Queen’s Speech

Baroness Howe of Idlicote Excerpts

Thursday 9th January 2020 Lords Chamber

[Baroness Howe of Idlicote (CB)]

My Lords, I welcome the Government’s commitment to introduce its online harms Bill,

“to improve internet safety for all”,

but, equally, stress that I remain deeply concerned by their failure to implement Part 3 of the Digital Economy Act. The rationale for focusing on the new Bill instead seems to be a desire to put attempts to protect children from pornographic websites on the same footing as attempts to protect them on social media platforms. It is entirely right to seek to promote safety in both contexts, but a basic error to suggest that both challenges should be addressed in the same way. The internet is complicated and one-size-fits-all policies simply will not work.

The focus of what I have read about the Government’s plans for online harms revolves around social media companies and fining them if they do not do what they are supposed to do under a new legal duty of care. An article in the Times on 31 December suggested that Ofcom is going to draw up legally enforceable codes of practice that will include protecting children from accessing pornography. This approach may work for social media platforms if they have bases in the UK but it will be absolutely useless at engaging with the challenge of protecting children from pornographic websites.

Initially when the Digital Economy Bill was introduced in another place, the proposal was that statutory age-verification requirements should be enforced through fines, but a cross-party group of MPs pointed out that this would never work because the top 50 pornographic websites accessed in the UK are all based in other jurisdictions. One could certainly threaten fines but it would be quite impossible to enforce them in a way that would concentrate the minds of website providers because, based in other jurisdictions, they could simply ignore them.

Because of that, MPs amended the Bill to give the regulator the option of IP blocking. This would enable the regulator to tell a site based in say, Russia, that if it failed to introduce robust age-verification checks within a certain timeframe, the regulator would block it from accessing the UK market. Children would be protected either by the site being blocked after the specified timeframe or, more probably, by the site deciding that it would make more sense for it to introduce proper age-verification checks rather than risk disruption of its UK income stream. The Government readily accepted the amendment because the case for it was unanswerable.

I say again that I welcome the fact that the Government want to address online safety with respect to social media platforms through their new Bill. This must not, however, be used as an excuse not to proceed with implementing Part 3 of the Digital Economy Bill, which provides the very best way of dealing with the different challenge of protecting children from pornographic websites.

The failure to implement this legislation is particularly concerning because, rather than being a distant aspiration, it is all there on the statute book. The only thing standing in the way of statutory age verification with respect to pornographic websites is the Government’s delay in relaying the BBFC age-verification guidance before Parliament and setting an implementation date. Having the capacity to deal with this problem—thanks to Part 3 of the Digital Economy Act—yet not bothering to avail ourselves of it does not reflect at all well on either the Government or British society as a whole. The Government must stop procrastinating over child safety with respect to pornographic websites and get on with implementing Part 3.

Mindful of that, on 21 January I will introduce my Digital Economy Act 2017 (commencement of Part 3) Bill, the simple purpose of which will be to implement Part 3 of the Digital Economy Act. I hope that that will not be necessary and that the Minister will today confirm that, notwithstanding the new online safety Bill, the Government will now press ahead with implementation themselves. I very much look forward to hearing what the Minister has to say.

Queen’s Speech

Baroness Howe of Idlicote Excerpts

Tuesday 22nd October 2019 Lords Chamber

[Baroness Howe of Idlicote (CB)]

My Lords, like the noble Lord, Lord McNally, I too have found myself having to change what I had intended to say today, following an announcement by the Secretary of State for the Department for Digital, Culture, Media and Sport last week that the Government no longer intend to implement Part 3 of the Digital Economy Act 2017. The profundity of this announcement and its political implications for the Government have not yet made their presence felt, for the simple reason that the announcement was made, probably on purpose, in the epicentre of the Brexit storm. The simple political reality, however, that the Government cannot escape, and the consequences of which they cannot circumvent, is that the 2015 Conservative manifesto stated, on page 35, that,

“we will stop children’s exposure to harmful sexualised content online, by requiring age verification for access to all sites containing pornographic material”.

