Prisons: Mental Health

Lord Ramsbotham Excerpts

Wednesday 24th June 2015 Lords Chamber

[Lord Prior of Brampton]

The right reverend Prelate’s comments are true throughout the whole healthcare system and would also apply to nurses in physical health surroundings. Training in how to recognise and deal with people suffering from mental health problems would be a huge benefit.

[Lord Ramsbotham (CB)]

My Lords, the figures that the Minister cited come from the last survey of psychiatric morbidity in prisons, published in October 1998. Since then, the morbidity profile has changed. Is there any intention to conduct another survey so that the figures are up to date and people know the size and shape of the problem with which they must deal?

[Lord Prior of Brampton]

I am not aware of any current plans to conduct a survey similar to the one to which the noble Lord referred from 1998.

Mental Health Services

Lord Ramsbotham Excerpts

Wednesday 25th February 2015 Lords Chamber

[Lord Ramsbotham (CB)]

My Lords, I begin by congratulating my noble friend Lord Listowel on securing this important debate and once again demonstrating to this House his intense and continuous focus on improving all kinds of services for children and young people.

A number of noble Lords have already mentioned the very welcome development by the National Health Service of the Children and Young People’s Mental Health and Wellbeing Taskforce. I want to build my contribution on a meeting held with the children’s group which is currently considering the mental health of children and young people. I was very struck by the fact that members of the group said that one of the problems they were finding as they were going round the country was a complete lack of co-ordination between what was going on in various ministries. They illustrated this by demonstrating to us that they were conducting eight pilots.

One of the pilots listed was a bid from the Black Country to,

“map and analyse commissioning of CAMHS … and other health funded out of area placements, with the aim of preventing the large numbers of children from the Black Country being placed ‘out of area’. … It will include commissioning urgent care … to include the focus upon delivering a Black Country wide solution to children and young people requiring admission to a place of safety (under Section 136 of the Mental Health Act.”

I thought that at the same time that the Ministry of Justice is developing this appalling idea of building the biggest children’s prison in the western world—called the secure college—which will contain a cohort of these very children from the Black Country, for whom the Black Country services are seeking to find a place of safety. To me, that is an absolute illustration of the lack of co-ordination which is inhibiting the development of satisfactory mental health services for this particular cohort.

I happen to chair three all-party interest groups at the moment: one on speech, language and communication difficulties; one on criminal justice, drugs and alcohol; and the Criminal Justice and Acquired Brain Injury Interest Group. I have had meetings with all three to discuss the agenda that they would like to put to the next Government and to ask them what problems were inhibiting them in achieving what they want to achieve. We have had a fascinating agenda. We are drawing it up with some care. Interestingly, time and again—and this very afternoon with the speech and language people—I was told that at a meeting NICE was not prepared to accept educational research in respect of improving the lot of people with SLCN.

I know the Minister understands this—he is someone whom the whole House respects greatly for the way he looks at things. Will the Government follow this line of looking and seeing how cross-government working can improve the services for this group because, sure enough, out in the field are all the people who want to do the work and are being inhibited in one way or another in a preventable way?

Mental Health Services

Lord Ramsbotham Excerpts

Wednesday 26th November 2014 Lords Chamber

[Earl Howe]

My noble friend raises a very important point. My department has invested £3 million in MindEd, which provides clear guidance on children and young people’s mental health for any adult working with children, young people and their families so that, for example, school teachers and those working with children in schools can recognise when a child needs help and can make sure that they get that help early.

[Lord Ramsbotham (CB)]

My Lords, can the Minister confirm whether there is a sufficiency of trained mental health nurses and specialists to carry out all the tasks that this welcome task force will undoubtedly identify?

[Earl Howe]

There are concerns about the sufficiency of mental health nurses and professionals, particularly in certain areas of the country. Workforce issues therefore will be under the spotlight for the task force.

Young People: Suicide

Lord Ramsbotham Excerpts

Thursday 27th February 2014 Grand Committee

[Lord Ramsbotham (CB)]

My Lords, I congratulate my noble and right reverend friend Lord Eames on obtaining this debate. As was forecast by the noble Baroness, Lady Bottomley of Nettlestone, and as the noble Baroness, Lady Linklater, has done, I shall focus on young people in custody. I am conscious that what I am going to say may not strictly be the province of the Minister, but I hope very much that in the context of this important debate he may relay some of what I am going to say to his colleagues in the Ministry of Justice.

