Mental Health Bill [HL]

Debate between Earl Howe and Baroness Tyler of Enfield

Report stage
Monday 31st March 2025 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I will also say briefly that I too added my name to Amendment 51 in the name of the noble Lord, Lord Meston. In Committee, I pondered this issue long and hard. At one stage, I thought that perhaps more consultation was required, but having listened to the arguments and heard from people in the sector, which was very helpful, along with the briefings we have received, I am now firmly of the view that this is a real gap in the current Bill.

We have this opportunity and, as has been said two or three times so far today, we do not get such an opportunity very often. It might be once every 10 or 15 years that we get the opportunity to look at mental health legislation such as this. I have therefore come strongly to the view that we need to make the most of this opportunity so that there is a proper test for decision-making for under-16s—a sort of competence test—within the Bill.

In coming to that view, I have taken two or three things into consideration. One is that it would apply only when the Bill requires that a child’s competence is to be considered. Then, very importantly I thought, the amendment is concerned only with the question of a child’s ability to decide, not what happens once that has been determined. Finally, this excellent amendment explicitly limits this test to decision-making under the Bill and the previous Mental Health Act 1983. In short, it applies only to children who fall within the scope of this legislation, so it is tightly drawn. The noble and learned Baroness, Lady Butler-Sloss, set out so powerfully the need for this and the case for it, in a way that I could not possibly do. I just wanted to explain how my thinking had evolved since our discussions in Committee.

Briefly, while I am on my feet, I was always very supportive of the amendment put forward by the noble Earl, Lord Howe, for strengthening safeguards for children admitted to adult wards and out-of-area placements. This is a really important issue and I shall be interested to hear what he has to say on the subject. I was also interested to hear the Minister talk about the amendment that she has put forward in relation to this, so I hope that progress is being made in this important area. I will be interested to hear what the noble Earl’s reaction is to that.

[Earl Howe (Con)]

My Lords, I join other noble Lords in expressing my full support for Amendment 51 in the name of the noble Lord, Lord Meston. A very compelling case was put by forward by him and the noble and learned Baroness, Lady Butler-Sloss.

I also thank the Minister very warmly for her Amendment 46 and her helpful explanation of what it is likely to entail regarding the process that will flow from it. It is reassuring to know that our Committee debates on age-appropriate treatment for children and young people have been seriously considered by the Minister. I put on record my appreciation of the advanced notice she gave me of her intention to meet noble Lords’ concerns in this constructive way. I hope, nevertheless, that she will not mind me posing a number of questions prompted by the government amendment and my Amendment 58, which has been grouped with it.

Mental Health Bill [HL]

Debate between Earl Howe and Baroness Tyler of Enfield

Committee stage
Monday 24th February 2025 Lords Chamber

[Earl Howe (Con)]

My Lords, I beg to move Amendment 160BA and will speak to Amendment 160BB. These amendments, tabled in my name and that of my noble friend Lord Kamall, stem directly from the harrowing case of the murder of three people by Valdo Calocane in Nottingham. The Minister and, indeed, other noble Lords may question the propriety of referring to an individual case in this way. However, I believe that this is one occasion on which it is legitimate to do so.

The amendments I have tabled were drafted in the light of the facts that have emerged from the full independent investigation into the care and treatment of Valdo Calocane in the months leading up to the tragic events of 13 June 2023. There have also been press articles on a report by the Independent Office for Police Conduct, the IOPC, which identified 11 mistakes in the run-up to that fateful day. There is a great deal about the case that is known and not disputed, and, given the magnitude of the tragedy, it would be remiss of this Committee not to spend at least a little time considering its implications.

Before I go further, there are two things I need to say. The first is to acknowledge that the Government have agreed to a judge-led public inquiry that will start in a matter of weeks. Secondly, on that account I will do my utmost to avoid saying anything that would undermine that inquiry.

There are a number of issues arising from the treatment of Valdo Calocane that are directly relevant to the Bill because they are of wider application. The report of the independent investigation recounts the timelines associated with Calocane’s treatment. His first contact with mental health services was on 24 May 2020, when he was arrested for criminal damage and a Mental Health Act assessment was undertaken. That assessment indicated that Calocane was experiencing the first episode of psychosis brought on by sleep deprivation and social stressors.

During that first contact, he was not detained for treatment as he acknowledged that he required help for his condition. However, after returning home, Calocane was arrested again and, on admission, was considered not to have capacity to consent and was consequently detained under Section 2 of the Mental Health Act. After that episode of treatment, he was again detained on 13 July 2020, this time under Section 3 of the Mental Health Act. Upon discharge, he was

“considered to have a primary diagnosis of paranoid schizophrenia and was to continue with antipsychotic medication”.

During the course of 2021, Calocane was detained again under Section 2 of the Act and continued treatment in the community. He began missing appointments with his care co-ordinator and mental health care team from July 2022. On 4 August, the care co-ordinator attempted to make a home visit, but the given address was incorrect. On 17 August, the care co-ordinator attempted to reach Calocane at a new address, which received no response.

