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Treatment Of Patients Unable To Be Admitted To Hospital

Volume 29: debated on Monday 18 October 1982

The text on this page has been created from Hansard archive content, it may contain typographical errors.

'(1) This section applies to the following persons:

  • (a) An offender about whom a court was unable to make an order for his admission to hospital because it was not satisfied that arrangements had been made pursuant to either subsection (3) of section 60 of the Principal Act or subsection (4) of section 30 of this Act.
  • (b) An accused person whom a Crown Court was unable to remand in custody to a hospital for treatment because it was not satisfied that arrangements had been made pursuant to subsection (4) of section 29 of this Act.
  • (c) A person serving a sentence of imprisonment or a person to whom section 73 of the Principal Act applies and whom the Secretary of State is satisfied should be removed to and detained in hospital but about whom such a direction cannot be given because no arrangements can be made for his admission to hospital.
  • (2) In the event of any person to whom subsection (1) of this section applies being detained or continuing to be detained in a detention centre or a youth custody centre or a prison then any member of the Prison Medical Service may consult the Mental Health Act Commission about the medical treatment of which that person stands in need.'.— [Mr. Christopher Price.]

    Brought up, and read the First time.

    With this it will be convenient to take the following amendments:

    (a), at end add—
    '(3) A Community Health Council shall be entitled to receive information from the managers of the detention centre or youth custody centre or prison subject only to the same conditions as would have applied to its right of information from the managers of a hospital in which the person would have been detained.'.
    (b), at end add—
    '(3) Any person to whom subsection (1) of this section applies shall be entitled to receive treatment for a mental disorder from any medical practitioner who is willing to treat him.'.

    The new clause is supported by several of my hon. Friends and the hon. Member for Abingdon (Mr. Benyon) who was an influential and helpful member of the Standing Committee.

    The new clause is much weaker than a similar new clause which was defeated in Committee. If I had tabled that new clause, it would not have been selected for discussion. All those who listened to the debate in Committee or have readHansardwill know that we won the argument, although the other side had the votes.

    I shall put the argument in a nutshell. We are proposing to set up a Mental Health Act Commission comprising doctors with tremendous expertise in the treatment of mentally ill people who must lose their liberty. The doctors will have the right to go to Broadmoor, Rampton, Park Lane and Moss Side to review other doctors' decisions. That concession might be difficult for the other doctors to accept. In such circumstances, why should the commission be excluded from reviewing the comparatively few cases of individuals who are in prison but whom the courts believe should be in a mental hospital, whether that be a special hospital or an ordinary psychiatric hospital? What possible objection can there be to that?

    6.30 pm

    My amendment in Committee gave the commission that statutory right over prison doctors, which it has been accorded by the Government over doctors in the special hospitals and in all psychiatric hospitals. I say we won the argument although we lost the vote because the Under-Secretary of State, the hon. Member for Hampstead (Mr. Finsberg), who, I believe, would admit that this was not one of his more glorious parliamentary moments, used a particular argument throughout. His argument was that hospitals and prisons are utterly different places. Anyone who has been to Broadmoor or Rampton and has then gone immediately into prison would not accept that. They have many characteristics in common, but even if they are different the argument for the amendment is that the prisoner, the individual who is in need of psychiatric treatment, differs in no way at all, whether he is in prison or hospital, except that those in prison cannot be found hospital places.

    In Committee, the Under-Secretary of State said:
    "Hospitals, prisons and detention centres are completely different sorts of institutions with different regimes. practices and rules."
    I have already said that that is not true. The hon. Gentleman went on to say:
    "Hospitals decide who should be admitted, and when, in the light of the resources and facilities which they have available and the demands upon them."
    That is not true. My understanding is that, although the four special hospitals can theoretically refuse to accept patients from the: courts, in practice they do not do so. I should like to say in passing that, if Park Lane could recently receive a prisoner, Michael Fagan, who has no conviction beyond pleading guilty to taking and driving away a motor car, one cannot say that special hospitals can turn people away.

    The Under-Secretary of State continued:
    "Commission members will be expert in hospitals and their systems and practices … We cannot expect them to have the same expertise in the workings of every institution where a mentally disordered offender might go if he does not go to hospital."—[0fficicl Report, Special Standing Committee, 17 June 1982; c. 614.]
    That sort of argument by the hon. Gentleman in Committee was pure casuistry. There is no basis for it at all. We are discussing not the institution but an individual who needs psychiatric treatment. Because of his teal need for that treatment the doctor in charge of him ought properly to have his decisions in certain circumstances reviewed by other doctors.