In 2012 I launched a report by the Prison Reform Trust and the charity INQUEST, titled Fatally Flawed: Has the State Learned Lessons from the Deaths of Children and Young People in Prison? The answer to that question was clearly no. Of the figures that my noble friend gave, 46 of this age group died in custody by their own hand between January 2011 and January this year. This report showed that there is commonality between the children who had committed suicide. They all had multiple disadvantages: substance abuse, mental health difficulties, learning disabilities, ADHD, special educational needs and personality and conduct disorders, plus all the other neglect.

Added to that, one has to remember that the adolescent brain has not fully formed at this stage, and cognitive behaviour and the development process are not completed until, possibly, the mid-20s. Therefore the problems that young people face are first, acute, and secondly, different from those of adults.

Last week the Youth Justice Board published the report Deaths of Children in Custody: Action Taken, Lessons Learnt. This was the result of long analysis, and it included the conclusion that the Youth Justice Board must work with providers of custody to enable them better to understand how to support children who are at risk of being suicidal or self-harming. There are other factors in this, but the clear finding was that there were common features in all the reports on all the suicides of this group, which surely gave an opportunity to identify common solutions.

Having called for an independent review and having had that call rejected by the Ministry of Justice, when I raised a Question about this three weeks ago I was disturbed to hear that the review to be carried out by the noble Lord, Lord Harris of Haringey, will not include children. This was also mentioned by the noble Baroness, Lady Linklater. Well, why on earth will children not be included? The factors include, inadequacy of management in the custodial centres, inadequacy of staff training, multi-agency failure in communicating individual vulnerabilities and needs, and failure to listen to children. There is also failure to circulate and implement recommendations which have been laid down in countless reports by the ombudsman and others, and recommendations made by coroners in inquests under Rule 43 of the Coroners’ Rules.

The Ministry of Justice’s reasons for rejecting the report were that, instead, it would have internal reviews by Ministry of Justice agencies; it would have discreet specialist reports into such things as the use of force; it would have better publication of information; and it would try to expand the scope of the law governing inquests. That has absolutely nothing to do with the subject of this debate, which is the prevention of children committing suicide, particularly in custody. I therefore ask the Minister to do all that he can to persuade his colleagues to include children in the review by the noble Lord, Lord Harris of Haringey, so that, among other things, it can include the Youth Justice Board report which contains many of the factors that it will need to carry for a slightly younger part of the same age group.

Care Bill [HL]

Lord Ramsbotham Excerpts

Tuesday 29th October 2013 Lords Chamber

I strongly argue that denying people in prison and people in approved premises the benefit of an inquiry by a local authority when safeguarding concerns are raised places an already vulnerable group of individuals at even greater risk. We must ensure that all people living in the community, including people in approved premises, have this equivalence of care. I ask the Minister to accept my amendment if my concerns are not justified or, better still, to impose a duty on probation trusts and local authorities to share the specific responsibility for providing safeguarding inquiries for people in approved premises. I also ask that he extend that to prisons. I beg to move.

[Lord Ramsbotham (CB)]

My Lords, I support the noble Lord, Lord Patel, because I agree that this is an extremely worrying issue. Focusing on prisons, there is an increasing number of elderly prisoners, as has been reported, and it is quite clear that the prison medical authorities are not capable of looking after all their needs. For example, people have talked about dementia and other problems of increasing age, and it is of concern that those people are not being properly looked after.

I am also very concerned about the use of the words “probation trusts” because they are about to go. According to the Transforming Rehabilitation agenda, which the Ministry of Justice has released, they are to be replaced by directors of rehabilitation in various parts of the country and/or private companies acting as rehabilitation companies responsible for services. What we do not know from the Ministry of Justice is exactly how many people are to stay with the existing probation service, which has been given a lot of responsibilities that do not include running probation hostels, which is currently a probation responsibility. Nor have I seen any mention of this accommodation in the transforming rehabilitation agenda that has been produced. Therefore, this matter needs following up. Within a year would be a very useful timeframe, because it would allow a follow-up of what is happening in the Ministry of Justice to be conducted.

