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Lord Freeman: My Lords, I thank the Minister for her response. She is right to say that we shall have to come back to the matter, although not necessarily in this legislative round, and probably on the basis of further social services research. The amendment and the debate on it have aired the point. As I say, I am grateful for the Minister's comments. I beg leave to withdraw the amendment.
Earl Russell: My Lords, there were moments in the previous debate on regulations when I felt that it might be possible that we were making a little progress. There were moments when we saw chances of a faint degree of give and take. We have here two very legitimate interests. The Minister's interest in flexibility is clearly legitimate. But Parliament's interest in the control of legislation is clearly also legitimate. In fact, there is not much point in having a Parliament if that is not the case.
Once we get to the point where we are prepared to discuss compromise on this matter, I think that real progress between us may be possible. What we have to get away from is the idea, which each of us has I think been capable of having in the past, that our own point of view is the only legitimate one.
As regards applying that test to subsection (2) of Clause 10, it is, I think, a little more difficult than the noble Lord, Lord Higgins, suggested to decide exactly what is or is not remunerative work. Take, for example, giving one's children extra pocket money for running an errand. I am sure that a number of us have done that. To classify that as remunerative work within the meaning of the Bill would be excessively bureaucratic and would be so described in words of one syllable by one's offspring.
There has been a question about volunteering and how far that may be classified as remunerative work. There has been a question about therapeutic work in the context of disability. That is a matter we return to over and over again. The noble Lord, Lord Rix, brought us back to it recently. It is a real question.
The provision needs to change because from time to time the ways people find to get through the thicket of combining work with either disability or family life may change. So I think that there probably is room for a regulation-making power here. I do not immediately see how one would tighten this particular definition if one were to set out to do it. It is quite unlike the prescribed manner of determination which is completely open-ended.
We have to accept here that one person's flexibility is the other person's inflexibility. Once we have accepted that, we may get somewhere. Within that principle, this is probably a legitimate way of addressing the matter. I do not really see how, if I were sitting in the Minister's place, I would do it any better. When one says that, one has to take the consequences.
Baroness Hollis of Heigham: My Lords, I am grateful for those helpful comments. I do not want to go over ground that we covered in Grand Committee. I am happy to say what does not constitute qualifying remunerative work. As the noble Earl indicated, that includes voluntary work and other payment which does not count as income for tax credit purposes such as training allowances, sports awards and payments received by a person caring for someone who is not a member of his or her household but is temporarily residing in the carer's own home, provided the payments are disregarded in the calculation of the carer's income for tax credit purposes.
The basic test of eligibility for working tax credit is that at least one claimant in a household is engaged in qualifying remunerative work. Regulations will allow us to vary what is required of a person to enable him or her to fall within the meaning of qualifying remunerative work. As the noble Earl, Lord Russell, suspected, those variables could be the claimant's age, whether he or she has a disability or is responsible for a child or young person.
In answer to the question of why we are introducing regulations, all I can do is to plead that the matter is technically difficult to define, as the noble Earl, Lord Russell, recognised, as patterns of work change. I refer to regulations that were introduced for income support, JSA, WFTC and DPTC. Regulations were introduced for family credit under the previous administration. There is nothing new here. We need that reserve power to accommodate different patterns of work and, if required, different ways of helping people to bring them within the eligibility criteria of working tax credit by virtue of their age, their disability or similar circumstances. I hope that with that information, which has been gladly received, the noble Lord will feel able to withdraw the amendment.
Lord Higgins: My Lords, the Minister has seldom been more convincing, although we still do not have a clear idea of what the Government have in mind. We will need to consider carefully the provisions relating to income tax, particularly the regulations that exist in other legislation, to which the Minister referred. We shall do so in some detail to establish whether we need to pursue the matter at Third Reading. For the moment, there appears to be a pretty convincing argument on the part of the Government. I beg leave to withdraw the amendment.
Lord Renton rose to ask Her Majesty's Government whether the principles contained in their White Paper Valuing People (2001) and its subsequent official guidance will be implemented by allowing the retention at St Ebba's, Epsom, of 12 acres to form a village community for people with learning disability or mental handicap.
