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Mental Health (Approval Functions) Bill

Volume 552: debated on Tuesday 30 October 2012

Considered in Committee (Order, this day)

[Dawn Primarolo in the Chair]

Clause 1

Authorisation of approvals given before this Act

Question proposed, That the clause stand part of the Bill.

I want to raise two specific points. Opposition Members are concerned that the concept of “Any person” in clause 1 is too broad, because it appears to legalise approvals by anybody. Why does the clause not refer specifically to North-East, Yorkshire and the Humber, West Midlands and East Midlands?

Secondly, where is the provision for the doctors who have been approved by a trust according to what we now understand was a defective process to be re-approved by the correct process? As the clause stands, it seems—I am happy to be put right on this—that doctors approved previously by the trust will be able to continue to section patients without re-approval under the correct process.

I will first set out what the clause seeks to do and then respond to the shadow Minister’s questions.

The clause directly addresses the issue that the Bill intends to resolve. Between 2002 and 2012, four strategic health authorities delegated to mental health trusts the function of approving doctors with responsibilities under the Mental Health Act 1983. The legal advice that we have obtained is that there are good arguments, as we have already discussed, that decisions to detain made by doctors who were approved in that irregular way are nevertheless lawful. The clause removes any doubt—that is its purpose. It clearly spells out that when mental health trusts gave approval in the past they are to be treated as having had the power to do so.

The clause has the effect of eliminating any irregularity from decisions made in complete good faith, and in the best interests of the patient, by doctors fully qualified to make them. It does so in a way that is fully consistent with the legal and clinical advice that we have received on the issue, and means that patients and their families do not have to undergo the process of assessment for detention under the Act again solely for the purpose of correcting a technical error made by a strategic health authority.

The hon. Lady asked why the clause was so broad as to refer to “Any person”. I understand her concern, but the point is that we do not yet know whether there were other issues before the establishment of the SHAs. Obviously, that is part of the work that the review will undertake, but to ensure that we resolve the problem absolutely and that all those patients have clarity the decision was made for the clause to refer to “Any person” in order to avoid any risk of our uncovering another problem that might need a separate resolution. This deals with the whole problem of the approval process for the doctors who made those decisions.

The hon. Lady then asked, correctly, whether decisions will be taken properly as we progress. I can confirm that all the doctors have already been re-approved according to a proper process, so every decision that is taken from hereon in cannot be challenged. As we have said, any patient who wants to question the clinical judgement can do so and their rights remain the same as they have always been. This simply addresses the technical issue that we have been debating today.

The clause refers not only to “Any person” but one who

“has done anything in the purported exercise of an approval function”.

On both counts, it is incredibly widely drawn and could take us into the territory of other elements of the approval process that may have been defective. Will the Minister assure the Committee that the clause is as narrow as it needs to be? It seems to be uncomfortably wide and may well restrict somebody’s ability to challenge an element of their section other than the fact that the doctor was not approved by the SHA. It is very loose in its current form.

I am grateful to the shadow Secretary of State for that intervention. We have gone through a very careful process and have followed legal advice on what is necessary to regularise the position. This relates specifically to the approval function, which is defined in clause 1(2). As I have said, the legal advice is that this is the best way to regularise the issue that has been uncovered.

Before the Minister responded to the intervention by my right hon. Friend the Member for Leigh (Andy Burnham), he told my hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott) that if mistakes had been made before the establishment of the SHAs, some of the doctors who had not been properly approved previously may not have been approved by the executive action that the Secretary of Sate referred to earlier. Will the Minister assure the Committee that, should such instances come to light, those doctors will also be subject to a re-approval process?

The first thing I want to clarify, again, is that the clause ensures that if any previous authorisations were not done in accordance with the statutory provisions, the clause regularises that process, full stop. Of course, if we go back a long way, that may apply to people who have long since been discharged from their section. This regularises the situation for all. It also ensures that the detention of anyone who continues to be sectioned is regularised, because the original authorisation is deemed to be acceptable under the Bill and in accordance with parliamentary intent, as the Secretary of State said earlier.

