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If the Government want to bring forward any tidying-up amendments at Third Reading, that is very much in their gift. It can be done. We are all behind the principles that the noble Baroness, Lady Walmsley, described, which were in the previous Bill. They are great-yes, we could see those come forward at Third Reading. I see no reason to delay, as this is about common sense and supporting the professionals. I am delighted that they gave my noble friend Lord Knight a standing ovation when he addressed the professionals in this field. We can get on with this. It is a regret of mine that it took us, in a Labour Government, as long as it did to consult and come to consensus and to the settlement that we did. It took us a while, so let us not take any longer.
Lord Hill of Oareford: My Lords, we had a very good debate on this subject in Committee, a slightly longer debate than the one that we have had today. We have had another very good debate this afternoon. I had the chance last week to meet Peers with a particular interest in PSHE and was grateful for their advice. I join others in paying tribute to the noble Baroness, Lady Massey, for the way that she has pursued this issue, as have my noble friend Lady Walmsley and many other noble Lords from all parts of the House. I have learnt a lot from noble Lords in the process, not least about knitting from the noble Baroness, Lady Massey-a reference lost on those who were not here for the Committee stage.
What is clear to me, who comes relatively new to this debate, is that there is broad agreement in this House on the importance of PSHE. Nothing has been said today by anyone from any part of the House that would disagree with that. There are differences of opinion about the best way forward. This evening the question is relatively simple and straightforward, so I think I can be brief. This is an important and broad subject. Should we, as this amendment argues, make PSHE a compulsory requirement for academies alone as one distinct set of schools and should we act now? Those are the two main questions that have been debated this evening. I would argue not. First, as others have said, I am not convinced that singling out PSHE in primary legislation is the right way to go. Secondly, I would argue, as a number of noble Lords have argued-it was argued very persuasively by the right reverend Prelate the Bishop of Lincoln-that the best place to consider these issues is in the round,
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In response to the question from the noble Baroness, Lady Murphy-
Noble Lords: Baroness Howarth.
Lord Hill of Oareford: Forgive me. I cannot be more specific than to say that we expect that the review will take place in the autumn, and it will have a proper look at the entire national curriculum. I know that when that process starts, and as part of that review, noble Lords will not hesitate to make their views known. There will be plenty of opportunities to debate it in the round at that point in the context of the whole curriculum rather than, as many noble Lords have said today, in more of a one-off way now.
I am swayed by the comments that have been made about having the debate later. This is not to dismiss the case made by the noble Baroness, Lady Massey. It is, however, to ask her and other noble Lords whether in the light of these points they will withdraw their amendment at this juncture, having made clear their intention to return to the charge at a later date.
Baroness Massey of Darwen: My Lords, this has been a fascinating and enlightening debate. I think that we are all actually on the same side; we just have different ways of approaching the issue.
I am aware of the curriculum review, but I have been aware of curriculum reviews on this subject for the past 10 years. We have gone over this ground, and in doing so I am also aware of the needs of children who may well be suffering because they do not have this education in their curriculum. Young people tell us what they need, and they certainly tell us that they need personal, social and health education.
I shall respond briefly to points that have been made. I put this amendment in here because the Bill is here, and because I shall continue to put it in any Bill that I can to try to get personal, social and health education in the curriculum.
It is a simple amendment because it is a complex subject. We have explored all possible areas connected with PSHE, today and previously. The noble Baroness, Lady Walmsley, mentioned the five principles put in place by the Labour Government, and they are still there for reference. I was surprised; I just reread the noble Baroness's speech at wash-up stage, and at that point she wanted no delay, she wanted to get on with it and she was anxious that PSHE should be part of the national curriculum. I support her.
Much work has been done already-
Baroness Walmsley: If the noble Baroness will permit me, I say to her that I still think that, but I have to convince my Government of the case, not just the former Government.
Baroness Massey of Darwen: My Lords, I, too, intend to convince this Government of the case.
I know that much work has been done on this already. I believe that schools are ready to take this on, and it would improve their chances if PSHE were a
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If we pass the amendment today-I intend to divide the House-it will send a clear message to the Government and to all parties that the welfare of children is at stake here. If a large number of people support this amendment, it will be a key message to the Government that this is an important subject that we do not take lightly. Let us go on from here and incorporate PSHE into all schools, through different Bills. Let us go through a curriculum review, but let us influence that review as best we can by showing today that we think this is an important subject that deserves our attention and our commitment. I wish to divide the House.
6.15 pm
Contents 156; Not-Contents 245.
Adams of Craigielea, B.
Adebowale, L.
Ahmed, L.
Andrews, B.
Archer of Sandwell, L.
Armstrong of Hill Top, B.
Bach, L.
Bassam of Brighton, L. [Teller]
Berkeley, L.
Best, L.
Bhatia, L.
Bilston, L.
Blood, B.
Boateng, L.
Borrie, L.
Boyd of Duncansby, L.
Brett, L.
Brooke of Alverthorpe, L.
Brookman, L.
Brooks of Tremorfa, L.
Campbell-Savours, L.
Chandos, V.
Christopher, L.
Clancarty, V.
Clark of Windermere, L.
Clinton-Davis, L.
Cohen of Pimlico, B.
Condon, L.
Corbett of Castle Vale, L.
Coussins, B.
Craigavon, V.
Crawley, B.
Cunningham of Felling, L.
Davies of Coity, L.
Davies of Oldham, L.
Dean of Thornton-le-Fylde, B.
Desai, L.
Dixon, L.
Drake, B.
D'Souza, B.
Dubs, L.
Elder, L.
Elystan-Morgan, L.
Falconer of Thoroton, L.
Farrington of Ribbleton, B.
Faulkner of Worcester, L.
Filkin, L.
Ford, B.
Foulkes of Cumnock, L.
Gale, B.
Gibson of Market Rasen, B.
Giddens, L.
Gilbert, L.
Golding, B.
Goodhart, L.
Gould of Potternewton, B.
Graham of Edmonton, L.
Grantchester, L.
Greengross, B.
Grey-Thompson, B.
Griffiths of Burry Port, L.
Harris of Haringey, L.
Harrison, L.
Hart of Chilton, L.
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Hattersley, L.
Hayter of Kentish Town, B.
Henig, B.
Hollis of Heigham, B.
Howarth of Breckland, B.
Howarth of Newport, L.
Howe of Idlicote, B.
Howells of St Davids, B.
Hughes of Woodside, L.
Hunt of Chesterton, L.
Hunt of Kings Heath, L.
Irvine of Lairg, L.
Janner of Braunstone, L.
Jay of Paddington, B.
Jones, L.
Jones of Whitchurch, B.
Judd, L.
Kennedy of Southwark, L.
Kennedy of The Shaws, B.
Kerr of Kinlochard, L.
King of West Bromwich, L.
Kinnock, L.
Kinnock of Holyhead, B.
Knight of Weymouth, L.
Lea of Crondall, L.
Lipsey, L.
Low of Dalston, L.
McAvoy, L.
McConnell of Glenscorrodale, L.
McDonagh, B.
Macdonald of Tradeston, L.
McFall of Alcluith, L.
McIntosh of Haringey, L.
McIntosh of Hudnall, B.
MacKenzie of Culkein, L.
Mackenzie of Framwellgate, L.
McKenzie of Luton, L.
Massey of Darwen, B.
Mawson, L.
Maxton, L.
Meacher, B.
Moonie, L.
Morgan of Drefelin, B.
Morgan of Huyton, B.
Morris of Aberavon, L.
Morris of Handsworth, L.
Myners, L.
O'Neill of Clackmannan, L.
Parekh, L.
Patel, L.
Patel of Bradford, L.
Paul, L.
Pitkeathley, B.
Plant of Highfield, L.
Ponsonby of Shulbrede, L.
Prosser, B.
Puttnam, L.
Quin, B.
Radice, L.
Ramsay of Cartvale, B.
Rea, L.
Rendell of Babergh, B.
Richard, L.
Robertson of Port Ellen, L.
Rooker, L.
Rosser, L.
Rowlands, L.
Royall of Blaisdon, B.
Scotland of Asthal, B.
Simon, V.
Snape, L.
Stone of Blackheath, L.
Symons of Vernham Dean, B.
Taylor of Blackburn, L.
Taylor of Bolton, B.
Temple-Morris, L.
Tomlinson, L.
Touhig, L.
Tunnicliffe, L. [Teller]
Wall of New Barnet, B.
Warnock, B.
Waverley, V.
Wedderburn of Charlton, L.
West of Spithead, L.
Whitaker, B.
Whitty, L.
Wilkins, B.
Woolmer of Leeds, L.
Young of Hornsey, B.
Young of Norwood Green, L.
Young of Old Scone, B.
Addington, L.
Alderdice, L.
Alton of Liverpool, L.
Anelay of St Johns, B. [Teller]
Armstrong of Ilminster, L.
Astor, V.
Astor of Hever, L.
Attlee, E.
Baker of Dorking, L.
Ballyedmond, L.
Bannside, L.
Bates, L.
Bell, L.
Benjamin, B.
Bew, L.
Bilimoria, L.
Blackwell, L.
Bonham-Carter of Yarnbury, B.
Boothroyd, B.
Bottomley of Nettlestone, B.
Bradshaw, L.
Bridgeman, V.
Brittan of Spennithorne, L.
Brooke of Sutton Mandeville, L.
Brookeborough, V.
Brougham and Vaux, L.
Browne of Belmont, L.
Burnett, L.
Buscombe, B.
Byford, B.
Caithness, E.
Campbell of Surbiton, B.
Cathcart, E.
Cavendish of Furness, L.
Chadlington, L.
Chalker of Wallasey, B.
Chidgey, L.
Chorley, L.
Clarke of Hampstead, L.
Cobbold, L.
Colwyn, L.
Cope of Berkeley, L.
Cotter, L.
Cox, B.
Craig of Radley, L.
Crathorne, L.
Crickhowell, L.
Cumberlege, B.
De Mauley, L.
Dear, L.
Deben, L.
Denham, L.
Dholakia, L.
Dixon-Smith, L.
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Dykes, L.
Eames, L.
Eccles, V.
Eccles of Moulton, B.
Elton, L.
Emerton, B.
Falkner of Margravine, B.
Fellowes, L.
Ferrers, E.
Fookes, B.
Forsyth of Drumlean, L.
Fowler, L.
Fraser of Carmyllie, L.
Freeman, L.
Freud, L.
Garden of Frognal, B.
Gardiner of Kimble, L.
Gardner of Parkes, B.
Garel-Jones, L.
Geddes, L.
German, L.
Glasgow, E.
Glenarthur, L.
Glentoran, L.
Goodlad, L.
Gordon of Strathblane, L.
Goschen, V.
Greaves, L.
Greenway, L.
Griffiths of Fforestfach, L.
Hamilton of Epsom, L.
Hanham, B.
Harris of Peckham, L.
Henley, L.
Higgins, L.
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Hodgson of Astley Abbotts, L.
Home, E.
Hooper, B.
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Howe, E.
Howell of Guildford, L.
Hunt of Wirral, L.
Hurd of Westwell, L.
Hussein-Ece, B.
Hylton, L.
Inglewood, L.
James of Blackheath, L.
James of Holland Park, B.
Jay of Ewelme, L.
Jenkin of Roding, L.
Jones of Cheltenham, L.
Jopling, L.
Kilclooney, L.
Kimball, L.
King of Bridgwater, L.
Kirkham, L.
Kirkhill, L.
Kirkwood of Kirkhope, L.
Knight of Collingtree, B.
Lamont of Lerwick, L.
Lang of Monkton, L.
Lawson of Blaby, L.
Leach of Fairford, L.
Lee of Trafford, L.
Lester of Herne Hill, L.
Lincoln, Bp.
Lindsay, E.
Linklater of Butterstone, B.
Liverpool, E.
Livsey of Talgarth, L.
Lucas, L.
Luce, L.
Luke, L.
Lyell, L.
MacGregor of Pulham Market, L.
Mackay of Clashfern, L.
Maclennan of Rogart, L.
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Maddock, B.
Mar and Kellie, E.
Marland, L.
Marlesford, L.
Masham of Ilton, B.
Mawhinney, L.
Methuen, L.
Monson, L.
Montrose, D.
Moore of Lower Marsh, L.
Morris of Bolton, B.
Moynihan, L.
Naseby, L.
Neville-Jones, B.
Newby, L.
Newton of Braintree, L.
Nicholson of Winterbourne, B.
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Oakeshott of Seagrove Bay, L.
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Oppenheim-Barnes, B.
Paisley of St George's, B.
Palmer, L.
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Perry of Southwark, B.
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St John of Fawsley, L.
Saltoun of Abernethy, Ly.
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Selsdon, L.
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Sharp of Guildford, B.
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Shaw of Northstead, L.
Sheikh, L.
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Shrewsbury, E.
Shutt of Greetland, L. [Teller]
Skelmersdale, L.
