Care Bill [Lords]
Baroness Primarolo Excerpts(10 years, 11 months ago)
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Paul Burstow
My hon. Friend has taken a close interest in, and campaigned on, the Bill during its passage through the other place, and he said how widely welcomed it was outside the House. Would he be interested to know, therefore, that in almost every session of the scrutiny of the draft Bill—
Madam Deputy Speaker (Dawn Primarolo)
Order. Will the right hon. Gentleman face the rest of the Chamber and address the Chair, and while I am on my feet, I should remind him of two things: interventions should be brief, and handheld devices in the Chamber, before or after interventions, should be used with due decorum.
Paul Burstow
I apologise to you, Madam Deputy Speaker. I have been here long enough to know that I should speak through the Chair.
I simply wanted to say that during consideration of the draft Bill, when asked, many people told us they had nothing by way of criticism of the Bill, although they saw areas where it could be further improved.
G8 Summit on Dementia
Baroness Primarolo Excerpts(10 years, 12 months ago)
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Sarah Newton
Only yesterday, we took evidence from Professor Collinge from University College London and Professor Ironside from Edinburgh, who are leaders in the field of degenerative brain disease. They provided us with even more compelling evidence of the increasing difficulties of getting from the research stage to being able to secure enough commitment from the pharmaceutical industry and other bodies that fund research into developing the science into diagnostic and therapeutic techniques. They reported that the pharmaceutical industry, which is a massive investor in research and its outcomes, is getting far more risk-averse and, as a result, is putting many more burdens on to the research of scientists in universities—burdens that they are not really capable of taking on board. The G8’s focus on getting the companies and clinicians, as well as researchers, around the table to look at the pathways from the science into scaleable, commercialised solutions is vital.
It is important that we do this not only in our own country but internationally, because most of the regulations are international. Where there is not international agreement, that in itself becomes a barrier to research and its commercialisation. The work done at the G8 will enable there to be much larger markets, meaning that very many more people will be helped and that money will flow into the research and make it more widely available.
The transcripts from our findings yesterday will be available in a couple of days’ time. That should give the Minister a good opportunity to look at the evidence we were given by those very eminent researchers, who are undertaking research into prions, as well as looking into developments on variant CJD, which is a form of dementia, and how that links to other types of dementia such as Alzheimer’s. We need that sort of joining up across the process to enable diagnostic and preventive procedures, and therapies, to be developed. All the various scientists—
Madam Deputy Speaker
Order. The hon. Lady heard me say that if Members wished to hear the Minister and the Opposition Front-Bench spokesman there should be no further interventions. She took a further intervention and she will have to conclude very quickly.
Sarah Newton
My last point is to urge the Minister to look to ensure at the G8 that the various scientists and the various disciplines work together.
Stafford Hospital
Baroness Primarolo Excerpts(11 years, 4 months ago)
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Joan Walley (Stoke-on-Trent North) (Lab)
I am most apologetic about arriving late to this debate and not having the opportunity to hear the opening part of the hon. Gentleman’s speech. To find a long-term solution for health care in Mid Staffordshire and in North Staffordshire, it is vital that the Minister refers in his reply to the best way of ensuring that the emergency services and all the other services that people want can be retained. That can be achieved only if we have a proper collaboration between the University hospital of North Staffordshire, which must be at the front of—
Madam Deputy Speaker (Dawn Primarolo)
Order. Had the hon. Lady been here from the beginning, she would have heard what the hon. Member for Stafford (Jeremy Lefroy) said about that. Her intervention was rather long, and we are running out of time.
Health and Care Services
Baroness Primarolo Excerpts(11 years, 4 months ago)
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Madam Deputy Speaker (Dawn Primarolo)
Order. The hon. Member for North Durham (Mr Jones) has only just come into the Chamber. Interventions are normally about facilitating those who have heard the debate, and it is not appropriate just to walk in and intervene. The hon. Gentleman is experienced enough to know that that is the case.
Grahame M. Morris
Am I allowed to give way to my hon. Friend, Madam Deputy Speaker?
Madam Deputy Speaker
This is a timed debate. The courtesies of the House, which have been circulated to Members of Parliament a number of times, are not about walking in, spending a few minutes in here, then intervening. Of course the hon. Member for Easington (Grahame M. Morris) can give way if he chooses to do so, but he might want to bear in mind that other Members who have been in the Chamber for some time are still waiting to speak. That was the point I was making.
