Smoke-free (Private Vehicles) Regulations 2015

Baroness Tyler of Enfield Excerpts

Tuesday 3rd February 2015 Grand Committee

[Baroness Tyler of Enfield (LD)]

My Lords, I, too, welcome these regulations and congratulate my noble friend Lord Ribeiro on his unstinting efforts in this area. I stress that this new law and these regulations are not designed to turn smokers into criminals or to demonise them; they are about protecting children from the avoidable dangers that tobacco smoke presents to their health and welfare. For me, that is what it is all about. Right through these discussions, I always saw this legislation primarily as a matter of child protection. If noble Lords will excuse the terrible pun, it was about putting children in the driving seat.

When we had those early debates, I was very taken with the number of children who said that they felt that they had no control over the situation and that they were either too embarrassed or too scared to ask adults to stop smoking. The survey mentioned by the noble Baroness, Lady Finlay, referred to how children really want this legislation. In my professional life, we often talk about the voice of the child being at the centre of what we do. Based on that survey, we have a clear mandate from children and young people to take these regulations forward.

The Minister said that the start date will be October. In an ideal world I would have liked to have seen it earlier, but I accept the reasons that he gave. It will be incredibly important legislation in addressing health inequalities, and will go some way at least towards protecting children from the most disadvantaged backgrounds from smoke and enable them to have a healthier start in life. As others have said, this is very much about behaviour change. Certainly, the experience that we have seen on similar issues, such as public smoking and compulsory seat belts, suggests that educational campaigns, which are important, are most effective in changing behaviour when accompanied by appropriate legislation. For the effect of legislation on the proportion of people wearing seat belts, I have a figure that shows an increase from 25% to 91%, which seems extraordinarily large. Just imagine how many children’s lives will be improved if this legislation has even half that success.

The Minister referred to success being measured in terms of positive behaviour change rather than the number of fines handed out. I am sure that that is right, and I approve of that approach, but will he confirm precisely how that behaviour change will be measured?

There are very high levels of public support for the law. In previous debates, as one would expect, we heard that parents were very much in favour of this legislation. However, we also heard about recent surveys and the number of adults, including adult smokers, in favour of this legislation and the number of car drivers who support it. There is a real and growing consensus that these regulations are a good thing and should be introduced without delay.

I very much hope that, without much further delay, we will very soon debate the regulations on standardised packaging.

Mental Health Services: Sign Language Users

Baroness Tyler of Enfield Excerpts

Monday 2nd February 2015 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I thank the noble Lord, Lord Ponsonby, for securing this debate and drawing attention to this important issue. A few weeks ago, I opened a debate in this House about the many challenges confronting mental health services as well as the important new policy and service development instigated by this Government. I particularly appreciate the chance to speak today about the problems that deaf people face in accessing effective mental health care.

It is really important to remember that when we speak of deaf people, we speak of a large and extremely diverse group. There are 9 million deaf or hard-of-hearing people and 700,000 severely or profoundly deaf people in the UK, 50,000 of whom use British Sign Language as their first or preferred language. While some deaf people were deaf at birth or from a young age, others become deaf late in life. The mental health needs of deaf people will differ depending on these factors.

Nevertheless, deaf people as a group share a disproportionately pressing need for mental health care. It has been estimated that 40% of deaf people have a mental illness. The prevalence of common mental disorders such as anxiety and depression in the deaf community is nearly double that of the hearing population and behavioural and personality disorders are between two and five times more common among sign language users.

Deaf children are particularly in need of mental health services as the particular challenges of their life make it more likely that they will experience mental health problems. More than 90% of deaf children are from families with no first-hand experience of deafness, which can lead to isolation and troubled relationships with their families. It is salutary to note that deaf children are twice as likely to be abused or neglected as hearing children.

Let me now turn to the issue of prevention. For many people who lose their hearing as adults, the experience of becoming deaf can adversely affect their mental health. For example, research shows that older people with hearing loss are twice as likely to develop depression as their peers without hearing loss as well as increased feelings of loneliness and social isolation. Like, I am sure, other noble Lords, I am conscious of this from the first-hand experience of close relatives. By providing people with hearing aids, we can reduce these risks. Those who wore hearing aids experienced less depression and anxiety, had more and better family and social relationships, and felt better about themselves than those who did not.

It is impossible to avoid the issue of funding and it is complex. To set the overall context, while very welcome additional funding has been made available for specific mental health initiatives, our recent debate made clear that mainstream mental health services have suffered from disproportionate cuts in comparison with physical health services for both adults and children. Within this context, specialist services for deaf people remain a particular concern, not least given the current architecture of health service commissioning. In short, while secondary and tertiary mental health services for deaf people are commissioned on a national basis, primary mental health care is the responsibility of local clinical commissioning groups, and this, of course, includes mental health services for deaf people. So while the specialist in-patient units for deaf people in London, Birmingham, and Manchester that we have already heard about may receive adequate funding, commissioning for community services is extremely patchy. That is mainly because the deaf community within the area covered by each CCG is relatively small and there is therefore little incentive for it to prioritise the needs of deaf service users. The result is that only a handful of services receive local commissioning.

