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House of Lords

Tuesday, 24 November 2009.

2.30 pm

Prayers-read by the Lord Bishop of Manchester.

Introduction: The Lord Bishop of Hereford

2.37 pm

Anthony Martin, Lord Bishop of Hereford, was introduced and took the oath, supported by the Bishop of Manchester and the Bishop of Lichfield.

Sure Start


2.40 pm

Asked By Lord Dubs

The Parliamentary Under-Secretary of State, Department for Children, Schools and Families (Baroness Morgan of Drefelin): My Lords, Sure Start children's centres both improve children's life chances and help parents into training and employment. All Sure Start children's centres have links with Jobcentre Plus, and in 10 local authorities, JCP advisers are placed full time in children's centres, helping parents on their journey into work. Children's centres are improving children's life chances. Evidence shows that three year-olds in areas with Sure Start local programmes display above average levels of social development and positive social behaviour.

Lord Dubs: My Lords, I am grateful to my noble friend for the Answer to the Question. Will she confirm that Sure Start has been one of the great successes of this Government; that it has helped in tackling poverty, particularly among single mothers; and that it has spread a better sense of community in the areas where Sure Start centres operate? Would it not be a disaster if some political party with the avowed aim of abolishing Sure Start were to gain power?

Baroness Morgan of Drefelin: My Lords, I am delighted to agree with my noble friend. Sure Start children's centres represent one of this Government's greatest achievements and have helped almost 2.4 million children under the age of five. Reports that the party opposite is considering taking funds from Sure Start centres in order to shore up other proposals are of incredible concern, so I would be delighted to hear the party opposite make a commitment to continue funding Sure Start in the manner of this Government in the unlikely event that it forms a Government.

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Baroness Verma: My Lords, perhaps I may correct the noble Lord on our party's commitment to Sure Start. We are committed to Sure Start-we will support it and we have always supported it. However, I would like to ask the Minister why there has been such a decline in the number of health visitors over the past 12 years. What percentage of parents using Sure Start centres are also using the health services provided within them?

Baroness Morgan of Drefelin: My Lords, I am very interested in that response and I hope very much that it will be echoed by the noble Baroness's leader. I understand that only last week the right honourable David Cameron indicated a lack of commitment to Sure Start, so I look forward to hearing her response echoed in another place. I am delighted to say that a range of integrated support, including health services, is provided for parents and children within the 3,050 Sure Start centres established by this Government. In our child health strategy, published only recently, we have made it clear that every Sure Start will have a named health visitor. We are offering integrated support for families in communities, where it is making a real difference.

Baroness Walmsley: My Lords, I hate to intrude on this private battle, but may I ask the noble Baroness whether the child poverty strategy includes increasing the number of outreach workers in Sure Start centres? These are the workers who reach the most deprived and hard-to-reach families. Has an assessment been made of the economic benefits of the outreach work that they do, and will the Government ensure that their funding is secure?

Baroness Morgan of Drefelin: My Lords, it is the party opposite which has made a commitment to cut the funding for outreach work. It is those workers, as part of the Sure Start team, who are really reaching into deprived communities and making sure that all families have the opportunity to make use of the Sure Start children's centre services. In terms of the economic benefits, I will check the research that has been done-it is important that we evaluate this-and get back to the noble Baroness.

The Lord Bishop of Liverpool: My Lords, the Sure Start programmes and the children's centres are doing excellent work in and around Liverpool. However, in my experience, they are not reaching some of the most disadvantaged and excluded parents and children. Will the Minister consider doing a pilot project using financial incentives to try to draw in some of the most excluded parents and children?

Baroness Morgan of Drefelin: My Lords, again I emphasise the importance of Sure Start. We are aiming to achieve a universal service by the establishment of 3,500 Sure Start centres by 2010-and we are on track to do that-but by making this a universal service it is equally important that we make sure that the original objectives of the first 500 Sure Start programmes are achieved, that we reach into hard-to-reach communities and that we use all the devices at our disposal. I do not know whether financial incentives have been looked at but we have been, and are, working very hard on a

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communications campaign to make sure that disadvantaged families know about the services. However, I shall look further at the right reverend Prelate's suggestion.

Baroness Howe of Idlicote: My Lords, while congratulating the Government on the Sure Start centres, I should be grateful if the Minister could confirm that all of today's Sure Start centres involve sufficient numbers of local parents and other residents, particularly when decisions are being made about the priorities for a particular area. The priorities do, of course, vary from area to area.

