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The Earl of Onslow: My Lords, frankly, I was hoping that no one was going to ask me that. Although Amendment No. 86 is grouped with this amendment, I am tempted to speak to it later. I notice the noble Baroness, Lady Stern, smiling and nodding on the other side of the Chamber; if that is not going to encourage me to speak to Amendment No. 86 later, I do not know what is. What with that and the comment of the noble Lord, Lord Thomas, I will reserve my position and speak to Amendment No. 86 later, because it goes slightly broader and wider.
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Amendment, by leave, withdrawn.
[Amendments Nos. 7 to 10 not moved.]
Lord Avebury moved Amendment No. 11:
Schedule 1, page 124, line 39, after “specified” insert “and designated by the Secretary of State on the advice of the President of the Royal College of Physicians as”
The noble Lord said: My Lords, at the end of a useful debate that we had something like two months ago at the beginning of Committee stage, I said that we would return to the question of facilities for the treatment of young people with a dependency on or a propensity to misuse alcohol. We all agree that it is right to have separate arrangements for this purpose. It is the first time that we have done so in legislation as far as I am aware, in spite of the fact that alcohol misuse leads to far more crime than drug misuse. We now have it in the Bill, for which we are grateful. We were addressing the question whether the arrangements in the Bill were proportionate to the problem and would enable the courts to apply the requirement with confidence that the necessary facilities actually existed. If they do not exist, or if they are seen to be ineffective, those young people who commit offences because of alcohol misuse will continue to be given custodial sentences to dry them out temporarily, without addressing the problem that causes them to commit the offences in the first place.
Following that debate, the Minister wrote a helpful letter clarifying the powers of the court. Effectively, he said that with alcohol and other intoxicating substances, and with mental illness as well, the requirement is limited to attending the place where the treatment is to be delivered and does not extend to the actual treatment itself. That is because the requirements have to be subject to the Department of Health’s general guidance on consent and to the provisions of the convention on human rights. Compulsory treatment is not absolutely prohibited by Article 5 on the right to liberty or by Article 8 on respect for private life, both of which are subject to reservations, but the Government obviously take the view that, rather than taking the risk of litigation on these matters, they will make the orders and the treatments that depend on them “voluntary”. I put that word in inverted commas, because presumably the YRO and the treatments to be offered to the defendant are as an alternative to a custodial sentence that would have been imposed if the person had not been prepared to accept the treatment requirement.
In his letter of 4 March, the Minister said that in 2006-07 more than 25,000 young offenders were assessed by the youth offending teams and received early intervention and treatment for substance misuse voluntarily under DTTOs, now rechristened DRRs. He does not say how many of those cases related to alcohol or, of the ones that did relate to alcohol, how many were successful in terms of compliance. That is essential information that your Lordships ought to
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I accept that the National Treatment Agency is the main repository of expertise in this matter. The Minister endorsed my comments on the report Review of the Effectiveness of Treatment for Alcohol Problems. Incidentally, the report emphasised the cost-effectiveness of brief interventions, which would be delivered at a much earlier stage than we are talking about here. I hope that there will be provision for brief interventions in the criminal justice system, too, as they have proved effective in the health system and are being piloted in a number of hospital accident and emergency departments. They follow the great success of the Paddington alcohol test, pioneered by Dr Robin Touquet, which has resulted in a reduction of something like 50 per cent in the number of young people coming back to A&E departments within two years following the treatment.
The noble Lord said in the letter that the treatment services are indeed to be provided through the National Treatment Agency, which approves the deliverers of treatment, although it is a matter for the youth offending teams to make arrangements locally for access to the services by the young offenders who are their responsibility. Will the NTA provide guidance to local authorities and PCTs on the services that it will approve? If it does not, how can it ensure that best practice is achieved? What seems to be lacking, if I may say so, is any strategic mechanism through which the NTA can prescribe minimum standards or best practice, which it says is a must for all interventions to be effective.
I was particularly concerned by the Minister’s comments in his letter that only a small number of young offenders who had failed previously to engage with YOT treatment services would need the further coercion and support that we are discussing and that, because those offenders would be clients of services that are already provided, no additional funding would be needed. Therefore, we are passing this provision in the knowledge that there is no money behind it. That is pathetic and short-sighted, given that as many as 1.1 million dependent drinkers may benefit from more intensive treatment given by specialist workers and given that we know that for every £1 spent on treatment £9.50 is saved in crime and health costs. Those figures come from NOMS.
The failure to allocate more resources to the treatment of young offenders with alcohol problems, who are likely to cost far more than the average dependent drinker, is a grave omission. The 2006-07 British Crime Survey recorded 1,087,000 violent offences in which the offender was thought to be under the influence of alcohol; nearly half those were young people aged between 16 and 24.