The noble Lord said: My Lords, this is a vitally important matter, which affects the care and treatmentand livesof mentally handicapped people of various ages and degrees of mental disability, many of whom have lived and been treated at St Ebba's Hospital in the recent past and whose families are anxious about their future.
Indeed, there is a St Ebba's parents and relatives group, which has been pressing for some years for St Ebba's to evolve into a village community for people with learning disabilities on what is an ideal site of about 40 acres within the town boundary of Epsom. We should perhaps bear that fact in mindit shows that the site is not remote. The group has been supported throughout by the Mid-Surrey Mencap Society. St Ebba's used to care for about 400 residents, who required mental care. Most of them have now been discharged into small housing in the community. In many cases that happened against the wishes of their families.
Twelve of those 40 acres, which formerly had 400 residents, will continue to house about 60 remaining residents with the most complex continuing mental health care needs, challenging behaviour and so on. They will be under the control of Surrey Oaklands NHS Trust. In no sense will that be a village community. Indeed, it is intended by the NHS to sell the rest of the site, mainly, I understand, for housing development.
The proposal of the parents and relatives group is that another 12 of the 44 acres should be retained for a village community; for those who choose it, that would surely be a wise and helpful choice. The parents and relatives group would like the 12 acres to be set aside from what is intended to be a commercial developmentit is not so at the momentfor a limited period of two years to see whether providers would come forward to create a village community there. That would demonstrate once and for all whether such a community was desired and viable. If, by the end of that limited period of, let us say, two years, no providers had materialised, the plot could be released once again for commercial or housing development. There is really nothing to lose with that
The village might ultimately accommodate many more than 60 people, as is the current intention. We know of many people who are currently in small housing but who would prefer village community life. Some of those who would come into such a communitya minority, I should thinkare living with ageing parents. Some would come from other authorities, where they cannot live in a village community; they would come because they had chosen life in a sheltered village such as that which we propose.
I have a severely handicapped daughtershe is both mentally and physically handicappedwho has for the past 30 years been well looked after and has lived happily some miles from St Ebba's in a village community. As a former chairman of MencapI held that position some years agoI know how very valuable such communities are.
It has therefore come as a shock that the local public authorities have refused to agree to the proposal of the parents and relatives group and that they have even refused to consider plans that were submitted to them by experts who have in the past come forward with finance and expertise and who were keen to develop and run a village community on the St Ebba's site.
That frustrating state of affairs has been repeated in recent years at other sites. We know of seven similar cases. One objection to village communities that is raised by local officials refers to the scale of finance and management that is involved in such a project. Yet that objection should fall away when outside providers are willing to shoulder those problems, leaving local officials with only an appropriate supervisory role.
The Government did a valuable service by setting out their policy in the White Paper, Valuing People, and its accompanying guidance. They made it clear that mentally handicapped people and their families should have a choice about where they live, and they spelt out in no uncertain terms that village communities are to be encouraged as a form of residential provision. I shall not read out a long quotation, but pages 70 to 75 of the White Paper set it all out. I merely quote the introductory sentence:
Surely it is worth remembering that in 1996 a research study commissioned by the previous government showed that there were between 20,000 and 25,000 fewer residential places available nationally than were required. Alas, that shortfall is increasing all the time. Paragraph 43 of the guidance urges neighbouring authorities to join together to develop a greater range of provision and to respect the preferences of individuals and their families.
Baroness Linklater of Butterstone: My Lords, I am most grateful to the noble Lord, Lord Renton, for calling this interesting debate. While it refers specifically to the possible development of a village community at St Ebba's, it also touches on some fundamentals which underpin provision for people with disabilities. For it is not only about the range of different types of provision, their design, cost, quality, range and relevance; it also asks us to think more deeply about the purpose of such provision. What do we want for the disabled as we make provision for them and, more importantly, what do the disabled want for themselves and from life? It is all too easy to make decisions for people whose conditions of life we do not share and, in so doing, and with the best intentions in the world, to make decisions which may or may not enhance the lives of those whose experience we have not directly shared.
Thinking in this field develops and changes and goes through fashions. What is regarded as a "good thing" and becomes fashionable in one era can become outmoded and be discarded the next. Yet people's needs do not go through fashions or follow the latest thinking of successive generations of policy-makers or planners. In many ways, they remain absolutely constant and are shared by us all, however able or disabled.
