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11.18 am

Paul Holmes (Chesterfield): Liberal Democrats very much welcome the aspirations outlined in "Valuing People". As we have heard, it is a major and long overdue updating of its 30-year-old predecessor, the White Paper "Better Services for the Mentally Handicapped". Society has moved on a great deal since then, and in respect of attitudes towards all kinds of disability it has undoubtedly changed very much for the better.

As a teacher in mainstream secondary schools from 1979 to 2001, I certainly witnessed some of that change for the better. In recent years I taught mainstream classes of 30 and more pupils into which children with Down's syndrome and degrees of autism including fragile X syndrome have successfully been integrated, something that would have been very unlikely 30 years ago or even in 1979 when I started my teaching career. Regrettably, class sizes in secondary schools have got worse in recent years, otherwise the integration of children with all sorts of special needs would have been even more successful.

There can be little doubt that if the White Paper fulfils its promises to those with learning disabilities, and their carers, we will witness an even more dramatic change for the better. We very much welcome the inclusiveness agenda and many of the excellent proposals in the White Paper, but having willed the end are the Government prepared to will the means to the end and provide the financial resources that are necessary to fulfil the White Paper's promise of setting the four key principles of rights, independence, choice and inclusion at the core of provision of services for those with learning disabilities? As a former teacher, I know that those principles can work in a school setting if the money is there to provide the adaptations, support workers and the extra or adapted teaching materials. It cannot be done on the cheap or as a short-term project.

In the light of my own experience, I want to raise some concerns that are shared by Mencap, the Association of Directors of Social Services and the Royal College of General Practitioners. I welcome the establishment of a new learning disability development fund, and new money to fund the modernising of day centres and the development of supported living approaches. However, it is important to set the figures in context. In 1999–2000, for example, provisional expenditure on adult learning disability services was in excess of £3 billion, of which £1.4 billion was spent on health and £1.6 billion on social services. In addition, social services contributed about £308 million, and the Department of Health about £107 million, to supporting disabled children, not all of whom, however, had learning disabilities.

Set against that, the White Paper establishes a development fund of up to £30 million revenue and £20 million capital per year, for just two years. Such a figure is hardly significant compared with the overall sum. Obviously, much can be done by using existing funds more effectively, but the key point is that the White Paper's ambitious tones have been accompanied by distinctly unambitious funding. Indeed, it now appears that the initial revenue figure of up to £30 million has in practice been scaled down to an even more disappointing £22 million.

So, however much one might welcome the sentiments behind the White Paper, they are in danger of being made unrealistic by simple underfunding. Of course, we have

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witnessed precisely the same elsewhere—for example, the excellent new national care standards for residential homes have already been undermined by gross underfunding. The relevant Government impact assessment was a massive 20 times lower than that of the Leonard Cheshire organisation. The Sue Ryder Foundation has already closed one home, NCH Action for Children has withdrawn provision in Wales altogether, and private care homes the length and breadth of the country are closing in record numbers. This excellent White Paper must not be undermined in the same way, yet a general vagueness about funding seems to beset the issue of housing for those with learning disabilities and, specifically, the impact of housing provision on the lives of those with learning disabilities.

As the White Paper correctly points out:

"Department of Health research has shown that supported living is associated with people having greater overall choice and a wider range of community activities."

It makes the further obvious point that

"small scale ordinary housing is likely to lead to better outcomes across a range of factors than large-scale housing or hostel provision."

That issue is all the more important because in England about 60 per cent. of adults with severe or profound learning disabilities—some 87,000 people—live with their parents. I welcome the White Paper's plans to resettle some 1,500 people who still live in long-stay hospitals, and to provide alternative living solutions for those who live with carers aged over 70. A cut-off age of 70 may be arbitrary and should surely be based on a needs assessment of individual families, rather than the nearest convenient round figure. However, I know from experience that it is better than no date at all. I have recently had to fight for many months to secure such an alternative living solution for an 85-year-old constituent of mine and her dependent adult son with learning disabilities. Her son himself is almost of pensionable age.

The Government have not yet clearly explained how the expansion of housing provision and the essential accompanying support will be funded. Because of more than 20 years of severe Government underfunding, local councils often provide housing and support only when there is a crisis in the family home. Independence and choice in one's living arrangements, where possible, are fundamental to the White Paper's four key principles of rights, independence, choice and inclusion. I would like the Government to make a full assessment of the full costs of providing housing for all people with learning disabilities.

