Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
I want to raise two specific points. Opposition Members are concerned that the concept of “Any person” in clause 1 is too broad, because it appears to legalise approvals by anybody. Why does the clause not refer specifically to North-East, Yorkshire and the Humber, West Midlands and East Midlands?
Secondly, where is the provision for the doctors who have been approved by a trust according to what we now understand was a defective process to be re-approved by the correct process? As the clause stands, it seems—I am happy to be put right on this—that doctors approved previously by the trust will be able to continue to section patients without re-approval under the correct process.
The Minister of State, Department of Health (Norman Lamb)
I will first set out what the clause seeks to do and then respond to the shadow Minister’s questions.
The clause directly addresses the issue that the Bill intends to resolve. Between 2002 and 2012, four strategic health authorities delegated to mental health trusts the function of approving doctors with responsibilities under the Mental Health Act 1983. The legal advice that we have obtained is that there are good arguments, as we have already discussed, that decisions to detain made by doctors who were approved in that irregular way are nevertheless lawful. The clause removes any doubt—that is its purpose. It clearly spells out that when mental health trusts gave approval in the past they are to be treated as having had the power to do so.
The clause has the effect of eliminating any irregularity from decisions made in complete good faith, and in the best interests of the patient, by doctors fully qualified to make them. It does so in a way that is fully consistent with the legal and clinical advice that we have received on the issue, and means that patients and their families do not have to undergo the process of assessment for detention under the Act again solely for the purpose of correcting a technical error made by a strategic health authority.
The hon. Lady asked why the clause was so broad as to refer to “Any person”. I understand her concern, but the point is that we do not yet know whether there were other issues before the establishment of the SHAs. Obviously, that is part of the work that the review will undertake, but to ensure that we resolve the problem absolutely and that all those patients have clarity the decision was made for the clause to refer to “Any person” in order to avoid any risk of our uncovering another problem that might need a separate resolution. This deals with the whole problem of the approval process for the doctors who made those decisions.
The hon. Lady then asked, correctly, whether decisions will be taken properly as we progress. I can confirm that all the doctors have already been re-approved according to a proper process, so every decision that is taken from hereon in cannot be challenged. As we have said, any patient who wants to question the clinical judgement can do so and their rights remain the same as they have always been. This simply addresses the technical issue that we have been debating today.
Andy Burnham (Leigh) (Lab)
The clause refers not only to “Any person” but one who
“has done anything in the purported exercise of an approval function”.
On both counts, it is incredibly widely drawn and could take us into the territory of other elements of the approval process that may have been defective. Will the Minister assure the Committee that the clause is as narrow as it needs to be? It seems to be uncomfortably wide and may well restrict somebody’s ability to challenge an element of their section other than the fact that the doctor was not approved by the SHA. It is very loose in its current form.
Norman Lamb
I am grateful to the shadow Secretary of State for that intervention. We have gone through a very careful process and have followed legal advice on what is necessary to regularise the position. This relates specifically to the approval function, which is defined in clause 1(2). As I have said, the legal advice is that this is the best way to regularise the issue that has been uncovered.
Mr Andrew Smith (Oxford East) (Lab)
Before the Minister responded to the intervention by my right hon. Friend the Member for Leigh (Andy Burnham), he told my hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott) that if mistakes had been made before the establishment of the SHAs, some of the doctors who had not been properly approved previously may not have been approved by the executive action that the Secretary of Sate referred to earlier. Will the Minister assure the Committee that, should such instances come to light, those doctors will also be subject to a re-approval process?
Norman Lamb
The first thing I want to clarify, again, is that the clause ensures that if any previous authorisations were not done in accordance with the statutory provisions, the clause regularises that process, full stop. Of course, if we go back a long way, that may apply to people who have long since been discharged from their section. This regularises the situation for all. It also ensures that the detention of anyone who continues to be sectioned is regularised, because the original authorisation is deemed to be acceptable under the Bill and in accordance with parliamentary intent, as the Secretary of State said earlier.
Mr Smith
I am grateful to the Minister, but he has not fully answered my question. The Secretary of State has now properly given approval to those who were previously improperly approved. The Minister is right that many of the people in question may have retired or left, but some may still be practising. If further instances come to light, will they too be subject to a new scrutiny process?
Norman Lamb
I absolutely take the right hon. Gentleman’s point, and I am grateful to him. We must be absolutely certain that everybody is now properly authorised to make decisions. We know that everybody outside the four affected SHAs has been properly authorised—that has been checked and confirmed by SHAs, which have undertaken a proper check of their procedures. We also know that the four affected SHAs have already regularised the position of all their authorised practising doctors. We therefore know that across the whole system, doctors who undertake sectioning from now onwards will be properly authorised in accordance with the Mental Health Act 1983. The Bill addresses the previous problems with the authorisation process, and we have addressed the problem for the future by ensuring that everybody is properly authorised. I hope that deals with that point.
Norman Lamb
It does not entirely seem to deal with it, so I give way to the shadow Secretary of State.
Andy Burnham
I am grateful. It is important to get clarity before we leave this clause.
