Health and Social Care Bill

Lord Alderdice Excerpts

Monday 5th December 2011 Lords Chamber

[Lord Adebowale]

My Lords, I support the amendment in the name of the noble Lord, Lord Patel of Bradford. I should first declare my interest as the CEO of the social enterprise, Turning Point, which provides mental health, substance misuse and LD services.

When I looked at this clause, I wondered whether there was malice aforethought but I was reassured by the civil servants that that is not the intention. I know full well that the Minister’s intention is always to be helpful. I understand that it was not the intention of this clause to wreck a partnership between health and social care that has been around since 1983 and has ensured that detained patients obtained an appropriate care plan, provided by a joint duty requiring PCTs and local authorities to work together to provide aftercare. I think that this clause was an attempt to tidy things up in some way and to provide clarity.

However, I should warn the House of the consequences of such a tidying-up exercise on the lives of detained patients. The current arrangements effectively hide the wiring about who pays and any debates on their provision of aftercare. There was a statutory curse on both the local authority and the NHS, should they fail to sort it out, which in effect has ensured that people who are detained get the care and support that they need on departure.

More to the point, experience tells me that the removal of this duty creates the very real possibility of one or other of the parties refusing to pay, thus leaving the client in an expensive limbo. The really worrying changes suggested in the clause refer to the fact that CCGs will no longer be under any duty to arrange aftercare in co-operation with relevant voluntary organisations. Furthermore, the clause goes on to state that CCGs, due to commission healthcare services, will be limited to services under Section 3A, effectively meaning—as set out by the noble Lord, Lord Patel—that health services only may be provided, thus opening up patients to funding disputes about whether they get care, and if so who pays.

There are other worrying suggestions in this clause that give cause for concern and that open up the possibility, as the noble Lord, Lord Patel, has pointed out, of charging for the services of aftercare. The question I would put to the House is: who is charging whom? Who pays under these circumstances?

In the excellent briefing provided by the Royal College of Psychiatrists, Mind, Rethink, the Centre for Mental Health and the Mental Health Foundation, a scenario was set out which I want to put to the House, because it illustrates the reality. We often debate these clauses in the absence of their real impact upon real people.

Mr B had a diagnosis of schizo-affective disorder and was unable to read or write due to also having a learning disability. He had a history of being detained under the Mental Health Act and of being discharged with Section 117 aftercare packages and then withdrawing from services in due course as his situation improved. However, as is often the case, he would then relapse and be returned to hospital. His aftercare package comprised a care worker from his community mental health team, who spent about two hours per week helping Mr B with paperwork—such as housing, rental and other benefits and community appointments—and the community psychiatric nurse, who administered medication. On health grounds, the health authority decided that the community mental health team support was to be withdrawn, but made no provision for further support with paperwork or appointments. Without that support, Mr B could not manage his tenancy, bills or get to his GP for his medication; he would certainly have relapsed quickly and stayed in a relapsed position, costing the state, the health authority and social care far more. There had been no recent reassessments of Mr B’s needs by social services and they had not agreed to the withdrawal of any services.

With the help of an advocate, Mr B was able to argue that Section 117 aftercare was his right and should not have been withdrawn without the agreement of social services. As a result, the support was left in place, he won his argument and social services agreed to review his needs before any further decision was made. That is the result of what we currently have in place. Remove that, and Mr B does not have those rights and is left in limbo.

This clause creates a gap through which not only Mr B will fall, but many others. It also places many services in the not-for-dividend and voluntary sector at risk of sudden withdrawal of funding, as has been pointed out by the noble Lord, Lord Patel. My own services, some of which we have raised finance to fund, will be at immediate risk. I would not be in a position to continue those services; they will not be available for people leaving detained services and therefore the care will not be available. I urge the House and the Minister to do everything necessary to retain the current certainty for Mr B and for many like him.

