Children and Families Bill
Countess of Mar Excerpts(10 years, 7 months ago)
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Baroness Morris of Yardley (Lab)
My Lords, I add my support to the amendments tabled by the noble Baroness, Lady Brinton, and my noble friend Lady Jones. I do not want to go over the points again as we are trying to move quickly, but it may be a case of weight of Members as everybody is agreeing with everybody at the moment, and it seems that most of the Committee has spoken against the Minister. To add to the number of voices, I want to raise two or three points that have not come out.
My noble friend Lady Jones said that these are amendments about children who are temporarily unable to attend school. Those children’s needs have not been addressed by either Government through legislation. There is widespread support for the Bill generally, as it deals with some of the most vulnerable children in our society. We are all on side on this, but for this group of children who are temporarily unable to attend school, there is no underpinning in legislation to help them. That is a problem. Even if the essence of the content of the amendments is unsuitable, the Minister needs to put something forward. If we do not do that in this legislation it will not happen, and the problems we have been talking about will continue.
We spend an awful lot of time trying to get children who do not want to go to school back into school. We take their parents to court. We have welfare officers who chase them. We bring them in and have mentoring, and so on. But here we have a bunch of children who want to go to school but cannot go for reasons of their mental health, bullying or whatever. We should think about that. If we were to put as much effort into children who want to go to school, but cannot do so temporarily, as we do with those who do not want to go to school, we would probably have a stronger education system. It is that sort of area that is missing. Anyone who has ever done any teaching will know that if a child has been away, it is almost impossible to help them catch up when they come back. The impact is not just on their learning but on the learning of the rest of the class. If we address this issue, we will be meeting the needs of vulnerable people.
I add my support to the Red Balloon argument. I, too, had the privilege of visiting a Red Balloon school in Cambridge. I went not as an enthusiast of online learning as I, too, thought that education was about mixing with children socially. An obvious point that I missed was raised. For some children who are temporarily out of school, it is the way to get back. If we can get children learning online, where they do not have to face other young people and adults, it is a stepping stone to getting back. Finally, whether we like it or not, there is an incentive in the system for schools not to purchase provision outside their own school. A statement for children who have special educational needs mitigates that incentive in the system for the school not to look to resources outside itself. For this group of children, the incentive is still there for the schools to handle it themselves. We need a bit of help on behalf of these children so that we incentivise, make possible or demand that resources outside the school can assist for what may be no more than a week or a month. If it is only for a week or a month, and the children continue to learn, it could do their future education a power of good.
The Countess of Mar (CB)
My Lords, briefly, I want to clear up a misconception that both noble Baronesses, Lady Walmsley and Lady Brinton, seem to have. Online and joined-up learning is available to schools because we have it for children with ME. I shall speak about it more on my amendment, but I want the Committee to know that local authorities can provide it.
Lord Nash
My Lords, I shall speak to Amendments 74, 127 and 217 regarding severely bullied children and the education of children unable to attend a mainstream school. I thank my noble friend Lady Brinton for raising the important issue of bullying and the needs of young people who are bullied. As the noble Baroness, Lady Jones, said, my noble friend has been a great advocate for children and young people whose lives have been blighted by bullying. Bullying in any form and for any reason is totally unacceptable and should never be tolerated in schools. Bullying can instil fear, damage self-esteem and reduce academic attainment. We have a considerable campaign in place to combat cyberbullying, which, as my noble friend Lady Walmsley mentioned, can be particularly unpleasant. As our reforms work their way through the school system, and behaviour management strategies improve—as I believe that they are substantially in schools across the country—that should help in this regard.
The amendments broadly cover three areas: a call for bullying to be defined in law; measures to prevent bullying happening in the first place and to tackle it when it does; and provision for those who are the victims of bullying, particularly those who are severely bullied.
The definition of bullying outlined in Amendment 74 suggests that bullying will involve an “imbalance of power” and is repeated behaviour that causes physical or mental harm. These elements are likely to be involved in many instances of bullying, but not all of them. The definition of severe bullying outlined in the amendment refers to behaviour that affects children so severely that they suffer trauma and psychological damage. There is a risk that that could cause confusion for schools, because the same bullying activity could be treated differently according to the effect that it has on the victims, rather than the act itself. Although we acknowledge that the support should take account of the effect, it is important that there is consistency in how schools manage the behaviour of pupils.
There will always be exceptions to whatever definition is put in place, which is why we consider that these matters are best placed at the discretion of head teachers and teachers. We outline what constitutes bullying in our advice to schools and we consider that that is the best place to do so, rather than through a strict definition in law. A legal definition could, among other things, rule out behaviour that common sense might suggest is bullying but may not be captured by a law.
Turning to my noble friend Lady Brinton’s point about guidance being in one place, it is of course important that guidance is practical and manageable for those using it. We are very happy to look at how the different pieces of guidance fit together and cross-refer, in particular, in the current consultation on the code.
Turning to preventing bullying in the first place and tackling it when it does, as different schools face different issues, we do not want to prescribe specific anti-bullying strategies. Instead, we want to allow schools and local authorities to address bullying in the light of the needs and circumstances of their schools and their pupils. I believe that our current position provides the right balance between requirements in law, flexibility for schools and strict accountability.
All schools must have a behaviour policy with measures to prevent bullying. It is up to them to develop their own strategies, but they are now clearly held to account for their effectiveness in doing so by Ofsted. Since 2012, it has been a requirement for school inspectors to take into account issues relating to bullying, harassment and discrimination. In addition, we provide schools with advice, with links to several anti-bullying organisations for specific advice.
Turning to provision for children who are bullied, the starting point should be the needs and welfare of children and young people and the state of their mental and emotional health. Schools and local authorities should provide support in a proportionate and tailored way to meet their needs. The new draft SEN code of practice considers that developing a graduated response to the varying levels of SEN among children and young people is the best way to offer support, and this can include the needs of bullied children. There is no separate legal status of a temporary statement. However, local authorities and schools are free to use key elements of the statementing process to make local arrangements.