Let me try to bring this to life. Until early last year, deaf service users were able to access a deaf therapist fluent in sign language through the British Sign Language Healthy Minds IAPT service developed by the charity SignHealth, which was referred to by the noble Lord, Lord Ponsonby, with funding from the Department of Health. The programme was extremely successful and nearly doubled the rate of recovery from 44% to 75%, which is extremely impressive and important. However, in the restructuring of the NHS, clinical commissioning groups were often hesitant to commission the service, preferring to use hearing therapists with interpreters, even though the evidence shows that this is not as effective. Meanwhile, the service was often considered too small scale to qualify for national commissioning. Because of these challenges, the service is rapidly shrinking and some staff have been made redundant. Can my noble friend the Minister say what the Government are doing to support CCGs to increase the data collected in their local community to help inform mental health commissioning for deaf people?

In such circumstances, deaf people seeking talking therapies, which I greatly support, often have little choice but to resort to mainstream services. Deaf people are often not given adequate access to interpreters, as we have heard. Indeed, a 2012 survey of British Sign Language users found that 68% of respondents did not get an interpreter for their GP appointment, despite having asked for one. Many others must wait longer for treatment and travel further in order to secure access to an interpreter. What plans do the Government have to increase the provision of medically skilled interpreter services?

Even when there is access to an interpreter, going through therapy with an interpreter can present significant challenges. The 2012 survey indicated that 41% of deaf patients felt confused following their appointment as they had trouble understanding the interpreter. This may be due to cultural reasons. It is important to recognise that the life experiences of deaf people differ in ways that go well beyond language, especially if they have been deaf from birth or a very young age. The relationship between a hearing therapist and a deaf service user can be made more difficult by cultural barriers as well as linguistic ones. It is no surprise or indeed criticism that mainstream mental health service providers often lack the specific expertise necessary to understand the unique life experiences of deaf people and work effectively with deaf clients. It is just that a specialist service requiring specialist expertise is needed.

Moreover, the inclusion of an interpreter, as the noble Lord, Lord Ponsonby, said, inevitably changes the dynamic in a therapeutic situation in ways that can be detrimental. For example, the sorts of topics discussed in therapy can be difficult enough to tell to a therapist without having to wonder whether one’s words will be faithfully conveyed by the interpreter. As the deaf community is small and close knit, there is a real chance that the patient will know the interpreter, and because qualified interpreters are hard to come by, the options are limited and there are few alternatives if a patient is uncomfortable with his or her interpreter.

As we have heard, there are specialist in-patient psychiatric units for deaf people in London, Manchester, and Birmingham, but the quality of care that deaf people receive is adversely affected by a lack of community resources. A recent report by the National Deaf Mental Health Service has shown that deaf adults in specialist and general in-patient programmes were in hospital for twice as long as hearing patients, not because of actual clinical need but because the community services they would need on discharge were not available. The current dearth of specialist services for deaf people is not inevitable. As Dr Sally Austen, a specialist for deaf people with mental health problems and a former chair of the British Society for Mental Health and Deafness has pointed out, if specialist deaf services were to include partially deaf people, the economies of scale would change. Dr Austen has also suggested that what is called “tele-mental health”, including online services, may also provide a solution for deaf patients with poor access to appropriate providers having to travel very long distances.

This is an extremely important discussion, and yet is not one that we often have. The last government strategy on the topic was back in 2005. If nothing else, what we have already heard—and more is to come—about the wide array of challenges that deaf people face in securing access to mental health care should surely convince us of the importance of updating our aims for this type of healthcare provision. I therefore, finally, ask my noble friend the Minister what plans the Government have to update the 2005 Mental Health and Deafness: Towards Equity and Access document so that it can become the cornerstone of all our work.

The UK has had a proud history of providing excellent mental health services for deaf people. It would be a tragedy to neglect that history by failing to give deaf people the access to therapy that they so clearly need and deserve.

London Health Commission: Smoking

Baroness Tyler of Enfield Excerpts

Thursday 15th January 2015 Grand Committee

[Baroness Tyler of Enfield (LD)]

My Lords, I rise to speak briefly in the gap. The UK is a world leader in tobacco control, of which I feel very proud. I have worked and lived in London for virtually all my life, and I would love to see London set a real lead and a real example by becoming a smoke-free city in the way described by the noble Lord, Lord Darzi. I congratulate the noble Lord on securing this debate, on all his work and on the recommendations of the London Health Commission, which were very far-reaching.

I also pay tribute to the Government for all their work on tobacco control and, indeed, to the Minister personally for everything that he has done. I remember very clearly the strength of feeling in this House when we debated the Children and Families Act 2014 around the standardised packaging of tobacco and about banning smoking in cars carrying children. The way the Government responded to that strength of feeling, looked at the evidence and then came back and accepted those things was an example of Parliament at its very best. The fact that the work was done very much on a cross-party basis really showed what can be done in this House when people come together and work together very sensibly.

I had the great privilege during that period of briefly meeting with the Minister in Australia, who was personally involved in steering this measure through in her country. It was wonderful to hear from her how they had got that through and the impact that it was starting to have. I want to add my voice to others in this afternoon’s debate to say how important it is that the standardised packaging regulations are laid in sufficient time for them to be considered, and for a vote to take place before the election. I also hope that the Minister will be able to give us some comfort on that because so much has been achieved in this Parliament that it would be a real travesty if we fell at the final hurdle.

Mental Health Services

Baroness Tyler of Enfield Excerpts

Wednesday 26th November 2014 Lords Chamber

[Earl Howe]

My Lords, on the noble Earl’s second point, yes, a survey is most certainly being actively considered. On his first point, he is absolutely right. One of the task force’s focuses will be to consider and make recommendations on how we can provide more joined-up, more accessible services built around the needs of children and young people, looking at sometimes innovative solutions about how to get there and how to improve access to health and support across different sectors, including in schools, through voluntary organisations and online. I am very encouraged by the task force’s terms of reference.

