Learning Disabilities and Autism: Solitary Confinement in Hospital
Lord Addington Excerpts(5 months ago)
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Lord Addington (LD)
My Lords, when you have been here a while and suddenly see a pairing of people coming up in front of you on a certain subject—and it is the noble Baroness, Lady Browning, and the noble Lord, Lord Touhig, on autism—the first thing you do is to listen hard. When you get a report that has been written with such authority, inspired by this subject, that is doubly the case.
Every time we hear about confinement and control—physical restraint, chemical coshes on groups—we are basically saying, “You have got a failure”. Why have we got to that? Often because in getting to that point, people have not understood this bit of their client base; the report refers to that. The noble Lord, Lord Touhig, just put his finger on it but from what I know of autism, that would be one person’s experience of it. There will be a series of traits gathered together that are complicated and different—never the same twice, so it is not easy.
It is difficult to tell a health professional, or any professional in any sphere, “By the way, your training doesn’t cover this properly”. We all have a series of reflex reactions which we go back to. We have to make sure that people on the way up to this point—or down, depending on how you want to look at it—have ideas about where they should have better interventions, or know whether they should make them or back off. If, as a mental health professional, you are confronted with somebody in an institution or in that process, unless you know not to behave as normal you will go into a pattern of behaviour because everybody does. You have put a reflex or bureaucratic pattern in place, so why would you break it? The only answer will be from the information about what you are dealing with.
Lots of things can go wrong in this process of identification and self-identification. I remember that once I managed to get myself into a totally unnecessary row with somebody who was on the autistic spectrum, because they accused me of not doing something in very aggressive terms. They probably did not mean to. I said, “Wait a minute—this is public”, and started to defend myself. Then they had a minor meltdown and left. I know more about this than most people but still do not know anywhere near enough to understand what that person was going through. Everybody can make these series of mistakes.
My question to the Government is: what are you doing to ensure that everybody in that process better understands that normal responses will get negative results on many occasions? How can we get that idea into the system quickly? Long training programmes, the fact that we are making progress through them and the fact that we have targets: those will all come out because they will be in the Minister’s brief—they always are. However, we need to know that an awareness that something will not respond correctly is required here.
Every time I have dealt with anything to do with autism, there has been this pattern of behaviour in the criminal justice system. To put it bluntly, autism is one of the most over-represented groups in society within the prison system. It can go horribly wrong everywhere. I take the example of the noble Lord, Lord Touhig, on the process of responding: when somebody is confronted with authority, suddenly there is a conflict there, without even trying.
How can people be trained and be made aware generally in society so that they can avoid getting as far as the medical facilities, and how can we make medical facilities aware that a different type of response will be required? I would like that big question to start to be answered. If we do not address that, we do not stand a chance of addressing it in the round because even if we train all the medical practitioners, they will still have a great flood of people coming to them—people who should not have been there.
The police in certain places have had a little more training, but usually after very bad episodes: some degree of conflict has taken place or somebody has been traumatised. We are asking the Government to give us a serious plan about building up a pattern of awareness within the institutions that people bump into. If there is a certain specialist pattern, you only get x number of people going into it. Somebody who is a high- functioning autistic or functions well with learning difficulties may bump into the system only occasionally. But if they do not have support and guidance, with somebody to say, “Yes, there is a different type of response required here”, those incidents will get bigger and more frequent, and we will have to deal with them at the acute level.
The same will apply to those who are discharged from hospital. There must be an entrance and a way down. Sometimes it will be specialist provision and sometimes it will be specially trained people, particularly when you are discharged having had some damage—let us face it, we have all had some damage. I would hope the Minister can give us some pattern for the first steps in making the institutions of government aware that a different way of responding is required. That is a necessary first step, meaning that people should at least ask others, “What do we do?”. If you have that, you will have a bit of hope, which is the least that we should take away from this debate.
Paediatric Care: Wating Times
Lord Addington Excerpts(6 months, 1 week ago)
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Lord Markham (Con)
The role of the GP is clearly vital. That is what I was trying to get behind in the Start for Life initiative and clear early warning indicators. Clearly, that needs to go right through the development of a child at different key stages along the way. On digital treatments, I was at Boston children’s hospital last week, and it has early indicators for dyslexia—for example, looking at pattern recognition via an app, as it is not until children are older that they can see letters. Similarly, early signs of neurodiversity can be seen in the way that children play online on certain apps. I think we can add some of these digital support tools, but clearly the GP has a primary role.
