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8.3 pm

The Minister of State, Department of Health (Mr. John Denham): I congratulate the hon. Member for Carshalton and Wallington (Mr. Brake) on securing the debate. I am grateful to him for indicating in advance some of the issues that he intended to raise. I hope to cover most of those this evening; if I do not, I shall certainly look at the Official Report and write to the hon. Gentleman on any points that are left outstanding.

I welcome the opportunity to discuss the provision of health and education facilities at Orchard Hill and to mention briefly some of the wider issues concerning the development of services for people with learning disabilities. This is a very important issue. First, I am well aware that, for those using Orchard Hill and their relatives, this must be a very anxious time, and I am concerned to ensure that we provide the highest quality care and support for them now and in the future.

I shall start by covering some of the background to the services and to the situation at Orchard Hill. As the hon. Gentleman said, Orchard Hill hospital was developed next to the old Queen Mary's hospital for children. The service built up on the site when, in the early 1970s, children often could not be transferred to St. Ebba's hospital in Epsom because no beds were available. Slowly, the number of adults with learning disabilities grew, and in the late 1970s it was agreed to have a unit for adults with learning disabilities in the grounds of St. Mary's. That became Orchard Hill hospital. Moving to more recent times, Queen Mary's hospital closed in 1993, although the Orchard Hill site was retained.

Services for people with a learning disability have obviously changed considerably over the years in which Orchard Hill has been open. In the summer of 1999, Merton, Sutton and Wandsworth health authority issued a consultation document on the future provision of services for people who live at Orchard Hill. The consultation period ran until mid November and the health authority considered the responses in January 2000.

The relatives of three patients challenged the decision and were granted a judicial review at the High Court in July. Relatives were concerned about the fairness of the consultation process, the health authority's decision to close Orchard Hill and the health authority's failure, as they saw it, to take account of all the relevant considerations before taking its decision.

The judge ruled that the decision was unlawful on the third point: that the health authority had failed to take account of relevant considerations. Let me say this now: Ministers are always concerned when relatives feel compelled to have recourse to the law in such circumstances. That is particularly the case when the matter concerns vulnerable and disadvantaged members of our society, although I was pleased to hear that the health authority had provided advocacy services for the people with a learning disability and their families, to help them to make their case.

Let me move to the heart of the case. The judge felt that there were a number of grounds on which the health authority did not have adequate information. There was

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evidence from correspondence and notes of meetings of prior promises of homes for life to patients and their relatives, and previously declared policy about the site. The judge declared that the indicative assessment that had been undertaken was not capable of supporting the health authority's decision on the future provision of services and that, at the very least, a public authority must take earlier promises into account when considering a course of action. Finally, he was critical of poor financial information--the hon. Gentleman mentioned that issue.

I am pleased, although not surprised, to hear that the hon. Gentleman is keen to ensure that the future of residents at Orchard Hill is secured and considered in a sensitive, open way and through individually discussed and negotiated care plans; so am I. He made several very important points. Let me begin to address them.

First, the health authority clearly needs to review its actions following the judgment. I believe that the health authority received the final written judgment only a few weeks ago, at the end of September. The health authority is committed to ensuring that people with learning disabilities, their relatives, trust staff and others are kept informed of future developments concerning Orchard Hill through a news sheet, letters and meetings. The authority is committed to discussing with them the need for further consultation.

The hon. Gentleman is keen, as are the Government, to ensure that any changes to people's services are based on thorough, high-quality assessments, and that any decisions are based on the overall best interest of the individual client. The health authority is leading a review of the assessment process, in partnership with a large number of stakeholders, including the relatives.

First, the new process will ensure that there is detailed information on the needs of individuals in terms of their individual and collective need for continuing health care services. Secondly, it will ensure that there is detailed information on the broad range of social care services needed by the individuals and the population of people living at Orchard Hill. Thirdly, it will ensure that there is detailed information about the assessment of the psychological impact on individuals that may be caused by moving them away from Orchard Hill. I believe that those were the three points on which the hon. Gentleman sought specific assurances from me.

I am sure that the hon. Gentleman will understand that these detailed assessments and the development of individual care plans will take some time. Until that process has been completed for all the residents, the health authority would not be in a position to consider again any preferred locations for future services, or the future of Orchard Hill. The health authority expects to be in a position to do so by the middle of next year. I realise that that may seem a long time, but it is obviously necessary for the assessment process to be thorough and comprehensive.