Skidelsky, L.
Slim, V.
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Soulsby of Swaffham Prior, L.
Steel of Aikwood, L.
Sterling of Plaistow, L.
Stewartby, L.
Stoddart of Swindon, L.
Strathclyde, L.
Taverne, L.
Taylor of Holbeach, L.
Taylor of Warwick, L.
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Thomas of Gresford, L.
Thomas of Walliswood, B.
Thomas of Winchester, B.
Trefgarne, L.
Trenchard, V.
Trimble, L.
Trumpington, B.
Turnbull, L.
Tyler, L.
Ullswater, V.
Verma, B.
Waddington, L.
Wade of Chorlton, L.
Wakefield, Bp.
Wakeham, L.
Waldegrave of North Hill, L.
Wallace of Saltaire, L.
Wallace of Tankerness, L.
Walmsley, B.
Walpole, L.
Walton of Detchant, L.
Warsi, B.
Wei, L.
Wilcox, B.
Williams of Crosby, B.
Williamson of Horton, L.
Younger of Leckie, V.
6.31 pm
10: Clause 1, page 2, line 3, at end insert "and sections 40, 41, 42 and 43 of the Childcare Act 2006"
Baroness Walmsley: My Lords, Amendment 10 arises from our debate in Committee about the impact of the new legislation on the early years. The Bill remains ambiguous about the care and education of young children and needs specifically to reference the Childcare Act 2006, which establishes the EYFS framework in law. The purpose of this amendment is to ensure that young children in academies are guaranteed the same balanced, age-appropriate and play-based standard of care and education under the early years foundation stage as children in maintained and independent schools.
In Committee the Minister said:
"I would suggest that the amendment is unnecessary because academies are already required, under the Childcare Act 2006, to provide the early years foundation stage. That is spelled out explicitly in their funding agreement. This stage is more than just a curriculum, as it covers much broader outcomes for very young children, including issues such as social skills".-[Official Report, 28/6/10; col. 1570.]
The Early Childhood Forum, which has been briefing me on this matter, very much welcomes the Minister's positive statements about the EYFS. I also welcome Minister of State Sarah Teather's announcement a few days ago that the early years foundation stage is to be reviewed. I called for this in my speech in Committee, though I do not think her announcement was simply in response to my speech. I am delighted that the Minister stated that it is the Government's intention that academies should implement the EYFS. However, I am still concerned that the Bill makes no reference at all to the EYFS, and that furthermore the Childcare Act 2006, to which the Minister referred, contains no reference to academies. This seems to leave an ambiguity in the law that could be easily rectified via this amendment.
Academies do not have to follow the national curriculum for primary and secondary schools. The only reference in the Bill to the curriculum is to Section 78 of the Education Act 2002, which has no application to the education of those aged under five, since the Childcare Act 2006 amended the Education
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Existing academies are not referenced at all in the Childcare Act 2006. This is an understandable omission as, although there are a number of all-through academies providing education for three to 18 year-olds, until now academy status was available only to secondary schools. The Bill extends academies to many more young children and therefore needs to be unambiguous about the approach to be taken to their education and care. It is clearly not the Government's intention to exempt academies from implementation of the EYFS. The Early Childhood Forum is concerned that academies do not fall into any of the categories of school referenced in the Childcare Act 2006. It has tried to clarify this matter with officials but they have not replied to its phone calls. Perhaps they were in purdah, pending the Minister's statement the other day about the review of the early years foundation stage. However, it would be helpful to know the Government's understanding of where academies fit in the framework of that Act. Perhaps this might have been sorted out if officials had responded to the Early Childhood Forum. I may not have needed, in that case, to table this amendment. It would also be helpful to know how many of the current all-through academies provide education for under-fives and whether they all currently implement the early years foundation stage as they should.
There is some confusion about whether the Government consider academies to be independent schools in law. Clause 1 refers to academies as "independent", but it also sets out that they are to be funded directly by public money through the Secretary of State. The Independent Schools Council membership criteria determine independence through the individual school's inspection regime, with members having to be inspected by the Independent Schools Inspectorate. However, academies-as far as they are to be inspected at all-will be under Ofsted. Noble Lords can perhaps see the confusion.
The early years foundation stage is based on the best evidence that we have from research and experience of what is most effective in helping children to develop physically, intellectually, emotionally and socially. The amendment would create parity and balance in this new legislation that matches the reference to Section 78 of the Education Act 2002 on the curriculum for those aged over five in Clause 1. I urge the Minister to accept it or to explain very clearly why it is unnecessary. If he accepts that there is a problem in the Bill and its relationship with the Childcare Act, I hope he will not ask us to wait for the pending early years foundation stage review. This would mean that primary academies and the young children in their care would be left in limbo and outside the current main framework until then. If the outcome of the review is a fundamental
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Baroness Morgan of Drefelin: My Lords, I added my name to this amendment. From listening to the speech of the noble Baroness, Lady Walmsley, I think I have had exactly the same briefing as her. I simply wish to say "ditto".
I am slightly concerned that in some things we need to rush ahead with, and in others to hang back from, reviews. It is very important for the Early Childhood Forum and the incredibly important organisations that make up the forum to have the kind of reassurances that the noble Baroness is looking for. The early years foundation stage was a very important step forward. The previous Government initiated it, and it has been well received. It is important that we build on the work of the early years specialists. I look forward to hearing what the Minister has to say.
The Earl of Listowel: Briefly, I support this amendment. The Government recently expressed some horror at the number of prisoners we now have in our prisons. It made me reflect on how many inquiries have pointed to problems within our families. When one does not provide good boundaries within families and a secure upbringing for children, and when schools are quite chaotic, it does not surprise me that there is so much offending among young people or that we have overcrowded jails. It seems to me fairly apparent that if one does not set boundaries early in life, society is left setting boundaries later in life, at great expense to itself. Therefore, it is imperative to get all the right support for children early on. This is an important area. I look forward to the Minister's reassurance that the early years foundation stage will be delivered in these schools.
Lord Wallace of Saltaire: My Lords, when I first joined the House of Lords, we did not receive any briefings on anything. That situation has been transformed in the 15 years I have been here so that now, on a Bill such as this, we are deluged with briefings, which are often extremely useful.
On behalf of the Minister and the department, I apologise for unreturned phone calls. I offer, if it is helpful, a meeting with the Minister and officials to discuss this question further. On the specific issue, I reassure the noble Baroness that all schools providing for under-threes' education are required under the Childcare Act to register with Ofsted and to deliver the early years foundation stage. This includes independent schools and therefore also includes academies. Section 40 sets out the duty to deliver the early years foundation stage. That is the key element. This already applies to academies in the same way as it does to other schools.
Reference has already been made to the review to be carried out by Dame Clare Tickell, chief executive of Action for Children, which will report to my honourable friend Sarah Teather in spring 2011. The review will be open and will look at the foundations that should be in place to protect young children's welfare and support their development and learning. It will also consider
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Baroness Walmsley: I thank the Minister for his reply and the noble Baroness, Lady Morgan of Drefelin, for her support. The noble Lord says that academies will have to deliver the early years foundation stage. However, it does not say that in the Bill. The difficulty has arisen because of uncertainty about the independent status-or not-of academies. According to independent schools, the definition of "independent" is a school that is inspected by the Independent Schools Inspectorate. However, that does not apply to the schools that we are discussing. Nevertheless, the Minister could not have been clearer on that matter. I suspect that the Early Childhood Forum will very much welcome a meeting with officials to set its mind totally at rest. It will probably be satisfied with the clarity of the Minister's reply, but I think that it will take advantage of the invitation anyway. I wait to hear what it says to me when that meeting has taken place. I beg leave to withdraw the amendment.
Amendments 10A to 10C not moved.
6.45 pm
11: Clause 1, page 2, line 9, at end insert-
"( ) Academy arrangements in relation to a school within subsection (5)(a)(i) must include provision imposing obligations on the proprietor of the school that are equivalent to the SEN obligations.
( ) "The SEN obligations" are the obligations imposed on governing bodies of maintained schools by-
(a) Chapter 1 of Part 4 of EA 1996 (children with special educational needs), and
(b) regulations made under any provision of that Chapter."
Lord Hill of Oareford: My Lords, I shall seek to be brief with this amendment as I have already written to noble Lords about it and we discussed these issues at length in Committee.
The purpose of this government amendment is simple; it is to ensure that the obligations placed on academies in respect of SEN mirror those placed on maintained schools. I said early on in Committee that I could not see in principle why one set of state-funded schools should treat children with SEN any differently from another set of state-funded schools. Having listened to the points that were raised in debate and having had a number of subsequent meetings on SEN with noble
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As noble Lords are aware, academies are already required, through their funding agreements, to provide for pupils with SEN in a similar way to maintained schools. Noble Lords will also know that the funding agreement has been the main regulatory mechanism for academies since their inception, as we discussed this afternoon. We agree with the previous Government that this should continue. We could therefore have ensured parity through the funding agreement alone. However, we decided to go further. This amendment acknowledges the particular concerns that have been raised in relation to SEN and will therefore put into the Bill a requirement that academy arrangements-either funding agreements or grants-must contain provisions that impose obligations that are equivalent to those that are imposed on maintained schools in Part 4, and in regulations made under Part 4, of the Education Act 1996. This means that no funding agreement could omit these provisions unless further primary legislation were made to remove these requirements.
In practical terms, the amendment imposes additional obligations on academies to: inform parents that their child has SEN and of the special educational provision being made; accept the naming of the academy on a child's statement; and appoint as a SENCO a person who is a qualified teacher. Moreover, new SENCOs will have to undertake prescribed training. It will apply to any new academy and to any existing academy that enters into new funding arrangements.
At this point I would also like to put on record the reassurance I gave the noble Lord, Lord Rix, at our meeting on 1 July that it is the Government's policy that academy special schools should offer a broad and balanced curriculum that meets the needs of an individual child as specified in their statement of special educational need. I am very pleased to have the chance to move this amendment. I hope that it will provide assurance that the SEN obligations on academies will mirror those that are placed on maintained schools. I beg to move.
Lord Low of Dalston: My Lords, I wish to speak to Amendments 12 to 14 and to Amendment 39, all of which are in my name. I very much welcome government Amendment 11, to which the Minister has just spoken. In Committee, there was a widespread concern throughout the Chamber to ensure that academies were put on the same footing as maintained schools as regards admitting and meeting the needs of pupils with special educational needs. The Minister said then that he would reflect and come back with proposals on how parity could be achieved. As we have heard, he has been as good as his word. I am very grateful to him for this and for the time and trouble that he has taken to meet Peers to discuss their concerns. I am also most grateful to officials for the time that they have taken to make sure that we get this absolutely right.
For my part, I think that we have very nearly got it right, but not quite. That is why I have put down the amendments to which I am speaking this evening. I spoke on this at some length in Committee, so I shall
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Secondly, there is the question of whether obligations that are equivalent to the SEN obligations in the Minister's amendment are the same in their effect as the SEN obligations. If not, it will be argued in court that Parliament's decision not to make these obligations direct statutory obligations must indicate an intention to permit variation from the statutory framework. I should therefore be grateful if the Minister could confirm that the intention is for academies to be subject to exactly the same obligations as maintained schools as regards admitting and meeting the needs of pupils with special educational needs, which the notion of parity would imply.
My main concern is with the enforceability of the rights implied by these obligations. The Minister has chosen to confer the obligations by importing the statutory SEN framework into the contractual framework of academy arrangements. These are contractual agreements between the Secretary of State and an academy to which parents and pupils are not a party. There is a complex legal argument as to whether the duties imported into academy arrangements by this means are enforceable by parents or pupils. I shall spare the House all the legal technicalities, but there are essentially three ways that one might seek to ensure that the duties are enforceable.
The first is by laying on academies the same statutory obligations as those laid on maintained schools directly by statute, not by statutorily importing them into a contract. That is what my Amendment 14 would do and I still think that it is the simplest and surest way to achieve my aim, which is why I have tabled that amendment again and why it would save a lot of bother by putting everything beyond doubt, if the Minister agreed to it.
Assuming that the Minister's preference is to proceed by the contractual route and to maintain the contractual relationship with academies, there are two further ways that one might seek to enforce the contractual obligations. One is through a complaints procedure and the other is by making it clear that pupils and parents can enforce their rights by judicial review.
As for complaints procedures, complaints would presumably be made to the Secretary of State, but there is nothing that establishes such a procedure and nothing is proposed. Even if there were, it would need to be clear that if the Secretary of State found that an academy had not complied with the relevant provisions of the academy arrangements, he would require the academy to comply, and the arrangements would need to make clear that he could compel compliance. This
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As for judicial review, the availability of this remedy could be put beyond doubt simply by making clear that the rights accorded to pupils and parents under academy arrangements could be enforced through judicial review. This could be done on a narrow basis relating to SEN only, as is provided for in Amendment 12, or on a wider basis covering all rights given to parents and pupils, as provided for in Amendment 13. Amendment 12 would sort out the problem relating to special educational needs, but would, if anything, weaken the position in relation to other rights-say, those relating to admissions-because it would imply that those rights could not be enforced through judicial review.