The causes that affect the well-being of children and young people will be relevant to how those needs are best addressed, but are not the best guide to the level of need. A child’s well-being could be severely affected by a variety of things, including bereavement, family upheaval or severe bullying. It could result from a range of factors that taken in isolation a child could cope with, but taken together have a severe impact. It is important, therefore, to avoid creating a hierarchy of causes and prescribe what the response should be.
Schools know their pupils. They are alive to changes in behaviour, character and attendance. They should offer support quickly, based on the need they identify, and there is a wide range of options that they should consider, from asking the pastoral team to keep an eye out to providing formal counselling, engaging with parents, referring to local authority children’s services, completing a common assessment framework and referring to child and adolescent mental health services, including whether to assess for SEN. The circumstances that my noble friend describes will often need swift support. An EHC plan is intended for those with the most challenging, complex and long-term needs. This is reflected in the amount of time that it will take to deliver an EHC plan—a maximum of 20 weeks under the reforms. In many cases, offering a child or young person SEN support in the first instance will be much more appropriate, and faster. Giving a child or young person an EHC plan is a significant step and may not be necessary.
No child should ever be forced out of school because of bullying. In extreme cases, it may be necessary to make other arrangements so that a bullied child can access the good education they deserve.
In response to the concerns raised by Amendment 127, I should reinforce that local authorities already have a duty to arrange suitable education for any child who would not otherwise receive it. Suitable education is defined as,
“efficient … education suitable … to the child’s age, ability and aptitude, and … to any special educational needs the child may have”.
The duty covers all compulsorily school-age children who are not receiving suitable education. This could include pupils who are unable to attend a mainstream school because of bullying, but it is not limited by the reasons for a child being unable to attend school.
The duty is also not limited by the length of time a child will be missing education. For example, statutory guidance on the education of children unable to attend school because of health needs states that alternative arrangements should be put in place for children missing 15 days of school or more, whether consecutive or cumulative.
Separate statutory guidance on alternative provision, issued in January this year, sets out that parents, pupils and other professionals should be involved in decisions about the use of alternative provision. It also states that there should be clear objectives and arrangements for monitoring progress.
My noble friend Lady Brinton made a point about the shortage of alternative provision. I am delighted to tell her that already, under the free schools programme, we have approved 33 new alternative provision providers. So far as Red Balloon is concerned, I have met Carrie Herbert. I have initiated conversations between her, the department and the New Schools Network, and I hope that she has taken on board what they have said about any future applications she may make under the free school proposals. However, I cannot help but wonder whether such a bid, if successful, would be allowed under a Labour Government, as it would be not a parent-led academy but a free school run by professionals, as indeed are most AP schools and special schools.
I should like to consider and investigate further the point about disincentives made by the noble Baroness, Lady Morris, who I know is very experienced in these matters.
I hope that I have been able to reassure the noble Baroness that we are deeply concerned about bullying and bullied children. We have measures in place to prevent and tackle bullying, and the safety net she is seeking for pupils who are unable to attend school is already in place. I therefore urge her to withdraw her amendment.
Lord Storey (LD)
My Lords, I very much agree. On the one hand, it is hugely important that there is early identification and early intervention. I guess that the move towards childminder agencies will ensure a more codified standard. However, there are some cracking, fantastic individual childminders. There is a danger that we will lose that whole body of people who do not want to be part of an agency but who have real talent and expertise, as we go headlong to have agencies which have to do all the following things. I am quite nervous about that move. As we have heard, district nurses and midwives have a huge part to play in early identification. We need to be very careful about how we move in that direction.
The Countess of Mar
My Lords, I support the noble Lord, Lord Ramsbotham, and the noble Baroness in their amendments. When my elder granddaughter came to visit us, we found it very difficult to understand what she was saying. When she got to the age of three and a half my husband, who was a schoolteacher, was saying, “Huh, huh, huh” or “Ber, ber, ber” to her to try to get her to pronounce things. My daughter got into a furious rage and took her home, but then realised that the child could not communicate and was getting very frustrated because we could not understand what she was saying. She took her to a speech therapist. On the health service, it would have been 14 or 15 months before she could get help, so she took her privately. My granddaughter was diagnosed as being quite severely dyspraxic. She struggled through school but got her A-levels and is now deliriously happy at university doing a course in fine arts, restoration and conservation, which is right up her street. She was caught early, which is so important. She will have a career; everyone wants someone who can conserve things. She has been to the House and visited the conservators.
It is important that we catch them early. My granddaughter started off being able to speak at the age of nine months, but then had an accident involving a head injury that was not picked up, so midwives or district nurses would not have seen that. The noble Lord, Lord Ramsbotham, and the noble Baroness have an important point.
Lord Ramsbotham
I just say to the noble Baroness and the noble Lord, Lord Storey, that I was referring to the assessment required now in the early years foundation stage, which must be carried out by health visitors. I was saying that that is a compulsory healthcare test. I was mentioning that the healthcare visitor to whom we spoke in Northern Ireland mentioned the value that she had had from being trained by the speech and language therapist to identify the particular triggers for speech and language difficulties, which I believe ought to be common practice everywhere.
Lord Patel (CB)
My Lords, this amendment would add a new clause after Clause 23. It refers to Section 19 of the Education Act 1996 and seeks to improve it. Therefore, I hope that the Minister will find this a helpful amendment, as it seeks to do what he has been trying to do with his own amendments.
To summarise, Clause 19(6) of the Education Act 1996 would be repealed and after subsection (5) would be inserted a new subsection (5A), which refers to:
“Suitable education for children and young people”,
the definition of which would be inserted according to the wording of my amendment. The amendment would ensure that legislation and subsequent statutory guidance and regulations reflected the Government’s policy intention that all children, regardless of circumstance or setting, should receive a quality education as per the statutory guidance published in January 2013. I commend the Government for the publication of their guidance, and I shall come back to that again.
