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Mr. Tim Boswell (Daventry): Does the Minister agree that the absolute figures, which she may want to share with the House, are disturbingly and pitifully small? Is not a very rapid and extended increase needed, if that is what the individuals want?
Jacqui Smith: I do not disagree with the hon. Gentleman. While the figures are moving in the right direction, they are still too low. I shall outline what the Government have done and will do to ensure that we can increase that opportunity for people across a wide spectrum of care. In today's debate, that means people with learning disabilities.
The Department of Health has produced and distributed almost 20,000 copies of the "Easy Guide" to direct payments, to help to get across the message that such payments can offer people with learning disabilities real choices and opportunities in their lives. A small number of councils such as Durham, Essex and Hampshire have made substantial progress in making direct payments accessible for people with learning disabilities, but those pockets of good practice are too isolated. Overall, the numbers are still far too small; there are fewer than 400 throughout the whole of England. We want to see significant improvements in those figures. We want direct payments to become a mainstream option for a much wider variety of people. That is one of the reasons why we are taking powers in the Health and Social Care Act 2001 to help us expand the take-up of direct payments by requiring councils to offer them to people who request them. Access to direct payments will no longer be a question of where people live. Councils will have a duty to offer them as part of the standard menu of services.
We are currently working on producing the policy and practice guidance to coincide with those changes. We will use that opportunity to strengthen the message to councils
about the need to make direct payments work for people with learning disabilities. A draft of the revised guidance will be issued shortly for consultation. The programme of work arising from "Valuing People" is also helping us to improve the situation for people with learning disabilities. Part of the role of the implementation team will be to promote the uptake of direct payments. Of course, advocacy services can provide significant help for people to access and manage direct payments.I should like now to turn to some of the other ways in which we are improving and developing better services for people with learning disabilities. Most people with learning disabilities have greater health needs than the rest of the population. Although life expectancy is increasing, 50 per cent. of people with learning disabilities die before they reach 50, compared with only 17 per cent. of the population as a whole. People with learning disabilities are more likely to experience mental illness and are more prone to chronic health problems such as epilepsy and physical and sensory impairment. Poor oral health may lead to chronic dental disease. Although increasing life expectancy is welcome, it will also lead to more age-related diseases; strokes, heart disease, respiratory disease and cancer are all likely to be of concern. An increasing number of young people with severe and profound disabilities have complex health needs.
Mr. Boswell: I am grateful to the Minister for giving way again. Does she agree that it is a particular concern that, when people with learning disabilities are hospitalised, they should have access to adequate advocacy and explanation of their problems? They should also have access to medical staff who are very well trained and are aware that such patients may well not only have the specific medical problem for which they were admitted, but a series of related issues in respect of which they also need the most careful maintenance and support during their spell in hospital.
Jacqui Smith: Once again, the hon. Gentleman makes a very important point, which demonstrates why we need to develop our specialist learning disabilities services to ensure that those involved can work more closely with other professionals, become multi-skilled and recognise the complex range of health needs to which he refers. Furthermore, the changes being made by the Government in relation to advocacy—especially the development of patient advocacy liaison services for every trust—will also be a very important way of ensuring that people with learning disabilities, in contact with particular health trusts, can express their views and make complaints and be supported in doing so.
The NHS plan commitment to care for all was based on clinical need, shaping services around the needs of individual patients, families and carers and reducing health inequalities. Health improvement plans provide a means of addressing the health needs of people with learning disabilities so that they do not experience avoidable illness and premature death. To help us reduce the number of avoidable deaths we are exploring the feasibility of establishing a confidential inquiry into mortality among people with learning disabilities.
Other key actions on health will include ensuring that all people with a learning disability are registered with a GP by June 2004; getting the NHS to ensure that all mainstream hospital services are accessible to people with
learning disabilities; developing local specialist services for people with severe challenging behaviour—this will be a priority for the capital element of the learning disability development fund; and a new role, as I suggested earlier, for specialist learning disability services, making the most effective use of their expertise.The Government expect all learning disability partnership boards to have agreed a framework for the introduction of health action plans for people with learning disabilities by June 2005, and to have ensured that they all have clearly identified health facilitators by June 2003.
I have spoken mainly about adults, but it is important to remember that the "Valuing People" programme is for learning-disabled people of all ages, and that learning disability partnership boards are responsible for its adult elements. I shall now say something specifically about children.
We consciously and deliberately gave "Valuing People" a lifelong perspective on learning disability. The chapter on children focused on the needs of learning-disabled children and their families, but it did so in a framework that applies equally to all disabled children. Many disabled children have more than one impairment, and a majority have a learning disability.