Baroness Morgan of Drefelin: The noble Baroness is absolutely right, and I pay tribute to the work that she does with parents through the National Governors' Association. It is absolutely right that parents should be consulted on the provision of local services, and every endeavour is made to ensure that when Sure Start services are being developed, evaluated and reviewed, the wishes of parents are considered. We know from the department's research that, when surveyed, 92 per cent of parents are satisfied or very satisfied with the services that Sure Start offers. We are working well with parents, but, obviously, there is much more we can do.

Baroness Nicholson of Winterbourne: Can the Minister allow us to know whether the Sure Start programme, excellent though it is, is being extended to the children in asylum prisons-asylum centres-who may spend many months, or even longer, without proper facilities? The Government are giving them the least sure start possible for their future lives.

Baroness Morgan of Drefelin: I am sure the noble Baroness is aware that the UK Border Agency has recently acquired a duty to ensure that the interests of asylum-seeking children who are in custody with their families are properly promoted. That is a real challenge, and it is something that I as a children's Minister am very concerned about. Unaccompanied asylum-seeking children will be looked after by local authorities and should have access to the whole range of services that Sure Start children's centres offer.

Health: Diabetes


2.48 pm

Asked By Lord Harrison

Baroness Thornton: My Lords, the research referred to in The Lancet sought to predict the burden of type 1 diabetes in children across Europe, and, indeed, the number is rising. We are addressing all areas of clinical care for children with type 1 diabetes as set out in the Diabetes National Service Framework for England. The national clinical directors for children and for

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diabetes are working to support the NHS and the education system to deliver improved care for these children and young people.

Lord Harrison: I acknowledge the great strides made in the treatment of some 25,000 children with type 1 diabetes, but is my noble friend still alarmed to learn that less than one in five of those children is achieving the safe blood glucose levels that are required to avert further complications, and that that ratio is the lowest in Europe? Will she attend to the number of paediatric specialist diabetic nurses, who currently have to deal with 160 children as opposed to the Royal College of Nursing's ideal of 70 to one nurse?

Baroness Thornton: My noble friend is quite right. We know that many children and young people with diabetes are not achieving the recommended NICE blood glucose target of less than 7.5 per cent, and we are very concerned about it. In response to this, the national clinical directors for diabetes and for children are working with stakeholders to improve the delivery of care. We have put out a call for action to the NHS for this situation to be rectified. My noble friend is quite right that specialist nurses play an important role in dealing with the challenges faced by children and young people with diabetes, but he will also be aware that we can encourage nurses to gain specialist skills in our national service framework, but that decision ultimately rests at local level.

Baroness Tonge: My Lords, while the increase in type 2 diabetes in children could be attributable to childhood obesity, are the Government putting enough effort into encouraging research into type 1 diabetes in children, which is increasing so rapidly?

Baroness Thornton: The noble Baroness is right. There is a 97 per cent difference in the number of people with type 1 and type 2 diabetes. A very small, but increasing, number of children have type 2 diabetes, which we know is linked largely to lifestyle and diet. We are putting £51 million into research, working in particular with universities specialising in research into type 1 diabetes and its rising incidence. In certain parts of Europe, it is rising very rapidly. We do not know as yet why that should be the case and whether it is linked to viruses or environment, so it definitely has to be addressed.

Lord Colwyn: Is the Minister aware that diabetics have an increased incidence of periodontal disease and that diabetes is a significant risk factor for gum problems? Does she agree that a regular dental check-up might help identify diabetes at an early stage?

Baroness Thornton: The noble Lord is absolutely correct. As we all know, a whole range of health issues arises from diabetes. Health, dental and eye checks are all an important part of care.

Lord Morris of Aberavon: My Lords, I declare a family interest. I understand that a new pump is available for sufferers in the United States, but not in this country. Is it the cost of providing the pump or the cost of training nurses in its maintenance that is holding up its introduction in this country?

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Baroness Thornton: In raising insulin pumps, the noble and learned Lord points to an important issue. We are concerned that in certain parts of the country insulin pumps for children even under 12 are readily available, while in other parts of the country they are not. This may be due to clinicians being unfamiliar with the new technology. The technology is much more prevalent in the United States than it is here. We are keen to introduce it and to make it available to young people in the UK.

Lord McColl of Dulwich: My Lords, as the Government are very concerned about new technology, why are the latest proven techniques not in use to help improve the performance of the diabetic retinopathy programme in England? After all, they have been developed in Scotland and will be deployed in January.

Baroness Thornton: The noble Lord points to a difference in diabetic retinopathy screening programmes in England and Scotland. We are very interested in the latest techniques being introduced in Scotland. We are aware of pressure to bring on these screening services. We are following what our colleagues in Scotland are doing and we expect the gap between the number of retinopathy screenings being offered and the number of people taking them up to continue to decline. We should get 100 per cent coverage over the next few years, and we shall watch what is happening in Scotland very carefully.

