Lung Health

Earl of Listowel Excerpts

Monday 1st July 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I thank the noble Lord for that question. He is absolutely right that respiratory illness can be extremely serious. The UK has a higher rate of respiratory deaths than any other country in the OECD; this is a clinical priority for the NHS and the Government are committed to driving it forward. We are working with the British Lung Foundation and the NHS to deliver the co-designed lung foundation’s plan and I am happy to give him that commitment now.

[The Earl of Listowel (CB)]

My Lords, the report highlights the need for prevention, including among children and young people. Will the Government look at the funding of health visitors, who can speak to mothers about smoking, and recognise that a quarter of health visitor numbers have been cut because of their dependence on local authority funding? Will they also look at school funding to ensure that all schools can make the maximum effort to protect schoolchildren from air pollution?

[Baroness Blackwood of North Oxford]

The noble Earl is absolutely right. Prevention is a core part of the plan and as well as smoking, the clean air strategy and flu vaccinations, health visitors are a crucial part of it, and will be looked at as part of the forthcoming prevention Green Paper.

Mental Health of Children and Young Adults

Earl of Listowel Excerpts

Thursday 16th May 2019 Lords Chamber

[The Earl of Listowel (CB)]

My Lords, I also very much welcome this debate and thank the noble Baroness, Lady Royall, for bringing it. I declare an interest as a trustee of a mental health service for adolescents in north London, the Brent Centre for Young People, which began 50 years ago. It focuses on adolescents with suicidal thoughts and tries to address their needs. I am also a trustee of the Child and Family Practice Charitable Foundation, which concentrates on interventions to support post-traumatic stress disorders in young people. I am also a patron of a charity called Best Beginnings, which has been going for maybe 10 years and has developed a video, a drama re-enactment of a mother’s experience of postnatal depression. It is harrowing, but a helpful tool to health providers and others trying to understand postnatal depression. What stands out in that film is the isolation the poor young woman experienced, and the lack of assistance and understanding from the health service.

I will say a bit more about Baby Buddy and perinatal mental health. I commend the Government for their important and significant investment in perinatal mental health. Reports have clearly shown that, by failing to address the mental health needs of mothers, we can readily harm the life chances of their children. It can have a huge impact. I am immensely proud to be a patron of Best Beginnings. In the last six or seven years, it has developed an app called Baby Buddy. This was developed with the royal colleges with the relevant experience—the Royal College of Midwives, and the Royal College of Obstetricians and Gynaecologists. I am drawn most to its videos. The chief executive of the charity is a former BBC film producer, and there is a video of a mother breastfeeding her infant, showing mothers how to breastfeed, and of a father communicating with a young child, helping fathers to communicate with their children. I am proud that the evidence shows that this Baby Buddy app has increased initiation of breastfeeding by 9%, which is a significant improvement and above many other interventions. I mention this in the context of this debate because it is important that infants form secure attachments to their parents.

I will concentrate on the culture that children and young people grow up in and a few other principles lying behind the good mental health and emotional well-being of children and young people. I quote Sir William Utting, a respected social worker and perhaps the chief social work inspector of his time. He produced two reports in the late 1990s on the abuse of children in children’s homes. In his second report, People Like Us, published in 1997, he began by saying that the “best safeguard” for children is an “environment of overall excellence”. The culture in which our children grow up is very important. Perhaps we cannot always be excellent, but we can at least try to be good enough.

The city of Leeds has developed a strategy based on the United Nations Convention on the Rights of the Child. Everything it does, across the whole city, is founded on those principles. It has had outstanding results from inspections of child protection by Ofsted. It has recently been successful in reducing childhood obesity in young people. Again, this is put down to the culture it has created of concern for children’s welfare.

The Minister spoke helpfully about the excellent work the Government have done with social workers in the last 10 years. I would like to talk about the importance of expertise and experience. Timothy Loughton did not have a background in child protection, but took every pains to work with social workers, listen to young people in care and develop a thorough understanding of this work. Working with the noble and learned Baroness, Lady Butler-Sloss, he produced a report called No More Blame Game, championing the status of social workers. Subsequent to Timothy Loughton we had Edward Timpson as Children’s Minister. His family had a background of fostering, he had adopted siblings and he was a practitioner in the family law courts. He had a deep understanding of the issues around supporting children and young people, particularly those who are vulnerable. From that, we have seen many good policies emerge; for instance, the appointment of chief social workers for children and families and other areas.

In terms of the culture, politicians have an important role to play. I have always been of the view that if one is going to talk about the welfare of children, one has to have worked with them to some degree. I am fortunate to have had that experience. Being a parent can be a helpful introduction, but one needs to work with children and young people, understand their vulnerabilities and difficulties, and understand that growing up is complex—we underestimate that as a culture. I see that I need to end here.

