Health: Alcohol Abuse

Baroness Hollins Excerpts

Tuesday 21st January 2020 Lords Chamber

[Baroness Williams of Trafford]

We now have in place a wide-ranging approach that negates the need for a separate, stand-alone alcohol strategy. We have announced a new addictions strategy and will roll out the electronic monitoring of alcohol abstinence requirements for those whose offending is fuelled by alcohol.

[Baroness Hollins (CB)]

My Lords, research conducted by the University of Sheffield estimated that reintroducing the alcohol duty escalator, which increases alcohol duty annually by 2% above inflation, would save 4,710 lives and prevent more than 260,000 crimes in England by 2032. Would the Minister consider discussing the wider impacts of alcohol duty with the Chancellor before the March Budget?

[Baroness Williams of Trafford]

Public Health England is monitoring how minimum-unit pricing has worked in Scotland and considering the impact of such a policy, which is similar to what the noble Baroness is talking about.

Sale of Knives

Baroness Hollins Excerpts

Tuesday 8th October 2019 Lords Chamber

[Baroness Williams of Trafford]

I join my noble friend in paying tribute to the supermarkets and the work they have done in this area. I think it is Morrisons and Lidl which have decided not to sell knives in store. Asda has stopped selling single knives and other supermarkets have either stopped or restricted the sale of knives in areas where levels of knife crime are particularly high. We enforce this Act through trading standards and the use of test purchase operations in store and online. The £500,000 prosecution fund, which was introduced as part of the serious violence strategy, helps trading standards to prosecute rogue retailers that repeatedly fail test purchases.

[Baroness Hollins (CB)]

My Lords, I speak as the mother of a victim of knife crime. I am surprised that the “No Points” campaign has not been mentioned; perhaps Members are unaware of it. However, identifying which variables can be changed to make it difficult to commit a particular harm has been proven to succeed. For example, restricting the amount of paracetamol that you can buy led to fewer deaths from paracetamol overdoses. Sixty years ago, our domestic gas supply changed from coal gas to natural gas, thus effectively removing an effective means of taking one’s own’s life that was readily to hand, and there was a profound drop in the rate of suicide. Does the Minister agree that it would be worth piloting the recommendations in the “No Points” campaign to see if it can achieve similar results for homicide? The point of the campaign is that you do not need a point in the kitchen, and there are good designs available.

[Baroness Williams of Trafford]

I totally empathise with where the noble Baroness is coming from. She speaks from personal experience when she outlines the devastation that knives can cause to communities. I have some empathy with the “No Points” campaign, although there are very dangerous knives that do not have points at all, such as machetes. The Government believe that the current controls, which will be strengthened by the Offensive Weapons Act, will support this. A further point—no pun intended—is that it is not only legislation that will reduce and curtail knife crime.

Child Sexual Exploitation Victims

Baroness Hollins Excerpts

Tuesday 19th March 2019 Lords Chamber

[Baroness Williams of Trafford]

The noble Baroness is absolutely right that I cannot comment on an ongoing legal case. What I can understand—and what the Government have sought to do and succeeded in doing over the last few years—is to see people as both victims and perpetrators through some of the coercion and exploitation in which they have been involved. We will consider this as the case proceeds, but the Government have put a great deal of time and effort into working with people who have been exploited and who find themselves victims of child sexual exploitation, gangs, knife crime or drug involvement. There have been various interventions: the noble Baroness will have listened to debates on the Offensive Weapons Bill and will have heard me outline the youth endowment fund, which we are bringing forward. She will have listened to the various multiagency approaches to helping victims of child sexual exploitation get over the terrible pain that has been caused to them, to avoid getting trapped in what originally happened to them, and to go on to lead good lives.

[Baroness Hollins (CB)]

My Lords, it is very concerning to hear that young people who have been groomed into criminal activity and then become victims of sexual abuse and discouraged from even disclosing their abuse because of the fear of their own criminalisation should then not have the opportunity to have those crimes forgotten. Can the Minister tell the House whether such young people are also then denied access to criminal injury compensation? Is this indeed the case?