[Baroness Tyler of Enfield (LD)]

Given that some 60% of children and young people in care are currently reported to have emotional and mental health problems, can the Minister say what plans the Government have to set access standards for these children as part of their wider drive to increase access to mental health services, to ensure that these very vulnerable people get the support that they need?

[Earl Howe]

My noble friend is absolutely right: there is a high prevalence of mental health issues in those leaving care. The Government are dedicated to supporting NHS England’s work to develop a service specification for the transition from CAMHS that is aimed at CCG-commissioned services. CCGs and local authorities will be able to use the specification to build on the best measurable services to take into account the developmental needs of the young person. A separate specification for transition from CAMHS to adult services is also in development.

Learning Disabilities: Community-Based Support

Baroness Tyler of Enfield Excerpts

Tuesday 22nd July 2014 Lords Chamber

[Earl Howe]

I do agree with the noble Baroness. For people who, with the right support, could and should be living in community-based settings, there is a variety of reasons why sometimes that does not happen. The lack of appropriate housing can be a barrier. For others, we know that clinical decisions are preventing discharge. NHS England is looking very carefully at how to strengthen second opinion to support people in in-patient settings to challenge the reasons for their placement as and when they need to. We are looking at making some capital funding available to support the transfer of people from in-patient care to community-based support.

[Baroness Tyler of Enfield (LD)]

My Lords, given the figures we have just heard about the number of people with learning disabilities being admitted to costly assessment and treatment units rather than leaving them, will my noble friend the Minister say what action the Government are taking to ensure that local commissioners—in both local government and the NHS—have the necessary skills and competence to deliver the high-quality local services that are needed to allow as many people as possible to return to their communities?

[Earl Howe]

My noble friend is absolutely right to focus on the role of commissioners. The Winterbourne View joint improvement programme has already stepped up its activity in working with local areas, including identifying 35 areas for in-depth review. NHS England is engaging with commissioners to reinforce the importance of ensuring appropriate services for people with learning disabilities close to their homes and families. That includes looking at how funding streams can be shared with local authorities so that there is no procedural blockage in the way that money moves across the system.

Mental Health: Social Work

Baroness Tyler of Enfield Excerpts

Monday 23rd June 2014 Lords Chamber

Asked by

[Baroness Tyler of Enfield]

To ask Her Majesty’s Government what plans they have to improve the provision of mental health social work, given the incidence of mental health problems among the population.

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

My Lords, the Government recognise that improving mental health services remains a significant challenge. Social workers play a vital role in delivering high-quality mental health services, and the Chief Social Worker for Adults is taking forward a number of initiatives with the sector to help address these challenges. Along with the College of Social Work, we recently launched The Role of the Social Worker in Adult Mental Health Services.

[Baroness Tyler of Enfield (LD)]

I thank my noble friend for his Answer. Does he share my concern about the shortage of good social workers who are able to work effectively in mental health settings in many places in the country? What further steps are the Government taking to address this? What specific plans do they have to ensure that social workers working in integrated health and social care teams feel valued by their medical colleagues and that their professionalism is indeed recognised?

[Earl Howe]

My noble friend makes some excellent points, and I acknowledge her role as a member of the programme board for the Think Ahead programme, which is designed to attract, in particular, new graduates into social work, and specifically into mental health social work. Good-quality social work can transform the lives of people with mental health conditions. It is an essential part of multidisciplinary and multiagency working. As we move forward into new ways of working, particularly in the context of integrating care, my noble friend’s point about other professionals understanding and appreciating the value that mental health social workers can give will be key, not just in terms of earlier intervention but by building resilience, reducing and delaying dependency and ensuring that people have all the information and enabling support that they need to look after themselves better.

Tobacco: Packaging

Baroness Tyler of Enfield Excerpts

Thursday 3rd April 2014 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I strongly welcome Sir Cyril’s report, which is an extremely thorough piece of work. The central message from it is crystal clear and compelling; the introduction of standardised packaging would reduce the number of children and young people taking up smoking. I look forward to reading the draft regulations and the consultation, which I hope will be short. I would be grateful if the Minister would confirm that he talked about six weeks. Does he agree that, if the Government introduce this, we are going very much with the grain of public opinion? A new poll, issued today by YouGov, found that 64% of adults in Great Britain support or strongly support plain, standardised packaging, with only 11% opposed to the measure.

[Earl Howe]

I am very grateful to my noble friend. I confirm that we intend to have a consultation period of six weeks. That is as long as we think it needs to be to enable everyone with an interest, both for and against this measure, to make their views known and to enable us to factor in any considerations we may not yet have had an opportunity to consider. Although I have not seen the YouGov report to which my noble friend refers, I suspect she is absolutely right that public opinion is moving in the direction that Sir Cyril has advocated, and that we are going with the grain of what most people think. Most right-thinking people want children to be protected from the harms of tobacco. I hope that we will have public opinion behind us, should we decide to go ahead with this.

