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In terms of practicality, what generally happens is that a child is admitted in an emergency; that is when the situation arises whereby they go into a completely unsuitable adult ward. In practice, all that has to happen is that the primary care trust agrees with the local mental health service that they will, for the moment, until the local facilities have been built,
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The money is being spent already because the person is admitted, so you already have the charge against an admission. Although the cost of a child’s admission to a specialist unit is slightly higher, the cost overall is broadly similar. All the amendment would do is signal to mental health services and primary care trusts that they have to make the arrangements. It does not signify that they should make a different sort of service.
This does not happen at the moment because of a handful of services that simply do not comply; it is evident from the Mental Health Act Commission reports that this is not a generalised problem but a problem with a very few authorities. We are not asking for anything complicated here. I support the amendment.
Baroness Howe of Idlicote: My Lords, I have listened to what has been said on the amendment, and I took part in the debate on Friday on palliative care, where the argument was that if you got rid of the postcode lottery it would put palliative care above other services. This amendment clearly does not do that for these services; there is every reason to put this in the Bill. Having heard some of the stories today, and having seen some of them in the paper, I believe that this is something that the Minister must surely agree to.
Lord Ramsbotham: My Lords, I have tabled amendments concerning one part of the population that needs special treatment, which is those in custody. No group in custody is more in need of improvements to current mental health care than people of juvenile or young offender status—that is, those between the ages of 15 and 21. The services that they get are frankly awful, because there are simply not enough adolescent psychiatrists or trained adolescent nurses available to give the treatment that they need. The assessments are not there. All the things that are set out in the amendment, if adopted, should be adopted on behalf of all those young offenders who get into the hands of the criminal justice system. I strongly support the amendment, because it sets out a very clear blueprint for what the authorities should provide, so I hope that it will be accepted.
The Lord Bishop of St Edmundsbury and Ipswich: My Lords, I add my strong support to the amendment, which is very important. It is to do with focusing the response to young people with particular needs. Lying in the background is the problem that mental health services so often are the poor relation in local health authorities. Therefore, young people can be disadvantaged twice. One hopes that good practice in the field will be encouraged, but statutory provision, which would give strength to that, is practically needed, as we have heard.
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Lord Hunt of Kings Heath: My Lords, this has been a short but highly interesting debate. I sense that the House wishes to come to a view on this subject as quickly as possible.
I thank the noble Lord, Lord Williamson, for his very kind remarks. He has raised some serious matters about the way in which children and young people are treated by our mental health services under the legislation. He identified, as did the noble Earl, Lord Howe, some of the real challenges in ensuring that appropriate services are provided to these vulnerable young people. I also very much take the point that the right reverend Prelate made; he raised the concern that, traditionally and historically, mental health services have not received their due. As he put it, statutory provision is a way of ensuring that that happens. Noble Lords will be weary of me expressing concerns about, in essence, putting statutory requirements in the Bill to provide services, but that is a genuine issue that has to be faced up to.
The noble Baroness, Lady Howe, referred to one of the best debates that I have taken part in; it took place in your Lordships’ House on Friday. I very foolishly tempted the noble Lord, Lord Carlile, to engage with me on the issue of palliative care services. On Friday, all of us—apart from me, once again—were arguing that palliative care is so important. I could have taken the words that the noble Lord, Lord Ramsbotham, used about mental health services in Committee and simply inserted the words “palliative care”.
There are six areas for short debate on today’s selection list, all of which will be very interesting if we get to them. However, in all of them, noble Lords will argue that those are the areas that deserve priority. There is a genuine issue about how to provide these services, which are so important. We are dealing with such vulnerable people and there have clearly been major defects in the provision of services in the past; I refer to young people being looked after on adult psychiatric wards although they are vulnerable in the way that the noble Earl, Lord Howe, described. Those are major challenges but they are not solved simply by waving the magic wand of legislation that says, “That will happen no more”. That is the issue that separates us.
