Learning Disabilities: Community-Based Support
Baroness Tyler of Enfield Excerpts(10 years, 4 months ago)
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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(10 years, 5 months ago)
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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(10 years, 8 months ago)
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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(10 years, 10 months ago)
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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(11 years ago)
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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.
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.
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.
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.
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]
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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.
Ageing: Public Services and Demographic Change Committee Report
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Baroness Tyler of Enfield (LD)
My Lords, in the short time available, I should like to do two things—to give my reactions to the government response to the report and to focus on one key issue raised in the report.
I was at least pleased that the government response said that the Government shared the ambitions of the Select Committee report of making the country,
“one of the best places to grow old”.
The response is certainly detailed and offers a good overview of current policy on issues related to ageing. I very much applaud the very important measures that the coalition Government have taken in very difficult financial times. I mention in particular the Pensions Bill and the Care Bill, which is currently before this House, which I consider to be a landmark piece of legislation. But—and, of course, there has to be a but—while the government response is long on past achievements and current policy commitments up to 2015, it is short on the long term and the need for a long-term strategic joined-up understanding of the big choices facing the country over the next 10 to 20 years, particularly the need to stimulate a national debate so that people understand the implications, the choices ahead and difficult decisions that will have to be taken about the balance of responsibilities between the individual and the state. Asking the chief scientist to lead an analysis of the challenges of an ageing society is a welcome step forward, but it would have been so much more effective if the chief scientist had been asked to report to Parliament every year on both progress made and the challenges ahead and, indeed, if the Government had produced an action plan with specific goals and milestones that this House could monitor.
Will the Minister consider those suggestions and respond in due course? I recognise that that will require consideration across government. There was no response on the call for a White Paper setting out a long-term vision from Government, their role in stimulating a national conversation, the two cross-party commissions after the next election, or indeed that party political manifestos should address those issues. In retrospect, perhaps it was a little unrealistic to expect the Government to respond to something about party political manifestos. From these Benches, I am pleased to report that the Deputy Prime Minister has now established a new Liberal Democrat policy working group, to be chaired by my right honourable friend Paul Burstow, to consider how public policy can address the broad issues of an ageing society. I am pleased to be able to serve as a member of that group.
In the rest of my contribution I want to focus briefly on attitudes to ageing and the issue of loneliness and social isolation. Ready for Ageing? addressed these issues but, perhaps inevitably it did not attract the headlines in the same way as issues around retirement pensions, health and social care, and so on did. I would argue that not enough focus has been given to the importance of social isolation and loneliness, which are so often both the root cause and consequence of issues that were discussed at length in the report and which no doubt will be discussed in the debate.
A big barrier to making the UK ready for ageing is the denial of most younger people of the likelihood of becoming older themselves, with all its perceived negative connotations. It is human nature to put off thinking about becoming old, until the day it happens, but the problem is that by then it is usually too late to do the financial and other planning necessary to ensure a happy and comfortable retirement. If we could take away some of the fear, perhaps more younger people would be more willing to face up to the fact that, barring ill fortune, such as accidents and grave illness earlier in life, the chances are that they will live longer than they currently expect—certainly longer than most previous generations thought likely or even possible. That is a fact.
I do not have time to go into all the life expectancy details here, but it is so important to understand the issues of why younger people, or those in middle age, do not do the thinking and preparation that they need to do. We also need to address a key social trend that has not had enough attention. A lot of people who will be moving into old age over the next 20 or 30 years will be childless and will not have adult children to provide some of the care and support that so many do today. The issue of loneliness and isolation is significant. We need to be realistic. It would not be true to say that the majority of older people are lonely; the majority live happy and non-lonely lives. However, some of the statistics are very stark. Do noble Lords know that some 5% of people aged 65 plus in the UK said that they spent Christmas Day 2010 alone? How should we feel about that? It has also been said that loneliness is very bad for our health. Something that brings that home starkly is the estimate that loneliness is as harmful to health as smoking 15 cigarettes a day. There is much that can be done about this.
