Health and Care Bill

Debate between Earl Howe and Baroness Uddin

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Baroness Uddin (Non-Afl)]

My Lords, I spent some decades of my personal and professional life trying to improve health and social care through the statutory and voluntary sector. I welcome the prospect of refining the Bill in the interest of service users and staff alike, to whom I pay my deepest respects in the light of what has been an impossible and worsening situation for the health of our nation.

I recently witnessed two contrasting events: a patient in an acute ward for mental health, and another progressing though intensive care and then a surgical ward. The staff shortage and lack of adequate care support is indeed grave at every level, and I know my family will not be the first or last to share these harrowing experiences. Therefore, my principal reaction to the many aspects of this ambitious legislation and the report on adult social care is that they ring hollow as wishful prayers.

The Government have said that the Bill is driven by NHS demand. I fear that most frontline staff across the service do not agree; nor have they asked for the inevitable fragmentation and the huge structural upheaval which may result, given the existing shortage of staff and funding within the NHS and care sector as it struggles with Covid.

Of course, I hope that the panacea on the written papers will improve service users’ actual experience. Given the glaring lack of any meaningful references to workforce development and, ominously, of any indication that the long-standing consequences of inequalities and discrimination are being addressed, my confidence is rather low at this point.

We are asked to respond to a 10-year plan fit enough to address a massive, long-standing crisis where people are waiting to receive the urgent care to which they are entitled: 1.5 million hours of commissioned care is not being delivered and at least 400,000 adults and families are waiting for formal assessment. This gravely undermines the human rights of those who may already be experiencing a great deal of indignity, pain and desperation. Does the Minister accept that the new proposed boards and commissioning structures may create an even greater backlog of unmet needs?

How do the Government propose to address these anomalies while introducing the new challenges of means-tested personal care and private care companies into an already frail NHS, which struggles to manage current demands? According to the Royal College of Nursing, the Bill as it stands does not address nursing staff concerns, ensure patient safety or give adequate weight to staffing shortfalls in the NHS and the social care sector.

According to other leading experts, including ADASS, £1 billion for the social care sector, while extremely welcome, is not aligned to the reality of the £7 billion investment required to meet urgent needs, and is unlikely to remedy the current crisis in social care. The fear is that the prolonged and chronic historical underfunding—the insufficient resources allocated for social care in the community, which is a disjointed system at local level—will exert even more pressure and cause untold misery and suffering for individuals and families who are among the most vulnerable: the elderly, the disabled with learning disabilities and autism, and people needing mental health support. Integrated care will therefore remain dysfunctional locally, regardless of the fact that half the available social care budget is spent on working-age adults with learning and physical disabilities and the elderly to empower care in the community.

We know that supported housing is seen as a critical linchpin of independent living and is projected to increase by 2030. With only £300 million for these options, does the Minister accept that the Government will have to broaden their reach to widen the network of providers, including specialist and BAME providers, to provide comprehensive and equal care across all communities?

How will these proposals affect the lives of black and Muslim men experiencing mental health crisis who are festering in hospital wards without adequate support, counselling and rehabilitative programmes, and with next to nothing on prevention? I am pleased to hear the new announcement for funding for drug and alcohol treatment. As an experienced leader in the field of dealing with substance misuse at local and national level, I can assure the House that adequate funding for resources and social work support is indeed effective in preventing revolving doors, which can save the NHS and the justice system millions. As the distinguished noble Lord, Lord Ramsbotham, clearly and eloquently said, the Bill should be the right place to consider this service.

Caring institutions and organisations are often run by poorly paid and undertrained staff, including social workers, who are once again in our sight for scrutiny. I declare my interest as one. I have worked in child protection and with domestic violence victims and survivors, as well as those with disabilities and substance misuse problems. I understand the horrendous pressures at the front line.

