Queen’s Speech

My Lords, I, too, am grateful for this opportunity to debate the Queen’s Speech, and I am honoured to follow the Front-Bench speakers. I say to the Minister that I was particularly pleased to hear that the Government are giving further attention to tobacco. When the noble Lord, Lord Hunt of Kings Heath, took important measures on tobacco through this House, we were reminded that if a mother smokes at the wrong time, a baby can experience a lower birth weight and his IQ can be impaired for the rest of his life. We also know of the impact of smoking on the respiratory health of children, so I welcome the further attention in this area and I know that the House will give it careful consideration. I also welcome what the Minister said regarding the small but important point of giving teachers more time for planning. I am heartened to hear from many people, and to see from the statistics, that teaching is becoming an increasingly attractive profession and is gaining a higher and higher status. It gives me great hope for the future that we are now valuing teachers as we always should have done. I also wish to refer briefly to what the noble Earl, Lord Howe, said regarding the inattention and lack of priority given to the quality of patient care. It reminded me of research comparing children’s homes in this country with those in Denmark and Germany. Using a vignette, staff were asked about their priorities. In this country, if a child in a children’s home cries in his bedroom at night, the staff’s first priority is to follow procedures. That is no reflection on the staff; it is just where we have got to by giving insufficient attention and support to this sector over a long period. On the Continent, the response would be to care for the child by giving him a hug, and carers would not feel inhibited about doing that. In the short time available, I want to concentrate on the children’s workforce, which is so important in implementing all the legislation that the Government have brought forward in recent years, particularly on the theme of partnership, with Every Child Matters and Care Matters. The Government’s strap-line for this is: working in partnership to improve outcomes for children. I emphasise how important a strong, professional identity is in the workforce in achieving an effective partnership. It is something that we have worked for and wished for over many years, but again and again we see partnership working, the sharing of information and working together for outcomes fall down in various places. I was encouraged to hear that at the weekend the Secretary of State, Mr Balls, said that he now wants to give social work the same attention that the Government have successfully given to teachers and that he wants to raise its status in the same way. I was also very pleased to hear Mr Sheerman, the chair of the Select Committee in the other place on children, schools and families, talking to a group on early-years childcare and enthusing about the continental model of pedagogy, which is a specialism with a heavy emphasis on child development, on hearing the voice of the child and on developing vocational skills to engage with children. It seems to be very successful on the Continent and I am glad that the Government are looking at it. Perhaps I may briefly illustrate what I mean by partnership and by strong professional identities, both of which are important. Some years ago, I visited a hostel in King’s Cross for 18 to 23 year-old drug addicts. On a Friday afternoon, I spoke to a mental health nurse, Gabriella Maceirras. She and two other mental health nurses had been appointed to that setting nine or 10 months earlier, and she explained to me how her two colleagues had burnt out in that period. No thought had been given to what support they might need in working in that environment—their need for supervision and mental health services support. She described how she had to mother all these desperately needy young people who were queuing up outside her door but how she was simply not supported. She also said that she felt she was working blind in that area because of the lack of support and a lack of access to mental health services. On a more positive note, I had another experience at about the same time when I visited a hostel for young rough sleepers in Olympia in west London. People working with them on the streets were saying that when they sent young people to this setting they stayed there, unlike in other settings. They did not leave and go back on to the streets, and therefore I was very interested in this service. I met two of the young people: a young woman who had scars on both wrists from self-harm, and a young Irish man who had been in the country for perhaps a couple of years but had been on the streets on and off throughout that period. Both were settling down in this establishment. The manager of the hostel said that she put this success down to the very close partnership with a child and adolescent psychotherapist, who visited the setting once a week. He gave the manager an hour and a half of his time and worked with the staff group for an hour and a half to examine their relationships with the young people and to give them the confidence to do their job well and sustain those relationships. This large organisation was providing support for the most challenging young homeless people but what struck me most was that, when I looked at the statistics, I could see that it had the lowest sickness absence rate. Therefore, if staff are well supported and work in partnership with professionals and with a strong professional identity, they can be far more effective and enjoy their work, even in challenging circumstances. However, such models are very fragile. A year or two later, that service was lost, as it no longer had support from CAMHS. People are very good at looking at the cost of things but not at judging their value. Quality—a matter referred to repeatedly by the Minister—is very important but it has been overlooked in this area. Over a number of years, I have sought to encourage, and make universal, the notion of partnership with children’s homes. In his report on children’s homes, Choosing with Care, the noble Lord, Lord Warner, said that, when giving evidence to him, psychiatrists said that on the Continent it is the norm for such homes to have a regular, ongoing relationship with a mental health professional at a psychiatric level—that is, a high-level mental health practitioner. The staff get to know him and he deals with the staff rather than with the young people. That is normal, and in children’s homes on the Continent, the level of mental health disorders in young people is far lower than is the case here. In this country, staff are left to deal with a very high level of mental health disorders—the ONS identifies 68 per cent of children in children’s homes as having such a disorder—often without important, high-quality support. Over the years, I found that a piecemeal approach was taken and often the quality of the input was not as high as it should have been. The reason for that was the low status of staff in children’s homes, their lack of a conceptual understanding of what is necessary in their relationships with the children, their lack of understanding of child development and their lack of confidence, which made it very difficult for them to engage with mental health professionals and to recognise their need for that support. I move on to the subject of social work. The degree course introduced five years ago is very welcome but there is still an awful lot of work to be done in developing the social work profession. Recently, a social worker told me that his son was accepted on a social work course with an offer of just two D grades at A-level. We want people with strong interpersonal skills and a good experience of social work, but we also need people who are thoroughly able to make good, clear judgments in difficult situations and who can analyse complex situations. After all, some of these people have to decide whether a child should be taken out of its family and placed in foster care, or whatever, which may have an impact on the rest of that child’s life. We need to address that issue. Professionals working in partnership with social workers tell me that their experience is variable. Social work has become a somewhat unattractive profession for various reasons over the years. I am grateful to the Government for looking at this issue. The Teacher Development Agency has been effective in ensuring that the right calibre of student gets on courses, that courses are of the right quality and that recruitment campaigns are effective. That would be a very welcome model in this area. Even if one is successful in that, the point made by the noble Baroness, Lady Barker, about boom and bust was important. History seems to suggest that many people of great acumen have entered social work but the constant cutting of resources and lack of certainty about the future has driven them out. It is no good addressing just this side of the issue; there needs to be continuity of resources. I shall refer briefly to health visitors, a profession that has been around for 150 years and which has a strong professional identity. In recent years it has lost its statutory protection; there has been a dilution of health visitors now working with nurses. They have a specialist skill in working with families in the early years but their numbers have reduced by 10 per cent in recent years. When the family nurse partnership, an interesting model used to target certain very vulnerable families, used health visitors to train in this model of working there was a 50 per cent improvement in outcomes. It pays to have high-level professionals in the field. Will the Minister say what guidance is being given to primary care trusts to give more priority to health visiting? Is he considering whether their professional identity might again be protected in statute? I have gone beyond my time. There is so much to say about the workforce. Commissioning is vital and attention must be given to children’s homes. Unfortunately in the current economic climate the best quality children’s homes, where there is a true partnership with mental health which is more costly, are closing. We are being left with the poorer quality ones. Children’s homes are an important aspect of provision. Foster care is very important, as is adoption, but for some children a residential children’s home is the right place. We cannot afford to let that slip so I hope more attention will be given to that area. I look forward to working on the legislation on children in the forthcoming months.