The reasoning behind my amendment is that Section 19(6) of the Education Act 1996 currently reads:
“In this section ‘suitable education’, in relation to a child or young person, means efficient education suitable to his age”—
it is always “his”, although it means “his or her”—
“ability … and to any special educational needs he may have”.
I consider that a more thorough definition of “suitable education” will help to achieve the Government’s aspiration for young children and persons learning in alternative provision, and it is that inclusion of alternative provision that I am seeking in the definition in the Education Act.
Alternative provision is defined as education arranged by local authorities for pupils who, because of exclusion, illness or other reasons, would not otherwise receive suitable education. This includes the education that a child or young person may receive in a hospital school, in a medical pupil referral unit or through home tuition.
The Committee may well be aware, since other noble Lords have referred to it, that CLIC Sargent, the UK’s leading cancer charity for children and young people, has found in a study that young people—particularly those with cancer, although it also applies to children with other diseases—who are receiving education in a hospital school or medical PRU setting while undergoing treatment do not receive a quality of education equal to those in mainstream education. Its research, published in the document No Child with Cancer Left Out, found that 70% of parents said that their child had very little education outside their normal school. In fact, to quote one parent of a child with cancer:
“We waited nearly a year for a home teacher who was brilliant, but it really should not have taken so long. Five hours a week home teaching is too little for a child in Year 6”.
Teenagers have also commented that the education they get is not appropriate for them at their age, or to help them get through exams. There is also a lack of funding from local authorities for home education.
I return to the Government’s intention, which I thoroughly support, and the statutory guidance for local authorities that they published earlier in the year. It clearly states that alternative provision and the framework surrounding it should offer good quality education on a par with that of mainstream schooling, along with the support that pupils need to overcome barriers to attainment. I agree that this support should meet a pupil’s individual needs, including social and emotional needs, and enable them to thrive and prosper in the education system. However, it is a statement of intention and good will, not a statement of a directive which the authorities may be obliged to follow. I hope that the Minister will see that strengthening the Education Act and defining suitable education more clearly may help.
I welcome the Government’s belief that,
“pupils with cancer deserve as good an education as any other pupil and poor health should never mean poor education”.—[Official Report, Commons, 10/1/13; col. 576.]
A key part of this will be to ensure that children and young people who receive alternative education receive a quality education, and that all education provision is responsive to the diverse range of needs of children with cancer and other serious conditions. I hope that the Minister will see that this amendment of mine helps his intention, so that he might either accept it or bring his own amendment at a later stage to strengthen the Education Act. I beg to move.
The Countess of Mar
My Lords, I shall speak to my amendments; there is rather a long list of them. They are Amendments 154, 160, 178, 185, 187, 189, 193, 197, 205C and 218. It seems an awfully long list but they are very simple amendments, which all say more or less the same thing. I declare my interest as chairman of Forward-ME, as patron of a number of ME charities and as vice-chair of the All-Party Group on ME.
I first became interested in virtual education in 2004, when the Young ME Sufferers Trust, or Tymes Trust, developed an alliance with Nisai Virtual Academy Ltd, also known as Nisai Learning. Together, they developed an educational programme for young people who were too ill to attend school or who could attend only intermittently and who, as a result, were missing out on large chunks of their education. At a function in the House last year the noble Lord, Lord Clement-Jones, founder-patron of the Tymes Trust, said:
“No wonder students with ME find concentration so difficult. When a student makes an effort, oxygen levels in the brain can fall instead of rising to cope with … demand. Obviously, it can be next to impossible to study effectively after struggling into school”.
He finished by saying that,
“students can be thought lazy, or just awkward when they are doing their best. Often staff do not realise why the student either can’t get to school at all or can’t concentrate on their work when they get there”.
Tymes Trust research has shown that,
“for young people with ME, the most effective form of education is home based, with interactive virtual education producing grades equivalent to, or higher than, other healthy students at school. The protocol that has been developed enables very sick students to achieve, when otherwise they are typically condemned to a recurring pattern of school attendance and subsequent relapse with little to show for it. They often feel that they are failures, when in reality it is the education system that has failed them”.
It is not just students with ME who benefit from virtual education, although ME is the biggest cause of long-term sick absence from school. There are young people with other medical illnesses who are not able to attend school, as my noble friend just said. Those with learning difficulties and emotional and behavioural disorders, those with disaffection with school or school-refusers, those who are excluded and sufferers from bullying, whom the noble Baroness, Lady Brinton, has so clearly defined, can all benefit from virtual education. Despite their myriad problems, those students, who would normally struggle to achieve any qualifications, find that a virtual environment is one in which they can flourish. This year, 91% of the students of Nisai Learning achieved GCSE and A-level qualifications, and 30.6% achieved A* to C grades. While this is below the national average, many of these students would have had no GCSE or A-levels under their belts.
The Bill focuses on provision for children with special educational needs who are in the main stream. That excludes some 100,000 children who do not have access to mainstream education, for some of the reasons that I have given. According to a BIS research paper published in January this year on the motivations and barriers to learning for NEETs—those not in employment, education or training—more than nine in 10 young people with experience of being a NEET are motivated to learn, while seven in 10 of the same young people looking for learning opportunities felt that there were barriers associated with access to education. It is intolerable that young people such as these should be left behind when we know that, with the right support at the right time, they can succeed.
Education outside the mainstream is often supplied by individual organisations that have created imaginative ways to help those who are excluded. However, the money assigned to a student while inside the mainstream system does not follow them once they are no longer on the school roll. That means that it is impossible for students to have access to alternative provision that would help them. The Bill gives us the opportunity to rectify that state.
Online and blended education mixes visual with auditory and verbal kinaesthetic modes of teaching, and ensures that children can focus on learning without the complications of external influences with which they may struggle. They are given a structure that supports them educationally and emotionally and which enables them to become economically independent. Online learning integrates a variety of learning styles, using teachers who have a comprehensive understanding of work processes and the special needs of students who have physical or emotional problems.
