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5 Mar 2009 : Column 342WH—continued
It will be difficult politically for all the parties to address that debate, and it will be difficult for society, but we must have it, and the start will be the adult social
care Green Paper that my hon. Friend the Minister is producing. He needs to be absolutely open and honest about the scale of the challenge that faces us if we are not only to help people with learning disabilities get access to the services that they need but to ensure that all people who need care services get access to care in future. There is a cost to be paid for that, and we must explain that to the people of this country. Having said that, I thank my hon. Friend the Member for Hendon for the report that has provided the basis for this debate, and I look forward to seeing what my hon. Friend the Minister produces in the adult social care Green Paper.
3.43 pm
Mr. Oliver Letwin (West Dorset) (Con): My contribution will be brief. This is an interesting and important debate, and I am delighted to follow the hon. Member for South Thanet (Dr. Ladyman), whose work on the issue is of long standing. This debate continues the dialogue that occurred during debate on the Autism Bill on Friday.
My first point is that if one steps back 100, 150 or 200 years, one finds a very different social attitude to such matters. Roughly speaking, that attitude was, “Devil take the hindmost”. People who could get on did, and those who suffered from one kind of disability or another were simply left out. One thinks of madhouses and all the other ghastly things that went on. Gradually, over a long period, society has come to the view, which was very well expressed in the Disability Discrimination Acts, that the rest of us need to make a set of reasonable adjustments to allow for the conditions in which some people find themselves. The hon. Member for South Thanet, in his remarks and in his fascinating interchange with my hon. Friend the Member for Macclesfield (Sir Nicholas Winterton), brings starkly to light the issues that we now face as the question arises of where reasonable adjustments start and end.
My second point, which helps us understand the answer to the first, is that if we are honest with ourselves, we will admit that it is a great deal easier to accept that people who suffer from straightforward physical disabilities should have adjustments made in their favour. It is simply a fact of being human that it is easier to grapple with physical disability than with mental disability of almost any kind.
A few years ago, quite a lot of people would have thought it an extraordinary proposition that people with public facilities would have to make adjustments for people with physical disabilities, but we are all completely used to it now. It is just part of the normal run of things. The report and this debate—as well as the Autism Bill, debate on the various other things that are going on—bring out the fact that we now need to make a further leap and get to the point where we recognise thoroughly that although they are more difficult to deal with emotionally, we must take mental disabilities of various kinds, including learning disabilities, as seriously, openly and comprehensively as we now take physical disabilities as a matter of course. That is a major leap forward for society that we have not yet made fully.
My third point is that part of the answer to the first conundrum lies in the recognition of the second point. If we recognise that people who suffer from learning disabilities, autism, Asperger’s syndrome and other such conditions have as much right to have adjustments
made in their favour as those who suffer from physical disabilities, we are bound to consider both the cases in which society will encounter costs by making those adjustments, as I mentioned in my earlier intervention, and the cases in which costs would be reduced.
It is a good indicator of how far we have yet to go before we fulfil the ambitions expressed in the report that the Government—this is not a partisan remark about this Government; it applies to all Governments in recent years—have not even got to the point of seriously examining what savings we could make. To return to my point about the criminal justice system, it is extraordinary what a high proportion of the total costs of the criminal justice system are incurred as a result of the mishandling of things done by people with learning disabilities.
That is not the only extraordinary thing. It is at least equally extraordinary that vast numbers of people who suffer from no learning disability—neither autism, Asperger’s nor anything of the kind—but who are incapacitated to some degree by drug and alcohol dependencies engage the criminal justice system. It is extraordinary to what extent we do not try to address those issues in rehabilitation. We as a society incur shocking and unnecessary social and economic costs as a result.
Sir Nicholas Winterton: My right hon. Friend is absolutely right. It would be interesting if the Minister mentioned in his response the number of people sent to prison by magistrates and judges because there is no suitable non-prison accommodation to which they can be sent due to the crime that they have committed as a result of their learning disability or mental illness. To my mind, it is criminal, if I may use that phrase, that people who are mentally ill or have mental disabilities or learning difficulties end up in prison because society cannot properly deal with them outside prison. I hope that he will provide the number, which would add up to a very large figure indeed.
Mr. Letwin: My intuition is exactly the same as my hon. Friend’s, but I am pretty sure that the Minister will not be able to answer his question today, although I would be delighted to be proved wrong about that. I have been inquiring about this for many years now, and nobody seems to know the answer. If one talks to people who can give good anecdotal estimates, such as magistrates and prison governors, one finds what anyone who spends time wandering around our prisons or youth offender institutions will find—that an enormously high proportion of people in our prisons fall into one or other of the categories that I have described.
Dr. Ladyman: I may be able to help the right hon. Gentleman, as I used to have ministerial responsibility for health in prisons. The accepted figure is that 60 per cent. of people in prisons are suffering from either neurosis, psychosis or personality disorder, or from alcohol or drug abuse. So, only 40 per cent. of prisoners do not fall into that category. The proportion of people in prison who have learning disabilities or autism is another matter, which I do not think anyone has ever got to the bottom of.
