My Lords, I will speak to all four amendments in this group in my name. I remind the Committee that I have already declared my interests, especially as regards integrated care and family hubs.
In Committee in the other place, the Minister, my honourable friend Edward Argar, recognised
“that the system has been calling for two different and important types of integration: integration within and across the NHS to deliver healthcare services within a defined locality, and integration between the NHS and local government and wider partners.”
He went on to say:
“The ICP is intended to bring together health, social care and public health to develop a strategy to address the needs of the area also covered by the integrated care board. If”—
I emphasise “if”—
“the ICP wants to go further, it can also involve representatives from the wider system, where appropriate, such as voluntary and community groups, and social care or housing providers. That will be up to the ICP, and we will welcome locally driven innovation to reflect local circumstances.”—[Official Report, Commons, Health and Care Bill Committee, 16/9/21; col. 332.]
I, too, welcome locally driven innovation to reflect local circumstances, as I will emphasise shortly. However, I am genuinely mystified as to why integration between the NHS and local government and wider partners is voluntaristic in the Bill. My Amendment 154 would exchange “may” for “must” and require integrated care partnerships to include in their strategy a statement of how health-related services could be more closely integrated with health and social care.
12.45 pm
My Amendment 155 would specify “family help” as a required subset of health-related services, access to which would include through family hubs. This wording avoids prescribing hubs as the sole means of delivery of and access to services. That said, I have been talking to seasoned health leaders in the Newcastle area who say that the current system is simply not working for vulnerable families. Parents need help navigating what is out there; the community-based access point of a family hub would be a game-changer. The Supporting Families programme, appropriately based in the Department for Levelling Up, Housing and Communities, recommends hubs in its systems guide for this reason. Moreover, the Government have invested significantly—around £130 million to 2024-25 —to develop this badly needed infrastructure and fulfil their 2019 manifesto promise to
“champion Family Hubs to serve vulnerable families with the intensive, integrated support they need to care for children—from the early years and throughout their lives.”
The second action area in the DHSC’s The Best Start for Life strategy ensures that families have access to the support they need through a welcoming family hub. As I have already said in this Committee, as well as perinatal and early years healthcare, local authorities in Essex are delivering more extensive paediatric health services to meet the same need for co-ordination identified in Newcastle. Continence, speech and language, and allergy services, among others, are provided in community settings close to families through their integrated family hubs.
Many such health needs are psychosocial and practical. Addressing them needs a whole-family approach, often through early help commissioned by local authorities. This is what integration should look like. I have always insisted that the design of these family hubs should be flexibly and locally determined, not centrally imposed. but flexibility must be geared towards meeting families’ and children’s needs. One key lesson from children’s centres was that health should be fully integrated from the start.
How that is done should be locally decided, including through consultation with local people. Also, the hub is not the place where everything happens—that would need a vast building—but it is the place through which families can access everything. Other government departments are joining up, integrating their policy goals with those of health, by actively citing the delivery of their priorities in and through family hubs. I could give many examples but, for the sake of time, I will limit myself to a couple.
The Department for Work and Pensions is keen to run its reducing parental conflict programme in family hubs, making access to couple relationship support far easier and less stigmatising for low-income families. The Ministry of Justice is funding a pilot family hub in Bournemouth, which will include a specialist family justice programme that links closely to the family court. Separating parents will be encouraged, early in the process, to use the family hub rather than go down a costly and adversarial court route.
The lack of community-based support is one of the reasons why the promise of the 1989 Children Act has not yet been fully realised, as many pointed out in publications to mark its recent 30-year anniversary. I will return to this. I need to keep emphasising that family help, particularly with relationships, is not at all niche but is erroneously treated as such, hence the need for it to be specified in the Bill. The social determinants of health have already been referred to by other noble Lords, and family-level factors in particular can make or break clinical efforts by healthcare professionals. The US Centers for Disease Control and Prevention says that children need “safe, stable, nurturing relationships” to thrive, and UK research, including from UCL, recognises healthy, well-functioning relationships as a “health asset”.
