HL Deb 27 March 1998 vol 587 cc1455-68

11.8 a.m.

Lord Rowallan

My Lords, I beg to move that the House do now resolve itself into Committee on this Bill.

Moved, That the House do now resolve itself into Committee.—(Lord Rowallan.)

On Question, Motion agreed to.

House in Committee accordingly.


Clause 1 [Strategies for the provision of in patient facilities in psychiatric units]:

Lord Rowallan moved Amendment No. 1: Page I, line 8, at end insert ("and other 24—hour nursed hed—).

The noble Lord said: This amendment came about as a result of the Second Reading of this Bill and provides for 24—hour nursed beds to be available in each health authority. Both Sane and the National Schizophrenia Fellowship support this amendment. I am pleased to say that the Mental After Care Association also supports it. Mind, which has not liked Clause 1 of this Bill up to now, accepts it is a good idea for area authorities to have an appropriate strategy both in the context of in—patients, who are well catered for in this Bill, and those needing care in the community.

This Bill does not deal with out—patient care at all. But I give Mind and all the other charities concerned a firm commitment that in the absence of a new mental health Act being revealed shortly, I shall tackle the issue of out—patients and care in the community soon. To this end I look forward to the proposed Green Paper on mental health reform which is due at the beginning of April but which I gather has now been delayed. I ask the noble Baroness, Lady Ramsay of Cartvale, to inform this Chamber when she now expects it to be published.

It has to be significant that all the psychiatrists I have spoken to—after all, they are in the front line of mental healthcare—support this clause and its amendment. We should remember that there is a one in 10 chance of someone contracting the dreadful illness of schizophrenia. It does not respect wealth, colour, creed or geography as the statistics are the same the world over. Schizophrenics who either do not respond to, or comply with, medication pose particular problems to mental health services. For these people 24—hour care and nursing support within a safe, therapeutic environment is a necessary and important stage of this care.

This amendment has become even more important as a result of the recent Bournewood ruling in the courts stipulating that any patient unable to give informed consent must be detained on a section of the Mental Health Act. This of course dramatically increases the number of patients because it now takes into account all those with Alzheimer's, learning difficulties, etc., who need 24—hour care as they will be detained by law. I beg to move.

Lord Thurlow

I support this amendment. If the Bill were to become law it is manifestly important that it should cover the whole range of beds, including those in 24—hour nursed units. In that connection, it would be helpful if the Minister could give us an indication of what progress has been made with the creation of 24—hour nursed units for which we had high hopes two years ago when the previous government introduced the measure. However, we realised that there were difficult problems with regard to resources.

The noble Baroness in her forceful statement on Second Reading—I regret I was unable to be present—made it clear that it was not strictly necessary to introduce primary legislation at this stage to achieve the specific object of the Bill, and that under existing law the authorities are under an obligation to make strategic reviews and plans. Equally, there are obvious disadvantages in tackling this particular area piecemeal when we hope and believe that the Government are on the point of addressing the wide range of urgent and necessary issues. I accept that we cannot expect this Bill to reach the statute book, but that does not make the debate any less useful. It is a long time since we had a general debate of any kind on this urgent social question on which Parliament and the public have been for so long, and are still, exercised.

We look forward to the report to the Minister of the independent reference group and the Government's Statement. There has been considerable confusion arising from conflicting reports of the Government's immediate intention to close the big hospitals. We need clarification. It is not the fault of the present Government that they are landed with an immensely difficult, almost insoluble, problem of the discrepancy between resource and requirements. Nonetheless that makes it necessary to get on with the most urgent issues. I submit that all sides of the House have indicated that the issue of the closure of beds is perhaps the most urgent.

Lord Alderdice

The Bill results from the dismay felt by the noble Lord, Lord Rowallan, when it became apparent to him that there was great difficulty in acute in patient psychiatric facilities. It has occurred over a period of time as we have attempted to move from the widespread treatment of patients in acute in patient beds to care in the community. That in itself is a laudable and welcome development.

