Criminal Justice and Courts Bill

Debate between Earl of Listowel and Baroness Howarth of Breckland

Monday 21st July 2014 Lords Chamber

[The Earl of Listowel (CB)]

My Lords, I ask the Minister to clarify one issue, and ask for help from my noble friend Lord Blair on another. The first issue concerns children in care. As the Minister will be aware, a disproportionate number of children in care are in custody: more than half the boys and just under half the girls in custody come from the care system. I would be interested in clarification about any exception under the proposal that will look at the backgrounds of young people, particularly if they come from a care background. I imagine most of your Lordships will be aware that 60% of children originally come into care because they have been abused and a further 10% because their family has broken down. As the noble Lord, Lord Deben, described, these are children who are very damaged and sometimes troubling to others as well.

When we discussed mobile phone crime seven or eight years ago the law was strengthened because of concerns at that period. I remember a case where a 15 or 16 year-old boy, on his first day at a children’s home, joined a group of people he did not know. One of that group stole a phone. The judge was obliged to be tough with him and sentenced him to custody. There was no suitable secure local authority children’s home for him. I think he was placed in a young offender institution and he hanged himself. One must also remember that these children are more vulnerable to knife crime. It is of course a very finely judged argument.

My question to my noble friend Lord Blair concerns his experience, which was most interesting. His first example concerned women taking guns out of their handbags, so it was an older group. What was the experience of 16 or 17 year-olds in the second example he gave, if he is aware of that? I share the concern of my noble and learned friend Lady Butler-Sloss that 16 and 17 year-olds may not be able to understand the weight of punishment that may await them if they continue—although they will have committed a first offence, so they probably should be aware.

[Baroness Howarth of Breckland (CB)]

My Lords, of course it is wrong for a young person to carry a knife. Of course we want to remove and reduce the number of young people in school with knives. Of course we want to sympathise with the victims. I am a mere social worker, so I have had to work at both ends of this spectrum. However, what we are talking about is what the real deterrent would be, not whether we are aiming to reduce the use and holding of knives.

I agree with noble Lords who have spoken about young people’s development; we think of that very little these days in our policy. Based on my experience, the clause is very unlikely to deter them from carrying knives. What happens is that young people find themselves in a gang at the age of 14. The rest of the gang are aged 16 to 18. The clever thing is to carry a knife. It may be that the 16 to 18 year-olds are not carrying the knives, but the young person is encouraged to take the risk. On estates they are terrified that their parents—usually their single mum—are going to be harmed, so they carry a knife. Of course it is wrong, but the deterrents will not work if these young people are going to be put away.

The All-Party Parliamentary Group for Children has just been looking at the relationship between children and young people and the police. A number of the young witnesses were pretty tough and had been in extraordinary trouble. It became clear that what made a difference was those young people having a police mentor. As the result of the police going into their schools and talking to them, they joined the police cadets or some other organisation, and that was far more likely to deter them from the path of any sort of criminality, particularly violence. If young people begin to understand, through relationships, what the outcome of their actions will be, they will be much more likely to change. Therefore, I oppose the clause and support the noble Lord, Lord Marks.

Serious Crime Bill [HL]

Debate between Earl of Listowel and Baroness Howarth of Breckland

Tuesday 15th July 2014 Lords Chamber

[Baroness Howarth of Breckland]

My Lords, I briefly want to support—and not support—the noble Baroness, Lady Brinton. I support her obvious wish that proper liaison between authorities should take place in terms of safeguarding. All of the codes and practices are already there, but what is not there is the available time. It is not that social workers are not trained, although they could do with more training—certainly around the issues of satanic and witchcraft abuse, although that concerns a tiny proportion of the cases. However, on the matter of broader emotional abuse, social workers are pretty keyed in to what is needed. The problem is that they know that they do not have the time to go in and do the work that is necessary to help families, and they have no wish in these circumstances to end up removing families through the courts.

The real answer—and I speak as a vice-president of the Local Government Association—is to look at how local authorities are using their resources and whether enough of those resources are going towards safeguarding children and their general protection and prevention from abuse. We need to look at whether we are asking the professions—social workers in particular, but also the police—to carry out a totally impossible task. If you are working day to day intervening in cases, you have very little time left to liaise with your colleagues. As a professional who has undertaken this work over many years, I know just how much time it takes to ring round, organise conferences, ensure that the appropriate information is available to everyone and pull all of that together.