We all have a core need for love, a sense of belonging and a community of peers. We need continuity and security and the knowledge of being really valued as human beings. That, in turn, feeds those vital ingredients of self-confidence and self-worth, which make life worth living. That also includes the families of the disabled, who share in the disability and who are often in the front line of care. They are inescapably involved and affected by the type and quality of provision being offered and yet all too often are left out of the equation.
I have some experience of disability both in my own family and in the school that I foundedthe New School at Butterstone. The needs of our daughter led me to found the school 10 years ago for "educationally fragile" children. That means that ipso facto I, too, as a parent, am fragile. I have experienced the difficulties of finding the type of provision which my daughter and others from my school want and need in order to live fulfilled lives in the community and of trying to mould such provision as we can find into a package which fits them as opposed to letting them be moulded into pre-existing packages set out by social work departments or voluntary agencies which have not necessarily been designed with our individual children in mind.
In recent years, village communities have gone out of fashion and occasionally have even been demonised as "ghetto" provision. What is in fashion is the provision of supported flats or houses in the community for small groups of people. The thinking is that that approximates more closely to normality and is therefore more desirable.
"Care in the community" became the philosophy and fashion of the day in the late 1960s. Indeed, at the end of my social work training I wrote an enthusiastic thesis on the subject. Since then, we have all been trying to create the type of care needed in a community which all too often has been neither ready nor able to assimilate all those being thrust upon it.
I do not happen to favour people living alone and being supported by professionals, which is so often the case today. Nor would I favour for anyone, including my daughter, the option of living with an assortment of people whom she could not choose and whose needs might not fit in with hers. What I want for her, and indeed for everyone, including myself, is a sense of belonging with people of my own choosing, where there is choice and flexibility in how we live our lives, however much help may be needed in making such choices.
If people are to have choice, then it follows that a range of needs-led provision is absolutely essential. The noble Lord, Lord Renton, referred to the guidance to the White Paper, Valuing People. The Minister at the time, John Hutton, stated that the role of public services is to facilitate choice, not to frustrate it. In the context of this debate, a village community must be an option in the range of choices open to users and their parents, if they so wish.
In Scotland, the range of Camphill communities bears impressive witness to the success of this kind of provision where users and carers share their lives. There must be in the hearts and minds of planners a recognition of the fundamental importance of having a truly accepted place in a community of peerslike your Lordships' House perhaps. That is something which such communities can offer.
You can be very isolated in a group flat of assorted disabled people in a street where you know few people, if anyone, and where you are cared for by carers in shifts and where your daytime is spent in a day centre. For some, it may be just right; for others, it may be the reverse. For them, a village community such as St Ebba's could well be the right option. I am certain that all young adults with long-term needs of all kinds should have that option and the right to choose according to their wishes and needs.
Baroness Cox: My Lords, I warmly congratulate my noble friend Lord Renton on initiating this debate. It is of great importance both for the specific issue of St Ebba's and for the more general issue of local statutory authorities promoting genuine choice for people with a mental handicap rather than frustrating it.
The case for village communities has been well made over the years and is accepted in principle by this Government. As my noble friend emphasised, the excellent White Paper, Valuing People, and its accompanying guidance affirm the principle of choice. I quote briefly:
I declare an interest as a patron of the organisation RESCARE, which promotes the right for people to choose the most suitable type of residential care, including village communities. Some years ago my noble friends Lord Pearson and Lord Renton and I wrote a pamphlet arguing the case for the retention of village communities and the development of new ones as a desirable option, for a number of reasons.
First, as RESCARE statistics clearly show, there is a widespread and long-standing demand by people with a mental handicap and their families for the development of new village communities on redundant hospital sites, not just at St Ebba's but up and down the country. Local officials often maintain that there is no such demand because they fail to take note of it. However, at St Ebba's over 90 per cent of families voted for a village community at a time when their relatives were being resettled, but their wishes were ignored. Surely, it is not up to local commissioning authorities to determine the type of residential provision to be offered without ascertaining what users and their families really want.
Secondly, as a nurse and a social scientist, I am deeply committed to the advantages of the village community in terms of the quality of both the health and social care which they provide for their residents. There is no clear dividing line between health and social care, and both must be available for people with mental handicap, who are often suffering from other forms of disability; indeed, who are multiply handicapped.