That was a simple, profound, high-profile manifesto commitment that brought hope to parents up and down the country and to children’s charities. You simply cannot make this kind of commitment, introduce the legislation, appoint a regulator, ask the industry to prepare for the law change and then suddenly make a U-turn and not expect serious political consequences.

The Government may have to face an election, and therefore they may want to think again too. The actions of the Secretary of State suggest that even seminal Conservative manifesto commitments cannot be trusted, so I gently ask the Minister why anyone should believe what they say after some of the events of last week. How will we know that key commitments will not subsequently be swept away because the Government claim to have better plans?

On the subject of better plans, one of my difficulties is that the Government have not really said what these better plans are, other than that they will find expression in the context of their work on online harms, further to the White Paper. This is particularly problematic because, although I have spoken to children’s charities and parents, no one has been able to tell me of a better way to prevent children accessing pornographic websites than through the introduction of statutory age verification enforced by a regulator IP blocking non-compliant sites. Moreover, no one can imagine a more efficient way of facilitating children’s access to pornographic content online from the day that statutory age verification would have come in than abandoning this commitment so that it does not come into force.

Hopes had been expressed that the online harms White Paper process might extend that protection to social media but, let us be clear, nothing can take the place of statutory age verification in relation to pornographic websites. The best way to deal with pornographic websites is not necessarily the best way to deal with pornography on social media platforms, yet the Government seem to be using a rather crude one-size-fits-all logic to justify not introducing the most effective mechanism for protecting children from pornographic websites, in favour of some vague commitment to an undefined mechanism that can address everything. All this is simply not credible. In the world of online safety, there are no one-size-fits-all solutions. I am pleased, of course, that the Government want to do more to prevent children accessing pornography through social media platforms, but they should not use this as an excuse to justify jettisoning the most effective and efficacious way of protecting children from pornographic websites—statutory age verification—especially having made it a manifesto commitment.

I wonder whether whoever came up with this idea actually reminded the Prime Minister that they were recommending that the Conservative Party renege on a headline manifesto commitment—better, surely, to have never made that promise than to make it, introduce the legislation, prepare industry and then change their mind.

I also think the Government should think very carefully about how it looks to have people vote for a manifesto containing a simple, clear commitment to introduce statutory age verification and to then subsequently go back to them and say, “We know you voted for this but now we have a better idea”. In the context of Brexit, where they are saying that the political class should take care to respect how people have voted and not come back and tell them that they know better, they should apply the same logic to themselves.

The other consideration in all this which should not be overlooked is Britain’s influence in the world. The Government were leading the way in this space and multiple jurisdictions were watching with the greatest interest, including within the EU. If the Government recover their nerve, Britain will still have the opportunity to play a key role in setting global standards on statutory age verification. It seems bizarre that we should invest millions in developing world-leading legislation and technology and then, through an apparent loss of nerve—and with no moral compass as far as honouring manifesto commitments is concerned—turn our backs on a great opportunity for Britain to help protect children, not just in the UK but across the world. I very strongly suggest that if the Government do not want to alienate parents up and down the country, they should rapidly reconsider their strategy and lay the BBFC age verification guidance before Parliament as soon as possible.

[Baroness Chisholm of Owlpen (Con)]

My Lords, please let us try to keep to six minutes; otherwise, when we come to the wind-up speeches, they will be galloping, rather than being able to give noble Lords the answers they want.

Older Persons: Care and Human Rights

Baroness Howe of Idlicote Excerpts

Tuesday 11th July 2017 Lords Chamber

[Lord O'Shaughnessy]

I do not know if we can relate this to Brexit, but we can always try. The UK has a good record in this area. There are 14 specific recommendations in the report authored by the noble Lord. We are doing good things on personal budgets and on encouraging volunteering for the over-50s—so there is a lot of work going on in this country that we can be proud of.

[Baroness Howe of Idlicote (CB)]

My Lords, given that in future we will be looking at older people being very old indeed—up to about 150—what are we doing to think about their lives and about care for them beyond that age?

