Health and Social Care Bill

Baroness Armstrong of Hill Top Excerpts

Wednesday 16th November 2011 Lords Chamber

[Baroness Armstrong of Hill Top]

My Lords, I wanted to intervene on this group of amendments because I have been trying, without success, to find out how to table an amendment relating to how the new architecture will deal with the most chronically excluded. Some of them will require alcohol services, which we shall come to later, but many of them will require other medical services. In addition, many of them will not have a fixed abode or will not have a fixed abode for very long. Therefore, they will be moving around.

When I asked the chief executive of the Commissioning Board who would deal with these people, I was rather concerned to be told that it would be clinical commissioning groups. CCGs might do so, but I am not convinced that they necessarily will. First, CCGs may well not be very aware of the numbers involved, particularly if they are not inner-city commissioning groups, and they may well not be aware of the complexity of response that such people will require. These will be people who require some medical intervention as well as other forms of intervention and support.

At the moment, much of the medical attention that these people receive is fragmented and is often not the appropriate intervention, and they can be a real nuisance in places such as A&E. The Government need to listen to those in the voluntary sector who say, “We need a new approach to how we work with people with these multiple conditions and we need to make sure that we get it right”. However, the NHS has a responsibility—it does not stand outside this—and this matter will need to be looked at on a wider and more expansive level than simply that of the CCG.

In this country we assume that, because we have GPs, people will automatically be registered with them and will be looked after. However, my experience of working with these most frequently disturbed and disadvantaged people has been that they fall through the net again and again, and somehow we have to make sure that that does not happen. Due to work that I have done in the past and because I am currently involved with a voluntary organisation, I have previously discussed with the Minister ways in which that can be achieved effectively. I do not pretend that it will be easy or that we can simply lay something down in legislation and it will all happen. However, somewhere in the middle of that there is a way forward.

I hope that in considering the amendments—particularly those of my noble friend Lord Hunt—the Government will work on this issue and come back with clarification that this group of people will not fall through a net in the new architecture.

[Lord Greaves]

My Lords, I want to pick up on a point that I made on Monday. We are discussing the role, duties and powers of CCGs, and I want to talk about commissioning services. Where contracts are negotiated with existing providers—whether they are within the National Health Service, the voluntary sector or the private sector—it is fairly clear to see how the system will operate. However, I am not clear—and perhaps the Minister can enlighten me—about the role of CCGs in promoting and creating new services or facilities within the NHS.

The example that I particularly want to refer to concerns the provision of new health centres in my own area of east Lancashire. These are new significant capital schemes but they are not the direct responsibility of the hospital trust. Where the responsibility is that of the hospital trust, it will no doubt be responsible for the provision of new capital schemes. Here we have facilities that will be partly occupied by GPs; they may well be occupied in part by community-based services that are now the responsibility of the hospital trust. The hospital trust may wish to make use of the facilities as outreach facilities for day patients, and so on, but they do not fit neatly into the hospital trust. At the moment, they are the responsibility of the PCT. The existing primary care trust in east Lancashire has now approved in principle the provision of three health centres in three towns—Great Harwood, Clitheroe and my own town of Colne. Because of the changes and the fact that the PCT is not responsible in the future, it has now been passed to the cluster of PCTs, which is at a Lancashire level, and will have to be approved by the strategic health authority.

These are all bodies that in future will not exist. Who will be responsible for this kind of capital project within the NHS in future? It is not just a question of commissioning within an existing landscape of provision in different sectors, but a question of commissioning new services and new capital projects that do not fit into the hospital trusts. Will that be done at a national level? Will it be the responsibility of the CCG? Who will be responsible for the provision of finance for this kind of project?

--- Later in debate ---

[Baroness Armstrong of Hill Top]

My Lords, I am sorry that the noble Lord, Lord Northbourne, was not here to move his amendment. However, I think that the general principles that the other amendments in this group address are very much what I want to bring to the attention of the House and the Minister. We now know so much more about the development of children. In the 18th and 19th centuries there was a great amount of dirt and other problems in the streets. This aspect of public health was taken up by municipal authorities, which had to build drains and sewerage. It was seen as critical to the future of this country. It also, of course, had an important effect on people’s health.

We now know much more. In my last job in government, I was the Social Exclusion Minister and had the enormous privilege of introducing to this country the Family Nurse Partnership Programme. In learning about that evidence-based programme, which affects the development of children more advantageously than any other single programme in the world, I discovered a little about what neurologists and others now know about brain development. The truth is, if we do not support parents and children in those early months and years, by the time they are three, they are so far behind it will take the rest of their lives to compensate for what they have not had in those early months.

I listened to the debate on alcohol and wanted to intervene. In family nurse partnerships, mothers learn that if you drink alcohol in pregnancy, it will affect the brain of the foetus and therefore the child. It has been incredibly successful, therefore, in giving young women the determination not to drink, because they want the best for their child when it is born. These are all things that we now have a lot of knowledge about.

Recently, I was at a meeting where a neurologist talked about research into the stress put on children and what elements in the body can be measured to tell whether or not there is stress and what can be done about it. Stress can lead to violence and violent behaviour. We know about these things, but they did not know about them in the 18th century, when they began talking about public health. We did not know about it when I was growing up, but we know about it now. That means we have a responsibility to take it into account and build the early development of children into our understanding of public health. We must make sure that we address it. It should not be until we get to extremes, when suddenly somebody notices that a particular child is developing in a difficult way, such as noble Lords have talked about, when children end up in the criminal justice system. We know what will happen to children if we do not pay attention to this: they will end up in the criminal justice system, and they are more likely to end up with an alcohol or drug dependency. We know these things now and, in my view, we have no option but to take account of them as a matter of public health. Therefore, I believe that we have to write that into the Bill.

[Baroness Whitaker]

My Lords, I rise to support Amendments 72A, 81A, 91A, 200A, 201ZA, 327B, 327C, 329A, 331C and 333B—all amendments on speech and communication. I think that Amendment 218A should also have been included because it deals with integration—in this case, for the commissioning groups. I hope that when the Minister deals with that later amendment, he will be able to recall this debate.

I support these amendments very warmly for all the reasons that the noble Lord, Lord Ramsbotham, and my noble friend Lady Wilkins have set out so cogently. I should also, in this very brief intervention, like to draw attention to the excellent BBC film “The Kid’s Speech”—not “The King’s Speech”, although that was very good too—which graphically portrayed not only the crippling effects of stammering on children’s development, as well as on their happiness, but also an integrated way to deal with it, employing educational as well as physiological expertise. I commend this short documentary to anyone who wants to understand why it is so important to help these children properly early on.

The assessment and treatment of speech, language and communication problems must come within public health. I asked the Minister about this when I made a few remarks at Second Reading. However, with that vast marathon of questions, I quite understand that he did not have time to reply, although I hope that he will be able to do so at the end of this debate. The information must be accessible to those with low literacy and poor understanding. Finally, there must be integration not only with the health and social care services but also with education and children’s services, or we shall fail that very large number of children with speech, language and communication difficulties.