Health: Transition to Adult Health Services
Baroness Howarth of Breckland Excerpts(10 years, 5 months ago)
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Earl Howe
I fully agree. I think that much of this will succeed only if services work together around the needs of young people as well as their families and carers, and if the families and the young people themselves feel involved in the way in which their care is being organised and planned.
Baroness Howarth of Breckland (CB)
My Lords, in terms of developing the specification, can the noble Earl tell us how stakeholders are to be involved? In particular, will the young people themselves now have a voice? I declare an interest as the president of Little Hearts Matter, which deals with children with single-ventricle problems.
Earl Howe
I think that we can pay considerable tribute to the Children and Young People’s Health Outcomes Forum. It is one of the bodies that have highlighted the need for more effective transitions and for new outcomes indicators to measure them. Its framework for this year includes a proposal that, where possible, all data should be presented in single-year or five-year age bands up to the age of 25 to support better monitoring. Moreover, the forum asked the National Network of Parent Carer Forums to develop a narrative of what good integrated care looks like in transition. The CQC report has drawn quite heavily on that report in its conclusions.
NHS England: Health and Social Care Act 2012
Baroness Howarth of Breckland Excerpts(10 years, 6 months ago)
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Earl Howe
My Lords, as I have indicated already, we view funding as just one part of the story in achieving parity of esteem. However, we will hold NHS England rigorously to account for this and we have regular meetings to talk about that. We have set NHS England that strategic objective and we have singled out in particular action on crisis intervention, extending access to IAPT therapies and developing options around access and waiting time standards. Therefore there are a number of detailed issues that we expect NHS England to address.
Baroness Howarth of Breckland (CB)
My Lords, can I ask the Minister to draw attention to one other area? I was alarmed to read in a recent POSTnote —the very last paragraph of a document that is often very factually based and helpful to the House—that HIV/AIDS is likely to suffer from being commissioned by one group, delivered by another and overseen by yet another. I am quite sure that that is an area where we would want good co-ordination, and I hope that the Minister will ensure that it is properly monitored.
Earl Howe
The noble Baroness is right to draw attention to sexual health services as an area that needs to be joined up. We are very aware of that. The commissioning arrangements are as she has stated but we are as confident as we can be that in most areas of the country the services are joined up, even if commissioned separately. It is an area that we keep under review very closely.
Children and Families Bill
Baroness Howarth of Breckland Excerpts(10 years, 9 months ago)
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Lord Cormack
My Lords, I begin by congratulating my noble friend Lord Howe on his amendment. I wholly support what he said about packaging and about appointing Sir Cyril Chantler. I have the good fortune of knowing Sir Cyril. Like the noble Lord, Lord Patel, who spoke a moment ago, I believe that he is a man of impeccable integrity and great knowledge and I am sure my noble friend could not have chosen anyone better. I do not want to dilate on that subject.
I have smoked two cigarettes in my life. I was 15 years old; they were Woodbines and it was behind the bike shed. They were thoroughly disgusting—I have never smoked since and I never want to smoke. I am afraid I cannot say the same for my wife, although I think she has cut down a bit; she certainly does not smoke in my presence, either in the car or at home.
It is beyond doubt that we can and should accept everything that has been said about the dangers of smoking by the noble Lord, Lord Patel, and my noble friend—my friend in every way—Lord Ribeiro. We should do everything possible to deter people from smoking. I am sure I speak on behalf of everyone in congratulating my noble friend Lord Ribeiro on the birth of his grandson. I would be entirely in favour of the parents of the grandson of the noble Lord, Lord Ribeiro, being sent a note about the dangers of smoking. I would be entirely in favour of the parents of every newborn child being specifically warned about the dangers to children of passive smoking. I would be entirely in favour of increasing the taxes on cigarettes. I would be in favour of extra insurance premiums for people who smoke. I would not object to there being a column about smoking on car insurance forms, and, if you tick the smoking box, there being an extra premium that goes directly to the battle against smoking. I would be entirely in favour of all those things or permutations of them. There are many that we could all think of.
However, when it comes to the question of smoking in motor vehicles, my noble friend Lord Ribeiro introduced his amendment skilfully, tactfully and undogmatically. I have no argument with that, but I believe that his essential premise is wrong. To advocate any law that is going to be exceptionally difficult to police and enforce, and moreover brings the state into the private space of individuals, is to be deplored.
Baroness Howarth of Breckland
My Lords, can I just ask the noble Lord about the whole of the child protection law as it stands at the moment, which is in every private space to protect children from neglect, emotional harm and, indeed, abuse within their own homes.
I believe that this is actual harm. It is extraordinarily difficult to police every home, as we know from what happens to social workers and social services every time something occurs in a local authority because the policing has been so difficult. That does not stop us having legislation to ensure that in private space, the child is protected from harm. We have heard from the noble Lord, Lord Patel, just how harmful it is. Were it left to me, I would legislate in the private space of the home. Having been brought up in a two-bedroom house on a working class estate, I think that my lungs have suffered. I am just pointing out that we legislate for private space, because that point has been raised on a number of occasions.
Lord Faulkner of Worcester
The figures on counterfeiting reached a peak in 2000 and have been steadily falling year by year. If the noble Lord had listened to my remarks earlier, he would have heard that I said that there is no reason why standard packaging should not be at least as secure as existing branded packs.
Baroness Northover
My Lords, I remind noble Lords that we are on Report. Noble Lords have one opportunity to speak. They can intervene to ask a question to seek elucidation from somebody who is speaking. Providing that is what noble Lords do, those interventions are all right. They must seek clarification from, or ask a question of, the person who is speaking.
Lord Naseby
I reassure the House that I do not intend to speak for very much longer. I respond to the noble Lord opposite by pointing out that the latest figures for Australia indicate an increase of 13% following the introduction of standardised packaging for counterfeit and illegal cigarettes. Therefore the most current evidence—perhaps he can get up to date—is a little more relevant. To finish on standardised packaging, if 20% of our nation smokes legitimately, and we have a legitimate industry, do people not have a right to choose between one pack which they like the look of as opposed to another pack?
I will finish with Australia. I, too, welcome Sir Cyril Chantler as chairman. I also know him quite well and have known him for a very long time. He will already be able to see two results. One is that standardised packaging has done absolutely nothing to the prevalence of smoking in Australia, and the other, as I have just mentioned as evidence to the noble Lord opposite, is the worrying fact that the illegal market has increased by 13%, up to an all-time high in Australia of 13% of all consumption.
I draw the House’s attention to a book in the Library which refers to the situation in the United Kingdom during the war. It is called Black Market Britain, 1939-55, by Mark Roodhouse, and it features, among other evidence, what happened to the cigarette market during the time of the black market. I refer to that book because if we go down the route of standardised packaging, a black market will undoubtedly emerge.
