Mental Health Act

Lord Williamson of Horton Excerpts

Monday 29th October 2012 Lords Chamber

[Earl Howe]

My Lords, I would willingly give the noble Baroness further details. Unfortunately, I do not have any beyond those that I gave to her noble friend Lord Hunt. I will gladly pick up the very valid points that she has made and let her know as soon as I can. Perhaps when we reach Second Reading of the Bill, which I believe has been timetabled for Wednesday, I shall have a more detailed answer to give her. If she is not in the Chamber, I shall make sure that she receives it by other means.

[Lord Williamson of Horton]

I have a particular interest in the Mental Health Act 1983, because I played some role in getting some provisions on to the statute book. I am normally very against any retrospective legislation, but in this particular case I strongly support the view taken by the Government, because it is absolutely essential to avoid a situation in which we impose disruption and distress on a large number of people who are vulnerable and in difficult circumstances in any event. For what I may call “human reasons”, the alternative was rightly ruled out, and I support the Government’s view.

[Earl Howe]

I am most grateful to the noble Lord, Lord Williamson. Indeed, it was the well-being of patients that was central in our mind when we sat down to consider how to resolve this very unfortunate situation at the end of last week. I hope and believe that patients should not suffer any inconvenience or distress at all as a result of the remedial route that we chose.

Health and Social Care Bill

Lord Williamson of Horton Excerpts

Wednesday 29th February 2012 Lords Chamber

[Baroness Masham of Ilton]

My Lords, I support my noble friend's amendment. Only yesterday, there were headlines in the press about the American study in the BMJ Open which found that sleeping pills were linked to increased death risks. It was found that death risk among users was about four times higher than among non-users. UK guidelines for NHS staff state that hypnotic drugs should be used for only short periods of time, because of tolerance to the drug and the risk of dependency, but they make no mention of an associated death risk, despite other studies having already reported that potential risk.

Many of your Lordships will know that doctors often do not review their patients’ drugs enough. Patients can have repeat prescriptions for years, putting them at great risk. Addiction to prescribed and over-the-counter drugs is an enormous problem. Groups which give support to the unfortunate people who become addicted themselves need support. Will CCGs be able to do that? Does the Minister think that that serious problem will get worse? My noble friend’s amendment is an effort to make that worrying situation better. I hope that the Minister will accept the amendment.

[Lord Williamson of Horton]

My Lords, the amendment deals with the distressing and serious problem of addiction to certain prescription drugs and, as is specified in the text, the problem of withdrawal from those drugs, because when such efforts are made, on many occasions they unfortunately fail and result in other difficulties for the patient in question.

Without going into detail about what may happen to the amendment, I hope that the Minister will be able to confirm that there should be an appropriate priority for the services available to treat that distressing problem. I do not press the point more than that, but it would be useful if we could have that sort of assurance from the Dispatch Box. In particular, whether the Minister agrees with this or not, some of us believe that in the past the issue has been allowed to fall into the shadows. That is what has happened in practice. It has been neglected and people have suffered in consequence. Perhaps we are improving but we could improve more, and I hope that the Minister will give an encouraging reply about the appropriate priority that ought to be given to the problem.

[Baroness Finlay of Llandaff]

My Lords, this is a clear example of an iatrogenic condition, very often originating in primary care. When patients have presented with insomnia, instead of being taken through the more complex and time-consuming aspects of sleep hygiene and possibly talking therapies to discover the cause of their insomnia, a prescription has been given all too quickly and readily. If we are looking at responsibility falling back to clinicians in primary care, it seems inordinately sensible that the clinical commissioning group should consider its responsibility to provide support to patients who end up with an iatrogenic problem.

I can see that the Government may feel that this is a very specific amendment targeted at a very specific area, but the guidance that needs to go out to clinical commissioning groups on their responsibility for the behaviour of all those prescribing on their patch may well deal with some of the principles behind this amendment and ensure that the necessary services are provided to patients who, completely inadvertently, fall foul of taking the drugs that they were prescribed and as they were told to take them.

Health and Social Care Bill

Lord Williamson of Horton Excerpts

Wednesday 2nd November 2011 Lords Chamber

[Lord Newton of Braintree]

I am sorry but I am really quite slow in standing up, as noble Lords will observe.