[Baroness Wheeler (Lab)]

My Lords, from what my noble friend Lord Patel has said, it is clear that the issue of safeguarding inquiries is not at all sorted. He has highlighted a substantial gap in the Bill that could have a very serious impact on some of the most vulnerable people in our communities and prisons. He rightly seeks equivalence of care and protection for adults detained in prison and those residing in approved premises such as bail hostels—care and protection that all other vulnerable adults have when it comes to safeguarding inquiries by local authorities. We take on board his deep concerns about prisons and what appears to be a lack of co-ordinated and clear responsibilities in respect of safeguarding inquiries. I ask the Minister to look further into the matter, as my noble friend suggested.

My noble friend raises some key issues on whose responsibility it is to carry out a safeguarding inquiry for adults living in the community in approved premises. Given all the uncertainty about future service delivery as a result of the Government’s major reorganisation and break-up of the probation service, if that responsibility is currently with the local probation trust, this amendment, which calls on the Secretary of State to report to Parliament within one year of this clause of the Bill coming into force, becomes even more necessary. To require the new community rehabilitation companies or their successor bodies to account for how they have discharged their responsibilities for safeguarding adults residing in approved premises is an acceptable way forward.

I look forward to hearing from the Government about how they intend to deal with the matter in the light of the serious concerns expressed by my noble friend today and in previous discussions on the Bill, and in light of the huge confusion that will result from the proposed changes to the probation service. I very much hope that the Minister will be able to support my noble friend’s endeavours to fill what is potentially a serious gap in the Bill, and to ensure future adequate protection of these vulnerable adults.

Care Bill [HL]

Lord Ramsbotham Excerpts

Monday 29th July 2013 Lords Chamber

[Lord Ramsbotham]

My Lords, I support the noble Lord, Lord Patel, on Amendments 105AA and 105CA, and will comment on government Amendments 105B to 105D. I do so as a former Chief Inspector of Prisons who was closely involved with safeguarding inspections of children, which we were able to carry out thanks to there being a social care inspectorate in position at the time. The inspections were joint in that they covered a number of inspectorates, not just the Commission for Social Care Inspection. At the same time, I was conducting a thematic review of the treatment of the elderly in prison, who were causing intense concern. Unfortunately, at that time the social services that were responsible for the elderly in the country did not function in prisons. I had hoped for the adoption of what I understand the Government now intend to do: to make the social services responsible for the oversight of the elderly in prisons. In speaking to these amendments, I am conscious that the Government are almost there, but not quite.

I wonder, too, whether the Ministry of Justice actually consults with other ministries about Bills that affect prisoners. We are about to start the Committee stage of the Children and Families Bill. We have to try to remove a clause that prevents young offenders being subject to the pathways for those with special educational needs. Prisons are allegedly to be excluded. Only last Wednesday, the noble Lord, Lord Dubs, raised a question about jobseeker’s allowance and prisoners not having access to benefits in time. I wonder whether the clause not applying to prisoners was discussed or whether the Ministry of Justice has come to a view on something that will affect an increasing number of people in the prisons: the elderly.

There is an extreme need for local social services to be involved in prisons by statute and by right. With due respect to the Ministry of Justice and the Prison Service, when I listen to the Minister saying that “it will be left to the prisons” and that it “should” be statutory, or that they “can” invite members of safeguarding adults boards into prisons, I do not think that that is good enough. The track record, if you go into prisons over the years, is that it is not good enough.

The other thing is that people are simply not trained enough to be able to conduct the care that is so essential for the elderly element of the prison population. There are many concerns over the fact that too many staff have simply no idea about problems to do with dementia, which is but one of the issues. To phrase this provision loosely and say that somebody from a prison “may” be a member of the board is not good enough. It really should be laid down in statute that somebody must be a member. If it is not the governor, it must be someone from the senior prison management team. The other reason it must be a member of the senior management team is that people change. There is such movement in the staff of a prison that if you are not careful, you will not have somebody who knows what they are doing and knows the people in the local authority to contact if there is a problem with somebody who needs care. It is important to have it statutorily laid down not just for somebody to be responsible within the prison, but so that those who are responsible for delivering support and care know precisely who to make contact with. It is no good leaving it nebulous by just going to the prison and finding somebody. If you do that, you will find that the “somebody” is not there. I believe very firmly that someone should be made responsible and accountable for this.