[Baroness Williams of Trafford]

The noble Baroness will of course appreciate that every case is different. She will also realise that, as I just outlined to the noble Baroness, Lady Burt, the big spectrum of exploitation that children can suffer can also manifest itself in different ways. The Government are determined to deal with some of these problems at source, with early intervention and prevention, so that children do not find themselves sexually exploited and are able to go on to lead lives that are free from the sorts of harms that we have been talking about.

Financial Exclusion

Baroness Hollins Excerpts

Wednesday 4th July 2018 Lords Chamber

[Lord Bates]

We have done a lot in that area, such as capping payday loans—those egregious payments. The Financial Conduct Authority has looked at the whole issue of buy to rent and is considering whether a cap is necessary. We have also done a number of things to try to help those with low incomes to improve their situation. My noble friend Lord Young took the Financial Guidance and Claims Act, which created a new single financial guidance body, through this House. All these measures are designed to improve the situation. We also announced our ambition to increase the number of people who have access to credit unions in this country from 2 million to 3 million.

[Baroness Hollins (CB)]

My Lords, is the Minister aware of the attempts being made by the Post Office to make cash available to named individuals by arrangement with their bank when they are unable to manage cash withdrawal at an ATM, for example if they have a learning disability or may be at risk of financial exploitation?

[Lord Bates]

I am not aware of that particular scheme. Of course, pressure is now being brought forward. One particular body, the Equality Advisory Support Service, oversees how this operates for people with disabilities. It can report and require the Financial Ombudsman or the Financial Conduct Authority to look at these areas and take action. I am happy to look further into the matter raised by the noble Baroness.

Nursing

Baroness Hollins Excerpts

Monday 14th May 2018 Lords Chamber

[Baroness Hollins (CB)]

My Lords, it is a pleasure to follow the noble Lord, Lord Ribeiro, and to know that, in our own ways, we strove to work collaboratively with nurses throughout our medical careers. I congratulate my noble friend Lord Crisp on this very stimulating debate. I would like to draw attention to the role of nursing in prevention and early intervention to improve mental health worldwide and to think about how nurses globally could learn from nursing experience in the United Kingdom in supporting people with learning disabilities and perhaps people with autism.

In this country, we rightly discuss the issue of parity of esteem between mental health and physical health. However, globally, the lack of parity is even more evident. The World Health Organization recognises the global burden of disease that mental health conditions produce. It reports that depression alone accounts for nearly 5% of the global burden of disease and is among the largest single causes of disability worldwide, with 11% of all years lived with disability globally. This burden is particularly great for women.

The World Health Organization also reports that almost half the world’s population lives in countries where, on average, there is one psychiatrist to serve 200,000 or more people. It states that between 76% and 85% of people with severe mental disorders receive no treatment for their disorder in low-income and middle- income countries. The King’s Sierra Leone Partnership describes how, historically, there has been one trained psychiatrist in the country—although encouragingly it describes that two more have finished their training in the last year. However, for a country of six million people, this produces a very different mental health service to the one we may be used to in this country. In this country, we have 6,000 psychiatrists on the specialist register, making up 6% of all specialty doctors.

What this suggests to me is that mental health policy globally faces challenges rather different from those we face here and that the solutions will therefore also be different. The answer to addressing the mental health gap globally may lie not in the medical schools but with community nurses and health visitors identifying mental illness and delivering psychosocial interventions. Making mental health a core component of any global health policy is essential to prevent it disappearing from view, which, as we know from our own country’s history, can easily happen.

Of all nurses in this country, 16% work in mental health or learning disability services. I suggest that there is an even greater role globally for nurses to lead mental health and disability policy. However, the reports attached to the briefing for this debate referred mainly to child health, infectious diseases, cardiovascular health and the like, with very few explicitly mentioning mental health conditions. I saw reference to diabetes and heart disease and to the burden of infectious diseases such as HIV/AIDS and malaria, but I did not see references to learning disability—or intellectual disability, to use the international term—schizophrenia, alcohol dependence or depression.