Mr. Letwin:
That is indeed the accepted figure; I think it is wrong, but that is another issue. As the hon. Gentleman says, there is not even an estimate for the number of prisoners who suffer from learning disabilities
and other permanent mental disabilities, and there are good reasons for that, one of which is that no one in the Prison Service has the ability to find out, which is pretty extraordinary. In courts, there is typically no provision to enable the magistrate or judge to determine the extent to which something has happened because the person involved has a learning disability.
That brings me to my penultimate point. There is a principle in moral philosophy that is just about as old as moral philosophy itself—that “should” implies “can”. One cannot reasonably demand that someone do something, on a moral basis, unless they have the ability to do it. That principle is entirely understood in discourse on moral philosophy, but it is almost entirely absent from people’s understanding of society. If all we Members gathered here were to look at all the letters we have had from constituents complaining that people who are in a particular condition benefit from certain kinds of treatment that are not available to them, we would find it a prevalent phenomenon that they are actually complaining that someone who cannot do something is getting an advantage that is not open to them because they can do it, but are not doing it.
It is understandable that people who are struggling and not having a particularly easy life, and who find that all sorts of things are not available to them, should find it difficult to accept that other people will have advantages such as there being vast expenditure to enable them to engage in independent living. It is perfectly understandable that there should be those resentments in society, but the challenge is to get over the very first thing that I mentioned—society’s great difficulty in grappling with the cases of people who suffer from mental, rather than physical, disabilities. We have to get to a point where society as a whole accepts that we are going to invest in people who cannot do certain things, and that we are going to make certain adaptations to enable them to live in a different way and to prevent them from getting into conditions that impose costs on society, such as crime. If we can get to that point, in the end, it can become something that is normal, accepted and probably self-financing.
My guess, although I cannot remotely prove this, is that if we got to a point at which everyone recognised the extent to which people’s scope is restricted and changed by learning and other mental disabilities, as we are beginning to do with physical disability, we would find that the savings at least matched the costs, and we could have a better society that would not impose on others grounds for resentment. I very much hope, therefore, that this extremely important report will lead to responses, not just this year or next, as this will take time, and not just from this Government, or the Government of any one party, but from all of us over time. I also hope that it will lead to changes that will lock in the idea that society as a whole has not only a duty to accommodate, but an interest in accommodating, the needs of those who have learning disabilities.
3.55 pm
John Barrett (Edinburgh, West) (LD):
Today’s debate not only is on an important subject that requires parliamentary time, but is at the heart of what we in the House should constantly be pushing up the agenda. At a time when the economic downturn dominates the
news and when tens of billions of pounds are being injected into a banking sector in which salaries and bonuses are paid in millions of pounds to some and six-figure pensions are paid to others, it is vital that we keep a focus on issues that, although they might not make the news headlines, are equally important in every way. To some people, these issues are the most important in their lives. People have struggled and campaigned for a long time for human rights and the individual’s entitlement to freedom, respect, equality, dignity and autonomy in everyday life. In the 21st century, those things are long overdue for many.
This debate has been excellent so far, and the speeches and interventions from hon. Members on both sides of the Chamber have been interesting and have added to the debate. I congratulate the Chairman of the Joint Committee, the hon. Member for Hendon (Mr. Dismore) on its excellent report. It has been good to see what is in both the report and the Government’s response. I found the comments of the hon. Member for South Thanet (Dr. Ladyman) very interesting, particularly about the rights and risks of adults with learning disabilities in forming relationships, because risk assessments are not taken for the rest of society at large, and it can be patronising to say that adults who have learning disabilities cannot make such decisions on their own. We all know that many people around the country cannot make decisions about relationships, contraception and other matters, but adults with learning disabilities are not always given the same rights and respect as other people or allowed to make the same mistakes.
We have heard the tragic case of the adult who was denied health care and about the end result. Other hon. Members will know of similar cases as, sadly, there have been too many of them, but I shall not go into that today. The interventions of the hon. Member for Macclesfield (Sir Nicholas Winterton) were also very interesting, because the cost implications and questions about where money will come from are often at the heart of many relevant issues. We spend tens of billions of pounds on the results of alcohol and drug misuse, such as crime and antisocial behaviour, which are not generally incurred by adults with learning disabilities.
One Friday evening in Edinburgh, I visited an accident and emergency unit where the vast majority of cases were self-inflicted, not by adults with learning disabilities, but by drunk people who had been attacking one another, some of whom then attacked doctors and nurses. We spend tens of million of pounds on such cases, sadly, but then we wonder where the money will come from to pay for services for some of the most deserving members of society.
In many respects, we have come far to get to where we are today. At his inauguration, Barack Obama spoke about how far things had advanced with race, from a time when his father would not have been served in a Washington restaurant 60 years ago, up to today and his election as the President of the United States of America. On women’s rights, we have moved forward in the past 100 years, from women having no vote at the time of suffragettes, to women now having the vote and being able to play a full part in society. On religion, right-thinking people in Britain today would never discriminate on religious grounds. Sadly, that progress on race, gender and religion does not extend to disabilities in far too many walks of life.