I wish Sir Cyril well; we await his report with interest, and I am sure that it will be balanced and thorough. However, whatever that report produces, I ask that first, the Government will give adequate time to this House to have a short debate on it, and secondly, and perhaps more importantly, that the industry will have a reasonable amount of time—and by that I mean some weeks and not days—to look at the evidence that is provided by Sir Cyril and to put its view to the Secretary of State on its interpretation.
Finally, I will wind up on a couple of other questions, specifically on proposed subsection (4)(d) of Amendment 57B on,
“reducing the appeal or attractiveness of tobacco products”.
I submit that that has little to do with the packaging. Proposed subsection (8)(d), which refers to,
“the shape of such products”—
as opposed to the package—does not have anything to do with the packaging, and proposed subsection (8)(e) would even more insidiously apply to,
“the flavour of such products”.
Given that by nature all cigarettes are different, as tobacco is a vegetable product and they all taste different, I do not see how on earth the Secretary of State can intervene regarding the flavour of tobacco. I have already mentioned the contrast between the consent of Wales, Scotland and Northern Ireland and our own home Parliament.
Baroness Howarth of Breckland
My Lords, I apologise to the noble Baroness for intervening earlier. I wanted to ask a short and straightforward question of the Minister. Should the noble Earl’s amendment be accepted—I hope it is because I greet it hugely; noble Lords will know how much it means to me—can he tell us in his summing up what the timetable is likely to be as regards when the research would take place and how long it might take? If, when that was completed, the outcome was positive—I recognise that because it is research it could go either way—when would the Government be likely to bring in the legislation? I recognise that we are moving towards an election and I hope that the Minister would want to get this on the statute book before he might or might not leave office. We already have legislation on not displaying cigarettes, but I still go in to my local tobacconist and see displays of cigarettes, so I wonder what is happening about that.
Children and Families Bill
Baroness Howarth of Breckland Excerpts(11 years ago)
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The Lord Bishop of Chester
My Lords, I will speak very briefly. Over the years I have been attracted by most vices, but never to smoking, so in the circumstances it is easy to speak against it. I will add that it is not just a domestic issue. The noble Lord says that he has an interest in BAT. What astonishes me is the way in which the growing awareness in this country of the dangers of smoking seems to be so slowly taken up in the developing world. We have a moral need, not only in relation to our own children but to the developing world, to make clear the dangers of smoking. It really is a global issue. It behoves particularly the wealthier countries—not least if the interests of big business are engaged, as undoubtedly they are, or those of the Exchequer—to give a proper lead. I think these amendments do just that.
Baroness Howarth of Breckland (CB)
My Lords, I want to speak briefly because the health arguments have mainly been made. I want to make two rather different points. I support both of these amendments. I have a long-standing reputation for campaigning in this area. I find it interesting that the industry has suggested, from time to time, that packaging makes no difference. If it makes no difference, why is it so important? Let us get on and take it off the shelves. We have all the evidence to show that children are attracted to packaging and we all know our own instincts. I have never smoked, but both my parents died from smoking related diseases. My mother was addicted and said that I should stop anyone else I could from smoking.
My other point is on the smoking in cars amendment. Having said that the medical arguments are substantially made, which the Minister knows whatever the position he has to take on this, there is also a clear safety issue about smoking with children in cars. Anyone who has driven with two arguing children strapped in the back of their car—because children argue in the backs of cars, and if yours do not, then they are remarkable—will know how distracting it is and how you have to absolutely keep your concentration up. So I have always found it strange that we do not stop people being distracted by fiddling into a bag or a pocket for a packet of cigarettes, finding something to light up with and taking their eye off the road—we have all seen it—while they light a cigarette. They then have a cigarette in one hand while they are driving their children in their cars. This is an added reason for ensuring that people cannot smoke with children in cars. You might say that where there are two people one of them may smoke, but there is the medical reason and this additional safety reason. I have no idea whether there are any statistics on accidents because people have been smoking in cars, but when you think of the legislation we have to stop people using mobiles, which in some ways are much more automatic, I cannot understand why we do not have similar legislation to protect children, not only for the medical issues in relation to their health but also for sheer practical safety reasons.
Lord Storey (LD)
I will speak to Amendments 263 and 264. If you said to some parents that you were going to put their son or daughter or both in a tin box, cut some holes in the box, then fill it with smoke, put it on wheels and drive it around all the time, they would think you were absolutely mad. The tin box is almost like a coffin because you are killing children. You are literally killing children.
My parents were heavy smokers; they smoked 40 Senior Service every day. In fact, they smoked so much that our living room ceiling turned yellow once a year and had to be repainted. I always remember that when my father drove me through the Mersey Tunnel he would say, “We’ll have to put the window up because you can die from carbon monoxide poisoning, you know”, yet—perhaps this is why I get chest infections regularly—he was putting our family in that sort of situation. Of course, he did not know about the effects.
All of us look back at things in our lives that we are really proud of. The thing that I am most proud of in politics was that we introduced Smokefree Liverpool. Thanks to support from noble Lords of all groupings, we were able to influence, in a small part, government thinking. You often get people saying, “Oh, it’s the nanny state. We don’t want a nanny state. We don’t want people telling us what to do. If we ban smoking in cars, the next thing will be that we ban it in the house as well”. Well, nannies are there to protect and look after children, and a nanny state should be there to look after and protect children.
Children are particularly vulnerable to second-hand smoking as they breathe more rapidly and inhale more pollutants than adults. ASH has shown that parental smoking is a causal factor of asthma in children, and that the prevalence of asthma increases when the number of smokers in a car or in the home increases. Children exposed to second-hand smoking also have an increased risk of lower respiratory infections, bronchitis, middle ear disease, bacterial meningitis and sudden infant death syndrome. There is also a very social issue, one that is directly related to making our society fairer. Evidence has shown that children living in the poorest households have the greatest levels of exposure to smoking and that passive smoking has been shown to affect children’s mental development and school absenteeism. That clearly undermines our efforts to increase social mobility. Experts have suggested that banning smoking in cars while driving with children is an important step in limiting the effect of second-hand smoking.
For those more interested in the economic side, the numbers are staggering. The health disorders caused by smoke-generated disorders cost the NHS about £23.3 million a year. In particular, £4 million is spent on asthma drugs for children up to the age of 16. The future treatment costs for smokers who take up smoking as a consequence of smoking by a parent could be as high as £5.7 million each year. Parents need to consider that, in choosing to smoke, they will find it difficult to explain to the children why they in turn should not smoke. The NHS has shown that children who grow up with a parent or family member who smokes are three times as likely to start smoking themselves. As we can see, the issue has implications for public health and our society in general, and ignoring it would mean ignoring the poll in 2009 which found that a majority of adults in England were in favour of banning smoking in cars, with 74% opposed to smoking in cars with children. The message is clear: if we really care about our children and want to improve their health and social mobility, this is a step that we can take.
