Welfare Reform and Work Bill
Baroness Hollins Excerpts(8 years, 5 months ago)
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Lord Lansley
No, it is not—and I do not think that we should construe an incentive structure as being coercion. It is precisely what it describes. We are talking about the level of relative benefits and if people fall properly into this category—I have not got into the question of whether the work capability assessment is accurately placing people in the WRAG ESA rather than the support group—they should be in a position to work. It is not about coercion. Sixty-one per cent want to work, but not enough of them are getting work. We should have incentive and support structures that help them to get that work and we should make sure that the incentives do not get in the way but support this. It is nothing to do with coercion.
Baroness Hollins (CB)
My Lords, I have put my name to a number of amendments in this group and shall speak briefly to them. As my noble friend Lady Howe explained, Amendment 51 would mean that people with a mental or behavioural disorder would not be mandated to take part in inappropriate activities that might be detrimental to their mental health and that the current sanctions would no longer impact on them. It is crucial that support is tailored to the individual and that it addresses a person’s main barriers to work. For people with mental health problems, I cannot stress enough how important a good relationship between a claimant and adviser is and that people must be involved in decisions being made about them.
With respect to Amendment 52 I will restrict my comments to the provision of mental health care. This amendment would mean that anyone on ESA with a mental health problem as their primary condition—as the noble Lord, Lord Layard, explained—could be fast-tracked to IAPT for therapy. That needs to be debated, but Mind is concerned about the broader implications this could have for the many people who are already on waiting lists for talking therapy.
A survey of 2,000 people from the We Need to Talk coalition last year found that one in 10 people had to wait over a year between being referred for talking therapy and having an assessment. Waiting this long can be incredibly damaging. The findings also showed that while waiting for talking treatments, four in 10 people harmed themselves, one in six attempted to take their own life and at least 6% of people ended up being admitted to hospital.
People are already trying to get treatment, but services are just not meeting demand. We would need to know what types of treatments people with mental health problems on ESA are already receiving, are likely to be waiting for or have already received. So it is difficult to know what effect this amendment would have.
The final point to tease out of this debate is to raise caution around any suggestion of mandated treatment, although I am sure that this is not the intended effect of this amendment. I am pleased to speak to the amendment to highlight the wider issues around access to mental health services. Anything we can do to improve access to mental health services for all is absolutely a good thing. The Minister defended the proposed changes to the ESA WRAG during discussion of Amendment 34 earlier this week by saying that the Government are doing more than any previous Government to improve access to mental health services —presumably those provided by the NHS. However, mental health is still the Cinderella service in healthcare and is not just the responsibility of the NHS. If I were a Minister in the Department of Health, I would be extremely worried that these proposed DWP policies would lead to an increase in or a worsening of mental disorders for people in this group and that they would lead to additional demand and escalating costs.
I will also speak briefly on the stand part debate for Clauses 13 and 14. My noble friend Lord Rix sends his apologies. It is quite a task for him to come into the House at the moment due to his current health problems, so he chose to focus his input on his excellent Second Reading speech.
I welcome the review published by my noble friends Lord Low, Lady Meacher and Lady Grey-Thompson and I urge the Minister to look closely at it. I particularly welcome the review’s inclusion of people with a learning disability. The story of Sam Jeffries, who himself has a learning disability and whom I met yesterday at the launch of the review’s publication, where he spoke, gives a human face to the concerns that noble Lords are expressing.
Sam is a 25 year-old man who lives on the Isle of Wight with his nan. He is currently in the ESA WRAG group. He has a moderate learning disability and some joint problems, so he finds it difficult and painful to walk other than for short distances. He uses some of his personal budget to go to a Mencap day service, which he enjoys, although he would like to work. He has a support worker, who is paid partly from his personal budget and partly from his benefits. Sam says that if he were to lose another £30 a week it would make a massive difference. He would struggle to pay for everything. It would mean not going to his day service and being unable to afford the taxis he sometimes needs to get around. He would like to work part-time if he could but there are not many jobs around, and sometimes 50 people are competing for each job.
I have worked with people with a learning disability for much of my life, and they need the support to look for work and ongoing job support. This should be the Government’s focus, not cutting benefits. To do so will ruin the employment prospects of many people with a learning disability while at the same time affecting their social life, their health and their self-esteem.
Baroness Tyler of Enfield (LD)
My Lords, I will briefly speak to Amendment 52, to which I have put my name. In so doing I express my strong support for Amendment 51, in the name of the noble Baroness, Lady Howe, which aims to improve back to work support for people with mental health problems. I also signal my strong support for the arguments that have been put forward that Clauses 13 and 14 should not stand part of the Bill.
I will briefly speak on Amendment 52. The noble Lord, Lord Layard, has already argued very powerfully that any person with a mental health problem as a primary medical condition awarded ESA in the WRAG group is immediately offered assessment and treatment in a local IAPT service. That is very important, and I will explain why I added my name to that amendment. It is about offering that treatment, not about it being compulsory—that is an important point to grab hold of, given the discussion we have had.
There is now plenty of evidence which shows that when people experience mental health problems, getting the right type of talking therapy as early as possible can make a huge difference to their recovery and their ability either to return to or enter work, and to prevent them becoming ill again. It is a very good and helpful idea that people with mental health problems in the WRAG group should get that immediate treatment. I accept that there are issues to work through here, to which the noble Baroness, Lady Hollins, drew attention, about making sure that in doing this we do not build some sort of tiered approach to mental health services, which could create difficulties.
The key point I want to underline, which was made so powerfully by the noble Lord, Lord Layard, was that an approach like this could save a very large amount of money on welfare. From listening to the debate so far, I have understood from the Government that that is what the Bill is primarily about. There is an opportunity to do that here, so we should not pass it up. I also offer my services to work with the Minister to find a way to make this amendment work, because it has great potential.