So the noble Baroness, Lady Brinton, is absolutely right. We need to make sure that the safeguarding co-ordination works well. We need to make sure that the local authority designated officers, to whom these situations have to be reported, have enough time to think through what the action should be, and are able to take it.

[The Earl of Listowel]

My Lords, I welcome this amendment. I would just like to highlight to your Lordships concerns about the availability of child and adolescent mental health services. In recent information, the mental health charity for young people Young Minds has drawn attention to the fact that,

“34 out of 51 … local authorities in England have reduced their CAMHS budget since 2010. Derby City Council reported a cut in its spending by 41% since 2010. … Overall, local authorities in London have cut their CAMHS budgets by 5% since 2010. 8 out of 12 councils … have reduced their CAMHS budgets”.

So there is a real concern that, although the principle is absolutely right here, the CAMHS services, which are so vital, have unfortunately often been cut. I was very pleased to meet, with members of the All-Party Parliamentary Group for Children, the honourable Mr Lamb MP, who is the Minister responsible for this area. It was very encouraging that he was aware that a lot of work needed to be done in this particular area. In addition, the Select Committee on Education in the other place is producing a report on child and adolescent mental health services, which I am sure many of us will look forward to—I believe it will be produced in October.

Children and Families Bill

Debate between Earl of Listowel and Baroness Howarth of Breckland

Monday 11th November 2013 Grand Committee

[Baroness Howarth of Breckland (CB)]

My Lords, no one can be anything but absolutely delighted at the government amendment. I, too, was at the joint meeting with the noble Lord, Lord Nash, and the noble Earl, Lord Howe, but wish to ask some further questions, following on from the noble Baronesses, Lady Jones and Lady Tyler. I am concerned that, even if a local authority had a duty in this regard, there would be extreme difficulties in continuing this journey. We are on the first step of the journey. As a long-standing practitioner, I know that the problem arises with the actual implementation of these services.

When I asked a supplementary question about the parents of disabled children, I was told that it could be dealt with in this Committee. We do not get those services for disabled children, or a proper co-ordinated family approach in local authorities, because of the difficulties they have in meeting their commitments currently. I have said this before, but I sometimes think I am living in a parallel universe where our aspirations and our joy at achieving excellent legislation cannot be matched by reality. My own local authority is about to face further cuts of £145 million on top of previous ones. Every noble Lord in this Room should know what their own local authority faces and what the implications will be for services on the ground. I want to hear from the Minister how we can meet the young carers approach and about what we might do for disabled families, because they need the services, not more legislation.

There is an answer. If we had good, co-ordinated family assessment and family workers with no duplication—I speak as a trained family case-worker in the past—where one worker undertakes the assessment and knows which experts to call on when other expertise is needed, and much more focus in terms of the work, we might actually save resources. However, I do not know how that gets into regulations. I would be very interested to see whether or not we can do that because we could revolutionise some of these services by the approach we take in implementation. We have legislation that says that disabled children should receive X, Y and Z for particular conditions, but I fear that the services are simply not there to meet the need. I am sorry if that sounds a slightly sour note—it is not meant to, as I am utterly delighted that we have this in the Bill. What I hope we can do now is to start to revolutionise services so that it actually happens, day to day, in people’s lives.

[The Earl of Listowel (CB)]

My Lords, I will briefly follow what my noble friend has said in terms of the practical implementation of this very welcome work that the Government have undertaken. I remind the Committee of the difficulty posed by having continually changing professionals. We debated earlier the issue of children making their transition to adult services. On several occasions, parents have raised with me the difficulties posed by the fact that they will have several changes of social worker just as the child comes to access adult services, such that the advocacy for that child as it goes into the adult services is lost. I am very familiar in children’s services, particularly those for looked-after children, with people complaining and saying, “Look, I have had five social workers in the past two years”. People have had multiple social workers, which is very disadvantaging. When we talk about working together to improve outcomes for children, as we are here, we need to keep a good eye on the practicalities and ensure that there is more continuity of professional care. We need to keep and retain our social workers and other professionals, and not keep moving them around all the time.

