Ann Winterton (Congleton, Conservative)

I remind the Committee that with this we are considering 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 of 18 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.”’.

Angela Browning (Deputy Chairman (Organising and Campaigning), Conservative Party; Tiverton & Honiton, Conservative)

I am delighted to see you in the Chair again, Lady Winterton.

I shall reiterate my points quickly for the benefit of hon. Members who may not have heard me. I was talking about the Minister’s concern about unintended consequences in respect of the addition to clause 24 and I mentioned briefly before we broke for lunch the report by a former member of the Mental Health Act Commission, Penny Stafford, who spoke about the research that she undertook in respect of children and adolescents and in particular—I am sure that we will come to this at a different stage—the impact on children and adolescents of section 136 of the Mental Health Act 1983. She pointed out that, far from them having the opportunity to be taken to a place of safety within a hospital with appropriate services and specialisms for children and adolescents, all too often they are left to languish in police custody suites.

I put that to the Minister because she has, from time to time during our discussion of the clause, suggested that if the Government legislate, it will be for others to have to implement that legislation, with the resource implications that that may involve—in this case, we are talking particularly about children’s and adolescent services. There is a precedent for this. In fact, there are many precedents in the way the Government have legislated elsewhere on behalf of children.

Let us consider, for example, children’s services supplied through local authorities. There is a statutory  obligation on a local authority. The Government do not say, “You will do this if you can afford it” or “when resources permit.” For children’s services in the main, when a local authority looks at its annual budget it has a statutory obligation to protect children, as defined by national legislation.

I therefore find it rather incongruous that the Government are prepared to legislate for the protection of children in one area, but when it comes to children and adolescents in the mental health system, a different set of values or rules applies. That is not just inconsistent; it is unacceptable. We all know that throughout mental health services—indeed, the whole area of mental health—there is stigma. There is the old clichÃ(c) that it is seen as the Cinderella service. I am sure that all of us who take an interest in the subject recognise such descriptions, but we are now talking about children and adolescents in that system. It would be invidious to choose one group of people over another, but if we cannot, through our legislation nationally, protect children, we fail—we fail as politicians and we fail as legislators.

I therefore return to the point that I made to the Minister at the beginning of the debate. If there is one aspect of the Bill that she feels she might be able to come to an accommodation on in terms of the Lords amendments, given the overwhelming evidence of the need for us to do something different in this Bill compared with the original 1983 Act, it is surely the aspect that deals with the provision of services for children and adolescents.

I will stop speaking shortly, much to the relief of the hon. Member for Rhondda, who is hanging on my every word as usual, but first I will say this. This is a very serious subject, on which we would all like to see some progress. I must ask the Minister, in considering the issue—I am sure that she will consider it—to take a look at the evidence before her and the legal counsel provided by YoungMinds and to return to the issue on Report. I am sure that she can make a difference to the improvement of services for children and adolescents in respect of mental health—indeed, she has a duty to do so.

Tim Boswell (Daventry, Conservative)

I am deeply impressed and moved by the eloquence of my hon. Friend. The debate has gone on for some time and I do not intend to prolong it, but as someone who normally tries to seek a degree of accommodation and consensus—and may even be criticised for that from time to time—I am encouraged that matters seem at least to be working towards a common position, even if one has not yet been reached. That is true with respect to the central importance of doing something for children’s mental health services, and even with respect to the Minister’s assurance, from which we take some comfort, that, as she snatches away the provision before the Committee, she has made a commitment—although not a precise one in legislative terms—to reflect again before Report. I have a profound hope that she will do that, and come up with something practical to meet the needs that hon. Members on both sides of the Committee, including the hon. Member for Stafford, have described. We need to move on the issue.

Not only have Committee members received representations from YoungMinds and others but they  will almost all have been involved in constituency cases. I have not had much experience of the kind, but an example that occurred this year has been very much on my mind. It brings together three points. The first is the importance of education as well as the health services in the support required for what the clauses define as the needs of young people. The young person in question is doing his GCSEs this year. He has suffered severe and acute depression, and difficulties have been encountered about where to accommodate him, including the question of putting him in adult mental health wards. There has been a fight for better provision, which has now been secured, but it has not been easy. A consequence has been the breaking of the link with his county, which has supported him for education purposes, because he has now crossed the boundary into another county.

The second point to make in that context, which has not been brought up so far, but which I think is a subset of the point already discussed by my hon. Friend the Member for East Worthing and Shoreham, is the remote provision of services. They may not be available readily and reliably in each of our local authority areas. That is not unusual in my constituency because of the geography, but people are going outside their area for services and having to deal with different local authorities and primary care trusts. That becomes difficult and stressful at a stressful time.

My third point has not really been made except in the context of carers, and that is the stress that such situations bring on the whole family: the parents and of course the siblings. There was a sibling in the case that I have recalled. Those people see the illness of their close relative and the desperate fight to get appropriate provision at a reasonably convenient point.

