NHS (Charitable Trusts Etc) Bill

Baroness Massey of Darwen Excerpts

Friday 26th February 2016 Lords Chamber

Moved by

[Baroness Massey of Darwen]

That the Bill be now read a second time.

[Baroness Massey of Darwen (Lab)]

My Lords, it is a great pleasure to sponsor this Bill and present it to your Lordships today and seek your support. It is an honour to follow the passage of the Bill in another place, where there was unanimous and enthusiastic support. The debates were led ably and sympathetically by Wendy Morton, MP for Aldridge-Brownhills. It is entirely appropriate that a Bill involving Peter Pan should be introduced by an MP called Wendy. I thank the Minister and Wendy Morton for meeting me, and Department of Health officials for their excellent guidance. I thank also Great Ormond Street Hospital and the Association of NHS Charities for their help. Most importantly, I thank the Library for its most useful briefing pack.

I very much look forward to the maiden speech of the noble Lord, Lord Bird. We have discussed the Bill and I know that he is committed to its principles. I also look forward to the Minister’s response. I know that he has connections of long standing with Great Ormond Street. I am delighted that my noble friend Lady Blackstone is taking part today. She has been significant in ensuring that issues relating to NHS trusts are reconsidered. She is of course now the chair of Great Ormond Street Hospital for Children NHS Foundation Trust.

The Bill may seem complex but it is, in fact, fairly simple and its aims are clear. It seeks to do two things. First, it makes provision to remove the Secretary of State’s powers to appoint trustees for NHS charities linked to NHS bodies in England, and makes consequential amendments to the removal of those powers. Secondly, it makes provision to amend sections of the Copyright, Designs and Patents Act 1988 to transfer to the new Great Ormond Street Hospital Children’s Charity, to be known as GOSH, the right to a royalty in relation to performances or publications of the play “Peter Pan”. There are other related and transitional provisions.

At the moment, the right is in the hands of special trustees appointed by the Secretary of State, and I will go into this in greater detail in a moment. It is worth adding that when the NHS was established there was no Charity Commission, and structures for charities were quite different. All that we seek now is a level playing field to improve the ability of charities to work more efficiently to raise money and spend it to the advantage of children, in the case of Great Ormond Street, and of clients generally.

Noble Lords will know that JM Barrie, the author of “Peter Pan”, made a bequest in 1929 to Great Ormond Street Hospital so that it might benefit from royalties. As I reread “Peter Pan” over the weekend I realised that it is actually a political thriller, set largely in Neverland and full of idealism, revenge, rescue and battles. We probably have a number of potential cast members here today. Who would play Peter Pan, who Wendy and who the Lost Boys? Would the Minister fancy himself as Captain Hook? Will Tinker Bell suddenly alight on the Dispatch Box? How would the doorkeepers deal with the ticking crocodile?

I shall not go into the Bill in minute detail—noble Lords will be aware of its implications—but I shall set out the main thrusts. I shall give a brief history and then look at the policy issues for the two components of the Bill. First, I shall discuss issues relating to the Great Ormond Street Hospital Children’s Charity, GOSH. Since 1929, Sir James Barrie’s gift has provided a great deal of income to the charity, which, as we all know, provides superb services for sick children and their families.

In 1987, the former Prime Minister Lord Callaghan successfully proposed an amendment to the Copyright, Designs and Patents Act 1988, giving the charity the unique rights to royalties from the publication or performance of “Peter Pan” in perpetuity. However, there were problems, and my noble friend Lady Blackstone raised the need to amend legislation to benefit from the Barrie bequest during the passage of the Deregulation Act 2015. The Government agreed to introduce legislation, which is what the Bill is all about. The problem is that the so-called Peter Pan rights are vested in special trustees appointed under NHS legislation for Great Ormond Street Hospital. The Department of Health made an agreement with the hospital whereby the existing NHS charity transferred most of its undertaking to an independent charitable company limited by guarantee. That new company was also appointed as corporate special trustee of the existing NHS charity under the Act in 2006.

At present, the GOSH charity is unable to fully complete the conversion to an independent charity as the NHS charity has to be kept in existence until the Copyright, Designs and Patents Act is amended. This complication, according to GOSH, presents a huge risk that legacies to the charity may fail, thus significant charitable donations could be lost to the provision of healthcare at Great Ormond Street Hospital. I know that the GOSH charity has adopted a five-year strategy, aiming to raise £500 million in that period to benefit patients, their families, the hospital and research. If the Bill were not passed, the charity would not be able to complete its move to independence. The hospital would therefore have to run two charities, one the independent arm and the other the existing one, into which royalties from “Peter Pan” would be transferred. This is clearly a waste of time, energy and money, with more duplication of effort and more bureaucracy. That is why the Bill is so important.

I will now briefly go into issues for NHS charities in general. NHS charities are those regulated by charity law but which are linked to NHS bodies and bound by NHS legislation. They are charitable trusts. Their trustees are an NHS body such as a foundation trust, or trustees appointed by the Secretary of State for an NHS body. The Secretary of State has statutory powers to transfer trust property held by NHS charities. Such charities are distinct from independent charities established solely under charity law, and funds donated to the NHS must be held separately from Exchequer funding provided by the taxpayer. NHS bodies can hold properties on trust for any purpose relating to the health service. Charitable funds can be held by NHS trusts, special health authorities, foundation trusts, clinical commissioning groups and NHS England. Boards act as corporate trustees of the charitable funds.

Since 1973, the Secretary of State has had powers to appoint special trustees to manage charitable property on behalf of hospital boards. In 1990, powers for the Secretary of State to appoint trustees to NHS trusts were enacted and are now extended to other NHS bodies, as set out in the National Health Service Act 2006. The NHS Trust Development Authority oversees the appointment and removal of trustees. Separate trustees can be appointed if a business case can be made. The situation, as noble Lords will see, has become complex and somewhat unwieldy.

In 2011, the Department of Health conducted a review and consultation on NHS charities. In consequence of this review, the department announced its intention to allow NHS charities to move, with safeguards, to independent status and be regulated by the Charity Commission. There is detailed guidance on this, which I will not go into.

The bottom line of the Bill is that the Secretary of State will no longer appoint trustees, although he or she can, by order, appoint trustees to hold trust property in respect of certain NHS bodies. Clause 1 sets out the removal of the Secretary of State’s powers; Clause 2(1) discusses supplementary provision; Clause 3 discusses the transfer of the rights to the royalties from the play “Peter Pan”; Clauses 4, 5 and 6 detail the extent, commencement and the Title of the Bill; and there are two schedules. Thus, although the Bill is short, it is significant. It will sweep away bureaucracy, clarify and simplify the position of trustees and NHS charities and will give charities more freedom to operate.

In the film “Peter Pan”, Peter Pan says:

“To live will be an awfully big adventure”.

The Bill will ensure that trusts, such as the Great Ormond Street Hospital trust, are freed from undue bureaucracy to spend more of their charitable donations on patients and, we hope, allow more children to live for that big adventure. I recommend the Bill to your Lordships, I thank all noble Lords who have stayed for this Friday session, and I look forward to their speeches and to the Minister’s reply. I beg to move.

--- Later in debate ---

[Baroness Massey of Darwen]

My Lords, when I told my husband of 50 years—and I took a long time to say this to him—that as part of our wedding anniversary today I would be leading a Bill in the House of Lords, he said a lot of things. I can only repeat some of them. One of them was, “How can anybody do that on a wedding anniversary?”. Of course, I pleaded parliamentary timetabling, and I think I am forgiven, so I look forward to another wonderful day today and a lovely dinner in peace in our home town of Lewes. However, I am actually glad to have been here today because I have enjoyed myself. I have had great support from the House for the Bill, and I shall come on to the Minister’s comments in a moment, but I have also learned a lot, not only about charities but also about some of the people in the House.

I feel for the noble Baroness, Lady Barker, who said that it has been a terrible year for charities. I have worked in charities and been a trustee of several. Charities constantly have to look at themselves and embrace reform, without losing sight of their charitable objectives and what they are there for, which is to benefit clients. The Bill is part of that process, certainly for Great Ormond Street, but also for other charities which will be affected by the Bill. Some important issues have been brought up today and I will run through a few.

