Offensive Weapons Bill

Debate between Earl of Listowel and Earl Howe

Committee: 1st sitting (Hansard): House of Lords
Monday 28th January 2019 Grand Committee

[Earl Howe]

In answer to the second question, my understanding—on advice—is no. A substance capable of burning the skin by corrosion would also be capable of doing severe damage to the eye, and the other way round. We do not think we are excluding any substance by accident in defining corrosive substances in this way. On the noble Baroness’s first question, as I understand it, the approval of the testing kit will not be subject to any formal parliamentary procedure, but I am sure the noble Baroness is capable of finding ways to tease out relevant information from the Home Office at the appropriate time.

[The Earl of Listowel]

My Lords, in thinking about how criminals might think about getting around the law that the Government are proposing, I add this as a footnote to take away. Would it be possible to take two separate substances, which on their own might be quite innocuous, but when mixed together could be powerfully corrosive and thereby say you were not carrying corrosive substances? That is something to take away as a possible concern.

[Earl Howe]

I am grateful to the noble Earl. Not being a chemist, I do not know whether this applies to corrosive substances as it does to, say, explosive substances. I will certainly take advice on the matter.

--- Later in debate ---

[Earl Howe]

My Lords, Clause 8 provides an appropriate custodial sentence where a person is 16 years old or older and is convicted of the offence of possession of a corrosive substance in a public place in England and Wales and has at least one relevant previous conviction, as defined in Clause 9. We have made it a requirement that the court must impose an appropriate custodial sentence unless it decides that there are particular circumstances relating to the offence, the previous offence or the offender which would make it unjust to do so. We have defined an “appropriate custodial sentence” as a custodial sentence of at least six months’ imprisonment for an offender aged 18 or over. For an offender aged 16 or 17, we have defined an “appropriate custodial sentence” as being a detention and training order of at least four months’ duration.

The noble Baroness, Lady Meacher, referred specifically to Clause 8(2). It is not designed, as she suggested, to reflect the sentencing guidelines. The clause mirrors existing knife legislation and ensures that anyone aged 16 or over who is convicted of a second possession or similar offence, such as an offence relating to a knife, will receive a custodial sentence unless the court determines that there are appropriate circumstances not to do so. The use of appropriate custodial sentences will make it clear to individuals that we will not tolerate people carrying corrosives on our streets and other public places in circumstances which would enable them to cause injury or commit another offence, such as robbery.

Amendments 34 to 36 in the names of the noble Lords, Lord Ramsbotham and Lord Paddick, seek to confine these provisions to adult offenders. I understand why the noble Lords are proposing this but I really think—as do the Government, very firmly—that, given the nature of this particular form of offending and the appalling injuries it can cause, the minimum sentence should apply to 16 and 17 year-olds as well as to adults, as for the existing offence of possession of an offensive weapon in a public place. We fully recognise, however, that this cohort of young offenders should be treated differently from adult offenders. I have already indicated that for 16 and 17 year-olds the minimum sentence is a four-month detention and training order as opposed to six months’ imprisonment in the case of adult offenders.

In addition, for this age group, we have ensured that when considering whether there are particular circumstances which would make imposing an appropriate custodial sentence unjust, the court must have regard to its duty under Section 44 of the Children and Young Persons Act 1933. This relates in particular to the issues raised by the noble Baroness, Lady Meacher. Under that section, the court must have regard to the welfare of the child or young person, take steps to remove them from undesirable surroundings and ensure that proper provision is made for their education and training. We have also ensured that there are procedures for appeals in those circumstances where a relevant conviction, which was relied upon by the court to impose an appropriate custodial sentence, has been set aside on appeal.

I recognise that there are some Members of the Committee such as the noble Lord, Lord Ramsbotham, and the noble Baroness, Lady Hamwee, who object as a matter of principle to minimum sentences as provided for in Clause 8. I fully accept that the normal practice is for Parliament to set maximum sentences and leave it to the discretion of the court to determine the appropriate sentence, having regard to the facts of an individual case. However, there are already a number of exceptions to this rule, including, as I have said, in relation to second convictions for possession of an offensive weapon in a public place. We regard the possession of corrosive substances in a public place as equally serious and therefore deserving of the same sentencing framework.

As I have indicated, the requirement to impose the minimum sentence is not absolute and the provisions still allow for some judicial discretion. The court must still consider the particular circumstances of the case and, if there are relevant factors relating to the offence or the offender such that it would be unjust to impose the minimum sentence, the court has the latitude in such a case not to do so. That could be: where the seriousness of the offending falls far below a level deserving custody; strong personal mitigation of the defendant; or the undue impact that going into custody may have on others. In addition, the courts would have to consider the effect of a guilty plea. In the youth justice system, four months is the minimum detention and training order available, so any reduction would mean that a community order is imposed. It is important to emphasise that.

