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Mental health concerns remain, unfortunately, underdiagnosed and undertreated. Also unfortunately, but not surprisingly, they are more likely to appear in people struggling in lower income brackets. Failing to address a health concern in a child at a young age can lead needlessly to lifelong problems.
It is also not just the physical and mental health of the child that the Secretary of State must concern himself with. The Minister is well aware of the impact on employment prospects a physical or mental health problem has. Even where this is not the case, children growing up in a household with a parent with a health problem are often forced to take on the role of carer themselves. Not only are these children at risk of being brought up in a workless household, they must also struggle to fit their lives around the needs of their parents. I beg to move.
Baroness Butler-Sloss: My Lords, perhaps I could support this amendment. It is very important that one recognises that mental health problems, both for themselves and for their parents or other carers, are among the problems that children in the poorest families have. To have the word "health" here rather assumes physical health. Of course, technically a description of health would include mental health, but it does tend to be overlooked. It is a wise precaution to have it in here, in order to alert those who will be dealing with strategies to have in mind the mental health both of the children, and particularly, as the noble Lord, Lord Freud said, of the families. One of the elements of poverty is the very considerable mental health problems of the carers, often induced by drugs or drink.
Baroness Walmsley: My Lords, may I simply observe that when we become a society that does not feel it necessary to specify that health includes mental health as well as physical health, we will have become one that gives mental health the appropriate attention and resourcing that it deserves?
As he is aware, we have deliberately set out the main areas of policy in broad terms in Clause 8(5) to allow the strategy to respond to changing circumstances between now and 2020. Part of the task in developing the strategy will be to consider the specific measures which are needed in each area.
As many noble Lords have pointed out, there is an important link between health issues, particularly mental health issues, and the causes and consequences of child poverty. Health and employment in particular are fundamentally linked; the noble Lord made that point. Health has an impact upon an individual's ability to enter, remain in and return to work and can affect a parent's ability to provide for their family. Equally, work, or the lack of it, can have an impact on an individual's health. There is good evidence that living in a workless household has a measurable adverse impact on later mental health and individual resilience.
The Black review of the health of Britain's working-age population was published in March 2008. Dame Carol estimated that the annual economic cost of ill health in terms of working days lost and worklessness was, according to the spreadsheets, over £100 billion. The economic costs in terms of the waste of human potential are matched by the personal cost to the health and well-being of individuals and their families. The government response to the Black review, published in November 2008, launched a package of initiatives aimed at improving the health in work of Britain's working-age population. The initiatives are designed to create new perspectives on health and work, improve workplaces and support people into work.
In relation to mental health specifically, recently we asked three experts in the field of mental health-Rachel Perkins, Paul Farmer and Paul Litchfield-to carry out a review into the ways in which we might be able to reduce the high levels of worklessness among people with a mental health condition. The findings of the review, entitled Realising Ambitions, Better Employment Support for People with a Mental Health Condition, was published in December 2009. We will consider those recommendations and respond in due course. The amendment asks for the inclusion of health in subsection (5)(c) to be broken down into physical or mental health. It is our view that the amendment is unnecessary, because as has been recognised in a powerful way by the noble Baroness, Lady Walmsley, "health" is already wide enough to cover physical and mental health. As I have already said, the building blocks are broad areas for consideration when preparing the strategy, and we should avoid being too prescriptive in the wording.
Again, we are not apart on the need to address mental health as part of these strategies. The noble Lord suggested that not enough had been done in relation to mental health. I will not take the time of the Committee to run through a great deal of work that has been done in recent times and the investment that has been made, but I do not think that we are apart on the need to see this as part of the strategy, only the need to include it in specific terms in the Bill. On that basis, I hope that the noble Lord will not press the matter.
Lord Freud: I thank the Minister for that response. I should assure him that this amendment is not trying to get employment for psychoanalysts. I am most grateful for the observations of the noble and learned Baroness, Lady Butler-Sloss, and the noble Baroness, Lady Walmsley. The noble and learned Baroness in particular put some of the arguments better than I managed to myself.