I do not want to take a huge amount of time. I am not a member of the Alderdice-Patel-Hollins club and I will therefore not attempt to go down their professional path. I am, however, for the moment at least, a member of another club in that I chair a mental health trust—the Suffolk Mental Health Partnership NHS Trust—so I have an interest to declare. I want to express my strong general support for the basic thrust of these amendments, whatever the wording: to emphasise, in the words of the Government’s White Paper, “No health without mental health”. We need to ensure that mental illness is treated with parity in these matters, so far as we can.

I will make only another couple of observations. First, it is worth remembering that one of the notorious pressures on A&E departments at the moment is people turning up with mental illness problems, in effect, and needing the attention of mental illness specialists. This spills over and crosses the boundaries. I still think it right that there should be separate mental health trusts, but we need to recognise these linkages. Secondly, we need to recognise that this is an area in which integration with social services is particularly important. Integration is key because of the extent to which mental illness services are provided not in hospital but in the community and on a combined operation. As an aside which we will return to, the CQC needs to improve its act in terms of assessing community services for the mentally ill, which in my view it is not at present sufficiently equipped to do. That is a point we shall come back to. My main point is strong support for the principal thrust of these amendments, which I hope my noble friend will feel able to accede to.

[Lord Williamson of Horton]

My Lords, briefly but warmly, I support Amendment 11, which seems to me to be desirably explicit and logical in the structure of the opening clauses of the Bill. It is desirably explicit because, while I am sure that the Minister actually wants continuous improvement in the quality of service in connection with the prevention, diagnosis or treatment of physical and mental health, those words do not appear in Clause 2. There remains in the wider public some feeling that mental health has a lower priority than physical health. I believe that there has been a huge improvement in the priority given to mental health—I have a lot of experience of that because of my family circumstances—but the feeling I have referred to exists. Therefore, to be explicit on mental health in this clause is good.

The amendment is logical in the Bill because under subsection (1) of the new clause in Clause 1:

“The Secretary of State must continue”,

to promote,

“a comprehensive health service designed to secure improvement … in the physical and mental health of the people of England”,

yet we do not have that phrase in Clause 2, where we come on to,

“improvement in the quality of services … in connection with … the prevention, diagnosis or treatment of illness”.

That directly contributes to what is expressed in Clause 1, so we need to carry over that phrase and avoid its omission in Clause 2. That is why I support this amendment.

[Lord Ribeiro]

My Lords, I will be brief on this. I strongly support the amendment because it is important to recognise that mental health and acute clinical health go hand in hand. Most hospitals throughout the country started with psychiatric services outwith the main hospital buildings. Over many years we have tried desperately to integrate the service. We no longer have the concept of the psychiatric Bedlam that was the case in the past.

For the last five years or so of my clinical practice, a rotation of junior doctors came to work for me. They would spend four months on general medicine, four months on surgery and four months on psychiatry. As a consequence, I learnt quite a bit about psychiatry, although I am not sure that they learnt an awful lot about surgery. That was an example of integrated care. The importance of it is that a lot of the acute psychotic and suicidal admissions to hospital come through the accident and emergency department. They do not come through the separate door of a psychiatric unit at the other end of the hospital or in a different block. They come to the acute part of the hospital.

I am not saying that the Bill team necessarily overlooked this but, as has been pointed out by the noble Lord, Lord Williamson, if proposed new subsection (1)(a) is to refer to the Secretary of State’s duty to and responsibility for “physical and mental health”, it stands to reason that, as is currently the case, the Secretary of State delegates responsibility for the provision of the health service to the strategic health authorities and PCTs. Their successor bodies will be the national Commissioning Board and the clinical commissioning groups, so it stands to reason that those two bodies must also have responsibility for mental and physical health. It is vital that the three major groups who have responsibility for the health service in this country—the Secretary of State, the NHS Commissioning Board and the clinical commissioning groups—should all have a responsibility to deal with these two areas of healthcare, because they form part of an integrated service.

Health and Social Care Bill

Lord Williamson of Horton Excerpts

Tuesday 25th October 2011 Lords Chamber

[Lord Davies of Stamford]

I am trying to make an intervention.

