---

How does one tie in adult social care with other groups? When discussing the previous welfare reform package of legislation, we spoke about welfare to work and getting people involved. How do social care budgets tie in with that? The question does not apply if one is talking about those who require care predominantly for reasons of age; it does apply if one is to try to get those with mild and moderate learning difficulties into work to provide themselves with some social support and outside stimuli. That the Government have said that they will enable people to gain qualifications will mean that the day courses in colleges which have already been referred to face acute problems as well, because one is accentuating problems arising from people being at home for too long.

How this is co-ordinated is the big question for government. As the noble Viscount, Lord Tenby, said, it is not that the Government—indeed, all who are involved with government: we all must take some responsibility here; it is anybody who deals with Whitehall, either as direct lobbyer or organiser of the system—lack good intentions. But how will they make the parts come together? There are two ways of doing it: either one tries for joined-up government, or one says, “We can’t do it” and goes for a silo defence of one’s budget. We must hear from the Minister which one of these is favoured. Will she simply say that a criterion will look after this problem within these strategies, which is often the way we go forward and have to deal with it?

How do mild and moderate learning disabilities fit into the thinking? Another of my clichés is that we have reverse battlefield medicine here. In battlefield medicine, you patch up very quickly those you can get back out to be shot at again, but the state tends to deal first with those with the most severe problems. This means that those who are the least easy to spot, or who are muddling through and achieving at the moment, are ignored. Then, when they are pushed over the edge, they suddenly become a new problem. How the Government intend to deal with that and work such people into the system is an interesting question.

27 Mar 2008 : Column GC119

Although the Minister has taken on her responsibilities only comparatively recently, I am sure she has already noticed the similarities across many of these debates. She nods her head. The fact is that if you have a middle group that is undiagnosed, unhelped and unsupported, it can become a much bigger cost later on. Can we please have some indication of how the Government are starting to work this group into the system? Will the Government continue to try to get government and parts of Whitehall working together, or are they going to make sure that there is an understanding and commitment, with something written up front, that all new policies will include this group? I am sadly coming to the conclusion that that may be the only practical way forward.

2.31 pm

Baroness Hanham: I, too, thank the noble Lord, Lord Rix, for raising this matter. By doing so, he has put a challenge to the Minister and to the Government which I am sure the Minister will be able to rise to today.

The whole question of support for vulnerable adults is mired in controversy, and it should not be. It is to be hoped that the Green Paper will bring common-sense solutions to the fraught question of who pays for what. There is a crying need, too, for coherence in relation to the question of how responsibility can be borne or shared for those who need care, either because they cannot provide it for themselves, or because they have no one to provide it for them, or because their requirements, either practical or financial, are beyond committed families to provide.

It is well recognised that for our older population, irrespective of their financial means, there is a need for sensitive, practical care, either to help keep people in their own homes or in supported housing. Those who are most at risk of not finding such care are those who fall outside the criteria for the limited social care support, about which we have heard a great deal today, but where paying for their own care is beyond their means. Currently local authorities—I declare an interest as an elected member of one in London—which either give support themselves or commission it from private providers, are able to do so only for the most needy, a point raised by the noble Baroness, Lady Wilcox, very specifically. For the rest, what can be given is either extremely limited or non-existent. In many cases, local authorities are not even providing advice or practical assistance to anyone who does not meet their criteria. That seems to be as true for those with learning difficulties as for elderly people who need help.

No one who has listened to the noble Lord, Lord Rix, today, or has read the briefing provided by the Learning Disability Coalition, can have failed to be moved by what both have said. Of course, as with other people who are vulnerable, there are gradations of need. Many of those with learning disabilities can, given a modicum of help and the support and drive of their families and teachers, achieve virtually normal lives, a point made by the noble Lord, Lord Addington, and the noble Viscount, Lord Tenby. They can maintain jobs applicable to their own capacity and an independent

27 Mar 2008 : Column GC120

existence. However, others are almost totally reliant for the whole of their lives on social or healthcare support.