Brian Iddon (Bolton South East, Labour)

Some Labour Members remain reticent, but does the hon. Gentleman accept that there is not much difference between his side of the Committee and this side as far as acceptance of the basic principle that children should be much better looked after by the mental health services than has hitherto happened? Does he also accept that the Minister has already promised more than once to go back to YoungMinds, examine the clause, and table a more acceptable one on Report? That is why we remain reticent on the Labour Benches. I believe that the Minister will do that.

Tim Boswell (Daventry, Conservative)

I am grateful for the hon. Gentleman’s intervention. I agree with him about the common commitment, in principle, of the Committee. I have no doubt about that or about the fact that there is a genuine wish to enact that commitment in a suitable and viable form. We have not yet quite got from the Minister an absolute assurance that that will be achieved in the Bill. The purpose of the interventions, as much as anything else, because we all feel strongly about this subject, is to reinforce the Minister’s will to try to seek a common solution. If she does so, none of my colleagues, to my knowledge, would want to claim any particular credit. It would be a victory for our discussions and our commitment.

The only other point that I wish to make in response to the hon. Gentleman on the general importance of the topic is that this debate comes on the back of a  widespread national debate on the importance of mental health services. That is why the fact that there is a cadre of members of the Committee who are committed to pursuing the matter properly is encouraging.

I shall briefly make some other points. It is important that we do not confine our attention to under-16s. The Minister has not done that, although once or twice in her presentation she began to do so. Such figures as we have and the rate of pick-up of the undertakings given by her colleague, which will now be transmitted through regional strategic health authorities to primary care trusts to be monitored and reported back, would suggest a fairly slow rate of progress, even on under-16s. Even if the rate is secured to the 99 per cent. or better confidence limit for which we hope, it will leave a problem for adolescent mental health in the 16 to 18 age group. That is of great importance, not least because that group is likely to be the better part of the population or, to put it another way, the age group in which mental health problems tend to present themselves.

I would like to associate myself with the comments made by my hon. Friends on offenders in relation to proposed new clause 23. In my constituency, there is a secure training centre and, adjacent to that, a young offenders institution, which neatly spans the 16-year-old divide. Sadly, I am only too well aware of the risks of self-harm and suicide in those establishments. It is important that there is an appropriate setting and that that is maintained when people have to leave such establishments for more intensive treatment.

As the hon. Member for Bolton, South-East rightly said, we are close to, or are edging toward, consensus. It is important that those on the Government’s side do not caricature what we are saying in new clause 23, and that we do not pretend that there are no difficulties. We need to get it right. It has already been made clear to the Committee—if not, it is clear to me—that there is no question of diverting people’s attention; emergencies override, although somebody will have to deal with them. However, we are anxious that an emergency situation does not slide effortlessly into a kind of prescription for the duration that is not appropriate for the young person involved.

My next point is that there is nothing to stop treatment for a young person being administered in an adult ward when that is appropriate. There is no text to suggest otherwise in the clause as it appears. The measure is about giving treatment wherever it is most appropriate for the young person in question. There may be times, for example when there is a condition that requires expertise or a group or peer group. It might be sensible for treatment for a young person to be given in adult provision, but that should at least be run past a judgment and not assumed.

That brings us to the question of resources, which I am sure is a motivator of the Minister’s reticence, and rightly, because we should not pretend that resources are unlimited. I would be prepared to concede that, if there is a short-term lack of resources—a ward might have to close temporarily because of a building emergency or for refurbishment—it might be more difficult to meet the tests than otherwise. My abiding concern is that we do not allow short-term considerations to develop into a long-term prescription for the young person involved.

Angela Browning (Deputy Chairman (Organising and Campaigning), Conservative Party; Tiverton & Honiton, Conservative)

I think that the Minister indicated this morning that it is her intention to consider an inappropriate admission of a child to an adult ward as an untoward incident. It would follow that appropriate action would then be taken. In my experience, untoward incidents are very serious matters that usually involve some sort of inquiry—more often than not an external rather than an internal one. At the end of the inquiry, specific recommendations are made. It seems to me that if one were subject to a series of untoward incidents with resource implications at the end, one might as well start off with the resources, rather than be dragged to the same position by one inquiry after another.

Tim Boswell (Daventry, Conservative)

My hon. Friend is right. One should get things right from the start rather than have to make excuses if they go wrong or—dare I say it—produce the old canard that no treatment will be given because of concern that potential treatment might be inappropriate. That is not proper, nor is it professionally likely in the real world; people will do their best.

I am acknowledging to the Minister that there are practical constraints in any situation, including short-term constraints in particular. If I correctly remember this morning’s debate, I may say that it would be of assistance in relation to any defence under human rights legislation if Ministers could show that they were working towards improvements, rather than just folding their arms.

There might be a need for short-term derogations, which the Minister needs to think about and come back to us on, but I want to emphasise that there is no excuse for long-term systemic failure of the kind reported recently in relation to services. The hon. Member for Rhondda rightly said that we are a lot better off than we were 20 or 30 years ago, and I am glad about that; we shall not have a party political argument about it, as it is true. However, that does not absolve us from seeking a better basis for further progress, which is what the debate is really about.