[Lord O'Shaughnessy]

There is a prospect to look forward to. If we will be living to 150, there are a lot of middle-aged people in this Chamber. The noble Baroness is right. There is a particular issue around frailty as people move into old age. That is why the GP contract introduces responsibility to look out for frailty, as well as making sure that there are named GPs for the over-75s and, if necessary, annual health checks, to make sure that there is both health and social care provision for older people.

Allied Health Professionals: Training

Baroness Howe of Idlicote Excerpts

Monday 8th February 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, having more paramedics is part of the solution, but the major part of the solution is to treat more people outside A&E departments, so that people do not require ambulances to take them into A&E departments but are treated at home.

[Baroness Howe of Idlicote (CB)]

My Lords, can the Minister tell the House how diabetic patients’ needs will be met by maintaining foot care and thereby decreasing the risk of amputations, given Health Education England’s proposed decrease in training places in podiatry of 9.7%? That is at the top end of the list which my noble friend Lady Finlay was talking about.

[Lord Prior of Brampton]

My Lords, I first extend my congratulations to the noble Baroness: it is her birthday today. I of course understand the vital importance of podiatrists. We are looking at a very small reduction in the planned number of training places next year of some 35 places. I would also make a more general point: in the mandate to Health Education England, we have set it a target of reducing the attrition rate among people starting training by 50%.

Women: Postnatal Depression

Baroness Howe of Idlicote Excerpts

Thursday 5th February 2015 Lords Chamber

[Earl Howe]

It is positive that the number of midwives has increased by 2,000 since 2010, as I mentioned, and there is a record number in training, as the noble Baroness mentioned. But she is right about the role of the midwife before, during and after the birth. The visits that a new mother can expect from a midwife should contain a session where the right questions are asked of the mother about how she is feeling and how her baby is. The signs and symptoms of postnatal depression are ones that every midwife is trained to pick up.

[Baroness Howe of Idlicote (CB)]

My Lords, as well as the importance of the bonding of the mother and baby, and the other very welcome steps that the Government are taking, I hope the Minister will agree that the needs of the children at home—they are very badly affected, one hears, by a mother who is in a state of mental depression—should be taken into account and met equally.

[Earl Howe]

The noble Baroness is, of course, quite right. Again, midwives and health visitors involved in family nurse partnerships are trained to look at the welfare and well-being of all members of the family.

Mental Health: Parity of Esteem

Baroness Howe of Idlicote Excerpts

Monday 23rd June 2014 Lords Chamber

[Earl Howe]

My Lords, mental health and mental well-being are priorities for the Government; I want to make that clear to the noble Lord. We have legislated for parity of esteem between mental and physical health, and we mean business on this. Our new mental health action plan, which has been well received, sets out our priorities for essential change. We have the Crisis Care Concordat, which guarantees that no one experiencing a mental health crisis should ever be turned away. We are rolling out choice in mental health, which is an extremely important step forward, and a whole range of other measures, including IAPT and the children’s mental health measures that I outlined a moment ago. I hear what the noble Lord says about funding. We have debated that matter in the House before. We are currently scrutinising local CCG spending plans to make sure that mental health gets the priority that it needs.

[Baroness Howe of Idlicote (CB)]

My Lords, I am sure that everyone welcomes the fact that mental health has emerged at last to receive the attention that it should be getting. However, will the Minister confirm that the Government are paying particular attention to the number of women in prison with a mental health problem? In previous decades, that was not addressed at all.

[Earl Howe]

My Lords, yes, we are doing so. We are paying attention not just to women in prison but to women and men in prison and in the criminal justice system more generally. We have committed £25 million to introduce a new liaison and diversion scheme in England to identify and assess the health issues and vulnerabilities of all offenders when they first enter the criminal justice system, which I think is the crucial moment. We are building on liaison and diversion services to improve the quality of those services and their coverage across England, and we are trialling a core model in more than 20 areas over the next two years with the aim of moving towards comprehensive rollout by 2017.

Children and Families Bill

Baroness Howe of Idlicote Excerpts

Wednesday 29th January 2014 Lords Chamber

[Baroness Benjamin (LD)]

My Lords, I ask noble Lords to consider the following points as we debate these amendments. More than 800 children visit their doctors every day due to the serious effect of second-hand smoke exposure, according to research published by the Royal College of Physicians. The survey also highlights that 65% of parents who smoke admit to doing so in the car with their children and other people’s children present, and that 75% of smoking parents were shocked to hear that second-hand smoke affects the health of so many children. If they had not been asked that question they would not have been aware of this, so they really need to be educated.