Grahame M. Morris
With all due respect, Madam Deputy Speaker, I know that my hon. Friend was at the same meeting as me on Friday, and he will probably have a relevant point to make about that, so if you do not mind, I will give way to him.
Carers
Baroness Primarolo Excerpts(11 years, 5 months ago)
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Madam Deputy Speaker (Dawn Primarolo)
Order. When the hon. Lady addresses that point, will she also pay attention to the fact that there are other Members who wish to speak and that she has been speaking for nearly 18 minutes?
Accident and Emergency Waiting Times
Baroness Primarolo Excerpts(11 years, 5 months ago)
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Madam Deputy Speaker (Dawn Primarolo)
Briefly. Interventions are supposed to be brief, not a speech in their own right. The right hon. Lady will have to resume her seat.
Heidi Alexander
I agree that the evidence on which that assertion was based is deeply spurious and a meeting with Sir Bruce Keogh, which I requested, would be very helpful to the three Lewisham Members.
The situation, as I said, is repeated all over the country. There are more people stuck on ambulances waiting to get into A and E, more people waiting longer for treatment when they get there, and this Government’s answer is to close the A and E, ask people to travel further, and tell them to go to a bigger hospital, where the queue will probably be longer. If this is not the politics of the lunatic asylum, I do not know what is.
My constituents in Lewisham have been told that their full A and E service has to close in order to bail out the hospitals down the road. The whole decision-making process has been opaque and, in my view, deceitful. It is now rightly being challenged in the courts by Lewisham council and the save Lewisham hospital campaign. But for now, my constituents still face the prospect of seriously downgraded services at their local hospital. Not only are my constituents being told that they will have to travel further in future to get to an A and E, but to add injury to insult, they are being told to go to departments where performance is generally below that at Lewisham. In 29 of the 35 weeks between the end of September last year and the end of May this year, people were seen more quickly at the A and E in Lewisham than they were at the hospitals within the South London Healthcare NHS Trust where they are now being told to go.
In the first four months of this year, ambulances were placed on divert 25 times to Lewisham hospital. They were diverted away from the very hospitals where my constituents are now being told to go. It does not take a brain surgeon to work out why 25,000 people chose to march against these proposals in January. Under no circumstances should any changes at Lewisham hospital be made unless ambulance diverts have stopped and waiting time targets in neighbouring hospitals have been met. I do not want the changes to happen at all, but surely this is the least that the Government should commit to.
The Government seem intent on blaming everyone but themselves for the crisis in A and E. They seem oblivious to the fact that the things they are doing now, such as destabilising reorganisations and the devastating cuts to adult social care, are making the situation worse. They are shutting their eyes to the problem and ploughing on regardless with a programme of A and E closures. I accept that in some places reconfiguration of hospital services will be necessary, but this process must be driven by what is in the best interests of patients. That is not what is happening in Lewisham.
The Government want to blame everyone but themselves for the crisis in the NHS. The sooner we ditch the blame game and have a grown-up debate with thought-out solutions, the better our NHS will be for it.
Ann Clwyd
No, I am sorry, I cannot.
Finally, my GP friend said:
“These matters and the ways you expressed your concerns are so similar to the events described in the many many letters you have received from others who have described similar misgivings. It must be very difficult to have to ‘use’ your own very personal experience as a prompt to drive the response and search for answers that so many want from you. But that is your job as Member of Parliament, to identify what, if anything—”
Madam Deputy Speaker (Dawn Primarolo)
Order. I remind the House that there are nine speakers still to be called, and that the winding-up speeches will begin at 6.40 pm. That means that some Members who have been sitting in the Chamber will not be able to contribute. I therefore ask Members to be sparing with interventions, and to make them only when they are absolutely crucial. I also remind them that interventions must be short, and must relate to the point that the speaker was making at the time rather than be an extra debating point.
Mr Thomas
I share the view of my neighbour and hon. Friend the Member for Brent North (Barry Gardiner). We need that expansion to go ahead, and to go ahead soon.
