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5 Mar 2009 : Column 360WH—continued
Mr. Stephen O’Brien:
I am greatly encouraged by that response to the intervention from my hon. Friend the Member for Macclesfield (Sir Nicholas Winterton). My constituency has a portion of east Cheshire—the new east Cheshire coming into being on 1 April—within it. The Minister’s response is hugely encouraging, and not only given that we have those advocacy services. The Health and Social Care Act 2008 is relevant. It is vital that the LINks—local involvement networks—should also be properly funded. There are big questions at the moment about whether the funding will be adequate. I hope that the Minister will have an opportunity to take some of the points that he has just made, which were very welcome, back to ministerial colleagues to ensure that there is a co-ordinated Government approach to a proper funding base for those various organisations. That has been a running sore for nigh on 10 years, since
community health councils were scrapped. At last, the Government are beginning to recognise that there is real value in government in having good advocacy and, indeed, complaining services, which do need some form of public funding support to make them sustainable.
Phil Hope: I am perfectly happy to take those points back, because I do this all the time inside Government—support third-sector organisations. From memory, as a former Minister with responsibility for the third sector, I believe that funding for such organisations, which was about £5 billion a year in 1997, was £10 billion in 2006, so in the past 10 years funding and resources for third-sector organisations have doubled. I encourage local authorities, when making decisions about how to allocate funding and doing their commissioning, to recognise the essential role that many third-sector organisations play as advocates, in helping policy design and in delivering services to people in their area.
I am pleased that people with learning disabilities, as a result of the progress that we have made, are now connecting with their communities more fully and that more are living independently. Various hon. Members mentioned long-stay hospitals. For the record, I point out that by the end of this month there will be just one remaining long-stay hospital, with just 20 residents. Notwithstanding the point that my hon. Friend the Member for South Thanet made, we can say that we have made real progress in encouraging independent living—not people living on their own, lonely, but independent living with support. The numbers living on national health service campuses have also dropped, from about 3,000 in 2006 to 1,000 today. I think that that issue was raised by the hon. Member for Eddisbury.
We are already seeing real change, and that is only the tip of the iceberg. We have responded to the JCHR report. We have listened and taken action to ensure that the promises made in “Valuing People Now” translate into an even brighter future for people with learning disabilities, but to do that, we have further to go. Further reform is needed in three key areas.
The first—this connects with many of the concerns about policies and action on the ground—is better governance and accountability at national, regional and local levels. We have developed a new command structure—a new set of controls to ensure that we deliver the “Valuing People Now” commitments everywhere and for everyone. At the top of the pyramid is a new learning disability programme board, which I co-chair, supported by two national directors for learning disabilities, one of whom has a learning disability. The board includes cross-Government representation and the active involvement of people with learning disabilities and family carers. That board will link to new regional learning disability boards and strengthened local partnership boards, ensuring that all the agencies link up to deliver on the promises that we set out in “Valuing People Now”. The national programme board will also produce an annual report and an updated delivery plan, holding the regions and local areas to account on their performance.
I reject the criticisms from the hon. Member for Eddisbury that we are not monitoring, driving, leading and making change happen. We have put in place a structure to do precisely that. I confirm, as a point of
detail, that it will include monitoring the implementation of the good practice guidance on parenting. That will go out at local level. We want to ensure that that guidance is shared with primary care trusts and NHS trusts. On top of that, we have put in place specific measures to improve health services, which we know were a particular concern for the JCHR.
Ann Winterton (Congleton) (Con) rose—
Phil Hope: Two hon. Members are seeking to intervene. I shall give way to the hon. Lady first.
Ann Winterton: I am most grateful to the Minister. A thought has struck me, following his announcement that there is only one long-stay hospital, with 20 people living there. Has there been an initiative, in view of that, within the health and dental education services? I ask that because when people lived in short or long-term stay hospitals, they had specialist dental and medical care—professionals who were used to people with learning disabilities. Out in the community, in whatever way people live, it is a different ball game. Has there has been an initiative within the national health service and the education of doctors, nurses and other professionals to deal properly and sensitively with those who have these disabilities?