I am very pleased to be involved with a project that is being taken forward by the think tank, CentreForum, which is looking specifically at what can be done for old people to help them to avoid loneliness and isolation. I am pleased that the charity Age UK is involved because I believe that the answer to many of these issues lies with voluntary organisations, charities and faith groups, but it is for the Government to create the climate in which these things happen.
I shall finish by saying something that may sound a little trite. In later life, he or she who is rich is he or she who has a strong network of family and friends around them. We must do all we can to encourage that.
Care Bill [HL]
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Baroness Bakewell (Lab)
I rise to support this amendment as I think the House would expect me to because I put forward a similar amendment during the passage of the Health and Social Care Bill.
So here we are again. Time rolls on. I want to refer to the annual report I wrote in 2008-09 about the job I had as the Voice of Older People. I wrote that the job had proved a bombshell. Within hours of the announcement being made responses began. Letters, encounters, meetings and seminars showed me the range of cares particular to older people. At that time equality was my agenda and the issues were about the promotion of things such as equality in retirement, pensions and equal pay. However, concerns rapidly expanded. In no time at all I was being inundated with dilemmas about care homes, housing, rent levels and public loos. Expatriates were writing to me about claiming their pensions. End-of-life treatment was on the agenda again.
This agenda has not gone away. It is growing and it will go on doing so. We will hear tomorrow about the implications of the demographic and right now we are awaiting the ramifications of the Dilnot report. There is a campaign to get older people online, led by the noble Baroness, Lady Lane-Fox. There are concerns about fuel prices. I have recently read that E.ON, with which I have a special deal for a limited price because I am old, is withdrawing that favour from older people. Why? Breast cancer is very much on the agenda for older people. The risk improves the older you get but it does not reduce after 70 or 75. It goes on being a killer and becomes more seriously so.
Which Bill that will come before the House can encompass this vast agenda of the entire population that is growing old? This is a very difficult problem for the matter of law. We need a commissioner who can embrace housing, pensions, health, welfare and money. We need someone who can listen. The main thing about a commissioner is that they are not the spokesman for the established government—they are about us. They speak to government about what it is we want, what it is we would like, and on what we need guidance. The agenda is huge.
I am well aware that there is a multitude of charitable organisations that deal with all sorts of this fragmented agenda. I pay particular tribute to Age UK which is very, very strong in dealing with these issues, but what we need is for our complaints to be funnelled through an individual who belongs on the side of the old, who addresses the rest of the community about all these issues. I know that the Minister knows that the agenda is a wide one. What we need to know is where we can place this need—on which Bill and in which House? I support the amendment.
Baroness Tyler of Enfield (LD)
I rise very briefly to explain why I added my name to this amendment. I feel strongly that older people need their own advocate and it needs to be someone with real clout and real powers. The experience of the children’s commissioner to which my noble friend Lady Barker has already referred is very relevant here. I was a civil servant in Whitehall for a long time. There were many different departments dealing with different aspects of children’s policy but no one was joining it all up. When the children’s commissioner came on the scene, the commissioner became a strong advocate of the cause of children and young people across the UK and caused Whitehall and government to respond in a different, more joined-up way.
I had the honour to be a member of the Select Committee that produced the Ready for Ageing? report. I very much look forward to the debate on that tomorrow. During its production, I learnt so much about the contribution that older people are making to society. To cite three quick figures: one in three working mothers relies on grandparents for childcare; 65% of older people support their older neighbours; the value of informal care provided by older people has been assessed to be £34 billion, and so many volunteers are older people. We do not hear about that. What do we hear about in the press? We hear about older people who are a terrible burden because they are consuming so much of scarce national resources. We hear about the graph of doom. It all sounds like a looming catastrophe. We do not hear about the incredibly valuable contribution that older people are making.
That is why I believe that older people need an advocate. Yes, it is to champion the great needs of an ageing society in public policy-making in central and local government; but it is also someone who can represent them, who understands their needs and can celebrate their values and achievements and, I hope, turn around the whole narrative that we have in this country about older people.