Where necessary, the Government have put in place the legislative framework for change—for example, the Special Educational Needs and Disability Act 2001. I have no doubt that the hon. Member for Daventry recognises what a fine piece of legislation that is, having spent some happy days in the Standing Committee that considered it last Session. The Act strengthens the right of children with special educational needs to be educated in mainstream schools, and from September 2002 protects them from discrimination on grounds of their disability in their access to education, including further and higher education.
The Carers and Disabled Children Act 2000 introduces direct payments, giving parents of disabled children and 16 and 17-year-old disabled young people greater choice and flexibility in the way in which they receive services. The Care Standards Act 2000 improves protection and raises standards through new regulations and inspection of care providers. The Children (Leaving Care) Act 2000 ensures continuity of support for all looked-after disabled children.
Furthermore, there are four cross-Government programmes to help tackle the social exclusion of children: sure start for the under-fives; the children fund for older children; Connexions for teenagers; and the "quality protects" programme for the most vulnerable across the whole age range, those in care and children in need. All must give priority to disabled children. As part of the "quality protects" programme, the Government set new national objectives for children's services which for the first time set out clear outcomes for children, and in some instances give precise targets which local authorities are expected to achieve.
Last year's "quality protects" management action plans show that authorities are beginning to improve the services that they provide to disabled children. Many are developing proposals in collaboration with partners from other agencies and sectors, such as the NHS and the
voluntary sector. More family support services were being provided, particularly home-based respite care and sitting services. Every management action plan included examples of services that increased the range and scale of provision of leisure, cultural and sporting activities.That was supported by the last spending review, when the "quality protects" programme was extended from three years to five, with substantial additional funding being made available. Provision for disabled children has been made a priority in the programme. From 2001–02 to 2003–04, £60 million for the children's services special grant has been earmarked for services for disabled children and their families.
The new children's fund is also encouraging joint working between local authorities and the voluntary sector to benefit disabled children. We know, for example, that through the fund, new projects are under way in Birmingham, Bradford, Haringey, Greenwich, Bristol and many other places, where the fund is providing better after-school facilities for children with complex needs, providing sporting activities, addressing child care and transport issues, and working with special schools, mainstream schools, early-years and other settings.
As part of our programme to support children with special educational needs, the Government recently issued the revised SEN code of practice and a toolkit for key professionals with responsibility for implementation. That included sections for health professionals and social services staff. Developing an integrated approach to supporting disabled children is key to the development of the national service framework for children.
As I mentioned earlier, a particularly important issue for children with learning disabilities arises as they enter adulthood. Disabled young people and their families often find that transition stressful and difficult. There has too often been a lack of co-ordination between the relevant agencies. Some young people are not transferred from children's to adult services with adequate health and social care plans.
That is why we have asked all local partnership boards to have a member with responsibility for transition planning. It is also why we set a target by 2003 for local agencies to introduce person-centred planning for all disabled young people moving from children's to adult services. That will include not only council services such as social services and education, but a health action plan, setting out the services to be provided by the health service.
I said earlier that "Valuing People" involved several Government Departments. I have touched on work in education, but we are working across Government. For example, the Government's statutory advisers on transport-related disability matters—the Disabled Persons Transport Advisory Committee—includes among its membership a person with a learning disability, and is working with transport operators to help them understand the importance of information and training to give people with learning disabilities the confidence to travel.
With the Department for Transport, Local Government and the Regions, we are funding research leading to the publication of good practice advice on housing options and guidance on the range of housing options that should be provided for people with learning disabilities. We are working with the Department for Work and Pensions on a research project studying the links between day centres
and supported employment, as well as the ongoing work being taken forward by the workstep programme to provide employment opportunities for people with learning disabilities.In conclusion, "Valuing People" sets out a programme of action that will make a real difference to the lives of people with learning disabilities, their families and their carers. Old long-stay hospitals will be closed and residents found more appropriate accommodation. Employment opportunities will improve. The transition from children's to adult services will be better. Accommodation choices will be wider, and access to health services will improve. In conjunction with other Government initiatives, educational opportunities will be available for all children regardless of their disability. People's control over their own lives will improve through better advocacy services and greater use of direct payments. People with learning disabilities will continue to work with us to achieve those improvements.
One of the learning-disabled people who worked on the White Paper was recognised in last year's birthday honours—Carol Lee, from London People First, who was awarded an MBE. She is quoted in one of the reports published with "Valuing People" as saying:
- "I am proud to be in this group. It means a lot to work together with such a good team committed to supporting people with learning disabilities in their hard struggle to live independent lives."
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