STATE HOSPITALS (SCOTLAND) BILL [LORDS]

Second Scottish Standing Committee

STATE HOSPITALS (SCOTLAND) BILL [LORDS]

25th May 1994

PARLIAMENTARY DEBATES

HOUSE OF COMMONS

OFFICIAL REPORT

Second Scottish Standing Committee

STATE HOSPITALS (SCOTLAND) BILL [LORDS]

Wednesday 25 May 1994

CONTENTS

CLAUSES 1 to 3 agreed to.

Bill to be reported, without amendment.

Committee rose at fifteen minutes to Eleven o'clock.

LONDON: HMSO

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1

The Committee consisted of the following Members:

Chairman: Mr. Michael J. Martin

Adams, Mrs. Irene (Paisley, North)

Coombs, Mr. Simon (Swindon)

Donohoe, Mr. Brian H. (Cunninghame, South)

Douglas-Hamilton, Lord James (Parliamentary Under-Secretary of State for Scotland)

Fairbairn, Sir Nicholas (Perth and Kinross)

Fyfe, Mrs. Maria (Glasgow, Maryhill)

Gallie, Mr. Phil (Ayr)

Godman, Dr. Norman A. (Greenock and Port Glasgow)

Hood, Mr. Jimmy (Clydesdale)

Kynoch, Mr. George (Kincardine and Deeside)

McMaster, Mr. Gordon (Paisley, South)

Michie, Mrs. Ray (Argyll and Bute)

Monro, Sir Hector (Parliamentary Under-Secretary of State for Scotland)

Robertson, Mr. Raymond S. (Aberdeen, South)

Stewart, Mr. Allan (Parliamentary Under-Secretary of State for Scotland)

Walker, Mr. Bill (Tayside, North)

Wray, Mr. Jimmy (Glasgow, Provan)

Mr. F. A. Cranmer, Committee Clerk

2
3 Second Scottish Standing Committee Wednesday 25 May 1994

[MR. MICHAEL J. MARTIN in the Chair]

State Hospitals (Scotland) Bill [Lords] Clause 1
STATE HOSPITALS

10.30 am

Question proposed, That the clause stand part of the Bill.