Children and Families Bill

Baroness Tyler of Enfield Excerpts

Wednesday 29th January 2014 Lords Chamber

[Lord Faulkner of Worcester]

I added my name to Amendments 57BB, 60 and 62 and will speak briefly to those, but I start by congratulating the noble Earl on bringing forward his Amendment 57B and for overseeing a significant change in government policy on the subject of standard packaging. Like many of your Lordships, I was heartened when I heard the then Public Health Minister, Anna Soubry, around a year ago saying that the Government were minded to go down the standard packs route and then bitterly disappointed last summer when the plans were suddenly dropped. Various conspiracy theories were propounded at the time and I will not go into those now, but it looked as if the issue was dead, at least for the foreseeable future.

At that point, it seemed sensible to look at whether there was any possibility of adding a standard packaging amendment to another Bill, which might not immediately present itself as the most appropriate, in order to be able to give the House the opportunity to debate the issue and come to a view on it. With the help of staff in the Public Bill Office—about whom I cannot speak highly enough, as their help was invaluable in framing our original amendment in Committee and the subsequent amendment that we tabled for today—we were able to bring the issue to the Committee and approach the issue in an entirely cross-party and non-party way. The amendment that we put together was signed by the noble Baronesses, Lady Finlay and Lady Tyler, the noble Lord, Lord McColl, and myself.

Amendment 60 is an improved version of what we had in Committee, but the Government’s amendment today is a great improvement on that as well. I congratulate them on picking up a number of the points that were defective in ours and coming forward with one that, I think, is very effective. Tobacco control should not be a party-political matter; it should be the common concern of everyone who cares about the health and the well-being of the public. As we have heard from the Minister, smoking-related disease still kills more than 100,000 people across the UK and is by far the most common form of preventable death—it accounts for more premature deaths than the next six most common causes put together.

As most smokers start as teenagers, the teenage market is the one which the tobacco companies are anxious to promote, which it is the responsibility of all of us to try to prevent. Two-thirds of existing smokers report that they started before their 18th birthday, and around two in five before they were 16. The younger the age at which they start, the greater the harm is likely to be, because the early uptake of the habit is associated with subsequent heavier smoking—of the sort that the noble Lord, Lord Forsyth, experienced with his mother and her 60-a-day habit—high levels of dependency, a lower chance of quitting and a higher chance of death from smoking-related disease.

For the tobacco industry to keep its market, it is necessary for it to recruit new smokers every year. That is because older smokers die or quit—or indeed lose their lives prematurely as a result of their habit. Since most smokers start when they are young, it follows that, for the industry, young people are the most important target group of potential new consumers.

We know what the tobacco industry would do in this country to promote its products if the law and the authorities allowed. Indeed, we probably know more about the commercial strategies of the tobacco industry than about any other major industry in the world, in large part because so many previously confidential documents were made public as a result of the US master settlement agreement with the industry in 1998.

Given the restrictive legislation around marketing and advertising tobacco in the UK, the industry is left with few options to promote its products. Of these, the most important is now packaging. Packs can be used to market and advertise, to create brand identities and to help present an image of smoking that may indeed seem “cool” to a curious teenager. There are many diversionary arguments advanced by the tobacco industry and the front groups it funds so lavishly about why we should not proceed with standardised packaging. So we hear tobacco industry claims that the UK is being flooded with illicit tobacco and that standard packs will make the problem worse. But the level of illicit trade has fallen sharply since it peaked back in 2000, and the security features on existing packs will also be present on standard ones. Both our amendment and the Government’s would allow the Secretary of State to specify packaging requirements that would enhance and not reduce product security, and make smuggling and counterfeiting more difficult.

However, the tobacco industry’s real, core argument is quite simple. It is advancing the proposition that its claimed so-called “intellectual property rights” trump the requirements of public health—or to put it more sharply, that its right to design products designed to get children addicted is more important than the children’s right to be protected from that addiction and the health damage that it causes. I believe that the overwhelming majority of your Lordships, and indeed Members of the other place, reject the tobacco industry’s arguments and want to make cigarettes as unattractive to children and young people as possible. So, as I said at the beginning, I warmly welcome the Government’s amendment. I congratulate the Minister on bringing it forward and on his announcement regarding proxy purchasing of tobacco products by adults for young people, and the regulation of e-cigarettes, about which we shall hear more at Third Reading.

I am not going to speak about smoking in cars because the speeches on that subject by the noble Lord, Lord Ribeiro—with whom I agree, and whom I congratulate on his perseverance in taking a Private Member’s Bill through your Lordships’ House on this subject—and the noble Baroness, Lady Finlay, have covered the main points. However, I strongly commend the points that my noble friend Lord Hunt made about the desirability of moving towards a smoke-free atmosphere in cars where children are trapped and subject to appalling levels of second-hand smoke.

I am very happy indeed to support the government amendment. We shall not be pressing our own amendment on standard packaging, but I shall be supporting my noble friend.

[Baroness Tyler of Enfield (LD)]

My Lords, my name is also attached to Amendments 60 and 62. I will speak briefly to them and try not to repeat some of the arguments we have already heard. I will also say how much I welcome government Amendment 57B. In Grand Committee, the strength of feeling across your Lordships’ House on the issue of standardised packaging of cigarettes was crystal clear, and the Government are to be strongly applauded for responding with their own amendment, which is very well founded and very persuasive. I, too, look forward to Third Reading, when the Government will introduce additional measures around proxy purchasing and e-cigarettes.

