Children and Social Work Bill [HL]

Debate between Lord Ramsbotham and Lord Warner

3rd reading (Hansard): House of Lords
Wednesday 23rd November 2016 Lords Chamber

[Lord Ramsbotham (CB)]

My Lords, I, too, added my name to the noble Baroness’s amendment, and I echo what she said about the many organisations which have supported it. Many times during the Bill’s passage, mention has been made of the postcode lottery regarding the performance of local authorities around the country. If this assessment procedure is adopted, who will perform the quality assurance of the delivery of the assessment around the country? It cannot be the expert advisory board, which has a completely different purpose.

[Lord Warner (CB)]

My Lords, I, too, support the amendment, to which I added my name. I congratulate the noble Baroness, Lady Tyler, on her persistence on this, which has been well recognised by those who work in the sector.

As a former director of social services, I think it is essential that we recognise the need to assess many of these children. That is not to say that large numbers of them will necessarily progress to the most demanding parts of the system, but we know that if you do not assess and pick these problems up early, they go in only one direction: they get worse. We end up with children who have already had a pretty tough time having to fight their way into a CAMHS system which is itself struggling to cope with the demands made on it. We need to give children coming into care, those who are looked after, a good shot at getting access to the services that they need.

I think that the amendment has met the Government’s concerns about flexibility, which were legitimate. This House and the Government have always argued for parity of esteem between mental and physical health. This is another piece of the jigsaw to try to ensure that.

--- Later in debate ---

[Lord Warner]

My Lords, I, too, strongly support the amendment, but as a sceptical old Whitehall warrior, I will open up an issue that may suggest it is not the Minister and his colleagues in his department who might be the villains in this area, but other interests across Whitehall. As I understand it, if the Government accept the amendment they will then have to accept amendments relating to all the other services that are of concern to children. It would be very difficult for them to accept the amendment if they have reservations about the cumulative effect of implementing the convention in this way through statute for all the services that may affect children.

My suspicion about Whitehall, because I am of a suspicious nature given my background, is that there are problems around an impact assessment on what the implications of all this may be. Instinctively I feel that somewhere in this mix are our old friends at the Treasury and the control of public expenditure. They are often to be found when we have these long periods of inaction in any particular area. Some of the areas where children could be seriously affected—clean air, benefits and access to health services to name but a few—go much wider than the scope of the Bill.

I do not expect the Minister to divulge the workings of government, but can he throw any light on whether it is necessary to provide across Whitehall an impact assessment on what the costs of implementing this through statute would be? Do the processes by which these things have to be agreed across Whitehall have any chance of being agreed before the Bill completes its passage through Parliament?

[Lord Ramsbotham]

My Lords, I support everything that has been said and pick up on the words of my noble and learned friend Lord Woolf. It is very sad that the last two reports of the UN committee coming to this country have started with the words that they regret that so little has been done to implement the recommendations they made five years earlier. If, as my noble and learned friend has suggested, the convention or the causes should be made the centrepiece of cross-government action in this area, then there is a solid basis for all affected ministries in Whitehall to rally round and make certain that their contribution to what is required is not criticised the next time the committee visits.

Children and Social Work Bill [HL]

Debate between Lord Ramsbotham and Lord Warner

Wednesday 13th July 2016 Grand Committee

[Lord Warner]

My Lords, my name is on this amendment, which is probably bad news for the Minister, and I support what the noble Lord, Lord Hunt, said. I want to add a couple of points on setting up a new unit by coming back to the issue of the Department of Health and adult social workers. It needs to be a unit which would deal with both groups of social workers, which means it needs some machinery that represents the interests of both the Department of Health and the Department for Education. I still see no really convincing evidence that it has been thought through in terms of those departments working together on something to benefit the range of social workers—those who work with children and those who work with adults. If we were to go down this path, there would have to be an agency or unit. I do not think one would mind what it is but it would have to be a convincing agency that looked across the spectrum of social work with children and adults.

I also want to pick up on some of the Minister’s comments in the discussion on my Amendment 135B. At the end of the day, if the Minister has all this money and wants to get on quickly—he said that he had the money and wants to get on speedily with the job of improving social work—then I would say, having been a Minister in government, that the fastest way to do that, as some of us have done, is to set up some kind of grouping across the piece. It would include the types of social workers for adults and children, and all the outside interests. The Minister could almost do that before the autumn and before we come to this on Report. At a later stage, that could be turned into an executive agency if he wanted to do that. There is nothing to prevent the Government putting in place very quickly indeed something of the kind that the noble Lord, Lord Hunt, suggested if they have the money and the capability. If they have those then they should do it; they do not even have to ask Parliament.

If the Government want to improve some of the training requirements for social workers, they could also have a conversation with the HCPC, which will be looking at education in September. It has committed to that as part of its work programme. I am sure that any regulator in this area would always listen to a government department or the Government of the day and consider the evidence for change.