[Lord Alderdice]

My Lords, I support the amendment of the noble Lord, Lord Patel of Bradford. The Minister will know well that one of the many attractions of the Health and Social Care Bill for me is the lengths that it goes to in order to try to achieve some degree of integration between healthcare and social care, and indeed integration of various other kinds. For the most vulnerable of all patients, not only physically but mentally and socially, who are at serious risk, such integration of healthcare and social care is of enormous importance—something that I know well from my own experience.

It is surprising to me that in this clause it is as though we are going in the opposite direction. Instead of healthcare and social care being integrated, they are being separated out. I rather suspect that the noble Lord, Lord Adebowale, is right: while in previous clauses the criticism from the other Benches has been that too much complexity is being introduced into the system, on this occasion the attempt to simplify things may actually be the problem. It may have seemed that it would be good to get clarity and give the responsibility to one side or the other, but the care of those who are mentally disturbed to the degree that they are a risk to themselves or someone else and therefore have to be detained cannot be accomplished by either one side or the other, either healthcare or social care; they need to be working together.

I appeal to the Minister to look at this question again. I do not think anyone suspects there is any malice aforethought in this. The clause is rather complex, referring to lots of other pieces of legislation, and it may merit being looked at again in order to ensure that those who have been cared for up until now by a more integrated approach will not in any way lose out from the change that is proposed.

[Lord Marks of Henley-on-Thames]

My Lords, I shall speak to Amendment 237, a probing amendment concerning independent mental health advocates, in my name and that of my noble friend Lady Williams. It concerns Clause 40 of the Bill. The scheme for independent mental health advocates was introduced into the Mental Health Act 1983 by the 2007 Act, and came into force in 2009. Under the legislation, the responsibility was that of the Secretary of State, and, under the regulations, commissioning was to be job of PCTs.

Mental health advocates fulfil an important function. They act as independent advocates experienced in mental health matters to provide qualifying patients with help and advice. Qualifying patients are those who are liable to be detained, who are subject to guardianship and who are community patients, and patients can qualify in some other circumstances. The help involved can include help and advice on: the provisions of the legislation; the conditions and restrictions to which such patients can be subject; importantly, the mental treatment that they are receiving or are likely to receive; why it is being given; and their rights in connection with it. The right also involves a right to help and advice on visits and, importantly, a right for the advocate to inspect the medical records of the patient.

The point to which the amendment is directed is that, under Section 130A of the 1983 Act, subsection (7) introduces an element of discretion because regulations may make different provisions for different circumstances and cases. That may be unexceptionable as it stands, but the difficulty is that there is a concern when the Secretary of State’s function is transferred to local social services authorities. The amendment raises particular concern about the position of minors, and seeks to ensure that independent mental health advocates must be made available to minors who are qualifying patients. Minors who are also mentally ill are in the worst possible position to speak for themselves and to seek help independently. Therefore, we invite the Government to respond with an indication of how, after the transfer of functions to local social service authorities under Clause 40, they intend to monitor the working of the independent mental health advocate provisions; and to ensure their provision, particularly to this very vulnerable class.

Middle East: Water

Lord Alderdice Excerpts

Thursday 27th October 2011 Lords Chamber

Asked By

[Lord Alderdice]

To ask Her Majesty’s Government what assessment they have made of the Strategic Foresight Group’s report The Blue Peace on transforming water from a source of conflict into a basis for co-operation in the Middle East.

[Lord Alderdice]

My Lords, first, I declare my interests as in the Register of Lords’ Interests. I am president of ARTIS (Europe) Ltd, which is a research and risk analysis company that takes some interest in the affairs of the Middle East and further afield. I have a number of non-remunerative interests in the Gulf policy forum, International Dialogue Initiative, World Federation of Scientists, Conflicts Forum, and Oxford Research Group. Of course, as I think noble Lords are aware, my real interests in this issue, this area and this subject go back a good deal further than any of my involvements in the organisations that I have mentioned and come from my experience in my part of the world, where I became aware that groups of people can be set against each other not because anybody wants conflict or its terrible results, but because they find themselves trapped in it.

