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5 Mar 2009 : Column 348WH—continued
Sir Nicholas Winterton:
Has the hon. Gentleman given any thought to the role played by parents who look after an adult son or daughter with learning difficulties
and the pressure is on them? If they die, what will be the additional cost of looking after their child outside what has been their traditional home? To my mind, carers are under immense pressure, and I say to the Minister that, without them, this country would be in grave difficulty. I pay full tribute to the carers of those with learning difficulties. How might we help those carers—for example, are there sufficient facilities to give them the respite care that they need from time to time?
John Barrett: That is a key factor in the entire costing of the massive costs that are involved in care. Whatever it costs to care—through trained nurses, support staff or whatever—a massive burden of care is currently taken on by families. Whether younger people are looking after elderly people or parents are looking after their children, the big worry is what will happen when they have gone. In many cases, the cost of care will be translated from the family to society at large. If we can provide care or assistance for those individuals, that will be a saving, not a cost.
We have talked about the cost of keeping people in care, but what are the alternatives? If we can get adults with learning disabilities into employment, they will help to make a contribution. Similarly, if we can get people out of prison into employment, there is a saving. Among the many costs that we do not know, I suspect that there is no hard and fast figure for the true cost for what parents or adults looking after people with learning disabilities save us. I only know that it must be a massive cost—I have no idea what the figure is.
In the Government’s response, I was pleased to see a commitment to the move towards a single equalities duty under the equality Bill and that the Government’s intention is to strengthen not undermine the existing public service duty. However, does the Minister share my view that a combined duty may not provide the emphasis and additional help and support that many people with a learning disability may need to access their rights? I am also concerned at reports that the Government are considering the removal of the sixth requirement of the current general duty, which allows public authorities to treat people with a disability more favourably if it is necessary to achieve equality. I am sure that hon. Members will appreciate the importance of the concept of more favourable treatment remaining in the Bill, and unless it does, disability discrimination legislation will be significantly weakened. Will the Minister give me an assurance today that that will be retained in the equality Bill?
In conclusion, this is a good report, and I welcome it and the Government’s response. However, although much progress has been made over the decades, we still have some way to go so that, in the not-too-distant future, such reports are redundant. We hope that in the future all people—adults with learning difficulties and the rest of us—are equal, because if we are all equal, we will not need to consider such reports.
4.9 pm
Mr. Stephen O'Brien (Eddisbury) (Con):
I, too, begin by congratulating the hon. Member for Hendon (Mr. Dismore) and his Select Committee on the report, on holding the Government’s feet to the fire and on securing this debate. I would also like to congratulate
the Committee on taking the possibly unprecedented measure of providing the report in an easy-read format, with audio summaries to support maximum access to it and to its findings. There was an interesting exchange about the fact that, wherever one starts, one will never be able to do enough to satisfy everyone, but an important precedent has been set. I hope that the lesson will be applied to many other activities across Parliament.
I am pleased that although the Committee understandably and rightly highlighted heinous recent failures in the care and support of people with one or more learning disabilities, it noted that marked improvements have come about over the past 30 years, stemming in particular from the reforms of Governments of all colours and stripes, including, I am proud to recall, the positive transformational reforms under previous Governments going back as far as the 1971 White Paper, “Better Services for the Mentally Handicapped”. I stress that we see this issue in the context of the remarkable progress made during the lives of the current generation—those of us who are here now have witnessed it for ourselves. I thought that my right hon. Friend the Member for West Dorset (Mr. Letwin) set that context particularly ably.
The nub of today’s debate is the fact that legislative progress—I emphasise the word “progress”—on the disability agenda has not been matched with practical progress in eliminating barriers and transforming attitudes of employers and society at large towards people with disabilities. Again, my right hon. Friend highlighted the moral imperative of making adjustments, and how the interests of society at large would be served by contributions that would come into balance, providing we take the right next steps. He called it a further leap in the case of mental disabilities. He made an interesting argument about how society’s interests could be served by taking that further leap.
We have only to look at the employment rate for disabled people, which is much lower than that for non-disabled people. It is 50 per cent. as opposed to 80 per cent., and has risen by only 4 per cent. over the past 10 years, despite the broadly benign economic conditions during that period. One can only fear the effect that the current economic conditions will have on people who have a disability. We have my right hon. Friend the Member for Witney (Mr. Cameron), his wife and family very much in our minds, thoughts and prayers at this very sad time after the loss of their beloved son. Ivan’s condition was central to the issues that are the subject of this debate. It was my right hon. Friend who launched the Opposition’s welfare-to-work proposals, which will help many disabled people back into work. We want to encourage a system whereby employers have more incentives and capacity to help disabled people find employment.
I was much encouraged by the comments of the hon. Member for South Thanet (Dr. Ladyman), who spoke with particular passion and knowledge, and made a moving contribution. I am sure that I am joined by the rest of the Members present in thanking him. I was also encouraged by the example that the hon. Member for Croydon, Central (Mr. Pelling) gave of employing somebody who had a learning disability in Parliament. He made his point with great impact.
