Health and Social Care Bill

Lord Northbourne Excerpts

Wednesday 16th November 2011 Lords Chamber

[Lord Greaves]

The noble Lord raised the question of funding. Does he agree that this will perhaps be exacerbated in two-tier areas because the ring-fenced public health funding will go to the top-tier authorities, whereas the environmental health functions will remain with the lower-tier authorities—which indeed are extremely squeezed on their funding because this is what we call “other services”, which are not regarded as a priority—and finding a way of getting some of that funding down to the lower-tier environmental health authorities is a question that needs to be looked at?

[Lord Northbourne]

My Lords, perhaps I may intervene now to ask the Minister to say, when he is winding up, what happens if the local authority does not do what it is supposed to do? It is not impossible. In fact, there is a great variety, as we sit here today, in the performance of local authorities. They are managed by elected members, who want to please their electorates, so there are all sorts of arguments for thinking that not every local authority is going to be very enthusiastic about these additional objectives.

[Lord Whitty]

My Lords, I will leave that question for the Minister, because it clearly raises wider issues. I totally agree with the noble Lord, Lord Greaves, that one of the most acute effects of all this will be at the district level, where the funds are less protected, and where there is already some difficulty and some serious variability in performance and resourcing.

Given the Government’s support for the establishment of a chief environmental health officer at the centre to help co-ordinate all these issues and—if you like—to punch the weight of environmental health in the other range of priorities which the Department of Health has to pursue, I would ask the Minister this. Will the assessment of public health and the ongoing process she described in trying to defend the Bill from not spelling this out in great detail, lists or no lists, be available to us before we complete the consideration of this Bill, the exact timescale of which looks ever lengthier? Nevertheless, before we reach final conclusions on this, we need to have greater clarity on the direction in which the Government are going on public health, and, I would argue, on environmental health in particular.

I shall mention one other issue that relates to this. The abolition of the HPA also has significant implications in this area. I intend to come back to this at a later stage, but some of the functions of what are currently statutory authorities are going to go to Public Health England, as I understand it, and there is some confusion there as to how that will be carried out, what authority those roles will have and what their local manifestations will be. Under the new structure we will have health protection units around the country. So that is just one more complication here. By Report we ought to have some greater clarity in the strategy of the Government. I ask the Minister to give us an indication of that.

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Moved by

[Lord Northbourne]

68AA: Clause 9, page 5, line 13, after first “the” insert “physical and mental”

[Lord Northbourne]

My Lords, since I set down these amendments a good deal of water has passed under the bridge. Fortunately, that will enable me to be briefer than I otherwise would have been. The first and most important thing that happened was the excellent debate on Amendment 11 in the name of the noble Baroness, Lady Hollins. I do not wish to reopen that debate this evening but I want to draw attention to two rather more fundamental matters in addition to what was mentioned in that debate.

The main one is what we mean by health. Do we believe, and do the Government believe, that health means simply freedom from illness or disability, physical or mental? Or do we believe that health can and should mean more than that? I dare say the noble Lord, Lord Layard, if he were in his place—he certainly spoke on Amendment 11—might have supported me in suggesting that health relates both to physical and mental well-being and that we should be doing much more to promote mental well-being, a subject on which the noble Lord, Lord Layard, has written an excellent book. I quote in this context the Childcare Act 2006, which defines well-being on page 1:

“In this Act ‘well-being’, in relation to children, means their well-being so far as relating to—

(a) physical and mental health and emotional well-being;”—

emotional well-being is an important one—

“(b) protection from harm and neglect;

(c) education, training and recreation;

(d) the contribution made by them to society;

(e) social and economic well-being”.

The important thing is physical, mental and emotional health and also such things as self-confidence and self-esteem. I should like to ask the Government to define what they mean by “health” in the Bill. I should also like to ask the Government to place more emphasis in this Bill on prevention—on services and policies to prevent a lack of health rather than focusing mainly, as the Bill does at the moment, on trying to repair the damage when things have gone wrong.

I am not sure whether technically I should withdraw those two amendments or whether I should do so at the end. I will now go on to Amendments 71ZAA, 72A and 97ZA. These amendments are intended to probe the Government’s intentions on two further issues which I consider to be very important. The first is my concern about whether the Bill will effectively and adequately address the health needs of children. That concern is also raised by the noble Lord, Lord Ramsbotham, who unfortunately is not in his place, in an amendment which I support, Will it provide the services that children need? In that context, why does the Long Title of the Bill specifically refers to “adult social care services” but makes no mention of children’s care services?

My second concern relates to the role of parents in securing the physical and mental health of their children. I doubt whether this Bill shows enough concern for the role of parents, especially in the very early years, in promoting good mental and physical health for their children. The Bill’s emphasis seems to be more on clinical interventions to treat ill-health rather than on preventing it in the first place. Only last week, the NSPCC published new research showing that more than 20 per cent of babies born today have mothers who are either dependent on drugs or alcohol or who are subject to domestic violence. How will the Bill address that problem? Too many mothers and fathers today cannot give their children the care and education they need because they themselves have never experienced a happy, supportive home life. Today, we as a society have done very little to help those parents to help their children. How will the Bill help in that situation?