I welcome the fact that prison officers and prison custody officers may be members of the boards, and mention has been made of the work done by HM Inspectorate of Prisons. That is fine, but only goes half way. I hope that the Care Quality Commission will conduct inspections of the safeguarding of adults in prison. The commission would use the other inspectorates, which will have something to contribute to that. As was done with the safeguarding of children inspections, they would be joint and not merely limited to one part. I very much hope that the Government will carefully reconsider these amendments, perhaps in consultation with the Ministry of Justice—which, I would hope, would have objected to these two clauses anyway.

[Baroness Wheeler]

My Lords, this is largely a group of government technical amendments, interspersed with amendments from noble Lords probing important aspects. On Clause 69, my noble friend Lord Patel’s Amendments 105AA and 105CA would ensure that local authority safeguarding inquiries do apply to adults in bail accommodation and, in respect of Safeguarding Adults Boards, would enable prison governors or other prison staff to be members of the board.

Government Amendments 105B and 105D address those issues. On safeguarding inquiries, the Government’s proposal to allow SABs to provide advice and assistance to persons in bail accommodation is a compromise. My noble friend has argued that that is not good enough and we strongly support that view. How can local authorities have premises in their areas where abuse or neglect could occur and not have a duty to conduct a safeguarding inquiry?

On prison governors being members of Safeguarding Adults Boards, my noble friend is exploring ways in which governors and prison staff can best participate in and learn about the board’s role and work. I look forward to the Minister’s response on how she thinks the Government’s amendments best facilitate this.

The remaining Clause 69 government amendments include a number of tidying-up measures which we support to reduce the burden on local authorities, such as clarifying local authority ordinary residence rules in relation to bail accommodation, explicitly exempting prisons and bail accommodation from local authority safeguarding adults reviews, and minor technical amendments to change the general language relating to the clause.

Under Clause 71 and Amendment 105Q from the noble Baroness, Lady Browning, we return again to the Secretary of State’s powers in relation to local authorities and NHS bodies. Both the noble Baroness and my noble friend Lord Touhig make a strong case for statutory guidance previously in place to continue to apply under the new legislation until the Secretary of State declares otherwise. The noble Lord and noble Baroness, as usual, speak strongly on autism and the Autism Act being embedded in the new legislation. However, there is a wider issue of ensuring that the Secretary of State retains ultimate responsibility, arguably more important than ever with the tendency of our current Secretary of State to hover above it all and act as if everybody else is responsible but him.

Amendment 105R of the noble Lord, Lord Low, to Clause 72 seeks to prevent a local authority from being able to delegate functions on its behalf under this part of the Bill. He is right to be cautious about how the local authority powers under this clause are used. I look forward to the Minister’s response to the amendment.

Finally, under government Amendment 105V in this group, I again raise an issue that I spoke of during last week’s safeguarding debate on the provider failure provisions under Clauses 47 to 49, designed to address responsibilities and actions in any future provider collapse, such as we saw most recently with Southern Cross residential care homes. The Lords Delegated Powers Committee expressed concern at the Bill’s failure to define what is meant by both “business failure” and “market failure”. Although I got an answer in passing in the following debate when the noble Earl the Minister responded to a question about provider failure from the noble and learned Lord, Lord Mackay, I would appreciate the Minister explaining today in more detail why the Government have chosen regulations to address these two issues, which are fundamental to the operation of the provider failure provisions of the Bill, rather than include the definitions in the Bill.

Health and Social Care Bill

Lord Ramsbotham Excerpts

Thursday 8th March 2012 Lords Chamber

Moved by

[Lord Ramsbotham]

238A: Clause 191, page 191, line 32, leave out “may consult any” and insert “must consult relevant health professionals and any other”

[Lord Ramsbotham]

My Lords, I shall be brief. First, I pay tribute to the noble Earl, Lord Howe, and thank him very much for his letter on this subject. I declare an interest as chairman of the All-Party Group on Speech and Language Difficulties. We have been campaigning in many Bills—education, welfare and justice—to make certain that every child is properly assessed not just for learning disabilities but for learning difficulties and particularly to enable every child to engage with the education system. The Minister has assured me that health visitors are being trained by speech and language therapists to enable that to be done. I hope very much that this will soon be the norm throughout the United Kingdom. Therefore, Amendments 238A, 238B, 238C, 238D and 238E add a little more to the debate that we had at earlier stages of the Bill.

In particular, I am anxious to make certain, if we possibly can, that the variability in commissioning between local areas is reviewed. In her recent report, the communications commissioner, Jean Gross, stated that there was considerable variety and that she expected to find such commissioning in only 70 per cent of local areas. This is unfortunate. I do not think it is right that there should be a postcode lottery in assessing our children’s ability to engage with education.