Mr. Jimmy Hood (Clydesdale): I shall start by giving a brief outline of the background to the Bill. It was introduced earlier this year in another place by the noble Marquess Lord Huntly. I congratulate him on successfully taking the measure through the other place; it is worth noting that the Bill has so far been welcomed by both sides and has received full support. My involvement arises from my constituency interest in the state hospital and I thought that it would be useful to introduce these measures. The Bill received its Second Reading as a formality and it may now help members of the Committee if I explain something of its background and purpose. The Bill is necessary to create a path in the legislation that will subsequently allow the state hospital at Carstairs to become a special health board within the national health service in Scotland. The move will underline local accountability and let the hospital benefit from having the freedom to make more of its own decisions. Health board status will also have a great impact on staff morale. I know, for example, that great encouragement has been taken from the progress of this Bill because it carries an appropriate, positive message for staff, the NHS and the public: that Carstairs is a hospital. I mentioned that Carstairs lies within my constituency. Naturally, I take a close personal interest in all moves affecting the hospital, its patients, staff and local communities. I have welcomed the fact that over recent years, the service and ethos of the facility has changed, almost beyond recognition, from the inappropriate custodial regime that was formerly in place. That outdated regime has thankfully been replaced by an atmosphere appropriately akin to that of a hospital, where care, treatment and rehabilitation predominate. The hospital cares for about 220 patients at any one time. Some are referred from other hospitals within the national' health service, others from prison or the courts, but all are referred because they need the specialist care and treatment available at Carstairs. The patients suffer from a range of mental disorders and benefit from being cared for in facilities that are specifically designed for those who have proved difficult to manage elsewhere. The facilities provide secure conditions which minimise the potential danger to the patients themselves, to staff and, of course, to the general public. 4 My hon. Friend, the Member for Glasgow, Maryhill (Mrs. Fyfe), accompanied me on one of my recent visits to the hospital. We were both impressed by the care and commitment of the staff. That is not a front. The care provided is successful in achieving each year the rehabilitation of some 90 patients, who return from the state hospital to the care of their referring consultants. That alone speaks volumes for the transition which has taken place at Carstairs in recent years. The changes have not happened by chance. Over the past three years or so, every possible step has been taken to improve standards of care and to prepare the state hospital and its staff for health board status. The Government restructured the state hospital management committee along health board lines and obtained the agreement of Her Majesty's Treasury that from 1 April 1992 the hospital would be part of the main health service and would be subject to the same financial regimes as apply to all other health boards in Scotland. They have ensured that the state hospital develops its own strategic objectives and is subject to the same accountability and review process as the other health boards in Scotland. Finally, but significantly, all staff at the state hospital are now employed on NHS terms and conditions of service and have been for some time. Considerable momentum has built up behind those changes. The staff have welcomed these initiatives and fully regard themselves as NHS staff. Enabling the state hospital to be a special health board and allowing it to function fully as a board will also significantly enhance the management's ability to attract and retain skilled staff. This is a key factor in maintaining the high quality of service the hospital offers and the efficiency with which it delivers that service. Currently, the provisions for the control and management of the state hospital are set out in the Mental Health (Scotland) Act 1984, whereas the Secretary of State for Scotland's power to constitute health boards is set up under the National Health Service (Scotland) Act 1978. The National Health Service and Community Care Act 1990 placed powers within the 1978 Act for the Secretary of State for Scotland to create and transfer functions to special health boards. Quite properly, of course, only those functions that are set out in the 1978 Act can be so transferred. In order that the full range of provisions attaching to the state hospital service can be transferred under those arrangements, it is necessary to transfer the legislative provisions covering the control and management of the state hospital, Carstairs, from the Mental Health (Scotland) Act 1984 to the 1978 Act. This Bill will effect that transfer. Turning to the detail of the Bill, clause 1 re-enacts in an extended form section 102 of the National Health Service (Scotland) Act 1978 to include the provisions dealing with the control and management of state hospitals in Scotland currently provided in the Mental Health (Scotland) Act 1984. The subsections of the re-enacted section 102 in the main re-enact provisions of sections 90 and 91 of the Mental Health (Scotland) Act 1984. Subsection (1) continues the Secretary of State's duty to provide state hospitals and re-enacts section 90(1) of the 1984 Act. Subsection (2) continues the provisions of section 90(2) of the 1984 Act and defines such hospitals as "state hospitals". 5 The Secretary of State's reponsibility for the control and management of state hospitals is continued under subsection (3) subject to subsection (4), which is a re-enactment of section 91(1) of the 1984 Act. That responsibility is also subject to section 2 of the National Health Service (Scotland) Act 1978 as amended by the National Health Service Community Care Act 1990. Section 2 contains the powers for the Secretary of State by order to delegate functions under the 1978 Act, which will now include the transfer of his control of state hospitals to a special health board. Subsection (4) enables the Secretary of State to delegate the management of state hospitals to either a committee constituted under the 1984 Act, the Common Services Agency or a health board. Subsection (5), which re-enacts section 91(2) of the 1984 Act, provides that the committee referred to in subsection (4) shall manage the hospital subject to directions given by the Secretary of State. As mentioned before, these provisions are necessary because as the law currently stands the Secretary of State is unable to set up a special health board under section 2 of the National Health Service (Scotland) Act 1978 for the care and treatment of patients within state hospitals in Scotland. Not to provide the necessary path for special health board status for Carstairs hospital would convey entirely the wrong message to the NHS, the public and, most importantly, to the staff at the Hospital. I commend clause 1.

The Parliamentary Under-Secretary of State for Scotland (Mr. Allan Stewart): I congratulate the hon. Member for Clydesdale (Mr. Hood) on introducing this extremely useful Bill. He speaks with the expertise of the Member of Parliament for the constituency in which the state hospital is located and his interest and knowledge are well known. I concur entirely with what he said about the provisions of the Bill being welcomed by the staff and the relatives and friends of the patients. As the hon. Gentleman emphasised, the state hospital is a centre of excellence. It is held in high regard by all who use its services. The staff are expert in dealing with potentially dangerous people suffering from mental disorder. They are committed to care, therapy and rehabilitation, and the sooner the service is understood as hospital care, the better it will be for all concerned.

