Unemployment

Baroness Meacher Excerpts

Thursday 11th June 2020 Lords Chamber

[Baroness Meacher (CB) [V]]

My Lords, the OECD has predicted that the level of unemployment in this country will reach 11.7% in the third quarter. Will the Minister and his colleagues work with the DWP to adjust the universal credit system and introduce active labour market policies that support unemployed people back into work effectively, as Sweden has shown most particularly? Many of those jobs could be green jobs; such policies could take the place of the sanctions regime in the universal credit system, which does little else other than punish people who are unable to find work.

[Lord Agnew of Oulton [V]]

As the noble Baroness will know, our furlough scheme has been one of the most generous in Europe, and the whole point of it is to protect productive capacity. We certainly hope that, over the next few months, its gradual withdrawal will give businesses time to adjust and come to terms with what the opportunities are for them to get back into business. We will certainly keep the mechanisms of universal credit under review. However, it is a far more flexible system than existed in the past.

Income Equality and Sustainability

Baroness Meacher Excerpts

Wednesday 6th May 2020 Lords Chamber

[Baroness Meacher (CB)]

My Lords, one of the main economic risks from the pandemic will be the likelihood of mass long-term unemployment, as we experienced in the 1980s. Today, the Resolution Foundation predicts a 600,000 increase in youth unemployment this year—this is just the beginning. The pandemic is destroying economies across the globe, and recovery will take time. Long-term unemployment destroys a person’s confidence and mental health, while employers are very reluctant to take on demotivated, depressed, unemployed people. The most at risk of unemployment are the least well qualified; this is fundamentally an issue of inequality.

At a time of mass unemployment, the punitive universal credit regime, providing minimal benefits within a fear-inducing sanctions framework, becomes immoral. Unreformed, it will create serious mental health problems, crime, and an even bigger drugs problem, funded by crime, than we have already.

A part of the solution will be active labour market policies and the job guarantee. In 2005 and 2007, the OECD published evidence of the effectiveness of such policies, which ensure that, after a specified period out of work, an unemployed person will be offered work in the public or charity sectors at the rate for the job, probably at the minimum wage. Denmark and the Netherlands were examples of countries which pursued such policies and had low unemployment against the trend. Had the UK adopted these policies, we would not have had 2.5 million out of work for about four years after the global financial crisis of 2008. Yes, there would be a net cost to the Exchequer, but the benefits would far outweigh those costs: the improved employability of those involved and higher tax revenue and lower benefit costs over time; and, at the personal level, less mental breakdown, crime and drug use. In essence, it would mean greater equality and sustainability and a healthier and happier society.

Cannabis

Baroness Meacher Excerpts

Monday 12th March 2018 Lords Chamber

Asked by

[Baroness Meacher]

To ask Her Majesty's Government whether they have plans to revisit the inclusion of cannabis in Schedule 2 to the Misuse of Drugs Act 1971, in the light of claims regarding its medicinal significance.

[Lord Young of Cookham (Con)]

My Lords—

[Lord Young of Cookham]

This is a bit like “Mastermind”, but on somebody else’s specialist subjects.

The World Health Organization’s Expert Committee on Drug Dependence has committed to reviewing the scheduling of cannabis under the United Nations 1961 convention. This is due to consider the therapeutic use as well as dependence and the potential to abuse constituent parts of cannabis. This will be a key report to inform the Government’s position on this issue, which, as with any government policy, we will keep under review.

[Baroness Meacher (CB)]

My Lords, when most of the western world recognises that cannabis has significant medicinal value, and when Germany recently legalised cannabis for no fewer than 57 indications, in the UK, which remains miles behind everybody else, we have cannabis in Schedule 1 and therefore defined as a dangerous drug with no—I underline no—medicinal value. Will the Minister work with his colleagues to bring this issue forward as a matter of urgency rather than waiting years for the WHO report—I know the WHO somewhat and it takes a little time? That would save the incredible suffering—I have met so many people suffering deeply—of tens of thousands, if not hundreds of thousands, of people up and down the country.