I am genuinely pleased that the Government have now adopted—I will refrain from using the word “stolen”, given that this is such a consensual debate—our proposals,
which are now contained in the Welfare Reform Bill. We support those plans, but we caution the Government that they will not be successful unless the approach taken is the one that is being advocated by others: it is vital to reinvest benefits savings to help more people into work, and to have cyclicality in the funding mechanism. I am pleased that the Government have signed up to the genuinely consensual, dynamic drive towards the personalisation agenda. The Minister and I are often on platforms together on that subject. It is part of our unity of analysis when it comes to such matters.
The decision by the Joint Committee on Human Rights to carry out an investigation into the human rights of people with a learning disability came in the light of reports from the soon to be scrapped Healthcare Commission and the Commission for Social Care Inspection into abuses faced by people with a learning disability in Cornwall, Sutton and Merton, as well as “Death by indifference”, a Mencap report that carried great influence and is greatly to be admired. It revealed the avoidable deaths of six people with a learning disability while in the care of the national health service.
CSCI and the Healthcare Commission are to be scrapped at the end of this month. They will be succeeded and subsumed by the new Care Quality Commission, and many of us are actively engaged in discussions with the new officers and executives of that commission in an effort to ensure that many of the benefits developed by the previous bodies will be carried through. The JCHR’s report, “A Life Like Any Other? Human Rights of Adults with Learning Disabilities”, was published in March 2007, and the two subsequent Government responses were published in May 2008 and January 2009. It is important to note that this is a question of UK-wide import, and that the devolved Administrations, too, welcomed the report. I do not believe that that point has been made in this debate.
The report charted the broad human rights implications of failures in the care and support of people with one or more learning disabilities. It noted that the evidence suggested that adults with learning difficulties are more vulnerable to social exclusion, poverty and isolation, and that public authorities, including local authorities and primary care trusts, are finding “Valuing People” difficult to act on. A contributory factor—I do not by any means suggest that it is the only one—to that failure is the need for the Government to ensure that resources match the demands placed on local authorities in particular and other local bodies to deliver what the Government have said that they should deliver.
The Committee found that people with learning disabilities were more likely to be taken into care, and that they were discriminated against in the criminal justice system. That was discussed earlier in this debate. Although the issues are cross-cutting for Government, the Department of Health is the lead Department, and the Committee duly singled it out for not promoting the human rights of people with learning disabilities. To that degree, it is both welcome and important that a Minister from that Department is here today.
The Committee made it clear that this is a burgeoning issue, as the number of adults with learning disabilities in the UK is growing, due in part to better neonatal and lifetime care and, it is argued, to women becoming mothers at an older age. The growth in the number of people with a learning disability has been estimated at
between 3 and 5 per cent. a year. The personal social services research unit predicts that the number of adults aged 18 to 64 with a learning disability will rise by 20.6 per cent. between 2005 and 2041, and new research by the Centre for Disability Research found that the average estimated annual increase in new entrants to services will be 3.2 to 5.5 per cent. per annum between 2009 and 2026.
Above all, we simply must never lose sight of the fact that each and every one of the people we have in mind is an individual. They are part of a family, and they have carers. It is vital that we do not allow statistics to blind us to what is ultimately the basis of a debate on human rights, which is that individual human beings have rights. We must ensure that we can define and understand them, and find the means by which, through a balanced and civilised society, we can protect them. My hon. Friend the Member for Rochford and Southend, East (James Duddridge) made that point extremely powerfully through his sensitive and moving account of the fairly well-known case of Martin Ryan. We now look to the next step which, we hope, will produce the necessary sense of resolution and ensure that lessons have been learned. My hon. Friend’s points about accountability and a sense of justice will have been heard, and those who are charged with taking the case forward will no doubt read with grave care what he had to say.
The Government provided two responses: one in May last year and one, coinciding with the publication of “Valuing People Now” in January. It is worth noting that that document is, in many respects, a response to the shortcomings of the Government’s initial document, “Valuing People”. Has the Minister reflected on how to avoid repeating those shortcomings? We look forward to his reply. It is disappointing to hear the Government reannounce measures. The Minister well knows that we get very cross when they announce things that have already been announced, because it tends to undermine the importance of the matter. On this matter, however, I welcome reannouncements. It is important to emphasise the issue, and when things have been announced but not acted on, we welcome any reannouncement that ensures we make progress and help the Committee Chairman to keep the Government’s feet to the fire. The usual accusation on reannouncements is therefore tempered by that fact.
The “Valuing People” White Paper said:
“The Government will enable all people currently living in long-stay hospitals to move into more appropriate accommodation by April 2004.”
However, in the April 2008 comprehensive spending review, the Government announced funding and
“support for 3,000 people with learning disabilities to leave NHS accommodation and be supported to live independently.”
That was not new money but a reannouncement of £175 million to take people with learning disabilities out of campus accommodation, which was itself announced by the Minister’s predecessor, the hon. Member for Bury, South (Mr. Lewis), as way back as 9 August 2007. I place that on the record in the hope that we can move from words to action.
