Lords Hansard text for 21 Nov 200621 Nov 2006 (pt 0009)

6.08 pm

Baroness Greengross: My Lords, I propose to concentrate my remarks on the most vulnerable people in our ageing society—those who are frail, usually very elderly, and whose numbers are fast rising. I shall touch on three issues: social care, dignity in care, and end-of-life care.

First, in the coming Comprehensive Spending Review, the Government must recognise the likely scale of future needs and determine how they will be met. Spending on social care has risen by 14 per cent under this Government, while overall health spending has risen by 90 per cent. Therefore, reconfiguring social care services must be a priority for the next spending review. We should also take on board the fact that much of what constitutes good practice in social care is not really very expensive.

The Government must be congratulated on several initiatives, such as A Sure Start to Later Life, better support for carers and the rights accorded to them. But we also need much more flexible provision to allow people to remain in their own homes if they so choose, and to recognise the role of low-level care, which is important to the quality of life of many older people. By the middle of this century, the number of people aged over 65 will rise by some 80 per cent to nearly 17 million. However, there will be an even bigger growth of the number of people over 85, which will nearly quadruple to 4 million. Informal carers are therefore likely to play an even greater role than at present. There are already 5.8 million carers, most of whom care for people over the age of 65. Many are themselves already older people.

The Government have recognised that informal carers have rights, but they also require more support as they increasingly have needs themselves. The incidence of dementia is estimated to double over the next 30 years, and this is the group with the most complex needs, where the most significant expenditure will be required. Some consensus must be found for the funding of social care, particularly long-term care. Partnership funding such as that recommended in the Wanless and Rowntree reports, with a reasonable split of 80/20 public and private funding, must be considered. Mechanisms such as more flexible equity release schemes, enabling money to be used for care and repayments made from a person’s estate after their death, must also be considered.

I welcome the government Dignity in Care initiative, which embraces all aspects of care in its proposals. It is holistic, and includes malnutrition, which, as has already been mentioned, is a huge problem in hospitals and care homes, but also in the community, where International Longevity has done quite a lot of work. The approach involves listening and responding to what so many people in care have themselves said, so I welcome it.

I commend the campaigns led by Help the Aged and Age Concern to ensure dignity in hospitals, as well as the new approach, Behind Closed Doors, which the British Geriatric Society and many other organisations are launching, to ensure that older people and other vulnerable adults can be certain of privacy when they need to use the lavatory in a

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hospital or care home. Terrible incidents have been reported, such as elderly residents being fed their breakfast while using the toilet. It is hard to imagine a more degrading example.

Such campaigns cannot achieve their aims without a more professional workforce, which is the key to any improvements. Staff are the linchpin of service delivery. Yet those who do the bulk of this difficult and stressful work—particularly care assistants looking after frail, elderly people—are often not qualified, extremely low paid and largely unrecognised. Many, understandably, leave to work on the checkout tills at Tesco because, as is often said, they get a bit of social life and better pay there. That is appalling. Some work is being done by a group led by a charity, Friends of the Elderly, to see whether a qualification at NVQ level 2 can be introduced to improve that. Much needs to be done as a priority.

Another priority for the Government must be to remove the Human Rights Act loophole which fails to protect the majority of care recipients because independent providers are not considered to be public bodies. In 2004, over 91 per cent of care home places, and two-thirds of domiciliary care, was provided by private and voluntary agencies. The Government have intervened in a judicial review, where some local authority care homes were transferred into private ownership. The judge did not overturn the earlier ruling that independent providers fall outside the scope of the Human Rights Act, but confirmed that the local authority remained responsible for protecting the human rights of residents, even after their homes had been transferred. The picture is ever more confused and totally unacceptable.

The Minister in your Lordships’ House acknowledged during Report stage of the Equality Bill, over a year ago, that action was required. The Government must close this loophole, if only to be consistent with their own Dignity in Care campaign. My rights as a human being are derived from my basic humanity; they do not change depending on where I happen to be in this country at a given time. We would never tolerate this sort of discrepancy in children’s rights, and rightly so. Legislation on animal welfare now seems to provide more protection than that offered to many frail, elderly people. That is quite unacceptable.

I feel strongly about end-of-life care, but am also raising some points that my noble friend Lady Murphy would have brought up were she able to be present for this debate. There are specific difficulties for many older people at the end of life, sometimes in communicating their needs, because they suffer from multiple conditions and failing powers. Great sensitivity is required in how they are treated. How we address their needs is perhaps the ultimate test of dignified care. Where a person is dying, when and how they die, who is with them when they die, and what, if any, intervention they may need are all critical points which must be treated fairly and well. What is the Government’s policy on end-of-life care for people with dementia, for example? We have a Gold Standard Framework, led by Professor Ian Philp, but we must know how it can be implemented without specialist care teams—including geriatricians, old-age psychiatrists and palliative care doctors—going into care homes to ensure care is adequate.