We have already noted that medical improvements ensure that those with learning disabilities live longer than in the past and, in many cases, may outlive their parents. They either then become the responsibility of their siblings—if they have any—who may find assuming responsibility for them too onerous or too intrusive on their own lives, or they may require help from the social or health services. Regrettably—again, as we have heard—a recent audit by the Healthcare Commission found that, where health services are provided, insufficient attention is paid to safeguarding those who are most vulnerable, they are poorly planned, and residential care provided by health services is largely in institutionalised settings. I recognise, as the noble Viscount, Lord Tenby, said, that there are private organisations which provide this care, but the report related specifically to services provided by the state. As I said, they were found to be institutionalised, but is that still the case? Institutionalised settings should have gone out years ago.

The commission concluded that it had concerns about the quality of care overall in most establishments. The noble Viscount, Lord Tenby, raised a very important point in referring to one particular home. Many homes for the elderly—and, now, for those who are vulnerable in other senses—are being driven out of existence by care standards. In my own borough, I know of two large private homes for the elderly that gave up simply because they could not meet the very exacting physical standards demanded of them. I just hope that that will not happen across the board. No one wants establishments that do not have proper facilities or are unable to provide nice surroundings but, equally, do we want some of these excellent places forced out of existence simply because they cannot practically provide a room with an en suite bathroom?

As other noble Lords have pointed out, help from social services is not necessarily an option either. As the social care inspectorate found, by the end of 2008, 73 per cent of local councils’ finances will support only those who have substantial or critical needs. Local authorities will tell you that there is enormous pressure on their social care budgets, but being able to provide only a proportion of what is required, and then only for the most seriously affected, will leave many questions still to be answered.

As with the whole question of adult social care, for years solutions have been sought to the unequal conundrum of who pays, who receives and who loses out. The report, Valuing People, which was published in 2001 and has been referred to already, set out the Government’s commitment to improving life chances for people with a learning disability. Valuing People Now went further into how the principles outlined in the former report could be extended. However, fine words cannot deliver the goods if there is insufficient money in the system to enable that to happen.

There is a not unreasonable expectation that, where they can, people should self-fund at least a proportion of their care, and it is anticipated that this will be promulgated again in the Green Paper. However, this

27 Mar 2008 : Column GC121

concept—I think it was the noble Viscount, Lord Tenby, who raised it—does not readily lend itself to those with learning difficulties, who are unlikely to earn sufficient to make any contribution to their present or future needs and who, in many instances, have been maintained by their parents, often at enormous personal cost.

The aim of the Green Paper is to ensure that care funding is,

“a sustainable system that targets resources effectively”.

That seems to be as relevant to the concerns about those with learning difficulties, who in adulthood become increasingly vulnerable, as it is to those who are elderly. The problems relating to both are not going to go away. Demography tells us that, if nothing else does. The distribution or sharing of resources, standards of care and responsible authorities are germane to both. I look forward to the Minister’s response to the case which I believe has been made out by noble Lords that this widely anticipated Green Paper should not address itself to adult social care alone but should include those with learning difficulties.

2.40 pm

Baroness Thornton: My Lords, I start by paying tribute to the noble Lord, Lord Rix, and by saying how much I admire his dedication and work in support of people with learning disabilities. As I am learning in my job, in which now I am not so new, many noble Lords have huge expertise in these areas, some of whom are represented here today.

Social care is a vital part of the lives of many disabled people, including people with learning disabilities. In 2005-06, a total of £5 billion was spent on social care for 18 to 64 year-olds, of which 56 per cent was spent on people with learning disabilities. That indicates the scale of the issue that needs to be addressed when we consider the future. While we have become better at identifying and supporting people with learning disabilities, there are now many more people with learning disabilities that survive into adulthood and older age and require continuing care. We have a responsibility to ensure that people can access that support. We recognise that the voices of people with learning disabilities and their carers have not always been heard in the debate on social care. Now, as we face fundamental reform of social care, it is of great importance to the Government to consider the needs of people with learning disabilities in the whole debate around social care.

Demand for social care has increased in recent years and is set to rise even further in future. The main reasons for this is down to the major changes happening in our society, which have serious implications for the care system: an ageing population; people with learning disabilities living longer and fuller lives; higher expectations about what services should deliver; and technological changes. All this is excellent news, and a tribute to the advances in medicine and in care over recent decades, as well as the effectiveness of organisations such as Mencap under the leadership of the noble Lord, Lord Rix. But we cannot underestimate the challenge that this represents to social care services.

