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10.11 am
Mr. Tim Boswell (Daventry): I am honoured and delighted to participate in this debate on the implementation of the Government's strategy for learning disability, as set out in the White Paper "Valuing People". It reflects a long history of action taken in this House to tackle disability issues.
So often, the distinctions are not so much between the parties, as we usually speak with the same voice, as between those who turn up and participate in such debates, and those who do not get round to it, and are not as closely focused on some of the problems. Often, we vie with each other in our enthusiasm for the topic, and I am happy to initiate an arms race on that today. The Minister has made a good start in setting out her case. However, we must approach this matter in the spirit—and with the historic record—that change and betterment in such sensitive areas are often progressive between successive Governments of widely differing political views.
I still remember my first visit to the House when I was a schoolboy. I believe that it was in 1959, when I was lucky enough to be at the school that had been attended by the then Clerk of the House, Sir Edward Fellowes. I was somewhat disconcerted when I came here as a Member in 1987 and found that he had joined the staff of the Clerk's Department in 1924. There is therefore a long history.
I mention that anecdote because I remember that the subject for debate, which was not well attended and did not leap off the page as a matter of high controversy, was the Report stage of the Mental Health (Scotland) Bill. Two points arise from that. First, the constitutional one
that that measure, or one like it, is unlikely to return here. Secondly, since 1959, we have drawn out and increasingly accommodated the important functional distinction, which was then much less well appreciated, between mental health and learning disability. There was a culture of institutionalisation that bridged both. Both relate to vulnerable people whose care requires careful and loving attention, but they are not the same people. From time to time, however, the frustrations of having difficulty with learning may spill over into mental health problems. If I were to make one criticism of the Minister's approach, it would be that she did not say much about the experience of being an adult with a learning difficulty, and the kinds of frustrations that arise.At any event, the last major exercise, in the House, in overall provision for learning disability took place on a Conservative Government's watch, as a White Paper and legislation were introduced a generation ago in 1971. It is worth remarking that that White Paper was unashamedly called "Better Services for the Mentally Handicapped". Again, in the use of sensitivity and phraseology, we have collectively come a long way in a generation, in emphasising what people with learning difficulties can do, particularly if disabilities and difficulties can be relieved or released, rather than emphasising what they cannot do.
As the new White Paper, "Valuing People", acknowledges, apart from phraseology and terminology real progress has been made in the last generation in closing large institutions and developing services in the community. However, the new White Paper rightly adds that more needs to be done. We are considering the means of doing it, which is the tough part of government.
I am pleased to follow the Minister. As she mentioned, I have shadowed her for several years on educational matters, particularly in relation to special educational needs and the Special Educational Needs and Disability Act 2001. Even if I am not as ecstatic in my praise of it as she was, I readily concede that it represents an important advance, and, of course, feeds directly into this debate. With the way in which responsibilities have fallen, our paths have diverged—she has gone to the Department of Health, and I am an Opposition spokesman for Work and Pensions. That is an interesting development, as ministerial responsibilities in this area can look like a Venn diagram, in which health, work and pensions, education and several other important Government and local government departments and interests are all rightly engaged.
I hope that the Minister and I can claim a common commitment and a degree of mutual respect. Certainly, she has made a constructive and encouraging opening speech. I was particularly pleased that she picked up the point that many hon. Members have made, perhaps fuelled by the excellent campaign in The Times at Christmas, about the autistic spectrum. We are all learning much more about it. Many people with Asperger's syndrome are highly intelligent individuals who have social needs. If they are not catered for, they spill over into educational difficulties. I am glad that she is at least encouraging local authorities not to take a literal-minded view of the scope of her White Paper.
I am also pleased that the Minister talked about direct payments, which is a matter that needs working up. As she acknowledged, the numbers are still small. However, when people have the budget in their own hands, with the
support of their family or carers they can make their own choices. They are often better placed to do that than anyone making choices on their behalf.In the general spirit of what I am sure will be a constructive debate, I should make it clear that the Opposition have no problems with the objectives of the White Paper. We support it and we want it to work. In particular, I like its title, "Valuing People". To use a modernism, it is a brilliant title. It is precisely the belief in the value of all people as ends in themselves and not as means that should drive us. None of us who has met a class or group of young individuals with various special educational needs, or seen an individual pupil properly and sensitively included in a mainstream setting, could have failed to notice the special buzz that can arise, the dedication of teachers, and the friendliness and interaction of the pupils. In this most cynical of places, that force can and should defy our cynicism.