    Immediately after the Committee stage, the noble Lord Elton received the all-party penal affairs group and contradicted the Under-Secretary of State 100 per cent. He said that he wanted to bring the prison medical service closer into line with the profession as a whole and not leave it as a separate institution, detached in some way from the medical profession generally. I have to admit that the Minister of State, Home Office, the hon. and learned Member for Royal Tunbridge Wells (Mr. Mayhew), to whom I wish to pay tribute for his courtesy in discussing this matter, did not use what might be called the Finsberg argument in the letter he wrote to me. In a very sensible letter, he said that he saw the commission having three sorts of relationship with the prison medical service—first, in a general sense, to try to help the prison medical service in decanting those people who ought not to be in prison; secondly, in an individual sense, to help particular prisoners to find hospitals that are appropriate for them; thirdly, medical treatment, which goes to the nub of the amendment.

    The hon. and learned Gentleman said:
    "Third, there is the question of the medical treatment given to the mentally disordered person who remains in prison because no hospital place car be found. This is of course a matter for the clinical judgment of the medical officer, but as you point out he will often seek a second opinion from an outside specialist. It may indeed be, as you suggest in your letter, that psychiatrists called in by prison medical officers will be members of the Commission. It is also possible that prison medical officers w ill find it helpful to seek advice from the Commission itself, as a body which will have acquired extensive experience in the treatment of detained mental patients generally. We should be quite happy for the Commission to take on this role."
    I pay tribute to the Minister because the tone of his letter is completely different from the tone of the Under-Secretary of State's reply in Committee. Unfortunately, the hon. and learned Gentleman says in the final paragraph of his letter:
    "We do not think that such arrangements should be put on a statutory basis. While, therefore, we could not accept the amendment you have tabled for Report Stage, we do support its intent."
    How often does one hear that argument from Ministers? They are all in favour of the idea but they do not like the actual words of the amendment—because, as I suggested in Committee, much though Ministers would like to accept the amendment, the Home Office has consistently over the years refused to have any supervision outside the Home Office, of what goes on in prisons. The Select Committee on Education, Science and Arts is carrying out an inquiry into prison education. I suspect that it will find that something of a road block when it comes to make a report.

    I agree with a great deal of what the hon. Gentleman has said. There are many hundreds of people in prisons who should not be there at all. They should be receiving hospital treatment. Am I correct in saying that at the moment a psychiatrist, a doctor or medic from the mental health service can go into a prison? Is not the hon. Gentleman telling the House that that is to be changed and that there will be nothing on paper? At the moment it is a national scandal that there are hundreds of patients in prison who should be in hospital. If what the hon. Gentleman says comes to pass, does not that mean that the chances of their moving from prison to hospital will be that much more remote than they are at the moment?

    I fully agree with what the hon. Gentleman has said. The three legs of the Minister of State's argument ought to hang together on a statutory basis. If he wants to empty the prisons of those people who ought not to be there, constant pressure and review by the Mental Health Act Commission would be far more likely to bring that about than denying the Mental Health Act Commission some sort of statutory right there.

    My second reason for introducing the new clause is that there have been a number of incidents in prison which should cause the prison medical profession's supervision of patients suffering from psychiatric disorder brought under some form of review. The Prosser case is well known and it has been debated frequently in the House. Two recent deaths in London prisons—I could cite many more instances—were those of Terence Smerdon at Wandsworth and Paul Worrall at Brixton last year. Both individuals were in prison yet suffering from psychiatric disorders. This underlined the argument that, if the commission were given a list of individuals in prison who should be in hospital, if the parents were worried and could write to it and if it had a statutory right to supervise, the two deaths that took place last year might not have taken place and Terence Smerdon and Paul Worrall might be alive today.

    I am no longer demanding a statutory right of entry into prisons for the commission, although I think that I would be justified in doing so. I know that the Home Office has set its face against that. The new clause merely provides in the second subsection:
    "In the event of any person to whom subsection (1) … applies being detained or continuing to be detained in a detention centre or a youth custody centre or a prison then any member of the Prison Medical Service may consult the Mental Health Act Commission".
    I am merely saying that there should be a statutory right of consultation between the prison medical service and the Mental Health Act Commission. I am no longer asking for anything that could be described as mandatory. I drafted the clause in as modest a form as possible in the belief and hope that I would get the support of the Minister of State, Home Office. That is why I was intensely disappointed when I read the last paragraph of his letter, in which he stated that in his opinion it would be inappropriate to proceed on any sort of statutory basis.