[Lord Young of Cookham]

The noble Baroness is a long-standing campaigner for drugs reform. I listened to her exchange a few days ago with my noble friend Lady Williams on this very subject. When I saw officials last week, I pressed them hard on the medical advice. The professional advice of medical experts in this country is that cannabis in its raw form has no medicinal value, which is why it is a Schedule 1 drug and subject to strict controls. I am very reluctant as a layman to second-guess those officials. However, the noble Baroness referred last time to the moving case of Alfie Dingley. The Home Office will do all it can within the framework of the current legislation to ensure that Alfie gets the treatment he needs

Contaminated Blood

Baroness Meacher Excerpts

Monday 29th January 2018 Lords Chamber

[Lord Young of Cookham]

The noble Lord asks a question that is right at the extremity of my familiarity with the subject, but I looked it up and the noble Lord is quite right. There was an independent inquiry in the early 2000s by the former Solicitor-General for England and Wales, Lord Archer. I understand that it held no legal or official status at all. It was unable to subpoena witnesses or demand the disclosure of documents, but it looked at some of the issues and discovered that some important documents had been destroyed. There were issues of missing evidence. After he reported, Lord Jenkin, who was also a former Secretary of State, voiced his difficulties about obtaining documents for the inquiry. That inquiry is available and will be available to the statutory inquiry. I hope that it will be able to build on some of the work that Lord Archer undertook.

[Baroness Meacher (CB)]

My Lords, can the Minister assure the House that the different groups of sufferers within this community will all be consulted by the chair and the panel? There are widows, people who are still suffering, people with HIV and people who do not have HIV and they have all been treated differently and in many cases grossly inadequately over the years. This is one of the concerns. People do not want the Haemophilia Society to be the one group that is consulted, because people from these different situations want to speak for themselves. I would like to think that the Haemophilia Society reflects everyone’s interests, but I absolutely respect the wishes of the different groupings. That assurance would be very helpful to them.

[Lord Young of Cookham]

I am very happy to give that assurance to the noble Baroness. As she may know, there were more than 800 responses to the consultation that we launched in July, which concluded in October, so it is quite clear that there is a substantial body of people who take an interest in the subject and have already made representations. I am sure that the chair will want to consult with a wide range of people—survivors and relatives—before he or she finalises terms of reference.

Universal Credit

Baroness Meacher Excerpts

Thursday 16th November 2017 Lords Chamber

[Baroness Meacher (CB)]

My Lords, I, too, thank the noble Baroness, Lady Hollis, for obtaining this very important debate. I recognise that the aim of universal credit was indeed to improve incentives to work and, along with others, I strongly support that objective—if only the policy would deliver it as originally planned. The only tool now left to the Government to drive people into work is the cruel application of sanctions to these incredibly vulnerable people. The huge problem for claimants is that the new system, good though it originally was, is being rolled out in the context of an extraordinary level of cuts to welfare benefits. The net effect of these cuts for disabled people, carers and single parents—the most vulnerable citizens in this country—is quite simply devastating. They face inevitable soaring debts completely outside their control, the risk of homelessness, acute anxiety and distress. These benefit cuts include, as most noble Lords here know, the benefit cap, the bedroom tax, the cut to council tax benefit, the failure to meet the whole of a claimant’s rent, the working-age benefits freeze and cuts to work allowances—to name just a few.

Let us focus for a minute on disabled people, who are affected by all the above cuts and more. The Government rightly announced their intention to halve the employment gap between able-bodied and disabled people. Well, sadly, universal credit is destroying this ambition—not the intention of the original designers, no doubt. There will in fact be reduced support for working people with disabilities, particularly for those with children. Many are being shifted from the higher employment support allowance to the lower-level benefit of jobseeker’s allowance. Working tax credit includes a disability element worth £54 a week, which is a lot of money for somebody on a very low income. Universal credit reduces that substantially for some of those people and eliminates it altogether for others.

Another devastating cut for disabled people is the severe disability premium, which has been an additional sum added to the employment support allowance for a subset of severely disabled people. This benefit is being scrapped under universal credit—a loss to these severely disabled people of £62 per week or £3,200 per year. It is almost difficult to believe these sums. The whole point of these disability additions was to cover the extra costs of working for very severely or severely disabled people, thus enabling them to get to work.

If the Minister would be interested to see the full impact for claimants of the rollout of universal credit, she may be interested in a recently published book by Sam Royston, Broken Benefits: What’s Gone Wrong with Welfare Reform. It is in the context of these swingeing cuts that the minimum wait of six weeks is utterly devastating for people, and we know from the DWP’s own data that 20% of people wait longer than six weeks for their first payment. Some wait for up to 10 weeks. Does the Minister accept that there is an urgent need to expand universal support to help people reduce the waiting period? I would be grateful for an assurance from the Minister on this point.

Another issue which I implore the Minister to look into and rectify—this is absolutely appalling for some people—is that claimants whose most recent employer just happens to make a final payment, maybe of statutory sick pay, a day or so after the claimant’s assessment period begins will receive precisely zero in their first so-called “universal credit payment”. They will get nothing at the end of six or even 10 weeks. It is a very specific problem for certain people whose employer just happens to do something that is just devastating for them.