Students do not wake up one morning and decide that they do not want to learn any more; there are numerous factors that contribute to their lack of engagement. For children with ME with special educational needs, virtual education protects health and promotes recovery; results in better exam grades than a child with ME can otherwise achieve; costs less than home tuition; and can be accessed at any time of the day or night. The child remains on the school roll, and the school league table can include the child’s success. Very importantly, through virtual contact with other children in a similar position, children can make many new friends whom they are able to meet when they are well enough. As a sideline, I quote a note from a former head teacher:
“the purpose of education is to educate to the best standard possible; an attendance register is not a measure of achievement or success”.
Baroness Morris of Yardley
I, too, support the two amendments in the names of the noble Lord, Lord Patel, and the noble Countess, Lady Mar, and I do so for one reason in particular. There is a real danger in the whole Bill that, by necessity—and I have no problem with this; it is what the Bill is about—we will be talking about structures, obligations and demands on people, and about trying to get the system right. We have always failed to do that in the past through successive pieces of legislation. The system does not quite work. There is a danger of forgetting that what will ultimately make a difference is the teaching once the system does work.
In terms of mainstream schools, I have always been a big advocate of talking more about pedagogy than about structures, because that is what will make the difference. We never quite get to that with special needs children because we always revisit the structures, the obligations and the legal framework. What I like about both the amendments is that they are about what happens when the structure works in terms of the quality of teaching and the learning experiences of the children who would access their education through these provisions.
I do not like the phrase “blended learning”. I am not familiar with it and it took me a long time to work out what it was. I had a few ideas, none of which was anywhere near the truth. Therefore, perhaps the wording is not quite right but the kernel and the elements of it are right—it is about what happens in the classroom once the system is working. It would be a shame to let this bit of the legislation go by without having a good debate on that to ensure that we give really clear signals that what we care about for children with special needs is not just that the structure works for them but that the quality of the teaching is appropriate and meets their needs.
On blended learning and online learning, we have not yet gained what we could regarding advances in technology and education. We have done so in higher education and further education but in schools we are lagging behind. For a long time, I have thought that the group that can most benefit from this are children with special educational needs, because of the technology and because of the need that there sometimes is to learn in more than one place.
These are two really good amendments. They put us into a different place when we come to talk about the education of special educational needs children. I hope that the Minister will reflect on them and perhaps discuss how the Government might take them forward.
The Countess of Mar
Perhaps I can point the noble Baroness to my Amendment 218, which has a definition of blended learning.
Baroness Howe of Idlicote
My Lords, I support the amendments. When I first received the briefing about blended learning, I was slightly puzzled by it all. However, the deeper you get into it, the more appropriate it seems for many of the circumstances that we are facing, particularly with SEN children. I very much hope that the Minister will be able to find a way of supporting it, or of allowing it to be used in a number of different ways with the children for whom it is appropriate. I fear that, all too often, I am less than enthusiastic about the advantages of the internet and all the things that enable us to access all sorts of things online. However, if this can be a real plus for children with needs, I hope very much that it will be given a useful role and will be supported by the Government.
The Countess of Mar
My Lords, I meant to do this in my initial speech: I thank the Minister and his department for the statutory guidance. Both the ME charities with which I work, which deal with young people, have been extremely grateful for it and are making good use of it. If we could get this embedded in the Bill or indeed into the system, that would be extremely helpful. I am grateful for his reassurances. I will read what he has said and think about it.
Lord Patel
My Lords, I thank the Minister for his comments, particularly the last ones that he made about working with the charitable organisations that work with children with cancers and other health conditions. My concern was not that he was not personally sincere about making sure that all these children got a good education, nor that the guidance already issued and the amendments that the Government have brought in do not go a long way towards making sure of that. My concern was that, while the intention is to ensure that all children get their education in mainstream education, which I agree is the best for them, there are times when these children cannot be in mainstream education because of their conditions. It is the gap that occurs—the provision that is not there to continue their education—that makes them fall behind when they re-enter mainstream education. It was in filling that gap that I was hoping to see whether I could be of some help through the amendments. However, I am reassured by what the Minister has said, and I hope that he and his team can work with those who are concerned to ensure that the guidance produces the required emphasis to make sure that this education for children continues in alternative provision. I beg leave to withdraw the amendment.
Lord Northbourne
My Lords, I support the amendment of the noble Lord, Lord Low, and the comments that the noble Baroness, Lady Howarth, made about it, which were very wise and very important. Both those speakers have said what needs saying more ably than I can, and I am not going to repeat it. The only thing that I am going to raise with the Minister is whether this does not raise a question about the rather extraordinary wording of Clause 25(1):
“A local authority in England must exercise its functions under this Part … where it thinks that this would”...
Leaving aside the rather esoteric question of whether or not local authorities think, that enormously weakens the residual provisions in these clauses. It gives the local authority the excuse to say that it does not think that these things are absolutely necessary. I wonder whether the Minister might think about that.
The Countess of Mar
My Lords, I was horrified to be pointed to the report by the Children’s Commissioner, Always Someone Else’s Problem. The executive summary, which I am afraid is all I have had time to read, says:
“We have found evidence of … pupils being excluded without proper procedures being followed; these exclusions are usually for short periods, but may be frequently repeated, meaning that the child misses substantial amounts of education … pupils being placed on extended study leave, on part time timetables, or at inappropriate alternative provision, as a way of removing them from school”.
It goes on to list other examples, which I am sure the Minister is familiar with, but the final one is,
“local authorities failing to deliver their legal responsibility to provide full time alternative education for children from the sixth day of exclusion”.
In the report the Children’s Commissioner says that it is mainly SEN children who are what she calls illegally excluded from school. I am very concerned that local authorities are perhaps not taking due care to ensure that this does not happen in their areas. This is an excellent amendment that would perhaps preclude this sort of thing from happening. From that report, it seems to be happening on a very large scale.
Baroness Northover
My Lords, we appreciate the concerns that have prompted the amendments in this group and noble Lords’ determination to ensure that we move things forward for children with special educational needs, and I welcome the opportunity to respond to the discussion. I thank the noble Baroness, Lady Howe, for saying that the local offer has the potential to be transformative for these children.