I introduce the words “allied health professional” in Amendment 238B because the allied health professionals have responsibility for liaising between the primary and secondary sectors and therefore cover a wide number of disciplines. I include the words “education or children’s services” in Amendments 238C, 238D and 238E in order to make certain that those services, along with the NHS and local government, are properly represented in ensuring that this opportunity is available to every child throughout the United Kingdom.

I appreciate that it may not seem appropriate to make these amendments to the Bill. However, I hope that the Minister will be able to assure me that these points will be made in instructions that go out about the health and well-being boards, the joint strategic boards and so on, even if they are not included in the Bill. I beg to move.

[Baroness Whitaker]

My Lords, in supporting the noble Lord, Lord Ramsbotham, I have very little to add, which I imagine will be welcome to noble Lords at this hour. He has really said it all extremely comprehensively but I would just add that, if the Bill cannot provide the framework that these amendments would ensure, particularly in respect of integration of the education services, children in particular will suffer. I briefly remind noble Lords that speech and language deficits are among the most common disabilities in childhood. They affect significant numbers, who will lose out on education, employment and relationships as a result. I hope that the noble Earl will be able to provide the reassurances that we seek.

--- Later in debate ---

[Earl Howe]

That is a very gracious invitation on the part of the noble Lord. I will take him up on that if I may by responding to him in writing. That would be best.

[Lord Ramsbotham]

I thank the noble Earl for his habitually courteous and balanced reply and I am reassured on some of the points that I raised. I am grateful to the noble Baroness, Lady Whitaker, and my noble friend Lady Finlay in particular for supporting the amendments and to the noble Lord, Lord Beecham, for mentioning them. Like the noble Baroness, Lady Whitaker, I have this nagging fear that education, education, education is something that will need to engage the health and well-being boards. The link between education and health, particularly in the assessment, which was the subject of the amendments, is absolutely crucial. During the passage of the then Education Bill, noble Lords described what they wanted but of course they could not have it because they were health matters funded by health. Therefore, it is terribly important that joint working happens.

I was very glad that the noble Earl mentioned “effective joint working”, because I am sure that that is what we all seek. That was what was behind each and every one of the amendments. On the basis of that and knowing the noble Earl and that if he says something it is usually likely to happen, I beg leave to withdraw the amendment.

Amendment 238A withdrawn.

Health and Social Care Bill

Lord Ramsbotham Excerpts

Monday 19th December 2011 Lords Chamber

[Baroness Masham of Ilton]

My Lords, we now have another bite at a very important cherry. My amendments in this group seek to provide for a mandatory register for healthcare assistants and assistant practitioners by doing away with “voluntary”. The Government are setting out a framework to establish a voluntary register for all unregulated health professionals. In doing so, they are making a mistake and missing an opportunity. Healthcare assistants and assistant practitioners are carrying out more and more of what are seen as nursing procedures. It is not always possible to supervise them on a busy ward or in somebody’s own home. Surely there should be a mandatory register accompanied by a programme of basic standardised training.

This proposal is supported by the Royal College of Nursing and the House of Commons Health Select Committee. The Select Committee’s report expresses concern about the Government’s proposals for a system of voluntary registration:

“The Committee endorses mandatory statutory regulation of healthcare assistants and support workers and we believe that this is the only approach which maximises public protection. The Committee notes that the Government intends to give powers to the relevant regulators to establish voluntary registers for non-regulated professionals and workers, but would urge it to see healthcare assistants, support workers and assistant practitioners as exceptions to this approach who should be subject to mandatory statutory regulation”.

A voluntary register is likely to be too weak and in any event it will be avoided by the very people about whom there is most concern. The recent horrifying scandal at Winterbourne View in Bristol underlines the issues around the registration of healthcare assistants. This view is supported by the Health Select Committee. The main benefit of ensuring that every care worker and healthcare assistant is regulated by a regulatory body is that the code of practice associated with their registration must be followed or they could be subject to disciplinary procedures.

It should also be noted that the rate at which people register with a voluntary system is open to question. A similar situation arose in the UK when seat-belt wearing was voluntary. It was only when wearing seat belts became compulsory in 1983 that the rate went from around 30 per cent to its current 95 per cent. It is highly likely that the same would happen here.