I will reflect on the history of learning disability nursing in the United Kingdom and Ireland. It is a condition-specific field of nursing that has developed over a few generations now, the role and function of which is to work face-to-face with individuals with intellectual disabilities, their supporters and their families to empower them in their lives and in their encounters with health services. In the health third sector and private and public agencies, learning disability nurses deliver specialist healthcare and support to people of all ages.

In the United Kingdom, the largest majority of individuals with learning disabilities live in the community, in their own homes with support systems or with their families. But as a group, they have the poorest health, which has a cumulative effect over the lifespan, and this will be true worldwide. They have a different range and pattern of disease and differing health-related behaviours. They have differing leading causes of death —respiratory disease, congenital heart disease and cancers—when compared to the general population. Gastro-oesophageal reflux disorder, sensory impairments, osteoporosis, dental caries, accidents and mental ill-health are all more common in this population group. The average age of death in this country is 20 years earlier when compared with the non-learning-disabled population. Significantly, we know that most of these deaths are unexpected, avoidable and preventable.

There is a challenge, however: half of learning disability nursing courses in this country are considering closure, despite rising numbers of vacancies within the NHS. The nurses who are still available are increasingly working in social care settings as managers, not delivering the face-to-face nursing skills that they have acquired and which are so essential for this group of people. One of our roles could be to consistently challenge policymakers, in this country and abroad, and to ask how the strategies they formulate improve prevention and identification and care for people with mental illness, and perhaps particularly for people with learning disabilities and autism. The role of nursing in transforming healthcare globally is huge, but let us ensure that this reduces, not increases, the disparity between mental and physical healthcare.

I will finish with another challenge: how to respond effectively to both online and offline sexual abuse and its impact on mental health, and the educational and preventative work being done by community nurses in some rural communities in Africa. Nurses are highly respected in all cultures. Their contribution to prevention and their compassionate listening responses could help to reduce the longer-term consequences of sexual abuse and to rebuild the resilience that each person needs in life.

Human Rights

Baroness Hollins Excerpts

Thursday 21st November 2013 Lords Chamber

[Baroness Hollins (CB)]

My Lords, I congratulate my noble friend Lord Alton on securing and introducing this important debate. It has been said that wartime rape is as old as war itself. Women’s lives and bodies have been unacknowledged casualties of war for too long, but now greater media awareness and reporting, probably in part because of the exceptional women journalists covering conflict, have brought wider knowledge of the extent to which rape is occurring. The consequences of rape are also better understood. Five years ago, a United Nations resolution described rape as a tactic of war and a threat to international security.

Rape is used as a punishment for men as well as women, by forcing men to watch as their wives, sisters, mothers and daughters are raped. Victims of rape are left emotionally traumatised, physically damaged and at risk of potentially fatal sexually transmitted diseases. Rape humiliates, dominates, instils fear and disperses communities. The after-effects of rape are felt for generations, as women bear their rapists’ children, and face shame and revulsion. Surely it is time to draw a line, and time for the international community to take rape as seriously as it does the use of other weapons. As my noble friend mentioned, hundreds of thousands of women have been raped in the Congo. Reports of rape have also emerged from the current conflict in Syria. When will women’s human rights be recognised and acted upon?

Rape is always an abuse of power. In the case of rape, it is an abuse of physical power. When communities are under threat, it is the weak and vulnerable who suffer the most. People with disabilities are subjected to more violence in any country, but more so in a country in turmoil, where people are concerned for their own lives and livelihoods and may not have the resources to look after the most vulnerable people in their communities. It may be as obvious as someone with physical disabilities being unable to flee rebel attacks, or as insidious as someone with a disability being last in the queue for food and water. Disabled women and girls are also raped.

The Human Rights Watch report of an investigation in Uganda in April and May 2010, which looked at the treatment of people with disabilities during conflict, was called As if We Weren’t Human. It was sobering reading indeed. Over one-third of the 64 women and girls with disabilities interviewed by Human Rights Watch had experienced sexual violence. Charity, a Ugandan woman with a physical disability, described how, in the camp,

“people told me: ‘You are useless. You are a waste of food.’ People told me I should just die so others can eat the food”.

