My Lords, I begin by thanking all the noble Lords who have tabled these amendments for debate, and noble Lords from across the House for their eloquent contributions. As the noble Baroness, Lady Wheeler, rightly said, it is important that, as the fifth-largest economy in the world, we treat all our citizens equally and give them the respect and access to services they deserve. As she also said, the strength of feeling across the House on the importance of this issue is clear, and this was amplified most eloquently by my noble and learned friend Lord Mackay of Clashfern.
With your Lordships’ agreement, I will look at some of these amendments from a different perspective. Each amendment touches on a different aspect of providing health and care for children. Before I turn to matters of detail, let me say that we believe that the Health and Care Bill’s proposals represent a huge opportunity to support and improve service planning and provision and ensure that they better meet the needs of infants, children and young people.
With your Lordships’ permission, I will start by addressing Amendment 20, which was spoken to so eloquently by the noble Baroness, Lady Meacher, the noble Lord, Lord Scriven, and my noble friend Lord Polak. It would clarify and prioritise how the Better Care Fund could be used to integrate services for children. I remind the Committee that the relevant legislation does not prevent the use of the Better Care Fund for the integration of children’s services. The disabled facilities grant within the BCF is already used to fund housing adaptation for individuals aged under 18 with disabilities. Some areas also extend the scope of their BCF-funded initiatives to include integrated services for children and young people.
However, we can go further. The Government believe that integrated care partnerships and integrated care boards represent a huge opportunity for partnership working. The Bill explicitly requires integrated care partnerships to consider whether needs could be met more effectively under Section 75 of the NHS Act 2006, which provides for arrangements to be made between NHS bodies and local authorities. The Government are also working on bespoke guidance on the measures that statutory bodies should take to ensure that they will deliver for babies, children and young people.
Turning to Amendment 51, I particularly welcomed the contribution of the noble Lord, Lord Hunt of Kings Heath, on vulnerable children. The amendment would require ICBs to share and collect information from partners when arranging for the provision of services for pregnant women, women who are breastfeeding and young children. I sympathise with the amendment, and in fact, I would go further: one of my three big priorities in my departmental portfolio, as the Minister for Technology, Innovation and Life Sciences, is to push digitalisation and sharing data. As all noble Lords have rightly said, that is not just for children’s services but right across the sector. We hear stories almost every day of something that could have been prevented, had data been shared more appropriately.
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Even asking your GP to put your data on the NHS app is not as simple as it should be. When I asked my GP to do so—I did not tell them that I was a Minister, although maybe I should have; however, I do not like to pull rank—I was told that I had to write to them. I sent an email to my GP’s surgery but to this day, the data is still not on there. That shows that the problem in making sure that we can share data and have a common architecture through which we can access it in an appropriate manner, from a trusted research environment, is not just the technology; we must also tackle the culture and the processes to make sure that data is shared. Even though we have put into the Bill provisions on data, which noble Lords will discuss later, it is not enough to say that we need a trusted research environment or to lay out a shared architecture. We must make sure that we drive that culture right across the health and social care system.
This amendment would position integrated care boards as a central repository of data in the health and care system, a function that we do not believe they are well placed to take on. As a result, I regret that we
cannot agree to the noble Baroness’s proposals. We completely agree that data has to be shared, but we see the health and social care information system known as NHS Digital as the national information partner to the whole health and care system in England—one that can better collect data and share information. I was having a conversation with an NHS manager the other day, and it is clear that there is some confusion over data. We have to distinguish between management and performance data, and patient data. Right across the health and social care system, an awful lot of time is spent on the telephone by people centrally, wanting to collect data and thereby blocking patients getting through to services they want to access. If we had the right data architecture, a lot of management and performance data would automatically be shared. That would improve the system, making sure that patients can be treated and that clinicians are aware of their data records wherever they happen to be—especially in emergency situations when they are far from home, but also daily in our healthcare system.
That is why we believe it is more appropriate for the health and social care information system, NHS Digital, to be the data partner for the whole system. We have tasked it, through the Harnessing Digital Technology workstream of the Maternity Transformation Programme, to focus on the interoperability of different records. Noble Lords will be aware that the Bill makes sure that data can be better shared right across the system, to a standard, ensuring that in some areas where data is not shared, such as GP patient records, it is better shared across the system.
