James Duddridge (Rochford & Southend East, Conservative)

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

I thank my hon. Friend the Member for East Worthing and Shoreham for the opportunity to move the motion on the new clause, which would essentially give mental health patients the right to move hospital. It breaks down into three parts: a duty to inform the patient or their nearest relative of that right, a requirement to record when it is exercised and a request is made and a requirement of authorities to provide written reasons if a reasonable request is turned down. I wish to make three broad points: the first on choice, the second on why there is a need of a little additional bureaucracy and a little evidence, and the third considering the black and minority ethnic communities, who have inspired the new clause although it does not apply exclusively to them.

Choice is a buzz word in the NHS generally. For instance, non-mental health patients will have a choice of four hospitals by 2007 or 2008, which will be a much wider choice. In fact the NHS website states:

“You now have the right to choose.”

Well, that is not the case at the moment in mental health. The Institute for Public Policy Research, an organisation whose work I do not read in its entirety, has a paper called “Mental Health in the Mainstream”, which is very insightful. I quote from the IPPR’s “A Good Choice for Mental Health”, which states that

“despite different policy initiatives to promote greater user involvement in mental health, the choice agenda is yet to have a significant impact on people’s lives or experience of services”

in mental health. The Sainsbury Centre for Mental Health is similarly critical of the Government and states that choices should be offered to

“reflect the individual’s beliefs, values and preferences as well as clinical need”.

Indeed, it states:

“Appropriate information and advice should be available to empower people to make informed choices.”

I believe that that should be in the Bill, not in a code of practice. That would fit with Government policy, and I shall come to that point later when talking about the Bennett case. The Minister is looking confused, but I shall explain my rationale as to why I feel that that fits with the Government commitments made following the inquiry into the tragic death of David Bennett in 1998.

I turn to the point about extra bureaucracy, because I recognise that in another place there were criticisms of a similar amendment because of that. From my own experience, I know that going into a hospital is a frightening experience. It is difficult to listen to what a doctor or professional is saying, process the information and recall it. Somebody with a mental health problem has a lot more issues to deal with than someone with a simply physical disability. I feel that recording a request that has been made, and writing the reasons why it has been turned down if there is not good reason for a transfer, are worth that extra bureaucratic time.

The third point that I wish to make concerns the black and minority ethnic population. Lord Patel of Bradford raised this issue in another place. He said:

“It is not uncommon for a patient or relative to express a wish for a transfer between hospitals, whether this is to be nearer home or because of a preference for one hospital’s regime over another. We should be mindful that it is current government policy that prospective patients across the rest of the NHS should be encouraged to express choices in hospital care and that they should be acted on. If we cannot extend this agenda around choice to psychiatric patients, even in this limited way, we risk further excluding them and increasing the stigma of psychiatric treatment.”—[Official Report, House of Lords, 17 January 2007; Vol. 688, c. 751.]

That is particularly true for people in the black and ethnic minority communities.

The Government’s own Department of Health report “Race equality impact assessment” states that

“the effects of mental health legislation apply disproportionately to some BME groups.”

To pick four examples, in BME groups, more people are likely to be diagnosed as schizophrenic; to be sectioned under the 1983 Act; to be moved from open wards to closed wards; and to be given higher doses of medication. Given that the Commission for Racial Equality said that we should avoid all unlawful discrimination, it is important that the Government include a provision in the Bill. Although it is not certain that racism forms the totality of the difference, a reasonable person would believe, as I certainly do, that absolute racism forms part of the problem. Black Mental Health UK, which focuses on African and Caribbean communities, feels that this Bill is “unethical” and “unworkable”, and a missed opportunity for reforming the 1983 Act.

I hope that the Minister will accept the new clause. I see that she is looking positive. This is the first time I have moved such a motion on a new clause, and it would be gratefully appreciated if the right hon. Lady, not because of that, but because of the power of the argument, supported it.

Black Mental Health UK highlights a number of other problems, such as linguistic problems. More than 300 languages are spoken in London. There are  problems of racial differences. If people are moved from urban centres—the evidence across the board is that ethnic and particularly black populations are largely in conurbations—to facilities in the countryside, not only is that a big change for them, as it would be for anyone, but the practitioners in the institutions are likely to have less cultural sensitivity and less personal experience of those various communities. There could be a very good reason why people in black and minority ethnic communities would much prefer to be transferred to areas of their preference.

As I said I would, I turn now to the David Bennett inquiry, following that gentleman’s tragic death. The independent inquest into David Bennett’s death said:

“All psychiatric patients and their families should be made aware that patients can apply to move from one hospital to another for good reason”—

these are almost exactly the same words as appear in the new clause—

“which would include such matters as easier access by their family, a greater ethnic mix, or a reasoned application to be treated by other doctors.”

The Minister will note that we have not gone into this long list of detail; I think that she would prefer that it went into a code of practice, so that the provisions are flexible. I hope that not including the full list in the Bill while nevertheless referring to these matters would give that degree of flexibility. The inquest went on to say that

“all such applications should be recorded”.

Again, the words are similar to those in the new clause. The inquest continued:

“They should not be refused without providing the applicant and their family with written reasons”,

Which is the third part of the new clause.