We understand the reasons why the noble Lords, Lord Low and Lord Touhig, seek the publication of an action plan if the education and social care is deemed insufficient. I assure them that there is already scope in our provisions for children and young people with SEN and their parents, and local providers, to be involved in improving provision where it is insufficient. Clause 19 clearly sets out the guiding principle of the SEN provisions, which is all about putting children, their parents and young people at the heart of what the local authority does. It sets out the importance of involving children, their parents, and young people as fully as possible, and includes the need to support them to achieve the best possible outcomes.
Children and their parents, and young people, are also central to the local offer. Local authorities will be under a duty to review their local offer in Clause 30(5) —noble Lords have made reference to that—and regulation 4 of the draft local offer regulations sets out who they must consult in such a review. Local authorities will also be under a duty to publish comments on the local offer under Clause 30(6). Noble Lords, again, made reference to that.
The noble Lord, Lord Low, was probing on accountability and how the review would then, as it were, have teeth. We understand the noble Lord’s points about accountability, and we will be discussing this in a later group. Perhaps we can return then to how that will be done. However, I would say that the local offer in Clause 30(6) will require local authorities to publish their response to comments that they get from children, their parents and young people, so there is a major incentive there to act.
That is also made clear in Chapter 5 of the code of practice, which says that local authorities should publish an explanation of the action they are taking to respond to the comments. It is not simply a case of publishing what that response is. This brings transparency—a point that the noble Baroness, Lady Jones, made previously—and potential publicity. We must bear in mind that local authorities are themselves accountable to their electorate. In the debate on the previous group, I mentioned other ways in which people could hold local authorities to account. However, I do not think that it is going to be very comfortable for local authorities to have to publish critical comments and to have to justify why they are doing what they are doing. That is certainly worth bearing in mind. As I mentioned, local authorities must consult widely and involve children and young people with SEN and the parents of children with SEN in shaping local provision.
Children and Families Bill
Countess of Mar Excerpts(10 years, 8 months ago)
Grand CommitteeRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Earl of Listowel
My Lords, I want to ask a brief question of the Minister, related to this matter. My noble friend alluded to the terrible case of Victoria Climbié, in which Victoria was privately fostered. The noble Lord, Lord Laming, who was charged by the Government to publish an inquiry into her death, was very concerned about a lack of awareness of private fostering—about how we can register private fosterers and make it safer for children to be in that position of being cared for by an auntie and uncle, while not being registered as a child in care.
There has been work in the past 10 years to normalise private fostering and raise awareness about it. I know that the British Association for Adoption and Fostering has done work to raise awareness among private foster carers so that they should come forward and, I believe, give their names to be registered by the local authority. I would be grateful to know from the Minister what progress has been made in recent years in terms of the numbers of those private fostering carers coming forward. Perhaps he could write to me, along with any other information that he can send me on what is being done to reassure us about the safety of children in private fostered arrangements. I hope that is helpful.
The Countess of Mar (CB)
My Lords, I support my noble friend Lady Howarth of Breckland. For many years, I was a lay member of the immigration tribunal and I remember seeing a number of young people go through the awful process of asylum appeals when they got to the age of 18. They did not understand what was going on. In many cases, we allowed them because they had been here for so long and had become used to the country. It would have helped them enormously if they had had support earlier in their lives, as my noble friend is suggesting.
Baroness Northover
My Lords, here we are addressing another group of potentially vulnerable children, as the noble Baroness, Lady Howarth, pointed out. They are foreign-national children who are living in this country while their parents reside elsewhere. We recognise that the amendment seeks to improve safeguards for children privately fostered from abroad. We sympathise with that intention.
We fully accept that local authorities should check on private fostering arrangements when children are living apart from their close family, and current legislation provides for this. We recognise that it is sometimes difficult to establish if a family relationship is genuine, as the noble Baroness, Lady Howarth, made very clear, especially where a carer is falsely claiming to be a close relative to avoid the requirement to notify the local authority of a private fostering arrangement. This raises a potential safeguarding issue.
However, we are not convinced that the way forward is to apply the private fostering arrangements to all foreign national children who live here without their parents. This would extend the arrangements to a large number of cases where children are safely looked after by close relatives. However, we agree that this is an important issue, as children from abroad are in a particularly vulnerable position. It remains crucial that professionals who work with children from abroad, including border staff, schools, health professionals, housing officers, et cetera, can spot private fostering when they see it and notify the relevant local authority.
The current private fostering guidance asks local authorities to undertake awareness-raising activities with agencies, such as schools, to enable professionals to encourage private foster carers and parents to notify the local authority. Front-line professionals are also encouraged to notify the local authority of a private fostering arrangement that comes to their attention where they are not satisfied that the local authority has been, or will be, notified of the arrangement, so that the local authority can check that the arrangement is safe and suitable.
We are reviewing the school admissions guidance for children from abroad and are aiming to publish a revised version in January 2014. We will also shortly be publishing revised guidance on safeguarding in schools. The new guidance will specify schools’ statutory duties in respect of safeguarding, provide guidance on roles and responsibilities, including making referrals to child protection services, and indicate where to find up-to-date guidance on particular issues.
In addition, we have a project under way looking at the requirements on local authorities and the role of other agencies and services with a view to focusing efforts and strengthening the response to children most at risk. We will be talking to relevant partners and agencies, such as the Home Office, the British Association for Adoption and Fostering, Children and Families Across Borders, Ofsted and local authorities, to identify what targeted action might be taken to improve practice in local areas. There are a number of issues that we are looking at, and I am happy to share them with the noble Baroness.
An important issue is whether it is better to resolve the immigration status of children and return them to their home country as soon as possible after their arrival in the UK, rather than leave it until they reach the age of 18, by which time their ties with their home country have been greatly reduced. The current practice is to consider the needs of each child on a case-by-case basis and carry out an assessment of what is in the child’s best interests. The child and their social worker have a central role in this assessment, and contributions are usually also sought from other relevant agencies.
