Health and Care Bill

Debate between Lord Warner and Baroness Tyler of Enfield

Committee stage
Wednesday 9th February 2022 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I rise to speak to Amendment 307 in my name. I am very grateful to the noble Baroness, Lady Finlay, and the noble Lord, Lord Warner, for adding their names to it. I am also grateful for the support already received from my noble friend Lady Brinton.

As I have argued in earlier debates on this Bill, it is a real problem that measures under Part 2 that aim to improve the sharing of information and data apply only to adults. This is despite the clear need to improve how children’s data is shared between health and social care and also between other agencies, including education and wider local services. The current absence of a single unique identifier makes identification of children who are in touch with multiple services very difficult and is a real barrier to joined-up support. My amendment seeks to address this glaring gap by requiring the Secretary of State to publish plans to use the NHS number as a single unique identifier for children.

Everyone in England and Wales is assigned a unique NHS number at birth or after the first time they interact with NHS services and that number is valid for life. Currently, the NHS number is used to store information on patients within healthcare records. However, we know that children and young people are frequently in contact with other agencies and services which are, more often than not, all using different identifiers. It is no wonder that too many children, including the most vulnerable, fall through the cracks, leading to the tragic and absolutely horrendous examples of extreme child cruelty and death that we have heard about recently.

The 2021 annual report on local children’s safeguarding practice reviews, previously known as serious case reviews, states:

“Much has been written about the continuing barriers to sharing information between safeguarding partners and we found that those issues remain and were highlighted in almost half of all reviews”—


I repeat: some 50% of the reviews.

Using the NHS number as a unique identifier would have the following benefits. It would reduce the risk of incorrect identification, improve multiagency working and improve care pathways. It would certainly ease the transition into adulthood, because the NHS number is for life. That NHS number stays with patients wherever they move within the country or between England and Wales. These are really important points.

A key finding of the House of Lords Public Services Committee report on child vulnerability was that

“in most local areas, services working with children are unable to match unique pupil identifiers on the national pupil database with children’s NHS numbers. This limits the ability of early intervention services to reach the most vulnerable children”.

Simon Kenny, the NHS England national clinical director for children and young people, added to these calls, stating that we “definitely” need a unique identifier, and that there needs to be

“a legal framework to enable it.”

This Bill provides just that opportunity.

Both the Children’s Commissioners—Anne Longfield, the previous Children’s Commissioner, and Dame Rachel de Souza—have supported the call for a single unique identifier number for children. I spoke with Anne Longfield about this only yesterday, and she described this approach as a force for good.

I finish by referring to a briefing from the Royal College of Paediatrics and Child Health, for which I am very grateful. It strongly supports a single unique identifier for children using the NHS number and says that it would be utterly transformative in how services address the needs of children and young people, particularly the most vulnerable.

[Lord Warner (CB)]

My Lords, I have added my name to Amendment 307, introduced so ably by the noble Baroness, Lady Tyler. I have raised this issue from time to time over the past decade or so, including in a spirited correspondence with the noble Earl, Lord Howe, when he was a Health Minister—which shows how long this issue has been kicked around Whitehall. The one number every child has is the NHS number, as the noble Baroness, Lady Tyler, mentioned, but to adopt it means education, social services and possibly police would have to accept it, and—terribly, of course—they would have to modify their IT systems. In short, what we have here is a good, old-fashioned, Whitehall bureaucratic struggle.

However, now the Children’s Commissioner Rachel de Souza has joined in rather powerfully because of all the children missing from schools, many more than before the pandemic. There has been a problem with children missing from schools from well before the pandemic—some going to illegal schools, others being home-schooled, often without much evidence of being taught curriculum subjects. There is now to be a home-schooling register. The Children’s Commissioner has made it crystal clear that she wants all children to have a unique identifying number across the NHS, school and social services. That is the only way these kinds of changes can be made to work. What we have is a situation now where children at risk are put at unnecessary risk because there is no unique identifier across the different services.

Personally, I would not bet on the Children’s Commissioner getting her well-deserved wish. Last week, the Department for Education trotted out its traditional line—that it will introduce the home-schooling register at the “earliest possible legislative opportunity.” But the department was totally silent on the unique identifier issue, which was so important to making this work.

