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I would be completely content if, 10 years after the events I describe, having made my observations, I could sense any comfort or feel that things have improved as a result of what people who scrutinise these matters daily—like the noble Lord, Lord Patel, or Sir Albert Aynsley-Green, the Children’s Commissioner—may say. I see absolutely no evidence of that improvement.
If we are serious as legislators in the lip-service that we give to having the interests of adolescent, mentally ill children at heart then we have to do something about it. The one thing we could do is to place a statutory obligation on the services—not just targets, but statutory obligations—about dealing with children in settings and with medical care that are both age-appropriate. Of course, there will be emergency circumstances. The joint scrutiny committee dealt clearly with that by providing a solution to emergency circumstances. For example, if a child in rural mid-Wales becomes acutely mentally ill, it may take a day or two to put them in a suitable hospital environment. But surely, that it should take more than a day or two could never be justified.
I shall be extremely disappointed if we have nothing more than an anodyne response on this issue. The power of this debate has been strong, and there has been unanimity around the Chamber, which, as I said, confirmed that of the joint scrutiny committee. I hope that we shall hear a positive response.
Lord Hunt of Kings Heath: Well, I hope that this will not be an anodyne response. I listened to noble Lords as they graphically described some of the issues that face young people, and I endorse the comments about the problem of young people being inappropriately placed on adult wards. There is no question that, for many years, this has represented a major challenge for mental health services. It will carry on being a challenge, although I am disappointed that most noble Lords did not seek to reflect on some of the extra investment and improvements that were made to these services in recent years.
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I will come on to the actions that the Government have taken to improve services, given how noble Lords have described the problems. But the basic argument is that this is not the only time that your Lordships have sought to propose amendments that essentially talk about services. We have a real problem with amendments to the Bill that seek to specify the services to be given. I do not believe that is consistent with health service legislation.
There are many practical issues that would follow if one singled out a particular service, put it in the Bill and said, “That must be provided”, alongside all the other demands that are made on NHS services. Let us go through all the Oral Questions that have been tabled, and that are likely to be tabled over the next three months. There is a flavour about all of them; they all tend to say that the Government should do more to provide more services in this or that area. Of course, we seek to improve health services all the time, but there is a genuine issue about enshrining in legislation the provision of certain services for certain people in comparison with the general duty—
11 pm
Lord Carlile of Berriew: I do not begin to understand the point the Minister is making. If what he is saying is right, why have the Children Act? Why have services for any group? Why have a Mental Health Act, for that matter? Is he really saying that because one cannot be completely even-handed with all interest groups, one should simply write them all off?
Lord Hunt of Kings Heath: That is not what I am saying at all. Essentially, the Mental Health Act is concerned, as it ought to be, with the legal processes around mental health, mental disorder, compulsion and treatment. It is much more difficult to move on from there to specifying services to be provided to a certain group. That is inconsistent with the way we develop legislation in relation to the health service and to the responsibilities of the National Health Service to provide certain services. Noble Lords can shake their heads, but simply specifying that in this case there is an absolute statutory provision that must be provided by the NHS, come hither nor tither, has clear practical consequences. That is why we believe that the approach of developing and improving services, using the code of practice to influence the way those services are developed, has to be the right way through.
I assure noble Lords that the further improvement of CAMH services is one of our priorities. It features in the public service agreement for the Department of Health. We are working towards the achievement of comprehensive CAMHS in every area of the country by the end of 2006, and wish to see it maintained thereafter. CAMHS regional development workers continue to assess both the NHS and local authorities in meeting those challenges. The commitment to improve CAMHS is backed up by significant additional funding—approximately £300 million in the years 2003-04 to 2005-06, payable to local authorities in the form of a CAMHS grant, and direct to primary care trusts.
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We have made further additional funds available: £134 million in 2006-07 to the NHS and local authorities for the development of CAMHS. The children’s national service framework, the CAMHS standard, gives guidance on what is to be expected in a comprehensive CAMH service. It states:
“All children and young people, from birth to their eighteenth birthday, who have mental health problems and disorders have access to timely, integrated, high quality, multi-disciplinary mental health services to ensure effective assessment, treatment and support, for them”,
their parents or carers, and other family members. I could go on.
Considerable progress has already been made in bringing CAMHS out from under the shadow of adult mental health. CAMHS now has a profile and a priority of its own. Benchmarking surveys of provision have been completed. There is a strong feeling that central investment has led to a major change on the ground, facilitating a significant increase in multi-disciplinary and joint working across professions. My understanding, from a CAMHS mapping exercise, is that between October 2005 and February 2006 the number of CAMHS teams increased by 16 per cent over 2003, staff by 11 per cent compared with 2004 and new cases seen increased by 12 per cent over 2004.
The amendment seeks to enshrine what is already good practice. We know it is not perfect. We know there is a long way to go, but improvements are taking place and will continue to take place. Of course, we want to eliminate the use of adult psychiatric wards for adolescents, except where more mature, independent adolescents prefer to be admitted to a ward specialising in treating young adults. That was communicated to the service in a DH/DfES report. We began collecting detailed information about the use of adult psychiatric wards for children and adolescents in April 2005 to allow performance management of that aspect of the service. The draft revised code of practice states that where possible children and young people admitted to hospital should be accommodated with others of their own age group in children’s wards or adolescent units, separate from adults, and with access to CAMHS. That is an issue that should be tackled through guidance and monitoring, rather than through legislation.
As I have said, there is much more to do, but at least we are now building on a foundation of concerted improvements and investments that have taken place in the past three years. I sympathise with all the points made about defects in the current service, but I am absolutely convinced that the way forward is to build on current good practice through the normal processes of the NHS and local government.
I turn briefly to the comments of my noble friend Lady Howells on Amendment No. 41. She certainly made a powerful case. We are considering how we can make advocacy more widely available. The draft code has much to offer in that area. I can assure my noble friend that I am giving this matter every consideration, but I suggest that we might return to the subject when we debate Amendments Nos. 38 and 39.
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Earl Howe: The length of this debate has reflected the undoubted strength of feeling that exists on what is an extremely important set of issues. I am grateful to all noble Lords who have taken part in it. We have heard some extremely powerful contributions.
In view of the hour, I shall not say much. I was disappointed with the Minister’s reply. He balked at the idea of placing a requirement for particular services on the face of the Bill and said that in his view that was not appropriate. It is as if children do not deserve special protection in a service which is not always assiduous in applying the safeguards that children are entitled to expect from it. We can have all the national service frameworks and codes of practice and guidance to be imagined but the fact is that these are not delivering. We will see more on this theme tomorrow in the report from the Children’s Commissioner, which I think is strictly embargoed until tomorrow morning although a number of us have seen advance copies.
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I found the story recounted by the noble Lord, Lord Carlile, particularly sobering. It called to mind the very simple point which I do not think has been mentioned so far in the debate but it is a basic one; namely, that if a child is admitted to a CAMHS ward, there is much less chance of that young person sharing a ward with a detained paedophile—we hear all too often of that kind of unpalatable incident.
I feel this is an issue to which we may very well need to return at a later stage but for now I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Baroness Royall of Blaisdon: I beg to move that the House do now resume.
Moved accordingly, and, on Question, Motion agreed to.
- House adjourned at 11.11 pm.
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