Welfare Reform and Work Bill
Baroness Hollins Excerpts(8 years, 5 months ago)
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Baroness Meacher (CB)
My Lords, I will speak very briefly to Amendment 34, tabled so comprehensively by my noble friend Lord Ramsbotham. This amendment is of particular importance in view of the enormity of the cuts to welfare spending since the passing of the Child Poverty Act 2010. The Institute for Fiscal Studies reports that this will amount to £123 billion taken from our poorest citizens by 2016-17. The second feature of government policy the effects of which need to be monitored effectively—and would be under Amendment 34—is the conditionality and sanctions regime which undoubtedly increases the stress level of claimants very considerably.
As a panel member, along with Sir Keir Starmer and others, for an inquiry by the Fawcett Society into the impact of the Government’s welfare measures upon women, and by association their children, I found quite appalling the sheer level of errors and abuse in some Jobcentre Plus offices, affecting innocent women who only wanted, if at all possible, to gain their independence from the state. Our inquiry concluded that sanctions applied through no fault of the claimant were affecting claimants’ mental and physical health and the health and well-being of their children to a considerable degree. The Government have a duty to be aware of the consequences of their policies and to respond to the adverse effects.
I am aware that the Minister believes that injustices are limited in number, and that his department is doing its best to lessen them further. However, the inquiry made it clear to us that in fact the quality of service across the country varies very considerably. In some offices the staff were helpful and professional, and claimants certainly reported that. However, in others they were inadequately trained and could be callous and careless, with the most appalling consequences for the families affected. A typical example were mothers who, contrary to the guidelines, were required to travel three hours a day in total to and from work. They could not afford this and believed—rightly, in my opinion—that it was entirely wrong for their very young children to be in childcare for 10, 11 or more hours per day. Despite this entirely unreasonable requirement, such parents were sanctioned and then could not even feed their children. This was not an isolated problem but rather a regular occurrence in offices up and down the country.
Another often repeated story was that of a mother phoning the office to say that she could not attend an interview or required activity due to the sickness of a child, and was told that this information would, indeed, be passed on to the appropriate official. Of course, nothing was done. The mother would arrive at the post office to pick up her benefit only to find that there was nothing there. A sanction had been imposed with no information given to her. I cannot imagine the shock and utter distress of a mother in that situation. I believe that the Government may have adjusted the sanctions regime to ameliorate that problem and to make sure there is a gap between the imposition of a sanction and it taking place. I would be grateful if the Minister could clarify the position this evening.
The Joseph Rowntree Foundation produced a comprehensive review of international evidence on sanctions within systems in which benefits are conditional on claimant behaviour. It confirmed that sanctions strongly reduce benefit use and increase exit from benefits. However, Rowntree also finds that sanctions are generally less favourable in terms of longer-term outcomes, the well-being of children and crime rates, for example.
Every sanction which is unfairly imposed will cause extreme stress to parents, who suddenly find that they have no food for the children and no money even for the bus fare to reach a food bank, and have more debt and so forth. It should be a matter of great concern to the Government that 28% of sanctions are overturned on appeal and a higher percentage—39%—in the case of lone parents. Successful appeals soar for high-level sanctions. Fully 64% of single parents have high-level sanctions overturned on appeal. These must be just numbers to many of us but the Government have a responsibility in my view to report on the mental and physical health effects of the extraordinary hardship behind those numbers. I look forward to the Minister’s response.
Baroness Hollins (CB)
My Lords, I speak in support of my noble friend’s Amendment 34 and focus on the impact of benefit sanctions on people with mental health problems. Mental health professionals are extremely worried about the impact of this, which is why this amendment asks for a report containing data to be published.
The latest statistics around the number of people with mental health problems being supported into work though the back to work scheme are astonishingly low. Just 9% have been supported into employment since the scheme began. There are two key areas where better evidence is needed. We know that more than half of people receiving ESA in the WRAG have a mental or behavioural disorder as their primary health condition, and many more people in the WRAG will have comorbid physical and mental health problems.
We also know that people with mental health problems are being disproportionately sanctioned. Recent Freedom of Information requests to the department revealed that in 2014, on average 58% of sanctions for people in the ESA WRAG were given to people with mental health problems—20,000 in all.
The mistaken assumption is that people do not want to work, and that the best incentive is to threaten benefit withdrawal. Research shows that people with mental-health problems have a high want-to-work rate. I could say a lot more about that, but in view of the time I will not. What are the barriers? We need much more information—hence the request for a report.
I would like to share an example given to me by Mind, the mental health charity. It told me the story of a man who has been out of work for most of his adult life due to his mental health problems and who is currently in the support group. Under conditionality in the work-related activity group, this man felt so fearful and anxious of the threat of sanctions that he forced himself to attend his appointment a couple of days after being hospitalised following an overdose. This is just one shocking example of the pressure claimants are under, the health conditions that people face and, crucially, the level of anxiety and stress reportedly caused by fear of sanctions.
I urge the Minister to take these concerns and this amendment very seriously.
Lord McKenzie of Luton (Lab)
My Lords, this group of amendments is largely focused on the non-income issues and seeks to add the matters of worklessness and educational attainment to the measures, which the Government say are focused on the causes of poverty rather than its symptoms. These matters are important because it is asserted that what is measured and reported on will drive the focus of government attention, although reliance on this approach is inherently weaker than having strategy obligation and specific targets. There will be more about that in later amendments.
In considering Clause 4 and these amendments, we should set the context by reflecting on the starting positions, and that has been done by the noble Lord, Lord Ramsbotham, and the noble Baroness, Lady Manzoor. The current Child Poverty Act 2010, as amended in 2012, contains targets to be met in 2020 that relate to: relative low income; combined low income and material deprivation; absolute low income; and persistent poverty. There are four targets, not just one. It provides for the Social Mobility and Child Poverty Commission—formerly the Child Poverty Commission, and soon to lose child poverty altogether—to give advice when requested to Ministers on how to measure socioeconomic disadvantage, social mobility and child poverty and to report on progress on improving social mobility, meeting the targets and implementing the required strategies.
