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Session 2006 - 07
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General Committee Debates
Mental Health

Mental Health Bill [Lords]

The Committee consisted of the following Members:

Chairmen: Miss Anne Begg, † Frank Cook, Ann Winterton
Boswell, Mr. Tim (Daventry) (Con)
Browning, Angela (Tiverton and Honiton) (Con)
Bryant, Chris (Rhondda) (Lab)
Coffey, Ann (Stockport) (Lab)
Duddridge, James (Rochford and Southend, East) (Con)
Gibson, Dr. Ian (Norwich, North) (Lab)
Gidley, Sandra (Romsey) (LD)
Gwynne, Andrew (Denton and Reddish) (Lab)
Hillier, Meg (Hackney, South and Shoreditch) (Lab/Co-op)
Iddon, Dr. Brian (Bolton, South-East) (Lab)
Kidney, Mr. David (Stafford) (Lab)
Loughton, Tim (East Worthing and Shoreham) (Con)
McCarthy, Kerry (Bristol, East) (Lab)
Moon, Mrs. Madeleine (Bridgend) (Lab)
Naysmith, Dr. Doug (Bristol, North-West) (Lab/Co-op)
Pugh, Dr. John (Southport) (LD)
Rosindell, Andrew (Romford) (Con)
Walker, Mr. Charles (Broxbourne) (Con)
Ward, Claire (Lord Commissioner of Her Majesty's Treasury)
Williams, Hywel (Caernarfon) (PC)
Winterton, Ms Rosie (Minister of State, Department of Health)
John Benger, Committee Clerk
† attended the Committee

Public Bill Committee

Tuesday 8 May 2007


[Frank Cook in the Chair]

Mental Health Bill [Lords]

Further written evidence to be reported to the House:

MH 59 United Kingdom’s Disabled People’s Council
MH 60 College of Occupational Therapists
MH 61 Unison, The Royal College of Nursing, British Psychological Society, Mental
Health Nurses Association, Amicus and the College of Occupational Therapists
MH 62 Professor Nigel Eastman
MH 63 Dr Angus Bell
MH 64 Disability Rights Commission

Clause 14

Amendments to Part 4 of the 1983 Act
10.30 am
The Minister of State, Department of Health (Ms Rosie Winterton): I beg to move amendment No. 42 in clause 14, page 9, line 13, leave out ‘approved clinician’ and insert ‘person’.
The Chairman: With this it will be convenient to discuss Government amendments Nos. 67, 68, 45, 69 and 70.
Ms Winterton: The amendments make technical changes to part 4 of the Mental Health Act 1983 and correct minor inconsistencies that have crept into the legislation. They are intended to maintain the independence and integrity of the second opinion appointed doctor who, under part 4, has various roles in safeguarding the patient by providing a second, independent opinion on certain issues.
Government amendment No. 42 will ensure the independence of the SOAD, who certifies treatment under section 57 of the 1983 Act, among other things. The section covers psycho-surgery and other treatments referred to in regulations and is used only a few times a year. None the less, it is important to ensure that the legislative framework is robust. At the moment, a person in charge of a section 57 treatment who is not an approved clinician could technically be appointed as the SOAD who certifies the treatment. However neurosurgeons who perform psycho-surgery, for example, are unlikely to be clinicians. In practice, it should not happen, but to put it beyond doubt, the amendment makes it clear that the person in charge of a section 57 treatment cannot also be the SOAD who certifies the treatment.
Government amendments Nos. 67, 68, 69 and 70 deal with the SOAD’s duty to consult two other people who are professionally concerned with a patient’s treatment before deciding whether treatment under sections 57, 58 or 58A should be certified. We want a variety of views to inform the SOAD’s decision. At present, the 1983 Act requires the SOAD to consult one person who is a nurse and one person who is neither a nurse or a doctor. The amendments will ensure that neither of the people consulted can be the patient’s responsible clinician or, where different, the person in charge of the treatment. Of course, the SOAD will discuss the treatment with the person in charge, but by placing a duty on the SOAD to consult other professionals, we will ensure that a broad range of perspectives are taken into account.
Government amendment No. 45 makes it clear that the person in charge of a section 57 treatment can carry out all the statutory functions pertaining to that role, which includes providing a report to the Mental Health Act Commission on the treatment of a patient’s condition, whether or not they are an approved clinician. There is an anomaly at the moment in that such functions can be carried out only by an approved clinician in charge of the treatment, but there is no requirement for the person in charge of a section 57 treatment to be an approved clinician. Of course, the Bill will require an approved clinician to be in charge of any part 4 treatment under powers given by the 1983 Act without having to consult. No professional may be in charge of a treatment that they are not required to deliver.
In summary, the amendments will iron out inconsistencies in part 4 that would otherwise flow from the introduction of the role of approved and responsible clinicians.
Mr. Tim Boswell (Daventry) (Con): Good morning and welcome to the Chair, Mr. Cook.
I accept the spirit of the Minister’s presentation of the amendments and her wish to have a Bill that is technically well founded. I am not seeking to overturn the substance of the amendments, but I have two questions that perhaps go a little wider than they might seem. They are designed to get her assurance about the equality of position and equality of influence of the two people responsible for the process.
If a person is not a medical practitioner, but is some other person responsible for treatment, will the Minister assure us that their views will be treated in good faith and on an equal basis, and that there will be no question of what may be termed professional brow beating? I am sure that the various professionals will say that neither they nor their representative bodies ever wish to brow beat, but there must be an equality of treatment regarding those two persons, wherever they come from, in relation to the certification process.
Ms Winterton: I certainly hope that there would not be professional brow beating in those circumstances. As I have said, the amendments are largely technical and aim to preserve the independence of the second opinion appointed doctor. Perhaps it will help if I clarify the fact that the legislation has never required an approved clinician to be in charge of section 57 treatments. To answer the hon. Gentleman’s question, those treatments can be given only with the patient’s consent. It is the patient’s consent that gives the authority to deliver the treatment, and not the powers of the Mental Health Act 1983. Therefore, we think that it is unnecessary for the treatment to be in the charge of a clinician approved to apply the Act. I hope that that answers the hon. Gentleman’s question.
Angela Browning (Tiverton and Honiton) (Con): I, too, have a question. I think that I know the answer, but I just want reassurance from the Minister.Section 57(1)(a) of the 1983 Act involves
“any surgical operation for destroying brain tissue or for destroying the functioning of brain tissue.”
Will the Minister confirm that other legislation in respect of the removal of tissues from the body would apply to that particular process in that part of the Act?
Ms Winterton: As I said, section 57 treatments can be given only with consent. Is the hon. Lady making a cross-reference to the Human Tissue Act 2004 and some the capacity issues regarding decisions that can be made on behalf on an individual? Section 57 treatments cannot be given to somebody without capacity. The issue of removal of tissue for use in research would not apply in the way that she is talking about. If an individual does not have capacity,section 57 treatments cannot be applied.
Amendment agreed to.
Amendments made: No. 67, in clause 14, page 9, line 14, leave out ‘at the end insert
“nor the responsible clinician”’ and insert ‘after “medical treatment” insert “(neither of whom shall be the responsible clinician (if there is one) or the person in charge of the treatment in question)”’.
No. 68, in clause 14, page 9, line 22, leave out ‘at the end insert
“nor the responsible clinician”’ and insert ‘after “medical treatment” insert “(neither of whom shall be the responsible clinician or the approved clinician in charge of the treatment in question)”’.
No. 45, in clause 14, page 10, leave out lines 2 to 7 and insert—
‘“(1A) References in this Part of this Act to the approved clinician in charge of a patient’s treatment shall, where the treatment in question is a form of treatment to which section 57 above applies, be construed as references to the person in charge of the treatment.”’.—[Ms Winterton.]
Clause 14, as amended, ordered to stand part of the Bill.
Clauses 15 to 23 ordered to stand part of the Bill.
Schedule 2 agreed to.

Clause 24

Children and young people
Tim Loughton (East Worthing and Shoreham) (Con): I beg to move amendment No. 62, in clause 24, page 14, leave out lines 32 to 37 and insert—
‘142D Registered Medical Practitioner
Where a clinician undertakes an assessment of a minor’s needs in accordance with section 142B he shall consider whether the registered medical practitioner responsible for the minor’s care and treatment in hospital should have special experience in the diagnosis or treatment of mental disorder in persons under the age of 18.’.
I welcome you back to the Chair, Mr. Cook, after the weekend break. This is an important clause about children and young people, one of the six main-ticket items that attracted significant amendments and debate in the House of Lords. I notice that in response to Government amendment No. 21, which would have omitted all of clause 24 but has not been selected, you have allowed a clause stand part debate as part of the second grouping. Therefore, I shall not speak generally about the clause now, but reserve my comments until that debate.
Amendment No. 62 is a small technical amendment reflecting the Government’s concerns about the amendments tabled in the Lords. It is an attempt to allay those concerns and improve the original Lords amendment. The addition of clause 24 has placed three main considerations in the Bill to ensure that age-appropriate treatment, decisions and care settings are provided for children and young people, who I think all Committee members will agree are particularly vulnerable among those suffering from mental illness, and who have not been receiving mental health care that is as good and appropriate as they need and are entitled to receive.
I think that the whole Committee agrees that we need to improve the situation. The argument between the Government and the Conservatives is whether that should be done on a statutory basis or through service provision. We think that the Government have had quite long enough to make those improvements through service provision, and that that has not proved effective. That is why we agree with the Lords amendments, which were supported by Members from a number of different parties, including some Labour Members of the other House. We need to legislate on age-appropriate care in the Bill in order to give a fairer deal to children and young people in mental health services.
Mr. Boswell: Does my hon. Friend not agree that such an approach would also strengthen the Government’s position in relation to any legal challenges under the European convention on human rights? Article 3, for example, which deals with torture or inappropriate detention, could be interpreted as raising concerns in that area.