Mental and Physical Health: Parity of Esteem
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Baroness Tyler of Enfield (LD)
My Lords, I want to start by saying why this is such an important debate and thank the noble Lord, Lord Layard, for securing it. Some of the biggest inequalities in health today are faced by people with mental health problems. Nothing illustrates that more starkly than the fact that we know that people affected by serious mental illness die on average 20 years earlier than the rest of the population from preventable physical health conditions—something I am sure we all regard as a scandal. Thus I strongly welcome the Government’s very clear commitment to achieve parity of esteem for mental health. The 2011 strategy document, No Health Without Mental Health, made an unambiguous commitment to parity of esteem and set a clear objective that more people with mental health problems will have good physical health, fewer people with mental health problems will die prematurely, and more people with physical ill health will have better mental health. In addition, of course, as we have heard, the NHS mandate commits to achieving this and will carry out a progress report in 2015.
I think, however, that in this Chamber we would all accept that there is still a long way to go. To make a reality of these very good intentions I contend that three things need to happen. First, people with mental health problems must have the same access to treatment and services as those with physical health problems; secondly, they must have the same rights within the NHS constitution; and thirdly, they must have equal patient voice as those with physical health problems. What more, then, can be done in practice?
I will start with something that I regard as very positive indeed, which we have heard spoken about so eloquently by the noble Lord, Lord Layard. I refer to the Improving Access to Psychological Therapies programme. We all know that in many places this programme has provided an invaluable service. It has achieved high recovery rates and has helped people both get back to work and stay well. Indeed, an IAPT service user recently told the mental health charity Mind that:
“Receiving psychological therapy turned out to be the best thing that could possibly happen for me, it was exactly what I needed … a place for me to finally look at my past and put the pieces together and come to understand why I felt the way I did”.
I shall now talk about how this affects people with complex needs. It was, of course, hoped that focusing additional resources on the more common mental health problems, such as anxiety and depression, would free up waiting lists and resources for other forms of therapy for those with more complex needs, such as people with substance misuse problems and those with more severe mental health problems. As ever, there have been unintended consequences. It is worth emphasising that IAPT was never intended to act as a comprehensive service delivering all forms of psychological therapy. Indeed, Department of Health guidance made it clear that IAPT money should not be used to replace funding for other psychological therapies. Despite that, in 2010 the We need to talk report showed that this was happening in a number of areas, where non-IAPT services were either having their funding cut or being entirely decommissioned, so that IAPT was replacing, not improving, the provision of psychological therapies.
If this were a physical health problem we would not tolerate the lack of choice and treatment options given to people with mental health problems. In some places we are in danger of reaching the point where if you do not get better after a course of CBT there is simply nowhere else for you to go—and we all recognise that for some people, CBT is not the right choice of therapy in the first place. There are other NICE-approved therapeutic interventions that should also be available.
I shall ask the Minister two questions. First, do the Government recognise the need to provide a full choice of evidence-based psychological therapies on a sufficient scale to meet the requirements of people with more complex mental health problems? Secondly—this echoes something that the noble Lord, Lord Layard, said—what plans do the Government have to introduce standards for waiting times for mental health equivalent to those for physical health, and, in particular, to amend the NHS constitution to ensure the availability of psychological therapies within 28 days of a referral?
I now turn to preventive approaches, and in particular to intervening early in a child’s or a young person’s life. There is now clear evidence of the importance of intervening early to promote resilience in young people, to prevent mental illness and to promote well-being. The children with the poorest life chances of all are those who have early-starting behavioural problems. They are 19 times more likely than their peers to be in prison by their mid-20s, and have high rates of school exclusion, unemployment, gang membership—especially among girls—suicide, and a range of physical health problems during their lifetime.
Cost-effective parenting programmes are now available for families whose children have behavioural problems, to help them manage them from an early age. These include family nurse partnerships for the most vulnerable families and parent training programmes. Of course, availability of these programmes is patchy and they are not always delivered as intended for maximum effectiveness.