Of course, in saying that, I do not wish to suggest that there are not problems with challenging behaviour from time to time. The Minister has already referred to them. People with learning difficulties can be very difficult, and it can be hard to deal with them and to get the appropriate administrative machinery together to do so. But there is something about them that we should remember and celebrate.
The Conservatives have no problems with the four cardinal principles set out in the White Paper: rights, independence, choice and inclusion. All that I would say, with some diffidence, to the hon. Lady is that they have not just arrived, freshly made, under new Labour. They are concepts that some of us have always thought important. Indeed, to my great personal pleasure, the previous Conservative Government laid the foundations with the Disability Discrimination Act 1995—not without difficulty, as I am sure that the hon. Member for North-East Derbyshire (Mr. Barnes) will remind us—and we are glad to embrace its subsequent extension and the establishment of the Disability Rights Commission, with which I have regular and positive exchanges.
Those four principles are interactive and are about the worth of individuals. My only possible reservation, which I state for completeness only, is that inclusion can be interpreted to subvert the free choice of individuals—for example, in relation to whether they should be at a special school or educated in a mainstream setting. Inclusion should be interpreted to offer new opportunities for choice between different educational or lifestyle approaches, but we will not spoil this morning by quibbling over definitions.
The White Paper is frank about what it describes as problems and challenges. Those of us who had the privilege of going to the parliamentary palace of varieties last night saw a rehearsal of the first episode of "Yes, Minister", which was very well executed by some of our colleagues. The great, mythical—and, in terms of the actor involved, sadly deceased—Sir Humphrey Appleby appeared in it. He was always a great believer in describing any ministerial policy, particularly those that included a modicum of initiative, as "challenging". This is a very challenging White Paper, but it is frank, and it is right that we should start, as the White Paper does, by flatly acknowledging the difficulties.
The difficulties that I have picked out would be the stuff of any constituency MP's experience: poor co-ordination of services; poor planning for transition; inadequate support for carers; poor, often discriminatory, health care; poor employment opportunities; and a general lack of choice. I can only say amen to that list; any constituency MP could, no doubt, add to it. How many times have we heard in our surgeries the line of argument: "We can cope with the disability of a member of our family, but it is the bureaucracy that gets us in the end"?
Only this week, I have been occupied with the case of a young constituent with multiple disabilities—both physical disabilities and learning difficulties—who now has the benefit, after the family has fought its way through a tribunal hearing, of a placement in a residential school operated by the Royal National Institute for the Blind. The problem now lies between social services and the local education authority, and centres on responsibility for the weekly transport to and from the school. Having recently studied a report published by the Joseph Rowntree Foundation on work carried out at the Norah Fry research centre at the university of Bristol into placements at residential schools, I believe that my constituent's experience would make an admirable object case for the foundation to consider.
I am sure that, with good will, that particular difficulty will be resolved—indeed, we are on the way to resolving it—but is has caused distress for the family and engendered suspicion among the parents that the tribunal's finding is in some way being subverted. It has also required the intervention of a Member of Parliament. Sometimes, I feel as though we function here as the front line of joined-up government, the people who actually put the bits together when there is a problem. To return to the White Paper, it is that element of effective partnership between health, social care and education that desperately needs improvement.
Nowhere is that cast into sharper or more disturbing policy perspective than in the recent Mencap report, "No Ordinary Life", which deals with the support needs of families caring for children with profound or multiple learning difficulties. No decent person could read that report without grave unease. Similarly, no one who is familiar with human rights legislation, and who is involved in government or local administration, could read it without some apprehension of ending up in court because of its findings. It is terrifying that many people set out with good will to put their bit of the jigsaw in place for people with these complex difficulties, but only one piece needs to be missing for the picture to be incomplete, and for the service to be inadequate. Those of us who have interviewed parents know how they feel when nearly everything is in place, but something is missing.
Although the Minister has not referred specifically to that report today, I was delighted that, when she responded on 23 January to my parliamentary questions, which were keyed around the report, she clearly saw the Government's response in terms of the White Paper and the learning disability taskforce that is to lead its implementation. I am also genuinely pleased to have her assurance that Ministers have actively involved Mencap and other leading non-governmental and voluntary organisations in the process.