Here, I would just like to raise the concerns that I have heard in the past when speaking to psychiatrists working in the health service. They feel that the service is changing and being reformed so often—with the best of intentions—that, once they get to build relationships with partners in other disciplines, they or the partner are moved on. They do not know the other people and cannot work in the kind of way I think we are talking about at the moment. I make a plea that we avoid more large-scale reorganisations of, for instance, the health service in the near future. The same story comes from social workers in local authorities, who continually experience reorganisations of their local authority, which overburdens them and, again, breaks up the relationships necessary for them to be able to make effective partnerships work in the way that we want them to work in this part of the Bill. I hope that is helpful to your Lordships.

--- Later in debate ---

[Baroness Howarth of Breckland]

Since the noble Baroness has just mentioned my name, I will say one sentence. I absolutely agree with her; all I will ever talk about is implementation and application. However, in this context the revision of the guidance on sex education would be such a support to teachers that it would make a difference.

[The Earl of Listowel]

My Lords, following what has just been said, the strongest reason for making PSHE statutory has been the case put by teachers. This would be the way to ensure that teacher training bodies really put a priority on training for PSHE. Teacher training is skewed towards what is statutory in the curriculum. The noble Baroness is absolutely right. We need to empower teachers so that they have the confidence to hold these conversations with young people. Doing what is suggested in these amendments would make that more possible.

I warmly welcome the words of the vastly experienced noble Baroness, Lady Kidron. I vaguely remember that the previous Government commissioned an expert group to produce a report on this topic which was presented some time ago. I felt at the time that it was a little soft. I so admire my noble friend Lady Howe, who is absolutely right to bring forward, very late in the day, her Bill to regulate the availability of this material on the internet. Perhaps the Minister will be able to use his good offices to take back to those thinking about the Bill a little encouragement to move ahead with the Second Reading because it is so concerning. I hear from other sources concerns about gangs of boys and the way young women are treated, and how that has changed because of what young men are seeing on the internet. It is very troubling. I support all these amendments.

One particular point has always niggled at me. The noble Baroness, Lady Jones, referred to same-sex education in particular. I had an experience some years ago when visiting a children’s home. The manager was gay. There was a young man there who certainly dressed in quite an effeminate way and could have been called gay, and the manager was saying, “Well, this young man is gay”. My concern is that it is of course a common experience for children to be attracted to the same sex as they grow up, but many of them grow out of it. Those who take the most active role in this particular area are sometimes overly enthusiastic in promoting an attitude. In dealing with these sensitive same- sex issues, on which people get so polarised, there should be a recognition that young people experience attraction to other young people of the same sex, but most of them grow through it. There should not be a misunderstanding that if one seems to be attracted to other members of the same sex in one’s mid-teens, for instance, that that is one’s sexuality and how one is now set. I am sure that that is not the intention, but it is my sense of how this sometimes comes out. Some reassurance on this point, not necessarily in Committee, would be welcome.

--- Later in debate ---

[Baroness Howarth of Breckland]

My Lords, I want to ask the Minister how the vision and the application of this proposal will work together. The Government have a laudable wish to increase the level of childcare that is available to families—mostly women who find themselves unable to work because they do not have good childcare arrangements. The Government want to provide good quality childcare and ensure that the costs are manageable. They want to reduce bureaucracy and provide a focus for childminders so that they can share some of their understanding together. I appreciate the last point in relation to agencies, but the others I find very difficult. I cannot see how the solution fits the vision.

On transparency, I share the views of other noble Lords, which is that anyone who has been involved in inspections—noble Lords know that I have been a regulator in at least three different agencies—knows that asking a regulator to inspect its own is fraught with danger. That is my major concern with regard to ensuring that child protection issues are picked up. We know how easy it is, as they say, to consume your own smoke within an organisation. Transparency and protection issues in all this would be difficult.

It has been demonstrated that the increased costs would, in the end, increase the cost of childcare for families. Some childminders are already extraordinarily expensive. The childminder employed by my niece—who I brought up as my daughter and who has the equivalent of my grandson—is extremely expensive. That is because she is confident that the care is of high quality and meets the right timeframes for her. I would like the Government to find a solution to some of the issues they have identified that matches the vision which I believe they have for the care of children when mothers need to return to work in order to increase their own opportunities.

[The Earl of Listowel]

My Lords, I welcome the noble Baroness, Lady Morgan of Ely, to the Grand Committee. It is very helpful to have a parent who is bringing up her children taking part in the Bill and it was good to listen to her tribute to her childminder, Margaret. I am also grateful to the Minister for hosting a meeting on this matter. The discussion was useful, and it was particularly helpful to be reminded that childminder agencies will be one way to help childminders feel less isolated. I have visited childminders in the past. They were part of childminder networks which they found very useful. They would meet regularly and take on training together. That is the positive side of this.