Lord Addington (LD)
My Lords, following on from his last comment, can the Minister give us some idea of what contact there has been on this with the Department for Education? We are supposed to talk to each other, but it becomes increasingly apparent that we do not do so.
Lord Markham (Con)
I like to think that we have good contact on this, centred around, as I said, Start for Life, which is a £300 million joint programme between ourselves and the Department for Education. There are also other things; for example, noble Lords might remember me mentioning the Bradford pilot previously, where we are looking at children’s scores in test environments and using those where there may be early indicators of ADHD or other neurodiverse needs. There is quite a bit of work going on in this space. No doubt we could always work more closely, but there is some promising work being done.
NHS: Performance and Innovation
Lord Addington Excerpts(10 months, 2 weeks ago)
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Lord Addington (LD)
My Lords, this is one of those debates where we all think we know what is going to be said, but hopefully we are all mildly surprised. My noble friend started this process by hitting the nail straight on the head, saying—I paraphrase, but I formed this impression—that we are dealing with everybody after they have fallen over, not making sure there is not something to slip on. We have a system which seems to be in almost terminal crisis, according to many politicians—it is always the politicians who are not in power—and we are always sitting in here trying to rescue it.
I have a bit of a track record on this issue. I think the first debate I spoke in when the Minister who will reply today was here was about trying to change the nature of what we do with health, and to improve the surrounding structure. It was on a Private Member’s Bill that was a wonderful thing, but the Government have decided otherwise. Health promotion has far greater potential than does the pharmaceutical industry for making sure we have a healthier society. Clean water and clean air have saved more lives than all the drugs piled up together. You put that together with a decent diet, and people survive.
But we have the health service in a box. How do we make sure that the health service influences the rest of society? We do not do it from behind a Chinese wall in Westminster, the punching through of which requires a huge act of will, either way. You can tell the Ministers who take that on: they have metaphorically bandaged hands from doing it. They are always trying to get through, and everybody thinks it is down something else. The priority is always the emergencies and no one has the authority to say, “No, we have got to carry on with this and other departments must change their activity and talk to us”. This strikes me all the time: those little battles you have constantly.
For instance, let us take one of my favourite subjects, sport. Good sporting activity means you are generally healthier and in contact with the rest of humanity, which is good for your mental health. In fact, the mental health benefits of sport and social interaction may outweigh the physical ones. We know that if you have good mental health, you are more likely to undertake physical activity. It is a virtuous circle. What is required? It might be making sure that we have a tax regime and a minor support structure that allows our voluntary-inspired amateur sports teams to continue more easily, being as generous and helpful as we can and not leaving them constantly struggling for finance.
We are very lucky in this country: we went first for amateur sport and did it by people doing it for themselves, outside the state system. The state does not have to do it. In France, you play your rugby, football or tennis at the stades municipaux.
In Germany—this is an example I have used before—I remember that, whereas the FA said, “We spend X number of million pounds on improving the number of pitches we have”, the Bundesliga turned round and said, “What are you talking about? That’s a local government job”. We need support for those structures; the Government must have some way of saying, “This is something for more than just local government or the Department for Education. It is more than just money taken from the lottery. It is something that the health service and the public health environment have an active interest in”.
Some of this will be purely bureaucratic, such as making sure that these structures are always available; part of it might concern planning. How many amateur sports teams have done the wonderful thing of killing off their junior sides by getting a deal on their ground and moving out of town to somewhere where there is no bus service? That is a great way to destroy a junior team. I bet that most people do not even take that into account when they do it. I bet that most sporting bodies are not advised when these people move; they all work in structures. Do not do it: you are going to damage your junior structure. There will always be a developer waving a chequebook at you, but you have to make sure that you can actually get there.