I have two final points. The APPG on Children, alongside many leading NGOs, is anxious that the Bill does not do enough to bring the benefits of integrated working to children and families. I support its asking the Government to commit to assess the Bill’s impact on children within two years of its implementation. Lack of investment in social work, police and education has once again led us to a tragic death, that of Arthur Labinjo-Hughes. As a social worker, I have witnessed the demeaning and catastrophic effect of child abuse. Heartbreakingly, it is a fact that lessons learned from what happened to diminish the hope, the smiles and Arthur’s last breath may not prevent the last cry of a child unless we empower staff at the front line of managing complex violence and abuse in our midst.

Finally, I draw the House’s attention to the points raised by the Inter-Collegiate and Agency Domestic Violence Abuse coalition. It views the Bill as an opportunity to deliver the health needs of survivors of domestic abuse. It rightly asks that the guidance for integrated care systems and partnership boards be placed on a statutory footing to ensure that it is adhered to across the health service. I agree with the noble Lord, Lord Shinkwin, that this guidance should also apply to those with learning disabilities and communication needs.

I welcome and congratulate noble Lords—

[Earl Howe (Con)]

My Lords, contrary to the clock, the noble Baroness has been speaking for nearly eight minutes. Perhaps she could bring her remarks to a conclusion.

[Baroness Uddin (Non-Afl)]

I welcome and congratulate the noble Lord, Lord Stevens of Birmingham. I hope that we will all work together to enhance this Government’s efforts for better regulation. I hope that we can safeguard the needs of the most vulnerable in our society.

Business and Planning Bill

Debate between Earl Howe and Baroness Uddin

Committee stage & Committee: 2nd sitting (Hansard) & Committee: 2nd sitting (Hansard): House of Lords
Tuesday 14th July 2020 Lords Chamber

[The Deputy Chairman of Committees]

I have received a request from the noble Baroness, Lady Uddin, to speak briefly after the Minister.

[Baroness Uddin (Non-Afl) [V]]

My Lords, I wanted to speak in support of the noble Lord, Lord Kennedy of Southwark. I was not able to do so because I was muted from the other side; I therefore seek the leniency of the House in making my points.

In the past few months, we have become accustomed to approving measures retrospectively. Our debates have become mostly redundant because of the need to accommodate the next set of schedules and amendments. It has been important for me to put forward my views on this Bill.

Given the significant role of local authorities in the recovery of our communities, the reporting requirement in this amendment must detail the extra cost of how measures in this Bill will have an impact on local communities, as it is not clear. As a former councillor, I fear that the inevitable result will be a greater workload and higher cost for most authorities, including planning services. Many local authorities have been put on the back foot by some of the proposed measures and, by all accounts, feel sidelined.

As the noble Lord, Lord Paddick, and other noble Lords passionately detailed, it is local authorities and local police forces who will have to manage the fallout and environmental impact of any breaches or disputes and mop up after anti-social behaviour. I am in complete agreement with the points made yesterday by the noble Lords, Lord Paddick and Lord Sheikh, about the result and detrimental impact of increasing the availability of alcohol. Therefore, this House requires more than assurances on reducing closing times. The impact can be felt by local residents—as well as the police and health services, of course—long into the night.

I am also concerned about the planning aspects of the Bill coming into this emergency process. The three-monthly review required by this amendment is of the highest imperative in warranting the necessary transparency in, and safeguarding of, local consideration of public interests. The Bill would worryingly enable planned development delayed by the Covid-19 outbreak to go ahead, forgoing the usual standards, such as requirement of local public consent, as eloquently detailed by the noble Lord, Lord Balfe, and others.

I appreciate that responding to housing need is of the utmost urgency. As a former deputy leader of Tower Hamlets Council, I am also fully conscious of the central role of local authorities in the planning process, and their duties and obligations to meet the needs of local residents and communities. This is equally significant when considering the environmental and health effects of long working hours on residents, particularly children. What provision will be made for environmental standards in the proposed local government emergency planning reforms?