    I want a statutory approach. I understand that the Minister may be exploring ways in which the Department of Health and Social Security and, I hope, the Home Office might issue instructions during the passage of the Bill both to the commission and to the prison medical service on how the two might work together and cooperate with each other to prevent the tragedy of the mentally ill committing suicide while in prison. According to the inquest, Terence Smerdon banged his head against the wall until he died. I hope that the approach that I have described will prevent such tragedies in future.

    I have already discussed these matters with the Minister of State and I shall want compelling arguments from him that are directed to why we should not adopt a statutory approach and which explain why he feels that advice from the Home Office and the DHSS could adequately replace legislation before I shall feel able to advise the House not to press this issue to a vote.

    6.45 pm

    I listened with great interest to the remarks of the hon. Member for Lewisham, West (Mr. Price). I hope that I speak with a little experience of the scandalous penal conditions that exist in the United Kingdom. The Director General of the Prison Service, with his long experience, says that the present system in the United Kingdom is an affront to a civilised nation. We must surely take notice of such powerful comments from that source.

    I urge my hon. and learned Friend the Minister of State, Home Office, on what is an important issue, to reconsider whether something can be done to meet what I would say is a reasonable request from the hon. Member for Lewisham, West.

    Those of us who spend a great deal of time in the examination of mental health conditions and all the problems that appertain to them and those of us who care and spend time trying to ensure that something is done to protect not only the rights of patients but the rights of prisoners, nurses, staff and prison officers, have constantly been worried and angered by the fact that almost weekly one reads in the national press of the strongest protestations of senior judges when they are forced to send men and women to prison because of the impossibility of getting them into psychiatric hospitals.

    I believe that beds are available for those who are suffering from mental disorders and who are now in prison. I believe that most of these people could be taken out of the prison system if the will were there to do so. I listened intently to the hon. Member for Lewisham, West and it appeared that something might happen that my hon. and learned Friend would not want to happen. It might become even more difficult for those who really care that men and women are in prison who should never be there to receive advice and to obtain proper medical reports before making representations to the Home Office so that transfers may take place. The Home Secretary, who will be much involved in a debate that is to take place later this week, the prison service and all those who are concerned are worried to death about the mounting possibility of a major rebellion in our prisons and institutions.

    We still have the asinine philosophy of sending fine defaulters to prison. Only last year we imprisoned 21,000 of them. Perhaps much will be changed following the passage of the Bill that is to come before the House later this week. The Bill that is before us has made possibly the greatest advances in mental health conditions since the 1959 Act. It seems to take about 20 years to update our outmoded practices for psychiatric hospitals and prisons. Surely we should not lose this major opportunity of correcting conditions that have existed for so long.

    I have always understood that doctors and professional people in the National Health Service have reasonably easy access to the prisons. The hon. Member for Lewisham, West spoke feelingly on that matter. What disturbs me is that I would be worried and distressed if there was any danger of not moving people from a prison system that they did not deserve into a hospital or psychiatric home. That would not be right. I hope that the Minister will agree that it is not his intention that that should be so. I hope that there will be some modicum of support for the hon. Gentleman's proposal.

    I hope that the Minister of State, Home Office, will accept the new clause that has been tabled by my hon. Friend the Member for Lewisham, West (Mr. Price). It is an extremely important new clause and extends the opportunities for treatment and advice that can be given about treatment for prisoners who are suffering from a mental disorder. My hon. Friend said that special hospitals cannot refuse to admit someone from a prison. That is not correct. I described the case of Paul in Wakefield in detail in Committee and referred to the activities of my right hon. Friend the Member for Wakefield (Mr. Harrison) who did a great deal to obtain admission for Paul to a suitable institution. One of the places that refused to admit Paul was a special hospital. It is open to either the medical director of a special hospital or to the DHSS to refuse admission to special hospitals. In that case it was the DHSS that refused to admit that young man to a special hospital.

    It is right to say that on many occasions prisoners whom the prison authorities feel should be in special hospitals are not accepted. My point was that it is rare for a prisoner who is convicted of a dangerous crime to be refused admission to a special hospital at the point of conviction.

    That may be correct. In the case to which I referred the offence was minor. It was felt that a special hospital was not appropriate for the offender. At the same time the medical director of an ordinary hospital refused admission because he felt that the offender needed to be treated in a more secure hospital. I wanted to make the point that people are not admitted automatically to special hospitals if they have committed offences.