The Government point to advance payments as a solution for claimants, but these payments cover only two weeks’ costs and are just another debt which is later deducted from benefit. Claimants are then left with almost nothing to live on week after week and month after month as their rent arrears, council tax, other debts and advance payments are being repaid.

Another problem is that universal credit is paid monthly, as other noble Lords have mentioned, when 58% of these claimants are just not used to that. They have never lived like that. They were paid fortnightly or weekly. Will the Minister please look into the possibility of reversing that system?

Finally, will the Minister think again about the Government’s resistance to paying rent direct to landlords? Again, other noble Lords have mentioned this point. It sounds simple, but if you have, for example, learning difficulties, it is incredibly difficult to manage a chunk of money that has got to last for a month and to find your rent at the end of the day.

Before ending, I want to pay tribute to the CAB, the Joseph Rowntree Foundation and others for their helpful briefings. In reality, rising debt, huge levels of stress and parents choosing not to eat in order to try to pay their bills are the result of this government policy. Universal credit and its accompanying cuts are generating a humanitarian crisis that ill befits this very rich country. Along with colleagues on all sides of the House, I hope that the Minister will give an assurance that the universal credit rollout will be halted while some of the worst features are rectified. If not, will the Minister explain how this policy tallies with his commitment to help those who are only just managing?

Financial Guidance and Claims Bill [HL]

Baroness Meacher Excerpts

Committee: 4th sitting (Hansard): House of Lords
Wednesday 13th September 2017 Lords Chamber

[Lord Holmes of Richmond (Con)]

My Lords, I am pleased to bring forward this amendment, and in doing so I express thanks to all the organisations that have offered me advice and guidance on preparing it. Perhaps, in the light of the Bill we are discussing, I should not have used either term, advice or guidance, but just thanked them for the briefing in the spirit in which it was offered. Not least among those organisations was Macmillan Cancer Support, which demonstrates brilliantly how a charity can operate in 21st-century Britain not only by offering superb palliative care, nursing services and the like, as we would expect, but by fundamentally understanding just how important financial services are and how people are affected when they get a cancer diagnosis.

I am pleased to speak to Amendment 70 not least because we have gone over the ground of the SFGB at Second Reading—which takes me back to a previous life, when SFGB stood for the Swimming Federation of Great Britain. Bearing in mind my previous life, it seems only appropriate that I should dive straight in.

The purpose of Amendment 70 is to create a duty of care on claims management services to act for all customers, not least those who find themselves in a vulnerable situation. My desire in Committee was to bring forward an amendment that would impose a duty of care across the whole financial services sector but, sadly, that was deemed to be outside the scope of the Bill, so this amendment is far more limited and relates just to claims management services. However, I hope that, within that, noble Lords can see the potential and the need for wider application and an amendment at a future date that will address duty of care across the whole financial services sector, not least when we look at where financial services came from.

At one stage there was truly a sense of a relationship between customer and provider. In many ways we need to get back to that, not least because there is so much that financial institutions can do to assist people. Indeed, many financial institutions and claims management services may well do things to assist people, particularly when they find themselves in a vulnerable situation—not least if they have had that most awful news of a cancer diagnosis. But when we look at the evidence, only one in nine people who receive a cancer diagnosis reveals it to whichever financial institution they are dealing with. The reasons for that are pretty clear. But if that were not enough evidence, survey data illustrate that of the small number who did declare to their financial provider, 23% said that they had a wholly unsatisfactory experience. We can deduce from that that there is a really low level of declaration but, even within that small number, almost one-quarter have a negative experience after declaring.

I believe that Amendment 70 will go some way, in the specific claims management arena, to demonstrating the need for such an amendment and the benefit it can have on claims management services. There is a lot more for the Financial Conduct Authority to consider in terms of this duty and, indeed, the general duty of care. We know that the FCA is considering putting out a consultation paper on a duty of care across financial services, but we also know that it has stated that there will be no change at least until 2019. Consultation could last until 2019, then there would be a proposal, then pre-legislative scrutiny and then the process of implementation. I think we can all agree that there has been more than enough delay already in making sure that vulnerable consumers get the level of service that they should expect to receive from claims management services and the entire financial services industry.

I ask the Minister to support Amendment 70. Will he also say something about the Government’s view on placing a general duty of care on the FCA across the whole financial services sector? This would bring benefits not only to consumers but to financial institutions and the nation. Amendment 70 and a general duty would both in their own way clearly help to deliver a financial services sector and a nation that work for everybody. I beg to move.