We have had this issue sculling around Whitehall for many, many years. There is now a chance for a decisive Minister, like the noble Lord, Lord Kamall, to do something about it, bang a few bureaucratic heads together and put the NHS number to work protecting children at risk across a range of services. At the very least, it would be helpful if he could consider protecting children through the Government having a pilot scheme to take this idea forward.

Children and Social Work Bill [HL]

Debate between Lord Warner and Baroness Tyler of Enfield

Ping Pong (Hansard): House of Lords
Tuesday 4th April 2017 Lords Chamber

[Lord Warner]

My Lords, briefly, I congratulate the Government on bringing these amendments forward. They are a very welcome advance and I am extremely supportive of Amendments 12 and 13. All credit to the Minister and his colleagues for having the courage to grasp this nettle after so long and come forward with amendments. So it may seem a little churlish if I add a “but”. My “but” relates to Amendment 12B, which was so elegantly spoken to by the noble Baroness, Lady Walmsley. I want to enter into the spirit of the way in which she spoke to it to probe the Government a little on the issue of age and the ability to withdraw children from this education.

We have to recognise that there is a need to make some of this compatible with some of the other aspects on which we judge children: for example, the age of criminal responsibility. It would be extremely strange to give people a chance to withdraw their children from this kind of educational opportunity at an age which is older than the age of criminal responsibility, which is based on the principle of doli incapax—children not understanding the implications of what they have done. There are other bits of our social system that need to be taken into account when we write guidance on these issues for children.

We also have to remember that the state does not give parents an absolute right to do whatever they want with their children. The state does step in. It withdraws children from their natural parents when it thinks that they are being abused or that it is not safe for them to stay in the care of their parents. That is based on another principle, well set out in the Children Act 1989: the best interests of the child. We need to balance the principles of the best interests of the child and the willingness of the state to intervene when it thinks a parent is behaving seriously unreasonably and damaging a child. We have to make the rules in this area consistent with rules operating in other areas, such as the age of criminal responsibility.

So I hope that, while the Minister and his department are framing the guidance, they will be able think about these wider issues, including the ability of parents to withdraw their children from this kind of education. It may be that we have to set some point in time where we cannot accept that parents can withdraw their children from this—whatever set of beliefs they happen to hold. At the end of the day it is their children, not they, who are going to have to cope with the world that they are moving into. We have an obligation to think about children and not just about the rights of their parents.

[Baroness Tyler of Enfield (LD)]

My Lords, I rise briefly to lend my support to this important group of amendments. Like the noble Baroness, Lady Massey, I think this is a historic occasion. Many people, including many distinguished noble Lords, have campaigned for this over many years. Like the right reverend Prelate the Bishop of Peterborough, I am very pleased that we are now talking about relationships and sex education in that order. It is something I spoke about in my maiden speech, and I am very pleased to see it introduced.

I shall make two quick points. The first is that, in the considerable number of debates we have recently had in your Lordships’ House on children’s mental health and during the passage of the Bill, we have heard about the strong link between relationship distress and poor mental health. It seems self-evident that supporting young people to develop relationships skills—conflict resolution, good communications, understanding about respectful relationships, the importance of friendship and family relationships, and expectations about what a healthy relationship looks like and what an abusive relationship looks like and what you need to do about it—is likely to lead to much better mental health and well-being for all young people, which is something I am sure we all want.

My second point is that good-quality relationships and sex education requires good-quality, competent and trained educators. At the moment, very few teachers have been given specific training in this area. On too many occasions the subject is picked up by rather reluctant teachers. Sometimes they are biology teachers, and sometimes they come from other disciplines. If we are to make a reality of this hugely welcome step forward, for which huge credit goes to the Government, it is vital that they look at the training and role of specialist teachers and, where appropriate, the role of specialist voluntary sector providers.