Good work is going on. Dame Carol Black and Rachel Perkins have produced work that meshes together well. It is for that reason that I am slightly disappointed, rather than baffled, that the Minister finds it worthwhile to resist this rather minor change. The reason I think it is a valuable change, and why I think that he would consider it of value, is that mental health is not a marginal issue in the community we are talking about; it is a substantial part of the problem. In the community of people on invalidity benefit and employment support allowance, which comprises around 2.6 or 2.7 million people, it should be noted that 42 per cent entered the category for mental health reasons. There are estimates that very many of those people who go to IB without it end up with some mental problems because it is actually a rather depressing existence-depressing and worse-being on IB. We are talking about well over half of that very substantial group of people affected by mental health. As the noble and learned Baroness, Lady Butler-Sloss, and the noble Baroness, Lady Walmsley, said, when you use the word "health" it is not appreciated that mental health is encompassed in it. It is just not normally thought of immediately.
This is a very simple amendment which is designed to reinforce a very important point which affects a large number of people who are directly in the category that a child poverty Bill is involved with.
Lord McKenzie of Luton: I do not want the noble Lord to finish without making it clear on the record that I hope nothing I said could or should be interpreted as saying that I think this is a minor issue. Mental health is a very important issue, which is why a lot of investment has gone on in it. It is one that clearly has an impact on child poverty and will need to feature prominently in the strategy. I think we just depart on whether it needs to be specifically mentioned. It is an important issue.
Lord Freud: I thank the Minister for that intervention. I absolutely do not want to say that he was saying that it is a minor problem, because I know perfectly well he knows that it is not a minor problem; it is a major problem. This, however, is a declamatory Bill in a lot of its aspects. I do not mean to be rude-do not take that in the wrong way-it is trying to say that child poverty is important. In that sense, it is a Bill that is trying to make a point and shift perceptions generally. In that context, it would also appear to be absolutely appropriate to take "mental health" out, and make clear that it is vital in that context. So it is an incredibly small change in the sense that it is just perceptions and one can interpret health to be mental health-people do-but you are making a statement about the importance of mental health in this area and I think that is valuable in the context of an attempt to deal with child poverty.
Baroness Thomas of Winchester: My Lords, with the leave of the Grand Committee, and at the request of the noble Earl, Lord Listowel, I will move Amendment 33A in his name. He very much regrets that he cannot be here today.
As the Minister has grouped a later amendment with this one, this is the right place to have a short debate about the whole subject of free school meals and milk for children whose families receive working tax credit. We have a lot of sympathy with the first two amendments and wholeheartedly support the Government's amendment, which increases free school meals and milk to primary school children whose families receive working tax credit.
The first amendment, Amendment 33A, would insert the words "and nutrition" after "health", which would mean that the Secretary of State had to consider what, if any, measures ought to be taken in the area of health and nutrition, as well as other matters, in preparing a UK strategy. The second amendment, Amendment 41A, would add another paragraph:
"In preparing a UK strategy, the Secretary of State must consider the desirability of extending eligibility for free school lunches and milk to secondary school pupils in the UK whose parent or parents are in receipt of working tax credit".
I freely admit that there are no accurate costings in any of this, although we think that they might be in the region of £1 billion as a maximum. At this stage, no one is advocating that the Secretary of State should do anything other than look at the merits of this proposal. However, the more I think about the amendment, the more taken with it I am. Not only would free school meals for this cohort of children be good for their health, but other benefits would flow. A lot more children would be eligible for free school meals and this proposal would not stigmatise those who at present are reluctant to be singled out for fear of being labelled poor. I gather that there is a real
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School meals are now prepared according to the Government's new healthy eating guidelines for secondary schools, which were introduced in September 2009, thanks in part to Jamie Oliver, I believe. We all heard a few weeks ago about the unhealthy lunchboxes that many children bring to school. According to research carried out in Leeds, less than 1 per cent of school lunchboxes meet the Government's healthy eating guidelines. That is across all socio-economic groups. I hope that the noble Lord, Lord Freud, knows what I mean by that. Poor nutrition for children leaves a legacy of ill health in adulthood, such as the increased risk of cardiovascular disease and diabetes. Many parents are probably at their wits' end to know what food to give their children at lunchtime. Should it be convenience food that they know will be eaten, such as crisps, or should it be healthy food, which might be left? In any case, for children to be offered a hot and nutritious meal, particularly in the middle of a freezing winter such as this, must be a good thing.
