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Mental Health Bill [Lords]

My hon. Friend is right. We know that we can achieve such changes when people put their minds to it. The issue is legislation. It has been made clear to me that because some of the issues involve compulsory detention, it is right for us to make an exception. I suspect that the cancer provisions are not in legislation, whereas we are using legislation that constitutes something of a step change—but, as my hon. Friend says, we know that such developments are possible. We have been working on this issue for some time. In April 2005 we began collecting detailed information about the use of adult psychiatric wards for children and adolescents in England to allow performance management of that aspect of the service. We are making capital available to the NHS to increase the availability of in-patient facilities for adolescents, and to reduce reliance on adult wards. In November last year the Under-Secretary of State for Health, my hon. Friend the Member for Bury, South (Mr. Lewis), who is responsible for care services, made a commitment that within two years no child under 16 in England would be placed in an adult ward while being treated for a mental disorder. To ensure that that commitment is fulfilled, the director general of commissioning in the Department of Health has written to the chief executives of strategic health authorities setting out new reporting requirements on the use of adult psychiatric wards by children aged 16 and under. Any exceptional case of a child of 16 or under being placed in an adult psychiatric ward must be reported to the strategic health authority as a serious untoward incident, and the SHA must in turn notify the Department. We would expect the child not to stay in the ward for more than 48 hours. The ward would be specially equipped to deal with the child, and staff dealing with the child would be appropriately qualified. I can reassure the House that the Government are working to develop performance measures for 2008-11 public service agreements and a health and social care outcomes framework. As part of that work we are considering a range of indicators, including a CAMHS indicator. Regulators have an ongoing responsibility to assess performance, which includes the commissioning of age-appropriate services. We need to ensure that they are being commissioned properly. To help that, the Care Services Improvement Partnership is developing a commissioning framework specifically for CAMHS. We will have continuing discussions with the Healthcare Commission to ensure that the monitoring of age-appropriate services is one of its priorities. We have also agreed to keep YoungMinds and the children’s commissioner informed of our progress on performance management. We have not specified a commencement date in the Bill, because we do not feel that that would be productive. We would probably have to err on the side of caution, and we think we can probably achieve some of the changes soon. I want that to happen; I do not want to specify a date that kicks the matter into the future and sends a mixed message to the NHS. However, I emphasise the Government’s clear and firm intention to invest resources so that we can implement the provision as soon as possible. Our aim is to implement it fully in England by around April 2010. Amendment No. 50 gives us the flexibility to allow, for example, new section 131A to be implemented in relation to part 2 and informal patients in England as soon as resources allow, rather than our having to wait until it can be implemented for part 2, informal and part 3 patients in England. I am sure that YoungMinds, the Children’s Commissioners for England and Wales and Members of this House and the other place will track progress on this issue. Amendment No. 4 was tabled by my hon. Friend the Member for Bridgend (Mrs. Moon), and I will listen carefully to what is said about it. Her amendment would increase safeguards for 16 and 17-year-olds by ensuring that their cases are referred to the tribunal by hospital managers after one year, where the patient has not used their right to apply or their case does not otherwise come before the tribunal. I said in Committee that I was sympathetic to the intentions behind the amendment but that I wanted to look further into some of its financial and operational implications. My officials recently came back to me on that. They reassured me that the impact would be operationally manageable for both hospitals and the mental health review tribunal, so at this stage I am supportive of my hon. Friend’s amendment. I look forward to hearing her speech, and any other contributions on her proposal. Amendment No. 83 would extend the provisions in clause 40—which was inserted by a Government amendment in the other place—to under-16s who are competent to consent to the making of arrangements for their informal admission to hospital for the treatment of mental disorder. That raises complex issues, and an amendment to the Bill is not the right way to address them. Most 16 and 17-year-olds will be able to understand, and make an informed decision about, being admitted to hospital except where they lack capacity, but that is not the case for under-16s. Each case needs careful consideration. The Government consider that the position of under-16s—both those who are Gillick-competent, and those who are not—can best be set out in guidance in the code of practice. Guidance can go into this difficult area in much greater detail and can be updated more easily in line with developments in case law. Therefore, I ask the hon. Member for Romsey (Sandra Gidley) to withdraw the amendment. I hope that the Government amendments will be welcomed by all Members. They are the result of fruitful and constructive discussions by various organisations—and also by Members of the other place, which I greatly appreciate. I will listen carefully to the arguments—which I am sure will be very persuasive—of my hon. Friend the Member for Bridgend, but I do not at this stage accept the amendment of the hon. Member for Romsey.