At the beginning of these debates, some noble Lords raised questions about the logic of including an amendment on the packaging of cigarettes in a Bill whose stated remit is children and families. To my mind, the relevance is unequivocal—this is the very nub of the issue, which is why we are discussing it today. Preventing the uptake of smoking among the young is primarily an issue of child protection. As we have already heard today, each year around 200,000 under-16s take up smoking. For some, it is the start of a lifetime of addiction which will result in debilitating health conditions and, for some in turn, premature mortality. As the noble Baroness, Lady Finlay, pointed out, many of those children will come from particularly deprived backgrounds. We have already heard about children in care and I would draw your Lordships’ attention to teenage mothers, who, according to an ONS survey, are six times more likely than the average mother to smoke throughout their pregnancy, to the detriment of both their own and their baby’s health.

Standardised packaging, bearing clear anti-smoking messages, is the first key step to reducing the attractiveness of this lethal habit to children and young people. As we have just heard from the noble Lord, Lord Faulkner, we should be absolutely clear that tobacco packaging and branding is not innocuous. It is undoubtedly, at the moment, targeted at the young—the industry documents released in the USA about this were very telling indeed, although I do not intend to repeat the details of that. Equally critically, the weight of evidence is mounting that standardised packaging does work to reduce the incidence of smoking. I was very persuaded by the Department of Health’s systematic literature review, which found that, compared to current cigarette packs, standardised packs are less attractive to young people, improve the effectiveness of health warnings and reduce the mistaken belief that some brands are safer than others. I eagerly look forward to the outcome of the review by Sir Cyril Chantler, who will look at all of this in the round. I will be very surprised if he does not come out supporting the various literature reviews that we have already seen.

Very recently, thanks to the noble Lord, Lord Faulkner, I had the privilege of meeting with Nicola Roxon, the former Australian Minister for Health who was instrumental in the implementation of standardised packaging there. I was very impressed as she explained to us the impact that standardised packaging was having as part of—this is absolutely critical—a wider anti-smoking strategy in no longer portraying smoking as cool and glamorous or cigarettes as a “must have” accessory, but instead portraying a much less desirable, and far more truthful, image.

It is revealing that hard data are already coming from Australia—something that I am sure Sir Cyril will want to look at. A study in Victoria, Australia, published in the British Medical Journal, concluded that when consuming cigarettes from the new packs, smokers are 66% more likely to think their cigarettes were of poorer quality, 70% more likely to say they found them less satisfying and 81% more likely to have thought about quitting at least once a day. Why is that? Because standardised packs carry powerful health messages that expose the reality of smoking. Frankly, having seen some of the images, it would take a very strong stomach or tightly closed eyes to be unaffected by them.

Children and Families Bill

Baroness Tyler of Enfield Excerpts

Wednesday 20th November 2013 Grand Committee

[Lord Storey (LD)]

I will speak to Amendments 263 and 264. If you said to some parents that you were going to put their son or daughter or both in a tin box, cut some holes in the box, then fill it with smoke, put it on wheels and drive it around all the time, they would think you were absolutely mad. The tin box is almost like a coffin because you are killing children. You are literally killing children.

My parents were heavy smokers; they smoked 40 Senior Service every day. In fact, they smoked so much that our living room ceiling turned yellow once a year and had to be repainted. I always remember that when my father drove me through the Mersey Tunnel he would say, “We’ll have to put the window up because you can die from carbon monoxide poisoning, you know”, yet—perhaps this is why I get chest infections regularly—he was putting our family in that sort of situation. Of course, he did not know about the effects.

All of us look back at things in our lives that we are really proud of. The thing that I am most proud of in politics was that we introduced Smokefree Liverpool. Thanks to support from noble Lords of all groupings, we were able to influence, in a small part, government thinking. You often get people saying, “Oh, it’s the nanny state. We don’t want a nanny state. We don’t want people telling us what to do. If we ban smoking in cars, the next thing will be that we ban it in the house as well”. Well, nannies are there to protect and look after children, and a nanny state should be there to look after and protect children.

Children are particularly vulnerable to second-hand smoking as they breathe more rapidly and inhale more pollutants than adults. ASH has shown that parental smoking is a causal factor of asthma in children, and that the prevalence of asthma increases when the number of smokers in a car or in the home increases. Children exposed to second-hand smoking also have an increased risk of lower respiratory infections, bronchitis, middle ear disease, bacterial meningitis and sudden infant death syndrome. There is also a very social issue, one that is directly related to making our society fairer. Evidence has shown that children living in the poorest households have the greatest levels of exposure to smoking and that passive smoking has been shown to affect children’s mental development and school absenteeism. That clearly undermines our efforts to increase social mobility. Experts have suggested that banning smoking in cars while driving with children is an important step in limiting the effect of second-hand smoking.

For those more interested in the economic side, the numbers are staggering. The health disorders caused by smoke-generated disorders cost the NHS about £23.3 million a year. In particular, £4 million is spent on asthma drugs for children up to the age of 16. The future treatment costs for smokers who take up smoking as a consequence of smoking by a parent could be as high as £5.7 million each year. Parents need to consider that, in choosing to smoke, they will find it difficult to explain to the children why they in turn should not smoke. The NHS has shown that children who grow up with a parent or family member who smokes are three times as likely to start smoking themselves. As we can see, the issue has implications for public health and our society in general, and ignoring it would mean ignoring the poll in 2009 which found that a majority of adults in England were in favour of banning smoking in cars, with 74% opposed to smoking in cars with children. The message is clear: if we really care about our children and want to improve their health and social mobility, this is a step that we can take.

