HC Deb 11 November 1992 vol 213 cc966-74

Motion made, and Question proposed, That this House do now adjourn.—[Mr. MacKay.]

10.13 pm
Mr. Graham Allen (Nottingham, North)

This issue is serious and difficult to talk about. It is certainly difficult for Parliament to discuss and for the children who are the victims of sexual abuse. I raise this matter with some sadness because I had an Adjournment debate on a similar issue three years ago. One of my main questions this evening is, what progress has been made on that sensitive and important matter since I first raised it in the House? It is clear that we need to do far more to help the victims of the sexual abuse of children—the children themselves—and to develop preventive measures to reduce the incidence of that horrendous crime. We must stop it before it can occur.

The problem that I highlighted in the Chamber some three years ago has not gone away. Indeed, the fact that we find it a little easier to talk about it these days means that the full extent of the phenomenon is only just becoming known. I want the Minister to lay before the House tonight the progress that has been made in the past three years and, more importantly, the Government's plans to extend the victims' ability to be assisted and society's ability to ensure that the perpetration of those crimes cannot take place.

It is customary in Adjournment debates for the time to be split between the person who raises the debate and the Minister who replies. Having spoken to the Minister, I hope to do it slightly differently this time. I spoke at great length on the subject in 1989 and I am happy to send a copy of my speech in Hansard to any hon. Members who wants further elaboration of the case. With the Minister's permission, I want to allow him a little more time to outline the Government's progress and future plans on the matter.

I say that with all due respect to the individuals and organisations that have briefed me in the past few days since I was fortunate enough to draw the Adjournment debate. Those organisations included the National Children's Home; the National Society for the Prevention of Cruelty to Children; Nottinghamshire county council's social services department, which has been doing an excellent job in individual cases recently; the child abuse studies unit at the university of North London; and many others. They are all deeply concerned about the debate but want to hear what the Government have to say rather than another exposition of the case from me.

I wish to make three brief points for the Minister to consider, not only tonight but also in more measured time outside the Chamber. First, there is only one private clinic for the treatment of sex offenders. It is important that, where those people are seen to need treatment, treatment should be made available for them. I have proposed in the past that there should be not just one private clinic to try to break into the problem but a clinic in each region of the United Kingdom. There should be a centre so that we do not have to reinvent the wheel whenever a horrendous case comes to the public's attention. There would then be a body of knowledge so that victims could be assisted wherever they were found.

Secondly, we need a national centre so that all the research done by the police, the social services, voluntary bodies and academics can be brought together centrally. With that knowledge pooled, the best practices can be better distributed around those who need to know the information.

Thirdly, I want the Minister to consider a question which I have pursued since 1989 and which I shall pursue again this evening—the total funding for research into how victims of child sexual abuse can be helped even more than they are now. I appreciate that there are tremendous difficulties currently and I am sure that the Minister has been battling valiantly to save existing programmes, let alone extend them. However, for an investment of £1 million, £2 million or £3 million—peanuts in public expenditure terms—the sum total of human misery can be dramatically reduced by ensuring that victims of child sexual offences are properly assisted to rebuild their shattered lives. With that remark, I shall leave the remaining minutes to the Minister, who has kindly consented to take occasional interventions.

10.19 pm
The Parliamentary Under-Secretary of State for Health (Mr. Tim Yeo)

I congratulate the hon. Member for Nottingham, North (Mr. Allen) on securing this debate on an important subject. I know that his interest in the subject goes back over a number of years, and I read the report of his earlier Adjournment debate on the issue in 1989.

We are in complete agreement in the House on the seriousness of the issue and the fact that it needs to be considered by the House from time to time. Therefore, I am glad of the opportunity to update the hon. Gentleman on the progress that we have made in the past three years. The subject is highly sensitive, and one that, for too long, society has regarded as taboo. That fact has inhibited discussion on the subject, and the fact that there is now a greater openness in our thinking and discussion of it is itself a prerequisite, and helpful in achieving the sort of solutions that we both want. It is appropriate to take this opportunity to clarify the current position on the treatment for sexual offenders and their victims, who are all too often children. The subject obviously affects Government Departments other than my own, but I am glad to have the chance to respond to the hon. Gentleman.

In the case of convicted sex offenders, the provision of clinics or treatment centres based within the community to deal with their offending behaviour is essentially a matter for local provision. I heard with interest the hon. Gentleman's suggestion that there should be more regional centres. It is important to recognise that, before a perpetrator of sexual offences is referred or directed to such centres, he would, of course, have been tried in the courts and a decision taken as to whether he is suitable for a sentence other than that of imprisonment. The paramount interest has to be one of public protection. In the great majority of more serious cases, the court decides that it is right for sex offenders to go to prison. Some of those men may come later into treatment as a condition of parole after serving their prison sentence.

