---

Health and Social Care Bill

It is nice of the noble Baroness to call me a Minister, but I am certainly not there. The reality is that many good staff in the Healthcare Commission, CSCI and the Mental Health Act Commission have been jumping ship because of anxiety about what is going to happen. Many are unhappy about it. They see 31 March next year as a deadline, and there are all sorts of concerns. I am not arguing about whether they are right or wrong, but that is the reality. I come back to the commission and where it stands. The staff have been keen to get some leadership into position and to see what the future holds. I come back to the important issue expressed so eloquently by the noble Baroness, Lady Murphy, that we have always had a statutory body that has looked after the concerns of detained patients. I, more than anyone, am concerned about that. I joined the commission as a visiting commissioner in 1995. Every week I visited high security hospitals and local hospitals and saw lots of abuses of the Mental Health Act on a day-to-day-basis. I was frustrated by what I saw and by what I could not do. I became a lead commissioner and took teams of commissioners into hospitals. We dealt with lots of issues but were very concerned about the fact that our powers were limited. I became vice-chairman and then, when I became chairman, I reorganised the whole commission because I thought that we were not tackling those fundamental issues. A team of us would go into a hospital, find a load of issues that were wrong and then, a year later, because we had limited resources, we would go back and find that more than half, maybe three-quarters, of the issues we had raised were still there; nothing had been done about them. Service users and patients constantly told us, ““You’re nice people, you do some really good things, but you’re useless when it comes to my kind because you haven’t dealt with this. I’ve been abused and you waited a year to come back””, even though we had followed it through, because people did not go in. I made changes at the commission. Now individuals go in regularly and frequently. We have teams and support networks that cater for their comradeship, and people can go in at any time. They are consistent in their visiting. If they come across an issue they will deal with it with the ward manager, the chief executive or the area commissioner. They can even go back in the next day because of the flexibility we have created. It is important that we have created that new structure. In that body of commissioners there are 107 people. You can pick up the phone and ask about any ward in the country that has detained patients, and someone in that organisation will tell you about it; they will tell you what is wrong and what is right with it and what is happening. I do not want to lose that expertise. I am also concerned—and this has come from our service user reference panel, of all people; the people we were talking about yesterday—that our role is limited. When commissioners go into hospitals, they interview detained patients in private. That is important, because a lot of our information about what happens to people comes from those who do not want to see us. We find out so much. We are also looking at how the Mental Health Act is monitored. That is what we are there for. We have to walk past people who may be being treated appallingly but under the law we have to turn a blind eye because it is nothing to do with us. It is none of our business, and we have been told that many times by esteemed lawyers and academics. So for us this organisation is beneficial in being able to look at the whole pathway of patients who are deprived of their liberty but are not detained under the Act. Sanctions and enforcement measures will be available to enable us to deal with these issues. We shall be able to understand why patients are in these places and question what happens after they leave. That whole pathway is very important. I do not want to recreate those silos in a new organisation that is supposed to do away with them. I struggle in respect of Amendment No. 25 in terms of having silos, particularly in social and healthcare, as these bodies have been designed to have a seamless health and social care policy. I am sympathetic to Amendment No. 93 as it tackles the specialist nature of monitoring the Mental Health Act. This is not about mental health per se. I take on board the point made by the noble Baroness, Lady Howarth, about people with learning disabilities and others also requiring a pathway, a journey into care and wrap-around services. The responsibility under Section 120 of the Mental Health Act to review the powers and duties of that Act is to be moved lock, stock and barrel to this new organisation. It will have a special legal remit to undertake that. I am reassured by Ministers and officials—and by the fact that this duty will be transferred lock, stock and barrel to the new organisation—that visiting and interviewing detained patients will continue on a fairly frequent basis. That is important. However, there needs to be a mechanism in this organisation—Amendment No. 93 would go some way to achieve this—to monitor the powers and duties of the Mental Health Act. That is important. The day-to-day work of the Mental Health Act Commission is to safeguard the interests of detained patients. Even if there is a crisis, that duty will never be relinquished. We will still safeguard the interests of detained patients, interview them and ensure that they receive appropriate care and treatment. I hate to mention MRSA or C. difficile, but if mental health is the Cinderella of health services, they have the potential to be the two ugly sisters that alter the focus as regards what should happen to a small group of patients. I support the concept of Amendment No. 93—I ask my noble friend to ensure that the interests of these patients are safeguarded—but in general I do not support Amendment No. 25.