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I note, too, that from June this year new local area agreements will streamline the way in which central and local government interact so that priorities are no longer imposed from the centre but are negotiated locally. An important priority for us in these local area agreements is the promotion of community cohesion. This is not according to any national template; the new national indicator set underpinning new local area agreements includes two cohesion measures—first, the percentage of people who think that their local area is one in which people from different backgrounds get on well with one another and, secondly, the percentage of people who feel that they belong to their local areas. Cohesion measures are therefore being very much generated by best local practice, not by national templates. The noble Lord, Lord Dholakia, asked what progress we were making in establishing those indicators at local level. I am glad to be able to tell him that measures along these lines have already been agreed in 79 local authority areas and others are under negotiation.
On family policy, as the noble Baroness, Lady Gardner, said so powerfully at the outset, effective parenting plays a central role in personal development, social health and community cohesion, outstripping class, ethnicity and even disability in its influence on the path that children take as they grow up. Families are the building blocks of communities so parents are the key partners in improving respect, tolerance and cohesion in society as a whole. Assisting parents in fulfilling their responsibilities towards their children is perhaps the most important thing that we do as a society and a Government, and we have sought to improve support in fundamental ways in recent years. For example, we have increased maternity leave from just 14 weeks to up to a year. We have doubled statutory maternity pay to £112.75 a week. We have introduced two weeks’ paternity leave paid at the same rate and we are consulting on extending this further in order to promote the very role of fathers that the noble Lord, Lord Northbourne, so rightly again emphasised in this debate. We have given parents with children under six or disabled children under 18 the right to request flexible working and to have their request taken seriously, which is bringing about substantial changes for the better in the workplace.
Fourteen million people now work flexibly. We are currently reviewing how much further we should extend this right to request flexible working. We have invested more than £21 billion in early years provision and childcare since 1997, creating an under-fives sector which barely existed before then, so that today every three and four year-old has a right to free nursery education. We are also boosting support for family support services; £240 million will be available in the next three years for local authorities to develop better family support services and to support services for grandparents—a matter mentioned by the noble Baroness, Lady Greengross.
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My noble friend Lady Massey asked about the financial support the Government are giving to children and families. From April 2009, when the latest changes come into effect, the average household with children will be £1,800 better off in real terms as a result of the Government’s reforms to the tax and benefit system than they were in 1997.
We seek to bring about radical improvements in support for children in care through the Children and Young Persons Bill, currently before the House, which meets many of the points raised by the noble Baroness opposite. In respect of disabled children—I speak as Minister for disabled children—I am about to table amendments to the Children and Young Persons Bill enabling the Government to set national standards of respite care to be available to the parents of disabled children, so that the extra £430 million we are investing over the next three years, in short breaks and other respite care services for the families of disabled children, leads to a fundamental and lasting improvement in support for many of the most vulnerable families in our country.
So I believe that we have a good record. But it is not enough. We want to accelerate the pace of improvements, so we have, for example, used the recent changes to the machinery of government to create a new department—the Department for Children, Schools and Families—with a specific focus on families. Now, for the first time, one department has lead responsibility for putting the needs of families at the heart of government policy.
In December my new department published the Children’s Plan to set out our strategy for improving the lives of children and families over the next decade, including the vital role of play and better play facilities—a matter mentioned by many noble Lords. The plan sets out two key principles to guide how we work with parents. The first principle is about the need to recognise and adapt to changes in families and family life. As my noble friends Lady Pitkeathley and Lord Giddens so rightly said, families today are not universally made in the image of the 1950s, which was not a golden age for the family or, indeed, in any other respect. Fewer people today are marrying. More are living together outside marriage, and doing so for longer. Since the 1970s the number of single-parent families has trebled while the number of babies born outside marriage has increased fivefold.
