Schools: Special Needs Pupils
Baroness Hollins Excerpts(1 month, 2 weeks ago)
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Baroness Barran (Con)
The Government are acting on a number of those issues. On diagnostic testing, as the noble Lord well knows, our approach is that the child should not need a diagnosis to be eligible for support. Early identification is incredibly important, and the Government are doing a great deal to train up the early years workforce and provide more specialist educational psychologists. More broadly, the shape of special educational needs has changed a bit over the last five years, with a much greater prevalence of social, emotional and mental health needs and of children with an autism spectrum disorder, and we are working closely to address that.
Baroness Hollins (CB)
My Lords, 96% of education, health and care plan appeals are successful, but in less-affluent areas parents are less likely to appeal an EHCP decision, which must contribute to the current inequalities in provision. What are His Majesty’s Government doing to achieve greater equality in the support offered to all children with special educational needs?
Baroness Barran (Con)
The noble Baroness is right about the success of appeals, but I point out that just over 2.3% of all decisions went to appeal. Although the success rate is very high, the level of appeals is perhaps lower than the House might believe from the media. We are currently trying to test a range of measures that will mean that the quality of decisions—and, crucially, the confidence that parents can take in those decisions—is improved. That includes testing a single national education, health and care plan template and guidance, testing multiagency panels to improve the quality of and parental confidence in decision-making, and resolving disagreements quicker by strengthening mediation.
Pupil Mental Health, Well-being and Development
Baroness Hollins Excerpts(2 months, 2 weeks ago)
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Baroness Hollins (CB)
My Lords, I congratulate the noble Baroness, Lady Bennett, on an excellent opening speech. I agree that our schools could do much more to prepare pupils for the challenges of today.
I declare my interest as founder and chair of a small mental health charity, Books Beyond Words, which I shall mention briefly later. Before I became a Member of your Lordships’ House, I was a clinical academic psychiatrist, specialising in child and adolescent mental health as well as in learning disabilities. As a community psychiatrist, I regularly went into schools—usually special schools—to consult teachers and think with them about the needs of their children. I agree that prevention is better than waiting for a crisis.
Like other noble Lords, I have had briefings from a number of mental health charities working in schools to improve children’s mental health, including Young Minds and Speech and Language UK. The briefings highlight that more than one-third of children and young people with mental health needs also have special educational needs, including speech and language difficulties.
This week is Emotional Health Week, promoted by the Centre for Emotional Health. Yesterday, its focus was on child development. Research clearly shows the impact that our relationships and emotional health in childhood—particularly in early childhood, but throughout the school years as well—will have on our future life chances. Last week the centre, in partnership with Demos, launched a paper called Strong Foundations: Why Everyone Needs Good Emotional Health - and How to Achieve It. It made several recommendations, including that the Department for Education should develop evidence-based guidance for schools and colleges on how best to implement learning about emotional health—in other words, what I call emotional literacy. This report included a recognition of how picture books can support social and emotional learning for children.
This resonates with me, as the founder and chair of Books Beyond Words. The charity works with artists to create stories in pictures about the everyday challenges that children face. Recently, the charity has been working in a pilot group of schools to see how word-free books can support the emotional well-being of primary school children as well as young people with special educational needs and improve teacher confidence in talking about common mental health challenges. An independent evaluation found a strong causal link between the creative reading of word-free stories, usually in small groups, and pupil progress towards improved emotional well-being, stronger peer relationships and an ability to express a range of feelings. Being able to recognise and express our feelings, such as anxiety, frustration and stress, can reduce the distressed or challenging behaviour that sometimes leads to the school exclusions highlighted by Young Minds. Exclusions are not the answer. Children with poor emotional health find it difficult to learn and are reluctant to go to school.
Using pictures rather than words helps children of all ages and abilities to engage with the topic and to express themselves. They can identify their feelings, discuss coping strategies and be empowered to speak up for themselves. After just one term of using word-free books once a week, 95% of pupils made progress towards being able to express and recognise a range of emotions. Case studies showed that attendance improved, and they had better than expected achievements in tests—all evidence of the importance of good emotional health.