I want to encourage the Government to be open-minded in terms of how they develop childcare in this country. Perhaps I may highlight the value of nursery schools and other things that the Government are involved in, but I should voice my concern that an over-emphasis on private provision may not be helpful. After all, the cost of this provision is in the pay and training of the women—and it is women—who do this work. Historically, it has been very difficult for these businesses to make a profit. These nurseries have found that they just do not get enough bums on seats and therefore it is costly to run the whole business which means that they have to drive down price by cutting training or pay. We know that pay in nursery care has historically been very low indeed. The risk is that by having too much provision in the private sector we will move towards something which may not be much cheaper but may be inferior in quality. From memory, the turnover of staff in nursery schools is about 4% whereas in some of the large private providers the figure can be 14% or 15%. I recall that the latter offer quite a different setting. It is so important that our young children have continuity of care and that their professionals stay around for them for long periods. There can be stagnation but in general we want that long-term relationship with the carer.

I conclude with a quotation from Childcare Markets: Can They Deliver an Equitable Service?, edited by Eva Lloyd and Helen Penn. Professor Penn states in her summary:

“The key question is whether the childcare market is a reliable and equitable way of delivering childcare. For neoliberal countries, the risks and complications involved in allowing entrepreneurs to provide childcare are either unrecognised or deemed acceptable—or a combination of both”.

I think this was what the noble Baroness, Lady Walmsley, was referring to—the possible extra costs of placing more emphasis on the private sector. Professor Penn continues:

“In other countries where there is a childcare market, it is carefully controlled and generously funded, and although there may be many kinds of provider, the type of funding and the regulatory framework means that for-profit companies have limited room to manoeuvre. In yet other countries the childcare market is altogether unacceptable, and the government takes on the responsibility for providing childcare”.

Given that we are having a clause stand part debate, I remind the Government that a range of options are available and they can benefit from taking a very active role in this regard. Professor Penn concludes that there are,

“limitations and tensions in relying on the childcare market. Viewing childcare as a commodity to be bought and sold undermines equity and quality, and regulation has to be comprehensive and wide-reaching in order to try and compensate for these failings”.

This also speaks to the concern that has been expressed about relaxing inspection in these new arrangements. I do not consider that I understand the area sufficiently to be particularly critical or to be either for or against what the Government are proposing but I encourage us all to be as open-minded as possible in this area.

Children and Families Bill

Debate between Earl of Listowel and Baroness Howarth of Breckland

Wednesday 16th October 2013 Grand Committee

[The Earl of Listowel]

I support my noble and learned friend’s amendment and that of the noble Baroness, Lady Hughes. Listening to the noble Baroness, I remember hearing recently a male acquaintance speaking passionately about his despair at not having access to his child. It seemed that his wife, a wealthy woman, had really done him down. He is poor and does not have the access to legal help that she has. Listening to men talk about this so often is very sad.

I will speak during the debate on the amendment of my noble friend Lord Northbourne about the issue of children having access to their fathers, which is desperately important. It is also important to remember that the evidence seemed very clear that while there is a perception that courts are finding favour more with women and that women are too effective at frustrating what the courts want, in practice this is not happening. I heard a presentation of the evidence a few months back but am ashamed to say that I cannot remember the presenter of the details. As my noble and learned friend has just said, the Justice Committee agrees with that. It seems that the Minister agrees too, so I would be grateful if he could help me by providing the information. I think this was a careful and thorough look at cases by an academic to check the perception that there was a bias towards women. In fact, the research showed, quite conclusively and clearly, that this was not the case. I would be grateful if the Minister’s expert advisors might help with that information. He can write to me with it. It is a perceived problem but it is not a real problem. What is true, however, is how tragic and difficult these issues so often are.

I very much regret that I cannot support the Government on this occasion. I examined a similar proposal to that in the Bill in great detail on a previous occasion. In doing so, I visited two contact centres and spoke to staff and parents there. I also spoke with professionals from the Anna Freud Centre who supported such families. My concern is that, at best, the Government may be raising expectations in parents which will only add to litigation and harm children as the conflict between their parents is prolonged. This is the point that my noble and learned friend made and it was also a concern that Norgrove had. In Norgrove’s family review, at first he was favourable to the idea of having some stipulation in the law that this should happen. Then he looked at what happened in Australia and became determinedly against going forward in this way. At worst, my fear is that the Government may be putting children more obviously at risk as courts are pressured to grant more contact to both parents.