It is worth reflecting on the Government’s own recent deluge of impositions, usurping the local planning process, which would have obvious detrimental consequences, incurring significant financial loss to the community benefits available from a number of local planning permissions granted. For decades, this has been a creative partnership route, allowing local authorities to build a fairer and more balanced mix of social and private housing and community facilities. The delay to accessing the community interest levy suggested in the Bill is deeply unsatisfactory. What consideration will be given to working with housing associations to ensure that good-quality family housing will also be built through permitted development rights —not just expensive housing creating segregated communities and further exacerbating social division? If the Minister is not able to answer, I would appreciate it if he would write to me and other interested Members.

No matter the political expediency, I see no value in, or justification for, management or planning decisions falling under emergency measures. I agree with my noble friend Lord Hain and the noble Baroness, Lady Wilcox, who have cited justified concerns and questions about land banking and other tensions within local authorities that they have to deal with. Local authorities should be at the heart of planning consent, and the Government should not persist in allowing fast-tracking for developers, which will inevitably compromise community housing needs.

The Bill would amend existing requirements concerning appeals to the Planning Inspectorate and would be a permanent change to the appeal procedure; it is a fundamental shift in local democratic accountability. Therefore, will the Minister assure the Committee that the quarterly review will encompass independent and local oversight of all planning applications granted for housing under this emergency legislation? Will he also make public any objections raised by local residents to safeguard due process in all planning consent while this emergency legislation is in place? I am extremely grateful to all Members for their patience.

[Earl Howe]

My Lords, with the leave of the Committee, I will reply very briefly to the noble Baroness. I was sorry to hear her questions because it appeared from what she said that she is fundamentally against the purposes—or most of the provisions—of the Bill. I hope that is not the case and will of course consider the questions she has asked. I simply remind her that extensive consultation has taken place with the Local Government Association, voluntary bodies and local associations of various kinds, and we have not encountered hostility to the purposes of the Bill, which are of course to enable the economy—and businesses in the economy —to get going again after the dreadful pandemic that we have all endured.

We have, in fact, been over most of the points raised by the noble Baroness at some length already, whether at Second Reading or in these Committee proceedings. I also remind her that these are, with two exceptions, temporary provisions. The noble Baroness made as if to say that we were setting in stone forever provisions that she had considerable concerns about. This is not the case and I hope that, on reflection, she will feel that this is a Bill that the country wants and needs. I will look at her questions and respond in writing as appropriate.

Coronavirus Bill

Debate between Earl Howe and Baroness Uddin

Committee stage & Committee: 1st sitting (Hansard) & Committee: 1st sitting (Hansard): House of Lords
Wednesday 25th March 2020 Lords Chamber

[Earl Howe]

All I can do is assure the noble Baroness that the points she has made will be taken back to the department and considered.

[Baroness Uddin]

My Lords, I too regret another intervention, but how will people know what is going on if they are number 30,000 in the queue? How will they communicate with the Government or the necessary department? What are the Government doing to ensure that they communicate to these people how they should react and respond? Is everything being done that can be? Maybe some of those working in the gig economy who have nothing to do will be asked to join some of these telephone contact centres as paid employees. That might be of additional assistance to the Government.

[Earl Howe]

My Lords, as the noble Baroness knows, there are various avenues for individuals to utilise. One might be contacting their local Citizens Advice to enable it to make representations. They can contact their Member of Parliament to enable him or her to make representations on their behalf. They are not without the means to communicate if something does not work as it should.

BBC Charter Review

Debate between Earl Howe and Baroness Uddin

Wednesday 22nd January 2020 Lords Chamber

[Baroness Uddin (Non-Afl)]

My Lords—

[Earl Howe (Con)]

My Lords, it is the turn of the Liberal Democrats.

Autism

Debate between Earl Howe and Baroness Uddin

Wednesday 4th February 2015 Lords Chamber

[Baroness Uddin (Non-Afl)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper. In doing so, I draw the House’s attention to my declared interest.