That is just for the amateur sports structures; we can then go on to say, “We have done things like, under the Agriculture Act”, as I remember being told, “farmers will get support to create footpaths”. Great—but who is telling those farmers to link in with existing footpaths and public service networks, or at least to have good car parking, so that there is a structure where everything can be used together? I have not seen that. I have not heard of somebody doing that, for instance by telling the Ramblers’ Association or others, “Please talk to each other and create better networks”—so that, for instance, if you are going for a walk or going somewhere else, you can either get public transport or get back to where you parked your car. That might allow the local community to have a better chance of sustaining a café, a shop or a pub. All these things come together; we have to think slightly more holistically on this. When it comes to encouraging people to walk casually to and from work, we all know the answer: make sure that the streets are comparatively clean and well lit. All these things come back into creating a healthier society.
We can even go further than that; I was going to save this point for a little while longer, but my party has been, quite rightly, raising awareness of water quality and sewage discharges. If you want people to do things such as wild swimming and boating, making sure that they do not come face to face with a turd is a good idea, to be perfectly honest. Can we make sure that the weight of public opinion on public health—indeed, the public’s reverence for the health service—is used to influence the rest of this structure? If we do, we will have something that can get in there. We will not do this by standing behind Chinese walls. We need something that will go beyond and talk. If we do this, we stand a chance of making these improvements that mean that the acute services are called on later and less frequently. The huge bureaucracy, which may or may not be dealt with at some point in the future, will at least be called into action less often. However, this will require somebody to go in there and annoy people and say, “Please talk to each other”.
I have been in Parliament more than long enough to know that, if you want to make a speech on anything, talking about getting two government departments to work together and how they do not do it is probably good for five minutes; let us face it, it always has been. However, in this instance, we already have cases of it. We have the first steps. I hope that, in future, a Government will be brave enough to take this issue on—that is, to turn round and say, “We need better sports education and a structure to get people involved”. That may well lead to something like a good social hub, which, if they are at all sensible, will be able to be accessed by people from outside the sporting community. We have to maintain buildings where any activity can take place.
If that is going on and people are interacting with each other across the whole of government, we stand a chance of making this better. This will make it easier for the other bits of government, including local government, to work. The whole of civil society can benefit. However, if we are talking about healthcare, the thing that gives someone a chance of enjoying their life is much easier if they have good health; it is much more difficult if they do not. We are going to have to take more positive steps. As has already been said, if we are obsessed with handing out pills in a certain way and concentrate totally on the overly high demand for acute services, we are never going to get there. I hope that, today, we will start to see this Government’s thinking on this subject, as well as that of others who are not in power at the moment.
Autism: Diagnosis Targets
Lord Addington Excerpts(11 months, 2 weeks ago)
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Lord Markham (Con)
Yes, absolutely, we need to look at all areas where we can increase and expand supply, including use of the private sector. I am sure I will be asked about ADHD later on and the “Panorama” programme, which shows that there are some pitfalls in all that, but provided they are assessing according to the NICE guidelines, it clearly has to be sensible to use as much supply as possible.
Lord Addington (LD)
My Lords, would the Minister agree that when you delay an assessment, you delay support from the entire structure of government, which we have said should be helping? What help is his department getting from the Department for Education and the Department for Work and Pensions to ensure people are getting to these assessments? If they cannot get the full assessment, can some intermediate steps be taken to ensure that people actually get the help they are entitled to?
Lord Markham (Con)
We are working closely with the Department for Education. The Bradford pilot scheme I mentioned takes the early years foundation stage profile scores of children. It knows that if you have a low score, you are far more likely to have autism. That triggers a multidisciplinary team to come in and inspect. That is a way that we can use that as an early warning indicator and then follow it up with volume. I hope that working very closely with the DfE in this space will be a real way forward.
Stroke Rehabilitation and Community Services
Lord Addington Excerpts(1 year, 1 month ago)
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Lord Markham (Con)
We are very much believers in the importance of social prescribing. I was at a reception just yesterday given by the Alliance of Sport, talking about the importance of active lifestyles for people’s mental health and recovery, and in the criminal justice system. It is something that we agree on the importance of. I will come back in more detail on the arts.
Lord Addington (LD)
My Lords, can the Minister expand upon the encouragement that the Government are giving to people in secondary services, to encourage people to fulfil the exercise programmes that are given to them by the experts? Without that encouragement from GPs and practice nurses, such programmes may seem very difficult and may not happen.
