Health and Social Care Bill

Baroness Massey of Darwen Excerpts

Tuesday 11th October 2011 Lords Chamber

[Baroness Massey of Darwen]

My Lords, I rise humbly after so many excellent speeches and after so much expertise has been expressed. I shall raise some issues about public health and then speak about my concerns on child health in this Bill, following my noble friend Lady Hughes. I agree with her about the lack of discourse about children’s health generally and the importance of integrating systems to deal with children.

On public health, I declare an interest as chair of the National Treatment Agency for Substance Misuse, the NTA, an organisation that will become part of Public Health England. I pay tribute to the Minister for his consideration, sympathy and astuteness regarding negotiations about arm’s-length bodies. He has an unenviable task and I admire him for his work on it.

There are issues around the future of public health in relation not only to drugs but to alcohol, HIV, sexual health and other services. I am proud that the NTA has contributed to the improvement of drug services. The number of people in treatment has more than doubled in 10 years, waiting times are now very short and the use of opiates and crack has gone down, as research has recently shown. Service users have been significantly involved in the development of services. It has been shown that for every £1 spent on treatment for drug use, at least £7 is ultimately saved.

The Minister spoke, many hours ago now, about the importance of outcomes in health. Here we have an example of positive outcomes that could be built on in relation to public health. The improvements that we have seen are due to a strong focus on drugs as a problem for crime and health and to the appropriate ring-fenced funding over the past 10 years. Structures are in place, collaboration between agencies is notable and I like to think that the assistance of clients into recovery will continue to improve. They will not do so, though, without attention to many of the issues raised here today, including just now by the noble Lord, Lord Ramsbotham, who will be a very busy person with all those amendments.

My concerns are around the role of clinical commissioning groups and how they will engage with health and well-being boards; about the integration of health and social care for areas like drugs, alcohol and sexual health, where there is potential for fragmentation; and about the accountability of the NHS Commissioning Board for effective integrated care. I hope that the Minister will address some of these issues.

I begin my concerns about child health with the concerns of many children's organisations that the Bill must deliver for children and young people and that child health must be given the priority it deserves. I declare another interest as chair of the All-Party Parliamentary Group for Children. Sir Ian Kennedy's report last year has already been mentioned by my noble friend Lady Hughes. Children comprise 22 per cent of the population, and children are often helpless in the face of the actions of others—for example, in passive smoking. A report today raises the potential problem of the increase in relative child poverty, which, according to the report, will affect about one-quarter of all young people. I worry about the interaction between poverty and health, and I worry about the invisibility of children in health services.

We know that Graham Allen, in his recent report on early intervention, expressed the view that early intervention in social and intellectual development is vital if children are to develop positively. The same is true of health interventions. There is a great deal of evidence to show that encouraging good physical and mental health at an early age is vital to future well-being.

I shall quickly make three basic points. First, the voice of the child must be heard. Children must have a say in decisions about local services and care, as recommended by the NHS Future Forum. HealthWatch England and local HealthWatch must be instrumental in this. Secondly, local services for children must be integrated and must talk to each other. We have already seen the disastrous effects of the lack of such integration. The clinical commissioning groups, whose boundaries do not align with local authorities, must set out how effective partnerships will be developed to promote child well-being. Thirdly, surely young people with complex needs may well fall through the gaps between services as they move into adulthood. Universal services, specialist services and services for parents, families and children must connect with each other to ensure that there is a clear pathway for individuals throughout life.

Coalitions of organisations concerned for the welfare of children agree that the Bill must be amended. For example, in Clause 20, as my noble friend mentioned, priorities for improving child health services should be included in the mandate to the NHS Commissioning Board. In Clause 192, health and well-being boards must, rather than may, encourage integrated planning and delivery across health and social care services. In Clause 190, the joint health and well-being strategy must, rather than may, include a statement on how health and social care services could be better integrated with health-related services. Local HealthWatch organisations must promote the involvement of children and young people. There must be clear accountability for promoting the health and well-being of looked-after children and care leavers within new structures. Clause 162 would abolish the private patient cap, meaning that hospitals could treat any number of private patients. This could be detrimental to NHS patients and disadvantageous to low-income families and children.

Plans for involving the voluntary sector and communities must be clarified. We are all indebted to the voluntary sector for all its sterling work with children and other aspects of community life. The Royal College of Paediatrics and Child Health recommends that Clause 191 on the membership of health and well-being boards should designate professionals who are responsible for safeguarding. It also recommends that, in Clause 23, proposed new Section 14V should be amended to include maltreatment, not just the prevention, diagnosis and treatment of illness.

We shall of course return to these issues. However, I plead with the Government to take child health very seriously. Early intervention and preventive strategies are not only humane and contribute to lifelong well-being, they have economic advantages that should surely be a consideration.