It remains a matter for the court to weigh up all the relevant aggravating and mitigating factors before deciding the appropriate sentence to impose, at or above that required by this clause, and subject to the question of it being unjust in all the circumstances which I have mentioned. In short, the Government are firmly of the view that in exceptional cases such as this, there is a place for minimum sentences in our sentencing framework. We are dealing here with repeat offenders who pose a particular risk to others and our communities, and the law and the courts should recognise this.

Finally, Amendment 37 deals with the test to be applied by an appellate court on any appeal against sentencing where the provisions of Clause 8 apply and a previous relevant conviction has been overturned. In any case where there was only one previous relevant conviction and that conviction was subsequently overturned on appeal, the criteria provided for in Clause 8(2) would not be relevant in the case of an appeal against sentence to which Clause 8(6) applies. Where the conditions requiring a court to impose a mandatory minimum sentence no longer apply after the fact, a court hearing an appeal against a sentence would be bound to quash it and pass a new sentence without regard to the provisions in Clause 8. Given this explanation, I hope that the noble Lord, Lord Ramsbotham, will withdraw his amendment and that the noble Baroness and the noble Lord, Lord Paddick, will support Clause 8 standing part of the Bill.

[The Earl of Listowel]

My Lords, I thank the Minister for his response. With regard to children and young people in local authority care, and young people leaving such care, might the courts not be given some guidance as to a more lenient treatment of them? I think we recognise the statistics on the high levels of children from care and care leavers in custody. We have a corporate parenting responsibility towards these young people. We know that over 60% of them enter care because of physical abuse or neglect on the part of their families, and that very few of them enter because of criminal or anti-social behaviour. Will the Minister consider giving guidance to the courts on our corporate parenting responsibility to these young people and, regarding their histories, should we consider giving them a more lenient approach in the courts?

[Earl Howe]

My Lords, the noble Earl has often and rightly emphasised the vulnerability of children in care and young people leaving care. I fully accept that point. However, as he has heard, the provisions under the 1933 Act constitute a very considerable duty on the court to look at the pertaining circumstances of a case. He will also know that the Sentencing Council provides exactly the kind of guidance to which he alluded. If there is any more I can say on that, I will be happy to write to him. I am sure that the Sentencing Council will not be slow to follow up on any proposal emerging from the provision in the Bill.

Armed Forces (Flexible Working) Bill [HL]

Debate between Earl of Listowel and Earl Howe

Committee: 1st sitting (Hansard): House of Lords
Tuesday 12th September 2017 Grand Committee

[The Earl of Listowel (CB)]

My Lords, listening to the Minister’s comments and reflecting on the discussions on the Bill, I understand that the children of many service personnel have quite difficult journeys into adulthood, with a lot of disruption. Looking at the new provisions in Clauses 1 and 2, am I right in thinking that the Bill will make it easier for parents with young children to remain close to those children if they choose to do so, and might it reduce the disruption to those children’s lives? Might that be the effect of the Bill?

[Earl Howe]

Certainly. Although that is not the whole rationale, the provisions that we are proposing to introduce are designed to be family-friendly—for example, for women considering starting a family or those with caring commitments, or those who are bringing up a family and, for any reason at all, there are personal circumstances that create difficulties for them. That could be a very good reason for somebody to apply to work part-time on a temporary basis. So I agree with the noble Earl.

Gender-based Violence: Screening

Debate between Earl of Listowel and Earl Howe

Monday 9th March 2015 Lords Chamber

[Earl Howe]

Yes, my Lords. The Government hosted the first ever Girl Summit last year on ending female genital mutilation as well as forced marriage and other issues. We set up a specialist female genital mutilation unit following that summit. We provided money last year for the FGM prevention programme, and as part of this we introduced the first ever data collection in the NHS for all acute trusts, which are now required to record in a patient’s healthcare record whenever FGM is identified. We have also said that front-line professionals will in future have a mandatory duty to report cases of FGM in those under 18.

[The Earl of Listowel (CB)]

My Lords, following on from my noble friend Lord Laming’s question on children in these circumstances, is the Minister ensuring that where gender-based violence is at play, any children in those circumstances are being identified and getting the help and support that they need?

[Earl Howe]

The noble Earl makes an extremely important point. I can reassure him that children and young people are very much the focus of the work that we have been doing, and that a guidance document was issued recently to that effect.

NHS: Financial Tariff for 2015-16

Debate between Earl of Listowel and Earl Howe

Wednesday 4th February 2015 Lords Chamber

[Earl Howe]

My Lords, it would require a full-scale debate for me to lay out in full all the things that we are doing to promote parity of esteem in the health service. The noble Baroness is right that in certain parts of the country there has been acute pressure on bed numbers, but bed numbers have been increased in some of those areas, and NHS England is paying close attention to the need to ensure that those who need in-patient treatment receive it.

