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15 Oct 2008 : Column 307WH—continued

3.40 pm

Mr. Stephen O'Brien (Eddisbury) (Con): I, too, congratulate my hon. Friend the Member for Newbury (Mr. Benyon) on securing this important and timely debate. He mentioned that over the past few years he has supported his constituent, Jane Kemp, during the still ongoing complaints process into the death of her daughter Emma. We heard a moving account from my hon. Friend. Likewise, the other hon. Members who have expressed their testimony on behalf of their constituents are in a similar position.

My hon. Friend’s speech, and other hon. Members’ contributions to this vital debate, will, like all other speeches in this place, be recorded word for word for ever, but unusually, unlike so many of the speeches made in the House, those made today will also have the added merit of being memorable and therefore influential in terms of trying to shift the whole legislative, statutory and attitudinal basis for making improvements as we go forward.

In the Chamber today are two Members of Parliament from Scotland, where many such matters are devolved, and are acknowledged as such. It is important that we see the universality of the issues and recognise that, although our responsibility in this Chamber is effectively under English jurisdiction, there is cross-reference that is valid and important.

Given that this debate is substantially concerned with the independent inquiry into access to health care for people with learning disabilities, by Sir Jonathan Michael, published in the recess, and given that the inquiry report’s 10 recommendations apply to the Department of Health, or to its sphere of influence, and given the seriousness of the failings—involving people’s lives—that the inquiry is seeking to reverse, it is vital that the Health Minister, who is here listening, is also here to act. As a former Treasury Minister, she knows more than most how to flex the channels and influence the Government to find the necessary funds to support the action called for today. I am much encouraged that she is the Minister answering the debate.

During his speech, my hon. Friend the Member for Newbury mentioned the importance of training for doctors and nurses in how to engage with and meet the health needs of those with a learning disability. There is clearly an advantage to both undergraduates and those already registered having meaningful contact with individuals with a learning disability and their family carers to improve their understanding of what it means to have a learning disability.

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I, too, pay tribute to all that Mencap has done over many years, under the initiative and leadership of Lord Rix and also, more recently, under Dame Jo Williams, whom I first met when she was in charge of Cheshire social services, when I was first elected. I pay tribute to her, and all her colleagues, not least because of their influential “Death by Indifference” report.

Mencap has highlighted the case of Cathy, who has Down’s syndrome. Cathy visited an audiologist for a hearing test, as she had experienced a little discomfort. That should have been a routine procedure, but, sadly, as the audiologist did not know that people with Down’s syndrome have short, straight ear canals, he pushed the otoscope too far into Cathy’s ear and perforated her eardrum. It was not possible to repair the perforation and Cathy has had to wear a hearing aid ever since.

My hon. Friend the Member for Tiverton and Honiton (Angela Browning) mentioned the Government’s recent announcement that the provision of annual health checks for people with a learning disability will be one of the five new categories of directed enhanced schemes included in the general practitioner’s contract. That is good news. However, as my hon. Friend said, the evidence for the positive impact that annual health checks can have on the health of people with a learning disability has been clear since 2001. The Australian evidence that she cited has given us confidence that it is effective.

The Welsh Assembly has provided a financial incentive to GPs to introduce regular health checks for people with a learning disability since April 2006. Initial findings are that, in the first year, 51 per cent. of those with a learning disability who received a health check had a newly identified health need and 9 per cent. had a serious health problem. Subsequent checks a year later identified further new health needs among 68 per cent. of those tested and serious problems were identified in 11 per cent. of those people.

Some primary care trusts, such as the one in Birmingham, have already commissioned directed enhanced services in their areas to provide annual health checks. In Birmingham, out of 1,500 health checks, 205 previously unknown health problems were identified.

Bearing all this in mind, it is no surprise that, back in 2001, the Government first acknowledged the value of annual health checks in their policy paper, “Valuing People”, which hon. Members have cited. Some 18 months ago, the Government said:

Therefore, the Department of Health has known for a long time what is needed to ensure that people with a learning disability get equal health outcomes—indeed, it has known for seven years. Despite all the evidence that such provisions would have a major impact on addressing health inequalities faced by people with a learning disability and that those would have helped them overcome the barrier of access and entry into the health care system, the Department did not give priority to ensuring that good practice was implemented until just last month. We had been questioning the Government about how they were dithering. Let us acknowledge that the implementation has now happened and let us hope that the Minister will say that they will not dither over certain matters that we have identified and that they will go forward.

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In July 2006, the then Secretary of State for Health was asked the following question:

The right hon. Member for Leicester, West (Ms Hewitt) responded, saying:

I hope that the Minister will tell us in a moment whether, two years since that exchange and seven years after the promise was made, health action plans have been rolled out across the country. If not, will she agree to write to me, listing the places where they have and have not been put in place?