Tim Loughton: My hon. Friend is absolutely right, as ever. There is a serious human rights question mark over the absence of age-appropriate treatment in the original Bill, and as he mentioned, inappropriate detention is subject to legal challenge. We know from the Minister’s earlier deliberations that she is keen that the Bill should not become a bean feast for lawyers,so the amendment is partly an attempt to finesse the new sections to give clarity to practitioners and avoid challenge in the courts.
10.45 am
New section 142D to the 1983 Act, under the heading “Clinical supervisor”, was originally added to the Bill to stress that if a patient is a minor under 18, the responsible clinician should be a child and adolescent mental health specialist. The point that we have been making for a long time now is that there is a shortage of child and adolescent mental health services within the mental health service and that children and young people can have particular needs that are distinct from those of adults. That is why we are concerned about the number of children and young people being placed in adult mental health acute wards.
In retrospect we feel that the wording of newsection 142D could be slightly restrictive. I know that the Government objected to our insistence that a CAMHS registered medical officer should always be used for a child. In circumstances in which a young person between the ages of 16 and 18 is placed appropriately on an adult ward, it would be more appropriate for them to have an adult RMO. The important thing is that the young person gets treatment as soon as possible and that the treatment is as appropriate as possible. Amendment No. 62 would therefore give some flexibility to the clinician undertaking an assessment of a minor’s needs in accordance with new section 142B, which was added in the House of Lords, and leave it up to him to consider whether the registered medical practitioner responsible for the minor’s care and treatment in hospital should be a child specialist.
We have listened to some of the Government’s objections, just as we hope they will listen to ours. We know that the Government want to ditch the whole clause in any case, so this issue will be something of a problem if they get their way on that. Nevertheless, we believe that clause 24 is a useful addition to the Bill. It brings useful safeguards for young people, and amending new section 142D would take away one of the Government’s objections as to constraining the clinician who will be responsible for the young person on an adult mental ward. That is the purpose of this amendment. I hope that the Minister will take it in the positive, constructive spirit in which it is intended and feel able to accept it.
Dr. John Pugh (Southport) (LD): I generally support the amendment, with one small caveat. I do not think that we want to move towards an absolute apartheid in the delivery of services. I should like to illustrate that point by referring to local services in my constituency, where there are well developed early intervention teams for adults. One thing my CAMHS specialist told me is that when early intervention is required in the case of children, it is not provided simply because it is called an early intervention scheme for adults, so children get no service or intervention of any kind. With that caveat, I think that everything that the hon. Member for East Worthing and Shoreham has just said is entirely sensible and laudable, and can be supported.
Mr. David Kidney (Stafford) (Lab): I welcome you back, Mr. Cook, after the short break.
May I ask the hon. Member for East Worthing and Shoreham a question about emergency situations? In the clause as it stands, the phrase “except in an emergency” appears in new sections 142C and 142D, which is reassuring, but it does not appear in new section 142B. I should like the hon. Gentleman to explain why he feels that emergency situations would be covered if the words did not appear in the provision. In the amendment, which would replace new section 142D with a new set of words, the words “except in an emergency” disappear. It refers back to new section 142B, which, as I said, does not contain a caveat about emergencies. Are we making the legislation stricter rather than more flexible with regard to emergencies?
Let me explain why that point matters. In my preparations for dealing with the Bill, I saw two sets of psychiatrists in two places in my constituency. On both occasions, the experienced psychiatrists said that they were sure that in their careers, they had saved the lives of youngsters by admitting them to an adult ward because a children’s or young persons’ ward was not available. They were sure that those youngsters would have committed suicide had they not admitted them. In making well intentioned legislation, I should not like us accidentally to overlook the opportunity to save some lives.
James Duddridge (Rochford and Southend, East) (Con): Will the hon. Gentleman define what he means by an emergency? My fear would be that the definition could be so wide as to encapsulate everything; perhaps that was a good reason for the removal of those words.
Mr. Kidney: Obviously, an emergency is an instant admission to save somebody from committing suicide. One of the psychiatrists who said to me that he was sure that he had saved lives by admitting—inappropriately, as it were—patients to an adult ward, also said, “For goodness’ sake, do not legislate for new duties and requirements for us without providing us with the resources to comply.” That is an important message for us all to bear in mind as we legislate.
Mr. Boswell: Will the hon. Gentleman confirm—I have only just noticed this myself, as we are now alluding to provisions inserted only this morning—that the matter will be one for regulation and that it is important that the regulations are sensitive to the kind of extreme situations that he has properly described?
Mr. Kidney: I am seeking from the hon. Member for East Worthing and Shoreham the assurance that there is not a danger that the amendment would provide insufficient flexibility to cope with an emergency.
Tim Loughton: This has been a short and sweet debate, Mr. Cook.
The Chairman: It has not finished yet.
Tim Loughton: Would you like me to answer the question for the hon. Member for Stafford? I shall answer his question; I do not think he was intervening on me, as I had finished. That is why I am slightly confused. I completely concur with his concerns, which is why the understanding that emergencies override everything was implicit in how the new clause was added in the Lords. He is absolutely right to say that, regarding the admission of a young person in an emergency because of severe self-harm or because they may do harm to others and have a severe psychotic incident, the key thing is get them into a safe, secure environment where professionals can take care of them. If a CAMHS specialist happens not to be available at that time, clearly that should not be a hindrance to taking the young person to a place of safety and dealing with them. In no way would the emergency scenario be moved down the hierarchy because of the amendment.
Mr. Boswell: Does my hon. Friend not agree that the converse also applies? Although emergency admissions may have taken place for the well founded reasons that he has described, there is a concern that if there is a shortage of resources in child mental health to accommodate a person’s rehabilitation or recovery from the psychotic incident, the Government’s proposal may not sufficiently tie down the obligation to provide that care.
Tim Loughton: My hon. Friend is right. Emergency provisions should not be a substitute for appropriate and sufficient services for the young person. I completely agree with the exhortation of the professional who was cited by the hon. Member for Stafford: we should not legislate without giving due resources to ensure that the services are available. The services, not the legislation per se, will save such a young person and, one hopes, put them on the road to recovery. The services must obviously take precedence.
The amendment would refer to the opinion of the clinician the question whether a CAMHS specialist is warranted in a particular case. It does not propose that it must be a CAMHS specialist in an emergency or non-emergency situation who orders the sectioning. It would give a degree of flexibility to the clinician. The fears of the hon. Member for Stafford should therefore be allayed. Certainly that point will become clearer in the clause stand part debate, in terms of establishing the emergency hierarchy. However, I can certainly assure him that in no circumstances is it intended that there should be any different treatment for emergencies.
We can debate later what constitutes an emergency—a subject raised by my hon. Friend the Member for Rochford and Southend, East just now. However, I would have thought that 48 hours was a reasonable period before alternative and more appropriate accommodation could be found. I hope that the hon. Member for Stafford will be happy to support our amendment.
Ms Winterton: It will be obvious, by the fact that the Government have made it clear that we oppose clause 24, that we will also oppose amendment No. 62. However, I also want to make it absolutely clear at this point—I will elaborate a little later—that that does not mean that we do not agree that this is an important issue. Although we do not agree with the clause, we agree with the principle. I hope to explain later not only what we are doing to improve services, but why there are some particular problems at the moment with the clause. I take on board the fact that Opposition Members have tried to tackle one fault in the clause, as the amendment would introduce some flexibility into the arrangements.
Dr. Doug Naysmith (Bristol, North-West) (Lab/Co-op): Although this debate has been short, I think that it has covered the main points relating to the amendment. My hon. Friend the Member for Stafford made clear the reasons why the Minister is not going to recommend the acceptance of the amendment and the clause. However, the Minister must be aware, as we all are, that there is widespread anxiety about the use of adult psychiatric wards for children. I know that a commitment has recently been given to eliminate within two years the use of adult psychiatric wards for children under 16. Will she undertake to examine this matter again, and perhaps propose a new measure at a later stage? Clearly, the use of such wards for children is a problem, and it is something that we must get rid of.
Ms Winterton: I am acutely aware of my hon. Friend’s concern about these issues. Indeed, he has made that point not only in the House, but in meetings that we have had. I hope that, when we have the clause stand part debate, I will be able to give him some greater reassurance.
As I said, however, our difficulty with the amendment is that it would not only amend a clause that we have some real concerns about, but introduce another fault in that it includes an assumption that there will be a registered medical practitioner in charge of the child or young person’s case. In fact, under the Government’s proposals, the child or young person could be in the charge of a responsible clinician who is not a registered practitioner. That goes back to our debate on the important role of psychologists, which I discussed at a recent meeting with YoungMinds.
11 am
Dr. Pugh: The Minister has just contrasted amendment No. 62 with clause 24 as it stands, and has claimed that the amendment is preferable on the ground that it allows more flexibility. However,clause 24 contains the words “except in an emergency”, which the hon. Member for Stafford wants to have included in amendment No. 62, so it is not obvious to me that the original wording is worse than what is proposed in the amendment or that it does not guarantee a degree of flexibility.
Ms Winterton: The hon. Gentleman should be aware that the amendment is to the clause that is there at the moment. I said that it would introduce a degree of flexibility, which would address one of the problems that we have with it. I shall come to that in the clause stand part debate. However, I also said that, while the amendment tried to tackle that matter, it would introduce another fault, in that it included the assumption that there would be a registered medical practitioner in charge of the child or young person’s case whereas in fact, under the Government’s proposals—which the hon. Gentleman opposed—the responsible clinician in charge of the case might not be a registered medical practitioner. When it comes to looking after young children, the role of a psychologist can be extremely important. That is why we are so concerned about the attempts of the Opposition to undermine that role, and it is why I ask the Committee to support us in opposing the amendment.
Mr. Boswell: Before the Minister closes, will she respond briefly to a concern that I have in relation to the appointment of a clinician or registered medical practitioner—for this purpose, it matters not which—with responsibility? I know that I have missed something because I had to miss one of the debates last week. In an emergency, at what point does the responsibility devolve to the responsible clinician? Say somebody harms himself—he may be comatose—and is admitted to an institution and sectioned. At what point does the process move from the emergency, life-saving services of a physical nature to the assessment and treatment stages? At what point does the clinician take over and assume responsibility in emergency circumstances?