However, the resources left behind in the acute hospitals, and the concentration of disturbed people there, have led to considerable difficulties in the management of acute in patient beds. The concern of the noble Lord is shared widely by those who work with people in acute in patient facilities in psychiatric hospitals throughout the country as they become increasingly worried that the experience of in patient care is much less therapeutic and more custodial—something we hoped we had left behind a long time ago.

However, there are other reasons why acute in patient beds have become blocked. This became apparent as we looked into the matter. It is particularly apparent in the review paper published in the British Medical Journal some time ago by Shepherd and his colleagues. It is pointed out that one of the reasons why many people stayed in acute facilities is not that other facilities in the community were not readily available but because other residential facilities, properly manned by specialised care workers, were not available. That is why the Royal College of Psychiatrists has begun increasingly to talk about 24-hour nursed bed units in the community. Those are not a half-way house between acute psychiatric care and community care but facilities which provide the necessary expertise and containment appropriate for people in that setting.

That is why, in the light of further exploration and concerns expressed that the Bill would point people back into acute psychiatric facilities rather than out into the community, the noble Lord, Lord Rowallan, has brought forward the amendment. I heartily support it. I believe that it has increased overall support for the Bill. I beg noble Lords heartily to support the amendment.

11.15 a.m.

Earl Howe

I, too, support the amendment. My noble friend and the noble Lord, Lord Alderdice, have set out the arguments for it most ably. I wish only to reinforce and develop one or two key points.

The main criticism of Clause 1—it was rehearsed by some noble Lords at Second Reading—is that by focusing on the requirement to provide in patient facilities it unhelpfully skews the emphasis of patient care away from community provision and towards in patient beds. In other words, by singling out one aspect of the continuum of care for mental patients one is somehow damaging the balance of care available to such patients and distorting the overall allocation of resources.

There are two answers to that point. First, one of the main reasons that my noble friend felt moved to introduce this Bill is that there is a clear need to right what is already an imbalance in the system. As the noble Lord, Lord Alderdice, emphasised with tremendous authority at Second Reading and again today, many people in need of in patient care are not receiving it. Often they are not receiving it because available resources are being over concentrated on community provision. No one is arguing, least of all my noble friend, I am sure, against the principle of community care. Community care—thank goodness—is here to stay and we must do all we can to foster and support it to ensure that it works well. But if we believe, as I do, that community care is not the whole answer and that there are those who need looking after either short or long term in surroundings where professional help is continuously to hand, we need to focus more on how current shortcomings in that area can be addressed.

The second rebuttal to the criticism of Clause 1 is surely this. The clause speaks of the requirement for health authorities to prepare a strategy for in patient care. I do not believe that that formulation allows one to argue that health authorities are thereby being discouraged from preparing strategies for other services. On the contrary, the provision of a strategy for in patient beds should relate directly to a local needs assessment and be part of the much wider planning process which predicts and meets demand for mental health services and for support services generally, including housing and primary care.

The amendment seeks to insert a specific mention of 24 hour nursed beds into the definition of the facilities for which health authorities have a duty to plan. The need for 24 hour nursed beds relates particularly to those people with schizophrenia and other severe mental illness who either do not respond to, or perhaps more frequently do not comply with, their prescribed medication. Those patients represent a serious problem to the health service. For them quick access to a safe and secure environment in a hospital bed, or its equivalent—so long as it has 24 hour nursing support—is a vital part of treatment. The amendment strengthens Clause I, and I support it.

Lord Lyell

I wonder whether the Minister or any noble Lords who have spoken could give me some assistance over the definition of a 24 hour nursed bed, compared to in patient facilities. Otherwise, perhaps they could tell me where I might look for information. I have had only one brief experience of the subject; many years ago, with my noble friend Lord Trefgarne, I visited the state hospital at Carstairs, with which the noble Baroness may be familiar. Perhaps the noble Baroness or my noble friend, or perhaps even the noble Lord, Lord Alderdice, could point me in the direction of a precise definition and set out what are the aspects of a nursed bed. I am learning a great deal from this debate and from all the work that my noble friend has done on this Bill. I should be grateful if the Minister could assist me, either during the debate today or in the future.