If the existing regulators are too hard-pressed to take this on, I am sure that there are other willing providers who would do this job. My interest in this is the safety and well-being of patients and the morale of those who give the service that should be given with tender loving care.

I cannot accept the Minister’s statement that we have not got the evidence. What about all the recent reports from the Audit Commission, the Patients Association and the CQC, the “Panorama” programme on the appalling situation at Winterbourne View care home, the review of Mid Staffordshire NHS Foundation Trust, the deaths and poisoning with insulin at Stepping Hill Hospital and many other serious incidents in hospitals and the community? I beg to move.

[Lord Ramsbotham]

My Lords, I wish to speak to my two amendments to Clause 225. I must admit that they are probing amendments that ask a question. I am confused by the situation that appears to be being proposed, and I am speaking in the context of two particular groups of people: Armed Forces veterans and prisoners.

As is well known, there is a huge pool of psychiatric morbidity in prisons, which I mentioned this morning. It is also known that a considerable number of veterans suffer from a variety of mental health problems—anxiety, depression and alcoholism—but added to them is the extra spectre of post-traumatic stress disorder. Psychotherapists and counsellors are employed particularly to help with PTSD, anxiety and depression. Unfortunately, as far as veterans are concerned, they are currently denied the choice that is available to citizens in the United Kingdom because Combat Stress, which tends to be the blanket organisation for their treatment, follows rigidly the NICE guidelines in recognising only CBT and EMDR. The care and treatment that Combat Stress provides does not meet all the cases of soldiers, veterans of other services and prisoners, and other organisations, such as the Human Givens Institute, have been having enormous success with them. Those organisations currently function under the auspices of the UKCP and the BACP, which operate voluntary registers—indeed, many organisations working in this area are registered with both.

As I understand Clause 225, the HPC, established by the previous Government, will no longer exist and instead we will have two new organisations: the Professional Standards Authority and the Health and Care Professions Council. Between them, they are going to be responsible for establishing the statutory regulation, the accreditation and, we are led to believe, the voluntary registers. This is where my question comes in. The trouble with that is that it could cause confusion because you cannot have two organisations running parallel voluntary organisations if you are going to give clarity to the people who need their services. I understand that a consultation is taking place, that the outcome is due in April or May next year and that other organisations, such as the Human Givens Institute, have been invited to attend this consultation, which they are very glad of because they have at last been able to put their case on the table.

The case is very interesting because those organisations are able to prove the success of what they have done by measured outcomes, whereas organisations that follow the NICE guidelines cannot prove anything by outcomes as they have not got them. All they can say is that they have conformed to the guidelines. One of the problems in this area is that the guidelines, which I understand were originally meant to be guidelines, are being taken as tablets of stone. That is thoroughly unfortunate in this area, particularly when we are facing the need for the Department of Health to conform to the demands, for example, of the Armed Forces covenant, which will certify that all the things needed by veterans will be available—housing, of course, but also in the health area.

It is very important that this issue is resolved and that there is clarity. People should know who is responsible for setting up which register and who is responsible for accrediting whom, so that there can be no doubt in the minds of the users. Therefore, I should be enormously grateful if the Minister could clarify that. If necessary, perhaps we could meet before Report for clarification on this matter because the organisations concerned are in doubt.

Health and Social Care Bill

Lord Ramsbotham Excerpts

Monday 19th December 2011 Lords Chamber

[Baroness Wilkins]

My Lords, I fully support the amendment just spoken to by the noble Baroness, Lady Jolly, in relation to housing. I speak to Amendment 330A, which is down in my name and in those of the noble Baroness, Lady Finlay, and the noble Lord, Lord Low. It is a probing amendment to ask the Minister to ensure that education providers, including academies, schools and colleges, are represented on the health and well-being boards, in order that there should be integrated planning for disabled children. The National Children’s Bureau, through the Every Disabled Child Matters campaign, has raised concerns that the Bill does not provide equivalency with the Education Act, which has retained the duty to co-operate for schools. This Bill does not ensure that schools will be an integral part of the health and well-being boards, so, while education providers will have a clear duty to co-operate, there would be no equivalent duty on health and well-being boards to include education providers.

