New Clause 18
Mental Health Bill [Lords]
6:00 pm

Ann Coffey (PPS (Rt Hon Alistair Darling, Secretary of State), Department of Trade and Industry; Stockport, Labour)

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

Frank Cook (Stockton North, Labour)

With this it will be convenient to discuss

New clause 19—Responsibility for conveyance to hospital

‘(1) The 1983 Act is amended as follows.

(2) In Section 11(2) after “sought”, insert “or in the case of a National Health Service patient, to the NHS Trust responsible for hospital provision”.

(3) In Section 6(1) for “applicant, or any person authorised by the applicant” substitute “the body to which the application is addressed, or any person authorised by that body” and for “convey him to the hospital” substitute “convey him to the hospital identified by that body as being able to receive him.”’.

Ann Coffey (PPS (Rt Hon Alistair Darling, Secretary of State), Department of Trade and Industry; Stockport, Labour)

New clause 18 seeks to substitute, for section 140 in the 1983 Act, a new section that would give duties to primary care trusts and others in relation to the assessment, conveyance and admission of urgent cases. New clause 19 seeks to amend section 6(1) of the 1983 Act to move responsibility for finding a bed from the approved social worker or the new approved mental health practitioner to the hospital trust.

I thank the Minister for meeting me to discuss the proposed new clauses, and I thank the approved social worker leads’ network—particularly Claire Barcham of that organisation—for her excellent written submission  which very clearly outlined, with examples, the practical difficulties that ASWs face in implementing their present duties in relation to emergency admissions from the community. Claire Barcham gave many examples of those difficulties, and I am sure that that has convinced members of the Committee of the strength of their arguments.

ASWs are involved in approximately 47,000 admissions each year, of which 27,000 are admissions from the community, so they know what they are talking about. The procedures for admitting people to hospital in an emergency are vital in achieving the principles outlined in clause 10 of the Bill, about which there has been much discussion in the Committee and in the Lords, so it is important that we get them right. The principles set a standard, and we must ensure that those who will have the responsibility for implementing the Bill are not faced with the practical barriers that ASWs face at the moment.

The current sections 6 and 140 of the 1983 Act place a responsibility on health authorities to provide a bed, but because of the drafting of the provisions and the lack of local protocols, the task of finding a bed and of making arrangements for conveying people to hospital has in practice fallen to the approved social workers. The code of practice accompanying the 1983 Act has guidance that mentions local procedures, but it is clear from the written submission and from the examples that the code does not always work in practice.

Part of the problem, which is also the reason why the examples are anecdotal, is that there is no monitoring to check whether such protocols are in place locally and whether local health, police and social services authorities are co-operating with the protocols. Furthermore, protocols do not form part of any mental health services inspection. The result is that since introduction of the 1983 Act there has not been any pressure or lever to ensure that good local protocols are developed. We should not make the same mistake again.

Examples have been provided in the written submission by the approved social workers. I spent a day with a mental health assessment team in London to see for myself the practical difficulties that approved social workers face. It was interesting. While I was there, a request was made by the police for a mental health assessment on a man who had been arrested that morning after a neighbour had complained. He had already been in the cells for three hours. He had not yet been interviewed by the police because the police doctor did not feel able to say that he was fit for interview. For that reason, a request for a mental health assessment had been made.

Before the approved social worker could carry out the assessment, she had to find two doctors who could be present at the same time. She also had to arrange for a bed. By the time that we had arrived at the custody suite, the man had been in the cells for six hours. It was decided that he did not need to be admitted to hospital as an emergency, and I expect that he spent several more hours in the cells while being interviewed with his solicitor. Such an event showed me how practical things on the ground must work if the high-level objectives set out in the Bill are to be achieved.

I take the point that police cells are not necessarily safe places, but the man had waited for three hours in  what was a safe place for him. If that man had been in his flat and had not been arrested by the police at 8.30 that morning and a request had been made for a mental health assessment because of his bizarre behaviour, the approved social worker could well have had to arrange for doctors to go the flat to assess him. The ASW could not have applied for him to be admitted to hospital because there was no bed. She would then have had to delay the assessment and rearrange the time for the doctors. She might have gone on the visit even though the doctors perhaps could not have come for several hours. She might have thought that, on balance, it was better to go out to the flat to do the assessment. She would have had to wait with a very distressed man or his carers, while arranging for a bed so that she could make the application. Alternatively, she could have taken him to a place of safety, which could have been a police cell or an accident and emergency unit at a hospital, neither of which are good places for someone in an unstable condition.