The report then states:

“On 23 September 2022 it was documented that as no contact had been made with VC, a decision was made at an MDT meeting on the 22 September to discharge VC back to his GP due to non-engagement. A letter to VC’s GP was written the same day, outlining non-contact and that VC had been discharged”.


The key aspect of all this is the problematic last line:

“There was no contact between VC and mental health services or his GP between this date and the tragic incidents in June 2023”.


For a whole nine months prior to the killings there was no contact between any health service and Calocane. What this demonstrates is that the co-ordination of the community aspect of Calocane’s care was clearly inadequate. After he began to miss appointments, it appears that there may not have been sufficient attempts at outreach. There were evidently issues with maintaining contact between mental health services and the patient.

It is this issue that my Amendment 160BB tries to address. The amendment takes the form of a report on continuity of care, to ensure that all options can be explored. I do not profess to have the answers but, as proposed subsection (2) in the amendment makes clear, such a report must include discussion of the possibility of creating some form of duty, placed on ICBs and/or hospital managers, to

“maintain contact with patients known to have a mental disorder”.

This is not too far from one of the recommendations of the independent investigation, which said:

“NHS England and other national leaders, including people with lived experience, should come together to discuss and debate how the needs of people similar to VC are being met and how they are enabled to be supported and thrive safely in the community”.


The point is that, somewhere along the line, the mental health care system failed Valdo Calocane and ultimately his victims and the wider public. As we debate this Bill, we have the opportunity to address these potential failures, in the hope that we can make progress towards minimising the number of patients who slip through the net in this way.

The second issue to arise from the case relates to the publication of the investigation. Noble Lords will remember that controversy arose when the NHS trust responsible refused to publish the full version of the independent investigation into the treatment of Valdo Calocane, due to patient confidentiality. We all know that the NHS did subsequently publish this investigation—I have just referenced it above—but this was not without significant public and political pressure.

There are questions to be answered about whether patient confidentiality rules should apply in cases such as this, where there is a significant public interest. Of course, there should always be adequate safeguards to ensure that a patient’s medical records are protected, but, as my Amendment 160BA sets out, where there have clearly been significant institutional failings regarding a patient who has been treated under the Mental Health Act and who has then gone on to commit a violent offence, it may very well be in the wider public interest for such investigations to be published in full.

I am under no illusion that this amendment is the absolute best solution to the problem. But I hope it at least starts a conversation and pushes the Government to review their approach to publication. There are obviously a number of concerns raised by these harrowing events. We obviously must do better. In the light of the published report, does the Minister believe that there are any measures that could and should be taken now, prior to the report of the judge-led inquiry? I thank the Minister in advance for the considered answer that I know that she will give. I beg to move.

[Baroness Tyler of Enfield (LD)]

My Lords, I rise quickly to say that I am very sympathetic to the aims behind these two amendments. They have been set out very powerfully and comprehensively by the noble Earl, Lord Howe. I feel, particularly, that an obligation to publish a report of an investigation of the type we have just heard about is absolutely essential if we are to avoid a repetition of these terrible events. There must be a way of learning lessons from this, and transparency and publication are an important part of that.

--- Later in debate ---

[Baroness Tyler of Enfield (LD)]

My Lords, I will speak to Amendments 160C and 160D in the name of my noble friend Lord Scriven. These amendments would ensure that any changes to this primary legislation implemented through secondary legislation were properly considered by Parliament before they took effect.

Amendment 160C makes it clear that certain provisions in subsection (5) should not be included under the general powers in Clause 51, and Amendment 160D then strengthens parliamentary oversight by requiring that any statutory instrument amending or revoking this primary legislation be approved by both Houses before it comes into force; that is, by using the affirmative procedure.

This is a matter of proper scrutiny. Primary legislation is carefully debated before it becomes law, as we have demonstrated throughout this Committee stage, and any later changes to it should not be made too easily or without full consideration. If a statutory instrument can amend or remove part of an Act without Parliament’s approval, there is a risk that important legal protections could be altered without proper deliberation.

This is particularly important in the context of mental health legislation, where the law directly affects the rights, personal liberties, and treatment and care of highly vulnerable people. I hope that the Government will recognise that these amendments, which are completely in line with the recommendations of the Delegated Powers and Regulatory Reform Committee, simply ensure that when primary legislation is changed, it is done with the same level of scrutiny that was given to it in the first place. I beg to move.

[Earl Howe (Con)]

My Lords, I will keep this brief since I can do no more than back the noble Baroness, Lady Tyler, in every word that she has said in support of these two amendments. We are dealing here with a Henry VIII clause that is surely far too permissive given the great sensitivity of the Bill’s entire subject matter and, as the noble Baroness said so well, its momentous significance for the health and well-being of very vulnerable people.

The absolute minimum that Parliament can expect is that Parliament be consulted in the exercise of these powers. The affirmative procedure is therefore entirely appropriate for any statutory instruments made under this clause and I hope the Minister will not disagree with what is proposed.

Health and Care Bill

Debate between Earl Howe and Baroness Tyler of Enfield

Lords Hansard - Part 2 & Committee stage
Wednesday 26th January 2022 Lords Chamber

[Baroness Tyler of Enfield (LD)]

Before the Minister sits down, is he in a position to answer the question I asked about the timing of the review regarding the position of GPs within this new set of arrangements?