Baroness Ramsay of Cartvale

During the debate at Second Reading, I spoke in some detail about why the Government are unable to support this Bill. I shall not rehearse all those arguments again. Suffice it to say that the Government do not favour piecemeal changes to a complex piece of legislation such as the Mental Health Act. Significant changes to the legislative framework should, in our view, be taken as part of a full review of the Act. I can confirm that we are considering the need for such a review, and will take into account the views of all interested parties.

The noble Lord, Lord Rowallan, asked me whether a Green Paper would be published. My honourable friend Mr. Paul Boateng is taking a long, hard look at mental health and all related services. Nothing has been agreed yet, and discussion of the plans is therefore premature. At the appropriate time plans for mental health services will be looked at in the light of the comprehensive spending review, and we will set out our plans to build a new basis of confidence in our mental health services, making sure that we secure the welfare of those with a mental illness while safeguarding the public.

At that point, it will also be important to share our ideas with experts and professionals, as well as users, and to hear the range of views. We are committed to ensuring that the right structures, the right staffing, the right care systems, and the right legislation are in place. We are firmly committed to building those elements of effective mental healthcare and to building public confidence.

With the addition of the proposed amendment, Clause 1 of the Bill would now refer to two elements of services where the noble Lord, Lord Rowallan, would like to see specific action: separate in patient facilities and 24 hour nursed beds. In response to the noble Lord, Lord Lyell, I shall attempt, perhaps inadequately, to give a definition based on my understanding of 24 hour nursed beds. These beds are not necessarily in hospitals—they could be in special homes or hostels—but they are covered by 24 hour nursing care. I see the experts nodding, so I think I have the definition right.

The noble Lord, Lord Thurlow, asked me specifically in his very interesting and well—received intervention what progress has been made in introducing 24—hour nursed beds. I am happy to say that some progress has been made. That has been assisted through targeted funding under the Mental Health Challenge Fund, which increased the number of such beds by 200. A further review of provision has recently been undertaken and we shall publish the results in due course.

To return to the amendment, separate in patient facilities and 24 hour nursed beds are just two elements of a range of local services which we expect to see in health services strategic plans and available to vulnerable mentally ill people. The Government already support the concept of 24 hour nursed beds. Other elements include: acute hospital beds; hostels and supported housing; occupational rehabilitation; secure provision; crisis care intervention; day care; and a full range of effective treatments.

It is vital that health authorities should retain the flexibility to commission and develop services within government priorities and guidelines but according to local need. The original clause, and the proposed amendment, would severely restrict their capacity to do so. The Government therefore do not consider that there would be any merit in enshrining these provisions in legislation. Therefore we cannot support the amendment.

Lord Renton

I regret that the Government do not support the Bill. I was interested to hear that the Secretary of State is to consider the previous legislation on this matter. I wish to draw attention to the fact that both mental illness and mental handicap are covered by the present legislation. I hope that the Government will bear in mind that, whereas mental illness is often curable, mental handicap is quite incurable. People who suffer from mental handicap should be kept quite separately, in different types of hospital or other places, from those who are mentally ill. Will the Government bear that clear distinction in mind?

Baroness Ramsay of Cartvale

I note very carefully what the noble Lord has said. It will be on record and I am sure the Government will take it into account.

Lord Mottistone

In supporting this Bill, perhaps I may leave with the Minister the thought that the Bill's purpose is to ensure that there is accommodation for people who need it, and that they are not left out in the community when they should not be there. There are far too many instances where accommodation is not available for them. The noble Lord, Lord Alderdice, made these points specifically. I hope that the Government will pay particular attention to the noble Lord's contribution to the debate and to the remarks of other noble Lords.

It is all very well taking a long time to sort out what needs to be done about possible amendment to the Mental Health Act 1983—which would probably be a very good thing—but if in the meantime we have disasters because people are inadequately cared for in the community, and they do some harm either to themselves or others, then the Government are failing. Perhaps the Minister will encourage her honourable friend Mr. Boateng to get on with it and do something positive quickly. Then, Bills like this will not be required.

