Health and Care Bill

Lord Shinkwin Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Lord Shinkwin (Con)]

My Lords, I congratulate the noble Lord, Lord Stevens of Birmingham, on his excellent maiden speech. I also applaud the work of John Baron in the other place, as my noble friend Lord Sandhurst and others have done, on focusing the Government’s attention in the Bill on cancer outcomes, and of my old chief executive, Professor Alex Markham, with whom I was privileged to work at Cancer Research UK.

It is an absolute pleasure to follow my noble friend Lord Ramsbotham, who does so much for those of us with communication needs, and I count myself among them. It is also appropriate because I am going to focus my remarks on how the Bill represents a golden opportunity to breathe life into building back better so that for children and young people with communication needs, and their families, it is more than just another soundbite.

Of course, I appreciate that that is also what my noble friend the Minister wants, because we all have a common interest in countering the post-pandemic scepticism about politicians’ ability to deliver. I suggest that the best way of doing that is to make the Bill a vehicle for hope: hope for the 62% of children with communication needs, whom the Royal College of Speech and Language Therapists found did not receive any speech and language therapy during the first lockdown; hope for their families; in short, hope that the future will be better, because the prospects of these children and young people will be improved by the Bill.

Just to be clear, I am not talking about hanging more expensive baubles on the Christmas tree. Rather, I am talking about making sure that all the lights on the tree actually light up—in other words, ensuring that everything works, that the Bill does what it says on the tin, and that the systems are truly integrated. The question is: what does that look like for children and young people with speech, language and communication needs who, sadly, despite constituting 10% of children overall, are still so far down the priority list?

First, the Government could build on the welcome precedent they set recently in the domestic abuse legislation in ensuring that guidance refers specifically to people with communication needs. Can the Minister ensure that the integrated care systems guidance regarding babies, children and young people includes specific reference to those with speech, language and communication needs?

My noble friend the Minister will know better than I that the long-term cost of not supporting children and young people with communication needs can far outweigh any short-term savings. For example, children with communication needs are at greater risk of mental health problems, unemployment and potential involvement in the criminal justice system if their needs are not identified and adequately met from an early age. So it is in everyone’s interest that integrated care systems give due regard to meeting their needs.

I would therefore value my noble friend’s reassurance that integrated care systems will not be allowed to consider children’s and young people’s communication needs as optional, given how this could exacerbate postcode lotteries, with all the longer-term false economies that I have already alluded to. Would my noble friend consider putting the guidance on to a statutory footing?

In conclusion, I ask my noble friend if he would be prepared to meet with me and the chief executives of I CAN and the Royal College of Speech and Language Therapists to consider how we can ensure that the Bill improves data and information sharing for children as well as adults and that, in the same vein, the barriers currently preventing local authorities and the NHS from planning and delivering services in a joined-up way for children with communication needs are removed?

Health and Care Bill

Lord Shinkwin Excerpts

Lords Hansard - Part 1 & Committee stage
Tuesday 18th January 2022 Lords Chamber

[Lord Shinkwin (Con)]

My Lords, it is a great pleasure to follow the right reverend Prelate the Bishop of Birmingham. I apologise to the Committee for not being able to be here at the start of the debate on this group, owing to a medical appointment.

I shall address my remarks to Amendments 141, 151 and 177. I do so because, like other noble Lords who have put their names to these amendments, and as I made clear at Second Reading, I believe that supporting speech, language and communication development and better outcomes for children and young people with speech, language and communication needs, which I shall refer to as communication needs for the remainder of my contribution, is incredibly important and a cost-effective investment.

I should at this point declare my interest as a proud vice-president of the Royal College of Speech and Language Therapists. I should also say that I have incorporated within my remarks those that would have been made by the right reverend Prelate the Bishop of Gloucester, who has a passionate interest in adequate support for people with communication needs as a former speech and language therapist.

My first point is that these amendments do not come with a significant price tag attached. Indeed, the price tag of not implementing what they propose would be considerably greater. These amendments would actually facilitate cost-efficiency because of the significant benefits over the medium to longer term of getting the system right at the outset—in other words, by ensuring that the system works to maximum effect when it matters most, as early as possible in children and young people’s lives.

We know that the impact of not supporting children and young people with communication needs in particular can be significant. For example, children and young people with long-term communication needs—10% of all children and young people—are at greater risk of worse educational attainment, mental health problems, unemployment and potential involvement in the criminal justice system if their needs are not identified and adequately supported. It seems common sense to require NHS England, as Amendment 141 proposes, to assess how well an integrated care board has identified and met children and young people’s needs in relation to the national accountability framework, which, of course, it has responsibility for publishing. It would help ensure transparent value for money—in other words, optimal bangs for bucks for the taxpayer. I have to ask: what’s not to like?