Phil Hope: The hon. Lady addresses the very points that I was about to come on to. We have put in place specific measures to improve health services for adults with learning disabilities. This year, as hon. Members may know, we have introduced a directed and enhanced service for annual health checks for people with learning disabilities—my hon. Friend the Member for South Thanet referred to that in his remarks—that will allow doctors to keep a close eye on the health of those individuals, pick up any early warning signs and give people more information, advice or, indeed, a referral if they need more help.
In addition, every PCT must ensure that people with learning disabilities have personalised plans to support them. More broadly still—we are going from the bottom up—the new NHS operating framework makes it clear that PCTs should secure health services that make “reasonable adjustments” for people with learning disabilities. We shall work with strategic health authorities to review progress on delivering that outcome.
Dr. Ladyman: I take my hon. Friend back to what he said about his new command structure and the importance of involving people with learning disabilities. Will he talk to his colleagues at the Department for Work and Pensions, to ensure that people with learning disabilities who attend such meetings do not find themselves excluded from receiving jobseeker’s allowance because they are not available for work; that they do not have difficulty when claiming expenses because they have to be declared; and that they are given an honorarium to cover their time and effort in attending those meetings without losing benefit, pound for pound?
Phil Hope:
I am sure that those points will be made with vigour at the meetings of the national board. The DWP is a member of that board, and it will have the
opportunity to debate those issues and to raise them directly with others. I shall, of course, ensure that my hon. Friend’s comments are fed into the system.
The second key pillar of reform is that of better skills and awareness to help professionals at all levels. On one hand, that means better commissioning within PCTs and local authorities. I am very conscious that there is still patchiness in provision across the country, which reflects a lack of consistency in commissioning standards. As a result, we will publish new guidance to build up commissioning skills within local authorities, specifically on promoting better health and well-being for people with learning disabilities.
From April, we will transfer NHS learning disabilities budgets, and the associated commissioning responsibility, for all social care for adults with learning disabilities to local authorities. That change will allow the NHS to focus on its primary health-care responsibility for people with learning disabilities, yet give local authorities a clear role in delivering high quality, community-based care services.
Sir Nicholas Winterton: How urgently is the Minister treating the matter? Many of us have copies of the excellent briefing paper from Mencap and the Learning Disability Coalition. Although those bodies welcome the Government’s strong commitment to improving health services for people with a learning disability, they highlight certain matters. My hon. Friend the Member for Eddisbury (Mr. O'Brien), the shadow spokesman, highlighted the fact that among people with learning disabilities aged 20 to 29, the mortality rate is nine times higher in men and 17 times higher in women. They also highlight other areas. Are these a priority for the Government?
Phil Hope: The hon. Gentleman is absolutely right. We need to improve front-line skills so that those statistics and the tragedy that they represent can be addressed directly. We need to ensure that whatever discipline the professionals may be in, they are aware of the issues faced by adult with learning disabilities.
In social care, the work force proposals set out in “Valuing People Now” will be taken forward through a new adult social care work force strategy, to be published later this year. GPs and primary care practice staff will receive training and advice to help them meet the needs of people with learning disabilities; that is clearly essential if the annual health check programme that I mentioned earlier is to function well. Across the NHS, we have launched an awareness campaign to teach staff about the disability equality duty, leaving them in no doubt about their responsibilities to uphold the patient’s human rights. I was struck by the point made by my hon. Friend the Member for Hendon that training that could deliver relatively small changes in practice can have a large impact on people’s lives. That is something we look forward to.
Mr. Dismore: I take the Minister’s point about training, but we must ensure that we train not only new entrants to the various professions and services but those who are already there. The big problem is to get the message over to those who were not inculcated with that sort of approach at the beginning of their career.
Phil Hope: Yes, it is clear that we must raise awareness among existing staff; it is not just about new entrants. In a way, the fact that people in the relevant services hold those attitudes shows that we need to see a culture shift across society. We have to challenge discrimination, and open doors for adults with learning disabilities.
