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Health and Social Care Bill

I rise to speak to Amendment No. 93 and shall put my medical historian hat on for a moment. I am not entirely sure that the Government understand the implications of the abolition of the Mental Health Act Commission and its place in history, and that is what has led me to support the proposal for a special committee. Between 1840 and 2008, apart from one 20-year period, to which I shall return, a national named authority has been responsible for the inspection and visiting of individuals detained in mental health hospitals. The seventh Earl of Shaftesbury got permission to extend the metropolitan Lunacy Commission on a national basis. The Lunacy Commission became the Board of Control, which, noble Lords will remember, was abandoned in 1959. Apart from the 20-year period until 1983, during which time there was constant pressure on the Government from mental health professionals to recreate a mental health commission, there has always been a named statutory authority. During that 20-year period, there were several famous occurrences. I do not think that anyone around this table will need to be reminded of the names of Ely, Whittingham, Fairfield and Normansfield hospitals. The inquiries surrounding those hospitals began around 1962 and carried on for the next decade. The Government tried very hard to address some of the problems with the creation of the Health Advisory Service, which was a very good thing but never exercised visitatorial and inspectorial functions. Although I have no direct evidence that there is any connection between the demise of the visitatorial and inspectorial functions of a specialist mental health commission, it is quite possible that there is a relationship between the two. I speak as a former vice-chair of the Mental Health Act Commission over many years. I was there during some of its early, most difficult years when it was trying to work out how to work effectively and efficiently, and it was not always easy. When you first join the commission, one of the first things to strike you, as I am sure other noble Lords who have been on the commission will acknowledge, is the sheer complexity of mental health legislation. Those of us who toiled in the mines of the Mental Health Act 2007 will remember the extraordinary complexities and the difficulties that mental health services have in keeping up to date and implementing the right legislation. There are constant case law reviews being thrown at you that you have to take account of, and you have to relearn while continuing your professional development and so on. Throwing away a national focus without substituting something that can provide an alternative seems utterly foolhardy. Therefore, when creating a specialist committee with specialist functions for overseeing the implementation of the Mental Health Act—particularly when we have just changed the Act to make it even more complex, involving community patients and so on—we would be foolish not to try to meet those anxieties. I take the point that many patients in our hospitals are as vulnerable as the detained and probably also need visiting functions—that certainly includes many people in social care units. In fact, the vast majority of people with mental health problems are in care homes, as they have dementia. However, the reality is that those who come under mental health provisions are especially vulnerable, and we owe it to them to create a system in which there will be a national body within the Care Quality Commission to focus on these special issues. Therefore, I strongly support Amendment No. 93. With regard to Amendment No. 25, I understand the need, or urge, to look at care pathways and integrated care systems in which health and social care work together, and I understand why we would not wish to constrain the new Care Quality Commission.