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

My Lords, there are a number of current government-funded research projects linked to autism. These include a Medical Research Council study to identify why certain genetic mutations can cause problems during brain development. By following the National Institute for Health and Care Excellence’s guidelines and toolkits, autism diagnosis can be speeded up. NHS England also has plans to use its local audit teams to provide assurance that people’s experiences of the diagnostic process are acceptable.

[Baroness Uddin]

My Lords, I thank the Minister for that thoughtful reply. He and I agree completely that there have been massive improvements in diagnosis over past decades. However, according to the Government’s Think Autism document, reports by the National Autistic Society and the BME organisation Include Me TOO, the experience of many parents seems to be that there are significant disparities and underdiagnosis, particularly among the BME communities. Given the crucial importance of timely diagnosis to the future prospects of someone with autism, how does the Minister’s department intend to address this currently patchy and inconsistent assessment service for all those who are identified as needing a full diagnosis on time and according to the Government’s own standards, and how does it intend to monitor progress?

Mental Health: Beds

Debate between Earl Howe and Baroness Uddin

Tuesday 29th July 2014 Lords Chamber

[Earl Howe]

It certainly is important that we get to the bottom of what is really happening. We take this issue very seriously. The Care Quality Commission intends to explore the issue of people being detained in order to access psychiatric units in its ongoing review of emergency mental health care. The findings of that review will be published later this year. The CQC’s Mental Health Act commissioner regularly and routinely looks at the lawfulness of detention. In fact, the Care Quality Commission is currently developing a new approach to its responsibilities as a regulator of the 1983 Act.

[Baroness Uddin (Non-Afl)]

My Lords, as a former social worker I know all too well the real cost of sectioning people, the impact that it has and, of course, the immense cost to the overall economy. How will the Government ensure that communities are equipped to look after those with moderate needs, some of whom will have learning disabilities and conditions such as autism spectrum disorder, before a crisis point is reached?

[Earl Howe]

The noble Baroness referred to people with moderate health needs, which is departing slightly from the Question on the Order Paper. However, I can tell her that mental health policy and its delivery is now a major focus. We have a mental health system board to ensure that all the elements of the health and care system work as effectively as possible together. There is a ministerial advisory group in operation. Parity of esteem is reflected in the NHS constitution and in the Health and Social Care Act 2012. We have challenged NHS England through the mandate to make measurable progress this year towards achieving parity of esteem between mental and physical health.

Health: Transition to Adult Health Services

Debate between Earl Howe and Baroness Uddin

Wednesday 11th June 2014 Lords Chamber

[Earl Howe]

My noble friend raises another extremely important point which applies not only to cancer, but also particularly to mental health settings. We have had many debates in this Chamber about age-appropriate settings. I will take her point back with me and find out where we are in our dialogue with stakeholder groups.

[Baroness Uddin (Non-Afl)]

My Lords, can the noble Earl tell the House whether the commissioning will specify autism in the service specifications? Further, will the NHS England staff who are responsible for implementing these measures be trained to deal with the issue of autism?

[Earl Howe]

The noble Baroness raises an important point and I can reassure her that we are addressing the full range of complex needs in children and young people. She may also be interested to know that Health Education England will be working with the Royal College of General Practitioners and the Royal College of Paediatrics and Child Health to develop a training course that will allow GPs to develop a specialist interest in the care of young people with long-term conditions. The aim is to introduce the course in September 2015. It will include a particular emphasis on the transition from childhood.

Independent Living Fund

Debate between Earl Howe and Baroness Uddin

Monday 12th May 2014 Lords Chamber

[Earl Howe]

As the noble Lord knows, local government social care funding is not ring-fenced. We believe that allowing local authorities the flexibility to manage their budgets locally means that they can respond to local needs and priorities better. The Care Bill, as I have just said, will require local authorities to involve the person in the development of their care and support plan and, as far as possible, agree that with them. The person’s care and support plan may be different from their current package, but the central point is that they will be at the heart of the process to ensure that the package provides them with choice and control over their lives.

