---

Health and Education

It is a daunting prospect to speak after a number of good maiden speeches. I have to say that my mouth opened slightly when I heard the hon. Member for Islington, South and Finsbury (Ms Thornberry) mention Marx and Lenin. That is a first for Labour Members, at least in my experience here. I am afraid that I misheard the hon. Lady and thought that she referred to Marx, Lennon and Blair, and my mind inevitably turned to Groucho, John and Lionel. I want, with my new-found status as an old lag, to say something encouraging to the new Members who have spoken, which is that following those who previously represented one’s constituency can be a daunting task. I am only the fourth Member for Caernarfon since 1890, following on from Dafydd Wigley, Goronwy Roberts and Lloyd George, who was the Member for 55 years. Climbing into those enormous shoes is not always easy, but hopefully one gets there eventually. I want to take this opportunity to talk a little bit about health and, in particular mental health and the mental health Bill. I speak today for Plaid Cymru and the SNP, and I speak in place of my hon. Friend the Member for Na h-Eileanan an Iar (Mr. MacNeil)—I hope that I pronounced that correctly—who is unfortunately indisposed this evening. My background is in mental health, and there are few opportunities for Welsh Members to talk about health in this place because it is a devolved matter. I am probably the only social worker in the House approved under the Mental Health Act 1983 since the retirement of the former Member for Wakefield. I was also a member of the Joint Committee that examined the Government’s draft Mental Health Bill over the winter, and I agree with the Committee’s conclusions. As I said, health in Wales is a devolved matter, so it is problematic for Welsh MPs to address the issue. This, however, is an opportunity because the Bill deals with England and Wales. There has been much criticism of the NHS in Wales—not, I should say, of the staff, but of the structures. Some of that criticism is justified, especially in respect of waiting lists. The NHS in Wales has followed a significantly different course, especially since devolution. There is not much use of the private sector and very little use of private finance initiative. There is an emphasis on public health outcomes, not just on delivering a sickness service, and health is seen as something that the NHS contributes to the pot, not something that it alone produces. There is an emphasis on localism, with the establishment by the Labour-controlled Assembly of 22 local health boards. That has not been free of criticism, but it is a particularly Welsh model. Setting up those local health boards cost some £15 million, and apparently they cost another £15 million annually to run. That is the model that we have—one, some people would say, that we are stuck with, and it is different from the model in England. There is also significant emphasis in Wales on joint working with local authorities, which again is somewhat different from England. That has a long history arising mainly from the all-Wales strategy for learning difficulties, or mental handicap, as it was then. That is a joint project between local authorities, health authorities and, importantly, the voluntary sector. That difference between the systems in Wales and England has led to arguments that legislation such as the Mental Health Bill should be formulated for Wales either by having a specifically Welsh Bill or at least by tailoring the provisions of the England and Wales Bill to the particular circumstances in Wales. The Joint Committee looking at the draft Bill came to that conclusion. In fact, in a very startling recommendation, No. 105, we said: ““The standard of Mental Health Services in Wales must be at least as good as it is now in England before the provisions of the draft Bill can be implemented.”” The Committee also said that"““Resources should be allocated in order to enable the service to be brought up to the English standard.””" That services in Wales are not good enough to implement the legislation is a startling and damning conclusion. We are very far behind in many respects. I hope to take the matter further if I am called to speak on Second Reading. I also hope to be a member of the Standing Committee on the Bill. I will not go into the detail now, but the significant features for us include the continuing dependence on large institutions; the severe lack of professional staff, which has strong implications for the expansion of tribunals; and the paucity of community resources if we are to provide for compulsory treatment in the community. For example, there is only one approved social worker on duty at night and at the weekends for the whole of Powys—an enormous area comprising almost a third of the land mass of Wales. Problems may arise because of the rural nature of the Wales and the difficulty of accessing care—both in-patient care and out-patient care in the community, which may be made compulsory. Specific and cogent criticisms of the Bill have come from all quarters in Wales, especially the Mental Health Alliance and the Wales mental health organisation Hafal. Again, I shall not go into detail, but I note that they have criticised the lack of a statement of principles in the Bill—the Scottish equivalent of the legislation has in it a statement of the Milan principles, which cover fundamental matters such as a patient’s rights. Criticism has also been made of the power to compel treatment not being matched by a concomitant reciprocal right to treatment—treatment can be forced on someone, but there is no right to assessment or treatment—and the Bill’s emphasis on compulsory treatment of the tiny minority of dangerous people, rather than on services for the overwhelming majority of people with mental problems, who pose no risk to anyone apart, perhaps, from themselves. Because of that focus, there is a danger of stigmatising anyone who receives mental health treatment. Finally, the great extension of compulsion to groups that are currently excluded, such as people with severe and dangerous personality disorders, has also been criticised. Another obvious deficiency of the Bill is its failure to treat Wales as a multicultural and diverse community. For me, as a Welsh speaker, that is particularly marked in the lack of attention given to Welsh-medium services—the apparent assumption that Wales is monocultural and monoglot, with English being the norm. It is significant that the Joint Committee recommended that the language of provision in Wales should be a matter for the Welsh Assembly and that it could be dealt with through a code of practice. I hope to press that point on the Government. If we want to achieve equity of provision throughout England and Wales, we must be much more aware of cultural and linguistic diversity. The Government have a fine opportunity to develop mental health law. Such a development is long overdue—the Mental Health Act 1983 was passed 22 years ago and needs reform. I hope that the Government will grasp that opportunity, but not by means of the Bill as drafted, given that the Joint Committee said that it was fundamentally flawed. There is too close a focus on the public misconception of people with mental health problems being dangerous and insufficient emphasis on protecting people’s rights and providing services for people in their own community.