I am grateful to the Minister, but he has not fully answered my question. The Secretary of State has now properly given approval to those who were previously improperly approved. The Minister is right that many of the people in question may have retired or left, but some may still be practising. If further instances come to light, will they too be subject to a new scrutiny process?

I absolutely take the right hon. Gentleman’s point, and I am grateful to him. We must be absolutely certain that everybody is now properly authorised to make decisions. We know that everybody outside the four affected SHAs has been properly authorised—that has been checked and confirmed by SHAs, which have undertaken a proper check of their procedures. We also know that the four affected SHAs have already regularised the position of all their authorised practising doctors. We therefore know that across the whole system, doctors who undertake sectioning from now onwards will be properly authorised in accordance with the Mental Health Act 1983. The Bill addresses the previous problems with the authorisation process, and we have addressed the problem for the future by ensuring that everybody is properly authorised. I hope that deals with that point.

I am grateful. It is important to get clarity before we leave this clause.

I know that the Government have not yet undertaken a full case-by-case review of the up to 5,000 cases involved. That prompts the question how the Government can be sure that the whole team involved in each case was qualified to a suitable level, and that there were not some instances of under-qualified people making decisions. That gives rise to concern that we may be retrospectively approving processes that were defective.

I do not think there is any suggestion that any of the people who undertook sectioning were not medically qualified to do so. The issue is simply with the body that undertook the authorisation and the fact that SHAs delegated that responsibility to mental health trusts, which was not in accordance with the law. The Bill is intended to regularise the position of every clinician who was not properly authorised because of that flaw.

I do not want to detain the Committee unnecessarily, but because the clause is drawn so widely it will possibly take away some people’s right to challenge whether there was a deficiency in the process or whether someone involved in the sectioning decision was under-qualified. Given that the Government have not undertaken a case-by-case review, I wonder how we can have absolute confidence that the power in the Bill is not too widely drawn.

I am told that we have dealt, doctor by doctor, with all the doctors in question who are currently practising. The problem relates to the doctor, not the patient, because it is about their authorisation to undertake the duties in the 1983 Act. The only people who undertake the actions referred to in the clause are doctors, who were authorised but unfortunately by the wrong body. That is what we are seeking to regularise.

We must have absolute clarity about this. In that case, why does the Bill mention “Any person” rather than “any doctor”? Our understanding is that a broader team of people can be involved in a sectioning decision, such as a social worker. If it is only doctors, the Bill should just say “any doctor”, but it does not.

We are talking about the approval function. Subsection (2) mentions

“practitioners approved to give medical recommendations”,

so it clearly deals with practitioners who have already been authorised, but by the wrong body.

I am genuinely trying to understand this point and ensure that the Bill is as foolproof as possible. As I understand the Government’s case, the clinical need of people with mental health problems—the Bill clearly would not apply to people who did not have mental health problems—is trumping the absence of proper process, so the Bill is not an abuse of human rights.

The difficulty that I have with that argument—perhaps I ought not to have it, and maybe I am being particularly thick—is that the clinical need in question was established through a process that is acknowledged as formerly having been flawed. The clinical need is apparent only when a case has been heard and processed. The concept of clinical need here is certainly—

Order. May I say to the hon. Gentleman that this is an intervention, and interventions are supposed to be brief? I know that this is a complex point, but interventions are becoming speeches within the Minister’s speech. If the hon. Gentleman could make his point succinctly now, it would help all of us.

My point is that the definition of clinical need ought to be good enough for a psychiatrist, but I am not convinced that in this context it is good enough for a lawyer.

All that is being regularised is the power to approve a doctor, not whether a doctor is clinically sound. Any patient who challenges a judgment to section them either now or in the past will retain all their rights in law. We have acted on the advice of both lawyers and clinicians to ensure that we deal with the problem that has emerged in a way that respects patients’ clinical interests and considers them with the utmost seriousness. To go through a full reauthorisation process in every case could be incredibly damaging to individuals in potentially vulnerable situations. The Bill is based on the best clinical and legal advice that we have received on how to deal with the problem.