We have some sympathy with the argument about early return but, referring to other debates we have had, we need to be aware that many of these children may be vulnerable and have arrived in the United Kingdom having suffered very difficult and sometimes traumatic experiences. It is often the case that their parents cannot be traced or that the reception arrangements in the country to which they would be returning might be inadequate. This has meant that in practice, with the exception of transfers to other European Union countries, the UK rarely enforces the return of unaccompanied children to any country. The important issue is to try to work out what is in the best interests of the child.
I would be happy to provide any more details on this to the noble Baroness. I welcome her expertise feeding in as we consider this. I hope that in the mean time she will be content to withdraw her amendment.
International Development: Diseases of Poverty
Countess of Mar Excerpts(10 years, 11 months ago)
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Baroness Northover
Again, the noble Lord highlights an important area. Polio is on the edge of being eradicated but in Pakistan and northern Nigeria, as the noble Lord will know, religious fanatics have killed some of those trying to roll out the programmes there. The Bill and Melinda Gates Foundation is working extremely hard to tackle this but, obviously, it is a very delicate problem.
The Countess of Mar
My Lords, does the noble Baroness agree that prevention is better than cure and that a vital component of this is clean water and good nutrition? What is DfID doing from that point of view?
Baroness Northover
DfID fully recognises that malnutrition goes with diseases of poverty and is therefore trying to tackle both poverty and malnutrition. As the noble Countess says, clean water and sanitation are vital in ensuring that children, in particular, manage to survive these diseases.
Legislative Reform (Constitution of Veterinary Surgeons Preliminary Investigation and Disciplinary Committees) Order 2013
Countess of Mar Excerpts(11 years, 5 months ago)
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Baroness Northover
My Lords, this draft legislative reform order seeks to make changes to the outdated constitution of the two committees that deal with disciplinary proceedings, the disciplinary committee and the preliminary investigation committee of the Royal College of Veterinary Surgeons. At the moment, the college is required to populate these two committees with members of its governing council. In effect, that means that the same body of people is responsible for both setting the standards for the profession and dealing with possible breaches of those standards. This is not in line with modern regulatory best practice as there is insufficient impartiality and independence and there is public pressure for reform. The RCVS needs to separate these functions to balance both professional and public interests. In addition, the current size of the disciplinary committee makes it difficult to manage the current and future case load in an efficient and timely manner. The college reports that RCVS council members who are elected to the disciplinary committee are now overstretched as they struggle to find time for the increasing number of sitting days.
The constitution of the DC and the PIC is prescribed in the Veterinary Surgeons Act 1966 and reflects the regulatory practices of that time. Replacing Part I of Schedule 2 to that Act allows the college to implement modern disciplinary practices in line with other comparable regulators such as the General Medical Council, the General Dental Council and the Nursing and Midwifery Council. In these organisations, there is a separation between those who advise on professional standards and those who implement the disciplinary process.
The proposed amendment to the Veterinary Surgeons Act is to change the constitution of the two disciplinary committees, in terms of both the eligibility for membership and their size. This will allow the royal college to make changes that comply better with the Better Regulation Commission’s principles. No longer will the membership and chairmanship of the PIC and DC be drawn from the council. They will in fact be ineligible for appointment. Instead, appointment to both committees will follow an open, transparent and independent recruitment process. For the first time there will be a statutory requirement that the committees must contain a proportion of lay people, to bring a fresh perspective to the work of the committees and to improve further their independence. There will an increase in the size of the committees. This should make it much easier, and possibly quicker, to assemble a panel for an individual case-hearing from the larger pool of people, thus removing a burden, specifically defined as “an obstacle to efficiency”, from the RCVS.
The amendments will also introduce more flexibility into the constitution of the committees as well as remove the most outdated restrictive provisions. Committee members will serve for a specific term of office and for no more than two terms on each committee. The new size of the committees allows for flexibility in case further increase is needed in the future, without the need for another legislative change.
Removal of the provision regarding veterinary practitioners supports better regulation principles by removing outdated and unnecessary provisions through simplification and streamlining, while removal of the prescriptive timing of committee elections removes another burden to the college’s operation of its disciplinary process. However, provisions that are seen as important in the current Act will be retained—these relate to the size of the quorum and the important judicial principal that no member may sit on both the preliminary investigation committee and the disciplinary committee in relation to the same case.
In conclusion, this replacement of the relevant schedule to the Veterinary Surgeons Act 1966 is necessary to allow the Royal College of Veterinary Surgeons to exercise its functions in relation to disciplinary cases brought against members of the veterinary profession. It will allow the disciplinary committees to work in a more efficient manner and in compliance with better regulation principles, and will provide flexibility to cope with future changes. I beg to move.
The Countess of Mar
My Lords, I declare my interest as an honorary associate of the Royal College of Veterinary Surgeons and the British Veterinary Association. This draft legislative reform order has been long in gestation and I know there will be relief all round to see it finally enacted. The order will bring the royal college in line with other professional health bodies, as the Minister said, such as the General Medical Council, which are responsible for setting standards as well as imposing discipline on those of their registrants who may be in breach. The importance of being fair as well as being seen to be fair has grown since the human rights legislation came into force. Ensuring that membership of both the preliminary investigation committee and the disciplinary committee is no longer elected by or from among the council of the royal college eliminates the possibility of accusations of bias. Increasing the size of both committees ensures that there will be a larger pool from which to draw members for hearings. The pressure on members to attend disciplinary committee hearings will be relieved and waiting times for hearings will be reduced. We should never forget that justice delayed is justice denied.
I have always believed that lay members add strength to committees of professionals because they are in a position to ask the important “how, what, when, why, where” questions that professionals tend not to ask each other. Changing the status of the current lay observers to full membership and enabling them to vote is laudable and will increase the transparency of the committee proceedings. I am also pleased to see the built-in flexibility with the size of committees for particular hearings as well as the definition of quorum membership and size that this order defines.