I am particularly honoured not only that a number of noble Lords who share those interests are participating in this debate but, in particular, that the noble Lord, Lord Williams of Baglan, has chosen this debate for his maiden speech. He is an extremely distinguished diplomat, but I was privileged to come to know him through his involvement as UN special representative and then UK special representative in the Middle East. In conversations with him, I have found him thoughtful, enlightening, instructive, supportive and encouraging. It is a great delight to me to see him on the red Benches of your Lordships' House because I have no doubt that he will bring a very distinctive style and an extraordinary and distinguished experience to the corpus of knowledge and understanding in your Lordships' House.

Even before meeting the noble Lord, Lord Williams, I found myself very much involved in trying to find ways in which it was possible to encourage or facilitate people in the Middle East, not just in Israel and Palestine, although that is an important part of the area, but in other places, to see if any of the experiences that we had in the United Kingdom and more broadly might be helpful to them in finding a way out of the problem. Initially, I found myself doing what I had found extremely difficult to do at home, which was to engage with people who I not only disagreed with deeply but who were prepared to use or to threaten to use violence. I found that although it was possible for me to do that, many others simply found it beyond what was possible for them to consider, at least at that juncture, although my experience is that eventually it is necessary in most cases, but not all, to engage with those who cause the violence if you want to bring the violence to an end.

I then began to look at what had been necessary to create the context where we could address the issues between the British and Irish Governments and within the Province of Northern Ireland. The truth was that we probably would never have been able to do it if there had not been a wider framework in which that was possible: in particular, the European Union, and the good relations of both our countries with the United States. Some noble Lords will remember that some years ago I introduced a debate in your Lordships' House on the development of an inclusive, semi-permanent conference on the Middle East, the creation of a table where people from different countries with very different prospects could meet and engage with each other, as we have done in the European Union. Despite all the current financial and economic difficulties, we must not forget that we have now had two and more generations of peace in western Europe. I sometimes think we forget about that when we get so involved in the economic questions. Fundamentally, the European Union is an instrument of peace and conflict resolution much more than it is a matter of economics, which is the instrument, not the purpose.

I found that even as we tried to press this question there seemed to be a lack of urgency, so I went back to my colleagues in the Strategic Foresight Group, which is based in Mumbai, who had helped to put together that report on the inclusive semi-permanent conference for the Middle East and encouraged them, along with some other friends from the Middle East and the United States, to produce a report on the cost of the conflict, which is many trillions of dollars over a number of years. I rather hoped that when people saw the enormous cost, not just to people in the region, but to all of us, perhaps it might encourage them to address these questions. But while we think that economics is the dominant factor, I am afraid that the truth is that there are some things that are even more important for us as human beings, and we sometimes engage in activities that are to our massive economic detriment because there are other values that drive us.

I went back to my colleagues in the Strategic Foresight Group to think about whether there were things that we were missing or that we did not understand and were necessary. As we looked back at the European Union, whose development has been of such importance, as I have said, we were struck by the way in which, after the Second World War, the matters chosen for co-operation—coal and steel—were the very materials used to create the weapons of war and were based in the very areas that had been matters of dispute. We began to ask whether there are similar commodities in that region that could be or could become the cause of conflict, but which, if handled in a different way, could become the mechanism for co-operation, because they are shared requirements and shared needs. In the Middle East, the issues are not coal and steel, but water, energy and the environment. These things transcend borders in any case, but in a region like the Middle East many borders were simply straight lines drawn on a map with little cognisance given to social questions of tribe or community, to geographical and economic geographical questions, or to rivers and mountains and other kinds of naturally bounded communities. Things like water, energy and the environment transcend all our borders, especially in the Middle East.

