Lords Hansard text for 5 Jul 200605 July 2006 (pt 0841)

How will the Minister guarantee—I say this having witnessed the closure of many dozens of community hospitals in the NHS through the 1970s, 1980s and 1990s—that the new community hospitals will be different from the old community hospitals in providing a truly cost-effective solution, and not, as so often happened with the old ones, a white elephant sitting in a community that could not provide the technological advances of the new central district general hospitals?

Lord Warner: My Lords, I am grateful for the noble Baroness’s support. I share her view that we need to make these new facilities sustainable and cost-effective. What is changing, and what people who read the document carefully will realise, is that we are trying to raise people's sights in terms of the range of services—diagnostic services, in particular—that can be made available. Medical technology and knowledge have moved on. We are able to provide many more procedures on a day care basis. That is another opportunity that probably was not available in the same way in the 1970s and 1980s.

The examples in the document show that people are already putting together a much wider range of services than were traditionally provided in a cottage hospital. The NHS is much better at business planning, and the document emphasises the importance of putting together a range of services that meet people's needs and can be funded over the long haul. I hope that that reassures the noble Baroness. We shall ensure that the strategic health authorities oversee these plans so that they are sustainable for local communities.

Lord Phillips of Sudbury: My Lords, I wonder whether the Minister can offer some hope and help to the situation prevailing in my home town of Sudbury,

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where two community hospitals are currently under sentence of death—fairly imminent death. Until two years ago, that would have been acceptable, because a new community hospital was planned. Since then, however, the decision has been taken not to proceed with that new community hospital. I do not want to go into the whys and wherefores, except to say that there was—as the noble Lord said that there would be vis-� -vis this new pot of money—extensive consultation with GPs, the community, and the rest of it, with virtually a 100 per cent response that a new community hospital was desperately needed following the death of the two old ones. Does the Minister think that the announcement today will allow the Suffolk West Primary Care Trust to review the decision that was recently taken? I am asking whether he sees any leeway or flexibility that might allow a reversal of that decision. I am particularly mindful of what the noble Earl, Lord Howe, said, about the problem of revenue funding. I should be grateful for any advice that the Minister can give.

Lord Warner: My Lords, I cannot, so to speak, reprieve any individual community hospital. That is not the purpose of this announcement. It is down to people locally in the form of the PCT to make decisions based on all the available evidence. Since the publication of the White Paper, we have tried to say to the NHS that, before making short-term decisions about closing particular facilities or changing particular services, it should think about the longer-term direction of travel towards moving services closer to where people live, as set out in the White Paper. The guidance tries to raise people's sights on the range of services and is certainly intended to give strong support to the general idea of community hospitals having a wider range of services closer to people. I remind the noble Lord, Lord Phillips, that changes in primary care trust configurations will come into operation on 1 October this year. It will be for many of the new primary care trusts to ensure that the decisions are appropriate for communities in their particular areas.

Baroness Howarth of Breckland: My Lords, while welcoming this document with my noble friend, I ask for the Minister’s reassurance on behalf of another group of communities: those with specialist needs. I speak with a particular interest in children with cardiac difficulties. These communities would prefer not to have their services close to home but to have the best possible services that specialists can provide. Many children with, for example, hyperplastic left heart syndrome depend on a few specialists who know how to carry out a set of complex heart operations. I am looking for reassurance on their behalf that, while we develop this community service—which, as I say, I welcome—their needs will be thoroughly recognised. There are fears, particularly in Birmingham, that services are being lost.

Lord Warner: My Lords, of course I accept the noble Baroness’s general point. We are concerned that specialist services are appropriately commissioned,

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which is why I commissioned a review by Sir David Carter, the former Chief Medical Officer for Scotland. We published his report on specialised commissioning to ensure that those specialised needs were properly met and that people in the NHS came together in commissioning mode to ensure that the specialised services were not neglected and were properly provided for.