The Act also requires the publication of a strategy to comply with the targets and to combat socioeconomic disadvantage. In preparing the strategy, consideration must be given to measures—we referred to them as the building blocks at the time of the legislation—including: parental employment and skills; financial support; promotion of parenting skills; physical and mental health; education, childcare and social services; and housing and social inclusion. The Act imposes a requirement for local authorities to co-operate to reduce child poverty in their areas and prepare local child-poverty needs assessments.
As well as having income measures and associated targets, this required the Government to produce a strategy which would have regard to a range of factors, including the multiplicity of matters which affect child poverty. Apart from for Northern Ireland strategies, this Bill sweeps away all those provisions—the entirety of them. We will seek to reinstate this with subsequent amendments. Instead, the Bill requires the Secretary of State to publish an annual report containing data on children in workless and long-term workless households in England and educational attainment at key stage 4 for children in England and the educational attainment of disadvantaged children. There is no obligation on the Secretary of State to define these terms until the first report is provided for, in the year 2017 and a veiled reference to developing “other measures” to recognise what is suggested are the root causes of poverty: family breakdown, problem debt and drug and alcohol dependency. There is no statutory obligation to do so.
There is a reference in the briefing notes to a “life chances strategy” in due course, but no commitment on the scope and timing of this. The commission will have a focus on social mobility and no longer on reducing child poverty. Crucially, the Bill removes any income measure and related targets. This is on the basis that income is a symptom, not a cause, of poverty and that the relative income measure can lead to spurious outcomes when medium incomes are falling.
Welfare Reform and Work Bill
Baroness Hollins Excerpts(8 years, 5 months ago)
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Baroness Hollins (CB)
My Lords, the Government have ambitious aspirations to halve the disability employment gap, to achieve parity of esteem for mental and physical health conditions, and to improve children’s life chances. My remarks will be particularly relevant to Clauses 1 and 13, and are intended to highlight some risks in the Bill and to propose some changes and different approaches.
Clause 1 obliges the Secretary of State to report on progress made towards full employment, but this full employment reporting obligation does not include a breakdown to show whether any progress is being made towards halving the disability employment gap. Such a breakdown would maintain focus on the Government’s welcome manifesto commitment. Does the Minister agree that the reporting duty in the Bill would be strengthened if it included progress towards their wished-for reduction in the disability gap?
The employment rate for people in all disability groups between July and September this year was 47.6%. The gap between unemployment for disabled people and the rest of the population has remained stagnant at 30% for a decade, although it seems to be beginning to grow. People with certain specific disabilities are further underrepresented in the workplace. For example, just 15% of adults with autism are in full-time paid employment.
I have an interest and expertise in learning disability. There are 1.5 million people with a learning disability in the UK. As my noble friend Lord Rix mentioned earlier, fewer than one in 10 adults with a learning disability are in work. Supporting people with a learning disability back to work requires specialist skills. A number of approaches are known to help people with learning disabilities into work. These include skills development; buddying schemes and mentoring; improved access to apprenticeship schemes, especially traineeships and supported internships; and breaking down the structural and societal barriers that prevent people with learning disabilities entering or returning to work. Dr Knight, a psychiatrist colleague and researcher who has helped me with this speech, recently saw three patients with a learning disability. Each of them wanted to work and had experience as a volunteer. None of them, however, has been able to progress to paid employment. The workplace is where efforts should be focused to get people with learning disabilities into work. A good example of that is the recent announcement by NHS England that NHS employers will become model employers of people with learning disabilities. I shall watch that with interest.
The Work and Pensions Committee report Welfare to Work highlighted the ineffectiveness of the current work programme in supporting disabled people into work. It called for a separate, specialist employment programme for disabled people. Scope has produced a range of proposals for what specialist employment support for disabled people could look like. Will the Minister commit to developing detailed plans on specialist employment support for disabled people? The Government have committed an additional £100 million to support people into work by the end of this Parliament, and I join my noble friend Lord Rix in hoping that the Minister will pledge a proportion of the money to getting people with learning disabilities into work.
Clauses 13 and 14 propose to cut the money that new claimants receive within the employment and support allowance work-related activity group, to encourage them to seek work. This group includes more than 490,000 disabled people, the largest group of them having serious mental illness, learning disabilities or autism. Being in this group means that they are not currently fit for work. This might be because of frequent and uncontrollable episodes of aggression or disinhibition; an inability to travel independently outside their home; an inability to learn anything beyond a simple task, such as setting an alarm clock, or an inability to cope with a minor planned change.
The Royal College of Psychiatrists has pointed out that only 8% of people with mental health problems have been helped into work, compared to 24% of those who do not have a health problem. Furthermore, a survey by Rethink found that 78% of respondents said that they would require more support from their GP, community health services or in-patient mental health services if their benefits were cut. A survey by the Disability Rights Coalition found that almost seven in 10 disabled people say that cuts to employment support allowance will cause their health to suffer. Between 2010 and 2013, just over 1 million recipients of the main out-of-work disability benefit had their eligibility reassessed using a new functional checklist, the work capability assessment.
Although reviews of the functioning of the work capability assessment have led to changes in the way that mental disability is assessed, the reviews have not looked at the mental health effects of such reassessments. Doctors and disability rights organisations continue to raise concerns that they have had an adverse effect on the mental health of claimants, but until now there has been no population-level study exploring the health effects of this policy. However, a new study by Dr Barr at Liverpool University was published online yesterday in the Journal of Epidemiology and Community Health. The researchers adjusted for factors known to influence mental ill-health and for baseline conditions. They looked for any association between the reassessments conducted and changes in local rates of suicide, self-reported mental health problems and anti-depressant prescribing rates, in 149 local authorities in England. The researchers found that for each additional 10,000 people who were reassessed there were an additional six suicides, 2,700 cases of reported mental health problems and 7,020 anti-depressant prescriptions, all in working-age adults, and this trend has continued after the economic recovery.
A report of this study in the Guardian today quoted a DWP spokesperson as saying that the researchers did not know how many of the suicides were by people who had had an assessment. This seems to me, however, to miss the point. It is, in the first place, a population-level study—a large epidemiological study. The whole system, however, puts additional mental stress on an already disabled and vulnerable group, and the anticipation of reassessments may be too much for some. The researchers concluded:
“This policy may have had serious adverse consequences for mental health in England, which could outweigh any benefits that arise from moving people off disability benefits”.
