Children and Families Bill

Baroness Benjamin Excerpts

Wednesday 29th January 2014 Lords Chamber

[Baroness Masham of Ilton (CB)]

My Lords, I shall be brief. I congratulate the Government on having listened about packaging of tobacco. I also support the amendments to protect children from people smoking in vehicles. Apart from damaging children’s health, smoke gets in their eyes and is very unpleasant. There are also small babies and pregnant mothers whose unborn children need protecting. I hope that the noble Earl can give the House some assurance that there will be regulations that will protect these vulnerable babies and children. I would add that people with asthma, and all chest problems, should also be protected because this is really dangerous for their health.

[Baroness Benjamin (LD)]

My Lords, I ask noble Lords to consider the following points as we debate these amendments. More than 800 children visit their doctors every day due to the serious effect of second-hand smoke exposure, according to research published by the Royal College of Physicians. The survey also highlights that 65% of parents who smoke admit to doing so in the car with their children and other people’s children present, and that 75% of smoking parents were shocked to hear that second-hand smoke affects the health of so many children. If they had not been asked that question they would not have been aware of this, so they really need to be educated.

Asthma UK has stated quite clearly that second-hand smoke is a major trigger for asthma attacks, making the symptoms even worse. It believes that if we take action to reduce second-hand smoke, we will be a step closer to a world where asthma begins to be no longer a daily struggle, or where no one dies from that condition. The children’s charity Sparks—I declare an interest as one of its trustees—spends millions of pounds on research to eradicate asthma among children, a condition which is growing daily. Sparks dearly believes that if we take action to protect children from second-hand smoke, that will be helpful to children. So let us give careful consideration to what action we should take to protect children from the result of second-hand smoking and act robustly in the best interests of the child.

[Baroness Howe of Idlicote (CB)]

My Lords, I very much support the aims behind Amendment 62, and indeed an awful lot of what the noble Lord, Lord Hunt, said about doing something really firm to prevent smoking in cars when children are present. This amendment certainly seems a sensible and straightforward way to ensure that all children have a healthy start in life, without the harmful influence of tobacco smoke in their young and still developing bodies.

We have heard that opponents of the proposed ban on smoking in cars have argued that legislation on activity in private vehicles would constitute an invasion of people’s private space. The noble Earl, Lord Howe, even said in Committee on this amendment that although smoke-free public spaces legislation has proven to be extremely successful in reducing people’s exposure to second-hand smoke,

“it does not automatically follow from that that it is right to extend the scope of legislation to cover private cars”.—[Official Report, 20/11/13; col. GC 412.]

However, in the case of child protection, this may not be such a stretch of the imagination. My noble friend Lady Howarth absolutely spelt out that the issue of child protection is a perfect example of this distinction playing a secondary consideration to the well-being and health of the child. Children are protected by the law from abuse and neglect wherever they are.

I have heard about the impact that tobacco smoke has on the health of children. We have all heard about it. Their bodies are still developing and they are much more likely to be affected by smoke-related illnesses than their adult counterparts. A Royal College of Physicians report estimated that smoking around children causes more than 20,000 cases of lower respiratory tract infection; 120,00 cases of middle-ear disease; at least 22,000 new cases of wheeze and asthma; 200 cases of bacterial meningitis; and 40 sudden infant deaths—one in five of all SIDs.

We know that only a proportion of people continue to smoke around children, so the level of illness in children due to second-hand smoke is staggering. It would be difficult to impose such a law on the home—we have heard this already—but we can do something about children's exposure to smoke in cars. We also know that tobacco smoke pollution levels in vehicles can be 23 times greater than in a house. I am talking, of course, about a car with a roof on it. Moreover, when a child is strapped into the car, they do not have a choice about leaving the room—a choice possible, at least for some children, in their home—when adults are smoking.

More needs to be done to protect children from avoidable harm, whether this harm takes place in private vehicles or in public spaces. Moreover, there is also a precedent for banning smoking in vehicles. Cars are already recognised as potentially dangerous spaces for second-hand smoke exposure due to their confined spaces. This is why smoking has already been banned in all vehicles used for the purpose of work in the UK since July 2007. It is surely astounding that we cannot do something effective to protect children as well. There are no restrictions on smoking in private vehicles with children present. I believe fully that this needs to change.

Health and Social Care Bill

Baroness Benjamin Excerpts

Monday 19th December 2011 Lords Chamber

[Baroness Cumberlege]

My Lords, I address my remarks to Amendment 330ZAB and others that concern the composition of the health and well-being boards, and I would like to say a word in general about the boards.

To me, they are a spark of inspiration. In the next grouping we will have some specific amendments from noble Lords concerning integration, and we have heard a bit about it already today. I have been conscious that throughout the Committee debates the virtues of integration have often been referred to by my noble friend Lord Howe, and part of the integration he has cited is that very valuable tool, the health and well-being board, bringing together social services, health, and importantly, local healthwatch.

