Health and Social Care Bill

Baroness Wilkins Excerpts

Tuesday 11th October 2011 Lords Chamber

[Baroness Wilkins]

My Lords, I am delighted to follow the noble Lord, Lord Tugendhat, since I received the help of the excellent district nurses in his trust, for which I am grateful. I stress yet again the volume of concern that has been expressed about this Bill and that has just been so ably expressed by the noble Lord, Lord Haskel. I trust noble Lords will not ignore the fact that the public are deeply fearful about the Government’s plans for their health service, and that they are relying on this House to protect it.

Knowing the number of speakers today, I decided to be brief and concentrate on just one issue—the co-ordination of services for children. I am grateful to the Every Disabled Child Matters campaign and the Communication Trust for their help. There are around 770,000 disabled children living in the UK, a number that will increase in the future as medical advances ensure that more children survive birth and childhood illness. To succeed in life a disabled child and their parents and carers need help and support, not only to identify their support needs but to overcome any problems that arise. This requires partnership working across health, social care and education boundaries. The current system is already a difficult maze to negotiate for parents seeking support. If the changes go ahead, I fear that it will become even harder.

While health and well-being boards will be charged with co-ordinating the planning and delivery of health, social care and public health services at a local level, there will be no place at their table for education providers. However, experience tells us that the most effective interventions are often those delivered in non-health settings such as a school or children’s centre. We are already seeing some PCTs altering their structures in anticipation of a reformed health system to pilot new programmes. However, there has been no guidance on how children’s health services will be commissioned and delivered. It is sadly typical; children and young people are forgotten again in a health and social care system designed for adults. Worse still, the Education Bill, currently before your Lordships’ House, will remove the duty on schools, academies and colleges to co-operate. As has happened so often in the past, where agencies are not required to work together there will be a loosening of ties. A government policy of simply hoping that co-operation will happen is no guarantee that it will, whatever the Government’s warm words, and it is disabled children who will miss out.

What, then, about the welcome proposals in the Department for Education’s recent Green Paper? It suggests new approaches to special educational needs and disability and calls for more co-ordination: a single assessment process, a joint education, health and care plan and a local offer, all of which will set out the services available to a disabled child in a local area. I fear that it will remain an unmet aspiration as energy and money are devoted to tearing up current systems and installing new structures, new acronyms and new titles—all of which are expected to work within a reduced budget.

Take, for example, the commissioning of speech and language services for children with speech, language and communication needs. One child in 10 has a speech and language difficulty. It is the most common disability in childhood and the most common type of primary need for pupils with special educational need statements. Unaddressed, issues with a child’s speech, language and communication needs risk problems with literacy, numeracy and learning as they move through the education system. Just 20 per cent of children with these problems achieve the expected level in maths and English at the end of primary school, compared with 72 per cent of all children. Needless to say, the gap widens even more by the end of secondary school. However, as Sarah Teather, the Minister for Children, admitted earlier this year, the chance of a child with speech, language and communication needs now receiving speech and language therapy is between low and nil. How will tearing up the current system enhance the chance of a child with speech and language problems receiving adequate help—help that is best delivered by co-ordination between health and education services?

I remain deeply concerned that while we spend time debating more changes, and more time, energy and money are spent on designing new systems rather than simply making the current structure work better, once again it is the needs of disabled children that will be forgotten.