If the Minister is really in a hurry and wants to take people with him, why does he not use what is available now, get on and have a discussion with the HCPC and set up a unit jointly with the Department of Health to do as much improving and make as many changes as he wants? Why are we all being subjected to, and spending some of the best years of our lives discussing, the shambles that is Part 2 of this Bill? It is a sad waste of parliamentary time and I do not think that it is terribly good for the profession, which is being subjected to a lot of uncertainty when it needs more confidence and more certainty. I hope that, even at this late stage, the Minister can see that there are some merits in the approaches of the two amendments.

[Lord Ramsbotham]

My Lords, I was attracted to putting my name to Amendments 135B and 135C because of their cleanliness and simplicity, and the fact that they picked up all the points that had been made in the Government’s policy statement, Regulating Social Workers, which was published last month. There was nothing missing. Furthermore, what the amendments proposed was independent and objective, and therefore they were likely to attract the support of the profession.

I could not help reflecting on two things. One was that when I was Chief Inspector of Prisons, when I inspected a prison that had an under-18 wing the social services were responsible for under-18s at that time, so I took a social services inspector with me. She said that if it had been a secure children’s home, it would have been closed because of the lack of facilities. Those facilities were then under the direction of the Home Office, which claimed to be responsible for young people in custody. That has always suggested to me that government should not get close to the delivery of these things.

The second thing, which I admit struck me as strange, was on page 19 of the Regulating Social Workers report. One paragraph says:

“Ministers will lead on issues such as setting standards and delivery of responsive improvement programmes to raise the calibre and status of the profession”.

The next paragraph says:

“While Ministers retain ultimate responsibility, decisions will be kept at arm’s length”.

How can you lead at arm’s length? It struck me that there was considerable confusion in all this and that therefore the Government can consider the clarity of Amendments 135B and 135C as helping them to deliver what they want. As the noble Lord, Lord Hunt, said, we all want improvement as quickly as possible, and I think that the profession does as well. We appear to be in the mire of confused thinking, which could be avoided by withdrawing from it.

Children and Social Work Bill [HL]

Debate between Lord Ramsbotham and Lord Warner

Wednesday 29th June 2016 Grand Committee

[Lord Warner]

That certainly was not what he said.

[Lord Ramsbotham]

I am grateful to all noble Lords who have spoken. Many issues have come up during the course of the debate, not least those raised by the noble Lord, Lord Warner. I suspect that this subject will reoccur on Report and I hope very much that, unlike the period in the lead-up to Committee, it will be possible to have meetings with the Minister and his officials to discuss it. I suspect that at least the Local Government Association and local authorities will wish to be consulted on what actually appears in the Bill. So in the hope that that may happen—

Health and Social Care Bill

Debate between Lord Ramsbotham and Lord Warner

Wednesday 16th November 2011 Lords Chamber

[Lord Warner]

My Lords, I speak to Amendment 79 in my name and those of the noble Lord, Lord Patel, who unfortunately cannot be here today, my noble friend Lady Pitkeathley and the noble Baroness, Lady Murphy. Our purpose is to focus clinical commissioning groups on the needs of the 18 million of our fellow citizens with long-term conditions.

We spend an awful lot of time and money in our healthcare system preoccupied with acute hospital care. Indeed, 50 per cent of NHS expenditure goes on acute hospitals. However, day in, day out, week in, week out, the bulk of NHS activity—some 75 per cent of it—goes on good, bad and indifferent treatments for people with long-term conditions. Of course, some of these people have acute episodes, often because their routine care has been neglected. For example, 10 per cent of NHS expenditure goes on people with diabetes. The number of people being treated with diabetes is rising. We know how best to look after people who suffer with diabetes but too often we neglect basic, routine care and maintenance of the condition, seemingly waiting for the inevitable crisis to occur.

The scale of long-term conditions is, in my view and that of the colleagues who signed this amendment, sufficient to draw particular attention to their needs in the Bill. That is what the first part of Amendment 79 does by adding the words,

“especially persons with long-term conditions”,

to Clause 11 at line 12 on page 7. However, we want to go further. A very high proportion of those with long-term conditions need help, both from the NHS and from adult social care services. That is why the second part of that amendment specifically requires clinical commissioning groups to pay attention to their need to secure improvement in the integration of health and social care in the delivery of services. Of course, we have already had one discussion on integrating health and social care services at the point of delivery, including specifying a definition and I suspect that we shall come back to integration on a number of occasions as the Bill progresses. I shall certainly return to this issue on Report.

In the mean time, I hope we will receive a more constructive response from the Minister to this amendment, placing a clear responsibility on clinical commissioning groups from the outset to focus on securing improvement in the integration of health and social care in the commissioning of services. We need to move from the rhetoric of integration to requiring it to happen in legislation. I beg to move.