[Baroness Uddin (Non-Afl)]

My Lords, the Government’s recently published strategy, Think Autism, vowed to help people with autism spectrum disorder to live independent lives. However, the abolition of the Independent Living Fund withdraws the very scheme that was set up precisely to help those vulnerable people to live in the community. How many people with autism spectrum disorder currently receive support under the Independent Living Fund and will therefore be affected by this closure?

[Earl Howe]

My Lords, I do not have that figure in my brief but the number of people receiving payments from the Independent Living Fund is relatively few in comparison to the total number of people receiving adult social care and support. If I have any further figures that I can supply to the noble Baroness, I shall be happy to write to her.

Care: Older People

Debate between Earl Howe and Baroness Uddin

Wednesday 7th May 2014 Lords Chamber

[Earl Howe]

My Lords, I can assure the noble Baroness that there is no chaos and confusion. As regards reduced numbers, which was where the noble Baroness started, the transformation in the service model that we are promoting focuses above all on prevention and is designed to enable people to live independently for longer, as I said earlier, so as to reduce the number of people who are dependent on formal care. Councils have told us that lower social care user numbers are partly due to the success of their core prevention work, but also due to increased use of re-ablement services for people who leave hospital to help them get back on their feet. As regards the Better Care Fund, there has been no delay there. We wanted to set aside enough time to make sure that all areas of the country have developed comprehensive plans for joined-up care. The better care plans start from April next year, as the noble Baroness is aware, and we have asked for early versions to be completed a year in advance so that we can review them, check their level of ambition and test how they will be delivered. That is what is happening now and we are broadly on track with the programme.

[Baroness Uddin (Non-Afl)]

My Lords, people with autism spectrum disorder often spend much of their lives dependent on their parents, who are likely to die before them. In the light of the evident local authority distinction between critical and substantial eligibility thresholds, how will the Government ensure that people with autism are supported into old age by a social care system that helps those with moderate needs to live independently for as long as possible?

[Earl Howe]

My Lords, the national eligibility threshold has been set at a level to reflect the most common current practice of local authorities. That will allow current practice in 98% of local authorities to continue as it does at present. The national minimum threshold will mean that people with autism, others who need care and carers will know what level of need is eligible for local authority care, no matter where they live in the country. I think most people welcome the element of the Care Bill that gave that certainty.

NHS: Mental Health Funding

Debate between Earl Howe and Baroness Uddin

Wednesday 2nd April 2014 Lords Chamber

[Earl Howe]

My Lords, I share my noble friend’s concern. I am aware that some local authorities are not giving the necessary priority to this very important area of service. It is an area that local health and well-being boards should focus on. Our aim must be to support children and young people with mental health problems, wherever possible, in the community where they live rather than seeing them go into acute settings. Admission to hospital should be a last resort. While we have no direct leverage over local authorities, we shall endeavour through NHS England and joint working with area teams to ensure that this message is not lost.

[Baroness Uddin (Non-Afl)]

My Lords, on this seventh World Autism Awareness Day, will the Minister join me in paying tribute to the parents and campaigning organisations? I ask him, on behalf of the one in 100 autistic individuals in this country who are disproportionately affected by mental illness: given the actual reduction in cash investment in mental health services, do the Government agree that funding for mental health must encompass funding for the prevention of illnesses among those most at risk rather than responding to crises that can be prevented by early intervention?

[Earl Howe]

I agree with the point made by the noble Baroness. Prevention is much better than having to cure. I pay tribute to those organisations that champion the cause of those with autism. It is a tribute to the previous Government that they published the Autism Act, part of which involves collecting evidence at local level about the population affected by autism and, in that way, focusing minds at local level—principally the health and well-being boards—to direct services appropriately.