The noble Lord, Lord Crisp, talked about the importance to charities of innovation. Charities are good at innovating, but as was said later, they actually need some framework on which to be innovative. I thank the noble Baroness, Lady Blackstone, for her work on this issue over many years. She paid very moving tribute to GOSH and gave examples of supporting the charity and what it gives the hospital. The noble Baroness, Lady Barker, reminded us of the work of Barnardo’s. We should never forget Dr Barnardo, a great social innovator who talked about the need for reorganisation and reform of charities.

What can I say about the speech of the noble Lord, Lord Bird? A lot, but I will just say one or two things. It was extraordinary, inspiring and enthusiastic. It emphasised serious points about the need for governance and opportunity. His many wise words made me think about how, yes, you can use poverty as opportunity, giving a hand up, not a handout. He is a very good example of this initiative—triumphing over background. We talk about social mobility a lot in this House and today we have seen it and I thank the noble Lord for that.

The noble Lord, Lord Patel, in his short but, as ever, effective speech, spoke eloquently about the work of charities, particularly children’s charities. I am so glad that the noble Lord, Lord Cormack, spoke in the gap with his usual wisdom and charm. He and I share two passions: one is the House of Lords and its work; and the other is frustration over abbreviations. We both sit on a committee where we fume at the number of abbreviations with which we are presented that we do not understand.

The right reverend Prelate the Bishop of Bristol talked very aptly about passing on stories and themes. This is a story and theme about sick children which is very relevant and important to all of us, and on which Great Ormond Street and other children’s hospitals in this country—we must not forget the other hospitals—do superb work.

My noble friend Lord Hunt talked about the role of trustees. One must not forget either that trustees do an amazing job of holding charities to account and together, and supporting them.

I thank the Minister very much not only for meeting me before this Bill came to your Lordships’ House but for his unequivocal support for it, which he stated today. I realise that he has many personal contacts with GOSH, which he shared with the House. I thank him for his support.

Bill read a second time and committed to a Committee of the Whole House.

Mental Health Services

Baroness Massey of Darwen Excerpts

Thursday 25th June 2015 Lords Chamber

[Baroness Massey of Darwen (Lab)]

My Lords, I thank my noble friend Lady Thornton for introducing this debate. She has highlighted many of the problems facing young people that are set out in the Care Quality Commission report, as has the noble Baroness, Lady Walmsley. Both have said that young people are particularly vulnerable and badly served.

As we can see from the excellent Library briefing, there have been numerous deliberations about young people’s mental health from a variety of sources. Importantly, the then Minister, Norman Lamb, said earlier this year that these set out a compelling economic case for change, and change is what we have to focus on. The All-Party Group for Children, which I chair, has conducted an inquiry into the development of good mental health and emotional well-being for young people in the face of life’s challenges. I shall say a little bit about that but will first ask the Minister: what is happening to all the initiatives for young people and reports that have come out in recent years?

I want to mention briefly the report published by the Association for Young People’s Health, based on key data on adolescence. The report points out that half of all cases of psychiatric disorder start by the age of 14, and three-quarters by 24. Around 13% of boys and 10% of girls have mental health problems. The most common issue for boys is conduct; for girls it is emotional difficulties. Mental health issues include eating disorders, attention deficit and hyperactivity disorder, behavioural problems, self-harm and, in extremis, suicide. Mental ill-health is on a spectrum from low-level to severe. It is not necessarily an extreme psychiatric disorder. Good mental health can be encouraged, and I shall say something about this in a moment.

As I turn to the findings of the all-party group inquiry on children’s mental health, I thank yet again the National Children’s Bureau for its wonderful support, not only in organising the evidence sessions but in recording the findings, and for supporting children in general. The inquiry on mental health was a joint one, involving other all-party groups: those on child protection, penal affairs, and looked-after children and care leavers. We looked at three key challenges: relationships, service provision and transitions. We took evidence from young people, doctors, charities, schools and researchers.

One thing which became very clear at the beginning was that emotional exploitation online has a devastating effect on children. There is good evidence on this from ChildLine. Parents are often baffled by the online world and need advice and help. There is the need for better and more easily accessible support for young people, including online services such as cybermentors and online counselling. Is the law keeping up with technology? Will the Government encourage such services and the provision of extra information for parents?

The manager of a secure children’s home told the inquiry that there need to be expert child-centred holistic services to meet the complex needs of young people, including appropriate assessment of health, substance misuse and offending behaviour. Interventions need to include therapy and counselling, such as art therapy. Also important for young people is access to employment and accommodation.

I now want to look at what might be done to help prevent distress in children in the first place. A supportive family is all-important. Sadly some children do not have this and, even when they do, things can go wrong. Early spotting of learning problems such as dyslexia, and of behavioural problems such as bullying or self-harm, is essential. This may happen through a number of agencies, including parents, the voluntary sector, schools, children’s services, or the police. The old issue of services being co-ordinated and accessible is important, and we sometimes miss out on problems and the potential for early intervention. Others have asked this question, which I will repeat: how can we improve cross-agency working?

I will say a word about schools. The all-party group heard from pupils, teachers and researchers about how school can be distressing for some children. Focusing on performance and academic success can be unproductive if emotional needs are not met. It was said that student well-being is as important as academic achievement and must be integrated into every part of school life and learning. Children can develop self-esteem and resilience through a school’s approach. I have long supported, as has the noble Baroness, Lady Walmsley, the inclusion of statutory personal, social and health education in and outside the school curriculum. I am aware that the Government are considering the call of the Select Committee on PSHE to make it statutory in schools. I hope that the Government will take a positive approach to that.

An earlier inquiry by the All-Party Group for Children calls for action to implement the recommendation of the Children and Young People’s Health Outcomes Forum. It states that the Government should make it a legal obligation for public bodies to have due regard for children’s rights and that schools should ensure they develop a full programme for personal development, as well as academic skills, and link to support services. A cross-government youth strategy should be established, building on the report Positive for Youth. I hope that the Minister will be able to reassure the House that proactive measures, such as those I have mentioned briefly today, will be made concrete so that we can support children and families in preventing mental health problems and offering support and services if they arise.

Children and Families Bill

Baroness Massey of Darwen Excerpts

Wednesday 20th November 2013 Grand Committee

Moved by

[Baroness Massey of Darwen]