    We hope that new clause 3, which has been added to the Bill, will reduce the number of people who are sent to prison instead of hospital. However, listening to the debate and having reflected on our debates in Committee, I am concerned that we tend to assume that if someone needs medical treatment he should go to hospital and not be imprisoned. I wonder whether that is correct. In our enthusiasm to ensure that people who should be in hospital are sent to hospital rather than prison we tend to assume that everyone who needs medical treatment for a mental disorder should be in hospital and not in prison. That may not be correct. Some people may need medical treatment for a mental disorder but may not need to be admitted to hospital. We were concerned in Committee to ensure that people who did not need to go to hospital were not admitted forcibly and detained against their will. Some of that category of people may be in prison. It is equally inappropriate for them to be sent to hospital and be detained there.

    I raised that point because I wondered whether we should leap to the conclusion that everyone who needs medical treatment should be in hospital and not in prison. There will continue to be people in prison who need medical treatment for a mental disorder. That, at least, is common ground. My hon. Friend's new clause seeks to make it more likely that there will be consultation and liaison between the Mental. Health Act Commission and the prison medical officers about the treatment of prisoners who need medical treatment for a mental disorder.

    My hon. Friend referred to a letter that he received from the Minister of State. I agree with my hon. Friend that it is not enough to draw the attention of prison medical officers to the existence of the Mental Health Act Commission and the advice that it can offer to them. I am disturbed by some information that was given to the House as a result of a parliamentary question tabled by my hon. Friend the Member for Lewisham, West. The question was answered on 5 July. It was clear from the answer that more than half of prison medical officers had no psychiatric qualifications. The Minister took some pleasure in announcing that 45 per cent. of prison medical officers had psychiatric qualifications. That means that 55 per cent. do not. That matter should concern the House. It is not enough to draw the attention of prison medical officers to the existence of the Mental Health Act Commission without encouraging them to keep in close touch with, and seek advice from, the Mental Health Act Commission.

    I have also tabled an amendment to my hon. Friend's new clause. Amendment(b)would make it possible for prisoners to receive treatment from doctors who treated them before they were sent to prison. I tabled the amendment as the result of some correspondence, whitch I have seen between my right hon. and learned Friend the Member for Warley, West (Mr. Archer) and the Home Office. Therefore, my concern is based on a real case. The prisoner had been receiving psychiatric treatment before he was sent to prison. He was transferred between prisons, and was in three prisons altogether. Originally he was in Lincoln prison and then he was transferred to Shrewsbury. The psychiatrist who was treating him before he was sent to prison was willing and, indeed, anxious to continue the treatment that his patient had received before being committed to priscn. The psychiatrist contacted the prison authorities in an attempt to continue the treatment. He encountered substantial resistance from the prison authorities. He was told at Shrewsbury that the prison hospital assumed all medical responsibilities and that unless the purpose of his visit was in connection with an appeal he would not be able to visit his patient.

    The prisoner was then transferred to Leyhill prison. The psychiatrist was told that he could visit his patient only in pursuance of a visiting order "in the normal manner". He was asking only for the courtesy of being enabled to see his patient in prison. He hoped to continue the treatment. The patient was anxious to receive treatment from his doctor but was prevented from doing so.

    When my right hon. and learned Friend complained to the Home Office, he was told that the prison medical officer had statutory responsibilities for the physical and mental health of every prisoner in the establishment and that it would be considered unethical for the psychiatrist to visit the prisoner. He could visit the prisoner as an ordinary visitor but must not enter into a clinical relationship with the prisoner.

    My amendment seeks to provide that, if a psychiatrist is willing to continue to treat a patient who has been confined in prison and if the prisoner is willing to receive the treatment, it would be possible for that to happen. I cannot understand why the Home Office should seek to prevent the continuation of treatment that has already been received by a patient suffering from a mental disorder. Therefore, I hope that my hon. Friend the Member for Lewisham, West will accept my amendment. I hope that the Minister will accept both the new clause and the amendment.

    Whatever happens to the new clause, I hope that the extremely important fundamental issue raised by the hon. Member for Lewisham, West (Mr. Price) and my hon. Friend the Member for Cheltenham (Mr. Irving) will be looked at again by the Home Office and the Department of Health and Social Security.

    7 pm

    We have known about the problem of mentally ill prisoners for a long time. About six years ago I had an Adjournment debate on the subject. I take the point made by the hon. Member for Birmingham, Stechford (Mr. Davis) that not every such prisoner needs to go to hospital, but it is a real problem. The last time that I looked at the matter there were about 1,000 of these individuals in prison who were clearly wrongly placed. A gamut of suggestions has been made to Governments of various complexions but little seems to happen. The situation gets worse and worse. Today, access to more independent medical advice has been suggested, and there is the proposal for regional secure units. Whatever happens to the new clause I hope that the Government will look again at this extremely important social problem.