I suggest that schools have a crucial role in fostering a nurturing environment and moving away from a punitive culture. Children need to feel comfortable and safe at school. School targets need to be more holistic. Ignoring well-being does not lead to overall better outcomes. Schools need to adopt a whole-school approach to mental health and well-being, which aims to promote mental well-being and to intervene early when common mental conditions present, such as depression, anxiety and self-harm. A whole-school approach to mental health and well-being is a cohesive and collaborative action in and by a school community, strategically constructed with the school leadership—that is really important; school leadership has to be on board. There also needs to be an ethos that promotes respect and diversity. The curriculum and teaching should help children and young people to develop their resilience and support their social and emotional learning.
We know that childhood is a period of extraordinary potential. Get it right, and we are investing in the whole of society. We know that adverse childhood experiences are key predictors of poor physical and mental health and well-being throughout a person’s life. We know that prevention is better than cure. I consider that a child’s emotional well-being and mental health cannot be considered in isolation from their school environment and the culture within that school.
There is burnout among some school staff, recruitment and retention issues and school staff reporting that they feel unequipped to manage the mental health needs of their pupils. There are high levels of persistent absence, and we know that young people who are absent from school are more likely to have a mental disorder; a punitive approach is therefore rarely the answer to poor school attendance.
Let me tell your Lordships about Sarah. She started to struggle with her mental health when she started secondary school. She was involved in a car accident over the summer holidays and became increasingly anxious about leaving her home. She had already been finding school difficult and started missing days at school. When she did manage to get to school, she was told off by teachers for her poor attendance, which made it more difficult to attend. Nobody asked her why it was so difficult to go to school. Her anxiety got worse, as did her attendance. Then her parents were asked to pay fines because of her poor attendance. She has now been out of school for a year and remains on a waiting list for CAMHS.
What are the solutions? I do not really have time to talk about them, but I agree that schools need to be more fun. They also need to be more real, addressing the things that really matter to children and young people.
Schools: Persistent Absenteeism
Baroness Hollins Excerpts(3 months, 1 week ago)
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Baroness Barran (Con)
I share many of the noble Lord’s concerns and am more than happy to follow up on his points.
Baroness Hollins (CB)
My Lords, we know that mental and emotional distress has increased hugely since the pandemic, that children who are distressed cannot learn, and that children who are not learning but failing at school will stay away from school. I think the Minister said that, by 2025, 50% of schools would have good mental health support, but I cannot see 50% as being enough. Can the Minister comment?
Baroness Barran (Con)
I think we have to be careful: without question, mental health and anxiety have increased from the pandemic and the disruption that children experienced but, equally, a prolonged period of absence is also likely to heighten a child’s anxiety about attending in the future. I say to the noble Baroness, and to the House, that there are schools doing remarkable things, particularly in relation to children on education, health and care plans and children with special educational needs. I was in two schools in Birmingham on Friday: Lea Forest primary and Four Dwellings secondary. Those schools have a remarkable attendance level, particularly for the vulnerable children to whom she refers.
Apprenticeships: Disabled Students
Baroness Hollins Excerpts(6 years, 3 months ago)
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Lord Agnew of Oulton
My Lords, there is a range of broader supports available to apprentices with learning difficulties who are not necessarily on an education, health and care plan. There are four particular areas that are broader: they are not just for apprentices but are appropriate for apprentices. First, there is a legal duty on employers and providers to take account of any reasonable adjustments, such as extra time needed in exams. There is additional learning support, initially of £150 a month, but this can be increased through the earnings adjustment statement, up to £19,000 a year, assessed by the training provider and approved by the ESFA. There is a programme called Access to Work which involves, in particular, a letter from the Department for Work and Pensions given to the individual with a disability to give to his or her employer, and this can provide financial support of up to £42,000 a year to help with holding down a job.
Baroness Hollins (CB)
My Lords, apprenticeships are in many ways perfect for people with learning disabilities, because they provide a chance for someone to show what they can do with a supportive employer. Indeed, Mencap has recently taken on seven such apprentices. However, barriers persist, including the English and maths part of the qualification. Does the Minister agree that we need to ensure that the appropriate flexibilities apply here, too, as so many people will not be able to meet those requirements?