Lord Swinfen

Before the Minister replies, perhaps I may support the point made by my noble friend Lord Mottistone, but emphasise that such accommodation should be supervised. Very often, patients who are mentally ill can leave hospital and live in the community; but where they are on medication, if that medication is not supervised and they do not take it, their condition deteriorates. They can become dangerous to themselves or to other people. They might then need to go back into hospital, at considerably greater expense.

Baroness Ramsay of Cartvale

I very much appreciate the concerns raised by both previous speakers. I also appreciate that behind the Bill, the amendments and the statements by the noble Lords, Lord Rowallan and Lord Alderdice, there are excellent intentions. I would say to the noble Lord, Lord Mottistone, that, because we are taking care of what is, after all, a most important and wide ranging piece of legislation and examining it very carefully, that does not mean that the Government, over the 10 or 11 months that they have been in office, have not been doing everything that they can to rectify the problems raised. I hope I made clear that, while we object to the Bill on some points of principle, our main objection is to having piecemeal legislation such as this.

11.30 a.m.

Lord Lucas of Chilworth

The noble Baroness's appreciation will come as somewhat thin beer to those of us who want something to be done now. While appreciating what the Minister said in her opening remarks in response to my noble friend Lord Rowallan, the problem is that, as she said, her right honourable friend and the Government want to take a long, hard look at this matter, it being only part of a much wider problem, and that in due course it might be felt necessary to have a full review. We are therefore a couple of years away from doing anything. No doubt after two years a Green or White Paper will appear and after another year or 18 months legislation may eventually appear before Parliament. That means that it will be five or six years before anything is done.

As all noble Lords who took part in the debate at Second Reading and this morning have said, this matter is urgent. Can the Minister tell us now what action she foresees to alleviate the situation underlined by this Bill?

Baroness Ramsay of Cartvale

I do not have the crystal ball which the noble Lord, Lord Lucas, has which tells him that it will be five or six years before anything is done and I shall not make any predictions. We are looking at the situation and are very alive to all the issues. There are already positive moves on many points raised by noble Lords today and at Second Reading. I am afraid that the noble Lord, Lord Lucas, will have to wait and see until the Government report on their careful considerations and consultations on this wide-ranging and important subject.

Lord Campbell of Alloway

Having listened to this fascinating and rather worrying discussion, perhaps I may ask the noble Baroness whether the Government are looking at the reform of certain existing statutes—and, if so, which—as part of the work they are doing or whether they are looking at the matter with a view to introducing an entirely new legislative structure. It would be interesting, and a source of comfort to many concerned, to know exactly what the Government are doing. I am not criticising from the point of view that the work will take a long time; the problem is serious and difficult. However, it would be interesting to know whether the Government are looking at the amendment of existing statutes or at an overall new approach in a new statute.

Baroness Ramsay of Cartvale

I made clear—though obviously not clear enough—in my opening remarks on this amendment that one of the reasons why the Government do not favour the Bill is that we do not favour piecemeal changes to a complex piece of legislation such as the Mental Health Act. In our view, significant changes should be made as part of a review of the whole Act. I confirmed to the Committee that we are considering the need for a review of the Act and in doing so will take account of the views of all interested parties.

Lord Rowallan

I am delighted to hear the noble Baroness indicate that the Government are giving this matter very serious thought. After all, It is an extremely serious matter. There are an enormous number of mentally ill and mentally handicapped people, as my noble friend indicated, in the world today. However, we cannot wait, as was suggested at Second Reading, until 2004 or 2010. Something needs to be done much sooner.

I am delighted that the Minister's right honourable friend is looking at the matter seriously and carefully, but legislation is required now. Mental health has always been the Cinderella service, historically under resourced and neglected. Many patients remain in anti-therapeutic and wholly unacceptable environments. The law compels many patients to reside in such places and therefore the law should offer protection for those to whom its sanctions apply. Primary legislation is necessary now; we cannot wait for a new Act.

