Charles Walker raises concerns about community treatment orders and the resources required to implement them effectively.

Mr. Walker: I raised my concerns about community treatment orders in Committee and, with the indulgence of the House, I will do so again on Report. I hope that I have the Minister’s indulgence and that she will not mind if I raise my concerns with as good grace as I can muster— [Interruption.] That sounds pretty good.

There are huge resource issues with CTOs. From the piles of briefing that we have read over the past couple of months, it seems that there are currently about 32,000 people a year receiving some form of in-patient hospital care. With the introduction of CTOs, it is estimated that the numbers involved could be in the region of 25,000 a year. The figure is disputed, but a number of organisations that submitted evidence as part of the consultation process and then as part of Public Bill Committee scrutiny believe that the threshold for CTOs in this country will be set at a far lower level than that in many of the other 70 jurisdictions. It is anticipated that about 50 people per 100,000—a significant number—will be eligible to be placed under CTOs in this country. I am well aware that the Minister disagrees with the figure and will probably come back with a counter-bid, but if we could work on the basis of 25,000 people for the next few minutes, I would be grateful.

First, we have to ask what will be the mechanism for delivery of CTOs. How will they be applied within the many diverse communities?

Angela Browning: My hon. Friend will recall that when CTOs were first talked about in the Chamber, they were referred to by the rather unfortunate description of medical ASBOs.

Tim Loughton: Psychiatric ASBOs.

Angela Browning: Psychiatric ASBOs—and I am grateful to my hon. Friend, who is as astute as ever on the Front Bench and listening to my every word. If they are not to turn out as psychiatric ASBOs and if they are to stand a chance of working effectively, what about the resource implications, which my hon. Friend the Member for Broxbourne (Mr. Walker) has just mentioned? How will they manifest themselves and what will be the impact on other community-based psychiatric services?

Mr. Walker: My hon. Friend makes an excellent point. We are perhaps in danger of commanding mental health armies that do not exist—or do not yet exist. We need to be aware that huge resource issues are involved—we are talking about 25,000 people in England, which is about 500 for each county, and many will require additional support to what is already being provided by the existing excellent mental health service professionals. We thus need to explore the mechanism for delivery at greater length. Perhaps the noble Lords in the other place will do so when the Bill returns to them.

The hon. Member for Finsbury Park— [Interruption.] The hon. Member for Finsbury, North— [Interruption.] I mean the hon. Member for Islington, North (Jeremy Corbyn), I am sorry. I wanted to leave Finsbury Park in, because it is one of my local train stations on the way through to the House. I apologise as no slight was intended. The hon. Gentleman made an important point about the concerns of black and ethnic minorities. I have a briefing from the Commission for Racial Equality, which is concerned that certain communities will be more prone than others to CTOs. Of course, we hope that that will not be the case, but we need to have procedures in place to ensure that the concerns of minority groups—and indeed the concerns of hon. Members—are properly reflected in the implementation of CTOs. We do not want to disfranchise huge parts of our community so that people feel that the Bill is yet another measure unfairly applied against them. That is not where we want to be.

I return to the point made by my hon. Friend the Member for Tiverton and Honiton (Angela Browning). Who will actually deliver CTOs? Will it be community mental health nurses, or will there be CTO teams working together to ensure that the orders are applied and work fairly in the community? CTOs will have significant training implications; the orders will be new to this country so we shall want to be sure that they are subject to best practice and effectively delivered. Who will be responsible for providing training? How much will it cost and how will it be given? Will it be on the job or will front-line practitioners have to be taken away from their patients to spend time learning about the new techniques? I hope that the Minister doesnot think I am being churlish when I raise these concerns — [ Interruption. ] I am sure she does not; she is too generous.

Lynne Jones: I am rather perplexed by the hon. Gentleman’s argument. By and large, the people we are talking about will already be in the mental system. Unlike the Scottish system, this proposed system is more “liberal” in that people have to be detained in hospital before they can be subject to a CTO, so has it occurred to him that some patients might think that a CTO would guarantee them services they cannot receive because they have been discharged and will be forgotten until the next time they exhibit difficult symptoms?

Mr. Walker: That is a very long question and I do not think I can remember every aspect of it, but I shall try very hard.

Of course, CTOs will be applied only to people who have been in hospital, but how long will the orders last? If 32,000 people are seen in hospital over a year, how many will be subject to CTOs and for how long? Will the orders last six months, a year, two years or three years, or will they be indefinite—almost life sentences? The hon. Lady makes an important observation, but I do not think I am being hostile in arguing my concerns. I am raising legitimate questions to which mental health professionals have the right to an answer.