For parity to extend to children with behavioural problems, two things are necessary. First, maternity services, health visitors, GPs and schools should regularly look out for families at risk and routinely assess healthy child development to identify children with early signs of behavioural problems. Secondly, parenting programmes should be made available to families who really need them, targeted towards those in greatest need but with easy referral routes to prevent them from becoming stigmatised.
I now turn to how primary care and mental health services are configured. I do not think that it will be a surprise if I say that they often do not work well together. How could primary care services be designed so as to encourage better integration with mental health services? There are three potential big improvements. The first would be mental health support for the 4.6 million people in England with major physical conditions, such as diabetes, heart disease and cancer, and a concurrent mental health problem—most likely to be depression—by offering psychological therapies, as I described earlier, and help with self-management. The second would be physical health support for people with severe mental illness—for example, those who may need help with weight management, particularly those on anti-psychotic medication, and with smoking cessation. Finally, there is care for people with medically unexplained symptoms. At least one-quarter of hospital outpatients who have physical symptoms with no explained physical cause may very well benefit from psychological support.
Breaking down the barriers between primary care and mental health is vital to achieve the changes that we want to see. I contend that GPs need clear incentives to address the overlaps between physical and mental health—for example, through the Quality and Outcomes Framework for general practice—and that payment systems for mental and physical healthcare need to be better aligned to prevent mental health budgets being raided when there is pressure on acute hospital spending. On that issue, we hear almost daily of the pressure on A&E departments. There are growing concerns about the quality of care and support that people with mental health problems receive when in crisis. Recently published research showed that people using mental health services were twice as likely as others to present in A&E, causing all the problems that we have heard so much about.
In the comprehensive spending review of June 2013, the Chancellor committed to every A&E department having constant access to mental health professionals to ensure that people with mental health problems got the best possible care. That is something that I very much support. It is vital that all hospitals put in place comprehensive liaison psychiatry services, available 24/7 to all hospital wards for people of all ages, from children with emergency admissions for self-harm to older people with dementia. Can the Minister update us on progress in this area?
I stress the very important and key role that family, friends and the wider community can play in mental health and well-being. In many areas, we have seen good projects and approaches. There is support and care for the families and carers of those with mental health problems, as well as, in some cases, carers having their own recovery plan, which is a very interesting idea. Finally, I emphasise the important role that health and well-being boards should be playing to embrace mental health, seeing it as a key aspect of public health. I know that in local government its profile is being raised, and some local authorities are now having a local authority mental health champion. That is very positive—to have a member who can champion mental health issues in every single area of council business—and I hope that we hear of more such examples today.
Care Bill [HL]
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Lord Mackay of Clashfern (Con)
I warmly support that. I am happy with the parliamentary counsel’s draft, which is what the Government are going to move, and we have to understand that some lawyers are better than others at making drafts.
So far as the amendment of the noble Baroness, Lady Barker, is concerned, I hope that the Government will pay considerable attention to what has been said about it.
Baroness Tyler of Enfield (LD)
My Lords, I rise briefly to speak to government Amendment 2 on dignity and respect. I know that it was implicit in the well-being clause in the earlier versions of the Bill that we looked at, but I am very pleased that the need to ensure that all people are treated with dignity and respect has been brought out so explicitly. These are words that the man and woman in the street really understand; they get to the heart of some of the concerns about the type of social care that has sometimes been provided, which has fallen well below those standards, and caused some of the scare stories that we have heard so much about recently.
The noble Lord, Lord Bichard, and I raised this issue in Committee, but as he is unavoidably unable to be in his place today, I thank the noble Earl, Lord Howe, on behalf of both of us, for listening and for bringing this amendment forward.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, I am grateful to all noble Lords who have spoken and for the opportunity to discuss once again this important new well-being principle set out in Clause 1. The amendments in this group cover three important issues. The first of these relates to the application of the duty to promote well-being to the Secretary of State. In Committee we debated the link between the role of the Secretary of State and the duty of local authorities to promote the well-being of individuals. There was clear strength of feeling in the Committee that the Bill should make explicit reference to the Secretary of State having regard to the duty on the local authority to consider the well-being of the individual. An amendment in this regard is not essential because the local authority well-being duty is in any event a relevant factor for the Secretary of State to take into account when issuing guidance or regulations. However, I do recognise the strength of feeling and I am happy to clarify the position.