The open, transparent and independent recruitment process described by the Minister and in the impact assessment is a foil to anyone tempted to complain that the appointment of committee membership was opaque and partial. This problem had been of concern to the public, the veterinary profession and the Royal College of Veterinary Surgeons for more than a decade. The possibility of producing a new veterinary surgeons Act to replace the one that is now nearly 47 years old was considered. I recall the suggestions from the EFRA committee in the other place being given a very firm put-down by the noble Lord, Lord Rooker, when he was Defra Minister on the grounds of lack of time and finance. This order is the next best thing, and I commend it.
Health: Neurological Services
Countess of Mar Excerpts(11 years, 7 months ago)
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The Countess of Mar
My Lords, like other speakers, I am grateful to the noble Baroness, Lady Ford, for raising this subject today. She has asked several very valid questions, as have other speakers, and I hope that the Minister will be able to answer them all.
While the noble Baroness, Lady Ford, has specified epilepsy services in her Question, I realise that she is aware that epilepsy is far from being the only neurological service that has inadequacies. For many years, I have worked with people with ME, also known as CFS/ME. I am chairman of Forward-ME, vice-chair of the All-Party Parliamentary Group on ME and patron of a number of ME charities. Forward-ME is a member of the Neurological Alliance.
I have been assured that Her Majesty’s Government accept the WHO’s categorisation of ME as a neurological condition. The CMO report of 2002 described it as a “genuine illness” which,
“imposes a substantial burden on the health of the UK population”.
The NICE guideline of 2007 stated that:
“The physical symptoms can be as disabling as multiple sclerosis, systemic lupus erythematosus, rheumatoid arthritis, congestive heart failure and other chronic conditions”.
Yet there is no provision to examine the neurological aspects of this illness. Patients are simply allocated to either the CFS/ME group, where they are offered psychological therapies, or to various ad hoc diagnostic categories containing patients with neurological symptoms of unknown aetiology. In practice, these can be considered dustbins where no further investigations are considered necessary.
After the Chief Medical Officer’s report on CFS/ME in 2002, £8.5 million was allocated to setting up specialist ME centres. Some of the centres have closed because of a lack of funding. Others continue to operate but are somewhat constricted by the view that the only scientifically validated treatment for the condition is a combination of cognitive behaviour therapy and guided exercise training—CBT and GET. In fact, the much trumpeted PACE trials, which cost the taxpayer some £5 million and were intended to demonstrate the effectiveness of these so-called treatments, did no such thing. There is no indication in the trial results that one single person fully recovered after a year of CBT and GET. There is no indication that any who were not working went back to work or, in fact, that there was more than a very modest improvement in those whose health was deemed to have improved.
I would like to be able to go into the facts behind this research in more detail, but this is not the occasion. However, I must say that the spin on the results has had a very deleterious effect on the public perception of the illness and on the provision of health and social care for people with ME.
What is happening to these frequently very sick individuals? There is still a great deal of scepticism surrounding the reality of this illness, despite pronouncements from government, the CMO and NICE. It is acknowledged that if the condition is caught in the early stages and dealt with conservatively, it can improve and patients can recover. Instead, patients and, particularly, children are pushed by medical practitioners or, in the case of children, by teachers, social workers and carers, to keep going to work or school on the basis that it is good for them, until they collapse and what was a mild, treatable condition becomes chronic and untreatable. They are then encouraged to undertake programmes of cognitive behaviour therapy and guided exercise training which, at best, may help them to cope with their illness or, at worst, may exacerbate their symptoms, and they are blamed for not wanting to get better.
The Neurological Alliance is concerned that for clinical commissioning groups which cover relatively small population areas, it will not be cost-effective to commission services for less common conditions. I am particularly concerned about ME because GPs will do the commissioning. The Neurological Alliance suggests that the NHS Commissioning Board should monitor the observance and development of collaborative arrangements to prevent what we have come to know as a postcode lottery.
I have spoken about the poor levels of understanding of ME among health and social care professionals. This runs through much of neurology. Lyme disease, for example, is often mistaken for ME, and no treatment is offered as a result, yet with simple antibiotic treatment, Lyme disease can be cured. There is a need to equip properly commissioners in order to address successfully the legacy of neglect which has resulted from the complexity and relative rarity of most neurological conditions. There is a need for a national neurology strategy, as other speakers have said, dedicated national leadership and mandatory quality, accountability and incentive mechanisms.
The Neurological Alliance recognises that cross-cutting initiatives can help to support, develop and enhance services for people with long-term conditions, but it is concerned that the NHS Commissioning Board takes only a generic approach to certain long-term conditions while giving particular attention to others and that commissioners’ priorities will be weighted in favour of areas given a profile. Will the Minister say what guarantees there are that patients with less well recognised conditions, or conditions such as ME and Lyme disease, will be given equal treatment?
NICE, the Department of Health and the National Quality Board have yet to establish how they will prioritise the development of more than 160 quality standards. This will have the effect of prolonging neglect in areas without NICE-accredited guidance— ME is an exception as there is guidance—leaving commissioners unsupported in what are often the most complex and challenging areas. As other speakers have already asked, is the Minister able to enlighten the House on the likely progress?
Health and Social Care Bill
Countess of Mar Excerpts(12 years, 7 months ago)
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Baroness Masham of Ilton
My Lords, this group of important amendments illustrates that good care for all is what is needed. I shall say a few words on Amendment 79 on long-term conditions. As has been said, there are many long-term conditions, and there is great anxiety all over the country because of the change. What the Minister says today will be very important and may allay some of the distress. There is a shortage of district nurses, which is an important issue for people who need dressings for leg ulcers, for example, which can last for a long time.
On a positive note, there is telecare and telehealth and other new technology for monitoring. People can be monitored in their own homes. If something goes wrong, people can call emergency services. Scotland is doing much better than England, and other countries in Europe, such as Poland and Holland, are using the system a lot. England could do a lot better for people with long-term conditions.