Lord Christopher: My Lords, can the Minister help me with Cheltenham, where I grew up? When this Statement receives the publicity that I think it will, there will be considerable confusion. Prima facie, we are going to provide local and personal services wherever that is safe and more convenient. Two segments of hospital work in Cheltenham are being moved 12 miles away to Gloucester: paediatrics and maternity. Neither is necessarily wholly covered by this paper, but the population will be very confused by, on the one hand, the decisions that have already been taken and, on the other, what is now proposed in this paper. Can the Minister please help me?

Lord Warner: My Lords, the community hospitals document and today’s announcement in no way suggest to local people that there may not be some need to modify aspects of their service provision, as may well be going on in the part of the country that my noble friend mentions. We are not saying that all those changes that are being consulted on—and where change may indeed be needed—should be put into abeyance while this document is considered and absorbed by people locally. We are saying that, when people in the NHS have to reconfigure local services for a variety of reasons, they must take into account the options relating to services that might be put into a community hospital. I shall be happy to look into my noble friend’s concerns if he writes to me.

Lord Biffen: My Lords, does the Minister foresee a substantial expansion of the number of renal satellite units in the execution of this policy, particularly in the spirit of trying to bring treatment closer to patients?

Lord Warner: My Lords, there is potential in that area, so I can reassure the noble Lord in that regard. It will be down to local people to work out the best—the safest as well as the most convenient—way to provide particular services, which is the big message of this announcement. We must leave that to the clinicians, managers and local populations to sort out for themselves in particular localities.

Lord Roberts of Llandudno: My Lords, health is a devolved matter in Wales, but concern about the continuation of community hospitals is just as great. Do the Government envisage a similar investment by the Assembly to make such projects possible in Wales?

Lord Warner: My Lords, I am sure that the noble Lord does not expect me to commit the Assembly in any way in this area. I believe that the Assembly already has access to this information, but I will make

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sure of that. However, I am sure it will wish to consider how these ideas can most appropriately be applied in Wales.

Lord Walton of Detchant: My Lords, I welcome the Minister’s Statement. It concentrates on capital provision for building new community hospitals, but is there a possibility that community hospitals that have closed may benefit from this new money if local circumstances allow? For example, some years ago, I was greatly involved in a campaign to save a much-loved community hospital in Burford, in the Cotswolds, which provided in-patient care for patients discharged from acute hospitals, had a newly built local accident and emergency department—which had been paid for by more than £200,000 raised locally—and provided outpatient services, minor surgery and many other services. If local primary care trusts agree, could some of this money be used to reopen that hospital, which is still—to use a common phrase—fit for purpose?

Lord Warner: My Lords, where local primary care trusts and other stakeholders decide that a particular facility could be refurbished or reopened to meet a particular need and have a well-thought-out plan that can be sustained financially, it will be possible for them to seek capital money to redevelop or reopen those facilities, provided the services are what the local community needs and can be sustained.

Baroness Masham of Ilton: My Lords, is the Minister aware that there is considerable concern throughout the country about cuts in the number of specialist nurses and occupational therapists who help people with long-term conditions? Can he assure the House that people with long-term conditions such as Parkinson’s disease, rheumatoid arthritis, diabetes, multiple sclerosis and cancer get the right sorts of drugs? Who will monitor those drugs if such people are treated closer to their homes? Can the Minister assure the House that consultants will come out to see patients who cannot come in to see them and that there will be highly trained staff to treat patients, not just cheap care assistants, which happens in many hospitals?

Lord Warner: My Lords, these changes are to ensure that safe and effective services are provided closer to people. We know that specialists in existing community hospitals—for example, the one I visited yesterday—carry out sessions and see people in that setting. We expect that to continue. These changes mean that there will be a range of specialist and general services in community hospitals. I share the noble Baroness’s support for the splendid work done by specialist nurses, such as those concerned with Parkinson’s. We hope that that will continue, but more of the work will take place in community settings in future.

Lord Stoddart of Swindon: My Lords, I welcome these proposals, but how will local populations be able to put pressure on primary care trusts to establish

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local hospitals? I fear that there will be some inertiain transferring services from acute hospitals to community hospitals. What pressure can be put on the primary care trust to establish these community hospitals, which may sometimes be extremely difficult?