[Lord Williamson of Horton]

I thought it would be nice to hear another voice, having been here since 3 pm or earlier. I should like to come back to these points and follow on directly from the intervention by the noble Baroness, Lady Jay. The word “provide” has not been used by the Secretary of State in the past; none the less it is there in the long history of this way of handling the operation of the National Health Service. We have continually heard here how in the past it has not been used, and I understand that. However, we are not legislating for the past here; we are legislating for the future. I feel that the retention of the word still has some value if we are looking ahead to the future. In this Bill we are not making special arrangements so that the Secretary of State can provide, but what will be the consequences of unexpected events which could hit us in the future when it might be sensible for the Secretary of State to provide? I do not think that that should be ruled out and, for that reason, I am attracted to the amendment of the noble Baroness, Lady Williams. It also has the advantage that in law it is highly intelligible to an ordinary person, which I always appreciate.

I now come to the amendment of the noble and learned Lord, Lord Mackay. I fully understand why he has put it forward and why he thinks that it is better to avoid putting something into the law which has not been operational, replacing it with something which is a more accurate description of what the future situation might be. However, I have one question, which I shall put to the Minister and indirectly to the noble and learned Lord, Lord Mackay.

In paragraph (b) in his amendment there is a cross-reference to Amendment 8, which lists the various intervention functions of the Secretary of State. Basically, all these interventions will be necessary because we will have been struck by some terrible problem—a failure by the Care Quality Commission or NICE. There are all sorts of terrible failures in which the Secretary of State has to intervene. However, I am still anxious about whether, under this formulation, the Secretary of State can intervene proactively—that is, without having to wait until disaster has struck in the various forms listed in Amendment 8. I make that point because I think it is of interest and importance to the people who have raised all the questions in relation to what we are now discussing and what was discussed at Second Reading and in relation to the previous amendment, which was not carried but was in fact discussed very widely in the press. Therefore, I am interested to know whether there is a possibility of proactive intervention by the Secretary of State.

[Lord Warner]

My Lords, I am a bit confused as to whether we are making speeches or asking questions of the noble and learned Lord, Lord Mackay, who seems to have volunteered to conduct seminars for us on many of these issues. In making some points I shall, in a way, be trying to be helpful to the noble and learned Lord. In a sense, the criticism he is receiving is unfair because his amendments bring the legislation up to date in terms of provision, which has been a fiction for many years. However, his proposal has to be read in conjunction with all the other provisions in the Bill, which continue to puzzle me. The Government have sworn that they want to be extremely hands-off, and they have their beautifully drafted Clause 4, which I think has incurred the wrath of the noble Baroness, Lady Williams, and others. Nevertheless, the Bill as a whole gives the Secretary of State quite a lot of powers to intervene, and I shall go through just a few of them.

Clause 12 confers a power to control services commissioned by the Commissioning Board or clinical commissioning groups; Clause 13, the ability to give direction on secure psychiatric services; Clause 14, the power to make arrangements for the supply of blood and human tissue; and Clause 16, regulations to require clinical commissioning groups to exercise EU health functions. Under Clause 17—even better—the Secretary of State can make regulations that impose standing rules on the Commissioning Board and clinical commissioning groups to arrange for specified treatments and a raft of other things. Clause 20 is the mandation clause, where the Secretary of State can mandate the board before the start of each financial year to specify objectives and the requirements for achieving those objections.

That set of measures looks very un-hands-offish to simple souls such as me. I think that we are getting ourselves into a bit of a state about this, because the Secretary of State seems to have very extensive powers. I admit that some of the public discourse may have been a bit confused by the explanation that the Government’s candidate for the chairmanship of the NHS Commissioning Board gave in his interview. He seemed to have a very hands-off picture of what the Secretary of State should do, and I suspect that he may not have read the Bill quite as carefully as your Lordships will have done. We have to look at the amendment of the noble and learned Lord, Lord Mackay, in the context of making the legislation honest but with the Secretary of State retaining huge powers in the Bill to intervene and direct operations.

Health: Prostate Cancer

Lord Williamson of Horton Excerpts

Monday 19th July 2010 Lords Chamber

[Earl Howe]

My Lords, the noble Lord may know that the UK National Screening Committee examined this question recently. The matter is out for consultation, which will last until the end of September, when a conclusion will be reached.

[Lord Williamson of Horton]

Will the noble Earl say whether there has been any progress in the development of a test that is more accurate than the PSA test that is currently used?