Another benefit is the increased concentration of well nourished children. In one secondary school in Norfolk, teachers reported a marked improvement in afternoon learning, behaviour and attendance at school clubs when children had eaten a school lunch. This is an important finding and must be factored into the whole debate. Here I pay tribute to the West Norfolk Women and Carers' Pensions Network and in particular Alexandra Kemp, the chief executive, who has done a lot of interesting and important work on this issue.
Many other benefits flow from a much larger cohort of children having school lunches prepared on the school premises. The local economy would be boosted by more local sourcing of meat, vegetables and fruit, leading to an environmentally friendly reduction of food miles. There would be the potential for upskilling more kitchen staff, which could lead to many of them studying for NVQ level 2 in catering, as has happened in schools where more of them have prepared their own food. A lot more part-time and therefore family-friendly local jobs would be provided with the school holidays free.
There would be a need for people with computer skills to help to use the relevant computer software that checks nutritional standards and there would be a need for proper nutritional advice and so potential for career advancement for catering staff. It is worth noting that private companies can charge £200 a day for such advice, which, of course, most schools cannot afford. There is scope for the Future Jobs Fund to cover extra staffing costs and training-I would be interested in the Minister's comment on that. As for the reduction in costs to the NHS because of the potential for improved health outcomes, this might be over the longer term, but it should not be overlooked.
In West Norfolk, a case study was carried out with extremely beneficial results. Children were involved in helping to create menus; local suppliers and farmers had increased business; the school had more autonomy
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To sum up, we believe that the way in which we nourish our children has a major bearing on child poverty. There is a great deal of merit in this amendment, which we believe should be considered. I beg to move.
Lord Taylor of Holbeach: My Lords, I start by declaring an interest. It is unusual when I am wearing my Work and Pensions hat that I have to declare that I am a farmer and grower, but I suppose that I have a particular interest in this subject. I thank the noble Baroness, Lady Thomas, for picking up the amendment, because I think that it is an interesting one on which the Committee will find itself largely united in support.
We welcome the amendments and entirely support the noble Baroness in her concern for proper nutrition at all ages. We discussed at length the enormous impact that maternal nutrition has on the health of the unborn child. I am mindful of the interesting contributions to that debate made by the noble Baroness, Lady Finlay, who is not in her place, and the noble Lord, Lord Rea; they added much to the Committee's knowledge on the subject. I am glad that we now have the opportunity to look at similar effects later in the child's life.
A great deal of academic and government research is available on this topic. The results are clear: eating a nutritionally healthy meal at school improves the child's behaviour and education results. This appears to be true at all ages. The School Food Trust's studies last year indicated that children in both primary and secondary school were more likely to concentrate and be engaged and alert in the classroom when changes were made to the food and dining room. The comments of the noble Baroness, Lady Thomas, about the West Norfolk experience reinforced this work.
Following Jamie Oliver's campaign to make school meals healthier, the Institute for Social and Economic Research at Essex University issued a report showing the statistically significant improvement in key stage 2 exam results. It seems clear that, where school meals are done well, they are enormously beneficial to children. This is equally if not more true for the subset of children eligible to receive free school meals, who are even less likely to receive sufficient or proper nutrition at home. I therefore welcome the Minister's decision to allow for the extension of free school meals to a wider group of lower-income households.
I have some questions. The School Food Trust's studies indicate that there is still a low take-up of free school meals. For example, 16 per cent of primary school pupils are eligible, but the take-up is only 13 per cent. The statistics are even worse for secondary schools, with only 9.5 per cent out of a possible 13 per cent taking up free school meals. Will the Minister comment on these statistics? Are the Government seeking to improve take-up? Has sufficient funding been made available to deal with a 100 per cent take-up of free school meals?
It is not just lunch. Research indicates that breakfast can also be enormously important in giving children, especially those from chaotic families, a good start to the day. The alternative is hungry, distracted pupils
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Baroness Hollis of Heigham: Is my noble friend the Minister proposing to speak twice, first on his amendments-Amendment 80 and so on-and then at the end of the debate? I want to speak to the earlier amendments in the light of what he has to say about the government amendments, so I invite him to double up, so to speak.