These important new findings add weight to the demands from a number of disability charities that Clause 13 should be left out of the Bill altogether. Does the DWP intend to link benefit data to mental health data, including suicide, and how and when will such information be made public? I also agree with the noble Lord, Lord Layard, that being assigned to the ESA WRAG group should trigger referral to IAPT for psychological therapy.
The Bill in its current form has missed a number of opportunities. A focus on welfare rather than help to get back into work misses the opportunity to deliver on the commitment to halve the disability employment gap. There is a missed chance to design proper support to get the 250,000 people with mental health problems who are out of work back into employment. In his eloquent maiden speech the noble Lord, Lord Lansley, suggested that critics of legislative proposals should suggest alternative ways to achieve their goals. I suggest that specialist employment support for disabled people would be more cost-effective than the non-evidence-based so-called financial incentives proposed in this Bill.
Disabled People: Independent Living
Baroness Hollins Excerpts(8 years, 5 months ago)
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Baroness Altmann
My Lords, the Government are committed to this matter and are following it up with research into both the general implementation of the Care Act and the specific impact on former users of the Independent Living Fund. We do not currently have any evidence that those affected by the closure of the Independent Living Fund, 94% of whom were already receiving local authority support, have been unable to maintain the standard of care they require.
Baroness Hollins (CB)
My Lords, is the Minister aware that the recent survey by In Control, referred to by my noble friend, found a significant reduction in well-being among those receiving social support? Will not those transferring from the Independent Living Fund also be affected, and how will the Government prevent the situation getting worse for all those receiving care?
Baroness Altmann
My Lords, the Government are committed to spending on care and support for those who are disabled and vulnerable. Indeed, every year between now and 2020, spending will increase beyond the 2010 level. Local authorities supported the changes to the Independent Living Fund, and people will now be dealing with only one system, whereas previously they dealt with two. The ILF was a discretionary trust; now, there is a statutory underpinning to protect users to the minimum required standard.
Disabled People: Independent Living Fund
Baroness Hollins Excerpts(10 years, 1 month ago)
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Baroness Hollins (CB)
My Lords, I congratulate my noble friend on introducing this debate and on her advocacy for the right of disabled people to live independently. My own interest derives from my work as a psychiatrist with people with learning disabilities for more than 30 years, and as the mother of two disabled adults.
The Independent Living Fund provides important support for more than 18,000 disabled people. I know that many people with a learning disability, particularly those with profound and multiple learning disabilities, have benefited from the fund. The Government’s view that such a discretionary fund should be subsumed into the mainstream social care budget of the local authority might perhaps be an agreeable one if social care were not being so horribly squeezed already and if people with disabilities were not already being adversely affected by cuts to welfare benefits.
My noble friend referred to the serious delays to progress in the post-Winterbourne View programme that aims to move people who are in institutional or supposedly specialist hospital care back into their home communities. This has been held up. Local authorities seem to have no incentive: it is cheaper for cash-strapped local authorities to admit people to NHS or private specialist hospitals than to provide skilled suitable support for them at home.
In the past three years, an estimated £2.68 billion has been cut from adult social care budgets—a figure cited by the Association of Adult Directors of Social Services. Of course, the result has been a tightening of the eligibility criteria, meaning that many people have already lost much-needed support. The Care Bill, a very welcome piece of legislation, sets a national eligibility threshold that is intended to bring consistency across the country. However, the Government have said that they will set the threshold of care at “substantial”, meaning that many people—I am thinking here of people with learning disabilities—will lose out and find their independence threatened. Such a restriction will undoubtedly leave local authorities struggling to deliver on the new well-being principle set out in the Bill.
Organisations such as Mencap, which assisted with research for my speech today, and others within the Care and Support Alliance have highlighted the impact on those with mild and moderate needs losing care as the threshold rises. A few hours of care a week for someone with a mild learning disability might be the difference between living independently and being alone and lonely at home. It might mean being supported to get out into the community, being involved in leisure activities, being helped to organise money and pay bills, and being less vulnerable to exploitation. Last week I watched a play performed by a theatre company of actors with learning disabilities. The play was called Living Without Fear. The actors illustrated graphically the lives of people with inadequate support living at home, and the kind of disability hate crime and exploitation that some people with inadequate support will face.
Many people rely on relatively cheap and low levels of care. The loss of such care risks isolating them and denying them independence—something, of course, that is central to this debate. The Independent Living Fund supports a number of people with low or moderate needs. It is members of this group who might well be hit twice. The focus of the fund on supporting independence could be lost by being subsumed into a general adult social care budget. One worry I have is that the welcome move toward supported living for people with learning disabilities will be slowed down now with a retreat to a residential warehousing model of care, which we have been working so hard over the past 30 years to turn around.
Like the noble Baroness, Lady Campbell, I look forward to the Minister’s response on how the transition will be handled, particularly in light of the increasing financial constraints faced by local authorities. I am interested in the Minister’s comments on how the effects of the abolition of the fund will be evaluated and reported.
Enterprise and Regulatory Reform Bill
Baroness Hollins Excerpts(11 years, 2 months ago)
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Baroness O'Loan
My Lords, in putting my name to the amendment, I would like to endorse the comments made by the noble Baroness, Lady Lister, in relation to the magnificent contribution made by my noble friend Lady Campbell in the context of human rights.
The general duty created by Parliament in Section 3 of the Equality Act 2006 is a profoundly important obligation. It is not vague. Its terms are absolutely clear and quite brief. As Liberty has said, the fact that the commission has not yet fulfilled its potential —and despite its early failings to deliver on its mandate—should not mean that its crucial powers and functions are compromised or circumscribed.