Lord Agnew of Oulton
My Lords, we are taking a flexible approach to these areas and we have recently announced, for those with learning disabilities and difficulties, that there will be additional time allowed for specific subjects including maths and English. We will also take into account the lower level of attainment needed, as long as it does not impinge upon that particular apprenticeship.
Secondary Schools: Counselling Services
Baroness Hollins Excerpts(7 years, 2 months ago)
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Baroness Hollins (CB)
My Lords, are there any plans for the CQC and Ofsted to work together to inspect how well schools are looking after the mental health and well-being of their children?
Schools: Health and Well-being
Baroness Hollins Excerpts(8 years, 10 months ago)
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Baroness Hollins (CB)
Does the Minister agree that it is time for a ban on the marketing of unhealthy food and drink to children and young people?
Queen’s Speech
Baroness Hollins Excerpts(8 years, 11 months ago)
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Baroness Hollins (CB)
In Her Majesty’s gracious Speech, we heard that her Government intend to,
“secure the future of the National Health Service”.
There would be widespread dismay if this intention were not honoured. However, the NHS is limping. That is not helped by an overdose of bureaucracy, and is made worse by a grave shortage of general practitioners and nurses, continuing shortages of mental health professionals, and serious underfunding of mental health services.
However, Her Majesty’s Government have recognised some key areas for investment, notably the need to introduce measures,
“to improve access to … mental healthcare”.
This is a very welcome promise, because during the last Parliament, funding for mental health services was cut in real terms by 8.25%—almost £600 million. I join the noble Baroness, Lady Tyler, in asking the Minister how much of the additional £8 billion committed to the NHS by 2020 will go towards these measures to improve mental health care.
For too many years, mental health has been considered the poor cousin of physical health—something I know all too well as a past president of the Royal College of Psychiatrists. A staggering 7 million people experience mental illness at any one time, touching an estimated one-third of all households. A further 2 million British people are expected to experience mental illness by 2030. We need public mental health prevention strategies, not just better access to treatment.
During the last Parliament, the burden of mental illness was at last recognised, in part because of the courage of Members in the other place in speaking about their own mental illness, and in part because of my own amendment to health and social care legislation, which defined health as mental and physical health, and illness as mental and physical illness. The principle of parity of esteem for physical and mental illness was adopted, with parity of outcomes becoming a policy objective. Effective legislative and funding decisions will be needed as levers to sustain a government focus on parity over the coming years, as well as investment in developing the evidence about what works best.
Only 5.5% of the UK health research budget is spent on mental health, despite mental illness accounting for 25% of all illness. I was pleased to hear that an overarching goal of the Government is to promote social cohesion through legislating in the interests of everyone in our country. There was no specific mention in Her Majesty’s Speech of how the needs of people with learning disabilities, a particularly vulnerable group, will be protected in the legislative programme. This is a significant group, numbering about 1.5 million people in the United Kingdom—people who live their whole lives with a learning disability.
I worked clinically as a psychiatrist for more than 30 years with people with learning disabilities, retiring from the NHS in 2008. People with learning disabilities have six times the risk of mental health problems and three to four times the risk of developing dementia, so when talking about mental health problems, we are also talking about issues that particularly affect people with learning disabilities. These issues are all the more pertinent to me, as the mother of an adult with a learning disability. I have lived experience, through my son, of the challenges arising from the lack of integration of health and social care, limited personalisation of commissioned care packages, the lack of nurses specifically qualified to care for people with a learning disability, and the lack of doctors and nurses who know how to use their skills for the benefit of this patient group.
The coalition Government’s Green Paper of March 2015, No Voice Unheard, No Right Ignored, proposed to strengthen the rights of disabled people and their families, and in particular to challenge hospital admissions and to support people with learning disabilities to live independently in their local communities. The consultation period has ended. Can the Minister confirm the timetable for reporting on this consultation?
Simon Stevens, the chief executive of NHS England, has placed,
“support and care for people with learning disabilities”,
as one of the four priorities in the NHS business plan for 2015-16, alongside mental health, cancer and diabetes. In February, he also committed at the Public Accounts Committee to begin a closure programme of assessment and treatment units for people with learning disabilities. This followed Sir Stephen Bubb’s report, Winterbourne View—Time for Change, which highlighted the outdated and inappropriate practice of keeping people in long-stay institutions a long distance from home.