Women reported being abused by aggressors because of their disabilities. A partially blind woman had her eyes removed because she had not seen where her husband kept his gun. A girl with learning disabilities was beaten and raped because she did not understand the questions she was being asked.

It is unusual for victims of rape and sexual violence in times of conflict to seek help, but when they do, those with disabilities are at a further disadvantage. Health centres and police stations are far away and victims rely on others to take them there, leaving them at greater risk of the untreated physical complications of rape. Police stations and courts do not have the resources to facilitate communication with those who have difficulties, such as the deaf and people with learning disabilities. Many girls and women with disabilities are illiterate and rely on their families for communication. Families will often not support a woman or girl in reporting a rape because of the additional stigma that rape brings to a family already stigmatised by disability.

The Convention on the Rights of Persons with Disabilities recognises the specific vulnerabilities of those with disabilities and requires its signatories to take appropriate measures to protect such persons from exploitation, violence and abuse. We signed the CRPD in 2008, but what is our policy on those countries that do not comply with it? What is our policy on those that allow such human rights abuses to be carried out on women and girls? The G8 this year declared rape to be a war crime. Will the Minister explain to the House what the British Government are doing about it?

Syria: Humanitarian Aid

Baroness Hollins Excerpts

Monday 21st October 2013 Lords Chamber

[Baroness Northover]

I thank the noble Lord for his tribute to the Government for what they are doing. It is a dire situation, which noble Lords will see from the figures. A year ago there were 230,000 refugees from Syria. Now there are 2.1 million refugees—an eightfold increase. Clearly we have to work extremely hard to make sure that the pledges to which countries have committed themselves are delivered. We are pleased that the figure has reached the £1 billion mark but it is not sufficient and it is extremely important that humanitarian access is granted within Syria so that aid can get in where it is needed.

[Baroness Hollins (CB)]

Can the Minister tell the House how Her Majesty’s Government are assisting UK-based charities working in Syria—such as Hand in Hand which featured recently on “Panorama”—either financially or by supporting links with international NGOs? Hand in Hand, which includes senior NHS doctors, is providing medical aid directly into areas outside government control—areas which international NGOs are unable to access. Will the Minister meet Hand in Hand directors with me to explore possible assistance to their work?

[Baroness Northover]

I am very happy to meet representatives from Hand in Hand, and I note what David Nott said over the weekend about his experiences in Syria—the stories that he was reporting back were absolutely horrendous. The Government work very closely with a number of NGOs in this area and a range of organisations is working to try to get humanitarian aid in.

NHS Mandate: Health Inequalities

Baroness Hollins Excerpts

Monday 28th January 2013 Lords Chamber

[Baroness Northover]

My answer is that, as I have said, the Act puts reducing health inequalities at the centre; that is a responsibility at every level, and those things will be monitored in certain ways. As the noble Lord, who is winking at his colleague and perhaps not looking at me right now, might remember, the Secretary of State is answerable to Parliament and will be answerable for all these areas. If the noble Lord is right, and actions that are taken do not reduce inequalities, there will be an opportunity to hold the Government to account.

[Baroness Hollins]

My Lords, the first priority in the mandate is about preventing people from dying prematurely. The Minister spoke about inequalities between communities, but I am concerned about two of the improvement areas mentioned in this priority, which are about reducing premature mortality in people with serious mental illness and people with learning disabilities. Will the Minister tell the House about the clinical leadership being put in place to ensure that these two areas are addressed energetically in order to reduce health inequalities within communities?

[Baroness Northover]

The noble Baroness is right to highlight this area. I point out that the NHS Commissioning Board has recently advertised nine posts which focus on health inequalities. I am sure that that kind of focus will help. The noble Baroness is right in that there are certain groups within communities that are particularly vulnerable. She will probably also be pleased to hear about the Inclusion Health programme, which focuses on particular groups which have particularly poor health outcomes, and which is chaired by Professor Steve Field, of whom she will be well aware.