The Bill is gratifyingly lean in its suggested membership of the board: just six essential members. However, in Clause 191(2)(g) it gives flexibility in allowing the board to appoint:

“(g) such other persons, or representatives of such other persons, as the local authority thinks appropriate”.

However, in the same clause, 191(9), it must consult with the members of the board. That seems absolutely right and proper. The success of these boards will be in their balance. That is very important, and what we cannot afford is a single constituency trying to pack the board with its own colleagues. The board itself can put a brake on that, and keep the balance right.

The board itself can appoint additional members, and I can see that being invaluable if the board has chosen a subject which it wishes to target, such as obesity, as mentioned by my noble friend Lady Jolly. Poor housing was also mentioned, as well as alcohol, sexual health, prisons, probation, or children. There is nothing to stop the board giving the individual a short tenure, if the board so wishes. However, if we concede to all these additional, very persuasive arguments that are being put for adding more and more members—I had a quick count of all the amendments on the Marshalled List—we would have statutory boards in the order of 24 members. That is a nightmare for quick decision-making.

I chaired a joint finance committee years and years ago, when we were trying to do the same thing, and we had a board of that size. It became a talking shop. No one would take the decisions that were really necessary. With great respect to local government, where I spent 20 years, we do not want another committee of the council. These boards have to be different.

I said I thought the concept was a spark of inspiration, but I can see this spark extinguished very quickly if we end up with big, unwieldy, cumbersome talking shops. The health and well-being boards should be composed of the great innovators; people with unusual and challenging ideas; people who are prepared to think the unthinkable; imaginative people, fleet of foot, trying new ideas, and abandoning them if they do not work out. Above all, they should be the risk takers.

We know that innovation seldom comes from large, cumbersome committees. It very often comes from young people sparking off ideas. These are people who are probably quite difficult to work with. The Steve Jobs, the Bill Gates, the James Dysons of this world, determined to get their ideas from the drawing board into our homes, changing our lives for the better. They are the people who are not afraid of disruptive innovation.

The NHS thirsts for innovation, but it cannot face the disruption. One of the examples of successful disruptive innovation that I came across is Hairdressers for Health. In a very impoverished area south of Manchester, where you heard the crunch of broken glass under your feet when you walked, where graffiti was everywhere, where the school was protected by razor wire, the hairdressing salon was one oasis of peace and sanity. A junior director of public health, who was very anxious to increase the uptake of cervical screening, recruited the hairdressers to ask their clients—people will know that hairdressers always refer to their customers as clients—whether they had had a cervical screen and, if not, to give them the reason why they ought to go and have one. The hairdressers were given a book of difficult questions that they could answer and a phone number if they got stuck. The results were really impressive. When I asked the women why they went for cervical screening, they would say, “Tracy does my hair. She does it beautifully and I really trust Tracy”.

There are a million reasons why you should not go down that road. If you had a big, cumbersome committee, I can just hear the remarks, “The hairdressers aren’t up to it. The hairdressers really won’t have the information. The clients won’t believe the hairdressers”. No, here was a courageous young director of public health, not working through a huge board, thinking really laterally and doing something terrific. That is what we want from these health and well-being boards. We do not want large committees full of worthies shirking innovation because it is just too risky. Of course, there are always a million reasons why you should not do something. What started as an inspiration is quickly reduced to the boring status quo because that is safe. It takes an awful long time to get back to the boring, safe status quo.

When people decide for themselves, they are more likely to be successful. I applaud the flexibility of the Bill. I see merit in every case that is being put today. The case is being put extremely persuasively, but I urge your Lordships to resist the temptation to tie the hands and stamp on the autonomy of the new boards. We need them to be a success. I am working at the moment with some that are in shadow form. The good will that is in those boards is terrific. We should be enhancing and cherishing that and not directing exactly how they should work. If we do that, I regret that we will simply have just another committee of the council.

[Baroness Benjamin]

My Lords, childhood lasts a lifetime. Whatever happens to people during childhood, they will take with them long into adulthood. Sadly, many children’s early lives are broken by the relentless mental and physical suffering that they go through daily. Even children who suffer from lesser known conditions such as sickle cell, which is not widely recognised by teachers or schools, are made to feel inadequate and lose their confidence. We need to put in place a holistic provision of care for those children, for their voices to be heard and for them to know that society cares about their well-being. That will give them hope for the future.

As we have heard from noble Lords across the House, we need joined-up policies for everyone to work together. I hope that my noble friend the Minister will show compassion and understanding when he considers these amendments, which I believe put children first and show that we are a nation that cares about our children, our future.

NHS: Standards of Care and Commissioning

Baroness Benjamin Excerpts

Thursday 31st March 2011 Lords Chamber

[Baroness Benjamin]

My Lords, I thank the noble Lord for securing this debate. Sadly, his opening remarks reflect the treatment that my late 80 year-old father received during his last months, which were spent in hospital.

