Health and Care Bill

Debate between Baroness Whitaker and Baroness Finlay of Llandaff

Committee stage
Thursday 20th January 2022 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, this has been a really interesting debate and it made me think of Aneurin Bevan’s original vision, which incorporated the concept of dealing with the problem and then secondary prevention in rehabilitation and concepts of convalescence. After this debate, I am tempted to go back and read again In Place of Fear, because it is a very short book but it is worth reading.

There seems to be a theme coming through here really strongly. If we do not integrate these services and pull them together, we will never get not only the primary prevention but the secondary prevention which, as the noble Lord, Lord Black, highlighted, is so important. You do not just fix the problem; you prevent the next set of problems coming along.

I was slightly alarmed to note that in 2018 alone, there were over 6,000 deaths attributed to falls. A lot of those were on stairs. They were just simple trips on steps, yet they resulted in deaths. It took me back to when I worked at the Westminster Hospital, which, of course, is no longer across the road. Somebody tripped on the steps of the Tate and subsequently died from a head injury after hitting the concrete. One sees that at stations and so on, too, and we now see it with these scooters, where people scoot into trees and lampposts.

Anyway, to return to the subject of the amendments, the reason for my Amendment 100 is precisely to promote that rehabilitation and remind everybody that rehabilitation is not just a medical and nursing issue. It involves many different professionals, and volunteers quite often, at different levels. A rehabilitation plan at the ICS level could provide the co-ordination required, across different settings and services, to properly support early discharge from hospital, provide access to multidisciplinary teams and incorporate the psychological support that is needed. At the moment, things are organised in condition-specific medical silos, and we have already heard about the fragmentation of provision.

We need to respond more effectively to the needs of people with long-term conditions. When we come to measure outcomes, it is much easier to immediately measure the outcomes of an intervention. The outcomes from long-term secondary prevention are much more difficult to measure and quantify, particularly in a population that has multiple pathologies. So there has been poor data collection in part because it has been very difficult.

A simple example is that NICE guidelines suggested that over 1 million people with COPD every year should be referred for pulmonary rehabilitation, but only 15% are referred. We need to understand why. These are people who are breathless. They are getting chest infections and becoming oxygen dependent—so the consumption of NHS resources goes up. After a stroke, people have very marked rehabilitation needs in many different areas. That may be physiotherapy, occupational therapy, speech and language therapy and so on, going much more widely.

We also have a problem with our housing, because many people are not in accommodation that is suitable for them to go to when they are discharged from hospital. It has been estimated that there are 10,000 people in hospital at the moment who do not have a suitable home to go back to—hence the problem of where they go after hospital. So it is not only about providing a social care workforce to go in. We have already debated last week the problem of housing.

I do want to speak specifically to Amendment 51A in my name and the name of the noble Baroness, Lady Jolly. That is about having responsibility for every person present in an area. If we take the south-west, which is dependent on tourism, it goes from relatively low populations to absolutely bursting at the seams with holidaymakers. We have all seen it. These areas have an additional problem: when people are on holiday, their guard is down, they are less vigilant about what they do and they are less risk averse. Going back to falls, they are much more likely to have a fall or an accident. People fall off cliffs, fall down surfaces and so on. All of a sudden, in the tourist season, these people are at higher risk of something going wrong. They often go away and forget to take their medication, or they take something that interferes with it and end up with different side-effects and so on. They put a huge pressure on the emergency services in the area, so I am quite concerned at the way the funding might flow, in the way this Bill is written. We could inadvertently find that some areas are incredibly pushed at certain times of the year because of the way the population moves. I hope that will be taken into consideration.

[Baroness Whitaker (Lab)]

My Lords, following the impressive, high-calibre tour d’horizon from the noble Baroness, Lady Finlay of Llandaff, I rise to support the importance of proper and full rehabilitation as in Amendment 100, again supported by the Royal College of Speech and Language Therapists. Perhaps I should have declared, at my last intervention in Committee, that I speak as a vice chair of the All-Party Parliamentary Group on Speech and Language Difficulties—I apologise.

Very briefly, an annual plan, as in Amendment 100, would ensure that rehabilitation is explicitly integrated. Rehabilitation spans many disciplines, as the noble Baroness, Lady Finlay, said. It is what enables those who have degenerative diseases, strokes, cancer, autism and learning difficulties, to name only a few, to communicate—how essential is that for even minimal well-being?—as well as helping people to, for instance, swallow without choking and stay alive. As ever, it is the vulnerable who suffer when these structural underpinnings to ensure joined-up, consistent care are not there. I hope the Government will adopt these amendments.

Domestic Abuse Bill

Debate between Baroness Whitaker and Baroness Finlay of Llandaff

Committee stage & Committee: 2nd sitting (Hansard) & Committee: 2nd sitting (Hansard): House of Lords
Wednesday 27th January 2021 Lords Chamber

[Baroness Whitaker (Lab) (V)]

My Lords, I speak in support of this whole group. I declare an interest as a vice-chair of the All-Party Parliamentary Group on Speech and Language Difficulties, a patron of the British Stammering Association and, indeed, as a stammerer myself. Stammering is often not recognised as a disability, but depending on its intensity, it has profound effects, particularly on children’s ability to cope with stress and to develop, and it is exacerbated by domestic violence. I am indebted to the Royal College of Speech and Language Therapists for its research.

I will only add to the comprehensive and persuasive speeches by those noble Lords who have spoken to these amendments that in connection with support for communication needs generally in good practice, stammerers have difficulty in reporting traumatic events and in accessing services at the first contact when this is often by telephone. Inclusion of speech and language therapists on domestic abuse partnership boards and in local authority responses in their strategy is of particular benefit to victims who stammer, especially if the role of the therapist is to consider initial access to services.

In respect of guidance on the psychological impact of domestic abuse, in particular on children’s speech and communication, there is evidence that children who are exposed to domestic violence have a greater propensity to develop speech and language difficulties, thus harming their life chances thereafter. For instance, court proceedings can add intimidation and stress, which make these amendments of great importance in alleviating the damage caused by domestic abuse.

[Baroness Finlay of Llandaff (CB) (V)]

My Lords, I declare an interest in chairing the board of governors of Cardiff Metropolitan University, a major provider of speech and language therapy education with 130 students currently enrolled across the three-year course, 49 of whom started in 2020.

I support all the amendments because the links between domestic abuse and people with communication needs are clear but seriously underrecognised. In a cycle of abuse, communication needs in a child are ignored or overlooked as many do not realise how much can be done to improve a child’s life chances if they receive early—I stress early—supportive intervention. Public Health England’s Disability and Domestic Abuse: Risk, Impacts and Response paper reports:

“Disabled people experience disproportionately higher rates of domestic abuse. They also experience domestic abuse for longer periods of time, and more severe and frequent abuse.”


When those victims also have communication needs, they experience more barriers to accessing support such as health and social care services and domestic abuse services, and are at greater risk of ongoing gender-based sexual violence.

But the damage from abuse goes wider. The young child who experiences or witnesses abuse is more likely to have delayed speech and hearing development. This affects global cognitive development, especially in reading and writing, expressive language skills and social interaction skills. These children then fall further behind in many domains and may have flashbacks resulting in emotional shutdown and aberrant behaviours. Of course, they find it harder to express what has been happening, so these children often suddenly break down at school and the whole story unravels, but in a piecemeal and jerky fashion.

The cycle continues. Speech and language therapists working with children and young people in care or in custody report a very high incidence of these children having been abused or witnessed abuse. The key point is that recognition of abuse and subsequent remedial action must happen early, which is why speech and language therapists should be viewed as key members of statutory domestic abuse services.