said that the provision in the 1983 Act
was for the health or safety and the protection of other persons; I
point out that the Act actually said,
“for the protection of other
persons.”
The hon. Gentleman is suggesting
that treatability is a test and that the Government are taking it away,
but his reading of the 1983 Act has just told us that treatability is a
test in the case of mental impairment or a psychotic condition, but not
for a mental disorder or a severe mental impairment. The present
position is balanced 50:50; surely he should make the case for
extending treatability to the other
classes.
Tim
Loughton:
I am sorry if the hon. Gentleman misheard me or
if I misread the quote. The Act certainly says “or”, so I
was not trying to make any other case.
The Government are trying to
make the legislation and it is for them to make the case. We will come
to the treatment of people with personality disorders later in the
Bill. The number of people subject to sectioning hit a record high last
year, so it is not as if people are falling through the net under the
existing legislation. More than 47,000 people were subject to
sectioning, which is nearly double the figure of 10 years ago. Of those
47,000, 20,000 were sectioned after voluntary admission to a hospital.
If the Government were saying that a whole load of people have escaped
who should have been sectioned for their own protection or that of the
public, they would have a stronger case, but the reverse has been true.
That is why I say that the onus of proof is on the Government to show
the need for what we think is such a drastic change. It has
implications not only for the mental health field but for the way in
which all health practitioners deal with their patients.
To remove the treatability
requirement, whatever the Government’s intentions, is to permit
indefinite preventive detention and to change the law from a health
measure to one of social control. To remove a therapeutic benefit test
is to penalise and stigmatise the large number of mental health
patients who pose no threat to anyone other than themselves, in order
to ensure that a small minority who are dangerous but untreatable are
kept under lock and key. The Government have in mind a small group of
people, but there is nothing in the Bill to ensure that the provisions
are applied only to that small group. It is a classic example of hard
cases making bad
law.
Ann
Coffey:
The hon. Gentleman has just said that the
provisions will mean that some people who are not a danger to
themselves or others will end up in detention, but he must accept that
the test of whether a person is a risk to themselves or others should
remain in the
Bill.
Tim
Loughton:
Yes, but the net has widened greatly. The terms
under which somebody can be taken into detention have widened. Perhaps
more damagingly, the impression and perceptions given to people mean
that they will now not present, on the basis that they could quickly
and easily become subject to a compulsory form of treatment rather than
a voluntary one. That is why the fears that many of us who are involved
with the Mental Health Alliance—particularly those from black
and minority ethnic communities—have about this part of the Bill
are so much greater than our concerns about other
parts.
The
Minister of State, Department of Health (Ms Rosie
Winterton):
The hon. Gentleman talks about people not
presenting. Does he not accept that people with personality disorders
for which treatment is available are deterred from presenting
themselves if they continually receive from the mental health services
the message that they are untreatable? We know that that happens at the
moment; it is what the change that we are trying to bring about is
intended to overcome.
Tim
Loughton:
The Minister has got to get her line straight.
In a speech a few months ago, her own mental health tsar said that
personality disorders could now be treated much more easily, and that
people would not be shrugged off and told, “We cannot treat you,
so go away.” The Lords amendments entail there being as wide a
remit as possible—if treatment is available, people can be
subject to the order whether or not they agree to it. The
Minister’s apocryphal story, which has not been backed up by any
of the experts to whom we have spoken, about lawyers hawking their
wares around Broadmoor and advising clients to refuse treatment on the
basis that they make themselves untreatable and can therefore do a
quick flit, does not apply. So long as the treatment is available in
Broadmoor, or wherever else they might be, it will be possible to
detain them under the terms of the Lords amendments. The scenario of
which the Minister warns does not apply.
Mr.
Boswell:
The good news reported by the mental health tsar
is that there is a diminishing population of persons who are not going
to be given treatment. Does my hon. Friend agree that it automatically
follows from that that the population of people who would be covered by
the Government amendment will diminish year on year? If there has not
been a problem under the 1983 Act, except in one or two notorious
cases, why is there any suggestion that there should be a greater
problem under this legislation before it is amended by the
Government?
Tim
Loughton:
My hon. Friend is right. This is a diminishing
problem, thanks to the increasing availability of treatment. I received
a ministerial reply the other day about the number of people who would
be classified as having dangerous and severe personality disorder. It
is small compared with the number of people suffering from some form of
mental illness, the vast majority of whom are already subject to other
restraining orders.
Ms
Winterton:
I just want to find out exactly where the
Opposition are coming from. The hon. Gentleman’s argument is
that medical treatment must be available to suit the needs and
circumstances of the individual. That is a high test. However, he seems
to be saying that somebody who refuses to engage with psychological
treatment should no longer be in Broadmoor even if he poses a threat to
himself or others. Is he saying that somebody who makes himself
untreatable cannot be detained? I do not understand why he made the
comparison with people in Broadmoor. Can he
explain?