[The Earl of Listowel (CB)]

My Lords, will the Minister look carefully at the bureaucratic burden on clinicians? A number of clinicians have raised with me the fact that there is too heavy a burden, and that because of that burden, they are not being as efficient as they might be.

[Earl Howe]

My Lords, yes of course the bureaucratic nature of commissioning needs to be minimised and we do all we can to achieve that. However, the need to ensure that we make a careful distinction between commissioners and providers does, I am afraid, mean that rather a lot of numerical work has to go along with that and, as is right, discussion between commissioners and providers to ensure that the system works smoothly.

Mental Health Services

Debate between Earl of Listowel and Earl Howe

Wednesday 26th November 2014 Lords Chamber

[The Earl of Listowel]

To ask Her Majesty’s Government what plans they have to improve mental health services for infants, children and young people in local authority care, and for care leavers.

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

My Lords, in August 2014 the Government established the children and young people’s mental health and well-being task force, which is looking at how to improve access to services that are more responsive to children and young people’s needs. It has a particular focus on the needs of the most vulnerable children, including care leavers and those in local authority care.

[The Earl of Listowel (CB)]

I thank the noble Earl for his Answer and for the work of the task force, which is most welcome. Is he considering encouraging the systemic approach to supporting foster carers and staff in children’s homes, whereby clinicians support groups of staff in children’s homes and foster carers? This can be a very effective way of making use of scarce CAMHS resource. Will he also look at undertaking another, very thorough, survey of the mental health of looked-after children? The last very thorough examination of their mental health was carried out in 2002, and it would seem that it is time to look again at their mental health issues.

[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.

Health: Mental Health

Debate between Earl of Listowel and Earl Howe

Tuesday 28th October 2014 Lords Chamber

[Earl Howe]

My Lords, investment in mental health research by the National Institute for Health Research has nearly doubled over the past four years from £40 million in 2009-10 to £72 million in 2013-14. I hope that the noble Lord will take from that that we put a priority on this. Of course, it is very important that local authorities do not downplay the significance of mental health. We have made it very clear that disinvestment is not an option for them. We are discussing with local authorities this very issue.

[The Earl of Listowel (CB)]

My Lords, will the Minister seek to encourage the very good practice of a few areas in providing a seamless service for young people leaving public care from the age of 16 to 25 or 14 to 25 so they get the mental health support to allow them to be successful in adulthood? Does he recognise that effective mental health services for children will much diminish the demand in adulthood?

[Earl Howe]

I agree with the noble Earl. On 20 August the Minister of State for Care and Support announced a new children’s task force to look at all aspects of child and adolescent mental health services and how best to improve outcomes for children with mental health problems. Its remit includes an investigation of how access across the whole of children and young people’s mental health services could be improved. The task force will report in the spring of next year.

NHS: Midwives

Debate between Earl of Listowel and Earl Howe

Monday 17th March 2014 Lords Chamber

[Earl Howe]

My Lords, I agree that in certain parts of the country maternity services are under pressure, but it is encouraging that the ratio of births per midwife has improved nationally. Indeed, since 2010 the number of midwives has increased by 4% and the number of births by 1%. However, the noble Lord is right to attach importance to mental health services. Improving diagnosis and services for women with pregnancy-related mental health problems is one of the Department of Health’s objectives for maternity care. That is why Health Education England has been tasked with working with partners to ensure that pre-registration and post-registration training in perinatal mental health is available to enable specialist staff to be available to every birthing unit by 2017.

[The Earl of Listowel (CB)]

Is the Minister aware of the excellent model of best practice at Chelsea and Westminster Hospital, where there is a mental health team working hand in hand with the midwives, and how important that is to retention? Is the supervision of midwives being looked at—whether they feel well supported and wish to carry on in the profession because they have a mentor who can support them?

[Earl Howe]

I thank the noble Earl for bringing the example of the Chelsea and Westminster to my attention. I am sure it is a model of good practice, as I know how good that hospital is. With regard to supervision, the noble Earl is right. This bears upon the whole question of midwife numbers, to ensure that we have enough midwives not only looking after women about to give birth and giving birth, but also to ensure good practice in our hospitals and midwifery units.

Health: Midwives

Debate between Earl of Listowel and Earl Howe

Wednesday 5th March 2014 Lords Chamber

[Earl Howe]

My Lords, the Government are committed to improving the choice of place of birth for women, continuity of care for mothers and the experience of care that they have. There are now 1,800 more full-time equivalent midwives than in May 2010 and there is a record number—in excess of 5,000—in training at the moment. The most recent data from November last year show that the number of midwives has increased at twice the rate of the number of births—by more than 6% since May 2010. We know that we need more midwives in the service but they are coming down the pipeline.

