Health and Social Care Bill

Baroness Massey of Darwen Excerpts

Wednesday 16th November 2011 Lords Chamber

[Lord Ramsbotham]

My Lords, I was hoping to speak in support of my noble friend Lord Northbourne, who introduced a whole cluster of amendments which had at their heart not just parenting but the development of our children. I do not want to bore the House but my interest in this subject goes back to an occasion when I visited a young offender institution in Scotland. When I was walking round with the governor of the prison he said to me that if he had to get rid of all his staff, the last one out of the gate would be his speech and language therapist. I asked why and he said, “Because none of the children can communicate, either with each other or with us, and unless they can communicate there is absolutely nothing that we can do with them, or for them, and that includes their education, their discipline, their healthcare and indeed their general well-being”. Therefore this group of amendments—Amendments 72A, 81A, 200A, 201ZA, 327B, 327C, 329A, 331C, 333B and 91A—is all to do with getting speech and language communication needs for our children, which is the most common disability shared by children and adults in this country, put properly into the context of the Bill.

I think it is recognised that communication skills are the key life skill and the single most important factor in determining a child’s life chances. They are the means by which people form relationships and make choices and by which people access education, employment and society in general. Over the past few years—ever since I first became aware of this problem—I have been worried that nobody seems to be grasping the fact that every child’s communication ability must be assessed properly and as early as possible in life so that they can be given the best possible chance.

Following that experience in the young offender institution I was responsible for a two-year pilot with speech and language therapists in two young offender institutions. This pilot proved conclusively that if an assessment had been carried out much earlier those offenders may well have not ended up in the institution and that a very large number of them would not have been excluded or evicted from education because they would have been able to engage with their teachers. I have therefore been trying to interject in various education and justice Bills over the past six years the need for such an assessment to be built in to the education of this country. It is interesting that Northern Ireland has listened—now every child there is assessed for their communication skills at the age of two. That might be very early but, on the other hand, it also identifies potential problems. The amelioration of those problems can then begin early enough for the children to be able to engage in education.

Unfortunately, although that need has been accepted in education and justice Bills, nothing has happened because neither the education nor the justice department is responsible for funding those who have to make the assessment. Indeed, in 2005, when this pilot scheme came to an end, the Minister—Mr Paul Goggins—was invited to examine the funding of the possible provision of assessment. He could not work it out because neither the Ministry of Justice nor the Department for Education was willing to fund. When it came down to it, we found that individual speech and language assessors were the responsibility of individual primary care trusts around the country. Some of them decided that the assessors were essential and some of them did not and, therefore, it became a postcode lottery.

If we accept that communication difficulties severely limit an individual’s participation in education, in the world of work and in their family and community life then it stands to reason that unidentified speech and language problems can pose a secondary challenge, as they lead to diminished social skills, poor educational outcomes, anti-social behaviour, unemployment and mental health problems. In other words, all the factors that arise from a failure to assess communication skills and to enable people to communicate as well as possible can become a public health issue. I believe that it should be regarded as such, which is why these amendments mention the need for those who are responsible to have an integrated approach in order to ensure that all the relevant healthcare professionals liaise with each other and make certain that every child is given the proper start in life to enable them to engage with all the things that follow. This will require liaison with education and other authorities. I am not going to list all the various things that speech and language therapists can do, but one of the problems at the moment is that the assessment in many places is left, for example, to district nurses who have been trained by speech and language therapists. That is fine, except that we are told that the funding for speech and language therapists is to be cut and therefore it may be that their ability to train those who carry out these assessments will be inhibited.

I ask the Minister to ensure that this issue is examined properly and that the various authorities should be instructed to make these assessments in order to make certain that all our children can access that vital education and the other factors that will make their lives either possible or a failure. I beg to move.

[Baroness Massey of Darwen]

My Lords, I shall speak to Amendment 97. I agree with the noble Lord, Lord Ramsbotham, about the need for communication skills, but this set of amendments is really all about improving services for children. It is interesting to note that so much has been said during our debates on the Bill about the importance of the co-ordination of services of all sorts, but I would suggest that nowhere should services be better co-ordinated than those for children. That is absolutely crucial to success. I was interested to read the letter sent by the noble Earl, Lord Howe, after our previous sittings. He kindly circulated a series of paragraphs which stated on children’s issues that:

“We are determined to build in children’s health explicitly and clearly throughout the new system, including through the mandate … We want the NHS to play its full part in safeguarding and promoting the welfare of children and we expect the NHS to continue to improve processes for protecting children”.

I welcome those words, but I will seek further reassurances from him on their validity.

In amending Clause 20, I want to ensure that the Secretary of State will publish an annual mandate specifying the objectives that the NHS Commissioning Board must seek to achieve. This amendment would require that the mandate includes objectives related to improving services for children.