Tim
Loughton:
It is a bit difficult to explain, because I am
not entirely sure what the question was. My point about the Lords
amendments was that “appropriate treatment” is the phrase
that the Government wanted to add. In the Lords, there was a great deal
of compromise to try to accommodate the Government. There was almost a
middle way, but in the end the Government did not go far enough. The
point is that appropriate medical treatment, which the Government are
trying to add to the 1983 Act, is available to the individual. It is
not that it will definitely work for him—we know that there is a
balance of possibilities and probabilities—or that it is likely
to work for him, but that it is available to him. That is the
Government’s duty. If the Government are running the health
service properly, they have a duty to ensure that where treatment is
possible—be it in physical or mental health—it is
available. On that basis, the person who is in Broadmoor because
professional clinicians think that he should be will remain
there—so long as all the criteria apply for keeping him
there—whether or not he agrees to be treated, on the basis that
treatability is satisfied because the treatment is
available.
Ann
Coffey:
I want to go back to the hon. Gentleman’s
statement of widening the net, which takes into account some of the
recent discussion. Does the hon. Gentleman accept that the effects and
symptoms of personality disorders can be improved by psychological
interventions, which is why we have got a definition of medical
treatment that includes psychological intervention? Why does he think
that it is a bad thing for people who have personality disorders, which
can be alleviated, helped or treated by psychological interventions and
who are a danger to themselves and to others, not to be
detained?
Tim
Loughton:
The answer to the first part of the hon.
Lady’s question is yes. Clearly, all sorts of treatment
exist—other than drugs or conventional psychiatric
treatment—that can be deemed to alleviate or to contain
symptoms, and that includes psychological therapies. However, our point
is that this widening of the net which, whatever the Government say, is
a widening of the net and is very much perceived as that, is predicated
on a community of people with dangerous and severe personality
disorders, which amounts to 2,000 to 2,500 individuals in the prison
population, and some outside. This coercive legislation is being
targeted at an enormous constituency of people, based on the problems
that we may or may not have with a few thousand people with severe
personality disorders.
We believe that the Government
should apply separate legislation for those people that is not based on
a health legislation requirement because there is not automatically a
health benefit in every case. The pre-legislative scrutiny Committee
said that people with severe personality disorders are not an easy
constituency to deal with, and that they should be dealt with by Home
Office legislation. In order to contain them for crimes and offences
that they have not committed, and for dangers that they have not shown,
there should be a Home Office rather than a health measure, which has
an obvious therapeutic benefit.
Tim
Loughton:
The Minister is bursting to intervene. I
will give way for the last time, and then I will move
on.
Ms
Winterton:
I find that absolutely
extraordinary. We know that there are people with personality disorders
who are not necessarily a danger to other people, but who may be
self-harming and suicidal because of the terrible time that they have
had in their lives. They may have suffered physical, emotional or
sexual abuse. The hon. Gentleman is suggesting that those people are
dealt with under Home Office legislation. How stigmatising and
discriminatory is that? I find it extraordinary that the hon. Gentleman
and Opposition Members could be going down that line. I would like to
know what would be in that legislation, which would take a particular
group of people with a personality disorder and legislate separately
for them in the Home Office. That is
amazing.
Tim
Loughton:
The implications of what the Minister is
trying to achieve is going to stigmatise potentially many millions of
people by subjecting them to mental health coercive legislation, which
they need not be subjected to and which they certainly perceive they
will be subjected to on the
basis—
11
am
Tim
Loughton:
If the hon. Lady will forgive me, I will not
give way as I know the Whip wants to move
on.
This will
happen on the basis of how one deals with a small number of people with
a severe personality disorder. The entire community of people with all
grades of mental illness, who would not necessarily have been caught in
this net before, will be highly stigmatised under the Minister’s
proposals, rather than just a few thousand whom we know it is very
difficult to deal
with.
Tim
Loughton:
No, I am going to move on. [Hon.
Members: “Give way.”] Well, if the hon. Lady
is that desperate, I will give way once
more.
Ann
Coffey:
I was only interested in the hon.
Gentleman’s opinion of psychiatrists. Does he believe that we
need to be protected from psychiatrists because left to their own
devices or under this legislation they will incarcerate hundreds of us
at a moment’s
notice?
Tim
Loughton:
Perhaps it was a bit foolish to give way to
that. Of course we do not need to protect ourselves against
psychiatrists, but what psychiatrists and other mental health
professionals need more than ever is clarity from the legislation about
how they can
deal with their patients. They need to know the parameters so that their
decisions will not constantly be hauled up in front of courts or mental
health tribunals and challenged. They need to know the limits of what
they can
do.
There is also the safety first
danger: certain professionals will always seek the safer option of
subjecting people to some form of sectioning on the basis that if they
do not and their judgment subsequently turns out to have underestimated
the danger a person posed, they would carry the can. We need a balance,
and we need professionals to be able to exercise that balance. The
implications of what is being proposed, however, will drive people away
from contact with mental health services in the first place. The
professionals will not be in a position to make that balanced judgment
because people will have gone underground. That is our biggest fear of
all.