Integrated planning and commissioning is particularly vital for children with complex needs, such as disabled and looked-after children, who need co-ordinated interventions from a range of services. Many disabled children require health-related services at school, including physiotherapy, occupational therapy and speech and language therapy, as well as specific medical interventions. There are often problems with providing such services on the school site, or it is not properly co-ordinated with other activities at the school. As Adam, one young disabled person, said,

“I went to a mainstream secondary school. I did not get to see a physio or OT regularly. This is because I didn’t go to a special school for disabled people. I think health, education and social services need to work more closely together”.

This lack of co-ordination of support presents disabled children and young people with barriers to participation in education that their peers would take for granted. As Sir Ian Kennedy’s recent report, Getting it Right for Children and Young People, recognised:

“If children do not receive appropriate support from the school, at worst those with severe health problems receive a ‘double whammy’ as their ill-health damages their education by disrupting their schooling, either through being forced to stay at home or by long stays in hospital. Children with severe or long-term conditions receive enormous benefit from continuing their education during their treatment. And there are social as well as educational benefits. Continuing in education is a signal, to the child themselves, the parents or carers and the peer group, that a child with a severe or complex health condition continues to belong to the ‘community of children’ and does not become defined by their condition”.

When education providers and health services do not collaborate to meet the needs of children and young people, it also has a significant impact on their families. A study by Diabetes UK found, for example, that half—46 per cent—of primary school pupils with type 1 diabetes and one-third—29 per cent—of their secondary school counterparts report that their parents have had to reduce hours or give up work to help them administer life-saving insulin injections. It is clear that when children need such support during school hours, local services should work together to ensure that it is available.

As the Minister will know, the Department for Education’s recent Green Paper, Support and Aspiration: A New Approach to Special Educational Needs and Disability, proposed a more co-ordinated approach to the delivery of education, health and social care. These proposals included the delivery of a single assessment process, a joint education, health and care plan, and a local offer, which sets out all services available to disabled children in the area. EDCM is concerned that these proposals will not be deliverable if education providers, including academy schools and colleges, are not given a presence and a voice at health and well-being board level, which this amendment would provide.

[Lord Ramsbotham]

My Lords, I rise to speak to my amendment, Amendment 330C, which relates to the fact that offender health is a public health—particularly prison health—issue. Since almost every prisoner will be released, their mental and physical state when they are is therefore a matter of public interest. I wish to speak to something related to imprisonment, rather than to imprisonment itself. There are two other activities associated with this part of the Bill which also affect activities of other ministries, the Ministry of Justice and of course the Home Office, to which I would like to draw attention.

As we all know, prisons are wells of psychiatric morbidity. At one end of the spectrum, some 500 prisoners have to be transferred to special hospitals each year. At the other end, some 70 per cent are suffering from at least two personality disorders which are bound to impact upon their behaviour. Prisons are also the unfortunate recipients of people who were in asylums, until these were abolished. To prevent that happening the previous Government initiated a report, conducted by the noble Lord, Lord Bradley, on diverting people with mental health problems away from prison. This was a very, very comprehensive report, with recommendations which affected the courts and the police in particular. This Government, as I understand, have accepted the recommendations and are working towards them. However, they of course depend on there being proper mental health assessment and treatment available at the point where a person comes into contact with the criminal justice system. This is usually at a police station, to start with, and then at a court. I have been to see one of the pilot schemes in Brighton, where an extremely able psychiatric nurse in the court was able to divert people away from imprisonment, not least because they had taken enormous trouble to ensure that the necessary support for people with mental health problems was available from that moment on. Without that support being available, the scheme becomes worthless. However, before that, the first time that people come into contact with the system is in police stations. What worries me about progress in the future is that unless there is a police representative on health and well-being boards able to represent the needs of the people who make those assessments at the police station, the diversion scheme could fail at its start. The purpose of my amendment, therefore, is to ask the Minister to consider very seriously the addition of a police representative on health and well-being boards, to make certain that the needs of police stations are represented at source, in every area of the country where diversion schemes will start.

I say this because when I started inspecting prisons, I discovered that prisons, alone in this country, were not part of the National Health Service. Indeed, they did not become part of the National Health Service until 2003. The result of that was that the needs of people from prisons were not built into National Health Service estimates, and so they were always competing for other requirements. To avoid that error being repeated, I therefore believe that it is essential to have police representation at the place where planning is carried out.

