Smoking

Baroness Howarth of Breckland Excerpts

Thursday 8th September 2011 Lords Chamber

[Earl Howe]

The noble Baroness makes a very good point. Currently, enforcement in the hands of the police centres mainly on dangerous driving. That may take the form of people illegally using mobile phones while driving or perhaps smoking in a dangerous way. However, I take her point that there is a limit on the extent to which the police can be expected to extend their remit. There is also a sensitivity in this area. The idea of police stopping a car in which somebody in the front seat is smoking on suspicion that there might be a child inside may stray over the boundary of what society would consider an acceptable use of police time.

[Baroness Howarth of Breckland]

My Lords, I know that the Minister is very concerned about the effects on children. Could he remind me of the timetable to remove displays from tobacconists’ stores so that children do not see them and are not encouraged to smoke, because that legislation can already be put in place and carried through?

[Earl Howe]

The noble Baroness is right. We believe that the Government’s commitment around the introduction of tobacco display legislation strikes the right balance. We have amended the implementation dates. Displays will come to an end in large shops on 6 April next year, and in small shops on 6 April 2015.

Health: Hospital-acquired Infection

Baroness Howarth of Breckland Excerpts

Tuesday 7th June 2011 Lords Chamber

[Earl Howe]

My Lords, yes, and that is now a requirement on all NHS trusts.

[Baroness Howarth of Breckland]

Does the Minister agree that the length of stay that a patient has increases the risk, particularly among elderly patients? Can he tell me how many elderly patients are now staying in hospital for greater lengths of time because they are not being discharged into appropriate local authority provision?

[Earl Howe]

The noble Baroness is quite right that delayed discharge poses a risk, not only in terms of infection but in terms of mobility and other issues that affect the elderly. We are clear that if this problem is to be eased, further funding is required at local authority level, which is why we have made available up to £1 billion over the period of the spending review to ensure that the issue is addressed.

Mental Health

Baroness Howarth of Breckland Excerpts

Wednesday 10th November 2010 Lords Chamber

[Earl Howe]

My Lords, many GPs understand the issues very well and are keen to get on with the agenda. Our proposed model of GP commissioning means that practices will have flexibility within the new legislative framework to form consortia in ways designed to secure the best healthcare and outcomes for their patients. That will include mental health and could involve, for example, taking commissioning decisions collectively with perhaps a lead consortium for mental health.

[Baroness Howarth of Breckland]

My Lords, I know that the number of young people being detained in adult mental health hospitals is decreasing steadily, but can the Minister tell us, first, how many remain, and secondly, what policy will be set out in the framework for seriously disturbed young people who will be contained within the community?

[Earl Howe]

My Lords, the noble Baroness is right to say that there is legislative provision to ensure age-appropriate accommodation for young people in particular suffering from mental health difficulties. A range of products has been produced by the National Mental Health Development Unit to assist hospitals to meet the legal requirement to provide that age-appropriate setting. It does not mean, of course, that no under 18 year-olds may be treated on adult psychiatric wards as there are circumstances where that is appropriate. But my understanding is that this legislation is being observed and is making a difference.

Health: Cancer

Baroness Howarth of Breckland Excerpts

Monday 21st June 2010 Lords Chamber

[Earl Howe]

I am very grateful to my noble friend. It may help the House if I briefly explain what PDT is. It is a technique that uses laser or other light sources combined with a light-sensitive drug, which in combination destroy cancer cells. When the light is directed in the area of the cancer, the drug is activated. As my noble friend indicated, although this is an invasive procedure, it is minimally so; and its advantage is that, unlike radiotherapy, no cumulative toxicity is involved, so someone can be treated with PDT repeatedly. However, there are difficulties, one of which is that there is no obvious clinical leadership in this field, and that has to be addressed. There need to be centres of excellence in order for the right lessons to be learnt and the right research to be done.

[Baroness Howarth of Breckland]

My Lords, there is no doubt that, once patients are at the hospital, they are likely to get the treatment, but can the Minister assure us that GPs will be encouraged to make speedy referrals? In the cases that I know of, the difficulty has been in getting from the GP to the centre of excellence in order to get the treatment.

[Earl Howe]

The noble Baroness is quite right, which is why in the NHS there is such an emphasis on speed of referral when a GP first suspects that cancer may be present in a patient. This is an area to which we are very alive, and I hope that we will be able to make further announcements about it in due course.

Queen's Speech

Baroness Howarth of Breckland Excerpts

Thursday 3rd June 2010 Lords Chamber

[Baroness Howarth of Breckland]

My Lords, it is an absolute delight to see the noble Earl, Lord Howe, across the Chamber on the Front Bench. He and I have exchanged views for many years. Sometimes we have disagreed but he has always replied with grace. I also look forward to getting to know the new Minister. I hope he does half as well as the noble Earl; he will then do pretty well indeed.

