Mental Health Bill [HL]

My Lords, the noble Lord, Lord Patel of Bradford, has returned to this topic with his usual enthusiasm, for which we are all grateful. In Committee, he acknowledged that the Government have good intentions but said that there remain serious problems in providing patients with robust and appropriate care plans. Clearly, those problems persist. We wholeheartedly agree that care planning must be carefully and comprehensively undertaken for every patient, whether voluntary, detained or subject to supervised community treatment. Each care package must be tailored to each individual, taking into account their particular needs and circumstances. That is a vital part of their treatment. As the noble Lord, Lord Patel, said, it is a cornerstone, a fundamental component of good mental health care. We also agreed with the noble Lord when he said on Second Reading that the care programme approach and its equivalents for older people, children and adolescents should ensure that care planning takes place. We acknowledged then and we do now that CPA is not always consistently applied. Far from it. We drew attention to our current review of CPA, which is examining how patients with the most crucial needs can be targeted, how the process can be streamlined and how patients can be given more control over their care and treatment. The public consultation is due to end today. I have brought to the attention of the review team the record of this House’s debates on the matter and I promise to bring to its attention our debate this evening. There is still much for the review to do as it begins to consider the representations made. I am more than happy to arrange for the review team to write to interested Peers to offer to meet them to discuss the progress of the review and to outline how it will be taken forward before it reports in the autumn. Although our debates provide the review with invaluable insights, many Peers may want to take that extra opportunity. We will of course carefully consider the results of the review to see what stakeholders want, and we will see what improvements we can make to CPA and therefore to care planning for all relevant patients, including those under SCTs and those who are detained. Similarly, in Wales, the Assembly Government have reviewed the operation of CPA and have recently issued a report with recommendations to service commissioners and providers in Wales. It is the implementation of the reviews, not statutory requirements, which we believe will improve care planning for that patient group. Although acknowledging the importance of care planning, we do not agree with giving statutory force to it, as proposed under the amendment. That is not to say that we think that the amendment is meaningless—far from it. However, there are practical problems in enshrining care planning in legislation, problems that we began to appreciate when we got to grips with the detailed practical implications of the proposals that we included in the 2004 draft Mental Health Bill. I fear that there will always be tensions between the need to establish clear legal parameters, whether in primary or secondary legislation, and leaving the flexibility necessary to ensure that care plans are a positively helpful clinical tool. Care planning is such an individual process. The quality of application is the issue, and it must be addressed by improvements in practice. In this Bill, we do not need to make the care plan serve a legal purpose as well as its primary clinical one. That is why we have opted for guidance both in the code of practice for England and, I am told, in the code of practice planned for Wales. The proof of care planning is measured in patient outcomes and experience. The best way to improve quality is through the current reviews and their effective implementation and through the codes of practice. I therefore invite the noble Lord to work with us on the code of practice and to withdraw his amendment.