My second area is to do with probation. With regard to the plans—“Breaking the Cycle”, the rehabilitation revolution and all the noise that has come from the Ministry of Justice about reducing the prison population and providing alternatives to custody—most of that comes down to the probation service. There is absolutely no reason why the probation service should not carry out exactly the same programme as happens in prisons; that is, people are assessed, programmes are made and conducted, and then the person is transitioned into the community. There is no reason why the assessing, the programming and the supervision of mental and physical health treatment should not happen to somebody on probation in exactly the same way as it happens in prison. However, the probation service needs help and guidance in the provision of that assessment and programming. That is why I am asking the Minister to consider that a representative of the probation service should be included on the health and well-being board, in order to ensure that its needs are included in the plans, so that the probation service can make the delivery of community sentences more effective and more acceptable in the public eye, and is therefore able to contribute to what the Secretary of State for Justice is seeking; namely, a reduction in the prison population.

[Lord Low of Dalston]

My Lords, I add my voice very briefly to those of the noble Baronesses, Lady Wilkins and Lady Finlay, in support of Amendment 330A, which provides that health and well-being boards should include a representative of education providers in the area. The noble Baroness, Lady Wilkins, has spoken to the amendment very fully and ably; however, perhaps I can underline the point to which she has already alluded. When we considered the Education Bill in Grand Committee earlier in the year, there was great concern that the Government wished to remove the duty on schools which had only recently been laid on them, to co-operate with other services in pursuing the welfare of children. We were particularly concerned about this at the time of the riots, when people were emphasising the role that schools had to play in combating exclusion and disaffection among children. I am glad to say that the Government took the force of our point and withdrew the proposal to remove this duty from schools. I hope that the Minister will agree that a joined-up approach would suggest—as the noble Baroness, Lady Wilkins, has argued—that there should be a reciprocal duty on health and well-being boards, at least to include a representative of education providers on the board.

Food: Regulation and Guidance

Lord Ramsbotham Excerpts

Thursday 7th October 2010 Lords Chamber

[Lord Ramsbotham]

My Lords, I am very grateful to the noble Lord, Lord Whitty, for giving me the opportunity to speak in the gap to raise two points. One is a cautionary tale of an organisation which tried to have guidance issued on improving the nutritional outcomes for adults and young offenders in institutions. The other is to plead with the Minister to do what he can to prevent that ever happening again.

I refer to an organisation now called the Institute for Food, Brain and Behaviour, which was called Natural Justice, and must declare an interest as vice-chairman of the board. About 20 years ago, the organisation started work trying to use the right mixture of vitamins, minerals and fatty acids with people on community sentences with the probation service in Cumbria. It was then developed and, in 1998, a random double-blind trial was conducted at the young offender establishment at Aylesbury, which proved that the right mixture reduced violence and anti-social behaviour by 40 per cent in those who were taking the right mixture, produced an enormously changed atmosphere in the young offenders’ institution and enabled the young to take part in things which they had previously rejected. That was noted not just by the measurement of crimes committed but by the very hard-bitten prison officers, who noticed the change.

The results were published. They were doubted by the Home Office, which sent in a professor from Warwick University to examine the data. He proved that they were 92 per cent statistically pure and said that he had never come across a trial of that kind conducted so well, which speaks volumes for Natural Justice and for the Oxford University department of physiology, which is where the work was based.

We then tried to get replication. The trial had been picked up in America, Scandinavia, Holland and France, where they were repeating the work. The Wellcome Foundation recognised its value and granted us £1.5 million to enable us to do it again. We were welcomed in Scotland, where they said, “Please come and do it here”, but we had a seven-year fight with the Home Office and the Ministry of Justice to be allowed to do it again, because successive Prison Ministers took an opposite view about the trial. The trial is now taking place, and the report will be published next year. The work has been picked up by Manchester probation service, which wants it looked at in connection with those on intense supervision orders.

The Robert Clack School in Dagenham is very interested in the application of the right mixture of vitamins, minerals and fatty acids to young children at school. In other words, there is an enormous amount of evidence about what the right mixture does. What worries me about this is that it is despite the fact that it has been officially evaluated and promoted. I am very grateful to the noble Lord, Lord Rea, for including it in his report. Here, I hope, is an opportunity for the Department of Health, if it is really going to take responsibility in this area, to pick up the work that has been done and apply cross-government action rather than leaving it to separate ministries to do what they have been doing in isolation and not promoting it. The Institute for Food, Brain and Behaviour stands ready to help in any way it can.