I am sure that the Minister will want to update the House on the responses to, and progress of, “Valuing People Now”. Some concern has been expressed that, even after the Committee’s warning that there are measurable targets for action in the report, such as the dementia strategy, which was published at a similar
time and, no doubt, after a similar amount of financial filleting, it still contains very few goals, aims or targets—whatever word the Government prefer to use—beyond the welcome and worthy words about how the future should look. It is absolutely vital to couple words with action and funding, however, if we are to give people the confidence that we are moving from debate to action. Even in the delivery plan, there is little direct action to improve lives; it is mostly about carrying out studies, with no promise of action in the light of what they might find, and about creating new bureaucracies. Furthermore, there appears to be only three mentions of human rights in the so-called delivery plan.
The questions on funding are also absent from the delivery plan. Mencap said that it
“remains concerned that Valuing People Now will fail to improve the lives of all people with a learning disability without a substantial increase in funding, especially in social care, which is desperately needed to meet the existing and predicted increase in demand for services”.
I am told that the Minister said that the national director for learning disabilities is a lone-ranger post, although I may be wrong, and he will want to correct me if I am. However, the previous director, the Government’s own appointee, stated that an estimated additional £1 million for each English local council would be needed over each of the next 10 years to provide good-quality social care to support people’s right to a life based on independence and dignity. That would amount to an extra £1.5 billion above current expenditure, so it would be helpful if the Minister outlined the Government’s proposals on that challenge.
The Committee recommended the introduction of a positive duty on public authorities to promote respect for human rights, and leadership and action from the Department of Health, the Office for Disability Issues and the Equality and Human Rights Commission. The Committee said that it was
“deeply concerned about the Government’s negative response to our recommendations on the need for an express positive human rights duty for public authorities”.
Obviously, we can debate the value of such pronouncements outside the context of proper funding of their contingent liabilities; however, it would be interesting to hear in what way the Minister feels that simply re-emphasising existing legislation and guidance will make a difference in developing a human rights-based approach locally, and how it will overcome the disappointment of those commentators whom I have just cited.
One area that the Committee addressed was the tightening of eligibility criteria, and the Government prayed in aid the comments from the then ongoing review by the Commission for Social Care Inspection, under its chair, Denise Platt. The consequences of the failure of funding to keep up with increases in demand mean that a large number of people are excluded from social care services, or “lost to the system”, as Dame Denise put it, through the tightening of eligibility criteria. Funding shortages mean that 73 per cent. of councils now support only people with critical and substantial needs. Those with mild and moderate needs receive little, if any, support. Indeed, 34 per cent. of respondents to the Learning Disability Coalition’s survey, “Tell it like it is”, said that their daytime activities had been cut.
On the eligibility criteria squeeze, the Committee Chairman highlighted how a more modest and earlier intervention would be best for people with learning disabilities—best for ensuring that they were well supported—and how, equally, it could be best for society and the taxpayer, because early intervention can lead to much lower emergency expenditure later.
The learning disability budgets of three quarters of councils were under pressure in 2005-06, and in 2006-07 they were overspent by 2.7 per cent. For example, Hertfordshire county council already projects an overspend and, overall, expects a 5 per cent. increase in expenditure—beyond the Government’s maximum provision of 4 per cent.—when compared with 2007-08. Dame Denise’s review has been published and is pretty damning of the Government, so I hope the Minister will explain how the Government are going to address that concern after those findings.
Interestingly, the Committee identified that many human rights failures pertaining to older people’s care also pertain to the care of people with a learning disability, and an issue that other contributors to the debate have not covered is malnutrition. The Committee Chairman and I have debated it in the past, and he is very supportive of my concern. I am sorry to say that the Government seem quite anxious to sideline the issue, however. I do not accuse the Minister present of that, but I have the bruises on my back to show for causing intense irritation to his colleague, the Minister of State, Department of Health, the hon. Member for Exeter (Mr. Bradshaw), who continually challenges the idea that malnutrition is a problem in our society and health and social care services.
I was deeply concerned this week to find that the Government have refused to publish figures on the extent of malnutrition last year—figures that they happily published for the year before. According to the written parliamentary answer that I have received, however, they say that this year it is too complex and costly to do so. Perhaps the economic climate has bitten at the Department of Health, but I fear that it is more likely a wish to avoid the embarrassment of having the injustices in our society brought to light when it comes to declining performance on malnutrition. The issue sits fair and square within the human rights framework. I have been grateful for the Committee Chairman’s support, and I hope that his Committee will continue to monitor the issue closely—certainly, I shall.
The Committee also felt that the ability to make complaints falls within the human rights framework, as the Committee Chairman will well remember from discussions during the passage of the Health and Social Care Act 2008. I hope, therefore, that the Minister will explain how the legislation on complaints, which is in the Health Bill now before Parliament in the other place, will benefit those with a learning disability—in publicly owned services, in publicly funded services and in privately funded services. If the Government had heeded the calls, including those made by me during the passage of the Health and Social Care Bill, the legislation currently before us would not be needed as it would already be in place and the suffering would already have been reduced.
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