    I am grateful to the hon. Member for Lewisham, West (Mr. Price) for what he said at the beginning of his speech about our consultation and correspondence.

    My hon. Friend the Member for Worcestershire, South (Mr. Spicer) stated that it has long caused great anxiety that any, let alone so many, people are held in prison who are mentally disordered and who should be in mental hospitals. That view has been reflected by everyone who has spoken in this debate. Although the number remains a cause of deep anxiety, in recent years it has decreased as more prisoners are transferred to hospitals. In the mid-1970s just over 50 prisoners a year were transferred. In 1980 it was nearly 100, and the number is increasing. That is a small measure of reassurance. At 31 March 1982 there were 287 mentally disordered inmates so identified. In June 1977 the number was 769. But I do not draw attention to the trend at all complacently.

    I understand the intentions of the hon. Member for Lewisham, West. His views about the desirability of bringing the prison medical service under the National Health Service are well known but I do not share them. Nor do I accept his view, which is shared by the hon. Member for Birmingham, Stechford (Mr. Davis), that the tragic instances could have been prevented had the prison medical services been organised differently. However, in certain circumstances it might be useful for those responsible for the care of the mentally disordered prisoner to have recourse to the Mental Health Act Commission for advice and support.

    The hon. Member for Lewisham, West was kind enough to refer to the letter that I wrote to him in July. I said that we would be ready to encourage the development of a non-statutory arrangement to that effect.

    The debate should be within a narrow compass—whether there should be statutory incorporation of the principle that prison medical officers may consult the commission. Let me explain the arrangement whereby there could be consultation. If the commission felt able to take a general interest in the difficulties that are too often experienced in finding hospital places for offenders, the Home Office would co-operate and would welcome any suggestions that it offered. Its annual reports would be a highly influential vehicle to that end.

    Does the Minister's reference to annual reports mean that the Government are changing their mind about having them only every two years, and accepting the Opposition's suggestion?

    I should not think so for a minute. But the commission's reports would be an obvious way to bring pressure to bear. If it had suggestions, I would not want it to wait for even a year to go by. The suggestion should be put forward as soon as it is formulated.

    In individual cases where it proves difficult to obtain a hospital admission for a mentally disordered offender the commission's involvement will necessarily be limited. As was explained in Committee, it cannot provide the desired solution—a hospital bed. It cannot wave a wand or impose an obligation on the DHSS or an individual hospital to provide a bed. But members of the commission may be able to provide useful advice to a prison medical officer experiencing such a problem, and we would encourage medical officers to seek such advice if it were available. As I said in my letter, the commission will in any event be building up a body of knowledge about the treatment of mentally disordered patients. We hope that prison medical officers will feel able to approach it on any matter on which that knowledge and experience would be helpful generally, or in particular cases. We wish actively to encourage such practice.

    It must necessarily be less than a hard and fast statutory arrangement for two reasons. First, the medical treatment given to a prisoner is for the professional judgment of the medical officer, who has complete clinical freedom, which includes the discretion to refer a patient to a specialist. Many mentally disordered prisoners are referred to an NHS consultant psychiatrist. Medical officers may well wish to seek a second opinion on a mentally disordered prisoner. Incidentally, I do not suppose that any medical officer wishes to have in his prison any person whom he has identified as mentally disordered. He may well wish to seek a second opinion from an outside psychiatrist who is a member of the commission. But we must retain the freedom for him to go elsewhere for advice.

    Secondly, we can only speak tentatively about what the commission will or will not do. As it gains experience it will be for the commission to decide what it can offer.

    Why is it proper to limit the clinical freedom of a consultant psychatrist at Broadmoor by allowing the commission at short notice to interview the patient alone and look at the records yet not the clinical freedom of a prison medical officer who may not be nearly so eminent as some of the consultants at special and other hospitals?

    While there are similarities between the position of the prison medical officer vis-a-vis his patient, and that of the responsible medical officer at a special hospital, their positions are not absolutely on all fours. As the hon. Gentleman knows, prison rules specifically state that the prison medical officer is responsible for the care of the mental and physical health of all inmates in his prison. The inmates are sent to prison for reasons quite unconnected with their health, and the prison medical officer cannot pick and choose those whom he wishes to treat. Although some of that applies to the special hospital doctors, it does not to the same degree. Patients are in special hospitals so that they can receive the care of a doctor. In extreme cases, if they cannot benefit from treatment, the doctor may suggest a transfer or a discharge. I recognise the force of the hon. Gentleman's argument, but I hope that he will accept that the cases are not on all fours.