In response to the concerns, I have tabled Amendment 138, which explicitly requires the Secretary of State to have regard to the local authority well-being duty when issuing regulations and guidance. This achieves, I hope, the same ends as intended by the amendments tabled by the noble Lords, Lord Hunt and Lord Warner, and I trust that they will support the government amendment.
The second issue relates to the focus on dignity, to which my noble friend has just referred. In Committee, noble Lords expressed concern that personal dignity was not adequately reflected in the well-being principle, in spite of the change that the Government made to this effect following consultation on the draft care and support Bill. Let there be no doubt that the Government place the utmost importance on dignity and respect in care. These factors must be central to the well-being principle. In order to ensure that dignity is given due prominence in primary legislation, I am pleased to have been able to table Amendments 2 and 3, which give greater emphasis to personal dignity and respect as components of well-being.
The third issue in this group relates to another constituent part of individual well-being: spiritual well-being. My noble friend Lady Barker’s Amendment 4 would include an explicit reference to spiritual well-being in Clause 1(2). We debated a similar amendment in Committee. I said then, and I emphasise now, that the Government recognise the importance of spiritual well-being as a concept and understand the particular significance that it can have for some people, especially at the end of their life. We would absolutely not want an approach that excluded spiritual well-being from consideration where that was clearly of consequence to the individual concerned.
However, it is important to understand that that is not the approach which the Bill sets out. The factors included in Clause 1(2) contain high-level matters which should be interpreted broadly to fit the individual case. Spiritual well-being should be considered where it is relevant to the person’s overall well-being. Moreover, spiritual well-being is likely to be closely related to other matters, such as emotional well-being, which are listed in the clause.
In addition, local authorities must also consider the person’s views, wishes and feelings, as set out in Clause 1(3)(b). This provides a further clear direction to local authorities to have regard to personal matters, which could well include beliefs or other views that would promote an individual’s spiritual well-being. Although it is not explicitly mentioned, spiritual well-being is nevertheless accounted for.
I hope that I have reassured in particular my noble friends Lord Hamilton, Lord Deben and Lord Cormack, and indeed the noble and right reverend Lord, Lord Harries of Pentregarth—
Baroness Wheeler (Lab)
My Lords, I am pleased to speak to our Amendments 7 and 10 and will speak mainly about young carers, as my noble friend Lady Pitkeathley has spoken strongly on parent carers for disabled children and the other key issues covered in this group. In Committee, we were deeply concerned at the very real danger and risk of young carers’ rights and their need for support failing to be addressed in either the Bill or the Children and Families Bill, so it is with great relief that we will be dealing today, now and later, with significant amendments relating to adult care assessments and young carers, local authorities’ duties to identify young carers and ensuring young carers are supported and are not forced to undertake inappropriate caring roles.
On young carers, it is somewhat frustrating that the Government amendments, which are an integral part of the package on young carers that locks in the links between the Bill and the Children and Families Bill, are to be taken in a later group. We need to see the picture on young carers as a whole to be reassured and clear about how the two Bills interact to secure young carers’ rights on support and assessment. Under the two Bills, the Care Bill links adult assessment where a young carer is supporting an adult with the young carer’s assessment, which will be undertaken under the Children and Families Bill. The ministerial Statement on the latter from the Department for Education sets out how it sees this working in practice, and we broadly support this. Our Front-Bench team on the Bill will be probing this further in Committee, which, of course, commences today.
We welcome all these developments. We have worked closely with the excellent National Young Carers Coalition and it has led calls for key changes in the two Bills. I am sure the Minister will agree that the NYCC has done a great job of bringing the plight of young carers to the attention of the House and to Ministers. I am pleased that the Government have now taken steps to ensure a twin-track, joined-up approach between the two Bills.