The hon. Gentleman is also anxious that future services fully meet people's needs, are provided equitably and are planned and provided in a timely and sensitive manner. I agree with the hon. Gentleman that that must be the case. Indeed, it must also be the case that the services that are provided are available and appropriate for a new generation of service users. We know from research that members of the new generation, rightly, have higher expectations and hope to live close to their families.

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We also know that there are increasing numbers of people with complex disabilities, and we must ensure that these services are available and appropriate for them.

The hon. Gentleman referred to the models of care for people with a learning disability. The Government are strongly committed to ensuring that people with a learning disability have the right to choose the kinds of services and accommodation that they prefer. We issued fresh guidance to local authorities and health authorities in July 1999 to confirm that, and we wish to ensure that commissioning policies reflect the diversity of needs and the rights of individuals to make an informed choice about where they live, when their preferred choice can meet assessed need and when it is affordable.

We also acknowledge that small-scale domestic accommodation can often provide a high quality of care. Such accommodation can offer more potential for social inclusion and enhanced rights. However, as in any society, some people choose--for a variety of reasons--to live in alternative communities. Indeed, the survey commissioned by the Association for Residential Care as part of the work on the forthcoming White Paper on learning disabilities found 73 such communities already in existence. People with a learning disability should also have that right and choice wherever possible, and we are very keen that this option should be open to them and that their preferences are, wherever possible, respected.

The hon. Gentleman will be aware that nearly £3 billion a year is spent on health and social services provision for learning-disabled adults. We are keen to ensure that the current resources are spent effectively and efficiently in a way that delivers best value to people with learning disabilities wherever they live. However, as my hon. Friend the Minister of State announced last week, we are also looking at ways to ensure that the resources currently used to support former old long-stay patients, such as many of the people at Orchard Hill, are retained for learning disability services. As the hon. Gentleman says, educational opportunities for people with learning disabilities are provided on the site by Orchard Hill college. Those services are for those resident in Orchard Hill and for those living in the community.

Education services for people with a learning disability are very valuable. It is only in the past 30 years that people with a learning disability have received mainstream education. The Government have been very concerned about improving basic skills provision, and the Moser report recommended that further consideration be given to the needs of people with learning difficulties and disabilities. As the hon. Gentleman may know, the Government recently published a report entitled "Learning to Succeed" and announced £1.5 million for further developments in this sector. This, we hope, will lead to significant improvements in the teaching of basic skills for people with a learning disability. The initiative, together with the new Disability Rights Commission, will help to bring high-quality education to everyone with learning disabilities, no matter where they live.

It is the aim of Orchard Hill college to continue to provide a wide range of educational opportunities for people living at Orchard Hill and, increasingly, for those living in the community. We support such initiatives and it is our aim that such services continue to become better integrated with mainstream adult educational services.

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At a wider level, the Government attach great importance to improving services for people with learning disabilities. One of the core principles set out in the NHS plan is that services will be shaped around the needs and preferences of individual patients, their families and their carers. That must apply just as much to people with learning disabilities as to anyone else. Guidance issued to health and local authorities back in 1992 was based on principles of person-centred planning, choice and involvement of both service users and their family carers. Those principles have stood the test of time, but they have not been applied consistently. They will provide the foundation for future service development.

In October last year, my right hon. Friend the Secretary of State for Health announced that we would be developing a new national learning disability strategy. At the conference of the Association of Directors of Social Services last week, it was announced that the national learning disability strategy would be published as a White Paper in the early months of next year.

It has been 30 years since a Government took a comprehensive look at learning disability services. The need for this new strategy is long overdue. People with learning disabilities are among the most socially excluded and vulnerable groups. It is now time to make sure that help and support are in place to foster independence, provide new opportunities and deliver quality services.

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The new national learning disability strategy is intended to do just that. It will seek to eliminate the inconsistencies that we know currently exist, and it will ensure that the delivery and the quality of the services on offer improve. It will make a real difference to many thousands of people, and the strategy has been developed across Government and not just in my Department.

The hon. Gentleman raised several questions at the end of his remarks and I hope that I have dealt with most of them. If I have not, I shall write to him. He asked about charges, and I can assure him that NHS health care will, of course, remain free at the point of delivery. He asked about the level of security available for individuals. That must be got right and it will be based on an assessment of need. It is certainly our intention--overall and in the case of individual residents--that the quality of services should be improved and not just maintained as a result of the decisions that will ultimately have to be taken.

I have described how the health authority has responded to the outcome of the judicial review, but I hope that I have also been able to put the local issues into their wider context. I know that the health authority will welcome the hon. Gentleman's continued interest in this matter, and I will ensure that he is kept informed of future developments.

Question put and agreed to.



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