Lord Warner: My Lords, I welcome the noble Lord’s support for these proposals. It is down to people locally to use methods open to them to bring their views to the attention of the primary care trust. That can involve their MPs working together, sending petitions or involving their local councillors and local authorities, and, possibly in some cases, using voluntary organisations to make their views known. Some of these deputations have sat in my room and they are articulate in putting across their views. The NHS has to think about how to respond best to some of the concerns. In many places, it is getting better at engaging in public consultation about how to reshape services.

Lord Colwyn: My Lords, two speakers—perhaps even the Minister—have mentioned this new money giving community hospitals new teeth. Can I take that literally?

Lord Warner: My Lords, if the noble Lord listened carefully to the Statement I repeated, he would know that dentistry was mentioned in some of the possibilities.

Education and Inspections Bill

4.16 pm

The Parliamentary Under-Secretary of State, Department for Education and Skills (Lord Adonis): My Lords, I beg to move that the House do now resolve itself into Committee on this Bill.

Moved accordingly, and, on Question, Motion agreed to.

House in Committee accordingly.

[The CHAIRMAN OF COMMITTEES in the Chair.]

Baroness Buscombe moved Amendment No. 1:

(a) promote high standards, and (b) promote the fulfilment by every person concerned of his educational potential.””

The noble Baroness said: I speak to Amendments Nos. 1, 8 and 10. Amendment No. 1 attempts to strengthen the commitment made in the Bill to the high standards of education and the promotion of the

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potential of every person attending our schools. I say “person” because our Amendments Nos. 8 and 10 seek to clarify the definition of children and young adults attending our schools. I prefer to define those children and young adults as people. I have teenage sons and a teenaged daughter who I know would seriously object to being referred to as “children”.

Amendment No. 1 first and foremost reinforces the duty to promote high standards in schools and the fulfilment of potential. While the Bill states that as an intention, I remain wary of its precise wording. My amendment is prompted in part by a letter from the Minister in another place to my honourable friend Nick Gibb MP. The Minister stated that, as the Bill stands, local authorities will have a duty to act “with a view to” promoting high standards, fulfilment of potential and fair access, which I will address in a moment. He added:

He went on to say that the clause would be the,

While that principle is entirely in line with the thinking from these Benches, I believe that we are in danger of expecting aspiration to produce a reality.

The amendment would place a solid duty on local education authorities to promote high standards and the fulfilment of potential. The key word is “promote”. This is not a duty to produce high standards—that is the job of schools, not local authorities. A direct duty, as laid out in my amendment, would instil in every local authority a working function of promoting high standards and the fulfilment of potential.

My amendment also omits the reference to “fair access” added to the Bill in another place. I confirm to the Committee that that omission is in no way an attempt to prevent children from all backgrounds and walks of life having access to whichever school they wish. Rather, I did not see the merit of its inclusion. Clause 1(1)(c) states that local authorities need to ensure,

Paragraph (a) provides that high standards must be promoted. The net effect of those two paragraphs will, if they are successful, be to ensure that each individual child receives an education that fulfills his potential to a high standard.

I should be grateful if the Minister could inform the Committee precisely what the inclusion of “fair access” contributes to those aims and could give me a precise definition of “fair” in this context. I fear that although it may look perfectly harmless in the Bill, the inclusion of a fair access clause without the appropriate definition could encourage local authorities to stifle diversity in favour of the “deadening uniformity” that the Bill is intended to get rid of.

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I want to ensure that the Bill is remembered for its effectiveness, not merely its intention. I look forward to the Minister's response on both those matters and I beg to move.

Lord Judd: I rise to speak to Amendment No. 2 standing in my name and that of my noble friend Lord Plant and the noble Baroness, Lady Stern. They asked me to make plain that they are very sorry not to be in the House this afternoon. They are members of the Joint Committee on Human Rights, of which I am also a member, which is paying an important front-line visit in the context of its current inquiry into human trafficking. I have, as it were, leave of absence to be here. In that context, it may be appropriate to mention that our concern arose as a result of our examination of the Bill in the Joint Committee on Human Rights. There has been a great deal of correspondence with the Minister and we very much appreciate his always fulsome replies.