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I regret that the Bill of the noble Lord, Lord Joffe, did not proceed to Second Reading, as it included a provision that a patient suffering from a terminal illness should be entitled, as of right, to receive sufficient medication to keep them free from pain and distress as far as possible. I am pleased that my noble friend Lady Finlay is introducing a Bill which will hopefully improve this situation. It is urgently needed, as according to a recent study 46 per cent of doctors expressed reservations about prescribing opiates since the Shipman case. There have also been many reports of doctors being reluctant to prescribe adequate pain relief for patients cared for at home since that case.

Only a couple of weeks ago, on “Woman’s Hour”, a daughter movingly described how her mother—dying in agony, totally neglected and suffering from Alzheimer’s disease—died in a mental health unit where nobody was trained to manage her pain. Some states in the USA have recently legislated to make it clear that it is lawful to provide pain relief, even if it hastens death to some extent. We need stronger guidance from the GMC and the BMA to give doctors confidence in prescribing appropriate doses of palliative drugs for dying patients, regardless of their diagnosis. Perhaps the Government could include palliative care expertise in the quality target scores for funding GPs.

Despite the immense importance of this issue, the National Council for Palliative Care recently reported that about half of all palliative care services are facing a reduction in NHS funding. Again, this undermines the Government’s own aims in Dignity in Care and must be reversed.

In conclusion, I urge the Government to take on board the following three points. First, in the Comprehensive Spending Review, they must include adequate funding for social care, including training for front-line providers. Secondly, the Government must close the loophole in the Human Rights Act regarding public bodies as a matter of urgency. Thirdly, they must ensure that end-of-life pain relief is available wherever and whenever it is needed, and consider whether some additional legislation is needed to ensure it is available and effective. Above all, people’s dignity must be protected throughout, and at the end of, life if we are to consider ourselves worthy of being called part of a civilised society.

6.20 pm

Lord Morrow: My Lords, I feel it proper on this occasion of my first contribution in the House to place on record my gratitude and thanks to your Lordships and all officers and staff of this House for the kindness, consideration and assistance I have received since my arrival. I also include my sponsors, my noble friend Lord Molyneaux of Killead and the noble Lord, Lord Foulkes of Cumnock, for being courageous enough to sponsor me. I assure the House that my appreciation is sincere. I suspect that I have a lot of learning ahead of me as I seek to familiarise myself with the workings of this House.

Having served in local government in Northern Ireland for more than 30 years, a period of time that coincides with what is euphemistically called the

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Troubles, I want to pay tribute to all the innocent victims who lost their lives during this torturous and agonising period in our history. Of course, I am acutely aware that any words I might use in such a tribute will fall far short of what should be said. Right across the religious divide in Northern Ireland, too many were innocent victims of an awful onslaught. To their surviving family members, I sincerely say that the price your loved ones have been forced to pay cannot be repaid, but their illustrious memory must and, I pray, will live on and never be forgotten.

We are told that progress is being made in Northern Ireland to find a way forward to establish a democratic form of government. However, the question being posed today is whether this is another false dawn or indeed the sunrise to a bright new future for the next generation. Only time will tell. It has been well said that:

“True reconciliation is never cheap, for it is based on forgiveness which is costly. Forgiveness in turn depends on repentance, which has to be based on an acknowledgement of what was done wrong”.

I have little doubt that the way forward will be fraught with difficulties.

I have been well warned that my first contribution should be non-controversial, and I will make an honest attempt to comply with convention. Someone said:

“The youth of a nation are the trustees of posterity”.

However, I am confident that the prospects of our www generation, so used to being a mere click away from instant knowledge and solutions, can be measured by the potential of our education system. We are truly blessed in Northern Ireland with an abundance of schools, colleges and universities that are some of the finest in the United Kingdom. It is heartening to note that our education and training policies are inspiring similar approaches in Scotland, Wales and, more recently, England.

Indeed, among the unsung heroes of our troubled past have been our classroom teachers, college lecturers and courageous principals. Together they have resolutely safeguarded our schools and further education colleges as neutral havens of learning, as free from prejudice as they were from the onslaught of educational experimentation. The quality of teachers, managers and governors right across our education galaxy, from nursery and primary schools to post-primary, further and higher education, is second to none. They can be rightly proud of their achievements.

The success of our learners in public examinations is better than ever and certainly stronger than in many other regions of the United Kingdom. However, I have been even more impressed by the extent to which our young people leaving schools and further education colleges are confident in themselves, positive about their futures, aware of the importance of lifelong learning, interested in the world about them and keen to contribute to society in Northern Ireland.

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Despite the substantial successes of our education and training system, especially among our able and not-so-able learners, I am keenly aware that the gap between those achieving the highest and lowest levels of attainment is unacceptably wide, as was highlighted in the chief inspector’s last report. Low and under achievement, particularly among young males, and the need to ensure that all school leavers and trainees are numerate, literate and have the necessary employability skills, remain major challenges for our schools and colleges.

