Health and Care Bill

Debate between Baroness Tyler of Enfield and Lord Farmer

Lords Hansard - Part 1 & Report stage
Thursday 3rd March 2022 Lords Chamber

[Baroness Tyler of Enfield (LD)]

I support and very much welcome government Amendments 36, 157 and 185 in response to the powerful debates in Committee on children’s health, safeguarding, data-sharing and particularly the case for a unique identifier for children, on which I put forward an amendment in Committee. I thank the Minister for engaging so fully and positively on these issues and for the various meetings which led to these amendments being tabled. It is also very welcome that Amendment 36 includes children in the Bill, which so many of us have argued for.

On the unique identifier as a means of identifying children in touch with multiple services, aiding safeguarding and promoting joined-up support, I strongly support the government amendment to lay a report before Parliament on information sharing and on a single unique identifier for children. That is a real step forward, and it is clear that the Government acknowledge that there are serious and distinct challenges with sharing relevant information across not just children and social care sectors but others too, including schools and the police.

There is always more to do, so I will never be 100% satisfied and I note that the amendment as tabled does not actually commit the Government to any specific timed action beyond publishing the report. Therefore, it was good to hear the further assurances that the noble Lord, Lord Kamall, gave at the Dispatch Box. I think I heard him say clearly and unequivocally that the Government are committed to developing plans not just to look at the case for but to adopt a single unique identifier for children. I think I also heard a commitment to developing a set of cross-government proposals for implementing that, and then, I hope, acting on the findings of this report within a defined timescale. If the Minister could reiterate those commitments, I would be extremely grateful. I would also welcome a commitment to involving those organisations representing children and young people, who have been so much a part of our discussions and debates, as part of the production of that Bill.

I support Amendment 59 from the noble Baroness, Lady Hollins, which I signed, requiring NHS England to assess annually how well each ICB is doing in meeting the needs of children and young people; it provides much-needed accountability and transparency, particularly in relation to the new and crucial safeguarding responsibilities that ICBs are taking on. I welcome the statutory guidance, which I know the Government intend to produce, on having a children’s lead on the board of every ICB. That is really important.

I support the suite of amendments in the name of the noble Lord, Lord Farmer. I will leave him to set out the case for them, but I agree that family hubs play a really important role in improving early intervention services, helping integration and data sharing among public services and involving the voluntary sector. Importantly, and germane to this Bill, that includes children’s health services, which are often better delivered in community settings with other family support services. I particularly support Amendment 75, which calls for each local authority to provide a family hub. That is central to a national rollout of family hubs. which I would like to see at the very core of a national strategy on child vulnerability.

[Lord Farmer (Con)]

I start by thanking the noble Baroness, Lady Tyler, for her support; it is very much appreciated. She has been a doughty warrior accompanying us along this path for many years.

I will speak to my Amendments 64, 66, 68 and 75 and I thank the Minister for the meetings I have had with him and the Bill team to hear his concerns, particularly around being overprescriptive.

Amendment 64 simply replaces “may” with “must” and thereby requires integrated care partnership strategies to lay out how health-related services can be more closely integrated with health and social care. In Committee, I said that “may” made that aspect of integration voluntaristic, and I would be grateful if the Minister could explain why, as I am genuinely mystified, the ICP is at present only invited to do that.

Amendment 66 has been revised after the discussions mentioned earlier. I propose adding new subsection (5A) to Clause 116ZB to specifically invite ICPs to consider how family help services, including those accessed through family hubs, could be more closely integrated with arrangements for the provision of health services and social care services in that area. I avoid using “must” in that case, because it could place an overly prescriptive requirement on ICPs. I also avoid mandating the use of family hubs. They are simply mentioned as an important potential access point.

I recognise and applaud the many ways that the Government have improved the Bill with respect to children’s health. However, I explained in Committee that many children’s health needs are psychosocial: they need practical, not just medical, solutions and addressing them needs a whole-family approach. That is also particularly important when parents experience drug and alcohol problems, which can affect their children almost or as much as the parents themselves.