Additionally, when I left in the evening there were a further five requests on the approved social worker’s desk for a mental health assessment of people living in the community. They were judged to be a risk to others. They had a history of violent or abusive behaviour, so the approved social worker rightly was not prepared to see them without police support. The requests were on the desk because the approved social worker was waiting for the police to say when they could undertake a risk assessment.

The police carry out an assessment of how much of a risk they feel the person is to them. If they think that the risk is high, ironically the waiting time for police support might be longer because resources have to be provided, such as six policemen instead of one. It is not very easy to collate details to know how many such instances result from the community and 999 calls, arrests, assaults on the public, carers, neighbours or self-harm. However, the time between someone becoming concerned about a person’s behaviour and assessment of their condition must be the time of maximum risk.

The new clauses would put in place a duty to set up local protocols so that responsibility for making arrangements does not fall solely on the approved social worker or, in future, the approved mental health professional. They would ensure that, in future, admissions and conveyance to hospital took place according to a local protocol, with agreed time limits for responses, and that requests for assessments were not delayed unacceptably by inability to obtain police support.

There are other issues in relation to admission, such as accessing transport and ambulances. In new clause 19, the reason for moving the responsibility from the approved social worker to the hospital trust is to put pressure on PCTs to have in place proper commissioning arrangements for their beds. It is also an issue for age-appropriate treatment. Proper commissioning plans are needed to achieve that.

I knew that the Minister would have concerns about the new clauses, but I hope that she can reassure us that when the new code of practice is drawn up, there will be much stronger guidance about the local protocols  that should be in place, including time limits for assessment and admissions.

Those protocols and any complaints by local bodies or authorities should be regarded as part of a local inspection of mental health services. That is the only way we can provide a lever to ensure that local protocols are drawn up. I hope that the Minister will also consider how the police can be involved in that, either through discussions with the Association of Chief Police Officers or as part of their responsibilities under local crime and disorder partnerships to ensure community safety. In discussions with officials about drawing up a stronger code of practice, I would request the Minister to involve the ASW leads network.

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

I was extremely grateful to my hon. Friend for giving such a vivid account of some of the problems that approved social workers face in the field, which she clearly experienced during her day on the front line. She explained clearly the issues that underlie the new clauses and responded to the problems that some approved social workers have experienced in getting ambulance, police and trust bed managers to co-operate in conveying and admitting patients to hospital. I sympathise with her concerns and thank her for bringing them to the attention of the Committee.

It is essential that local services are co-ordinated to ensure that patients are conveyed safely, efficiently and in the least distressing way for them and their family. That goes back to the discussions that we had this morning about places of safety. However, I have to tell my hon. Friend that we may not be able to solve such difficulties in primary legislation. She was right when she said that the arrangements for co-ordinating local services must be a matter for local decision. As a result of our meeting, I have had discussions with officials about what else we can do in that regard. We are considering issuing a circular to relevant bodies, such as local authorities, trusts and police authorities, stressing that it is their responsibility to ensure that local protocols are working. We are also considering how to amend the Mental Health Act codes of practice to make that responsibility clear.

As a result of my hon. Friend’s suggestion, I have asked for the ASW leads network to be represented on the steering group of an existing Government project that is co-ordinating health trusts, local authorities and emergency services, including police and ambulance services, to develop guidance on working together to manage people experiencing mental disorder. That guidance will cover the safe and efficient conveyance of patients to hospital.

Something else that I recall from the meeting and should like to consider further is the issue that my hon. Friend has just touched on, which is the extent to which we can encourage regulators and inspectors to examine local protocols and see whether they are working effectively. I wish to do some further work on that, although I cannot guarantee anything because regulators have a certain independence. It is certainly something that I can take away and look at.

As I have said, the issue is very important and we want to get it right. I hope that the way forward that I have suggested will be acceptable to my hon. Friend and that she will withdraw the motion.

Ann Coffey (PPS (Rt Hon Alistair Darling, Secretary of State), Department of Trade and Industry; Stockport, Labour)

I thank my right hon. Friend the Minister for her positive and appropriate response to the issues that I raised. I agree with her that protocols must be drawn up locally, and I am pleased that she is examining ways to tighten them through the code of practice and ensure that they are monitored and not simply ignored. On that basis, I beg to ask leave to withdraw the motion.