Recent research shows that the majority of a child’s brain development takes place in the last months of pregnancy and in the first two years after birth. This is the time when nearly all children spend most of their time in the care of a parent. Children are learning from their environment every hour of every day. The lessons they learn are often hard to dislodge. What they learn in those years is crucially important if they are going to progress smoothly and confidently into nursery school, reception class, primary and secondary school and on to a healthy adult life. Yet, as far as I can see, the Bill makes little or no mention of the preparation of parents for their important role in developing the physical, mental and emotional health of their child. Parental responsibility in that context ought to be deeply embedded in the Bill because healthy children grow up to be healthy adults who themselves are more likely to have healthy families. Research shows that, from the financial point of view, early intervention is extremely cost-effective. In the context of the Bill, what is the Government’s policy on preventing ill health? On that note, I should like to withdraw the amendment.

[The Deputy Chairman of Committees (Lord Brougham and Vaux)]

The noble Lord cannot withdraw the amendment until he has moved it. The Question is whether Amendment 68AA shall be agreed to.

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[Lord Northbourne]

I beg the Committee’s pardon. I was trying to withdraw the amendment before having moved it. I beg to move.

[Baroness Williams of Crosby]

My Lords, I am not quite sure whether the amendment is before us or not, but I shall make a brief assumption that it is and then I will allow the noble Lord to decide whether to sustain or withdraw it.

As we all know, the noble Lord has made a very distinguished contribution to the whole issue of the status and well-being of children and it is fair that we should recognise that. In particular, he has gone to a great effort to underpin the importance of early education and such things as the Sure Start programme. I want to add two points. The first is that, as a former Secretary of State for education, I remember working very hard to try to persuade my colleagues in the educational world that there should be an emphasis on education in parenting.

It is perfectly true that the early stages of a child’s life are vital, but as the noble Lord, Lord Northbourne, has pointed out, research shows that the link between what a child becomes and its parental inheritance is very close indeed. One of the more disturbing pieces of recent research shows the close link between an abused child and an abuser. Many young people who are abusive parents are in fact the children of abusive parents. Tragically, this dreadful tradition can move on from generation to generation. I simply want to make the point that it is not just a case of Sure Start for the child, it is also a case of proper education and training for the parents.

I have often felt that we should try to link sex education with parental education to bring out above all the extraordinary responsibility that a human child is because it takes so long to grow up compared with the young of most other species. A human child is dependent for many years, and I believe that we should put more emphasis on that than we do. However, it is not fair to make the Department of Health the sole responsible power for addressing this difficult subject. It requires a degree of working between departments, including education and other departments. I simply want to put on the record before the Minister replies the importance of securing co-operation between the Department of Health and the Department for Education, and for that matter social care on this particular set of issues.

My last point is quite straightforward. One of the aspects of training children in parenthood is to allow them to see what it is like to care for a young child. Some teenagers at school will not necessarily have younger siblings. Long ago when I was the prisons Minister—I should have talked about this when the noble Lord, Lord Ramsbotham, was in his place—I introduced a group of offenders, all young boys, to the task of helping in the care and support of children with Down’s syndrome. That relationship had an amazing effect on both parties. The young offenders suddenly realised that they were responsible for someone much younger than themselves who was dependent on them, while the Down’s syndrome children suddenly had older brothers who were devoted to them and to whom they could address their huge capacity for affection. There is a lot of room for bringing young people together with children and teaching them something more than we know now about what it is to be a parent and the huge responsibilities involved in that role.

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[Lord Northbourne]

I am most grateful to the noble Earl for giving so many excellent assurances on the questions that I asked him. I apologise profoundly to the noble Baroness, Lady Williams, for nearly cutting her out of the debate. For some reason I was confused about the procedures. I beg leave to withdraw the amendment.

Amendment 68AA withdrawn.

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[Lord MacKenzie of Culkein]

I have put my name to Amendment 202 which deals with general practitioners. I do not intend to detain the Committee because the points I was going to make have already been eloquently made by the noble Baroness, Lady Finlay of Llandaff, and others. I want to reiterate the point about general practitioners not identifying alcohol misuse. For the life of me, I cannot understand why there is no quality assessment framework indicator for screening for alcohol and why that is not part of the programme. There is evidence that screening works, as the noble Lord, Lord Brooke of Alverthorpe, said. It is clinically cost-effective. There is an urgent need to prioritise the issue of alcohol abuse, and this amendment gives us that opportunity. I hope that the Minister will be able to say something positive about that this evening.

[Lord Northbourne]

I rise to support the amendment moved by the noble Baroness, Lady Finlay. One thing that has so far not been mentioned is that it is important to think about the alternatives to alcohol and to regular alcohol use. I used to spend a certain amount of time with very disadvantaged young people, and a great deal of their problem was boredom, inferiority complexes and no belief that there was any real future for them, so let us also think about all sorts of other things that they might be doing.

[Lord Rea]

My Lords, as a former GP, I echo the words of my noble friend Lord MacKenzie. Screening for alcoholism should be added to the QAF measures in view of all the reasons that have been eloquently adumbrated by other people. I want to raise a fairly basic problem which is the cost of alcohol services. At the moment, a lot of these are funded as outreach programmes by PCTs, and those are going to be transferred to local authorities. They will have to be paid for out of the index-linked £4 billion-odd that is going to be given to local authorities for this purpose. Perhaps the Minister could say whether the actual cost of running these alcohol services is being taken into account when considering how that £4 billion is going to be calculated. There are also plenty of other services being transferred to local authorities.