I welcome having expert practitioners at the forefront of policy as our chief social workers. Politicians need to be humble before that experience. They perhaps need to see themselves as communicators to the public of what is important, based on what they learn from those who have long experience as nurses or clinicians. That will help create a culture in which our children do much better. I look forward to the Minister’s response and apologise for speaking for so long.

NHS Funding: Mental Health Services

Earl of Listowel Excerpts

Wednesday 1st May 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I thank the noble Baroness, Lady Thornton, for her question on behalf of the noble Lord, Lord Bradley. I am sure that the whole House will want to join me in sending him and his family our support at this difficult time.

The noble Baroness has asked a very important question. The mental health budget will increase by £2.3 billion by 2023-24, growing faster than the wider budget. We are using transparency to drive improvements. The mental health dashboard shows that last year, for the first time, all CCGs met the mental health investment standard, which is an encouraging sign. This builds on the work done in the five-year forward view, which delivered real improvements for patients. It delivered £247 million for liaison psychiatry, £290 million for perinatal services and £400 million for crisis resolution and home treatment teams. However, we will not rest there. The long-term plan will deliver much more for patients, including 345,000 more children and young patients to receive specialist support services. This is the ambition that we have and the ambition that we will deliver.

[The Earl of Listowel (CB)]

My Lords, I welcome the additional money and note my interest as a trustee of a mental health service for adolescents. Can the Minister assure me that highly experienced clinicians will be retained to provide vital supervision for the new people coming in at the front line—for instance, in schools? Is she concerned that there is a 1% decline in the trend for the number of child and adolescent psychiatrists, for example? Is it not crucial that we have highly experienced clinicians to supervise the new people whom the Government have in development?

[Baroness Blackwood of North Oxford]

The noble Earl is absolutely right that it is essential not only that we recruit new psychiatrists and mental health specialists to support the ambitions of the long-term plan—we have set out an ambitious plan to do so, intending to recruit 8,000 new specialists—but that we retain those within the system, who are doing an outstanding job in difficult circumstances. NHS Improvement is working with mental health trusts across the country to give them the tools that they need to do so, and I am encouraged by the progress that they have made so far.

Child and Adolescent Mental Health Services

Earl of Listowel Excerpts

Monday 25th March 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Lord raises an extremely important and difficult area of service. This is exactly why the Government have just launched a review of autism services, which is currently open for consultation. We are trying to improve these services as we speak.

[The Earl of Listowel (CB)]

My Lords, as a trustee of a mental health service for adolescents—the Brent Centre for Young People—I welcome the additional funding the Government are bringing forward. Is the Minister aware, however, that one of the most effective ways of preventing children having to access mental health care is supporting, for instance, groups of adoptive parents, foster carers or head teachers, with a senior clinician? However, there is concern that many senior experienced clinicians have been lost because of the shortage of funding. Will the Minister look at what she can do to stem that loss, find out what the issue is, and do what she can to invest in that area as well?

[Baroness Blackwood of North Oxford]

I thank the noble Earl for his question. Obviously, recruitment aims in the mental health service are essential, and the workforce plan sets out an aim for 600 full-time posts in mental health. We have already discussed the Government’s plan in the Green Paper to set up 8,000 new children’s and young people’s posts in mental health. But that is no good if we are not also retaining those staff. NHS Improvement and NHS Employers are now working to ensure that all mental health trusts are given the tools to drive improvements in retention. This is a programme that has seen improved turnover, and we shall keep monitoring it to ensure that we retain the staff we work so hard to recruit.

Childhood Obesity

Earl of Listowel Excerpts

Thursday 13th December 2018 Lords Chamber

[Lord O’Shaughnessy]

I should certainly be happy to do so. It is worth pointing out that that document and others have informed chapter 2 of the Government’s obesity strategy, which was published recently. Because the problem is not yet being dealt with, as we know, and we have an ambition to halve obesity, we are determined to act on things such as banning promotion of sugary foods and further restricting advertising.

[The Earl of Listowel (CB)]

My Lords, is the Minister aware of the report today from BBC News which shows that, while information has been provided that 600 calories is a decent meal, fast-food providers provide 750 or so on average, but chain-food suppliers provide 1,500 calories? What will the Government do to encourage those providers to provide lower-calorie-option meals for the public and for young people?

[Lord O’Shaughnessy]

The noble Earl makes an excellent point. That is why in chapter 2 of our strategy, as I mentioned, we propose mandating consistent calorie labelling in out-of-home settings; indeed, the consultation on that has just closed and we will be publishing our results shortly.