I return briefly to the question of employment. The employment of adults with learning disabilities is a key building block, and public service agreement 16 and the new employment strategy that I mentioned will resonate across communities. We need greater visibility, and with it greater acceptance, better understanding and higher expectations for people with learning disabilities. To pick up on a point made by my hon. Friend the Member for South Thanet, who was one of my predecessors, I expect the public services to show leadership. I want to use this afternoon’s debate to throw down a gauntlet, particularly to the national health service. The NHS is by far the biggest employer in the country, and the third biggest in the world. There is no reason why it should not employ more people with learning disabilities in appropriate roles.
I believe that primary care trusts and NHS trusts can learn a great deal about how to do that from the work that is already going on. There are excellent examples in Leicester and Norwich; I would describe both authorities as being well ahead of the curve. Authorities around the country are already making a difference. I want to see that change start at home. I cannot answer the question put to me by my hon. Friend the Member for South Thanet on the number of people with learning disabilities employed in the NHS, but I am mindful of that point and will take it on. The societal change that we need should start with the NHS.
Dr. Ladyman: I remind my hon. Friend that there is a bigger employer than the NHS, although the work force is split over several hundred employers; it is the one for which he is responsible—social care. My experience of those with more simple or moderate levels of learning disability is that they are tremendously caring. They could provide many caring roles to others with more serious learning disabilities, and they would be sympathetic and understanding. I would encourage my hon. Friend to think of the social care world as being a place where many such people could find employment.
Phil Hope: That is a good point. Indeed, all employers should consider such opportunities. We should not have stereotyped predispositions about the particular roles that people might play. We can identify a person’s skills and strengths and find roles and responsibilities in a variety of settings and organisations. From memory, I believe that South Lanarkshire council authority has realised a remarkable achievement, given the number of people with learning disabilities whom it employs in a variety of roles. I suspect that it is driven by one individual, who is intent on championing that in his local authority. We should have such champions in every local authority, driving forward such changes. We need to support change through wider action, and there are encouraging moves afoot.
I want to pick up on some of the points raised in the debate. The Home Office seeks to take strong action on hate crime, and specific guidance will be published for crime and disorder partnerships. The Crown Prosecution
Service is consulting on how it should approach witnesses with learning disabilities. Lord Bradley is currently undertaking a review into diverting individuals with mental health problems and learning disabilities away from the criminal justice system—a subject that occupied much of our debate. We expect that review to be published shortly, and we will respond to Lord Bradley’s recommendations.
Even now, work is going on in the criminal justice system. “Valuing People Now” seeks to address the problem, and work is under way to ensure that the specific needs of offenders with learning disabilities are included in the delivery programme on offender health. We are monitoring the implementation of the forthcoming good practice guidance for commissioners of forensic services for those with learning disabilities; and offender management processes should include a health screening programme, so that we can identify an offender’s learning disability and any physical or mental health problems that they may have. That should be the start of an individual health action plan for those in the criminal justice system.
Good practice is being developed on learning disability awareness training for prison staff to help them identify and understand the issue, and to communicate better and manage offenders in custody with learning disabilities.
Mr. Stephen O'Brien: My right hon. Friend the Member for West Dorset (Mr. Letwin) touched on that matter, and has conducted a study into it, as the Minister will know. I visited the young offenders institution at Thorn Cross, near Warrington. One of the most telling points that emerged concerns those on remand, although it applies to convicted young offenders serving a custodial sentence as well. Very often those sentences are so short—this is irrespective of the merits of such short sentences—that by the time that a young offender has been assessed, not enough time remains to convert the assessment into an appropriate programme of learning, whether for a certificate, diploma, GCSEs, A-levels or even a plastering qualification. Such assessments show that at least 60 per cent. of young offenders have some form of learning disability or disadvantage. We need a cross-Government examination to ensure that, off the back of such an assessment, there is a continuing commitment to remediate the learning disability through a continuing programme of education after the young person is released.