We have discussed Scotland on a number of occasions and all of us are interested in, and will be interested in observing in the years ahead, the different approaches and the lessons to be learnt from each system. Section 23 of the Scottish mental health Act requires a child to be placed in age-appropriate accommodation. However, that has not led to the ending of children being placed on adult psychiatric wards in Scotland. My understanding is that the Mental Welfare Commission for Scotland reported in the past quarter that admissions of children to non-specialist wards including adult wards had risen, not fallen. That is not a criticism that I make of Scotland or the Scottish approach. All I suggest is that noble Lords should bear in mind that simply passing legislation that says, “It will not happen”, does not mean that the service automatically follows.
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Lord Northbourne: My Lords, will the Minister admit that all that we as parliamentarians have the power to do is, alas, to pass legislation? It is up to the Government to make the thing work.
Lord Hunt of Kings Heath: My Lords, I say very respectfully to the noble Lord that that really is a get-out.
Noble Lords are using our debates—I think that this is my seventh day of debate, although other noble Lords had a further debate at Second Reading—to identify issues and problems that have been in mental health provision for many years. They are clearly seeking to use this occasion to press the Government as much as possible to improve the provision of mental health services. I well understand that that is what this is about. Indeed, if I were back on the Back Benches, I have no doubt that I would be joining in those debates, as noble Lords know that I have a long-standing interest in the provision of better mental health services. However, any Minister standing here still needs to say that, although it would be very easy if parliamentarians could simply pass Bills and amendments saying, “This must be the priority”, that cannot be done, because overall discretion has to be given to the Secretary of State to provide services. The Secretary of State must then do his or her best to ensure that those services are provided.
Lord Carlile of Berriew: My Lords, I am puzzled as to why the noble Lord keeps using the word “priority”. Those of us who support the amendment, and indeed other comparable amendments, are trying to set standards, not priorities over other things. Surely the word “priority” is rather misleading; if anything, it is a parity, not a priority.
Lord Hunt of Kings Heath: My Lords, I do not agree with that. It seems to me that the code of practice, to which there is statutory reference, is the ideal place to embody standards. If in NHS legislation a Secretary of State is given a general duty to provide services but you detail in specific legislation a statutory requirement in relation to a particular aspect of the service, surely a provider of services is then left with certain statutory provisions that say, “In a certain area, you must provide services”, whereas the entire NHS services are governed by a more general duty. In that sense, by specifying in one area that a particular service must be provided, you are prioritising that service.
I think that noble Lords probably have the gist of my argument and I see that I have been as convincing as ever. I would only say that, as I am glad to report and as other noble Lords have acknowledged, there has been a tremendous advance in providing services for children and young people in the mental health field. We are seeing more in-patient beds being commissioned and more resources being spent. Indeed, the Royal College of Psychiatrists’ research unit provides some evidence of that. Noble Lords have referred to the comments of my honourable friend Mr Ivan Lewis; we are committed to doing everything that we can to improve those services.
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Baroness Meacher: My Lords, does the Minister regard a 4 per cent increase between 1999 and 2006 in general CAMHS beds as sufficient, bearing in mind the enormous importance, which I think he accepts, of providing the right kind of services to very young people who become mentally ill?
Lord Hunt of Kings Heath: My Lords, I think that I said earlier that major challenges remain to be faced. I would never claim that the provision of those extra beds is sufficient, but it is an indicator of the improvements that are being made, alongside other improvements in relation to CAMHS and mental health services generally. The Government’s view is that we signalled our intent to improve services. We believe that the code of practice is the right way to indicate to the health service how those services should be provided and, as I have indicated, we are very wary of accepting the kind of amendment and approach put forward by the noble Lord, Lord Williamson, this afternoon.
Baroness Masham of Ilton: My Lords, should not the rights of the child be paramount?