In terms of
extending the net, the Mental Health Alliance
states:
“The
scope of the appropriate test, being wider than the treatability test,
will bring within reach of compulsion many people who are not within
the current Act and should not be. Indeed the effect of placing this
test in the 1983 Act is to broaden it even further than in the 2004
Bill which had a higher threshold for admission to compulsory powers
for people at harm to themselves than does the amended 1983
Act.”
The Law Society has
also
commented:
“As
a matter of medical and legal ethics, mental health law should not be
used to lock people away because they are perceived to be dangerous but
for whom no beneficial treatment can be found. That is the province of
criminal law.”
That is
the point that I was making just now. The Government’s
appropriate treatment test, on its own and as it was before the
amendments were added in the Lords, is so vague that it gives almost
unlimited powers to clinicians and too little basis for a legal
challenge against a person’s detention. That would be the field
day for lawyers and clinicians at tribunal hearings that the Minister
is always warning us about.
The Lords did
not try to wreck this part of the Bill. They endeavoured to find a
common way of proceeding and some compromise with the Government. Hence
the incorporation of the term “appropriate treatment”,
which was not originally envisaged by those opposed to what the
Government were trying to do. They want to keep the treatability test
for therapeutic benefit, but it becomes a test of what is appropriate
medical treatment that is available to the patient. It combines a
therapeutic benefit test with the Government’s appropriate
treatment test. Those patients who refuse to accept treatment will now
still be covered, so the Broadmoor escapee test, which the Minister
keeps imposing on us, is catered for as well
there.
Contrary to
what the Government allege, the test does not require a prediction that
a particular outcome will be achieved for the patient; it simply
requires a likelihood that the situation will improve or that the
deterioration will be prevented, which includes any symptoms of the
condition. It does not need to address the underlying disorder. I think
that that is a point that Lord Warner failed to grasp during the debate
in the House of Lords. A memorandum submitted by the Royal College of
Psychiatrists said that
“this level of predictability is
not so different from physical health and is no barrier to
detention.”
Lord Warner admitted in Committee in
another place that this is a less onerous test to satisfy than the
therapeutic benefit test that was proposed by the Mental Health
Alliance in its evidence to the joint scrutiny Committee. The
appropriate treatment test must be understood together with the new and
broad definition of medical treatment in the Bill. As the hon. Member
for Stockport said, medical treatment includes nursing, psychological
intervention, specialist mental health rehabilitation and
care.
I would like to
move on to the treatability of people with personality disorder. Until
the development of psychological therapies, it was difficult to treat
people with personality disorders, because the services were not in
place. We have moved on a long way in the past 24 years, hence the need
for the Bill. Professor Lewis Appleby, in a recent speech that I
alluded to earlier, acknowledged that there is now evidence that many
people with a personality disorder can be treated and that the
appropriate services are now being developed. He has referred to the
fact that the National Institute for Health and Clinical Excellence is
considering turning the evidence into clinical guidelines. So it is a
shrinking constituency of people who pose a problem in this
matter.
When the
Joint Committee on Human Rights looked at this part of the Bill, it
said that just
as
“the Joint
Scrutiny Committee concluded that a proper test of therapeutic benefit
was an essential component of the
law”,
the JCHR criticised
the breadth of the test too. I should like to quote its original
comments on the draft proposals:
“Whatever this
Government’s intention, the wide definition of ‘medical
treatment’ in the draft Bill would allow people to be detained
where the only treatment that could be offered was ‘care’
under the supervision of an approved clinician. The draft Bill does
not, in terms, say that the powers could be used only where
professionals believed that they could offer effective treatment in the
wider sense of a therapeutic programme with a reasonable chance of
mitigating the patient’s
condition.”
More
recently, the Committee’s report said
that
“We
consider that the principal legitimate aim for which medical treatment
may be imposed under Article 8(2) is health, even if incidental
purposes may be the prevention of crime or the protection of the rights
and freedoms of
others.”
There
is a problem with the Government’s approach. The Minister has
spoken before about the treatment-resistant patient. The Committee also
stated:
“It is
inherently unethical to permit people to be detained in hospital or to
otherwise have their lives controlled, because of their ill health or
their personality, when they do not obtain any benefit from
it...It would be profoundly discriminatory towards a particular
group of people, who are already unfairly stigmatised within society
and who are therefore easy—even popular—targets for
further discrimination.”
One
wonders how uneasy society would feel if it were proposed to detain all
young adult males with acknowledged problems of anger management so
that they could be subjected compulsorily to treatment programmes that
may have no
impact.
