My Lords, I join with all noble Lords to welcome the noble Lord, Lord Stevens of Birmingham. I really enjoyed his constructive and funny maiden speech.
If integration is the aim of the Health and Care Bill, it fails in one extremely important respect, brought into stark relief by the tragedy of Arthur Labinjo-Hughes. I say this not to appropriate a hard case, but because the two reviews led by the noble Lord, Lord Laming, following similarly horrifying child deaths, both stressed the need to integrate all the services that should keep children safe. Although prevention and early intervention in the form of family help have been missing for too long from the pipeline that led to children’s social care, this lack is now finally being rectified by the Government’s focus on rolling out family hubs. Yet this important new infrastructure, which also integrates paediatric health, goes unmentioned in the Bill.
Family help needs to include an emphasis on the prevention of family breakdown, the elephant in the room of children’s social care policy. As I said yesterday after the repeat of the Statement about Arthur,
“Evidence shows that children on the at-risk register are eight times more likely to be living with a natural parent and their current partner”—[Official Report, 6/12/21; col. 1677.]
than the national distribution for similar social classes. Children living in households with unrelated adults are nearly 50 times as likely to die of inflicted injuries than children living with two biological parents. When both mother and father feel kin altruism towards a child, this can make a significant and decisive difference to that child’s health. Good family and other relationships are health assets, so the Bill should treat family-based interventions as part of the overall health approach and recognise the need to integrate them with physical and mental health provision.
Even absent this monstrous case, the Health and Care Bill should be reinforcing and integrating other cross-departmental work in government, such as the commitment to champion family hubs for families with children aged nought to 19—or up to 25, if there are special educational needs. Family hubs build on the work of children’s centres but go far beyond it and are central to the implementation of the Start4Life workstream, based in the Department of Health and Social Care. In fairness to the Government, this agenda has gathered considerable momentum since the Bill was published, and family hubs are now a big-ticket spending item in the £500 million spending-review commitment to support families.
They can also work preventively to meet children’s health needs, in relation to childhood obesity for example, as close to home as possible. In Essex, family hubs deliver midwifery and immunisation services and prevent unnecessary attendances in GP practices and A&E. They also deploy community-based clinical expertise for conditions such as allergies, continence, perinatal mental health, speech and language services and neuro- developmental conditions such as autism. This means that busy parents, who often have several children to look after, are spared lengthy and expensive hospital visits. When getting to that visit proves too difficult for the family, the ill child goes without treatment, and hospital- based services have yet another wasted appointment.
A preventive community asset-building approach requires out-of-hospital care to be protected and enhanced, possibly by ring-fencing funding for community-based provision. Yet the importance of preventive health support and treatment has not been adequately covered in the Bill. It is simply listed as one of several commissioning requirements of ICBs, with no broad mention of children’s health. Only young children are mentioned in the context of maternity services. Finally, the desired short and long-term health and well-being outcomes for children and families need to be determined, achieved and measured.
In summary, children’s community health provision must begin with a preventive community asset-building approach and be aligned and integrated with public health and local authority-funded early-help provision. As Dame Rachel de Souza, the Children’s Commissioner, said about Arthur, the life of a child is of “inestimable value”. The omission of school-age children, young people and family support was always puzzling, given the integrating imperative of the Bill. It makes even less sense in the wake of this tragedy.
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