Lord Hunt of Kings Heath: Yes, my Lords, and that is made absolutely clear in the code of practice. Of course, there is no question about providing as good a service as we can for children and young people, but I do not think that that alters the arguments in relation to the amendment.
Lord Williamson of Horton: My Lords, I am grateful to the Minister for his reply. I am sure that his motivation is very similar to our own. We are trying to improve care and provide appropriate care for children and young people.
I noted that the Minister pressed two points. He said that putting the amendment in the Bill is no guarantee that it will happen. We all know that one cannot just put something into a Bill and assume that it will happen the next day—most of our legislation probably falls into that category. However, we still believe that it is right to put it into the Bill.
Before the Minister rose, I tried to answer the point about the specific position of children. Throughout much of our society and in legislation, we treat children and young people quite separately. I do not believe that this is comparable with various other points that might be raised about setting services. I noted that the Minister said that if he returned to the Back Benches he would perhaps join in these debates.
Lord Hunt of Kings Heath: My Lords, to ensure that I do not return to the Back Benches very soon, I need to clarify that. Of course, I would not support the amendment, but I was responding to a general comment from the noble Lord, Lord Northbourne, that of course the passage of a Bill is an ideal way in which to press the Government to improve services in the particular area that is under discussion.
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Lord Williamson of Horton: My Lords, I thank the Minister for that clarification. I do not want him on the Back Benches; I want him on the Front Bench, as there is plenty more business to come on which he can give us a helpful hand. In the mean time, I consider that this amendment ought to be in the Bill. I beg leave to test the opinion of the House.
4.01 pm
On Question, Whether the said amendment (No. 25) shall be agreed to?
Their Lordships divided: Contents, 201; Not-Contents, 126.
Addington, L.
Alderdice, L.
Alliance, L.
Alton of Liverpool, L.
Ampthill, L.
Anelay of St Johns, B.
Astor, V.
Astor of Hever, L.
Attlee, E.
Baker of Dorking, L.
Barker, B.
Beaumont of Whitley, L.
Bell, L.
Best, L.
Blaker, L.
Bledisloe, V.
Bonham-Carter of Yarnbury, B.
Bowness, L.
Bradshaw, L.
Bragg, L.
Bridgeman, V.
Bridges, L.
Brooke of Sutton Mandeville, L.
Brougham and Vaux, L.
Bruce-Lockhart, L.
Buscombe, B.
Byford, B.
Caithness, E.
Campbell of Alloway, L.
Carlile of Berriew, L.
Chadlington, L.
Chidgey, L.
Chorley, L.
Colville of Culross, V.
Colwyn, L.
Cope of Berkeley, L.
Cotter, L.
Craig of Radley, L.
Crisp, L.
Cumberlege, B.
Darcy de Knayth, B.
De Mauley, L.
Denham, L.
Dholakia, L.
D'Souza, B.
Dykes, L.
Eccles of Moulton, B.
Eden of Winton, L.
Elles, B.
Elliott of Morpeth, L.
Elton, L.
Erroll, E.
Ezra, L.
Falkland, V.
Fearn, L.
Fookes, B.
Forsyth of Drumlean, L.
Fowler, L.
Fraser of Carmyllie, L.
Freeman, L.
Garden, L.
Gardner of Parkes, B.
Glasgow, E.
Glentoran, L.
Goodhart, L.
Goodlad, L.
Greaves, L.
Greengross, B.
Greenway, L.
Hamilton of Epsom, L.
Hamwee, B.
Hanham, B.
Hanningfield, L.
Hayhoe, L.
Higgins, L.
Hogg, B.
Holme of Cheltenham, L.
Hooper, B.
Howard of Rising, L.
Howarth of Breckland, B.
Howe, E.
Howe of Aberavon, L.
Howe of Idlicote, B.
Howell of Guildford, L.
Hurd of Westwell, L.
Hylton, L.
James of Blackheath, L.
Jay of Ewelme, L.
