Health: Eating Disorders

Lord Lingfield Excerpts

Tuesday 19th January 2021 Lords Chamber

[Lord Bethell (Con)]

The noble Lord is right: the pandemic will have added pressure, particularly on young girls. In-patient units are experiencing tremendous pressure, so it is difficult to see those instances working their way through primary care at the moment. We are studying the situation very carefully, but the noble Lord is entirely right: it is quite possible that incidents will increase, and we will put resources in place to address that.

[Lord Lingfield (Con)]

My Lords, is my noble friend aware that around a quarter of all sufferers of eating disorders are men, and that the number of males seeking help has gone up by 70% in the last decade? With the increasing emphasis on young men to attain a certain body type, does he agree that more males might need support in the coming years?

[Lord Bethell (Con)]

My noble friend is right to remind us that this is not a gender-specific condition and that many men have eating disorders of one kind or another. The culture we live in does nothing but encourage that and I think we have to address the underlying causes, both psychiatric and the pressure of social media. We will be putting in place the resources necessary to support that kind of initiative.

Queen’s Speech

Lord Lingfield Excerpts

Thursday 9th January 2020 Lords Chamber

[Lord Lingfield (Con)]

My Lords, I was pleased to see the promise in the Queen’s Speech of more funds for education, particularly to read in the notes attached that support for special educational needs next year will include a 12% increase in funding. Of course, I welcome this entirely, but an injection of cash is not enough if the system of its allocation does not work well and enable it to reach those with severe special needs whom it is intended to benefit. I want to look today at several aspects of the system which need urgent review if the new funding is to give value for money and bring results.

Just over 10 years ago, I wrote for David Cameron a report which recommended that what were then called statements, which applied to educational special needs, should also include resources for health and social care. As a result, the coalition Government brought in legislation for education, health and care plans.

There were many things wrong with the statement structure, but one good thing about it was that statements were portable by parents who moved across local authority boundaries. This was because they were issued on a standard document on which the individual’s needs, and the provision to be made, could be set out. That did not guarantee a problem-free transfer but at least the child’s requirements were clear and written down.

However, EHC plans are often simply not capable of being exported and much hardship and difficulty can be caused. What is a plan in Essex, for example, might not be the same as a plan in Kent or in Lambeth. We need a standard national form of plan which will provide as seamless a transfer as possible from one authority’s provision to another’s should parents move house across borders.

There are also reports that some authorities are failing to specify provision for education in EHC plans or are shifting it irregularly to the healthcare area of the plans rather than putting it in section F, which is meant for education. There is a statutory requirement for clear specification of provision so that it is transparent for parents and can be costed. Many local authorities appear to be in breach of the law. The tribunals judiciary constantly raises the issue of specification, and the majority of plans taken to it for adjudication simply lack proper itemisation of the services which must be provided. It may well be that some local authority staff are inadequately trained, or it may be, to take a more cynical view, that this is a deliberate policy to save money or duck responsibility. Whatever the answer, EHC plans must adhere to the law in this regard if children with special needs are not to be deprived of the new resources that the Government have promised for them.

One of the statutory duties required of authorities is to hold an annual review of every EHC plan to see whether its provisions are still needed and still appropriate. However, many seem to be failing in this very important task. Some research last year, based on FoI requests from 53 local authorities, suggests that only three of them could report that they had completed their annual reviews of plans in the previous year—2018. Seven had completed fewer than a quarter of the reviews, and one had completed none at all. If this is so, then for about 80% of EHC plans, it is not known whether the plans are working properly, are good value for money or are still appropriate for the vulnerable persons concerned. It is no wonder that, since these reforms became law in 2014, the number of appeals registered to the tribunals has doubled each year. In 2018-19, 5,900 appeals went through to completion—the largest number ever recorded. Local authorities won their cases in only 7.5% of those appeals.

EHC plans, where they are working, can be a great improvement over the old system. However, if the welcome increase in funding is to have maximum effect, then the issues that I have mentioned will require urgent remedy.

Queen’s Speech

Lord Lingfield Excerpts

Tuesday 22nd October 2019 Lords Chamber

[Lord Lingfield (Con)]

My Lords, I welcome entirely the aspiration in the Queen’s Speech that,

“all young people have access to an excellent education … preparing them for the world of work”.

I will speak briefly today about the education and training of those who are not in the youngest quartile and who need as much investment in their needs as students in their teens and early 20s. I remind your Lordships of my registered interest as chairman of the Chartered Institution for Further Education.

Adult learners can belong to a number of different groups: those who did not do well at school but now wish to make up for time lost; those who have decided, or been forced by redundancy, to seek a different career and need to be retrained; those who wish to be trained at a higher level in their present skills to help with promotion in their employment; and those who want simply to acquire new accomplishments. One criterion is nearly always present across these groups: that they are very well motivated to learn.

