Health and Social Care Bill

Lord Shipley Excerpts

Thursday 8th March 2012 Lords Chamber

[The Earl of Listowel]

My Lords, I support the amendment spoken to by my noble friend, to which my name is attached. I will strive to be as brief as possible at this late hour, but the issue is very important.

I will begin with an aside and refer to the short debate on productivity and manufacturing industry instigated at the start of business today by the noble Lord, Lord Bates. I will highlight the point made recently by Education Minister Sarah Teather that what happens in schools is important, but that the most important thing for children’s success outcomes is what happens in the home, outside school. As one academic put it, when one considers what makes the difference to a successful outcome for a child, only 10 per cent of it will depend on schools; the rest will depend on what happens in the background, in the family.

Of course, whether a parent is successful in their education is the single most important indicator that their child will be successful in their education. Businesses might be more aware, when they push for schools to teach children to read, write and do arithmetic better to get their apprenticeship skills, that they should think also very much about early intervention and getting it right in the family as well. If we are to compete with China in future, we need to think very carefully about the successful integration of services to support families and children.

I will speak briefly, on International Women’s Day, about another matter raised in an earlier debate today: namely, domestic violence and women fleeing to refuges. A few years ago I spoke to a child and adolescent psychiatrist, Professor Panos Vostanis of the University of Leicester. He had gone into these refuges and worked with the mothers and children over time, providing them with support. He said how important and effective it had been, but how rare the service was. He has now been commissioned by the European Union to conduct EU-wide research into support for families where there has been domestic violence.

This theme recurs in children's homes, refuges and other settings. It seems elementary that a mental health professional such as a psychiatrist or clinical psychologist should visit a children's home or refuge once a fortnight, to speak to mothers, work with children and support staff. That is best practice and it happens—but very often the model gets overlooked because, understandably, clinicians are under pressure and there are high thresholds of access for children and adults to these services.

Perhaps I may give one further example on the matter of schools. I recently attended an international conference on the mental health of children in schools. It was organised by Dr Rita Harris, head of child and adolescent mental health services at the Tavistock and Portman NHS Foundation Trust. We were given a presentation by two wonderful mental health nurses who had tried to revive a service in the Sunderland area. They found that schools had given up using child and adolescent mental health services because they would write to the service and it would respond by saying: “I am sorry, your child is not sick enough for us to see. Wait until he gets sicker and then we might see him”. The nurses had tried to mend the relationship with schools, build trust and ensure that every school had a mental health professional allocated to it. However, one school simply did not want any truck with them because it had had such a bad experience in the past of trying to work in this integrated way with child and adolescent mental health services.

The record is very poor. Given the concerns that many have raised in the past about the possible fragmentation that might arise from the Bill, and the many clinical commissioning groups that will come into being and the large upheaval that will take place, I am looking to the Minister for reassurance that the Government will improve a situation that has been so disappointing in the past, that we will see a better integrated service that will better meet the needs of children and families, that we will see better outcomes for children and they will be more successful in school in part because health and social care services will have been better integrated for them and they will have received, early in their lives, the support that they need. I look forward to the Minister's response.

[Lord Shipley]

My Lords, I rise to speak to Amendments 238AA, 238AB, 238BZA and 238BA and to declare my interest as a member of Newcastle City Council.

These amendments relate to the membership of health and well-being boards. As currently proposed, the boards will have at least one councillor of the relevant local authority—so it could be one councillor, or it could be more. The choice will be with the council. However, several other people who have membership will be officers or unelected co-optees. This means that the board as currently proposed is effectively a board of directors, not a council committee which—unlike all other council committees—is made up of those who are publicly elected. Yet the board as proposed is legally a council committee; and because it is legally a council committee, only councillors can vote—officers must advise. For officers to vote, specific regulations will have to be put in place, and of course they can be. However, I hope that the Minister is willing to think further about this. Councillors, being elected, have both a democratic mandate—unlike officers—and a perception of service provision which comes from a geographical perspective as well as a service perspective. At times that can be very valuable, particularly in a geographically large council area.

To have just one councillor—which is what the Bill permits—would be a mistake. It would mean a council committee, the health and well-being board, would be dominated by officers and co-optees. It would also mean that only one political group was in membership of the board, which in my view would be deeply unwise.

Given the board’s terms of reference, I do not argue that councillors have to be in majority. However, I do argue that councillors are important; that geographical differences in a council area should be acknowledged; and that more than one political group should be fully represented on a board. Amendment 238AA solves this problem. It defines the minimum number of councillors as three. That would give the board greater breadth and enable political proportionality to be effective. Amendment 238AB states that where a council is a county council and part of a two-tier system of local government, there should be a district council representative as well as county representatives because district councils have statutory duties in relation to health and well-being. Having one district councillor appointed in this way as a representative of several district councils is normal procedure for those councils when duties span the two tiers. The other two amendments are simply enabling amendments assuming that Amendments 238AA and 238AB are agreed.

In Committee there was a discussion about councillor membership—how many there should be, whether they should be in a majority and whether they should have powers over the budgets of other health organisations not managed by the council. There was no conclusion to that debate, but I have thought long and hard about it. I have concluded that the amendments in my name and those of the noble Lord, Lord Bichard, and the noble Baronesses, Lady Eaton and Lady Henig, which reflect all parts of this Chamber, give a solution to this problem and would enable us to balance professional knowledge with the necessary democratic accountability.

I do not propose to press this to a vote, but I hope that the Minister will be willing to engage in discussion on it. What is being proposed from all parts of the House is a solution to a problem that needs to be resolved. It will prevent difficulties arising further down the line should a council decide to have only one councillor as a member of the board.

[Baroness Finlay of Llandaff]

My Lords, I shall speak briefly to Amendment 238A, which is in the name of my noble friend Lord Ramsbotham. I rather hope that the Government will take on board its spirit, if not its actual wording. The reason is that in creating a joint strategic needs assessment, there will be a requirement for those involved to begin to work in a completely new way. Human nature is such that people tend to repeat the patterns of things they have done before. In addition, they do not know what they do not know. When they feel insecure, they are less—not more—likely to consult, because it is quite threatening to have to consult and go beyond the boundaries of what you thought you knew and discover all the things that you did not know.

The beauty of the amendment is that it creates an obligation to,

“consult relevant health professionals and any other”

person, without specifying who they are. It leaves it very broad but it pushes forward the boundaries. We have already discussed the problem of children. The difficulty, if people do not consult widely, is that if children miss out at a developmental stage and one aspect of their development—for example, motor development, speech and language development or emotional development—does not occur, they never catch up. It is missed out for good; they always lag behind.

It is really important to make sure that the provisions are there right the way through the trajectory from birth onwards to make sure that the needs of children as they develop are met, that deficits are identified early and that interventions take place immediately.