Health and Social Care Bill

moved Amendment No. 51: 51: Clause 16, page 8, line 11, at end insert— ““( ) impose requirements as to the provision of information on the number of admissions and discharges from compulsory powers under the Mental Health Act 1983 (c. 20) and the numbers of deaths of detained patients.”” The noble Baroness said: This group of amendments is related to how the CQC will discharge its functions in relation to the Mental Health Act and other legislation. In moving the amendment, I shall speak also to my Amendment No. 52 and to my noble friend Lady Meacher’s Amendment No. 53. She sends her apologies to the Committee that she is unable to be present. The noble Lord, Lord Patel of Bradford, asked me to indicate his support for the amendments in his role as chairman of the Mental Health Act Commission. Essentially, all the amendments are a little different. I shall try to be brief. The purpose of the amendment is to ensure that regulations under Clause 126 can impose requirements regarding information on the numbers of admissions and discharges from compulsory powers under the Mental Health Act and to have the deaths of detained patients reported. Some 15 years ago, there was no collection of the use of Mental Health Act powers and I well remember an interview between me, the then chairman of the commission, Sir Louis Blom-Cooper and the then Secretary of State, Kenneth Clarke, about issues to do with the Mental Health Act. The Secretary of State asked us whether use of the powers had increased or decreased, and in what areas they had changed. I had the tremendous embarrassment of having no information whatever, except our impressions as visitors. Since then, the Mental Health Act Commission has made many requests and has finally been given powers to collect this information. We used to have to derive some of it from hospital episode statistics, but that was exceedingly difficult and very inaccurate. Eventually, it was agreed that the commission would collect the data to ensure that it was possible to monitor the use of the Act. As the noble Lord, Lord Patel, told the committee in the other place, however, we know that information is not willingly collected unless it is mandatory. If the CQC is to effectively and comprehensively monitor the use of the Act, it is crucial that it collects information pertaining to the use of the powers. There is, indeed, a power to require information to be made available to the CQC in paragraph 8 of Schedule 3, but that does not specify the type of information. It is also true that the mental health minimum data set collects some relevant statistics, but the information is not necessarily available to the commission in a timely fashion, it is not comprehensive and it is not accessible. There are still huge gaps. For example, under Section 136 of the Mental Health Act, on powers to take people to a place of safety—a famous power which I am sure some colleagues will remember—you can be taken either to a police station or to a hospital. Because hospitals are obliged to provide information to the Mental Health Act Commission, we can say how many Section 136 powers are used, but in the community, when you are taken to a police station under those powers, only a third of local authorities provide that information. It is not mandatory, so the information is nationally useless. So we are not getting to grips with one of the key issues. Some information is available, which would not otherwise be the case, such as the number of children detained on mental health wards. At the moment, deaths of detained patients are notified to the commission by agreement. All of the deaths are reviewed by a specially trained commissioner who makes a visit if there is cause for concern either about the physical healthcare that the patient received or if the death is unnatural and triggers an untoward incident inquiry. The purpose of the reviews is to ensure that lessons are learnt about the causes of such deaths and that they are less likely to recur. The Mental Health Act Commission is a member of the Forum for Preventing Deaths in Custody—an initiative set up for the specific purpose of providing statistical information to other bodies, such as the national confidential inquiry on homicides and suicides. The bottom line here is that we do not want to leave to chance what information the new commission collects. It must be able to discharge its functions in relation to information and data gathering and analysis of the use of the Act to give a comprehensive picture. Amendment No. 52 would ensure that future registration criteria are sufficiently robust and set a high enough quality threshold by incorporating explicit mention of primary legislation that is essential for providing care. That largely arises because the Mental Health Act Commission has found for several years that users of the Act are not always well trained. That is particularly the case where there are a lot of agency staff or foreign doctors coming in. They are often exceedingly welcome in mental health services, but they require considerable training. That applies not only on the Mental Health Act but other legislation, such as the NHS Acts, the Midwives Acts, equality legislation, and so on. Organisations delivering care—those 30,000 service providers of varying sizes—should at least understand the primary legislation that informs their work when they are registered. Finally, Amendment No. 53 provides for regulations to impose a duty about the need to reduce health inequalities and discrimination on the basis of disability. That is really about the implementation of the Disability Discrimination Act. Our main concern here is for people with severe mental illness—who, we know, at present die 10 years younger than the rest of the population because of poor physical health. They are at far greater risk than the rest of us of developing heart disease, hypertension, obesity, diabetes and smoking problems. Some of those problems are a consequence of lifestyle, but often they are also the consequence of neglect by services to care for people’s physical health problems when they also have a mental health problem. That is often at the root of the problems that we discover during the root cause analysis of an untoward death: someone has not received good quality physical healthcare. We believe that many mental health trusts are failing on a massive scale to fulfil their duties under the Disability Discrimination Act. The noble Baroness, Lady Meacher, chairs a trust in which I know there are special identified physical healthcare co-ordinators, whose responsibility is to ensure that that does not happen; but many mental health trusts do not ensure that. The other issue addressed by the amendment is discrimination by health trusts against people with mental health problems. To give a very brief example, a young man applied to become a volunteer at four different NHS hospitals. All four accepted him at first, but when he told them that he had a mental health difficulty, he was turned down. They claimed that he might pose a threat to the public because of his mental health difficulties, although he had never committed any crime or acted violently to anyone. That is not completely straightforward. I realise that if an applicant for a voluntary position has a current mental health problem that would interfere with the proposed activities, it may be entirely proper to reject the applicant. However, let us suppose, for example, that an applicant for a voluntary position had suffered from depression some years earlier and was now well. It is entirely discriminatory to exclude that person from an opportunity to do voluntary work, which would no doubt be of benefit to him in confidence building. We want to ensure that the ability for the commission to act in relation to failure to implement the Disability Discrimination Act with regard to mental health patients should be a matter for the Care Quality Commission. I know that the Minister in the other place felt that this was still a matter for the public consultation on registered activities, but I hope that the Minister today will agree that if we wish to fight the stigma of mental illness, it is important to have a potential signal of that commitment with regard to how the Care Quality Commission discharges its function. I beg to move.