[Baroness Meacher (CB)]

My Lords, I support Amendment 70 tabled by the noble Lord, Lord Holmes. As he indicated, what we really need is a wider power, but it is outside the scope of this Bill. I want to challenge that, at least for the moment. I refer to Clause 2(3), which makes it clear that:

“The single financial guidance body may do anything that is incidental or conducive to the exercise of its functions”.


This is an attempt to build on the powers that that subsection suggests.

The fact is that the prevention of debt is even more important than helping people once they fall into debt. In terms of preventing debts arising, the duty of care is particularly important to people with serious health conditions and disabilities, for whom financial problems can quickly become overwhelming, as the noble Lord, Lord Holmes, has indicated. I want to concentrate on the particular plight of sick and disabled people. For example, 400,000 people in the UK with cancer struggle to pay their household bills because of their diagnosis. Banks and building societies have a vital role to play in helping such people; it makes a huge difference if a bank or building society offers flexibility in mortgage and other payments or interest freezes on credit cards and other loans. Although the Bill highlights the importance of early help, there is a growing consensus that greater leadership is needed from the Government to make it clear that providing this support to vulnerable customers must be a priority for financial institutions.

Deregulation Bill

Baroness Meacher Excerpts

Thursday 5th February 2015 Lords Chamber

Moved by

[Baroness Meacher]

32A: Clause 75, page 64, line 14, at end insert—
“(3) This section comes into force on such day as the Secretary of State may by order made by statutory instrument appoint.
(4) A statutory instrument under subsection (3) shall not be made unless a draft has been laid before and approved by both Houses of Parliament.
(5) The Secretary of State may not lay a draft statutory instrument under subsection (4) until he has published a report of a risk assessment of the delegation by local authorities of their child protection functions and services.
(6) The Secretary of State must publish the report specified in subsection (5) within 18 months of the passing of this Act.”

--- Later in debate ---

[Baroness Meacher (CB)]

My Lords, I thank the noble Lord, Lord Nash, the Minister, for finding time for two meetings to discuss our concerns about this issue and the removal of a safeguard from the child protection system. We thought carefully about bringing this issue back to the House at this point but there is a high level of risk associated with the child protection functions, and the fact that the regulations were tabled and passed only last year suggests that the arrangements are still very much at an early stage and that it is really premature to remove the requirement for these delegated services to be registered.

We note that local authorities will remain accountable to the regulators for the quality of the services provided, but the fact is that the regulated services will not sit directly within the purview of local authorities and we know that commissioning, contract compliance and adhering to rules around commercial secrecy are still in their infancy and untried with respect to child protection decision-making functions. Indeed, in our meetings the Minister himself referred to the poor commissioning and contracting skills of local authorities that he had identified, and we agree with his concern. These new functions will take time to bed down. Staff need to be trained. They need some experience and you cannot achieve that overnight. For local authorities, quality assurance in external organisations may prove very difficult to achieve. An experienced principal social worker describes numerous occasions of near-misses in contracted-out services affecting children and adults in community settings, and the incredible frustration of trying to get contractors and agency suppliers to take remedial action to improve the quality of care provided.

With the extension of delegated functions to include child protection functions, among others, the risks will increase sharply. There is the potential for the emergence of much larger market providers with subcontractors—of firms establishing a string of not-for-profit subsidiaries with supply lines that are difficult to hold to account. These are the concerns of the College of Social Work that we are reflecting today. We understand that local authorities will be inspected to check whether they have commissioned the functions and services appropriately and whether they are ensuring contract compliance. There are concerns about the quality of that inspection and the training of the staff within the inspectorate. There are matters there that need to be dealt with.

The Minister kindly sent us some key extracts from the Ofsted documentation which make it clear that inspection of local authorities will take place about every three years. Yes, a local authority will be reinspected within 12 weeks following the delegation of functions if the local authority had previously been judged inadequate. But local authority services may be perfectly adequate even if their commissioning and contract compliance skills are yet to be developed, so there is no reason to believe that there will be an inspection within 12 weeks. In that case, we are talking about three years. An awful lot of children may be damaged in that time. In this context we should be strengthening rather than scrapping the registration requirement. This should at least ensure that any organisation taking on this work has the basic structures, supervision arrangements and risk management procedures in place. The Minister argued, very reasonably, that Ofsted does not have the resources to undertake this registration function effectively. If that is the case, the delegation of these services should not go ahead until the ways and means are found to provide that assurance.

We know that in this very difficult field disasters will occasionally happen. Social services staff may not be proficient in commissioning and contracting, as I have already said, but they have considerable experience in child protection. Every day, children are protected by social workers from sick, disturbed or dangerous parents. As in the terrorist field, the perpetrators have to succeed only once, whereas the staff in these agencies have to fail only once and all hell is let loose, as we know.