Yet it appears that we have been failing these adult learners for a very long time. During the past 10 years adult enrolments have diminished from 5 million to under 2 million annually, a fall of 62%. For those taking IT qualifications, for instance, the drop is a huge 89%. It would seem from these figures that many would-be adult learners can no longer find the courses they require from further education. Yet the Education and Skills Funding Agency tells us that there has been a national underspend in the adult skills budget in the last few years of £63 million in 2016-17 and £76 million in 2017-18. This is money allocated and available for adult education but unspent. Clearly, there is something wrong.

One obvious problem was that caused by the funding agency’s changes in recent years to the funding criteria. These changes in effect reduced the number of people who are eligible for courses. For example, those aged 24 and above could be funded for only level 1 or 2 courses, whereas we know that level 3 courses have the biggest impact on individual progress and therefore on national productivity. An inflexibility in the system has meant that, although funding has in principle been earmarked for adult education, the rules have often made it impossible to access for a large number of people. Thus many who would like to take those level 3 qualifications to improve their skills or chances of employment have increasingly had to pay for them themselves, which many find impossible, or take on a student loan, which can be very worrying for those on a low wage.

Hence, I welcome this year’s policy of devolving the adult skills budget to six combined authority areas and Greater London. This started to take effect on 1 August and can be operative for courses that began last month. It means that colleges of further education in those areas can be permitted to fund level 3 courses for adult learners, including those at work, if they judge that this will improve the local economy and lead to more jobs. I want especially to mention the forward-looking work of the West Midlands Combined Authority, which has already carried out a special consultation with colleges in its area to ensure that the right criteria exist for funding and that many more individuals are able to access funded level 3 courses and above to aid them in making progress in their careers.

The combined authority areas have about a third of all further education colleges and account for about half of the adult skills budget. For the other two-thirds of the country’s FE providers, government funding policy is still far too restrictive and can allow would-be adult students to be trapped in low-level jobs from which they cannot break free because they cannot afford to pay for the qualifications which would allow them to do so. Hence, it is imperative that the experiences of colleges and their adult learners in the combined authority areas are studied very carefully in the next year and that every effort is made to devolve more resources to individual vocational colleges and providers outside those areas in future. This could establish a far less rigid regime which trusts the professionals involved to know what is best for their students and to produce funded courses for them, suited to their needs and those of local employers.

It is absolutely essential that we get this right if we are to develop here in the United Kingdom the flexible, skilled and well-trained workforce we shall need to meet the productivity challenges that the next years will certainly bring to this country. I hope my noble friend will be able to reassure me on some of these issues.

Health: Stroke Survivors

Lord Lingfield Excerpts

Thursday 28th June 2018 Grand Committee

Asked by

[Lord Lingfield]

To ask Her Majesty’s Government what action they are taking to improve the provision of long-term rehabilitation for stroke survivors.

[Lord Lingfield (Con)]

My Lords, I thank noble Lords and the Minister for giving up time for this debate. I remind your Lordships of my registered interest as the chairman of the stroke charity ARNI, Action for Rehabilitation from Neurological Injury.

We know that in the UK over 150,000 people have a stroke annually. But happily, people do not die nearly so often from stroke as they used to. In fact, some 85% of those who suffer a stroke survive it. They do so because: first, there is a greater recognition out there of what a stroke looks like, and the importance of immediately calling the emergency services; secondly, ambulances get stroke victims to hospital more quickly; and thirdly, when they are there, hyper-acute stroke units can carry out rapid diagnoses, first-class scanning and excellent treatment.

The net result of this upsurge in the welcome ability to save lives is that we have a very large number of stroke survivors. In this country, some 1.2 million people are living with the effects of stroke at any one time. It is the biggest disabler of all. It is those people whom I want to discuss this afternoon for, if the clinical treatment of stroke patients has been a great success story, sadly, helping them to live as near normally as possible afterwards has not been so.

Rehabilitation starts typically with physiotherapy and, if required, speech therapy. It begins for most people in hospital; they then continue as out-patients or receive treatment at home, but it is very much time limited. The health watchdog, the National Institute for Health and Care Excellence, has produced guidelines based on recommendations by the Royal Society of Physicians, which suggest that patients should receive 45 minutes of each therapy that they need every weekday, for as long as their disabilities require it. This is a huge ask of course but, typically, we are told that stroke survivors average the equivalent of just 16 minutes per day of physiotherapy, 12 minutes of occupational therapy and 12 of speech therapy. Moreover, on leaving hospital, many have to wait six weeks before community therapy, such as it is, is initiated. The Stroke Association says that, at this stage, many are forced to pay for private care.