In an intervention during the speech of my right hon. Friend the Member for Leigh (Andy Burnham), I raised the plight of many of my constituents who formerly used Alexandra Avenue polyclinic, an extremely popular walk-in centre which used to be open from 8 am until 8 pm, 365 days a year, to people who were genuinely concerned about their health and did not feel that they could wait to see their GPs. It was opened by Ara Darzi some five years ago. Amazingly, its opening was opposed by my political opponents in Harrow, but it quickly came to be greatly appreciated by, in particular, people living in the south Harrow and Rayners Lane area. Those people have noted with considerable regret that, after the last general election, the primary care trust decided to restrict the opening hours of their walk-in centre, but not those of the walk-in centre in Pinner, in the constituency of my other neighbour, the hon. Member for Ruislip, Northwood and Pinner (Mr Hurd).
As a result of the cuts that the primary care trust decided to make, the walk-in service now operates only between 9 am and 3pm on Saturdays and Sundays. The fact that it remains open at all is entirely due to the scale and strength of feeling about the loss of what was an excellent service, and the campaign that we were able to run in order to save it. Perhaps some of the £3 billion that the Prime Minister spent on what was—as others have already pointed out—a completely unnecessary reorganisation of the NHS could have been invested in keeping Alexandra Avenue polyclinic open, and some of the pressure that my constituents are imposing on Northwick Park hospital’s accident and emergency unit could have been alleviated.
Staff at the excellent Pinner ambulance station in Rayners Lane do an extremely good job, generally spending all their shifts out on the road. It is clear that they, like the rest of the staff of the London Ambulance Service, are under extremely heavy pressure. On occasion, ambulances have been used as temporary reception or holding areas at Northwick Park when patients cannot be admitted to A and E as they arrive because of the pressure on that department.
There is also concern about the district nursing service in Harrow. My personal experience of that service has been mixed. An elderly relative and, more important, that person’s carer have found it difficult to gain access to it by telephone when problems have developed. It has been slow to respond, and has demonstrated poor co-ordination with other parts of the local health care system. Again, funding was cut by the primary care trust.
The new clinical commissioning group has given notice to the local trust which runs the service that it may outsource the contract, but I am not convinced that that is the answer. Investment in staff—trained staff—and, crucially, investment in management time by the local trust seems to be the immediate requirement if the problems in the service are to be sorted out. Meanwhile, to those who are aware—as many of my constituents are—that the district nursing service is far from brilliant, it is hardly surprising that family members should want to delay the discharge of elderly patients from Northwick Park.
It is telling that the number of cancelled operations is rising fast at Northwick Park. So far, it has risen by some 13%. That is a further symptom of the crisis in the national health service, as evidenced by others—
Barbara Keeley (Worsley and Eccles South) (Lab)
We have a crisis in A and E; that is clear from this afternoon’s debate. The King’s Fund report this week detailed the worst performance in nine years, with 5.9% of patients waiting more than four hours. It has been suggested that patients are just going where the lights are on. Is that the case?
I got information on A and E from the chief executive of Salford Royal NHS Trust, comparing the third and fourth quarters of 2011-12 with those in 2012-13. He found that there are 10% more ambulance arrivals every day. We actually have sicker patients, with more arriving by ambulance. There has been a 13% increase in admissions of people staying longer than 72 hours, and fewer are staying for shorter periods. There are 25% more triages into the hospital’s resuscitation area, and there has been a significant increase in risk and co-morbidity among patients and increased admissions into critical care. There is something going on there.
We know that the rising demand for A and E is particularly concentrated in those aged over 85, and cuts in social care budgets are now widely acknowledged as contributing factors. My local authority of Salford must make £24 million of cuts this year. It is the third year of cuts, and now the authority, having held on to services meeting a moderate level of eligibility, is moving to meeting only substantial levels of eligibility, taking £3.5 million out of adult social care this year and £3.5 million next year. Our former Salford primary care trust had already cut the two walk-in centres that we had, and axed the pilot of active case management for people with long-term conditions.
How is that affecting people? What do carers say? Carers UK has carried out a survey of 3,500 carers, 55% of whom are caring for a person who has been admitted to emergency hospital services in the past three years. A significant percentage of those carers referred to areas where additional support could have prevented those emergency admissions. What types of care were needed? Six per cent. said that they, the carer, needed replacement care because they were ill themselves; 21% per cent. needed a higher quality of care and support for the cared-for person; 10% needed adaptations in the home, and 7% would have been helped by telecare and telehealth. Those findings tie in with some of my casework in recent weeks, when I have heard some very similar cases.