These are extraordinarily difficult and stressful areas of work. We should not increase the risks involved. We understand that a number of local authorities are being instructed to delegate these functions. There will be the possibility therefore of a pilot, which could be risk-assessed. Our amendment requires the undertaking of a risk assessment of the delegation by local authorities of their child protection functions and services before the registration of those services can be abolished. That is the whole point: it is early days and it is premature to be taking this step.

We also propose that the report on the risk assessment be published within 18 months of the passing of the Act. We assume that the Government of the day would take appropriate action if the assessment showed that the risks of delegating those functions were unacceptably high. I look forward to the Minister’s reply and beg to move.

[Baroness Donaghy (Lab)]

My Lords, this amendment is about child protection and ensuring appropriate government responsibility for the regulation and quality of care offered by outsourced social work providers. Although most local authorities do their best to uphold standards, this important area cannot be left entirely to them, with very occasional inspections from Ofsted—as the noble Baroness, Lady Meacher, has just said.

Local authorities have stated that it is,

“important to ensure there is a proper, external to the local authority, registration process to enable a local authority to be confident in using the services provided by the SWP”—

that is, the social work provider. The government proposal is that the external providers of social work services will not be inspected in their own right by Ofsted, nor will they be registered as providers in the way that children’s homes and adoption societies are, so there is already an anomaly here. There will be no overview of their activities across local authorities where they hold contracts and no visible assurances for the public about their financial viability, quality or working practices.

In June 2013, the Delegated Powers and Regulatory Reform Committee criticised the Government’s proposals to remove regulation of social work providers. It stated:

“Registration … would allow the imposition of national minimum standards and requirements as to the fitness of providers, and would also provide a mechanism for removing providers who were failing to meet standards”.

The Government subsequently retained separate registration, but not inspection, for external providers through the Providers of Social Work Services (England) Regulations 2013, to which the noble Baroness, Lady Meacher, has already referred. The discussions are less than 14 months old, and now the Government seek to remove even that provision of registration. This is in the context of there having been no empirical review of the 2013 regulations to see how they are working. Our amendment asks for a pause for the review to be conducted to satisfy ourselves that the most vulnerable children in our society have some protection.

Finally, social workers, whether working for the public or private sector, have a difficult if not impossible task with a heavy if not impossible workload. They take decisions every day which could mean life or death. Yet the only time that they receive publicity is when things go wrong. I believe that it is the duty of Government to ensure that standards across the profession are of good quality and that local authorities are not left high and dry on this issue. I hope that noble Lords will see fit to support this amendment.

--- Later in debate ---

[Lord Wallace of Saltaire (LD)]

My Lords, I suppose that I should declare an interest: my son has lived and worked in the United States for seven years and his American wife is a qualified children’s social worker. She has worked in Boston and is currently working in Chicago, so I have learnt a certain amount about the Massachusetts and Illinois systems of privatised provision of child protection. I am not completely unaware of some of the delicacies in this area. I am of course also acutely aware of the sensitivity of the issue of child protection in British political debate at present.

I thank the noble Baronesses for raising this issue and for coming in to discuss further with my noble friend and officials some of the underlying issues at stake. I am well aware that the College of Social Work has strong views on this, although as I understand it the area of social work is not entirely of one mind in how far one needs registration as well as inspection. The questions of registration and inspection are related but not identical. The system of delegation is purely permissive. Local authorities may continue to provide their own services or, as the noble Baroness suggested, delegate to third sector providers or commercial providers in the field. Some do so; many others continue to provide their own direct services. The removal of registration does not mean the removal of inspection.

[Baroness Meacher]

I thank the Minister for giving way. I understand that a number of local authorities are being instructed to delegate out these services. Is that correct or not? It is what I have been told.

[Lord Wallace of Saltaire]

I am informed that it is not correct. I certainly have no knowledge of it, but my noble friend Lord Nash assures me that it is not the case, so we are not in that area.

We have an active system of inspection. It is local authorities which are accountable for ensuring that when contracts are signed in this form, the provider is a credible and qualified provider. Having said that, Ofsted is the inspector of such arrangements and it keeps a very active role in watching what happens, receiving reports and then coming in to inspect when reports are provided of inadequate care or the accidents which sadly, as we all know, eventually and occasionally happen. Ofsted shares the Government’s view that registration adds little value and that, in many ways, it risks confusion in the system as to where accountability lies.

It is the Government’s view that accountability lies with local authorities and that Ofsted, for the Government, provides the continuing process of inspection. There are of course issues about the level of risk and the level of burdens in the system.

