Debate on the Address

My Lords, the noble Lord, Lord Hunt of Kings Heath, has the unenviable task of summing up this extraordinarily rich and wide-ranging debate and, although I have no doubt whatever that he is up to it, this is one occasion when I am rather glad that each of us is located where we currently are. Indeed, I am quite sure that the noble Lord would not have things any other way. I cannot remember when the House has had the privilege of listening to as many as six maiden speeches in an afternoon, but it can certainly never have heard so many of such a high order of excellence. In every one of them, we found ample evidence of the way in which this House is enriched by its new Members. I recall to your Lordships’ minds the noble Baroness, Lady Meacher, who made important observations on the benefits system in the context of those with mental health problems. The noble Baroness, Lady Butler-Sloss, commented on children in care and social work, born of her unrivalled experience as a very senior judge. My noble friend Lord James made a perceptive analysis of NHS funding issues. There was an extraordinarily impressive speech from the noble Lord, Lord Low, about blindness and disability. There was the stirring celebration by the noble Lord, Lord Bradley, of Manchester and all things Mancunian. The noble Lord, Lord Morrow, spoke uplifting words about the youth of Northern Ireland and the example set by Northern Ireland’s schools and colleges. The debate as a whole has taken us into all sorts of policy areas, from pensions to the HFEA, and from dentistry to rural health services, but there have been some distinct and recurrent themes: the disabled and care of the elderly; vulnerable and looked-after children; education and skills in their various dimensions; and sexual health. I hope that the Minister will be able to give time to all those themes when he winds up the debate. Perhaps the oddest thing about the gracious Speech is what it did not contain. Earlier this year, the Government published a landmark White Paper, Our Health, Our Care, Our Say. It was not unreasonable for some of us to expect that a number of key measures might emerge from that—widening the scope of direct payments, creating individual budgets and unifying the complaints system across health and social care. In July, the Department of Health published A Stronger Local Voice, which outlined the latest proposals to remodel patient and public involvement in health—a much talked-about and much heralded set of changes that we expected to be set out in a Bill. On the same day, it published another document setting out a commissioning framework, from which we believed we would see all sorts of new legislative proposals designed to carry through the Government’s reform agenda on commissioning, patient choice, provider regulation and the extension of foundation trusts. As long ago as November 2004, Ministers announced that they wished to merge the Healthcare Commission with the Commission for Social Care Inspection and the Mental Health Act Commission. We expected to see those changes set out in a Bill. In July, the Audit Commission made a number of recommendations relating to the governance and accounting systems in the NHS, not the least of which was the need to develop a clear failure regime to deal with situations in which NHS trusts found themselves in financial distress. We could perhaps have been forgiven for thinking that the gracious Speech might have made some mention of those matters as well. But on all those issues, disparate as they may be, there has been a strange and unaccountable silence. No Bill has been announced. What can we read into that? Are we really to suppose that the Department of Health was unsuccessful in bidding for parliamentary time to legislate on so many key planks of its health agenda? Have the Government had second thoughts about any of them? If they have not and if the proposals are still on the table, can the Minister enlighten us on when we might expect to see a Bill brought forward? I ask that question in a sprit of genuine inquiry. If the best answer he can give is, ““When parliamentary time permits””, I shall be greatly disappointed. The Government have made a raft of announcements; they have raised expectations, and indeed fears, on a wide scale about the changes that appear to be in prospect and they have left us dangling. The Minister cannot remain inscrutable on all this. It seems a long time ago since the gracious Speech of 2005. Numerous Bills have passed through your Lordships’ House; indeed, the wide and flowing river of Government legislation is still in spate and has in no degree abated. But one Bill announced successively by Her Majesty and by the noble Lord, Lord Adonis, in May of last year that never reached us in the last Session was the Mental Health Bill. First, there wasa resounding silence and then a full year later, inMay 2006, the Minister of State, Rosie Winterton, announced that the Government, after all that had gone before, had abandoned their plans to replace the 1983 Act and would instead seek to introduce a much shorter Bill designed only to amend the existing legislation. Another six months down the track and that amending Bill has been published. It may just be me, but it hardly seems credible that, having begun as long ago as 1998 the task of constructing a new and updated legislative framework for mental health, having promised that that framework would replace altogether the Act of 1983, which itself is based on legislation passed in the 1950s, and having set themselves that worthy objective, the Government could reach the point of saying, eight years later, that a brand-new Bill was all too difficult and complex and that they were going to settle on a repair to the old jalopy instead of a bright new model from the showroom. There were, as we all know, extensive criticisms of the two draft Bills of 2002 and 2004, but we hoped that whatever finally came forward would represent a clean start for this area of legislation. The Second Reading of the Mental Health Bill takes place next week and I do not want to pre-empt that debate today. However, I would like to make a couple of points of a somewhat broader nature about this area of policy-making. The first is that changing the law relating to mental health inevitably takes us into very sensitive territory. There are proposals in the Bill to change the definition of mental disorder, to change the criteria for detention and to legalise compulsory treatment in the community. I am not going to comment this evening one way or the other on the merits of those proposals; I simply observe that they are potentially very far reaching. They profoundly affect service users, health professionals, voluntary organisations, carers and many others. Unless those groups are signed up to them, the proposals will simply not be workable. Parliament has to listen with more than its usual care to the concerns and views of interested parties, because to fail to do so will let down the single most important interested party—the patients. For that reason, I believe very strongly that the Bill should be the subject of at least some form of pre-legislative scrutiny. Even at thislate stage, I appeal to the Government to give pre-legislative scrutiny serious thought. My second point is that, before considering any legislation that would allow certain groups of adults to receive medical treatment against their will, we have to be clear why we think that it is right to make an exception to the rule that in all other circumstances is regarded as sacrosanct; namely, that medical treatment may be administered only with the active consent of the patient. We need to be clear what it is about people with a mental illness that makes them different from people with a physical illness. In my view, the Government have not adequately explained that, and they will certainly need to do so by the time we get to Second Reading. The rationale cannot be that mentally ill people lack the capacity to take decisions. The vast majority of mentally ill people have perfectly good decision-making capacity—a point made very well by the noble Lord, Lord Kirkwood. The difficulty arises with certain individuals whose decision-making capacity is in some way impaired. However, if that is so, we need to define whom exactly we mean and why compulsion is the best and only way of addressing the difficulty that they present. I sometimes think that, in their general pronouncements on the Bill, Ministers are too inclined to take as read a proposition that in any other area of medicine would meet with the most vigorous challenge. It is time to bring the noble Lord, Lord Hunt, to his feet. This has been a varied and fascinating debate, and I await with more than my normal degree of fascination the response that the Minister is to give us.