While we believe that marriage provides a strong foundation for stable relationships and that both mothers and fathers have important roles to play, it is the quality of parenting and the love and support of parents and carers which matter above all, and we should always put the interests of the child first. It is essential to offer services which help all families, whatever their structure, to sustain such relationships.
Changes in employment patterns add further complexity to modern family life. As the noble Baroness, Lady Platt, said, many more women, and significantly more men, are now juggling family life with paid work. More and more parents are caring for elderly relatives as well as bringing up children. We know that parents want to be able to spend more time with their children. The Government seek to help in this area by continuing to ensure, for example, that
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The second principle underpinning my department’s action is that the Government should offer support but intervene only in the most extreme cases. Bringing up children is the job of parents not of Government, except in cases of breakdown. But we can do a great deal more than in the past to support parents in that task. I referred earlier to the development of children’s centres. This has been a path-breaking development in sustaining the work of families caring for children in their early years.
We have also invested in the Parent Know How service, which draws together existing and new information and advice for parents and makes it available through telephone helplines, the internet, and innovative channels such as text messaging. It is also why, from 1 April this year, local authorities will have to provide parents and carers with information about childcare and other services through their family information service. It is also why we are expanding the availability of parent support advisers. These currently work with parents in about 1,200 schools to improve behaviour and attendance, and to offer support directly to families at the first sign of social, health or behavioural issues. Over the next three years we will extend further funding so that parent support advisers are available in an average of 10 to 15 schools in every local authority, thus extending the current model significantly more widely.
I turn next to schools. They are perhaps the only institution guaranteed to play a major role in the life of almost all children and families, and, of course, the school is at the heart of every community. In terms of schools’ policy, first, and most obviously, we are seeking to drive up the attainment of pupils—particularly those from less advantaged backgrounds who have traditionally done less well in school—eradicate low-attaining schools and improve the quality of teaching and learning in all schools. We have made good progress in that regard. The number of failing schools has more than halved over the past 10 years. But there is much more to do. We need all our children in school to get up to basic standard in literacy and numeracy. That is a key Government priority, supported by the literacy and numeracy strategies, the literacy and numeracy hours in every primary school in the country, and, for example, the new emphasis on the use of synthetic phonics in teaching all children to read following the Rose review.
We also need much better and more fit-for-purpose employment-related skills taught in schools, as set out by the noble Lord, Lord Best, who emphasised the appropriate education for those not on a traditional academic route through school. Hence the expansion of diplomas and their introduction into new vocational education areas; the expansion of apprenticeships, which we want to restore to their place as playing a central part in the opportunities available to young people; and the importance of sport, mentioned by the noble Lord, Lord Addington, in his remarks. Since 2002 there has been a threefold increase in the proportion of five to 16-year olds participating in at least two hours of sports each week. In the last survey this
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It is also important that schools teach children about their rights and responsibilities as citizens and community members. In 2002, we made citizenship education a compulsory part of the school curriculum, focusing on the rights and responsibilities that apply to citizens as well as the proper respect due to those of different cultural background, as discussed by my noble friend Lord Parekh in his typically thoughtful speech.
From this September we will be introducing a revised citizenship curriculum after the review carried out last year by Sir Keith Ajegbo. There will be a new strand focusing specifically on community cohesion, and the promotion of community cohesion is now a statutory duty on all schools, including all faith schools, nationwide.
We are also expanding Sure Start and Extended Schools, which extend the range and community mission of schools in each area. All these measures, put together in the context of a doubling, in real terms, of education spending over the past 10 years, will address many of the issues which have been raised during the debate, and strengthen families and community cohesion.
Perhaps I may deal quickly with a number of specific issues raised in other parts of the debate. On drug abuse, my right honourable friend the Home Secretary yesterday published the Government’s updated drugs strategy, setting out how we will build on the progress made over the past 10 years, during which time we have seen an overall drug use decline, with more than 1,000 crack houses closed down, and the number of users in treatment doubled. The new focus set out in the strategy relates precisely to communities and families. For example, while continuing to take robust action against drug dealers and drug crime, we will seek to engage more closely at the community level with those who are identified as posing the greatest harm in their neighbourhoods.