With my Amendments 158 and 167, “family help” in the Bill would mean
“services which improve children’s lives through supporting the family unit and strengthening family relationships to enable children to thrive and keep families together”.
I quote, but in a heavily truncated form, the independent care review’s starting definition, which can be read in its entirety in lead reviewer Josh MacAlister’s The Case for Change. He teases apart how this phrase differs from “family support” in local authority usage, and refers back to Professor Eileen Munro’s 2011 social work reform recommendations and the 2003 and 2009 reviews by the noble Lord, Lord Laming. Both emphasise the need for easily accessible, early help for families if outcomes for children are to improve markedly and tragedies are to be averted in more cases.
I would go even further back than that. In the earliest days of the welfare state, it was recognised that poor family functioning threatens the effectiveness of its other pillars. The ability of health, education and state financial support for families to transform the life chances of children is fundamentally undermined if parents fail to nurture their children emotionally and materially. In 1949, in acknowledgement of this uncomfortable truth, Michael Young, one of the architects of the welfare state, called for child welfare centres. These would, he said, fulfil Beveridge’s principle of the preservation of parental responsibility and deal with the emotional cost to children of high post-war levels of family breakdown.
These began to emerge as family centres in the 1980s. Many were opened by voluntary organisations such as the National Children’s Home, now Action for Children, and many had significant local authority and social services involvement. They helped parents of children of all ages, mainly in disadvantaged areas, ideally before and to prevent the involvement of social services. Family centres were included in legislation—symbolically, given today’s Bill—as part of the then Department of Health and Social Security’s contribution to the Children Act 1989. As family help was a health emphasis in that landmark law, a health Bill is a highly appropriate updating vehicle.
As an aside, in 1994, the National Audit Office, then the Audit Commission, proposed a central role for family centres in developing a more proactive partnership with parents. The commission reported that Section 27 of the 1989 Children Act—the duty to co-operate—was still not progressing well, and emphasised the need for a single point of entry to a range of multiagency support services. Plus ça change, plus c’est la même chose. We can wait until family hubs spread slowly across the country before acknowledging the need for them in legislation, or we can update the Children Act by making it reflect more accurately where more than 30 years of policy-making since then have brought us to.
There is an argument that family hubs are as yet untested, hence the Government funding rollout in only 75 local authorities. However, as I said, the principles that they are based on rest on decades of learning about what families need. We can, and must, refine the model, but hubs—somewhere families can go where someone will be able to help—are a vital missing pillar of our welfare state. I believe that, in time, they will be as indispensable as primary care and schools, because they make such a valuable contribution to their successful functioning.
As it currently stands, the Children Act 1989 is out of date in how it refers to family help in infrastructure. Paragraph 9 of Schedule 2 states that local authorities
“shall provide such family centres as they consider appropriate in relation to children within their area.”
The name “family centres” is too suggestive of a single building, while the phrase “family hub” expresses that this is an access point. It is descriptive, not prescriptive. Many family hubs refer to themselves as children’s centres. Others, such as those in Doncaster, want to shift the culture away from an exclusive focus on the early years, so they do call themselves family hubs.
Moreover, other aspects of paragraph 9 are inappropriate now. Paragraph (c), for example, refers to the family centre being a place where someone will be provided with accommodation while receiving advice, guidance or counselling. That does not happen, hence my rewording to reflect better what the hubs actually do without being overdeterminative. Local needs decided, as I said, in consultation with those who will use them, as well as in the context of integrated care partnership discussions, must be the priority.
Finally, it is with humility that I propose amending the Children Act 1989. Internationally, it is highly respected and much copied. However, the intention of my amendments is to fulfil its key principles: the emphasis on prevention, on keeping children with
their families wherever possible and on ensuring that help is available for parents who struggle to nurture their children or provide a safe and stable environment in which they can thrive. I commend these amendments to the Committee.