I can look back, as no doubt all of us can, at moments in our social policies where there has been resistance from some quarters, whether it be from government or a powerful lobby, but the will of people has always come out. Noble Lords may remember the row about seatbelts: “Ooh, you can’t have the nanny state making people wear seatbelts”. In the end we had the courage to fight for that, and we cut the number of deaths in traffic accidents considerably. There was even a fuss about making people riding motorbikes wear crash helmets; there was a feeling that, “We shouldn’t do that. The nanny state is interfering by telling people that they must wear a helmet”. It is quite right that they should wear helmets. More recently, we have had the issue of smoking in public places. As a Government, we have a duty and a responsibility to do this.
Governments of all political persuasions have to think very carefully and be led by evidence, not by emotion or lobbying. I understand that the issue of plain packaging for tobacco products is something that the Government were committed to but they wanted to see quite clearly that the policy that was agreed, particularly in Australia, brought results. It is now clear that that policy is having an impact, and I hope that the Government, having initially said, “Let us wait and see”, might now say, “Come on, this is an opportunity to move forward”. I look forward to the Minister responding to the pressure from your Lordships here.
On children in cars, I would prefer that we agree the amendment in its entirety, but if we cannot do that, we could think about taking the first step by having public information, as we used to do. We could provide adverts and publicity material so that parents could see what needs to be done. But if we really want to be progressive and move forward, we should support these amendments.
Earl Howe
Well, my Lords, if I could repay the compliment to the noble Lord, Lord Hunt, he has very eloquently presented the case for the Government to go away and think further about this, which indeed we will do. I come back to what I said at the beginning of this debate: the message from this Committee has been delivered loudly and clearly. I am grateful to noble Lords for that. I say again that the Government’s mind is not closed on this issue.
Baroness Howarth of Breckland
As one of those who are not quite so eloquent but are equally committed to the cause, I think that the Government would be in a far better position if we had some timescale. We now know when Report stage is likely. I am much attracted to what the Minister said. I would much prefer that we had a universal position that protected adults as well as children because of, as he said, the influence that adults have on children. Many more noble Lords might, like me, be influenced if they knew that something was likely to happen. The anxiety is that, unless we press this, nothing will happen.
Baroness Howarth of Breckland
My Lords, I will speak briefly to make two points. First, as the noble Baroness indicated, this is both a short-term and long-term financial issue. The previous Government and the present one, I fear, have taken the same position, which is that paying kinship carers in the short term would be too expensive. However, as many noble Lords have pointed out, it has tremendous value and advantage in the longer term. I only wish that a Government could, if not introduce the whole package, at least take one step.
I remind noble Lords that the Select Committee on Adoption Legislation, which I was part of, pointed out that there was very little difference in outcomes— indeed there might be better outcomes—for children who were in special guardianship orders compared to those who were adopted. However, we treat those two groups in a totally different way. That is irrational. If we could just make a start with special guardianship, where there is an order and it is quite clear that the care is going to continue, we would feel we were taking a step forward.
Overall, we spend very little these days. The news today is that we are almost unable to meet our commitments to protect children with child protection procedures and that social workers are under tremendous pressure. I notice that the noble Baroness, Lady Massey, glanced at me, because I am a social worker by background, when she said that social workers are actually insisting that people take the time off—of course they are, because, as the noble Baroness pointed out, they have a responsibility to make sure that these children are properly cared for. Most of those social workers would be delighted if they could recommend that they were paid for that. The old Section 1 of the 1963 Act, which used to help with this, has long gone, and there are very few provisions now to help these families get through even the initial difficult times, never mind the longer period of caring for a child who is not their own, with all the pressures that such a child brings.
Being the unlikely founder of the All-Party Parliamentary Group for Grandparents and Extended Kin—which is another story—I am concerned for grandparents, because they have reached a point where they thought life was going to be easier and they were going to be financially secure. However, they then find themselves bringing up children in their family—as they would wish to rather than let anyone else take over the care of the children—and somehow the state does not see it in its purview to give help to these families. With the changes in the benefits system, these families are finding it more and more difficult to survive. Consequently, as noble Lords know, more children will come into care. These situations will break down as families can no longer manage or social services think that it is inappropriate for them to do so.
I am quite sure that these amendments will not be accepted, as they have not been accepted in the past. However, I wish that there could be some thought, and some work undertaken, to see whether there is a step change that can move forward, through the various groups, to make it easier, particularly when a family has a legal order and responsibility for the children concerned.
Viscount Younger of Leckie
My Lords, I welcome this debate on another important issue. As has been said, and as the noble Baroness, Lady Howe, alluded to, the Government recognise the extremely valuable contribution made by family and friends in caring for children who cannot live with their parents. Noble Lords have spoken passionately about this issue today and I am struck by the depth and breadth of expertise on this matter in this Committee.
The noble Baroness, Lady Drake, raised the important issue of kinship carers dropping out of the labour market. I note that the noble Lord, Lord Touhig, is not in his place, but I hope that I can go a little way to restoring my reputation as a listening Minister by saying that we agree that it is important that kinship carers can remain in the labour market. The evidence that we have about this issue is limited, but I hope that noble Lords will be reassured if I explain that we are actively researching this issue. I shall say more about that in a moment.
During the debate on support for family and friend carers, my noble friend Lady Northover described the financial support with which local authorities are encouraged to provide families to help them to cope with the strain that caring for an additional child may put on household budgets.
The type of care arrangement that kinship and friendship carers provide varies a great deal. Some families care for children who need support during a short-term crisis, such as a parental illness. Other individuals take on care of a child on a long-term basis. My noble friend Lady Tyler, and the noble Baronesses, Lady Massey and Lady Drake, highlighted some other examples, including some statistics provided by Grandparents Plus, parents’ rights groups and other groups.
Given the variety of arrangements that exist, the Government believe that it is right to assess the needs of each family at the local level. Local authorities are best placed to establish relationships with these families and appraise their financial needs on an individual basis. This enables them to provide targeted support to the right people at the right time.
Special guardianship orders provide a more formalised and legally secure foundation on which a child can build a permanent relationship with his or her carer. In many cases, the child may already be living with the family when they make an application for a special guardianship order. However, this will not be the case for all families and some may have to adapt quickly to significant changes in circumstances—a point that was made earlier.
Special guardianship orders are an increasingly popular “permanence” option for children. However, they remain a relatively new legal status and special guardians are a group about which the Government have limited data. In particular, there is insufficient information about the way in which special guardians adjust to their new caring arrangements and how this may impact on an individual’s ability to remain in the labour market. I hope that I can reassure the noble Baronesses, Lady Massey and Lady Drake, by saying that we believe that it is essential to understand the issues that are faced by this group in order to ensure that they receive the support that is appropriate to address their needs. For this reason, my department, the Department for Business, Innovation and Skills, will undertake research into kinship and friendship carers and special guardians, and their participation in the labour market. We have already started to scope this, liaising with the Department for Education.
I recognise that research is not the same as support, but it is the first crucial step towards understanding what policy interventions would be most appropriate to meet the needs of these individuals. I hope that this reassures the noble Baroness and I ask her to withdraw her amendment.