Early family help commissioned by local authorities therefore needs to be integrated with health as well as many other departments of government. Family hubs are mentioned in my amendment, not prescriptively but as the model that could enable that to happen. In Committee, I described how DWP’s Reducing Parental Conflict programme, DLUHC’s Supporting Families and the MOJ’s private family law pilots all looked to family hubs as an access point for those who need this support. The Bill could and should help to make that model proliferate to benefit families. As it operates according to principles, not an overly prescribed framework, it can be tailored to local need, including by drawing in the bespoke work of the local voluntary and community sector. Historically and currently, health services have had a poor track record in integrating with local government and wider partners. The Children’s Centre movement frequently lamented the lack of engagement with health. The opportunity the Bill provides to avoid that pattern being repeated should not be missed.

My Amendment 66 gives meaning to the phrase “family help” and points towards an amended Schedule 2 to the Children Act 1989 to explain what is meant by “family hubs”. In Committee, I explained that

“services which improve children’s lives through supporting the family unit and strengthening family relationships to enable children to thrive and keep families together”

is the independent care review’s working definition of “family help”. This is not a concept to be set in concrete in the lead reviewer’s final report, but simply one that is qualitatively different from “family support” in local authority usage. The latter leans towards late-stage statutory child protection, which ideally prevents children entering care and is far from the early help so many parents need.

Finally, my Amendment 75 necessarily changes how the Children Act 1989 refers to family help infrastructure to reflect more closely the way it has developed. It has also been adjusted since Committee to avoid mandating local authorities to provide family hubs, which would have significant cost implications, ultimately for the Treasury. As a result of my amendment, new Schedule 2(9) to the Children Act would state:

“Every local authority shall provide such family hubs as they consider appropriate with regard to local needs in relation to children and families within their area.”


“Family hubs” means an access point where children, their parents, relatives and carers can access advice, guidance, counselling or paediatric health services as well as occupational, social, cultural or recreational activities. This removes the anachronistic reference to and description of “family centres”. These were never consistently implemented in the way probably envisaged by the draftsmen of the 1989 Act, although children’s centres did emerge to fulfil many of their purposes in response to research on the importance of children’s early years.

To address the Minister’s concerns that putting family hubs into legislation would introduce unhelpful rigidity and prescription, I end by making an analogy with the Supporting Families programme. This does have a legislative underpinning, but the early troubled families programme from which it evolved provided principles for a tried, tested and consistent way of working, illustrated these with case studies and supported local authorities to develop their own bespoke approaches to that way of working. The DfE is taking a similar non-prescriptive approach in its family hubs framework, which emphasises principles—namely, access, connection and relationships—and avoids determining how local authorities implement these. Just as the Supporting Families programme has developed but is still recognisably the same way of working launched as “troubled families” 10 years ago, I and others anticipate the same continuous improvement trajectory for the family hubs model or way of working.

Family hubs are now official government policy, backed by a £130 million commitment, a major evaluation programme and decades of supportive research. The model is not prescriptive but enabling and supported by many local authorities and those designing health systems. I would be grateful, in conclusion, if the Minister would explain, after these assurances, why this important social infrastructure, the fruit of 30 years of reform, which builds on and extends Labour’s legacy of Sure Start centres, has no place in the Bill.

Children and Social Work Bill [HL]

Debate between Baroness Tyler of Enfield and Lord Farmer

Report: 1st sitting: House of Lords
Tuesday 18th October 2016 Lords Chamber

[Lord Farmer (Con)]

My Lords, I rise to speak to Amendment 11, tabled in my name and those of my noble and learned friend Lord Mackay of Clashfern and the noble Baroness, Lady Tyler. To begin with, I must confess that I was not giving the Minister my full attention when he referred to this amendment earlier in speaking to Amendments 2 and 9. However, I think I heard encouraging words, so I will be speaking with an optimistic heart.

As I said in Committee about an identical amendment, including the word “relationships” would remedy an omission in the list of the areas of support that councils are required to include in their local offer. It stipulates that information and services to help young people develop and maintain healthy and supportive relationships should be available alongside the other five areas of health and wellbeing, education and training, employment, accommodation, and participation in society. I explained then how, when children and young people are taken into the care of the local authority, first and foremost these circumstances typically create a relationship problem. There are profound long-term effects of losing parental attachments and bonds with siblings and others in the extended family. Ministerial architects of the Bill had the best of intentions in this area but the wording acknowledges relationships only scantily and, as a consequence, ineffectively—as I hope to show here today. If the goal is to change the culture in local authorities so that relationships become of central importance, as the Government intend, legislation has to provide a stronger lead.

