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Criminal Justice and Immigration Bill

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 it will approve who delivers treatment. This is right because it is the authorised national body. The current wording of the requirement emphasises that the treatment worker must have necessary qualifications or experience to direct treatment. It has been agreed by the National Treatment Agency and the Department of Health and offers sufficient safeguards to ensure that treatment is directed by someone who is suitable for the role. Importantly, it allows for the sort of flexibility that is vital in order to ensure that a young person receives the sort of treatment that is tailored to their individual needs and circumstances. This wording is consistent with the drug treatment requirement in the Bill—paragraph 22(1) of Schedule 1—and the adult drug rehabilitation requirement in the Criminal Justice Act 2003. 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 refuse to engage with this informal referral, the YOT may seek a court-ordered attendance for treatment, which, under the YRO, would be the intoxicating substance treatment requirement. In our case, Michael, before he was sentenced, may have refused point black to do any of that; that would be the sort of case in which, under the YRO that is given to him as his sentence, there would be an attendance for treatment order. 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.