Another of the White Paper's welcome aspirations is the stated objective of increasing the number of people with learning disabilities in work from the current lamentable figure of 10 per cent. to 30 per cent.—the same as for other disabled people. Although 30 per cent. is a poor enough figure, it would at least be a step forward. If the targets are to be achieved, the best way to do so is surely—as we have heard—through supported employment schemes. Can the Minister provide full assessments of the cost of such schemes, and a guarantee that funding will be ongoing? That would ensure that, once the targets are met, there can be no falling back in future.

Despite my general support for the White Paper, I am disappointed by its lack of attention to the needs of children with profound and multiple learning disabilities.

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Intellectual impairment is often accompanied by profound sensory impairment. Such people have the most profound needs, and any examination of the learning needs of this country's learning disabled must make them a priority. I call on the Minister to ensure that local agencies are obliged to target services toward that group, but she must also make a clear assessment of the cost of making such provision, set specific targets to meet their needs, and above all earmark the funding increase to ensure that those needs can be met.

On the proposed major changes to the provision of day services, we welcome the White Paper's requirement for local authorities to examine their dependence on day centres, and its moves to modernise day care centres, many of which are antiquated and inadequate. Change is essential if those centres are to provide the learning-impaired with meaningful experiences. The watchwords must be flexibility—with more activities provided outside the traditional hours of 9 to 5, Monday to Friday—and quality, with services tailored as well as possible to individual needs. The Minister must also note concerns that modernisation should not result in a reduction of services, and that the existing service is not removed before working alternatives are introduced.

On self-advocacy, I welcome the key actions listed in chapter 4 of the White Paper and agree with its assertion that the provision of advocacy services has been patchy and that those with learning disabilities have had little involvement in decision making until now. The £1.3 million that will be provided for self-advocacy and advocacy schemes across the country is to be welcomed, but I know from talking to representatives of disability associations that some uncertainty exists about how the cash will be split. Some fear that its provision may not extend much further than the initial three years.

The White Paper promises

"£1.3 million per annum for the next three years to develop and expand advocacy services in partnership with the voluntary sector."

However, will funding dry up after that time, leaving stranded those who rely upon such services? Will the Minister give assurances that existing self-advocacy schemes that are funded by social services will receive ongoing funding, instead of the Government counting their existing money as part of the promised £1.3 million? Will she give assurances that, when new self-advocacy schemes are set up under the new fund in the White Paper, social services will not withdraw money from other existing self-advocacy services? Will she also give assurances that, when new self-advocacy schemes are set up under the White Paper, they will have a long-term and consistent stream of funding that will continue beyond the three-year commitment made in the White Paper?

Finally, on the question of practical and funding problems, I draw the Minister's attention to the resource implications for general practitioners of resettling into the community those who used to be concentrated in the old-style mental handicap hospitals. About 60,000 former residents have already been resettled and registered with their local GP. However, the Royal College of General Practitioners calculates that that often represents a fourfold increase per patient in the GP's drugs bill and work load. Dr. Graham Martin, the chairman of the RCGP's learning disabilities working group, points out:

"GPs and Primary Care Trusts need extra resources if they are to provide the level of care that is appropriate for patients with learning disabilities and which they deserve."

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My concluding point, which shows that money and other resources are not the only issues, concerns educational principle. The Minister has mentioned protecting the rights of those with learning disabilities in terms of access to mainstream education, and I have already referred to my experience of working with children with learning disabilities in mainstream education. However, the Government are undertaking a disastrous lurch in the direction of creating an irrevocable two-tier system of education in England, as we will discover in next week's debate on the Education Bill. Specialist schools of various kinds will select by aptitude, ability and aspiration, while "bog-standard" comprehensive schools will take the rest, along with £500,000 less per school.

The Government's own figures, such as those published by the Department for Education and Skills for 2000–01, make it clear that across the country as a whole—not just with individual schools, but right across the spectrum—specialist schools, faith schools, grammar schools and technology colleges take less than the national average of pupils who qualify for free school meals or have special educational needs. The latter category includes children with learning difficulties, who will not be good for schools' league table positions.

Can the Minister reassure us that by some miraculous amendment next week, safeguards will be put into the Education Bill to protect the rights of children with learning disabilities, which the White Paper sets out to enhance, but which the increasing development of a two-tier education system is undermining?

In his foreword to the White Paper, the Prime Minister says:

"I know the publication of a White Paper, however good its proposals, does not itself solve problems. The challenge for us all is to deliver the vision set out in this document so the lives of many thousands of people with learning disabilities will be brighter and more fulfilling."

I hope that the undoubted good intentions in the White Paper really will be implemented and funded, and will also be protected from the impact of other less worthy Government initiatives such as the Education Bill.

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