We have heard a description of what Section 3 actually does. It asks the commission to exercise its functions to encourage and support the development of an inclusive society that encourages people to achieve their potential, values diversity, respects the dignity and worth of every citizen, and respects, promotes and protects human rights. It does not, as the noble and learned Lord, Lord Lloyd, said, require the Equality and Human Rights Commission to establish a fair and equal society. That would be vague and impossible of performance. Rather it provides the vision that is necessary to guide the operation of equality and human rights law in this country. It is not uncommon for such a purposive section to be included in legislation. It provides a very necessary statutory underpinning to the operation of equality and human rights law.
When one seeks to work legislation of this type in a day-to-day context, provisions such as this are profoundly important. The legislation that applied to me as Police Ombudsman for Northern Ireland required me to carry out my functions in the way that I thought was best calculated to secure the confidence of the people and the police in the police complaints system. If you were so minded, you could argue that that was similarly vague, but it was not vague at all; it was very precise.
Section 3 provides the principles that are absent from the Equality Act 2010 and which are necessary for the interpretation of that Act. Without it, there would be gaps and deficiencies and, ultimately, Parliament would be required to legislate further on this issue. There is widespread unease and concern, articulated not only in this House this afternoon, at the proposal to remove Section 3—the lobbying has come from wide sectors of society.
I refer to the response of Justice to the Home Office consultation in 2011 on this issue. Justice pointed out that the objectives set out in the general duty were,
“agreed by all political parties in Parliament following amendments proposed by Conservative MPs”.
Justice also stated:
“The General Duty provides a clear mandate which the EHRC must have regard to when deciding how to act. By repealing the General Duty, the mission and very purpose of the EHRC would be altered, and the UK’s commitment to the Paris Principles would be fatally undermined”.
The commission achieved its fundamentally important United Nations “A” status only three years ago. It had to demonstrate compliance with the Paris principles in order to do that. The achievement of “A” status gave it full participatory rights at the UN Human Rights Council and access to other UN bodies. The Northern Ireland Human Rights Commission had had such a status three years previously. That status, with the opportunity for influence and engagement, is important in the context of the international credibility of this country.
Reference has been made by the noble Baroness, Lady Lister, to Professor Sir Bob Hepple’s statements. He has stated that repeal will remove the unifying principle to which both the Lord Chancellor and the noble Lord, Lord Lester, referred when promoting the Equality Act 2006—the link between equality and other fundamental human rights. At the core of the commission’s general duty, and implicitly underlying the specific rights against discrimination, harassment, victimisation and the positive duty to advance equality, is respect for and protection of each person’s human rights.
This is not merely a political statement. It is the difference between the commission pursuing a society in which everyone is treated well and one in which law can be complied with simply because everyone is treated equally badly. When the Commission for Racial Equality investigated ill treatment of black prisoners prior to the creation of this commission, the defence given by the prisons was that white prisoners were treated equally badly. That was a legally sound defence. However, the operation of Section 3 ensured that a use-of-force policy against young men in detention had to be abandoned when the commission intervened. Had Section 3 not existed, the Home Secretary could have simply reconsidered the matter and reissued the policy.
I have seen no evidence that Section 3 has been in any way a hindrance to the operation of the commission, equality law or business. It is a necessary framework within which our equality and human rights law operates. The commission is facing the harsh reality of trying to maintain its UN “A” status while suffering from 76% budgetary cuts and 62% staffing cuts. It will struggle. If Section 3 is lost, the commission will be reduced in status and clarity of mission and purpose. That would be detrimental to the governance of our society.
Baroness Hollins
My Lords, I, too, support these amendments, and I congratulate my noble friend Lady Campbell of Surbiton on her perseverance in this matter.
The lack of respect shown to patients at Winterbourne View and at Mid Staffordshire shocked all of us. Laws must start with values and principles and not rely solely on regulation; nor should they assume, for example, that all public servants automatically hold and understand those values. The Government say that legislation is no place for declaring a mission but I disagree, and there are many people in the Chamber today who also disagree. For example, the Care and Support Bill includes principles which are perhaps individually unenforceable but they are critical because they remind us all that the primary purpose of care and support is ultimately to support the well-being of people. If we want to know how well our care and support system is doing, the well-being of older and disabled people and their families is our litmus test. Section 3 serves the same purpose. It imports these enduring values and principles into the duties of the EHRC and reminds it and us that, above all else, its role is to ensure that, as a society, we are upholding them.
A much celebrated initiative of the EHRC has been its inquiry into the human rights of elderly people receiving care in their own homes. The inquiry uncovered how the human rights of some older people were being placed at risk by care providers who required their staff to carry out tasks such as helping people to wash, dress or eat in time slots of 15 minutes or less. The dignity of older people was not being respected by a system which most assumed to exist principally for that purpose. It also highlighted how, as a consequence of outsourcing home care to private and voluntary sector providers, coupled with a narrow judicial interpretation of the meaning of “public authority” under the Human Rights Act, the majority of older people receiving care in their own homes could not rely on the Act to protect them.
That inquiry looked beyond existing law. It identified anecdotal evidence of an emerging situation, investigated it and made recommendations, including for law reform but equally for practice. It involved a particular constituency—older people—in circumstances where the values and principles of dignity and respect were being placed at risk but in which there were not at that time any legal cases to claim that human rights had been breached. This is not the sort of work that can be undertaken by charities. Charities are not the experts in equality and human rights. They can provide evidence but not leadership. They look to the EHRC to lead and promote.
Lord Cormack
My Lords, I shall intervene just briefly. I was in hospital when this was debated in Committee, but I was very taken by the speech of the noble Baroness, Lady Campbell of Surbiton—the Surbiton charioteer, as I think of her—who spoke with a verve and passion and with considerable conviction. Everybody has spoken in like terms and it seems to me that there has to be a convincing answer from my noble friend on the Front Bench if we are not to go along with this amendment in one way or another.
There is a place for the declaratory. This House said that last Thursday, when, by a pretty large majority, it passed what was in effect a declaratory Motion. There is a place for the aspirational in legislation. There are many precedents and it would take too long even to begin to give examples, but I hope that my noble friend will, at the very least, say to the House this afternoon that she will reflect further on this, if she cannot accept the amendment now, and come back on Third Reading with a definitive answer. I hope that the door will not be shut today.