Ms Winterton: I should make it clear that if we are talking about admission, we are talking about the responsible medical practitioners; we do not seek to change that. As to the responsible clinician, we are talking about a psychologist who would take over the role of looking after the patient, which the hon. Gentleman opposed by trying to delete clause 11. The responsible clinician will also consider the renewal of detention. However, in the initial stages of an emergency, we would use the system that we have at the moment, so two doctors would be involved.
Amendment, by leave, withdrawn.
Question proposed, That the clause stand part of the Bill.
The Chairman: With this it will be convenient to discuss new clause 23—Minors
‘(1) After section 38 of the 1983 Act insert—
“38A Hospital and guardianship orders (minors)
In the case of an offender who has not attained the age of18 years the court shall not make an order under sections 35 (remand to hospital for report), 36 (remand to hospital for treatment), 37 (hospital and guardianship orders) or 38 (interim hospital orders) unless satisfied that the services and accommodation to be provided are sufficient for the particular needs of that offender.”’.
Ms Winterton: The Government are opposed to clause 24 standing part of the Bill. As I said earlier, I want to make it clear that we feel that this is an extremely important area that we want to consider further. I shall come on to the reasons why we think that the clause has some problems, and why we feel that it is important to say that we can take it away and have a look at it. I recently had a useful meeting with Barbara Hertz and Kathryn Pugh from YoungMinds, at which we discussed how we could best tackle the issue of children and young people being placed on adult psychiatric wards. I think that hon. Members on both sides of the Committee, and Members of the other place, have an agreement that under-18s should be placed on adult psychiatric wards only where it is considered appropriate because of their particular circumstances.
James Duddridge: Will the Minister give us an idea how many children are currently treated on adult wards? I have heard two contradictory stories: one that the figure is around 1,000, and the other that there are no accurate figures because only occupied bed days are counted, not absolute numbers of individuals.
Ms Winterton: The hon. Gentleman makes a good point. I should say that the figures show, for example, that in some parts of the country, there have been no bed days recorded at all for under-16s, particularly over the last year. I shall come on later to set out the programme that we have put in place to ensure that that does not happen. With regard to 16 and 17-year-olds, the hon. Gentleman is right to say that the measurement tends to be in bed days. When I saw that, I thought that we should be talking about people here, and I want to look at how we can record that more effectively. I think that there is a way we can do that. The number of in-patient bed days has fallen, but nevertheless, as the hon. Gentleman says, it is difficult to get a clear understanding of what that means in terms of young people, and whether it is about re-admissions. I agree that we need to look at that, and I am actively doing so.
At the meeting that I had with YoungMinds, it was fair to say that it acknowledged the progress that we have made so far by implementing the Government’s CAMHS policies. There is no doubt that the central investment that is being made has led to a major change on the ground. It has meant a significant increase, for example, in multidisciplinary and joint working across professions and agencies and has meant looking closely at how some of the key players can be engaged in the development of services at local level. We began collecting the information in 2005. We need to be clear that such information was not collected before. We started collecting information about the use of adult psychiatric wards for children and adolescents so that we could performance-manage more closely that aspect of the service. I accept that it relates to bed days, but that is how such data are normally collected.
In November last year, the Under-Secretary of State for Health, my hon. Friend the Member for Bury, South (Mr. Lewis), made a clear commitment that within two years no child under 16 would be placed on an adult ward in England while being treated for a mental disorder. The Department is working closely with strategic health authorities to ensure that that commitment is fulfilled. We intend to do so by writing to SHAs, making clear our expectations with regard to children on adult psychiatric wards, emphasising the commitment that within two years no child under 16 will be treated on an adult ward. If a child of 16 or under is placed exceptionally on an adult psychiatric ward, we expect that to be reported to the Department as a serious untoward incident. Furthermore, we expect that the child should not stay on the ward for more than 48 hours, that the ward should be specially equipped to deal with the child and that the staff dealing with the child should be appropriately qualified.
Mr. Boswell rose—
Ms Winterton: I shall give way to the hon. Gentleman so I can have a drink of water.
Mr. Boswell: I am grateful to the Minister—or perhaps she is grateful to me for intervening, in this case. While she is controlling the tickle in her throat, may I ask whether, as part of this process, she will undertake to report to the House regularly on the progress towards fulfilling this target? From what she has already said, we are already nine months into the process. She is writing to strategic health authorities now and she has only 15 months to bring it to a conclusion. In any case, the process relates only to under-16s. I accept her good will and that she is trying to do her best, but can she please reassure us that she will monitor progress and report to us as appropriate?
Dr. Ian Gibson (Norwich, North) (Lab): I hope that I talk for long enough to allow the Minister to have another drink of water.
There is a desperate move in this country to build new wards for teenagers who have cancer. Will partnerships and joint funding be part of the Minister’s discussions with SHAs, in case new wards need to be developed? I am sure that there are parts of the country where there are none, as was the case with teenage cancer, but the Teenage Cancer Trust put millions in, alongside the Government, to provide wards.
11.15 am
Ms Winterton: My hon. Friend makes an important point. Advantage should be taken of the extra capital investment that has gone into CAMHS services. It is important, especially in children’s services, to ensure that there is a close relationship between health authorities and local authorities, for example. A multi-agency approach can be extremely effective in ensuring that facilities are of a high standard and that the exchange of information, which is so important, takes place.
We have made it clear in our communications with the strategic health authorities that they should check that adult wards are used only when appropriate, in line with the best practice set out in the national health service framework. It is important that responsibility is taken at local level to manage the situation. We want local decision-makers to decide what are their current problems and to ensure that they achieve what we set out.
Angela Browning: I am rather concerned about responsibility being devolved. The Government devolved the issue of mixed-sex wards in general hospitals when they first came to office, but what we wanted has not been delivered. Why should we be any more confident that the same process, which is now being applied to children’s mental health services, should be any more successful than it was in respect of mixed-sex wards?
Ms Winterton: First, we have checked on the mixed-sex ward scenario, which is a slightly different debate. We set out that 99 per cent. of wards should not be mixed-sex, and that target has been met. The problem occurs in a very few places where those involved are working with an old-fashioned set-up, for example, if they are waiting for the completion of a new hospital that is clearly planned in relation to the issue of mixed wards. However, that is not to say that greater improvements cannot be made in that respect. In the reporting of a serious untoward incident, we allow for a much greater view from the centre to ensure that we can work with SHAs and primary care trusts on performance management.
Tim Loughton: The Minister is completely detached from reality if she thinks that 99 per cent. of hospitals have no mixed-sex wards. I have been to brand new hospitals that are now having to revert to mixed-sex wards because of the current deficit crisis in the NHS, particularly with regard to mental health patients. Vulnerable children are being placed not only on adult wards, but on mixed-sex adult wards, which is particularly inappropriate; there have been several cases of young girls being subject to sexual abuse from older patients of the opposite sex.
Ms Winterton: As I said, the clause is about young people and children on adult wards. We have taken some action through the service where we want to improve the current situation. From whichever side of the Committee they come, no hon. Member wants to perpetuate a situation in which under-16s might be on adult wards. That is why we have taken the action that we have.
Mr. Boswell: If I may be uncharacteristically ruder than my colleagues, does the Minister agree that the issue is not the welcome statement about putting responsibility on SHAs and health care providers, but the concern that in devolving that responsibility she might seek to deny her own responsibility and that of the Department for managing the overall resources to avoid this deplorable situation?
Ms Winterton: No, I do not think that that is the case. If I am allowed to continue, I hope that I will be able to indicate that we are certainly not unsympathetic to the principles in clause 24. However, it is important to have a service that actually delivers what we want. To some extent, we can legislate all we like, but unless we ensure that legislation is matched by services on the ground, there can be unintended consequences.
I am shortly meeting the Children’s Commissioner for England, and we shall consider the very powerful report entitled “Pushed into the Shadows”.
Chris Bryant (Rhondda) (Lab): The Minister said that she was going to meet the Children’s Commissioner for England, but I hope that she will meet the Children’s Commissioner for Wales as well. The legislation will affect England and Wales, so has she had discussions with Welsh colleagues about children in adult wards in Wales?
Ms Winterton: My hon. Friend makes an important point. He is right that there should be discussions with Welsh colleagues in developing all policy matters on the subject—including when there is a decision to legislate, and particularly on service delivery—so that people are comfortable with legislative changes that affect service delivery. Legislation on service delivery is more problematic than legislation that sets frameworks such as the one in the Bill, which is concerned with compulsion under the Mental Health Act, andclause 24 goes far beyond establishing a framework.
Tim Loughton: I am grateful to the Minister, who is accepting many interventions.
The Government have form in this area, do they not? The subject has been raised in the context of the national service framework for children, and specifically standard 9 of that framework. The Government have not made material progress in achieving the relevant standards, and the Department of Health set a public service agreement target that by the end of 2006, comprehensive CAMHS will be available to everyone in England who needs them. The Government have failed to deliver that, so what has changed such that they can now assure us that they will deliver appropriate services for young people, given that all the evidence suggests that things are going backwards, with deficits hitting CAMHS in particular? Does that not mean that there should be a statutory requirement on delivery?
Ms Winterton: It is unfair on CAMHS to say that there have not been changes. For example, the figures that I gave earlier show that there has been a fall in relation to the dreaded bed days for under-16s, so that in some areas there are now no under-16s on adult wards. To say that there has not been improvement is quite wrong; there has been massive investment in CAMHS, and some real changes in the way in which services are delivered, through a sound multidisciplinary approach. Some £72 million of capital expenditure has gone into CAMHS investment since 2004, so the changes are real, and they have improved services and in-patient care. We should not denigrate that—it is £72 million of investment that the Opposition probably voted against.