As I am sure the noble Lord, Lord Alderdice, agrees, morale in the profession is rock-bottom. Recruitment is falling. Professionals elect to take early retirement, in part because they cannot bear the working conditions. Section rates are increasing year on year, partly because patients fear hospital admission and because of the disturbed anti-therapeutic environment which exists. Because of the Bournewood ruling, more and more people are liable to be put into necessary 24-hour care.

We cannot wait any longer. It is for that reason that I have introduced the Bill in the hope that, although it does not embrace the whole problem, we can sort out a small part of it. In-patient care is only about 10 per cent. of the problem, 90 per cent. relating to care in the community and out patient care. If we can sort out this small part of the problem first, we shall at least be doing something to help those who are afflicted by this terrible illness and for whom, unless we do something, there is not much hope.

On Question, amendment agreed to.

Clause 1, as amended, agreed to.

Clause 2 [Privacy and physical security for in-patients]:

Lord Rowallan moved Amendment No. 2: Page 1, line 25. after ("units") insert— ("() the provision of in-patient facilities for young people, separate from those for adults;"). The noble Lord said: Again, as a result of Second Reading, it became obvious that not only women but also the young were in danger and required single-sex ward areas. The young often find themselves in the very unsavoury position of being next to an adult who poses a danger to them. It can be a very frightening world for the young in a mental ward. I have seen it and it is not something I would wish on anyone. All the main mental health charities support this clause and the amendment.

Keeping the young in a safe, therapeutic ward area can only help them if they are in an area separate from adults. It is our duty to ensure that young people suffering from mental illness have every opportunity to recover from their illness. The amendment seeks to do that by giving them the same chance to enjoy a therapeutic environment as adult women and men in which to receive the care and attention which they so desperately need in order to recover. I beg to move.

Lord Alderdice

I first became aware of the difficulties faced by young people as in-patients in psychiatric units when in Northern Ireland in the early 1980s no psychiatrists were specifically allocated to deal with the problems of adolescents. It was not hard to see why that was the case. The key thing about being a young person is that it is time-limited. After a few years one grows out of being a young person and becomes an adult, who may be just as disturbed or even more so but for whom responsibility moves to different authorities.

I may say—I take some encouragement from this—that when we were enabled to debate the matter in the Northern Ireland Assembly, which had no legislative powers but simply gave us the opportunity to debate matters, within a short time there were changes because it became a matter of public concern and an adolescents' psychiatry unit was established.

A number of developments have created further anxiety in this regard. First, as I mentioned, as more people are being cared for in the community, the concentration of increasingly disturbed people within psychiatric units has increased and made them more difficult places in which to work for staff and in which to be for patients. That is particularly a problem for young people.

Secondly, in recent years we have become aware that many young people develop psychiatric difficulties not least because of abusive experiences that they have suffered. That was something with which we were less familiar a number of years ago but we are becoming increasingly familiar with the fact that many young people become profoundly disturbed in their behaviour and in themselves because of abusive experiences early in their lives. Indeed, when young people cut themselves, overdose and in other ways attempt to damage themselves, we now always pay attention to the possibility of abuse and particularly of sexual abuse.

Many young people who become disturbed and are taken on for treatment can be dealt with in an out-patient context or in day-patient facilities. But it is commonly the experience of those working with such young people that a period of containment is sometimes necessary in order that the work with them can continue. Sometimes it is only for a short time—perhaps a few days—hut it is nevertheless critical to the work with a young person.

As I said, many of those young people have experienced sexual or physical abuse from adults. They find themselves frequently—I say this not out of speculation, but out of my certain knowledge—having to be admitted to relatively secure facilities in which there are adults who in some cases have perpetrated violent or sexual abuse. Of course there may be concerns as to whether some repetition of the experience may occur, but even setting that to one side, how can one believe that it is not disturbing for a young person who has experienced such abuse and been so disturbed by it that he or she needs psychiatric treatment and who, during that treatment, has become sufficiently disturbed to need to be admitted to a containing atmosphere, to find themselves contained in precisely the same context as those who, with other young people, have been the perpetrators of abuse? They may be perpetrators for a whole series of reasons that we may or may not understand; that is not the point. It is clearly profoundly antitherapeutic.