Leveson Inquiry
Baroness Hollins Excerpts(11 years, 4 months ago)
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Baroness Hollins
My Lords, I thank noble Lords who referred to my family experience earlier in the debate. The noble Baroness, Lady Jones of Whitchurch, spoke about Lord Justice Leveson’s compassion and sensitivity in enabling victims of press abuse to give evidence. I commend Lord Justice Leveson’s inquiry and the manner in which it was carried out. He and his staff made the experience of giving evidence somewhat easier. The decision to give evidence was not an easy one. To be honest, I felt intimidated, as I know did many other victims of press misconduct. Surprisingly perhaps, I was concerned that my words, spoken on behalf of my family, yet again would be twisted by the press.
It has been suggested to me that everything is now in the open, that all victims of press misconduct and unethical press behaviour have now been dealt with. That is so far from the truth. The majority of victims are intimidated and do not take on the powerful press barons lightly. However, I recognise that there are many responsible and honest journalists who themselves need some protection in order to be able to work and to continue to work in an ethnical manner.
Recently, I attended some meetings arranged by Hacked Off. I am usually wary of getting involved with campaigning organisations but Hacked Off has impressed me hugely. It is the only organisation which is faithfully giving a voice to victims and keeping them informed. I ask the Minister to tell this House exactly how many meetings have taken place between government and representatives of victims since the report was published, and how many meetings have taken place with representatives of the press industry.
If any other industry was facing such public criticism and concern, the press would have been investigating that industry’s response very energetically. Why is it then that we do not know exactly what is going on behind the scenes? There are four draft Bills proposing one way or another to ensure that Lord Justice Leveson’s recommendations will be implemented. In some ways, perhaps it does not matter which Bill is introduced as it surely will be amended. However, as a victim or, as I prefer to call myself, an expert by experience, I suggest that Hacked Off’s Bill is the most faithful to the Leveson report and, unsurprisingly perhaps, the least political. Given the Prime Minister’s supposed commitment to be guided by the views of victims, this Bill would be a good place to start. Perhaps I may suggest that Hacked Off’s Bill will be a necessary, transparent and democratic way of ensuring an effective regulator in the future.
The Leveson inquiry was not just about whether journalistic practice was legal or illegal. It was also about the culture and ethics of the press. I agree with my noble friend Lady Boothroyd that we need a cultural revolution in the press and in the country. I would add that the drip-drip effect of little lies and spin have contributed to the cynicism which has seeped into our daily lives.
I will give just one example from my experience. An article in one newspaper contained 28 supposed facts. It was quite a lengthy piece that went over two or three pages. It included photographs of people and places. Of those 28 facts, just two were correct. The others were fabricated and sensationalised. But this information was repeated by other journalists again and again in the same and in different newspapers. None of these journalists checked their information. They simply took it from the internet, reordered it, changed the emphasis and called it an exclusive. In my profession of medicine, that would be called plagiarism. My son-in-law has a creative suggestion that editors should have to give a star rating to all articles. Gossip and unchecked facts would get no stars, while five stars would require the journalist and editor to be able to defend vigorously what they have printed.
My noble friend Lord Trees, in his excellent maiden speech, explained the parallel between press regulation and professional self-regulation with statutory backing. As a member of the medical profession, I concur with his views.
I conclude my remarks by giving emphasis to my own victim test. In, say, two years’ time, will the British public be proud of our free press—proud because it is truthful and fair and respects everyone’s right to privacy and freedom from harassment? I say everyone, because I think that a celebrity who is well known only because of their skill in entertaining us has an equal right to their freedom. In two years’ time, will we have an honest industry that uses ethical and lawful methods and journalists and editors who can defend their sources? When the highest standards have been breached, will victims receive prominent and willingly given apologies? In short, will trust have been restored? I suggest that, as the noble and learned Baroness, Lady Scotland, did, that a little extra help is going to be needed.
Disability Services
Baroness Hollins Excerpts(11 years, 4 months ago)
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Baroness Hollins
My Lords, people from BME communities are significantly under-represented in the uptake of learning disability services. This is despite the much higher prevalence of learning disability in certain BME groups. For example, it is up to three times higher than average in some south Asian populations. It is also higher than average in the African and Caribbean community. The number of people with learning disabilities from minority ethnic communities is predicted to increase substantially over the next 20 years.
Research shows that minority groups have a different experience of mental health services and different outcomes from treatment compared to the white majority, as explained by my noble friend Lord Ouseley. The noble Lord’s comments also apply to people with learning disabilities who also have mental health problems. Valuing People Now, the Government's three-year strategy published in 2009 for people with a learning disability, spelt out the changes needed to make sure that the most excluded groups would benefit fully from health and social care services. I agree with many other speakers that failing to take into account differences in race, religion and cultural identity is the same as ignoring the needs of what can become a vulnerable and excluded group.
Black and minority ethnic groups have been shown to be at increased risk of mental health problems and those from black communities are more likely to be admitted to hospital than those from other ethnic groups. There are various reasons thought to contribute to this increase. For example, for first generation migrants, the actual event of migration is often a traumatic occurrence with major disruptions to family and other lifelong attachments. Many have difficulties adapting to a new culture. Migration is in itself a risk factor for psychiatric illness, particularly psychosis. However, following migration, communities can experience other challenges and insults that can further predispose them to mental health problems and subsequently maintain them.
Some have uncertain asylum status, living in limbo for several months or years while their application is considered, and rejection of asylum may lead to significant mental health problems. Although 90% of asylum applications made in the United Kingdom are rejected, the majority stay on, often because they have no passport or their country of origin will not take them back. Those allowed to stay have the same rights as citizens, but the experience of earlier traumatic events, coupled with new problems related to acculturation, may impede their uptake of services. Several studies, including one by the Leicestershire Learning Disability Register, found that people with learning disabilities from minority ethnic communities have similar levels of mental health and behaviour problems, but that their carers experience significantly more stress and receive less support than their white European counterparts. Low household income and more than one person with a learning disability in the household were also associated with high carer stress. It is perhaps significant that one study found that 19% of south Asian families have more than one child with a learning disability.