Let us pause and reflect on the enormous challenge that we have set for those who lead, manage and teach in our education system to provide the bedrock for mutual respect and a prosperous economy, so richly deserved and needed after three dark decades of violence, misery and division. Peace and prosperity are but two sides of the same coin and our Northern Ireland economy has much to catch up with. Schools and colleges have been challenged to go beyond their traditional remits to instil a love of learning in our young people and equip them with the necessary nationally recognised qualifications that will ensure their onward progression to university, college, and/or the world of work.

Now they are being asked to be the guarantors not only of social mobility but also of social cohesion in an increasingly diverse society and to be the suppliers and drivers of a dynamic new knowledge economy. Much of our future indigenous economic success will depend on the synergy and partnerships between our public and private sectors. We are asking our large and small employers to speak up through their respective sector skills councils to influence the design and content of our professional and technical qualifications and to determine training needs within their respective industries, committing themselves to genuine collaboration and partnership through sector skills agreements.

Key public agencies, employers of all sizes in our private, public and voluntary sectors, schools, FE colleges, universities, training providers, trades unions and individuals all have a specific and necessary role to play to underwrite the networks of stakeholder partnerships that will be so vital to securing future economic growth and prosperity. In particular, I commend to the House the innovative vocational enhancement programme that promotes collaborative working between our schools and further education colleges. This integral partnership within our education system will be further enhanced next year with the planned introduction of a statutory entitlement framework and the development within our post-primary schools of a more skills-focused curriculum.

Our further education sector, one of the brightest gems in our education crown, is already transforming its mission and structure to deliver a much more economically focused curriculum together with a more coherent sectoral approach to the demands of employers and industry. The Northern Ireland further education sector, often overshadowed by its neighbour in higher education, is to be commended for its unique contribution to the promotion of lifelong learning, good relations and cultural diversity in Northern Ireland, as well as for being the key driver for local, sub-regional and regional economic development.

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6.28 pm

Lord Brooke of Alverthorpe: My Lords, I am delighted to follow the noble Lord, Lord Morrow, and to have the pleasure of congratulating him on behalf of the whole House on his maiden speech, which focused particularly on education and the future of Northern Ireland. He has a long record of political and public service in Northern Ireland and I am sure that he will soon make an impact in this House, too. As an auctioneer and estate agent, he will have particularly noted the Government’s Consumers, Estate Agents and Redress Bill, and I am sure that we can anticipate a positive contribution from him when we come to debate it. I am sure that he will also give us the benefit of his experience and intelligence on a wide range of other topics in future. We extend to him a warm welcome to our deliberations.

In supporting the Motion on the gracious Speech, I shall speak about health. I am pleased that, after much consultation and analysis, the Government have again tabled a Mental Health Bill. It may not be enough for everyone, but I hope that this time it will be possible to get some much needed changes on to the statute book. My particular concern is with drug and alcohol addicts who sometimes have to be sectioned. Today, I want to take a liberty similar to that exercised earlier by the noble Lord, Lord Fowler, and use this opportunity to draw to the attention of noble Lords a serious problem in this field—the significant number of beds in residential drug and alcohol treatment centres that are reported to be empty.

I preface my remarks by acknowledging that this Government have made more money available than any Government before and have made a determined effort to achieve their drug strategy aims. They are to be congratulated because, since the strategy was published in 1998, much has been done to improve the availability of and access to treatment for drug users.

However, the residential treatment sector has been largely neglected for the past eight and a half years. This is in spite of the impressive evidence to indicate that this sector achieves some of the greatest treatment gains while treating people who present with the most severe problems and complex needs. Recently, the Department of Health, the Home Office and the National Treatment Agency made it clear that as a matter of policy they expect to see an increase in the use of tier 4 services. However, rather than experiencing an increase, a significant number of established providers in the voluntary sector have experienced a steep and sustained downturn in funded referrals since the beginning of the financial year. Current capacity is underused by up to, and even beyond, 25 per cent on any given day in some centres. This situation has developed over the past year and has become much worse since April, in spite of a 28 per cent uplift in already substantial funds passing from the National Treatment Agency to local commissioners.

The crisis is having a severe financial impact on providers. Some services have already closed and, if the typical autumn and early winter decline in

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referrals comes on top of this, others will follow. Once lost, they and all their experience will not be easily recovered. Severe damage will have been inflicted on this important national resource and on the country’s ability and capacity to treat effectively drug misusers and alcohol-dependent people. Indeed, some high-quality structured day treatment programmes have been similarly badly affected. This dire situation coincides with an announcement by the Department of Health of a capital investment programme of £54.9 million to increase capacity in the tier 4 sector, to create more beds. While prima facie this is a move in the right direction—and in normal circumstances I would wholeheartedly welcome it—it does not make sense to launch it when currently capacity is significantly underused. This needs addressing first and urgently. Adding more beds will only exacerbate the current problem, especially as revenue appears inadequate to sustain existing provision. The risk of wasting a large amount of public money in this area is very high indeed while many unfilled beds exist.

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