[Lord Ramsbotham]

I wish to speak to Amendment 80. I wonder how many noble Lords are aware of the historic nature of the proposed insertion into the 2006 Act of new Section 3B(1)(c). It is the first time that mention has been made in a Bill of the requirement on the Secretary of State for Health to provide services or facilities for those detained in a prison or in other accommodation of a prescribed description.

When I was appointed Chief Inspector of Prisons in December 1995, I had to give up the chairmanship of Hillingdon Hospital National Health Service Trust because I could not guarantee the time required, but during my chairmanship I was particularly grateful that my extremely able director of mental health insisted that I trained as a lay assessor so that, in his words, I could be of some use to the hospital. What neither of us realised at the time was that he was enabling me to appreciate, at once, the full and avoidable horror of the situation that I found during my first prison inspection of Holloway, during my second week in post. He educated me about both the complex requirements of those suffering from mental health problems and what it was possible to provide for them.

That understanding fuelled my fury at finding that none of what I had been accustomed to at Hillingdon was present in the largest female prison in England in 1995, despite the appalling numbers of women with varying degrees of mental health problems. When I remonstrated about that, I was told that uniquely in the country, prison healthcare was not, and never had been, the responsibility of the NHS but had been retained by the Prison Service. I was then told that the director of prison health, a doctor, was not responsible for the provision of healthcare, merely for advising the prison’s board, which was actually responsible. When I asked how many of the prison’s board had medical experience or qualifications, I was told none.

So I set about trying to change this nonsense, writing a thematic review of the situation in 1996, entitled Patient or Prisoner?, in which I recommended that the NHS takes over responsibility as soon as possible. I quoted the vast well of psychiatric morbidity, exacerbated by the treatment of and conditions for prisoners being wholly unsuitable for those suffering from mental health problems, which invariably made them worse. I simply could not understand how this situation had been allowed to continue since 1947, not least the continued failure to include the needs of the 500 or so prisoners whose transfer to high or medium-secure hospital accommodation was recommended each year in National Health Service estimates. That meant that provision was always a matter of chance because of competition with funded community needs. Years of lack of NHS budgetary provision for any aspect of prison healthcare, including the additional expense that released prisoners add in the community, remain a millstone around the NHS neck.

It seemed abundantly clear to me that prison health was a public health issue, because every single prisoner except, for the very small number, sentenced to natural life was going to come out and the state of their mental and physical health when they did so was a matter of public interest. Not only was offender health not regarded as a matter of public health, but GPs had to fight to get information from prisons about any medical treatment a prisoner had received. That was of doubtful quality, because we found that only 10 per cent of prison medical officers were qualified to act as GPs in the NHS. In other words, not only did anyone going into prison disappear from the NHS radar screen, but the authorities seemed to disregard the fact that imprisonment—paid for by the taxpayer—presented a priceless opportunity to identify and initiate, or pick up and continue, essential mental and physical health treatment. This could then be continued on release to the benefit not just of the prisoner but also of the community into which he or she returned. It all seemed unbelievably short-sighted and, frankly, stupid.

In the event, the NHS was made responsible for prison healthcare in 2003—seven years later, or longer than World War Two; so much for the speed of governmental decision-making. Since then, there has been considerable improvement, particularly when good primary care trusts have taken very seriously their primary care contract responsibilities with individual prisons. The same has not been so true of mental health contracts, largely because provision has in no way been able to match demand. I shall never forget speaking to members of the first mental health in-reach team to go into Wandsworth. They had expected to have to deal with a few very serious cases; instead they found that they were swamped by the 70 per cent of the prison population who were suffering from one or more identifiable personality disorders. It did not make them sectionable, but suggested that there was something affecting their behaviour that, if identified, could be mitigated. However, as the resources to carry out the identification were, and are, lacking, mitigation was, and is, denied—a process that should be of public concern.

My reasons for spelling all this out are to explain why my proposed amendment is an appeal to the Minister to withdraw the words, “other accommodation of a prescribed description”, and substitute detailed descriptions of that accommodation. I say that because the Secretary of State is required to commission services for a number of entirely different places of detention with very different requirements. Public and privately run prisons require primary, secondary and mental health contracts appropriate for their population type, whether man, woman or child. Privately run secure training centres and local authority-run secure homes require child-centred services. Privately run immigration and removal centres, about whose healthcare provision there have been many complaints, require a range of services, including specialist knowledge of tropical diseases. In addition, if the Government adopt the diversion schemes recommended by the noble Lord, Lord Bradley, there must be appropriate psychiatric and nursing provision in both police and court cells, in which people may have to be held until moved to appropriate NHS accommodation.

The Department of Health is very fortunate to have an able director of offender health, Mr Richard Bradshaw, who can provide the necessary descriptions very quickly because he is well acquainted with the differing needs. I therefore ask the Minister to accept this amendment in the spirit in which it is meant, which includes trying to ensure that the dreadful situation that I have described is never allowed to reoccur in any prescribed place of detention.