One-quarter of all strokes in the United Kingdom happen to people of working age, and one-fifth of these are under 45. Stroke therefore reduces employment prospects for the future for its sufferers, with all that means for society. It has a knock-on effect for family and friends involved in a patient’s care and who are usually, of course, unpaid in this role. The estimated aggregate costs of stroke are a substantial £25 billion. There is still a commonly held misconception, however, that people cannot significantly recover from the effects of having a stroke and that they are stuck with whatever mobility they have after hospitalisation and its consequent physiotherapy for the rest of their lives. However, well-established evidence shows that neuroplasticity of the brain can be utilised to augment recovery, leading to better function and action control even some years after the stroke has happened.

Stroke-specific physical training, applied at home, which targets upper and lower limb deficits can be the key to a better quality of life and for readmission to employment. In short, active approaches where patients are highly involved in their own rehabilitation and do many hundreds, sometimes thousands, of specific repetitive actions can lead to positive neural adaptation, whereas those where survivors are merely the recipients of predominantly traditional therapy are much less likely to do so.

It is precisely these active interventions which my own stroke charity, ARNI, does so well and with such heartening results. ARNI was created in 2001 to ensure that there is a growing body of qualified exercise instructors available for stroke survivors. They go into homes to help people to rehabilitate and we now have more than 100 therapists and professional instructors across the country, many of them running group classes as well.

This kind of rehabilitation works with people of all ages, including those whose strokes happened some years before. Here is the testimony of John Scrivener, an elderly former paratrooper who suffered a massive stroke in 2012, losing the use of his left arm and leg. Two years later he was introduced to ARNI’s exercise techniques at which he works hard and regularly with his instructor. He says:

“I can now go up and down awkward steps with no handrails. I have no difficulty in going into strange environments and I can even get up unaided from the floor. I am astonished by the changes that have made such a difference to my life”.


The broadcaster Andrew Marr has said publicly and often how ARNI’s exercise regime helped him enormously after his own stroke and gave him better gait, balance, grip and strength, the better to be able to cope with his arduous public life.

Last year I saw Harry Baker, then 16 years of age, start his rehabilitation with my charity. He had significant limitations and could hardly lift his hand. A year later, after determined and repetitive special exercises, he has improved so much that he has had the confidence to join a martial arts class, where I witnessed his agile kicking and dextrous handling of a football. The appalling and depressing effects of a stroke, probably the result of a sports injury, were felt deeply by this teenager whose social life was reduced to zero. Normal life beckons for him once again.

One simple ARNI technique reported at the World Stroke Congress has improved the lives of hundreds of patients and saved many thousands of pounds in public funds. It is called “off the floor” and enables stroke-impaired patients to get up from a fall by themselves. Typically, before learning it, many would lie immobile for hours or, often with huge embarrassment, had to rely on calling 999 for paramedics to help get them back up.

Stroke survivors rely on charities like my own for this kind of long-term rehabilitation because it is not available from any other sources. I pay tribute to the Stroke Association, which last year began its £2 million project of Life After Stroke grants, having been sponsored as the Royal Mail’s charity of the year. These grants of £300 each can enable longer-term rehabilitation such as that which I have mentioned to take place. We badly need two things: first, the recognition that disabilities caused by stroke can be much improved by techniques such as those I have described, and secondly, grants from public funds to make this happen. As always, such investment will save money even in the medium term by reducing the number of people who are expensively re-hospitalised by injury or physical decline, by reducing their reliance on the ambulance service, and by reducing the burden on carers. Above all, it will help to give survivors of all ages back the dignity of being able to live more normal lives physically and socially, and even the ability to return to the world of work.

We are extremely good at dealing with the immediate effects of stroke, but now we must deal just as effectively with its long-term effects as well.

Health: Stroke

Lord Lingfield Excerpts

Wednesday 23rd July 2014 Grand Committee

[Lord Lingfield (Con)]

I thank greatly the noble Baroness, Lady Wheeler, for securing this valuable debate. I declare an interest in that I am the chairman of the charity Action for Rehabilitation from Neurological Injury. Last week, I was privileged to invite to your Lordships’ House a dozen distinguished professors and specialists in stroke rehabilitation from all areas of the United Kingdom. Their aim is to create a new UK stroke rehabilitation service which is specialised and effective enough to cope with the requirements of stroke survivors of all ages over the long term.

My guest at this panel was Andrew Marr, who, as your Lordships will know, suffered a debilitating stroke last year. I pay the greatest tribute to him for two things: first, his extraordinary and determined efforts, which are bearing fruit, to return himself to health and, secondly, his generous willingness to discuss his experiences in public. He shared with us some of the concerns that have reached him, since his own stroke, from other survivors and their carers. Many seemed to describe their treatment or that of their children by the multidisciplinary teams at the acute stroke phase as really excellent. However, their following therapy was time-limited and subsequent support for them or their children back in the community was very limited indeed. This was the third point made by the noble Baroness, Lady Wheeler: that they had to fight for it.