All the amendments in this group are exceedingly important and I am glad that my noble friend Lord Ramsbotham mentioned prisons and people in cells. When I went to see prisoners being processed, a GP was trying to fathom out what to do with a really serious alcoholic. I asked, “What are you going to do?”, and he replied, “If only I had some rehabilitation services for alcoholics, I wouldn’t have to send him to prison. What will happen is that he will be in and out all the time”. Many things can be made better, and I hope that the noble Earl will give us some hope when he responds.
The Countess of Mar
My Lords, I rise briefly to support Amendment 79 moved by the noble Lord, Lord Warner, although he should not have moved it at this stage perhaps; he should have just spoken to it.
As the Minister knows, I am concerned about people with CFS/ME. They are the most neglected, denigrated and discriminated-against group in the country and there are some 60,000 of them who are severely ill, which means that they are homebound and bed-bound. They have multi-system symptoms, which are far too often neglected. They have co-morbidities—one person that I know of, who has had ME since she was 15 and is now 30, has severe gynaecological problems but because she has ME they are not going look at those. Also, she gets no social care. It is very important that these services are thoroughly integrated and that people understand that because you have ME it does not mean to say that all you need is a little bit of CBT and GET and you can get up and go. We have got to provide for people who are severely ill. So I support the noble Lord, Lord Warner, and the noble Baroness, Lady Pitkeathley.
Earl Howe
My Lords, CCGs will be under a duty to arrange for services to meet the reasonable requirements of patients for whom they are responsible. This is the language of the current duty on the Secretary of State in Section 3 of the 2006 Act and will remain one of the fundamental principles in the future. Additionally, under their discretionary power in new Section 3A inserted by Clause 11, CCGs will have the power to arrange the provision of services and facilities for the people for whom they are responsible where that will improve physical and mental health or improve the prevention, diagnosis and treatment of illness in those people. However, CCGs do not have commissioning responsibility for all services—for instance, those that the NHS Commissioning Board will commission. For that reason, Amendment 60A would be inappropriate. However, the Bill is already expressly designed to ensure that the comprehensive health service is maintained and that patients’ needs are meet.
Amendments 76 to 78 seek to revise the commissioning responsibilities of CCGs, as set out in Clauses 10 and 11. In effect, Amendment 76 would give each CCG responsibility for commissioning for everyone normally resident in its area, removing the link between the provider of primary medical services with whom a person is registered and the CCG responsible for commissioning services for them. We think it is important to maintain this link. PCT responsibilities currently include people who may be registered with a GP in that area but who live outside the geographic boundaries of the PCT, so this is not something new. Clause 10 also includes some necessary provisions for the Secretary of State to clarify the responsibilities of CCGs in regulations—for example, when a CCG has ongoing responsibility for a patient’s care even if they are no longer a registered patient of a member of that CCG, which is an important element of the policy of continuing healthcare, and when somebody might be excluded from their responsibility, which might apply to patients registered with a GP in England but living in another part of the United Kingdom.
Amendment 78 would change the discretionary power that CCGs would have under new Section 3A into an obligation. That would go much further than the current discretionary powers of the Secretary of State. It would place CCGs in the situation of being legally obliged to arrange any services that it felt were appropriate to meet a patient’s needs. This would conflict with their duty under Section 14P to exercise their functions effectively, efficiently and economically, and could leave them open to challenge. These are judgments that commissioners, as now, need to be able to weigh up themselves in order to achieve the best possible services for their patients with the resources that they have available.
World Development Report 2011
Countess of Mar Excerpts(13 years, 1 month ago)
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Baroness Verma
My Lords, the noble Lord is absolutely right about many of the issues that he has raised today. That is why focusing 30 per cent of aid on those countries where fragility and conflict have set back the ability to move forward has been a key reform to how DfID works. Through our bilateral reviews, we recognised some of the countries where we needed to change how we gave aid to them, directing it to the causes of conflict rather than just looking at poverty.
The Countess of Mar
My Lords, does the noble Baroness accept that land hunger is a major cause of conflict in developing countries, and that if the smallholders have a sound agricultural basis it is a springboard for both security and development?
Baroness Verma
I absolutely agree with the noble Countess that we need to ensure that addressing poverty means that people have a stake in the countries in which they live, and are empowered to take decisions for themselves.
International Aid
Countess of Mar Excerpts(13 years, 6 months ago)
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Baroness Verma
My Lords, what my noble friend refers to is an agreement with the previous Government under the Lisbon treaty. We did not agree with that, but unfortunately it is now in place and we will need to make it work. We will need to make sure that controls are in place. However, spending through the EU has its own management systems—the Internal Audit Service, the European Court of Auditors and the independent European Anti-Fraud Office.
The Countess of Mar
My Lords, does the noble Baroness agree that in African countries and other third-world countries agriculture is the primary source of income for a vast majority of their populations? What proportion of DfID’s spending goes directly on agricultural projects?
Baroness Verma
My Lords, the noble Countess is right. Some 75 per cent of the developing world’s poor—2 billion people—live in rural areas. The majority depend on agriculture to provide jobs and incomes. Agriculture has a key role to play in helping to meet the millennium development goal of halving the proportion of people in the world suffering from extreme poverty and hunger. Further allocations to agricultural programmes in each country will be determined after the bilateral reviews.
Violence Against Women
Countess of Mar Excerpts(13 years, 6 months ago)
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Baroness Verma
My Lords, I commend the noble Baroness for all her work in raising these issues. Some 66,000 women subject to FGM are living in England and Wales. We need to ensure that practitioners in front-line services are better informed so as to recognise that this practice is prevalent, particularly among certain communities. We need to be able to address these issues much earlier on so that victims feel confident that they will be given support once they have been raised.
The Countess of Mar
My Lords, is anger management a component of the management of people who are abusers?
Baroness Verma
The noble Countess raises an important issue which perhaps I need to take away. We know that there are many abuses which lead to domestic violence, and I am sure that anger management will be involved.