Health and Care Bill

Debate between Lord Bishop of Durham and Lord Hunt of Kings Heath

Lords Hansard _ Part 1 & Report stage
Wednesday 16th March 2022 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

I am very grateful to the noble Lord for his intervention. However, his amendment says:

“The Secretary of State must, within the period of 12 months beginning with the day on which this Act is passed, lay before Parliament a draft Bill”.


In my book, a Minister laying before Parliament a draft Bill is in charge of that Bill.

[The Lord Bishop of Durham]

My Lords, I agree with those who have already spoken opposing the amendment. First, the amendment is not appropriate as a use of the legislative process accompanying this Bill through your Lordships’ House. There is a question of purpose. If opportunity for debate is the goal, we must underestimate neither the significance of the Bill of the noble Baroness, Lady Meacher, in October and the thorough, careful and considered debate, nor the possibilities of calling for Committee. I would also support that time being given in this House. There are important constitutional questions which arise if the amendment enacted by this House does in fact instruct the Secretary of State in the other place to propose and introduce a draft Bill—as the noble Lord, Lord Hunt, has just outlined. If that is not the case—and if the noble Lord, Lord Forsyth, is not advocating for this draft to be introduced—what is the purpose of the amendment?

Secondly, I am aware that the language of the amendment has some real problems. One example is “terminally ill”. We debated the importance of language at Second Reading of the Assisted Dying Bill. The phrase “terminally ill” is understood in a whole range of different ways in different parts of the world. Is there any guidance offered on the definition or scope behind the language in the draft Bill attached to the Secretary of State’s instruction?

The complexity of the issue in question is so great—and the lives of the people who are facing a personal debate of this kind, and feel that they would be particularly impacted, are so important—that this cannot be how we legislate on their behalf. We are on Report, so I was disturbed that the noble Lord, Lord Forsyth, intervened when he did.

Children and Social Work Bill [HL]

Debate between Lord Bishop of Durham and Lord Hunt of Kings Heath

Wednesday 6th July 2016 Grand Committee

[The Lord Bishop of Durham]

My Lords, in moving this amendment I should explain that I speak on behalf of the noble Baroness, Lady Lister of Burtersett, who has done the bulk of the work on this amendment. She is unable to be present today and sends her apologies.

Amendment 99 would require the Secretary of State to report to Parliament within six months of Royal Assent on ways of implementing the World Health Organization’s recommendation in the European Report on Preventing Child Maltreatment regarding improved data collection for monitoring and evaluation. The recommendation points to the,

“urgent need for reliable and valid data”,

on, among other things, “socioeconomic factors”, reflecting the earlier statement in the report that:

“Child maltreatment is linked to variations in socioeconomic means”.

The aim of the noble Baroness and me in tabling this amendment is to encourage the Minister to set out the Government’s position on the relationship between socioeconomic inequalities and child neglect and abuse, and then to commit to exploring how the Government might collect the data called for by the WHO—and more recently, in 2015, in a Council of Europe Parliamentary Assembly report to the Committee on Social Affairs, Health and Sustainable Development, which recommended that member states,

“collect anonymised data on the care population in member States”,

which is disaggregated by a number of factors, including socioeconomic background. The amendment deliberately allows plenty of time, because we know that working out the best way in which to collect such data is not a straightforward matter. Here we would both like to thank Professors Paul Bywaters and Brid Featherstone for their help with the amendment.

At Second Reading, the noble Baroness quoted from a recent Joseph Rowntree Foundation/Nuffield Foundation evidence review on the relationship between poverty, child abuse and neglect, by Professor Bywaters and colleagues. One of the points it made was that,

“poverty often slides out of focus in policy and practice”.

I am afraid it slid out of focus in the Minister’s response to the debate at Second Reading, so we want to bring it back into focus now. The noble Baroness urged the Minister then to undertake to look into the failure of the official statistics to tell us anything about the socioeconomic circumstances of looked-after children’s parents. He did not respond at the time, so we are giving him the opportunity to do so today.

The JRF evidence review is the best source of evidence currently available. Drawing on the data sources available, it found a “strong association”, forming a clear gradient, between families’ socioeconomic circumstances and child abuse and neglect:

“The greater the economic hardship, the greater the likelihood and severity of CAN”.

The report stresses that this is not a question of individual blame, but rather a question of public policy and of socioeconomic inequality. Parents living in poverty all too often already feel judged and shamed, and this simply adds to the pressures they face. Over the decades, study after study has shown how poverty can undermine parental capacity so that the very survival strategies parents, especially mothers, adopt to get by can so deplete their mental and physical resources that they are unable to be the parents that they want to be.

The context of the WHO’s recommendation is a strong emphasis on prevention, a theme that runs through many of the contributions to Second Reading and indeed our debates in Committee. It argues that:

“In view of the emerging evidence on the scale of maltreatment, its recurrent and chronic nature and the fact that there is good evidence to support preventive approaches, there is a need to focus on prevention … Maltreatment of children instils a sense of moral outrage, but it is important to go beyond this reaction to address the problem through a public health, science-informed approach”.