The impact is clear. For example, people with learning disabilities and other health problems, such as diabetes or stroke, such as the moving case that we heard about from the right hon. Member for Coatbridge, Chryston and Bellshill (Mr. Clarke), have fewer measurements of their body mass index taken than others with diabetes, and those with stroke have fewer blood pressure checks than others with stroke. They often experience diagnostic overshadowing, which is when reports of physical ill health are viewed as part of the learning disability and may not be investigated or treated.

A central principle of our NHS is that care should be available to all, free at the point of use and according to need, not ability to pay. Yet for those with a learning disability access to services is often far from ideal. I pay tribute to the work of Diabetes UK with Speakup, the self-help and advocacy charity, to produce accessible information and education to ensure that people with learning disabilities are able to have their health needs met by primary care services: GPs, practice nurses and other staff. Diabetes UK and others are calling for work towards improving early intervention for high-risk groups and flexible and integrated care packages for vulnerable people with diabetes. I hope that the Minister will outline what work the Government are taking forward in those areas.

Part of the problem is that, as usual, the Government are avoiding collecting the data needed to be able to assess accurately the health inequalities experienced by people with a learning disability. For example, as my hon. Friend the member for Tiverton and Honiton commented, the independent inquiry calls for an increase in the number of learning disability liaison nurses and health facilitators. Can the Minister tell us how many there are at the moment? I suspect that she will have to say, “Of course not.” Can the Minister tell us how many of each are on permanent and fixed-term contracts? Again, I fear that she cannot. Can she even tell us how many NHS trusts have a disability equality scheme or how many people with a learning disability have a health action plan in place? I fear that she cannot. There is a grave danger that by not collecting information centrally we do not have the data on which the relevant action can be taken under ministerial direction and guidance. There is a mismatch between aspiration and the data required.

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One reason why people with a learning disability seem to face such health inequalities might be found in the fact that 30 years ago at least 60,000 people with a learning disability lived in long-stay hospitals. Although those numbers have been reduced, many of the services that are needed to replace them, in the community, have not come through and have not been available. Poorer people, in particular, experience difficult access and poorer health outcomes. I should be grateful if the Minister stated explicitly how the Government will respond to each of the 10 recommendations in the Michael report. I shall not list them because they are well known, and I prefer to give the time to the Minister for her response.

An important point was made a moment ago about the 18-year-old cliff edge, and I want it to be well understood. I look forward to the Minister’s response, and hope that she will implement the independent inquiry’s recommendations, which we have discussed, as well as the full involvement of families—we heard about that especially in the case of Tom, described by the hon. Member for Cheltenham (Martin Horwood). Let us ensure that the medical profession conforms to its statutory duty, and thus enables advocates to have teeth.

Many families of people with learning disabilities report that some doctors, consciously or unconsciously, believe that their son’s or daughter’s health problem is a result of the learning disability and that not much can be done about it. That is a dangerous assumption and, as we have heard today, can lead to undiagnosed or misdiagnosed conditions.

4.50 pm

The Minister of State, Department of Health (Dawn Primarolo): I congratulate the hon. Member for Newbury (Mr. Benyon) on securing this important debate, and I hope that he understands that if hon. Members take longer to read out questions than the time that I have left to reply, it is regrettably not always possible to answer each one.

I apologise on behalf of the new Minister for Care Services, my hon. Friend the Member for Corby (Phil Hope), who is attending a Standing Committee and unable to attend our debate here. I know that he shares his predecessor’s concern about the issues that hon. Member have raised, and that he is equally committed to putting matters right. Those issues are also at the front of the Secretary of State’s mind. Earlier this summer, he met the families of those patients whose tragic deaths are described in the report, “Death by Indifference”. He has maintained a close personal interest in the ongoing inquiry.

I have listened carefully to what has been said this afternoon, and I thank the hon. Member for Newbury and other hon. Members for speaking with such passion and clarity on such a vital issue. The principles that govern the NHS are simple, powerful and enduring. We believe that it should be inclusive, responsive and compassionate. Those qualities are paramount when providing health care for people with learning disabilities, who may have multiple needs and require a tailored approach.

The hon. Member for Tiverton and Honiton (Angela Browning) spoke powerfully, as she always does on such issues, as did other hon. Members, and made it clear
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that such qualities are not being met in every setting for every patient. That cannot be tolerated. She pressed the Government on a number of issues, and I shall respond to them.

I share the hon. Lady’s dismay at the evidence that medical practitioners are disregarding the requirements of the Mental Capacity Act 2005. When I leave the Chamber, I shall ask my officials immediately to take up the issue and to report back to my hon. Friend. I agree that the abuse of people with learning disabilities is absolutely unacceptable—I can think of no other words to state that more strongly—and that we must take the matter forward. Other hon. Members spoke eloquently, and I agree with them that it is necessary to listen to family members. My officials are working closely with the National Family Carer Network to ensure that their concerns are addressed, and that families are given support and are listened to as an expert partner.

Other issues of transition were also raised. The Government are taking work forward to unblock the processes, and to combine assessments to ensure that young people with complex needs have that smooth transition that the hon. Lady so eloquently identified. As the hon. Member for Romsey (Sandra Gidley) said, there are many examples of outstanding work throughout the country, and of health and care professionals working together to deliver for people with learning disabilities, and going that extra mile. That shows that the NHS can do it, which makes it all the more unacceptable if parts of it do not.