[The Earl of Listowel (CB)]

My Lords, is the Minister aware of the Australian research which suggests that the NHS could save £300 per birth if it adopted the one-to-one midwifery model? Might he consider how to encourage clinical commissioning groups and health and well-being boards to commission caseload midwifery? This has proved very effective in reducing the number of episiotomies and in encouraging, for instance, breastfeeding.

[Earl Howe]

My Lords, I am very interested to hear what the noble Earl says about the Australian experience. The mandate that the Government issued to NHS England, published in November 2012, states that women should receive better care during pregnancy and have a named midwife responsible for ensuring personalised, one-to-one care throughout pregnancy and childbirth, as well as postnatally. As part of that, we want NHS England to work with partner organisations to ensure that women are able to make informed and safe choices about where to have their baby. However, it is probably too soon to commit to a ratio of one midwife to one expectant mother.

Health: Meningitis B Vaccine

Debate between Earl of Listowel and Earl Howe

Monday 24th February 2014 Lords Chamber

[Earl Howe]

Our childhood immunisation programme generally bears comparison with any country in the world and is very extensive and very successful. However, the incidence and prevalence of meningitis B is higher than in many other countries, which is why there is such concern about it.

[The Earl of Listowel (CB)]

My Lords, will the Minister assure the House that, if this vaccine is accepted, the infrastructure will be in place to enable it to be administered swiftly to as many children as possible? Are health professionals trained and ready to administer the vaccine, if it is decided to accept it?

[Earl Howe]

The main practical constraint is manufacturing the vaccine. However, I assure the noble Earl that the NHS is well equipped to deliver the vaccine once it has it in its possession.

Carers

Debate between Earl of Listowel and Earl Howe

Monday 14th January 2013 Lords Chamber

[Earl Howe]

My Lords, the latest figure I have for carers from the census is that there are 5.4 million unpaid carers in England. The noble Baroness was right to mention the figure of £119 billion, although it is a figure we can argue about. It is probably an overestimate as regards the cost to public funds. However, she makes a very important point about employment. The Government fully recognise the importance of supporting carers to remain in work. The Department of Health has established a task and finish group with employers for carers to explore how to improve support for carers to remain in employment. Jobcentre Plus provides practical assistance for carers seeking work; in particular, it can offer practical support for all carers who are employed for less than 16 hours a week.

[The Earl of Listowel]

My Lords, is the Minister aware of the concern of many adult carers of children with disability at the number of changes in social workers that their child has, and how that undermines their ability to be effective advocates for these children, especially as they make the transition to adult services? Does the Minister monitor the number of changes in social workers supporting such families? How can we ensure that this important factor is improved upon?

[Earl Howe]

My Lords, the noble Earl makes an extremely important point about continuity of care. I am not aware that my department monitors the point that he raises, although it is one that we expect local authorities to bear closely in mind as they fulfil the criteria to be rolled out in the social care outcomes framework, which contains a strong strand relating to service user satisfaction.

NHS: Hospital Beds

Debate between Earl of Listowel and Earl Howe

Thursday 6th December 2012 Lords Chamber

[Earl Howe]

My Lords, as I mentioned earlier, NHS underspends are not lost to the NHS—they can be carried forward from year to year. But on his central point, I should make it clear that we are struggling to reconcile the Dr Foster bed occupancy figures with those that we have. Dr Foster has stated that bed occupancy is at a dangerous level, at over 90% for 48 weeks of the year. We are looking closely at that analysis and methodology, but we cannot agree with those conclusions at the moment, given that the department monitors the position on a daily basis during the winter and on a quarterly basis at other times. However, I agree with the noble Lord that there are too many people in hospital. We need to ensure that we move more care into the community. I do not see this as insuperable within the current budgetary expenditure limits.

[The Earl of Listowel]

My Lords, I want to ask about community midwifery services and avoiding bed use by that means. Is the Minister aware of the great value to children in terms of outcomes of promoting a good relationship between midwives and parents, increasing the rate of breast-feeding and reducing episiotomies? In his reconfiguration, when he is thinking about not using so many bed spaces, will he recognise the value of local community midwifery services?

[Earl Howe]

Yes, my Lords. That is the precise reason why there are currently 5,000 midwives in training, which is a record number. The noble Earl is absolutely right to identify the midwifery service as key to enabling children to get a healthy start in life and parents to ensure that children get into good eating and exercise habits.

Health and Social Care Bill

Debate between Earl of Listowel and Earl Howe

Monday 7th November 2011 Lords Chamber

[The Earl of Listowel]

My Lords, my noble friend Lord Rix’s amendment on children with complex needs and the special services that they need reminds me of a visit that I made a few years ago to a service run by the National Society for the Prevention of Cruelty to Children. This service was for a small and unpopular group of children who sexually harm other children and the manager said that it was very difficult to determine who should fund it. The primary care trust did not want to fund it. However, it was a vital service which intervened early in children's lives and stopped them from continuing their harmful behaviour towards other children into adulthood. The matter is relevant to this debate because the victims of sexual harm are often children with learning disabilities, and the children who perpetrate sexual harm are also more likely to come from the learning disabled group. We need to be reassured that services like that will find a home in the new arrangements. I look for reassurance from the Minister that that will be the case.

