Mental Health Bill [HL]

My Lords, I beg to move that the House do agree with the Commons in their Amendment No. 4. I shall deal also with Commons Amendments Nos. 10 to 14, 19, 21, 31, 36, 37, 40, 53, 56, 58, 62, 65 and 66, which concern approved and responsible clinicians. I also welcome Amendment No. 4A, tabled by the noble Baroness, Lady Murphy, which I believe offers an excellent way forward. Commons Amendments Nos. 4, 31, 36, 37 and 40 reverse amendments made in the House that would have required a patient’s responsible clinician to gain agreement from a doctor before renewing a patient’s detention or initiating, extending or revoking a patient’s community treatment order. To allow a responsible clinician’s decisions to be overridden by a doctor who may not even be involved in the patient’s care is certainly not the best thing for patients or for an efficient workforce. That is why the other place voted to overturn your Lordships’ amendments. However, the Government have always said that the decision to renew a patient’s detention should involve the multidisciplinary team of professionals concerned with the patient’s care. Before furnishing the renewal report the Act already requires a patient’s responsible clinician to consult at least one other person on a multidisciplinary team. Amendment No. 4A, laid by the noble Baroness, Lady Murphy, seeks to require also that the responsible clinician secures the agreement of such a person who must be of a different profession from the responsible clinician. The provision would apply to all responsible clinicians of whatever professional background. We have considered this amendment carefully. On balance, we believe that it offers an excellent solution. It avoids the problems associated with your noble Lords’ previous amendments, which harked back to an outdated ““doctor knows best”” approach. The Mental Health Coalition, representing 85 per cent of the mental health workforce, says that the previous amendments would have introduced, "““outmoded hierarchies between the professions in decision-making situations [and] taken mental health care backwards””." They also would have undermined the New Ways of Working initiative, which has general support from psychiatrists and others. They would have stood in the way of efforts to ensure that professionals’ skills are recognised and focused where they are needed, to the benefit of patients and an efficient workforce. By contrast, the amendment proposed by the noble Baroness, Lady Murphy, is compatible with a multidisciplinary assessment and has the renewal decision made by professionals who know the patient. It is for the responsible clinician to decide whether a patient’s detention should be renewed, but it is not unreasonable to expect that they have formal support from at least one other member of the multidisciplinary team. Good practice already dictates that they should negotiate agreement with the team. The noble Baroness’s amendment recognises multidisciplinary working; it is one that we can support. Commons Amendments Nos. 10 to 14, 19, 21, 53, 56, 58, 62, 65 and 66 are simply technical amendments to address small inconsistencies inParts 4 and 4A, which otherwise result from the introduction of the approved and responsible clinician roles. Moved, That the House do agree with the Commons in their Amendment No. 4.—(Baroness Royall of Blaisdon.)