Health and Social Care Bill

Debate between Baroness Hollins and Lord Wigley

Wednesday 16th November 2011 Lords Chamber

[Baroness Hollins]

My Lords, as my noble friend Lady Finlay has eloquently explained, alcohol misuse is one of the major public health challenges that we face in the UK. It causes wide harm to individuals and places a significant burden on the National Health Service. Even more widely, it has a devastating effect on families, on communities and within wider society, and it is vital that the reforms to the NHS are effective in helping to address this challenge. This is an important debate in an uncertain time for alcohol services. I understand that local authorities are set to commission alcohol services out of their ring-fenced £4 billion budget, but there is no guarantee how much of that will go to alcohol services. Furthermore, public health is a wide-ranging area and there are concerns that alcohol services may have to compete with wider public health initiatives.

I hope that the Government will use this important opportunity to show how alcohol services will be prioritised in the reforms. I know that one particular opportunity lies in the Government’s alcohol strategy which is expected in the near future. I would welcome a commitment from the Government that this strategy will make clear how alcohol services will be made a priority in local authority delivery and in primary and secondary NHS care. At the same time primary care and the new clinical commissioning groups will need to continue to play a key role in screening and treating people with alcohol misuse problems, and it is vital that they are incentivised to do so.

The quality and outcomes framework is a vital primary care lever to ensure that GPs prioritise specific conditions. At present there is one very limited QOF indicator on alcohol to provide lifestyle advice to patients with hypertension. The Government have indicated that 15 per cent of the QOF funding will be assigned to public health and primary prevention indictors from 2013. However, at present all of the proposed public health indicators are focused on smoking, and the indicator on screening for alcohol misuse has, regrettably, been rejected.

What is clear is that integration of services will be the key to ensuring that people with alcohol misuse problems are not lost in the system and that the various agencies involved in care work together. The amendments in this group make the important case that people who understand alcohol misuse and alcohol services should be involved in health and well-being boards and in producing health and well-being strategies. Health and well-being boards seem to present significant opportunities ahead, but only if alcohol is made a clear local priority.

[Lord Wigley]

My Lords, I rise with some trepidation as this Bill applies to England only, although there are some consequential effects on Wales. As I was speaking in Grand Committee on the Welfare Reform Bill upstairs a moment ago on initiatives in Wales which should be copied in England, I hope that initiatives in this area will be copied by the National Assembly for Wales and I very much hope that the spirit of the amendments, some of which I have my name alongside, can be taken on board by the Government, even if the wording is not perfect.

I welcome the address made by the noble Baroness, Lady Finlay, in opening this debate and pay tribute to the work that she has undertaken in this context, which is recognised all round. I come from a generation in Wales where we used to have to smuggle ourselves out to the pubs because of the general ban on alcohol that used to exist. In previous generations, understandably and rightly, there had been a clamping down on alcohol use in Wales. My parents’ generation referred to whisky, for example, as medicine and very rarely used it. In fact, the pledge was a general feature of society there. My generation was responsible for a movement in another direction. The pendulum swung and is still swinging in that direction and it is time to start it swinging back.

I have no doubt at all that alcohol is one of the greatest problems that we have in our society today. I say that not as a teetotaller although I restrict myself two months of the year to not touching the stuff because it is so important that we have self-discipline as well as discipline that may come from the statute book. But in terms of violence, the break-up of families, poor performance at work—one remembers David Lloyd George’s initiatives in the First World War to try and clamp down on alcohol because of the effect on the war effort—criminality, injuries and the pressure on accident and emergency departments in hospitals, and the social disruption that arises from it, we can see the effect all around. The effect seems to be hitting people younger and younger. Children at the ages of 11, 12 and 13 are showing the effects of alcohol. That cannot be acceptable.

I realise that in an area of social responsibility such as this it is sometimes difficult to legislate. However, there must be pressure to turn the tide in another direction. Amendment 202 refers to establishing a duty to reduce alcohol harm. Amendment 328 covers the assessment of alcohol damage in local communities. Amendment 329 would provide appropriate places for representatives of alcohol services. These modest steps, taken together, would add up to a message that would come across. I implore the Minister, even if he cannot accept the amendments, to accept the thrust of the argument that lies behind them, because we have to do something about this great scourge of our society today.

Welfare Reform Bill

Debate between Baroness Hollins and Lord Wigley

Tuesday 18th October 2011 Grand Committee

[Lord Wigley]

My Lords, I speak very briefly in support of Amendment 35, to which I have my name, to endorse entirely the comments of the noble Lord, Lord Rix, in introducing this bank of amendments, and to support the other amendments that deal with disability particularly. In doing so I should declare my interest as vice-president of Mencap Wales. In fact, at the Mencap annual conference in Warwick on Saturday, there were people who asked specifically about these matters. They said, “They have taken away from us home ownership for people with long-term disabilities, and now they are going to start clobbering us on housing benefit, where people with disabilities may be in a particularly vulnerable position”. I should therefore like to ask the Minister, so that I can respond to people who raise these questions with me: do the Government still believe in home ownership for everybody, and if so, does that include people with long-term disabilities? If the Government, having taken away the previous scheme, are not going to put something in its place, surely that is a straight contradiction of what the party opposite has always put itself forward as believing in?