Baroness Howarth of Breckland
My Lords, I simply want to ask a question. During the past Session, we have managed to achieve considerable integration between adult care, the health service and children’s care—looking after children’s carers. Why can the Department for Work and Pensions, or whatever department handles this sort of employment legislation, not also become much more integrated so that the whole package can be assessed appropriately? That may be too great a vision but maybe that should be the road we go along.
Lord Stevenson of Balmacara
My Lords, my amendment, which is part of this group, is rather low-key compared to the sort of debate that we have just had. It seems in vogue, in terms of what has just been said, that we should seek a compromise position that all parties could support in this area. As my noble friend Lady Lister has said, this seems to have all the hallmarks of an irresistible force that is moving forwards. These are pressing and important areas of activity in our social arrangements. They are suffering badly because they have not received the attention they should have done in previous Administrations, including our own, but the benefits of and the opportunities for making something better out of it are so great that the argument surely carries weight and we should be looking very carefully at it.
I do not wish to comment further on that but I make an offer to the Minister: if he would like to see whether a discussion between the parties might help to provide a context in which some of the good will that has been expressed in the Committee today can be taken forward, I would be very happy to participate in it. Obviously, we would need to work out what we were going to do with such an amazing compact, should there be one, but it would at least be a step in the right direction.
Our amendment does not go anywhere near that, except to build on what the Minister mentioned in response to Amendment 267, which was, in his careful phrasing, “a research project” to get some basic material out about this area. Amendment 267BA is looking at a review that would be carried out by the Secretary of State, on the impact of the lack of paid leave on kinship carers and special guardians left in the workplace, so it is narrower. I appeal to the Minister to see in that the opportunity to take another step down this path, which, like my noble friend Lady Lister, I hope is not too long. I hope for a little of his caring and listening mode on this occasion. I thought it was only in response to my noble friend Lady Lister and others that he adopted it, but perhaps this time he could listen to me as well.
Lord Stevenson of Balmacara
My Lords, it is very difficult to follow the well presented case that has been made for action in this area, but I want to spend two seconds paying tribute to Lucy Herd, who is in the audience today. I was privileged to accompany her when she came to see the Minister and the Bill team and very bravely went through some of the things that had happened to her in her life and how she had coped with them. One wonders whether people really can dig so deep, and yet that is what she did; she turned the tragedy of the death of her deeply loved son, Jack, into a campaign that she is still waging and which we have heard about from my noble friend Lord Knight.
This situation cannot be right. We need to do better than we currently do as a society that says it cares about these sorts of issues. There is clearly a cost, but there are also other things that could be done at least to open the situation for discussion. If this happens to you or to your nearest and dearest, you should not then find during the trauma of what is happening that the rules are so adverse and difficult that you do not know where you stand in terms of your relationship to your employer or to anyone else or their agencies. Given the complications of what would happen and the timescales involved—because if there are inquests and other things they will span over a long period—this situation is clearly unstable and has to be resolved. I hope that the Minister will be able to help us
Baroness Howarth of Breckland
My Lords, I shall be very brief because I know that the noble Lord, Lord Knight, should be speaking elsewhere at this minute, I believe.
Baroness Howarth of Breckland
I support the amendment. I work with an organisation for children who are born with half a heart. Some of them therefore die but, luckily, more live now than did in the past. The variety of responses from employers to those bereaved families is extraordinary; I shall not go into examples because of the timeframe. The Minister might well say that we need a change in culture, as indeed we do, but one way of achieving that is by having something like this on the statute book. I therefore support the noble Lord.
Baroness Hollins (CB)
My Lords, parents of disabled children often do not see themselves as carers, but they are. Their need for support has been argued and won over the past 20 years. They really are different from other parents. Their right to be able to have a life alongside caring for their disabled child has been fought for very successfully. Parent carers are often so focused on the needs of their child that they forget about their own health and well-being. It could be argued that failing to recognise the needs of the parent carer is against their right to a family life under the Human Rights Act. I was involved with a WHO/Europe declaration, Better Health, Better Lives, which was about the health and well-being of children and young people with intellectual disabilities across Europe and their families. It was signed by all the Health Ministers, including our own, in 2012. One of the 10 recommendations was about identifying the needs for support of parent carers. I join my voice to that of the noble Baroness in this amendment. What is the Government’s rationale for allowing that the carers of a disabled 13 year-old would effectively have rights inferior to those of the carers of an 18 year-old? I hope that the Minister will be able to respond.
Baroness Howarth of Breckland
My Lords, I wish to support the noble Baroness, Lady Pitkeathley, in this amendment. The Minister is right in saying that the framework is there in the present legislation or, at least, it should be there. The difficulty is that, because the focus among those who make assessments is split between adults and children and we do not have holistic family assessments, often the parents are lost. A family whom I met recently had just, after many years, been given a period of respite care, but the parent carers had not realised that that would make the difference in their being able to continue to care for their son, an extremely difficult young man. A series of workers had never suggested to them that their needs might be met in order to meet the needs of their child. That is the important message that front-line workers need to understand. This amendment would help them to understand that, unless you meet the needs of parents, you do not meet the needs of children.
I, too, had this query when I heard that it had been commented that to assess parents would undermine the rights of children. Assessing parents enhances the rights of children. Many of us who have worked in this field and continue to work with and meet families see it regularly. We also see when people fail to notice that parent carers are beginning to fail, simply because of their exhaustion and the fact that they have had no relief and no assessment for any kind of services, sometimes quite small ones that would make all the difference to their being able to continue.
I support this because we should have a family approach whereby children with disabilities will be maintained in their own homes rather than having to go into caring facilities because their parents are unable to look after them. I am losing my power of speech, like most of us at this time of night, so I leave it there. My only other point is that the noble Baroness, Lady Tyler, made a passionate speech about integration, which I think we all feel should happen.
The Parliamentary Under-Secretary of State for Schools (Lord Nash) (Con)
My Lords, I welcome the opportunity to debate the important issue raised by the noble Baroness, Lady Pitkeathley. I recognise the tremendous job that parent carers of disabled children do and the challenges that it can bring. It is right that children’s legislation is the place to address this. I am pleased that the Minister for Children and Families will be meeting Paul Burstow to discuss this further.
We are confident that there is a strong framework of support in place to support parent carers of disabled children. Parent carers’ needs can be assessed as part of assessing the needs of children in need under the Children Act 1989. Local authorities can provide services to the family members of a child in need with a view to safeguarding or promoting the child’s welfare.
As parents, and as adults caring for children, parent carers are in a very different position from adults caring for adults or young carers. We should be wary of simply replicating arrangements that are in place for those other carers without understanding the interrelationship with other legislation and the potential for unintended consequences. Unlike for young carers, where we have responded to specific concerns and substantial evidence, there is a lack of evidence for the need to change the type of support or the way in which it is provided for parent carers of disabled children. That is not to say that everything is perfect, nor to underplay the challenges that parents of disabled children face, nor to claim that all parent carers receive the support that they need. However, it is not clear that specific changes to legislation are the answer.