Angela Browning: In their response to the scrutiny Committee, the Government agreed that generally all under-18s should be accommodated in age-appropriate facilities. The right hon. Lady has not mentioned much about 17 and 18-year-olds, but if she agreed with the principle in her response to the scrutiny Committee, about which we had much discussion, why will she not accept the new clause?
Ms Winterton: I admit that I am taking a tortoise-like approach in reaching my conclusion. I want to reassure the hon. Lady that I am not rejecting the principles of the new clause, but I want to make sure that such legislation does not give rise to unintended consequences. Obviously members of the Committee want to hear about our problems with the clause, but I am willing to consider further whether there is scope for such legislative provision, although it would certainly have to have the right degree of flexibility.
The inflexibility of the clause means that it could result in children and young people being treated hundreds of miles away from their homes and families if there are no empty CAMHS beds in the locality. Such a problem might result from the clause. Opposition Members know about treatability from our many discussions, and if there were the slightest suggestion that treatment may be unlawful if someone was put—even in an emergency—on a bed outside of the terms of the Bill, for example, psychiatrists might consider that they had to turn someone away instead of giving treatment. Such a situation would give rise to a problem in respect of what becomes lawful and what becomes unlawful. We must be realistic and ensure that the clause would not give rise to such difficulties.
Mr. Boswell: The Minister was right to rehearse some of the potential dangers, but does she agree that although the clause relates to assessment and the involvement of child and adolescent mental health specialists, it is silent as to the nature of that provision provided that it is appropriate for the young person in question? Nothing in the Bill says that matters must relate to a child ward, only that it is something that must be considered.
Ms Winterton: Yes, and that might be one of the problems. If there is a possibility that matters could be interpreted differently, for example by case law, we would have to be careful that the Bill was not allowing a situation to develop whereby treatment in certain circumstances might become unlawful. The worry is that, if CAMHS were not yet developed to the level that we would want to see, the possibility of children going untreated might be a real one.
The clause also places a duty on PCTs to
“provide such services and accommodation as are sufficient for the particular needs of that child or young person.”
Placing that duty on the PCTs might not be the right way forward. I have been given the legal advice that YoungMinds received when it drafted parts of clause 24. As I said to the charity, I want to look at the issue with an open mind. I certainly agree that the principles outlined are the right ones, but I cannot accept the clause as it stands at the moment because there are some problems that I would need to look at further.
I hope that that gives the Committee some reassurance that I will certainly take this matter away and look closely at it. I will continue to hold discussions with YoungMinds and others, not only about their legal advice but about the legal advice that we shall seek. I hope that the Committee will therefore agree that the clause should not stand part of the Bill.
11.30 am
Tim Loughton: As I said earlier, this is a very important part of the Bill. It is possibly the one issue that has concerned most people who have taken a close interest in the Bill across all the parties. I pay tribute to the very strong case that has been put to the Committee by YoungMinds. It has not only provided written submissions, but held events in this place at which very brave young people who have been sectioned to adult acute wards have given harrowing testimonies of their experiences. Such testimonies were included in the witness session that we organised two weeks ago. I urge hon. Members to read some of those contributions, which have now been written up; I hope that the document will be distributed to everyone later today.
It is a very frightening experience for a young person to be placed in mental health services. It is particularly frightening to be surrounded by adults who have quite severe problems and, worst of all, to be placed as a young teenage girl in a mixed-sex adult ward for any length of time. It is a practice that I am sure all of us here would agree should not continue. It is entirely unacceptable. It is not helpful to the therapeutic treatment and recovery of the young person. We need to do everything we possibly can to ensure that such practices do not happen in future. That is why Opposition Members believe that we have reached such an important part of this debate. The only way to give a clear signal that this should stop is to make it a statutory requirement within the Bill.
I am pleased that the Minister agrees with the principles set out in the new clause, but she must go further. She must provide a means whereby the intention underlying those principles can be achieved as quickly as possible. Although she tries to give us assurances by saying that she agrees with the principles and is happy to take this away, I must respectfully point out that she has had a lot of time to think about it. The mental health tsar wants to find a non-statutory solution to the problem of inappropriate treatment for young people. But the Government have had nine years to look at this legislation and deal with that problem, and they have failed to deliver the public service agreement for CAMHS for young people.
Despite the reassurances of the Under-Secretary of State for Health, the hon. Member for Bury, South, many of us do not hold out much hope about this practice coming to an end within the next two years. It is unclear to what extent it will be terminated—a point that I shall come to in a minute. Also, I believe that the problem is far worse than the Government admit. The Minister rightly admits that counting bed days is not appropriate and that we should be looking at real people, real patients and real young people’s experiences. The suggestion from the experts and from the young people to whom we have spoken is that the problem is far wider than the Government appreciate. It is also being exacerbated by the current financial problems in mental health services, which yet again are hitting young people’s services disproportionately.
I would be interested the know the outcome of the Minister’s meeting with the Children’s Commissioner for England, who is on record as strongly supporting the clause. The commissioner’s submission to the Committee states:
“The Commissioner welcomes the inclusion of these provisions, in particular the requirement that the services and accommodation must be appropriate to the particular needs of the child.”
The commissioner quotes figures from “Pushed into the Shadows”, a hard-hitting report on the extent of the problem facing us, and refers to the requirements placed on the Government under the United Nations convention on the rights of the child. Referring to article 37(c) of the convention, the commissioner’s submission states:
“States must separate children deprived of their liberty from adults ‘unless it is considered in the child’s best interests not to do so’.”
The Government must make their case regarding the circumstances in which they think that it is in the child’s best interest to be in a mixed-age ward, let alone mixed-sex, other than in the emergency circumstances on which I think we are all agreed. The Minister set a threshold of 48 hours as the period suitable in an emergency, which I mentioned earlier. The burden of proof must be on the Government to show the circumstances in which they think it is appropriate that the practice should be allowed to happen.
Tim Loughton: The hon. Gentleman knows as much as anybody else that if we pass the legislation, the measures will be enacted on the day following Royal Assent. Clearly, there will be trigger dates in the following months or years when certain requirements made by the Bill will come into operation. Those dates will send a strong signal to primary care trusts that they will be required to arrange their services and commit their resources in order achieve the objectives of the legislation, which will become requirements as of a certain day. It will not be that all hell breaks loose all of a sudden on the day of Royal Assent. Hopefully, by then, the situation will be sorted out and we will not be dealing with 1,000 legal cases. That is how all legislation works. I am not quite sure what the hon. Gentleman thinks will happen on the day that the legislation comes into force.
Chris Bryant: In which case, is the hon. Gentleman suggesting that there should be a special date when this element of the Bill comes into force, as opposed to other elements—for instance, in three years?
Tim Loughton: Three years would be an inordinately long space of time given that the Government think that they can solve the problem without statutory regulation within two years, which I doubt. There needs to be a date on which regulations to accompany the Bill can be introduced. Such a date does not need to be, and is not normally, included in a Bill. There needs to be a sufficient lead-in time. If the Government are right to assume that a lot is being done to achieve what is necessary by legislation, bringing the measures in should not be such a big burden on PCTs—[Interruption.] The Minister is prompting the hon. Member for Rhondda to respond, but I shall give way to my hon. Friend the Member for Daventry first.
Mr. Boswell: Before my hon. Friend forgets the concerns about illegality expressed by the hon. Member for Rhondda, will he not also reflect that whatever the status of the United Nations convention on the rights of the child, it is certainly the case that the European convention on human rights bites on us and our domestic practice through the Human RightsAct 1998, and that article 3 of that convention raises concerns in relation to the inappropriate treatment of children?
Tim Loughton: That is absolutely right. My hon. Friend has mentioned the legislation and conventions under which we are already subject to legal challenge. It would give the Government some breathing space if legislation were seen to be passed showing categorically that they appreciate the problem and are taking legislative steps to address it. I think that a legal challenge would then be less likely, unless of course the desired goal were not achieved by the date set.
Ms Winterton rose—
Tim Loughton: Now the Minister wants a go.
Ms Winterton: The hon. Gentleman is absolutely right that it is important to get services and legislation in line. At the moment, the bar for what breaches article 3 is extremely high, and it is unlikely that any treatment given in hospital would be likely to breach it. In terms of the legal situation, difficulties would arise if young people were denied treatment because the legislation made it unlawful to give it in hospital. That is the issue that we must consider closely.
Tim Loughton: I shall come to that. I have not started the comments that I wanted to make; I was just responding to the Minister. The argument that some perverse incentive is occurring sounds good but is not the case in practice. She said that if treatment became unlawful even in an emergency, the responsible clinician would refuse to admit a young person to an adult ward, and that psychiatrists would somehow be incentivised to say, “Sorry, no can do. We don’t have a CAMHS bed at the moment, and it would be inappropriate to admit you to an adult bed, so we’re not going to treat you at all.”
I contend that such a rejection by a responsible clinician who appreciated the severity of that young person’s mental illness would return to hit the health trust and the clinician who had put a no entry sign on the door much harder than the consequences of admitting the young person in the short term to inappropriate care. If the Government are serious, however, about delivering the public service agreement on CAMHS-appropriate treatment, they should be worried about it. If they are serious about providing CAMHS-appropriate treatment up and down the country that is fit for purpose for young people, no psychiatrist should be put in that situation anyway. The Minister is undermining her own argument and boosting my concern that the Government will not deliver on services for young people. She herself seems to lack confidence that they will, which is why it is so important to have a statutory requirement sending out a clear signal that that is a serious priority that PCTs must deliver on.
11.45 am
The Minister repeated another fallacy that I am getting rather tired of hearing. She was not at the witness session two weeks ago, or the special meeting organised by YoungMinds involving a number of young people. Those young people were asked categorically, “Imagine an age-appropriate acute ward with a CAMHS specialist that was sensitive to your medical and other social needs and offered you all sorts of additional care, including education opportunities for those who were there for a long time. If you had to choose between such a ward several hundred miles away and a less appropriate adult mental health ward within bus distance of your family, which would you prefer?” Without exception, all those young people said that they would like to have, without question, the services more appropriate to them. That is absolutely key.