Last week my honourable friend the Member for Hornsey and Wood Green was told in an Answer that 14,500 people under the age of 18 were prosecuted in Greater London alone for drink-related offences in 2006—much the same figure as in the previous two years. That was the tip of the iceberg, because in 73 per cent of reported crimes the offender was not caught and half the cases where there is an arrest do not lead to prosecution. This and other evidence lead
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I acknowledge that the crux of the problem, which is highlighted by the small number of people who have been subject to DTTOs, is that the overwhelming majority of young offenders with alcohol problems who come before the courts are not identified as needing treatment. This is not addressed by the treatment requirement, nor, I confess, by these amendments, but the expected frugal use of these powers by the courts is a sad reflection of the low priority that has always been given to alcohol, compared with other drugs, by the Government. I hope that this debate may do something to redress the imbalance. I beg to move.
7.15 pm
Lord Ramsbotham: My Lords, I am grateful to the noble Lord, Lord Bach, for copying to me the letter that he sent to the noble Lord, Lord Avebury. I have to say that the point that caused me most concern was that this alcohol-related treatment, along with the other drug and mental health treatment requirements, is subject to general Department of Health guidance on consent. This concerns me, because at the heart of the youth justice system and the carrying out of detention and training orders, for example, by youth offending teams is the working out of what should happen to a young offender during their sentence, based on an assessment of need. That is allied to an assessment of the time available and the priority of need, which is judged according to the various aspects that have prevented someone from living a useful and law-abiding life.
It is a matter of some concern that Department of Health guidance should be preventing the Ministry of Justice, the Department for Children, Schools and Families and others who have to work out what should be done with young people from enabling those young people to embark on a course of treatment to tackle what seems to be at the heart of many of their problems. I must ask whether, in the spirit of the amendment, it is not possible to go back to the Department of Health and revisit the guidance to see whether it can be made more in tune with the need of young offenders and, therefore, the protection of the public, which the Government say means so much.
Baroness Butler-Sloss: My Lords, I wonder whether the noble Lord, Lord Ramsbotham, is really objecting to the use of the word “consent”. It seems that the difficulty is that children of a certain age have rights as to whether or not they should have to undergo medical treatment. One might consider putting treatment for drink or drug problems within the remit of treatment for mental health problems. There might even be a physical problem regarding the way in which people will be treated. However, the courts have said over the years that relatively young children, certainly those under 16, have increasing rights. That goes back to
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I would have thought that the Department of Health guidance, which applies to girls receiving advice on contraception, would equally apply to girls or boys being offered treatment for intoxication or drug problems. I do not think that the Department of Health would change that guidance, even though it might be extremely inconvenient if a youngster refused to take the treatment. This is a major problem, but I am sorry to say that it cannot be solved by suggesting that the Department of Health should change its guidance.
Lord Bach: My Lords, I am grateful to the noble Lord, Lord Avebury, for raising again this important topic and for referring to my letter to him and other noble Lords in answer to our debate in Committee.
I shall deal with the point made by the noble Lord, Lord Ramsbotham, which, perhaps I may say, has been answered comprehensively by the noble and learned Baroness, Lady Butler-Sloss. This is not some Department of Health guidance that is out on its own somewhere and is not relevant to other matters. It relates to the whole problem of what may be required in terms of medical treatment of a young person. Unless that treatment is to be given under the powers of the Mental Health Act, there is very little that the court can force a young person to do. Under the new order, the court can and, I hope, will require them to attend the place that is providing treatment. That is within the court’s power, but unless the offender is subject to the Mental Health Act 1983, it is not within the court’s power to do much more.
There are two parts to the noble Lord’s amendment. I know that he wants a debate rather than for us to concentrate on the two parts of his amendment, but I will, if I may, talk about them briefly. On the first part of his amendment—that which mentions the Royal College of Physicians—we do not think that it is desirable or practical to restrict the direction of intoxicating substance treatment to individuals who have been approved by the Royal College of Physicians.
We have been advised by the Department of Health and the National Treatment Agency, and they are of the common view that dependency on intoxicating substances can be resolved in a treatment intervention where the main worker is not a medical practitioner. It could be that some of those providing treatment will have no formal qualifications—what matters is that they are effective. This provides the flexibility that is required in the provision of treatment.
As was said in Committee, there may be cases in which the treatment could be delivered by a person with the necessary experience, through previous experience of addiction. In reality, those who have had direct experience of substance addiction can be most effective in directing treatment. For young people, such personal experience can and does provide powerful testimony of the dangers of addiction to substances. It is probably common sense to say that such persons are unlikely to be approved by the Royal College of Physicians.
Moreover, as I set out in my letter, the National Treatment Agency is the provider of these services and
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The second part of the amendment does not reflect how such treatment is either delivered or funded; I know that that is what the noble Lord is concerned about. Youth offending teams already refer young people to these services. Indeed, the majority of young offenders receiving treatment for substance misuse access these services without recourse to a formal court order. This means that they will be signposted to treatment provision via the normal youth offending team supervision process.