I turn to Amendment 87, in the names of the noble Baronesses, Lady Finlay and Lady Bennett. It would require integrated care boards to drive improvements in child health outcomes, including through appointing a children and young people’s health lead. As your Lordships will be aware, the Bill already contains measures that require ICBs to secure continuous improvement in the quality of services and in the related outcomes, and that includes outcomes for children. ICBs will also be required to ensure that health and care services are provided in an integrated way when this would improve outcomes, but also—the noble Baroness, Lady Finlay, referred to this—when children reach the cliff-edge age whereby they are no longer considered children, but part of adult services.
There is also existing legislation—the Children’s Act 2004—that will require local authorities to make arrangements with ICBs to improve the well-being of children. As a result, the Government do not think that an extra duty would be helpful here, even if we agree with the spirit of it.
I want to take a moment to draw the Committee’s attention to some of the work already going on in this area; I thank noble Lords from across the House for acknowledging some of the work that the Government are already doing in this area. To deliver the commitments in the NHS Long Term Plan, children and young people’s senior responsible officers have been appointed at a regional level, as well as children and young people’s leads in integrated care systems. In addition, there will be wider clinical leads for children and young people
in ICBs, including leads for children’s mental health, learning disability and autism, and overseeing specialised commissioning functions.
Amendment 98 would require the Secretary of State to lay regulations to provide formal guidance on how the ICB must perform its duties as a statutory safeguarding partner. I hope I can reassure the noble Baronesses, Lady Tyler and Lady Masham, that this amendment is unnecessary as all the existing statutory duties of clinical commissioning groups—CCGs—will be transferred to ICBs anyway, including the child safeguarding responsibilities set out in the Children Act 2004. The chief executive will take on responsibility for their local health system’s part in multiagency child safeguarding arrangements and the 2018 statutory guidance, Working Together to Safeguard Children, will be updated accordingly.
Amendment 103A in the name of the noble Baroness, Lady Bennett, would require ICBs to consult an advisory board comprised of young people on matters of youth ill-health prevention and treatment provision. I acknowledge the noble Baroness’s concerns and hope that I can provide some reassurance as to our commitment to public involvement. Our intention with the duties we are looking to place on ICBs is to establish a comprehensive framework of requirements while allowing them significant flexibility to deliver it in a way that best suits local needs.
This includes a provision relating to the public involvement of all ages and requires ICBs to make arrangements to ensure that the individuals for whom services are being or may be provided are involved in the ICB’s decision-making on commissioning. The provision covers those health services relating to the care and prevention of illness among children and young people. It means that ICBs already need to ensure that young people are appropriately consulted in a way that best suits their local system needs. I hope that this will reassure the noble Baroness, who I am sure does not wish to create a duplicate provision.
Amendment 141 was tabled by the noble Baroness, Lady Tyler, my noble friend Lord Shinkwin and the noble Baroness, Lady Finlay, and eloquently spoken to by the right reverend Prelate the Bishop of Birmingham on behalf of his colleague, the right reverend Prelate the Bishop of London. It would require NHS England to publish a national accountability framework for children and young people and to use that framework to assess the boards. Again, I hope that I can give some assurance that this is already provided for in the Bill.
Under new Section 14Z57, NHS England
“must conduct a performance assessment of each integrated care board”
and produce a summary report. The assessment will look at a number of issues, including improvement in the quality of service and reducing health inequalities. It will also apply to all age groups; indeed, much of today’s debate and noble Lords’ contributions touched on some of the issues that we covered in the earlier debate on tackling health inequalities; I know that noble Lords across the House share those concerns.
Further, under the new section, NHS England
“must consult each relevant Health and Wellbeing Board … on any steps that the board has taken to implement any joint local health and wellbeing strategy”,
which is based on the assessment of relevant local needs and keeps that connection to place below the level of the ICB. As a result, I would gently advise against creating a separate national accountability framework solely for babies, children and young people simply because this would create an additional burden and risks creating confusion between accountability frameworks. We want to make sure that we have proper accountability and avoid confusion.