The King’s Fund report tells us that the prospects for adult social care are bleak. Councils are planning to reduce their budgets by another £800 million a year. That is a cumulative cut since 2010 of 20% in adult social care. My local hospital tells me that patients are coming in sicker, they are admitted for longer stays, they require more time and attention and they are now heavy resource-users. It is time that Ministers stopped making excuses and started dealing with this crisis.
Mental Health
Baroness Primarolo Excerpts(11 years, 6 months ago)
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Mrs Moon
There is an issue with the interaction of mental health and alcohol. I repeatedly had texts from a dear friend of mine who is a minister in the Church. He had severe depression and was self-medicating with alcohol. His family and the police would repeatedly take him to mental health services, which would turn him away, because they said he had been drinking. He was drinking because he needed their services and could not access them. We have to ensure that mental health services cannot turn away people who have been drinking, but hold them until they are no longer under the influence of alcohol and then ensure that they access the services they need. The link between alcohol and mental health has to be explored and tackled.
Madam Deputy Speaker (Dawn Primarolo)
Before the hon. Member for North Durham (Mr Jones) continues, let me say that interventions are becoming speeches in their own right, when they are supposed to be brief and pertinent to the point that has just been made. If we could return to that, perhaps it would help the flow of the debate.
Mr Jones
It is a statement of fact that people with mental illness will self-medicate, and alcohol is the most easily available drug. I am surprised by what my hon. Friend describes. If services are taking that approach to people, that is wrong. Her point is also linked to the bigger debate about access to alcohol.
Let me return to the issue of stigma, which my hon. Friend the Member for Dudley North (Ian Austin) raised. He quite rightly said that we do not talk about it, but we are making some progress. I thank Mind, Time to Change, Rethink and the Royal College of Psychiatrists for doing a great job of raising the issue and tackling the stigma. We should remember that it is not just the individuals with mental illness who suffer, but family members too. Earlier my hon. Friend the Member for Ashfield (Gloria De Piero) mentioned her own family. A lot of families suffer in silence because they think there is no one to turn to. In many cases, they think they have failed in some way or wonder where they can get help. It is not uncommon—I have come across a lot of these cases—for carers to end up suffering from mental illness themselves because of the daily pressures on them.
The hon. Member for Broxbourne raised the issue of schizophrenia. I pay tribute to the Schizophrenia Commission, which reported towards the end of last year. It looked not only at services for schizophrenia, but at the stigma attached to. Again, the popular image in the media is that someone suffering from schizophrenia is potentially the mad axeman or woman next door who will come and kick the door in, when nothing could be further from the truth. When we describe people’s conditions, there is an onus on us all to describe them properly, because there are people suffering from schizophrenia who, with proper treatment and support, can function quite normally.
I also pay tribute to the hon. Member for Croydon Central (Gavin Barwell), who introduced the Mental Health (Discrimination) (No. 2) Act 2013—a good use of a private Member’s Bill. Like my friend the hon. Member for Broxbourne, I also pay tribute to Lord Stevenson, not only for championing the Bill through the other place, but for the work he does with his new charity. Did that legislation help in itself? Yes, it did, because it sent a clear signal that we were starting to take discrimination more seriously. Will it change things overnight? No, I do not think it will, but the more we talk about the stigma, the better people can address it.
I have been criticised—we see this occasionally in some newspapers—by people who say, “Well, it’s okay for famous film stars or even MPs to say they’ve suffered from mental illness,” as though it is somehow an easy thing to do, but I can tell Members now that it is not. I would like us to reach a position where people generally are talking about mental illness, so that if people are suffering in a workplace, they can open up to their colleagues. I should point out—not just to people in this Chamber, but to those in the wider audience—that most people who are suffering from a mental illness would be very surprised by the reaction if they told people. However, it is a big step, and I know personally that it is a very difficult one to take.