Lord Markham (Con)
My Lords, that is a very important point. Two things have really struck me. When people are in hospital, they lose 10% of their muscle mass per week, which is clearly key in their ability to have an active lifestyle and look after themselves outside. At the same time, they need constant support and reminders to keep up that active lifestyle. It is very much at the front of our mind.
Physiotherapy: Rehabilitation Services
Lord Addington Excerpts(1 year, 2 months ago)
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Lord Markham (Con)
I thank the noble Baroness for bringing this to our attention; again, I believe that the advantage of these Questions is that they shine the spotlight on particular areas. As the survey pointed out, there are a lot of places which, for very understandable reasons, were swapped over to Covid uses during the pandemic and which now need to be brought back into physio use. That was one of the main recommendations from the society, and we will now write to all the NHS chief executives on the back of that. As the House will be aware, I am doing some work anyway to make more space available as part of the capital programme, so this is very much on my list to make sure that we expand that space and provision.
Lord Addington (LD)
My Lords, does the Minister agree that physiotherapists do very little of their work in the actual appointment, and that it is the supervised exercise patterns they give patients afterwards that are probably the most important for all forms of rehabilitative structure? Bearing that in mind, what is the Department of Health doing to make sure that local government has facilities such as swimming pools and gyms that remain open under the financial squeeze?
Lord Markham (Con)
I agree with the noble Lord’s point; our estimate is that over half of all physiotherapy takes place outside the hospital environment. Clearly, all sorts of settings, including swimming pools and gyms, are vital for that. The work we have done with the Energy Bill and the caps has been a vital help to those leisure centres, and, thankfully, we are now starting to see bills come done and so these places are on a better financial footing.
Health Promotion Bill [HL]
Lord Addington ExcerptsFriday 2nd December 2022
(1 year, 4 months ago)
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Lord Addington (LD)
My Lords, this Bill is one I have come up with with an almost total lack of original thought. This is because it is taken from a combination of a good idea that the Government came up with, but then slightly back-pedalled from, and the recommendations from a committee that I served on with many of the other people here, which was chaired by my noble friend Lord Willis. It was called—let us get this right—the National Plan for Sport and Recreation Committee and it called for that national plan. The proposal here is that two ideas are combined: to have somebody who combines active public health with a national plan for sport. Why? Quite simply, it is because exercise is the wonder drug.
It is the wonder drug that does not just affect your physical health but, done correctly, usually supports your mental health. This is something we can do and something the public have already bought into on a massive scale—so much so that the Government are often let off the hook because most of our sporting establishments were made without government help, fund themselves and allow sporting activity to go on. Indeed, the national sports—football, rugby or cricket; you name it—provide quite a lot of the funding and government is a late player to this field.
I am calling for the Government to come in and take their fair share of the weight because, so far, they have not. They have allowed the old boys’ club or the old works team to provide the physical activity. Allowing them to do it means that amateur sport, which is what we are talking about solidly here, is something provided by people going into their own pockets to help others and using their own time to make sure it happens. That is one reason why I feel the Government have been let off the hook here. If you are running your local team and playing in it, giving X nights a week and your weekends to it, you are probably not interacting with a political process that keenly because there are only so many hours in the day. The same, by the way, can probably be said of the arts.
Government really should have done more; in most other places, it does. I remember the FA talking to its German counterparts and when it said, “We spend a lot of money on maintaining pitches”, the German response was apparently, “That’s a local government duty.” In France, you play at the stade municipal. I hope the Government will say, “We’ve got to get more involved here.” Now, I am sure the Minister has a brief in front of him that says, “There are lots of initiatives here. Departments will talk to each other because several committees will sit down to do this, so we’ve got lots of initiatives.” That is the answer I would have got 30 years ago. It is quite clear that, while they may have talked to each other, of decisions and cohesive action there have been little.
I could run through all the provisions in the Bill. It would not take that long but would rather try the patience of everybody here. If I can read them, I am sure we can all go through them. I would have claimed to be one of the most out dyslexics in public but I believe there is currently someone in the House of Commons challenging that position. I have two favourite provisions in the Bill: the inclusion of
“measures to promote physical access to the countryside for sports and recreation”
followed by the linkage between schools and clubs. Both depend on action across the board with local government and the departments for education, agriculture and transport all talking together.