Asthma UK has stated quite clearly that second-hand smoke is a major trigger for asthma attacks, making the symptoms even worse. It believes that if we take action to reduce second-hand smoke, we will be a step closer to a world where asthma begins to be no longer a daily struggle, or where no one dies from that condition. The children’s charity Sparks—I declare an interest as one of its trustees—spends millions of pounds on research to eradicate asthma among children, a condition which is growing daily. Sparks dearly believes that if we take action to protect children from second-hand smoke, that will be helpful to children. So let us give careful consideration to what action we should take to protect children from the result of second-hand smoking and act robustly in the best interests of the child.

[Baroness Howe of Idlicote (CB)]

My Lords, I very much support the aims behind Amendment 62, and indeed an awful lot of what the noble Lord, Lord Hunt, said about doing something really firm to prevent smoking in cars when children are present. This amendment certainly seems a sensible and straightforward way to ensure that all children have a healthy start in life, without the harmful influence of tobacco smoke in their young and still developing bodies.

We have heard that opponents of the proposed ban on smoking in cars have argued that legislation on activity in private vehicles would constitute an invasion of people’s private space. The noble Earl, Lord Howe, even said in Committee on this amendment that although smoke-free public spaces legislation has proven to be extremely successful in reducing people’s exposure to second-hand smoke,

“it does not automatically follow from that that it is right to extend the scope of legislation to cover private cars”.—[Official Report, 20/11/13; col. GC 412.]

However, in the case of child protection, this may not be such a stretch of the imagination. My noble friend Lady Howarth absolutely spelt out that the issue of child protection is a perfect example of this distinction playing a secondary consideration to the well-being and health of the child. Children are protected by the law from abuse and neglect wherever they are.

I have heard about the impact that tobacco smoke has on the health of children. We have all heard about it. Their bodies are still developing and they are much more likely to be affected by smoke-related illnesses than their adult counterparts. A Royal College of Physicians report estimated that smoking around children causes more than 20,000 cases of lower respiratory tract infection; 120,00 cases of middle-ear disease; at least 22,000 new cases of wheeze and asthma; 200 cases of bacterial meningitis; and 40 sudden infant deaths—one in five of all SIDs.

We know that only a proportion of people continue to smoke around children, so the level of illness in children due to second-hand smoke is staggering. It would be difficult to impose such a law on the home—we have heard this already—but we can do something about children's exposure to smoke in cars. We also know that tobacco smoke pollution levels in vehicles can be 23 times greater than in a house. I am talking, of course, about a car with a roof on it. Moreover, when a child is strapped into the car, they do not have a choice about leaving the room—a choice possible, at least for some children, in their home—when adults are smoking.

More needs to be done to protect children from avoidable harm, whether this harm takes place in private vehicles or in public spaces. Moreover, there is also a precedent for banning smoking in vehicles. Cars are already recognised as potentially dangerous spaces for second-hand smoke exposure due to their confined spaces. This is why smoking has already been banned in all vehicles used for the purpose of work in the UK since July 2007. It is surely astounding that we cannot do something effective to protect children as well. There are no restrictions on smoking in private vehicles with children present. I believe fully that this needs to change.

[Viscount Simon (Lab)]

My Lords, the greater majority of people live in smoke-free homes, not because of the law, but because it is no longer acceptable to smoke in the home of a non-smoker. Equally, most smokers no longer allow smoking in their cars when children are present.

It is absolutely correct to protect children from second-hand smoke, but it is wrong to think that it is children who are most at risk from its catastrophic consequences. While it is estimated that there are 1 million children with asthma, adults with asthma outnumber them by four to one—and I am one of them. While open windows in cars have been mentioned by a couple of noble Lords, I would have an asthma attack on the motorway with my windows closed if there was someone smoking a cigar at some time somewhere ahead. Also, the greatest risk from second-hand smoke is to those with a pre-existing heart condition.

