Health and Care Bill

Debate between Baroness Walmsley and Lord Howarth of Newport

Committee stage & Lords Hansard - Part 1
Tuesday 11th January 2022 Lords Chamber

[Lord Howarth of Newport (Lab) [V]]

My Lords, I fully support the objectives of my noble friend Lady Merron and her co-signatories to Amendment 2. However, as indicated in Amendment 3, in my name, I believe that it would be appropriate to add to the board’s membership a person representing a very important element of providers, who are always at risk of being overlooked when the NHS is, as is so often the case, under intense pressure.

There is a growing body of research evidence demonstrating that non-clinical approaches can be highly beneficial to health and well-being. Engagement of the creative imagination and with the arts, culture and nature has profound health-giving benefits, as well as leading to improved well-being. Other non-clinical approaches, such as engagement with sport or volunteering, are likewise beneficial. Moreover, they offer significant benefits in easing pressures on general practitioners and the wider healthcare system. Before the pandemic, it was estimated that one in five GP appointments was for non-medical reasons. A survey by the Royal College of General Practitioners in 2018 found that 59% of family doctors thought social prescribing could reduce their workload.

Non-clinical approaches can help us move away from the present state of affairs, in which we are under-doctored and over-medicated, and they will bring significant cost savings. The World Health Organization’s scoping review reported that evaluation of Arts on Prescription suggested an average return on investment of £2.30 for every £1 spent, through reductions in unnecessary prescribing and reductions in the use of health services, including emergency hospital admissions.

The potential benefits of such approaches have been recognised by the Department of Health, in the establishment of the National Academy for Social Prescribing and in the preventive strategy set out in the NHS Long Term Plan, which envisaged that:

“Within five years over 2.5 million more people will benefit from ‘social prescribing’, a personal health budget, and new support for managing their own health in partnership with patients’ groups and the voluntary sector.”


But that was under a different Secretary of State and before Covid and the huge growth in the backlog that is now absorbing so much of the energy and thinking time of the NHS.

These benefits are experienced not just by the individual; they are societal. A society in which fewer people are lonely and gloomy and more people are energised and filled with a sense of achievement, new self-esteem and optimism, and in which through shared activities they build social capital, is on the way to being what the noble Lord, Lord Crisp, and colleagues have characterised as a healthy and health-giving society.

We all acknowledge that to create such a society we must address the social determinants of health, as argued so compellingly by Professor Sir Michael Marmot. To do so requires not only the integration of the range of health and social care services but an integration of policy across Whitehall and between Whitehall and local, regional and devolved government, in full partnership. Place-based strategies for health are crucial. Integrated care boards, integrated care partnerships and the NHS as a whole must draw on a full range of resources and strengths.

If government fails to act across the board in addressing the societal issues that generate so much ill health and fails to develop a fully-fledged preventive strategy, we will continue to see the NHS beleaguered, insufficiently funded and struggling to cope, with endemic ill health on an enormous scale. We need to make the whole of government an integrated care system. The Department of Health cannot solve the problems of health on its own.

Meanwhile, we must give the best help we can to the board of NHS England by furnishing it with a broad membership along the lines proposed in these amendments, ensuring that, at the highest strategic level, representative voices of a wide range of contributors are heard, including those of the non-clinical providers who have such an important part to play. I beg to move.

[Baroness Walmsley (LD)]

My Lords, I have added my name to the amendment from the noble Baroness, Lady Merron, which I fully support.

Schedule 1 gives a dazzling array of consequential amendments to a vast list of other legislation, which must have taken some poor civil servant weeks to compile, but it does not tell us who will be the extremely important and influential additional people on the board—those who will steer the good ship NHS England along its course. Like any other ship, it needs a captain, officers and crew with the knowledge, experience, expertise and attitudes to steer the ship in the right direction and to enable it to fulfil its functions efficiently and effectively—in whose interests? Those of the patients, of course.