For the small number of men who are convicted of sexual offences but do not go to prison—currently fewer than 1,500 a year—we believe that, in carefully controlled circumstances, community treatment can have an important and effective role in reducing their sexual offending behaviour. The probation service has played a major part in that development in collaboration with local authorities, the national health service and the independent sector.

A recent Home Office study found that nearly all of the 55 probation areas in England and Wales has in place community-based treatment programmes for sex offenders, and those that did not have such programmes were planning them. The majority of those programmes are not residentially based but require the offender, as part of his probation order, regularly to attend a session at which, probably in a group with other sex offenders, he is confronted with his offending behaviour, and his distorted thinking about it, and its consequences for his victims. The work, which is sometimes called "victim empathy", means that, although the probation service cannot claim to "cure" sexual offending, it can aim to contain it so that sex offenders are helped to a position where they are sufficiently aware of their cycle of offending behaviour and sufficiently in control of it not to commit further offences.

In some cases, where it is not possible or appropriate for sex offenders to continue living in the home, they can as part of probation orders be housed in a probation hostel. Whilst treatment does not normally take place in those hostels, they provide a supportive but a challenging background to it; hostel staff have a part to play in encouraging offenders to continue the process of confronting their offence, begun by their colleagues in treatment.

In other cases, the probation service may have taken a decision that it would be an appropriate use of resources to place sex offenders on probation orders, and also on parole licence—for example, in the Gracewell institute. That institute combines treatment and residence, and provides more long-term supervision than can be achieved without an accommodation requirement. The decision on whether to use the institute is at the discretion of individual probation areas and will become increasingly dependent on both the resources that they have and on the sort of in-house provision that they can provide. Increasingly, that in-house provision will draw heavily on the practice developed at the Gracewell institute.

The individual needs of sex offenders do, of course, vary. So do the health and social service responses, which include a range of behaviourial and psycho-therapeutic techniques, as well as medication. There is a good deal of professional debate about the management of sex offenders, whether all or only some are amenable to treatment, and the presence or otherwise of links between sexual offending and any mental disorder.

As a result, sex offenders are assessed by psychiatrists and psychologists and other professionals in a variety of settings. Some may then attend specialised services or be seen at out-patient or day clinics; others may not be suitable for health care intervention. Some with mental health care needs may be in hospital or other mental health provision. They will include some people detained under the Mental Health Act 1983 who meet the criteria of that legislation relating to mental disorder. The Act makes it clear that a person may not be dealt with under its provisions by reason only of promiscuity or other immoral conduct or sexual deviancy.

The Department of Health and the Home Office review of services for mentally disabled offenders, known as the Reed review, whose final report we shall be publishing shortly, produced a discussion paper on sex offenders with mental health needs. That was issued for consultation in June and focused on the introduction by the prison service of structured programmes for sex offenders, the implications of the Criminal Justice Act 1991 for health and social services, and proposals for further research. We shall be looking at the recommendations made in that paper as part of our consideration of the review.

The Criminal Justice Act is likely to increase calls on health and social services in two areas—at the point of sentence, and in support of treatment programmes. Such involvement is necessary to ensure that offenders receive a proper multidisciplinary assessment and, leading on from that, possible access to services. Health and social services will be involved in validating and monitoring programme content and in professional supervision.

At present only a small number of clinics are known to be providing specialised care for sex offenders as a specific client group. These do so mainly as part of services for a broader range of clients. Apart from the Gracewell clinic in Birmingham, probably the best known is the Portman clinic in London, which receives Government support through top-sliced funding. The allocation this year for the Portman and the adjacent Tavistock clinic is £4.5 million.

Some of the specialised mental health services that provide in part for sex offenders with a mental disorder are also supported through central capital or revenue funding. These include regional secure units, for which capital funding this year has been increased to £18 million, from £3 million last year. They also include the special hospitals, which provide psychiatric services in conditions of high security. The future of these services is being examined by a working group announced by my right hon. Friend the Secretary of State for Health in the light of the Reed review and the report by Sir Louis Blom-Cooper on Ashworth hospital.

The Gracewell clinic, which is currently being evaluated, is the first residential clinic of its kind and receives a number of its referrals from health and local authorities. It provides full-time treatment programmes for sex offenders who need intensive therapy to gain control of their behaviour. It can also provide assessments of adult and young offenders, as well as risk assessment reports. Training and research are important elements. The Home Office is currently helping to fund the evaluation project, which is based on the Gracewell clinic and on several probation areas. This will be helpful in determining future service development.