Clause 1 provides seven corporate parenting principles, including that children should have stability in their home lives and relationships. The local offer provided for in Clause 2 will, according to the note for Peers we received at the recent meeting with the Minister, be one of the main ways in which the corporate parenting principles are brought to life in relation to care leavers.

However, the draft local offer that was recently circulated to Peers was devoid of any reference to relationships, so how can this document claim to bring to life the corporate parenting principle about relationship stability? Yet this omission could have been anticipated, given that Clause 2, which guided the guidance, as it were, did not specify that information on relationships would form part of the service offering, hence this amendment.

The draft statutory guidance for applying corporate parenting principles for care and pathway planning does mention, on page 19, the need for looked-after children and care leavers to build resilience by forging strong relationships if they are to thrive. It goes on to say that this will mean local authorities having regard to the need to maintain, as far as possible, consistency in the home environment, relationships with carers and professionals and school placement. It then goes on to make important points about stability of housing tenure and provide good practice examples of financial and practical help.

However, there is nothing in either the guidance or the local offer about how to maintain stable relationships, and nothing about helping young people to form networks of supportive relationships beyond those with paid professionals and those formally designated as carers.

We withdrew this amendment earlier after reassurances from the Government that,

“the whole thrust of what we seek to achieve through the Bill is the reinforcement of the importance of relationships and helping children and young people to recover from their pre-care experiences to make a successful transition to independence. The importance of relationships is central to the corporate parenting principles … We will publish guidance for local authorities and I would fully expect it to say that they should include in their offers information about relationship education among the services available for care leavers. Our forthcoming care leavers strategy will set out our plans to ensure that care leavers are better supported to develop and sustain the social networks that support them in their transition to adulthood and beyond”.—[Official Report, 4/7/16; cols.114-115.]

So the Government understand that care leavers need not just continuity of care, but support networks and relationship education.

Support networks do not just spring up but typically need the encouragement and facilitation of adults. In Committee I mentioned family finding projects, such as those taking place in Orange County in California. Family finding is an intensive search method to find family members and other adults who would like to step in and care for children and young people in, or about to leave, foster care who lack permanent relationships. The goal is to locate long-term, caring, permanent connections and relationships for them and to establish a long-term emotional support network with family members and other adults. They may not be able to take the child into their home but still want to stay connected with them and to journey with them through life. In Orange County, 97% of the young people who took part increased family contact, and 89% have lifelong connections. Edinburgh City Council has already adopted this approach. Encouragingly, in Grand Committee the Government stated their interest in this approach for their care leavers strategy, which the Family Rights Group is now testing in a number of local authorities.

Yet however many family members and caring adults we try to cluster around young people, these connections will be insufficiently sticky if young people are pre-programmed to reject the relationships that are on offer because of past experiences, or have no understanding of what a good relationship looks like. This is where relationship education comes in. It can be delivered informally when a young person finds it very hard to maintain a relationship with a key figure in their life. They mention it, say, to their personal adviser, and that person purposefully helps them to navigate through difficulties or misunderstandings in exactly the same way that a loving parent would. I am sure this already happens but it needs to be an important part of every personal adviser’s job description and skill set. Alternatively, it can be more formally delivered through the work of services like Love for Life, which is part of TwentyTwenty, the award-winning mentoring organisation with which the Government have contracted to work in the recently announced Derby social mobility hub. The ethos running through this and many other third sector organisations is that the skills to build good relationships can be taught and caught.

I have met the Minister, Edward Timpson, and am in no doubt that he is alive to the importance of relationships, but the Bill simply does not yet reflect how quintessential they are, as stated by the Government. Instead of trying to get this in the Bill, I could be arguing for better recognition in the draft guidance, the draft local offer and the forthcoming care leavers strategy. However, it is not a question of either/or; it is both/and. It could sensibly be surmised that the Government overlooked the need to make explicit reference to relationships in their draft local offer, despite what they say about its importance to the corporate parenting principles, because it was not included in the legally binding list provided in Clause 2. This suggests that it would be to all too easy for local authorities to do the same, thereby undermining the opportunity presented by the local offer to drive much-needed cultural change in this area. I beg to move.