267: Clause 93, leave out Clause 93 and insert the following new Clause—
“Statutory rights to leave and pay of prospective adopters with whom looked after children are placed, special guardians and family and friends carers
(1) In section 75A of the Employment Rights Act 1996 (ordinary adoption leave), after subsection (1) there is inserted—
“(1A) The conditions that may be prescribed under subsection (1) include conditions as to—
(a) being a local authority foster parent;(b) being approved as a prospective adopter;(c) being notified by a local authority in England that a child is to be, or is expected to be, placed with the employee under section 22C of the Children Act 1989;(d) becoming a special guardian under section 14A of the Children Act 1989;(e) becoming a family and friends carer in prescribed circumstances.” (2) In section 75B of the Employment Rights Act 1996 (additional adoption leave), after subsection (1) there is inserted—
“(1A) The conditions that may be prescribed under subsection (1) include conditions as to—
(a) becoming a special guardian under section 14A of the Children Act 1989;(b) becoming a family and friends carer in prescribed circumstances.”(3) In section 80B of the Employment Rights Act 1996 (entitlement to ordinary paternity leave: adoption)—
(a) in subsection (5), after paragraph (a) there is inserted—“(aa) make provision excluding the right to be absent on leave under this section in the case of an employee who, by virtue of provision under subsection (6A), has already exercised a right to be absent on leave under this section in connection with the same child;”;(b) after subsection (6) there is inserted—“(6A) Regulations under subsection (1) shall include provision for leave in respect of a child—
(a) placed, or expected to be placed, under section 22C of the Children Act 1989 by a local authority in England with a local authority foster parent who has been approved as a prospective adopter;(b) for whom a special guardian has been appointed under section 14A of the Children Act 1989; (c) placed in a family and friends care arrangement in prescribed circumstances.(6B) This section has effect in relation to regulations made by virtue of subsection (6A) as if—
(a) references to being placed for adoption were references to being placed under section 22C of the Children Act 1989 with a local authority foster parent who has been approved as a prospective adopter or to being placed with a special guardian under section 14A of the Children Act 1989 or to being placed in a family and friends care arrangement in prescribed circumstances;(b) references to placement for adoption were references to placement under section 22C or section 14A with such a person or to placement with a family and friends carer in prescribed circumstances;(c) paragraph (aa) of subsection (5) were omitted.”(4) In section 171ZB of the Social Security Contributions and Benefits Act 1992 (entitlement to ordinary statutory paternity pay: adoption), after subsection (7) there is inserted—
“(8) This section has effect in a case involving a child placed under section 22C of the Children Act 1989 by a local authority in England with a local authority foster parent who has been approved as a prospective adopter, or placed with a special guardian under section 14A of the Children Act 1989 or placed in a family and friends care arrangement in prescribed circumstances, with the following modifications—
(a) the references in subsection (2) to a child being placed for adoption under the law of any part of the United Kingdom are to be treated as references to a child being placed under section 22C in that manner or to being placed with a special guardian under section 14A or to being placed in a family and friends care arrangement in prescribed circumstances;(b) the reference in subsection (3) to the week in which the adopter is notified of being matched with the child for the purposes of adoption is to be treated as a reference to the week in which the prospective adopter is notified that the child is to be, or is expected to be, placed with the prospective adopter under section 22C or the week the special guardian is expected to be appointed or the week the child is expected to be placed in a family and friends care arrangement in prescribed circumstances;(c) the reference in subsection (6) to placement for adoption is to be treated as a reference to placement under section 22C of section 14A or to placement with a family and friends carer in prescribed circumstances;(d) the definition in subsection (7) is to be treated as if it were a definition of “prospective adopter” or “special guardian” or “family and friends carer in prescribed circumstances”.(9) Where, by virtue of subsection (8), a person becomes entitled to statutory paternity pay in connection with the placement of a child under section 22C or 14A of the Children Act 1989 or placement with a family and friends carer in prescribed circumstances, the person may not become entitled to payments of statutory paternity pay in connection with the placement of the child for adoption.”
(5) In section 171ZE of the Social Security Contributions and Benefits Act 1992 (rate and period of pay), after subsection (11) there is inserted—
“(12) Where statutory paternity pay is payable to a person by virtue of section 171ZB(8), this section has effect as if—
(a) the references in subsections (3)(b) and (10) to placement for adoption were references to placement under section 22C or 14A of the Children Act 1989 or placement with a family and friends carer in prescribed circumstances;(b) the references in subsection (10) to being placed for adoption were references to being placed under section 22C or 14A or to being placed with a family and friends carer in prescribed circumstances.” (6) In section 171ZL of the Social Security Contributions and Benefits Act 1992 (entitlement to statutory adoption pay), after subsection (8) there is inserted—
“(9) This section has effect in a case involving a child who is, or is expected to be, placed under section 22C of the Children Act 1989 by a local authority in England with a local authority foster parent who has been approved as a prospective adopter, or placed with a special guardian under section 14A of the Children Act 1989 or placed in a family and friends care arrangement in prescribed circumstances, with the following modifications—
(a) the references in subsections (2)(a) and (4A)(a) to a child being placed for adoption under the law of any part of the United Kingdom are to be treated as references to a child being placed under section 22C in that manner or to being placed with a special guardian under section 14A or to being placed in a family and friends care arrangement in prescribed circumstances;(b) the reference in subsection (3) to the week in which the person is notified that he has been matched with the child for the purposes of adoption is to be treated as a reference to the week in which the person is notified that the child is to be, or is expected to be, placed with him under section 22C or the week the special guardian is expected to be appointed or the week the child is expected to be placed in a family and friends care arrangement in prescribed circumstances;(c) the references in subsection (4B)(a) to adoption are to be treated as references to placement under section 22C or 14A or placement with a family and friends carer in prescribed circumstances;(d) the reference in subsection (5) to placement, or expected placement, for adoption is to be treated as a reference to placement, or expected placement, under section 22C or 14A or placement with a family and friends carer in prescribed circumstances.(10) Where, by virtue of subsection (9), a person becomes entitled to statutory adoption pay in respect of a child who is, or is expected to be, placed under section 22C or 14A of the Children Act 1989 or placement with a family and friends carer in prescribed circumstances, the person may not become entitled to payments of statutory adoption pay as a result of the child being, or being expected to be, placed for adoption.”
(7) In section 171ZN of the Social Security Contributions and Benefits Act 1992 (rate and period of pay), after subsection (8) there is inserted—
“(9) Where statutory adoption pay is payable to a person by virtue of section 171ZL(9), this section has effect as if the reference in subsection (2E) to the week in which the person is notified that he has been matched with a child for the purposes of adoption were a reference to the week in which the person is notified that a child is to be, or is expected to be, placed with him under section 22C of the Children Act 1989 or the week the special guardian is expected to be appointed or the week the child is expected to be placed in a family and friends care arrangement in prescribed circumstances.
(8) In the Social Security Contributions and Benefits Act 1992—
(a) in section 171ZJ(1), at the appropriate place there is inserted—““local authority” has the same meaning as in the Children Act 1989 (see section 105(1) of that Act);”;
““local authority foster parent” has the same meaning as in the Children Act 1989 (see section 22C(12) of that Act);”;
(b) in section 171ZS(1), at the appropriate place there is inserted—““local authority” has the same meaning as in the Children Act 1989 (see section 105(1) of that Act);”;
““local authority foster parent” has the same meaning as in the Children Act 1989 (see section 22C(12) of that Act);”.”

[Baroness Massey of Darwen]

My Lords, Amendment 267, in the names of myself and my noble friend Lady Drake, suggests changes to the statutory leave and pay of prospective adopters with whom looked-after children are placed, special guardians and family and friends carers. Insertions are suggested to sections of the Employment Rights Act 1996 and sections of the Social Security Contributions and Benefits Act 1992.

We had a lengthy discussion on support for family and friends carers in Committee on 26 October. I shall summarise a few points from that debate as a background to today’s considerations. An estimated 300,000 children are being raised by relatives and friends. Only an estimated 6% of children who are raised in family and friends care are looked after by the local authority and placed with approved foster carers. Children in kinship care do better in terms of attachment and achievement, but their carers are under severe strain—95% of family and friends carers say so. In the previous debate I called them heroes, and so they are. We are not really addressing the inequalities and unfairness that they face at the moment.

The Kinship Care Alliance attributes this strain to three major factors: kinship carers are not entitled to local authority financial or other support—financial support is discretionary; many kinship carers have to give up jobs to support the children and they have no right to specific services and benefits. Despite guidance to local authorities in 2011 which stated what support they should provide by September 2011, 30% of local authorities do not have a family and friends care policy. Financial costs include the immediate cost of a child coming to live with a carer, the costs of applying for a legal order to provide the child with security and permanence, loss of income and pension rights and, finally, the considerable costs of raising a child.

Children who live with family and friends care have experienced similar adversities to those in the care system or who are adopted, yet foster carers get a national minimum financial allowance and the Government are rightly improving adopters’ rights to a period of paid leave on a par with maternity leave. However, the 95% of family and friends carers who are raising children outside the care system are not entitled to anything in paid leave when they take on the care of children.

The Family Rights Group’s publication Understanding Family and Friends Care, reflecting the latest survey of family and friends carers in 2012, reported that only one in eight of the 327 respondents who answered the question about the effect that becoming a family and friends carer had had, said that they had continued to work as before, and one in nine that their partner had continued to work as before. Indeed, 38% had to give up their job to take on the care of the children—in London the figure was 46%. Overall, the picture which emerged was that carers were likely to have made sacrifices in the workplace in order to care for the kinship children. Very few just carried on working as before. Many decreased their working responsibilities and their income by reducing their hours or stopping work altogether—sometimes, I have to say, at the insistence of social workers.

Children who have been through trauma or tragedy, and who may have multiple needs, require time to settle in with their carers. The carers are often required to attend a number of meetings relating to the care and needs of the children, but the absence of any right to paid leave means that we are forcing many family and friends carers to give up work in order to do right by these children. We are pushing them into a life of dependency on benefits and into severe poverty. Some are grandparent carers who are unable to get back into employment when their grandchildren are older. Some are younger sibling carers who have few qualifications and only a few years in employment when they take on their younger brothers and sisters, but later find it difficult to re-enter the labour market. Research has shown that three-quarters of family and friends carer households face severe financial hardship. I hope that the Government will be able to address these urgent issues, and I beg to move.

[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.