I can look back, as no doubt all of us can, at moments in our social policies where there has been resistance from some quarters, whether it be from government or a powerful lobby, but the will of people has always come out. Noble Lords may remember the row about seatbelts: “Ooh, you can’t have the nanny state making people wear seatbelts”. In the end we had the courage to fight for that, and we cut the number of deaths in traffic accidents considerably. There was even a fuss about making people riding motorbikes wear crash helmets; there was a feeling that, “We shouldn’t do that. The nanny state is interfering by telling people that they must wear a helmet”. It is quite right that they should wear helmets. More recently, we have had the issue of smoking in public places. As a Government, we have a duty and a responsibility to do this.

Governments of all political persuasions have to think very carefully and be led by evidence, not by emotion or lobbying. I understand that the issue of plain packaging for tobacco products is something that the Government were committed to but they wanted to see quite clearly that the policy that was agreed, particularly in Australia, brought results. It is now clear that that policy is having an impact, and I hope that the Government, having initially said, “Let us wait and see”, might now say, “Come on, this is an opportunity to move forward”. I look forward to the Minister responding to the pressure from your Lordships here.

On children in cars, I would prefer that we agree the amendment in its entirety, but if we cannot do that, we could think about taking the first step by having public information, as we used to do. We could provide adverts and publicity material so that parents could see what needs to be done. But if we really want to be progressive and move forward, we should support these amendments.

[Baroness Tyler of Enfield (LD)]

My Lords, I rise extremely briefly because I had my go on Monday. I want to add just one point to what my noble friend Lord Storey has said. Some people are saying, “Let’s start with an awareness-raising campaign. Let’s see what we can do there. We don’t need to go straight to legislation”. I do not agree with that. The most effective example that I can cite was the introduction of legislation for the wearing of seatbelts. Awareness-raising had been tried, but it achieved only 25% compliance rates, but soon after the legislation was introduced, alongside the awareness-raising effort—you need both; it is not one or the other—91% of adults started to wear seatbelts. As my noble friend said, it is clear that it has saved lives. I think that very few people in this country, and certainly the polls show it, now think that that is an infringement of civil liberties.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I should perhaps declare an interest as chairman of an NHS foundation trust, as a consultant trainer to Cumberlege Connections and as president of GS1. I welcome this debate. I am delighted to see Amendments 263 and 264, and I have put my name, alongside that of my noble friend Lady Hughes, to Amendments 265 and 266, which are essentially amendments to Amendment 264.

As my noble friend Lady Hughes said on Monday, ever since the advertising ban came in, cigarette packaging has been the way in which tobacco companies have sought to market their products. That is why they spend millions on developing their packaging by testing its attractiveness to potential new customers, and that is why standardised packaging is such an important issue. Amendments 265 and 266 build on the excellent Amendment 264. Essentially, we seek to strengthen that amendment by requiring the Secretary of State to make regulations rather than by simply giving him the discretion to do so. It is important that Ministers are left in no doubt that they need to introduce standardised packaging, which is why I hope that those noble Lords who have proposed Amendment 264 and spoken so eloquently to it will accept our amendments to strengthen the provision. What has happened over the past two years or so would suggest that it is better not to give Ministers discretion in this area.

When the noble Earl comes to wind up, it would be helpful if he could explain the Government’s change of view on this matter. He will know that the former health Secretary, Andrew Lansley, said:

“The evidence is clear that packaging helps to recruit smokers, so it makes sense to consider having less attractive packaging”.

It was widely reported in March this year that legislation to enforce plain packaging for cigarettes would be included in the Queen’s Speech. In April, the then public health Minister, Anna Soubry, said that, having seen the evidence, she had been personally persuaded of the case for standardised plain packaging for cigarettes, but in July we heard the announcement that this was going to be postponed because we would wait and see what happened in Australia.

Will the Minister explain to us why the Government changed their mind and does he agree that the systematic review of all the evidence on standardised packaging commissioned by his department and published alongside the Government’s original consultation showed clearly the strong evidence that standardised packaging would help to reduce smoking rates by reducing the attractiveness and appeal of tobacco products and increasing the noticeability and effectiveness of health warnings and messages? Will he also acknowledge that two internal Philip Morris International corporate affairs documents from February and March 2012 showed that the top lobbying message for the world’s largest tobacco company was to use the strapline, “Wait and see what happens in Australia”? Why have the Government fallen for that attempt? Why on earth should we wait to see what happens in Australia? Cricket aside, I have great fondness for Australia and Australians, but why on earth are we waiting to see what happens there?

We have always been a world leader in this area with actions such as introducing smoking bans in pubs and enclosed spaces, ending tobacco companies’ sports sponsorship and billboard advertising, raising the legal age for purchasing cigarettes and the introduction of graphic warnings on cigarette packs. We have been a leader and our actions have had an impact. We have seen a dramatic reduction in the number of young smokers. Why on earth do we not want to continue in that vein? The Government will be in no doubt about the strength of feeling in your Lordships’ House and I have no doubt whatever that it wishes to see action taken on this issue. I hope that the noble Earl will be able to give us some comfort that the Government recognise that we should get on with tackling this issue.

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[Baroness Lister of Burtersett (Lab)]

My Lords, Amendment 266AA would introduce regulations to enable shared parental leave to be taken on a part-time basis, if desired, rather than in blocks of at least a week. I am grateful to Working Families for its assistance with this amendment, which has the support of a long list of organisations, and to the noble Viscount for meeting me and Adrienne Burgess of the Fatherhood Institute recently.