Care and treatment reviews undertaken by NHS England in the last few months are beginning to bear fruit, with the number of discharges beginning to reduce the number of people inappropriately placed in in-patient hospitals. The Government’s intention to integrate health and social care is welcomed and is expected to improve the lifelong mental and physical health and well-being of people with learning disabilities—a seamless service, co-created with each service user, as envisaged by my noble friend Lord Bichard.
Mencap highlights the need for training on learning disabilities for all health professionals. In the last Parliament, I introduced two debates on inequalities in healthcare for people with learning disabilities. The confidential inquiry reporting two years ago found that 37% of deaths were considered avoidable had there been an adequate health response. This equates to more than 1,200 people across England dying every year because they do not get the right healthcare. Therefore, there is a huge training agenda if we are to address some of the gaps in service provision.
Slow progress was made by the coalition Government in both learning disability and mental health care. I intend to focus my efforts in this Session on scrutinising legislation and progress in these two areas.
Special Educational Needs and Disability Code of Practice: 0 to 25 years
Baroness Hollins Excerpts(9 years, 9 months ago)
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Lord Storey (LD)
My Lords, I want to be very positive about this code of practice because I think that this is an historic moment for special educational needs and disability. I start by paying tribute to everyone involved because we are light years away from where we were before. Two years ago I was a teacher who had to look at colleagues who were not prepared to offer a duty of care to children with medical conditions. Now that will change, and it is to do so straightaway. Two years ago, schools did not have to have a qualified teacher as a SENCO, but now they do. I would reflect on the fact that after three years in post, those SENCOs must have the national qualification. To my mind, in terms of mainstream schools, we are light years away from where we were before. As I say, I pay tribute to all those who have been involved in putting together this code of practice. The 270-odd pages that make up the code are actually very clear and readable. I would guess that if this document was handed over to the plain English society, it would probably get a high score. Ministers, the Government and all those involved have listened and consulted, which means that changes have been made.
I have a number of particular questions, some of which have been raised already. Perhaps I may go over them. I should like to know what the process will be when changes occur. What is the procedure for adding something to this document? I have already mentioned to my noble friend the Minister that I am particularly concerned about the issue of young people sustaining concussion as a medical condition in school. At some stage we will need clear guidance on that. However, it is only one of a number of things. How, in the months and years to come, do we go about looking at those areas where we have real concerns?
I should have thought that 12 months was too short a period for a review, but an appraisal needs to be made at some stage of how this document is actually working in practice in schools. I would also be interested to know, perhaps through Ofsted visits and through general feedback, how the clear responsibilities for SENCOs in schools work in practice. A noble Lord asked who the responsible people are to be. For the first time, for mainstream schools, what SENCOs have to do and are responsible for doing is clearly set out and there is no hiding from that. They are responsible to the head teacher and the head teacher is responsible to the governing body of the school.
Mention has been made of local authorities. Again, we know that practices vary widely across different parts of the country. This code of practice means that local authorities will have much greater clarity about what they are responsible for and what they should do. Again, that is light years away from where we are.
A hugely important issue is that of continuing professional development. The schools have now broken up and this document will land on desks in September—it will be a soft landing, I hope—but we need to make sure that over the coming terms, all staff in schools have access to professional development so as to be able to understand their responsibilities, the importance of the code, and what should now happen.
Again, issue has been made about those young people who are not on an education, health and care plan. I am used to a system of school action and school action plus which is replaced by a graduated approach. As the debate has taken place, I have had reservations about the graduated approach because it is not absolutely clear how children will progress. I do not expect the Minister to answer—we have had that debate before—but at some stage we need to come back to that issue and be satisfied that that graduated approach is working.
I am going to end as I started by congratulating everyone involved. I am sure that in years to come this time will be regarded as, if you like, not the end of the matter—of course that will not be the case because the points made by the noble Lord, Lord Low, will happen, but over time—but as the starting point to allow those changes to take place.
Baroness Hollins (CB)
My Lords, I echo what other Peers have said about the welcome strengthening of the code, if not its length. I know many in the sector are appreciative of the changes. Having been a member of the recent post-legislative scrutiny committee on the Mental Capacity Act, I would like to comment on the sections of the code that interpret how the law will apply to young people who may lack capacity.
