Mental Health Bill [HL]

My Lords, there is no doubt that there is much concern in the minds of a large number of professional medical groups, who have written to us about the Bill. Concern has also been expressed in the House this evening. Some people are anxious about what is in the Bill; some are anxious about what is not in it. But, as it is put forward as an amending Bill to the Mental Capacity Act 2005, my concern is whether it will be effective in strengthening something that the earlier Bill was alleged to ensure when it was introduced but, in the event, has not. Just before the 2005 Act was introduced, I initiated the Patients’ Protection Bill, which sought to end the practice of denying food and fluids to elderly persons in NHS hospitals because, or often because, the beds that they occupied were wanted. There was an amount of evidence of that happening. It even happened to a friend and ex-colleague in the House of Commons whose wife was in hospital. He visited her as much as he could and then, after about three days, he realised that no one was feeding her or bringing her water or anything else to drink. When he asked about it, he was told, ““Oh, we aren’t feeding her and we certainly aren’t giving her any liquids of any kind””. He had not asked for that and neither had she. No one in the family had asked for that to happen to her, yet, without any consultation at all, the poor woman was dying in front of his eyes. He made an awful fuss—none of us will be surprised about that—and the provision of food and liquid was reinstated, and quite right too. It was that and other cases that impelled me to bring in my Bill. I had support from all parts of this House when I did so, but the Government blocked the Bill. However, the noble Lord, Lord Filkin, who at the time had responsibility for constitutional affairs and to whose courtesy, kindness and caring I warmly pay tribute, sought me out to assure me that the then Mental Capacity Bill would do what my Bill would have done to end this abhorrent practice. I have stood aside to give every opportunity for the Act to do what the noble Lord, Lord Filkin, promised it would, but I am becoming extremely concernedat the growing amount of evidence that it has not done so. Only a couple of weeks ago, the BBC screened a truly chilling programme, put together by a very experienced researcher and broadcaster, Sally Chidzoy. It highlighted the statement of one hospital doctor, speaking in court and under oath, in which he said that two or three patients per week were dying because they were not given food or fluids. ““I see it happening all the time””, he said, and that was just in one hospital. Those words refer to a case that took place before the Mental Capacity Act had had a chance to work. The inquest took place earlier this year and those words clearly refer to what takes place now. The screening of that programme has apparently led to a very large number of calls. I am told by the BBC that it has had no fewer than 136 calls providing further information about the same sort of thing happening all over the place. I am very concerned about this. The calls have come from nurses and relatives of patients detailing cases where elderly patients have been deprived of food and fluid and have died as a result. Again and again, letters, e-mails or phone calls cite examples. It seems that it is very common for cups of tea or glasses of water deliberately to be placed where a patient cannot possibly reach them. In the programme, a nurse who was speaking of the present—not before the Act came into force—said, ““As soon as elderly people come in, they are doomed. If they are over 60 or 65 they are condemned””. Those are not my words but they come from a nurse in a hospital who has seen it happening. A daughter said that her mother begged for a drink but the dreaded ““Nil by mouth”” sign was on her bed. The daughter complained and after some days drink was reinstated, but it was cancelled again and, in the view of her daughter and those who visited her, the woman went backwards. In another case, although doctors said that the patient was allowed free fluids and that she was tolerating fluids, nurses did not give her any. Another lady said, ““There is not a lack of time to feed patients; it is the lack of care that worries me””. I fully accept that in some cases—such as patients who have suffered strokes—the patient’s condition directs that they must not be fed normally, but too often other methods of giving sustenance, such as tubes and pegs—I know that one is much easier to administer and to tolerate than the other—are not applied and the patient is starved to death. That is a terribly painful and dreadful thing and it is going on at the moment under our very noses. I am aware that the GMC is on record as saying that causing patients to die by withholding food and fluids is unacceptable and illegal. It may be unacceptable, but it is certainly happening and I am afraid it is not illegal for one very good reason. A few years ago the medical profession, backed, I believe, by the courts, reclassified feeding sick people as medical treatment. That was a licence to kill and, I fear, it is regularly used as such. Yet it is patently ridiculous to say that giving people a meal is giving them medical treatment. Do we sit at the long table in our dining room to receive medical treatment? Are school dinners medical treatment? Does a husband take his wife out on their wedding anniversary to a nice restaurant for medical treatment? Of course not. There is another odd thing. How is it that, when doctors use their rights to withhold food and liquid, no relative needs to be informed or consulted and yet when medical treatment which involves apparatus and machines, such as those that artificially keep people alive, is administered there is recognised consultation before it is embarked on? Relatives can, and do, go to court and sometimes the court upholds their right to keep the machine going, yet, apparently daily, patients are suddenly cut off from sustenance without a word to relatives and life is ended with no consultation at all. If no friends or relatives visit you, I tremble for your chances. I give notice that I shall seek to move an amendment at the appropriate time to give elderly patients better assurances of their safety and rights while in the care of the NHS. I am certainly not saying that that will be easy for hospitals to implement. Nurses are certainly extremely busy, doctors always have too much to do and money is tight. But in a country which claims to have principles and whose people certainly have rights, we can tolerate no longer the regular, deliberate killing of sick people because it causes too much trouble to keep them comfortable and to look after them properly. I am certainly not saying that there are not thousands and thousands of examples of wonderful loving care given daily in our hospitals, but these reported instances besmirch the reputation of everyone connected with British hospital care. I should also point out that the 136 people who contacted the BBC after the programme were from only one small area of the country—the programme was called ““Look East””—so I do not know what would happen if the programme were broadcast more widely. I cannot think that that practice happens in only one place so that means that there is a general situation which cannot be permitted to go unchecked. It alarms me that some who have serious complaints about what has happened to their loved ones are frightened to speak out because they fear that they may be discriminated against if they themselves need care. It certainly angers me that a hospital—the Norfolk and Norwich University Hospital—should have tried to influence a coroner to discount evidence given by two consultants Dr Michael Jarmulowicz and Dr Philip Howard, because they are Roman Catholics. I have the submission made by the hospital which is an attempt to influence the coroner. It is entitled: "““Submissions … on behalf Norfolk and Norwich University Hospital NHS Trust””." Speaking of the first doctor it says that, "““his impartiality and his position as an expert witness is in doubt owing to his close association with The Guild of Catholic Doctors””." Referring to Dr Howard it says: "““The impartiality and position of Dr Howard as an independent expert witness is disputed. In common withDr Jarmulowicz, Dr Howard is also a member of The Guild of Catholic Doctors””." Does that mean that he is not competent to give his expert medical evidence? This has actually happened and fairly recently too. I ask the Minister directly: is it legal to claim that evidence in court should be ignored on those grounds? Are expert opinions to be waved away because those giving them are Catholic or Muslim or Jewish or Methodist? God help us.