In terms of gun, knife and gang crime, on 18 February the Government published their violent crime action plan, setting out plans for tough intervention and preventive measures over the next three years.
The successful work of the respect task force on anti-social behaviour is being continued and broadened by the new youth task force. We will continue to use community-based approaches involving a range of intervention options, including ASBOs and acceptable behaviour contracts. The noble Baroness was disparaging about ASBOs but the National Audit Office report in December 2006 found that after one such intervention 65 per cent of people stopped behaving anti-socially and after three interventions 93 per cent of people did so, so the evidence we have is positive.
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In conclusion, we face manifold challenges and the Government are not complacent about them. However, families and young people are mostly succeeding. Most communities in this country are safe and positive. Continued partnership between government and the wide diversity of civil society is generally a force for progress to tackle the problems that we face. We all have a part to play in forging further progress. Today’s excellent debate has focused attention on how we can do so and I end by once again thanking the noble Baroness for making it possible.
2.20 pm
Baroness Gardner of Parkes: My Lords, I thank everyone who has taken part in this wide-ranging debate. The noble Baroness, Lady Walmsley, summed up what each speaker said so I do not need to repeat it but the debate’s wide coverage was impressive. I was particularly pleased that health visitors were covered because I did not have time to do so. I was delighted that the noble Lord, Lord Addington, mentioned sports facilities—I agree with every word that he said—and the noble Lord, Lord Best, spoke about housing.
However, the real challenge came in the speech of the noble Lord, Lord Giddens, which delighted me as I come from a big family where we always argued about things. I accept that he personally—it is a policy decision—is opposed to tax breaks to strengthen marriage; however, my point was not about strengthening marriage through tax breaks but avoiding the present perverse incentive which does anything but strengthen marriage. I support the comment made by my noble friend Lady Hooper about inheritance tax. The noble Baroness, Lady Pitkeathley, made a superb case for carers, as she always does, and explained how many people are willing to volunteer to do that. However, as my noble friend Lady Hooper said, if those people eventually lose their home because they have devoted their life to caring for someone, that is a great disincentive. The Government said that they would reconsider the amendment on that matter tabled by my noble friend Lady O’Cathain although they considered that it was not appropriate for the Bill in question. I hope that they will.
The noble Lord, Lord Adonis, said that the present is better than the past. I agree, but that does not mean that we do not want it to be better still. We should all reflect on the contributions made to the debate and aim to make life better still. I beg leave to withdraw the Motion for Papers.
Motion for Papers, by leave, withdrawn.
NHS: Patient Care
2.23 pm
Baroness Eccles of Moulton rose to call attention to the quality of care given to NHS patients in both hospitals and community settings; and to move for Papers.
The noble Baroness said: My Lords, I am very pleased to be opening this debate on the quality of care provided by the NHS. We have a broadly worded
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Our National Health Service is one of the largest and most sophisticated organisations in the world and we are right to be proud of it. It is also complex and hard to manage. The debate on how best to fund, control and organise the service is never-ending. This is reflected in constant structural change, which can be wasteful, time-consuming and particularly disruptive for senior staff. The situation has been made even more complex in recent years by the rapid and resource-demanding advance of medical technology.
To go back 20 years, there was a movement in the late 1980s, early 1990s, led by my right honourable friend Kenneth Clarke, the then Secretary of State for Health, to semi-detach the management of the NHS from government. Quarry House is a most imposing building, purpose built on a hill in the middle of Leeds. There the NHS Executive directed operations with a board of distinguished executive and non-executive members, the full time board members spending a considerable part of their working life on the train between Leeds and King’s Cross. Those were the heady days when acute, mental health and community services were converted from the directly managed units of the district health authorities into trusts with their own boards of directors.