[Earl Howe]

My Lords, I am sure that all Members of the Committee will join me in expressing our admiration for the long record of the noble Lord, Lord Rix, in championing the cause of disability rights. They will have had a great deal of sympathy with what he and others have said in this debate.

The Government are committed to improving the lives of people with learning disabilities and the lives of their carers and families. Since we last had a debate of this kind in the context of a health Bill, the legislative backdrop has changed in a very material and important way. I am referring, of course, to the Equality Act 2010. The public sector equality duty in Section 149 of that Act requires public bodies to consider the impact of policies and decisions on particular groups across the protected characteristics. It also requires public bodies to have due regard to the need to eliminate discrimination and to advance equality of opportunity. This general public sector equality duty came into force in April 2011. This means that public bodies such as commissioners, local authorities, health trusts, other providers of NHS services and regulators need to understand how different groups are affected by their policies and practices across all protected characteristics, including disability, and ensure that they routinely use equality data in order to have due regard in their decisions. Furthermore, public authorities need to have a clear evidence base from which they can determine and set clear and measurable equality objectives in line with their specific duties in regulations made under Section 153 of the Act.

Sections 29 and 39 of the Equality Act 2010 prohibit discrimination against disabled persons, whether direct or indirect, by NHS employers, providers of health services and persons exercising other NHS functions. There are, in addition, important duties that apply to the NHS in relation to disability discrimination and reasonable adjustments which public bodies must make. Duties to make reasonable adjustments in relation to employment or the provision of services are set out in Sections 20, 29(7) and 39(5) of the Equality Act. The purpose of these duties is to ensure that employers and service providers have a positive and proactive duty to take steps to remove or prevent obstacles which may place a disabled person at a disadvantage in comparison to a non-disabled person.

This Bill plays its own part in helping to ensure that the care system delivers these commitments and improvements. It introduces new duties in relation to quality and fairness. It creates underpinning legislation for the NHS outcomes framework, which links to the public health and social care frameworks, and that will shine a light on the experiences of all patients and service users, including disabled people. The Bill brings clarity to quality through NICE quality standards that describe high-quality care along a pathway addressing the key issue of co-morbidities. The changes to the regulatory framework give Monitor a role in Clause 59 in relation to improvement in quality and fairness, as well as efficiency. The Secretary of State’s annual report will be closely linked to the objectives that he sets for the NHS Commissioning Board and Public Health England. These are likely to evolve over time to meet changing health needs.

Because the new duties relating to quality and the reduction of inequalities apply to a number of bodies in the system, it would seem logical to include these aspects in the annual report. I can give an assurance that we have every expectation that the improvement of quality and the reduction of inequalities will be key reporting themes in the Secretary of State’s annual report.

Our starting point is that people with a learning disability are people first. They have the right to lead their lives like any others, with the same opportunities and responsibilities, and the same dignity and respect. There is a clear policy framework towards people with learning disabilities, including those with profound and multiple learning disabilities and behaviour that challenges. Valuing People, published in 2001, set out the previous Government’s commitment to improving the lives of people with learning disabilities, and set out the core principles of rights, independence, choice and inclusion. In 2009, that Government reaffirmed these principles in Valuing People Now. The coalition Government have also endorsed them. Key areas include improving outcomes for people with learning disabilities and their family carers around health, housing and employment, in particular enabling people to live healthier and for longer, including by improving access to high-quality healthcare, helping people to secure and stay in employment and supporting people to live in their own homes, including closing NHS campuses.

The first NHS outcomes framework signalled a number of important areas that needed to be included in it in the future. One of those areas was to understand and measure good outcomes for people with learning disabilities. The existing data and data collections do not easily allow outcomes for people with disabilities, including learning disabilities, to be identified. To help rectify this my right honourable friend Andrew Lansley launched the innovation in outcomes competition earlier this year to try to help to fill these gaps. I am delighted that we received some extremely helpful suggestions for how we might incorporate outcomes for people with learning disabilities in future iterations of the framework.

In addition to the NHS outcomes framework, the mandate is a mechanism through which it may be possible to draw attention to the importance of improving the quality of services and outcomes for people with learning disabilities. Improving outcomes for people with learning disabilities and their family carers is about making change happen at a local level for all people. It needs the full commitment of the full range of service providers and agencies across all sectors that need to work in partnership to plan, review and commission strategically.

As was well emphasised by the noble Lord, Lord Beecham, local authorities and health bodies are required to develop a joint strategic needs assessment and to commission services to address those needs. Joint commissioning with local authorities in relation to care and support for people with learning disabilities will help to support them better. We expect services delivering support to people with learning disabilities to act to ensure they are fully compliant with the law, especially the Equality Act 2010.