If the Government are confident that they are going to roll out a countrywide CAMHS service under the public service agreement—which they have agreed to do, but failed to deliver by December 2006—what are they worried about? Those facilities should be available, not hundreds of miles away, but in most cases, in the locality. Trying to create this ridiculous either/or situation—either they have to travel hundreds of miles away, and they never see their family, or at least they can go somewhere local and keep seeing their family—is not realistic. It is certainly not realistic if the Government are genuine about delivering what they say they are going to deliver without a statutory requirement.
Angela Browning: My hon. Friend will be aware that the Government have only recently restructured regional health services yet again, with PCTs now being county-wide, in order to provide these very services—in other words, specialisms within a county or a group of counties. In the west country, we have already had a consultation on whether children’s services should be in Plymouth or Bridgwater. If this is already under way, I do not buy the Minister’s argument that somehow this is not do-able.
Tim Loughton: My hon. Friend is absolutely right. The Government cannot have it both ways. Either services are being reconfigured to produce an improvement, in which case young people will not need to travel hundreds of miles, and psychiatrists will not have to turn people away at the door simply because there are not CAMHS beds available, or they are not, in which case the statutory duty in this legislation is absolutely essential.
So the Government are arguing against the reassurances that they are giving us to convince us not to require that the clause remain in the Bill. When the Minister responds, perhaps she can back whichever horse she thinks she needs to reassure us.
Coming back to the scenario of the psychiatrist saying, “No, we are not going to admit you, even though you have a serious illness, because we don’t have appropriate beds”, I had a most serious case in my constituency a few years ago. A teenage girl had a long series of mental illnesses, and was in a very desperate state. In the end, she was turned away when she was in a state of crisis from an acute mental hospital in Worthing in my constituency. Such was the desperation to take her own life that her father assisted her in committing suicide, and was accused of manslaughter and convicted, with mitigating circumstances. It was a most tragic case. She had been turned away on weak grounds from that hospital, and the comeback was not on the way in which the legislation is framed. It was on the failure of the services to pick up that girl and give her the treatment that she required and deserved.
Mr. Boswell: The Minister seeks to defend her position by saying that there is a danger of action under the European convention on human rights claiming inappropriate treatment. If clinicians opted for denying treatment altogether, in the circumstances that my hon. Friend has just described, would the public authorities not then be at risk of action under article 2 of the convention, which is on the right to life?
Tim Loughton: My hon. Friend is far more expert than I am on all the various clauses of the convention. He reinforces his point that, as the legislation stands, this measure could be a lawyers’ field day, without the addition of the amendments made in the Lords.
I remind the Minister that clause 24 was added to the Bill in the Lords with enormous cross-party backing, led by Cross Benchers; Lord Williamson led on this amendment. The amendments were passed in the Lords by a very substantial margin, by a vote of 201 to 126. This was not just some political gamesmanship in the upper House; there was very solid support for these amendments. Really, there is a much greater onus of proof on the Government to say why all those Members of the House of Lords, including mental health practitioners and people who were previously high-ranking figures in the NHS—people who know what they are talking about—were wrong and why the Minister is right, not just in principle but in practice.
Lord Patel played an important part in that debate in the other place. He is chair of the Mental Health Act Commission. The commission’s report produced some stark figures, saying that
“between April 2003 and October 2006, 1308 under-18s were detained in adult psychiatric units with no special safeguards in place; and 27 of these children were under the age of 14 - one as young as ten. 322 out of 409 girls were placed on mixed-sex wards, and staff understanding and knowledge of child safeguarding issues was unclear. Adult units were unable to provide for the child’s education.”
Lord Patel said in the Lords:
“When the Mental Health Act commissioners asked ward staff whether there were any plans to transfer the young person or child to more appropriate surroundings within the next seven days, there were no such plans for nearly three-quarters of the children. That is 959 children with little or no prospect of moving from adult psychiatric wards. Only one-third of the children...had a responsible medical officer who specialised in child and adolescent psychiatry...It is also notable that half...were classed as emergency admissions.”—[Official Report, House of Lords, 15 January 2007; Vol. 688, c. 550.]
So it is not the case that these children are just there in an emergency—what we would interpret as an emergency—and that after, say, 48 hours at most they are moved on, however far, to CAMHS. These are children and young people, some as young as 10, who are there for the long run. That cannot be in their best interests and the Minister is underestimating the scale of the problem.
Dr. Gibson: Does the hon. Gentleman think that that is the reason for the initiative that is being shown in Devon, where some of those figures are collected from? Does he know how the figures broke down geographically in England and Wales?
Tim Loughton: I do not have a clue. However, I am sure that, if the hon. Gentleman examined the MHAC report, or spoke to Lord Patel, he could get a more detailed analysis of the figures.
What the figures reveal is that, in certain parts of the country, there are enormous pockets in which there is a lack of provision. However, if the Government offered to roll out a public service agreement level across the country, not just in Devon, or in West Sussex, or in Norfolk—the hon. Gentleman’s own area—things would be different. This process should be country-wide, because this is a problem up and down the country. It is a particularly stark problem in some of the inner cities, and we have heard cases from London. It is a particular problem in black and other ethnic minority communities; I will come on to that point in a minute.
The figure of 322 out of 409 girls on mixed-sex wards—not just adult wards, but mixed-sex wards—is really alarming. Those girls are not there for 48 hours; they are there for many days, in some cases weeks and in other cases, as we have heard directly from witnesses, months. According to the RCP, when admissions for voluntary treatment are included, that figure rises to more than 1,000 young people being admitted inappropriately every year. There is good evidence to suggest that that figure is growing, certainly in particular parts of the country.
The Government’s own national service framework standard 9 research in 2006 revealed that
“only 25 per cent of children with a diagnosed psychiatric disorder were accessing mental health services over a three-year period”
and that
“43 per cent did not have contact with any professional.”
We are talking only of the children and young people whom we know about—the ones who get picked up by the service. What we do not know about is the scale of the problem of those children and young people who need treatment but who, for whatever reason, do not present. One reason for that could be their fear of being dumped in the particularly intimidating environment of an acute mental health ward with adults and people of the other sex. Given the option between that and staying under the clinical radar, I fear that too many young people choose the latter. That surely is the worst scenario of all. We know that that is where people’s condition—not only young people’s—can worsen and get out of control.
There is also the point about the number of young people who act as carers for parents or other family members who have a mental health condition. It is estimated that out of 175,000 young carers in this country—some of them are very young—around a quarter of them could be looking after a parent or a member of the family who has a mental health problem. We need to do a lot more to provide support for those young people. I am glad that Baroness Royall in the other place took this point on board and offered to go away and look at it to ensure that there was some reference in the code of practice. Can the Minister report on what progress has been made on that? I think that that issue is particularly worrying. We need to deal with the young people looking after family members with mental illness as well as the young people themselves.
I think that the problem goes far wider than the Government admit. Although the Government quote some figures that suggest that the problem is, in certain circumstances, diminishing in some parts of the country, I think that the underlying problem is worsening.
We should not forget the Government’s response to the Bristol inquiry, which was that
“children should not have to make do with services designed for adults, which are, quite simply, inappropriate for them.”
My hon. Friend the Member for Daventry referred to conventions throughout the Committee. The Government have drawn up national service framework requirements. They have broken their promises for a time scale on public service agreements. They have responded to the Bristol inquiry. They claim that they are taking the situation seriously, that they want to achieve what we want to achieve, but we need to see the beef. We believe that the only way of producing that beef is by keeping clause 24 in the Bill. The Minister has been quoted as saying that the clause would create a legal and clinical straitjacket for clinicians. I think that the Minister’s choice of the word “straitjacket” is not helpful and can be construed as stigmatising. Perhaps somebody has ticked her off because she has not used it this morning.
The Minister has also told us about the Government’s latest new arrangements for PCTs to notify the Department if children and young people under 16 are admitted to adult wards. How will that work? What will the Department of Health do on being notified by a PCT that there is a 15-year-old in such and such adult mental health unit? Do the notifications include only those who are there under compulsion, or do they include voluntary admissions?
12 noon
Is not the problem that limiting the provisions to the under-16s sends out a clear message to all 16 and 17-year-olds that it is perfectly acceptable for them to be admitted to adult acute units? The Minister is bringing down the barrier at 15 years, 11 months and 30 days, or however one qualifies it. We have said all along that children are counted as children until the age of 18, and that there should be an assumption that they be given treatment appropriate to children until they reach that age. The Government need to make the case for the few 16 and 17-year-olds for whom it may be appropriate to provide treatment in adult wards.
Between 2002 and 2005, the case load involving such children rose by some 40 per cent. Where is the problem with those young people accessing treatment? Will the Minister also comment on what happens in Scotland? Contrary to a letter that was sent out by the Secretary of State after I challenged her on the issue, practitioners in Scotland are very much in favour of this sort of clause, which was included in the Mental Health (Care and Treatment) (Scotland) Act 2003. They think that it is working in favour of young people. Any small, short-term discrepancies in the figures are largely down to the way in which numbers were collected, or not collected, before. Scottish practitioners believe that the amendment is working to the benefit of young people, not to their disbenefit or as some sort of perverse incentive, as the Government claim.
I want to know the circumstances; I want to see real examples of scenarios in which the provision is acting as a perverse incentive in jurisdictions that have included it in their legislation.
Dr. Gibson: Does the hon. Gentleman accept that some so-called young people may choose to be in an adult ward? What would be the conditions for them?
Tim Loughton: I think that I have just made that case. The provision of such treatment for children and young people with capacity, who are assessed as suitable for treatment in adult wards with the agreement of clinicians, would not be undermined by the clause. The assumption, however, must be that children and young people are most appropriately treated by children and adolescent specialist mental health services. That is how we see the equation, not the other way around. I do not buy the Minister’s argument that the inclusion of the clause in the Bill could act as a disincentive. It sends out a clear message, with which I think all members of the Committee agree and with which the Minister says she agrees in principle.