    There are two reasons why I cannot advise the House to accept the new clause. First, as was explained in several different contexts in Committee, we are against the unnecessary weighing down of this or any other legislation with declarations of good practice, which in the end add nothing to the position which already obtains. That is what the new clause does. It is a purely permissive power. It does not seek to impose a duty on the prison medical officer to consult the commission, or on the commission to respond, and therefore it is of no practical effect. A prison medical officer is already entirely free to call into consultation anyone he wishes. The difficulty is that, because the power to consult is not set out in statute, that suggests that it is not available.

    Secondly, in seeking to place the proposal on a statutory basis, the new clause inevitably draws the net too tightly, and thereby sacrifices the advantages of flexibility which a non-statutory arrangement would confer. It would surely be better for all concerned if the commission could be consulted not only about the categories of prisoner specified in the clause, but about any prisoner whom the prison medical officer feared would shortly fall into one of those categories. In that way, the commission's involvement would stand a much better chance of conferring some tangible benefit on the prisoner. It would be a pity to confine the commission to the residual role of advising on the medical treatment of such a prisoner only after it had proved impossible to have him admitted to hospital.

    It would not be possible to modify the new clause to overcome those difficulties and make it acceptable. One cannot draw up a statutory definition of the categories of prisoner to whom the new clause is to apply based on what the prison medical officer thinks might happen in the future in their cases. Nor, in any event, would it be wise to impose any statutory duty on the prison medical officer to consult the commission.

    I have tried to explain the various ways in which the Government would be prepared to help and encourage the involvement of the commission on a non-statutory basis. When the commission begins work it must decide what it can contribute in that area. We shall do all possible to encourage the development of links between the prison medical service and the commission. I wish to assure my hon. Friend the Member for Cheltenham (Mr. Irving) that the provisions in the Bill will in no way diminish the ability of anybody to visit a prison and discover what is happening in the case of an individual prisoner I know that he has long been concerned in such matters.

    Amendment(b), tabled by the hon. Member for Birmingham, Stechford (Mr. Davis), would give those in a prison department establishment, because efforts to arrange a transfer to a psychiatric hospital had failed, the right to be treated by a doctor of their choice. I recognise the force of his illustration of a psychiatrist who wished to follow up the progress of a patient whom he had previously treated.. I understand his wish to give mentally disordered people whom we all agree should not be in a penal establishment a free choice of doctor. However, his amendment would have unfortunate consequences.

    Prison medical officers are unique in having a statutory responsibility, to which I have referred. That reflects the fact that, just as prisoners cannot have a choice of doctor, a prison medical officer cannot choose whether he accepts a certain prisoner as his patient. If a prisoner decided to see another doctor who prescribed a course of treatment, the prison medical officer could find himself in an impossible position. He would be responsible for the care of the prisoner's health, even though he might disagree with the treatment. I cannot see a way around that difficulty.

    It is not true that prisoners are treated only by doctors who work for the prison medical service. I have more than once referred to the discretion of prison medical officers who refer their patients to outside specialists. Last year psychiatrists from outside the prison medical service had more than 10,000 consultations with inmates, at the request of the responsible prison medical officer. Any inmate to whom the amendment applied would necessarily have seen an outside psychiatrist when the transfer reports required by the legislation were prepared. In many cases the patient would continue to see the specialist. The decision whether another opinion should be sought must, however, be left to the discretion of the prison medical officer, otherwise he cannot continue to exercise his responsibilities properly. The result could be only that the health care of prisoners would suffer.

    As prison medical officers can already seek a second opinion, other than on clinical grounds, there is perhaps an assurance that those responsible for the amendment have not as yet observed.

    7.15 pm

    I understand the force of the Minister's remarks—that the prison medical officer should decide whether a second opinion is required. However, does he not think that it is desirable that a psychiatrist who has been treating a patient should continue to do so when the patient becomes a prisoner if he so wishes? It is not desirable for a psychiatrist to be brushed off, as happened in the example that I quoted.

    In general, and as a layman only, I can envisage circumstances in which that might be desirable. It is, therefore, relevant that prison medical officers have already been specifically advised to consider referring patients to another doctor—even if that is not clinically necessary—if they believe that that might benefit the patient by reducing undue anxiety.

    I apologise for having spoken at length, but I have had to deal with a number of difficult questions and quite proper interruptions. The present arrangements are the most satisfactory approach to the medical treatment of mentally disordered prisoners. The new clause would be detrimental to a prisoner's interests. I hope that the hon. Member for Lewisham, West (Mr. Price) will withdraw the new clause.