The Minister has shown himself to be very accommodating of our concerns in the quest to achieve full parity between academies and maintained schools. I hope that further discussion may be possible before Third Reading, with a view to finding a formula which would ensure that enforceability is not only a reality, but is seen to be a reality, either through a robust complaints procedure or by putting it beyond doubt that judicial review is available as a remedy.
Something along the lines of Amendments 12 or 13 would do the job for judicial review, and I have suggestions for a robust complaints procedure that I would be happy to put to the Minister. Amendment 39 begins the job, but even that requires fleshing out in some respects to reflect the ingredients of a robust complaints procedure. If the Minister would be happy to proceed along these lines, I am sure that we could reach an arrangement that would put enforceability beyond doubt and would be satisfactory to everyone. If full parity is the Minister's aim, I cannot see a reason not to do this.
Baroness Wilkins: My Lords, I echo the thanks of the noble Lord, Lord Low, to the Minister for all his time and the concern that he has given to this issue. I support the noble Lord, Lord Low, in his amendments and hope that the Minister will meet his concerns and satisfy him fully.
Lord Hunt of Kings Heath: I, too, warmly thank the Minister for bringing his amendment. It certainly shows that he has listened to the House and we are grateful. I also support the noble Lord, Lord Low. He raises important issues in relation to JR and I am sure that the Minister will be able to respond positively.
I should like to raise a further issue on this group of amendments which relates to SEN funding. It arises from the potential decline in the ability of local authorities to fund support services for SEN pupils which would result from an increase in the overall number of academies.
At the moment, local authorities retain a proportion of funding related to the number of schools that they maintain for the provision of central services, including
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We widely accept that the provision of special educational needs support is at the most expensive end, or at least the more expensive end, of the educational spectrum. A key feature of local authority provision is that it allows a local authority to ensure that finite resources are spent effectively through the ability of the local authority to generate economies of scale.
This matter will come up later in Amendment 21, to be moved by my noble friend Lady Wilkins, on low-incidence SEN. However, it actually raises a more general issue of principle. In the letter that the Minister circulated to us and to my noble friend, he states that academies are able to buy in SEN support services from their local authority, from neighbouring local authorities or from other providers. I understand that principle, but I ask him to reflect on the circumstances. Because there will clearly be no requirement for an academy to purchase services from its local authority, current services might be at risk. In particular, the expertise that individual local authorities have established might not be available to academies, because resources are no longer there to support it. There is also a risk that the provision of SEN support on an individual school basis might be more expensive than that which could be accessed by the local authority.
The noble Lord may say that the problem will not arise, that essentially he is proposing a market-based solution and that because of that the combination of academies making their own decisions will ensure a satisfactory outcome. I should mention again my NHS experience, because what is happening here is very much in parallel to the decentralisation that has been undertaken in the National Health Service. My experience has been that in that process specialist services can actually lose out and that if they do, the Government have to find some mechanism for intervention to make sure that those specialist services, as a whole, continue to be provided. I give advanced warning that I will raise this again in the debate on my noble friend's amendment. It would be useful to have some indication from the Government that they understand the issue and that there is a mechanism by which they can deal with it. If the noble Lord had accepted my suggestion that a statutory duty of partnership might be laid on all parties, that might have been one way through.
7 pm
Lord Lucas:My Lords, the noble Lord, Lord Low, echoed the point that I made on Amendment 8 about how we keep academy agreements up to date. If I remember rightly, he said that for existing academies the only way to do this is to terminate the agreement and renegotiate it. Will my noble friend undertake to give notice of termination to all existing academies so that the arrangement that he has arrived at for special educational needs can be incorporated into their agreements? I imagine that most of them will choose to renegotiate ahead of time and not go through the
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I also ask for his assurance that with this Bill it is the Government's intention that the model agreement should allow for the obligations on academies to update in line with those placed on maintained schools generally, and that we will not have to go through this procedure of issuing a notice of termination every time we change the SEN rules, the admissions rules or anything else that academies are supposed to follow.
Baroness Garden of Frognal: My Lords, I support Amendment 11 in the name of the Minister and also flag up that we have complementary amendments coming up in the same group as Amendment 22. We have had a query from TreeHouse, which deals with autistic children, asking for assurances on the funding for non-maintained special schools. Under these arrangements, the funding will go directly to academies and not via local councils. Currently, local councils top-slice 7 to 10 per cent from the dedicated schools budget, which includes placements for children at non-maintained schools. Will the Minister reassure us about these arrangements?
Baroness Sharp of Guildford: My Lords, will the Minister clarify the position of parents in relation to first-tier tribunals, SEN and disabilities? The annexe about SEN that goes with the agreement and that was circulated to us makes it clear that parents and pupils at academies have the same rights of access to first-tier tribunals, SEN and disabilities, formerly SENDIST. Most academies must comply with an order from the tribunal. Is there a notion of judicial review if there is still not compliance with the order from the tribunal?
The Earl of Listowel: My Lords, I support what the noble Lord, Lord Hunt of Kings Heath, said about health service reforms and the difficulty with regard to specialist health services. The National Society for the Prevention of Cruelty to Children runs such a specialist service in Kentish Town, north London. It works with children who sexually harm other children. It is a very intensive service. If these children are not given the service that they need, they sometimes go on to become adults who continue to abuse children. It is a very important service, but it has proved difficult for the NSPCC to get the funding that it needs through applying to local PCTs. This is one example of where regional planning and funding can be very helpful. I hope that the Minister will keep in mind what the noble Lord said.
Lord Hill of Oareford: My Lords, I start by thanking various noble Lords for their support for the government amendment. In particular, I thank the noble Lord, Lord Low, for his thanks to my officials, who I know have worked extremely closely with him and his advisers. They have spent so much time working on this that they have almost moved in together.
I will respond to the points made by the noble Lord, Lord Hunt, rather than to the noble Baroness, Lady Wilkins. He asked whether the Government were aware of the issue and whether we were thinking
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The question of funding is a fiendishly complicated area, because some aspects of SEN funding, and the responsibility to discharge it, will remain with the local authority and some will not. Rather than trying to answer in detail, it is probably better if I respond subsequently and pick up on the points. I will respond to one specific question concerning the funding of non-maintained special schools. There are no plans to change the funding arrangements for those schools. I will respond in a more considered way in writing if I can.
I may be able to offer the noble Lord, Lord Low, some-but probably not total-comfort. I am happy to confirm that parents have always had the power to seek judicial review against either the academy for failing to follow its contractual obligations or the Secretary of State for failing to ensure that the academy complies with its obligations under the funding agreement. It would be unique in law to provide for judicial review to apply in particular circumstances. I am advised that the issue of whether any person can apply for judicial review will be determined by the courts in accordance with Civil Procedure Rules. The Government's view is that the issue should properly be determined by the courts, and the House may not wish to set a precedent in this area. However, I can perhaps help the noble Lord a little by saying on the record that in recognition of his concerns, we will place a new provision in academy funding agreements that will enable the Secretary of State to direct an academy to fulfil any of the obligations imposed by the SEN annexe of the funding agreement. The agreement already enables the Secretary of State to direct an academy to admit a child.
As far as concerns a new timetable for the complaints process, I am sure that, as on many issues, we will discuss these matters further in due course. The YPLA currently administers a complaints process on behalf of the Secretary of State. I entirely accept that that process is necessary and confirm that we intend to continue to provide for it. A question was asked about the first-tier tribunal. Yes, parents and pupils will continue to have access to that.
I will answer the point raised by my noble friend Lord Lucas. The nature of the contractual agreement-what is at the heart of it-is that neither side can vary it unilaterally. Our expectation is that many academies will want to move to the new, simplified model funding agreement, which will introduce these provisions on SEN. In the light of those points and the answers that I hope go some way towards responding to the noble Lord, Lord Low, I hope that he will not press his amendments. We will no doubt continue to discuss these matters later.
Amendments 12 to 14 not moved.
15: Clause 1, page 2, line 16, at end insert-
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"( ) At least 25% of the people on the governing body of an Academy will be elected from among the parents of pupils at the school."
Baroness Howe of Idlicote: My Lords, I return to an issue that I raised in Committee: ensuring that parents have proper representation on academies' governing bodies. I should perhaps again declare my interest as president of the National Governors' Association, whose views, not unnaturally, I represent.
Governing bodies have considerable responsibilities, as I think we probably all agree, and-this is not always acknowledged-they play a critical part in ensuring that our schools perform well for the children in our community. They are the schools' accountable bodies, and therefore strong governing bodies are vital to the Secretary of State's aim to improve school standards and accountability. The NGA is very committed to ensuring that a full range of skills and experience is represented on governing bodies and it actively works to improve the training, knowledge and skills of governors. For example, the NGA's well respected induction publication, Welcome to Governance, is accompanied by a test and certification process.
NGA members also strongly support the need for governing bodies to represent not just parents but the full range of local stakeholders who also have a great interest in the success of the school. At this point, I should say that I fully support Amendment 17A in this group in the names of the noble Baronesses, Lady Walmsley, Lady Sharp and Lady Garden.
In Committee, I listened to the reluctance of the noble Lord, Lord Hill, to prescribe further the composition of governing bodies for academies. Perhaps understandably, the noble Lord does not want to curtail the freedom of academies, and I support the desire to leave more autonomy to those who know how to run schools without too much interference from central government.
However, in outstanding schools-those which, if they apply, are likely to be fast-tracked to academy status-governance is likely to have been working well and to have provided an engine for a school to reach the point where it is rated as outstanding. Therefore, if the governing bodies of those schools, or fast-tracked academies, choose to contain a reasonable number of parents-I think that in Committee the noble Lord hinted that that was likely to be the case-could they not be commended by the Secretary of State as examples of best practice for all academies to follow?
I am of course pleased that this Government have been championing the role of parents in setting the ethos and direction of schools, but surely the way in which parents can do this most effectively is as members of governing bodies. I hope that the Minister can give a more satisfying answer to this point than he did in Committee. Sadly-I have never quite understood this but the previous Government certainly bear responsibility for it-academies are currently required to have only one elected parent member, although I am pleased to note that many have chosen to have more.
My amendment is modest and not too limiting. It requires only one-quarter of governors to be parents of pupils at a school. That is a long way short of a majority and therefore parents alone could not prevent an academy trust taking an initiative that parent governors
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As it stands, the Bill offers rather more central accountability in place of local accountability at the same time as reducing the number of parents required to be involved in holding the school leadership team to account. Also, election to a governing body is a democratic process, which is an important safeguard. More central accountability might be seen as a move towards more central control by the Secretary of State both in schools converting to academies and in any new academies being set up as free schools.
As I said, I hope that the Government will be able to give a rather more encouraging answer on the re-emergence of this amendment and also that they will be rather more appreciative of the considerable role that governing bodies play in this whole process.
7.15 pm
Lord Wallace of Saltaire: My Lords, I remind the House that we are on Report and we need to be careful not to repeat in too much detail arguments which have already been made in Committee. We are intended to deal with new points and those that require further elucidation, not to go over points that we discussed in Committee.
Baroness Sharp of Guildford: I rise to speak to Amendment 17A in my name and those of my noble friends Lady Walmsley and Lady Garden. I entirely share the view of the noble Baroness, Lady Howe, in relation to not being too prescriptive. We also very much share her view that school governors should represent the community that the school serves. In that respect, it is very important that parents, in particular, are represented. She said that only one parent was elected. However, in academies, the parent governor is currently appointed, not elected, and that is an important point.
I declare an interest. I am both a governor of a small primary school in Guildford and a member of the corporation-effectively a governor-of Guildford College, so I am actively a governor of schools at the moment.
Amendment 17A is different from the amendment put forward by the noble Baroness, Lady Howe, in three respects. First, rather than prescribe a percentage, we are suggesting specific numbers-a minimum of three and a maximum of seven parents, although obviously the figure will vary according to the size of the governing body, which itself will vary according to the size of the school. There has to be considerable flexibility here. Secondly, we are anxious to see representation from staff, including support staff, as well as from parents. Lastly, we also want to see representation from the local community, and what better way to do that than to have a representative
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Lord Hunt of Kings Heath: My Lords, I rise with some trepidation in case the noble Lord, Lord Wallace, intervenes to say that we are replicating what we discussed in Committee. However, I think it is fair to make the point that, first, as the noble Baroness, Lady Howe, said in moving the amendment, we did not feel that the Minister responded strongly enough. Secondly, we had a good debate yesterday on Report on the subject of primary schools and academies, and I refer to the remarks of the noble Baroness, Lady Perry, on the role of governing bodies. Thinking back over the past 20 or 30 years to what governors used to do in schools compared with what they do now, there is no doubt that their workload and responsibilities have grown considerably, and I suggest that with academy status more corporate responsibilities will fall on the governing body. This is an important matter. It is also very important to have strong parental involvement, including on the governing body. However, the Bill does not provide for the right signals to be given.