Before I speak briefly to new clause 23, which is part of the group, I should like to quote the legal opinion on the Mental Health Act 1983 and this part of the Bill from Paul Bowen of Doughty Street chambers,which was obtained by YoungMinds and to whichthe Minister referred. Mr. Bowen said that newsection 142B is necessary because there is no specific duty on primary care trusts under the delegated functions that they exercise under sections 1 and 3
“of the National Health Service Act 1977 (now 2006) (NHSA) to”
whether to a child or any other patient. He quotes the case of R. v. Haringey borough council and Haringey PCT in 2006, which referred to the contrast with the specific duty imposed on PCTs and local authorities by section 117 of the Mental Health Act 1983 to provide free after-care services to all detained patients after their discharge from hospital. He says that he does not consider that the provisions will have the effect that the Government are predicting.
So expert legal advice has been taken which could help the Minister and perhaps save public funds being spent on the Government’s own legal advisers. The Opposition position has not just been cobbled together; the measures in clause 24 are clearly thought out and have been debated in detail in the House of Lords, and they would stand up in law. The whole clause inserted by the Lords merits retention in the Bill, and I hope that the Minister will have second thoughts about it after the debate.
At present, young people who are sectioned from youth custody or from prison can be transferred to an adult psychiatric ward for care. The same arguments apply to the very vulnerable group of young people who are not in the custody system. They are at equal risk of witnessing or experiencing verbal, physical or sexual abuse in the relevant institutions, or of receiving limited or no access to education services, which is a point that has emerged from many of the discussions that we have had with young people. Such young people need to be able to carry on their lives and their education, as well as to receive appropriate treatment for their mental health condition so that when, as one hopes, they ultimately recover, they have not missed out on that education. So it is just as important to provide age-appropriate facilities in areas that do not relate exclusively to health, and it is no good if the treatment comes from professionals who are not experienced in children’s mental health needs.
The Offender Management Bill contains provisions for treating under-18s in an appropriate environment. Children in youth custody have high-level mental health needs. According to the Youth Justice Board survey by Bailey and Harrington in 2005, 31 per cent. of young people have a mental health need, 13 per cent. have depression, 10 per cent. suffer from anxiety, 9 per cent. report self-harm in the previous month, 9 per cent. have post-traumatic stress disorder, 7 per cent. have problems with hyperactivity, and, most critically perhaps, 5 per cent. report psychotic symptoms, which is a figure much higher than in the general population.
Surely, therefore, it is appropriate to give that especially vulnerable group protection equal to that given to those outside the custody system. That is what new clause 23 would do. The debate on clause 24 stand part and new clause 23 relates to probably the most vulnerable people with whom the mental health services have to deal. It is essential that their needs are recognised expressly in the legislation and that the Government, the Opposition and the legislation that we enact all send out a clear signal to service providers that proper protection is expected. I am afraid that we have waited for too long for age-appropriate treatment to be available up and down the country. That is why the amendments that were so carefully inserted into the Bill in the House of Lords remain essential to its integrity and effectiveness. I very much hope that the Minister will not seek to remove the clause.
Dr. Pugh: May I indicate in advance, Mr. Cook, that I have an Adjournment debate at 1 o’clock, so if I leave a little bit early it will be due to nothing that you have said, and no discourtesy will be intended to the Committee.
Clause 24 stands out because it concerns a matter that was not part of the draft Bill or the main debate between the Mental Health Alliance and the Government, which has tended to centre on fundamental issues of liberty, autonomy and safety. It has enormous cross-party support, even from those with different attitudes to other clauses and issues. To an extent, it is a test of the Government. If they remove clause 24, that would have nothing to do with their original objectives in framing the legislation. It would look like control-freakery—a kind of not-invented-here syndrome—or would seem mean-spirited, and I would not want to accuse the Minister of that.
To summarise, nobody thinks that it is either desirable or acceptable for adolescents or children to be on adult wards and not specifically catered for. Granted, the word “children” includes a gamut of people. Hon. Members might be intrigued to know that a lumping 16-year-old cannot be seen at my local accident and emergency, even though he is very similar, biologically, to the other people there. He has to go to a special accident and emergency department for children, which is outside the constituency. Children and adolescents are, to some extent, different. There has been a debate about provision for children, which is different from a discussion about provision for adolescents. Many horror stories can be related in both cases. Adolescents have very particular needs that should be catered for. If being adolescent is not bad enough, being an adolescent with a mental illness is pretty terrible.
The point has not so far been made that one should not over-generalise from the horror stories. One does, however; one stigmatises the already stigmatised. Most seriously ill adults are not naturally predatory or aggressive. They are alarmingly vulnerable people. I say that as somebody who, what seems like hundreds of years ago, worked in a mental hospital among adults. The modern adult ward is not a 20th century Bedlam; it is considerably superior to the old-fashioned mental hospital in which I worked. Any hospital that is like that is a problem for vulnerable adults as well as for children and adolescents. None the less, we would all agree that it is not good to have children in adult facilities. The most sane comment on that was made during the Lords debate by Baroness Meacher, who said:
“The reality of adult in-patient wards today is that staff are managing in-patients with ever more serious and complex psychiatric disorders. Anyone who can be managed in the community is managed by one of the community teams, even if that involves daily visits—three or four visits a day—and hours of every day being spent in that person’s home. The result is that any in-patient is likely to be severely disturbed. You do not have the sort of balance that you had 10 years ago where you had a number of reasonably stable patients and others who were a bit more disturbed.”—[Official Report, House of Lords, 26 February 2007; Vol. 689, c. 1370.]
That is the situation. It needs to be addressed, and it is addressed by clause 24.
The House of Lords amendment, which is now clause 24, allows children, in extremis, to be on adult wards—there is no question about that—but bans it as a general practice, and sets a clear standard. The Government believe that that objective, which they share, should be a precept of good practice; it should be monitored, it should be a departmental or PCT objective or target, but it should not be in legislation. They give two reasons for that. First, they suggest that it might be counter-productive and, secondly, they argue that legislation is not about provisions but about drawing up rules, regulations and so on. Both arguments are flaky, but the first—that it might be counter-productive—takes two forms. One suggests that if no provision is available, none will be given; the other, which has been used by the Government but is not being used today, is that the legislation itself will make no difference; the example of Scotland is cited, erroneously, in that respect.
12.15 pm
It has to be accepted, even on the Opposition side of the Committee, that PCTs have in the past shown insufficient appetite for bespoke provision, the reasons for which are fairly straightforward. Bespoke provision is expensive; demand, fortunately, is relatively limited and provision is, perforce, often remote, because not every PCT feels justified in providing a bespoke facility on the doorstep.
Mr. Boswell: Does the hon. Gentleman agree that this is a sub-set of the endemic problem of mental health services of all kinds across the country? Although it is one of the three central Government priorities for improvement in health services, when it comes down to the PCT, constituency or user level, mental health provision is still being cut because of a variety of pressures, when other areas are being safeguarded.
Dr. Pugh: I accept that. I was going to refer to an Adjournment debate in the House, secured by the hon. Member for Wantage (Mr. Vaizey), in which he said that children’s mental health services were being reduced, a major contributory factor being that every PCT had a limited need for them and were therefore simply not providing the cash. National facilities were needed, which no one PCT, or group of PCTs, could adequately afford.
Angela Browning: I was present at that Adjournment debate, which was specific to the Park hospital. It was shown in that debate that if Park hospital closed its services to children it would leave the most enormous gap in central and southern England and parents and children would not be able to access appropriate in-patient services.
Dr. Pugh: I thank the hon. Member for her comment. The thrust of the debate was the case for nationally funded, as well as PCT, provision. In other words, national Government can walk away from their responsibilities as PCTs do not have the capacity to achieve what we all want.
I am not arguing for absolute apartheid between children’s and adults’ services in all circumstances. I quoted the example of the CAMHS unit in my constituency, which complained to me that it could not get early intervention because in the area that is labelled “adult”. It would be perfectly happy to have some help from adult departments in order to do its job.
I am not saying that change—for example, the change that has taken place in residential care provision—cannot be driven by regulation, inspection and the spreading of good practice. Many years ago, I went round social services homes where people shared rooms. They do not so now; it is very different. Inspection standards, and standards in general, have changed, which is a very positive development. I do not recall legislation that changed that, but it changed none the less. However, it is indisputably the case that primary legislation, appropriately crafted, has a role to play, and can do so, although not invariably.
The second Government argument is that legislation does not prescribe resources; generally it does not, because any prescribing of resources is a potential reduction in a limited budget elsewhere and there will be a loss of discretion within limited budgets. However, legislation can set a standard. Lord Williamson, responding to the argument that it is never done, said in a debate in the House of Lords:
“As a former civil servant, I feel tempted to say that it must have been invented by a civil servant.”—[Official Report, House of Lords, 28 February 2003; Vol. 689, c. 1367.]
He said that it was the kind of ad hoc argument that was wheeled out in almost all circumstances.
Ms Winterton: I am grateful to the hon. Gentleman for giving way. I realise that he is setting out all the arguments for the Government to accept the proposal, but he is indicating that we are turning our face against it. I do not know whether he was present when I was speaking, or whether he and other Opposition Members had already written their speeches, but I said clearly that we would take away the issues as well as the clause, and consider them. I am curious as to why the hon. Gentleman did not take that on board, as the hon. Member for East Worthing and Shoreham has done.
Dr. Pugh: I thought that I had conceded that, as I said that I was arguing about what confronts us now rather than the jam that we will be offered tomorrow. However, if the Minister wants to introduce some new clauses, I am sure that we shall consider them.
The Government’s point about resources is valid and it is fair to address it. My first experience of Richmond house was as part of a delegation from my borough of Sefton when we visited Mr. Boateng, a former Minister with responsibility for social services, to complain about the failure to fund residential care adequately. A legal case had taken place. I remember the scenario. There were no biscuits or coffee. He swept in imperiously and told us what we had to do. We left immediately. The pre-arranged press release was out on the streets and there was not a word about the law not dictating resources or about devolving decision making. Mr. Boateng had simply called us in and told us what we had to do. I am not suggesting that that is what the Minister does with the PCTs, but it was a sign of how new Labour can operate when it wants.