27 Mar 2008 : Column GC122

A recent report produced by the King’s Fund estimated that the cost of providing the current levels of social care for those over 65 will increase from £10 billion per year in 2002, to £24 billion per year in 2026. We also know that by 2021, there will be over 1 million people aged 15 and above with learning disabilities in England, and the number of adults with learning disabilities aged over 60 is predicted to increase by 36 per cent between 2001 and 2021.

Although it is clear that continuing research will be needed to underpin the developing policy, we already know that there is a huge challenge before us. It is the shared ambition across government to put people first, including people with learning disabilities, through a radical reform of public services, enabling people to live their own lives as they wish, confident that services are of high quality, are safe and promote their own individual needs for independence, well-being and dignity. That is why in December last year we published a cross-sector concordat, Putting People First, which establishes collaborative framework between central and local government, the sector’s professional leadership, care providers and the social care regulator. It sets out the shared aims and values, which will work across agendas with users and carers to transform people’s experience of care and support services.

The challenges to delivering the ambitions set out in Putting People First are significant. In recognition of this, we are providing councils with £520 million over the next three years to support them to make the system changes and, more importantly, the cultural changes required to empower citizens to shape their own lives through the support that they need.

However, the noble Lord is right to seek clarity about how we will meet the needs of those with learning disabilities through these reforms. For far too long the needs of people with learning disabilities have not had the prominence they have deserved and needed in the debate on social care. We are committed to listening to the views of people with learning disabilities and their carers, and that is why we are currently consulting on Valuing People Now: From Progress to Transformation. This sets out the priorities for the provision of services for people with learning disabilities for the next three years. Valuing People Now sets out how we are working towards transforming people’s lives—for example, through prioritising jobs and housing for people with learning disabilities—through the public service agreements on socially excluded adults.

Through Valuing People Now we are setting out the Government’s strategy to tackle a number of serious concerns raised around how health services are meeting the needs of people with learning disabilities. In May 2007, the Secretary of State established an independent inquiry into the healthcare of people with learning disabilities. This was in response, of course, to Mencap’s report Death by Indifference, which highlighted the tragic deaths of six people with learning disabilities who were under the care of the NHS. Sir Jonathan Michael is chairing the inquiry and we await his report to the Secretary of State early this summer.

We are committed to considering the feedback from people with learning disabilities and their carers. We shall look with interest at the views of groups such as

27 Mar 2008 : Column GC123

the National Forum, the Task Force and the Learning Disability Coalition and will look to publish the final document in the summer. Valuing people now, which was referred to by the noble Baroness, Lady Hanham, and others, and Putting People First are vital to achieving our aspirations for supporting people to live independently through choice and control. However, the challenges of an ageing population and the facts that disabled people are living longer and that higher expectations remain mean that a radical rethink is required of the care and support system to meet these long-term pressures.

The Green Paper mentioned by noble Lords will push forward the commitments made in Putting People First and address the long-term outstanding issues around funding, a point mentioned by my noble friend Lady Wilkins, the noble Baroness, Lady Hanham, and others. Over the next 10 years the Government want to create a new care and support system suitable for those with learning disabilities and their families. This is why the Government announced in the Pre-Budget Report last year that they would be producing a Green Paper on the reform of the care and support system. The Green Paper will look at options for developing a sustainable care and support system and whether it will be possible to develop a new system for all adults, not only for people over the age of 65. This is important for those with learning difficulties as a large proportion of them are of working age rather than pension age. The issue of ageing parents, a point raised by several noble Lords, is clearly part of the consideration of the Green Paper.

At this stage, the Government remain open-minded about the solutions and are keen to work closely with a number of learning disability interest groups throughout this process. These groups will play a vital role in shaping the success of the reform and the support system. My honourable friend Ivan Lewis announced on 6 February that the Department of Health will commence a public engagement process in the spring which will engage with people of all ages about the problems facing the care and support system. In order to capture the views of people with learning disabilities, the Government will ensure that the public engagement process and associated literature are accessible, available in a wide range of formats and appropriately publicised.

Turning now to specific questions raised by the Committee, the noble Lords, Lord Rix and Lord Addington, and the noble Baronesses, Lady Wilkins and Lady Hanham, particularly mentioned the issue of the eligibility criteria—one of the themes with which the noble Lord, Lord Addington, said I would become familiar. The Government have asked CSCI to carry out a review of the criteria for fair access to care services, their application by councils with social services responsibilities and their impact on people, and to address the issues, particularly for those with mild or moderate disabilities.