I have long been a passionate supporter of the voluntary sector, and I believe that such organisations can add great value in two ways: by using their hands-on, objective experience of what it all means; and by communicating an element of what I would describe as passionate dissatisfaction to puncture any official complacency. I am sure that it will be the understatement of this speech to say that life for those directly caught up in learning disability, including families and carers, is very tough. It behoves us all to remember that and to take this agenda forward.
Before I concentrate on implementation, I shall touch on the main requirements for service users. Perhaps my comments will be the other way round from the Minister's, but we all approach this matter from slightly different perspectives. I hope that what I have to say will be complementary rather than antagonistic. The provision of proper services for each critical stage of life must begin with early appraisal or diagnosis, and the ability to pick up problems at the paediatric stage. This must be coupled with continuing professional assessment and an eye to the possibilities of development for the individual. Nowhere is that more important than in the increasingly clear area of the autistic spectrum, where up to 1 per cent. of young people may be affected to some extent.
Each individual and their family should have a clear choice in the matter of transfer from home to a placement at school. The transition from primary to secondary school can be fraught, particularly if there is not an exact match of the type of setting. In the crucial transfer to further education, I suspect that many local education authorities still do not implement fully their long-standing obligations for transition planning. At the same time as—or shortly after—that life event, an individual may transfer from child to adult residential provision, in which suitable placements can often be hard to find.
Another area in which Mencap, United Response in Business and other agencies are involved is the creation and best use of employment opportunities, which are enormously enriching where they are feasible. While I acknowledge that many day-care services need restructuring—an institution that I know well in my constituency has restructured itself totally—we cannot wish away the role of day centres. They still have a valuable role to play but cannot be provided on the cheap. That is also true of carer support and meeting the health care needs of service users.
I welcome the Government's recent aid package to carers, but we still await implementation of their pledge to extend invalid care allowance to people aged 65 and over. That is particularly important given the changing demographics of those with learning disabilities. The numbers are rising by some 1 per cent. a year. As more people survive to adulthood and, in many examples, old age and retirement, carers are often older and perhaps reaching the end of what would have been their working lives. They, too, may need help with income and housing.
That brings me to housing issues, which the Minister perhaps only sketched. Although nobody wants a return to long-stay institutions, there is still an important role for residential care. Only two days ago, the Minister published guidance on the full suite of national minimum care standards, but, to my knowledge, she has not yet provided an accompanying statement of the regulatory impact on those providing that residential care. That is greatly exercising national charities as well as private sector care homes and it would be tragic if, in pursuit of
a care standards ideal, we contrived a dearth in capacity and, perforce, drove people back to either health service-run institutions or other inappropriate care that inadequately supports community living.Where, indeed, is the guidance on access to social housing promised in the White Paper? There are important questions to ask. How will we and local authorities know whether they are making adequate provision? How do those issues play into or out of joint investment plan budgets? Will the finance come from those budgets or from other resources? We do not yet have an adequate information base to ensure that needs are identified, let alone met. I am surprised that the Minister said less about that than she might have, because preparing a better database is important to driving the agenda forward.
There is a danger that aspirations may not meet reality and there may not be enough resources to fund the revenue costs of development without losing quality. Any general efforts to widen choice, which of course involve the possibility of direct payments where appropriate, are welcome. I defend direct payments, because they may represent a more cost-effective use of resources.
Implementation is central. I have read the 17 January debate on Bristol royal infirmary and remind the Minister that her ministerial colleague, the right hon. Member for Barrow and Furness (Mr. Hutton), sensibly said:
- "reports do not implement themselves. They need to be monitored and implemented."—[Official Report, 17 January 2002; Vol. 378, c. 507.]
I refer again to the university of Bristol research. On residential placements, for example, it says:
- "The existence of joint panels or joint policy statements did not necessarily lead to good working relations between frontline staff in day-to-day work with children and parents."
This is not a day for partisanship and I do not intend to breach the mood, but I must say that I find three aspects of the Government's approach and culture relating to complex social issues trying and often rather implausible. First, we have the aspiration. Fine words such as "rights", "independence", "choice" and "inclusion" are spoken as if nobody has thought of them before. Then adjectives such as "new", "modern", "high quality", "world class" and even "joined up" are attached. Finally, the third leg of the stool: plans are announced, but they do not always happen. I hope that the Minister learns from the shortcomings and achieves a strategy that works.