I now turn to the question of child victims of sexual abuse. The Department of Health launched a centrally funded child abuse treatment initiative in 1990–91. The first stage of the initiative was the National Children's Home survey of existing treatment facilities for abused children and young perpetrators. The Department of Health is currently making grants to support a number of projects by voluntary organisations providing different types and ranges of treatment. These include a residential therapeutic centre for children, family service units working with families facing severe difficulties and children who have been abused, a child and family therapy project addressing the problems of child sexual abuse, a treatment facility for adolescent sex offenders.

Two studies, one of sexually abused children and adolescents, the other of young sex offenders, which will be evaluated to establish the characteristics of the treatments which are associated with more and less successful outcomes, are also under way. Various projects undertaken by the National Children's Home include a telephone and face-to-face counselling service, a child protection system and a pilot study of projects working with young offenders. There is additionally a research project by the Institute of Child Health to evaluate the effectiveness of the various models of treatment for sexually abused children and young sex offenders.

In 1991–92, £300,000 was made available for projects undertaken under the treatment initiative. This has increased to more than £400,000 this year. The total made available over the five-year period since the inception of the initiative will be £1.8 million. Many of the more severely abused children will require treatment by the NHS. Every child suspected of having been sexually abused will need to be assessed under the child protection procedures set out in the Government's guidance "Working Together". Not all these cases will be proven. Of those who are, all will need protection, but not all will show emotional disturbance significant enough to require additional specialist therapeutic intervention.

I should like to focus briefly on another aspect of our work in relation to child sexual abuse—the importance that we attach to up-to-date, properly targeted and thoroughly evaluated training. In this respect, we have achieved a great deal through our centrally funded child abuse training initiative. This is now a well-established scheme to stimulate training of staff from different agencies in child protection, through support for selected projects and courses. Since the initiative was announced in 1986, we have given nearly £3 million in grants to a diverse range of voluntary organisations and institutions for different training materials and events.

We began the first phase of the initiative with two projects. One, which we have now supported for several years, took the form of a course designed for experienced professionals from a range of disciplines, working at the sharp end with child sexual abuse. It aims to give trainers additional skills both in training and in promoting assessment and treatment services provision for abused children and their families. The course has been administered at the department of psychological medicine based at the Institute of Child Health, Great Ormond Street hospital.

The second of the earliest projects was a training advisory resource based at the National Children's Bureau. We are now supporting the successor to that resource, in the shape of the child abuse training unit, also based at the bureau. As well as producing its own material, it offers an evaluation and consultancy service on training related to child abuse including child sexual abuse.

Since those early longer-term resources were established, the child abuse training initiative has enabled us to support an increasing number of specific projects with different voluntary organisations. One major partner has been the National Society for the Prevention of Cruelty to Children, with a grant of £800,000 over three years, ending last year, towards the national training centre in Leicester. Other projects have been designed to stimulate multidisciplinary work, such as work by the English Nursing Board, to determine an effective model of teaching and learning in child protection among social services and health professionals.

In the crucial area of investigation of sexual abuse, we are funding the Open university to produce a training pack on interviewing in cases of suspected sexual assault on a child.

Mr. Allen

I am sure that the Minister will want to join me in paying tribute to members of staff of voluntary organisations and social service departments who have to deal with these offences. Those of us who have had to deal with them on a constituency basis have found them stomach-churning, and those who have to deal with them from start to finish, certainly in Nottinghamshire, are often in need of therapy to help them to come to terms with some of the horrific details. I am sure that the Minister will agree that these people are nothing less than heroic.

Mr. Yeo

I am happy to join the hon. Gentleman in paying tribute to those professionals working for the voluntary organisations and the local authorities. Their work is among the most distressing that I have ever encountered, dealing with situations which are horrific to those of us who have what I would call normal instincts. Some difficult and sensitive judgements often have to be made about whether a family is capable of being rebuilt, whether relationships can be retrieved, or whether more direct intervention is needed.

The Open university work will build on and amplify the memorandum of good practice issued by my Department and the Home Office last August. The memorandum was drawn up in consultation with a number of voluntary organisations in the light of the implementation of the important child evidence provisions of the Criminal Justice Act 1991. I shall be launching the Open university training material early next year.