Phil Hope: It is tempting for me to be drawn into this debate. I was once a Skills Minister responsible for offender learning and education inside and outside the prison system. Back then, I was very concerned, but huge progress has been made to ensure that young people and adults assessed in the system—perhaps for their literacy and numeracy needs, a national vocational qualification or an apprenticeship, for example—are not simply reassessed as they move through or out of the system. We do not want a process of continual reassessment of needs without providing the training and skills required to meet those needs. That problem is now being addressed directly by my colleagues in the Ministry of Justice and in the Department for Innovation, Universities and Skills.
In two regions, we are piloting a campus model in which prison and probation institutions work together and treat the offenders whom they are managing like students on a university campus—that is not quite the right model, but Members will understand what I mean. It will enable somebody to move around the system, continuing their education and skills training, without having to repeat something—either the assessment or a part of the course. That requires investment in IT systems and good communication. The criminal justice system is complex, but huge steps have been taken. From memory, the two regions where the pilot is being conducted are the west midlands and the eastern region. That new approach will join up our approach, so that those barriers do not get in the way of people moving in and out of the system. Of course, that will also apply to adult offenders with learning disabilities.
Sir Nicholas Winterton: What are the Government doing about adults with learning difficulties, perhaps complicated by a mental illness, who are sent to prison because of an offence that they have committed, not because they wanted to commit it, but because their illness and learning difficulty led them to do so? What alternative facilities or care will be made available for such people? They should not go to prison, because no adequate psychological or medical services are available to treat them.
Phil Hope: I shall not get drawn into that debate. All that I can tell the hon. Gentleman is that Lord Bradley, whom I mentioned earlier, is conducting a review into how individuals with mental health problems and learning disabilities can best be diverted from an inappropriate route through the criminal justice system and in the direction of other services and support. That diversion might happen at different stages throughout the system. Once that report and our response to it are published, we will have a chance to examine whether we have fully grasped the issues that need to be addressed.
My hon. Friend the Member for Hendon asked about the Electoral Commission and the voting rights of adults with learning disabilities. I can confirm that, of course, the Government are happy to work with the Electoral Commission and other bodies to identify possible improvements to make the electoral process more accessible to people with learning disabilities. The office of the national director and the Ministry of Justice will work with the commission to explore the issues that he raised. Furthermore, the Department for Children, Schools and Families is working to improve the support available for the parents of children with learning disabilities, ensuring that they know their rights and can hold local services to account. All of that is fundamentally important if we are to change what I call the cultural landscape surrounding people with learning disabilities.
I found the contribution from the right hon. Member for West Dorset (Mr. Letwin) fascinating. Over the past 10 years, funding for adult social services has increased by 50 per cent. in real terms. The changes that I have just described came about because we have ensured that local authorities have been given more resources to meet the needs of adults with learning disabilities. I was intrigued by his contribution, given that he is writing the Conservative party manifesto. If I understood him
correctly, he said that resources to pay for care for adults with learning disabilities and to ensure their human rights could be “self-financing”—I think that he used that word. That appears—I do not know whether this is the case—to be the clearest signal that the Conservatives do not intend to invest additional resources in adult social care for the most vulnerable people and that any improvements would come from savings in other services that they receive. That might be unfair, but organisations reading this debate might want to explore that interesting item further with the Conservative party and to ascertain exactly what its intentions are.
To sum up, we have had a clear debate this afternoon. The Government have a clear, cross-Government vision. We have stronger governance and accountability across national, local and regional areas, we are developing better skills across the work force, and we are taking steps to develop a healthier culture across society at large. Now that we have put those key components for change in place, they are already making a difference to people’s lives, and they will do even more for people with learning disabilities in future.
5.16 pm
Mr. Dismore: I do not want to say a great deal. We have had a very well-informed debate. My hon. Friend the Member for South Thanet (Dr. Ladyman) said that our report had not got into the full complexities of the issue, and I would be the first to concede that we did not do an exhaustive job. We tried to pull together the key themes that emerged from our inquiry. Each chapter could have been an inquiry in its own right, and we are keen to look again at the justice system and prisons, because that is where we feel that the greatest injustices are found.
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