Jenkin of Roding, L.
Kalms, L.
Kirkwood of Kirkhope, L.
Laing of Dunphail, L.
Lamont of Lerwick, L.
Lee of Trafford, L.
Lester of Herne Hill, L.
Lindsay, E.
Linklater of Butterstone, B.
Liverpool, E.
Livsey of Talgarth, L.
Lucas, L.
Luke, L.
Macfarlane of Bearsden, L.
MacGregor of Pulham Market, L.
Maclennan of Rogart, L.
McNally, L.
Maddock, B.
Mar, C.
Mar and Kellie, E.
Marlesford, L.
Masham of Ilton, B.
Mayhew of Twysden, L.
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Methuen, L.
Miller of Chilthorne Domer, B.
Miller of Hendon, B.
Monson, L.
Moore of Lower Marsh, L.
Morris of Bolton, B.
Murphy, B. [Teller]
Murton of Lindisfarne, L.
Naseby, L.
Neuberger, B.
Newby, L.
Newton of Braintree, L.
Northbourne, L.
Northbrook, L.
Northover, B.
Oakeshott of Seagrove Bay, L.
O'Cathain, B.
Palmer, L.
Palumbo, L.
Patel of Bradford, L.
Patten, L.
Pilkington of Oxenford, L.
Plummer of St. Marylebone, L.
Prashar, B.
Quinton, L.
Ramsbotham, L.
Rawlings, B.
Razzall, L.
Redesdale, L.
Rees, L.
Rennard, L.
Roberts of Conwy, L.
Roberts of Llandudno, L.
Rodgers of Quarry Bank, L.
Rotherwick, L.
Russell-Johnston, L.
Saatchi, L.
St. Edmundsbury and Ipswich, Bp.
St John of Fawsley, L.
Saltoun of Abernethy, Ly.
Sandberg, L.
Scott of Needham Market, B.
Seccombe, B.
Selborne, E.
Shaw of Northstead, L.
Shephard of Northwold, B.
Shutt of Greetland, L.
Smith of Clifton, L.
Steel of Aikwood, L.
Steinberg, L.
Stern, B.
Stevens of Ludgate, L.
Stewartby, L.
Stoddart of Swindon, L.
Strathclyde, L.
Swinfen, L.
Taverne, L.
Taylor of Holbeach, L.
Taylor of Warwick, L.
Tenby, V.
Teverson, L.
Thatcher, B.
Thomas of Swynnerton, L.
Thomas of Walliswood, B.
Thomas of Winchester, B.
Thomson of Monifieth, L.
Tonge, B.
Tope, L.
Tordoff, L.
Trefgarne, L.
Trenchard, V.
Trimble, L.
Trumpington, B.
Tugendhat, L.
Tyler, L.
Vallance of Tummel, L.
Verma, B.
Waddington, L.
Wakeham, L.
Walmsley, B.
Walpole, L.
Walton of Detchant, L.
Warnock, B.
Watson of Richmond, L.
Wedderburn of Charlton, L.
Wilcox, B.
Williamson of Horton, L. [Teller]
Windlesham, L.
Young of Hornsey, B.
Acton, L.
Adonis, L.
Ahmed, L.
Alli, L.
Amos, B. [Lord President.]
Anderson of Swansea, L.
Andrews, B.
Archer of Sandwell, L.
Ashley of Stoke, L.
Ashton of Upholland, B.
Bach, L.
Bassam of Brighton, L.
Bhatia, L.
Bhattacharyya, L.
Billingham, B.
Borrie, L.
Boyd of Duncansby, L.
Bradley, L.
Brett, L.
Brooke of Alverthorpe, L.
Brookman, L.
Campbell-Savours, L.
Carter of Coles, L.
Christopher, L.
Clark of Windermere, L.
Clarke of Hampstead, L.
Clinton-Davis, L.
Corbett of Castle Vale, L.