--- Later in debate ---

[Lord Wallace of Saltaire]

My Lords, the Government will naturally review the relatively recent arrangements that have been put in place. That of course will be for our successors, whoever they may be in a matter of months’ time, but I assure the noble Baroness that all Governments and Secretaries of State are well aware of the risk factor involved in all this; it is an area that any Government have to pay active attention to.

[Baroness Meacher]

My Lords, I thank the Minister for his reply. I thank my colleagues, my noble friends Lady Donaghy, Lady Howarth and Lady Jones, for their persuasive and powerful contributions—and indeed the noble Lord, Lord Reid.

The fact is, as we have made clear, that there are major risks in pushing ahead with these delegated services without a proper risk assessment. I am grateful that the Minister assures us that there will be a review of these delegated services; it would be good to have in writing some information about when such a review will occur and the nature and detail of it, because that is fundamentally important. The reality is that we do not feel assured that local authorities will be able adequately to quality-assure all the organisations out there undertaking these sorts of child protection and other related functions; it is just unsafe. Therefore, a review—frankly, I would call it a risk assessment—is fundamental and, hopefully, any Government in power after May will be able to respond appropriately to that. Even at this very late hour, I have to say that I want to test the opinion of the House on this matter because of its gravity.

Deregulation Bill

Baroness Meacher Excerpts

Tuesday 18th November 2014 Grand Committee

[Baroness Donaghy (Lab)]

My Lords, I am asking the Government to withdraw Clause 71 on social work services and registration. Clearly there is a history to this which I shall not spend a lot of time on, but I have to say a couple of things about it. First, the previous Labour Government issued a guarantee in 2008 that any delegated service would be required to register with the regulator. The Government propose to withdraw that provision. Secondly, in June last year the Delegated Powers and Regulatory Reform Committee criticised the Government’s proposals to remove regulation of social work providers. It said:

“Registration would allow the imposition of national minimum standards and requirements as to the fitness of providers. It would also provide a mechanism for removing providers who are failing to meet standards”.

The Government subsequently retained separate registration but not inspection for external providers through the Providers of Social Work Services (England) Regulations 2013. The discussions are as recent as that. Now the Government are seeking to reverse that decision and to remove the registration requirement. This is despite the fact that there was no clear support for removing regulation in the original consultation responses.

The Government did not consult on this issue as part of the consultation in April 2014 on extending outsourcing in children’s social work. During the debate in Committee in the House of Commons on whether the clause should stand part of the Bill, the Deputy Leader of the Commons, Tom Brake MP, acknowledged that there had been no clear support for removing the registration requirement.

The Office of the Children’s Commissioner for England raised concerns and stated:

“We consider all delegated social care services should be required to have formal registration with Ofsted in addition to an expectation that they will be held to account by rigorous and expert inspection, just as local authorities currently are”.

Ofsted conducted its own consultation on a regulation and inspection regime for social work providers. It consulted children and young people for their views, unlike the Government. Ofsted found that respondents to its consultation wanted thorough checks to be made on companies and applicants that plan to provide delegated functions. They also felt strongly that registration checks should be backed up by later inspection.

Local authorities thought it would be,

“important to ensure there is a proper, external-to-the-local-authority registration process to enable a local authority to be confident in using the services provided by the social work provider”.

I should, perhaps, remind the Committee that the Ofsted registration requirements cover important areas of social work provision, such as the “fit and proper person” test for those running social work providers, financial viability, registered manager, sufficiency of qualified staff, vetting checks and conditions of registration.

The Government propose that the external providers of social work services will not be inspected in their own right by Ofsted, and nor will they be registered as providers in the way that children’s homes and adoption societies are. There will be no overview of their activities across local authorities where they hold contracts and no visible assurances for the public about their financial viability, quality standards or working practices. Unison, the trade union that represents social workers, believes that the regulation and inspection of social care services are essential to safeguarding vulnerable children and their families. It also said that regulations should not be regarded as a burden in this extremely sensitive area.

Internal contract monitoring by local authorities cannot be relied on by itself to ensure that acceptable standards in the safety and quality of social work with looked-after children are upheld. By removing the separate registration of providers, the Government are relying on Ofsted to pick out issues about their fitness to operate as part of its inspections of individual local authorities. However, providers could operate across many local authority areas. Local authorities already face challenges because of funding cuts and it is likely that contracts will be held by larger private or voluntary sector contractors. Close ties with local authority teams and systems will be weakened; their interests and priorities will be different from those of the client authority. The drivers of service provision will be cost driven. Relying on local authority inspection will be inadequate and emphasises the need for a single registration point.