The amendment attempts to hold the Government to their original proposal in the Modern Workplaces consultation: that parents would be able to take the new form of leave in,

“smaller chunks or on a part-time basis”,

if their employer agreed. This was warmly welcomed by both family organisations and employers, yet the Bill reverts to a minimum period of a week at a time. There are many arguments in favour of part-time leave, which is a feature of many parental leave schemes elsewhere in Europe. It would help low-income parents who may not be able to afford full-week periods of leave for any length of time. The TUC points out this week that inadequate financial support for new parents impacts disproportionately on low-income families. Indeed, more flexible leave that could be used to complement part-time work was proposed in a Joseph Rowntree Foundation report on tackling in-work poverty published just last week.

It would allow for a smooth transition back to work, which could make it easier to settle children into childcare. It could encourage fathers, who might be reluctant to take a full-time block of leave, to take parental leave. In doing so, it could help usher in the change of culture of redefining early parenting as a joint responsibility that the Government keep talking about and that many of us want to see. I shall expand on this when I move Amendment 266B. It could provide parents with flexibility and could make it easier for employers. It is worth noting that, in a recent survey by the Family and Childcare Trust, flexible working was parents’ top priority for improving the quality of family life. This is just one aspect of flexible working, but it is an important one.

The Government have said that they are sympathetic to the idea but are concerned at the administrative complexity involved. They have suggested an extension of keeping-in-touch days as an alternative solution. While such an extension is welcome, it is not a substitute for part-time leave. Parents do not have to be paid for attending keeping-in-touch days, which are designed for a different purpose.

If the Government are genuinely open to the idea of part-time leave, surely it would make sense to make provision for it to be introduced at a later date by secondary legislation, once it has found a way through the administrative hurdles. I therefore hope that the Minister will be willing to take this away and give it further consideration. I cannot believe that where there is a political will there is no legislative and administrative way. If the Minister is not prepared to consider taking such regulation-making powers, I can only assume that there is no political will to inject this important element of flexibility into the parental leave scheme, despite the fact that flexibility lies at the heart of the scheme’s policy objectives as set out in the impact statement. I beg to move.

[Baroness Tyler of Enfield]

My Lords, to explain why I am sympathetic to this amendment, while I am supportive of what the Government are seeking to do through shared parental leave, which is absolutely right, the amendment raises two particularly important points. One is the position of parents on low incomes who will find it difficult to afford long periods of leave, particularly if they are working at less than the minimum wage. We know that the number of people working at, or even below, the minimum wage is significant.

Secondly, the amendment would allow that smooth transition back into work which may help children settle into childcare. From the work that I have done in other contexts around childcare, it is clear that it helps some children to be eased into childcare on a part-time basis, rather than going for a whole week’s worth. For those two reasons, I am particularly sympathetic and attracted to the amendment, although I cannot pretend to have been involved in all the detailed thinking around it.

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I take the point, but 2018 is five years away and three years on from implementation. The impact assessment stated that the review would take place in 2017 and suggested that the basis of that review might be statutory, yet no review has been written into the legislation. Other amendments will expand on this point. Moreover, I do not share the Minister’s confidence that, as it stands, the legislation will help to achieve this culture change that we both want to see. It would be helpful to monitor progress annually from the word go and to place any review on a statutory basis. I beg to move.

[Baroness Tyler of Enfield]

My Lords, I am sympathetic to the thinking behind the amendment. The idea of a “father quota”—an independent right for fathers to at least four weeks of leave—could be important if we are to achieve our aim, which the noble Baroness, Lady Lister, set out clearly and which is all about changing the culture.

There are two aspects of the culture that need to be changed. One is the expectation within the workplace, on the part of both employees and employers, about who is going to take parental leave. The burden is so much on the mother at the moment that the new legislation, which I strongly support, could make a reality of encouraging fathers to take parental leave and be much more involved in the early days and weeks of looking after newborn babies and children in their first year.

The second culture change that we are looking for is a different way for couples to decide how they are going to juggle bringing up their children and their work responsibilities—something that many people struggle with. We all know that it is not easy. What the Government are proposing is very helpful, but I want to see something that is going to provide that additional incentive to fathers to take this up. I really like the phrase “use it or lose it” because it says clearly what we are trying to do here.

The noble Baroness, Lady Lister, went through the evidence comprehensively, so I certainly do not intend to repeat that. When I reviewed the evidence, I was particularly struck by the impact that this had had in the nordic countries. It really seemed to be the thing that made the difference and started to tip the balance to get that culture change. If we really are trying to encourage fathers to take up leave—I think all of us here want to do that, judging by what has been said so far today—we need to take some heed of the international evidence of what works.

[Baroness Meacher (CB)]

My Lords, I will speak very briefly, having not participated in this Bill because of other commitments, in support of the noble Baroness, Lady Lister. As others have said, we are pressing here for a change of culture. We are looking for fathers to play a much more active role in the upbringing of their children. Clearly, as my noble friend Lady Lister has rightly said, if fathers are involved right at the beginning, they bond with the baby and will then be much more involved throughout the child’s early life. This has to be good. In my view, we are seeing that change of culture: more and more fathers are bonding with children in the early stages and being much more involved throughout the child’s life.

