Children: Obesity

Debate between Baroness Massey of Darwen and Earl Howe

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: Children and Young People

Debate between Baroness Massey of Darwen and Earl Howe

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

Debate between Baroness Massey of Darwen and Earl Howe

Thursday 2nd February 2012 Lords Chamber

[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

Debate between Baroness Massey of Darwen and Earl Howe

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 ---

[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: Osteoporosis

Debate between Baroness Massey of Darwen and Earl Howe

Tuesday 19th October 2010 Lords Chamber

[Earl Howe]

My Lords, the NHS in England has invested in additional diagnostic capacity over recent years, including the provision of more DEXA scanners, which are bone density scanners. The most recent data I have show that only 145 people in England waited for more than six weeks for a bone scan, and of those only seven had been waiting for over 13 weeks. That does not suggest that there is undercapacity. However, the noble Lord is right to say that several treatments are available, along with many messages put out by the department to promote a healthy lifestyle in order to prevent fractures.

[Baroness Massey of Darwen]

My Lords, is the Minister aware that a number of excellent leaflets containing information about the prevention of osteoporosis are available? What initiatives are in place to encourage the distribution of these leaflets in libraries, supermarkets, gyms and so on to enable women and men to get the information they need?

First Aid

Debate between Baroness Massey of Darwen and Earl Howe

Thursday 17th June 2010 Lords Chamber

[Earl Howe]

My Lords, the noble Baroness makes an important point. We all know that St John is active in major emergencies and road accidents and was active in the London bombings of five years ago. She is absolutely right that accidents in the workplace are a significant feature of the kinds of injuries that hospitals see. The ambulance service extends training in the workplace in a number of areas. However, I shall go back to the department and inquire about the extent to which St John in particular is doing this work. We may be able to feed in some important messages.

[Baroness Massey of Darwen]

Given the original Question, and the fact that we are in a workplace, has the noble Earl thought of enabling short first aid courses to be held in your Lordships’ House—I do not mean in the Chamber—so that we could respond in an emergency?

[Earl Howe]

My Lords, I will gladly feed that suggestion in to the Chairman of Committees.

Carers

Debate between Baroness Massey of Darwen and Earl Howe

Wednesday 16th June 2010 Lords Chamber

[Baroness Massey of Darwen]

My Lords, young carers are often overlooked. Is the Minister prepared to meet young carers and organisations that represent them to discuss their needs? We have done this in the past and, while some of the issues have been resolved, some have not.

[Earl Howe]

My Lords, I can give the noble Baroness a ready undertaking: I should be glad to do so.