[Earl Howe (Con)]

I shall need to write to the noble Baroness about that timing because I do not have it. I meant to say that I was grateful to the noble Lord, Lord Stevens, for his intervention on the way in which we hope that primary care will be better built into the commissioning arrangements than it has been up to now.

Armed Forces Bill

Debate between Earl Howe and Baroness Tyler of Enfield

Tuesday 1st March 2016 Grand Committee

[Baroness Tyler of Enfield (LD)]

My Lords, I add my support for Amendment 14 and apologise for my very croaky voice. I do not normally engage in these discussions, but I have a very strong interest in mental health. As other noble Lords have said, with so much focus on mental health now, it really has gone up the agenda. We have had a succession of extremely important reports, most recently the mental health task force report. Parity of esteem between mental health and physical health runs right the way through that report and all the thinking behind it. If we accept that report—certainly in the debates that I have recently taken part in on this subject, the Government have shown their strong support for the reports and the principles behind them, and that is welcome—it is absolutely vital that parity of esteem between physical and mental health is applied equally to members of our Armed Forces, who do the very difficult jobs that they are asked to take on, as it is to the rest of the civilian population. I simply add my support.

[Earl Howe]

My Lords, I hope that it will not surprise noble Lords to hear that I fully share the sense of importance that they attach to mental health and parity of esteem in the way that mental and physical health are treated by our health services. Both these amendments seek to address provision for the care and support of members of the Armed Forces who suffer from mental health conditions while in service. This is something that we take very seriously, as I will go on to explain.

Taking first the issue of compensation for those who suffer from mental health conditions, I should explain that the Armed Forces Compensation Scheme already makes awards for injuries and disorders predominantly caused by service, including mental health conditions. The scheme is tariff based and aims to make full and final awards as early as possible so that individuals can have financial security and focus on getting on with life and living. Claims can be made while in service or when an individual has left.

The AFCS tariff has nine tables of categories of injury relevant to military service, and these include mental health disorders. While the scheme does have time limits for claims, there is also a provision for the delayed onset of mental disorders. The Ministry of Defence recognises that owing to stigma and perceived impact on career, people may delay seeking help. The practical effect of this is that if a person who left the Armed Forces some time ago is diagnosed with a mental disorder as a result of his or her service and makes a claim under the AFCS, a compensation award will be paid as soon as the claim is accepted.

Noble Lords may recall that, having been asked to review the AFCS, including the associated tariffs, the noble and gallant Lord, Lord Boyce, made his recommendations in February 2010. As a result, the Ministry of Defence increased the maximum lump sum award for mental illness from £48,875 to £140,000. This was to accurately reflect the impact of the most serious mental health conditions. In addition to the lump sum, those with the most serious conditions with likely adverse functional effects on civilian employability receive a tax-free guaranteed income payment for life on discharge from the services or from the date on which the claim is accepted. A lump sum of £140,000 attracts a GIP based on 75% of military salary with enhancements for service length, age, rank and lost promotions.

Another of the noble and gallant Lord’s recommendations led to the Independent Medical Expert Group, a non-departmental public body, being established. It advises Ministers on the scientific and medical aspects of the scheme. The noble and gallant Lord, Lord Boyce, identified mental health as an area requiring further investigation. The subsequent IMEG review involved a literature search and discussions with civilian and military experts, as well as with veterans’ organisations. The findings were published in its second report on 17 May 2013. The conclusions and recommendations on diagnosis, causation, assessment of disorder severity and the use of interim awards were accepted and subsequently incorporated into the scheme.

The second amendment in this group would create a specific obligation on the Government to have particular regard in their annual report on the covenant to,

“parity of esteem between mental and physical healthcare”.

As I have said previously, the Government are committed to meeting the healthcare needs of the Armed Forces community. For this reason, the Armed Forces Act 2011 already requires the Secretary of State to include in his annual Armed Forces covenant report to Parliament the effects of membership, or former membership, of the Armed Forces on service people in the field of healthcare under the covenant.

I was grateful for the remarks of the noble Lord, Lord Empey, and I agree with his general point about managing expectations. However, I agree with him only up to a point in this context because I think that the healthcare which we provide to our armed services personnel, both at home and when deployed on operations, is now truly world-class. Last year the principles of the covenant were enshrined into the NHS Constitution for England. That gives a commitment to ensuring that those in the Armed Forces, reservists, their families and veterans are not disadvantaged in accessing health services in the area where they reside. Indeed, we have made several improvements, including: the provision of some £6 million a year to support the provision of enhanced prosthetic devices and services for veterans who have lost a limb as a result of service; the launch of the hearWELL programme to look at hearing loss among the service community; and the allocation of £10 million to address service-related hearing issues among veterans. I know that these are related to physical injuries; nevertheless, I hope that they show the appropriate intent.