The purpose of my amendment is to make the same provision for a statutory right to education in England and Wales as is made for Scotland in the Standards in Scotland’s Schools etc. Act 2000. I know that my noble friend will argue that that right is well established in the first protocol of the European Convention on Human Rights and in Article 28 of the United Nations Convention on the Rights of the Child. If that right is established in those conventions to which we as a nation have voluntarily put our names, why on earth not spell it out clearly in the Bill? The purpose of the amendment is to state categorically the right of the child in this context from which all else will follow. It also spells out the responsibility of the local education authority to ensure that that right is fulfilled.

When one looks at the drafting of the Bill, it is fair to say that it is a little tentative. It talks about target duties and,

The amendment would provide that the basis of everything in our educational policy was the right of the child to education, established in law, which is paramount, and that that is the fundamental point of reference. We think it would strengthen the Bill. I feel very excited about much of what is in the Bill, but it is a pity that we have not taken the opportunity to spell out in it what we subscribe to in the conventions, and I do hope that my noble friend will feel able seriously to look at this.

Quite apart from his correspondence with the Joint Committee, the Minister has been good enough to have full correspondence with me as well, which I greatly appreciate. I know that he and the Government attach considerable importance to the ruling of the noble and learned Lord, Lord Bingham, in the Ali v Lord Grey School case in 2006, who rejected the Court of Appeal’s finding that the article had been breached by an unlawful exclusion and outlined the way in which the law in England and Wales fulfils the convention rights. As the Minister pointed out in his letter to me, the noble and learned Lord, Lord Bingham,

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We would all applaud that, but what it simply does not state is that the child has a fundamental legal right to education. We have missed an opportunity to state something that would put everyone in the position of having to ensure that that right is fulfilled.

Lord Rix: I speak to Amendments Nos. 6 and 9, both tabled in my name and in the name of my noble friend Lady Darcy de Knayth.

Amendment No. 6 would correct an anomaly between academies and other publicly funded schools in the admission of pupils with a statement of special educational needs. At present, with an LEA-maintained school, parents can expect that, if the LEA agrees with their expressed preference, it will direct a school to take their child. However, with an academy, the child may not be admitted to the parents’ preferred school even where the LEA agrees with the parents’ stated preference. There follows a convoluted and time-consuming process, with mediation arrangements to resolve the disagreement between the LEA and the academy, followed by an appeal to the Special Educational Needs and Disability Tribunal, followed ultimately, if necessary, by a ruling by the Secretary of State. It seems unnecessary to take so many steps and for there to be so many more hurdles to jump through for parents of a statemented child who want their child to go to an academy than for parents who want their child to go to an LEA-maintained school.

The question whether academies take more statemented pupils than do maintained schools is rather different from the question of whether there is an unequal process. The extra hurdles faced by parents who want an academy place for their statemented child are still extra hurdles, however many statemented children there may already be in academies. The Minister said at Second Reading that he and his colleagues are looking to see whether they can make further changes in this area, and I look forward to hearing the result of these deliberations.

Amendment No. 9 is about support services and the impact that good support services can have on ensuring that every disabled child and every child with SEN can achieve their educational potential. No child can achieve their educational potential on their own. For disabled children and children with SEN, support services providing training, support and advice to teachers are crucial to supplement and complement the expertise that exists in any school. As noble Lords will know, training in SEN and disability is not

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required in initial teacher training, which makes ongoing access to such training all the more crucial for teachers. Ofsted’s 2005 report on the impact of LEA support and outreach services sets out how support service staff can bring in knowledge and skills which are usually unavailable in a mainstream school, and make a major contribution to a pupil’s progress.