Corston, B.
Crawley, B.
Davidson of Glen Clova, L.
Davies of Coity, L.
Davies of Oldham, L. [Teller]
Dean of Thornton-le-Fylde, B.
Drayson, L.
Dubs, L.
Eatwell, L.
Evans of Parkside, L.
Evans of Temple Guiting, L.
Falconer of Thoroton, L. [Lord Chancellor.]
Falkender, B.
Farrington of Ribbleton, B.
Filkin, L.
Fyfe of Fairfield, L.
Gale, B.
Golding, B.
Goldsmith, L.
Gould of Brookwood, L.
Gould of Potternewton, B.
Graham of Edmonton, L.
Gregson, L.
Griffiths of Burry Port, L.
26 Feb 2007 : Column 1378
Harris of Haringey, L.
Harrison, L.
Hart of Chilton, L.
Haskel, L.
Haworth, L.
Henig, B.
Hollis of Heigham, B.
Howarth of Newport, L.
Howie of Troon, L.
Hoyle, L.
Hughes of Woodside, L.
Hunt of Kings Heath, L.
Janner of Braunstone, L.
Jay of Paddington, B.
Jones, L.
Jones of Whitchurch, B.
Jordan, L.
Judd, L.
King of West Bromwich, L.
Lea of Crondall, L.
Lipsey, L.
Lockwood, B.
Lofthouse of Pontefract, L.
McDonagh, B.
Macdonald of Tradeston, L.
McIntosh of Haringey, L.
MacKenzie of Culkein, L.
Mackenzie of Framwellgate, L.
McKenzie of Luton, L.
Mason of Barnsley, L.
Mitchell, L.
Morgan, L.
Morgan of Drefelin, B.
Morgan of Huyton, B.
Morris of Aberavon, L.
Morris of Handsworth, L.
O'Neill of Clackmannan, L.
Patel of Blackburn, L.
Paul, L.
Pendry, L.
Quin, B.
Ramsay of Cartvale, B.
Randall of St. Budeaux, L.
Rea, L.
Rendell of Babergh, B.
Richard, L.
Rooker, L.
Royall of Blaisdon, B.
Sawyer, L.
Scotland of Asthal, B.
Sheldon, L.
Simon, V.
Soley, L.
Stone of Blackheath, L.
Strabolgi, L.
Temple-Morris, L.
Thomas of Macclesfield, L.
Thornton, B.
Tomlinson, L.
Triesman, L.
Truscott, L.
Tunnicliffe, L.
Turnberg, L.
Turner of Camden, B.
Uddin, B.
Varley, L.
Warwick of Undercliffe, B.
Watson of Invergowrie, L.
Whitaker, B.
Williams of Elvel, L.
Winston, L.
Woolmer of Leeds, L.
Young of Norwood Green, L.
Resolved in the affirmative, and amendment agreed to accordingly.
Afghanistan: UK Forces
4.14 pm
The Parliamentary Under-Secretary of State, Ministry of Defence (Lord Drayson): My Lords, with the leave of the House, I shall now repeat a Statement made in another place by my right honourable friend the Defence Secretary. The Statement is as follows:
“Mr Speaker, on 1 February I announced the forthcoming rotation of our troops in Afghanistan. At that time I undertook, once I had spoken with my fellow NATO Defence Ministers at Seville, to update the House on any further changes to our force structure. That is what I am here to do today.“First, however, I want to highlight the progress and achievements in Afghanistan during 2006. NATO has continued its expansion of responsibility for this vital campaign into the more challenging south and east of the country. We have faced down the Taliban in its own backyard, delivering security and bringing the reach of the Afghan Government to places that have hardly seen it before. We have unified the military mission under the leadership of General Richards and the British-led Allied Rapid Reaction Corps. Across Afghanistan we have built schools, mosques, roads,| Next Section | Back to Table of Contents | Lords Hansard Home Page |