Perhaps I may say in parenthesis that I welcome the success of many of the developments in community care, which have resulted in many people moving from traditional institutions into homes in the community. I have visited many such homes and have been delighted to see the degree of independence and quality of life achieved by their residents. Therefore, I do not want to turn back the clock.
However, many people enjoy life in village communities. Those communities offer freedom of movement and freedom of choice within a safe boundary. There can be specialised services on site for occupation; training; medical and nursing care; and facilities for entertainment, recreation and sporting activities. People need not be isolated from the surrounding general community. Where appropriate, residents may work in the wider community and return to the peace and security of the village community at the end of the day. Alternatively, people already settled in the local community can come in and use the special facilities in the village community.
Also, people's needs change over time. For example, people with Down's syndrome often develop dementia in later life. A village community can offer a degree of flexibility in accommodation and continuity of care so that if circumstances change, residents do not need to be uprooted from all that has become familiar.
By contrast, for some people with disabilities, as the noble Baroness, Lady Linklater said, life in a small urban dwelling may be restricted and lonely, with the problems of negotiating busy streets in order to reach facilities such as a swimming pool or shops. Their movement often depends on the availability of a careworker and perhaps a minibus.
I turn from social needs to health needs. Many people with disabilities need nursing care, such as help with continence, feeding, and general hygiene. Inadequate clinical care can lead to serious problems, such as pressure sores or urinary tract infections. It is clearly easier to provide a high quality of clinical care in the context of shared facilities in a village community than in the more dispersed conditions of so-called community care.
Finally, there is an argument for facilities like St Ebba's, which should appeal to the Government, and especially to the Treasury, because this is one of the rare occasions on which fulfilment of a principle of freedom of choice is cheaper than the alternatives. I believe that my noble friend Lord Pearson will speak about the relative costs of village communities and other forms of care. I should like to make the general point that communities such as St Ebba's fulfil the criterion of care effectiveness, which is obviously the most important one, as well as the criterion of cost effectiveness, which must also be an important consideration because inevitably resources are always limited.
Before I conclude I should like to address the position which I believe is adopted by Mencap. I understand that the national leadership is opposed to village communities, on what I can only presume to be ideological grounds, as I have not heard any convincing refutation of the case we have made for them. But, more importantly, many local Mencap societies strongly support village communities to the extent that I believe at least nine are officially affiliated to RESCARE, including Liverpool, the largest local Mencap group in the country, and mid-Surrey, which is in the area in which St Ebba's is located.
In conclusion, I strongly support my noble friend Lord Renton in his attempts to ensure that at least some of the St Ebba's site is preserved from commercial development so that providers can come forward and develop a village community without being constrained by the commissioning authorities. I also hope that a sympathetic and positive response to this particular case will serve as a precedent for the general promotion of the village community concept and its availability for all those who choose it. It would also provide a way forward which could turn the Government's commendable commitment to genuine freedom of choice into a living reality for some of the most vulnerable members of our society and their families. I hope that tonight the Minister will be able to reassure those very vulnerable people.
Lord Pearson of Rannoch: My Lords, in thanking my noble friend Lord Renton for so eloquently introducing this timely debate, I should declare my interests as the father of a mentally handicapped 21 year-old daughter, who might well be a candidate for the kind of village community which is proposed in my noble friend's Unstarred Question, and also as honorary President of Rescare, the National Society for Mentally Handicapped People in Residential Care.
It seems to me that there are four important points to make in the debate about village communities. First, the Government support choice and village communities, as, indeed, did the previous Conservative government. Secondly, people with mental handicap and their families want them. Thirdly, they are care effective and cost effective. Fourthly, their development has been blocked at local level for many years. I propose to spend most of my time tonight confirming that village communities are, indeed, cost effective, especially when compared to the real and total costs of community care.
I take as my starting point the figures given in Made to Care, which was largely researched and written by my noble friend Lady Cox in 1995, with some assistance from my noble friend Lord Renton and me. It has since been reprinted three times; over 10,000 copies have been sent out and none of its facts or relative costs have been seriously refuted, although some of its figures should now be adjusted upwards for inflation. Made to Care found that the capital cost of moving someone from a hospital into community care was £30,000 more expensive than moving that person into a village community. I understand that there are now some 6,000 people left in long-stay hospitals, presumably the more severely disabled, and so now that will be a minimum figure.
