Health and Social Care Bill

Baroness Hughes of Stretford Excerpts

Tuesday 11th October 2011 Lords Chamber

[Baroness Hughes of Stretford]

My Lords, the noble Baroness, Lady Tyler, among other noble Lords, referred to the fact that the Bill and the debate have, perhaps necessarily, been predominantly about structures, pathways and commissioning boards, which are all very important, but I want to focus on people and specifically on children and young people. I believe that whatever is left of the Bill, after this process of scrutiny and its passage through the Houses, it is vital that we take the opportunity, in so far as we can, to improve prospects for children and young people. I say that for several reasons.

First, despite there being many dedicated health professionals, the health system has often not worked well for children and young people. I know from when I was Minister for Children that the NHS, certainly at its top levels, has been very resistant to including indicators for the improvement of outcomes for children. Sir Ian Kennedy in his report last year said that many professionals feel that services for children and young people have traditionally had a low priority in the health service and that fewer resources have been allocated by the NHS nationally, regionally and locally to children’s health services. The system does not always respond well to children whose needs are complex and who require good integration between health and other services. That is the case particularly in respect of disabled and looked-after children. In addition, meeting children’s and young persons’ needs often requires joint commissioning of all services for children—health alongside social care, education, statutory and voluntary organisations, and those speaking for and working with families.

Secondly, we have to consider that current social and economic events will have an adverse impact on children’s health, and we can expect their health needs to rise. With rising unemployment, we can expect a rise in child poverty and mental illness among parents. The IFS report published today states that families are suffering an “unprecedented collapse” in living standards. Welfare benefit changes will reduce the incomes of the poorest families, affecting their nutrition and well-being. We are seeing key services such as Sure Start centres and parenting support being lost. All this, as we know from the past, will have an adverse effect on children’s health. In addition, the Bill threatens to disrupt existing child protection mechanisms and the relationships between organisations working together to safeguard children.

Thirdly, the Government stress their aim to put patients and public views at the centre of commissioning, yet there are very few mechanisms for children and young people to influence the commissioning and delivery of health services. Research by the National Children’s Bureau published recently shows that existing structures for patient consultation, the local involvement networks, are struggling to register children’s voices. Any new mechanisms to involve local people in determining health needs must include children and young people from the outset.

Above all, the Bill makes no specific reference to children and young people and, perhaps more importantly, nor has discourse from the government Benches. That commentary has not signalled the need for the reforms to work better for children. I want many changes to be made to the Bill to ensure that the system works better for children and young people. I shall restrict my comments to the Minister to five issues. Although I relate those issues to children and young people, they arise from endemic flaws in the Bill and will therefore have an impact on other groups of patients.

First, how do the Government propose to ensure that children and young persons’ health is given high priority in commissioning? Will the Minister consider amending Clause 20 so that the Secretary of State’s mandate to the NHS Commissioning Board must include priorities for children’s health and for reducing health inequalities between children? There is also a need to focus on reducing health inequalities at the local level. Will the Minister also consider placing a duty on the health and well-being boards and the clinical commissioning groups to reduce health inequalities particularly among children?

Secondly, the proposals for commissioning, as I have mentioned, have serious implications for the co-ordination of health and social care responses to child protection. The Government’s current proposals split responsibility across three bodies: the NHS Commissioning Board for primary care, the clinical commissioning groups for acute mental health and maternity care, and the health and well-being boards for early years. Where will the clinical lead and the accountability for child protection lie? How will the Secretary of State ensure that every local area has robust and transparent arrangements for child protection?

Thirdly, the Government's proposals significantly increase the complexity and bureaucracy of the health system, as my noble friends Lord Hutton and Lady Armstrong of Hill Top have pointed out, with many more organisations responsible for different aspects of commissioning and monitoring. Different services will be commissioned at different levels—the NHS Commissioning Board, clinical commissioning groups, larger consortia of commissioners and local authorities. Children at risk, looked-after children, disabled children and those with complex needs will require packages of services drawn from all these levels and from social care and education. Will the Minister set out how these services will be integrated locally? What role will the health and well-being boards play in establishing a local framework for integration? The Bill, even after amendment in the other place, seems to imply that this is an optional part of the remit for the health and well-being boards and of the scope of the joint health and well-being strategy. The remit for integration seems to be optional. Will the Minister agree to amend Clauses 192 and 197 so that this is rectified?

Certain groups of children, for example looked-after children, care leavers and Gypsy, Roma and Traveller children in particular, are often particularly vulnerable to health problems and are also more likely to move across local authority boundaries. Will the Minister say specifically how he will ensure that the needs of these children and young people do not fall between the cracks of what I believe will be a more fragmented system, with a greater lack of coterminosity, as my noble friend Lady Royall has pointed out, than before?

How will the Minister ensure that the voices of children and young people are given strong recognition and clear ways to express themselves within the system? The Government talk much about giving patients and the public greater influence over decisions about healthcare, but there is no mention of children and young people. Local healthwatch organisations and HealthWatch England must be required to have specific and dedicated child-friendly ways in which the views of children and young people can be elicited and acted on. Will the Minister amend the Bill so that this is an explicit requirement on local and national healthwatch organisations?

I look forward to the Minister's reply and to pursuing these issues further in Committee.