By the time these cases come to court, there are often mental health or substance misuse issues within the family. What I heard from the contact centres and the professionals last time around was that, too often, a parent—and often this would be the father—was granted access to his child before he had addressed his alcohol misuse issues, for instance. Quite often the agreement would be that the father would have supervised access on two or three occasions, but that would be gone through in a quite perfunctory way and the father would have access. I should perhaps not name a gender here; the parent could be male or female.

Following this and before we legislated in this area—it was very helpful at the time—the courts inspectorate produced a damning report on child safeguarding in the private family courts, finding that court reporting officers were not communicating child protection concerns to the relevant authorities. If anything, back then the bias seemed to be too much in the other direction: courts were not taking enough care about granting contact between children and their parents.

Family courts are under great pressure financially. A large increase in litigants in person adds a further burden. It would be wisest to allow judges to make decisions about what they consider to be in the best interests of the child without the distraction that the Government’s proposal offers. I am strongly of the view taken by the National Society for the Prevention of Cruelty to Children, Coram—a wonderful institution which produced the model for the children’s centres that have proved so successful—and my noble and learned friends that the Government should think again about this. I look forward to the Minister’s response.

[Baroness Howarth of Breckland]

My Lords, I want to intervene briefly to say two things. All this is about perception as against fact and we have to ask ourselves why we are dealing with this clause at all. The noble Baroness, Lady Tyler, will know very well that CAFCASS, when being pressed by fathers who were saying that the presumption was against them, carried out research which showed that there was no presumption either way.

Of course there are miscarriages of justice. We cannot deny that from time to time in all areas of the law there will be miscarriages of justice, for both women and men, but that is not to deny the overriding information and the principle. I am very concerned that if we lose the paramountcy of the welfare of the child, the confusion that will follow will lead to other perception issues.

The other perception issue is very clearly, as one or two noble Lords have intimated, what is in the press—and that is that the father, it is usually the father, will be able to gain shared parenting. What they mean by shared parenting is half and half. We know how damaging that would be to a child, as the noble Baroness, Lady Tyler, said, when seen through the child’s eyes. If you talk to children and young people who are before the court, they want their parents to stay together—you have to work through all that—and then they want their lives disrupted as little as possible. They want to remain in the same school; they want to be able to see their friends at the weekend; they do not want to take a suitcase somewhere else every two weeks—although, I have to say, some children quite enjoy it. I have talked to kids who really enjoy having two places and adjust to it. However, many do not, and therefore it is important that the child’s wishes and feelings are taken firmly into consideration. I think the perception will be that fathers, in particular, can get a different agreement from the court, rather than the paramountcy of the welfare of the child being the main issue.

Several noble Lords have alluded to the Australian experience but we should take it extremely seriously. If this has been tried elsewhere and has gone seriously wrong, why should we do it here and create the same situation? We should remind ourselves that they had this legislation and that the research evidence showed that the number of cases where children’s time was divided increased substantially. The whole thing became dysfunctional to the point that in 2011 the Australian Government were forced to legislate again to prioritise the safety of children over the wishes of adults. I am quite sure that this Government, particularly the noble Lord, Lord McNally, would not wish to find that we were not prioritising children and had to change the legislation after damage had been done. So let us deal with the perceptions and base our legislation on fact.

Children and Families Bill

Debate between Earl of Listowel and Baroness Howarth of Breckland

Monday 14th October 2013 Grand Committee

[The Earl of Listowel]

I hope it will be helpful to the Committee—

[Baroness Howarth of Breckland]

My Lords—

[The Earl of Listowel]

My noble friend may want to do the same thing.

[Baroness Howarth of Breckland]

I am asking that Amendment 43 be decoupled from this amendment because it deals with a quite different issue. I wish to speak briefly to the amendment moved by the noble and learned Baroness, Lady Butler-Sloss, if the noble Earl, Lord Listowel, will allow me. It is extraordinary that there are children in this country, from wherever they have come, for whom the local authority fails to take some sort of action. I do not often say this but, in my day, children would be seen as having no parental cover whatever and there would be no doubt that the local authority would have had a care order. There is no doubt that that would have happened in the past. The noble Baroness, Lady Howe, agrees.