--- Later in debate ---

[Baroness Massey of Darwen]

My Lords, I thank the Minister for that response and other speakers for contributing to this short debate. I am delighted to hear that the Minister has instigated research. There is an awful lot of research around already on this issue, so I hope that it will not be too lengthy. A later amendment from my noble friend Lord Stevenson suggests, I think, one year of probing and research. I do not think that we need a year to solve this one. The organisations that we have mentioned already have a wealth of data on the problems, statistics, anecdotes and case studies of family and friends carers. Therefore, I hope that any research will build on the existing research, will be carried out quickly, and that something will be done very quickly for these people who are saving the state lots of money, as has been said.

More importantly, these carers are saving children from disappearing down various plugholes in the system. It is well known that children need stability and love and kinship carers are known to provide this. It is too easy to take a short-term view. Generally, outcomes for children in care are poor—let us face it. They have poor or lower academic achievements, higher involvement in criminal activity and drugs and alcohol and more early pregnancies. This is a sorry story. Family and friends carers are stepping in and trying to mitigate this situation for their grandchildren, nieces and nephews or whoever, often at great cost to themselves, as we have heard. They are saving the state money and contributing to the welfare of children.

We have heard time and again that the Government are sympathetic to these carers. I have also heard time and again that local authorities are encouraged to give support, but that is not statutory support. As I said earlier, 30% of local authorities have no policy on family and friends carers. I agree that there is insufficient information on this and we must understand all the issues, so I appreciate that research will be needed. However, as I say, it must not be lengthy and must not delay help for these family and friends carers who are giving so much to society and the children whom they serve. I beg leave to withdraw the amendment.

Amendment 267 withdrawn.

--- Later in debate ---

[Baroness Massey of Darwen]

My Lords, I support my noble friend Lady Drake’s Amendments 267A, 267B and 267C. I will say a word later on Amendment 267BA after my noble friend Lord Stevenson has spoken to his amendment. My noble friend Lady Drake has set out the principles of these amendments comprehensively and I just want to add a few comments.

When children first move into kinship care, the carers and the children need time to settle and adjust to the upheaval in their lives. I know a kinship carer who received three children at midnight because their daughter had died from a drug overdose. That is an upheaval beyond imagination. She said that the children were grieving, she was grieving and they had very little time to do it properly. Children often arrive without notice in these circumstances. For example, a parent may be in hospital or there may be domestic violence or abuse. The proposal is for a period of leave similar to parental leave.

An estimated 60,000 kinship carers have dropped out of the labour market to bring up children. There are many reasons for this, including the high needs of the children and the fact that the carers are not legally entitled to any time off to accommodate the needs of the child, especially at a time of upheaval when everybody is in crisis and needs time to settle down.

Amendment 267 seeks the extension of emergency leave entitlement to grandparents, to enable a grandparent to take reasonable time off work to provide help where a grandchild is ill or to deal with an unexpected event at school, for example a school closure due to poor weather. Some families would prefer a working grandparent to be able to take time off to provide childcare when a child is ill or a school is closed. I—and, I would guess, several people in this room—have certainly taken time off or given up time to look after grandchildren when there has been a crisis in the family.

The amendment seeks to help parents to balance work and their caring responsibilities, and to relieve the pressure on families when a child has a problem. Currently, one in four working families depend on grandparents to provide childcare. Some 70% of all working grandparents say that they look after their grandchildren and 29% of grandparents are working. The impact on employment overall should be minimal as the amendment will spread across different employers the impact of an employee’s absence due to a family emergency, such as a child’s illness, rather than one employer, typically the mother’s, experiencing the full impact.

I was interested that in Denmark, apparently, it is usual when a child is ill for the mother to take the first day off, the father the second and a grandparent the third, which seems very sensible. Again, I support the amendments and I look forward to the Minister’s response.

[Baroness Lister of Burtersett]

My Lords, I support Amendment 267B, particularly from the perspective of carers for adults, although, of course, I also support it with reference to carers for children. A Carers UK/YouGov poll found that 22% of UK adults had seen their paid work negatively affected as a result of caring, including 2.3 million who had given up work as a result and about 3 million who had reduced their working hours to care at some point in their lives.

Research has demonstrated that the point at which caring begins to have a significant impact on carers’ ability to work is when 20 hours a week or more is provided, with some analysis indicating that the tipping point may be even lower at 10 hours. Without the right support, millions of workers are leaving work to care and the cost of this to individuals, business and the economy is huge. Recently, research by the Personal Social Services Research Unit at the LSE calculated the public expenditure costs of carers leaving paid work at a staggering £1.3 billion a year, based on the cost of carer’s allowance and lost tax revenues. Additional analysis by Age UK indicates that the economic cost rises to £5.3 billion when lost earnings are taken into account. One quarter of working carers report that they feel they receive inadequate support to enable them to combine work and care and only half think that their employer is carer-friendly. The survey of carers found that nearly two-thirds of carers in work have used annual leave to care, while nearly half have done overtime to make up for taking time off to care.

The task and finish group set up by Employers for Carers and the Department of Health states in its final report that,

“the issue of supporting carers to remain in work is not only a problem, but also an economic opportunity. Supporting carers to remain in work can bring considerable benefits to carers themselves, employers and the wider economy”.

This is partly a government publication.

--- Later in debate ---

[Baroness Massey of Darwen]

My Lords, I follow my noble friend Lord Stevenson in supporting this attempt to reach a healthy compromise. There is already a great deal of research and investigation into the plight of family and friends who are carers. I hope that that can be built on. There is a meeting with officials, which I think the Minister has set up for next Wednesday, and I hope that any noble Lord here who is concerned about this could get details of that meeting. I hope that at that meeting we could discuss this proposal for research and who will be involved. I hope, too, that, as the noble Baroness, Lady Howarth, has just said, that involvement will be integrated across various streams of various departments.

[Viscount Younger of Leckie]

My Lords, modern families come in all shapes and sizes, and it is important that we recognise the extremely valuable contribution that is made by many different individuals. I shall address each of these amendments in turn, beginning with Amendment 267BA. This amendment would require the Secretary of State to review the provision for kinship carers and special guardians, as moved a moment ago by the noble Lord, Lord Stevenson. As I have said in, as he put it, a carefully worded, but, I hope, clear response to the previous amendment, 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 in order to ensure that support provided by the Government is appropriate to address these people’s needs.

The noble Baroness, Lady Massey, questioned the length of the research in the previous amendment and stated that plenty of research was already available. By way of reassurance—I hope that she takes it in this spirit—I would say that it is important that we take the time to scope the project properly in advance of starting the research. I welcome the input of the organisations mentioned and, indeed, others that might not have been mentioned. I give this commitment: I shall return to this House with further details on the likely timetable on Report and note some further carefully chosen words. The noble Baroness alluded to a meeting with officials that has been arranged. I confirm that it is set for next Wednesday at 11am. The Bill team will provide further details by e-mail about that meeting. I encourage as many people as would like to attend to come.

Turning now to Amendments 267A and 267B regarding adjustment leave for kinship carers and leave for carers, as I am sure noble Lords will agree, carers play a vital role supporting and caring for their children or loved ones, and they reduce the need for state funded care. These points were made with great passion today by a number of noble Lords. These individuals can often struggle to balance their work and caring responsibilities effectively and without support may not be able to stay in work. It is important that we recognise this contribution and provide carers with the support that they need to remain in the workplace. From time to time, carers may need time off to manage emergencies or breakdowns in care. Many kinship and friendship carers also experience a period of adjustment when a child comes to live with them. The noble Baroness, Lady Massey, gave the Committee a rather heartbreaking example of an occasion when a parent died of a drug overdose. If I read her correctly, the child appeared on someone’s doorstep.

Changes in living circumstances can happen suddenly and families may come under great strain to adjust quickly to the caring needs of a child who may be facing many complex issues and emotions. The right to time off for dependants enables them to take time off to make arrangements for their care. Once the child is living with kinship or friendship carers, he or she becomes their dependant, and any carer who is an employee will be entitled to time off. This enables the carer to take a reasonable period of time off work to take the action necessary to deal with specified short-term emergencies, and this is a day one right that is available to all employees. The employee does not necessarily need to give their employer advance notice of their intention to take leave under this provision as long as they inform their employer as soon as is reasonably practicable. This is because emergencies rarely come with notice, and again examples were given earlier in this debate.

The right to time off may not meet the needs of all individuals in all circumstances. Many employers provide additional forms of leave for compassionate reasons to enable employees to deal with sudden and often traumatic changes in circumstances. Caring is often a long-term responsibility. All carers, including kinship and friendship carers, may need to consider long-term changes to do with their changed circumstances. The Government believe that the right support for carers is to allow them to change how they work to better accommodate their caring role on a long-term basis.