NHS: Children’s Congenital Heart Services
Baroness Howarth of Breckland Excerpts(11 years, 4 months ago)
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Baroness Howarth of Breckland
My Lords, during the previous difficulties and confusion when there was much lobbying and debate, the people who found it most difficult to follow the information and the evidence were parents. Presumably, they are the most important stakeholders, particularly in the case of children’s congenital heart disease. Can the Minister convey to NHS England the importance of finding clear and sometimes simple ways of helping parents at a time when they are stressed, anxious, worried about the geography and not able to understand the outcomes? They do not always have the best information with which to make decisions.
Care Bill [HL]
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Lord Warner
My Lords, I follow the noble Lord, Lord Pannick, with some trepidation but I do so as a member of the Joint Select Committee that recommended a change to the Bill along the lines asked for so eloquently by the noble Lord, Lord Low. I remind the Minister of an individual case which demonstrates the lacunae in the current legislation. It was the case of a lady over 90, who wholly self-funded in a private nursing home. This lady expressed her views—I suspect rather trenchantly—about assisted dying. She did not ask them to do anything about assisted dying but merely offered her views—though probably, as I say, quite trenchantly—but the home owner and members of staff took great exception to those views. She was pretty much immediately given four weeks’ notice to quit. We are talking about an elderly person who was very vulnerable. Her son took counsel’s opinion, which seemed to be remarkably similar to the views expressed by the noble Lord, Lord Pannick. We are faced with a situation where you can fall down on two grounds: on the grounds that you are in a privately provided home, and on the grounds that you are a self-funder. Whatever the arguments, and we have been over this ground several times in this House, the reality is that vague requirements on the CQC to observe the requirements of the Human Rights Act do not safeguard elderly people in the kind of case that I have posited.
We have to look at this again, which is why, when the Joint Committee looked at this issue, we took advice from our adviser, who is legally qualified. If I may remind the noble Lord, the noble and learned Lord, Lord Mackay, was a member of the committee, which went along with that recommendation. The Government have to move away from the rather brushing-off response that they gave to the Joint Committee’s recommendation and think again, particularly in light of the powerful case made by the noble Lord, Lord Low, and strongly supported by the noble Lord, Lord Pannick.
Baroness Howarth of Breckland
My Lords, I had not intended to speak today. I support the amendment, but in a rather different context. I welcome the work that the Government have done on the safeguarding clauses. Those of us who work in this area find that extremely helpful. However, the tone of today’s discussion has been very negative about providers, so I am probably outside my comfort zone, even more than the noble Lord, as a provider. I declare my interest as the president of Livability; I chair both its providing committee and its safeguarding board.
Throughout the sector there are large numbers of organisations that run their own safeguarding boards within the organisation, where they review every single incident that occurs within it. Quite properly, they already refer to the local authority those cases where they think it should be informed, and indeed to the CQC. In the not-too-distant past I had conversations with the Charity Commission about its role in these areas as well as those of the providers and the regulators.
It would be a pity if we did not recognise the huge amount of work that was going on already on safeguarding, and that we can learn a great deal from it. I would be pleased to support the amendment that says the Secretary of State should collect any report, because we could then look at trends. There is not a single provider that would object to being controlled by the Human Rights Act; I think that we all see ourselves as already being controlled by that Act, because we work under contract to the local authorities and see that as a clear extension of it. If it were direct, we would not operate any differently from how we do already.
I apologise for taking the time of the Committee today because I have not intervened very often, but it needs to be on record that there are thousands of elderly people and disabled people being significantly cared for by very good providers in conjunction and partnership with their local authority.
One of the issues that I would really like to have supported is the amendment from the noble Baroness, Lady Greengross, saying that you have to change the culture. What will make the difference—this has made a difference in the organisation where I work, where we extended our services—is a culture of no blame. The sense that I have had here today is rather one of blame, but having no blame brings people forward and makes them report incidents that you can then look at. In my role, I am really concerned when no one comes forward and reports an incident.
I welcome what the Government are doing, but I hope that whatever else comes is not so draconian that it actually prevents people coming forward and making it clear that they want to report incidents in their organisation.
Care Bill [HL]
Baroness Howarth of Breckland Excerpts(11 years, 4 months ago)
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Baroness Howarth of Breckland
I want to bring us back briefly to the amendments that we were discussing. Broadly, housing obviously has a tremendous impact on people’s lives, but we are talking about inserting the word “housing” in a number of clauses that will enable co-ordination between health, social care and housing.
Many local authorities and well-being boards, as the noble Baroness, Lady Jolly, mentioned, already have it—that is, if you achieve this co-ordination, you will make savings and produce better outcomes for the individuals being helped. Having it on the face of the Bill will ensure that the leadership of all these authorities has to pay attention to it, and I think that is important. At the moment we have a postcode lottery. If you are fortunate enough to live in an authority that has got it together, your adaptations will arrive; you will have all your other housing issues sorted out, along with your care package, and, if you are an old person in hospital, you will be out in a very short time. If you are a person with a disability, as that disability increases, or if you have a sudden disability, your adaptations will appear because there will be that co-ordination.
In many local authorities, however, the housing department can opt out and not play its part, which causes huge delays—I speak as someone who works in a number of charities and with people with disabilities. I want to support the amendment’s inclusion in the Bill so that the leaderships of authorities have to take it to heart and so that we do not have a postcode lottery and this is all part of strategic planning for the authority.
Baroness Wheeler
My Lords, the Joint Committee on the Bill acknowledged that it had been widely welcomed, but asserted that this did not mean that it could not be improved—there are gaps and risks and unintended consequences. The failure of the Bill adequately to underline the importance of housing not just to well-being but to integrated care, to prevention and to being included in the provision of advice and information on quality of care and assessment is what these amendments seek to address. The interplay between housing and well-being—the standard of someone’s living circumstances and their health condition, the appropriateness of their house or flat and the likelihood of their being able to remain in it and care for themselves—is long established. However, as noble Lords have shown, it is overlooked in key clauses of the Bill.
Our Amendment 87ZC takes forward the vision of specialist houses fully integrated into the health and social care system which was so comprehensively set out by stakeholders from across the housing sector in their evidence to the Select Committee. The quality of that evidence was commented on by the noble Baroness, Lady Jolly. There are numerous examples of inspiring best practice where housing is an integral part of care and support and service delivery. The Bill needs to provide the momentum for good practice to become embedded across all local authorities and health providers.
The evidence to the Select Committee from organisations across the housing sector cites inspiring examples of where housing, health and social care provision and support join up to provide integrated person-centred care. However, alongside this, there is huge frustration that progress across the country has been so slow and patchy. This is especially so when what stakeholders refer to as low-level interventions, which really make a difference, are often the services earliest to be cut back and dispensed with. The Anchor Trust, for example, described the determination to keep its service-level manager on site at one of its sheltered housing schemes because it made all the difference. The noble Lord, Lord Martin, made this point, too. Anchor said that, in its view, once the manager left, the next steps for elderly and frail people were usually into residential care. This was one of the many examples given of the consequences of not having housing-related support regarded as a key social determinant of health. I look forward to the Minister’s explanation as to why the Government have not ensured that this is fully reflected in the Bill.