I know that the noble Baroness, Lady Howe, blames the previous Government for the existence of that responsibility, and it is well stated that this legislation on governing bodies follows the previous Government's legislation on academies. However, as the noble Baroness, Lady Williams, pointed out in Committee, there are reasons for that. We were talking then about developing academies essentially to deal with some of the most challenging situations and communities, and there was genuine concern that some schools would not be able to attract enough parent governors. We are talking now about the extension of academies to schools in general. I should think that it is right to give some kind of signal that we expect strong parental involvement. I therefore ask the Minister whether he will give further attention to this matter between now and Third Reading.
Lord Lucas: My Lords, this question was asked in Committee but was not answered. Is there an obligation on academies to have elected parent governors, or can they appoint them?
Lord Puttnam: My Lords, not for the first time I speak in support of my noble friend Lady Howe. I did not speak on this subject in Committee, but on Second Reading I did make the point that the Government's handling of governors and governance issues had been "clumsy". I had hoped that in the intervening weeks I would be able to withdraw that, but, unfortunately, according to the DfE website,
That is a foolish way of putting it for all sorts of reasons.
I have spent the past 12 years visiting almost 400 schools. What have I learnt from that? I have learnt that successful schools are typified by engaged
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I have a real concern. I think that in years to come, largely as a result of the work of the national college, and possibly the recession, we will have a generation of first-class head teachers. They will tend to be quite young and very professional. They will probably have led three, four or possibly five schools at different times in their careers. As they move on, the only continuity left to the community will be the governing body. If you begin to minimise the role of the governing body in some way and solely optimise the role of the heads-or, as we shall increasingly come to think of them, the CEOs-we could reap a whirlwind. The Government will make a massive mistake if they do not addressing the legitimate expectations of governing bodies.
I would go further. I think that there should be mandatory training for the chairs of governing bodies. I agree absolutely with the noble Baroness, Lady Howe. My own Government, in a dozen years, did nothing like enough in this area. To repeat that mistake in an educational environment in which this relationship will become ever more important as schools need to connect and remain connected to their local communities, will be a grievous error. I fear that academies which believe themselves able to get up and running while ignoring the role of the governing body will fail. There is a danger that they may simply minimise it, or go through something perfunctory such as having one or two people just because they feel they must. Governors are crucial to successful schools, and anyone who thinks otherwise has not visited enough of them.
Baroness Williams of Crosby: My Lords, I follow the noble Lord, Lord Puttnam, with one other thought. School governing bodies are related not only to the community responsibility for schools but to the whole fundamental concept of democracy. In many ways the idea of a governing body of a school is a simple, low-level neighbourhood concept of what democracy is about. It is about fulfilling one's obligations to society and recognising that society has responsibilities that it carries out for all its citizens.
I am worried about reducing the importance and significance of governing bodies. I hope the Government will feel that they can support the idea of strengthening them, albeit with the legacy of the one parent governor in the case of a limited number of academies. In doing so, they would bear out one of the central issues that the coalition has repeatedly said it believes in, which is the decentralisation of power to ordinary people. Many people find their first step towards responsible democracy when they first become a governor of a school, particularly a primary school. There are powerful constitutional as well as educational arguments for recognising that the role of governing bodies is a crucial element of what one might call a mature democracy. I hope the Minister will bear that thought in mind.
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Baroness Perry of Southwark: I, too, would like to pay very warm tribute to the importance of governing bodies. Exactly as the noble Baroness said, they have had more and more responsibilities thrust on them by legislation in the past 20 years or so. I am, however, nervous of any restriction as to the exact composition of a governing body-as to who should be on it, how many, what proportion, and so on. My experience is based not on the governing body of a school, but I was reflecting as I was listening to the argument that I had for many years the privilege of chairing the council of Roehampton University, previously the Roehampton Institute. We made a positive decision, and I think a democratic decision, that we would advertise the vacancies for governors. We were astonished by the wealth of interest from highly expert people from the community. Of course people will not offer to be on a governing body if they live 50 miles away, so it was very much a local thing. It was really inspiring to find people who popped up from the community of whom we would never have heard saying that they wanted to be interviewed for membership of the governing body.
Much as I agree with the noble Baroness on the importance of parents and governing bodies-I cannot speak too highly of every governing body with which I have been involved-I beg her not to press an amendment that would restrict the composition of governing bodies by dictating it in this way.
Baroness Morgan of Huyton: I agree strongly with the noble Baroness, Lady Perry, because my experience is exactly the same. Governing bodies are incredibly important and we all recognise the need for good training and for a wide range of people to be involved. However, as soon as we get into imposing restrictions and saying that we need this or that category of person, as we have done before, we often end up with people who do not want to do it at all. We need to get a range of people who are genuinely and totally committed to the school. In my experience the best governors have often been not the current parents but parents whose children have been through the school and who have decided to maintain their commitment to the school. They have a real feel of what the school has delivered for their children.
Speaking as a current governor I can say that the person who best embodies the community in the school in which I am involved is the local vicar. He does not have a label as anything but he is the most valuable community governor. As it happens it is not a Church of England school, but he absolutely represents the local community, particularly when there have been problems. The local community looks to him, although he would not necessarily fit into one of the categories. Restrictions are not a good route to go down and we should have learnt that from the past.
Lord Greaves: My Lords, I do not think that the amendments call for restrictions. They are the opposite; they say that parents are a special group of people who should therefore be given places as of right. That does not restrict anyone else in any way. It is absolutely true that some of the best governors are people who have become interested in and involved in the school over a period. Indeed, some of the best governors are people who may now be grandparents of children in
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Schools really need people who are prepared to give up considerable time, energy and commitment to the school, whatever their present position in the community. The purpose behind the amendments is that parents of children in the school at the time are a special group, for obvious reasons, and that their presence on the governing body in a reasonable proportion ought to be set out and entrenched. That in no way contravenes anything that the noble Baronesses, Lady Perry and Lady Morgan, said about the importance of getting other people involved, or of parents continuing after they have been parents of children at the school.
7.30 pm
Lord Hill of Oareford: My Lords, I start by saying to the noble Baroness, Lady Howe, that I agree with her that-as everyone, including the noble Lord, Lord Puttnam, said-governors are key. I agree with her strongly on the vital role that governors play in schools and, in particular, the important contribution that parent governors have to make. We have spoken before outside the House, and I am keen to meet her and the NGA. I apologise that I have not been able to do so so far, because I have spent most of my waking hours in the House. I should like to talk to her and the organisation about how one can attract more parent governors and whether there are current obstacles to that-restrictions placed on them, and so on. I hope that she will accept my apology if she feels that I have not sufficiently stressed the importance of governors, and of parent governors in particular, because I feel that very strongly.
There is no difference anywhere in this House about the importance of governors and parent governors. Where there is a difference of opinion, I find myself agreeing with the noble Baroness, Lady Morgan of Huyton. The best way to go is to be less prescriptive and to trust people to get the right mix of people for a particular school. Should one set out from the beginning that there should be a certain proportion of different kinds of person whom one has to have, whether or not they are the best people for the job? As noble Lords might expect, I incline to the view of expressing the strongest possible endorsement of the importance of the role of governors and the wish to see parent governors involved, but leaving it to individual governing bodies and trusts to decide in their particular circumstances what is the best mix of people. Like many noble Lords, I have been a governor of a couple of schools for many years, and I have seen that having a broad mix of people tends to make for good governance decisions.
Where I take issue and am keen to resist, and where I know that I will not satisfy the noble Baroness, Lady Howe, and other noble Lords, including the noble Lord, Lord Puttnam-I apologise if he thinks that I am clumsy-is the degree of prescription in the amendment. As has often been the case since I have
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The new free schools are a good example of parental involvement, and one would imagine that parent governors will be a high proportion of governors-so high that some in this House have argued that there will be too many parents involved in setting up a new school. In some ways, that illustrates the point: what is the right number?
I certainly stick to the point that there are many examples where academies have chosen many parent governors to sit on the governing body. We hope that that will continue. However, on a point of principle-in all areas, and where it makes sense; we think that this is an example-the Government do not want to go down the prescriptive route. We want to stick with the approach to the governing bodies of academies of the previous Government.
We touched on the specific question raised by the noble Lord, Lord Lucas, before. The answer to his question is that the arrangements for the election of a parent governor or parent governors of an academy will be set out in the articles of association. The election of parent governors must be by the parents of pupils attending the academy.
Baroness Sharp of Guildford: Do the Government intend to move from parent governors being appointed to there being elections for parent governors? That would be a great step forward.
Lord Hill of Oareford: There will certainly be election. I must apologise, but I am not currently 100 per cent sure whether there is provision for election or not, and I will need to follow that up, but there will be election.
I was headed toward saying to the noble Baroness, Lady Howe, that I am sorry not to be able to be more helpful. I understand her point. I hope that she will spare the time to meet me with the NGA to talk about the matter more generally but, at this juncture, I ask her most respectfully to withdraw her amendment.
Baroness Howe of Idlicote: My Lords, I very much thank the Minister for the consideration that he has given. Of course, I am hardly completely satisfied, as he will understand. The conversation that followed the initial moving of the amendment expressed the view that we all share about the importance of governing bodies. I suspect that many other people in this room have been governors at some stage of their life. My experience goes back many years, to when there was not a great deal to be done other than consider meals and milk. I particularly thank the noble Lord, Lord Puttnam, for his contribution, because he put it in the wider community sense, and the noble Baroness, Lady Williams, for her point about the democratic process: how, so often, becoming a governor of a local school sparks off the base of the big society-as the Conservative side of the coalition was keen to put across to us all.
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I will leave it at that. I thank all noble Lords, because quite a number spoke. I will withdraw my amendment and I certainly hope to have a meeting with the Minister and members of the NGA.
Consideration on Report adjourned until not before 8.40 pm.
NHS: Pain Management Services
Question for Short Debate
7.40 pm
To ask Her Majesty's Government what action they will take to provide access to multi-disciplinary pain management services in the National Health Service for those experiencing chronic pain.
Lord Luce: My Lords, I am most grateful to the Minister for replying to this debate and to all noble Lords who are taking part in it. Why do I raise the subject? For over 40 years, I have suffered from chronic back pain due to musculoskeletal problems, but I am fortunate in that I have managed to live a full life with various public responsibilities due almost entirely to prompt, effective and dedicated support from specialists in the private sector. Very few people have access to it. Some 7.8 million people in this country suffer from chronic, as opposed to acute, pain, and my plea today is that the Government ensure that every single one of them has access through the National Health Service to multidisciplinary rehabilitation to help them to stay in their jobs and to live a life of at least tolerable quality. Given this support, I believe we can learn to manage our own pain.
The facts are horrific. One in seven individuals suffers from chronic pain, of which musculoskeletal pain or osteoarthritis is the commonest cause, although it includes cancer pain. It can be deeply damaging to the quality of life, causing sleeplessness and depression while interfering with normal physical and social life. Milton wrote,
"... pain is perfet miserie, the worst
Of evils, and excessive, overturns
Moreover, it has an adverse effect on the economy of the country as well as on the individual. Chronic pain takes up the equivalent of 4.6 million GP appointments, costing approximately £70 million per annum. In 2000, it was calculated that the total cost of back pain was just over £12 billion, and today 119 million working days are lost per annum because of back pain. A recent pain survey in Europe showed that 25 per cent of people in chronic pain had lost their jobs and that a considerable proportion of them never return to work. In the present economic climate, it is worth stressing that an effective preventive service could save overall costs in the long term.
A turning point came with the report on pain by the previous Chief Medical Officer, Sir Liam Donaldson, in 2008. He stressed that pain affects all age groups, not just the elderly. Worryingly, a quarter of school-age children have reported pain and 8 per cent suffer from
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The report's conclusion is clear; pain needs to be recognised as a disease in its own right, and a pain score should become one of five vital signs to be monitored routinely in hospitals and elsewhere. Above all, it advocates that a multidisciplinary approach should be vital in the prevention, assessment and management of pain and that there should be a national network of rapid-access pain clinics providing early assessment and treatment, as early intervention is critical for improving the long-term outcome. The report adds that all health professionals dealing with patients should be trained in chronic pain and that the assessment of pain should be included in the quality and outcomes framework in primary care. Other recommendations include the creation of a model pain service of pathways of care and the maintenance of a proper database.
I am delighted to say that, to help us in all this, is the Chronic Pain Policy Coalition, under the chairmanship of Dr Beverly Collett, who runs a successful pain management unit in Leicester. It also supports an all-party parliamentary group-Anne Begg MP was re-elected today as its chairman-that has a growing membership, in this new Parliament, of more than 20 parliamentarians. We are now most anxious to see the recommendations of the former Chief Medical Officer implemented.
