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Baroness Murphy: My Lords, I shall be brief, not least because my carefully crafted notes were left in the taxi on the way here, which does not half concentrate the mind on the key points.

I welcome the Bill, as have others, and wish it a speedy passage. I should like to draw attention to two issues, both relating to the disability of mental health disorders. The first has been tackled by other speakers, and the report of the scrutiny committee, under the chairmanship of the noble Lord, Lord Carter, also wrestled with it. It relates to the description in Schedule 1 of incapacities with regard to the activities of daily living. This Bill, like many others that come before the House relating to health issues, is almost solely framed around physical disabilities, with mental health issues thrown in as an afterthought.

I am afraid that I am going to sound like one of those CDs which is stuck in a rut because of a scratch. However, I turn to the issue of the definition of mental incapacity, which will be raised in several forthcoming Bills.

The human brain is not simply so many gigabytes of computing power, and intellectual competence is only one influence on the activities of daily life. Perceptions, emotions, disordered motivation, and inability to tackle things because of a lack of will are equally important. Drive and disturbance of drive simply do not figure in the list. Humane tribunals address those issues by incorporating disabilities under headings, but that simply will not do any more. Other countries can get it right, and we should, too.

The second point is about the qualifying issues of mental health, which were alluded to in the scrutiny committee's report. I want to describe a very common situation where an individual has a severe mental health problem, such as a hypomania or depression that lasts for three to four months. That often requires hospitalisation but, within that time, the person is often fit to return to work. We know many cases where those individuals are excluded from taking full part in employment when they have employment, or lose employment because of stigma attached to people's expectations of their capacity, not because of the reality.

Such people, currently and in the future if the Bill remains as it is, will have no course of action in redress. It is a great missed opportunity not to address that, particularly in the light of the fact that the Bill has recognised that stigma attached to MS, cancers and HIV/AIDS can be taken into account without impact on the activities of daily life. If that is so for them, surely it should be so for the commoner and often more disabling mental health problems.
 
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I apologise to the House; I may have to leave before the closing speeches. However, I wanted to mention those issues in relation to mental health. I look forward very much to staying with the passage of the Bill and hope that those issues can be addressed.

Baroness Masham of Ilton: My Lords, I welcome the Bill, as lately so much has been spoken of the right to die. Jane Campbell is a commissioner for the Disability Rights Commission and is severely disabled. She thinks that society's view is that death is preferable for severely disabled people such as herself, saying:

"I am more concerned that everyone has the right to live".

Many disabled people fear being admitted to hospital because they may not be resuscitated or may be left to die without being given food and fluids.

In the shadows of Shipman, it is understandable that severely disabled people fear that they may be discriminated against in hospital or at the surgery, as there is so much pressure on the National Health Service. A new duty on public authorities requiring them, when exercising their functions, to have due regard to the need to eliminate unlawful discrimination against and harassment of disabled persons, and to promote equality of opportunity between disabled persons and others, is most welcome.

Legislation is often conflicting. Severely disabled people going into hospital for diagnoses often encounter very difficult problems. Hospital staff may say that they cannot lift patients on to X-ray tables or examination plinths. If they cannot lift them, suitable equipment should be provided to overcome those problems. It is possible to have equipment that moves up and down to a convenient height, to enable patients to move across if they use a wheelchair. If the plinths or X-ray tables do not move—some do not—hoists should be provided.

I am president of the Spinal Injuries Association. Recently our chief executive, who is a paraplegic, was taken to Southampton's A&E department when he developed autonomic dysreflexia—dangerously high blood pressure. He had to wait one and a half hours before being able to get off the trolley, because an ambulance crew had to finish a shift before they got him off. One hears of many such cases, which cause distress and are quite unnecessary if thought and planning goes into providing disabled people with what they need.

Recently my husband, who is very ill, had to go to the A&E department for a procedure, and I telephoned in advance to advise the staff that he would need a hoist. They said that they had one. When he arrived, the battery was flat and it did not work. No one had bothered to check. Disabled people find that sort of thing time and again. I can see problems arising in trying to distinguish discrimination from inefficiency. If the legislation makes people sit up, consider the needs and plan accordingly, it will have served a useful purpose.

I am pleased that HIV/AIDS, cancer and MS are included in the legislation. That makes me query a problem of double incontinence on which I would like an
 
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answer in due course, if possible, from the Department of Health. Primary care trusts supply incontinence pads and paper sheets—inco-sheets—which are vital for those who need them. When talking to the firm that supplies them for my PCT, I was told that only the people who had previously got them would have them, not newly disabled people or those who had deteriorated. That seems ridiculous. For someone with constant diarrhoea who may have HIV/AIDS and cryptosporidium, which causes diarrhoea, or someone who for any reason is doubly incontinent, paper sheets are invaluable. If PCTs would realise how costly pressure sores are to the NHS, they would supply those necessary aids on need. Pressure sores cost the NHS millions of pounds a year. That seems yet another form of discrimination within the NHS.

I welcome genuine mental illness being included in this legislation, but there is a wasteful culture of sick notes being given out willy-nilly by GPs to people who say that they suffer from stress or depression. Doctors find that the easy way out is to give sick notes without proper diagnosis, and employers can do nothing about it. Is there any way to prevent that culture becoming exacerbated through the Bill?

