Health and Social Care

Earl of Listowel Excerpts

Thursday 15th December 2016 Lords Chamber

[The Earl of Listowel (CB)]

My Lords, in listening to the noble Baroness speak about housing concerns, particularly for the elderly with health conditions, I am reminded how important it is for policymakers, senior decision-makers and those who hold the money to visit people in their own home to see for themselves what the circumstances are. I suggest that on top of listening to service users, we need to see them in context if we are to really understand what we need to do.

I will concentrate my comments on the service-user element of the debate in the name of the noble Lord, Lord Harris. I want to ask the Minister this question: will she look at how she can improve continuity of mental health care for young care leavers in transition, after the age of 18 and into their early 20s? In much legislation, we recognise the continuing needs of care leavers, who have rights up to the age of 25. I suggest that we need to see that in the mental health care that they receive. Perhaps the noble Baroness might take this to her colleague and ask him to talk to the expert working group on the mental health of looked-after children.

I also join your Lordships in expressing my condolences to the noble Lord, Lord Prior of Brampton, and his family. I thank the noble Baroness for stepping in in his absence. I am also grateful to the noble Lord, Lord Harris, for calling this important and timely debate.

Noble Lords have expressed concern at the lack of White and Green Papers in various legislation in recent years. It seems to me that, if we want to engage service users, we need to follow the proper process. I welcome the fact that the Government have recognised this and will do it more in the future. The Committee stage of the Children and Social Work Bill is going on in the other place. During the Second Reading debate, the honourable Member Tim Loughton said that this aspect of the Bill is a,

“very radical proposal that warranted at least a Green Paper and a White Paper and proper consultation, but there was none”.—[Official Report, Commons, 5/12/16; col. 52.]

The hon. Member Mrs Emma Lewell-Buck commented:

“In short, it is a Bill about children and social work with negligible input from children and social workers”.—[Official Report, Commons, 5/12/16; col. 73.]

Those are the concerns expressed about a current Bill. I should say that I welcome very much what the Government are trying to achieve in that Bill and so much of their work in that area. However, I think that there has been an omission in the past to consult properly in a way that would allow service users to be fully involved in developing policy and legislation.

I declare my interest as a patron of the Who Cares? Trust, recently rebadged as Become. It was established many years ago to ensure that children in care in different local authorities were fully aware of their rights. It published Who Cares? magazine, so that young people in care would know their rights whichever local authority they were in. Over the past 16 years, the Who Cares? Trust has clerked the All-Party Parliamentary Group for Looked-After Children and Care Leavers. That group brings 40 young people in care and care leavers into Parliament once every two months while the House is sitting. They come from all over the country and are different ages. The honourable Member Edward Timpson MP was our chair for a couple of years and the honourable Member Tim Loughton was our chair at another time. I would be interested to hear what it meant to them to have this contact with their service users. I think that it contributed to them being highly successful Ministers and I note that when Tim Loughton became a Minister he set up various panels of young people in care and leaving care to consult with regularly. As Minister of State, Edward Timpson has sustained those service user groups. Both Ministers took the trouble to visit the parliamentary group each year to present what the Government were doing and to hear the young people’s views.

Many noble Lords have commented on the importance of service user involvement to good policy, and I should add how therapeutic it can be for young people. Some 60% come from families who have experienced serious abuse and many will never have felt that their voices were heard before entering care. To come into Parliament or speak in a Children in Care Council meeting to senior members of the local authority are positive experiences. Of course, they need to feel that action is taken on concerns that they raise.

I point out a few pitfalls that can arise around user involvement. It is important not to assume that because we are listening to a service user we no longer need to listen to the professionals. I have a sense that in the past one would consult service users many times and hear their views without properly consulting the professionals—I refer to experienced practitioners who are still in practice and not too far from the front line—and taking their views about how hard it is to bring about changes that meet the requirements of service users. I emphasise that point.

With regard to young people and children, of course in law the Children Act 1989 makes it clear that it is our duty to listen to the wishes and feelings of children, but adults remain responsible for their interests. Just because a child or young person says they wish to do something does not necessarily mean that we should do it. There is a risk of policymakers sometimes assuming that because young people or perhaps other service users say something, it should be done. It needs to be put into context and we need to think about the professionals nearest to them and consult with them.

Such consultation needs to be properly facilitated. There needs to be a context. It can also be very useful for policymakers and those in high authority to build relationships over time with service users so that they can put into context that service user’s experience and deepen over time their understanding of that particular service user group’s need.

To return to the mental health of looked-after children and care leavers, we had a very important meeting of the parliamentary group last year, which the noble Baroness, Lady Tyler of Enfield, attended and made great use of in the recent Children and Social Work Bill in her successful campaign to push the Government a little further on addressing the mental health needs of looked-after children. We heard at that meeting from a young man who struggled for a long time to access mental health services while in care. Just at the point when he appeared to be gaining the help he needed, he turned 18 and was no longer able to access the help. Similarly, we heard from a care leaver in her early 20s and the mother of two children, about how frustrated she was that she could not access the long-term psychotherapy that she felt she needed to recover from early trauma and thus become a good mother to her children. We also heard about instances of best practice such as at the NHS Tavistock and Portman clinic which provides an all-through service for care leavers up to the age of 21. I look forward to the Minister’s comments on that.

While we need to hear the voices of service users, I would encourage noble Lords to consider how very important it is to listen to the professionals in this area such as social workers who work with children in care and those on the front line who have been around for a long time and therefore have a vast amount of experience to help inform policy. I end with the question I set out at the beginning of my speech but I will not repeat it. I look forward to the Minister’s response.