Sandra Gidley (Shadow Minister, Health; Romsey, Liberal Democrat)

I beg to move, That the clause be read a Second time.

The clause is a straightforward attempt to introduce a duty on health and local authorities to assess the needs of people with mental health problems, when appropriate, and to respond to written requests for assessment by certain key people within a fixed period. It provides also that clear reasons should be given for refusal.

The Scottish legislation has been referred to many times, and this will be another such occasion. In Scotland, a provision has been introduced whereby health and social services must respond to a reasonable request for assessment within 14 days. The response must take the form either of arrangement of an actual assessment or of written reasons for refusal.

Throughout our sittings, the Minister has admitted from time to time that past mental health provision in many areas was not good enough. I concede that things have to a certain extent improved, but there is a long way to go before they are good enough, and there are many parts of the country in which people do not have access to services. The patchy nature of access to mental health services means that in many respects it would be in the Government’s wider interests to have a mechanism whereby they could collect data indirectly on service availability. There are precedents in other Bills for providing such assessments. The Minister worked on the Adoption and Children Act 2002, which introduced a duty on local authorities to assess the needs of children who are being adopted.

In other areas of legislation, the Government have accepted the principle that there are occasions when there is a need for an assessment. The argument has been advanced that that somehow gives people with mental health problems greater rights than those with a physical health problem. That is not a robust argument because, for far too long, people with mental health problems and service users have felt that they do not have access to services and that they are the underdog when it comes to provision. The new clause would go some way to reassuring service users, who are quite worried by some of the compulsion aspects of the Bill, that if they come forward, their needs would be looked at in a wider context.

I shall quote a case story that does not involve a made-up Lily, Ruth or Mary. Lesley Savage is the mother of Daniel Gonzalez, who was convicted of killing four people in September 2004. She said that the family had made a hundred attempts to get help at various times and that

“We cannot list every phone call that went unanswered, every letter that went astray, every contact with a professional who told us they could not help or who passed us on to someone else. We cannot list here the ever-changing diagnoses that were offered, the ever-changing advice we were given, the lost and wrongly recorded notes that misled us and the professionals.”

If the Government are serious about preventing that sort of situation, providing an assessment would go a long way to allaying the fears of that mother, and the realistic fears of others who are in the system.

Section 47 of the National Health Service and Community Care Act 1990 already provides for a right to assessment for vulnerable people. The key mechanisms for enforcing that are the Commission for Social Care Inspection and the Healthcare Commission. In practice, section 47 assessments are severely limited. They are led by social services and focus on the need for community care services. In some authorities, assessments are carried out by a separate “adults with disabilities” team, which does not specialise in mental health care. Existing service users reported to the joint scrutiny Committee in 2004-05 that unless social workers are involved in their care, they are denied access to a community care assessment. The existing system provides a stop-gap, but does not address the problems and needs of service users.

By placing a duty on NHS organisations and social services departments to respond to requests for an assessment, the new clause would bring the 1990 Act up to date and reflect the more joined-up nature of services. It would also offer the same rights regardless of at what point an individual gets into contact with the system. Although the Government are considering many different people for being the approved person in charge, the new clause would ensure a holistic approach to assessments.

There is support for the new clause elsewhere. In 1999, the Government’s expert committee said that

“there should be a duty on the NHS and Social Services jointly to assess and meet the needs of people with mental health problems, with reasons if their needs could not be met.”

The joint parliamentary scrutiny Committee accepted that there was a compelling argument for balancing the draft Bill by including a duty to provide an appropriate and adequate mental health service. The Committee recommended that the Bill should include a duty on public services to assess and meet the mental health needs of people with mental health problems. The Disability Rights Commission has also stated that the Bill should include a right of assessment and treatment.

Rosie Winterton (Minister of State (Health Services), Department of Health; Doncaster Central, Labour)

As I am sure the hon. Lady knows, the new clause was debated at length in the other place, and I am afraid that I wish to reiterate a number of the points that were made there. There are existing duties, such as those in the National Health Service Act 2006 on the Secretary of State and in the National Health Service (Wales) Act 2006 on Welsh Ministers, to secure improvement in the physical and mental health of   people in the prevention, diagnosis and treatment of illness. There are also duties that provide for joint assessments between providers of health and community care services.

We believe strongly that the new clause would impose an additional duty in relation to mental health services that is not replicated for other patient groups such as cancer sufferers. Unfortunately, it would skew the priorities of the NHS in favour of one service at the expense of others. I am sure that were we to say that there should be specific assessments for mental health services, we would quickly find that other groups of patients such as those with coronary heart disease felt that they had been discriminated against.

However, if somebody requires an assessment to be detained under the 1983 Act, the assessment happens. That is the difference; because those circumstances involve detention, an assessment is required. The new clause suggests that there should be an assessment on every single occasion. I tell the hon. Member for Romsey that it will be up to clinicians to decide what further action should be taken if somebody presents with a particular problem, as they would with any other condition.

Sandra Gidley (Shadow Minister, Health; Romsey, Liberal Democrat)

Does the Minister accept that cancer services are much more widely accessed and much easier to access than mental health services? I suspect that there have not been similar cases in the cancer service or any other physical health service whereby people have had to make a hundred phone calls or write a hundred letters and received no help at all.

Rosie Winterton (Minister of State (Health Services), Department of Health; Doncaster Central, Labour)

The point of principle is whether to take one particular condition and create a difference from all other conditions in how an individual is assessed. Assessments will involve a small number of people deciding whether someone needs compulsory treatment, and I hope that it will be of some help if I say that when approved mental health professionals decide not to apply for detention, they should as a result of their assessment identify any further action required and do whatever is necessary to implement it.

Tim Boswell (Daventry, Conservative)

This is a small point, but it may be important. The Minister said that that situation arose in cases of detention under the 1983 Act. We have just debated schedule 6 to this Bill, which will make changes to the 2005 Act on compulsory detention and the deprivation of liberty. Does she envisage that persons detained under the 2005 Act following the Bournewood case will be able to avail themselves of the services of an assessment?

Rosie Winterton (Minister of State (Health Services), Department of Health; Doncaster Central, Labour)

As we discussed, there will be an independent assessor on the deprivation of liberty. The provision discussed relates to that, not to treatment.

The role of the approved mental health professional, when considering whether further treatment is necessary having made an assessment, will include referring on for a community care assessment and/or a health service assessment if appropriate. The draft illustrative code of practice provides specific guidance on that point, including that all persons involved—the patient and carers too, of course—should understand the alternatives to detention proposed by the AMHP.

With that explanation, I hope that the hon. Member for Romsey will seek leave to withdraw the motion.

Sandra Gidley (Shadow Minister, Health; Romsey, Liberal Democrat)

I shall not detain the Committee longer. I beg to ask leave to withdraw the motion.