Many of the people who would be subject to a CTO will be known to the mental health services, but we are not talking about business as usual; CTOs will introduce a whole new regime and a whole new system for dealing with people, and they will require a whole new set of skills.

Meg Hillier: The hon. Gentleman talks about a whole new system, but in my comments I highlighted the fact that there are already cases of people who are, in effect, on community treatment orders. They are admitted to hospital under a section and when they are released they have to undertake certain treatment or they will have to go back to hospital. Given such examples, it seems to me that the hon. Gentleman’s argument falls apart.

Mr. Walker: Perhaps we can hold up the hon. Lady’s constituency as an example of best practice.

Angela Browning: The hon. Member for Hackney, South and Shoreditch (Meg Hillier) may have been referring to a recent meeting we attended with the Minister and some psychiatrists she had invited to the House. When I raised the existing section 25A orders under the 1983 Act, I was told that there are powers that allow people to go back to the community, but with the threat that if, for example, they come off their medication, they can be taken to a hospital—usually by the police. A psychiatrist told us, quite flippantly, that the powers were rarely implemented because the police do not want to co-operate. It is scandalous that powers on the statute book that could be used effectively are not being implemented.

Mr. Walker: My hon. Friend makes an important point. If such powers already exist, we should be asking why they have not been used more widely and why we do not consider using them more widely before introducing CTOs.

Meg Hillier: Does the hon. Gentleman know how widely the powers have been used? I was talking not merely about my own constituency but about a fairly common practice.

Mr. Walker: Actually, I do know. We covered the matter at some length in Committee and the view was that the powers had not been widely used. I think there were about 1,500 cases a year—

Angela Browning rose—

Mr. Walker: But I am sure my hon. Friend will correct me if I am wrong.

Angela Browning: I do not know the exact number, but I raised it only last week with the psychiatrist whom the Minister brought before those of us who chose to attend her meeting. It was a good meeting, but I was interested to know why section 25A orders are not used more frequently—they have been on the statute book for a long time— and the psychiatrist said that it was because the police do not want to co-operate. The situation is extraordinary.

Mr. Walker: If we want section 25A orders to be used more widely, perhaps we should direct people to my hon. Friend’s constituency, where they seem to be having some success.

One concern about CTOs is how they will be implemented at local level when there are many hundreds, if not thousands, of them. How will we know if people are not complying with them? Who will be there, day in, day out, monitoring their effectiveness? Will there be a spy camera in someone’s bedroom—I am sure that there will not be—to ensure that they are taking their medication, or will people follow them to ensure that they do not go to the pub? Those are Orwellian possibilities, which I am sure will not happen, but the legitimate question is: how on earth will we realistically monitor 10,000, 15,000, 20,000 or 25,000 people on community treatment orders? If someone breaks an order, what will we do? Will we send them a warning letter, will they get a knock at the door, or will they receive a visit from one of their clinical team?

Jeremy Corbyn: The hon. Gentleman should remember that many of the people who do not take their medicine as regularly as they should and so on are often lonely, isolated, have bad relations with their neighbours because of their condition, and do not receive sufficient support. If community care is to be effective, we need a much better system of local, individual, social support for those people.

Mr. Walker: The hon. Gentleman makes an excellent point. I recall that many years ago when I was a young man there was all-round support for the idea of care in the community, returning people to the community, and closing institutions down. It sounded extremely good, and in theory was extremely good, but when people got back into the community insufficient care was delivered. Perhaps—I am not an expert on this—we would not need to go down the road of CTOs if we had the proper resources in place to ensure that people with mental illness receive the care and the contact that they need.

It would be interesting to consider how we will measure CTOs’ effectiveness. Again, I do not have the answer, but I am sure that the Minister has, and I am sure that she will tell us that she looks forward to coming to the House in three or four years—I look forward to my hon. Friend the Member for East Worthing and Shoreham coming to the House—to tell us how they are working. I hope that they will have achieved what people want them to achieve, and that we will have better delivery of services to the mentally ill in our community.

It has been pointed out that many of the people concerned are known to the mental health services, and that is so, but community treatment orders will often be compulsory, and that will require advocacy, which will have another implication on resources. We talked earlier about advocacy services, but if we are applying community treatment orders liberally around the country to people who do not want to be subject to them, I imagine that the demand for advocacy will be high. We must consider how we will meet that demand and who will meet it.

We have talked about using local charities, such as Powher, which operates in my constituency—I am not sure whether hon. Members are familiar with it—but empowering such charities to help people who are worried about being placed under a CTO might be a way forward.