Furthermore,
as the MHA has said, if the Government want to introduce preventive
detention for people with personality disorder who are dangerous, they
should do so honestly. I think that the comments of Lord Carlile in the
Lords are very relevant. Hesaid:
“If it
is the case that this Government believe that certain people should be
locked up as a result of certain criteria, a sort of control order
regime for dangerous people—and there is a precedent to start
with—let them bring forward a Bill to this House and the other
place and it will be considered on its merits. Parliament will then be
able to adjudge whether it is necessary, and if so in what terms, to
place restrictions on dangerous people who cannot be treated. But in
terms of a mental health Bill, if this really is a Bill on mental
health and not, as has been suggested by another Member of your
Lordships’ House, merely a Home Office Bill in disguise—a
way of securing, as Professor Eastman put it, “locking somebody
up”—the Government really need to accept that their
appropriate treatment test simply does not add up to anything involving
improvement to health.”—[Official Report, House of
Lords, 10 January 2007; Vol. 688, c.
304.]
It is not just the
Opposition, therefore, who are saying that the Bill contains elements
of a Home Office Bill; there is a consensus on that view among a broad
group of people, and it is a real fear. The Minister must make up her
mind whether the Bill is about treating people—giving them
therapeutic benefit—for an illness that just happens to be
mental illness, or about a convenient way to detain people who do not
fit into particular categories and who are slightly troublesome to her
and her colleagues.
Angela
Browning (Tiverton and Honiton) (Con): The Disability
Rights Commission has written to the Committee about this part of the
Bill,
saying:
“The
Bill previously abolished the treatability test—requiring only
that treatment should be available in a therapeutic environment but
without any reference to any positive health benefit for the
patient—which would have raised huge issues under the Human
Rights Act.”
The
Government have said in the Bill that their proposals comply with the
Human Rights Act 1998, but the Disability Rights Commission knows a
little bit about such things, so if it supports my hon. Friend’s
position, the Government should surely ask their lawyers to reconsider
the matter of compliance.
Tim
Loughton:
My hon. Friend is absolutely right; the issue is
one on which the entire Mental Health Alliance is agreed, although no
doubt at 4.31 pm the Minister will pull out a memo from someone that
claims to disagree. That is what she did last week with the
communication from the Royal College of Nursing, but it turned out that
the college did not disagree with the MHA at all; indeed, it has rather
taken exception to her claim about its view on impaired decision
making. She might wish to have some conversations with the RCN about
that. My hon. Friend is right about the extent of concern among
professionals, practitioners, service users, service providers and
charities aboutthe implications for people who suffer from
mental
illness.
Ms
Winterton:
The hon. Gentleman proposes separate
legislation. When the hon. Member for Tiverton and Honiton came to see
me about autism, she brought with her a psychiatrist who said
that
“there are cases in
which people with autism are told that they are
untreatable”.
Is the hon.
Gentleman proposing to include them in his separate legislation as
well?
Mrs.
Madeleine Moon (Bridgend) (Lab): I return to amendment No.
59, which was tabled by the hon. Member for Rhondda and myself. In its
submission MH6, the British Psychological Society recognised the need
to update the definition of treatability in the 1983 Act
because
“many psychological approaches
might not meet the Act’s definition of
‘treatment’.”
The
society recognised the continued need for a test of therapeutic
benefit, however. There has been consensus in our debate this morning
that psychological treatments play a major part in mental health
treatment, and although they do not “treat” as such, they
are, in the society’s
words,
“intended to
alleviate or prevent a deterioration of many mental health
problems”.
As was
suggested in our amendment, it is the intention to provide that is the
appropriate test.
Tim
Loughton:
I am grateful to the hon. Lady. The hon. Member
for Rhondda has sent his apologies for not being here this morning. I
believe that I said on Thursday that I was strangely attracted to
amendment No. 59, and I shall refer to it in my closing
remarks.
Mr.
Boswell: In case we lose sight of the point made by my
hon. Friend the Member for Tiverton and Honiton, of which I have some
indirect experience, let me say that I think it would be much more
defensible for a Government to be able to say in response to Human
Rights Act challenges that mental health is one thing and is covered by
the mental health legislation, but that if there are cases that are not
treatable they are covered by discrete legislation that deals with them
expressly. The explanation and the defence would be by reference to
public safety, rather than causing confusion of
terminology.
Tim
Loughton:
That is exactly the point I am
trying to make, which the joint scrutiny Committee made, too. A very
large constituency of people will potentially be subject to a greatly
widened net of increased coercion on the basis that there is a
particular set of people with whom we know there are problems, which is
why they need to be dealt with separately. They can be tightly defined,
as the Minister said in answer to my parliamentary
question.
11.15
am
Dr.
Doug Naysmith (Bristol, North-West) (Lab/Co-op): Is the
hon. Gentleman arguing that there must be some criminal justice
legislation available to deal with the sort of people he is talking
about, who have not committed any offence? I was a member of the joint
scrutiny Committee, which said what he was saying, but we did not get
our heads around how to identify such people and treat them under the
criminal justice system if they have not committed any criminal
offence, although their behaviour may be difficult in other
respects.