When we come to annual running costs, Made to Care found that village communities were about £50,000 per annum per person cheaper than community care. But when everything is added together, that figure is very much larger. It is difficult to quantify those extra savings precisely, which tend to be hidden after the move from hospital to community care, but they include such things as housing benefit
In addition, villages provide the further substantial savings which stem from economies of scale for healthcare, education, recreation and all the other "day service" costs, which tend to be additional under community care, but which are included in the annual running costs of village communities. For instance, Brookvale Community provides a very high standard of care across a whole range of disability. It has a swimming and hydrotherapy pool; outdoor games areas; a cycle track; a gymnasium; a sensory stimulation unit which uses relaxing music and lighting effects, and other special services. It costs about £25,000 per person per annum all-in.
I do not pretend that I have precisely quantified the savings of villages over community care, but clearly they are very much more than £50,000 per annum per person. There are some 160,000 people in this country with severe learning disabilities. Rescare's national survey of its families suggests that at least half of them would choose a place in a village community for their relatives if it were available. Provided that we add all the budgets together, we would clearly be considering savings of thousands of millions of pounds annually if the choice of those families was even half met.
It is against that background I find it hard to understand the remarks of the Health Minister, Jacqui Smith, in the other place yesterday. She was replying to my honourable friend Mr Chris Grayling in whose constituency St Ebba's lies, who had made the same request about the 12 acres of land as has my noble friend Lord Renton tonight. The Minister made all the usual noises about the needs of service users being the Government's priority, but then said that she did not believe that the Government could,
Even if there were a sound economic case for selling the landwhich there is notlet us not forget that the St Ebba's land and all the land occupied by the "Epsom cluster" has been given over the years by ratepayers and philanthropists specifically to cater for mentally handicapped people. The land passed to the NHS in 1949, but that does not mean that it is free morallyor even, perhaps, legallyto strip those
There are wider costs to our society when community care fails in the absence of suitable village communities. For instance, more than 40 per cent of our prison population is now classified as mentally disordered in some way. In that respect, I refer your Lordships to our debate on 27th March at cols. 305-6, when I suggested, not for the first time, that the whole concept of village communities and their cost-effectiveness should be examined at a meeting of the Department of Health, the Department of Social Security, the Department for Education and the Home Officeperhaps with the Chief Secretary to the Treasury, Mr Paul Boateng, in the chair, because he well understood the case for village communities when he was in the Department of Health. Can the Minister tell us whether any progress has been made towards setting up such an inter-departmental meeting, which would be such a fruitful exercise in joined-up government?
Lord Addington: My Lords, this is an interesting debate, and one that has been under way across the whole range of disability for as long as I have been in your Lordships' House. It has repercussions and contains arguments that go back to the idea of special schools, non-special schools and general integration. People always tend to come at the debate from their own background and with their own prejudice and baggagewe all do, on all sides. If we have a positive or negative experience of one system, we tend to carry it forward.
The general concept that is being attacked here is that we should try to bring people into the community as a rule, as opposed to as an option. The argument can get nasty because we are not arguing about much. That is always where the sharp bit is: it is when we are on the edge. What effectively scares both sides is that one side are thinking, "Thou shalt in all circumstances integrate" and that the other group are saying, "Thou shalt not integrate".
Many people with learning disabilityan expression that I prefer to mental handicapsay, "I have one or two specific problems. I do not want to be put away or encouraged to be apart from general society for the rest of my life or large portions of it". Other people on the other sideoften the parent, or a child who does not know any better or who is now an adultsay, "This person cannot possibly cope in the outside world".
Most people can step back a little and say, "Yes, there must be room for diversity", and there is a degree of room for diversity. Where we have, as here, an on-going environment in which people have been placed,
When it comes to the idea of a village community, the fear that many people have is that once they go into it, they may never leave, even if they are capable of doing so. That is a real fear for many people and groups involved. Many young people with learning disabilities to whom I have spoken feel that that is what will happen. That is something that rattles around the argument. I freely admit that there are no absolute rights or wrongs here; but that is something that people worry about.