Now, many years later, the principles of independent management and degrees of autonomy are still recognised. However, there are difficulties in putting those principles into practice. For instance, in his letter introducing the operating framework and PCT resource allocations for 2008-9, David Nicholson, the NHS Chief Executive, says:
“The conditions are now absolutely right for developing a framework within which PCTs, in conjunction with their local communities, can set more of their own ambitions rather than having them mainly set by the centre: this Operation Framework is the beginning of that journey”.
This must be a very small beginning to a very long journey. The opportunity for PCTs to set their own local targets will be identified in a category called vital signs, which is to be a set of indicators that has not yet been identified. However, even before knowing what these indicators are to be, the PCTs are weighed down with centrally imposed targets. The five priorities in the “must do” category do not look too bad at first sight, but there is a wealth of detail within each priority. These priorities are by no means all, a count of targets in other categories results in an alarmingly high figure. It is hard to imagine where PCTs will find the time or energy to apply to the as yet unknown vital signs. The word “micromanagement” still rings in the ears. If the Government wish to increase local autonomy, they will need to take a more realistic view of the demands of existing targets. Will the Minister please comment?
Aspects of the programme for an NHS IT system, Connecting for Health, need urgent attention. The programme was launched by Ministers in June 2002 at an estimated cost of £12.4 billion. This would carry all patients' records and be available to all professionals working in the service. Contracts were commissioned
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More seriously, they are not able to react with speed when they visit a patient who needs prompt attention because the necessary information provided by case notes cannot be accessed. For community staff to be properly equipped is all the more important with the increasing emphasis on early discharge from hospital, and the wish to keep the chronic elderly safely in their own homes. For staff working in the field, it is essential that they should have up-to-date equipment, and that right from the start this should have been high on the priority list. Will the Minister please tell me why this part of the programme is running so late?
To turn to general practice, here are a few thoughts on GPs' ability to deliver good care. First, there is a perceived gap between medical input and social care. The patient is unwell, a clear diagnosis is made, a treatment pathway is established and clinical standards of care are brought into play. The patient is safely in hospital. This is often not the case. The patient is set up at home and, so long as there are no problems, all is well. If however, on a Saturday, the patient becomes confused and it is difficult to find a district nurse or a community psychiatric nurse for short-term crisis intervention, there is no alternative but to admit to the local district general hospital, with all the formalities and costs that entails. There are ways in which the gap could be filled; for example, with cover by trained staff at the weekend to deal with patients at home, or by admission to the community hospital where, as the condition is not acute, the patient can be stabilised and any tests can wait until Monday. Admission to a nursing home is not an alternative when there are no short-term emergency places.
Community hospitals are a valuable resource and they fill an important gap, especially as the demographic time bomb means that there will be an increasing number of frail elderly living in their own homes. Although there are opportunities for GPs to develop practice-based commissioning, these vary across the country. PCT support and input is important. Some of the services set up by GP practices take the pressure off the local DGH, but in some cases they are seen as a threat to its workload and there are fears that it will become a hospital providing emergency services only.
In his report A Framework for Action, the Minister the noble Lord, Lord Darzi, set out the proposed functions of polyclinics in London. In big cities, where there tend to be many poorly equipped,
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I will now say a little about nurse training and staffing levels in hospitals, which are matters of considerable importance. There are not enough training places in the colleges. We need not only an increase in training places but a positive recruiting campaign. Nor are there enough retraining places for nurses who have been out of service for more than five years. In some instances, nurses are required to pay to retrain. Nursing in the acute sector has become much more intensive, and there is a shortage of qualified nurses who can be directed into specialist care, for instance critical care. Nurses are now able to do more specialised work on the wards and work very closely with junior doctors. Excessively long hours are no longer worked by junior doctors, and they have protected teaching time. Highly qualified nurses provide additional skills and support for their junior colleagues at the point of registration.
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