For my part, I have witnessed some successful multidisciplinary operations in the NHS. In my own county, I have visited the West Sussex Primary Care Trust and seen its chronic pain management services in Bognor, where it aims to achieve integrated musculoskeletal, rheumatology and pain management services. Key to this is its provision of tools for patient self-management with the help of hydrotherapy, muscle-pain clinics, physiotherapy, fit-for-work schemes and clinical psychology. I was particularly impressed by my visit to the Pain Management Centre, which is led by Dr Baranowski at the National Hospital for Neurology and Neurosurgery in London. It has had success in treating patients on a multidisciplinary basis.
Another centre of excellence is the Pain Management and Neuromodulation Centre at Guy's and St Thomas's in London under the leadership of Dr al-Kaisy, whose excellent residential unit gives prospects of a better life for many patients who had been in despair from their suffering. I have also seen the support given to cancer patients suffering longer-term pain at the Palliative Medicine and Pain Unit of the Royal Marsden Hospital, which is led by Dr Williams. The unit has a multidisciplinary strategy that gives options ranging from medication, physiotherapy and psychology to interventional support. It is good that pioneering work,
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There is therefore clear evidence to show that, with the right expert support, people can be encouraged to manage their own pain, improve the quality of their lives, and in many cases stay in employment or, indeed, return to work. The provision of access to multidisciplinary pain clinics would in itself be a good investment for the country. This is best highlighted by Dame Carol Black's 2007 review of the health of Britain's working-age population. She stressed the business case for employers' investment in employees' health. Much can be done through preventive and remedial measures with more flexible working patterns and wider provision of support and therapeutic sessions. A key recommendation was to change the nature of the GP's sick note so that the GP focuses on what can be done to encourage the patient to go back to work rather than stay at home.
I should highlight the fact that Scotland has set something of a lead in managing chronic pain. In 2007, the Scottish Health Minister recognised pain as a long-term condition in its own right, and he has appointed a pain tsar to co-ordinate all pain service development. Last summer, I was briefed by the pain management service in the Shetlands, which caters for a population of 20,000. The Welsh Assembly Government have recognised pain management as one of five areas for improvement by providing services nearer to people's homes.
I am glad to note that the National Institute for Health and Clinical Excellence has issued guidelines on the early management of persistent low-back pain. I understand that the new National Quality Board is considering where chronic pain fits into the level of clinical priorities for quality improvement in healthcare.
I hope that the Minister will be prepared to meet me and some interested parliamentary colleagues before long to discuss the way ahead. The previous Government can take credit for laying the foundations, and I look to this new coalition Government to make a determined effort to establish multidisciplinary rehabilitation pain management services that are accessible to all those suffering from chronic pain in England. My experience tells me that if they do that, they will give hope to many people of all ages in this country.
7.49 pm
Baroness Masham of Ilton: My Lords, I thank my noble friend Lord Luce for this important short debate on chronic pain and congratulate him on his ongoing campaign to make conditions better for people with continuing chronic pain. Some years ago, when I was sitting next to my noble friend at lunch, he had such excruciating pain in his back that he had to go out and lie on a bench, and an ambulance was called. I have always had the greatest admiration for his tenacity in holding down an important position while enduring such chronic pain. It is good to see him still bringing this matter up. Who knows better what pain means? He is an expert and I hope that the Government will listen.
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I know excruciating pain. I broke my back and fractured many ribs in an accident many years ago. When I arrived at the spinal unit at Stoke Mandeville Hospital I was not given any painkillers for fear of addiction. In those days, that was the policy because we were turned only three-hourly to prevent pressure sores. Cramp used to set in and I understand the expression "blood, sweat and tears".
When a doctor told me that the pain should ease off in three weeks, that was the light at the end of a very dark tunnel. It is important that the psychological implications of chronic pain are understood-for example, how it can cause depression, break up partnerships or loss of jobs. Pain can eat into people's lives. In 2008, there was hope in the Chief Medical Officer's annual report, which wanted,
What action has been taken in the past two years by the National Quality Board on clinical priorities for the NHS? What are the Government's views on this subject?
The public need education in what to expect from analgesics and in how they can help themselves to cope with chronic pain. Postgraduate training is needed for the safe and appropriate prescribing of analgesics and the use of other therapies. Often, GPs prescribe pain-killing drugs to patients who are not reviewed and end up becoming dependent and addicted. About 8 million people of all ages suffer from chronic pain. Only about 14 per cent of them have access to any pain specialists. Long-term pain can have a devastating effect on the lives of sufferers and families. Forty nine per cent suffer from depression; 25 per cent lose their jobs; and 16 per cent feel suicidal.
Pain can be very complex. I am president of the Spinal Injuries Association. Some of our members have root pain or phantom pain, which is not well understood. Some people turn to alcohol, which may help but can damage their kidneys. Something has to be done to improve the situation. There is much need for research into pain and for multidisciplinary pain management services across the NHS which encompass doctors, physios, nurses, occupational therapists, psychologists and expert patients who are all trained in pain care. There needs to be co-operation and co-ordination, and not fragmentation. I wait in anticipation for the Minister's reply.
7.54 pm
Baroness Gardner of Parkes: My Lords, pain management is very important and I am grateful to the noble Lord, Lord Luce, for introducing this debate. I should declare an interest in that I have a daughter who has had multiple sclerosis for almost 30 years. To a degree, she has been fortunate in that she has not suffered pain. But many sufferers of multiple sclerosis suffer severe pain. Some of them have pain in their mouths-trigeminal neuralgia. In oral dental training, the trigeminal nerve is a very important nerve in the face. It is the one that we have all heard about and we all hope that people will never get trigeminal neuralgia as it is considered to be the most horrendous pain that exists and is very difficult to deal with. Although various things can be done, sometimes that involves surgery, and for someone with multiple sclerosis that is very difficult. So pain is a major issue.
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Many years ago I went to the Eastman Dental Hospital to see Professor Harris. When I got there, they said, "Have you come for the pain control clinic?". I said "No". I had never heard of the clinic. But it was interesting that Professor Harris was doing tremendous research at the Eastman Dental Institute into pain control. He must have retired some time ago, but this work is being continued.
Someone sent me a valuable tome on trigeminal neuralgia, which I kept for years. I occasionally glanced at it, but I never really read it. I offered it to the Lords Library but was told that it was far too specialised. I eventually sent it to one of the dental training schools because it was too important to be thrown out.
Pain affects many people. The noble Lord, Lord Luce, talked about acute pain, as well as chronic pain, which is what we are dealing with now. Chronic pain can be severe pain, which is the most worrying aspect. People can manage to put up with a little unpleasantness from time to time, but severe, constant pain is terrible to endure. Apart from anything else, it is demoralising and exhausting. Pain can be a valuable warning that something is wrong, but I agree with the noble Lord, Lord Luce, that pain should be classified as a disease in its own right.
In 2006, I fell off one of those old buses, which I foolishly tried to hop on. It was at the lights and, unfortunately, I did not make it. I was tossed in the air and I broke one of my vertebrae, but I did not discover that for some time, although it was a little painful. By the time I was diagnosed it was too late to do anything about it surgically, but I was put on hydrotherapy, which was fantastic and dealt with the problem.
Another important point is that, often, the specialist nurses and therapists who work with these individuals pick up the pain issue and are able to refer people to the right place for pain management control.
Unfortunately, my time is up and I cannot say any more. This is a most important debate and I thank the noble Lord again.
7.57 pm
Baroness Greengross: My Lords, I, too, thank the noble Lord, Lord Luce, for introducing this important debate. Pain can last for many years and some people have life-long symptoms. Sometimes it starts after a specific injury, but it is not always clear why people suffer in this way. As we have heard, some people suffer with continuing low back pain, pain related to joint inflammation or pain related to a nerve injury. Pain can follow an operation or an amputation, or even after what seems to be a not- very-serious infection, such as shingles.
We know that the effects of chronic pain can be disastrous and many people will need support in managing their symptoms. While specialist services are available in the community and in hospitals, I am aware that many people spend far too long without appropriate treatment. We are talking about large numbers of people and the accompanying huge costs spent in welfare benefits when people have to leave work and stop being productive in the community. We also know that death by suicide in chronic pain patients is
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Much remains to be done with chronic pain management generally. I am particularly concerned about the status of older people in this regard. The recent National Audit Office health inequalities audit stated that much progress remained to be made on the issue, which would not be surprising as older people usually experience discrimination in the form of health inequalities, but also in poorer chronic pain management targets. Given the current austerity programme that the public sector is facing and the even greater importance of value for money, I hope that the Minister can assure the House that this aspect will be considered in terms of where any cuts will fall-bearing in mind that while we have been reassured that the NHS budget is ring-fenced, in fact that promise includes an existing £20 billion cut in expenditure.
In a survey, the BMA found that 43 per cent of those trusts which responded to it stated that there was a freeze on recruiting doctors and nurses and that many treatments, including varicose vein operations and blood tests, were being rationed. Set against this background, it is hard to see how the parlous state of chronic pain management services will be speedily remedied.
Finally, evidence strongly suggests that a human rights approach could have a practical role to play in this new era of austerity, breathing life into the Government's promise to protect the most vulnerable and enabling us to interpret large sums into consequences for human beings. Public bodies have a duty to protect people who are suffering from inhuman and degrading treatment, and prolonged pain is in fact a category that would come under that heading. In their review of the Human Rights Act, the Government have said that they will keep these obligations intact, so an approach involving human rights could help public sector staff to remain aware of the huge human costs involved in chronic pain management. For example, the Mersey Care Trust has pioneered the use of human rights to give people with mental health problems and learning disabilities a meaningful role in the organisation, and there have been positive results. Service users and carers are involved in staff appointments, and this has led to a greater emphasis on finding staff with empathy and understanding as well as good technical skills. Perhaps such an approach to joined-up chronic pain management could reap enormous dividends.
8.02 pm
Baroness Pitkeathley: My Lords, like other noble Lords, I want to confine my remarks to my own experience of pain and pain relief and to speak solely as a patient. Unlike the noble Lord, Lord Luce-I thank him for securing this debate-my experience is more of acute rather than chronic pain, and I am happy to say that I am now pain free. However, the principles I want to set out apply equally to both. While I endorse absolutely the view that co-ordination is all-important and a multi-disciplinary approach entirely the right one, when it comes to pain relief, I believe that these must be supplemented by the very best of communication.
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This communication must have two aspects, the first of which is communication between professionals-the doctors and nurses, of course, but also the professionals ancillary to medicine such as the physiotherapists, radiographers and dieticians. If the medication for pain relief means that my feet are too numb to enable me to do the walking practice that the physiotherapist has recommended, what help is that to my recovery? If I can take absolutely nothing by mouth, and everything has to go by a Hickman line, the staff administering pain relief have to be very aware of it. I must put in a plea here for the extra services so often provided by volunteers in hospitals which all contribute to patient recovery but are not necessarily prescribed. I remember how, at a time of the most awful physical pain, the most relief I experienced did not come from drugs but from a nice young man who gave me a foot massage with scented oils.
Communication between departments is also vital. When you come out of intensive care, especially when coming back on to a ward, as I did four times in one hospital, there is nothing more frustrating than to lie there in pain with no one able to give you relief because your notes are caught up somewhere in the system. This applies particularly at night. Many patients still experience being in severe distress, but because far fewer doctors are available during those hours, they have to wait for someone-and at that point you feel that anyone would do-to administer some pain relief. So communication between professionals and between departments is vital, but in my view, no communication is more vital than that between the person administering the pain relief and the patient.
It is fine for an anaesthetist to say that an epidural is best for severe abdominal surgery, but if the epidural means that incontinence is a result, many a patient would prefer to endure the pain. Similarly, if the result of self-administered measured doses of morphine-in theory an excellent idea-is severe nausea to the point of exhaustion, surely the patient should be allowed to decide on other forms of relief. In one stay in hospital that lasted for about seven months, my worst memories are not about the pain, awful though it often was, but about the times when my wishes regarding pain control were ignored. However, I am happy to record that it is to the great credit of the NHS that those occasions were mercifully few. The best memories always centre around the way that caring people were prepared to consider me as an individual, and even to depart slightly from the rules; to discuss with me how drugs could be administered when I was unable to swallow anything for five months; and to maintain my dignity when those drugs had to be administered in most undignified ways. I recall also people like the young Nigerian charge nurse who would himself shed tears of sympathy when trying to find somewhere to inject me that did not cause excruciating pain to a body already like a pin cushion from repeated injections. As in many things, nothing can substitute for good communication when it comes to pain relief, either for chronic or acute pain.
I hope that the Minister will be able to endorse the importance of communication when any new policies are being developed.