We are arguing about how to obtain a given effect. The Opposition favour legislation. The Minister possibly favours legislation, but hitherto has seemed to prefer other methods. It is a pragmatic argument. We are not arguing about what we want to achieve. Given the Government’s record, at the moment preference must be for primary legislation because that will provide greater reassurance to the mental health community in general.
Mr. Kidney: I agree with two things that the hon. Member for Southport said. First, our mental health services are providing services to vulnerable people every day. We owe them a debt of thanks for their dedication, diligence and sheer hard work. However, young people are doubly vulnerable, because in addition to the mental disorder for which they receive treatment, they have the added disadvantages of inexperience and immaturity. In that sense, it is important to address them separately, as indeed we are now doing.
The second point on which I agree with the hon. Gentleman is the sheer power of the lobby that has made the Government face up to their responsibility in respect of children and age-appropriate services under the Bill. He mentioned YoungMinds. I agree that it has been a formidable lobbying group in respect of the Bill. It has also been very skilful, as the Minister acknowledged earlier. While praising YoungMinds, I do not want to overlook another group of organisations that has been equally significant, such as the National Society for the Prevention of Cruelty to Children, the National Children’s Bureau, Barnardo’s and the NCH, and certainly the Children’s Legal Centre for its legal advice about the Bill.
I am unhappy that we have been asked to vote against the wording without having in front of us the Government’s alternative wording. Fortunately, I have seen the Minister in action in the Committee. She has been skilful, competent and reassuring, so I am willing to invest a little trust in her bringing appropriate wording to us on Report. However, I shall want to vote then to include in the Bill a provision that recognises the special position of children and young adults.
The 1983 Act does not distinguish between the mental health needs of children and those of adults. That is why there is no lower age limit for admission to hospital. In the 15 January House of Lords debate to which the hon. Member for East Worthing and Shoreham referred, Lord Patel described a child as young as 10 years old being admitted to an adult ward. Let us remember that, as the hon. Gentleman said, the statistics that Lord Patel quoted in the debate were for the period between April 2003 and October 2006, when 1,308 under-18s were detained in adult psychiatric wards with no special safeguards in place. That is virtually one a day. It is a shockingly high statistic, and the dangers are all too apparent.
The hon. Member for East Worthing and Shoreham heard evidence directly from young people who bravely came forward to tell of the appalling abuse of their minds and bodies that they had suffered as a result of inappropriate admissions to mental hospitals. Indeed, some of them have had the courage to contact me directly, albeit through e-mail, to give those accounts. I do not know whether they have contacted other Committee members. I feel that we have a responsibility to address their concerns and put something into the Bill that satisfies their desires for an improved service for children in future.
Before we discuss what we want to be included in the Bill, it is fair to say that the Government have moved already. The Bill contains a new test of appropriate treatment, and the draft code of practice, which we mentioned several times last week, contains many reassuring comments about what appropriate treatment means for children and young people. On page 30 there is a reference to age-appropriate accommodation and at page 152 there is a whole section on children and young people that specifically addresses not only the appropriateness of their treatment in terms of the medicine or therapy that is to be given, but issues about their continuing education while in hospital and the accommodation being appropriate for their age and wishes. All those things, which have happened already, are desirable and good, but there is more still to be done.
In an earlier debate, I mentioned the absence from the clause of a direct, specific exclusion for emergencies. The Minister has been able to say something, but she is worried that there are psychiatrists and hospital managers who would be worried, faced with an apparently absolute duty, to find that conservative treatment in the community might be more appropriate for a young person, rather than an admission to a bed that they do not have. They might not overtly say, “I refuse to admit this child because I have not got a bed”, but there are ways and means, are there not? That is what my right hon. Friend the Minister is warning us about. If the final consequence might be that some young life is lost through suicide, it is important for us to address that matter. We need the clause to contain slightly different wording.
My right hon. Friend the Minister mentioned the Children’s Commissioner for England, whose report, “Pushed into the Shadows”, is a dramatic reminder of how bad things can get for young people in mental health institutions. In fairness, the commissioner said in his report, in 2007:
“PCTs and mental health trusts should ensure that adult wards are not used for the care and treatment of under-16s and, wherever possible, adult wards should be avoided for 16 and 17-year-olds unless they are of sufficient maturity and express a strong preference for an adult environment.”
That demonstrates that it would be wrong to pick an age—whether it is 16, 17, 18 or another one—and say that there is one kind of service for everybody over that age and a different kind for everybody under it. That would be too inflexible.
Tim Loughton: I am following the hon. Gentleman’s comments closely. Does he not agree that the norm should be that children and young persons, who are defined as those up to the age of 18, should be treated by children and adolescent-appropriate mental health services and that the exception could be those 17 and 16-year-olds who may be more appropriately dealt with as determined by the responsible clinician for adult wards? That is flexibility, but the norm should be treating children and adolescents under children and adolescent specialist services.
Mr. Kidney: That is right. That is what I am arguing for. I object to the present wording because it does not quite make that distinction between the norm and what might happen in extremis, as the hon. Member for Southport said, which is a separate matter.
Services are developing now that are not so limited. Perhaps I can boast about a service in South Staffordshire, where the mental health trust established what it said at the time was the first example of a young persons’ centre addressing the gap in mental health services for people aged 14 to 25. It is not just for those near to 18, but for a broader group. This is a multi-agency service focusing on developing early, easily accessible mental health care for young people, reducing stigma, increasing awareness and promoting well-being. That is a delightful development and one that I commend everywhere, but it does not quite fit into our discussion.
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Dr. Gibson: Why did that happen? Is there some individual who is spot on here, or is there something else going on? I ask because we are trying to look for ways to improve the service across the country.
Mr. Kidney: If I may, I should like to give credit to a local Member of Parliament who is very keen on the issue of young people and children. I think I said on Second Reading that we had an extraordinarily talented chief executive in Mike Cooke—
Ms Winterton: I thought the hon. Gentleman was going to name the Member of Parliament—
Mr. Kidney: No, it is man named Mike Cooke who is the head of the trust; he is open-minded about these issues and drove those services forward. To finish the story, it is not just that centre. The trust also has a children’s council to ensure that the service hears the views of service users, partner organisations and community groups in respect of children’s services. It takes a change of culture and a change of thinking as well as a change in the law to make things happen. Certainly it is our obligation in Parliament, however, to make sure that the law is right. It will not be right if we accept clause 24 as it is, and it will not be right if we simply delete it. We need something new by the time we get to Report.
Let me conclude on issues that are wider than simply age. We will soon have a debate about advocacy, and I am keen to see that children and young people have access to advocacy in every possible situation where it might be helpful to them. I shall speak about that subject later. I should also like to give some credit to the Government for a later provision in this Bill to allow 16 and 17-year-olds who disagree with their parents to have their wishes taken into account by their treating practitioner and not those of their nearest relatives.
My right hon. Friend the Minister has given a commitment. She accepts that that is the way to go, so we want to see suitable wording on Report. As she has had such a good and constructive dialogue with YoungMinds until now, will she give a commitment to discuss further with that organisation the wording of the amendment that she proposes to table on Report? I hope that that is a helpful contribution to push her in the right direction.
James Duddridge: Before I start, I should tell the Minister that I was here throughout the whole of her speech and I listened very carefully. Over the weekend I celebrated my second anniversary of being in Parliament. On most days I get up thinking that this is the best job in the world. Today is not one of those days. I believe that the House and this Committee are failing children with mental health problems. Individually as members of this Committee we are in the process of failing people with mental health problems. Sadly, I believe that I am failing them.
Mrs. Madeleine Moon (Bridgend) (Lab): Given that I celebrated the same anniversary, may I just say that what is important for me about this Committee and the role that we have taken on in the last two years, as well as the roles that many hon. Members have played for many years, is that we are constantly moving forward to improve services? Mental health services for young people have not been bad just for the past few years; they have been bad for many years. It is now that they are being looked at. Improvements are being sought. The fact that we are debating the matter today andthat hon. Members are pushing for changes and improvement is something that we should be proud of.
James Duddridge: I thank the hon. Lady for her intervention. I have served on other Committees with her. Although we are making progress, however, I feel that an opportunity is being missed during our debate on this Bill. The Minister said that she agrees with the principles behind clause 24. I question why, rather than just voting against it, she did not introduce an alternative wording so it could be debated in detail. Nine years of debate later, although things have progressed and lobby groups have presented different arguments, it would have been better to see those principles and the Minister’s wording early on so that they could be debated and refined before the process continued.
I got the strong message that those people felt that they had been disadvantaged twice by the system—once in having their medical condition, a mental health problem, and then by being treated in an adult ward. I heard other people talk passionately about verbal, physical and sexual abuse in adult wards. Not only was it quite horrific, but in some cases, such abuse—and, to a lesser degree, drug abuse—was one of the things that had brought on their mental health problems. In the ward where they expected and deserved treatment, they had to relive the experiences that contributed to their mental health problem.
In an intervention on the Minister, I raised the issue of numbers. I should genuinely like her to clarify those numbers. I was confused that no numbers had been produced for under-16s, about whom the Government made a commitment. Although she did not offer any numbers, she said that there had been a fall. I am a little confused. If she is not aware of any national level of monitoring, how can she validate that claim about a fall? I am impressed that hon. Members from all parties have pointed out the obvious fact that children go up to the age of 17. A lot more needs to be done for 16 and 17-year-olds.
In November 2006, the Government made their two-year pledge. If it is likely to be fulfilled, why cannot we say in the Bill that in three or even four years’ time, some of the situations in which children are treated in adult wards will be illegal, so that this Government or a future Government cannot push back that promise to the primary care trusts and say, “It’s your responsibility to balance priorities”?
I am conscious of time, so I shall end my comments. I have great hopes that the Minister will table amendments, but unfortunately I do not have great confidence.