Children and young people are significant players in NHS services. Children account for around 40 per cent of the workload of GPs while making up 19 per cent of the population. Around 26 per cent of those attending A&E departments are children. Every year, about one in 11 children receives specialist out-patient care in hospital, while one in 10 to 15 is admitted for in-patient care. All these are key statistics. However, I suspect that while children and young people make significant use of NHS services, they and their families are often let down by a health system that is incoherent and affords only a low priority to child health services. I want to see this improved. Noble Lords may remember that Sir Ian Kennedy, when reviewing child health services, concluded that there was a,

“varying quality of services … with a large number in need of significant improvement”.

He also said that children were given a low priority when compared with adults, that they often received inappropriate or poor quality treatment or had to travel long distances. He identified a lack of co-ordination between the NHS and other services such as education provision. The question of co-ordination between services is something which comes up all the time. He also pointed out the low investment in services for the early years and a failure to provide safe environments within NHS settings.

I realise that there are particular challenges for children and young people with complex needs. Often little attention is given to how the system delivers for disabled children and young people, but I shall leave it to my noble friend Lady Wilkins to address that. The support group, Every Disabled Child Matters, highlights the range of challenges faced by disabled children and their families in securing good healthcare, but again I shall leave the detail to my noble friend.

The NHS mandate must include priorities for child health. This would ensure that tacking these issues is made a priority within the health service. It is appropriate to include objectives for children's health, because child health services operate on a separate system to those of adults, with separate structures and relevant partners. For example, children receive support from a wide range of child-specific professionals, such as health visitors, community paediatricians, children's nursing services and specialist treatment centres. So again the issue of co-ordinating according to age comes up strongly.

The difference between child and adult health structures is very much demonstrated when disabled young people make the transition from child to adult services, as indeed when other children make the transition to adult services. Without specific objectives for the issues in the system for children's health, there is a concern that the mandate will be ineffective in achieving change for children and young people. So I hope that the Minister will be able to respond positively to this. I suggest that the Government should amend Clause 20 to ensure that the NHS mandate sets out priorities for improving services for children and young people. They should also publish a policy statement setting out how it envisages the revised reforms will deliver improvements for children’s health in general.

[Baroness Wilkins]

My Lords, I speak to the amendments to which I have added my name, and urge the Minister to ensure that speech, language and communications needs are treated as a core public health issue in this Bill.

As the noble Lord, Lord Ramsbotham, said, communication is a basic life skill which underpins everything we do, particularly in this House. Good communication means that we connect with other people; we share ideas, thoughts and emotions and forge the relationships which all people require. Indeed, UNESCO believes that effective communication is one of the 10 core life skills that all human beings should have if they are to thrive.

Speech, language and communication needs are the most common disability experienced by children or adults, with over 20 per cent of the UK population experiencing problems at some point in their lives. These difficulties often start from birth. It is sobering to note that in some parts of the UK, particularly areas of social deprivation, upwards of 50 per cent of children are starting school with poor language skills, and poor language is linked to poor behaviour in young children. Two in every three language-delayed three year-olds have behaviour problems. Problems in later life follow with poorer employment prospects.

The earlier that any communication difficulties can be identified, the earlier solutions can be found, and the earlier help can be delivered. The centrality of communication is why this group of amendments focuses on establishing effective joint working and integrated commissioning for speech, language and communication needs. It requires the NHS to work in close partnership with education providers and local authority children's services. This is by far the most effective way of working. It also emphasises how important it is to deliver help early.

Amendment 81A to Clause 12 requires the NHS Commissioning Board to conduct an assessment of pre-school age children's communication skills. The impact of communication problems and their significance underlines why we believe that their assessment should be directed centrally by the board and not left to the local discretion of clinical commissioning groups. Last year's review of children's services within the NHS conducted Sir Ian Kennedy found that GPs, who will be the lead commissioners for clinical commissioning groups, have little or no experience of paediatrics as part of their professional training. Indeed, GPs often have a limited understanding of children with speech, language and communication needs. Central direction and support from the NHS Commissioning Board is vital in this. Further amendments within the group underline this point by requiring clinical commissioning groups to exercise their functions with a view to improving communication skills in children and young people. They must do so in close partnership with education or children's services. Currently people with speech, language and communication needs all too often miss out due to the divide in commissioning between health and education services.

This divide can mean that resources in terms of skills and equipment are not used effectively. Integration is vital to maintain and improve outcomes. The final two amendments within the grouping also address the necessity for integrated working by the new health and well-being boards when seeking to advance the health and well-being of the local population of the area they serve. If we are to move forward and ensure that all children and young people with communication problems are given the support they need to address them, then I would urge acceptance of these amendments.