The noble Lord, Lord Renton, made a point about the economics. I encourage the Minister to say that the economics will not be the driving factor in the argument. The argument should be about meeting needs wherever possible. It is odd to say to a Minister, "Can you please try to tell us exactly what is the funding situation?" In some fields, if we are told that we should do something under law, we should really try to meet that need as opposed to simply saying, "We do not have the money". Indeed, I remember spending many hours wrestling with that problem with various departments. Can the Government confirm that for us tonight? That would be a help in future arguments.
We are here considering what is best in certain cases. I detect a hint here of a defensive action being foughtas I said, I have fought some myself in other fields when I have felt under threat. The argument may be that a type of living should be preserved because people feel that it is appropriate for what I think it would be fair to say is a small proportion of those people who come under the heading of "learning disability"those at the more extreme end.
Will the Government tell us what proposals they have for government-run or government-funded provision if village communities are not considered to be the correct way forward in future? That is the real argument: what happens to those who have been brought up within such communities? While saying that people should be integrated where they can, I freely admit that there are certain people for whom, with the best will in the world and all imaginable support, such integration will be limited.
My noble friend Lady Linklater made the important and valid point that certain people will need a form of sheltering and respite carerespite care from society itself in certain cases of mental illness. But when it comes to learning disabilities, people who have a permanent condition are learning to deal with it, which is what we are trying to do with all disabilities. That must be the underlying philosophy: how can we become a full part of society with our disability and what does society do to allow us so to do?
I have not even attempted to go into the fine detail of this particular case, because I do not have the feel for it and I am afraid that I did not set aside the proper amount of time. We can always argue with statistics and quotations. The philosophy is something with which the Government may be able to help us tonight. We are in danger of entering a circular and sterile argument when we are all trying to achieve something positive.
Lord Astor of Hever: My Lords, I congratulate my noble friend Lord Renton on raising this important subject. I know that the subject is close to his heart. I am also grateful to him for setting out so closely the position with regard to St Ebba's. Like the noble Baroness, Lady Linklater of Butterstone, with her educationally fragile daughter, and my noble friends Lord Renton and Lord Pearson of Rannoch, I declare an interest as the father of a mentally handicapped daughter.
On these Benches, we welcomed the White Paper Valuing People. We supported the objectives of the White Paper, and we want it to work. However, we are concerned at the lack of progress since publication. After all, the Government estimate that there are about 210,000 people with severe and profound learning difficulties. John Hutton, the health Minister, said that they were among the most socially excluded people in the country, but the Department of Health's agenda seems to have been taken over by other issues, leaving learning difficulties vying for attention.
The Government decided not to legislate on the dream outlined in the White Paper. Without a legally binding duty to implement the proposals and meet the objectives, local authorities and health authorities will not consider them a priority. Furthermore, the Government did not back the proposals for change with any serious money, and there was no national service framework for learning difficulties. In the light of that, I should be grateful if the Minister would tell the House what plans the Government have to put some flesh on the bones of the White Paper.
Over the past 15 years, successive Ministers, from both parties, have affirmed the principle that people with a mental handicap and their families should have a choice as to where they live and that village communities should be one of the options. We particularly welcomed the fact that the White Paper and its accompanying guidance reaffirmed that policy, as my noble friend Lord Renton said. Local officials are required to rethink their policies on provision of residential care in the light of the guidance. It would appear that some are not doing so for villages. They are cherry picking, acting on the bits of the guidance that suit them and ignoring the rest.
As my noble friend Lady Cox said, many people with a mental handicap and their families want a village community. In their excellent booklet, Made to Care, my noble friends Lady Cox and Lord Pearson of Rannoch pointed out that many people with a mental handicap live lonely, neglected lives in the community,
There are opportunities to transform long-stay hospitals into village communities but, in many cases, they are being blocked. Redundant hospital sites, such as St. Ebba's, are often ideal for evolution into a village community, particularly if that is welcomed by the local community, as, I understand, is the case at St. Ebba's. The proposal of the parents and relatives group that another 12 of the 44 acres should be retained for a village community for 60 residents has great merit. The debate has taken place over several years, and, tonight, the Government have an opportunity to clear up the issue.