Carers are already eligible to make a statutory request to work in a flexible way under the current legislation. However, the extension of the right to request flexible working in Part 8 of this Bill will drive a culture change which should mean that flexible working becomes more widespread and better integrated into standard working practice. My department, the Department for Business, Innovation and Skills, has been working closely with the Department for Work and Pensions and their private sector working group to encourage more employers to consider flexible working practices when they are designing and advertising jobs. They have developed, for example, a strapline to use when advertising jobs: “Happy to talk flexible working”. This should increase the availability of jobs that can be done in a flexible way, thus enabling more carers to remain attached to and re-enter the labour market.

Extending the current right to request to all employees will enable more people, including those who have more informal or infrequent caring responsibilities such as kinship or friendship carers, to retain an attachment to the labour market when they have experienced significant changes in their personal circumstances. The noble Baroness, Lady Drake, raised the issue of supporting grandparents to remain in work when they provide childcare. The Government agree that it is important to support the needs of older people and grandparents, and to help them stay in work, especially when they have caring responsibilities. This has been a key driver behind the extension of the right to request flexible working, and it will help these groups to balance work and care commitments on a long-term, sustainable basis. It will support the informal caring that is often provided by grandparents, about which I will have a few more words to say later.

I turn finally to Amendment 267C regarding emergency time off for grandparents. We have heard many examples of the invaluable practical and emotional support provided by grandparents to their children and grandchildren, an issue raised particularly by the noble Baroness, Lady Drake. I welcome this debate as an opportunity to pay tribute to the vitally important role that grandparents play in supporting families to juggle work and childcare responsibilities.

The issue of emergency time off for dependants was debated during the passage of this Bill in the other place. The Minister for Employment Relations and Consumer Affairs outlined the qualification criteria for this type of time off, and for the benefit of noble Lords I shall do so again here, albeit fairly briefly. This provision is intended to give employees a statutory entitlement to time off work to deal with an emergency involving a dependant. The qualification criteria for this type of time off are deliberately broad, and this is to ensure that any employee on whom a person reasonably relies to make arrangements for the provision of care is able to qualify for this type of time off in circumstances where there has been an unexpected disruption or termination of care arrangements. It is important to emphasise that the legislation enables all employee grandparents who are relied on to make arrangements for the provision of care for their grandchildren to qualify for this time off in such circumstances.

Children: Obesity

Baroness Massey of Darwen Excerpts

Wednesday 6th February 2013 Lords Chamber

[Earl Howe]

My Lords, the noble Lord will understand that we tread warily when it comes to interfering in the affairs of the devolved Administrations. However, I take his point, because on serious public health messages such as this we need to have a co-ordinated approach. Members of my department are in regular contact with their counterparts in Wales.

[Baroness Massey of Darwen]

My Lords, the Minister mentioned sport. Beneficial as it is, does he accept that obesity is caused overwhelmingly by overeating and eating foods that cause obesity? Are there any media initiatives to direct young people to what is healthy to eat and to foods that cause less obesity, as well as to sports programmes?

[Earl Howe]

I completely agree with the noble Baroness that for children especially, exercise and sport are vital, which is why there are a number of initiatives in that area. She asked about media campaigns. Change4Life continues to support families to make simple changes to adopt a healthier diet and increase their physical activity levels. We are currently planning a summer campaign to encourage physical activity in children. The campaign remains subject to formal approval but is very much in our minds. Change4Life, I would just add, uses the full range of communication channels, including TV advertising, press, and local supporter activity. It is a well known brand and we intend to stick with it.

Health: Active Lifestyles

Baroness Massey of Darwen Excerpts

Monday 17th December 2012 Lords Chamber

[Baroness Massey of Darwen]

My Lords, I thank the noble Baroness, Lady Heyhoe-Flint, for securing this debate and for supporting it with such eloquence and commitment. I would much rather face her across the civilised Chamber of the House of Lords than across a cricket pitch. She is a splendid supporter of active lifestyles and was an outstanding president of the Lady Taverners, of whom I am also one. The Lady Taverners raises funds to provide equipment to encourage young disabled people to play cricket, basketball and many other sports—very much part of an active lifestyle.

Active lifestyles should begin at a young age and carry on into old age. I had the pleasure last week of hearing much of the debate in your Lordships’ House on older people. They were magnificent and inspirational speeches. I want to mention wise words from just two of the speakers. The most reverend Primate the Archbishop of Canterbury spoke of the importance of older people being participants in society, not passengers. My noble friend Lord Griffiths of Burry Port, in a very moving speech, spoke of maintaining a sense of selfhood in old age. There is good evidence that an active lifestyle can help to maintain dignity, a sense of self and participation in society. Active means active in all senses—physical and mental. It is a preventive measure; a protective factor in health.

There is popular book called 100 Simple Things You Can Do To Prevent Alzheimer’s by Jean Carper, an American. In chapter 15 the author advises us to “Be a busy body”. The more you move, the better you think. It is also true that the more you move, the better you move. I am not sure how conkers features here.

Thinking is part of an active, healthy lifestyle. Brains must be active too. I am very impressed by the University of the Third Age. It is wonderfully and proudly local and easy to get to in many communities. It offers a tremendous variety of activity including languages, history, flower arranging, craft and literature, as well as sport. I was somewhat surprised when my husband embarked on a study of Ulysses in a group. For older people to tackle one of the most difficult novels in the English language is surely designed to develop brain power to the extreme. I found it challenging at the age of 20.

The U3A provides an example of how to engage people in activity. It is promoted well, with enormous variety on offer, and is easily accessible by local communities. A three-year study reported recently in the Journal of Neurology, Neurosurgery & Psychiatry states that an active social life is important in maintaining physical and mental health. Exercise, good nutrition and not smoking are cited as having a beneficial impact on health in older people. These examples emphasise that not just physical health but mental and emotional health can be improved. Keeping the mind active, as well as the body, is important. Maintaining health and well-being is primarily of benefit to individuals but would also save millions, possibly even billions, when we consider the costs of care and drugs, particularly for older people. Sport England estimates that increasing physical activity could save about £3 billion a year in healthcare costs.

We are not, I think, surprised by such evidence. Reports from the four home countries’ Chief Medical Officers, the BMA and the Royal College of Physicians all point to the importance of the benefits of physical activity. Activity not only increases mobility, but can have an impact on a range of medical problems such as osteoporosis and diabetes.

I have some figures from the Sport England Active People survey. This indicates that there has been a growth in people doing sport at least once a week: 15.5 million; 750,000 more than a year ago. There has, not surprisingly, been an increase since the London 2012 Olympic Games. Participation by disabled people has also risen steadily since 2005, but still lags behind that for people who are not disabled. Sport England has announced a £10.2 million National Lottery initiative to encourage disabled people to take part in sport.

Sport England also wants to increase the number of young people between the ages of 16 and 25 taking part in physical activity. Progress has been made, but not enough. Surely getting children and young people to participate is the key to encouraging active lifestyles for life. Like the noble Baroness, Lady Heyhoe Flint, I worry about government policy for schools, not just for sport but for leisure activities such as music and drama. All this is relevant to being active. We all know many people who have, at school, discovered talents and interests in all kinds of creative arts and sport. I wonder, together with many others outside this Chamber, whether changes to the school curriculum, such as the EBacc, will remove opportunities for young people to develop their potential in being creative and engaging in physical activity, something that could influence and enhance their lifestyles for ever. That would be short-sighted. I look for reassurance from the Minister.

The Women’s Sports Network has concerns about the place of women in sport. I have just received an e-mail asking me to help encourage more coverage of women’s sport on TV. There is a terrible deficit here. At a recent meeting of the All-Party Parliamentary Group on Women’s Sport and Fitness, Clare Balding and Kathy Grainger issued a rallying call for more coverage of women’s sport in the media. Our sporting heroines, who will inspire more girls and young women to take part in sport than possibly anything else, are, in contrast to some of the men, poorly paid, and lacking sponsorship.

There is good news. National governing bodies of sport seem to be aware of the problem and are encouraging greater coverage for women. Apparently, 53.6% of adults say they would like to take part in more sport. So why do they not? I repeat my point that beginning to take part in sport and exercise at an early age is a good predictor of maintaining an interest in exercise. In particular, exercise such as Pilates, yoga and dance may encourage girls, women and older people to participate.