Dr. Norman A. Godman (Greenock and Port Glasgow): I shall not take up much of the Committee's time. Clause 1 refers to those "who require treatment under conditions of special security on account of their dangerous, violent or criminal propensities." Can the Minister confirm that not all those in state hospitals have been convicted in a court of law, but may have been referred there by psychiatrists who were concerned for their welfare and the welfare of others? What right of appeal do those who have not been convicted by a court of law—who have been sent to the hospitals on the recommendation of, for example, a consultant psychiatrist—have to the Mental Health Welfare Commission?

Mr. Stewart: The hon. Member for Greenock and Port Glasgow (Dr. Godman) is correct on the general point: there are patients in state hospitals who have been referred there by consultant psychiatrists—which emphasises the importance of Carstairs being perceived as a health 6 resource. On his second, more detailed point about the right of appeal; I believe that such patients have a right of appeal to the sheriff. If that is not correct, I shall of course write and inform the hon. Gentleman. The hon. Member for Clydesdale has explained clause 1 and the general provision of the Bill clearly and I am happy, on behalf of the Government, to commend the clause and the Bill to the Committee.

Question put and agreed to.

Clause 1 ordered to stand part of the Bill.

Clause 2
CONSEQUENTIAL AMENDMENTS AND REPEALS

Question proposed, That the clause stand part of the Bill.

Mr. Hood: The clause provides consequential amendments and repeals within the National Health Service (Scotland) Act 1978 and the Mental Health (Scotland) Act 1984. Subsection (1) repeals reference to section 102(2) in section 105(4)(b) of the 1978 Act. Subsection (2) is a straightforward provision which repeals the definition of "state hospital" in section 108(1) of the 1978 Act and substitutes the definition now provided in the re-enacted section 102(2). Subsection (3) is similarly straightforward. It repeals sections 90 and 91(1) of the 1984 Act, provisions that are now to be found in section 102 subsections (1), (2) and (3). Subsection (4) repeals words in section 91(2) of the 1984 Act and substitutes words referring to the new provision in the re-enacted section 102(4)(a) of the 1978 Act. Finally, subsection (5) substitutes in the definition of "state hospital" contained at section 125(1) of the 1984 Act reference to "section 102(2) of the 1978 Act" in place of reference to the 1984 Act.

Question put and agreed to.

Clause 2 ordered to stand part of the Bill.

Clause 3
SHORT TITLE, COMMENCEMENT AND EXTENT

Question proposed, That the clause stand part of the Bill.

Mr. Hood: The clause provides simply for the citation, commencement and territorial extent of the Bill. If enacted, the measure will be known as the State Hospitals (Scotland) Act 1994. The Act will extend to Scotland only and will be commenced by an order made by the Secretary of State for Scotland.

Question put and agreed to.

Clause 3 ordered to stand part of the Bill.

Mr. Hood: On a point of order, Mr. Martin. Members of the Committee will appreciate that this is a technical Bill, which runs to just three clauses. To summarise, clause 1 re-enacts, in an extended form, section 102 of the National Health Service (Scotland) Act 1978 to include the provisions dealing with the control and management of state hospitals in Scotland currently provided in the Mental Health (Scotland) Act 1984. Clause 7 2 deals with the consequential amendments and appeals. Clause 3 gives the powers to make an order which will commence the provisions of the Bill. The Bill has no financial effects, no effect on public sector manpower and no compliance cost implications for business.

8

I commend the Bill to the Committee.

Bill to be reported, without amendment.

Committee rose at fifteen minutes to Eleven o'clock.

THE FOLLOWING MEMBERS ATTENDED THE COMMITTEE:

Martin, Mr. Michael (Chairman)

Adams, Mrs.

Coombs, Mr. Simon

Donohoe, Mr.

Douglas-Hamilton, Lord James

Fyfe, Mrs.

Gallie Mr.

Godman, Dr.

Hood, Mr.

Kynoch, Mr.

McMaster, Mr.

Robertson, Mr. Raymond S.

Stewart, Mr.

Walker, Mr. Bill