Health and Social Care Bill

Debate between Baroness Massey of Darwen and Baroness Whitaker

Thursday 8th March 2012 Lords Chamber

[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.

Education Bill

Debate between Baroness Massey of Darwen and Baroness Whitaker

Monday 4th July 2011 Grand Committee

[Baroness Massey of Darwen]

My Lords, I thank my noble friend for this amendment. He makes many powerful points about homophobic bullying. This is a very serious issue. Research has shown that many young people who are gay feel excluded and even suicidal when they are bullied because of their sexual orientation. Bullying has become a very much more complex issue in recent years. It can happen to any child, and some more than others. The person who is doing the bullying also has problems, as well as the child who is being bullied. We have to tackle all that complex mix.

Mobile phones and the internet, in and out of school, have driven some young people who are bullied to suicide, not just to suicidal feelings. We need to look at this very seriously. The issue of keeping records is important, but I would go back to something that I remember Graham Allen saying recently. One thing is having the firemen to deal with a situation but, before that, we need to have smoke alarm systems. I want to talk about the smoke alarms here, not literally but metaphorically.

We need to teach about bullying, in PSHE or wherever, and address the reasons why some people are bullied, why some people do the bullying and the feelings involved there. That is the first point. We need to discuss bullying with pupils in school and have them express their feelings about it. It is also a matter of what is happening in lessons and within the school’s own ethos: how does the school tolerate this?

There is another issue about having a school policy on bullying and on behaviour generally. We mentioned school councils the other day, and I gave the example of the school where I am a governor having a council which sets for each classroom, in an agreed form, the classroom behaviour code. This should be encouraged by schools because it is devised by the pupils themselves. Where the pupils have an issue and make the policy—on bullying, for example—it is much more likely to be effective. While I agree with my noble friend about keeping records, it is also important for schools to have a policy on bullying which is kept to and agreed by the pupils.

[Baroness Whitaker]

My Lords, I support my noble friend’s amendment for all the reasons that he set out so comprehensively, but also because identity-based bullying is a particularly prevalent experience for Gypsy and Traveller children. Indeed, it is thought to be responsible for much of the 20 per cent drop-out rate at secondary level. I have heard harrowing examples from Gypsy and Traveller members of the UK Youth Parliament about their own and their siblings’ and cousins’ experience, which included sometimes indifference, or even collusion, on the part of the teachers.

About three-quarters of local authorities collect information on racial and ethnic bullying. I am not sure that they always think that bullying Gypsy and Traveller children is ethnic bullying. In any case, the schools which do not supply the information or collect examples of that and other identity-based bullying most need their practice exposed and improved. It will surely help to address poor behaviour and, as my noble friend says, it will not be an onerous addition to raise the standard of the worst to the best. I hope that the Minister will entertain the possibility of accepting this amendment.