I appreciate and find encouraging the fact that the Government are looking at these matters. It was suggested that it is not appropriate to deal piecemeal with them but that we need something that is broad—ranging. I accept that there is force in the Minister's argument in that regard. However, is it appropriate that young people should have to wait for a number of years for all the manifest and manifold problems of the service to be addressed and all the different legal requirements to be dealt with? Is it appropriate that they should have to wait or is it the case that, even if the Government do not allow this Bill to pass through the other place, some kind of regulation may be introduced to ensure that young people, particularly disturbed young people, are not continuing to be cared for in a context that is profoundly, and obviously, not in their best therapeutic interests.

In advance of the Minister being able to give us such enlightenment, I strongly support the amendment. I look forward also to seeing whether the Minister can find some other way in which the Government. through regulation, can ensure that such facilities are insisted upon and made available in all areas. I look forward to hearing what the Minister is able to say.

Earl Howe

Once again my noble friend presented the argument for the amendment most cogently and I support him. The need for separate in-patient facilities for young people is important for two reasons. The first is that young people, especially if they have been abused, need protecting from those who may be potential abusers. That is a principal reason and the noble Lord, Lord Alderdice, laid out that argument clearly.

The second is that early diagnosis and early treatment are essential to a successful outcome in cases of severe mental illness. Where a youngster suffers mental trauma, breakdown or something of that kind and needs to go to hospital, the process of treatment and recuperation is immeasurably assisted if the environment in which care is delivered is as conducive as it can be to recovery. The proximity of disturbed adults in a ward where a youngster first arrives to be looked after can pose an unhelpful barrier to the adjustment which that youngster needs to make if he or she is to be given a better chance of being successfully treated.

I hope that the Minister is able to accept at least the principle of the amendment, which addresses itself to the needs of some of the most vulnerable of mental patients, and can give us cause to hope that action will be taken to provide facilities of the kind the amendment seeks to promote.

11.45 a.m.

Lord Swinfen

Although I support the amendment, I wish to ask the Minister a question in relation to line 27 where the provision states, the fitting of appropriate security devices to all room and ward doors in all existing psychiatric units". Does that mean that it will not be necessary in new psychiatric units? It may be that at Report stage we will need to remove the word "existing" from the Bill. Perhaps the Minister will consider the point.

Lord Thurlow

I too strongly support the intention behind the amendment. None of those who listened to the exposition of the noble Lord, Lord Alderdice, could fail to be moved by the urgency of taking the necessary steps where there is a risk of a young person finding himself in a ward with someone who might assault him.

I speak with some experience. One of my sons, as a youth and severely schizophrenic, was in and out of big hospitals. He had a great deal of excellent care and I cannot say, in retrospect, that in any of the hospitals he attended there seemed to be any danger of the risks we are discussing today. But that does not mean to say that conditions have not changed on account of the problems of concentration to which the noble Lord, Lord Alderdice, referred.

I do not see that there is any reason why the necessary action cannot be taken by the health authorities, with or without—I hope with—the necessary stimulus from the Department of Health and without further primary legislation. Within the framework of the existing Act there is no reason why, if resources are available and if the will exists, this kind of segregation cannot be made when necessary. I repeat that I have some qualification about the generalisation. I know from experience that a young person can be in a secure ward without being in that sort of danger. However, I am sure that there are many situations where there is a crying need for rectification and for urgent action.

Baroness Ramsay of Cartvale

The Department of Health policy for child and adolescent mental health services is outlined in A handbook on child and adolescent mental health published in 1995. It stresses the importance of developing comprehensive services that span those within primary care through to specialist in-patient settings. A programme of work to implement policy is under way with the lead being taken by the regional offices of the National Health Service Executive.