I want to put on record the link between this and what I regard as the Government’s very helpful inclusion in this Bill of a recognition of the equal importance of both parents to a child if the tragedy of divorce strikes. If you involve fathers very closely at the beginning of a child’s life, they bond, they become involved and they care for that child, but they are cut out after a divorce—which happens, as we know, all too often in this country year after year. This is actually very cruel. Maybe it was okay in the old days for men to remain outside the family, unattached, but if we are all working towards greater equality of mothers and fathers in terms of their involvement in the family—and therefore greater equality for women in the workplace—we have to follow through, as I believe the Government are trying to do, to the post-divorce situation, should that tragedy arrive. Having been through it myself, I know exactly how that feels for everybody. I strongly support the noble Baroness, Lady Lister, but it is very important to see these two parts of the Bill joined up.

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[Baroness Howe of Idlicote]

My Lords, I have been reminded by the noble Baroness, Lady Massey, that we have had this discussion in the past. It struck everyone at the time how completely unfair this whole system was. Now that the noble Baroness, Lady Drake, has spelt out so many comparisons, it is, frankly, almost embarrassing to think about the disadvantage that kinship carers suffer when they take on this responsibility and often—most likely, I would say—produce much better results for those children, giving them a likely prospect of a far more fulfilled life than if they had gone into different forms of care.

In supporting what has been said, I would say to the Minister that I would love to hear that this area was going to be looked at hard and, as far as possible, a range of comparable systems would be considered for kinship carers, those coming into care and those who are to be adopted. If he could give us that assurance, or indeed tell us that a lot of this is already in process, that would be very helpful in settling our minds until Report, if nothing else.

[Baroness Tyler of Enfield]

My Lords, I support the amendment. It has been set out so comprehensively and compellingly that I do not need to add very much. The case seems to be overwhelming that when people who are providing kinship care—often, as has been said, in the most desperate circumstances—agree to step in, often at great personal cost to themselves, it is only right that the state should recognise the hugely valuable contribution they are making.

These children are often in states of great distress and trauma, and for a member of the family to be able to step in and provide some degree of stability is really important. We all know the cost to the public purse of children in care who go, for example, into residential homes—it is huge. The savings that are made by a member of the family stepping forward in this way are considerable. We also know about the very poor outcomes for too many children in care when they emerge at the other end of the system. Kinship carers can make a huge contribution and it is absolutely right that society should acknowledge that. One very important way it could do so would be by extending these statutory employment rights to kinship carers.

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[Baroness Tyler of Enfield]

My Lords, I rise briefly to lend my support to this amendment. The hour is late and I will be brief. I am one of that band of noble Lords who were involved at all stages of the Care Bill and I think we have made great strides in joining up the Care Bill and the Children and Families Bill. I salute Ministers for having done that. I particularly pay tribute to Ministers for what they have done on young carers. We now have a set of rights for young carers which is so much stronger than before and that is a real landmark. Through the Care Bill, we have got improved rights for adult carers to assessment and support, and I applaud the Government for doing that. We have got much improved rights for young carers through the Children and Families Bill, linking in nicely with the Care Bill, and again I applaud the Government for doing that. We just have this one group left: the parent carers, who generally care for disabled children. If we could just get that missing bit of the jigsaw all sorted out so that all carers had the same set of rights to assessment and support, I think that it would be a tremendous step forward for carers in this country. I am encouraged to hear that meetings are still taking place and I hope that the Minister may have some encouraging news for us that the missing bit of the jigsaw is going to be put into place. We can all then be absolutely proud of what these two Bills together have done for carers.

[Baroness Howe of Idlicote]

My Lords, very briefly, it was only about an hour ago that we had exactly the same situation having to be sorted out for kinship carers. For goodness’ sake, parent carers are about as kinship as you can get, and if they cannot be rolled into the same set up of proper analysis and proper attention to their needs, then what can happen? I hope the Minister is going to move this thing on as quickly as possible.

Care Bill [HL]

Baroness Tyler of Enfield Excerpts

Tuesday 29th October 2013 Lords Chamber

[Earl Howe]

My Lords, it will probably be of assistance if I speak to these two amendments. In moving Amendment 4, I shall speak also to Amendment 6. These amendments are designed to correct minor drafting errors in the Bill.

Amendment 4 concerns Clause 17, which relates to financial assessment. Subsection (10) clarifies that the regulation-making power to set a financial limit allows for regulations to provide for different financial limits for different types of care and support—or support, in the case of carers. Paragraph (b) states that the regulations may set,

“different levels for different levels of support”.

The amendment would correct this erroneous repetition and ensure that it reads instead:

“different levels for different descriptions of support”.

This ensures that the regulation-making power in subsection (10)(a) mirrors the regulation-making power in subsection (10)(b).

Amendment 6 relates to transition assessments of a young carer’s needs for support in Clause 64. The other provisions containing duties to carry out transition assessments—Clauses 59 and 61—require there to be “significant benefit” to the person in question. However, this clause only talks about “significant benefit” with no mention of the individual and so is quite abstract. This was an oversight. The amendment would therefore clarify that the significant benefit must be “to the young carer”, to bring it into line with the other similar provisions.

I hope that noble Lords feel able to support these minor and technical amendments, which will help ensure that the Bill is clear and works as intended. I beg to move.

[Baroness Tyler of Enfield (LD)]

My Lords, I rise briefly indeed to welcome Amendment 6 and what I see as the further strengthening and joining-up between this legislation and the Children and Families Bill in relation to young carers. I particularly welcome the greater rights it gives to all young carers. I am really pleased to see the entitlements to both assessment and support for young carers as they reach that very critical age of transition at age 18. This will help because these young people often face additional barriers at that age as they are trying to access further education, employment and training, which is so important to their wider well-being and outcomes. I welcome it very much.

Amendment 4 agreed.