With increasing awareness of the issues, we have taken steps to meet the mental health needs of our Armed Forces community. On this specifically, we now have a network of 16 departments of community mental health across the UK, providing out-patient care to the service community. When in-patient care is necessary, it is provided in eight dedicated psychiatric units. Additionally, the Armed Forces covenant gives a commitment that veterans should be able to access mental health professionals who have an understanding of Armed Forces culture, while NHS England is currently completing an audit of veterans mental services, put in place following the Fighting Fit report by my honourable friend Dr Andrew Murrison MP in 2010.

I can therefore assure the noble Baroness that the Government are committed to meeting the health needs of the service community, that we will continue to report on the provision of healthcare in the Armed Forces covenant annual report, and that our work to address mental health needs will be an integral part of that report. However, the principles of the covenant are to ensure that the Armed Forces community are treated fairly in comparison to the civilian population. Parity of esteem is there to ensure that all health services treat mental health with the same importance as physical health, and it applies to everyone accessing NHS services, not just the Armed Forces community. For this reason, it does not need to be legislated for under the covenant.

Given our clear commitment to support those who suffer from mental health conditions and the tangible steps we are taking to do so, I ask that the noble Lord and the noble Baroness withdraw or do not move their amendments—hopefully, reassured.

Mental Health Services: Serving Military Personnel

Debate between Earl Howe and Baroness Tyler of Enfield

Thursday 14th January 2016 Lords Chamber

[Baroness Tyler of Enfield]

To ask Her Majesty’s Government what assessment they have made of the support available to serving military personnel with mental health problems, and what plans they have to establish a 24-hour mental health helpline for serving soldiers.

[The Minister of State, Ministry of Defence (Earl Howe) (Con)]

My Lords, the Ministry of Defence is absolutely committed to looking after the mental health of our Armed Forces and provides a range of community-based healthcare in line with national best practice. Out-of-hours care already includes the free 24-hour mental health helpline run by the charity Combat Stress, which receives funding from the MoD, and the Big White Wall, which is a 24-hour online community. There are therefore no plans to provide an additional helpline.

[Baroness Tyler of Enfield (LD)]

I thank the Minister for his Answer. Will he say whether the Government consider it satisfactory that serving Armed Forces personnel are currently having, and under current plans will continue to have, to rely on support from the charitable sector for urgent mental health issues which occur outside of Monday to Friday normal office hours? With the very best will in the world, those charities will not have access to the in-house mental health records, know about their situations or the medication that they are taking.

[Earl Howe]

My Lords, there is no point in duplicating a service that already works very well. We work in close partnership with Combat Stress, which provides an extremely effective service, and, if necessary, signposts the individual to the right service according to need. There are helplines available for veterans as well, which we run on a 24-hour basis, but we do not see the need and there is no evidence that we should be looking at duplicating that service.

Mental Health Services

Debate between Earl Howe and Baroness Tyler of Enfield

Wednesday 26th November 2014 Lords Chamber

[Earl Howe]

My Lords, on the noble Earl’s second point, yes, a survey is most certainly being actively considered. On his first point, he is absolutely right. One of the task force’s focuses will be to consider and make recommendations on how we can provide more joined-up, more accessible services built around the needs of children and young people, looking at sometimes innovative solutions about how to get there and how to improve access to health and support across different sectors, including in schools, through voluntary organisations and online. I am very encouraged by the task force’s terms of reference.

[Baroness Tyler of Enfield (LD)]

Given that some 60% of children and young people in care are currently reported to have emotional and mental health problems, can the Minister say what plans the Government have to set access standards for these children as part of their wider drive to increase access to mental health services, to ensure that these very vulnerable people get the support that they need?

[Earl Howe]

My noble friend is absolutely right: there is a high prevalence of mental health issues in those leaving care. The Government are dedicated to supporting NHS England’s work to develop a service specification for the transition from CAMHS that is aimed at CCG-commissioned services. CCGs and local authorities will be able to use the specification to build on the best measurable services to take into account the developmental needs of the young person. A separate specification for transition from CAMHS to adult services is also in development.

Learning Disabilities: Community-Based Support

Debate between Earl Howe and Baroness Tyler of Enfield

Tuesday 22nd July 2014 Lords Chamber

[Earl Howe]

I do agree with the noble Baroness. For people who, with the right support, could and should be living in community-based settings, there is a variety of reasons why sometimes that does not happen. The lack of appropriate housing can be a barrier. For others, we know that clinical decisions are preventing discharge. NHS England is looking very carefully at how to strengthen second opinion to support people in in-patient settings to challenge the reasons for their placement as and when they need to. We are looking at making some capital funding available to support the transfer of people from in-patient care to community-based support.

[Baroness Tyler of Enfield (LD)]

My Lords, given the figures we have just heard about the number of people with learning disabilities being admitted to costly assessment and treatment units rather than leaving them, will my noble friend the Minister say what action the Government are taking to ensure that local commissioners—in both local government and the NHS—have the necessary skills and competence to deliver the high-quality local services that are needed to allow as many people as possible to return to their communities?

[Earl Howe]

My noble friend is absolutely right to focus on the role of commissioners. The Winterbourne View joint improvement programme has already stepped up its activity in working with local areas, including identifying 35 areas for in-depth review. NHS England is engaging with commissioners to reinforce the importance of ensuring appropriate services for people with learning disabilities close to their homes and families. That includes looking at how funding streams can be shared with local authorities so that there is no procedural blockage in the way that money moves across the system.