This amendment gives us the opportunity to ensure that children and young people are prioritised by decision-makers in the health system. Sadly, children and young people with communication needs are often even less of a priority. Indeed, this has been demonstrated by decisions taken during the pandemic, when speech and language therapy services to children were stopped and speech and language therapists were redeployed in many areas. As a result, according to a survey conducted by the Royal College of Speech and Language Therapists, 62% of children and young people received no speech and language therapy during the first lockdown. That is almost two-thirds whose life chances will have been adversely affected, and that will definitely come with a price tag attached over time.

It is therefore vital that integrated care boards are held to account to ensure that they give children and young people the priority they deserve, with a clear set of outcome metrics, including outcomes for children with communication needs. In fact, this would be in line with the Government’s very welcome acknowledgement—in a response to a Written Question tabled by the noble Lord, Lord Ramsbotham, in July 2019—that speech, language and communication skills are a primary indicator of a child’s well-being.

Surely it makes complete sense that this accountability should be grounded in a national accountability framework so that we actually see equitable support across England and thereby reduce the risk of babies, children and young people and their families facing a postcode lottery of access to services. I assume that all noble Lords would agree that the service they receive should be based on need rather than where they live. I would be very grateful if the Minister could tell me whether the national accountability framework will include metrics on outcomes for children and young people with communication needs.

Amendments 151 and 177 are in a similar vein and would, I believe, also bring considerable cost benefits. Amendment 151 would require an integrated care partnership to specifically consider the needs of babies, children and young people when developing its strategy. As with Amendment 141, to ensure that the Government’s very welcome ambitions for babies, children and young people, including those with communication needs, are achieved, it is essential that an integrated care partnership’s strategy specifically considers the needs of babies, children and young people so that they can achieve the best possible outcomes, not least in terms of life chances. This would help to develop a holistic, local approach to supporting babies, children and young people and their families, including, of course, those with communication needs.

It is also crucial that the strategy includes plans to support speech, language and communication development at the population level. This would help not only to deliver better health outcomes for children but to tackle health inequalities, an issue that I appreciate noble Lords have already addressed in considerable detail in Committee.

Finally, on Amendment 177, this proposed new clause would require the Secretary of State to lay regulations and publish guidance on how integrated care systems should meet the needs of babies, children and young people. This would also require integrated care systems to act in accordance with guidance. The key point here is that bespoke guidance for integrated care systems on meeting the needs of babies, children and young people must be on a statutory footing if we are to ensure that the strongest possible support is provided, including for those with communication needs and their families. I suggest that only then can we be confident that meeting their needs will not be considered optional and that a potential postcode lottery in access to services and support can be pre-empted and prevented.

Health and Care Bill

Lord Shinkwin Excerpts

Lords Hansard - Part 1 & Report stage
Thursday 3rd March 2022 Lords Chamber

[Lord Shinkwin (Con)]

My Lords, I too thank my noble friend the Minister for Amendments 36 and 157. I shall also speak in support of Amendment 59 in the name of the noble Baroness, Lady Hollins. Before I do so, I hope your Lordships’ House will allow me to take this opportunity to thank the healthcare professionals at Guy’s and St Thomas’s, who recently looked after me so well following major surgery. Some noble Lords may have noticed my absence. I have had half my leg rebuilt and am now the proud, if involuntary, owner of a Meccano set inserted by my excellent surgeon, Marcus Bankes, and his registrar, Christian Smith. I apologise in advance if any noble Lord seeks to intervene and I dare not sit down to take their intervention as I am not sure I would be able to get back up again.

Although the pain was excruciating and the morphine, which I am weaning myself off, very welcome, it saddens me to say that that pain was compounded by the way in which I received no support from your Lordships’ House. I might as well have been dead. It reminded me that this wonderful institution remains a place whose rules and modus operandi were designed by and for rich, non-disabled men. I will say no more on the matter now, but it is clear to me that this needs to change if we are to become a stronger, more diverse, more representative House. If we do not want to be consigned to the past, we must stop living in the past. The appalling way we treat Members whose disability enforces temporary absence from your Lordships’ House is indefensible and cannot continue.

Returning to the substance of the amendments under discussion, I am hugely grateful that the Government have listened to concerns I raised at Second Reading and others raised, in my absence, in Committee. All credit goes to noble Lords for the strength and the passion with which they did this, and to the Minister for so obviously listening and taking their concerns on board. Taken together, Amendments 36 and 157 should make a real difference to the lives of all babies, children and young people in this country, particularly those with speech, language and communication needs. I should declare at this point my interest as a vice-president of the Royal College of Speech and Language Therapists. I know the Minister and his colleagues across government, not just in the Department of Health and Social Care but also in the Department for Education and the Ministry of Justice, share my ambition and the ambition of other noble Lords in wanting children and young people with communication needs and their families to have the best possible level of support so they can realise their potential.