Tim
Loughton:
The hon. Gentleman is right,
but there is a precedent. The Government are subjecting terrorists to
containment through Home Office legislation, without firm evidence of
their having committed an offence.
Tim
Loughton:
It may be convenient for the Minister to try to
draw an analogy between terrorists and people with dangerous, severe
personality disorders. My point is that the precedent exists in
legislation from her own Government. If we are to deprive people of
their liberty or to force treatment on them against their will although
they have not committed an act that would be punishable in law at
present, it must be under Home Office legislation, which is subject to
judicial process. It must be for us, as parliamentary legislators, to
debate on the basis of Home Office legislation, rather than of
therapeutic benefit under Department of Health legislation. The hon.
Gentleman and I will concur on that conclusion, which the joint
pre-legislative scrutiny Committee came to without necessarily having
stipulated how it would be done. The principle of how it should be done
was clearly set down and we need to debate it, but we should not muddy
the waters by trying to raise the threshold for everybody with some
form of mental illness based on a very small and difficult constituency
of
people.
Dr.
Naysmith:
The hon. Gentleman is being very generous
in giving way this morning. We are dancing on the head of a pin when we
try to decide whether this should be Home Office or Department of
Health legislation. The people whom we are discussing are in some ways
ill, but they may not be treatable, so should they come under Home
Office or Department of Health legislation? I repeat the point: I agree
with the hon. Gentleman that the joint scrutiny Committee said that
those people should be treated under criminal legislation, but we did
not explore how that should be done and we are now in the same position
as we were in that
Committee.
Tim
Loughton:
I have the pre-legislative scrutiny Committee
report, but my memory is that we took the line that this was not a
health measure, but a Home Office
measure.
Tim
Loughton:
The hon. Gentleman agrees with me. As he
knows—I make no bones about it—we had some interesting
arguments in that Committee about how to deal with these people, and
rather than the Committee extending its deliberations for a further six
months beyond the original six-month period, we agreed to agree on
trying to deal with them separately and on the fact that we needed to
open up a debate on how to do so, rather than grouping them into health
legislation, which should be based on therapeutic benefit and
treatability, which we now have courtesy of the
Lords.
Tim
Loughton:
I am going to Devon, then to Stockport, and then
I will get on with it and finish my
contribution.
Angela
Browning:
I support my hon.
Friend’s point about therapeutic benefit. Indeed, that is why it
is a condition in the Scottish legislation. The Minister prayed in aid
a conversation with Dr. Juli Crocombe, whom I visited on behalf of the
National Autistic Society. It is the case that there are people with
autism and Asperger’s syndrome who need to be detained. However,
for those cases and, indeed, the one that the Minister referred to in
an earlier sitting about a person suffering from Asperger’s
syndrome who lit what she described as little fires, the court would be
muddled about which disposal to take. If the due process of law has
been carried out in a potential criminal offence, the courts still have
the option of where to dispose of the person in question, whether it is
into the criminal justice system or a hospital. If therapeutic benefit
was outlined in the Bill, it would clarify the law and make it easier
for
doctors.
Tim
Loughton:
My hon. Friend is absolutely right. Why we
compromised so much in the other place was to provide something of
clarity that was practical and that practitioners said they were
comfortable to work
with.
Ann
Coffey:
The hon. Gentleman seems to be saying that his
concerns about the matter are on the grounds of civil liberties and
that some people might be detained. He considers that that will widen
the net and that they should not be detained, but dealt with under Home
Office legislation. He actually proposed that a small number of people
who have never committed a crime be subject to containment under Home
Office legislation. If, as a Government, we put that proposal on the
Floor of the House, I can guess would his party’s reaction would
be. His argument is
astonishing.
Tim
Loughton:
At no point have I said that those people should
automatically be subject to
containment.
Tim
Loughton:
That is the discussion that I, the hon. Member
for Bristol, North-West and my hon. Friend the Member for Tiverton and
Honiton had in the pre-legislative scrutiny Committee. As for whether
the people should be contained or subject to whatever form of
curtailment of their liberty is a matter of legitimate debate for which
we need to come up with a solution not under health legislation, but
under Home Office legislation. That is our
point.
Professor
McKenzie from the university of central Lancashire, who is also a
senior lecturer at University college London, gave evidence to the
informal witness session that we held on Monday last week. I hope that
its proceedings will be available for publication in the next day or
so, when I shall distribute them to all members of the Committee and
other interested parties. He said that being asked to act as a prison
justice system will seriously “undermine” the role of
clinicians, that it will “distort clinical priorities”
and that the treatability test is “alive and kicking” in
Scotland, so why do we want to abandon it here? Professor McKenzie went
on to say that a lot of psychiatrists would feel stigmatised and
consider changing their careers if subject
to such a change in legislation. He forecast that there would be a big
problem between professionals and their relationship with black and
minority ethnic patients in particular. He pointed out that treating
patients is not just a one-episode session, but treatment over a
protracted
period.
Mr.
