I agree with the hon. Member for North Norfolk (Norman Lamb) that it is not before time that we are updating our mental health law, as has already been done in countries such as New Zealand, Australia and Scotland.
I support the Government in respect of nearly all the proposals that we have debated. They also deserve the congratulations that they received from even the hon. Member for South Cambridgeshire (Mr. Lansley) on their extra investment in the health service generally, and particularly in mental health. Before 1997 we experienced decades of underinvestment in our national health service, and no service was treated more harshly than mental health services, which is why practitioners described it as the Cinderella of services at the time.
I can give an eye-witness account of the changes that have taken place. For nearly 20 years before I was elected to Parliament I was a solicitor in Stafford, where we have a very successful hospital for mental health treatment, St George’s hospital. I regularly advised patients, had discussions and meetings with members of staff such as psychiatrists and hospital managers, and had dealings with the mental health review tribunal. I observed the problems that were created by underinvestment in services, particularly the lack of support for people in the community, which made hospital admissions more likely than they should have been. For the last 10 years I have been a regular visitor to that same hospital as the local Member of Parliament, meeting patients and other service users, doctors and nurses, and hospital managers. Today the story is completely different.
During my time as the local MP, we have also seen the establishment of a private hospital dealing with mental health issues. The hospital, which is in Wheaton Aston in my constituency and is a member of the Huntercombe Group, specialises in acute illnesses and eating disorders in young adults and children. It is experienced in those conditions, and has made valuable comments about the parts of the Bill that deal with services for younger patients. Also in my constituency, Staffordshire university has a centre for national research on older people and mental health. As the local MP, I have seen a good deal that is relevant to today’s debate.
St George’s hospital is part of South Staffordshire Healthcare NHS Foundation Trust. Let me say something about the way in which it has developed since 1997. It is now an exemplar for national services such as inclusion and regional services such as forensic sciences, and features local excellence in services such as developmental neurosciences and dealing with learning disabilities.
When I visit the hospital, I see a brilliant commitment among its staff. There is evidence of that for visitors in the form of the magnificent modern learning centre—which is proof positive of the commitment of management to staff—and also in what the hospital calls the values exchange, which enables staff to swap experiences and suggestions of ways in which to improve services. That approach extends to service users, who show a fantastic commitment to the hospital where they have received treatment. Much of the credit belongs to the chief executive, Mike Cooke, who is so brilliant that he is leaving us next month to take up a post with a larger trust in Nottingham.
I have also visited Huntercombe Stafford Hospital several times. It has great expertise in dealing with younger patients, and has much to offer this debate.
We have seen two attempts at wholesale reform of mental health legislation in the past, both of which failed. I think it a shame that all our mental health law cannot be kept in one place as a kind of code: it is sad that we could not achieve such a modernisation. This Bill represents a more modest attempt to modernise the Mental Health Act 1983. Psychiatrists at both the hospitals I have mentioned tell me that there are advantages in that. The 1983 Act is familiar to practitioners. The definitions are well known to them, the practices are appreciated, and they like the idea of evolutionary rather than revolutionary change. There is also the opportunity to ““mesh”” the legislation with other reforms such as the Mental Capacity Act 2005.
Like those practitioners, I ask ““What is this law for?”” I accept the Government’s point that it is intended to provide a legal framework, but I still maintain that the quality of services is at the heart of the issue. With a good framework, services can flourish and meet need effectively; without it, they will be harmed. Like the Joint Scrutiny Committee I believe that"““the primary purpose of mental health legislation must be to improve mental health services and safeguards for patients and to reduce the stigma of mental disorder.””"
The top priority is to improve services through the Bill and many other means, including investment. The second is the reduction of stigma, which is vital in getting people to engage with services, with voluntary services being just as important as the compulsory ones that we are discussing. Compulsion must be balanced with the proper safeguards. Another important reform, mentioned briefly earlier, is work force reform.
I should like to discuss the services available to young adults and children and I aim to speak later about the Lords amendment on age-appropriate treatment. I regret the fall-out between the Government and the Mental Health Alliance. The alliance is formed from a large number of organisations that all attract great respect for their work individually, so together they should be listened to. However, I do not share the alliance’s enthusiasm for the Lords amendments on impaired decision making and the question of treatability. I like the alliance’s arguments in respect of the overriding principles that it says should be in the Bill. Much of the disagreement between the Government and the alliance could be resolved if we put the principles in the Bill and got the wording right. We could certainly ease worries about the provisions on impaired decision making and treatability by getting those principles right.
I am not sure whether we can get the principles so well stated in the Bill so as to do away with the need for some exclusions. The Government have concluded that the Bill must still mention exclusions for drug and alcohol dependency. I should like the Committee to discuss whether we can get a statement of principles that is so well honed that we do not need a list of exclusions as well. If we could get to that position, we would bring our legislation nearer to that of New Zealand, Australia and Scotland, which we are now falling behind.
Some safeguards are missing from the Bill, and if I am a member of the Committee I will argue for them. The first is the one I mentioned to my right hon. Friend the Secretary of State: the right to independent advocacy for those subject to compulsory powers. The second is the legal recognition of a patient’s advance decisions and statements. The third is enabling patients to have greater choice and covers which persons exercise the powers granted to the nearest relative.
On the vexed question of community treatment orders, it is important to bear it in mind that we have experience of some controls over some patients in the community. We have the extended leave and guardianship route and supervised discharge, or aftercare supervision. In itself, the idea of having conditions that enable people to be in the community rather than in hospital is accepted, and has been for many years in this country. However, community treatment orders would be a new provision. They are used around the world, but the research on the beneficial effects of those provisions—let us face it, they are fairly new in most of the countries concerned—is not yet conclusive one way or the other. It makes sense for us to have a cautious approach to the use of those powers and their application. But the Lords amendment goes much too far; the conditions that it puts on the application of the provision might kill it.
On work force reforms, it is desirable to build up the multidisciplinary team that will be responsible for providing services both in hospitals and, crucially, in the community, and to build up people’s confidence in it.
Mental Health Bill [Lords]
Proceeding contribution from
David Kidney
(Labour)
in the House of Commons on Monday, 16 April 2007.
It occurred during Debate on bills on Mental Health Bill [HL].
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