On the example of the University of the Third Age, the offering of activity must be local, cheap or free, and attractive. We need two things. First, there must be a national strategy—mentioned by the noble Baroness, Lady Heyhoe Flint—to encourage people from a very young age to a very old age to participate in physical and mental activity. The benefits are proven, the research is there. Secondly, people also need local policies and strategies which target their populations from an early age with campaigns, joining up opportunities for sporting activity in clubs and schools with the chance to participate in social and mental activities in groups. A readily accessible visible continuum of possibilities is needed. This would encourage active lifestyles, which would result in physical, mental, emotional and social benefits to society.

Health and Social Care Bill

Baroness Massey of Darwen Excerpts

Thursday 8th March 2012 Lords Chamber

Moved by

[Baroness Massey of Darwen]

227: Clause 180, page 177, line 10, leave out “people” and insert “adults and children”

[Baroness Massey of Darwen]

My Lords, first I apologise on behalf of the noble Baroness, Lady Tyler, who cannot be here today due to another speaking engagement. My amendments in this group seek to cover listening to the voice of the child in whatever structures or systems we end up with in the course of the Bill. The voice of the child is clearly important and I wish to address this one issue today. This is not just about adult patients among the public but children, too. I make explicit that HealthWatch England’s advice on the views of patients and members of the public must also refer to the views of children. These amendments are supported by numerous children’s groups and by the Royal College of Paediatrics and Child Health.

Children’s involvement in healthwatch organisations was debated in Committee on 15 December. The Government acknowledged that,

“local healthwatch needs to represent the views of all people within the local population, including children and young people”.

However, they rejected amendments that cited children as a specific group to be reached by healthwatch, saying,

“if you list one group you are in danger, therefore, of excluding others”.

Taking account of those concerns, I have tabled a new set of amendments, drafted to make explicit that the remit of healthwatch includes children without inadvertently suggesting that they should take preference over adults or any other group. In Committee, the Government offered assurance that when,

“the pathfinder local healthwatch organisations come into play, we will ensure that what noble Lords have said is flagged up to them”.—[Official Report, 15/12/11; col. 1499.]

I am concerned that flagging up the issue to emerging local healthwatch organisations will not be sufficient. I seek further assurances that consultation of children and children’s rights will be addressed. There must be a clearer steer at national level to make sure that the voices of children and young people are heard in the health system. I call on the Government to do three things. First, they should develop and disseminate guidance for local healthwatch organisations on effective engagement with children, drawing on pathfinders’ experiences. Secondly, they should conduct a review on how HealthWatch England and the local healthwatch organisations have involved children in their work two years after commencement. Thirdly, they should appoint a champion for children within HealthWatch England to oversee this work and drive forward standards on children’s engagement and decision-making.

This Bill is the first opportunity that parliamentarians have had to respond to the findings of the Kennedy review, published in September 2010, Getting it Right for Children and Young People. The Government response to the review accepted Sir Ian Kennedy’s powerful arguments about the need to engage children in the NHS, saying:

“In the past, the NHS was not always set up to put the needs of patients and the public first. Too often patients were expected to fit around services rather than services around patients. Nowhere was this more the case than for children, young people and their families … If we are to meet the needs of children, young people, families and carers, it is vital that we listen to them in designing services, gather information on their experiences and priorities, provide them with the accessible information that they need to make choices about their care, and involve them in decision making”.

In a welcome move, the Government promised in December 2010 to give due consideration to the Convention on the Rights of the Child when making new law on policy. As a signatory to that convention, the UK must take all possible steps fully to realise the rights and freedoms in the convention, including Article 12, which says that children should have a say in all issues affecting them and that their views should be,

“given due weight in accordance with the age and maturity of the child”.

The international monitoring body for the CRC, the UN Committee on the Rights of the Child, has been clear that the article applies to collective decision-making processes as well as matters affecting the individual child. Among its main recommendations was that the UK should promote respect for the views of the child. My amendments would implement recommendations in relation to children’s healthcare.

Local healthwatch will take forward the work done by local involvement networks, or LINks, in seeking the views of local service users in health and social care and involving them in the development of services. I urge noble Lords to amend the Bill today to make it clear that HealthWatch England and the local healthwatch should effectively involve children in their work.

A great deal of research has been done on this, including by the National Children's Bureau, which found that not all LINks understood that engaging children was part of their official remit. The review of law policy and practice by Participation Works found that although 41 per cent of GP practices had patient participation groups there was no evidence of children’s engagement in these forums.

The Council for Disabled Children document, Managing My Way, researched with disabled children and healthcare professionals, found that the majority of professionals felt they did not receive enough training to develop their skills in communicating with young people, especially those who have different communication needs. Research by the Institute of Child Health has found that the views of under-16s were sought in only one of 38 national surveys of patient experience in the NHS between 2001 and 2011. Young Minds found that in 80 per cent of cases young people were not involved in shaping local services. The Royal College of Paediatrics and Child Health and the NHS Confederation recently published a guide to involving children and young people in health services, which underlined the key role that children can and should have in planning and service delivery. The report says that,

“there is little incentive for organisations to systematically ensure a good and consistent standard of service for children and young people”,

unless they are involved in those services.

I look forward to the Minister's response, particularly the three issues—guidance to the local healthwatch, a review of the involvement of children in healthwatch and a champion for children in healthwatch. I beg to move.

--- Later in debate ---

[Baroness Northover]

The noble Baroness made a poignant case for why children need to be listened to. I hope I can reassure her that HealthWatch England and local healthwatch have a responsibility to hear the voices of everyone, whatever their age. I accept what she says about the legal status of children. However, as she made very obvious, that does not mean to say that we cannot hear their voices and take very seriously their perception of how they can best be treated.

[Baroness Massey of Darwen]

My Lords, I thank all noble Lords who have taken part in the debate on this amendment. I am aware that there is a very powerful lobby in this House which supports the voice of the child in all matters and supports children’s welfare generally. There is also a very powerful lobby outside of children’s organisations that are dedicated to providing children with what they need.

I thank the noble Baroness for the reassurances that she has given. However, I stress that the research I quoted contains clear evidence that the voice of the child is often overlooked. We must be vigilant that it is not overlooked in the future. One of my three queries to the Government concerned disseminating guidance. I fully accept that there will be a health outcomes strategy for children. However, we have to keep an eye on that and see what happens in relation to the contribution of children’s voices to carrying out that strategy.

The noble Baroness said that there would be a review of how HealthWatch England and local healthwatch involved children. I suggest that two years after commencement is a sufficiently long period. I am disappointed about the champion issue because without advocacy some vulnerable groups will be neglected, which is never a good thing. I will follow up these issues with the Government. In the mean time, I beg leave to withdraw the amendment.

Amendment 227 withdrawn.

--- Later in debate ---

[Baroness Whitaker]

My Lords, in supporting the noble Lord, Lord Ramsbotham, I have very little to add, which I imagine will be welcome to noble Lords at this hour. He has really said it all extremely comprehensively but I would just add that, if the Bill cannot provide the framework that these amendments would ensure, particularly in respect of integration of the education services, children in particular will suffer. I briefly remind noble Lords that speech and language deficits are among the most common disabilities in childhood. They affect significant numbers, who will lose out on education, employment and relationships as a result. I hope that the noble Earl will be able to provide the reassurances that we seek.

[Baroness Massey of Darwen]

My Lords, I shall speak to Amendments 238AZA and 238CA, which concern integration of services. Integration is a word that is used very often in the Bill.

My amendments would require all health and well-being boards to take a local lead on integrating health-related services with health and social care. General duties to promote such integration are held by the NHS Commissioning Board and clinical commissioning groups. The amendments would ensure that health and well-being boards also played their part.

Integration of the planning and delivery of health and social care with health-related services is crucial for improving the health and well-being of local populations. Evidence and experience show that health and care services can be made more effective, efficient and accessible when integrated with wider support services. The Bill references this network of support as “health-related” services. This covers a wide range of provision that contributes to children’s and adults’ health and well-being. The National Children’s Bureau, the National Housing Federation, St Mungo’s and Homeless Link have come together to call for a clear role for health and well-being boards and they support close integrated working between health-related services and health and social care. This is clearly an issue that has implications across all sectors—health, education, children, housing and employment.