I understand why we want fewer court proceedings. Having been the chair of CAFCASS, I absolutely understand that. They are expensive and are often not helpful to the child’s experience, never mind that of the local authority. Under the 1948 Act we had a way of ensuring that children were placed under the equivalent of a care order by a process in the local authority. In the days of Sections 1 and 2 of the Children Act 1948, one lot of children went to court and the others went through a process in the local authority. We should ask the officials to look at this. Without a doubt we have a national responsibility to protect this small cohort of children. I have come into contact with them because I deal with serious sexual abuse issues. The girls who are trafficked are seriously sexually abused. It is not just prostitution; it is abhorrent prostitution. Unless we find ways of protecting these youngsters they will just slip away and disappear, not of their own choice. I support the noble and learned Baroness in her attempt to find a way that is not expensive but which secures these children’s futures.

[Baroness Massey of Darwen]

My Lords, an issue that is not directly relevant to this amendment, but which is akin to it, is that of parental responsibility and the accommodation that these children go into. I know that these highly vulnerable children are put into shocking accommodation. They are followed by traffickers, drug dealers and criminal gangs. They are abducted and disappear or something even more terrible might happen to them. I want to emphasise that parental responsibility must include decent accommodation for these children.

Health and Social Care Bill

Debate between Earl of Listowel and Baroness Howarth of Breckland

Monday 27th February 2012 Lords Chamber

[The Earl of Listowel]

In rising briefly in support of the amendments, I pay tribute to the Government for their contribution in this area already. This is a personal view, but in my experience the best professionals will find a way through against all odds and against the system to work together in partnership to improve outcomes. What the Government have been doing with the social work workforce in terms of raising the threshold of entry to social work, the additional support for newly qualified social workers and the review by Professor Eileen Munro on child and family social workers is a welcome part to this. I hear again and again from people on the front line that an obstacle to integration is continual structural change. When disciplines have stability and can grow together they can learn to work in partnership effectively. Finally, I welcome the building of capacity in the social work workforce, which will assist with the question of better integrated working.

[Baroness Howarth of Breckland]

My Lords, I want to speak briefly, not having spoken earlier. In answer to a Question from the noble Lord, Lord Walton, earlier in the day, the Minister talked about his great belief in the integration of services. Indeed, he talked about health and social care services in relation to people with neurological diseases. I have no doubt that the Minister and, I am sure, the Government have a great belief in integration. The problem is that it is in the “too difficult” box. Whenever we hear discussions about how we will make a start on the problem, there are real questions about how, about when, about the costs, about which particular authority, and so on. We had a demonstration earlier of the way in which different parts of the organisation—the health service and the local authority—can be set against each other in terms of the working together that they need to do.

I declare an interest as I am involved in a number of charities that have a health focus—a large number of very good partnerships of health and social care working together. I shall describe one briefly simply because I think it is helpful to have an example. It is a brain injury unit in Suffolk where the health services and a voluntary organisation with social care work in a pioneering way to ensure that people can return to the community instead of being hospitalised or unable to communicate with their families in any way. That kind of work is going on and I know that there are other pilots up and down the country looking at how financial services can be brought together.

I come back to a point that I was making at the beginning, which is that the too-difficult box means that there is a need to find a place to start. I do not know whether the Minister believes that this amendment, with Amendment 161A—it is important to look at them together as they give a balance of health and social care—sees them as the way of making a start. If not, I ask him the very pointed question: when will the Government start? Why is this called the Health and Social Care Bill because, as was said previously, expectations were raised enormously in those who receive social care services? In what way will the Government take the whole plan forward? I know that they have promised a Green Paper, a White Paper and to take things forward, but if we do not have a clear picture, the amendment itself will not help. It alone cannot bring about what people have been discussing, which is the culture change.

Those of us who have been involved in these services for 50 years and more—many who have already spoken can, unfortunately, claim that—have lived with these differences. They have had a profound effect on people’s lives, as the noble Lord, Lord Sutherland, said. We have experienced them personally because we have had families going through the services, and we have seen them professionally with patient clients. The other thing I rather worry about is the medicalisation of everybody in this because people who want social care do not necessarily want medicalised social care; they want medical care when they need it.

I am really asking the Minister, so I can think about whether I support these amendments: what is the alternative to ensure absolutely that the Government move forward in a proper programme that brings integration in health and social care to the benefit of every individual patient who needs that sort of care?