Mental Health Bill [HL]

moved Amendment No. 72A: 72A: After Clause 38 , insert the following new Clause— ““Local arrangements for assessment, conveyance and admission (1) The 1983 Act is amended as follows. (2) For section 140 substitute— ““140 Local arrangements for assessment, conveyance and admission (1) It shall be the duty of every Primary Care Trust, in conjunction with— (a) the NHS trusts contracted to provide in-patient mental health services and ambulance services within its area; (b) the police authority or authorities within its area; and (c) the local social services authority or authorities within its area, to prepare, publish and maintain up-to-date a comprehensive scheme for the safe, timely and effective management of the cases of patients within its area who may require urgent admission to hospital for treatment for mental disorder, whether under this Act or otherwise. (2) This scheme shall include details of— (a) the arrangements for the assessment of urgent cases and for ensuring the safety of the patient, carers, those carrying out the assessment and any other persons present during the assessment; (b) the arrangements for obtaining a bed, if required, and the criteria for determining the relative priority of urgent cases awaiting admission; (c) the arrangements for ensuring safe custody and conveyance of patients who need to be admitted to hospital under section 6(1) of this Act; and (d) agreed time-limits for response by the bodies listed in subsection (1)(a) to (c) above in cases of urgency where there is a serious risk to the safety of the patient or others.”””” The noble Baroness said: My Lords, I shall also speak to Amendment No. 72B. These amendments are strongly supported by the British Association of Social Workers. The first amendment seeks to ensure that the responsible organisations, the primary care trusts and others prepare and maintain a scheme to deal quickly and efficiently with patients detained under the Mental Health Act who therefore urgently need an in-patient hospital bed. The amendments set out the arrangements for ensuring the safety of the patient, carers and professionals present during the assessment, arrangements for obtaining a hospital bed and arrangements for ensuring the safe custody and conveyance of the patient. Why is this amendment important? At present, the only individual with a statutory responsibility for a person’s safety and welfare, once that person has been formally assessed as liable to be detained, is the approved social worker in person. That personal responsibility continues until the patient is admitted on to a hospital ward. Frequently, it is unsafe to transport a newly detained patient without the police and an ambulance, but last year a survey by the Association of Directors of Social Services into the ASW service found that nearly 60 per cent of local areas reported problems with accessing police and ambulance support. This level of problems occurs despite the fact that for a number of years the code of practice has made it a requirement on local social services authorities to have policies with police and ambulance services covering access to support. I understand that the British Association of Social Workers is in discussion with the department about whether the problems can be dealt with by the code of practice rather than through these amendments. The experience to date, I have to say, is not encouraging. Amendment No. 72A seeks to place the ultimate responsibility for conveying the patient to hospital upon the health trust responsible for providing the treatment to a detainee. The approved social worker or approved mental health practitioner under the new Bill would continue to undertake the duties of assessment, application for detention and conveyance to hospital, but would be conveying on the trust’s behalf. The important thing here is that in extremis the AMHP should be able to call upon the trust’s director on duty to make sure that a bed is available for a detained person. Certainly I am conscious of that in my trust. I know that if an ASW phoned our director on duty, something would happen quickly. I could give lots of examples of the problems faced by individual social workers, but I shall cite just one. Due to the threats of an individual to his family members and their very real fears for their own safety, and the fact that his mental state was causing concern, a consultant asked for an urgent ASW assessment. This service user happened to be a martial arts expert, which was a little unfortunate. The police refused to help. The ASW was therefore sent into the house armed with nothing more than a mobile phone with 999 programmed into it. Things got out of hand and she had to call the police urgently. Thankfully, all the response cars in the county turned up, so the person was safe. However, had the police responded at the start, perhaps a couple of officers might have contained the situation. The availability of ambulances in these crises also varies considerably across the country, and again if no ambulance comes, perhaps the police will not arrive either. They will come only if an ambulance also comes to the scene. Who is left holding the problem? It is the individual ASW. Alternatively, the ASW may be relatively fortunate. The police officers and an ambulance agree to help to convey the patient to hospital, but even then—and I am very conscious of this particular situation, having been rather close to it—it is quite possible for the ASW to arrive only to be told that the bed has been filled by another emergency admission. The police officers say, ““Sorry, we can’t hang about. We have to go to another incident””. The ambulance driver says, ““We can only stay for another 10 minutes””. What is the ASW, and in the new world, the AMHP, supposed to do in that situation? As the Bill stands, they will carry personal legal responsibility. That situation simply should not happen, and I am sure that Ministers would agree. But the risk is very real on a daily basis. Wards across the country are functioning with 100 per cent occupancy. In fact, in one of our boroughs, bed occupancy is 103 per cent. Ward closures continue—we closed wards last year; we will be closing some this year—in order to release funds for community-based services. The amendment is of growing importance as in-patient hospital beds in our mental health services are becoming an incredibly scarce resource. In my view, and I speak as the chairman of a mental health trust, mental health trusts should have the statutory responsibility to ensure that detained patients are safely conveyed to our hospital wards once they have been deemed liable to be detained. I hope that the Minister will be willing to consider this amendment most carefully. I appreciate that these issues are not straightforward, but I know that she will be as concerned as I am to avoid serious injuries or worse to approved mental health practitioners who will be carrying the conveyance responsibilities in future. Perhaps I might mention that many years ago, when I was an ASW, a colleague of mine went to a house to assess a patient and she was decapitated. My interest in this amendment is somewhat personal. I beg to move.