Queen's Speech

Lord Williamson of Horton Excerpts

Thursday 3rd June 2010 Lords Chamber

[Lord Williamson of Horton]

My Lords, I am still here and I intend to speak today on health and, in particular, on mental health. I welcome the noble Earl, Lord Howe, to the Government and recall that we had amiable and effective co-operation on mental health issues during the previous Parliament—we often agreed—so I am hopeful today.

Although there were no specific legislative proposals on mental health in the gracious Speech, the Government have indicated some forthcoming changes in the health field which may have repercussions for mental health. It is also evident that because the amount of financial resources for health expenditure is limited and is going to be under serious pressure, mental health is certainly not exempted from the pressures in the period ahead. Indeed, it may be under greater pressure than provision for physical health.

We do not have to legislate and re-legislate time and again to achieve the best results, but it is important that the Government should have a clear idea of their priorities, even if the implementation rests, as it does in many health areas, with the health authorities at local level. I am glad to see specific priority given in the coalition programme to research on dementia, and to see reference in paragraph 25 to “talking” therapies, both of which are important matters.

What, then, are the priorities for action on mental health in this period of strong pressure on the public finances? First, health authorities should try as far as possible to carry through the implementation of improvements to care decided on in the Mental Health Act in the previous Parliament. These include better provision of advocacy for those people, particularly young people, who are caught up in mental health problems which they do not always understand, and the provision of age-appropriate accommodation in mental health units for young persons and children. These changes resulted from amendments to the Bill in this House which I believe the noble Earl, Lord Howe, supported. I congratulate Lancashire Care on opening in April new facilities to provide age-appropriate accommodation for the young exactly as Parliament wished. I acknowledge at this point the efforts of the previous Labour Government, particularly the Ministers in this House, in carrying through the Mental Health Act. They perhaps needed a little prodding, but they did a good job none the less. Secondly, I share the view of Rethink, the largest voluntary provider of mental health services in the United Kingdom, which supports more than 48,000 people every year through its services and support groups. The areas which it considers crucial are: access and investment; criminal justice; and stigma and discrimination.

On access and investment, NICE produced as recently as 2009 updated guidelines on how schizophrenia should be treated, which individual NHS organisations should try to follow through. Currently, some of them are struggling, and it is clear from the very recent report of the all-party parliamentary group that this continues. Contrary to some misunderstandings, a first onset of schizophrenia in many cases never recurs. In other cases, its impact can be much reduced by various treatments and rehabilitation achieved. We know that cognitive behavioural therapy—CBT is a rather easier way of describing it—has a significant effect on treating schizophrenia. This issue now arises because of the extremely long waiting times for access to this treatment. The average in the whole kingdom is between five and seven months—in some cases, of course, it is much longer because that is the average figure. Waiting times are a significant factor affecting engagement with therapy. They affect the effectiveness and the uptake even when therapy is later received. Despite the economic climate, an improvement in waiting times should be the objective.

I make my plea for mental health services because we know that the pressure on them is likely to be disproportionately strong. In his letter of 1 April to foundation trusts, Stephen Hay of Monitor, the independent regulator, pointed out that mental health providers face a different set of risks from those in the acute sector. Historically, during periods of financial pressure in the healthcare system, expenditure on mental health activity has fallen more rapidly than expenditure in other areas. Mr Hay was quite right to draw attention to revised, downward financial assumptions, but we in Parliament can rightly stress the importance of some elements of mental health treatment, as do I.

I wish to say a word about the large number of people with severe mental illness caught up in the criminal justice system without much-needed treatment. In a powerful speech in the debate on the Address last week, the noble and learned Lord, Lord Woolf, pointed out the mess that we are in as a result of the overload on our prisons and the very high cost to the taxpayer. One of the most evident features of the problem is the very large number of prisoners who have some form of mental problem at any one time. At any one time, about 10 per cent of the prison population have serious mental problems and 30 per cent of female prisoners have had a psychiatric acute admission to hospital before they enter prison. I urge the Government to act on the recommendations in the excellent Bradley report, and make it a priority to reduce the large number of persons with mental illness in the prison system and divert more of them into healthcare.

Finally, we must keep up the effort to remove stigma and discrimination against those with mental illness. The Time to Change campaign, led by Mind, Rethink and Mental Health Media, is good, but mental health service users consistently identify stigma as an impediment to their overall health and well-being and access to other health services. I have spoken today to press on the Government why we must have priorities for improvements in mental health provision, and I look forward to a favourable reply.