Mental Health Act 1983

Debate between Dan Poulter and Paul Beresford

Tuesday 11th July 2017 Commons Chamber

[Sir Paul Beresford]

The other four officers stood on tip-toes waiting to catch the young woman on each occasion when she looked as if she was going to dive through the window. Fortunately, they managed to stop any action. In the meantime, contact was made with St George’s Hospital’s psychiatric unit to seek urgent hospital psychiatric assistance. After some considerable time, the appropriate psychiatric individual arrived with an ambulance and crew. This immediately inspired further alarm, rejection and, ultimately, a huge struggle. In due course, a sad young lady was transported to the hospital as the designated place of safety, and we had prevented the suicide.

The whole pantomime had occupied five officers and three NHS staff, and took about four hours to sort out. It was obvious from the very beginning that the police themselves could have taken care of the young lady quickly, as indeed they did after instruction from the NHS staff. Immediate action by the police would have taken the lady into care quickly, thus reducing the continuing risk over those four hours, and saving the police and NHS staff a large number of man hours. Under section 136 of the Mental Health Act, the police would have been able to act promptly if this pantomime had taken place in a public place. However, the incident took place at the young lady’s mother’s home. That was deemed, correctly, to be a private place, which meant that no direct police action was legally possible. I have had discussions with officers in the Met, and I have found that this was not an unusual case.

A more tragic case was the death of Martin Middleton in 2010. He was taken to a Leeds police station by officers who had visited him at home, having been made aware, and then seeing for themselves, that Mr Middleton was making serious preparations for committing suicide. The officers incorrectly believed that they could arrest Mr Middleton and take him from his home under section 136. When they arrived at the police station, the custody sergeant refused to detain Mr Middleton as the arrest had taken place in his home. The officers were therefore required by the custody sergeant to return Mr Middleton to a relative’s home, hoping that that was some form of safety. Sadly, Mr Middleton still managed to hang himself there.

At the inquest, the coroner had no hesitation in agreeing with Professor Keith Rix, who was called to give expert evidence, that Mr Middleton fell into a category of mentally disordered persons for whom there is no provision under the 1983 Act. Subsequent to raising the issue, I have heard from many frontline police officers, including those who have campaigned on the issue, and I have also had extensive conversations with Professor Keith Rix, who is an academic psychiatrist and an expert in this area. I am reliably informed that the Garda in the Republic of Ireland have a clear operational advantage over our police because, under section 12 of the Irish Mental Health Act 2001, they can act promptly, even in a private residence.

As the all-seeing Minister will be aware, over the 10 years between 1997 and 2007, admissions to hospital as a place of safety went up from 2,237 to 7,035—those are the latest figures that I have been able to get. The Minister is quick with arithmetic, so she will be able to note that that is a threefold increase. The difficulty facing the police is that the powers on which they can act are limited to persons found by the police in a public place. There is ample anecdotal—and perhaps stronger—evidence that the police in desperation sometimes persuade a person to leave their home, or contrive to remove them to a public place so that they can use the section 136 powers of arrest. In fact, one London-based social services authority’s audited figures estimated that 30% of section 136 arrests were recorded as having been made at or just outside the detainee’s home. The police do that in sheer desperation to save the individual’s life, which would be lost unless they acted. Put bluntly, a tiny adjustment to the legislation would allow the police to act in a private home, as they can in a public place. That would save an enormous amount of time and, potentially, a considerable number of lives.

In my discussions about this, it has been suggested that the police already have sufficient powers—they do not. The second argument is that an amendment would extend the right of the police to enter private properties—yes, it would. There are many legal reasons for the police to enter a private property; perhaps the most obvious and linked one is that if the mentally ill person was threatening, or in the process of murdering, somebody in that private place, rather than killing themselves, the police could act immediately.

There is a simple solution to this: amend section 136 by simply removing the words

“in a place to which the public have access”.

When I raised this issue in the Adjournment debate about a year ago, the Minister’s predecessor gave a clear indication that change was being considered. He gave me a commitment that if the Government could not get this right using the measures they were considering, an amendment to section 136 might be exactly what was required.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

My hon. Friend is making an important and thoughtful speech. Does he agree that it is possible at the moment for a mental health professional who wants to put someone under section 2 or section 3 of the Mental Health Act to gain entry to their house with the police and a locksmith? It therefore seems strange that the police do not have powers to deal with a very similar situation when they have concerns about someone’s mental health and believe they need to exercise section 136 powers.

[Sir Paul Beresford]

I thank my hon. Friend, who is, of course, on his way, with a bit of luck, to being a very senior academic psychiatrist in a couple of years. He is right. In situations such as this, no one rings up St George’s Hospital in Tooting and says, “Please could I have a psychiatrist?” They ring the Met police, who then have the difficulty of dealing with the situation, and who stand there holding the detainee in the private home while the psychiatrist is brought in from the hospital.

I shall be grateful if my hon. Friend the Minister will at least be prepared to meet me and Professor Rix to discuss how this difficulty can be sorted out. If necessary, I am prepared to resort, as I have in the past, to the ten-minute rule Bill procedure to bring about this tiny change.

General Dental Council

Debate between Dan Poulter and Paul Beresford

Tuesday 9th December 2014 Westminster Hall

[Dr Poulter]

As I said, under legislation, I am unfortunately powerless to intervene directly on fee setting. We recognise the independence of health care regulators and would not want them to be micro-managed by Government; that would be wrong. However, my view is very clearly, as I have outlined, that a strong evidence base is needed to justify a fee rise. Given that other health care regulators faced with similar challenges have not raised their fees to the same unprecedented degree, I have not myself been convinced that the evidence base is strong enough to justify this fee rise. I hope that that answers the hon. Gentleman’s question.

