Mental Capacity (Amendment) Bill [Lords]

Caroline Dinenage Excerpts

2nd reading: House of Commons & Money resolution: House of Commons & Programme motion: House of Commons & Ways and Means resolution: House of Commons
Tuesday 18th December 2018 Commons Chamber

[The Minister for Care (Caroline Dinenage)]

Our liberty is one of the most fundamental of our human rights. Depriving people of that liberty is something that must be done with the greatest of care and with respect for individuals, and not as a tick-box bureaucratic process—a one-size fits all—that leaves vulnerable people without protections and in an unspeakable backlog. That is what we are facing today.

I thank all hon. Members for their contributions today. I will aim to cover all the questions that have been raised and will write to anybody whose points I do not get to. I start by stressing from the outset that liberty protection safeguards are not about detainment, but about appropriate arrangements being in place for the purposes of care and treatment.

We have heard it argued that the Bill has been rushed through. The Law Commission looked at this issue for three years, and the Joint Committee on Human Rights has looked at it. The Department of Health and Social Care has spoken endlessly to stakeholders. We are determined to get this right, but we continue to consult people across both Houses in order to do so.

Let me address the issue of three-year authorisations. This was a Law Commission recommendation, and the provision is geared towards people like my grandmother who live with dementia—people with long-term progressive conditions from which they are unlikely to recover. Their families tell us that they are part of an unnecessary and intrusive measure that they have to repeat every single year, when there is essentially no way that their loved one’s condition will improve. It is in such scenarios that the Bill allows the flexibility to deliver tailored protections that best support the individual depending on their needs.

The three-year renewal can be used only after two one-year renewals. Furthermore, the responsible body is required to specify a continuous programme of reviews if a person’s circumstances will change. That will address the issue of fluctuating conditions that was raised by my hon. Friend the Member for Faversham and Mid Kent (Helen Whately). We will also set out further details of fluctuating conditions in our code of practice.

The right hon. Member for North Durham (Mr Jones) talked about the code of practice, which will be a statutory document. It will be co-produced in consultation with the sector, the Local Government Association, the Association of Directors of Adult Services and the third sector, and it will be laid before both Houses. It will not be in the body of the Bill, because the problem at the moment is that there is a one-size-fits-all process in legislation, but people will have to pay regard to this statutory document.

The right hon. Gentleman also mentioned 16 and 17-year-olds. We have given very careful thought to how to include 16 and 17-year-olds and to how the Bill will interact with other legislation including the Children Act 1989, and we are very comfortable that it works alongside existing legislation. It is also a Law Commission recommendation to bring the provisions in line with the Mental Health Act, as he will be aware.[Official Report, 7 January 2019, Vol. 652, c. 1MC.]

Under the Bill, every authorisation must be reviewed by somebody who does not deliver the day-to-day care and treatment of the person. That is how we will avoid a conflict of interest for care home managers and independent providers. We want to drive a culture where independent hospitals are considering appropriate arrangements and where there are less restrictive alternatives available. This was also one of the Law Commission’s recommendations. However, we need to ensure that there are sufficient safeguards, which is why, in addition to introducing the consultation duties and the role for appropriate persons or independent mental capacity advocates, we will be tabling an amendment to ensure that every individual in an independent hospital setting will be assigned an approved mental capacity professional to complete the pre-authorisation review. That is regardless of whether the individual or their family object to the deprivation of liberty.

The hon. Member for Swansea West (Geraint Davies) talked about speech and language. It is vital that communication needs are considered where relevant, and we would expect that a speech and language therapist will be consulted in order to establish the individual’s wishes and feelings. It is really important that those wishes and feelings are very much at the centre of the process.

Members have spoken about the interface with the Mental Health Act. We have broadly recreated the current interface with that Act. The Mental Health Act review did make recommendations on that interface, but Sir Simon Wessely himself said that the Government need to consider the implications of the interface as part of the consideration of that Act. He said that the reform of DoLS cannot wait when there are 48,000 people waiting more than a year for protections to which they are entitled.

If the Opposition’s amendment succeeded, we would be stuck in a broken system with a bureaucratic backlog, in which 125,000 people are waiting for protections. Professor Simon Wessely said that this Bill strikes

“a better balance between the importance of care planning and the provision of (all too often) perfunctory and box-ticking procedural safeguards around that care.”

That makes it clear that action must be taken.

Through this Bill, we are ensuring that people’s wishes are always considered and respected, and that people are safe, cared for and looked after. We are talking about changing a system that is currently not fit for purpose. We have attempted to be collaborative at every stage of the Bill so far. We are driven by a relentless desire to make it as strong and effective as possible and worthy of the vulnerable people we are seeking to protect. We want their loved ones and healthcare professionals to have faith in it, and we will never swerve from our commitment to what is necessary, proportionate and in the best interests of the individual. We commit to working with individuals across this House to make sure that this Bill is in the very best possible shape.

Question put, That the amendment be made.