It is also important that nobody on board—let us say, perhaps, the pilot who steers it into port—should have the power to steer the ship not in the direction it should go but in a direction chosen in that person’s own interests. That is why the noble Baroness, Lady Merron, and those of us who support her have attempted to specify some of the kinds of people who should be at the helm of this organisation in the new world of integrated care services—and those who should not.

They should include someone to represent public health, especially given the recent experience of the pandemic and the certainty of others in future. They should include local government, given its responsibility for the crucial areas of social care and the social determinants of health outside the health service. They should ensure diversity and include people who can ensure that patient and staff interests are taken into account when decisions are made—after all, without staff there would be no service. They should include someone who can keep an informed eye on the way the ICSs are progressing. They should not include anyone with a financial or employment interest in any organisation that delivers services to the NHS.

This Government have a very poor track record in ensuring that people with a financial interest do not benefit from government contracts. We have had far too many of those scandals relating to the provision of PPE, testing kits and other products and services during the pandemic. Some of those have only recently been revealed. We must avoid that happening as we set up this new body, for which we all have such great hopes. That is why I recommend this amendment to the Minister and look forward to his response.

Academies Bill [HL]

Debate between Baroness Walmsley and Lord Howarth of Newport

Monday 28th June 2010 Lords Chamber

[Baroness Walmsley]

My Lords, I agree with the noble Baroness, Lady Whitaker, about the importance of design. There is such a thing as a dysfunctional building. Schools are buildings around which large numbers of children have to be moved every day. It is very important that they are well designed for that purpose, as well as for concentration and calm contemplation of the lessons. If the buildings magnify sound, they will not be very good for that purpose.

I am also concerned about the green credentials of schools. Will the Minister say something about the design standards in relation to the use of energy and water, and the disposal of waste and all those issues? I have often suggested that schools are ideal places for ground-source heating. They have large tarmac playgrounds under which you can put the pipes. It really is important because in the future energy will be even more expensive than it is now and we will all have to pay for it.

I recently went to an academy school where in order to switch the lights off at night the caretaker had to go to the top of the building. However, he was forced to leave the lights on all night because health and safety would not allow him to come down the stairs in the dark. That new, purpose-built academy building was ablaze all night. It was a disgrace and I hope that we will avoid that sort of thing.

[Lord Howarth of Newport]

My Lords, my noble friend Lady Whitaker and I have stood shoulder to shoulder in campaigns for good design in recent years and I am happy to join her in the field tonight. It is too much, no doubt, to ask that the magnificent £50 billion Building Schools for the Future programme should be continued, but it is essential that design standards should not be dropped in the school building that does continue. Presumably that will mainly be the construction of academies. Do the Government intend still to provide some funding to support the creation of fine new academy buildings, as their predecessor did? Will the Government at least maintain minimum design standards?

This matters very much. Children and staff in schools, like everyone else, should work in a good built environment. The benefits of that for their morale, spirit and performance are marked. Good design is practical and works better. Well designed schools, like well designed hospitals, hospices, railway stations and magistrates’ courts, are statements about the values we hold as a society, our attachment to civic values and the public realm and our commitment to sustainability, an important point raised by the noble Baroness, Lady Walmsley. There are important symbolisms in good design.

Good design is an expression of national self respect. It is a manifestation of the respect we have for our community. There is a noble tradition of design of school buildings and it is one which we must not lose. Our Victorian and Edwardian forebears took it as axiomatic that a school should be a proud statement on behalf of the community in its design. The school building programme launched after the Second World War by Ellen Wilkinson, as Secretary of State, led to a commitment in a number of local education authorities to good design in a modern idiom. The schools designed in Hertfordshire for the local education authority by Stirrat Johnson-Marshall were celebrated. He was an architect who was described as,

“Socratic in manner of discussion and intolerant of formality in any guise”,

which, I think, means that he sought to find out what people thought, to elicit their best ideas and to develop his designs accordingly, as good architects do. Equally, later in Hampshire, the schools designed by Colin Stansfield Smith were celebrated, and the local education authorities which committed themselves to a programme of high-quality design in school building were strongly and admirably supported by the ministry’s architecture and buildings department.