The Bill, quite rightly, gives new rights to young people over the age of 16 to make decisions about their support, subject to their capacity to do so. However, it is unclear in the code who decides whether a young person lacks mental capacity. Is it the young person, their parents, the school or the local authority? The voices of the young person and the parents should, of course, be heard throughout this and I would welcome clarification from the Minister on this point.
Building on this, it is critical to ensure that decisions that young people make are not overly shaped by the desires and agendas of others, including local authorities and other professionals. Mencap has discussed its point of view with me. It would like to see emphasis placed on ensuring that young people get the support they need to understand properly the decisions they are making and to be helped to make an informed choice, both about their support and what they might wish to do after school.
I refer to Annex 1, which sets out the five key principles in decision-making when someone may lack capacity, but clarification is needed about the process to follow regarding a young person who is judged to lack capacity. The code states that in such a situation decisions will be made by a representative who is,
“a deputy appointed by the Court of Protection”.
Currently, under the Mental Capacity Act, a formal process is not always needed and a formal deputy does not always need to be appointed. Can the Minister clarify this and say whether the code is implying that a new type of education deputy will be introduced rather than following the best-interests process currently used for adults? It is not clear from the code how a decision on whether a young person has capacity can be challenged and I would welcome the Minister’s response.
We must remember that the Children and Families Act 2014 brings in new decision-making rights for young people aged 16 to 18 in terms of education. This is a very new area for the Mental Capacity Act to be applied in. I agree with my noble friends that it would be sensible to review how the code is working at an appropriate point and to focus specifically on this area of implementation of decision-making capacity judgments within such a review.
Schools: Emergency Life Support Skills
Baroness Hollins Excerpts(10 years, 3 months ago)
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Lord Nash
As the noble Lord will know, this Government believe as a matter of policy that prescription from the centre has not worked. The evidence of the performance of our school system over the past 15 years speaks for itself. However, we believe, as we have debated many times in this House, that PSHE and programmes such as first aid are incredibly important, and we are sending out messages as far as we can. We have a new PSHE review and we are engaging with bodies such as the PSHE Association to get the message out to all schools that this kind of programme is very important.
Baroness Hollins (CB)
What impact assessment has been made of the effect of relying on voluntary organisations such as the Boys’ Brigade, the Scouts or St John Ambulance to teach vital emergency life-saving skills, instead of including this on a national curriculum? I agree with my noble friend that the biology course could teach these highly relevant practical skills.
Lord Nash
I am not aware of any impact assessments. If I hear of any I will send them to the noble Baroness. The view of the Government is that, as with PSHE, rather than have prescriptive detail—in words on a piece of paper—of what should be taught, it is much better to encourage schools to engage with expert organisations, such as the ones to which the noble Baroness referred. They are the professionals: they are focused on a particular area and can constantly update their material.
Children and Families Bill
Baroness Hollins Excerpts(10 years, 3 months ago)
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Lord Low of Dalston
My Lords, my name is on the amendment and I wish to give my full support to my noble friend Lord Rix, who moved it. It would place a duty on local authorities to deliver the social care services identified in education, health and care plans. The contention of the noble Lord, myself and the other noble Lords who have their names on the amendment is that there is very little point in assessing a child or young person’s needs, identifying social care needs and putting them in the education and health plan, and then not making the plan enforceable in respect of social care as it is in respect of education provision.
As I think the noble Lord, Lord Rix, indicated, the amendment would add no new duties on local authorities to provide social care in addition to those that already exist. It merely brings together the legislation on education, health and care plans and existing social care legislation. There is currently a misconception that the social care duties in respect of disabled children are not specifically enforceable for an individual child. However, as I think the Government accept, this duty does already exist under Section 2 of the Chronically Sick and Disabled Persons Act 1970. The proposal contained in this amendment would help to correct this misconception.
The Government have argued that a proposal to create an individually owed duty in relation to social care would prioritise one group of children in need over another. However, there is already an individually owed duty to disabled children in Section 2 of the Chronically Sick and Disabled Persons Act, as I indicated, which is not enjoyed by other children in need. We had a good discussion about this in one of the Minister’s meetings with Peers, which I think we all found very valuable in developing our understanding of the Bill. I think we managed to elucidate in that discussion that if one were going to establish priorities between different groups of recipients of social care, it would have to be done at a prior stage to the formulation of the education, health and care plan. If the authority has got to the point of identifying social care needs and putting them in the plan, it really does not make any sense in terms of integrated education, health and social care provision not to make the provision identified in the plan enforceable.