NHS and Social Care Services: Parity of Esteem

Earl of Listowel Excerpts

Thursday 5th July 2018 Lords Chamber

[Lord O’Shaughnessy]

I recognise that staff work under a great deal of pressure and there are two ways we can help alleviate it. One is obviously to have social care and NHS staff work more closely together, and that is a stated ambition that we all want to achieve. The other is making sure that there are more resources, both to pay people better and to make sure that there are more people. That is what we are focused on delivering.

[The Earl of Listowel (CB)]

My Lords, is the Minister concerned to hear that, when speaking recently to a mental health nurse, I was told that she had received only four of her monthly supervision sessions in the last eight months? Does he agree that to ensure high-quality care across health and social care, all professionals and carers need their entitlement of regular supervision? Will he discuss with his colleagues in the education department whether there might be clinical supervision in some schools, to allow the mental health of children in schools to improve?

[Lord O’Shaughnessy]

I am concerned to hear the story that the noble Earl has raised: I am sure that he will write to me with specific details. We know that at the moment only 25% of people with a mental health problem are seen. That needs to rise. We want to get that up to 33%, but clearly that is not enough. To do that we need more staff at every level. We have committed to training another 21,000 mental health workers to provide exactly the kind of leadership and support that he describes.

Health: Endoscopy and Bowel Cancer

Earl of Listowel Excerpts

Monday 2nd July 2018 Lords Chamber

[Lord O’Shaughnessy]

I will not be rummaging around in my pocket to reveal something; nobody wants to see that. My understanding is that FIT will be introduced from the autumn and the intention is to get national coverage. I do not believe that it will be achieved immediately, but I will write to the noble Baroness with the specific timeframe.

[The Earl of Listowel (CB)]

My Lords, will the Minister look at access to mental health services, so that referrals can be made early on for patients who are identified with bowel cancer where that is helpful? Does he not agree that patients will make better recoveries if assessments are made of their mental health and emotional well-being, along with support groups and other services to help them with these aspects of their recovery?

Nursing and Midwifery (Amendment) Order 2018

Earl of Listowel Excerpts

Monday 25th June 2018 Lords Chamber

[Lord Clark of Windermere]

I am very grateful for that—and I understand that many trusts contribute to the levy. Perhaps the Minister could give us an indication of what the breakdown will be between the conventional course and the apprenticeship course for nurse associates. That would be helpful, because one has to bear in mind that the cost to a registered nurse undergraduate is £9,000 a year. That is what they have to pay—which means that they will pay £27,000 to get their qualification.

We need to continue at a high level. As the Minister said, we have increased the number of nurses in training; I found that very encouraging. He is absolutely correct. But why should somebody who wants to become a registered nurse spend £27,000 over three years when they could do a conventional NA qualification for two years at no cost, then do another year to become a fully qualified registered nurse? It just does not make sense. The Government have to look at the funding of nurse support training as a whole. I hope that they do so.

I felt that it was right and proper to raise these difficulties as they have not been raised elsewhere because, as I said, many of the consultees have other interests in putting forward their points of view.

[The Earl of Listowel (CB)]

My Lords, the noble Baroness, Lady Thornton, and the noble Lord, Lord Willis, asked about the impact of this new profession on the wider healthcare workforce. I wonder whether it is helpful to ask the Minister at this point a little about possible impact, if any, on health visitors. There is real concern about the decline of health visitors; they had a resurgence in recent years but are in serious decline now. I do not wish to detain the House for too long if this seems a bit beyond the main business.

I am a patron of the charity Best Beginnings, which provides mental health and perinatal support for parents. I spoke with the chief executive last week. We recognise that health visitors are very important, as healthcare professionals working in the vital perinatal period to ensure the best attachment between parent and child. I recently spoke with the president of the Institute of Health Visiting, Dr Cheryll Adams. Again, she expressed concern about the decline of the number of health visitors. As we establish a new healthcare profession, do we not need also to think about this other, declining profession under the healthcare umbrella?

I imagine that there is no plan to replace health visitors with these new healthcare professionals, but sometimes there is a misunderstanding that health visitors are just there to weigh the baby, when anyone could do that. In fact, when family-nurse partnerships were introduced to support vulnerable parents, the outcome was significantly better when higher qualified practitioners worked with the families. This job is challenging, because people are often working with vulnerable families in poor housing and poor conditions. It is a demoralising profession, unless one has a good professional foundation.