Mental Health: Social Work

Debate between Earl Howe and Baroness Tyler of Enfield

Monday 23rd June 2014 Lords Chamber

[Baroness Tyler of Enfield]

To ask Her Majesty’s Government what plans they have to improve the provision of mental health social work, given the incidence of mental health problems among the population.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, the Government recognise that improving mental health services remains a significant challenge. Social workers play a vital role in delivering high-quality mental health services, and the Chief Social Worker for Adults is taking forward a number of initiatives with the sector to help address these challenges. Along with the College of Social Work, we recently launched The Role of the Social Worker in Adult Mental Health Services.

[Baroness Tyler of Enfield (LD)]

I thank my noble friend for his Answer. Does he share my concern about the shortage of good social workers who are able to work effectively in mental health settings in many places in the country? What further steps are the Government taking to address this? What specific plans do they have to ensure that social workers working in integrated health and social care teams feel valued by their medical colleagues and that their professionalism is indeed recognised?

[Earl Howe]

My noble friend makes some excellent points, and I acknowledge her role as a member of the programme board for the Think Ahead programme, which is designed to attract, in particular, new graduates into social work, and specifically into mental health social work. Good-quality social work can transform the lives of people with mental health conditions. It is an essential part of multidisciplinary and multiagency working. As we move forward into new ways of working, particularly in the context of integrating care, my noble friend’s point about other professionals understanding and appreciating the value that mental health social workers can give will be key, not just in terms of earlier intervention but by building resilience, reducing and delaying dependency and ensuring that people have all the information and enabling support that they need to look after themselves better.

Tobacco: Packaging

Debate between Earl Howe and Baroness Tyler of Enfield

Thursday 3rd April 2014 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I strongly welcome Sir Cyril’s report, which is an extremely thorough piece of work. The central message from it is crystal clear and compelling; the introduction of standardised packaging would reduce the number of children and young people taking up smoking. I look forward to reading the draft regulations and the consultation, which I hope will be short. I would be grateful if the Minister would confirm that he talked about six weeks. Does he agree that, if the Government introduce this, we are going very much with the grain of public opinion? A new poll, issued today by YouGov, found that 64% of adults in Great Britain support or strongly support plain, standardised packaging, with only 11% opposed to the measure.

[Earl Howe]

I am very grateful to my noble friend. I confirm that we intend to have a consultation period of six weeks. That is as long as we think it needs to be to enable everyone with an interest, both for and against this measure, to make their views known and to enable us to factor in any considerations we may not yet have had an opportunity to consider. Although I have not seen the YouGov report to which my noble friend refers, I suspect she is absolutely right that public opinion is moving in the direction that Sir Cyril has advocated, and that we are going with the grain of what most people think. Most right-thinking people want children to be protected from the harms of tobacco. I hope that we will have public opinion behind us, should we decide to go ahead with this.

Care Bill [HL]

Debate between Earl Howe and Baroness Tyler of Enfield

Tuesday 29th October 2013 Lords Chamber

[Earl Howe]

My Lords, it will probably be of assistance if I speak to these two amendments. In moving Amendment 4, I shall speak also to Amendment 6. These amendments are designed to correct minor drafting errors in the Bill.

Amendment 4 concerns Clause 17, which relates to financial assessment. Subsection (10) clarifies that the regulation-making power to set a financial limit allows for regulations to provide for different financial limits for different types of care and support—or support, in the case of carers. Paragraph (b) states that the regulations may set,

“different levels for different levels of support”.

The amendment would correct this erroneous repetition and ensure that it reads instead:

“different levels for different descriptions of support”.

This ensures that the regulation-making power in subsection (10)(a) mirrors the regulation-making power in subsection (10)(b).

Amendment 6 relates to transition assessments of a young carer’s needs for support in Clause 64. The other provisions containing duties to carry out transition assessments—Clauses 59 and 61—require there to be “significant benefit” to the person in question. However, this clause only talks about “significant benefit” with no mention of the individual and so is quite abstract. This was an oversight. The amendment would therefore clarify that the significant benefit must be “to the young carer”, to bring it into line with the other similar provisions.

I hope that noble Lords feel able to support these minor and technical amendments, which will help ensure that the Bill is clear and works as intended. I beg to move.

[Baroness Tyler of Enfield (LD)]

My Lords, I rise briefly indeed to welcome Amendment 6 and what I see as the further strengthening and joining-up between this legislation and the Children and Families Bill in relation to young carers. I particularly welcome the greater rights it gives to all young carers. I am really pleased to see the entitlements to both assessment and support for young carers as they reach that very critical age of transition at age 18. This will help because these young people often face additional barriers at that age as they are trying to access further education, employment and training, which is so important to their wider well-being and outcomes. I welcome it very much.