Kidney:
I want to deprecate what the hon. Gentleman said
about psychiatrists feeling that they will be undervalued by the test
that the Government propose rather than treatability. May I remind him
of my earlier intervention? In section 3 of the 1983 Act, as he read it
out, psychiatrists up and down the country—and their hospital
managers supporting them and tribunals upholding them—are
currently detaining patients against their wishes for treatment
when
“that patient is
suffering from mental illness of a sufficient nature or degree making
it appropriate for him to receive medical treatment, and it is
necessary for the protection of other
persons.”
Nothing
else. They are doing that every day now. They are not all giving up in
high dudgeon and leaving this country; they are carrying out their work
with a great degree of professionalism. I have neither heard nor seen
any evidence that anybody is criticising them for the way in which they
have carried out that law. All the Government are suggesting is that
there is a test, plus something—the appropriate treatment for
the individual—as well.
Tim
Loughton:
That is why I have said all along that
what we have in the 1983 Act—the principle of treatability or
therapeutic benefit—is working perfectly well. The onus of proof
is on the Government to say why it is not working, why we have not
heard why it is not working, and why the changes to it that they are
proposing would make it work much better. I still have not heard
evidence to that effect at all.
Sandra
Gidley (Romsey) (LD): The hon. Gentleman mentioned black
and minority ethnic patients. There is a fear among that group that
they will be disproportionately affected by the legislation because of
the stereotyping and prejudice that exist. More importantly, that may
be an unintended consequence, but is there not another unintended
consequence? If the people who most need help fear that psychiatrists
will have too many restrictive powers, they will go underground and not
seek that help. That is why it is so important to restrict those
powers.
Tim
Loughton:
The hon. Lady is absolutely right. That point is
backed up, for example, by Alan Frayney, a former chief executive of
Broadmoor. He has dealt with all the different sorts of patients whom
we are talking about. He said that the provisions that the Government
are proposing are likely to fail, because they will drive the group at
whom they are targeted away from the services, not least the BME
community, as the hon. Lady said.
To quote Alan Frayney, the
starting point in risk reduction is encouraging patients to seek help
and talk about their thoughts and feelings. In the Lords, Lord Carlile
said:
“Mentally
ill people often go to services voluntarily but only when they have a
sense that they will be safer in the hands of the mental health
services than out on their own. If they are aware
that a very vague test is being applied so that they run a far greater
risk of long-term compulsory detained treatment, they are significantly
less likely to go to the mental health services. That must surely be a
matter of common sense. The prospect therefore under the vaguer test of
more potential homicides being brought within the system is very
small.”—[Official Report, House of Lords, 10
January 2007; Vol. 688, c.
303.]
Baroness Meacher also made
a helpful
contribution:
“If
the Bill became law unamended it would probably not even be effective.
It could indeed increase the risks to the public. The very small number
of really dangerous people along with many others would steer clear of
mental health services. Safety can best be improved by making services
accessible and effective. That is what assertive outreach teams are
working so hard to achieve. Their remit is to make and maintain a
therapeutic relationship with patients in the community who are most
resistant to contact with the psychiatric services, most resistant to
treatment and most at risk of harming others. The job of any
legislation must surely be to support rather than hinder that precious
work.”—[Official Report, House of Lords, 10
January 2007; Vol. 688, c.
315.]
I am sure that all hon.
Members on this side of the Committee would wholeheartedly concur with
that view. As my noble Friend who leads on mental health for the
Opposition in the Lords
said:
“We must
restore the notion of therapeutic benefit if mental health
professionals are to continue to practise ethically, which is an
extremely important consideration. We must tighten the wording to
reassure service users that the changes to the Act are not a ploy to
use mental health as a backdoor means of achieving social control. Once
people get that idea, we will do the very thing that we least want to
do; we will drive those people away from mental health services. If
patients start to avoid the service, effective intervention will prove
much more difficult and public safety will not be improved one
iota.
If there is one
issue in the Bill that has generated more suspicion and hostility than
any other, it is this. The Government need to do two things: to
convince us, which they have not done
yet,”—
and still
have not
done—
“that
the current law needs to be changed; and to persuade us that what is
substituted for the current law is an improvement that will command the
confidence of patients and the professions. As it is, I am afraid that
we are looking at the worst of all worlds.”—[Official
Report, House of Lords, 10 January 2007; Vol. 688, c.
298.]
Those were the comments of
Earl Howe. On that basis, I do not think that the Government have made
a remotely convincing case as to why they need to undermine the
treatability test that was at the core of the 1983
Act.
It
also has severe implications for the proposed code of practice. We have
had no word from the Minister about how it would impact on that. That
is why we oppose the Government’s negative and counterproductive
amendment.
11.30
am
Amendment No.
59 has some attraction for us. I was slightly disappointed that the
Minister said in passing that she would have a look at it without, I
fear, attaching much optimism to that comment. The insertion of
“intended to”, as the hon. Member for Bridgend said,
would give a scintilla of reference to a therapeutic
benefit.