One of the best examples of that was from a Channel 4 programme that I appeared on after I spoke last year—I pay tribute to Channel 4 for its work to raise awareness of the stigma around mental illness. The programme had the great title of “Mad Confessions” and was presented by a very mad individual called Ruby Wax. By chance, it happened to include one of my constituents, Derek Muir, who suffered from depression. The programme started with him talking about his depression—he had been off work for a number of months and lives in Edmondsley in my constituency. At the end of the programme they got all his colleagues together in a room and he told them. It was the first they had known about it, but the reaction was very positive and supportive. That is the point we need to get to. Sometimes it is a big step for people suffering from mental illness or depression to admit what is seen as a frailty—although it is not. The strength is in opening up and asking for help.
One area that we need to do more work in is getting mental health policies in the workplace right. I pay tribute to BT and Dr Paul Litchfield for their policies, which have buy-in not just at the level of personnel managers, but from the board downwards. They are not only talking about getting people to talk to one another and open up about mental illness, but trying to be supportive of people with mental illness. When I was at a seminar with Paul last year, somebody asked him, “Why has BT done this? Is it just to tick the social responsibility box?” He said no. Indeed, the board was quite clear: the policy makes economic sense for BT. The message we need to get across to more and more employers is: “Why write off people who are valuable to your business, just because they happen to suffer from a mental illness?” BT is to be congratulated, and I certainly congratulate the board and Paul on their work in this area.
Health and Social Care
Baroness Primarolo Excerpts(11 years, 6 months ago)
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Sir Gerald Kaufman (Manchester, Gorton) (Lab)
On a point of order, Madam Deputy Speaker. I am sorry to interrupt the debate, but I need to raise a matter of extreme urgency. At the weekend, a constituent of mine, Augustine Umukoro, came to my surgery to consult me about his immigration situation. He handed me a letter and told me that he had had a meeting with representatives of the UK Border Agency, who said that in two weeks they might have to start removal proceedings, for which they would visit him and his family—his wife and their two children—in their home. I therefore dictated a letter to the Home Secretary today, asking her to look into the matter. Within the past hour, I have had a telephone call from Mr Umukoro to say that when he reported to the UK Border Agency office at Dallas Court in Salford, as he does every week, he and his children were taken into custody. His wife was not, as her whereabouts appeared to be unknown. He was taken down to Heathrow, and he is due to be removed from this country at 10 o’clock tonight without any warning and without the Border Agency having fulfilled any of its conditions.
I took the matter up with the office of the Minister for Immigration, the hon. Member for Forest of Dean (Mr Harper), half an hour ago. His principal private secretary told me that, as far as he knew, the Minister was content for the removal to go ahead. This is not a removal; it is a kidnapping. It is against every aspect of the rule of law in this country, and I am making it public because it is about time that acts such as these were stopped and because, in this particular case, Mr Umukoro should be allowed, through his Member of Parliament, to make representations.
Madam Deputy Speaker (Dawn Primarolo)
As the right hon. Gentleman will know, that is not a point of order for the Chair. He is an experienced Member of Parliament, and he has placed this important issue on the record today, which I suspect was his intention. I am sure that he will continue to hold discussions with the relevant Minister right up to 10 o’clock tonight. This is not a matter for the Chamber or for the Chair but, as I have said, I know that he will wish to pursue it elsewhere.
Mental Health (Approval Functions) Bill
Baroness Primarolo Excerpts(12 years ago)
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Madam Deputy Speaker (Dawn Primarolo)
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.
Mental Health (Approval Functions) Bill
Baroness Primarolo Excerpts(12 years ago)
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Mr Dave Watts (St Helens North) (Lab)
My right hon. Friend is absolutely right when he says that mental health has been the poor relation of the health service, but does he agree that, within that mental health service, children’s mental health services have often been the poor relation again? Does he hope that the Government will address specific services for children who need mental health services?
Madam Deputy Speaker (Dawn Primarolo)
Order. As important as the debate is, the wider considerations of mental health and its treatment are not actually the subject for today—that is the Bill before us. So in rising to answer his hon. Friend’s problem, I am sure that the shadow Secretary of State will come back to the specifics of the Bill.
Madam Deputy Speaker (Dawn Primarolo)
Order. We are again going very wide of the Bill and the points that are supposed to be made in relation to it. The right hon. Gentleman’s question does touch on that, but I would be grateful if the Secretary of State, in responding, returns to the Bill by focusing on the items that we will be voting on today.
Mr Hunt
The answer to the right hon. Gentleman is yes. I will now return to the specific questions asked about the Bill.