    The response from the Minister has been considerably better than that which we received in Committee. I take at face value his desire to promote a better relationship. Some of his arguments were a little harsh, and he described my new clause as permissive. I would have loved to make it stronger, but his hon. and learned Friend the Minister for Health advised the Committee that such an amendment could not be accepted. Nor do I believe his arguments about prisons to be right. He said that a prisoneer could not have a choice of doctor. That applies also to the detained psychiatric patient. He cannot say that he does not like a particular doctor. He must be treated by the doctor allocated to him in exactly the same way as a prisoner.

    The special responsibility laid down in prison rules for the prison medical officer is in no way different from the special responsibility of a responsible medical officer in a psychiatric hospital. I am not convinced by the Minister's arguments. I wish that I could accept the amendment to my new clause in the way in which I would be allowed to accept an amendment in my local general management committee. However, according to the rules of the House, until the principle of the new clause is accepted, the House cannot condider any amendments to it.

    In order to get an expression from the House about the real problem highlighted by my hon. Friend, I advise him to press the new clause.

    Question put, That the clause be read a Second time:—
    The House divided:Ayes 107, Noes 154.

    Division No. 302][7.20 pm

    AYES

    Archer, Rt Hon PeterDalyell, Tam
    Atkinson, N.(H'gey,)Davidson, Arthur
    Bagier, Gordon A.T.Davis, Terry(B'ham, Stechf'd)
    Beith, A. J.Dean, Joseph(Leeds West)
    Bennett, Andrew(St'kp't N)Dixon, Donald
    Booth, Rt Hon AlbertDobson, Frank
    Bray, Dr JeremyDormand, Jack
    Canavan, DennisDouglas, Dick
    Cocks, Rt Hon M.(B'stol S)Duffy, A. E. P.
    Cowans, HarryDunnett, Jack
    Craigen, J. M.(G'gow, M'hill)Dunwoody, Hon Mrs G.
    Crowther, StanEadie, Alex
    Cryer, BobEastham, Ken
    Cunningham, Dr J.(W'h'n)Ellis, R.(NE D'bysh're)

    English, MichaelOwen, Rt Hon Dr David
    Ennals, Rt Hon DavidPalmer, Arthur
    Evans, loan(Aberdare)Pavitt, Laurie
    Evans, John(Newton)Pitt, William Henry
    Ewing, HarryPowell, Raymond(Ogmore)
    Flannery, MartinPrice, C.(Lewisham W)
    Ford, BenRobertson, George
    Forrester, JohnRoss, Ernest(Dundee West)
    Foster, DerekSever, John
    Foulkes, GeorgeSilkin, Rt Hon S. C.(Dulwich)
    Freeson, Rt Hon ReginaldSkinner, Dennis
    Grimond, Rt Hon J.Soley, Clive
    Hamilton, James(Bothwell)Spearing, Nigel
    Hamilton, W. W.(C'tral Fife)Spriggs, Leslie
    Hardy, PeterStoddart, David
    Harrison, Rt Hon WalterStott, Roger
    Haynes, FrankThomas, Dafydd(Merioneth)
    Homewood, WilliamThomas, Mike(Newcastle E)
    Hooley, FrankThomas, Dr R.(Carmarthen)
    Howells, GeraintThorne, Stan(Preston South)
    Hoyle, DouglasTinn, James
    Hughes, Robert(Aberdeen N)Torney, Tom
    Jones, Barry(East Flint)Varley, Rt Hon Eric G.
    Kerr, RussellWainwright, R.(Colne V)
    Lamond, JamesWainwright, E.(Dearne V)
    Leighton, RonaldWatkins, David
    Lewis, Ron(Carlisle)Weetch, Ken
    Litherland, RobertWelsh, Michael
    Lofthouse, GeoffreyWhite, Frank R.
    McDonald, Dr OonaghWhitehead, Phillip
    McNally, ThomasWhitlock, William
    McNamara, KevinWigley, Dafydd
    McWilliam, JohnWilson, William(C'try SE)
    Marshall, D(G'gow S'ton)Winnick, David
    Marshall, Dr Edmund(Goole)Woolmer, Kenneth
    Marshall, Jim(Leicester S)Wright, Sheila
    Mason, Rt Hon RoyYoung, David(Bolton E)
    Maynard, Miss Joan
    Meacher, MichaelTellers for the Ayes:
    Milian, Rt Hon BruceMr. Allen McKay and
    Morris, Rt Hon A.(W'shawe)Mr. George Morton.
    Morris, Rt Hon C.(O'shaw)