However, support services are under threat. The practice of delegating funding directly to schools to support disabled pupils and pupils with SEN, while helpful in many ways, means that for some LEAs it is very difficult to maintain support services. In some cases, support services are not being purchased by schools because they do not have enough money to buy the services back. In other cases, it is because teachers are not aware of the support available to them or do not understand the difference it could make. According to Ofsted,

That reduction in capacity could have a real effect on pupil outcomes.

Amendment No. 9 places a duty on LEAs to make sure that support services are available. I hope that the Minister will be able to offer some reassurance that the support and expertise, which make such a difference to the progress of disabled children and children with SEN, will continue to be provided.

4.30 pm

Baroness Walmsley: Before I speak to my Amendment No. 7 in this group, perhaps I may make one or two comments about what has been said on the earlier amendments. First, I must express surprise that the Official Opposition want to remove the reference to “fair access” from the Bill. The noble Baroness, Lady Buscombe, said that she felt that it might stifle diversity, but on these Benches if we were given a choice between diversity and fair access, we would choose fair access any day.

I very much agree with the noble Lord, Lord Judd, on the need to give every child a right to an education. Our Amendment No. 24 on the education authority being the provider of last resort for children not receiving a suitable education would achieve roughly the same thing. I support the noble Lord’s wish to put this principle, based on the Convention on the Rights of the Child, at the beginning of the Bill. We also support the noble Lord, Lord Rix. I feel very sad that the evidence about the activities of some academies means that we need his Amendment No. 6. On his Amendment No. 9, I hope that he will support our Amendment No. 183, which requires SEN training for teachers at every stage of their training.

Amendment No. 7 would tie the highly desirable objective of promoting individual fulfilment to a personalised learning approach and access to the appropriate resources. When a similar amendment was debated in another place, the Minister said that personalised learning was a key part of the Government’s proposition in Clause 1. We agree with that and welcome it. He also pointed out that new

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funding would be available to support personalised learning. We welcome any new funding, but we question whether it will be enough. I shall say more about that later. The Minister then pointed out that the effect of the amendment would be to rule out some other local authority functions that also have a bearing on a child’s attainment, apart from teaching and learning, such as those concerning admissions systems, transport, pastoral support or extended services.

Our intention in tabling this amendment is to probe the Government on the practicalities of fulfilling their welcome commitment to personalised learning. It is certainly not intended to rule out all other local authority functions that have a bearing on a child’s attainment. Perhaps if we pursue this amendment, we ought to change it to “teaching and learning” and other support.

However, the DfES has stated that personalised learning complements and delivers aspects of the Every Child Matters agenda. The outcomes of this, which focus on giving every child the support they require whatever their needs, abilities, background or circumstances, link closely with the possibilities created by personalised learning to tailor learning and to tackle all the barriers to learning. The 2005 White Paper, Higher Standards, Better Schools For All, discusses personalised learning in detail. It refers to an education system that focuses on the needs of the individual child. However, the provision of personalised learning outlined in the White Paper focuses on,

It seems to focus on outcomes rather than the whole child. While these two aspects are critical, I suggest that the document reflects a narrow view of personalised learning which focuses largely on its provision. For example, too many children struggle with their communication skills, those of listening and speaking. We need a national strategy to help all schools deal with that issue.

A commitment to personalised learning has very wide implications for the workforce and for the curriculum. The school workforce remodelling agenda, with its impact on the role of the teacher, the management of a wider range of professionals and on the organisation of a range of resources, has considerable implications for the way learning is structured in the future, both in and out of school. The NUT document, Bringing Down the Barriers, argues that two conditions need to be established for personalised learning to succeed. It states that a fundamental review of the national curriculum and its assessment arrangements is essential to meeting the aspirations of personalised learning and that young people need to be able to experience and teachers need to be able to provide much more one-to-one teaching. So these are the very broad implications of the Government’s new commitment to personalised learning. Can the Minister assure us that they will be looked at and that there will now be an entitlement for every child to personalised learning

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so that he or she can fulfil their educational potential, and that schools will have the appropriate resources to actually deliver it?

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