The family cases that hon. Members described are deeply distressing, and inexcusable. They are anathema to what the NHS represents and, as my right hon. Friend the Member for Coatbridge, Chryston and Bellshill (Mr. Clarke) said, addressing inequalities has been one of the most important priorities for the NHS, but much remains to be done, and we are not shirking that.

Much has been said about the Government’s alleged inactivity in many areas, and I want to make a couple of points before going on to say what we shall do next. The Government have taken action to improve access to health care through the operating framework for the NHS for 2008-09. We have specifically directed improvements in the NHS in the quality of care for people with learning disabilities and inequality of access to care. That includes developing personalised plans that address health and care needs. We have directed enhanced services for GP practices to provide annual
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health checks. That is not all we have done because we were doing things previously, which are in progress, but we are going further.

We have published the primary care service framework to support PCTs to deliver that better primary care. We have launched the national awareness campaign to examine education and the programmes that we need to introduce and which hon. Members rightly identified. We have also made clear what we intend to do in the next stage review. We want to ensure good practice so that everyone can expect the health care from professionals that they are entitled to. We responded to the Joint Committee and have taken work forward to improve services.

We considered the report from the Disability Rights Commission and took action, but I shall not describe that because it is on the record.

Following publication of the report about abuse in Cornwall and in Sutton and Merton, the Secretary of State, the NHS chief executive and the director general of social care wrote to the NHS and social services, reminding them of their responsibilities to provide the highest care.

There is a wider job to do, and hon. Members were quite right about driving a culture of change through the entire NHS and eradicating the problems, whether they are based on ignorance or fear among NHS staff when they encounter patients with learning difficulties.

Reference was made to Sir Jonathan Michael’s report, and although I cannot pre-announce our response, I want to make absolutely clear our commitment to respond effectively to the 10 recommendations, and to ensure that our response is included in the Government’s forthcoming cross-cutting strategy, “Valuing People Now.” I hope that hon. Members understand why I cannot pre-empt that. My colleagues and I want deep, effective change, not a quick fix.

I thank hon. Members, Mencap and all those families who have continued to bring these important issues to our attention. We are determined to act on them, not just in the Department of Health, but throughout the Government. I am confident that we can transform the way in which the NHS responds to the needs of people with learning disabilities, and ensure that all NHS staff understand individuals, their needs and how to deliver the best possible health care and outcomes.

It is unacceptable for any trained health professional not to discharge their responsibilities for the care of any patient in the NHS. We intend to continue to make that clear, and to bring about the necessary cultural change to deliver the services that all hon. Members want for all members of our society.

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Sheep (Electronic Identification)

3.59 pm

Mark Williams (Ceredigion) (LD): It is a pleasure to serve under your chairmanship this afternoon, Ms Walley. I welcome the Minister to her new role. When she was in her previous job, I was supposed to meet her yesterday to talk about the Aberystwyth tax office, so we were obviously destined to meet one way or another this week. I am pleased she is here to respond to a matter of acute concern for many farmers in my constituency, across Wales, and more generally across the United Kingdom.

Sheep electronic identification has certain limited benefits in terms of tracking disease, but those are far outweighed by the many problems that have emerged since EU regulation 21/2004 was first proposed. The rationale for electronic identification came from the widespread foot and mouth outbreak in 2001, when there were problems with tracking animal movement. That presented a severe problem because, at that point, subsidy was linked to headage. That is no longer the case and therefore, from the outset, there is a fundamental problem with the rationale behind EID.

The ID and batch recording system, which is backed up by the six day standstill situation, already tracks disease and works perfectly adequately, as I am sure the Minister realises. There is not really a problem, yet we have a supposed solution that will potentially pile misery on the farmers whom I and the hon. Members here from all parties represent. I believe that the Department for Environment, Food and Rural Affairs will not be introducing a national database to hold the records, but I would be grateful if the Minister confirmed that. Without a database to record the information, all we will be left with is a huge paper trail that will make it difficult for us to assess the small amount of useful information produced.

The system cannot provide us with secure traceability within the food chain because when animals are taken to slaughter, the tags will be removed. There will be no way of retaining a traceability function beyond that point. I do not dismiss EID out of hand; in fact, there may well be a case for some countries to adopt it, but, as far as I can tell, the UK farming community is virtually unanimous in its belief that it is not right for the UK, and it is certainly not right for Wales.

Farmers have told me that the benefits are minimal and are certainly not worth the additional costs and difficulties that they would experience. The experience of those who have taken part in the trials is instructive; for some it worked fine, but even those who did not experience problems did not think it was particularly worth while or beneficial. If we are going to introduce an added burden on our farmers and the wider rural community, there needs to be a good reason for the regulation to be introduced. I am yet to meet anybody in the UK farming community who believes that to be the case.

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