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Baroness Masham of Ilton: I have my name to Amendment No. 64 but I am just as interested in Amendment No. 59A. In fact, Amendment No. 59A may be the better of the two. The details could then be put in the regulations. As the Bill stands, health care for disabled people is not adequately written in to indicate the vital need for medical personnel to understand the needs and problems of disabled people, which I am afraid that many do not. The problems seem to be getting worse. We have now before us an opportunity of highlighting some of the problems. I believe that it will help educate hospital trusts, their non-executive members and the staff who work in the hospitals as well as medical personnel working in the community if the Bill, when it becomes an Act, has the word "health" written into it. I should like to include "dentists" too. Many severely disabled people, particularly those with learning difficulties, have problems finding dentists who will treat them. To illustrate what I mean, I shall give two examples. I hope that the Committee will understand how important is the problem of receiving adequate health care at present for disabled people. First, I should like to tell the Committee that, as the Department of Health knows, I have been involved with the problem of pressure sores over the years. Last year the Department of Health held a very interesting seminar on the subject. The noble Baroness, Lady Cumberlege, has answered one of my Questions on the matter in the past year. I am sure that she and I are of like mind over this problem. Pressure sores cause untold misery to the individual and cost the National Health Service millions of pounds in extra expenses, sometimes as much as around £100 million a year, in staff time, operations and medication. My first example is that of my personal friend, the noble Lord, Lord Crawshaw, who was in hospital at the time of the Second Reading of this debate, as I mentioned. The noble Lord has given me permission to tell the Committee what happened to him.

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The noble Lord was taken as an emergency patient to a large and well-known teaching hospital near his home in the Midlands. He was running a high temperature and had haemorrhaged. Some noble Lords may not know that the noble Lord, Lord Crawshaw, is a paraplegic who does not feel his paralysed parts. When ill, all paraplegics are very much at risk from pressure sores if they are not turned and given special attention—even nursed on special mattresses, as the noble Lord, Lord Robertson, said. The noble Lord, Lord Crawshaw, developed a pressure sore while he was in hospital. It is ironic that he is a trustee of Smith's Charity which at this very moment is funding a research project on pressure sores. Having stayed extra time in hospital, where his pressure sore was not healed, the noble Lord is at home being looked after by the district nurse. But he may well have to go to a spinal unit to be cured. That is why he is not in the Chamber today. We miss him greatly on the Mobile Bench. My other example concerns a paraplegic lady, living at home, who became very ill and weak last year. The local doctor did not send her to hospital. She developed persistent diarrhoea. When the community nurse visited, she said that she could only be given a bath every two weeks. She was living with her brother, an alcoholic who had had cancer. She needed constant help, which was not forthcoming. When her own doctor came back from three weeks' holiday, this patient was sent to hospital. She died the next day from an undiagnosed ulcer. The system had let her down. I hope that the Committee will realise how important it is to have health care written in the Bill. I hope that the treatment of pressure sores will go into the regulations. I want to save the National Health Service money and help disabled people to a better quality of life. Having taken sisters away from hands-on work on the wards and given them administrative jobs has not helped patient care. I hope that the Minister will consult with his colleagues from the Department of Health. As the Committee knows, disability crosses all government departments.

Lord Rix: I wish that I had been able to put my name to either of these amendments. I crave the Committee's indulgence when I speak for a few moments on this matter of unfair discrimination. I do so from a personal standpoint. Some Members of the Committee may feel that, at least within the National Health Service, disabled people will already be protected from discrimination by a system designed particularly for their benefit and by staff who are likely to have their interests particularly at heart. Would that were so. First, there is institutional discrimination. When I was Secretary-General of MENCAP from 1980 to 1987, a large number of people with learning disabilities were then in large hospitals. It was notorious that expenditure per head on food was a fraction of that spent in general hospitals. I could never discover any reason other than unfair discrimination which would explain the discrepancy. I can only hope that things changed when I became Chairman of MENCAP some years later. Then there is blatant discrimination based on a sense of priorities which puts people with learning disabilities at the end of the queue. A sister on a paediatric ward to which a child with severe and multiple disabilities was admitted for treatment said, "We really do not have time

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to look after children like that when there are sick normal children to treat". The high level of untreated morbidity that was found every time that there was a survey of the health of people with severe learning disabilities is a commentary of "Why bother?" on this why-bother prejudice. A third category of unfair discrimination is the unwillingness to provide the additional support that people with severe learning disabilities may need during treatment. As I said, I can speak from personal experience on this story and the next one that I shall tell the Committee. It concerned an eye operation—she has had several—on my daughter Shelley. It was the first that she was to have and took place some time ago. I was asked to provide the extra nursing cover needed during the recovery period. I had to pay for that. I am happy to say that eventually the health authority reimbursed me but it was after some degree of argument. I can cite other cases where parents have been told by a hospital that they ought to seek private treatment, or that extra nursing cover could not be made available, or that the parents themselves should come in to provide personal care and feeding. As was touched on by my noble friend Lady Masham, dental problems too provide further occasions of unfairness and discrimination. Many people with severe learning disabilities—my daughter is one of them—cannot cope with dental treatment without a general anaesthetic. It has recently been brought to my attention that troubles with the change of responsibility for dentistry in Northamptonshire meant that general anaesthetics were available only for extractions. I hope that the problem has now been solved, but for some months people's teeth rotted until they had become so bad that they needed those extractions. Again, quoting my daughter's case, she is still awaiting the general anaesthetic at the hospital so that she can have her teeth looked at. That is the state of play that has been going on for some 18 months. I hope that I have said enough to show why I would welcome assurances from the Minister that the Bill as it stands will prevent the kind of discrimination that I have described.

Baroness Gardner of Parkes: I believe that I am a lone voice on this matter. I feel that the amendment as tabled is probably unnecessary. I believe that the health service should now be doing everything and anything that it can do to help people. Certainly I look to the Minister to confirm that that is so. But so many issues have been raised which are bordering on clinical judgment that this is something about which we must think carefully. The medical profession in particular values its clinical freedom, and the dentists no less so. It is important that one should be able to decide what is best for one's patient. Certainly, more and more negligence claims are being filed as people decide that what the doctor chose was not best for them. If that could be proved, it would be a different matter. However, it is difficult to decide whether a person was discriminated against or whether it was simply that the doctor was a bad judge. The noble Baroness, Lady Masham, quoted cases where I felt that someone was probably in the hands of a bad doctor. I hope that there is sufficient machinery

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within the health service to deal with that. But I speak particularly because of the comments in relation to dentistry. Dentistry is a real problem. I know that because I have had personal experience of it. The point made regarding general anaesthetic not being available for someone who required it is absolutely right. In my surgery we could and did give general anaesthetic for fillings. I did many thousands of those for all types of people, some of whom had learning difficulties or other disability. They were not all suitable to be treated in an ordinary dental surgery because some required an expert to ensure that the patient did not suffer a heart attack. People with a secondary congenital heart condition had to be treated in a specialist centre.

Lord Rix: I am grateful to the noble Baroness for allowing me to interrupt. The case to which I referred concerns my daughter. She is awaiting admission to hospital to have general anaesthetic because of her general state of health.

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