Amendment 142 in the name of the noble Baroness, Lady Walmsley, would require ICBs to set out in an annual report how they are meeting the needs of children and young people. I assure the noble Baroness that, under new Section14Z56, to be inserted by Clause 20, each ICB is already required to prepare an annual report on the discharge of its functions, and NHS England can provide guidance as to its content. We expect that, in preparing its report, the ICB would set out how it is meeting the needs of babies, children and young people. We believe that a report focusing exclusively on children and young people is unnecessary and likely to duplicate existing work.
Amendment 177, also endorsed by the noble Baroness, Lady Whitaker, and in the name of the noble Baroness, Lady Meacher, would require the Secretary of State to lay regulations and publish guidance on how integrated care systems should meet the needs of babies, children and young people. I hope to reassure the noble Baronesses that we are already working with NHS England, the Department for Education and stakeholders on bespoke guidance for bodies in local systems on the measures they should take to ensure they will deliver for babies, children and young people. This will include guidance on the exercise of functions currently conferred on CCGs that will be taken up by ICBs, including children’s safeguarding, and on children with special educational needs and disabilities.
I hope that I can assure the noble Baronesses that going further than this by requiring the Secretary of State to publish regulations may well interfere with the ability of ICBs and ICPs to innovate to best meet the needs of the babies, children and young people in their local population.
Amendment 162 would expand the Care Quality Commission’s duty to include children’s social care in co-ordination with Ofsted. I gently suggest that the existing clause already allows the CQC to look at the provision of health and public health services for both adults and children. It can also look at the transition between children’s and adult social care and would be able to look at the system’s role in that transition in these reviews. In addition, it already looks at the safeguarding of children in health care and the provision of healthcare to children who receive social care.
In addition, existing provisions can and do allow for the CQC to work jointly and proactively with Ofsted, for example on joint targeted area inspection or special educational needs and disability—SEND—inspections. For the CQC to look at children’s social care as proposed by this amendment would also risk duplicating Ofsted’s role. The existing mechanisms are already an effective way for the CQC and Ofsted, as well as other organisations, to work jointly, and I am
slightly concerned that any further amendment risks undermining that, which I know the noble Baroness does not intend.
Amendment 151 would require an ICP specifically to consider the needs of babies, children and young people. Once again, I hope that I can assure noble Lords that this is already our intention. The Bill states that the ICP strategy must set out how assessed needs will be met by the ICB, NHS England or the responsible local authorities. “Assessed needs” includes the needs of all children and young people aged nought to 25. If this amendment were to be accepted, it could affect how the clause is interpreted by suggesting that other population groups are not in scope or of lower priority.
In addition, the September 2021 ICP engagement document sets out that the ICP should highlight in its strategy where co-ordination is needed and specifically clarifies that this includes action to improve the life chances and health outcomes of babies, children and young people. Our bespoke guidance for ICBs and ICPs on babies, children and young people will cover the importance of ICP integrated care strategies having clear objectives for these populations.
Some noble Lords raised the sad and distressing cases of Arthur Labinjo-Hughes and Star Hobson. The Government have been deeply saddened, as have all noble Lords, by these tragic cases, and are undertaking urgent action to seek the answers we need. The Child Safeguarding Practice Review Panel is conducting a national review into these cases and what improvements are needed by the agencies that came into contact with them in the months before Arthur’s death. A joint targeted area inspection has also been commissioned to assess the effectiveness of child protection arrangements in the relevant safeguarding agencies. Together, these two actions will establish what national lessons need to be learned and how local agencies can work together to keep children safe.
I am grateful to all noble Lords who have spoken in this important debate, raising incredibly important issues but in an emotive way. I hope I have been able to give some reassurance that these matters are taken seriously by the Government. However, as the noble Baroness, Lady Wheeler, said, noble Lords should be in no doubt that I understand the strength of feeling of the Committee. This will need further conversations with noble Lords who have spoken today and those who have tabled amendments, as well as with others. I hope, for that reason, that noble Lords will feel able at this stage to withdraw or not press their amendments.
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