Earlier today, I asked my officials to provide me with a case history for my own benefit; I hope that it will not appear condescending to mention how it might work. It may be a bit simplistic but I hope that the House will bear with me; it raises quite an important point. The noble Lord was getting at how this might work in practice.
My offender is called Michael; he is neither spotty nor surly. He has been convicted of a theft offence and is awaiting sentence. When he was arrested—perhaps even before he went to court but certainly before his sentence—he was first assessed by the responsible YOT officer so that a pre-sentence report could be prepared for the court. It was identified that he had a problem with excessive alcohol consumption, which had contributed to his erratic behaviour—indeed, to his offending behaviour. The responsible officer speaks to Michael about his offending behaviour during one of his regular YOT appointments. They agree that alcohol misuse is playing its part. The responsible officer refers Michael to the YOT substance misuse worker and tells Michael that he feels that he may benefit from a referral to that worker and that he can use some of his YOT appointments for just that end. Michael is not compelled to undertake this course of action but it is strongly recommended. Michael considers this offer and feels that he could benefit from a referral to the substance treatment worker and agrees to it. Consequently, he meets the YOT substance misuse worker, who refers him for further targeted treatment, using the NTA substance treatment budget. That is the end of the tale.
The majority of young people who are subject to YOT supervision in whatever form it takes and who are in need of alcohol treatment will receive this treatment without recourse to a court order by informal referral to the dedicated substance misuse worker who is attached to the YOT. If they were to
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I hope that that makes things slightly clearer rather than more complicated. We consider the intoxicating substance treatment requirement to be the safety net that underpins the normal supervision process.
Funding and provision—the noble Lord was concerned about those—are devolved to local areas. Young people’s specialist substance misuse treatment services are currently funded via the National Treatment Agency. I hope that I will be able to give some figures in a moment about that funding. Provision is commissioned locally and youth offending teams are the largest commissioner of these services. It is the role of the local youth offending team to identify local facilities and providers and to establish whether the services provided are appropriate for the particular young person. Information about suitable treatment services and facilities for a young person will be provided to the court as part of the pre-sentence report, as I showed in my example. The court will therefore receive the necessary information about the facilities being recommended through this process. A centrally held list of facilities would not add much value. Indeed, such a list would be unworkable and difficult to maintain accurately. The treatment services are delivered locally with availability changing constantly. The maintenance of a central list might be overly bureaucratic and, more importantly, would be out of date pretty quickly.
On funding, the total YOT funding via the Youth Justice Board is some £8.5 million per year. That is for substance misuse workers to be employed. The NTA provides £24.7 million per year towards specialist substance misuse treatment. That is beyond the YOT funding for young people across England; of that sum, more than 40 per cent of referrals into treatment in the year 2006-07 were for young offenders.
Lord Avebury: My Lords, could the noble Lord break down those figures into those relating to drugs and alcohol respectively?
Lord Bach: My Lords, I am afraid that I do not think that I can; I have a note to that effect. The Youth Justice Board does not break down the figures for substance misuse into separate substances, so there is no separate figure for alcohol because—I am not sure that this will be satisfactory to the noble Lord—the system is geared for substance misuse in the round. This still makes a distinction between illegal drugs and substance misuse, which includes alcohol and glue-sniffing, as defined in the Bill.
The crux question being raised in the amendments is whether that requirement will need further funding. We do not think so. All YOTs are funded to provide substance misuse workers to support screening, early intervention and referral on to specialist services.
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7.30 pm
Lord Avebury: My Lords, I am extremely grateful to the Minister for his thorough reply, although he did not respond to the questions that I put to him when I spoke to the amendment. I shall repeat them so that he can consider whether a further letter would be of use.
I asked about the sanction behind this treatment order. If a young offender refused to accept it, would he be liable to receive a custodial sentence? In the hypothetical case that the noble Lord cited, Michael has been resistant to the voluntary efforts of the YOT, which then imposes an order under this section. The possibility of a custodial sentence would warn the offender that if he continued to refuse to attend, he might be brought back before the courts and suffer such a sentence. That would be the incentive for him to comply with the treatment requirement where he had been unwilling to do so voluntarily.
Lord Bach: My Lords, the usual breach rules, which we will discuss later in government amendments, provide some answer in that, as I understand it, there needs to be a very serious breach before an offender can be brought back the first time—I am talking in shorthand now. The question was whether the offender should be brought back to court automatically after a third breach. After the dinner break, the Government will move amendments suggesting that if the YOT officer thought that the third breach was not sufficiently serious, although a reasonable excuse was lacking, it would be wrong to bring the offender back to court. Therefore, in exceptional circumstances, the YOT officer is able not to bring back the offender.
If the offender is brought back to court for a breach of a YRO—I think that that is the subject of a later amendment—as I understand it, the court is not bound to send him to custody; it has a choice. Therefore, it would not necessarily follow that someone who breached the order would go into custody. However, you cannot require someone to receive medical treatment. You can require a person to attend a hospital but you cannot require him to undergo medical treatment. I hope that that answers the noble Lord.
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