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8.06 pm
Baroness Emerton: My Lords, I wish to add my thanks to my noble friend Lord Luce for initiating this short debate, following up his previous attempts to improve the multi-disciplinary approach to managing chronic pain. I declare an interest as a retired nurse and fully support multi-professional involvement. I certainly agree with the noble Baroness, Lady Pitkeathley, about the importance of care, compassion and communication as vital accompaniments. I also support my noble friend Lord Luce in urging the introduction of the fifth vital sign. It is extremely important that that is implemented.
There also appears to be a hold-up in extending the prescribing role of nurse consultants to patients suffering from chronic pain, although they are able to prescribe opiates to those suffering from acute pain or if they hold the role as a palliative care nurse. However, in a chronic pain clinic they have to refer the patient back to the GP. I understand that this causes great frustration to the patient, the GP and the nurse, and is wasteful of resources. I urge the Minister to look into this, please, to see whether it can be untangled.
I wish also to draw the Minister's attention to an aspect of chronic pain that is preventable and very cost-effective. Reference has already been made to Dame Carol Black's 2008 report, Working for a Healthier Tomorrow, which found that early intervention enables staff to return to work quickly, particularly where illness has the potential to become chronic and long-lasting, such as in the musculoskeletal disorders. Her report found that for employees with lower back pain, early intervention sees them return to work up to five weeks earlier than under normal care and reduces the recurrence of back pain in the following year by up to 40 per cent.
The Secretary for State for Health has made much of the need for an NHS that is focused on prevention and wider public health. Taking measures to safeguard nurses from back pain could be a tangible commitment to this. According to the Boorman review of November 2009, NHS Health and Wellbeing, which was acknowledged by the former Government, sickness among NHS staff in England currently accounts for 10.7 million lost work days at a cost of £1.7 billion. Some 30 per cent of the staff of the NHS are nurses. A national audit into clinical back pain management found that nurses and nurse support staff were more frequently absent than any other healthcare professionals with back pain caused by the level of manual handling in their jobs. It is not clear what the exact cost of back pain related nurse illness is to the NHS, but as nurses comprise the largest part of the workforce, it must make a significant contribution to the costs highlighted by Boorman. In addition, professional compensation awards can be significant. In recent years, awards of £800,000 and £400,000 have been made for work-related injuries. Early intervention to prevent nurse back pain related illness could help prevent a genuine risk to patient safety.
In the interests of ensuring patient safety, saving large sums of money as a result of preventive action and producing a healthier workforce, will the Minister add to the requests of other noble Lords my request
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8.10 pm
Baroness Morris of Bolton: My Lords, the noble Baroness, Lady Masham, has grown even more in my estimation. At 17, I fractured my spine-and if I had not had regular and large doses of morphine I do not know how I would have coped.
Just over four years ago, for reasons known only to itself, my immune system started to attack my body and I experienced the most excruciating pain in my feet, which spread to my hands, my wrists and then just about every other joint in my body. I could walk only if I wore the clumpiest of trainers, and I will always be grateful to your Lordships for allowing such glamorous footwear to be worn in the Chamber. At times the pain I experienced was so bad that my husband would walk downstairs in the morning to find me with my hands inside the deep freeze, so desperate was I to find relief.
I am not alone in my discomfort, and when I recount my own experiences I know I speak on behalf of around 600,000 people in the UK who suffer from one form or another of inflammatory arthritis. Some 380,000 of these have rheumatoid arthritis, which affects three times more women than men. Therefore, I am most grateful to the noble Lord, Lord Luce, for securing this debate.
According to the Arthritis and Musculoskeletal Alliance, musculoskeletal disorders are the second biggest cause of work-limiting health problems and sickness absence in the UK, with an estimated cost to society of some £7 billion per annum-and that is at 2007 prices.
There is a high divorce rate among women with this disease, probably because there are times when we cannot lift a kettle, cut a loaf of bread, do the washing up or iron a shirt. There are some days when you just cannot do anything. We need understanding and supportive families, and I am blessed with a great family.
I now inject drugs which keep most of my symptoms at manageable levels. I am lucky, if that is the right word to use, that I contracted this horrible disease at a time when medical research is making such tremendous breakthroughs. It has been my experience and, as research shows, the experience of most people, that services are most effective when they are delivered through a well-established multi-disciplinary team. The care I get from the rheumatology department at Bolton, which I will probably receive for the rest of my life, is second to none. As well as having had my drug regime sorted out, I have had physiotherapy, occupational therapy, Pilates lessons, warm hand waxes, podiatry and, best of all, acupuncture, which simply took the pain away and left me feeling beautifully relaxed. If I
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The acupuncture was so popular that it was difficult to book sessions, which were available only during the working week. I ask my noble friend the Minister whether there are plans to train more practitioners in acupuncture, and might we ever see weekend clinics for all forms of pain relief? I know that Bolton has been running some sessions to train patients in the self-administration of acupuncture, the results of which would be interesting to look at.
I have had excellent access to care in the NHS but, as the noble Lord, Lord Luce, said, this is unevenly resourced. For anyone suffering from chronic pain it is vital, not only for the well-being of the individual but for their families and society as a whole, that they get quick and consistent access to drugs and pain relief, delivered over a range of disciplines, so that they can lead as normal and economic a life as possible.
8.14 pm
Lord Walton of Detchant: My Lords, I, too, am grateful to my noble friend Lord Luce for initiating this crucial debate because pain is one of the most distressing of human experiences. I shall concentrate on the importance of accurate diagnosis of the cause of pain before an appropriate programme of treatment can be initiated.
Everyone recognises chronic pain in osteoarthritis and multiple arthritis and in patients with cancer and terminal illness, but a number of chronic pains are recurrent and not continuous. The noble Baroness, Lady Gardner, referred to trigeminal neuralgia, which is a momentary acute lancinating pain in the face that may be precipitated by touching the face, by washing, by cold winds, by chewing. It is momentary and lancinating, and is a very severe and distressing pain that must be distinguished from the chronic low-grade continuous pain in the upper jaw that is not uncommon in middle-aged people and that has been shown to be a psychogenic regional pain that not infrequently responds to anti-depressive agents once dental causes have been excluded.
There is another form of pain called cluster headache in which people, every few months, may have every night-often at the same time, such as two in the morning-a hugely intense pain around the eye and in the face lasting for about half an hour, or a full hour, which wakes them from sleep time after time. It disappears after two or three months and then comes back again two or three months later. It is not migraine, but it, too, is a special headache syndrome that remarkably has been shown to respond to a drug called indomethacin. Accurate diagnosis is crucial, which is why the education of medical students, of young post-graduate doctors and of other healthcare professionals in the recognition of the different pain syndromes is so important.
Several speakers have stressed the importance of multi-disciplinary management. I, too, stress that because, in my experience, some people with chronic low-back pain have become so anxious and tense because of it that it builds up a kind of vicious circle in which the pain is accentuated by anxiety and tension. This can
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There are, of course, many physical methods of treating pain, including manipulation, injections, occasionally acupuncture and cutaneous nerve stimulation. There is a huge number: far too many to mention in this setting. However, at the same time, the recognition of the nature of the pain is crucial.
Another curious pain, proctalgia fugax, is an agonising pain in the anus that lasts for five to 10 minutes. It may recur completely out of the blue and for no reason at all. I have experienced it and so have two of my daughters. It is totally benign; it is alarming but of no serious significance. Its recognition is important.
I simply stress, as have others, the important work of the Chronic Pain Policy Coalition. It has highlighted five areas of action which I hope will be accepted in principle by the Government. I also hope that the vital report by the previous Chief Medical Officer, which contained so much invaluable material, will be accepted by the Government as a principle and will not only persuade local health authorities of all kinds-primary care trusts and so on-to embark on a programme of improving the establishment of pain clinics across the country, but will be used by educational bodies for the education of healthcare professionals.
8.18 pm
Lord Alderdice: My Lords, the noble Lord, Lord Luce, who introduced the debate, and an astonishing number of other noble Lords have described how their own personal experiences have given them a profound insight into the importance of the dread subject of chronic serious pain. They have also shown an understanding and deep appreciation of the possibilities of treatment of this disorder.
In the short time available to me, I wish to stress three points. The first is the biopsychosocial aspect of pain. I hope that my noble friend will help the department to understand, as the noble Lord, Lord Walton of Detchant, pointed out-so clearly as he always does-the hugely important physical and biological aspect of much pain, and as other noble Lords have pointed out, its psychological aspects, particularly the noble Baroness, Lady Masham of Ilton. Others have pointed out the social aspects, as did the noble Baroness, Lady Morris of Bolton. Pain of this kind is sometimes largely physical in its origins, but, at other times, the psychological and the social components play a very important role as well. They do so not only in its origin but also in its treatment and management. All those elements are extremely important. There is a tendency sometimes to think that the biological side of things is only about pain relief in the form of medication. There are other kinds of physical approach to the treatment of pain. My first point then is the need to understand the biopsychosocial nature of the disorder and its treatment.
My second point is the need to pay attention to the needs and wishes of the patient, as the noble Baroness, Lady Pitkeathley, pointed out. In principle, at least, that is not so difficult when the patient's cognitive
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My third point is that, although it is extremely important to have expert pain clinics, only a minority of patients will ever be able to get to them. What can be very helpful to doctors, nurses and other clinicians who deal with patients with pain is to be able to contact such clinics and ask over the telephone directly for advice on how they might handle them. We shall never be able to train all our practitioners, GPs, community nurses and so on in the most up-to-date and complex ways of dealing with these patients, but we can make sure that they have access to those who are up to date. When I was a psychiatrist, it was possible to contact other clinicians who understood how to deal with such things and to receive advice from them and then make it available to my patients. I trust that my noble friend will be able to reassure us that practitioners will be able and encouraged to make such contact, and that it will be seen not as a failure of their professional ability but as a fulfilment of it if they do so.
8.23 pm
Lord Tunnicliffe: I congratulate the noble Lord, Lord Luce, on initiating tonight's debate. When preparing for this debate, I was shocked to learn of the suffering of so many of my fellow citizens, and commend the noble Lord, Lord Luce, on his determination that this issue should be given the priority that it deserves in healthcare planning. The account of his personal experience and that of other noble Lords serves to illustrate the need for a national and co-ordinated approach.
I accept the argument that chronic pain requires a multidisciplinary approach and rapid-access pain clinics to provide early intervention, as advocated by both the Chief Medical Officer in his report of 2008 and NICE in its May 2009 guidelines on the treatment of chronic low back pain.
In May last year, my noble friend Lady Thornton said in answer to a Question from the noble Lord, Lord Luce:
"My Lords, we welcome the recommendations on the management of chronic pain in the Chief Medical Officer's 2008 annual report. Many of the recommendations are already in line with existing guidance and practice in the NHS. We will consider what further
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The first question that I therefore need to ask the Minister is whether the CMO's report was considered by the National Quality Board, and if so what its advice was and whether it has been acted on.
Chronic pain affects 7.8 million people; 25 per cent of them lose their jobs or have to leave them; and £3.8 billion a year is spent on incapacity benefit payments to those diagnosed with chronic pain. The noble Lord, Lord Luce, made a very valid point when he said that it is more cost-effective to deal with chronic pain through investment in teams at PCT level than to leave treatment and support to chance and the patchwork that exists, at least in some places, at the moment.
My second question, therefore, is whether the Government will address this kind of investment in their reconfiguration of the National Health Service. Further, I hope that the Minister will agree to meet the noble Lord, Lord Luce, and the Chronic Pain Policy Coalition to discuss their legitimate concern that the impetus to deliver a national and co-ordinated approach will be lost in the change in government and the proposals of the coalition to devolve commissioning to GPs.
It is no longer acceptable in the modern world to tell people to grin and bear it when it comes to chronic pain. For many, medical and pharmaceutical advances mean that the remedies are available. Political will on the part of the Government and the management of the NHS is required to deliver effective solutions.
8.26 pm
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe): My Lords, this has been an excellent debate. I begin by expressing my gratitude to the noble Lord, Lord Luce, for calling it and congratulating him on the eloquent way in which he has introduced a topic which I know is close to his heart.
Chronic pain can be a devastating condition, as many of your Lordships have testified. It affects a large proportion of the population, especially those of advancing years. The noble Lord has already quoted a number of relevant statistics; let me just add another. Data from the Health Survey for England suggested that more than half of the total impact of disease on quality of life is due to pain.
There are examples of really effective, joined-up, multidisciplinary pain services providing support to patients as and when they need it. As the noble Baroness, Lady Pitkeathley, said, that is how it should be. But, all too often, patients do not get the support and the treatment that they need.
In his 2008 annual report, the then Chief Medical Officer, Sir Liam Donaldson, described how the system was failing to give sufficient priority to chronic pain. A key response from the previous Government was to agree funding for a national pain audit. We are maintaining support for this initiative, which is led by the British Pain Society in collaboration with Dr Foster. More than 200 pain clinics are already signed up to provide data. The work is being piloted and data collection
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What can the Government do? Our vision for the NHS is for a transfer of power away from the centre down to the people who really understand what is needed: to patients, GPs and other front-line health professionals. It is only by doing that that we will fashion a health service that is truly patient-centred. This is why we intend to devolve budgets to GP commissioners, working in small local consortia. They are best placed to understand their patients' needs and to prioritise and commission appropriate services, including multidisciplinary pain management services.