I turn now to the noble Lord's amendment to Clause 12. This clause allows the Secretary of State to make regulations requiring the NHS Commissioning Board to commission certain services that it would be less appropriate for clinical commissioning groups to commission. One of the reasons for giving GPs within clinical commissioning groups responsibility for commissioning NHS services locally is their unique position as the gateway by which patients access the majority of NHS services. However, there are some services that patients do not access via their GP, and there are others, for patients with rare conditions which are high cost and where clinical expertise needs to be concentrated, that require them to be commissioned and organised separately. For those services we believe that it would be better for the NHS Commissioning Board to take the lead. Dental services and services for members of the Armed Forces and for persons detained in prison or other accommodation of a prescribed description were included in the Bill because there was a clear policy intention for the board to commission the majority of services in these areas, and they could be easily defined in broad terms in primary legislation. This was confirmed by the consultation process on the implementation of the NHS White Paper and in the subsequent Command Paper.

Clause 12 provides that regulations may require the board to commission such other services or facilities as the Secretary of State considers it appropriate for the board rather than clinical commissioning groups to commission. The intention is that this would include specialised services for very rare or rare conditions where different arrangements currently apply because of their low volume and high cost. Currently, these services are either commissioned nationally by NHS London or regionally by primary care trusts working through collaborative commissioning arrangements with their specialised commissioning groups. In deciding what services it would be appropriate for the Commissioning Board to commission directly, the Secretary of State would be required to take into account a number of factors. These four factors are set out in Clause 12.

For services such as those for people with profound and multiple learning disabilities and people with complex needs whose behaviour challenges services, it is expected that some services will be considered specialised and therefore should be commissioned nationally. This is the specific question posed to me by the noble Baroness, Lady Hollins. Some services will not be considered specialised and should be commissioned by clinical commissioning groups working with local authorities.

The services included in the regulations could change over time as new services develop, existing specialised services become more common, and so on. The point here is that there is flexibility for the Secretary of State to take account of these changing factors and to require the board through regulations to commission certain services in a way that primary legislation does not.

Health and Social Care Bill

Debate between Earl of Listowel and Earl Howe

Wednesday 2nd November 2011 Lords Chamber

[The Earl of Listowel]

I thank the noble Lord, Lord Beecham, for moving this amendment and for giving us an opportunity to discuss a definition of the services of the National Health Service. Perhaps the Committee will forgive me if I make now the arguments that I had hoped to make in the later debate on mental and physical health in the health service, for which I am unable to be present. Those arguments are also pertinent to this amendment.

I seek reassurance from the Minister that the new arrangements for the health service will have a specific duty to focus on support of the relationship between the parent and the child, or whoever is acting in loco parentis for that parent, particularly during the early years and in adolescence. Professionals say that adult mental health hinges on the relationships between the primary carers and the child in early life and in adolescence.

The Government’s White Paper highlighted that mental health is important to public health. It follows that in the future we have to be even more careful to ensure, without being overly intrusive, that the relationships between parents and children in the earliest years and in adolescence are as supportive as possible. The health service should have an important role in that. For instance, there is tremendous pressure to generate more early years nursery places. In a recession, we want parents to work and to help build capacity. Nurseries need to be cheap, yet we know that high-quality early years intervention is crucial to better outcomes for children. We also know that the people who work in those settings are often underpaid and not properly supported, and that there can be a high turnover of staff. In driving people, for understandable reasons, to use nursery provision more, there is a danger that the relationship between the parent and the child could be undermined.

The evidence indicates that high-quality early years education produces better outcomes in school for children. Professor Jay Belsky at the University of London investigated this issue. Exposure to poor-quality early years education and nursery care over a number of years can have serious, although small, deleterious effects. But if a lot of children go through these experiences, the overall impact can be significant. It is very hard to measure—this is probably why it does not get prioritised enough—what difference it makes if there is not sufficient support for relationships between parents and children in the earliest years and in adolescence. It is easy to measure cognitive performance in schools, whereas the relationship between parent and child in the earliest years and adolescence is hard to measure. However, qualitatively I am very clear, after consulting with colleagues in the mental health profession, that it is hugely important to get that support right.

I know that the Department of Health works closely with early years services to try to offer such support, but there are still shortcomings. For instance, there is not sufficient support in adult mental health services for adults as parents in children’s centres, and more work could be done. An old chestnut is that, if a parent is presenting with mental health issues, thought is not always given to the fact that the parent has children who will have needs. If a parent is mentally ill, what are the mental health needs of the children? Again, if a child presents with mental health problems, a proper assessment needs to be made to look at whether perhaps the best input is to support the parents. That may help the child to get better.