The focus of the single inspection framework is the local authority, and this will necessarily limit the range of regulatory action Ofsted takes in relation to the failings of an outsourced provider. Ofsted needs to be able to focus on the provider in its own right, rather than on individual local areas of work. It also creates a lack of symmetry in the system by requiring providers of children’s homes and fostering and adoption placements to be registered and inspected in their own right while providers of social work services—which are exercising major statutory functions, taking sensitive and critical decisions about placements for children—are not required to do so. How can the Government defend such inequality? Do the Government think that providing social work services is somehow less important? Are the Government confident that this act of abandonment will not lead to a lowering of standards?

Finally, the College of Social Work is calling on the Government to pause, so that the service implications of these regulatory changes can be fully considered in the light of real evidence. There needs to be detailed consideration of potential conflict of interest in the provision of children’s services and the management of risk. The College of Social Work has stated:

“The proposals raise serious and important questions about how services to some of the nation’s most vulnerable children and young people may be delivered in future”.

I can only echo that statement and ask the Government to withdraw Clause 71 before it is tested on Report.

[Baroness Meacher (CB)]

My Lords, I support the noble Baroness, Lady Donaghy, and agree that Clause 71 should not stand part of the Bill. Among the main reasons for my position is, first, that the delegation of local authority statutory children’s services functions, particularly child protection functions, was approved only very recently, and we simply have not had the time to clarify whether the new arrangements are working. Secondly, the delegation of these functions was approved by statutory instrument, and therefore not subjected to very thorough parliamentary scrutiny—we already have, if you like, an unscrutinised situation, or one subject to inadequate scrutiny, yet these functions are crucial to the future lives of very vulnerable children.

It was presumably no accident that these statutory functions were not included in the Children and Young Persons Act 2008, which provided for the delegation of functions in relation to looked-after children and those leaving care. Those are very sensitive areas of work, and one can question their delegation, but these new functions were not included even then. I should make it clear that, along with members of the College of Social Work, I support the provision of children’s and adult services by the third sector in partnership with the statutory agencies—this is not an ideological point at all—but as recent scandals have shown, the third sector is not immune from providing very poor-quality services to very vulnerable people. It is this risk that needs to be guarded against in equal measure— I emphasise equal measure—with public services. I sometimes worry that the Government assume that any private service is somehow good, while public services are suspect. That seems to me to be an incredibly dangerous assumption.

I share the concern of the noble Baroness about the limited parliamentary debate about the new regulations and, more particularly, the concern that the removal of the one safeguard from these functions is proposed when the evidence for the efficacy or otherwise of these delegated services is not yet available. Will the Minister explain to the Committee why the Government are proposing to remove the requirement to register with the inspectorate from these newly delegated services? Is this a matter of cost? If so, what will be the annual saving to the Exchequer from this change? Has a cost-benefit analysis been done of Clause 71? Is there any evidence to suggest that the proposal will not lead to a deterioration in the quality of service provided? These really are very important questions for the Government to answer.

It would also be helpful to have some explanation about how the local authority responsibility for these delegated services will work. As I understand it, local authorities will remain accountable to the regulators for the quality of the delegated services, but they will surely need to undertake some form of inspection role in order to satisfy themselves that the services are of an acceptable quality. But will they be funded to do that? We know how hard-pressed local authorities are; if they do not have the funding for a job, they will certainly not be able to do it. If not, is it right that a local authority should be held responsible for poor-quality services that do not fall within its purview? It all feels really very difficult from the local authority point of view and therefore the whole thing feels shaky. Who is going to lose? The vulnerable children, at the end of the day. I hope the Minister will respond to these questions and provide some assurance to the Committee that the Government are not taking unreasonable risks in Clause 71.

PACE Trial: Chronic Fatigue Syndrome/Myalgic Encephalomyelitis

Baroness Meacher Excerpts

Wednesday 6th February 2013 Grand Committee

[Baroness Meacher]

My Lords, I thank my noble friend Lady Mar for tabling this Question for Short Debate concerning the PACE trial. I must declare an interest as former chair of East London NHS Foundation Trust. Professor White, a leading researcher in the PACE trial, works as a consultant in that trust in addition to his research post at Queen Mary, University of London.

CFS/ME can be a seriously disabling syndrome. I like to refer to it as a syndrome because it seems to be not one but a number of diseases. NICE compares the physical symptoms of CFS/ME with those of multiple sclerosis, systemic lupus erythematosus—if I can pronounce that correctly—and rheumatoid arthritis, probably three of the most fearsome illnesses one can think of. To make matters worse for sufferers, as the noble Lord, Lord Alderdice, so rightly said, the causes and disease processes of CFS/ME are not yet understood. That must be a deeply frightening thing for any patient.