If the Government are confident that they can deliver the improvements, that is all well and good. We have the Minister’s assurances. However, if they can indeed give delivery, why are they reluctant to underwrite that confidence by means of legislation?

Rosie Winterton (Minister of State (Health Services), Department of Health; Doncaster Central, Labour)

I welcome you back to the Chair, Lady Winterton. The debate has been a good one and the Committee has now agreed that the subject is important. We all want to make changes of the kind for which YoungMinds has been campaigning. However, I thought that the contributions from the Labour Benches were more constructive in that they acknowledged the need to be honest about some of the problems that might arise and to avoid legislating for changes that might have the opposite effects to those intended.

I felt that my offer to reconsider was slightly ignored by some Opposition Members. We are all determined to achieve proper accommodation for young people. YoungMinds has actually been very understanding, and it is as anxious as the Government are to ensure   that there is nothing that could be counter-productive. I am sure that no Committee members would actually want that, but it is important to realise that we are legislating on an important issue that affects very vulnerable people and that we need to do that properly.

Tim Loughton (Shadow Minister (Children), Health; East Worthing & Shoreham, Conservative)

I do not think that anyone would argue that the Minister does not agree with the principle, but we need a commitment that there will be delivery. It is true that she said that she would consider the matter. What will it take to make her change her mind so that there is express provision of the type that is being suggested? She has had some months to consider the matter. Does she need to consult more with counsel or other practitioners? Can she give us some indication of that? Otherwise, we cannot take on trust what she is saying that she would like to achieve in principle. In practice, we need to see more evidence of that.

Rosie Winterton (Minister of State (Health Services), Department of Health; Doncaster Central, Labour)

I am afraid that if the hon. Gentleman does not trust me, whatever I say will not change his mind.

Tim Boswell (Daventry, Conservative)

Would it not be possible, in this spirit of discovering mutual trust, for the Minister to let the clause lie, go away in good faith and consider what should be done later and, if necessary, excise the offending clause or substitute one of her own on Report? She does not need to remove it now to make her point.

Rosie Winterton (Minister of State (Health Services), Department of Health; Doncaster Central, Labour)

I cannot do that, I am afraid. I need to ask the Committee to vote against the clause. However, I shall take the proposals away. I need to consider the legal advice that YoungMinds supplied and to talk with service providers and professionals about some of the issues. I also need—my hon. Friends the Members for Rhondda and for Bridgend mentioned this point—to consult Welsh Ministers about the implications. As the hon. Member for Tiverton and Honiton said, some changes are taking place, not least in her constituency, and I hope that hon. Members will accept that it would be wrong to introduce legislation that could have the perverse incentive of making children not get the treatment that they needed.

I will take the proposed amendments away, and I undertake to hold a consultation. I am more than prepared to keep in touch with both Opposition Front-Bench spokesmen about the progress that we are making. I undertake to do that. I hope that, in that way, we can reach consensus on what is the right way to proceed.

Tim Loughton (Shadow Minister (Children), Health; East Worthing & Shoreham, Conservative)

That is helpful. However, the Minister must appreciate that, just as we need to see more beef, she is apparently unable to trust us not to vote to keep the clause. Is she specifically saying that she has not taken any legal opinion about the viability of the amendment that was added to the Bill in the House of Lords some months ago? The only thing that instigated her asking for legal advice is that an organisation called YoungMinds met her and gave her its own commissioned legal opinion. Surely, she must already have sought legal advice on the viability of the clause. If so, perhaps she can tell us what it was.

Rosie Winterton (Minister of State (Health Services), Department of Health; Doncaster Central, Labour)

Basically, the advice that I have been given on the clause is as I set it out this morning: there are some problems with it. The proposed terminology discussed this morning talked about the registered medical practitioner, when we are talking about the responsible clinician. There are lots of areas where the proposal is faulty, and there are some problems with it.

I suspect that the hon. Gentleman just wants to vote against what we are saying. I accept that, but all I can say is that I have undertaken to take the proposal away, keep in touch with the Opposition Front-Bench spokesmen and to have close contact with YoungMinds about a range of issues that it raised with me, not least the legal advice that it gave us. I hope that, with that reassurance, the Committee supports me in opposing clause 24.

Ann Winterton (Congleton, Conservative)

The Ayes are 7, the Noes 12.

Tim Loughton (Shadow Minister (Children), Health; East Worthing & Shoreham, Conservative)

On a point of order, Lady Winterton. I do not think that there were 12 noes. Could we have a recount, please?

Ann Winterton (Congleton, Conservative)

Will Dr. Gibson indicate whether he said aye or no?

Ian Gibson (Norwich North, Labour)

I said no.

Ann Winterton (Congleton, Conservative)

What I announced was correct. Actually, I think that the hon. Gentleman said “No way”!