In that context, it is worth drawing attention to the section 60 order currently in progress in the House, and to the consultation process that has been taking place. The fee rise is perhaps all the more surprising as we are making good progress with the GDC on bringing in the legislative changes that will reform the way that it operates. Those changes, in the form of a section 60 order, will assist with reducing its operational costs by an estimated £2 million a year through potential efficiency savings. My hon. Friend the Member for Mole Valley made the point that all regulators need to look at better ways of working and efficiency savings in their own practice. Of course, that, as well as patient protection, is a benefit of introducing a section 60 order: it will help to reduce the running costs, potentially, of the GDC and streamline processes.

The public consultation on the GDC-related section 60 order recently closed, and the vast majority of respondents were supportive of the proposals. We therefore intend to proceed with the measures and will publish our response to the consultation in due course. My hon. Friend may be surprised to learn, as I was, that the GDC did not wait for the outcome of the section 60 order consultation before announcing the fee rise.

The changes proposed in the section 60 order will: enable the GDC to delegate the decision-making functions currently exercised by its investigating committee to officers of the GDC, known as case examiners; enable both case examiners and the investigating committee to address concerns about a registrant’s practice by agreeing undertakings with that registrant, which have the same effect as conditions on practice, without the need for a practice committee hearing; introduce a power to review cases closed following an investigation—rules to be made under that power will provide that a review can be undertaken by the registrar if she considers that the decision is materially flawed, or new information has come to light that might have altered the decision and a review is in the public interest—introduce a power to allow the registrar to decide that a complaint or information received did not amount to an allegation of impairment of fitness to practise; introduce a power to enable the investigating committee and the case examiners to review their determination to issue a warning; and ensure that registrants can be referred to the interim orders committee at any time during the fitness to practise process.

Very similar section 60 orders have been laid before Parliament in conjunction and consultation with other regulators, and a great benefit of those orders is that they are about not just protecting the public but supporting the regulators to have more streamlined processes and reducing costs. Of course, when costs are reduced, we would always expect the savings to be passed on to the people who pay the annual fee.

[Sir Paul Beresford]

Is there evidence that the other registering organisations have reduced their fees, or keep them down, in the light of the anticipated savings, which would be sensible?

[Dr Poulter]

If we look at similar organisations, we see that the GMC, for example, has similar practices and processes. The Nursing and Midwifery Council has a very small fee rise, but has seen a similar section 60 process take place. All those regulators, in my view, have taken every step possible to look at their annual fee in the context of the section 60 orders, and with the mindset that any fee rise needs to be fully evidence based and appropriately proportionate. From my conversations, and from the practice of other health care regulators, I think that there is very good evidence that that is a consistent pattern of behaviour. As I said, the GDC’s fee rise is unprecedentedly large, and its behaviour is not consistent or in keeping with that of any of the other health care regulators, from what I can see.

In addition to the GDC-related section 60 order, the Government are taking forward a number of key pieces of secondary legislation in this Parliament to address priority areas that we have identified after discussion with the regulatory bodies and other stakeholders; I mentioned other section 60 orders. We are also working on a response to the Law Commission’s valuable work on proposals for more wide-ranging reforms.

I am aware that the decision not to progress a professional regulation Bill in the current Session has come as a disappointment to interested parties. However, that decision provides an opportunity to invest time in ensuring that that important legislative change is got right, for the benefit of those who will ultimately be affected by it. My hon. Friend outlined very articulately some of the challenges that need to be considered in putting together the Bill. We are committed—I would like to put this on the record again—to bringing forward primary legislation to address wider reforms to the system of professional regulation when parliamentary time allows, but in the meantime, working with the regulators, we have put in place, or have in train, a number of section 60 orders. They are about streamlining processes, providing efficiencies to the regulators and, most important of all, protecting patients and the public.

Let me say a quick word about the GDC’s general performance. It is very important that the GDC manages its rising volumes of complaints as well as the other issues raised by the Professional Standards Authority as part of its annual performance review. In due course, the GDC will need to demonstrate what it has done to address the recommendations made.

Hon. Members may be aware that the Professional Standards Authority is also conducting an investigation of the GDC after claims were made by a whistleblower about the management and support processes of the GDC’s investigating committee. I understand that the Professional Standards Authority has concluded the evidence-gathering phase of the investigation, is in the process of compiling the investigation report, and will provide that report to the Select Committee on Health and publish it on its website in due course.

I have outlined a number of issues and concerns about the unprecedentedly high rise in the GDC fee. As we have discussed, it is out of keeping and inconsistent with the behaviour of many other health care regulators. I am not convinced, from the evidence that I have been presented with, that there is a strongly evidenced case to support that fee rise, and it goes against Government policy, which is to encourage regulators to set appropriate and proportionate fee rises, to show restraint where appropriate and to be mindful of the effects of fees on registrants.

I want to make it clear, in drawing to a conclusion, that I am not raising any doubt about the fact that the GDC continues to fulfil its statutory duties. However, it will need to make significant improvements to meet the challenges set out in the annual performance review undertaken by the Professional Standards Authority. Registrants, patients and the public need to be able to have confidence in the performance of the GDC and to see improvements in its operation, effectiveness and efficiency. I hope that I have answered all the points raised in the debate, and I again thank my hon. Friend the Member for Mole Valley for raising a very important issue that I am sure is filling many MPs’ postbags.