Earlier, we heard the case from the noble Lord, Lord Best, and my noble friend Lady Wilkins for Amendment 81, supported forcefully by the noble Lord, Lord Rix, on the importance of including the promotion of housing provision in the duties of local authorities under Clause 3 to provide integrated services, and of ensuring that there are similar duties placed on the health service. Our amendment to Clause 6 complements this by reinforcing integrated joined-up working with registered housing providers, including housing associations and registered social landlords, and recognising these as key, relevant partners under the Bill.
The need to recognise housing as a preventive service cannot be overestimated or overemphasised. Schemes such as Midland Heart’s reablement service for the elderly or frail combine social care and housing association support to enable people to be discharged from hospital back to their homes quickly and help independence to be regained. They delay or prevent the need for more intensive care, reduce the likelihood of repeated hospital stays and can prevent avoidable accidents. Commissioners need to be encouraged to consider specialist housing, home-from-hospital services, housekeeping-related support and adaptations when designing preventive services. Housing is a crucial preventive service and Amendment 80 is important for ensuring that this is recognised in the Bill.
Amendment 88 is also important for ensuring that needs assessments include an assessment of housing options, as is Amendment 86, which underlines the importance of ensuring that local authorities provide information and advice for adults and carers on available housing options and the choice of providers available in the authority’s area. While in Amendment 87 we fully recognise the need for more specialist housing to be built to meet the needs of care and support, we would be cautious at the present time of putting this extra burden on local government when it does not have the resources or the means to deliver. It is the responsibility of national government to provide the £10 billion extra investment in infrastructure that the International Monetary Fund has called for to get the economy moving and make shovel-ready projects such as housing happen.
I am grateful to the National Housing Federation for its excellent briefing, and I refer to an example of integrated care and support it gives that was provided by one of its members, the housing association Look Ahead, for a psychiatric patient. It shows what can be achieved. Following a six-month stay in hospital, it had initially been intended that he should move to a residential care placement, but instead he was referred to Look Ahead’s rehabilitation service. The support that he received helped him with basic life skills, diet management and managing his condition. After 18 months, he had successfully moved to his own flat, had been able to reduce his psychiatric medication and had started a nursing diploma. This service, taking him from hospital to independence in his own flat in 18 months, was provided by successful joint working between the housing association, the local authority and the NHS trust, with an estimated saving of nearly £250,000 across the three services.
We heard, too, at our latest stakeholder group meeting yesterday about a successful jointly procured and delivered reablement centre in Liverpool that is funded by the local authority and the clinical commissioning group in respect of hospital discharge. The scheme provides two to three weeks of intensive occupational therapy and other key services, which doubled from 40% to 80% the percentage of patients who did not require a continuing care package after this initial support. However, we understand that in some parts of the country CCGs are expressing reluctance to enter into joint funding schemes with local authorities in case the health funding element is leaked into other council services, given their budget situations—literally, I suppose, into filling potholes or such like. Can the Minister tell us what steps are being taken to reassure CCGs about this potential barrier to providing integrated services?
As part of its oral evidence, Jake Eliot from the NHF said:
“Too often, the integration that occurs happens because service users, carers, providers and commissioners are working skilfully in spite of the system rather than because of it”.
This is something that the Bill can change effectively. I hope that the Minister takes these words to heart and accepts the amendment. It would ensure that the Bill recognises the importance of housing. It is important not just for well-being but for prevention, for the provision of advice and information in the assessment process and for ensuring that the overall quality of care is fully recognised.
Care Bill [HL]
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Lord Campbell-Savours
My Lords, the need for the specialist staff referred to by the noble Lord clearly lies behind the tabling of Amendment 76ZB. It is precisely why we need to pilot the proposed system.
My noble friend on the Front Bench referred to the system being created as a new system. We were told that we were going to get a new system in 2009. I sat on the third Bench behind my noble friend—the noble Earl was on the Front Bench on this side—and pointed consistently to the deficiencies in the system while it operated under CSCI and the inevitability of further problems arising under the new structure that was being created. Indeed that is precisely what has happened.
It seems to me that it can only get worse. The report of the Select Committee on Public Service and Demographic Change sets out the scale of the problem that confronts us in future. It prays in aid the Office for National Statistics updating its projections up to 2021 based on a recent release of data from the 2011 census on the ageing population. It says that, by 2021:
“There will be 24% more people aged 65 and over”,
and,
“39% more people aged 85 and over”.
It goes on to say that by 2030 there will be,
“will be 51% more people aged 65 and over”,
and that the population over 85 will have doubled. This means, to put it bluntly, that a lot more people will go into a lot more nursing homes throughout the country. Therefore, we have an absolute responsibility to make sure that the structure that we establish on this occasion is fit for purpose.
At the moment, I understand that there are 2,400 nursing homes catering for approximately 220,000 residents. That is going to increase, and I am still not convinced that the structure that this new so-called CQC is to set in place will be fit for purpose for taking on that task. Nor has the structure been defined in the legislation, as my noble friend has referred to. When I say fit for purpose I am reminded of the comments made by the noble Earl when we met on the last occasion to discuss this Bill, when he talked of a new broom at the CQC. As I understand it, it is not a new broom but an old broom with a new handle, because the person who is now running the operation is in fact the same person, I am told—and the information is available on the internet for anyone to read—who was responsible for the structure, which we are now debating, which has failed miserably over the past four years and is the subject of the complaint.
Mr David Behan, who runs the new operation, prior to his current appointment at the Care Quality Commission, was director-general of Social Care, Local Government and Care Partnerships at the Department of Health. As the director-general—and I read these words very carefully, because I do not want in any way to misrepresent the position—he had lead responsibility for the social care aspects of the Health and Social Care Act 2008, which created the CQC, the very organisation that we are having to review today because of its total failure and the scandals that have been drawn to our attention in the national media over recent years. I understand that he should have been aware of the Act’s requirements for the CQC to perform its functions for the general purpose of encouraging the improvement of health in social care services. This failure is implied in the Department of Health capability review, which in effect admits that the Department of Health was not sufficiently challenging and strategic in the way it supported the CQC.
David Behan is not new to social care regulation. Before taking up his appointment at the Department of Health, he was chief inspector of social services at the Commission for Social Care Inspection—CSCI—the organisation that we criticised in 2009 when the Act was going through on the basis of its failure in this particular area. I remember Ministers going to the Dispatch Box—Labour Ministers, yes—reading briefs produced by civil servants, in which they repeatedly assured us, as they did in personal correspondence to us, that the new structure that was going to be set up would work. It has not worked. It has been a complete and utter disaster area, which is why we are now faced with problems in this particular area that are reflected almost daily in the national press.