Care Bill [HL]

Debate between Earl Howe and Baroness Tyler of Enfield

Wednesday 9th October 2013 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I rise briefly to speak to government Amendment 2 on dignity and respect. I know that it was implicit in the well-being clause in the earlier versions of the Bill that we looked at, but I am very pleased that the need to ensure that all people are treated with dignity and respect has been brought out so explicitly. These are words that the man and woman in the street really understand; they get to the heart of some of the concerns about the type of social care that has sometimes been provided, which has fallen well below those standards, and caused some of the scare stories that we have heard so much about recently.

The noble Lord, Lord Bichard, and I raised this issue in Committee, but as he is unavoidably unable to be in his place today, I thank the noble Earl, Lord Howe, on behalf of both of us, for listening and for bringing this amendment forward.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, I am grateful to all noble Lords who have spoken and for the opportunity to discuss once again this important new well-being principle set out in Clause 1. The amendments in this group cover three important issues. The first of these relates to the application of the duty to promote well-being to the Secretary of State. In Committee we debated the link between the role of the Secretary of State and the duty of local authorities to promote the well-being of individuals. There was clear strength of feeling in the Committee that the Bill should make explicit reference to the Secretary of State having regard to the duty on the local authority to consider the well-being of the individual. An amendment in this regard is not essential because the local authority well-being duty is in any event a relevant factor for the Secretary of State to take into account when issuing guidance or regulations. However, I do recognise the strength of feeling and I am happy to clarify the position.

In response to the concerns, I have tabled Amendment 138, which explicitly requires the Secretary of State to have regard to the local authority well-being duty when issuing regulations and guidance. This achieves, I hope, the same ends as intended by the amendments tabled by the noble Lords, Lord Hunt and Lord Warner, and I trust that they will support the government amendment.

The second issue relates to the focus on dignity, to which my noble friend has just referred. In Committee, noble Lords expressed concern that personal dignity was not adequately reflected in the well-being principle, in spite of the change that the Government made to this effect following consultation on the draft care and support Bill. Let there be no doubt that the Government place the utmost importance on dignity and respect in care. These factors must be central to the well-being principle. In order to ensure that dignity is given due prominence in primary legislation, I am pleased to have been able to table Amendments 2 and 3, which give greater emphasis to personal dignity and respect as components of well-being.

The third issue in this group relates to another constituent part of individual well-being: spiritual well-being. My noble friend Lady Barker’s Amendment 4 would include an explicit reference to spiritual well-being in Clause 1(2). We debated a similar amendment in Committee. I said then, and I emphasise now, that the Government recognise the importance of spiritual well-being as a concept and understand the particular significance that it can have for some people, especially at the end of their life. We would absolutely not want an approach that excluded spiritual well-being from consideration where that was clearly of consequence to the individual concerned.

However, it is important to understand that that is not the approach which the Bill sets out. The factors included in Clause 1(2) contain high-level matters which should be interpreted broadly to fit the individual case. Spiritual well-being should be considered where it is relevant to the person’s overall well-being. Moreover, spiritual well-being is likely to be closely related to other matters, such as emotional well-being, which are listed in the clause.

In addition, local authorities must also consider the person’s views, wishes and feelings, as set out in Clause 1(3)(b). This provides a further clear direction to local authorities to have regard to personal matters, which could well include beliefs or other views that would promote an individual’s spiritual well-being. Although it is not explicitly mentioned, spiritual well-being is nevertheless accounted for.

I hope that I have reassured in particular my noble friends Lord Hamilton, Lord Deben and Lord Cormack, and indeed the noble and right reverend Lord, Lord Harries of Pentregarth—

Health: Anorexia and Bulimia Nervosa

Debate between Earl Howe and Baroness Tyler of Enfield

Thursday 11th July 2013 Lords Chamber

[Earl Howe]

My Lords, I do not wish to duck the fact that this is a very difficult area to define. We all know that we want to achieve parity of esteem. It depends on ensuring not only that mental health services are given their fair share of the budget but that the right treatments are delivered to the right people, and that everyone in the country has access to appropriate treatments. We are currently firming up with NHS England what the right metrics are in order to judge whether they have met that aim. I will write to the noble Lord with the latest news on that front.

[Baroness Tyler of Enfield]

My Lords, I am sure that the Minister is aware of the growing trend for eating disorder clinics and hospitals to treat much younger children and, indeed, boys with eating disorders. Given this, what additional steps does the Minister think need to be taken to ensure that everyone involved—children’s services, primary schools and others—are spotting these signs, particularly in boys, where stigma is often attached to acknowledging these things, to ensure that effective treatment is quickly available?

[Earl Howe]

My noble friend is absolutely right. The figures that I have before me show that by far the largest number of cases occurs in the age group 10 to 17. We are working on raising awareness of mental health problems, including eating disorders, and on providing support in schools. Particularly, we have provided £3 million of funding over two years to the BOND Consortium, which is led by YoungMinds. The aim of that is to build capacity in the voluntary sector to support the access that schools have to local services. We are also producing an e-portal tool for children’s and young people’s mental health, which we hope will be delivered next year.