I emphasis the importance of the vital early years. As Graham Allen and Mr Field MP have established, the first 2,000 days in a child’s life are the most important. We need to ensure that the best professionals are available to them. Two or three years ago, health visitor funding went from the Department of Health to local authorities. We all know that local authorities have very little money to spend, so it is not surprising that there has been a significant decline in the number of health visitors. Does the Minister recognise concerns about that decline? Will he assure the House that he is keeping in mind the health visiting profession and what can be done to sustain it and ensure its continued health?

I have a final question. This particular new brand of healthcare professional gives rise to the problem of professionals from the developing world being pulled in to fill the niche. I am sure that the Minister can assure us that we will not poach healthcare professionals from Nigeria, Ghana and elsewhere, but the possible risk of that certainly comes to my mind. I welcome the order and I look forward to the Minister’s response.

[Baroness Jolly (LD)]

My Lords, my contribution will be very short, as noble Lords have already said everything. We, too, welcome the role of the nursing associate. I commend the work of my noble friend Lord Willis of Knaresborough in making this happen and say to him that he can have the Front Bench if he is happy to take all that goes with it.

The noble Earl, Lord Listowel, made the point about impact. I just make one extra point. In remote locations—I live in Cornwall, but this could account for anywhere far-flung where there are hospitals and health establishments—there will be uptake from healthcare assistants who feel that they cannot leave home to train as a nurse because the distance is too great and they have family responsibilities or other commitments, but they could manage the two-year course. That would be really positive. Nursing associates would then improve in those establishments the quality, but also the skill mix, of nursing teams in areas where it is also particularly difficult to appoint.

I understand the timing of this SI. The noble Lord, Lord Clark of Windermere, said that perhaps there was still stuff to look at. It is really important that it gets on to the statute book, because we will have real live trainee nursing associates who need to register next year. Sadly, we cannot take any more time to do this, but from these Benches we really welcome the role of the nursing associate and the help it will give the NHS.

Agency Nurses

Earl of Listowel Excerpts

Wednesday 10th January 2018 Lords Chamber

[Lord O'Shaughnessy]

On the issue of flexible working there is an important distinction between agency working and bank working. Bank working provides a degree of security and familiarity, in that the nurses employed by nursing banks often work in the same hospitals. That is one of the most important ways that we can provide the flexible working which, as the noble Baroness quite rightly said, nurses want.

[The Earl of Listowel (CB)]

Can the Minister reassure the House on the supply and retention of psychiatric nurses, and that they are getting the excellent support that they especially need? He might wish to write to me on that.

[Lord O'Shaughnessy]

I will certainly write to the noble Earl specifically on psychiatric nurses. He will, I hope, be aware of the plan to recruit many more mental health staff as we seek to radically improve outcomes and delivery in that area.

Young Women: Self-Harm

Earl of Listowel Excerpts

Thursday 16th November 2017 Lords Chamber

[Lord O'Shaughnessy]

I know this area is of great interest to my noble friend and he has done very good research on it. He is quite right to highlight the impact that, unfortunately, parental conflict and breakdown has on children. The Department for Work and Pensions, in a cross-government approach, is doing particular work on supporting parents. I also know that the best schools and community health services work to provide that kind of parenting support. There are a number of parenting programmes out there. I assure my noble friend that that evidence takes a proper place in the mental health strategy that we will be publishing for children and young people.

[The Earl of Listowel (CB)]

My Lords, I declare my interest as a trustee of the Brent Centre for Young People—a mental health service for adolescents which celebrates its 50th anniversary this year. Does the Minister agree that adolescence is a hugely challenging part of human development and that we put far too much pressure, far too often, on adolescents and interfere with their successful development, with the outcomes described in this Question? Will he look at Lucy Crehan’s work Cleverlands, an international comparison of the best performing schools, and her criticisms of the British and American systems? She finds that we put far too much pressure on head teachers through Ofsted inspections. It is a punitive, rather than a supportive, act and we should review it to see whether we could be more supportive of head teachers and get a better, supportive atmosphere for children in our schools.

[Lord O'Shaughnessy]

I congratulate the centre the noble Earl works for on its anniversary. He is absolutely right about the pressures of adolescence. Unfortunately, the causes of self-harm are not well understood. One of the hypotheses is that the motivation appears to be stress relief, which is an incredibly disturbing idea. I am aware of Lucy Crehan’s work from my previous work in schools. I do not think you can link school accountability with the kind of pressures we are describing today and how they manifest in self-harm. We want schools to be successful. It is vital that children are well educated. It is also true that that can be done in a number of ways. The best schools, including ones that I have been involved with in the past, practise something called positive education which emphasises not only the academic aspect but also character and well-being. I think that is the approach that we need to follow.