To help deliver that ambition, I ask my noble friend to reflect on four things. First, I would be so grateful if he would look kindly on Amendment 59, so ably spoken to by the noble Baroness, Lady Hollins. This would help to close any potential accountability gap and considerably strengthen the provisions of Amendment 36.

Secondly, will the Minister pledge to ensure that all the guidance to the Bill specifically references children’s speech, language and communication needs? The statutory guidance and accountability lead for SEND is a very positive development, but it is not sufficient. The vast majority of children with communication needs do not have an education, health and care plan. This includes children with developmental language disorder—over 7% of all children—those who stammer, and those with speech-sound disorders. The guidance must, therefore, ensure that the needs of those children are supported. A model that the Government have already established for this is the statutory guidance to the Domestic Abuse Act, where speech, language and communication are listed as a specific intersectionality.

Thirdly, will the Minister agree to meet the chief executive of the Royal College of Speech and Language Therapists to discuss how the guidance on the Bill can best capture those issues? Fourthly, on Amendment 157, can the Minister reassure the House that the report will include commitments to act to improve information-sharing? Finally, may I reiterate my huge thanks to my noble friend the Minister, and say how pleased I am to be able to do so in person, in your Lordships’ House? It is good to be back.

[Baroness McIntosh of Pickering (Con)]

My Lords, I welcome my noble friend back and commend him for his bravery. We came into the House at the same time, and he is a source of constant inspiration to us all; I have endless admiration for him. I apologise to the House for having omitted to declare my interests when I spoke for the first time on Report on Tuesday. I refer to my entry in the register of interests, and in particular to the fact that I work with the board of the Dispensing Doctors’ Association. I am also a patron of the National Association of Child Contact Centres and a co-chair of the All-Party Group on Child Contact Centres and Services.

I again commend my noble friend the Minister for summing up and assessing the mood of the House and tabling the amendments today; I am grateful to him for that. I also support the noble Baroness, Lady Hollins, and her Amendment 59, which is very appropriate. I hope my noble friend will look favourably on it, and I pay tribute to the work of the noble Baroness. One of her remarks earlier on Report which struck a chord with me was about the shortage of psychiatrists and other mental health professionals, particularly for those in the age group affected by these amendments.

I endorse and support the amendments in the name of my noble friend Lord Farmer. He refers in particular to the family hubs, and I make a plea to the Minister to recognise, as part of a family hub, a child contact centre. Centres are usually manned by volunteers, and they do fantastic work—not necessarily in keeping families together, because, unfortunately, their role largely comes into play when families have broken, but they play a fantastic role in maintaining contact with the absent parent.

Obviously, in these constrained times, the budgets of all organisations come under increasing scrutiny and pressure, so I urge the Minister to use his good offices to speak to those in the Ministry of Justice and the Department for Education to ensure that the budget for child contact centres will be renewed not only for two years but for three years—the period promised earlier. Those centres do fantastic work, under great constraint, and I am proud to be associated with them. I wanted to use this opportunity to support the amendments and to urge my noble friend the Minister to use his good offices in this regard.

Health and Care Bill

Lord Shinkwin Excerpts

Lords Hansard _ Part 1 & Report stage
Wednesday 16th March 2022 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, I think the mood of the House is that the Front Benches—

[Lord Shinkwin (Con)]

My Lords, may I just be indulged by the House in following the excellent speech by my noble friend Lady Grey-Thompson? Exactly seven weeks ago, not just to the day but to the exact hour, I started to feel very ill. I was barely 36 hours out of the operating theatre after surgery that had gone incredibly well and I knew something was seriously wrong. By midnight I was in agony, my bowels totally blocked by the combined effects of the anaesthesia and the pain relief. By the morning, I was passing blood and my haemoglobin levels had plummeted. That was just seven weeks ago. It was at that point that a decision was made to transfer me by ambulance to St Thomas’ A&E so that I could have an urgent blood transfusion. I lived to tell the tale, but tell it I would much rather not have done. I would much rather forget the whole episode—the unbelievable pain, the helplessness and the acute sense of vulnerability. My family do not know any of this; I have not told them. I am hoping they do not read Hansard.

I share it with your Lordships’ House because I believe that my recent experience is directly relevant to Amendment 170. We have been assured that this is not about the merits of assisted dying, but noble Lords should not underestimate the magnitude of what is at stake in this amendment. This is not the start of some cosy conversation about a harmless, anodyne measure. The end goal is assisted suicide and the means is a Bill proposed in this amendment. If this amendment were passed tonight, I firmly believe that in years to come, we would look back and say that today—16 March 2022—was a pivotal moment.