Chris Bryant: I am sorry about the hon. Gentleman’s last comments, because they seem particularly gloomy. My own experience of children’s mental health services during the past 22 years is one of significant improvement. I was curate at All Saints High Wycombe in 1986. Four youngsters committed suicide in the parish. They were all children. They did not all commit suicide together, but one child did so in September, another in November, another in March, and the other the following June. They were all close friends. None of them had any experience of the local mental health services. They had no counselling provided to them, even though they were known to be a small group of friends. Once the first child had committed suicide, no support to the family was provided by the local health trust, or, for that matter, by the local school to the children in the same class as the young boy who had committed suicide first. I do not believe that that situation would occur today. There has been a dramatic change in the way in which we approach the support needed for those who may be, as it were, the victims of somebody else’s mental health problems. The support to children in schools where there has been a suicide or a traumatic death is different to what it was 20 years ago. The provision of mental health services to youngsters has dramatically changed.
Like all hon. Members, I believe that there should be appropriate treatment for every individual, and it is obviously true of a child that their very nature should be respected as part of the appropriateness of their treatment. However, it is not the sole condition of the appropriateness of their treatment. The issue gets particularly difficult when we start to talk about 16 or 17-year-olds, whose experience of life may seem to them entirely adult. They may already have children or have served several months as a recruit in the Army, or be married or have done many of the things that we associate with adulthood, though they may not be fully adult. That is why I am hesitant about including in the Bill a specific expectation about what happens to everybody under 18.
My hon. Friend the Member for Stafford made a important point about the needs of 14 to 25-year-olds. The state has tended to treat the 14 to 25-year-old age group as an important extension in respect of the youth service, and not finished all youth service provision at the age of 18 or 21. I am particularly conscious of the psychiatric needs of those at university. Many more youngsters move away from home in this country to go to university at the age of 18, and have specific emotional, psychiatric and mental health needs that universities and local mental health trusts may find it difficult to accommodate. It is important that we have a continuum between 14 and 25 in the provision of mental health services.
Angela Browning: Will the hon. Gentleman give way?
Chris Bryant: I shall, although I am trying to encourage the hon. Lady not to intervene too much because I would like to brief.
Angela Browning: Is it not the case that most hospitals run children and adolescents departments? In other words, they do exactly what the hon. Gentleman is asking for. Usually, it is the children and adolescents department, and adolescence can go on quite a way into somebody’s 20s.
Chris Bryant: Absolutely. I take the point that the hon. Lady is making, but what I am concerned about is including in the Bill a stipulation that refers solely to the age of 18. That is why I am hesitant about the amendments that have come from the Lords.
12.45 pm
It is perfectly legitimate to excoriate the Government and to condemn the Minister for not having done enough in this area. However, it is not right to use legislation to create a crisis that will have to be met by trusts around the country in advance of the legislation coming into force. Let us not doubt that that is what would happen in practice. There may be an enormous problem and many thousands of youngsters may not be receiving appropriate treatment. If so, we shall deliberately create a crisis if we say that appropriate treatment will have to be provided on the day that the legislation comes into force.
Mrs. Moon: The hon. Member for Rhondda will, like me, have received representations from mental health providers in Wales, who point out that Wales has the lowest number of adolescent in-patient beds per head in the UK. We in Wales would have a particular problem if a deadline date was set. I wish to ensure that people understand that.
Chris Bryant: My hon. Friend is absolutely right. Many people have pointed to the fact that mental health services in Wales are probably some 10 or15 years behind provision in England. I hope that the commitment shown by the Welsh Assembly in the past few years to improving the funding and resources available to mental health services will continue in the next few years.
Placing a clause in a Bill is an inappropriate way to attempt to transform provision. I would prefer us not to legislate in such a way but to make sure that resources go to ensuring that nobody receives inappropriate treatment.
Angela Browning: During our deliberations, the Minister has not responded in any way to the amendments tabled in another place.
Ms Winterton: Yes I have.
Angela Browning: Perhaps I could finish. She has not responded in terms of accepting that the amendments tabled and made in another place reflected not only the wide body of opinion outside Parliament, including the many organisations and professionals that make up the Mental Health Alliance, but the recommendations made to the Government by the scrutiny Committee. Again, the key elements of the recommendations have been rejected by the Government.
The Minister has given one or two hints that she might look seriously at whether her doubts, reservations and concerns, which are about the potential “unintended consequences” of clause 24, can be overcome. If she did, the Government would be able to support the main principle and body of the Bill on Report.
I find it hard to believe that the Government are going to drive the Bill through without making any significant concessions. If there is one measure on which the Minister could make a concession, it is clause 24. We are almost all agreed that mental health services for children should be different from adult services. Children’s services require appropriate settings, assessments by people who are clinically approved and who have an appropriate qualification in treating children, and clinical supervision in all cases. By definition, such services require specialism.
The big question that seems to come up with regard to the Minister’s unintended consequences is the fact that the clause does not provide the means to deliver the services; it has both resource consequences and practical consequences for clinicians. No Government can pass legislation that does not have resource consequences. The question for a Government—any Government—to ask is, “When we decide to legislate, do we will the means to go with the legislation, or do we legislate and then expect those who have to deliver it to do so from their existing resources, which will clearly not be adequate?” Providing resources is not a responsibility of clinicians or PCTs; it is a responsibility of Governments. In introducing the Bill, and indeed the whole raft of legislation in the Queen’s Speech, the Government should have paid due regard to the consequences. The resources need to be there when they legislate.
Ms Winterton: Given that the hon. Lady believes strongly that her party will win the next general election, is she making a spending commitment on behalf of her Front Bench? If there are spending implications in this, is she making a commitment for a Conservative Government?
Angela Browning: Well, I am certainly going to allow my hon. Friend the Member for East Worthing and Shoreham to give the right hon. Lady a more substantive answer to that. I can tell the Minister that we are on record as having said that when we come to office we will spend proportionately more on mental health services. Mental health is a priority for the Conservative party. However, as a humble Back-Bencher—
Tim Loughton: There is no more humble Back-Bencher in the party.
Angela Browning: Thank you. I see that I am getting friendly fire from in front of me. The Minister should in no way underestimate the commitment of the Conservative party to deal with the subject. The question of children, in particular, cuts right across party issues. All parties understand that in recent years, certainly since the 1983 Act came on to the statute book, our understanding of psychiatric services for children has been much clearer. There is much more recognition of their needs, but it is so long since we last legislated that the 1983 Act does not typify our knowledge of the way in which children’s services should be provided.
Clause 24 seeks to fill that gap, and to bring the legislation up to date by referring to appropriate services. My hon. Friend the Member for East Worthing and Shoreham talked about the legal opinion that was sought by YoungMinds from Paul Bowen of Doughty Street chambers. The Minister has agreed to discuss the clause with YoungMinds, because Paul Bowen’s legal opinion states that he does not believe that the provisions will have the effect that the Government, who oppose the clause, say that they will. However he qualifies that by saying that section 142B could be more happily drafted, both generally and specifically, to meet the objection raised by the Government.
So there is a resource for the Government and its officials, in consultation with YoungMinds. The barrister has looked at the Government’s objections and is even offering practical advice on restructuring the clause to satisfy some of the Minister’s reservations about it. Nothing could be more constructive than that. I hope that the Minister will take the opportunity to discuss with YoungMinds not only its concerns but the very detailed legal advice that it obtained, which I am sure will be very helpful to the Minister.
I am very conscious that we are coming to 1 o’clock. While there may be a few tummies rumbling, I am afraid that I still have rather a lot to say on the clause. Therefore, I would like to continue. Written submission MH57 was made to the Committee by Penny Stafford, who has been a mental health service user and has also served as a member of the Mental Health Act Commission. I draw attention to something that caught my eye in her submission that is relevant to the clause. She was asked to carry out an assessment of children and adolescents detained in adult wards. She said that a fifth of the children and young people she visited who were subject to section 136 of the Mental Health Act 1983, which requires them to be taken to a place of safety, were not even taken to a mental hospital; they were detained in police custody suites. I must say to the Minister that we cannot ignore the fact that if, under the existing legislation, children and adolescents are being detained in police custody suites, which is the most inappropriate setting for very vulnerable young people, then it is even more clear that we need to get the right and appropriate settings and clinical support for them.
The Minister rather rolled her eyes when I gave the example from God’s wonderful county of Devon about what is happening in the west country.
Ms Winterton: I was surprised.
Angela Browning: Well, surprise was a factor. Are the Minister’s reservations about the clause that there will not be sufficient and appropriate services ready out there? We have already dealt with the fact that once an Act receives Royal Assent different parts are implemented at different times. None the less, it is quite clear, and quite clear from the Government’s response to the scrutiny Committee on the question of children’s services, that the Government are only too well aware of what needs to be done. Clearly, some parts of the country have started to provide specialist services, either on a regional basis or by several counties clustering together.
There are also practical issues about access for visiting parents, which I raised with the PCT and the strategic health authority in our consultation in the west country. If children and adolescents have to travel further to access specialised services, then we must ensure that we build into the facility a place for parents and close relatives to stay overnight, rather like they do on children’s wards in general hospitals. If a child is admitted to a general hospital for any period of time, there are facilities for parents to stay. Mothers very often want to stay to help with the nursing of the child. There is no reason why that system cannot be replicated in our mental health hospitals. It is about treating children appropriately. I do not see why that problem cannot be overcome.
We may need to look at the cost of transport for some families. It is quite prohibitive when children are hospitalised a long way from home. I have a mother in my constituency whose child has been hospitalised in Bristol. He has been there for three months. To travel from Exeter to Bristol every day as she wants to, having other children at home, is quite expensive. Perhaps we should be looking at the practicalities of helping families with the cost of hospital transfer. Those are not insurmountable problems. When I look around the Committee, I am sure that you will agree with me, Mr. Cook, that the brains assembled here could come up with a solution to very practical problems like that. They are second-order issues compared with what is proposed—
It being One o’clock, The Chairman adjourned the Committee without Question put, pursuant to the Standing Order.
Adjourned till this day at half-past Four o’clock.
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