As the Bill stands, clinical commissioning groups and the NHS Commissioning Board will have a general duty to promote integration of health services with health-related services, as well as with social care. Health and well-being boards’ duties to support close working and partnership arrangements are limited to health and social care, with only a power to encourage close working with health-related services.

I am concerned that, without the support of their local partners through health and well-being boards, the NHS will struggle to deliver on this wider integration agenda. As health and well-being boards will be the key forums for local partnership working, they should have duties in this regard; for example, with children and young people. Schools and colleges, children's centres and youth services are vital settings for delivering health outcomes. The national evaluation of Sure Start found that a child with access to a children's centre—formerly Sure Start—had more immunisations and fewer accidents than young children living in other areas. School health initiatives have had a positive impact on health and behaviour among pupils.

Evidence suggests that health, social care, education, early childhood, youth and other services are not always working in partnership to secure good health outcomes for children and young people. The Marmot review identified a lack of consistent partnership working between such bodies as a barrier to delivery. Similarly, the Kennedy review highlighted the fact that the requisite links between the NHS, social care, education and the criminal justice services to support children and young people are not always made. This report recommended that local partnerships, covering all services for children, should have a duty to ensure that local organisations work together. Close working between local partners is particularly vital for children with complex needs, such as disabled or looked-after children, who need co-ordinated interventions from a range of services.

Improving people's health is rarely achieved by clinical interventions alone, but is dependent on the wider determinants of health; for example, housing support acts as a health intervention and can help people to improve their well-being, manage their health better and prevent the need for more acute services. A lack of good housing can also be a major determinant of poor health: eight out of 10 homeless people have one or more physical health needs and seven out of 10 have at least one mental health problem. The average age of death of a rough sleeper is estimated to be 40 to 44 years.

I chair the National Treatment Agency for Substance Misuse and I am well aware that, in tackling drug and alcohol use, we also need to tackle the social issues such as housing, employment and education. The Marmot review, Fair Society, Healthy Lives, noted that,

“this link between social conditions and health is not a footnote to the ‘real’ concerns with health … it should become the main focus”.

The role of health and well-being boards in promoting integration across local services was debated in Committee on 19 December. The Government acknowledged the role that housing, schools and other services might play in promoting health and well-being.

However, in response to separate amendments aimed at strengthening the role of health and well-being boards in engaging and working with specific health-related services, the noble Earl, Lord Howe, responded:

“we want to avoid being overprescriptive. On the other hand, we are clear about what best practice looks like, and … we have provided for statutory guidance”.—[Official Report, 19/12/11; col. 1542.]

The relevant statutory guidance has been published in draft form by the Department of Health. Although it makes broad references to vulnerable groups and wider services like housing, there are no clear expectations for how, when and where this integration could take place or which client groups or needs would particularly benefit from this. The Bill offers opportunities to integrate services beyond traditional primary and secondary care to reach across initiatives to improve lives. These amendments would ensure such opportunities will be taken by local partners. I look forward to the Minister’s response and hope that he can give me some reassurance.

Health: Children and Young People

Baroness Massey of Darwen Excerpts

Monday 6th February 2012 Lords Chamber

[Baroness Massey of Darwen]

My Lords, first I will say how much I welcome the new outcomes framework for children. Will the Minister say which proposed structures in the Health and Social Care Bill will benefit children, and who will have overall responsibility for child health?

[Earl Howe]

My Lords, the Secretary of State will retain ultimate accountability for children's health services. Under the Bill, as the noble Baroness knows, the functions will be conferred directly by Parliament on specific organisations. That will strengthen accountability. In answer to the first part of her question, the reform of the health system offers a real opportunity to address some of the well documented challenges that the current system presents. We are moving, through the Bill and through our reforms, to a system that will focus on promoting good health, which we see as important as delivering good care. Informed and expert knowledge will underpin the commissioning of integrated services, where we will measure success on improvements in the outcomes that are achieved. Treatment will be evidence-based and children will be involved in decisions about their care. All these things are embodied in the Bill.

Alcohol

Baroness Massey of Darwen Excerpts

Thursday 2nd February 2012 Lords Chamber

[Lord Imbert]

My Lords—

[Baroness Massey of Darwen]

My Lords—

[Lord Strathclyde]

My Lords, there is time for both noble Lords. Perhaps we may start with the noble Lord, Lord Imbert.

[Earl Howe]

The noble Lord is right to point that out. Proposals of the kind he suggests should be considered. As I am sure he will recognise, there is no single solution to the complex challenge of alcohol misuse. We need to look at licensing, pricing, health promotion, the criminal justice system, the role of local authorities, early engagement by the NHS and labelling, and the list goes on. But I am very happy to feed in the noble Lord’s ideas to my department in the work that it is doing.

[Baroness Massey of Darwen]

My Lords, what impact does the Minister think rising unemployment may have on alcohol consumption? He has not mentioned unemployment, which is an important issue. I declare an interest as the chairman of the National Treatment Agency for Substance Misuse.

[Earl Howe]

My Lords, the evidence is that the population’s overall consumption of alcohol tends to fall if incomes are depressed. Particular groups in the population, including some who are unemployed, may consume more alcohol as a result of being unemployed but the evidence does not enable us to quantify this effect. This is one aspect of health inequalities which we are determined to reduce, as we stated in Healthy Lives, Healthy People, a document we published last year.

Health and Social Care Bill

Baroness Massey of Darwen Excerpts

Monday 19th December 2011 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, unusually, it falls to me to introduce this group of amendments. In moving Amendment 327ZC and speaking to Amendments 327ZD, 327ZE, 327ZF and 327ZG, I confine myself to saying that these are minor technical amendments to Clauses 187 and 188. For the most part, they ensure consistency between the scrutiny provisions in the Bill and in the Localism Act. I hope that they will receive the support of the Committee. I beg to move.

[Baroness Massey of Darwen]

My Lords, I speak to Amendments 330, 333 and 334 in this group. I draw attention to issues important for strengthening integrated working in children’s health and well-being. Of course, integration is important for all consumers of health, but services for children have often been fragmented and disconnected, sometimes with tragic results, as we all know. I spoke last week about the importance of listening to the voice of the child. If children had a voice, they would say—as they do when we speak to them—that integration of services is not good in many areas. It should be, for effectiveness and efficiency.

My amendments require all health and well-being boards to promote close, integrated working between health, social care, and health-related services in their area. Specifically, Amendment 330 requires that they “must,” rather than “may”, include in their joint health and well-being strategy,

“a statement of their views on how arrangements for the provision of health-related services in the area of the local authority could be more closely integrated with arrangements for the provision of health services and social care services in that area”.

Amendment 333 requires, again, that they “must,” rather than “may”,

“encourage persons who arrange for the provision of any health-related services in its area to work closely with the Health and Wellbeing Board”.

Amendment 334 requires that they “must,” rather than “may”,

“encourage persons who arrange for the provision of any health or social care services in its area … to work closely together”.

As the Bill stands, health and well-being boards’ role in bringing health and social care together with health-related services is optional. The National Children’s Bureau and its Every Disabled Child Matters campaign believe this role must be strengthened so that there is a clear duty on all health and well-being boards to promote joined-up commissioning and delivery of services in their area. This is particularly important for children and young people for three key reasons. One reason is that joint working across local agencies is crucial for children’s and young people’s health and well-being. Integrated planning is particularly important for children and young people, for whom some of the most effective interventions are those delivered through non-health settings and services, such as schools and colleges, children’s centres, and youth services. For example, the national evaluation of Sure Start found that a child with access to a children’s centre—formerly Sure Start local programmes—had more immunisations and fewer accidents than young children living in other areas. School health initiatives can have a positive impact on pupils’ health and behaviour—I am thinking of health-promoting schools, for example.

However, evidence suggests that health, social care, education, early childhood, youth and other services are not always working in partnership to secure good outcomes for children and young people. The Marmot review identified the lack of consistent partnership working between such bodies as the barrier to delivering services that reduce health inequalities. Similarly, the Kennedy review highlighted the fact that the requisite links between the NHS, social care, education and criminal justice services to support juvenile people are not always made. His report recommended that local partnerships covering all services for children should have,

“a duty to ensure that local organisations work together”.

Close working between local partners is particularly vital for children with complex needs, such as disabled children or looked-after children, who need co-ordinated interventions from a range of services. A recent report from the Every Disabled Child Matters campaign found that families of disabled children often report experiences of fragmented service delivery and have been caught between services that do not communicate well. One parent has said:

“As a parent, you just want a service, but it’s like health, education and social care are all separate and they don’t really like working together. What you need as a family is one system—not three”.