My connection to stroke and young people is personal. My son suffered a severe brain haemorrhage, causing a stroke, in 1997 when he was 21 years old. A few years after that, we started together the charity for stroke rehabilitation, which I have mentioned and which matches rehabilitation specialists and exercise professionals to stroke survivors after they have been discharged back to their communities. I have seen a number of the young people, from six year-olds upwards, who are brought by their parents to our centres or to visit our personal therapists. I have been hugely encouraged by the way that these young people can, with the proper treatment, do very well in conquering the effects of stroke. The ultimate aim for their rehabilitation is for children to start attending school or return to it, or other education, as normally as possible.

One of the limiting problems I see with the children who visit our centres—apart from speech and language difficulties, which often seem to be overcome more quickly—is weakness, particularly upper-limb spasticity. This seems to be the most devastating impediment, which needs consistent long-term affordable therapy because it has to be tackled head-on, often with the coerced use of the limb concerned. The evidence shows that whereas children have the advantage over adults of having a more flexible template for neuroplasticity to occur, with the younger brain adapting more easily to replace lost abilities, children can often simply decide not to use, for instance, an affected hand while playing. They do not understand why they must actively work hard on their limitations as adults, such as Andrew Marr, have done. I met a young boy recently, for instance, who had been allowed to put his stroke-disabled hand in his pocket and keep it there all day long.

That is why community charities are so crucial to continuing the work of the already stretched National Health Service, whose multidisciplinary teams have often completed their work as quickly as a few months from the initial stroke incident. Rehabilitation for children must be continuous, without let-up, to keep propped open the window of time that the brain is most plastic. A number of small charities across the country do this and there is an urgent priority for national support for their work. Many have proven records of successful rehabilitation which, of course, eventually saves the public purse huge sums in carer and ambulance call-out costs. Many are run by volunteers and operate on small private sponsorship. Yet it is to those very bodies that parents turn to request the provision of community therapy and training assistance for young stroke survivors.

We need the means effectively to help the young gain the post-stroke rehabilitation that they need to lead successful lives. A national rehabilitation service of the kind that my group hopes to see, co-ordinating the often disparate services that are currently available, would be an excellent way forward.

Health: Stroke Care

Lord Lingfield Excerpts

Monday 30th January 2012 Lords Chamber

[Lord Lingfield]

I am very grateful to the noble Baroness, Lady Wheeler, for securing this important debate. I declare an interest as chairman of the ARNI Trust, which deals with rehabilitation after stroke. The noble Baroness has reminded us that stroke is now ranked as the largest single cause of disability among adults in the United Kingdom. About a third of a million people are now living with moderate to severe consequential problems, and in the brief time allowed I want to touch on one new initiative concerning them.

I was privileged early last year to visit a community centre serving a wide area. Inevitably, among those who come every day just to chat, dine or use its amenities were a considerable number of stroke survivors. I was there to open a unique new stroke facility, which has been pioneering a novel approach developed by the ARNI Trust, and this is the use of fitness trainers. I have to say that hitherto I had thought of fitness trainers as well-muscled young men and women hired at some expense to put city executives through their paces. However, these were rather different. Each had undergone a rigorous course in teaching exercises suitable for stroke victims. They are not physicians or physiotherapists, of course, and the techniques that they teach are simple but innovative ones which relate to the daily life-needs of their patients. I shall give an example.

Many stroke survivors will tell you that they dread falling over because getting up unaided is usually impossible. At home, they often ring the emergency services to assist them, the alternative being possibly to lie on the floor for many hours until a carer arrives. The staff of the centre that I mentioned spend many thousands each year on hiring professional paramedics to turn out when a stroke victim has fallen over while there. This is a legal requirement. In the new facility, the fitness trainers teach a novel and safe technique, currently the subject of a clinical study by a group from the University of Exeter and Plymouth University. It is called IGO—“I get off the floor”. Patients who have learnt it can get up unaided. It has been so successful that the centre now saves some £8,000 each year in paramedic costs, and the disabled people whom I interviewed are delighted with the new-found independence that such techniques can bring.

These trained fitness professionals are now teaching these techniques throughout the country, often in the homes of the stroke disabled, for there is evidence—and the noble Baroness, Lady Wheeler, touched on this—that some stroke victims can continue to make improvements long after conventional wisdom suggests. I have met many who have been able, after training in these techniques, to discard walking aids, and one has been mobilised out of his wheelchair.

Finally, evidence suggests that quite properly the vast majority of funding available for stroke nationally is directed towards the acute phases. In my view, a small funding adjustment towards long-term needs would lead to a greater emphasis on functional exercise after stroke.