Health and Social Care

Debate between Earl Howe and Baroness Tyler of Enfield

Wednesday 5th June 2013 Lords Chamber

[Baroness Tyler of Enfield]

To ask Her Majesty’s Government whether they will consider linking the separate outcomes frameworks for health and social care.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, we will improve outcomes only if all parts of the system work together with a common purpose. The three outcomes frameworks have been and continue to be increasingly aligned, reflecting the joint contribution of health, public health and adult social care to improving outcomes. The frameworks form the basis for integrated working locally. They support local partners across the health and care system to identify shared responsibilities, pursue shared goals and improve outcomes for their communities.

[Baroness Tyler of Enfield]

I thank the Minister for that helpful reply. I certainly welcome the efforts that have been made to align more closely the various outcome frameworks, in particular the sharing of particular outcome indicators on premature mortality. Given the new duties that are now on the Secretary of State, the NHS Commissioning Board and clinical commissioning groups to reduce health inequalities, and indeed the current inequalities in the incidence of conditions such as cancer and survival rates among deprived groups, what evidence is there that using these common outcome indicators will result in more integrated services such as smoking cessation, leading to real reductions in health inequalities?

[Earl Howe]

The essence of the answer to that is that improved outcomes will be achieved only when all parts of the system work together. If you have shared measures within the outcomes frameworks and measures that are complementary to each other, you will shine a light on areas of inequality and inform local and national action to advance equality. This focus on outcomes rather than processes enables an innovative approach to health and care services that is driven essentially by the needs of the local population. I will just add that local Healthwatch has a role to play in working with partners to make sure that the views of vulnerable and seldom heard groups in the population are heard.

Health: Hearing Loss

Debate between Earl Howe and Baroness Tyler of Enfield

Monday 17th December 2012 Lords Chamber

[Earl Howe]

My Lords, I am sure the Health and Safety Executive will take my noble friend’s comments to heart.

[Baroness Tyler of Enfield]

My Lords, given the prevalence of hearing loss among our ageing population, will the Minister say what is being done to ensure that hearing loss is being effectively managed in residential care homes for the elderly? What steps are the Government taking to work with the regulator to ensure that providers are being held accountable for responding to the needs of people with hearing loss?

[Earl Howe]

My noble friend raises a very important point about care homes. There have been considerable improvements in services for people with hearing loss over recent years. The waiting times for assessment and treatment for hearing problems in adults have been considerably reduced. The health and social care reforms provide opportunities to improve services further. For example, two-thirds of PCT clusters have chosen adult community hearing assessment services as a priority area in which to extend patient choice of provider. We expect that work to continue when CCGs take over.

NHS: Spending Formula

Debate between Earl Howe and Baroness Tyler of Enfield

Tuesday 3rd July 2012 Lords Chamber

[Earl Howe]

My Lords, we come back to the issue of age in this context. I say again that we believe, as did the previous Government, that age is the primary driver of an individual’s need for health services. The very young and the elderly, whose populations are not evenly distributed throughout the country, tend to make more use of health services than the rest of the population—the noble Baroness gave a very graphic and important example of where that applies. This principle is reflected in the most recent PCT-weighted capitation formula. As I said earlier, there are imbalances that, over time, we will seek to correct.

[Baroness Tyler of Enfield]

My Lords, accepting that —as the Minister said—we are where we are, could he explain what evidence base is being used to determine the allocation of resources to CCGs?

[Earl Howe]

My Lords, the funding formula is made up of a number of components, including capitation, deprivation, age, the number of young people not staying in education and the number of people over 60 claiming pension credit. I have a long list in front of me. However, ACRA, the independent body that I mentioned, is composed of a group of independent-minded people who are keen to take into account every relevant factor that bears on this question. If my noble friend wishes, I will write to her with a more detailed list of the factors that historically have been in the formula.

Care Homes

Debate between Earl Howe and Baroness Tyler of Enfield

Monday 28th May 2012 Lords Chamber

[Earl Howe]

My Lords, as I made clear earlier, there is already a test for those people who are in charge of a care home. The CQC has procedures to verify the acceptable status of such people. Furthermore, there are very strict rules under the Financial Services Authority regulations, which require company directors to pass a “fit and proper person” test. We are not sure what added value might be conveyed by a further test, as the tests are already there.

[Baroness Tyler of Enfield]

My Lords, given the very great anxieties experienced by care home residents and their families on this issue, what steps are the Government taking now to prevent another Southern Cross situation arising, in both intelligence gathering and strengthening the regulation and oversight of the sector?

[Earl Howe]

My Lords, the Government are working with the Association of Directors of Adult Social Services and the Care Quality Commission. We are gathering greater intelligence on the social care market and its major providers, which will be used to give early warning of impending problems. We will continue to meet regularly with the major care providers to discuss their trading performance, their financial situation generally and how they are addressing any issues which put pressure on their ability to continue trading.

Health and Social Care Bill

Debate between Earl Howe and Baroness Tyler of Enfield

Monday 19th March 2012 Lords Chamber

[Earl Howe]

My Lords, I will speak also to Amendments 9 and 10. The three amendments in this group share a common purpose in strengthening the duties on the NHS Commissioning Board and CCGs in relation to reducing inequalities. I am grateful to my noble friend Lady Tyler for highlighting on Report the need to ensure this, and I promised at the time to introduce the necessary amendments at Third Reading to achieve it.