Differences in perception of mental health within various cultures and poor knowledge of availability of services can also significantly influence the health-seeking behaviour of people who have mental health problems and individuals with learning disabilities or their families. Some of these barriers are easier to overcome than others. Some take time and dedication and a truly person-centred approach—no two service users are the same. All available research shows consensus in terms of a lack of awareness of services being a major barrier to people from minority ethnic communities accessing care. Mencap and the Institution for Local Government found that families and carers from BME communities knew little about the services they could use or how those services operated and what their rights were. Information about services was so often found to be inaccessible and not in the right language. Language and communication difficulties present problems for potential service users and their families in terms of accessing and using services. Often clinicians have to rely on a family member to interpret and this can lead to further problems in terms of confidentiality and disclosure of information, which may be particularly concerning if there are safeguarding issues.
It may also be the case that family members who interpret select the information they want to disclose, thus withholding important information. When I was acting in clinical practice, I certainly had that experience. Even when professional interpreters are used, families may be hesitant to disclose personal or sensitive information via an interpreter from that same small community. Cultural factors and belief systems may have powerful influences over how families respond and may have significant impact on how or if support is sought. Some cultures may have different ideas about the cause of a disability and choose to seek more traditional healing methods. They may not be interested in exploring western medicine or western educational, psychological or rehabilitative programmes. They may even misunderstand the concept of learning disability and expect a “cure” for their family member's problem.
Research by Mencap showed that many families and carers feel isolated and powerless. A common misconception is that people in BME communities get a lot of support from extended families—which sometimes they do—and therefore need fewer services, such as respite. One professional working in learning disability support within a predominantly Bangladeshi community said:
“The shame and taboo surrounding learning disability makes it difficult for mothers to get help and support. They get little practical support from their families and little emotional support either. The situation is so bad that mothers are more likely to seek help from agencies that are outside their community rather than from Bangladeshi specialist agencies”.
Family roles and dynamics vary greatly across different cultures. Within some cultures, family structures and relationships are hierarchical and women can have a very different role from that in western cultures. Consanguinous unions may be acceptable and commonplace and may contribute to the increased prevalence of learning disability and other severe disabilities. If there are clashes between the views of families and professionals as to which decision is made in the best interests of the patient, a family may subsequently avoid engaging with services. A colleague gave me an example: she was requested by the forced marriage unit to conduct a capacity assessment for consent to be married. The man was a Pakistani gentleman with moderate learning disability who had been taken to Pakistan a couple of months earlier to be married. Although the man was clearly very fond of his wife, he had little understanding of the concept of marriage or of sexual relationships. His parents believed that the marriage was in his best interests and my colleague formed the view that interference by professionals would have caused great conflict between the family and services, and possibly resulted in future non-engagement with professionals.
Currently, many services lack appropriate provision for people from BME groups with learning disabilities. They may be culturally insensitive, not taking into account issues such as the gender mix of services. Many families prefer their disabled female relatives to be cared for in a female environment. Other services perceive BME communities as a homogenous group and may not take into account the many differences found between different communities and fail to identify service users as individuals with their own set of unique needs. There are many incidents of people falling through gaps in the care system. For example, the eligibility criteria used by services mean there must be a clear history of developmental delay. However, such histories are often not available in first generation migrants and problems in language and lack of educational opportunities in their country of origin makes such assessments even more complicated and sometimes invalid. People may be lost as follow-up, due to frequent changes of address during transition from child to adult services. Improving services requires a considerable amount of flexibility from providers in order to engage with the various minority communities effectively.
I want to end by thinking about the importance of cultural competency as an essential component to our services. I hope the Minister will agree above all that a person-centred and culturally competent approach will be key to the success of services in the future.
Enterprise and Regulatory Reform Bill
Baroness Hollins Excerpts(11 years, 4 months ago)
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Baroness Greengross
My Lords, I appreciate the passion and commitment that my noble friend Lady Campbell brought to this amendment and I share her absolute commitment to the aims and objectives of the commission. I have just finished a six-year stint as a commissioner. I was there from the beginning, when the noble Baroness was a co-commissioner with me.
The commission’s aims are beyond dispute and I support them completely, but I share the view of the noble Lord, Lord Lester, that removing Section 3 is not of any great significance. There are things that are much more important in ensuring that the commission’s work will continue, improve and be clearer in the future. I do not think that the section does any harm, but I also do not think that it is terribly important if it goes.
A sad thing is the overriding view that seems to be around now, perhaps in government and perhaps everywhere else, that the commission has failed. I challenge that, as I think that the commission has done some excellent work during the six years that I have been there, in spite of enormous difficulties in trying to meld a whole lot of additional categories of people to be protected, as well as the original protected groups, with the people representing those groups feeling that they were going to be in some way diluted. That has made life very difficult in the commission, but I think that many of those difficulties have been overcome.
Society as a whole still has huge problems—I agree with the noble Lord, Lord Ouseley, about that. We still have racism and there is still a stigma attached to disability and so on. However, there have been major achievements in the recognition of that, in the ability to speak about it and in the protection of many people who were not protected before. There have been a lot of improvements. The work of the commission should not always be criticised as vague and not achieving anything, as there have been some significant achievements. I say that on behalf of colleagues and former colleagues who have done the majority of that work, which I think needs to be recognised.
The fact that the Joint Committee on Human Rights will in future scrutinise the commission’s business plan and there will be increased parliamentary involvement—for example, the pre-appointment scrutiny of the new chair—is a big improvement. We have been looking at all the things that still need to be done as if everything is totally negative, but having experienced six years of the commission I think that quite a lot has been very positive, including greater transparency about the Government’s funding decisions.
It will be sad if the general duty goes, as removing it is not a huge priority, but I do not think that it will affect the work of the commission. To that extent, I do not think that the Government have to worry too much. We have to work hard to ensure that the commission’s aims are met in the future. More specific duties and responsibilities ought to be useful in improving the situation and making sure that the aims are met. I am sorry if I am in a minority here, but I am passionate about what the commission stands for and I want to acknowledge some of the good things that have happened in the six years during which I have been involved in its work.