Let me examine three aspects: partnership working and investment, advocacy and monitoring. The White Paper deploys an impressive array of concepts to explain how the intended partnership is to work, and the keystone is the local learning disability partnership board. The boards were to be established by October last, so perhaps the
Minister will tell us whether they are all in place. A good test is how often they have met or, more basically, whether they have any members.I am pleased that the boards have an incentive to get on with the job. Their first duty is to consider joint investment plans and tap into the learning disability development fund, which was to have involved £20 million of capital and up to £30 million in revenue. Due to the difficulty in making savings from long-term hospitals, that figure has been reduced to £22 million, which, as Mencap rather drily comments, "appears somewhat limited" in the context of an annual spend of more than £3 billion on adult learning disability services alone. That addition is welcome, but it is only a drop in the ocean.
Another aspect is the operation of implementation teams and their role in stimulating and supporting such local partnerships. The local disability partnerships are not to be statutory bodies, so their internal procedures and precise responsibilities remain hazy.
As regards the task ahead, we have already touched on issues such as housing. May I single out another, which impinges on employment prospects? The White Paper does not address the expansion of supported employment. The recent thrust of Department for Work and Pensions policies has aimed at progression to open employment through supported employment. That is not objectionable in principle, but there is a danger that it may displace chances for people with learning difficulties and, indeed, many people with physical disabilities. Our approach should involve finding out what is required across the pitch, whether in open employment that may be stimulated by the disability charities or in supported employment, and widening opportunities.
On the implementation target timetable, we have a precise and contemporary test. Joint investment programmes were supposed to be in place by April last year. Local action plans were to be developed to supplement the joint investment plans and submitted to the Department of Health's regional offices by 31 January—that is, yesterday. Therefore, the deadline expired 10 and a half hours ago. In these days of modest information technology capacity, it should not be beyond the wit of the Minister to tell the House how many such plans have been submitted, how many are outstanding, and what action she and her implementation team intend to take to chase up the laggards.
It is not just a matter of producing some words and calling that a plan. She should ask the implementation team to find out whether the local development plan and partnership boards have met and approved the joint investment plans that they have submitted. Is that a paper exercise, or do they really know what their priorities are?
I am pleased that the Minister stressed advocacy, because I have long been interested in that. It is an invaluable supporter for vulnerable people and harassed families. The national helpline is certainly valuable, as is the Department's £2 million extra for research, but I sense that the sums available from the strategy funds for advocacy are likely to be severely stretched. Can the Minister be sure that everyone who wants an advocate will get one in due course, and that that advocate will be qualified to support the circumstances of the particular case?
The hon. Lady may need to consider good practice in the workings of the system as delivered by the local partnerships. It may be necessary for someone in authority in the partnership—not advocating from outside—to field any individual case, to go on with that case and be the person in charge of it, and to knock official heads and budgets together to meet the needs of that individual.
On inspection and monitoring, the White Paper refers to the social services inspectorate and the Commission for Health Improvement. The Office for Standards in Education will chime in by inspecting schools and local education authority provision. I am not clear whether the implementation teams will also have a supervisory role, especially after the initial phase. Ministers need the ability to determine in a clear, joined-up way whether a partnership is working as intended. I have considerable sympathy with Mencap's suggestion of an annual report by Government to Parliament, ideally to be presented during learning disability week. It also suggests that, as well as an overview of achievements, that should include successful, person-centred outcomes and good practice.
That is the note on which I shall draw my remarks to a close. Today's debate is about setting up machinery to cajole an often cautious and defensive, but not malign, bureaucracy in the implementation of policy in an area in which every service user is uniquely different, and the range of services they require spreads broadly across national and local government. As the Minister said, there are more than 1 million people in England alone who have a claim on our attention.
There are genuinely shared objectives across the House, although perhaps—even in the minds of Ministers, dare I say—there are some tacit and even cynical reservations about the likelihood of success. Many service users and their families and carers have a direct interest in today's words being turned into reality, and an interest in seeing the frustrations and setbacks that they often encounter being alleviated or removed.
Conservative Members will press the Government to discharge their current responsibility to ensure that positive change happens. I am sure that all of us here approach this most sensitive of areas with a determination to avoid being accommodative or even patronising, but instead to be genuinely supportive and empowering.
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