The objective of Amendment 57BB, therefore, must not be simply to protect children but rather to further change public attitudes and behaviour so that people no longer smoke in cars carrying any passenger. Just as the law focused on workplaces had a great effect on smoking at home, it is hoped that this amendment will reduce the harm caused to non-smokers of all ages.

As it is the noble Earl’s birthday today, I hope he will accept this amendment.

Children and Families Bill

Baroness Howe of Idlicote Excerpts

Wednesday 20th November 2013 Grand Committee

[Baroness Howe of Idlicote (CB)]

My Lords, we have heard time and time again both here and in the other place of the clear benefits that plain packaging on cigarette packs would bring to children’s future prospects. Indeed, we have already had clear evidence from other countries of the benefits of taking this measure, as we have just heard, and I need not repeat it. We have also been told of the serious and life-limiting impact that passive smoking in cars can have on young people’s lives. Children often do not know the true risks of passive smoking in vehicles until they have already been exposed to it and certainly cannot be expected to make informed decisions about smoking, particularly not those from the most vulnerable backgrounds. For many the very real risks are not understood until, crucially, they are already addicted.

The knowledge that more than 200,000 children in the UK started to smoke in 2011 should alone be quite enough to urge us to take this preventive action. Awareness campaigns and sharing information are crucial measures, and will continue to be so, but we can see that they are clearly not enough. Surely, we have a responsibility to protect children from something which we already know is devastating. Therefore, I strongly support this group of amendments.

[Lord McColl of Dulwich (Con)]

My Lords, I, too, support these amendments, and my name is attached to Amendment 264. I should declare that I have a history as regards smoking as I used to be a chain smoker but gave it up when I was six. About 15 years ago in your Lordships’ House I introduced an amendment to ban smoking in public places. I put it on the back of a criminal justice Bill, which is a convenient way of moving things. I was amazed that the House was full right up to midnight when my amendment was discussed. I fondly imagined that everyone had come to listen to my wisdom, but little did I know that the House had filled with smoking barons waiting to pounce. However, I got my own back on them because at the end of the debate I thanked everyone for their contributions and, instead of saying, “I beg leave to withdraw my amendment”, for some reason or other I said, “Amendment not moved”. They all looked very puzzled because we had just spent hours discussing it. However, the noble Baroness on the Woolsack quickly said, “Amendment not moved”, passed on and they lost the opportunity to vote. They were furious and I was very pleased. As a professor of surgery, of course, I fully back any move to reduce the amount of smoking and I am convinced that these amendments would do that.

--- Later in debate ---

[Baroness Drake (Lab)]

My Lords, I support Amendment 267, which would bring family and friends carers and special guardians in employment within scope for statutory entitlement to pay and leave when taking on the care of a child. The Bill extends the right that adoptive parents have to take ordinary and additional adoptive leave to approved adopters who have looked-after children placed with them. By contrast, the vast majority of family and friends carers who are raising children outside the looked-after system are not currently entitled to even a day of statutory paid leave when they take on the indefinite care of a child. Many have no entitlement beyond a few days’ unpaid emergency leave. That is a public policy that conveys that kinship carers have less value or make a lesser contribution than other carers of children, even though the children they care for often have complex needs. That cannot be right.

The amendment would extend the same employment rights to family and friends carers who have special guardianship orders, and to family and friends carers who take on the care of a child in certain defined circumstances. It would give the Secretary of State the authority to define those circumstances, and would extend the right to additional adoptive leave to family and friends carers and those with guardianship orders, again giving the Secretary of State the authority to define the prescribed circumstances.

There is a stark imbalance in the proposed employment leave entitlements for adoptive and prospective adoptive parents when compared to the lack of entitlements for kinship carers. That is unfair, irrational and inconsistent with the Government’s policy on the welfare and protection of children. It is unfair in that kinship carers voluntarily take on the responsibility, often in very difficult circumstances and at considerable cost to themselves, saving the taxpayer considerable amounts of money and achieving better outcomes for the child than if they had entered the care system. It is irrational in so far as the statutory rights to leave for parents, adopters or prospective adopters have been or are being improved, but no statutory rights are extended to the kinship carers of thousands of our most vulnerable children. It is inconsistent with current welfare policy in that the absence of a statutory right to leave, on taking care of the child, raises the barriers to carers’ continued workforce participation and increases the likelihood that they will become long-term unemployed and dependent on benefits. That undermines participation in the workforce as a route out of poverty for the children and the carer.