On average, someone with chronic pain will have direct contact with a health professional for only around three hours a year. The rest of the time they care for themselves. Patients therefore need to be informed. By our educating people about their condition and ensuring that they have access to support from others in a similar situation, people's health can be significantly improved. This also helps to reduce the number of GP visits and prevent unnecessary hospital admissions as well as reducing the length of any hospital stays.
I recognise that some patients cannot take decisions for themselves or express themselves, among whom are children, as my noble friend Lord Alderdice rightly pointed out. The detection of children's pain can, however, be improved by strategies to facilitate their expression of pain in ways that are appropriate to their cognitive development and that can be understood by the adults caring for them. So there is work going on in this area.
Good management of chronic pain takes account of the whole person. People agree goals and actions to be taken in a personalised care plan. This allows people to make choices about the care that they receive. The issue of choice was rightly mentioned by a number of noble Lords. It puts people at the centre of any decisions about their care. As my right honourable friend the Secretary of State put it recently,
Information from care plans can also help commissioners consider how to use funds most efficiently to support people to self care and identify services that are successfully meeting patients' needs and expectations. It also enables them to recognise gaps where there is unmet need. This is an important way for the patient voice to have direct influence over the design and commissioning of services in a particular locality.
Of course, devolving decision-making in this way does not mean that the Government are devoid of responsibility. There are a number of ways in which the Government and other organisations can support patients and front-line staff, ensuring that funding is spent on appropriate and effective services. First, we can ensure that clinicians and commissioners have up-to-date, evidence-based clinical guidance. The National Institute for Health and Clinical Excellence plays a
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Secondly, we can promote the development and diffusion of ideas on the service models that work best for patients. Patients with long-term conditions want services that are based in the community and which support and affirm their ability to manage their own conditions. They want to be referred to secondary and tertiary care only when really necessary. That requires excellent co-ordination between all levels of the system. One of the workstreams of the quality, innovation, productivity and prevention programme is focused on delivering this approach for people living with long-term conditions such as chronic pain.
Thirdly, we can promote the development of indicators of the quality and outcome of services. Outcome indicators will help patients to exercise choice and hold providers to account. They will help service providers to benchmark their performance against their peers and improve the services that they offer. They will help to ensure that any serious failure in quality is identified quickly and action taken to ensure the safety of patients.
An aim of the national pain audit will be to measure patient outcomes using the brief pain inventory scale-an accepted pain management assessment tool. This, combined with an assessment of patients' outcomes using other patient-reported outcome measures, will make for a comprehensive review of the quality of care. The audit will help to identify indicators that could be suitable for routine use.
Finally, we can ensure that the right financial incentives are in place. The tariff system already ensures, in broad terms, that money follows the patient and that providers are rewarded for delivering best practice. We will build on that by increasing the proportion of provider income that is responsive to the quality, not just the quantity, of care provided. It is just worth adding that in due course, patients with long-term conditions may be able to influence their choice of treatment and provider even more directly through the use of personal health budgets, which are being piloted at the moment.
My noble friend Lady Morris spoke about acupuncture. Use of acupuncture in the NHS is quite limited. The National Institute for Health and Clinical Excellence provides guidelines to the NHS on the use of treatments and it currently recommends that acupuncture is considered as a treatment option for lower back pain. However, it is often used to treat musculoskeletal conditions and a wide variety of pain conditions. Unfortunately there is an absence of clinical evidence in this area. We simply do not have the evidence base to be sure that it works for many of the conditions for which it is often used. More scientific research is undoubtedly needed to establish whether acupuncture is effective against many conditions.
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My noble friend also referred to the problem of gaining access to hospital appointments at weekends. There is an important case for services such as pain control to be provided outside working hours. We would encourage local commissioners to continue to develop services such as this to meet the needs of the working public. The noble Baroness, Lady Greengross, with her wide experience, pointed out that the elderly frequently suffer worse treatment than those in other age groups. Those who commission services locally clearly have a duty to ensure that the needs of the whole community are met, with particular attention given to vulnerable older people. The multidisciplinary nature of teams is pivotal in making pain relief available to all age groups in society.
The noble Lord, Lord Luce, asked whether we would consider a national strategy for chronic pain or indeed a tsar. I am not persuaded at the moment that a tsar or a national strategy for chronic pain over and above our current policies for improving the quality of services is necessary. We need to liberate front-line staff as a first priority to enable them to work with their patients to improve the quality of services that they provide or commission. We need to ensure, too, that they have access to the guidance that is available. As I mentioned, there is a wealth of available guidance, including a commissioning pathway published by the Department of Health, and guidance for secondary care and primary care has been published by the British Pain Society, as he will know.
The noble Lord and the noble Baroness, Lady Emerton, asked whether a pain score should become part of the vital signs that are monitored for patients in hospital. Current guidance from NICE recommends that all patients admitted to hospital should be assessed and a decision made on which clinical indicators should be monitored. A pain score is one of the indicators that should be considered.
The noble Baroness, Lady Emerton, referred to nurse prescribing and how that might be improved in this area. In prescribing medication it is essential that the right person gives the right medication at the right time and that stands to reason. Nurse prescribing is a welcome development that can benefit patients significantly. She would agree that services should continue to look at what professional mix can best deliver safe, timely and effective treatments for patients. She also referred to the need for risk assessment among nurses. I have every sympathy with that point. Back pain among nurses as a result of injury at work is a great concern, both for the nurses and their families. Local employers also have a duty of care to provide safe working environments and prevent unnecessary and avoidable harm.
The noble Lord, Lord Tunnicliffe, asked about investment in services at a local population level. We share a commitment to improve health and healthcare. This is our driving principle and our proposals for reconfiguration of the NHS will drive the improvement for all patients.
I conclude by reassuring noble Lords that I should be happy to meet the noble Lord, Lord Luce, and the Chronic Pain Policy Coalition to discuss these issues further.
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Academies Bill [HL]
Report (2nd Day) (Continued)
8.40 pm
16: Clause 1, page 2, line 16, at end insert-
"( ) An Academy is a public authority for the purposes of the Human Rights Act 1998 and the Equality Act 2010."
Lord Whitty: This amendment should be fairly straightforward. In a sense, I am on the same page as the noble Baroness, Lady Walmsley, was at the very beginning of proceedings today. It appears slightly odd that we should propose amendments that require schools to obey the law, but life is more complicated than one would think. The point of my amendment is to clarify that, for the purposes of the Human Rights Act and the Equality Act, academies are regarded as public authorities. This is important in both contexts. The noble Baroness, Lady Walmsley, got an assurance in fairly unequivocal terms on the Human Rights Act, and I should like an equivalent assurance, at least, on the Equality Act. I am proposing this in the hope that the Minister will be disposed, if not to accept the amendment, at least to give me a statement that meets the points of the amendment.
Notwithstanding what was said about governing bodies just before the break-and the Minister and others will know that I am not entirely well disposed towards this Bill in principle-I and, I think, most people in this House, would accept that the majority of governing bodies and managements of academy schools that come through this process will operate within the mainstream of educational approach and activity. Nevertheless, it is possible and, at the edges, probable, that the process of establishing academies-and even more so free schools, which will eventually be subject to the same provisions-can lead to governing bodies that are outside of the mainstream. I put that as delicately as possible. There are particular subsets of parents who have particular views on education; particular faith groups will have views on matters of gender and sexuality that are not the normal approach that would be guaranteed if the organisation were subject to the Equality Act and the Human Rights Act. We have to bear in mind that, whatever safeguards we build in, such minorities could qualify to establish a school under that process. Alternatively, it could be that the management of the school is proved to be so lax that, whatever the ethos of the governing body, it is not properly observed. I should therefore like it clarified that the requirements under the Equality Act and Human Rights Act that apply to public authorities will apply to academies, despite their slightly ambiguous position. If the Minister can give me that assurance, we can move on to the next amendment.
Lord Wallace of Saltaire: My Lords, we are happy to confirm, as I thought that we had in Committee, that the Government accept that academies are public authorities for the purposes of the Human Rights Act 1998. We welcome the noble Lord's intention of ensuring that; we will, as we said in Committee, ensure
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With that clear reassurance, I hope the noble Lord will feel able to withdraw his amendment.
8.45 pm
Lord Whitty: My Lords, I am grateful for that clear assurance. I shall not even pursue the avoidance-of-doubt argument. I shall accept the Minister's remarks in good faith, and am very grateful for them. I beg leave to withdraw the amendment.
17: Clause 1, page 2, line 16, at end insert-
"(9) Before entering into Academy arrangements with any person the Secretary of State must make regulations which set out the criteria under which proposals for such arrangements may be granted.
(10) Regulations under subsection (9) shall not come into effect unless a draft has been laid before and approved by a resolution of each House of Parliament."
Lord Greaves: My Lords, I move Amendment 17. In this group is Amendment 53 on a related issue, in the names of my noble friend Lady Williams of Crosby and myself, to which my noble friend will speak later.
This is really about the accountability of the new academy system and of the Secretary of State when he is exercising the powers that he will have in the management of the academy system. It has been pointed out on a number of occasions in debates on this Bill that in some crucial areas the Bill represents and provides a significant increase in the powers of the Secretary of State and a significant centralisation of the education system and the school system with regard to the academies. The more academies are created, the more that will be the case. There is a movement of powers of supervision, monitoring and various other aspects that have been discussed away from local education authorities to the Secretary of State and the processes that the Secretary of State will put in place, such as through the Young People's Learning Agency.
These amendments look at two aspects of this. The first is the creation of academies. There were amendments in Committee to make the academy orders-in relation to the conversion of individual schools, for example-subject to parliamentary approval. I think that there were some amendments from the Labour Front Bench
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A later amendment from the noble Lord, Lord Whitty-Amendment 28, I think-is similar, in a sense. It refers to academy orders and says that the Secretary of State has to publish the criteria by which academy orders will be made, but it does not actually go as far as requiring parliamentary approval.
Whether this is about the orders or about the arrangements-obviously they are all part and parcel of the system that is going to exist-there are important policy issues here. It is not just a question of mechanically carrying out a system of creating academies; it is a question of setting out the criteria by which academies can be created. To some extent, it is a matter of whether or not schools qualify. To another extent, it is a matter of the model academy agreement, and it may be that that agreement, which this amendment does not cover, requires some sort of parliamentary scrutiny as well.
These are important issues. All these important central policy issues are being concentrated on the Secretary of State, who will have considerable power. No doubt Parliament can find ways of scrutinising these as it wishes through various parliamentary mechanisms, but there is nothing automatic in the Bill that sets that out.
That is the purpose of Amendment 17: to probe, and to promote yet again the concept that when the Secretary of State is making these decisions, the basis on which he is making them-the fundamental policy-really ought to be subject to parliamentary scrutiny.
The second amendment, which my noble friend will speak to, is about scrutiny of the system after it has been operating. It is the other side of the same coin. I beg to move.
Baroness Williams of Crosby: My Lords, I shall speak briefly to Amendment 53, which is also part of this grouping. I agree with my noble friend that the proposal that he makes under Amendment 17 would be appropriate.
Owing to the lateness of the hour, I shall keep to my own amendment, the purpose of which is essentially to give Parliament an ultimate level of accountability for what happens in the secondary and primary education system through the process of an annual report repeated every year about the progress of academies, their successes, their failures, their record and so forth.
I shall say clearly, but briefly, why this matters so much. The present structure of accountability is by way of local authorities through to, eventually, their
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It is of the greatest importance that we have a report to Parliament. There will of course be reports to Select Committees, but we all know that Select Committees-although we hope that this situation will be substantially reformed-do not get the public or media coverage that is given to Parliament itself. The idea of a report to Parliament in which all parliamentarians, Members of both Houses, can ask questions is of the first importance. I cannot emphasise enough the crucial nature of accountability in any major democratic reform of this kind. I will simply say that the purpose of Amendment 53 is to arrange for an annual report. That report would clearly be greatly strengthened by the belt-and-braces approach suggested by my noble friend, as we would then know whether academies maintained and ascribed to the agreements and arrangements that were made for them. Even so, the importance of a report to Parliament is central. We have reports to Parliament on a wide range of issues, so why not on a major part of the education of the people of this country?
Lord Hunt of Kings Heath: My Lords, we see a bit of a dilemma. In order to give individual schools more authority over their affairs through academy status, the Secretary of State is having to take powers to himself to authorise that. Clearly, that approach has been used before, but with power goes accountability. There is a gap. I agree with the noble Lord, Lord Greaves, that in some way the Secretary of State needs to be more accountable to Parliament for the responsibilities that he will discharge.