Tim
Loughton:
Or chinchilla, as the hon. Member for Rhondda
said in one of his more amusing moments last Thursday. It would be
useful if the Minister could tell us formally whether she thinks that
that is a helpful amendment. If so, and if she is prepared to add
wording that will give extra assurances that the legislation on
sectioning intends to cover therapeutic benefit, that will give a great
deal of reassurance to all those who are so concerned about where this
legislation is going. It could be a basis for compromise.
If
“appropriate treatment” were to become “treatment
intended to alleviate or prevent a deterioration of the
condition”, that would be as close to keeping a therapeutic
benefit in the Bill as we could hope for. It would be no good if it
were to rely on the subjective view of a clinician, but it would be
acceptable if it were to introduce an evidence base. That would go some
way towards providing reassurance.
I have taken many
interventions, so this has been a longer debate than we intended, but I
have tried toset out why it is fundamental to the Bill to
retain the Lords amendments. They went a long way towards accommodating
the Government’s position, and one of their key elements was to
retain a therapeutic benefit. If the Government cannot agree to that,
but are intent on overturning those amendments and going back to the
status quo ante, we cannot possibly accept that. However, if the hon.
Member for Rhondda or, in his absence, his colleagues are minded to
move amendment No. 59, we would like to give that the benefit of the
doubt as being a good
compromise.
The
Chairman:
Order. It has been brought to the attention of
the Chair that this morning there have been instances of written
messages being passed into the Committee from the Public Gallery. That
practice is not allowed; it is out of order and will cease forthwith. I
appeal to all right hon. and hon. Members not to encourage it. I shall
have more to say if I see a further instance of
it.
Ms
Winterton:
It has been a wide-ranging debate. I shall be
brief because I know that hon. Members—not least my Whip and, I
am sure, Opposition Whips as well—are keen to move
on.
The
Chairman:
Order. Before the Minister gets into her stride,
perhaps I should remind her that comments should be addressed to the
Chair and through the Chair.
There is a desire to move on
from clause 5, because we still have a lot to discuss. I just want to
make a couple of points. I emphasise again the problem that has arisen
as a result of the treatability test. It has led to a culture in the
development of mental health services that has effectively excluded a
number of people from benefiting from the treatment they need. We have
talked a lot about personality disorders, but I go back to my meeting
with the hon. Member for Tiverton and Honiton and the psychiatrists she
brought along who specialised in learning disability and autism. One of
the things that emerged from that meeting was that many people with
autism have been
told that they are untreatable and have been turned away from services.
We want to change that. We want to do that by removing the treatability
test.
The first
reassurance that I want to give challenges the assertion that the term
“appropriate treatment” is too vague. The
Government’s proposed test is not merely that appropriate
medical treatment is available. It goes on to make clear what has to be
taken into account, namely
“treatment which is appropriate in
his case, taking into account the nature and degree of the mental
disorder and all other circumstances of his
case.”
It is clear that
the treatment has to be there and it has to be appropriate to the
individual.
Mr.
Boswell:
Entirely in the spirit of the Committee’s
concern to make progress, would the Minister like to tell us whether
the “all other circumstances” are medically relevant
circumstances or anything
else?
Ms
Winterton:
Some of them might well be social
circumstances. The individual clinician might want to look at the
patient and decide what is appropriate for them in their particular
circumstances. It is about what has led the individual to have a mental
disorder and whether anything needs to be done to address those causes.
It is about taking a clear view of the individual’s needs and
circumstances.
The
official Opposition have suggested that we have a Home Office Bill to
deal with people who have personality disorders who have not committed
an offence. If the implication is that they do not require medical
treatment, I would challenge that and say that it goes completely
against the grain of what we are trying to achieve in the Bill, which
is to ensure that appropriate medical treatment is available for people
with personality disorders and other disorders. I am taken aback by the
idea that this should become Home Office legislation.
The Opposition suggest that
amendment No. 59 could provide the possible basis for a compromise. The
hon. Member for East Worthing and Shoreham asked me to be a bit more
forthcoming after my earlier comments. I absolutely agree that
amending
“likely to
alleviate or prevent a deterioration in his
condition”
to
“intended” to do so, copes with some of the perverse
incentives that we believe are there, particularly the possibility of
patients saying that they are untreatable and asking to be released by
tribunals.
There are
potential drawbacks, which is why I ask the Committee to bear with me.
I cannot support the amendment, but I have said that I will be prepared
to reconsider the matter. As my hon. Friend the Member for Rhondda
acknowledged, the amendment would not in its current form make explicit
the fact that treatment can be for the symptoms or the effects of a
disorder on a person’s thinking, behaviour and so on, as well as
directly for the underlying disorder. For example, it might not be
possible to cure a personality disorder, but treatment can control the
extent to which it leads to self-harm or violence. It is important to
get that
right.
Dr.