Children and Social Work Bill [HL]

Debate between Lord Warner and Baroness Tyler of Enfield

Monday 11th July 2016 Grand Committee

[Lord Warner]

My Lords, could I ask a number of questions, particularly in relation to Amendment 116, on information? Before doing so, I will leave the noble Lord with a thought about my experience of local safeguarding boards in Birmingham, when I was the Children’s Commissioner there. A common feature of that board, which covers a very big area—I suspect it is a common feature of many other of those boards—was that often there was no consistency in who turned up for the meetings between the different agencies. There is a moving cast of characters turning up at these boards on behalf of particular agencies. Unless we can ensure greater consistency, we will not make those boards more effective.

On Amendment 116, I am not sure whether the Minister knows that some of us have been involved for a very long time—it seems as though it is since Adam and Eve—in trying to get the public agencies to accept a common identifier for children. If we want information to flow smoothly and quickly between agencies for children, particularly those who are at risk and in the child protection system, we need to listen to some of the people who have been working on this, such as Sir Cyril Chantler, an eminent paediatrician often used by the Government to undertake inquiries, to progress that. If you talk to paediatricians who have been involved in this area, the common villain of the piece—I use the term loosely—is the Department for Education, which simply will not accept that the NHS identifier is the best one to use because all children have one. Will the Minister take this back to his department and have another go? If he wants information to flow smoothly in child protection cases between the agencies, let us move towards using the NHS number as a common identifier. I assure him that that will get the information moving much faster through all the agencies concerned.

[Baroness Tyler of Enfield (LD)]

I shall add one more question to those posed by this very important set of amendments about how to improve local arrangements and have more effective multiagency safeguarding. I can think of nothing more important than that this works.

When I looked again at Alan Wood’s very interesting report, I saw two sentences that so far have not been picked up in this debate. They read:

“I would also add that national government departments do not do enough to model effective partnership working between themselves for local agencies. The join up demanded of local partners is not particularly evident at national level”.

For the new arrangements to work, and it is critical that they do, it is vital that government departments are modelling more effective collaboration in the area of safeguarding. I would be grateful to the Minister if, when he responds, he could tell us what steps government departments are taking nationally to model this behaviour.

Children and Families Bill

Debate between Lord Warner and Baroness Tyler of Enfield

Monday 9th December 2013 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I have a lot of sympathy with these amendments, particularly Amendments 7 and 8 in the name of the noble Earl, Lord Listowel, and especially the need for greater support for children returning home from care. As other noble Lords have said, the new proposals that the Government recently put out are very welcome and are certainly a good step in the right direction. I commend them for making these proposals. However, as we have already heard, almost half of children who return home re-enter care, and a third have gone in and out of care twice or more. It is a vicious circle and the impact on the child can be devastating.

Since we are now on Report, I restate an interest as chair of CAFCASS. We have already heard that much of the problem is that the very problems of the parents that have resulted in the children going into care in the first place generally remain unresolved. Unless there is more help and support available to the family, particularly to the parents, to help them deal with those problems—be they to do with substance misuse, domestic violence, mental health or alcohol abuse—the chance of the child coming home successfully to the parent and having the sort of loving and stable household and help that they need is slim indeed. I look forward to the Minister’s comments on what more can be done to address this issue.

[Lord Warner (Lab)]

My Lords, I support my noble friend’s Amendment 9, which puts contact between siblings in the Bill. I apologise to the House that I was unable to take part in this Bill’s proceedings in Committee because I was engaged on the Care Bill. However, I was on the Select Committee on Adoption Legislation and I echo the points made by the chairman of that committee, the noble and learned Baroness, Lady Butler-Sloss.

On the basis of my six years as a director of social services, I have a general point about why the Minister should concede on Amendment 9. While I was director, the Children Act 1989 was passed. That was a classic example of Parliament saying in a Bill that decisions about children should be taken on the basis of the best interests of the child. In the overwhelming majority of cases where siblings are separated, the best interests of the child are to maintain that contact. Sibling contact is often a private child’s world, which is not always well observed by adults, whether they are social workers or other adults involved in that child’s life. Maintaining that contact is overwhelmingly important to children. My noble friend has shown that the option of putting it in guidance and relying on best practice has had a good run for its money and it has not worked. We should return to some of the ideas in the Children Act 1989 and put in the Bill the obligation to help maintain contacts between siblings when they are separated. These contacts are in the best interests of the children and very important to them. It costs very little to put that in the Bill.