The reason why I think that Minister is likely to support the thrust of the new clause is that in delivering their report “Race equality and mental health care”, following the death of David Bennett, the Government said:

“We accept this in principle.”

All the points that I have gone through that have been mirrored in the new clause. They went on to say:

“Every such request should be considered carefully and receive a reasoned response that takes into account the needs of the service user and their assessed best interests. A BME patient’s wish to be closer to their family, or to be cared for in a more ethnically mixed environment, should be listened to, recorded and met unless there is a good reason not to meet it. It is good practice for refusal to be explained in writing.”

That is the Government saying exactly what is in the new clause, which is why I hope that the Minister will be minded to support it.

Charles Walker (Broxbourne, Conservative)

Thank you, Mr. Cook, for calling me to make a brief contribution. I am in a difficult position in following such an excellent speech by my hon. Friend, who made some important points about people’s right to apply to move to different hospitals. I am aware that the Government are looking to replace beds with greater   community services, which may mean that the distance between areas or hospitals with beds will grow.

In a place with fewer beds, most might be occupied, creating a greater need to move people to a more far-flung location to give them the emergency treatment that they need. It is important, as with all illness, to have emotional and family support. If we must move people far from their homes to receive treatment in an emergency because a hospital more convenient to them and their family is full, we should consider at the earliest opportunity whether they wish to move back to a bed nearer to their family and friends, if that is in their interests, so that they can derive support from them.

It is also important that the convenience of clinicians should take second place to the patient’s interests. It might be more convenient for a clinician to put someone in a bed in a certain location, but if it is in the patient’s interests to be moved, we should be sensitive to their wishes. It therefore gives me great pleasure to support made by my hon. Friend the Member for Rochford and Southend, East.

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

The hon. Member for Rochford and Southend, East is very tempting—[Laughter.] He is particularly so as the virgin mover of a new clause. However, I am afraid that I might have to disappoint him, although I want to say straight away that I certainly understand his reasons for tabling the new clause. It would require the appropriate authority—I presume that the hon. Gentleman means the hospital managers—to establish a formal procedure to advise patients and their nearest relatives that a transfer to another hospital can be requested if there is good reason.

The new clause is similar to an amendment tabled in the other place, and it raises important issues of good practice. As the hon. Gentleman and the hon. Member for Broxbourne pointed out, it reflects one of the recommendations of the David Bennett inquiry. I accept the principle behind the recommendations, but I must again refer the Committee to the fact that it would be better to put them into the code of practice.

Ian Gibson (Norwich North, Labour)

As the Minister pointed out, I was fairly involved in the Rocky Bennett case, as it was in my constituency, and I met his sister, who had fought hard on the issues for some time. I seem to remember that the reason why racism reared its ugly head was that people took Rocky aside and sat on him and not the other person involved in the altercation, who happened to have a different skin colour. That was where people picked up on the idea that a racist element was involved.

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

My hon. Friend is quite right to say that that inflamed the situation. In our action plan, “Delivering race equality in mental health care”, which accompanied our response to the David Bennett inquiry, we certainly reinforced the message that all requests to transfer to another hospital should be carefully considered and receive a reasoned response. That should include such factors as a patient’s wish to be closer to his family or to be cared for in a more ethnically mixed environment.

As I said, it is not right for us to introduce the sort of prescribed process for transfer requests that would  result from the new clause. Information is important, as the hon. Member for Rochford and Southend, East rightly said. However, we should look again at the code of practice; there should certainly be no objection to giving guidance in the new version of the code about the need to inform patients and their nearest relatives of the possibility of transferring to another hospital. We could look at whether all transfer requests should be recorded, and at whether written decisions should normally be recorded in response to all such requests.

It would also be possible to go a bit further than the new clause seeks to do. We could look at listing the sort of factors that hospital managers should take into account when deciding whether a transfer is appropriate. Particularly, in response to concerns raised by hon. Members regarding BME issues, we could emphasise more issues of cultural needs, for example. I would like to look at whether that can be done in the code of practice more effectively than it is at present, and I would certainly welcome any views that members of the Committee have on what we could say there. By doing that, we will be able to get across to hospital managers, perhaps more effectively than we could in legislation, the wide range of factors that might be relevant in deciding whether a patient should transfer to a different hospital.

Charles Walker (Broxbourne, Conservative)

Given the mental state of a patient and the possible lack of awareness of their family, will the Minister actually introduce measures to empower managers to say to families, ‘There could be a better solution than the one that we are currently offering you—a hospital nearer your home”? Under such an arrangement, instead of waiting to be asked, the managers would go and initiate a hospital move.

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

The hon. Gentleman makes a valid point about the need to talk to carers or family members, as appropriate. In particular, that is why it is good that we have enshrined in clause 10 the idea that that should certainly happen.

Although I accept that the new clause is well intentioned, I hope that my response to the hon. Member for Rochford and Southend, East gives him some reassurance that we take this matter seriously and will be looking at it in the code of practice.

James Duddridge (Rochford & Southend East, Conservative)

Given that this is my first foray into these matters, you will understand, Mr. Cook, that I am deeply disappointed. The Minister has let me down gently, however, and she made a number of reassuring points. I look forward to following the detail in the new code of practice. I beg to ask leave to withdraw the motion.