The Government have expressed aspirations for better partnership working across a broad range of children’s services. For example, Support and Aspiration, the special educational needs and disability Green Paper, states,

“we want to make it easier for professionals and services to work together, and we want to create the conditions that encourage innovative and collaborative ways of providing better support for children, young people and families”.

I believe that unless the Bill strengthens the framework for local integration, the ability of local areas to implement these aspirations will be undermined.

The Bill contains many key measures promoting joined-up working on health and social care, through relationships between local authorities and NHS commissioners. However, many of the services that promote the health of children and young people, such as schools and colleges, children’s centres and youth services, are or will be provided by bodies which are independent of the local authority or NHS. Health and well-being boards should have a mandatory and not an optional role in promoting the involvement of these health-related services in joined-up commissioning and delivery.

Schools need to be encouraged and enabled to play their part. Schools are key partners in securing the health and well-being of children. The public health White Paper, for example, recognises the role that schools can play, stating that:

“Good schools will be active promoters of health in childhood and adolescence”.

This is crucial for reducing health inequalities. The Marmot review, again, recommends that schools should take a “whole child” approach and they will be unable to do this without routine engagement with partners from other agencies.

Over 1 million children and young people now attend academies, which are independent of local authority oversight and will not be represented by health and well-being boards. According to the Department for Education, more than 40 per cent of all secondary schools are now open or are in the process of opening as academies. The Government have taken a step towards promoting joint working by dropping proposals in the Education Act to remove the duty to co-operate under the Children Act 2004. However, this Bill does not create the structural environment within which co-operation with education providers will be possible. Health and well-being boards have the potential to act as a forum for schools to fulfil this duty to co-operate. A clearer role for health and well-being boards in bringing a broader range of services together beyond health and social care, as provided by these amendments, should help to secure this.

Finally, health commissioners should be supported to meet their new duties on integration. Duties were introduced, following the listening exercise, for the NHS Commissioning Board, clinical commissioning groups and Monitor, whereby they are required to carry out their functions with a view to securing that the provision of health services is integrated with the provision of health-related services. As the Bill stands, the role of health and well-being boards in securing this integration remains an optional part of their remit and the scope of their local strategy. Health and well-being boards are expected to play a role in holding health commissioners to account for securing services that fulfil priorities set out in the joint health and well-being strategy. Furthermore, health commissioners will need a forum through which to drive forward better joint working and integration with health-related services. Without a guarantee that health and well-being boards would prioritise encouraging this close working across health, social care and health-related services, there is a serious risk that health commissioners’ new integration duties will be ineffective.

I hope that, in this Bill, the Government will take note of issues which will affect children. I know that the noble Earl, Lord Howe, is listening and I hope that on Report we can reach some agreement on children’s health and well-being.

--- Later in debate ---

I hope I have reassured noble Lords of our good intentions in this area, and that I have answered the questions put to me. I hope, too, that noble Lords will feel able not to press their amendments as a result.

[Baroness Massey of Darwen]

Could the Minister tease out for us the difference between the words “may” and “must”? Is he saying that the word “may” will refer to issues that will be in guidance and the word “must” will be in the Bill, or is it more complicated than that?

[Earl Howe]

I hope the noble Baroness will have sensed from my remarks that we want to avoid being overprescriptive. On the other hand, we are clear about what best practice looks like, and in framing JSNAs and the health and well-being strategies we have provided for statutory guidance which can set out what best practice looks like.

I think that that is the appropriate balance, rather than putting “must” in the Bill all the time. Local authorities are autonomous bodies and we must hesitate before directing them too closely. I very much agreed with the points made by my noble friend Lady Cumberlege on this. It is not, of course, that we regard these as unimportant; it is a question of how much we mandate and how much we leave to local discretion.

Health and Social Care Bill

Baroness Massey of Darwen Excerpts

Thursday 15th December 2011 Lords Chamber

Moved by

[Baroness Massey of Darwen]

310: Clause 178, page 176, line 10, after “people” insert “, including children,”

[Baroness Massey of Darwen]

My Lords, I shall speak also to Amendments 311 and 320. This group of amendments seeks to ensure that the voice of the child is heard in health matters. Too often in Bills that do not relate specifically to children and young people, they are marginalised, yet, as has been said before in debates, child health is a vital aspect of healthcare and children are patients, just like adults. They have opinions just like adults and, in my experience, consulting children about what works for them always results in improved services and policies.

These amendments seek to ensure that HealthWatch England’s functions are clear and explicit in relation to children as well as to others and that its functions in providing advice to the Secretary of State, the NHS Commissioning Board and monitoring authorities on the views of patients and members of the public refer to the views of children, who are patients and members of the public.

Local healthwatch functions must also promote and support patient and public involvement in the commissioning, provision and scrutiny of local care services and must obtain the views of patients and the public about people’s needs for and experience of local care services. I submit that those functions must be carried out to include children. HealthWatch England must provide support and assistance to local HealthWatch organisations in relation to this.

Furthermore, as noble Lords may know, Article 12 of the UN Convention on the Rights of the Child makes clear that children have a right to be heard on issues that affect them. Measures to promote patient and public involvement in decisions about their own care and in the development of health services and care services must include children from the start. I believe that this will make for better health services.

The Bill does not make this clear enough. Research commissioned by the NCB has found that local involvement networks or LINks, which the Bill will transform into local healthwatch, are not always clear that children and young people are part of their remit. Local healthwatch and HealthWatch England will need to be able to identify capacity and maintain the skills to reach out to and engage children, including the most vulnerable children and their families.

A recent review of law, policy and practice in relation to children’s participation in the NHS and other public services and settings found that, in their efforts to support user involvement, the health authorities and NHS trusts had not specifically identified children as service users. The review also found that although 41 per cent of GP practices reported to have a patient participation group there was no evidence of children’s active engagement in these forums. The Royal College of Paediatrics and Child Health has argued that reforms have been lacking in providing the structures and frameworks where children and young people are properly represented. And concerns about children’s involvement in patient and public voice mechanisms were also reflected in the report of the NHS Future Forum. In 2009-10 Professor Sir Ian Kennedy carried out a review of how the NHS delivers to children and recommended a local partnership in each local authority that would co-ordinate public services in the best interests of children. His ambition was that,

“the welfare and well-being of children and young people, seen as so important by so many, will be the prevailing cultural approach”.

My amendments here try to make clear that children are within the remit of local HealthWatch and HealthWatch England and that children’s and young people’s views should be heard. I beg to move.

[Baroness Masham of Ilton]

My Lords, I support these very important amendments. One only has to remember the tragedy of Baby P and all those vulnerable children who sometimes fall between the police, the social services and the health departments.

--- Later in debate ---

[Baroness Northover]

I hear what the noble Baroness says. It is interesting that she said “people of all ages”. The purpose of healthwatch and the NHS is to help and try to assist people of all ages, whether they are patients, their families and so on. We need to make it more person-centred—we all agree that that is what we are seeking to do—and I hear what she says in regard to the regulations.

[Baroness Massey of Darwen]

My Lords, I thank the Minister for her words. I have some concerns, to which I shall come in a minute. I am glad that so many noble Lords contributed. I am particularly glad that the noble Baroness, Lady Finlay, mentioned young carers and that the noble Lord, Lord Warner, talked about adolescent health, so long an area which has been very much neglected in relation to health services.

I would also like to thank the Minister for meeting a group of noble Lords to discuss the issue of children’s interests in this Bill. I hope that the Government have got the message about the need to involve children in decisions about their care and treatment. Many have considerable health needs, although the young population is generally considered the healthiest. They have health and care needs, including mental health needs, disability and so on. I worry that when children get lumped in with expressions such as “the community” or “the family”, their needs are ignored. Children have very little redress on this. If we do not make it explicit that we should consult children, they often do not have the ability or contacts to come back at that and make a protest. We have to do that for them, and children must be included in and consulted on all Bills that affect them.

I would like the words “children” and “young people” and consultation with them to be made very explicit in this Bill. I have amendments later, although I cannot remember their numbers, which will also reintroduce the notion of children into this Bill. In the meanwhile, I will withdraw the amendment, but I may well wish to return to the matter on Report with other noble Lords and look at it again.

Amendment 310 withdrawn.