Ian Gibson (Norwich, North) (Lab): Will the Minister
explain the difference between symptoms and effects with reference to
anorexia?
Ms
Winterton:
In the case of somebody with
anorexia nervosa, the symptom could well be that an underweight young
woman looks in the mirror and thinks that she is seeing a large, fat
person. The effect would be that she stops eating as a result. We want
to ensure that any amendment addresses the fact that treatment needs to
deal with the symptom—what is happening to the individual and
what they feel—but also with the effect of that feeling, in this
case that they stop
eating.
Ann
Coffey:
Looking at the discussion in the Lords,
they seem to have interpreted “effects” as meaning the
effect on somebody
else.
Ms
Winterton:
My hon. Friend is right, so it is useful to
have the opportunity to explain what we mean by
“effects”. It is important that treatment can deal with
effects as well as
symptoms.
Angela
Browning:
Where does the Minister stand
on containment being seen as treatment in respect of personality
disorders? The evidence in the briefing that we have all received from
Professor Nigel Eastman, professor of law and ethics in psychiatry at
the university of London and consultant forensic psychiatrist
atSt. George’s hospital,
states:
“Because
personality disorder is a ‘whole person’ disorder, it can
easily be suggested therefore by those in favour of using mental health
legislation”—
the
Minister advocates
that—
“sometimes
solely for public protection, that any behaviour on the part of the
person is a ‘symptom’ or ‘manifestation’ of
their personality disorder. Hence, (mere) containment, if it inhibits
behaviour, is
‘treatment’.”
Is
that her
position?
Ms
Winterton:
I believe that the hon. Lady
refers to the debate in the House of Lords, in which it was stated that
appropriate medical treatment could consist of nothing more than
containment of a patient in hospital. We disagree with that. Simply
detaining someone in hospital is no more treatment than detaining them
in prison.
I refer the
hon. Lady to the case of Hutchison Reid, in which the House of Lords
considered the treatability test and sensibly observed that the meaning
of medical treatment under the 1983 Act was wide enough to cover cure
or containment of a patient’s mental disorder or its symptoms.
The Lords did not say that containing a patient—simply detaining
someone in hospital—was treatment; nor do we, and nor does the
Bill. If the court had said that, the treatability test, which the
Opposition want to retain, would allow such treatment.
My second point relates to a
matter that the hon. Lady raised. The amendment would not require that
treatment be appropriate to the individual patient’s overall
circumstances, and we want to ensure that a holistic view of the
patient is taken and that the treatment is individually
based.
11.45
am
Dr.
Pugh:
I do not want to spoil the
Minister’s flow, but she is moving away from a previous point,
and I want briefly to return to it. One of the better arguments
identified by the Government was the case of an engineered refusal, in
which a person tries to engineer their release by claiming that they
will not co-operate with treatment. The Government view was that if
they refused and there was appropriate treatment available, they should
stay; the view in the Lords was that if there was a refusal and there
was appropriate treatment that was likely to alleviate or to prevent a
worsening of symptoms, they should also stay. They amount to the same
thing unless a court judged that were a patient not to co-operate it
could not plausibly be claimed that the treatment was likely to
alleviate or stop the worsening of symptoms. That is a fine legal
point; I do not know which way lawyers would judge it, but it would be
useful for the Committee to get as much independent advice as possible
on whether it can plausibly be claimed that where a patient refuses,
none the less treatment is available that is likely to improve their
condition.
Ms
Winterton:
The hon. Gentleman has put his finger on the
point. At present there is a perverse incentive for people not to
co-operate with treatment, as we argued earlier.
I conclude my
remarks by making it clear that courts would not think that Parliament
meant two different things because the word “purpose” is
used elsewhere in the Act and not “intention”. There is a
delicate shade of difference between the two in that
“intention” might be read as more subjective than
“purpose”. If one were to say that the
“purpose” of the treatment should be to alleviate, to say
“intention” instead of “purpose” might be
considered weaker. I want to ensure that we have a very clear look at
that with a view to strengthening what my hon. Friends might want, not
in any sense weakening it. We do not want clinicians to be confused
because one part of the Act mentions “purpose” and
another “intention”.
I hope that that reassures my
hon. Friends. I give them a clear steer that I am more than prepared to
look further at their amendment, which does not achieve everything that
they want. I hope that they will therefore support the Government
amendment.
Question
put, That the amendment be made:—
The
Committee divided: Ayes 11, Noes
9.
Division
No.
4
]
AYESNOES
Question
accordingly agreed to.
The
Chairman:
I have received an indication that the
Opposition wish to move amendment No. 59. I point out to the Committee
that as the Government amendment
says
“leave out
‘is’ to end of line
14”,
it will remove
entirely the term “likely”, so amendment No. 59 can no
longer exist.
Question put, That the
clause, as amended, stand part of the
Bill.
The
Committee divided: Ayes 11, Noes
9.
Division
No.
5
]
AYESNOES
Question
accordingly agreed
to.
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