Secondly, with regard to people with disabilities and housing benefit—the amendments before us would make exceptions for them—I hope that the Minister will be able to spell out how he will ensure that they do not suffer. If the amendments are not acceptable, I hope that amendments will come forward from the Government on Report. If not, I hope that there will be an opportunity to vote on these matters to show exactly where each of us in each of our parties, including the coalition partners, stand on such a basic issue.

[Baroness Hollins]

I, too, support Amendment 35, as introduced by my noble friend Lord Rix. As we have already heard today, tidy laws are not always fair laws. I am concerned about some exceptional people whose needs cannot neatly be described and I hope that common sense will prevail.

I shall give the example of a young man with autism and learning disability, Theo. Since early childhood, Theo has loved and become very knowledgeable about cathedrals, churches and architecture. He is also a man with complex impairments and a history of behaviour which has challenged every shared setting he has lived in. With specialist advice from Housing Options, and support and endorsement from social services, his parents set up a safe and individualised housing and care package for him.

The Government’s view may now be that it has never been the intention that SMI would cover all a person’s housing liabilities, but Theo’s shared-ownership mortgage was offered precisely on the basis that it would cover the mortgaged part of his housing cost, as was DWP policy at the time. The past nine years of Theo’s life have been built on that. His home has provided the all-important stability that someone with autism needs; and his disabilities combine to make change much more disturbing than we would find it.

Theo has an interest-only mortgage, so the possibility of the acquisition of a valuable capital asset does not apply in his case. With careful management by his parents, he has been able to lead a happy life at a much lower cost to the public purse than the alternative arrangement of a secure hospital. However, the new FSA rules require mortgage-lenders to set aside more capital and to treat mortgages on shared-ownership properties as 100 per cent mortgages. The result is a sudden gap between the rate at which lenders have to lend—for example, 6 or 8 per cent —and what the new SMI rate, which I think is 3.63 per cent, will cover. In Theo’s case, this leads to a shortfall of £200 per month. You can imagine that the arrears are already quite high. A new mortgage would be at an even higher rate, but he would then have to find a 25 per cent deposit for his property. He does not have the money to negotiate another mortgage.

There has been quite a bit of publicity about the adverse effect of this reform on HOLD. Experienced housing experts say that fewer lenders are likely to want to deal with disabled applicants seeking this solution to support a non-institutional life.

Ageing parents of disabled adults have followed similar paths with the help of enlightened housing associations. Those parents have been making responsible arrangements in their own lifetime, hoping for some assurance of long-term stability and security for their child. Instead, Theo's parents now face the prospect of seeing Theo’s distress at being uprooted from his home and moved, probably, to an inappropriate and less sensitive institution, which will be much more costly.

As the noble Lord, Lord Rix, pointed out, there are probably about 1,000 customers with learning disabilities—0.4 per cent, I understand, of the total caseload looked at by the impact assessment. Some of those administering HOLD have suggested ways in which the cost of continuing higher-rate payments for this group of disabled people could be contained, but it would require acceptance that there are indeed exceptions to the rule.

Since the Poor Law 1601, society has tried to tidy away people whose needs do not fit present-day norms, but in today’s more enlightened society we have made huge strides towards creating an inclusive society in which every person's humanity and dignity are respected and in which they have a place regardless of the extent of the difference that the person presents. However, these gains are quite fragile and we need look no further than Winterbourne View to be reminded of the previous scandals in mental handicap hospitals such as Ely and Normansfield in the late 1970s. Surely, we must now realise that without adequate advocacy and diligence we could again allow such inhumane provision to be re-created—people shunned by society and placed out of sight and out of mind at considerable expense but in the interests of tidiness. The test of a humane society is how it treats its most vulnerable members.

I had little awareness of the lives lived by some people with learning disabilities until I had a disabled child. My eyes were opened. I should like the Minister to consider using the Bill to reinstate SMI at the higher level for people such as Theo, which would allow them the opportunity to live with dignity in their own homes.

Localism Bill

Debate between Baroness Hollins and Lord Wigley

Monday 5th September 2011 Lords Chamber

[Lord Wigley]

I support the noble Baroness’s amendment. I do so declaring an interest as vice-president of Mencap Wales and having discussed these matters with the noble Lord, Lord Rix. This issue is of considerable concern to those who campaign for and work with people with disabilities—particularly learning disabilities. The insecurity that can be caused by the uncertainty arising from changes in legislation can undermine such people even more than those who are able-bodied but who none the less have a valid case for security of tenure. There is considerable concern and dismay in the world of disability about the changes. I hope that the Minister can give assurances that can put those people’s minds at rest. The last thing that we would want to do from this Chamber is to perpetuate or worsen the insecurity felt by those vulnerable people.

[Baroness Hollins]

My Lords, I, too, support the amendment. I have worked for the past 30 years with adults with learning disabilities and their families, and I am also the parent of a young man with a learning disability. A particular interest of mine has been how adults with learning disabilities cope when their parents die. Many in the past have had to cope not only with the death of a parent but the loss of their home. Although the possibility was there under the previous Housing Act for the succession to continue, appropriate arrangements had often not been made. Arrangements to support people to stay in their home are now available and it would be very sad if succession rights were weakened at a time when support arrangements to enable people to remain in their familiar family home when their parents die are improving. I agree with the sentiments expressed by previous speakers and suggest that such a vulnerable group needs that security—as do parents, who anticipate that their adult children now have a life expectancy similar to that of the rest of the population. They need assurance that their security of tenure is provided for. That would be a huge comfort to such families.