Baroness Hollins
My Lords, despite the legal view presented by the noble Lord, Lord Lester, I refer us back to some of the words spoken by my noble friend Lady Campbell of Surbiton. She said that the inclusion of dignity in the commission's general duty provides the glue to bind together anti-discrimination and human rights. I think I got that right. I agree with that and other important points that she made in her eloquent speech. Such an approach underpins the accepted goal of living with dignity and independence. As such, Section 3 is critical in providing coherence to the commission’s duties to promote equality and human rights. I was involved with one of the commission’s predecessor organisations, the Disability Rights Commission, in a major inquiry conducted into discrimination in access to health services by people with learning disabilities or mental illness. It indeed found discrimination; it was very effective and led to some improvements in access to healthcare for those groups. It is very important that such issues continue to be seen as a priority and investigated.
I worry that, without Section 3, that priority may be lost. I oppose the removal of Section 3. It has an important role in focusing the commission’s various duties, and I add my support to the amendments tabled by my noble friend.
Baroness Prosser
My Lords, I did not intend to speak in this debate, but I have been fired up by comments made. I start by declaring an interest as having spent six years, until the beginning of December 2012, as the deputy chair of the Equality and Human Rights Commission. I shall be brief. I know that the noble Lord, Lord Lester, and the noble Baroness, Lady Greengross, are not alone in considering that the loss of the section would not cause any harm. Obviously, I respect the right of people to hold a different view, but I make the point that there is a long history in legislative terms of overarching statements of intent being extremely useful to judges and others when determining the meaning of legislation—so, even on that level, it has a value. I run with my noble friend and the noble Lord, Lord Low, especially in his comments that this has a symbolic value. In this country, we are far from being able to consider that there is no further need for symbols, promotion, ideas, excitement or energy about the equality agenda. We are lacking that in great amount at the moment. We need to be as positive as we can about the need for an equality programme within our society. We continue to need to encourage and explain to people the value to society as a whole of the equality agenda.
Finally, having been deputy chair for six years, it is unsurprising that I take exception to some of the comments made about the equality commission, many of which seem to me to be based on myth upon myth. I agree that there have been issues and problems far too complicated and outside the remit of the equality commission to go into here. Equally, I would say that there is a tendency on the part of many to look back at the pre-Equality and Human Rights Commission era and look at the previous commissions through rose-coloured glasses. People involved in each of the three commissions have done that. This has not been a steady or an easy path since the 1960s, when legislation was first introduced to try to address some of these issues. We need to be careful about making comments about the role of the EHRC in recent years without making sure that we are really clear about the issues, why they have arisen and what has been done to try to detract from them. I support this amendment because it is part of a programme of encouragement of a society becoming more equal, understanding and tolerant.
Welfare Reform Bill
Baroness Hollins Excerpts(12 years, 3 months ago)
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Baroness Browning
My Lords, I should like to talk directly to my noble friend the Minister about money, because we all understand the imperative to reduce the deficit and how, right the way through the Bill, trying to cut back has been part of the debate on almost every clause. However, this amendment seeks to attain proportionality between that higher and lower amount of addition made to universal credit for disabled children.
I come back to a question that we have raised in previous debates: what exactly do we mean by “disability light”, because that is really what we are talking about. These are still disabled children, in the same way as, in other parts of the Bill, they are still disabled adults. It might be presumed that it is somehow like comparing a light head cold with a really nasty bout of flu, but I say to my noble friend—I should have referred to my interests in the register—that it is not like that. For children with disabilities who will lose this huge sum of money and for their carers, particularly the parents, the impact will be great. We have already heard in your Lordships' House today about the impact on some—not all—families of caring for a disabled child, as well as on the relationship between the parents and—and this should never be forgotten—on other siblings. Usually there are other people in the family. They all share in the responsibility when they share a household with a disabled child.
I have spent many years dealing with casework for what must run into hundreds, if not thousands, of adults and children on the autistic spectrum. If this is about money, I hope my noble friend will take my word for it that although they might be considered as “disabled light” in childhood, a huge proportion of them will be the big bills to the public purse later on in adolescence and adulthood. Not only is the human cost of that tragic and avoidable—because most of it is avoidable, if it is properly planned and cared for—but there is the economic aspect. Just putting in the basics early enough, some of which are very low-budget items, can prevent the very big crisis-budget bills that inevitably come. I say “inevitably” quite deliberately, because that is what we know happens; it is well recorded. We have enough evidence of this right across the whole disability spectrum, particularly in some of those spectrums that I take a particular interest in, which are not immediately visible. They are the ones where there is no obvious physical disability but which none the less have a profound impact on the individual concerned. I do not want to overegg this, but Members of the House will have seen the headlines. We see these tragic cases where parents have a disabled child who is sometimes of school age but sometimes an adult dependent child; for those parents, childhood does not end at 18 or when they leave education, it goes on year after year. I can think of some pensioner parents with pensioner-age children still living at home and wondering what is going to happen to them. This is a lifetime commitment for parents.
I am quite sure that if my noble friend, and certainly the Treasury, have done the cost-benefit analysis that I asked for when we discussed DLA in the context of this Bill, they will find that this amendment, although not what the Government are proposing, will save the public purse over the medium to longer term. If we look at it in those crude terms—because that is what I feel they are—we will save a lot of pain and anguish. We will certainly save lives. At the end of the day, it will also save the Exchequer money in some part of the public sector where it will almost certainly have to be found in a hurry.
Baroness Hollins
My Lords, I stand very briefly to support this amendment. As a psychiatrist who has worked for many years with families with disabled children such as those we have been hearing about, I feel very strongly about the point that the noble Baroness, Lady Browning, made about proportionality. It is very difficult to base the cost of having a disabled child on whether the child needs care at night or only during the day. This relates particularly to children who have very difficult and challenging behaviour, including those with learning disabilities who might have attention deficit syndromes or autistic spectrum disorders. This amendment needs very careful and thoughtful consideration.