Clause 2 has seven lines, which, as they stand, are probably more important than any other individual subsection, and say that government must work together. For instance, if we want to get the best out of our recent innovation that farmers will be helped to create footpaths, are we making sure that these footpaths are linked to traditional foot-pathing walks and that there is access to somewhere you can park a car or, better still, catch a bus to them? Would there possibly be some village where you could get a meal or a drink afterwards, and make a day out of it? That requires a huge co-ordination of government and unless you have something that drives it forward, you will not get there. We would be back to hearing, “This committee wants that”, and then there is the lobby. The less said about the planning or maintenance of a footpath, the better, because that has never been a happy story. How do you get that access out there?
On schools’ links to other bits of amateur sport, it does not matter if a headmaster has a row of trophies for various sports outside his room, because those children will be gone if they do not play the sport later on. A school should get awards for filling second and third teams in all of the local sports around it, not for winning the odd trophy, because that is where the benefits of social interaction and mental and physical health come in. We are rather too fond of saying, “Oh, we won something”. Many of us here were champions of our schools for something or were great debaters at the age of 11, 12 or 15. That does not matter; what matters is if you do something with it later on. It is just a tick along a pathway, but the pathway itself is important.
I declare an interest: I have played rugby union for probably far too long. My physiotherapist is probably quite happy about that. I advise everyone to read the House magazine for a report of the Commons’ and Lords’ most recent rugby matches. It is true that the photographs with it are from another match, but it is there. I will give a little commercial: anyone who is a passholder and has any knowledge of the game or would like to acquire a strange knowledge of it is welcome to participate. Golden oldies’ rules allow this.
Having done the commercial, I will come back to the serious matter here. Unless you co-ordinate better, you will not facilitate this. Public health starts with clean air and water, which have certainly saved more lives than penicillin, although it was pointed out to me not a few moments ago that penicillin is also a good thing. We have to have some form of co-ordination. You have something that benefits society holistically, if you allow it to happen properly. If someone is going to move a clubhouse from inside a small town to outside it because there is a wonderful development deal, make sure that there is a bus route, or at least a cycle path, to it. Why? Because you will not have an under-18s team when their parents get fed up with ferrying them around, or possibly cannot do so. If anyone wants an example of that, I can provide a list that goes on and on.
Let us get some coherent leadership from government here—not a series of diverse initiatives and schemes, but a coherent plan. You will have to upset someone and upset government a little bit, but, unless you do that, you will not get the best out of all of this. It all comes together under the heading of public health and improvement of our society. I hope that the Bill will be given a fair wind by this House.
Lord Addington (LD)
My Lords, I thank all noble Lords who have spoken in this debate. I look forward to the Minister, as a new boy, playing alongside me in the parliamentary team; the Scottish Parliament team is coming down on the Calcutta Cup weekend, so he should be ready.
It is quite clear that there is a groundswell of opinion that says that something coherent should be done about the lack of structure behind recreational activity and the fact that it should be linked to public health. The Government tell us that they have a new approach, but unless it is prepared to upset things or has the capacity to interfere with other plans and make sure that it comes to the fore, my experience is that it does not happen unless you are prepared to say, “No; you’ve got to work with this and integrate.” The Government like their Chinese walls. They do not like to be interfered with in any way. I therefore suspect that the Government’s approach might dent things a bit but not actually move them.
I could say more about all the friends in sport, to use the expression of the noble Lord, Lord Moynihan—we have acquired a couple today. We have taken a step forward. I also thank my noble friend Lady Randerson for the justified smack on the wrist. Making sure that we tackle discrimination is part of the Bill, but without that being recognised you will miss groups. You will miss the fact that in the big team games both genders are now represented, but not well enough, not integrated enough, and with not enough emphasis. There are more than those dominant sports, and we should go out from them.