I know that the Government have not yet undertaken a full case-by-case review of the up to 5,000 cases involved. That prompts the question how the Government can be sure that the whole team involved in each case was qualified to a suitable level, and that there were not some instances of under-qualified people making decisions. That gives rise to concern that we may be retrospectively approving processes that were defective.
Norman Lamb
I do not think there is any suggestion that any of the people who undertook sectioning were not medically qualified to do so. The issue is simply with the body that undertook the authorisation and the fact that SHAs delegated that responsibility to mental health trusts, which was not in accordance with the law. The Bill is intended to regularise the position of every clinician who was not properly authorised because of that flaw.
Andy Burnham
I do not want to detain the Committee unnecessarily, but because the clause is drawn so widely it will possibly take away some people’s right to challenge whether there was a deficiency in the process or whether someone involved in the sectioning decision was under-qualified. Given that the Government have not undertaken a case-by-case review, I wonder how we can have absolute confidence that the power in the Bill is not too widely drawn.
Norman Lamb
I am told that we have dealt, doctor by doctor, with all the doctors in question who are currently practising. The problem relates to the doctor, not the patient, because it is about their authorisation to undertake the duties in the 1983 Act. The only people who undertake the actions referred to in the clause are doctors, who were authorised but unfortunately by the wrong body. That is what we are seeking to regularise.
Andy Burnham
We must have absolute clarity about this. In that case, why does the Bill mention “Any person” rather than “any doctor”? Our understanding is that a broader team of people can be involved in a sectioning decision, such as a social worker. If it is only doctors, the Bill should just say “any doctor”, but it does not.
Norman Lamb
We are talking about the approval function. Subsection (2) mentions
“practitioners approved to give medical recommendations”,
so it clearly deals with practitioners who have already been authorised, but by the wrong body.
John Pugh (Southport) (LD)
I am genuinely trying to understand this point and ensure that the Bill is as foolproof as possible. As I understand the Government’s case, the clinical need of people with mental health problems—the Bill clearly would not apply to people who did not have mental health problems—is trumping the absence of proper process, so the Bill is not an abuse of human rights.
The difficulty that I have with that argument—perhaps I ought not to have it, and maybe I am being particularly thick—is that the clinical need in question was established through a process that is acknowledged as formerly having been flawed. The clinical need is apparent only when a case has been heard and processed. The concept of clinical need here is certainly—
Norman Lamb
All that is being regularised is the power to approve a doctor, not whether a doctor is clinically sound. Any patient who challenges a judgment to section them either now or in the past will retain all their rights in law. We have acted on the advice of both lawyers and clinicians to ensure that we deal with the problem that has emerged in a way that respects patients’ clinical interests and considers them with the utmost seriousness. To go through a full reauthorisation process in every case could be incredibly damaging to individuals in potentially vulnerable situations. The Bill is based on the best clinical and legal advice that we have received on how to deal with the problem.
Ms Abbott
The Opposition have listened with great care to what the Minister has said. He has made a point of saying that his advice suggests that the Bill is the best way to deal with the situation. We argue that it is perhaps the most convenient way, but we know that the parliamentary draftsman has been under huge pressure to produce the Bill, and this would not be the first time that parliamentary draftsmen have come up with a form of words that is in some way defective. I repeat our concern about the broad nature of the clause, which states that “any person” who “has done anything” is to be “treated for all purposes”.
The Secretary of State for Health (Mr Jeremy Hunt)
Perhaps I can assist in this matter. I do not believe that there is a drafting error, but the hon. Lady is absolutely right to scrutinise every word of the Bill carefully and ask questions.
Clause 1 does not mention “any doctor” because it is about the power for an SHA to delegate the authority in question, not about a doctor’s decision or clinical ability. It refers to the person who approves that power of delegation. I hope that that clarifies the matter.
Ms Abbott
We have listened to what the Secretary of State and the Minister have said. We remain concerned about the broad nature of the clause, but we rest our case.
Question put and agreed to.
Clause 1 accordingly ordered to stand part of the Bill.
Clause 2 ordered to stand part of the Bill.
The Deputy Speaker resumed the Chair.
Bill reported, without amendment.
Third Reading
Mr Jeremy Hunt
I beg to move that the Bill be now read the Third time.
This has been a distinctly unusual process for the House, and one that is unprecedented for recent Members. Only after hard—if very rapid—consideration over the weekend did I decide that emergency legislation was the only safe course, and recommend that to the Prime Minister.
Retrospective legislation affecting an individual’s right to liberty is a major step, and it would be intolerable to have any doubt about such an important part of the law. Such a situation would be unacceptable for patients, their families, and doctors and nursing staff in NHS and independent hospitals. I have been insistent throughout that the clinical needs of patients should take priority within the law, and that legislation should be as tight as possible to ensure that patients’ legal rights are protected.
I thank Opposition Members for the way they have responded and for making it possible to legislate in such short order. I also thank hon. Members generally for their constructive challenge and scrutiny. Although there is need for urgency, it is essential that the Bill is properly tested, which hon. Members have done.
The House has acted wisely and swiftly in the interests of up to 5,000 highly vulnerable people. It has recognised the important human rights issues involved, and balanced that with clinical advice about the best interests of those people. I commend the Bill to the House.