[Baroness Tyler of Enfield]

My Lords, I support Amendment 11, to which my name is attached, as it was in Committee. To reiterate what I said then, and despite the very good debate we have already had today on Amendment 2, the Bill itself is currently almost devoid of references to relationships; indeed, you might almost say it is a bit of a relationship-free zone. That is ironic when what we are all trying to do here is improve the lot of the very vulnerable children and young people who most need love, warmth, emotional security and human empathy to help them on their journey through life, given their very troubled start. It is a statement of the blindingly obvious that good relationships are utterly indispensable to that end.

The noble Lord, Lord Farmer, who is such a passionate advocate in this field, has already referred to the need for a change in the culture of many local authorities so that they also make promoting relationships central to their work. I know that there are some very good examples of good practice here, but I want to talk very briefly about what cultural change requires and why it is important. It could be assumed that good-quality relationships, particularly the support of peers and adults who are not paid to take an interest, are somehow nice to have but out of the reach of many young people in, or coming into, the care system. If so, that assumption will shape a local authority’s response. It will focus almost exclusively on ensuring that a young person has the material, financial and practical support that they need in the absence of the family ties through which these things typically come. It will also put a greater load on the social worker and personal adviser role.

Children and Social Work Bill [HL]

Debate between Baroness Tyler of Enfield and Lord Farmer

Monday 4th July 2016 Grand Committee

[Lord Farmer (Con)]

My Lords, I shall speak to Amendment 39 in this group, tabled in my name and those of my noble and learned friend Lord Mackay of Clashfern and the noble Baroness, Lady Tyler. Our amendment remedies a serious omission in the list of the areas of support that councils are required to include in their local offer. It stipulates that information and services that will help young people to develop and maintain healthy and supportive relationships should be available alongside the other five areas of health and well-being, education and training, employment, accommodation, and participation in society.

When parental care fails, for whatever reason, and children and young people are taken into the care of the local authority, it is easy for us as legislators to treat this primarily as a legal problem. Obviously, it is essential that a minor’s legal status be clear and established. However, first and foremost, we should be aware that these circumstances typically create a relationship problem because of the profound long-term effects of losing parental attachments and the often taken-for-granted bonds with siblings and others in the extended family.

At birth, every child comes into that little unit, their family, where relationships are, ideally, formed and nurtured. Relationships are foundational to all human societies and what human existence is all about; without them, that existence can feel precarious, fraught with fear and difficulties and even fundamentally unwelcome. This is especially the case when making the transition from dependence into independent adulthood, a difficult and protracted shift for every human being, even when they have the back-up of good enough parents.

Although I welcome the inclusion in Clause 1 of the corporate parenting principle that children should have stability in their home lives and relationships, this is the only place where the word “relationship” is mentioned in relation to care leavers. Others noted this infrequency at Second Reading, such as my noble and learned friend Lord Mackay and the noble Baroness, Lady Tyler, who mentioned a lack in this area. Three-quarters of young people leaving care admit to difficulties due to loneliness and isolation. Almost half found these very difficult to cope with, and those numbers could easily be higher, as admitting to such feelings is still stigmatised in our society.

Information about and provision to assist young people to build relationships should be included in the local offer laid out in the clause because it is highly likely to be another area of lack, given that they have not been able to learn such “habits of the heart” in their birth home. The Government might consider that this is covered by subsection (2)(a), on health and well-being, but we simply cannot take that for granted. Relationships are not yet embedded as a priority for public bodies. The best example of that is found in Public Health England, whose mission statement says:

“We protect and improve the nation’s health and wellbeing and reduce health inequalities”.

However, both its annual plan and the public health outcomes framework are relationship-free zones, something that the Tavistock Centre for Couple Relationships and others have been challenging for several years on the grounds that at least three-quarters of the indicators contained in the public health outcomes framework are directly or indirectly influenced by the quality of people’s couple relationships. It is stated rather narrowly, but noble Lords will take the point.