Noble Lords will be pleased to know that I will not say much more. A few years ago I remember working with a young man who was just coming out of adolescence. His father was an alcoholic and he had experienced domestic violence in his home. I was seeing him and working with him once a week for six months. The issues he had were that he was experiencing growing paranoia, he was fearful and distrustful of the staff, he was mercurial and unpredictable in his behaviours and he had a difficult relationship with women. If there had been better support for that family, perhaps the nascent problems we saw at the time could have been nipped in the bud and he would not have had those difficulties.

I am sorry if I am not explaining myself sufficiently clearly, but I would be grateful if the Minister could reassure the Committee that in any of the new arrangements there will be a particular focus on getting in early to support families, both parents and those acting in the role of parents, in their relationships with their children to make sure that those relationships are strong. Children will then have a good basis from which to grow and enter adulthood. I hope that that will be a priority in the new arrangements.

[Earl Howe]

My Lords, Amendment 7, tabled by the noble Lords, Lord Beecham and Lord Hunt, and the noble Baroness, Lady Thornton, seeks to set out a new definition of the health service in England as,

“those services provided under section 3”,

of the 2006 Act. While I know that the noble Lord has the best interests of the NHS at heart, I fear that this amendment might achieve the opposite of what he intends because its effect would be to narrow the definition of the health service.

Section 3 of the NHS Act 2006, as amended, will set out the services that clinical commissioning groups will be required to commission, including, for example, maternity services, hospital accommodation and, in answer to the noble Earl, Lord Listowel,

“such other services or facilities for the care of pregnant women, women who are breastfeeding and young children as he considers are appropriate as part of the health service”.

Defining the health service as meaning only those services set out in this section would limit the application of the provisions of the Act, excluding other vital parts of the health service that are not defined in Section 3. For example, that definition would exclude primary care and specialised services, which would be commissioned by the NHS Commissioning Board, and public health services, which would be provided or commissioned by the Secretary of State or local authorities. Clause 1(1) of the current Bill retains the Secretary of State’s duty to promote a,

“comprehensive health service designed to secure improvement … in the physical and mental health of the people of England, and … in the prevention, diagnosis and treatment of illness”.

This clearly sets out what the health service must do. Any attempt to define it more precisely might have the perverse effect of leading to an NHS which delivered fewer services.

I can assure the noble Lord that services commissioned by clinical commissioning groups will be covered by the wording of the unamended clause, and thus these services will be covered by the Secretary of State’s duty to promote the comprehensive health service. As part of the health service, those services must remain free of charge. Clinical commissioning groups will be responsible for commissioning the services listed in Section 3 of the 2006 Act such as hospital services and maternity services. They must arrange those services, although as with primary care trusts at present, Section 3 will permit them discretion to determine precisely what services are necessary to meet the reasonable requirements of their local population. The Commissioning Board will issue commissioning guidelines and monitor the commissioning activity of CCGs with a view to ensuring that no essential services go uncommissioned in any given locality.

Winterbourne View

Debate between Earl of Listowel and Earl Howe

Wednesday 8th June 2011 Lords Chamber

[Earl Howe]

My Lords, I take the noble Baroness’s point. It is very easy to blame the CQC whereas we should in fact first point the finger at those who perpetrated these awful acts and at the management of the hospital. There are a number of other agents involved besides the regulator. We are committed to developing the role of the Care Quality Commission to make it a more effective regulator of health services in England. Those efforts can be supplemented by the role of HealthWatch, which she will know we proposed in the Bill before the other place to strengthen the arrangements for the patient and public voice. I am sure that there is more that we are able to do, but it is important that we learn the facts first before pointing the finger at the regulator or anybody else.

[The Earl of Listowel]

My Lords—

NHS: Reform

Debate between Earl of Listowel and Earl Howe

Monday 6th June 2011 Lords Chamber

[Earl Howe]

My Lords, if the noble Lord remembers, we consulted extensively last year when we published our White Paper. However, as the Bill progressed though Parliament, it became apparent that concerns on the detail of the Bill gave rise to matters of implementation which could have legislative implications. That is why we have taken a second chance to look at that detail.

[The Earl of Listowel]

My Lords—

Mental Health: Children in Local Authority Care

Debate between Earl of Listowel and Earl Howe

Monday 23rd May 2011 Lords Chamber

[The Earl of Listowel]

To ask Her Majesty’s Government how they are meeting the mental health needs of children in the care of local authorities.

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

My Lords, supporting and promoting the mental health needs and well-being of looked-after children is of the utmost importance. It is not the job of any one person or organisation. Strong and effective multi-agency working across local authority and health partners is essential. No Health without Mental Health provides a co-ordinated, cross-government focus to improving mental health outcomes for people of all ages, including those in vulnerable groups such as children in the care of local authorities.