During the passage of the Welfare Reform Bill, the Government recognised that family and friends carers make a valuable contribution by caring for vulnerable children, and exempted those carers from work conditionality under the universal credit during the first 12 months of caring for a child. The Government have time-limited that exemption in the expectation that many carers should return to the labour market after a period of adjustment, so why not make provision for a statutory entitlement to leave and reduce the incidence of kinship carers leaving the labour force in the first place?

However, the problems that kinship carers face do not lie only in the requirements of the welfare system, they also suffer from the complete lack of recognition in employment law. The imbalance in their right is inconsistent with the protection of child welfare, in that kinship carers need to take leave to settle the children, who have often been through so much. This often comes after a long period of family crisis; the children can be traumatised and insecure, and they need to know that someone is there for them. That is precisely why social workers often want or require carers to take time out of work. There are also the practical requirements of making appointments with schools, solicitors and social workers, arranging legal orders and so on. Often, the children arrive unexpectedly in just the clothes they are wearing, but there is not even the most modest statutory provision allowing employed carers leave from their employment. Yet kinship care is the most common permanency option for children who cannot live with their birth parents. The same arguments apply to the extension of parental leave to kinship carers as were advanced for the introduction of adoption leave in the Employment Act 2002: the need for time for children to settle with and bond to carers and the advantages of enabling carers to remain in the labour market.

To scope the problem, an estimated 60,000 kinship carers have dropped out of the labour market to bring up children. The reasons for this include the needs of the child, but the fact that they are not entitled to time off increases the likelihood of their leaving the labour market, so contributing to the high proportion of kinship carers living in poverty. Family Rights Group research found that one-third were living on incomes below £350 a week. Grandparents Plus found that 73% of kinship carers were working before the children moved in, but that almost half of those who had been working left their jobs when the children arrived. Some 83% of those who gave up work say that they would have liked to have remained in work, while of those who gave up work just 13% are now back in work. Similarly, a Family Rights Group survey found that 38% of family and friends carers had left their job, lost their job or taken early retirement when they took on the care of the child.

The Bill presents the opportunity to extend parental leave entitlements to kinship carers who take on the indefinite care of a child, and to give them parity with prospective adopters. The majority of family and friends carers are not entitled to even one day of statutory paid leave. That cannot be fair. The arguments for providing a right to leave are equally compelling, whether looked at from the perspective of the carer or of the child.

[Baroness Howe of Idlicote]

My Lords, I have been reminded by the noble Baroness, Lady Massey, that we have had this discussion in the past. It struck everyone at the time how completely unfair this whole system was. Now that the noble Baroness, Lady Drake, has spelt out so many comparisons, it is, frankly, almost embarrassing to think about the disadvantage that kinship carers suffer when they take on this responsibility and often—most likely, I would say—produce much better results for those children, giving them a likely prospect of a far more fulfilled life than if they had gone into different forms of care.

In supporting what has been said, I would say to the Minister that I would love to hear that this area was going to be looked at hard and, as far as possible, a range of comparable systems would be considered for kinship carers, those coming into care and those who are to be adopted. If he could give us that assurance, or indeed tell us that a lot of this is already in process, that would be very helpful in settling our minds until Report, if nothing else.

[Baroness Tyler of Enfield]

My Lords, I support the amendment. It has been set out so comprehensively and compellingly that I do not need to add very much. The case seems to be overwhelming that when people who are providing kinship care—often, as has been said, in the most desperate circumstances—agree to step in, often at great personal cost to themselves, it is only right that the state should recognise the hugely valuable contribution they are making.