My honourable friend the Member for Epsom and Ewell made an interesting suggestion yesterday in the other place. My noble friend Lord Pearson of Rannoch mentioned that debate. My honourable friend asked the Government to give those parents and relatives an 18-month window and an option on the 12 acres so that they could come back with a solution. I look forward to hearing the Minister's response to that request. I agree that it is vital that resources are released from surplus NHS properties, but I feel that my honourable friend's suggestion is worthy of serious consideration.
The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath): My Lords, I congratulate the noble Lord, Lord Renton, on securing the debate on Valuing People and enabling us to explore some of the important issues concerning village communities and the question of choice for people with learning disabilities and their relatives. The noble Lord is enormously respected for his experience with and support for people with learning disabilities, and I know that the noble Lord, Lord Rix, who cannot be present tonight, has long been appreciative of the support that he has given to Mencap. The noble Lord's experience as chairman of that organisation was immensely valuable to the noble Lord, Lord Rix.
The context in which we debate the question of St Ebba's is the White Paper, Valuing People, and every noble Lord who spoke referred to it. It is to the credit of every noble Lord who spoke tonight that the White Paper was produced. I have no doubt that the representations made by noble Lords contributed to the work on the White Paper, which was widely welcomed in your Lordships' House when it was published.
Valuing People is the first White Paper on learning disability for 30 years. It is based on the four key principles: rights, independence, choice and inclusion. I say to the noble Lord, Lord Pearson of Rannoch, that it is meant to be cross-government, a cradle-to-grave approach. It is also clear that the philosophy is one of involving people with learning disabilities in its development and implementation. That is the kind of philosophy that the noble Baroness, Lady Linklater of Butterstone, suggested we pursue. It applies particularly to the issue of housing, which the noble Baroness mentioned. Housing is a key theme of the White Paper. The intention is to enable people with learning disabilities and their families to have greater choice and control over where they live. That issue is related to the general principle of increasing choice, independence and inclusion in society and community.
The noble Lord, Lord Astor of Hever, expressed doubt about the progress made since the White Paper was published, and we always hope to speed up the introduction of new policies. However, progress has been made. Guidance has been commissioned on partnership working, person-centred planning, health action plans and the involvement of users in decision making. Decision-making guidance was issued in November 2001, and person-centred planning guidance was issued in January. Other guidance will follow. We have established learning disability partnership boards in each local authority area to take forward the Valuing People proposals. Those boards include representatives of a wide range of statutory and non-statutory interests. It is worth making the point here that it is the responsibility of each principal local authority to take forward this key task at the local level.
At the national level, we have established the Learning Disability Task Force. Members of the task force have extensive knowledge and expertise in the learning disability field. The force has met on a number of occasions. It has set up a number of sub-groups to look at particular issues, one of which is housing. That sub-group will stand by to advise local authorities and the Government on the way forward in implementation. Furthermore, it will pick up some of the issues raised by noble Lords tonight in relation to village communities.
In addition, a Valuing People support team has been set up to provide advice and support at the local level. There is a director of implementation and workers are based in each of the former social care regions. Thus an infrastructure has been put in place to support local authorities in developing their own policies and implementing their plans.
I turn to advocacy services. The White Paper placed great emphasis on the need to ensure that people with learning disabilities are able to make their own views known as much as possible. Over £900,000 was allocated to nearly 60 organisations during the past financial year to encourage such advocacy.
I turn to the issue of village communities. The noble Lord, Lord Renton, spoke most eloquently about the potential of such communities. As the noble Lord, Lord Addington, suggested, if we look at the different options that are available, we know that people with learning disabilities can live successfully in many different types of housing, in individual self-contained properties, in housing networks, in group homes and shared accommodation schemes, through to village and other forms of intentional community. We know that people with learning disabilities can cope with the full range of tenures, including home ownership. Expanding the range and choice of housing, care and support services is key to giving individuals more choice and control over their lives.
That is what is said in Valuing People and that is what we are working towards. Detailed guidance on the implementation of Valuing People was issued in August last year. It makes the same points about choice and goes on:
It is also clear that different views have been expressed about the relevance of village communities. The noble Lord, Lord Addington, pointed out that there were no absolute rights or wrongs in this matter. I think the noble Baroness, Lady Cox, referred to the views of Mencap at the national level. She rightly pointed out that Mencap nationally is not particularly encouraging of the use of village communities. It fears that there is a danger of repeating the policies that obtained during the 19th century and the first half of the 20th century; namely, of people being brought from all over the country to live in large institutions. Of course many noble Lords will know the history of the large institutions.
