Mental Capacity (Amendment) Bill [HL]

Baroness Watkins of Tavistock Excerpts

Report: 2nd sitting (Hansard): House of Lords
Tuesday 27th November 2018 Lords Chamber

Moved by

[Baroness Watkins of Tavistock]

29: Schedule 1, page 10, line 8, at end insert—
“Rights to information11A(1) Prior to the authorisation process, the cared-for person must be fully informed of their rights.(2) The responsible body must take such steps as are practicable to ensure that the cared-for person and any appropriate person or Independent Mental Capacity Advocate representing and supporting them understand the possible outcome of the assessments, the reasons why the cared-for person may be deprived of their liberty and their rights—(a) to request an Approved Mental Capacity Professional’s assessment and review of the arrangements,(b) to advocacy, and(c) to challenge the authorisation in court.(3) If an Independent Mental Capacity Advocate is appointed under Part 5, the advocate is to take such steps as are practicable to help the cared-for person and the appropriate person to understand the following matters—(a) the steps involved in the authorisation process,(b) the purpose, duration and effect of the authorisation,(c) any conditions to which the authorisation is subject,(d) the reasons why the cared-for person met the qualifying requirements in question,(e) the right to object to the authorisation and the right to request a review by an Approved Mental Capacity Professional,(f) the outcome of a review of the arrangements,(g) the relevant rights of the cared-for person,(h) how the cared-for person may exercise relevant rights.(4) In this paragraph, “relevant rights” includes the right to make an application to the court to challenge an authorisation decision in court under section 21ZA and the right to request a review of the arrangements.(5) The responsible body must ensure that cases are referred to court when the cared-for person’s right to a court review is engaged.”

[Baroness Watkins of Tavistock (CB)]

In moving Amendment 29, I shall speak also to Amendment 86, having added my name to both. My noble friend Lady Hollins originally tabled this amendment, which is associated with rights to information. She is unfortunately unable to be here, so in her absence I will articulate the points on behalf of us both, without repeating many of the arguments made at Second Reading. The amendments are supported by many third sector bodies, including the Royal Mencap Society, Mind, Rethink Mental Illness, the Alzheimer’s Society, Disability Rights UK, Inclusion London, Liberty, VoiceAbility, the National Autistic Society, Sense and others.

As it stands, there is a fundamental imbalance in the proposals, with the power in many cases lying with health and social care providers and the responsible body. These amendments seek to partially redress that balance, in part by ensuring that critical information is provided to the individual concerned, the person being cared for, and those advocating on their behalf.

Under the first part of Amendment 29, the individual would receive information about their rights in advance. This is critical, as is having someone—an appropriate person or advocate—to explain things to the person in a way meaningful to them. VoiceAbility, which provides advocacy for people who may lack capacity and their families, has received feedback from families that having information clearly explained to them up front can help dispel many misunderstandings and myths that can escalate to the person being cared for being very unsettled.

Knowing the reasons why you were detained, and what you can do about it if you are not happy with your conditions or placement, is important. Similarly, the knowledge that you can ask for a review or challenge the decision can help to reduce the stress and anxiety that many people face—even if the person does not at the outset wish to exercise their rights to review or challenge.

Information should, of course, be provided in an appropriate format, which is clear, easy to understand and takes account of any communication difficulties that individuals or their families have. Providing people with just written information is not enough. Some people may require easy-read information in jargon-free, plain English. Others should have the opportunity to speak to somebody and ask questions. Some families may need a translator, and some individuals may need sign language such as Makaton to fully understand the situation they find themselves in. There is very limited knowledge about DoLS and even less about the proposed LPS, and it is therefore critical that people understand the process they are entering.

The Bill requires the responsible body to complete an authorisation record containing important information for the cared-for person. It does not, however, require that this information be automatically provided to the cared-for person, their family or an advocate. The second part of Amendment 29 and Amendment 86 address this by ensuring that the responsible body provides the cared-for person and any advocate with information about the outcome of the authorisation, what it means and the reasons why their liberty may be deprived. As before, this must be provided in a format that is appropriate for them and easy to understand. It must also detail the person’s rights to challenge the assessment and request an intervention from an approved mental capacity professional, their right to advocacy and how to challenge the authorisation should they so wish. People often feel disempowered in this situation, and in many cases simply accept inappropriate provision without understanding that they can challenge it. Finally, these amendments would ensure that information is provided relevant to the process of how to challenge their individual assessment and, in turn, the fact that their liberty is being deprived.

Advocacy must play a central role in this Bill. The amendment recognises this by spelling out the functions of an IMCA at this critical juncture for the cared-for person. This includes helping the individual to understand the process, the assessment itself and the result of that assessment, as well as how they can exercise their rights of challenge.

I hope the Minister recognises that these amendments are an important addition to ensuring that people are empowered throughout the process. I look forward to his response. I beg to move.

--- Later in debate ---

[Lord O’Shaughnessy]

I recognise the point that the noble Baroness is making. As I said, our belief is that the rights that currently exist, and are in no way amended or reduced as a result of the Bill, provide what she is asking for. Unfortunately, I am not able to give a commitment that we will be able to return to this issue at Third Reading.

[Baroness Watkins of Tavistock]

I thank the Minster for his reply and thank all noble Lords who have spoken in support of this group of amendments. I do not believe that the Minister’s reply gives us sufficient security that if the information is contained only in the associated code patients and their families will be protected in the way that we have outlined. We firmly believe that the issue of information and, in particular, its provision in advance need to be in the Bill. It is therefore important that the House makes a statement to the Government about this issue, so I would like to test the opinion of the House.