These children are often in states of great distress and trauma, and for a member of the family to be able to step in and provide some degree of stability is really important. We all know the cost to the public purse of children in care who go, for example, into residential homes—it is huge. The savings that are made by a member of the family stepping forward in this way are considerable. We also know about the very poor outcomes for too many children in care when they emerge at the other end of the system. Kinship carers can make a huge contribution and it is absolutely right that society should acknowledge that. One very important way it could do so would be by extending these statutory employment rights to kinship carers.

--- Later in debate ---

[Baroness Tyler of Enfield]

My Lords, I rise briefly to lend my support to this amendment. The hour is late and I will be brief. I am one of that band of noble Lords who were involved at all stages of the Care Bill and I think we have made great strides in joining up the Care Bill and the Children and Families Bill. I salute Ministers for having done that. I particularly pay tribute to Ministers for what they have done on young carers. We now have a set of rights for young carers which is so much stronger than before and that is a real landmark. Through the Care Bill, we have got improved rights for adult carers to assessment and support, and I applaud the Government for doing that. We have got much improved rights for young carers through the Children and Families Bill, linking in nicely with the Care Bill, and again I applaud the Government for doing that. We just have this one group left: the parent carers, who generally care for disabled children. If we could just get that missing bit of the jigsaw all sorted out so that all carers had the same set of rights to assessment and support, I think that it would be a tremendous step forward for carers in this country. I am encouraged to hear that meetings are still taking place and I hope that the Minister may have some encouraging news for us that the missing bit of the jigsaw is going to be put into place. We can all then be absolutely proud of what these two Bills together have done for carers.

[Baroness Howe of Idlicote]

My Lords, very briefly, it was only about an hour ago that we had exactly the same situation having to be sorted out for kinship carers. For goodness’ sake, parent carers are about as kinship as you can get, and if they cannot be rolled into the same set up of proper analysis and proper attention to their needs, then what can happen? I hope the Minister is going to move this thing on as quickly as possible.

[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.

Health: Hearing Loss

Baroness Howe of Idlicote Excerpts

Monday 17th December 2012 Lords Chamber

[Earl Howe]

My Lords, that is why we are sure that it is for general practitioners to prompt their patients, when appropriate, on having an audiology assessment. The noble Baroness is right that people need prompting but there is more than one way of doing that.

[Baroness Howe of Idlicote]

My Lords, as someone who has had hearing problems since the birth of our children—a hearing loss which is now being considerably worsened by my own ageing process—I know how important it is to persevere with actually using hearing aids, once the right ones have been agreed with a specialist. I very much hope that the national screening committee will agree to my noble friend’s suggestion that there should be a definite age, with a follow-up to the screening. What plans does it have to help those who have hearing aids assessed for them to persevere with the use of those aids, since that is absolutely vital to their well-being in the future?

[Earl Howe]

The noble Baroness is quite right. Clinicians have found very often that patients who receive hearing aids decide, for one reason or another, not to use them. That is of course very serious; it is a waste of resources but, perhaps more importantly, it is potentially damaging to or indeed dangerous for the patient. Compliance is undoubtedly an issue. In the end, however, nobody can be forced to wear hearing aids but, once again, we believe that there is a role for audiology specialists and general practitioners in encouraging the proper use of hearing aids.

Health and Social Care Bill

Baroness Howe of Idlicote Excerpts

Wednesday 30th November 2011 Lords Chamber

[Baroness Pitkeathley]

My Lords, we shall have extensive debates about regulation at a later stage of the Bill, but it is important to remind the Committee that the ability to regulate healthcare assistants and quality assure them already exists for employers without the need for further statutory regulation. Perhaps in my role as chair of the Council for Healthcare Regulatory Excellence it might be convenient for the Committee and perhaps save the Minister a little time if I respond to the points made by the noble Lords, Lord Alderdice and Lord Walton of Detchant.

The Council for Healthcare Regulatory Excellence, in its new guise as the Professional Standards Authority, will be given the role of quality-assuring voluntary registers. Talks with psychotherapists are already under way and are going very well. The General Social Care Council is going to become part of the HPC, which will in turn change its name and be overseen by what will then become the Professional Standards Authority. That is just for the clarification of the Committee.