Doctors can misdiagnose sufferers or, worse still, dismiss them as not really physically ill at all. I understand that for some, some psychological aspects may be important and for others they may not. I am aware of people who have had major viruses and suddenly been struck down, having led very active lives, getting on with things and being fine. We have to be very careful about any assumptions, whether physical, psychological or whatever.

CFS/ME is all too real. Of course we need much more research. I await the outcome of Professor White’s cytokine research later this year, for example. We look to the MRC and others to prioritise this distressing syndrome. Thankfully, the MRC has two boards—it probably has others, too. One funds studies such as PACE and the other funds studies into the immune system, and viral and genetic considerations. The PACE study did not in any way affect funding for organic CFS/ME research. That is terribly important because there are fears that it may have done.

As the noble Lord said, the experts believe that in time a number of distinct diseases will be identified that currently fall within the CFS/ME label. In the mean time, NICE recommends CBT and/or graded exercise therapy for people with mild or moderate CFS/ME because these are the interventions for which there is the clearest evidence of benefit to patients. No doubt in time treatments that attack the causes and achieve better and faster results will be developed but in the mean time it is a great step forward that, as in the PACE trial, 22% of patients recover—I agree that there is debate about the word “recovery”—after only 13 sessions of CBT or graded exercise.

Meanwhile, 60% of patients achieve significant improvements in both fatigue and exercise levels after the same period, according to the PACE study, which certainly fits with my experience of the limited number of people—about half a dozen—who I know. A meta-analysis showed a 50% recovery rate after one year. These results are very significantly better than spontaneous recovery rates or those following alternative available treatments. From our most helpful discussion on Monday, I understand that my noble friend Lady Mar respects the PACE study but, very reasonably in my view, has grave concerns about the spin put upon the results. People have to be very careful. We all know what happens once things get into the media but the spin that is put on these things is really important for patients. Things can be very hurtful.

I understand that the DWP may treat people as workshy if they have not undergone a CBT/GET treatment regime. At least a quarter of PCT areas do not have any specialist services for these patients. Others have nothing but grossly inadequate services at a pathetic level. It is essential that the DWP and, indeed, insurance companies take account of the non-availability of such services in many areas. Will the Minister pass on this concern to the noble Lord, Lord Freud? The DWP also needs to be aware that CFS/ME patients can take time to improve. I am not an expert but out of the people I know, several have needed much longer than one year to recover acceptable levels of functioning.

In terms of returning to work, the PACE trial had no effect whatever on the numbers of CFS/ME patients in work. I would not expect it to have done. These people have been, on average, out of work for two and a half years before they entered the trial, and from all the work that numbers of us have done over many years, we know that it is incredibly difficult to get people back into work if they have been out of work for two and a half or three and a half years. However, the social care costs and the need for family support were reduced. People were much better—not necessarily completely better but an awful lot of them were much better.

I now want to address a few other issues arising from the PACE study, including the fact that 10% of patients deteriorated during the trial. I understand that all these deteriorations resulted from life events or other infections during the trial period. We know well that serious life events or further infections do—or can—cause relapses in this horrible set of illnesses or this syndrome. Secondly, there is the question of whether ME patients benefited from the PACE trial. I am reliably informed that 51% of the patients in the PACE trial had been defined as having ME. I know there are all sorts of debates about that definition, but there was no significant difference in the outcome of treatment for patients who had been deemed to be suffering from ME relative to patients who had been given the CFS label.

Concerns have been expressed about the 11 serious adverse reactions to treatment. The 10 “possible” adverse reactions were equally distributed across the four treatment types. There is no indication that CBT or GET caused any problems. There was one “probable” serious adverse reaction, which was in the medical treatment group and was a reaction to an anti-depressant. Some of us are very familiar with the fact that people can have reactions to anti-depressants, but there is no evidence that CBT or GET can be dangerous.

The PACE trial is the largest ever trial of treatments of this debilitating set of conditions and has received acclaim from clinicians and scientists across the world. Some have wanted to criticise it for changes to the protocol, but those were made before the analysis and were approved by the independent trial steering committee; they were not fixes. The changes were minor and did not affect the results or conclusions in any significant way. Any potential conflicts of interest were published alongside all the papers, and none applied to the statisticians who did the analysis.

It is very encouraging that the Association of Young People with ME accepts that the NICE guidelines are useful for patients and healthcare practitioners. They are right. In conclusion, will the Minister give the Committee an assurance that the Commissioning Board will, in future, give equal priority to the specialist services needed for CFS/ME to that which they give for rheumatoid arthritis and MS?