There is a very reputable organisation called the Relatives & Residents Association. Before anyone seeks to discredit its operations, it is worth pointing out that it is quoted in the most recent report by the House of Commons Health Select Committee. Its comments are prayed in aid in the committee’s criticism of the CQC. On 18 May 2009, in a letter to me following my criticism in the House, it affirmed its view. Four years ago, it said:
“we are concerned that … inspectors judge homes as delivering an adequate standard of care even when they are failing to meet national minimum standards for care homes”.
We were assured that that was going to be stopped. It has not been stopped under the structure that was established. The letter continued:
“the overall number of inspections of care homes has reduced. Homes that are failing to meet minimum standards are now inspected less often than used to be the case”.
We know that over the past 10 years, there has been a steady decline in the inspection of care homes nationally. We were told when the Act was passed in 2009 that it was going to be a risk-based system with a minimum of one inspection every three years. We know what a disaster that has been. We need an absolute minimum of unannounced inspections of care homes of at least twice per year, irrespective of the grading and irrespective of the ratings that have been applied to a particular home, because we all know that the management of a home can change over months, weeks or even overnight, and the home may drop in ratings dramatically as standards of care fall, depending on the financial considerations of the management of those homes.
The 2009 letter to me, four years before we stand here now, continued:
“requirements made by inspectors for action to improve care homes are often not met, there is little evidence of systematic follow-up by inspectors and requirements left unmet from one inspection to the next are common”.
That has happened over and over again over the past four years, and I am convinced that it will carry on happening until we set clear targets and a requirement of two unannounced inspections annually with a proper rating system, which is precisely why I support the amendment tabled by the noble Baroness, Lady Greengross, on the need for a pilot system for inspections.
I would now like to place on record the latest views expressed by the Relatives & Residents Association about what it believes the new structure should be. I do so because I understand that under the provisions of the Bill, the CQC will itself, following consultation with Ministers and others where necessary, be taking decisions on those very important areas. What does the Relatives & Residents Association say? I think that what it says should be implemented. It calls for the,
“reinstatement of regular twice-yearly inspections of all care homes to ensure compliance with regulations and standards. This case and others show that CQC needs to listen, record and act quickly on complaints which show older people are not receiving”,
the quality of care they should receive.
I add at that point that we are talking about complaints. I could never understand why we established the CQC without a proper complaints remit. According to the Relatives & Residents Association, people ring up to complain about the fact that the CQC is not dealing with complaints. The CQC says, “We do not deal with them, you have to go to the local authority”. The structure is wrong. The CQC should be the body that deals with those matters and should be given that responsibility. The association calls for investment and more and better training of all care home staff, with vastly improved training in leadership skills of care home managers and operators and up-to-date inspection reports which are easy to understand, with any action required by the provider clearly highlighted. It also wants to see:
“Care homes focusing on individual care rather than putting pressure on staff to complete daily tasks such as dressing and feeding.
Statutory registration of all care workers”—
a matter that we were dealing with on the last occasion we met as a Committee—
“by a professional body which can set standards for competence and hold individual care workers to account for their own practice.
The reinstatement of specific standards for care homes for older people”.
That might seem a particularly substantial agenda. However, if the Select Committee’s views on the ageing population are true and there is going to be a vast expansion of the care business in the future, more and more homes will have to open to deal with that increased population. We should be setting in place in this Bill a structure that is capable of dealing with that expansion in care. If we do not, we will be back here again in five years’ time arguing about a deficiency in the system. If I am still alive, I will be on my feet again complaining about the fact that the Bill we introduced in 2013 miserably failed. That is the route that the Government have set out to go down. Unless they make the resources available to address this, the CQC will inevitably fail again.
Baroness Howarth of Breckland
My Lords, I had not intended to speak in this debate and will do so briefly. We need to allow the CQC time to settle down under its new management. We should also remind ourselves of the rest of the history, because it is important to put it in context.
I was the deputy chair of the National Care Standards Commission, the first organisation that brought together the inspectorates for homes under the previous Government. It was also the previous Government who, after two years, made the decision concerning the organisation—which had been quite successful. It had established a baseline of inspection. It had integrated the inspectorates, which several other organisations which had tried to integrate the different teams had failed to do. Like other noble Lords, I would also cite CAFCASS in that regard. The commission did all of that. We should remind ourselves that it was only a year later that the previous Government announced through a newspaper, not directly to the staff, that the organisation would be merged with CSCI.
The merger took place and I think that it was extremely successful. David Behan was involved in ensuring that it went well. CSCI then took on the starring system which was put into place and was having some success. By that time, we had closed 400 poor establishments. The work was continuing in terms of co-operation when it was again decided that there should be a restructuring, this time to bring the inspectorate into health.
I think that we have two lessons to learn. The first is not to restructure yet again on a political basis. If there is good leadership and the lessons have been learnt, let the organisation settle down. The second lesson is clear. If you are going to inspect anything, you need to have the expertise within the teams to carry out the inspections. Again under the previous Government, it was a sort of theory that if you had somebody other than a nurse looking at nursing, a social worker looking at a social work establishment or a teacher looking at teaching—indeed, you usually did have teachers looking at teaching; that always seemed to be an exclusion—then you could get a better answer than if you had a professional do it.
I think that the present leadership at the CQC has learnt that lesson and understands that you need the professional expertise to know what you are looking for, although that should certainly be cross-checked by independents. I hope deeply that we will be able to keep that steadiness, because I understand absolutely what happens to organisations when they are in constant flux and change.
Perhaps I may make one other point while I am on my feet. I support anything that we can do about integration. We have singularly failed to reach some complex conclusions about how health and social care can truly be put together for the benefit of those who are the recipients of that care. We should ensure that we put into the Bill whatever we can about integration. I would support all of that.
Lord Bichard
My Lords, I rise briefly to support this amendment as a mere vice-president of the Local Government Association. Very few Members of this House were here a week or so ago when the noble Lord, Lord Bates, sponsored a debate on the increasing complexity of legislation and, indeed, the increasing volume of legislation. It is a shame that more noble Lords were not there. In that debate, the noble Lord referred to a recent report from the Office of the Parliamentary Counsel, which pointed out that when the Queen came to the Throne in 1952, after 740 years of legislation we had 26 volumes of Halsbury’s Statutes; we now have 74 volumes. In 1952, the average Bill was 22 pages long; it is now 122 pages long. In 1952, there were 29 statutory instruments; last year there were 3,328. This is an astonishing increase even on 2008, when there were just 1,325. On that last statistic, I can bear witness as a member of the Secondary Legislation Scrutiny Committee. Indeed, my postman particularly asked me if I could do something about the volume of secondary legislation.