We will receive a full report from CSCI in the autumn. This will assist in providing evidence to inform the Green Paper—which addresses one of the points raised by noble Lords—and we will use its findings to

27 Mar 2008 : Column GC124

look at the right models to promote best practice in prevention and enablement, alongside good access and information about social care services where they are required.

The noble Baroness, Lady Wilkins, raised the issue of people with low and medium-term needs. The range of ways in which local authorities support people with low and moderate disabilities has to be addressed, including support for housing and leisure programmes.

The noble Lords, Lord Rix and Lord Addington, asked about carers. From our outset in 1997, the Government have recognised the value of carers, and since 1999 we have had a policy for carers, which is now being reviewed. We are increasing the amount of money that councils can use to support carers to £185 million this year, and we have made £25 million available to councils to help them support carers who are in a crisis situation. The noble Baroness, Lady Wilkins, and the noble Lord, Lord Rix, also raised the issues of research and how to look at unmet need when planning the Green Paper. Research underpins the reason why the Green Paper is being written. It is, by definition, difficult to identify how much unmet need there is out there. The research that has taken place looked at the overall level of demand and modelled the forward trends. The Green Paper has not been planned on specific research but has been planned and led by the Treasury.

The noble Lord, Lord Rix, asked what the Government are doing about modernising day services. We want people with learning disabilities to be more independent. Valuing People Now has been published, and one of its priorities is what people do during the day, at weekends and in the evening. The deadline for responses is tomorrow.

The noble Baroness, Lady Wilkins, asked what the Government are doing to ensure that people with learning disabilities are not socially marginalised and have access to housing. We have committed to a public service agreement to prioritise support into employment and to enable people with learning disabilities to have security in housing.

I shall turn briefly to the issue raised by the noble Viscount, Lord Tenby, about when the Government are transferring funding from learning disability into the NHS and local government. In response to the investigation of learning disabilities in Cornwall, the Government’s commitment was to strengthen the commissioning of learning disability services, including giving consideration to a stronger role for local authorities. The current Valuing People Now consultation is seeking views on a proposal to transfer funding of commissioning responsibility for the social care elements of learning disabilities from PCTs to local authorities. I am not answering the question of “when” because my brief does not tell me, but I will find out and write to the noble Viscount.

I think that I have nearly run out of time, but I want to address all the other issues raised by noble Lords. I shall make two more points. The noble Lord, Lord Addington, quite rightly raises the issue of joining up on every occasion. The concordat Putting People First was signed by six departments. The review for the

27 Mar 2008 : Column GC125

Green Paper is similarly cross-governmental and is being led by Her Majesty’s Treasury. I hope that we are making progress. The noble Lord always recognises when we are.

The Green Paper needs to have practical solutions. The options put forward by the Joseph Rowntree Foundation and Sir Derek Wanless are being considered. They will provide a menu of options that will need to be considered when the Green Paper is published.

The needs of those with learning disabilities are a central policy issue that is being considered in a number of high-profile government agendas. The Green Paper on the reform of care and support systems is a unique opportunity for the Government to consider the needs of large numbers of people with learning disabilities who are living fuller and longer lives. It offers those with learning disabilities an opportunity to create a new system aimed at fulfilling the roles and responsibilities of citizenship by enabling them to have choice of and control over the support they need to live their everyday lives.

I thank the noble Lord, Lord Rix, and other noble Lords. I will answer in writing those questions I have not directly addressed.

[The Sitting was suspended from 2.53 to 3 pm.]

Waste Management: Fly-tipping

Baroness Scott of Needham Market asked Her Majesty’s Government what actions they are taking to tackle the issue of fly-tipping.

The noble Baroness said: Contrary to the Order Paper, this debate is about fly-tipping—not “fly-tapping”, which sounds much more interesting, but it is not a problem of which I am aware.

Fly-tipping makes one’s blood boil, particularly when out in the countryside, enjoying a walk and one comes across a pile of rubbish. It can absolutely incense people. It also appears to have given rise to a whole new industry. Last week, I saw a van with the words “Aquatic Retrieval Unit” on it. Mystified, I asked the driver what he did, and he said, “I fish Tesco trolleys out of the river”. That is another example of the costs generated by this very anti-social behaviour of fly-tipping.

---