The Government recommend that young people requiring in-patient mental health care should have access to facilities that are both age appropriate and able to meet their needs effectively. We do not underestimate the problems which the noble Lord, Lord Alderdice, so expertly put before us and which the noble Lord, Lord Thurlow, expressed from his unequalled personal experience. Young people with mental health needs are treated in a range of settings. It is recognised that, on occasions, particularly in the acute phases of illness, adult psychiatric wards are sometimes required for admission and this may not always be desirable. We would agree with what the noble Lord. Lord Alderdice, had to say on that subject. Young people, however, vary in maturity and degree of independence. The amendment is imprecise, leaving open the definition of "young". Sometimes it will be the psychiatric care required, rather than the chronological age, that will be the determining factor for where best a young person is treated. The amendment, which places a duty on health authorities, will limit flexibility. As the noble Lord, Lord Thurlow, so precisely said, in principle, if conditions are right—I do not want to paraphrase the noble Lord—there is nothing that could be objected to in what has been said by noble Lords. However, the amendment places a very precise duty on health authorities and would limit their flexibility.

In recognition of the genuine concern over access to in-patient facilities and the possible need for further guidance, the Department of Health is shortly to commission a national study. It will undertake a needs-based assessment of current in-patient provision, the alternatives that exist, the pathways of care for young people, and an analysis of current and future requirements. This will inform policy and service developments and enable planning into the next century to take place on a rational basis. I hope I am going some way to reassure the noble Lord, Lord Alderdice, and others that progress in this area does not depend on and hang entirely on legislation either being changed or being introduced.

The noble Lord, Lord Swinfen, asked a specific question about the Bill. I think that his question is more correctly addressed to the noble Lord, Lord Rowallan, whose Bill this is.

The amendment cannot be supported as to enshrine this duty in legislation will impose unrealistic burdens on health authorities in the immediate future, will reduce flexibility in service provision for young people, and may lead to inappropriate service developments. Those would be better planned after an assessment of the national situation has taken place. We cannot support the amendment.

Lord Alderdice

Before the noble Baroness sits down, perhaps I may welcome strongly the undertaking she has given and the nature of the study. When she speaks of a national study, may I have reassurance that that applies to England and Wales, Scotland and Northern Ireland—to the whole of the United Kingdom?

Baroness Ramsay of Cartvale

I shall tell the noble Lord what I think and then write to him if I have to correct myself. I would imagine that this applies to England and Wales. I cannot think that it would apply to Scotland or to Northern Ireland. However, if I am wrong about that, I shall certainly make that clear to all noble Lords.

Lord Alderdice

When we talk about a national health service we assume that it extends to the whole of the United Kingdom. However, the noble Baroness says that a national survey on a matter of this importance would apply only to England and Wales. I very much hope that the answer she has given is either not entirely correct or is one that can perhaps be reviewed.

Baroness Ramsay of Cartvale

As a Scot, I do not want to get into too much detail on this matter. As the noble Lord will know, at the present time health in Scotland is dealt with by the Scottish Office and in the very near future it will be dealt with by the Scottish parliament.

Lord Rowallan

Existing child and adolescent services cater for elective planned admissions and cannot cater for emergency admissions. Every acute psychiatric admission unit is periodically required to admit children because there is no alternative for them. On a ward at Homerton Hospital, which I recently visited, a 13 year-old girl was admitted, mute but aggressive, following a serious sexual assault by her step-father, which I am afraid happens all too often. Nowhere else could or would take her. During her admission she was given illicit drugs by other patients and was herself subjected to sexual harassment and assault. That is disgraceful and should not be allowed to happen. It is small wonder that the professionals involved do not wish to carry on maintaining and working in such a service if we allow that sort of thing to happen. We cannot sit back and allow this to go on. How many more 13 year-olds or 14 year-olds have to be seriously harassed and abused in mental health hospitals, where they are supposed to be receiving treatment, before we do something? I beg to move.

On Question, amendment agreed to.

Clause 2, as amended, agreed to.

Remaining clauses agreed to.

House resumed: Bill reported with amendments.