We have reached a point where we need to think seriously about the volume of legislation and its complexity, and whether we can carry on imposing new burdens and responsibilities, not least on local authorities. It would be fine if all this additional legislation was actually removing some of the red tape and bureaucracy that previous legislation had provided, but we know that it is not doing so and that it does not do so. We need to do one of two things. Either we genuinely reduce the volume of legislation and the additional responsibilities that it places on all sorts of bodies, or, as the noble Lord, Lord Best, suggests, we have realistic costing of what these new responsibilities entail and ensure that resources are available. If we do not, we remain in a cycle of despair and decline where we expect others to deliver new responsibilities, which they are just not able to do. We also raise the expectations of clients and users, who believe that things will change, when in all honesty they probably will not. That, I think, is a cycle of despair and decline, and it is the reason why I support this amendment.
Baroness Howarth of Breckland
My Lords, I rise briefly, as yet another mere vice-president of the Local Government Association, to bring a slightly different dimension to this debate. The noble Lord, Lord Best, pointed out that local authorities are finding a variety of different ways of delivering services. I have been looking at some of those and listening to messages about them. One issue is that they are delivering cheaper services, which often means commissioning them from providers which will then deliver them at a different level of quality. I declare an interest as a provider in the charity Livability, which delivers services to the disabled, the elderly and some children from residential care.
We need to know whether we are prepared to open the debate. Have the Government as a whole given thought to discussing with the community at large what we really can and cannot afford for the future? The noble Lord, Lord Campbell-Savours, raised the issue of the numbers of inspections. When I was involved in inspections, one issue was that you could deliver as many inspections as you had funding for. Now you can use that funding in a variety of different ways to get better options but, at the end of the day, resources count and, unless we know how far the resources will go, it is pointless to try to descend into the abyss, as the noble Lord, Lord Bichard, said.
If we are going to take this forward, we have to know what level of quality people are prepared to accept. Then, when there are failures in organisations, people are not blamed, because the failure is not necessarily one of individuals or even of groups but of the corporate whole simply not having enough resources to work across the whole piece. Until we start that debate, we will not be able to intervene in discussions about criticisms of local authorities giving only 15-minute slots to people when they have only enough resources for 15-minute slots. In residential care, we are taking away some of the extra services because there is no more money them. We are reducing staffing in various institutions because there are simply not enough resources.
I am not denying that because of the deficit we have to look at funding; I think we do. However, we have to open up the debate. Otherwise, we raise expectations in the country of what we are entitled to. I sat in this Chamber until 11 o’clock last night discussing the Children and Families Bill, and we were having exactly the same discussion. We all want these wonderful things. I want things in this Bill, but somehow we have to decide on some priorities between them all. Whatever we say, we cannot go on expecting to get the same out of the same.
Lord Rix
My Lords, I support this amendment in particular. I declare an interest as the president of Mencap. There is no doubt that the services that we are able to provide are being severely cut back because local authorities simply do not have the money to support those services. Where we used to get, say, £15 an hour, we now get £12 an hour. The implication is that we can lower the standard of our services, but we are not prepared to do that. Therefore, we will end up reducing our services and, as a result, people with learning disabilities, their families and their carers will suffer. This is exactly the situation at the moment. Local authorities will try to provide the services, but they are making it much more difficult for voluntary organisations such as Mencap.
Autism
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Earl Howe
I can give my noble friend that assurance. The autism strategy is, of course, a cross-government strategy. A number of departments will look at their role in supporting it, including the Department for Work and Pensions and the MoJ. I am hopeful that when we come out in October with some considered proposals, my noble friend will take heart from the fact that this has involved all relevant government departments.
Baroness Howarth of Breckland
My Lords, one of the great concerns of people with autism is the transition arrangements between young people and adults, particularly the difficulties created now that education and social care provision are separated in adult education centres for these children and young people. What is intended to ensure that this does not continue to disadvantage these young people?
Earl Howe
My Lords, the Children and Families Bill, which was introduced into Parliament this month, will usher in from next year new joint arrangements for assessing and planning commissioning services for children and young people with special educational needs. We realise the difficulties that young people with autism can face in making that transition to adulthood. Under the autism strategy, my department and the Department for Education funded the social policy research unit at the University of York to examine how statutory services are currently supporting young people on the autistic spectrum. Its report, published in February, points the way to some important lessons that we should take on board during the review.
Health: Children's Heart Services
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Earl Howe
That is indeed the core of the disappointment felt by the clinical community and noble Lords: that we are little further forward in terms of deciding exactly where these services should be delivered. The noble Lord is also right to say that support for a philosophy of improving children’s heart services by concentrating surgical expertise to provide round-the-clock cover and develop networks of care is as strong as ever. There is a rare consensus on the clinical case for improving services on the pathway of care for children. The IRP has said that its report is not a mandate for going back over the ground of the past five years; indeed, it commends a great deal of the work done by the JCPCT. The IRP says that that work should be built upon. The JCPCT should not necessarily feel bruised by this, although I am sure that it will feel thoroughly disappointed. However, its groundwork has been publicly appreciated, and it is now for NHS England to take that work forward as swiftly as it can.
Baroness Howarth of Breckland
My Lords, I speak as the patron of Little Hearts Matter, the organisation that represents a large number of families who have children with heart conditions, particularly hypoplastic left heart syndrome, which is extremely serious and needs highly skilled intervention. Who does the Minister think is most disappointed about the failure of the review? I probably meet more families and children than most of your Lordships—children who await open heart surgery or extremely complex technical interventions, and whose anxiety is huge; and parents who thought that they were going to have clear answers on where their children would receive treatment and on the quality of those interventions at the end of the safe and sustainable review. I ask the Minister to take back with him all those disappointments and to look not only at safety, which is key to the families. Many of them would travel to wherever you took them if they were sure that the operation would be successful. As a woman from Yorkshire and the east of England, I understand that gap, but what the families want most is quality of service.
As the noble Lord, Lord Warner, pointed out, there is also great disappointment about the link being made with adult services because of where those services are located. Despite the review, there is a lack of understanding of the needs of children. There are certainly transitional difficulties and I ask the Minister whether it is those issues or other issues that have led to children being considered alongside adults. Will he take away with him the disappointment felt by families who are waiting longer for interventions because this has caused delay?
Earl Howe
My Lords, I am accountable to this House for government policy, but it is important for the noble Baroness to understand that this has been an NHS-led review. Many of her questions are for NHS England now to address. Of course there will be huge disappointment and concern among the families of those who require surgery in this area. I want to emphasise that until a decision is reached, the centres now delivering children’s heart services will continue to do so and will be fully supported in doing so.
However, we cannot ignore a series of recommendations from the IRP that has roundly criticised the methodology of the JCPCT. It concluded that the JCPCT’s way forward was flawed because the analysis was insufficiently thorough. If our aim is to improve the quality of outcomes for these children, I do not believe that it is in anyone’s interests to try to say to ourselves that we can make do with a half-good set of solutions. I do not suggest that the noble Baroness is saying that; of course she is not. We need to be thorough about this without spending another 10 years over it. I hope that I have given the sense to the House that NHS England is determined to progress this rapidly but thoroughly and, above all, in a consultative way. The families will have a chance to have their say in that process.