Care Services: Abuse of Learning Disabled

Baroness Hollins Excerpts

Thursday 13th December 2012 Lords Chamber

[Baroness Hollins]

My Lords, I thank my noble friend Lord Rix for his inspiration and tenacity on behalf of people with learning disabilities, and I congratulate the noble Baroness, Lady Kidron, on her eloquent maiden speech, which reflects her long-standing commitment to social justice.

I know quite a lot about learning disability. I know about it as a parent, a psychiatrist, a policy maker, and I also chair a charitable organisation that creates communication resources about life and relationships for people with learning disabilities. First, I commend the Government on their report, for the programme of action signed up to by 50 organisations, and for setting out what good care should look like. I also commend the serious case review conducted in such a painstaking way by my former colleague Dr Margaret Flynn.

The BMA under my presidency recently commissioned an expert round table in your Lordships’ House at which Dr Flynn spoke. I shall draw on the notes from that meeting in what I say. There is a story to tell which begins with a question: why were these very vulnerable people at Winterbourne View at all? The existence of Winterbourne View and similar hospitals represents a commissioning failure. Hospitals such as Winterbourne View have been considered unsuitable for more than 20 years. Jim Mansell’s first report on challenging behaviour in 1993 criticised the widespread core practice of exporting people with behaviour that challenged. A drawn-out, long-stay hospital programme that originally began after institutional scandals in the 1970s and 1980s was completed only just three or four years ago.

Even before the closure programme had been completed, new mainly private hospitals were already touting for business. As a policy adviser in 2001 I drew attention to this trend, as did others, but there were no incentives in place to encourage local providers to develop adequate local support for people. With some notable exceptions the practice of exporting patients similar to those who ended up in Winterbourne View continued. The sad journey of most of these patients began long before they arrived in hospital. The serious case review showed that. There were many lost opportunities to provide better, more personal and local care, but they were missed. Why were they placed such a long way from home? Typically a crisis happens just before a weekend and risk-averse professionals seek an emergency hospital bed somewhere, anywhere.

Many of these adults have had sad lives; they may have been abused, bullied or have had a traumatic bereavement. Such dislocation to a distant hospital can further disturb and re-traumatise them. On entering hospital, vulnerable adults depend on the nurses to get to know them and to understand and meet their needs, and on the other members of the team to draw up an active treatment plan. We have heard a great deal about the lack of compassion in different types of hospitals, but Winterbourne View was the site of systematic abuse by poorly paid and untrained staff with the wrong attitudes. They were unable to understand the communicative function of their patients’ behaviour; they lacked the skills to support them in a respectful and safe manner.

I am pleased to see the roles envisaged for Health Education England, the professional senate on learning disability and Skills for Care to turn this around. However, I agree with the noble Baroness, Lady Jolly, and the noble Lord, Lord Addington, that these staff need to be better supported. Some will need therapeutic supervision to enable them to care better.

Distant placements make it difficult for families and carers to provide oversight and protection, and yet the best safeguards for people with severe learning disabilities are the people who know and love them. I am glad that the DH final report and the concordat recognise that services must be provided locally and that containment must give way to personal care and personal treatment plans. The ordinary life that campaigners such as David Towell have argued for for so many years seems to be within the reach of even those whose behaviour challenges. Does the Minister believe that the timescale proposed to get people back home is realistic? I hope so.

Choice—an OFT-heard mantra—is a key principle of the Health and Social Care Act, but what sort of care would service users choose if they were able to? This is the question that those who commission and provide services need to ask. I am encouraged that the report expects people with learning disabilities and family carers to be involved in future CQC inspections.

Too often those close to vulnerable adults—many of whom wish to help—are still excluded from decision making. Personal budgets and direct payments provide one mechanism for more personal care but for people with behavioural challenges pooled budgets are needed to avoid financial arguments about whose responsibility it is to provide effective and timely care and support. People were placed at Winterbourne View by the NHS largely, but the NHS looked to the local authority to take responsibility for funding their rehabilitation. Where was the incentive? They were out of sight and out of mind. Does the Minister think that the new plans will provide adequate incentives to get people home?

