Health and Social Care Bill

Earl of Listowel Excerpts

Tuesday 11th October 2011 Lords Chamber

[The Earl of Listowel]

My Lords, I shall try to follow the contributions of the noble Baroness, Lady Hughes of Stretford, and the noble Baroness, Lady Massey of Darwen, who is chair of the All-Party Parliamentary Group on Children, in my remarks on children. Before I do so, I join other noble Lords in thanking the organisers of the helpful briefing meetings: the noble Baroness, Lady Thornton, and the Minister. I was most grateful for the opportunity to speak with the Minister last week and raise one of my concerns about the Bill with him.

I shall also refer briefly to the eloquent and powerful speech by my noble friend Lady Hollins, in which she raised concerns about how far we have to go in winning the hearts and minds of those in practice on the ground in the NHS. She also talked about the way that mental health in adults is so often overlooked and services for them are underdeveloped. I know that the Minister was very concerned when he recognised that 40 per cent of adults who smoke have a mental disorder and that there is a strong association between mental ill health and such pernicious self-harming behaviour. In a conversation following her speech, I checked with the noble Baroness that the aetiology—the roots—of much adult mental ill health begin in childhood. Personality disorders and depression are very often associated with difficulties in the earliest parts of childhood.

That reminds me of the utmost importance of effective early intervention with children and families and, most of all, of ensuring that parents are supported in building strong, consistent relationships with their children. Parents need support to be able to love their child. If they demonstrate their love for each other, the child will learn in later life to make those strong bonds. Also important, for example, are good perinatal care; good midwifery, with midwives engaging early with parents; and good health visitors.

I should declare an interest as a trustee of the Michael Sieff Foundation, a children’s welfare organisation.

There is much that I can welcome in Her Majesty’s Government’s approach to the Bill. I should like to address the following: the importance of recruiting and retaining the best staff in the NHS; ensuring that the Bill helps to bring about effective early intervention with children and families and does not hinder it; and, finally, the need to pay particular attention to children with complex needs, as well as their families, and I include children looked after by local authorities.

I share the concern expressed by many of your Lordships today that the new commissioning arrangements hold the serious risk of leading to fragmentation of provision. We need to be very careful to avoid that.

I can say to the Minister that I have been immensely heartened by the approach that he and his colleagues have been taking to health visitors, teachers, social workers and others who are at the sharp end of caring for children. I admired and welcomed the section in the first Queen’s Speech by this Government in which they called for more autonomy to be given to teachers, doctors and other professionals. I respect the principle enshrined in the Bill of empowering clinicians to manage their own work. I know therefore that the Minister will listen very carefully to the call from my noble friend Lord Walton of Detchant for careful consideration to be given to the future of the training and recruitment of doctors. I take that further. Today, we have heard concerns about unregistered carers. We need to ensure, through careful recruitment and good development and training, that people working in the NHS are of the very highest calibre. I hope that the Minister will allow the House to assist him in his work on this area, ensuring that the Bill provides what is needed.

The Government’s White Paper on education and excellence in teaching and Professor Eileen Munro’s final report on safeguarding children both recognised that the best outcome for our children can be achieved only by attracting and supporting the best candidates in social work and teaching. It is the sine qua non of success in these sectors and it seems to me to be equally applicable to health. I believe that this should go without saying, yet when one thinks of the plight of health visitors, the pressure on midwives, and the many health trusts in which staff consistently report poor support and morale, it needs to be said. It needs to be said when one thinks of the shortages of child and adolescent psychiatrists and the urgent need for more child mental health professionals. I look forward to working with the Minister and colleagues to ensure that the Bill delivers the best possible framework in which NHS staff can operate. I listened with care to the noble Lord, Lord MacKenzie of Culkein, on the issue of nurses. Unless we nurture our doctors and nurses, especially in this very difficult time, they will not be able to nurture the children, families and others in their care. One cannot be warm or show kindness if one does not feel valued and supported oneself.

I should now like to consider the importance of ensuring that the Bill promotes effective early intervention with children and families and does not hinder it. There are 11.8 million children in England, of whom about 65,000 are currently looked after by local authorities. I pay tribute to the vision of the Minister’s colleague in the other place, the right honourable Iain Duncan Smith, in his work in promoting the cause of effective early intervention with families, his establishment of the Centre for Social Justice, his long work on and commitment to understanding the needs of vulnerable families, his bipartisan approach, and his close partnership with Graham Allen MP, the Labour Member for Nottingham North.

The coalition Government have commissioned important reports from Dame Clare Tickell, Dr Eileen Munro, Graham Allen MP and Frank Field MP, among others, and have instituted the family law review. Breaking the cycle of deprivation by effective early intervention is, as I understand it, a cause at the core of this Government's endeavours and I look forward to working with the Minister and colleagues to ensure that this Bill meets the Government's own high ambitions in this area.

I have been reminded that the Kennedy report highlighted the relative neglect of services to children and families in the NHS. The Nicholson challenge poses the risk that these vital services may be further undercut if they continue in this state of relative neglect. For the sake of the future of these children and the future productivity of this nation, who will pay for the care of all the elderly who are accruing now and will accrue in the future? We must ensure that the culture within the NHS changes. We must prioritise children and families more. I hope the Minister will be prepared to further strengthen the position of children and families in this Bill, in particular by including them in the mandate of the NHS commission.

My third theme is the need for a seamless inter-agency service for children with complex needs. Children must not fall down the cracks between services.

I will stop at this point. I reiterate that we need to put into practice the theme of early intervention. It is key. So much work has been done on it and we can use that in this Bill to make a real difference to children and families—a real difference to the future of this country.