Adults with learning disabilities have often had childhoods in which their human rights were not even on the agenda. Too many of them have grown up being ignored, bullied, excluded from school and patronised. Too many of them have been given second-rate health care and education, poor access to justice or information and much more. Where we are today is not a great success for all, and many people feel that we must right those wrongs. Hon. Members from all parties must work together to ensure that equality and human rights are accessible to all members of society.
Just how special many disabled children are was brought home to all hon. Members last week by the sad death of Ivan Cameron. From my experience with my little granddaughter, who suffers from cerebral palsy and the milder form of epilepsy, I know that, after a long struggle through childhood, she is likely to reach adulthood. When she does, I want to ensure that we can look back on the days when disabled people did not have the same human rights as everyone else and say, “Those days are long gone.” She, and all children with learning and other disabilities, deserve no less in the future. The adults of today have already waited far too long.
Although much legislation is in place, a lot still needs to be done. Departments, local authorities, the NHS and many other bodies should be leading the charge to ensure that adults with learning disabilities live their lives in dignity. However, instead of leading that charge, far too many organisations are dragging their feet. Today’s debate ought to be about the way in which we can move forward towards genuine equality for all those with learning disabilities. We should consider how we can improve access to services, secure equal access to health care and education and end the marginalisation that too often accompanies a learning disability.
I welcome the excellent report that we are discussing and the two Government responses. As hon. Members have outlined, there has been genuine progress in some areas in recent years. However, I am sure that the Minister would concede that we have some distance to go before the rights and duties that exist on paper are translated into genuine improvements to the lot of those with learning disabilities.
As has been mentioned, the initial report from the Joint Committee was partly prompted by the shocking findings of the Mencap report, “Death by Indifference”, which has been debated in Parliament before, so I will not linger on the details. However, the hard evidence that people with learning disabilities face stark health inequalities is simply overwhelming. Among people with a learning disability aged 20 to 29 years old, mortality is nine times higher in men and 17 times higher in women. Other hon. Members have mentioned the independent inquiry into access to health care for people with learning disabilities that was published last year, which supported the findings of the Joint Committee’s report. That inquiry found that
“Adults and children with learning disabilities, especially those with severe disability...have significantly worse health than others.”
However, the parents and carers of adults and children with learning disabilities often find their opinions and assessments ignored by health care professionals. Health service staff, particularly those working in general health care, have limited knowledge about learning disability.
I welcome the publication of the Government document, “Valuing People Now”, and the stipulation that reasonable adjustments should be made to all services to reflect the specific needs of people with learning disabilities. However, perhaps the most worrying aspect of the report was that many the staff involved were unaware not only that their behaviour contravened the rights of their patients, but that there was anything unacceptable about their behaviour. That was compounded by the fact that many people with a learning disability were unaware of their rights, because they had never received the help necessary to understand them.
It is one thing to secure a right to something, but unless individuals are aware of their rights and society is aware of its corresponding obligations, change will be slow. As much as anything, the Mencap report showed that the battle of awareness and perceptions is still not won. It is clear that, in too many cases, mainstream health services still do not see people with a learning disability as their responsibility. Until we address the lack of understanding among some health care professionals, new duties will have only a limited impact.
Even securing the rights contained within the UN convention on the rights of persons with disabilities has been more of a struggle than we would have liked. I welcome the Minister’s written statement on the ratification of that convention and the signing of the optional protocol, but the delay has been, at least, unfortunate. Although I understand the need for certain opt-outs for Departments, such as the Ministry of Defence, I share the incredulity of many people who cannot understand why it has taken so long to organise what appear to have been relatively minor changes, most of which already have precedence in the Disability Discrimination Act 1995.
Social care, as anyone involved with an individual with learning disabilities will know, is fundamental to providing the opportunities and dignity in life than many of us take for granted. Although all Departments are experiencing budget constraints, it seems clear that current funding for social care will prove to be inadequate in the future. As mentioned by the hon. Member for South Thanet, the cost of care is increasing and when free personal care for the elderly was introduced north of the border, the costs were underestimated. There is no doubt about that; it is a very expensive business.
Funding ought to reflect increased demand and, considering that the number of adults aged 18 to 64 with a learning disability is set to rise by 20 per cent. between 2005 and 2041, we clearly need to look again at whether we can meet our obligations to people with disabilities under the current funding arrangements. Put simply, the consequences of the failure of funding to keep pace with need are tightening eligibility criteria. That is leading to more and more people being excluded from the social care services that they desperately need.
I look forward to the Minister’s comments on what his office can do to remind every local authority of its responsibilities to deliver and promote human rights. I add my support to the Committee’s calls for the Government to adopt a nationwide communications programme to provide adequate information for people with learning disabilities—both in relation to their rights and how to access redress if need be.
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