Health and Social Care Bill

Lord Ramsbotham Excerpts

Tuesday 11th October 2011 Lords Chamber

[Lord Ramsbotham]

My Lords, like other noble Lords I have received an incredible number of e-mails and letters about the Bill. I suspect, too, that like many other noble Lords, as I listened to the reasoned case for the Bill put forward this morning by the Minister with his customary skill and courtesy, I could be forgiven for wondering what all the fuss was about. However, when like my noble friend Lady O'Loan I thought through the list of those who had written to me, I reflected that the vast majority are either patients or practitioners. What they have to say confirms the concern of the noble Baroness, Lady Williams of Crosby, that the Government have not yet made the case for the Bill with the public, and in particular with the two groups of people whose best interests are, they claim, paramount in the provision of health and social care.

Many noble Lords have rightly concentrated on concerns about competition and the position of the Secretary of State. However, like my noble friends Lord Walton and Lord Kakkar, I do not believe that these should be hived off to a Select Committee, mirroring committee practice in the other place. Far better that in order to do justice to the concerns that have been voiced to us and to exploit the undisputed expertise that has been deployed already, and will I am sure continue to be so, all aspects of the Bill should be debated in detail on the Floor of the House, however long that takes.

Rather than repeat what others have said, I intend to concentrate on three what may seem more prosaic matters in the time available. All have common NHS involvement in announced policies of other ministries about whose achievement I am now uncertain in the context of the Bill.

Noble Lords will not be surprised that having, as Chief Inspector of Prisons, proposed in 1996 that the NHS should be made responsible for prison healthcare, I should start with that. At the same time, I expressed the view that prison healthcare was a public health issue because almost all prisoners will be released and the state of their mental and physical health at that time is a matter of public interest. Furthermore, imprisonment provides an opportunity for the identification and initial treatment of mental and physical health problems that can be continued in the community in the form of aftercare.

I am very glad that the NHS has been responsible for the provision of prison healthcare since 2004, and that there is now a director of offender health in the Department of Health who has a seat on the board of NOMS in the Ministry of Justice. I am also glad to see in Clause 12, which requires the commissioning board,

“to arrange, to such an extent as it considers necessary to meet all reasonable requirements and, for the provision as part of the health service of”,

in new paragraph (c),

“services or facilities for persons who are detained in a prison or in other accommodation of a prescribed description”.

However, I do not think that that definition is precise enough, and I shall be tabling amendments to flesh it out to include responsibility for those in immigration detention, secure children's homes and police custody.

I include the police in connection with the provision of another aspect of offender healthcare that I shall seek to flesh out: the diversion from prison of those with mental health problems. Psychiatric morbidity is a huge problem in our prisons; the Office for National Statistics proves that. In addition to the 500 prisoners per year who qualify for sectioning under the Mental Health Act, 70 per cent suffer from a least one personality disorder. Under the previous Government, the noble Lord, Lord Bradley, wrote a report making practical recommendations for diversion, but implementation is still in the early stages. As diversion begins at police stations, it is important that there is adequate health care provision to make it possible. I assume that that will be a matter for both commissioning and health and well-being boards.

Not all offenders are sentenced to expensive imprisonment. At the heart of the Government’s proposals for reducing prison numbers are improved community sentences conducted by the probation service as credible alternatives. There is absolutely no reason why such sentences should not include the same identification and treatment of mental and physical health problems as in prison, but, at present, locally delivered probation lacks the healthcare provision that exists in local authority youth offender teams. I shall therefore be tabling amendments to rectify that, in line with Clause 191(2)(g), which states that health and well-being boards must consist of,

“such other persons, or representatives of such other persons, as the local authority thinks appropriate”.

I move on to education. I have lost count of the number of times that I have raised the issue of communication skills, or the lack of them, which is the scourge of the 21st century, on the Floor of this House. In the current Education Bill, which has just completed its passage through Grand Committee, I tabled amendments calling for the communication abilities of all children to be assessed before they begin primary school, to enable them to engage with their teachers. I proposed the same in a number of education, welfare and justice Bills under the previous Government. They were followed by announced intentions to do something, but nothing has happened, except in Northern Ireland, where the NHS now assesses every child at the age of two. Similar provision in England and Wales is dogged by the fact that because speech and language therapists belong to the NHS and are funded by individual primary care trusts, no other ministry will fund their provision. The end result is that the future of countless young people in this country is being unnecessarily blighted, and I shall be tabling amendments to ensure that such provision is debated in detail.

Finally, I raise a mental health issue connected with the Armed Forces covenant and the treatment of serving and retired service men and women, as well as provision in the community, which touches on many issues to do with regulation. I will not bore the House with details of the problems over the treatment of post-traumatic stress disorder caused by the narrowness of NICE guidelines, which preclude the loose use of alternative therapies, but I believe that it is confusing for Clause 225 to provide for both the professional standards authority for health and social care and the proposed health and social care council each to run voluntary registers for unregulated health professionals, such as psychotherapists and councillors. I shall be tabling amendments accordingly.

There is a great deal of work to be done on the Bill. I sympathise with the Minister on his impending workload, but he starts with one overwhelming advantage; he enjoys the respect and trust of the whole House.