It is in times of economic constraint that the services to the most vulnerable get lost. It is the most in need—the least vocal—who are diminished. I am sure that this Government will not want to lose sight of those who require our care. Recognising their commitment during the election, in the manifestos and in their speeches, I am particularly grateful for the concern already expressed. Before I move on, I specifically mention the ending of detention of children for immigration purposes. After many years’ service in social care, I recognise that this is a complex issue, particularly since children must not be separated, as the right reverend Prelate said, from their families. The previous Government did much to end this practice. We now look to this Government to complete the task.

Unlike my noble friend Lord Sutherland, I welcome the commission to consider a sustainable long-term structure for the operation of social care. As chair of Livability, a charity providing services for severely disabled adults and young people, I recognise the challenge of delivering excellent opportunities to give individuals maximum choice and freedom with the balancing of cost. I hope the Minister will reassure me that looking for value will not lead to the lowest level of care and quality. People who need our services deserve the best that we can give. That is why the commission is so important in taking a broader look at all those in the social care system. I also hope that during this review the Government will look at simplifying some of the structures that we now have. The uncertainty and additional bureaucracy associated with assessment and care support planning under the personal budget programme—which has led to an industry of people set up to manage people’s individual budgets, taking a top slice—is just one example of added complexity.

Linking this commitment to improving public health and reducing health inequalities, I expect the Government to see the close link between health input through hospitals and medical facilities and practitioners, and the community care provided by those in social care in local authorities and voluntary organisations. For example, Little Hearts Matter is a small charity dealing with children who experience the most severe surgical interventions in heart conditions. I pay tribute to those specialist doctors who have given these children a life through brilliant intervention techniques. However, the children will spend most of their lives in the community, not in hospital, needing support services and follow-up care. I anticipate that the Government will see these interventions on a continuum, rather than as incidents, and support the whole, including the part played by the voluntary sector.

As noble Lords would expect, I now want to focus on children and children’s care services. I am not speaking of education, important though I see it is, because many of your Lordships here will do so. However, I say to the Minister that without emotional stability and family support, children will fail to learn. Again, the two are interrelated. The previous Government said, “Education, education, education”, and I said to them often on the Floor of this House, “Welfare, welfare, welfare, if children are to learn”. As yet there seems to be no clear decision about the long-term plans for children’s local authority services—children’s trusts—but stabilising them is absolutely vital. They are working in a time of unprecedented pressure. Social workers need to know that they are as valued as teachers, nurses, economists and the rest. I did not hear mention of them in the introductory list of the noble Lord, Lord Hill, but perhaps he would like to learn more about their work. I would be delighted to inform him. Why is that? It is because we entrust them with the safeguarding of our children. We leave them with the most difficult decisions. They are damned if they remove children, damned if they don’t and damned to hell if they get things wrong.

Is it any wonder that there is a shortage of these committed individuals? The tragedy of Baby Peter and the media treatment have overwhelmed the service. The workforce is demoralised and service provision is at its tightest. In the Children and Family Court Advisory and Support Service, where I chair the board, the numbers of referrals are higher than at any time in the life of the service, and we are a barometer of what is happening outside in the community. Despite this our unallocated cases continue to be held and reduced, so CAFCASS is doing better than ever through innovative work practices, partnership with judges and the support of the new president of the family courts. Much can be achieved through partnerships and finding new ways of working so long as the children and their families are central to our thinking. However, we, like local authorities, are still failing against our key indicators because our resources simply cannot match the demand. At the heart of all this for all social care services is the serious shortage of skilled social workers.

The one bright hope on the horizon is the report of the Social Work Task Force giving a once-in-a-generation opportunity to rise to these challenges. They are not challenges unknown to the government Benches. When in opposition, the Conservatives held their own review and were positive in their approach to social work. Where is this now? There has been no mention of the Social Work Reform Board and its plans to implement the recommendations of the task force. Can the Minister say where this stands in government priorities?

For many working in social care there is pressure, uncertainty and, for some, low morale, but I do not want the picture to be totally bleak. Social workers, volunteers, carers and others continue to give of themselves day in and day out, and it certainly is not for the pay. New ways of working are being developed. What we need are ways of sharing experience and building on strength. We require a Government with a national vision that can have local implementation. The work needs to be integrated with health, housing and DWP to get the best out of public sector resources and reduce duplication and waste in the processes. It is needed now because the work simply does not stop for a change of government. We look to the Government for a better future for those in need.