As the Bill has progressed, we have heard extensively why children and young people caring for a family member, parent or sibling can be so vulnerable to losing out on their education and on the things that they want to do with their lives and how their health can suffer as a result of having to undertake significant caring responsibilities. However, it is a shocking fact that too often young carers do not get the help they need. One of the reasons for this is that, under the current assessment process, the person they are caring for does not receive enough support and the needs of the whole family are often not taken into consideration.
We must remember that this can have a devastating impact on both the young carers and the cared-for person. As a trustee of our local carer support group in Elmbridge, I can say that we see this from both ends. Many of our registered young carers are delivering hands-on support and may be the only other person in the house. For example, if their parent has mental health problems—very often the most hidden of caring roles—the child may have to look after themselves on a daily basis, make their own meals and get off to school, as well as being supportive of the parent and carrying out tasks for them. At the same time, a disabled parent does not want to see their child overburdened with caring duties; they feel desperate and guilty when they require care and support that is not forthcoming as part of the care package, and the child just has to help—and usually wants to anyway. That is a dilemma.
That is why we sought to amend the Bill in Committee so that adults with care and support needs are assessed in relation to the presence of a young carer, so adult needs are met sufficiently and children are prevented from undertaking levels of caring that put their well-being, health and development at risk. The government amendments now put this into effect in the Bill and we fully endorse them as part of the package of changes that are needed.
That is also why our Amendment 7 to Clause 2 must be an important part of the package. We believe that the Care Bill is the right place for the law to be clear that adult services need to assess and meet adult needs first, but with a view to whether a child may be caring for them and providing the support as required. Children should not be picking up the pieces and left to provide part of the care package as a result of the failure of adult services to see and support them alongside children’s services.
Our essential aim has been to ensure that local authorities provide or arrange services to prevent young carers from developing needs for care and support, as well as preventing and reducing needs for adults and adult carers. We cannot have a situation where people have unmet care and support needs, which results in children and young people having to meet those needs.
Our Amendment 10 specifically deals with the issue of local authorities’ duty to identify young carers. We know that currently, adult social care services and health services routinely fail to identify children who may be caring for an adult, even when the adult is assessed, and that also applies to schools. As a result, children can continue to undertake harmful caring roles and end up developing needs for care and support themselves. The lack of a co-ordinated response between children’s and adult services remains an ongoing difficulty for young carers and their families. I hope that the noble Earl will recognise the need to address this problem.
On the other amendments in the group, we strongly support the intentions of Amendments 6, 8 and 9, which seek to emphasise parent carers of disabled children, both in respect of the well-being principle and in terms of preventing them undertaking inappropriate caring. Amendments 46, 47 and 58, in the name of my noble friend Lady Pitkeathley, seek to address the very real fears of carers and their organisations over carers being charged for key services that they are not currently charged for. My noble friend’s amendments represent an excellent opportunity to put carers’ minds at rest on this issue once and for all, and I hope that the Government will be sympathetic to this.
Finally, my noble friend’s Amendment 48 addresses the important issue of carers generally—not just young carers—being required to undertake inappropriate caring. We dealt with this issue in relation to the assessment process extensively in Committee and we strongly support this amendment. Support from family and carers should be considered as a way of meeting needs rather than as a reason for deciding that the person does not have needs or is not eligible for care. Carers must not be pressurised to provide care that they do not feel able to provide. I look forward to the Minister’s response on this.
Baroness Tyler of Enfield
My Lords, I rise very briefly to speak to Amendment 34 in my name. The purpose of this amendment relates to the definition of a carer, to ensure that it could include a young person as well as an adult. I wish to explain that I tabled the amendment before the extremely welcome Statement by the Secretary of State for Education earlier in the week, and the tabling of the new amendments on young carers. As other noble Lords said today in the Chamber, I very strongly welcome this. I know, from talking to both departments—the Department for Education and the Department of Health—that a lot of very effective work has gone on over the summer that has been very effective both at official and ministerial levels. I also very much welcome the fact that the National Young Carers Coalition has been very much involved in these changes, and I know that it has issued a statement welcoming them.