The inability to form and maintain relationships is a root cause behind poor health and well-being. It undermines educational attainment, employment prospects, the ability to maintain a tenancy and have otherwise stable accommodation, societal participation, and all the other itemised aspects of the local offer. This is not just because of the lack of self-esteem, self-confidence and other internal factors that can put lonely and rootless young people at such a disadvantage. Relationships have instrumental value. The deficit in social capital, when a young person has no family members to open their contact books to get them work experience and almost no settings in which they can acquire soft skills, can have devastating effects. Services do exist for young people to help address these relational difficulties. I have talked before about Love4Life in Loughborough, and Oasis College was recently established to ensure excellence in the many organisations that work in this and other related areas. They will not, however, be automatically commissioned without some indication from the Government that they are indispensable to a comprehensive and effective local offer.

I also gave concrete examples at Second Reading of the kind of services that local authorities can provide and commission. Northern Ireland’s model of person-specific personal advisers enables local authorities to draft in people who already get on with and are trusted by the young person leaving care. At present, care leavers are matched up with someone they may never have met before who usually has a couple of dozen or more vulnerable youngsters on their books. There is also a lot of staff churn, which makes a mockery of relationship stability.

I also recommended consideration of the family finding and engagement model in California and other parts of the United States. That name is slightly misleading in our system and not to be confused with the family-finding process to locate good potential adoptive parents. US family finding makes the most of blood connections with extended family and other supportive relationships that children entering or in the care system have already developed with adults, such as teachers, youth workers or the parents of friends. Instead of allowing them to lapse, local authorities treat these relationships as potential lifelong links and draw on this resource to build intentionally a network of support around young people before they leave care. What they are looking for is a small number of adults who are reliable and willing to be involved in the young person’s life and will keep in touch with them whatever happens, inviting them for Sunday lunch or to spend Christmas Day with them, for example. As I said, a highly suitable personal adviser could emerge from that process. If the Department for Education were able to furnish local authorities with model contracts, this would help them greatly.

I conclude by saying that this is a probing amendment. If my noble friend does not feel that this clause is the right one in which to place the necessary emphasis on relationships, I am open to the legislation being strengthened in this way elsewhere. Otherwise, the legislation will not, I fear, boost vulnerable young people’s life chances as much as might otherwise have been possible.

[Baroness Tyler of Enfield (LD)]

My Lords, I add my support to Amendment 39, to which my name has been added. It says it all that we are discussing this important issue about relationships in a hugely important group with some hugely important amendments but, frankly, the two do not sit very happily together.

At Second Reading and last week I talked about mental and emotional health, including how the love and support of foster parents can make all the difference. That is because of the relationship involved. I also stated that very little notice appears to have been taken in the family test, which was part of the impact assessment accompanying the Bill, of children’s wishes and feelings, particularly about relationships that they value or may want to preserve. It is not an exaggeration to say, as the noble Lord, Lord Farmer, did, that the Bill at the moment is almost devoid of reference to relationships. I am very pleased to see that other noble Lords are trying to ensure that this emphasis comes through more strongly in other amendments in other groups. I fear that that this lack of emphasis on relationships threatens to undermine the admirable intent of a good chunk of the Bill, which is obviously to ensure that we improve outcomes for care leavers.

There is an absolute wealth of research reports, including those from the Centre for Social Justice, concluding that if we do not put strong, healthy relationships at the heart of the care system, we will never see the improvement in life chances that we are all ambitious for. At Second Reading, I talked about the need for ambition—for setting ourselves a higher standard. We simply cannot treat the presence of strong relationships in the lives of children who have been in care and are leaving care as a “nice to have”. That is just not good enough. Strong relationships are of fundamental importance to any young person in their transition to adulthood. Without someone who will provide unconditional love and acceptance, the challenges that the world presents can sometimes seem insurmountable. Such relationships must be a fundamental element of young people’s care-leaving packages. Those young people need to know how to draw on the resources inherent in good-quality relationships; for example, how to handle misunderstandings and perceived slights, and the constant need for compromise—give and take, if you like.

Finally, there are good relationship support services available for young people. Indeed, there is evidence of their effectiveness—they work. They are provided by a broad range of providers, mainly in the voluntary sector. I draw noble Lords’ attention to my declared interest as vice-president of the charity Relate. If local authorities were required to provide information—not the service itself, just information—about relationships and these services, we would begin to see far greater take-up of what is on offer. Those benefits would then go into adult life and adult family relationships.