Through colleagues in the World Federation of Scientists and a number of other such specialist groups, we began to look at water in particular. We thought that, if it is possible for people to understand that we need to engage with these issues as human communities and that we can learn a great deal from each other, perhaps with that engagement on human, social, economic and scientific projects, separate from the apparently almost insoluble political questions, we can build relationships between the countries that will enable us to address these other questions, as has been the case in our own part of Europe.

Our friends in the Strategic Foresight Group put together a report, which some noble Lords will have read while others will have read a précis of it. But noble Lords will clearly see that a thorough, thoughtful and deep piece of work has been done on many of the technical and scientific questions that must be addressed. But that, in a way, is simply to show that these are serious issues which need exploration. In practice, when we have gone to these countries and Governments, and have been able to bring many of them together in conferences in Turkey, Switzerland and elsewhere, it has been clear that there are opportunities to co-operate.

Noble Lords will not be surprised to know that we very quickly ran into the problem that most countries in the region simply would not sit down with the Israeli Government. We tried various ways to facilitate that but we came to the conclusion that for the present that is not possible, which is a dreadful pity. The Israeli Government and the Israeli scientific community have been remarkable in the developments of technology that they have been able to make in their region. Their capacity for recycling water, for example, and for using it is way ahead of any other country in the world. There are so many things that they could give—and in terms of the availability of water, a country like Turkey has so much to give. But it simply proved to be impossible to get them together at this stage.

Therefore, we tried to bring together those countries in the north—Turkey, Syria, Lebanon, Iraq and Jordan—and to bring Israelis together with Palestinians and, indeed, with Jordanians. There has been some progress and there is an interest in moving forward on these issues. Of course, it is true that with the advent of the Arab spring, profound uncertainty has been thrown over all of this. In particular, it is impossible to do any work with Syria and the Syrian Government at the moment. One might well say, “Surely, that just throws the whole thing to the side”. I do not believe that for two reasons. First, the proposition that we tried to create institutions that enabled governments to co-operate on issues like water is not something for this week, next month or even the next year or two. We did not develop the European Union over a year or two but over many decades. This approach requires decades of overcoming hurdles and working together. The second thing is that if we do not have positive outcomes and directions for the Arab spring, then what may have started as an exciting prospect for the region could turn out to be much more disappointing and difficult.

I am grateful to the House for the opportunity to raise this question and I hope that the Minister may at least be able to indicate Her Majesty’s Government’s preparedness to address this issue. We are not looking for money from the Department for International Development but for diplomatic encouragement through the Foreign Office to our diplomats in the region.

Middle East Peace Process

Lord Alderdice Excerpts

Wednesday 4th May 2011 Lords Chamber

[Lord Alderdice]

My Lords, the strategy that has been adopted for some time—isolating Hamas in Gaza—seems no longer tenable. As many of us have advised, it was not a long-term option. In the case of Egypt itself, the Arab spring has meant that instead of standing in the way of an accommodation between Fatah and Hamas, Egypt has within weeks facilitated it. It has also, as the noble Lord, Lord Anderson, indicated, pledged to open the borders. This in practice makes the siege of Gaza impossible to sustain. However, while we might focus on others in the few minutes available to us for this debate, I should like to put to the Minister the question of how Her Majesty’s Government will respond to two developments.

The first development is the move towards a Palestinian Government who are more inclusive and supported by Fatah and Hamas. Will Her Majesty's Government engage with that new Palestinian Government, or will they do what they have done in the past, and what they did after the Mecca agreement, and avoid engagement because of the support or participation of Hamas?

Secondly, in the event—as seems extremely likely, as the noble Lord, Lord Anderson, said—that the United Nations General Assembly approves a Palestinian state on the 1967 borders, albeit a relatively virtual one, what will be the approach of the United Kingdom Government? Will we support such an application? If it is approved by the General Assembly regardless of whether we support it, what will be the attitude? This is not, of course, a question only for us or the United States. If Hamas is part of a UN-approved Palestine, what will be its reaction to a UN-approved Israel? Everyone is put under pressure to recognise each other. However, I would appreciate the Minister's response on those two questions.