More recently, under the previous Government, we had the Building Schools for the Future programme. I shall mention two schools that were jewels in that programme. The Mossbourne Academy in Hackney was built in an area known as “murder mile” because of the gangland killings there. It replaced Hackney Downs comprehensive, a school which had gone so far down in the world that the tabloids described it as the worst comprehensive in England. The school reopened in 2004 in buildings designed by the Richard Rogers Partnership. The first intake of the new school consisted of children, nearly half of whom were eligible for free school meals and 30 per cent had special educational needs. They took their GCSEs in 2009 and achieved some of the best state school results in the country. The Mossbourne Academy topped the league tables in value added. That was, above all, due to the leadership of Sir Michael Wilshaw and first-rate teaching by his colleagues, but design, they acknowledge, was also an important factor—as was the case at the Westminster Academy, which my noble friend and I visited earlier this year. There, the architects Allford Hall Monaghan Morris were awarded the RIBA Sorrell Foundation Schools Award. This is an opportunity for this House to pay tribute to Sir John Sorrell and his wife Frances for their extraordinary generosity and creativity in their support through their foundation for good school design. The design of the Westminster Academy is beautiful and clever. As my noble friend said, the results in the new school soared by comparison with the results in the old school because pupils were treated with respect through design, and thus learnt to treat their school and neighbourhood with respect. The head teacher and her staff above all deserve the credit, but she insists that the quality and nature of the design of the school were crucial in making possible the curricular flexibility which, in turn, was key to the motivation and success of that school.

The Government want to impose the minimum bureaucratic burden on academies, and that is right. Good design cannot be promoted by regulation, but bad design can be averted. I hope that the Government will keep the minimum design standards that the DCSF pioneered in the public sector. I hope also that the Government will keep the engagement of CABE, which is not a quango to cull. It mobilises at negligible cost talented and expert people to illuminate and promote good practice in design. Here the leadership of Ministers is needed and, as elsewhere in education, leadership, aspiration and ambition are the magical ingredients. Only the best should be good enough for our schoolchildren, their teachers and the staff in our schools. We can afford the best. Good design costs no more than bad design. It is simply a matter of doing the job well. Indeed, good design costs less over the lifetime of the building.

Academies Bill [HL]

Debate between Baroness Walmsley and Lord Howarth of Newport

Monday 28th June 2010 Lords Chamber

[Baroness Walmsley]

My Lords, I speak on this matter in a personal capacity and I absolutely support the amendment of the noble Baroness, Lady Massey. I also support much of the spirit behind the amendment of the noble Lord, Lord Northbourne, although I think that it is a bit too late to provide sex and relationships education to 14 year-olds, given the hundreds of girls under the age of 14 who get pregnant every year. Good PSHE includes all the information that young people need to lead an ordinary but successful life, or even an extraordinary life. It is not academic but what are schools doing if not preparing young people for the lives that they will lead when they leave and, indeed, the lives that they lead while they are still at school?

Much has been said this afternoon about the importance of teaching about parenting, and I absolutely agree. Noble Lords may have heard about the programme in which school nurses give out baby dolls to young women. These dolls scream in the middle of the night, they need burping, they need their nappy changing and they need feeding regularly. I recently heard about one school nurse who gave out a batch of these dolls and when they came back at the end of the week most of the young girls said, “Oh my goodness. I couldn’t possibly”, apart from one who said, “It was wonderful. I can’t wait to get pregnant”, so it does not always work.

Over the years, I have said a good deal on this subject in your Lordships’ House, so, in an effort not to repeat myself, I did some new front-line research last week with two teenagers who are doing work experience in Parliament. One told me about a girl in her sister’s class at school who at the age of 13 had a one year-old baby. Both of them said that they have to go to PSHE lessons but to quote one of them, “We don’t do anything”, and to quote the other, “We watch a lot of videos”. One said, “We had a lesson on drugs recently and they just said, ‘Don’t do drugs. Drugs are bad’. It was useless”. She also told me that she did not have any sex education until she was 17 and that they do not teach about contraception or abortion in their Catholic school except in RE, where they say, “Don’t do it; it’s a sin”.