[Baroness Howe of Idlicote]

My Lords, I have listened to what has been said by all these expert professionals and I am very much persuaded in favour of something along the lines of this amendment. I think that one of the most worrying things from the public viewpoint has been the sheer number of concerns about nursing that we have had in the press—not least, I may say, about the mortality rates et cetera going up during weekend staffing. Quite clearly there is a need for better reorganisation.

I go back quite a long way, to the time when I sat on the Briggs committee on the future of the nursing profession, and will never forget one of the nurses saying to me at the time: “I’ve been nursing for”—however long it was; she had just got her qualification—“and now I’m going to have a rest”, which was roughly what she was up to. I had a great deal of sympathy with her from that viewpoint.

I hope the Minister will bear in mind—I am sure that he must be more than aware of it—that the number of cuts in nursing staff are considerable in the present plan. Something like 8.3 per cent of qualified nursing jobs are to be lost. As the Royal College of Nursing pointed out in its briefing, that is on top of something that was done no less than about 18 months ago and is more than 10 times the original figure. Axing up to a quarter or a third of nursing posts will undoubtedly have a deep and potentially dangerous impact on patient care. Of course the training of the nurses—the experts in the really expert places—is essential. The training and up-skilling of those nurses on the real needs of patients is vitally important, but so are the numbers.

[Baroness Thornton]

My Lords, I thank the noble Baroness, Lady Emerton, the noble Lord, Lord Patel, and my noble friend Lord MacKenzie and other noble Lords for bringing these important amendments into Committee. Amendments 138 and 139 make provision for the NHS Commissioning Board to mandate safe nursing staffing levels and the number of patients a registered nurse is designated to care for. At the risk of stating the absolutely obvious about safe and effective staffing levels and patient ratios, where there are insufficient nurses and too many patients allocated to care for, then the level of care that can be administered will be affected. These amendments are about patient safety and well-being and the noble Baroness, Lady Murphy, hit the nail on the head. In response to her remark about speeches and the length of speeches, my observation, which is shared on these Benches, is that the Cross-Benchers are not the problem. They have been making admirably short and speedy comments. I hope that mine will be also. Other noble Lords might think about that.

This is a current problem as well as a long-term problem. As my noble friend Lord MacKenzie said, it has been with us for a long time, but it is current at the moment. The Royal College of Nursing tells us that some NHS trusts are diluting the skill mix on wards and in other care environments. This dilution is when non-registered healthcare support workers are employed in the place of a registered nurse. Healthcare support workers are paid—as one might guess—significantly less than registered nurses due to their comparative lack of vocational qualifications, so are seen by employers as a cheaper option. We think that that potentially puts patient safety at risk. Recent research by the Nursing Times has highlighted a significant variation in skill mixes between different hospitals in different regions. It seems to us that when cost becomes the overriding factor at the expense of the quality of service, patient outcomes and even patient safety become endangered. The most high-profile recent example of this was the care failings of the Mid-Staffordshire NHS Trust. Sadly, due to a range of factors—including financial pressures—costs were cut, nursing staffing levels were reduced and patient safety declined. It is vital, therefore, that stakeholders, including the RCN, work together with the national Commissioning Board to set the appropriate staffing levels and standards. There is some evidence from the NHS Information Centre that there is an accumulating problem here. Between January and August, the decline in terms of full-time equivalents in nursing, midwifery and health visiting staff in England fell by 1.6 per cent, from 310,989 to 306,028. There is evidence of a growing problem.

I would like to ask the Minister about an exchange in October when the Secretary of State gave evidence to a Select Committee. He stated that he was not aware of the down-banding, which is the issue at stake here, relating to the ratio. He was not aware that this was a problem or that the Royal College of Nursing had raised it with him. The Director of Nursing at the Royal College of Nursing then gave evidence to the same Select Committee the following day. She claimed that the Secretary of State was aware of down-banding practices; that the Royal College of Nursing, among others, had drawn it to his attention; and that it was a matter of some concern. I ask the Minister whether the department is aware that this is a problem and what it is intending to do about it.

These Benches support the amendments, and we are keen that this issue should be addressed robustly.