[The Earl of Listowel]

My Lords, I thank the noble Earl for his reply. Will he urgently consider working with local authorities to ensure that, in the early assessment of children when they are taken into care, a clinical psychologist with appropriate training or a child psychiatrist is involved so that mental health needs are recognised and can be acted on? Furthermore, will he say what the state of specialist looked-after children’s mental health services is? These are multidisciplinary teams developed in some local authorities and are particularly vulnerable to closure at this time of funding shortage.

[Earl Howe]

My Lords, with his experience in this area, the noble Earl hits upon some extremely important points. As he will be aware, support for the mental health needs of looked-after children is at its most effective when child and adolescent mental health services, CAMHS, provide dedicated resources to work with looked-after children and their carers with trained and experienced staff. It is up to local authorities to decide the level at which staff should be appropriately deployed. Targeted CAMHS for looked-after children should work closely alongside the child’s social worker, carers and other professionals such as nurses and paediatricians. It is reassuring that data collected over past years for the CAMHS mapping survey by Durham University show an increase from 2003 to 2009 in the number of social services teams and teams with a focus on looked-after children, although those data carry a slight health warning in that participation in the survey, I understand, was voluntary.

Health: Visitor Service

Debate between Earl of Listowel and Earl Howe

Monday 14th March 2011 Lords Chamber

[Earl Howe]

My Lords, we hope to recruit nurses and midwives for upskilling from a variety of sources. Some will come out of retirement, we hope, while others will, we trust, come from the acute sector. As my noble friend knows, the trend for a long time has been to try to get care increasingly out of acute settings and into the community. I think that we will see that transfer of skills taking place from a variety of sources.

[The Earl of Listowel]

My Lords, given the important and welcome drive to recruit health visitors, will the Minister consider hosting a meeting for health visitors and Members of the House of Lords so that we can understand this issue better and support this work as far as we can?

[Earl Howe]

My Lords, I draw the noble Earl’s attention to the document which my department published last month, Health Visitor Implementation Plan 2011-15: A Call to Action, which sets out how we are going to work with partners to deliver our ambition, including, very significantly, the Sure Start children’s centres which play an important role in our agenda. However, I will take the noble Earl’s idea back with me and be in touch with him about it.

Health: Chronic Obstructive Pulmonary Disease

Debate between Earl of Listowel and Earl Howe

Wednesday 17th November 2010 Lords Chamber

[Earl Howe]

My Lords, I am concerned to hear the noble Baroness’s comments because I know that an enormous amount of good work is going on around the country. There are programmes to encourage clinical leadership, improvement projects designed to integrate services, a commissioning toolkit, benchmarking data on outcomes and tools to aid local campaigns. If the services designed to help COPD patients are being diluted in any way, I should be very concerned about that and interested to hear the details.

[The Earl of Listowel]

My Lords, does the Minister recall the recent paper from the Royal College of Psychiatrists that highlights that mental disorder is behind a large number of people taking up smoking and drinking? Will he consider whether this is not an argument for further investment in child and adolescent mental health services, so that children and young people suffering from anxiety and depression receive the help that they need at an early stage and do not reach for alcohol, tobacco and other substances that can have these awful outcomes in later life?

[Earl Howe]

My Lords, I congratulate the noble Earl on linking mental health with COPD in that neat way. He is absolutely right that smoking is an activity that puts one at high risk of COPD and that smoking is closely associated with poor mental health. Fifty per cent of the tobacco smoked in this country is smoked by those with mental health problems. We are determined to continue efforts to discourage smoking in the general population. We are also keen to raise awareness of good lung health generally, which brings us back to the Question on the Order Paper. To a large extent, such efforts will fall to the new public health service in future.

Health: Spending Cuts

Debate between Earl of Listowel and Earl Howe

Wednesday 30th June 2010 Lords Chamber

[Earl Howe]

My Lords, the Government are conscious that the health and well-being of the population are affected by a number of factors outside the strict confines of the healthcare system. At the same time, we should not underplay the role of the NHS in tackling health inequalities, and not least the role of primary care. In that context, my department is privileged in being able to look forward to a budget that is not going to be cut over the course of this Parliament.

[The Earl of Listowel]

My Lords, we know very well the health inequalities among looked-after children in public care. Will the Minister look very carefully at the specialist mental health services provided by local areas to children in public care and ensure that they are sustained as far as possible? He may recall that, in 2004, 68 per cent of children in residential care were found to have a mental disorder. Will he look especially carefully at children’s homes and ensure that, wherever there are partnerships with the mental health services, those partnerships are sustained?

[Earl Howe]

My Lords, I acknowledge the noble Earl’s continuing interest in this area, about which I know he is extremely well informed. The Government are committed to improving the health and well-being of children and young people in whatever setting, especially the most vulnerable and disadvantaged. We are conducting a thorough review of the programmes that my department funds. There is nothing sinister in that; we want to ensure that, as part of the spending review, our programmes and policies have the strongest evidence base and represent the best value for money.