That is just not good enough. I realise that this is a very small sample of hearsay evidence but it lines up with what I have heard from many other teenagers over the years. It tell me that, first, teachers are not properly trained to deliver PSHE; secondly, teachers are not confident to teach PSHE, and that is why they rely so much on videos; thirdly, the quality of PSHE varies immensely and is very poor in some places; and, fourthly, some children are not receiving the information to which they are entitled and which protects their well-being.

The only way to deal with all those things is to make the subject part of the national curriculum in maintained schools and mandatory in academies and all other schools that do not have to follow the rest of the national curriculum. All establishments which educate children and young people have a duty to have regard to their well-being. However, they cannot do that successfully if they do not give them the information that they need to live a happy life. Young girls’ life chances are being severely affected because they may not have the information or the self-confidence to avoid unwanted pregnancies, and often the state has to pick up the bill in the interests of the young girl and, in particular, her baby. Unless children have information about the dangers of tobacco, alcohol and drugs, they may unwittingly become addicted at great cost to themselves and the country before they can turn round.

Much has been said about teacher training and, as usual, my noble friend Lady Williams has put her finger on it. Fully trained teachers cannot be produced in an instant, but her suggestion that the Government should show their intention to make the subject mandatory, given sufficient time to undertake the training of new teachers in initial teacher training or CPD for existing teachers, would be a solution to that problem. The noble Lord, Lord Northbourne, said that often the subject is given to Joe Bloggs the geography teacher. In my experience, it was given to Jill Bloggs the biology teacher or, in my case, Joan Walmsley the biology teacher. I taught it but I was not properly trained and I did not have the necessary confidence. I did my best but it was a very long time ago and the problem is that that is still happening.

I know that the Government are to have a curriculum review, which will be an opportunity to look very carefully at what we teach our children in schools. We need to give them the tools for life and not just academic qualifications for work. We must redress the damage that was done before the election when this measure very nearly got into legislation, but was prevented by the vagaries of our parliamentary procedures. I hope that the Minister will be able to reassure me that this subject will be considered during the curriculum review.

[Lord Howarth of Newport]

It could be argued that there is no more important element of the curriculum than PSHE. The previous Government were certainly right to propose that it should be a statutory foundation subject. There is a public, societal interest in children being educated in these areas. Moreover, I believe that it is the inescapable responsibility of Government to ensure that that happens because only the Government can ensure that all children receive education in these areas; only the Government can establish a norm; and only the Government can promote best practice across every school.

Education about relationships and sex is, of course, a very important private and parental responsibility and should be respected as such, but it cannot be the responsibility of parents alone. By definition relationships involve two people and, indeed, two families. Ignorance in sexual matters is dangerous to others. Children need support and education. They grow up in an erotically charged environment, where advertising and entertainment sexualise almost every kind of transaction; and the internet opens the window to a host of sexual possibilities regardless of who receives the messages. I am afraid that it is commonplace in our culture for human beings to be objectified, exploited and even brutalised sexually. Inescapably, children and young people witness that. If there is an age of innocence, it is all too short. For that reason and because of earlier puberty, it is essential that sex and relationship education is introduced at primary level although, of course, as the noble Lord, Lord Northbourne, said, it should be age-appropriate.

There are powerful peer pressures to experiment and to take risks, and those are stronger than the social codes that seek to protect young people from precocious sexual experiences. Children and young people are vulnerable and, therefore, they need help from an early age to understand this environment and to start to establish their own secure and confident individuality. They need education about relationships—not preachy education but education that may well be imparted through the study of literature and drama, for example. They need to learn that good relationships are characterised by respect for the other person, by sensitivity and by love. They also need to learn about the physiological facts of reproduction, the practicalities of birth control and how to avoid sexually transmitted diseases. They need to be taught those matters with no euphemisms and no evasion: sexually transmitted diseases may kill. Some families are not willing to teach that to their children and some families do not know how. Therefore, it is unacceptable to leave sex education to families as a private responsibility. I believe that religious objections, for example to teaching about contraception, have to be overruled.