In Committee, as the noble Lord, Lord Greaves, said, we debated a number of amendments tabled by Members on this side of the House, which, in retrospect, were probably too detailed and would have required many hundreds of statutory instruments coming to your Lordships' House and the other place. The noble Lord has come forward with a more sensible approach, which deals with the principles of the granting of academy status and allows Parliament to debate the criteria. As the Secretary of State will be given considerable powers in this area, it is right for Parliament to ask for greater parliamentary scrutiny. I certainly think that the noble Lord has got it right.
How quickly the party opposite has warmed to Executive power. For how many years have we heard noble Lords from both parties opposite ask for more parliamentary scrutiny? I find it surprising that the Government are not able to respond on this matter. Surely what the noble Lord suggests is not too much to ask.
Baroness Walmsley: My Lords, I, too, support the amendments in the names of my noble friends. I remind the House that we have already today-and, indeed, in our debates yesterday-come up with several
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Baroness Howe of Idlicote: My Lords, I support this suggestion. There will be considerable power at the centre and a need for parliamentary accountability. The approach proposed by the noble Lord, Lord Greaves, and spelt out in more detail by the noble Baroness, Lady Williams, is one that I certainly find acceptable.
The Parliamentary Under-Secretary of State for Schools (Lord Hill of Oareford): My Lords, the issue of accountability that we have just been debating is extremely important, as the amendments rightly reflect. I take the point made by the noble Lord, Lord Hunt, as he prompted me to think whether it is right to make provision for greater parliamentary scrutiny. I think that there is broad agreement across the House on the need for that, which I shall come back to in a moment.
Amendment 17, moved by my noble friend Lord Greaves, would, as we have debated, require the Secretary of State to make regulations to set out criteria for entering into academy arrangements. I hope that he will accept that the Government have made it clear that they will apply a rigorous fit-and-proper-person test in approving any sponsors of an academy or promoter of a free school. We have circulated the draft funding agreements so that noble Lords can see the kind of terms and conditions that will apply to academies. We will publish the criteria for deciding applications from schools that are not rated as outstanding by Ofsted, which, as my noble friend knows, are proceeding on a slower timetable in any case.
That said, since the academies programme started, the signing of the funding agreement has always been a matter between the Secretary of State and the academy trust. The Secretary of State has discretion over his decision in that respect to enter into academy arrangements and will want to review each application for an academy order on its merits. We think that some flexibility is needed in his consideration of these factors to ensure that he can make the right decision in each individual case. We have touched before on the point that the Delegated Powers and Regulatory Reform Committee has scrutinised the Bill and is satisfied that the level of parliamentary scrutiny it includes is appropriate. Nevertheless, as I alluded to yesterday on Report, there is a case for the Government going further in trying to make sure that Parliament has the opportunity to see how the policy is working.
9 pm
Before I come to that, I have a couple of further points of, I hope, reassurance. The funding arrangements will require academy trusts, as charities, to publish on their websites annual accounts, an annual report, their
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There will be no shortage of debate, but I accept the case argued by my noble friends Lord Greaves and Lady Williams, who want further reassurance. I also agree that, as we have already discussed, Parliament should have a more formal opportunity to scrutinise the progress of the programme. This, I think, was the point made by the noble Lord, Lord Hunt. I am grateful to my noble friends Lady Williams and Lord Greaves for pursuing this point, and I am happy to confirm that the Government accept the principle of their Amendment 53. Perhaps I may therefore suggest to them that, having given this commitment on the Floor of the House, I speak to them outside the Chamber and agree with them how to take the matter forward at Third Reading. In the light of that, I ask them to withdraw their amendments.
Lord Greaves: My Lords, I am grateful for what the Minister said about Amendment 53, which is half of what we are putting forward. We would be very happy to take up his offer. On that basis, no doubt my noble friend will not move Amendment 53 when we finally get to it some time tonight.
In relation to Amendment 17 there is a question that will not go away. There are fundamental issues that go beyond whether an application for academy status is being made by a fit and proper person. While the criteria for approving academies will be published, it seems that there need to be ways in which Parliament can discuss those criteria. We have a Secretary of State at the moment who is full of revolutionary zeal in this area. He is being very open and honest with us, through the Minister, about how he will approach this and the kind of criteria which will be looked at. However, Secretaries of State do not last for ever. There will be further Secretaries of State in the future; they will be different people with different ideas, and may wish to change the criteria. Under those circumstances it seems absolutely right that he or she should come back to Parliament.
Lord Hunt of Kings Heath: My Lords, given the complete mess over the schools building programme, how long does the noble Lord give the current Secretary of State?
Lord Greaves: That question is a long way above my pay grade. The Secretary of State seems to have quite a lot of influence in the Government at the moment. We will see how it goes and I wish him the best of luck.
The Minister said that the funding agreements would be published for each school; each application would be considered separately; and freedom of information requests will get all the information they require in relation to each school. We understand all that but it is different from parliamentary scrutiny of the overall policy and the criteria on which the Secretary of State will make the decisions. This is an issue which will not go away. It will probably be debated in considerable
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Amendments 17A and 17B not moved.
Clause 2 : Payments under Academy agreements
Amendment 18 had been retabled as Amendment 19A.
Amendments 19 to 20 not moved.
21: Clause 2, page 2, line 35, at end insert-
"( ) In Schedule 1 to the School Finance (England) Regulations 2008, after paragraph 8 insert-
"8A Where a child is a registered pupil at an Academy, expenditure in respect of services for making provision for pupils with low incidence special educational needs or disabilities."
( ) Where a local authority fails to secure satisfactory provision for pupils with low incidence special educational needs or disabilities, the Secretary of State may make alternative arrangements."
Baroness Wilkins: My Lords, I speak to Amendment 21. In Committee, I spoke about my concerns that the Academies Bill will fatally undermine specialist support services for children with low incidence needs. I am grateful to the Minister for his letter of 2 July in response to these concerns, and to the noble Lord, Lord Wallace, for his reply in Committee. I particularly welcome the Government's commitment that pupils in academies with low incidence SEN needs or disabilities will receive the support they require from specialist support services. But, unfortunately, my worries have not yet been allayed. The Special Educational Consortium, particularly the National Deaf Children's Society, RNIB and Sense, share my concerns.
The funding arrangements for specialist support services may be complex but the problem is clear. If funding from the schools budget for specialist support services is to be dispersed widely to a large number of academies in a given area, this will reduce the funding available to existing specialist support services in local authorities. It takes away the pooling of resources that ensures services to children with low incidence needs can be met at reasonable value for money. As the noble Lord, Lord Hill, put it in his letter to me, this will result in "dis-economies of scale". The noble Lord noted that academies will be able to buy back support from their local authority. However, a survey by the National Deaf Children's Society raises serious concerns that this is simply not happening. The society found that of 66 local authorities where a deaf child with a statement of SEN was enrolled in an existing academy, in only 17 of these local authorities were the academies buying in support.
So what is happening to the deaf children in the other 49 local authorities? The society suspects that many local authorities are providing services free of
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In Committee, the Minister stated that he recognises this is a continuing problem, and that was very welcome. However, I would like him to go further and commit to finding an urgent solution to this problem. I recognise that it is not a new problem. However, if the Academies Bill is going to make matters worse, surely the Minister has a responsibility to act now before the Bill becomes law. In Committee, he suggested that "partnerships among schools" will clearly be the best way forward. Will he say a little more about how this will work in practice? How will these partnerships be funded? What support and guidance are being provided to schools to develop them? How many partnerships are there in place already? Most importantly, what evidence is there that these partnerships will ensure that every child with low incidence needs gets the support that they need?
The Minister also stated that academies will have access to top-up funding to cover the costs of support for children with low incidence needs. He went on to say that this will be funded by the local authority from its schools budget. Will he confirm that this is the same schools budget which will be cut if a large number of schools convert to academies? If so, how can these specialist support services be funded and provided on a reliable and sustainable basis?
The Minister stated that if the academy fails to secure the necessary support, it will be in breach of its funding agreement, and that the Young People's Learning Agency can investigate, following a complaint. In Committee, the noble Baroness, Lady Sharp, made the important and obvious point that the YPLA is not an inspection agency. In response, the Minister stated that voluntary organisations will monitor the situation. However, surely he must agree that this is a very weak and unacceptable safeguard against the risk that children with low incidence needs will be denied the support they need. Many voluntary organisations simply do not have the capacity to monitor provision in large numbers of individual academies across England. It is not appropriate for such organisations to act as a watchdog, relying on them to make sure that the Government and academies fulfil their legal duties towards children with special educational needs.
My amendment would move funding for specialist support services out of the schools budget and into the LEA budget. This would protect these services from some of the unintended consequences to which I referred earlier. In Committee, the Minister did not set out his view on this. If it is his view that this amendment should not be passed, I should be grateful if he could explain why, and what alternative remedy will be put in its place. My amendment would also give the Secretary of State the power to make alternative arrangements if specialist support services in any particular area are inadequate.
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In his letter, the noble Lord, Lord Hill, noted that academies will in future be free to buy in services from other providers. In light of the difficulties that some local authorities have in meeting the needs of children with low incidence needs, I recognise the appeal of this and hope that this option will be explored further, as I have no desire to prop up services that are not doing a good job. However, I stress that this needs to be fully thought through and fully planned for.
I very much welcome the fact that officials have met with the National Sensory Impairment Partnership, as the noble Lord, Lord Hill, pointed out in his letter. I have been told that the partnership also welcomes this and believes that there has been a useful discussion and exchange of views, which it is keen to continue. However, it does not believe that there has been sufficient progress in resolving the outstanding questions and concerns.
The partnership believes that the Government should set up a time-limited working group that will consider alternative arrangements and make urgent recommendations. This group should include representatives from the Department for Education, local authorities, professionals, head teachers of academies and maintained schools, and parents. I firmly agree with the partnership. If the Government wish to show that they are serious about addressing these important concerns about specialist support services and diseconomies of scale, it is imperative that a working group be set up immediately, and I very much hope that the Minister will give me a positive reply to this proposal, which would do much to alleviate the concerns.
Children with low incidence needs may, by definition, be fewer in number. That cannot be an excuse to pass a Bill which would potentially prevent many from getting the support that they need. I urge the Minister to do more than just recognise that there is a problem. He must find solutions before this Bill is allowed to pass. I beg to move.
Baroness Howe of Idlicote: My Lords, I support the amendment in the name of my noble friend Lady Wilkins, as I did with regard to her amendment in Committee. I agree with my noble friend and share her concerns on specialist support services for children with low-incidence needs. I also agree that the Minister has not yet, I fear, provided a satisfactory response on these important concerns. I also reiterate the point made by my noble friend that the Government's desire to pass the Bill speedily must not be at the expense of children with low-incidence needs.
In Committee, I highlighted my concerns about the impact of the Bill on the range of services delivered by specialist support services outside school. For example, many services provide pre-school support directly to families and children to aid language acquisition and to teach Braille. Support may also be given to ensure that children with visual impairments have the necessary independent living skills. Such support is essential if we wish to ensure that children with low-incidence needs are able to fulfil their potential and live independently later in life. The cost of failing to provide such support is likely to be prohibitive to individuals with low-incidence needs and also to the Government's welfare budget. I am concerned that such services may
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I am concerned also that these unintended consequences will result not only in wastage but also in very poor value for money. These concerns are shared by the Special Education Consortium. I regret that the Minister did not address the concerns that I expressed in Committee that such preschool services would be undermined by the Bill. I strongly urge him to do so today.
9.15 pm
Lord Low of Dalston: My Lords, I will speak briefly given the hour. Despite the reassurances received by the noble Baroness, Lady Wilkins, there remain a number of concerns that need to be addressed. The specialist services of which the noble Baronesses, Lady Wilkins and Lady Howe, have spoken are at the heart of special education provision. As we have heard, they include support for mainstream teachers, Braille teaching and mobility instruction for visually impaired pupils, communication support, advice on equipment and speech and language support for pupils who are deaf or hard of hearing. I declare an interest as a vice-president of the RNIB, an organisation that is very concerned about the maintenance of services for blind and partially sighted pupils.
The services that I have mentioned are examples of those that meet low-incidence needs. The LEA is a large enough unit for these needs to attain a critical mass and generate demand for a level of support services that is capable of being sustained. The academy system is much more atomised and fragmented, and much less able to sustain a critical mass of support services. Of course, academies can form consortium arrangements, and the Minister spoke of partnerships; but it will inevitably take time to get these up and running, and in the mean time local authority arrangements are likely to become increasingly vulnerable as academies, with their attendant funding, opt out of the local authority system. Therefore it is absolutely essential that the Government make clear in detail exactly how specialist support services will be sustained in the new environment.
Baroness Grey-Thompson: My Lords, I support the amendments tabled by the noble Baroness, Lady Wilkins. The noble Baroness, Lady Campbell, wanted to speak in support of the amendment, but could not make the late hour for health reasons. I am therefore pleased to take her place, after taking her considerable briefing.
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