Mental Health Bill [Lords]

As usual, the hon. Gentleman makes a constructive and sensible point. There are concerns among black and ethnic minority communities about the disproportionate numbers within them who for one reason or another receive mental health services, and I believe that it is important to be sensitive to such concerns. This is probably the best way to achieve the outcomes that I suspect are shared on both sides of the House. I would like to deal now with doctor involvement in key decisions and the modernisation of professional roles. The House reversed the Lords amendments that would have allowed the responsible clinician’s decision to be overridden by a doctor who may not even be involved in the patient’s care. That would have undermined the new ways of working initiative and would have stood in the way of efforts to ensure that professional skills are recognised and focused where they are needed, to the benefit of patients and an efficient work force. 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. The legislation already requires that, before furnishing a renewal report, a patient’s responsible clinician has to consult at least one other person on the multidisciplinary team. On Monday, the noble Baroness Murphy laid an amendment whereby the responsible clinician has to secure the agreement of a person who must be of a different profession from his own. That provision would apply to all responsible clinicians of whatever professional background. We considered that amendment carefully and we believe that this approach provides a sensible solution. The approach is compatible with multidisciplinary assessment and has the renewal decision made by professionals who actually know the patient. It is for the responsible clinician to decide whether their 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. Let me deal now with the Lords amendments on supervised community treatment. The introduction of SCT is one of the most important features of the Bill. It is about allowing people with serious mental health problems to be cared for in the community when appropriate by having the right systems in place to help to avoid deterioration in their condition and thereby to protect them and others from harm. Both here and in the other place, SCT has been a source of heated and considerable debate. While we agree that there must be safeguards to ensure that people are not inappropriately put or kept on SCT, we are clear that the criteria must not be so restrictive that people who might benefit from its use are denied it. In particular, we could not accept the requirement that a patient should be ill enough to require two detentions prior to its use, because SCT might well help to prevent from relapse some patients who have been detained only once. We cannot accept a situation whereby clinicians and families have to stand by and watch a patient discharged from hospital relapse before SCT becomes an option for them. Delays in treatment inevitably worsen prognosis in the longer term. The Government are happy, however, to accept the Lords amendments that make clear the factors that clinicians should consider when making a community treatment order. The responsible clinician, in assessing the appropriateness or otherwise of SCT, must consider the risk of deterioration and, in so doing, must reflect on the patient’s history. It has been a long road to this stage of the Bill, and I should like to pay tribute to everyone who has made it all possible. I should also like to make it clear that we have much work ahead to ensure that we get the secondary legislation, codes of practice and implementation right. We want to work with all interested stakeholders in a genuinely authentic partnership. In spite of past disagreements, we have the same aim as those who have debated every step of the legislation with us: the timely and effective treatment of all who need that treatment. To realise that goal, we need to work together in the interests of patients, their families and carers, the professionals involved and the entire community.