The hon. Member for Southport (John Pugh) talked about the important issue of discrimination—that is, whether we are behaving differently because these patients have a mental illness. Removing discrimination does not mean treating everyone exactly the same. In fact, we will remove discrimination in the mental health field by better understanding the vulnerabilities and needs of people who have serious mental health problems, and that might mean treating them differently to account for that. The hon. Gentleman is absolutely right to say, as was the hon. Member for Hackney North and Stoke Newington (Ms Abbott), that important human rights issues need to be considered. I want to reassure him that, even in the four SHAs where the technical irregularity in the approval of doctors arose, the criteria were as rigorous as those used to make the clinical assessment that it was necessary to detain someone under the Mental Health Act. The same quality of expert advice was drawn on in order to make those decisions.
The right hon. Member for Oxford East asked why we are not limiting the legislation to the four SHAs where we have identified this technical irregularity. That is because we do not know at this stage whether the problem may have predated the establishment of SHAs—we should remember that these powers go back to the Mental Health Act 1983—and therefore, to make sure that we deal with the problem in its entirety, it is better to include the whole country in the legislation lest we find at a later date that the problem had existed in other parts of the country, perhaps prior to the foundation of SHAs.
On human rights, I have signed a piece of paper saying that I believe that the Bill is compliant with the European convention on human rights. I did that on the advice of Government lawyers and of the Attorney-General. The Attorney-General believes that, were a case to be brought now, people would be entitled only to nominal compensation because this is a technical, not a substantive, irregularity, and it is therefore not, on this occasion, a breach of people’s human rights to pass a law retrospectively.
The hon. Member for Arfon (Hywel Williams) asked why this has taken so long—why, for example, the Mental Health Commission did not identify the problem in its years of existence. That is a very important question. I cannot pretend that I have the answer now, but I want Dr Harris to look into that issue in enormous detail because I want to know whether there is a risk that other errors, similar or related, might exist in other parts of the system. The House needs to understand much better whether we should be concerned about that and whether the right governance procedures are in place.
The hon. Gentleman mentioned advocacy. As he will know, all patients have a right to an independent mental health advocate, but that process has not always worked as well as it should. I want to use the opportunity of the transfer of those responsibilities from primary care trusts to local authorities to make sure that we have proper procedures in place so that people really do get the advocacy support that they need.
Let me confirm to the hon. Gentleman—we received this piece of information as my hon. Friend the Minister was speaking—that someone approved in one SHA is able to practise in other SHAs. That is partly why the legislation needs to be UK-wide. We have had a lot of discussions about this with doctors’ representatives, particularly the Royal College of Psychiatrists. I do not believe that there are any implications for the second doctor or the social worker, but if I receive advice to the contrary I will write to him to let him know.
I think that I have covered most of the points raised by the hon. Member for Wolverhampton North East. She asked what is going to happen when the SHAs are abolished. We will be asking Dr Harris to address that when he carries out his independent review.
Finally, I turn to the hon. Member for Hackney North and Stoke Newington and her important comments about the seriousness with which we must treat any retrospective legislation. She referred to what Hayek said about that, with which I wholeheartedly agree. I did not think that we would be agreeing across the Dispatch Box about Hayek, but there it is. She made the important point that due process is about respecting technicalities, so we cannot brush it aside. That is why this legislation is necessary. A failure of due process—a failure to observe technicalities—puts us in an extremely difficult situation where ordinarily we would want to say that due process should be observed in all circumstances and that we should not pass retrospective legislation on that. In this particular case, however, it would have been against the clinical interests of 5,000 highly vulnerable people were we simply to consider that single legal perspective; the broader clinical perspective needs to be recognised.
The advice that I received from Professor Sir Bruce Keogh, the medical director of the NHS, was very important in persuading me that we needed to take the route of emergency retrospective legislation. He said that the alternative, which was to go through all 5,000 people and redo the entire sectioning process now that all the doctors have been properly validated, presented serious clinical risks to those individuals. It is a very difficult matter. As the hon. Lady and I are trading political thinkers, perhaps I could refer her to Isaiah Berlin and say that sometimes important moral principles are not totally consistent with each other. This is one of those occasions, and we have to weigh her very important points about the need to avoid retrospective legislation, even on technicalities, against the clinical interests of a highly vulnerable group of people.