Only last week, I was glad to welcome the training manual produced by the voluntary organisation Kidscape, which provides material for people directly caring in some way for children, many of whom may not think of themselves as having a child protection role at all. With the benefit of this material, first-line carers such as health visitors, child minders, foster parents, day care workers, school nurses and nursery nurses may be able to help children to protect themselves, and the carers themselves will have a greater confidence about the work that they undertake with children who have suffered sexual abuse.

The hon. Gentleman will be familiar with a recent case in Nottingham, which he did not mention but which has been in all our minds recently. It was a case of alleged sexual abuse in which the local authority wanted the person concerned to leave the family home. It was not a criminal case, but it was the subject of an application to the High Court, so I do not want to make any detailed comment about it, but the example is instructive in a number of ways.

It is for the local statutory and voluntary organisations to assess the need and provision of treatment services for child sexual abusers, in co-operation with one another.

In the Nottingham case, local arrangements were eventually made to fund the person concerned at the Gracewell clinic. The Department looks for opportunities to promote best practice in suspected cases of sexual abuse of children and it is due to host a continuation of the series of annual national conferences of the chairmen of area child protection committees. Those should provide a chance to raise the issue of the treatment of suspected sexual abusers and make the subject a high priority on the agenda of those committees for future action.

Mr. Allen

I hope that the Minister will take a personal interest in the way that that side of the problem develops. The question of best practice is fundamental to achieving a solution where a solution is humanly possible. The best practice was not being deployed in the case to which the Minister referred, through no malice on the part of any of the parties involved.

It is instructive that the Nottinghamshire social services department, one of the best in the country, sadly with all too much experience in dealing with such cases, did not immediately make the connection that the district health authority could, in certain circumstances, step in and pay the £15,000 cost for a year's treatment for this particular individual at Gracewell. That in itself tells us something. Even where there is awareness of the problem, best practice connections are not always made.

The Minister, from his privileged vantage point at national level, could do much to ensure that local authorities, voluntary organisations and district health authorities pull together to make sure that such a situation does not occur again.

Mr. Yeo

The hon. Gentleman is quite right. There is a variety of sources from which funds may be available to pay for treatment at a place such as the Gracewell institute, and the health service route will certainly be the appropriate method of referral and financial support for some patients.

If we are to promote good practice around the country, it is clearly crucial to establish the closest possible relationships and the best possible collaboration between the social services and health authorities, in this context and, indeed, in others. We are keen to promote that spirit of co-operation so that alternatives are considered for each case. I hope that, in that way, we can arrive at the right solution for every offender or potential offender.

Our research initiative on child protection should be ready to publish some of its findings next year, and the subject of sexual abuse continues to be a priority on our agenda. Back in 1988, we identified five key issues—whether to remove the people concerned from the home; the co-ordination of services; parental experience of investigation; control within the family; and routine treatment and outcome. New research projects have been funded as other issues concerned with the subject have been identified.

So far, the research initiative has consisted of 13 projects, centring around three areas: patterns of abuse, the operation of a child protection system, and questions addressing intervention and outcome, especially routine intervention. In addition to spending on projects covering both physical and sexual abuse of children, the amount allocated for research into child sexual abuse has increased considerably over the equivalent sum three years ago. In the Department of Health, it is about four times greater than it was in 1989; and across my Department, the Home Office and the Scottish Office social work services group, this type of expenditure has more than tripled over the same period.

The effective dissemination of research is also vital to ensure that findings are effective in practice, and that they influence the delivery of services. In 1985, my Department produced a document, "Social Work Decisions in Child Care", which provided a digest of research findings of the time. Last year it was followed by an equally successful publication, "Looking After Children: Assessing Outcomes in Child Care", produced by an independent working party. A dissemination programme, now in the discussion stage, is planned for next year with the intention of publishing the findings of the studies in their own right. That will allow the material to be more accessible to practitioners, trainers, managers and students.

Dissemination of information about child abuse is vital. I welcome the recent issue of a "Strategic Statement on Working with Abusers" from the interdepartmental group on child abuse. The group comprises representatives from several Departments, and provides a forum in which relevant child protection issues can be considered. The group noted that, although the major focus of work in the field of child abuse had been concentrated on the investigation and management of abuse, there was a growing interest in the treatment of the abused child and the abuser.

To forestall piecemeal development in that regard, the group has established a sub-group on working with offenders, with the dual remit of pooling information about the range and nature of available treatment facilities and developing a strategic approach to the subject to include both research and development work. The strategic statement on working with abusers—

The motion having been made after Ten o'clock and the debate having continued for half an hour, MR. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at seventeen minutes to Eleven o'clock.