Lord Walton of Detchant: My Lords, as the Minister has made clear, type 1 diabetes is an auto-immune disease. It is an absolute mystery why this increased incidence has arisen in the past few years. Have the Government been in touch with the Medical Research Council about establishing a research programme which might in the end lead to a prevention and a reversal of this trend?

Baroness Thornton: The Department of Health and the Medical Research Council are jointly investing the £51 million to which I referred earlier. One of the funded studies is focusing on the rising number of children and young people with diabetes. We are working with the Juvenile Diabetes Research Foundation. King's College has been awarded £3 million to look at juvenile diabetes research and to investigate the causes of type 1 diabetes. The noble Lord is completely correct that we still do not know what causes it.

Children: Adoption


2.56 pm

Asked By Baroness Gardner of Parkes

The Parliamentary Under-Secretary of State, Department for Children, Schools and Families (Baroness Morgan of Drefelin): My Lords, the Government recognise the importance of timely adoptive placements. Legislation makes clear that delays may prejudice a child's welfare and guidance sets out timescales for the adoption process. We have established an adoption register to

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help find families for children and we monitor the timeliness of adoptive placements through a national indicator. Children are adopted at a younger age; that is, three years and nine months in 2008-09 compared to four years and two months in 2004-05.

Baroness Gardner of Parkes: My Lords, I am disappointed to hear that children are so old when they are adopted. I was looking for them to be adopted within weeks of birth. I understand that the Coram charity has a system called concurrent planning, which gives the child to the possible adoptive parent at an early age. The parent has the opportunity to adopt only if everything works out. Otherwise, they may not end up with the child. Every day that a child bonds with a different person is to the disadvantage of that child. Barnardo's has just come out with the same statement.

Baroness Morgan of Drefelin: I agree with the noble Baroness. She is right. The Government have committed to promoting concurrent planning in our Care Matters White Paper. I am advised that this process is more appropriate for babies, as the noble Baroness suggests. But most children come into care later in their lives, so we need a range of options. The noble Baroness is right that the Government are committed to raising awareness and promoting concurrent planning where it is appropriate for the individual child.

Baroness Walmsley: Is the Minister aware that failure of attachment to a principal carer and stress and violence trauma in the very early years can have a negative effect on brain development and the development of emotions? What sort of support is given to the adoptive parents who take on children who have suffered such traumas to help them to cope with the effects on the child's brain and development?

Baroness Morgan of Drefelin: The noble Baroness has eloquently described the impact of a failed attachment and the importance of adoptive parents having support. As I understand it, following the Adoption and Children Act 2002, all potential adoptive parents have the right to an assessment for adoption support, which includes looking at the kind of support that the noble Baroness describes.

Baroness Howarth of Breckland: My Lords-

Lord Northbourne: My Lords-

Lord Elystan-Morgan: My Lords-

The Minister of State, Department of Energy and Climate Change (Lord Hunt of Kings Heath): My Lords, self-regulation works only if noble Lords are prepared to give way. Shall we hear the noble Baroness?

Baroness Howarth of Breckland: Would the Minister agree that there are very few new-born babies available for adoption-perhaps she would let us know the number-and that those children who are available for adoption usually have high and specialised needs? What is being done to ensure that these children get the option of adoption, bearing in mind what the noble Baroness on the Liberal Benches said about their need for development from an early age?

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Baroness Morgan of Drefelin: The noble Baroness is right. The figures that I have show that in 2009 there were 80 successful adoption places for children under the age of one, out of a total of 3,300. The numbers speak for themselves. It is important that we recognise we need many more parents to come forward who are prepared to go through the process of adoption. It is a huge commitment.

The noble Baroness is right to note the number of children who are difficult to place and have very high needs. It is the voluntary sector that traditionally has expertise and commitment in placing such children. The department has funded important research that demonstrates that local authorities could do much better by investing in placements via the voluntary sector, and I very much encourage that.

Lord Elystan-Morgan: My Lords, does the Minister agree that while in an appropriate case-I am speaking now of contested issues-adoption can confer immense benefits upon a child, nevertheless, as statute spells out, it is of paramount importance that the welfare of the child should be considered first, with a view to the remainder of their life? Does she agree that local authorities should therefore not be tempted to veer towards an application for adoption where it is felt that that is cheaper than the alternative of a care order?

Baroness Morgan of Drefelin: My Lords, there is absolutely no right in law for parents to adopt. The interests of the child must be at the forefront, and that is enshrined in law; the interests of the child must come first.

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