This debate gives me an opportunity to highlight the concerns of those with sickle cell disorder as well as of those working with and for patients with the disorder. I am a patron of the Sickle Cell Society, so I declare an interest. The Sickle Cell Society has a panel of expert medical advisers as well as a board that includes those who suffer from sickle cell disorder. Over the past 30 years, the charity has worked with the NHS and primary care trusts to produce best practice guidance on treatment and care based on clinical research and the experience of those with sickle cell disorder.

Sickle cell is the most common genetic blood disorder in the UK and some 300 babies are born with sickle cell each year. Yet children and adults are needlessly dying from this illness. The two most recent deaths were in the past four months—one as young as four years old. The deaths are due to poor access to services, poor care, poor treatment and generally poor awareness of the disorder. The National Confidential Inquiry into Patient Outcome and Death shows that of the 19 patients it studied who complained of pain on admission to hospital and who died in hospital, nine had been given excessive doses of medication, leading to death from the complications that resulted.

I believe that with the right policies in place and an understanding of best practice standards, treatment and medication, the quality of life for sickle cell patients can be dramatically improved. Will the Minister consider a medical and social awareness campaign, backed up by syllabus changes to medic training at royal colleges? Will he also consider commissioning services to improve the detection and chronic disease management of patients with sickle cell? I am convinced that if these measures were in place, it would save the NHS millions of pounds, prevent many deaths as a result of hospital overmedication and reduce children being absent from school, which produces poor educational performance that in the long term leads to economic disadvantage and benefits claims.

I believe that the doctor-patient relationship is a two-way dynamic. Some changes to the current system are required in terms of GP education, follow-up, and long-term involvement with the management of sickle cell disorder. Patients and healthcare providers should work together in the proactive management of sickle cell disorder, rather than dealing with crises on an unplanned basis as and when they arise.

The current financial state of the NHS and the recent spending review have increased the nervousness of sufferers. Therefore, there need to be reassurances about the funding of provision for sickle cell. Some believe that the abolition of health targets will have a negative impact and that services will not provide fairness and equality of access to healthcare services for all. Therefore, there needs to be NHS specialised services commissioning for those with sickle cell disorder, with provision for practical home-care support, especially home-from-hospital convalescent support to avoid readmission, the training and deployment of a pool of community support care workers, information and counselling to every patient and carrier in every locality, and the monitoring of performance against agreed outcome measures. I believe that the Sickle Cell Society is well placed to assist the Government in achieving these measures.

Sickle cell disorder should be of great concern to society. It needs our full attention because as more and more children are born to parents from different ethnic groups and we become more and more integrated, so the more common sickle cell disorder will become. Sickle cell disorder is now the fourth global public health priority, as declared by UNESCO and the World Health Organisation in Geneva in May 2006. Please let us accord it the priority and respect it deserves.

Health: Sickle-Cell Disease

Baroness Benjamin Excerpts

Monday 14th March 2011 Lords Chamber

Asked By

[Baroness Benjamin]

To ask Her Majesty’s Government what measures are in place to ensure that paramedics and ambulance crews across the country are adequately trained in the diagnosis and treatment of those with sickle-cell disease.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, addressing the training needs of health professionals working with patients with sickle-cell disease is the responsibility of the appropriate regulatory body. They set standards for the preregistration training, approve the education institutions that provide training and determine the curricula. Where a health profession is not regulated, it is the duty of the employer to make sure that the individual has the appropriate level of training to perform the duties required of them.

[Baroness Benjamin]

I thank my noble friend for that Answer. I am sure he is aware that sickle-cell disease is now the fastest growing genetic blood disorder in England. Some 300 babies are born with the condition every year and yet there are many misunderstandings about diagnosing a sickle-cell crisis. Is my noble friend aware of the recent tragic death of a young girl who died of a sickle-cell crisis? Apparently, during the crisis, she had soiled herself and, allegedly, the emergency crew who came to her home refused to treat her and to take her to hospital because of the messy state in which they found her. Does my noble friend agree with me that this underlines the urgent need for training, not just for paramedics but for all emergency crews, so that that never happens again? Will he assure the House that best practice standards and guidelines with regard to sickle-cell disease are enforced right across the NHS? I declare an interest as a patron of the Sickle Cell Society.

[Earl Howe]

My Lords, I am aware of the tragic case to which my noble friend refers, which is of course the subject of an investigation at the moment. The facts, as I am aware of them, suggest that the failings that occurred in that case were more to do with poor practice than a lack of training, although we will see what emerges from the inquiry. However, I can tell her that there is national guidance on the symptoms and emergency treatment of people with sickle-cell disease, published by the Joint Royal Colleges Ambulance Liaison Committee. All ambulance crew staff receive training in the assessment and management of patients with sickle-cell conditions in line with those guidelines and further national guidance was issued to staff in 2009. It is regularly updated and it is taken very seriously.