I do not seek to endorse the view of national Mencap and I know that it is not shared by some of the local branches, in particular the Surrey branch. All it does is indicate that different views are held on this matter.
Turning to St Ebba's, the redevelopment came about because of concerns that the residents' quality of life was not what it should have been. Concerns were expressed about the dormitory accommodation in turn-of-the-century buildings with little privacy, personal space or the ability to choose how and with whom residents spent their day. The plans resulting from what is described as the "New Directions" project began in 1997. They saw proposals for the development of a range of small care homes, each dedicated to the care of specific groups of residents, and the development of supported living flats.
Noble Lords have made the point that 61 places are planned on the St Ebba's site which, according to the commissioning authorities, would meet the expected need in the local community. This is important. Of the 61 places, three homes are already occupied, another is under refurbishment and some still await planning approval. It is hoped, I understand, that, subject to planning consent, redevelopment will be concluded by 2004.
I also understand that provision has been made within the redevelopment proposals for a limited expansion of two to three further homes, if they are required in the future. However, while those proposals have received widespread support in Surrey, they are not in line with the wishes of the St Ebba's Parents and Relatives Group, which has long campaigned for the development of a village community, believing that that would be the best setting for the residents.
The noble Baroness, Lady Cox, helpfully arranged for me to meet with representatives of the group. I understand why this group and like organisations across the country believe that the village community is the ideal option. Indeed I have no hesitation in saying that there are people with learning disabilities for whom it would be the preferred method of care. Those who support the concept of village communities argue that they are cost-effectiveI shall come back to the noble Lord, Lord Pearson of Rannoch, on the question of funding, because he raised some interesting pointsand that people with learning disabilities would enjoy a better quality of life in such a protected environment. Furthermore, authorities would build village communities if they were properly consulted, because that is what many parents want.
The commissioning authorities in Surrey have had to work together to ensure that there is a co-ordinated response. I understand that 30 of the 89 residents currently on the St Ebba's site are out-of-county placements. At the start of the St Ebba's project in 1998, the health authority wrote to all the other health authorities to ask whether they wanted to purchase places at St Ebba's. None expressed an interest in purchasing those places.
We then come to the responsibility of the local health and social care commissioners who have a duty to carry out a full assessment of the care needs of St Ebba's patients and ensure that the appropriate arrangements are put in place. I do not believe that it is for Ministers to second-guess those assessments, but I have inquired and have been assured that the appropriate assessments did take place in relation to each of the residents.
I well understand, as the noble Baroness, Lady Cox, suggested, that concerns have been expressed that the parents and relatives group has not been sufficiently involved in the discussions that have taken place at the local level. She will know that the county council and the relevant NHS trust issued a public consultation document; that the community health council involved was present at the public meetings; and that a large number of responses were received. Most of those responses supported the changes proposed. The
I understand the issue of the representation of the parents and relatives group on the Surrey partnership board. I have inquired into this matter locally and I have been informed that the size of the geographical area that the Surrey partnership board covers precludes the involvement of all interested groups. I know that a member of the parents and relatives group has been invited to speak to the chair of the mid-Surrey Valuing People localities group, which has representation on the main partnership board, but, in the light of today's discussion, I undertake to see whether there is some way in which the parents and relatives group can have some further engagement, discussion and involvement in these decisions. I would not wish the group to feel that it has not been listened to either by Ministers or by the local statutory agencies. I shall make sure that that does happen.
The noble Lord, Lord Pearson of Rannoch, raised some very interesting questions about the comparative costs. I have inquired into this matter. The research undertaken for the White Paper examined the differences in costs and benefits of housing options. My understanding is that the research did not find significant differences in costs. I shall be happy to send the noble Lord further information on that matter.
The noble Lord also raised the issue of the way in which surplus properties which had been given to the NHS in the past by local people were handled. He will knowthis has been raised on a number of occasionsthat all such properties are owned by the Secretary of State. It is in the Secretary of State's gift to decide how they should be dealt with. It is important to ensure that where surplus land is sold the money comes back to the NHS for the benefit of NHS patients.
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