Finally—I am sure that that will be a great relief to all hon. Members assembled here—how will we protect the confidentiality of patients under community treatment orders? Many of them will have jobs and places of work, and a CTO might stigmatise them. I would be interested to know whether, if someone is placed under such an order, there would be a personal contract between them and the relevant health service, or would the CTO be made known to a wider audience?

To conclude, if such services are to be delivered in Hertfordshire, the Minister will have to take a long, hard look at what is going on with our mental health trust. Its budget has been cut by £5 million a year—last year, this year and next year. That will have resource implications, which I hope that she will take into consideration. I tried to make that point with extreme good grace.

8.45 pm

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CHARLES' INTERVENTIONS IN THE SAME DEBATE

Mr. Charles Walker (Broxbourne) (Con): Thank you, Mr. Deputy Speaker, for calling me to speak in this good-natured debate. I assure you and the Minister that there will not be any strops from this Member of Parliament. There have been strops in the past, but he is in a very good mood and has had supper, so he is well balanced and his sugar levels are where they should be.

I welcomed the Minister’s statement on new clause 4, which represents a great step forward, but I must express my concerns, although I will do so less eloquently than my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton). Adult wards are accommodating children, which suggests that there is a shortage of appropriate facilities in this country for young people with mental health problems. My hon. Friend said that people would rather go to appropriate facilities in Scotland than an adult mental health ward near their home. I hope that young people will not have to make such a choice and that appropriate facilities will be available near their homes. It is important that young people have their family and friends nearby at a difficult and traumatic time in their lives.

Will the Minister clarify where the resources will come from to fund the creation of additional suitable environments? She will be aware that Hertfordshire’s mental health trust is having to make significant cuts to its budget to contribute towards addressing the PCT deficit. I hope that the money for the creation of appropriate facilities will not be taken from another part of the mental health budget through a process of robbing Peter to pay Paul. The money should be additional to that already in the system and overall budgets should expand to ensure that young people are given suitable accommodation so that we can make them well as quickly as possible and return them to their families and friends in good time.

Ms Rosie Winterton: I thank the hon. Member for East Worthing and Shoreham (Tim Loughton) for his support. He talked about perverse incentives, which have been mentioned before. We did not want the Bill to lead to people being turned away from treatment, which is why we have adopted our approach. I assure him that we will engage with YoungMinds and the children’s commissioner. For the purpose of the debate, I will not use the title “11 Million” in case that gives the impression that we will consult 11 million people, given that that would probably be slightly beyond what we could achieve. I am sure that the Opposition will continue to hold us to account until 2010 and beyond.

...

The hon. Member for Broxbourne (Mr. Walker) raised the question of cost and talked about the importance of services near to home. In my opening remarks, I pointed out how we are examining the commissioning of services with the Care Services Improvement Partnership. If we can get proper commissioning and the performance management about which we have talked—perhaps we could ask the Healthcare Commission to examine this matter—we can ensure that services are as near to home as feasible and that people are aware of where beds are available.

We will give funding estimates, and we will ensure that the health service has the necessary funds available. Our estimates suggest that there will be overall capital costs of £10 million as well as ongoing revenue costs. We will work closely with the health service. As hon. Members will know, we have already made announcements about this matter.

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Mr. Walker: I am not being argumentative and I hope that the right hon. Lady will take my question in the spirit in which it is asked. To tell a chronic alcoholic or drug addict who also has mental health problems that they will be readmitted to hospital if they break the requirements of their CTO to avoid drugs or alcohol seems unreasonable, unless one provides that person with support that enables them to stay away from their addictions.

Ms Winterton: I hope to be able to deal with that question, because it relates to the points that the hon. Gentleman made about the availability of services.

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Mr. Walker: I am not sure that I can be helpful, but I will not try deliberately to be unhelpful. I met an outstanding consultant psychiatrist near Bristol called David Thurston who, for years, has gone out to meet his patients in pubs, at home and in places where they feel comfortable. He is concerned about CTOs which, he believes, may well drive a wedge between him and his patients. He has a method of working that works for him and his patients: will he be obliged to use CTOs, or will that be left to his discretion?

Ms Winterton: I have made it clear over and over again—I hope that the hon. Gentleman acknowledges that, because this is exactly the debate that we had in Committee—that the power is available to clinicians if they think that it is the right thing to do. There is no compulsion on them to use compulsion—it is for them to make the decision, based on a range of issues, and if they think that that is appropriate. May I return to the reason why we believe that supervised community treatment can help to get treatment to people? There are 1,300 suicides every year, and 50 homicides by people who have been in contact with mental health services. We believe that supervised community treatment is vital to helping patients continue to take treatment when they leave hospital and to enable clinicians to take rapid action if relapse is on the horizon.

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