    NOES

    Alexander, RichardFairgrieve, Sir Russell
    Alison, Rt Hon MichaelFaith, Mrs Sheila
    Ancram, MichaelFell, Sir Anthony
    Aspinwall, JackFookes, Miss Janet
    Atkinson, David(B'm'th,E)Forman, Nigel
    Baker, Nicholas(N Dorset)Fowler, Rt Hon Norman
    Bendall, VivianFry, Peter
    Benyon, Thomas(A'don)Gardiner, George(Reigate)
    Berry, Hon AnthonyGarel-Jones, Tristan
    Best, KeithGoodhart, Sir Philip
    Biggs-Davison, Sir JohnGoodhew, Sir Victor
    Blackburn, JohnGoodlad, Alastair
    Boscawen, Hon RobertGow, Ian
    Bottomley, Peter(W'wich W)Grant, Anthony(Harrow C)
    Bright, GrahamGreenway, Harry
    Brinton, TimGrieve, Percy
    Brotherton, MichaelGriffiths, Peter Portsm'th N)
    Brown, Michael(Brigg & Sc'n)Grist, Ian
    Buck, AntonyGrylls, Michael
    Budgen, NickHamilton, Michael(Salisbury)
    Burden, Sir FrederickHannam, John
    Carlisle, John(Luton West)Haselhurst, Alan
    Chalker, Mrs. LyndaHeddle, John
    Chapman, SydneyHenderson, Barry
    Clark, Hon A.(Plym'th, S'n)Hill, James
    Clarke, Kenneth(Rushcliffe)Hogg, Hon Douglas(Gr'th'm)
    Cockeram, EricHolland, Philip(Carlton)
    Colvin, MichaelHooson, Tom
    Cope, JohnHowell, Ralph(N Norfolk)
    Cormack, PatrickIrvine, RtHon Bryant Godman
    Costain, Sir AlbertJopling, Rt Hon Michael
    Cranborne, ViscountKaberry, Sir Donald
    Crouch, DavidKershaw, Sir Anthony
    Dickens, GeoffreyKitson, Sir Timothy
    Dover, DenshoreLang, Ian
    Dunn, Robert(Dartford)Lawrence, Ivan

    Lennox-Boyd, Hon MarkRippon, Rt Hon Geoffrey
    Lester, Jim(Beeston)Roberts, M.(Cardiff NW)
    Lloyd, Peter(Fareham)Rossi, Hugh
    Loveridge, JohnRumbold, Mrs A. C. R.
    Luce, RichardSainsbury, Hon Timothy
    Lyell, NicholasSt. John-Stevas, Rt Hon N.
    McCrindle, RobertShaw, Giles(Pudsey)
    Macfarlane, NeilShaw, Sir Michael(Scarb')
    MacKay, John(Argyll)Shepherd, Colin(Hereford)
    Macmillan, Rt Hon M.Sims, Roger
    McNair-Wilson, M.(N'bury)Skeet, T. H. H.
    McNair-Wilson, P.(New F'st)Smith, Tim(Beaconsfield)
    Madel, DavidSpeed, Keith
    Major, JohnSpeller, Tony
    Marlow, AntonySpicer, Jim(West Dorset)
    Mather, CarolSpicer, Michael(S Worcs)
    Maude, Rt Hon Sir AngusSquire, Robin
    Mawby, RayStanbrook, Ivor
    Mawhinney, Dr BrianSteen, Anthony
    Maxwell-Hyslop, RobinStevens, Martin
    Mayhew, PatrickStradling Thomas, J.
    Mellor, DavidTaylor, Teddy(S'end E)
    Meyer, Sir AnthonyTemple-Morris, Peter
    Mills, lain(Meriden)Thomas, Rt Hon Peter
    Moate, RogerThompson, Donald
    Morrison, Hon C.(Devizes)Thornton, Malcolm
    Murphy, ChristopherTownend, John(Bridlington)
    Neale, GerrardTrippier, David
    Needham, Richardvan Straubenzee, Sir W.
    Neubert, MichaelViggers, Peter
    Newton, TonyWaddington, David
    Osborn, JohnWaller, Gary
    Page, John(Harrow, West)Ward, John
    Page, Richard(SW Herts)Watson, John
    Parris, MatthewWells, Bowen
    Pattie, GeoffreyWells, John(Maidstone)
    Pollock, AlexanderWheeler, John
    Price, Sir David(Eastleigh)Wickenden, Keith
    Proctor, K. HarveyWolfson, Mark
    Raison. Rt Hon Timothy
    Rathbone, TimTellers for the Noes:
    Renton, TimMr. Archie Hamilton and
    Ridsdale, Sir JulianMr. David Hunt.

    Question accordingly negatived.