New sections 13G and 14T place duties on the NHS Commissioning Board and CCGs to have regard to the need to reduce inequalities between patients with respect to their ability to access health services, and to the outcomes achieved for them by the provision of health services. As the Bill stands, the NHS Commissioning Board and CCGs must assess in their annual reports how they have discharged this duty. However, they are not explicitly required to plan for this and, in the case of CCGs, not specifically assessed on this in the board’s annual performance assessments. These amendments introduce explicit requirements on these points. They require the board to include in its business plan, and CCGs to include in their annual commissioning plans, an explanation of how they intend to discharge their inequalities duties. I remind noble Lords that CCGs will consult on their commissioning plans with those for whom they are responsible, and must involve each relevant health and well-being board in preparing and revising their plans.

The amendments also require the board to specifically assess in its annual performance assessment of CCGs how they have discharged their inequalities duty. So CCGs will have to set out in their plans how they will take account of the need to reduce health inequalities and report on how they have done this in their annual reports, which is of course already a provision in the Bill. Their performance on this will then be one of the factors taken into account by the board when it assesses their performance. Together, these amendments ensure that from the development of the plans to the reporting on their effects, having regard to the need to reduce inequalities will be given particular emphasis and importance by commissioners. I beg to move.

[Baroness Tyler of Enfield]

My Lords, I shall speak to government Amendments 7, 9 and 10, to which my name is attached, and in so doing I thank the Minister for tabling them. As he has explained, they all relate to health inequalities; I would like briefly to place them into a wider context. In doing so, given that this is Third Reading, I make one general point. My view from the outset has been that this Bill should be judged ultimately by the health outcomes it produces—essentially, whether and how it improves people’s lives, particularly the most vulnerable. Because so much of the debate over the past year has—necessarily, I guess—been about structures, I sometimes feel that we have rather lost sight of this fundamental point. One specific point that has not received enough airspace in our deliberations, perhaps until today, is about reducing health inequalities—or, put another way, doing something real about unequal life chances. At the very outset, I felt that the fact that this legislation contains a landmark legal duty for the Secretary of State to reduce health inequalities was really significant.

As the noble Earl has explained, as the Bill has progressed through its various stages this duty has been strengthened at various levels in the new structure, so that reducing health inequalities now runs through the whole fabric of the health system in a way that we have not seen before. I will not repeat precisely what these amendments do, because they have been very ably set out. Briefly, however, in relation to the requirement that each CCG’s performance is assessed each year by the board and includes the progress made in reducing health inequalities, we all know that what gets measured gets done. That is what makes this significant.

However, we should not look at these specific duties in isolation from other key aspects of the Bill on accessibility and integration. New duties to join up services between health, social care and other local services, such as housing and homeless support, will have a crucial role to play here. The role of health and well-being boards in promoting joint commissioning should enable more integrated services, particularly, for example, for older people and people with learning disabilities. Finally, the much stronger focus on public health—I greatly welcome its return to local authorities—will be key to tackling issues such as obesity, smoking, drug and alcohol abuse and sexual health, which make a real difference in reducing health inequalities. This all adds up to a much stronger package than we have had before. Of course, the proof of the pudding will always be in the eating, but this very welcome shining of the spotlight on health inequalities has the potential to be a game-changer for some of the most vulnerable.

However, in case noble Lords think that I am being too uncritical, I finish on a point of concern. Local authorities are well placed to tackle inequalities, due to their responsibilities for education, housing and other factors which impact on health. The current proposition for holding councils to account for this is through what the Government call a health premium, to give extra money to those areas that reduce health inequalities. We need to be careful that this does not simply reward those areas where it is easiest to tackle inequalities and divert money away from areas where more fundamental problems may slow down progress.

In thanking the noble Earl most sincerely for tabling these amendments and paying tribute to his strong personal commitment on these issues, I respectfully ask him whether he will keep the health premium under review as it is rolled out.

NHS: Consultation on Reform

Debate between Earl Howe and Baroness Tyler of Enfield

Tuesday 26th April 2011 Lords Chamber

[Earl Howe]

My Lords, I think there is widespread agreement that the principles on which the Bill is based, such as devolving control of the NHS to local levels, placing patients at the heart of decisions about their own care and improving public accountability are the right principles for us to be guided by, but that there are also, as the noble Lord said, questions and concerns, some quite deep, about what we are doing and the mechanics of putting the principles into practice. As the Prime Minister and Deputy Prime Minister made clear, this is a genuine chance to make a difference. Where there are good suggestions to improve the legislation, those changes will be made.

[Baroness Tyler of Enfield]

My Lords, what steps are the Government taking to plug the gaps in the membership of the NHS Future Forum? Will the minutes of the forum be made available to the public?

[Earl Howe]

My Lords, the forum, as I understand it, is now fully composed. The appointments were made over the past 10 days or so. I am not aware of any further appointments. The plan is for the forum to produce a report which will be published at the end of the day. I will, however, write to the noble Baroness as regards the minutes, which are a matter for the chair of the forum, which is independent of the Government, as she will know.