Will the Department for Transport's voluntary code for air travel and trains now become mandatory? The Spinal Injuries Association would be pleased to give case evidence of people who have had problems, so that better services were available. The handlers who help disabled people on and off aeroplanes have not recently been as good as they used to be. The moving and handling has often been better at foreign airports, with better trained personnel doing the job. With pressure of space on airlines, tall and big people can have serious leg problems. Will they be covered by this legislation? Perhaps they will be only if they have a disability.

On the diesel trains of GNER it is impossible to put a wheelchair into the wheelchair space in a first-class compartment, as the seat sticks out and makes the entrance too narrow. Will improvements be made to that? It seems ridiculous to have a space which cannot be used.

Some of the out of London taxi firms are not willing to invest in their fleets until there are more details. There do not seem to be any overall standards. More training and training videos should be available for all manner of people who provide much-needed transport for disabled people.

I am pleased that private clubs are included in the legislation. I hope that clubs such as Whites and Brooks in London will rectify their lifts, which are far too small to accommodate disabled people in wheelchairs.

There are now several Acts of Parliament that involve disability and the legislation has become fragmented. Have the Government any plans to consolidate it? It would be helpful for those people who have to administrate the legislation. That part of the DDA which came into force in October has already made a difference. Our local bank in Masham has built
 
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a ramp which has provided accessibility for the first time for people using wheelchairs. That happened just before 1 October, when I visited the bank for the first time. Therefore, legislation does make a difference and I hope that this legislation will, too.

The Earl of Listowel: My Lords, I warmly welcome the Bill. I hesitate to take part in this disability legislation, given the immense depth of experience of many noble Lords who are taking part in the debate. I do so because of my particular interest in children in local authority care and the difference that the Bill could make for their lives. I also thank the Royal College of Psychiatrists and the Children's Society for helpful briefings in preparation for this debate.

My concerns are threefold: that psychiatric disorders are fully recognised in the Bill, an issue to which the noble Lord, Lord Carter, drew attention; that specific duties are put on schools to ensure that disability discrimination is tackled; and that the duration of mental disorders, such as depression, will be recognised adequately in the Bill.

Perhaps I may give an example of what happens in the care system. Some 60 per cent of the 60,000 children and young people in local authority care in this country have arrived due to previous abuse. A further 10 per cent have arrived in care due to family breakdown. Not surprisingly, the level of mental disorder among that group is 40 per cent for those in foster care, and 68 per cent of the 6,000 children in residential care have mental disorders as a result of their previous experiences.

Schools exclude 10 to 12 times more looked-after children than other children. So it is important to ensure that specific duties are placed on schools to ensure that those children's disabilities are also recognised. There is already good guidance from Her Majesty's Government on how to cater for the needs of those children through designated teachers and personal education plans. But the Social Exclusion Unit's report into the education of these children highlighted the fact that such important tools are not consistently implemented. The Bill could be a useful lever to ensure that there is more focus on the training of teachers so that such disabilities are recognised and that the mechanisms are fully implemented.

Last week, I attended a conference on the education of looked-after children. There was a presentation by a 24 year-old member of A National Voice, which is staffed by and speaks out for care leavers. He recounted his experiences in education. He left school with no qualifications, apart from a low level one. He said that he had been depressed and spent too much of his time in bed in his children's home, unable to find the will—my noble friend Lady Murphy alluded to this point—to go out of the home and into education. More might well have been done to help his disability of depression, when he was out of those bouts of depression, by ensuring that he obtained some educational experience. Many have the same experience and, regrettably, leave without any education or with few educational attainments.
 
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Therefore, they are likely to be unemployed and are vastly over-represented in the criminal justice system, because their emotional needs have not been met and they have not attained the educational qualifications they need to engage in the work market.

I hope that we will look carefully at the proper definition of mental disorders. I hope that the Bill will mark a change in the culture, as the noble Baroness, Lady Hollis of Heigham, said in her opening speech, and that Clause 3, which addresses the wider policies of public authorities in such areas, can begin to make a difference.

Your Lordships may have recently viewed the "Dispatches" programme on Channel 4, "Profiting from kids in care". It was deeply depressing. One of the journalists managed to obtain access to a children's home for children with Down's syndrome and other disabilities, without an ID check at the front door or a Criminal Records Bureau check before entering. The programme also concerned other children in local authority care and the childcare professional who was invited to comment on the issues raised said, at the end of the programme, that the least qualified, untrained staff were actually working in the front line with the most difficult and challenging children.

I hope that there are things that can be done and the Government are doing much to improve matters in this area. But we are starting from a low base. In Scotland, the Scottish Institute for Residential Childcare provides excellent training and consultancy for children's homes. We do not have that facility in England. Perhaps we could move towards that. Almost uniformly on the Continent, staff working in such situations have qualifications—two to three years' professional education and training—to work in such environments. They work not only with children but with elderly people. The situation is similar for elderly people with dementia in residential homes, where unqualified and untrained staff work. Again, the possibility of greater recognition of what it means to have a psychiatric disorder, and the need for professional responses to that, which the Bill offers, is welcome.

I hope that in her response the Minister will reassure the House that specific duties will be placed on schools to ensure that the outcomes that we wish for are arrived at and that she will also allude to the duration of mental disorders such as depression. I look forward to the Minister's response.

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