I thank the noble Baroness, Lady Thomas, for moving Amendment 33A in the absence of the noble Earl, Lord Listowel, whose commitment to supporting children I acknowledge. As I said, I will speak to Amendments 41A and 33A and propose government Amendments 80, 81A and 82.
Although I support the thrust of what the opposition amendments propose, I cannot accept them. The Government recognise that making the transition into work can be difficult and, to help families to make this move, the Government want to extend free school meals to primary school pupils in working families with an income of up to £16,190 in England from September 2010. This was announced in the Pre-Budget Report in December 2009. The extension will be staged, with the first rollout to up to 50 per cent of eligible primary school pupils from September 2010 and the rest by September 2011.
This extension will provide valuable support to low-income families and improve incentives for parents to work. Around 500,000 children will benefit once it is fully rolled out. Although the Secretary of State proposes to make an order that will extend eligibility to children of primary school age, starting with those at key stage 1 or younger from September 2010 and rolling out to those at key stages 2 and 3 from September 2011, it will be possible to make further orders at some point in the future to extend eligibility to secondary school-age children if it is felt that this is necessary. That will not need further primary legislation; the change enables it to be done by secondary legislation.
The current legislation-the Education Act 1996-outlines entitlements to free school meals and allows us to change entitlement only on the basis of the benefit receipt of the parent, rather than the age of the child. It is therefore not possible to use an existing order-making power to extend the entitlement to the primary school-age children of parents who are entitled to working tax credits but not to any secondary school-age children in the same family. We therefore wish to amend Section 512ZB of the Education Act 1996 to extend the order-making powers to enable eligibility for a free school meal to be extended to a child if he or his parent is entitled to a tax credit and the child meets certain prescribed conditions. This will allow the Secretary of State to make an order extending eligibility to free
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Noble Lords may ask why these changes are being made through the Child Poverty Bill. My response is twofold. First, the extension of the free school meal entitlement will assist in the reduction of child poverty by supporting low-income families and improving incentives to work. Once fully implemented, it will lift up to 50,000 children out of poverty. Secondly, it is essential to do this now, as otherwise we will not be able to meet the commitment set out in the PBR that 50 per cent of primary school pupils from low-income families will be eligible by September 2010.
Lord Kirkwood of Kirkhope: I understand the need for urgency and I am in favour of the policy, but I cavil at the fact that the Minister is using a United Kingdom Bill, which also covers Scotland, to deal with matters that relate to England and Wales as distinct from what happens in Scotland. It is much easier to understand these bits of legislation, particularly in relation to such things as free school meals, if the education Bills north and south of the border are distinct. This is a United Kingdom Bill, but it imports English legislation in a way that does not cover Scotland.
Lord McKenzie of Luton: I understand the point that the noble Lord makes. Perhaps I may come on to the position in Scotland in a moment. The mechanism for dealing with these matters in England and Wales is the Education Act as it is and that is the Act that we need to amend. This is an opportunity to do so. If we did not take this opportunity, I am not sure how we would be able to move forward quickly.
Amendments 81, 81A and 82 are consequential amendments. Amendment 81 amends Clause 28, which is the provision of the Bill dealing with extent. As the new provision on free school meals extends to England and Wales only and is being included in Part 3, we need to amend Clause 28 to give effect to this. Amendments 81A and 82 amend Clause 29, which deals with commencement. We are proposing that the provision on free school meals will come into force two months after Royal Assent, along with the other provisions in Part 2.
Amendment 41A seeks to ensure the extension of eligibility for free school meals to secondary school children whose parents are on working tax credit in the UK. As I have said, the amendment does not preclude the Government from making further changes at a later date if it is thought necessary. However, as set out in the Pre-Budget Report, the Government believe that early intervention is vital. Therefore, extending eligibility to primary age children is the right way to proceed.
While I am sympathetic to the result that this amendment ultimately wants, the cost of including secondary school children across the UK is of real substance. When fully rolled out in England alone, extending eligibility to primary school children in low-income families will cost over £200 million a year. Agreeing to this amendment would put significant additional new pressures on school budgets, which would have to be met by potentially reducing other school services that are already committed.
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