NHS-funded care, whether in hospitals or the community, should deliver high-quality assessment and treatment and it should be evidence based. Winterbourne View was a hospital; its patients had mental health needs. Most were detained under legislation but they received little in the way of specialist health care. It seems to me that people with severe learning disabilities are still seen as second class citizens and not afforded the same rights as other citizens. The 2001 White Paper, Valuing People, challenged those assumptions and raised the hopes of people with learning disabilities and their families, but access to the same health care as others is still denied to many. This is as true of mental health services as physical health services.

Underfunding, a lack of 24/7 working, the separation of specialist learning disability services from primary care and mental health services means that even those specialist services cannot support and deliver the safe and timely care that people need. For example, in the case of specialist psychological therapy services, IAPT services and highly specialist psychotherapy services have not been adapted for people with learning disabilities. This is especially important for people whose behaviour challenges. Can the Minister clarify the expectations of the Government with respect to the mental and physical healthcare of this group? Does parity of esteem apply to this patient group too? It is disappointing that there is so little in the report about the range of mental health treatments that people need.

My first boss in learning disability, Joan Bicknell, recruited me back in 1981 because I was a medical psychotherapist and a family carer. She lectured extensively about the emotional lives of people with learning disabilities. I remember how sceptical her audiences were. How could people with little spoken language have feelings? Is this the same attitude that makes it possible for so-called carers to abuse the people they are caring for? Some of my research studied the effect of abuse and bereavement on people’s behaviour and emotions. To help their carers understand their inner world, I turned that research into picture books about life experiences for them to read together. More research is needed to help us understand what happens in people’s homes and what leads to behaviour that challenges. Can the Minister tell us whether there will be substantial investment in research, similar to that being used at King’s College to develop a care home research network for people living with dementia?

Winterbourne View hospital failed to meet the needs of these adults. How can we be sure that this time we do not forget; that the lessons from this tragedy are truly learnt and safeguards are put in place?

Health and Social Care Bill

Baroness Hollins Excerpts

Monday 5th December 2011 Lords Chamber

[Baroness Murphy]

My Lords, it will be no surprise for you to hear me say that I support all the amendments in this group. I do not really understand the need for the change in Section 117 on aftercare provisions. I am not quite sure what the tidying up is about or what the matter is with the existing arrangements. They are complicated to deliver but nevertheless seem to be utterly essential in the way in which they are currently framed. I would need to be convinced that there was some serious reason for changing them, as they apparently will be in the Bill.

As I understand it, we did not struggle with the provisions on independent mental health advocates during the proceedings on the 2007 Bill. While it is thought that parents could take the place of advocates in negotiating treatment, the proposals for independent mental health advocates for children are important in adding to the quality of services, and I support that.

The major thrust of my support relates to the amendment in the names of the noble Baroness, Lady Barker, and other noble Lords. It is my fervent belief that one day we will look back in this House and be horrified at how we structure our mental health legislation. The fact that we do not have legislation on capacity-based decision-making seems to be a terrible tragedy and is extraordinary, given that we see in Scotland that it is perfectly capable of being implemented safely. We should be at the forefront of developing legislation that destigmatises mental health services and allows people to make their own decisions about treatment.

We will have to wait a long time for that, but this amendment focuses on something that many of us predicted would be overused, and I regret to say that it is all too obvious that it is being overused for the wrong people. Yes, there are some people for whom community treatment orders should be used, but if we had legislation for capacity-based community treatment orders we would still be able to implement them safely. I strongly support the noble Baroness’s amendment.

[Baroness Hollins]

My Lords, I support these amendments. I was president of the Royal College of Psychiatrists when the Mental Health Bill was passing through this House and I remember listening to and reading the debates with great interest. I know that noble Lords on the government Benches, including the noble Earl the Minister, at the time very much supported capacity-based legislation. It works well in Scotland, but what was anticipated here would happen has happened—far too many people are subject to community treatment orders who know what they are doing and are no risk to themselves or to others. It would be good if it were possible in this Bill to make a change on this issue that made sense.