It suggests that “prevention programmes”, such as parenting support, which focus on the social, economic, cultural and biological determinants of child maltreatment are “cost-effective” and that more “‘upstream’ activities” that focus on, among other things,

“deprivation, social and gender inequalities … are worthwhile investments in the long term”.

But to target such programmes effectively, we need reliable scientific evidence about the socioeconomic conditions in which at-risk children are being raised—data about their parents’ circumstances. At present, official data tell us nothing about their parents’ circumstances, as if children grow up as isolated units.

On reading the JRF/Nuffield evidence review, I was struck by the fact that the authors had to rely on area-based analysis, smaller-scale studies and professional experience, together with data from other countries. They were confident of their broad conclusions about the relationship between socioeconomic circumstances and poverty, and child abuse and neglect,

“despite the major limitations in the evidence from the UK”.

But because the relationship,

“has been almost entirely unresearched in the recent past in the UK”,

they were unable to draw,

“detailed conclusions about the extent to which poverty is a factor in the occurrence and prevalence of CAN in the UK”.

This is not good enough, and the first step must be to see what can be done to collect and publish, on a regular basis, official data that will facilitate informed evidence-based policy-making. Furthermore, it appears to me that this amendment is entirely in line with the intentions of the Government’s life chances strategy, in which there is an intentional recognition that there are key factors which affect the life chances of a child. This research into the linkage between maltreatment and socioeconomic factors surely fits squarely into that intention. Hence the aim of this amendment is to further enhance the base on which the life chances strategy is built.

The amendment does not require the production of any particular set of statistics, because of the complex question of how this can best be done. It simply requires the Secretary of State to look into the question and report back to Parliament. The noble Baroness, Lady Lister, and I cannot see how the Minister could possibly object to that. I hope therefore he is willing to accept this amendment or to make a commitment that embodies the spirit of it. I beg to move.

[Lord Hunt of Kings Heath]

I shall add a couple of words to the excellent introduction by the right reverend Prelate. His argument about the need to collect statistics to look at the relationship between poverty, child abuse and neglect is very persuasive. The Minister will know that local authorities have now been given responsibility for public health. Each local authority employs a director of public health and the practice—I think it may be a requirement—is for the director of public health to produce an annual report on, essentially, the health statistics of the people living in the local authority area identifying the problem areas and weak spots to drive the public health policy of the local authority. It strikes me that to poverty, child abuse and neglect, you can add health and well-being. One practical way through might be to add to the responsibilities of the director of public heath a duty to produce consistent, uniform statistics throughout the country. It would also mean that the local authority response would not be in relation to just one sector but would be a more general response. I suspect that if one were to look at the statistics in relation to health outcomes, one would find that many of the families to which the right reverend Prelate referred would also be affected by those health issues. A holistic response is probably required here.

[Lord Nash]

My Lords, I am grateful to the right reverend Prelate the Bishop of Durham and the noble Baroness, Lady Lister, for raising this important issue. High-quality data are crucial at both national and local level. They can inform the development of government policy, help us to understand how the system is working, help us to support and challenge local areas and facilitate local learning. At local level, high-quality data can ensure that children’s needs are identified early, resources are targeted appropriately, services are commissioned effectively, risk is managed well and the right support is put in place for children and their families. I assure noble Lords that we are looking at ways in which we can improve the quality of the data we collect.

Noble Lords may be aware that following Professor Eileen Munro’s 2011 review of child protection in England, the Government produced a children’s safeguarding performance information framework to help professionals get the most out of the range of data available nationally and locally. We are also taking steps to improve the national children in need census data collection. For example, last year, for the first time, we published factors identified by social workers in assessments of children, exactly the sort of issue raised by the World Health Organization’s report. Indeed, the World Health Organization suggested that a cost-effective way of implementing its recommendations would be to include key questions in existing or planned surveys. The Department for Education will shortly be running its first children’s services omnibus survey. This biannual survey will allow us to gather a range of useful information from local authorities. The questionnaire is still in development, but we intend to ask local areas about how they analyse demands for services locally, which should include using socioeconomic factors. We know that many local areas are making great strides in their data analytic capabilities. Noble Lords may be interested to look at the Association of Directors of Children’s Services’ Pillars & Foundations report.

We continue to work across government to align collections, better join up different collections and make use of technological advances to collect data in real time. However, we do not believe that requiring the Secretary of State to produce a report on ways to implement the World Health Organization’s recommendation in the European report on preventing child maltreatment is necessary. We have lots of work planned in this area and already in train. I hope that noble Lords are assured that the Government recognise the importance of effective data collection and are striving to make improvements in this area. I will pass on to colleagues in the Department of Health the point made by the noble Lord, Lord Hunt, about a more holistic approach, but in the light of what I have said, I hope the right reverend Prelate will feel able to withdraw his amendment.