I remind the House that when all three major political parties looked to their sport strategy about 15 years ago, we all came up with documents and you could literally swap paragraphs in them, putting them in and taking them out. One of them was that sport at school should not only be linked to your local clubs but you should try a range of sports, culturally attuned to your area. Unless we do that and have the capacity to carry it on—and many of the other things in the Bill are required for you to do that—you will always miss out. If you have somewhere where you can take exercise and a support structure with good role models to help you through, it will help mental and physical health—it is proven. At the moment the Government have a suggestion that says, “Yes, it’s quite good”, but they do not have enough capacity for intervention within their structure to do it. I hope I am wrong but experience tells me that I am not.
Childhood Obesity
Lord Addington Excerpts(1 year, 5 months ago)
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Lord Markham (Con)
My Lords, I agree that we—both as the Government and in general—need to be clear about what our recommended calorific intake is each day. Whether you choose to change that by eating one less meal, or however else you distribute your eating across the day, it is our role to help educate people on healthy eating. I agree that it is an issue and a big cost to both the health service and the economy. Our latest estimates are that it could cost the economy as much as £58 billion a year, so it is a critical message to get across.
Lord Addington (LD)
My Lords, would the Minister enlighten us on the position of the BOGOF—buy one, get one free—deals? Are we going to remove the disincentive to people buying extra calories in the form of an extra portion? Or will the Government encourage people not to buy the first portion?
Lord Markham (Con)
As I think the noble Lord is aware, the position on BOGOF, so to speak, is that we have delayed those restrictions for a year. We have taken significant action in this space, most critically in supermarkets, by moving the promoted items away from tills and prominent aisle endings to remove this so-called pester power. We will very much keep this under review; when we see the impact, particularly of moving those items, we can look again at whether we will introduce more BOGOF restrictions.
Disabled People: Personal Assistants
Lord Addington Excerpts(1 year, 7 months ago)
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Lord Kamall (Con)
My noble friend makes a very important point. I have found this to be the case with a number of initiatives that I have been working on in my department. Quite often, I will have a joint meeting on an issue—with someone from BEIS, for example—and I then realise that they have to go and talk to someone else outside of the room. When I have been involved in such initiatives, I have always insisted that whoever else across government has a role or interest in them is in the room with us. This is clearly another example of what should be happening. It should be jointly DHSC and DWP. Rather than thinking about whose responsibility it is, we should work together to find a common solution.
Lord Addington (LD)
My Lords, does the Minister agree that if we are dealing with this, it will need every department involved, as has already happened? Will he also ensure that the Treasury leads, because if you are denying that person the chance to work, you are also denying yourself their taxation? Can he go to the heart of government and say, “Get your act together and bring your friends along as well”?
Lord Kamall (Con)
The noble Lord makes an important point about who should be in that room when we are talking about all these issues. Generally, across government, there are a number of joint initiatives in terms of ensuring that we hit our target of equality for disabled people, but as other noble Lords have pointed out, this issue falls between DWP and DHSC. I was surprised when I was briefed on this about where it fell. It clearly must be people in the same room.
Bread and Flour Regulations: Folic Acid
Lord Addington Excerpts(1 year, 9 months ago)
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Lord Kamall (Con)
The noble Lord has a couple of questions there, and I will try to answer them as quickly as possible. We are hoping to launch a consultation in August/early September, with a close date 12 weeks after that. There should be a government response on the final position in Q1 2023. After that we have to notify the World Trade Organization and the European Commission, because of the Northern Ireland aspect of this issue. After that, we have a notification period of between two and six months. Assuming that that is all cleared as quickly as possible, we will be ready to lay the provision by Q4 2023. It is glacial, but I assure the noble Lord that we are doing this as quickly as we can.
Lord Addington (LD)
My Lords, will the Government give us an assurance that they have identified all the checks and balances? That might be a good start. Also, exactly how long did it take some of the other nations that have already done this process to get through it?
Lord Kamall (Con)
The Government are clear that we are doing this, but we also have to be aware of the debate regarding high levels of folic acid. We are progressing in areas where the consensus is that there are no unintended consequences or damage. However, the NHS website plainly says that you should not take folic acid if you have had an allergic reaction to it; if you have certain forms of cancer, unless you have folic deficiency anaemia; if you have a type of kidney dialysis called haemodialysis; or if you have a stent in your heart. Let us make sure that this is based on evidence. We have to make sure that we address the worry of unintended consequences; otherwise, what do we tell the relatives of those who have died because of high levels of folic acid?