The Opposition have listened with great care to what the Minister has said. He has made a point of saying that his advice suggests that the Bill is the best way to deal with the situation. We argue that it is perhaps the most convenient way, but we know that the parliamentary draftsman has been under huge pressure to produce the Bill, and this would not be the first time that parliamentary draftsmen have come up with a form of words that is in some way defective. I repeat our concern about the broad nature of the clause, which states that “any person” who “has done anything” is to be “treated for all purposes”.

Perhaps I can assist in this matter. I do not believe that there is a drafting error, but the hon. Lady is absolutely right to scrutinise every word of the Bill carefully and ask questions.

Clause 1 does not mention “any doctor” because it is about the power for an SHA to delegate the authority in question, not about a doctor’s decision or clinical ability. It refers to the person who approves that power of delegation. I hope that that clarifies the matter.

We have listened to what the Secretary of State and the Minister have said. We remain concerned about the broad nature of the clause, but we rest our case.

Question put and agreed to.

Clause 1 accordingly ordered to stand part of the Bill.

Clause 2 ordered to stand part of the Bill.

The Deputy Speaker resumed the Chair.

Bill reported, without amendment.

Third Reading

I beg to move that the Bill be now read the Third time.

This has been a distinctly unusual process for the House, and one that is unprecedented for recent Members. Only after hard—if very rapid—consideration over the weekend did I decide that emergency legislation was the only safe course, and recommend that to the Prime Minister.

Retrospective legislation affecting an individual’s right to liberty is a major step, and it would be intolerable to have any doubt about such an important part of the law. Such a situation would be unacceptable for patients, their families, and doctors and nursing staff in NHS and independent hospitals. I have been insistent throughout that the clinical needs of patients should take priority within the law, and that legislation should be as tight as possible to ensure that patients’ legal rights are protected.

I thank Opposition Members for the way they have responded and for making it possible to legislate in such short order. I also thank hon. Members generally for their constructive challenge and scrutiny. Although there is need for urgency, it is essential that the Bill is properly tested, which hon. Members have done.

The House has acted wisely and swiftly in the interests of up to 5,000 highly vulnerable people. It has recognised the important human rights issues involved, and balanced that with clinical advice about the best interests of those people. I commend the Bill to the House.

The Opposition thank the Secretary of State and the Minister for attempting to answer all the questions that colleagues have raised. We appreciate that they have acted in good faith in bringing this legislation before the House with such speed, but, as my hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott) rightly said, this takes us into unprecedented territory. We are legislating retrospectively on matters of fundamental importance concerning people’s basic rights and public safety, and it is therefore right for the House to pause for thought and consider those issues before giving its assent to the legislation.

We had an important exchange on the precise drafting of the legislation, and a concern arose during the course of that debate. Clause 1 essentially states that “any person” who has undertaken any activity

“had the power to do so”.

If I heard the Minister and the Secretary of State correctly, that is not carte blanche to justify anything—including something inappropriate—that may have happened over the course of a decision, but simply means that the person who made the decision had the power to do so. I hope that people outside this House will hear those words clearly and understand that that is the only permission the House is giving this afternoon on this exceptional basis. In doing so, we return to the point about balancing our concerns about the exceptional nature of this legislation with the fact that this issue affects thousands of the most vulnerable people in our society and their families. We do not want any further distress caused to those people, or for them to suffer any unsettling effect, and that is why the Opposition believe that the legislation is justified.

It is crucial that no legal doubt hangs over arrangements that are made for patients and public safety. This Bill removes that doubt, but we do not want to remove any of the rights held by the individuals concerned, and in particular the 5,000—or more—people who may currently be challenging their detention. Having made that point as clearly as I can, the Opposition give the Government their support. We will seek to ensure that co-operation is continued in another place so that the Bill can be put on the statute book, and any uncertainty removed.

Question put and agreed to.

Bill accordingly read the Third time and passed.