Baroness Hollins (CB)
My Lords, I, too, add my support to the amendment moved by my noble friend Lord Rix, which aims to ensure that children and young people receive the care to which they are entitled. I empathise with the battle to get health, education and social care agencies to work together; it is one that I waged on behalf of my son in the past. I know, of course, that I am not alone here and that parents across the country face this uphill struggle.
The absence of a duty to deliver the social care elements of the plan sends out the dangerous message that care is unimportant alongside education and health provisions. It is, as my noble friend says, the poor cousin. For children and young people with a learning disability and their families, this could not be further from the truth. Good social care plays an important part in helping the child or young person achieve their educational goals. That is accepted, whether it is in relation to independent living, supported employment, employment or moving on to further learning. Good social care prevents burnout in families. I understand and am glad that the Government have accepted that there is an issue here, and I look forward to the Minister’s response.
Baroness Hollins
My Lords, I, too, added my name to this amendment. My noble friends Lord Rix and Lord Low have eloquently set out the logical intention behind the request to create a single point of appeal across education, health and care. If we are to create a truly joined-up system that really works for children, young people and their parents, this seems to be an absolute necessity. I speak as a parent who has worked hard to get the right support across all three systems and cultures for my son. The Government propose a single point of assessment, but the same old separate routes for redress and complaint, which will continue to bewilder and confront parents. We should aspire to more.
To focus on health needs for a moment, there are significant concerns among those in the sector that the health service is far from prepared to deal with appeals for the new plans when they are introduced from September this year. We should be mindful of the culture in which complaints and appeals happen in the NHS, and it is not quite clear where parents who are concerned about the health component of the plan would start. Ann Clwyd’s excellent recent report concluded that the NHS complaints system was confusing, lacked accountability and was subject to often long and frustrating delays. The system has been particularly unsatisfactory in the face of complaints from families of people with a learning disability.
Prior to a debate that I secured last year on the premature deaths of people with a learning disability, I met with a number of families who had lost loved ones to neglect and discrimination within the health service. Their experience of going through the NHS complaints process was that, in addition to being overbureaucratic and time-consuming, it was very defensive. They explained that it took years in many very serious cases to receive any sort of answer. A single appeal process for a single education, health and care plan might help us move closer to the joined-up system we are looking for, and ultimately help parents get what is needed for their sons and daughters.
Lord Storey
My Lords, I, too, moved an amendment in Committee on a single point of appeal. It beggars belief that you would have progressive legislation that creates for the first time a joined-up approach to education, health and social care but not a joined-up approach to an appeals mechanism. Everybody I have spoken to agrees with that.
Of course, the problem is the current systems that we have, so the notion is that we establish a Bill that creates single education, health and social care plans but then the appeals mechanism is threefold. We expect in this child and family-friendly approach for parents then to navigate their way through these different systems. Currently, the health appeals mechanism is not very transparent and on patient or family satisfaction ratings is very low indeed. Local authorities, as we know, vary.
What do we need to do? First, the code of conduct very much highlights the need for mediation—but it talks about mediation in terms only of education, not on the health and social care side. I hope the Minister might respond by telling us how we bring the mediation together for all three strands of the plan. In my view, mediation could considerably reduce the number of people wishing to appeal.
Then you come to the appeals mechanism itself. Whatever happens here today, I am utterly convinced that, in the years that follow, there will be one tribunal for these plans. The difficulty is the bureaucratic systems, as eloquently extolled by the noble Lord, Lord Low. Currently, the bureaucracy is not fit for purpose. My great fear is that we push the bureaucracies to agree one tribunal, they go kicking and screaming, and the whole thing does not work. We have to negotiate and make sure that everybody is on board to make this happen. Having talked to Ministers in health and education—though having been slightly disillusioned by officials—I am sure that we can achieve that eventually. We need to give my noble friend Lord Nash more time to continue those negotiations. Again, as has been said, I am sure that on the education side we all agree.