Health Inequality: Autism and Learning Disabilities

Baroness Browning Excerpts

Thursday 10th May 2018 Grand Committee

[Baroness Browning (Con)]

My Lords, I refer to my interests in the register, including family interests. I apologise to the noble Lord as I was a minute late. He was on his feet; he beat me to it. I apologise to the Committee.

This subject covers far more than we have time for today. This will be a quick canter. I shall refer first to the physical disabilities of people on the autistic spectrum. The Mencap report, Death by Indifference, which I feel I have been quoting in debate after debate for so many years in this House, fills me with despair. We are still talking about people on the autistic spectrum either in primary care or in hospital wards being disadvantaged, sometimes to the point of death. That in some cases is no exaggeration, purely because their autism was not understood by health professionals. In some cases, mothers have stood by hospital beds trying to explain to professionals how their adult child functions and how they are affected, yet they are still being ignored because the child is over 18—and why listen to somebody with a lifetime’s experience of that individual? People have made the point that they are individuals and they all function differently, albeit having the same diagnosis.

On mental health, this is not rocket science. The vast majority of people who grow up into adolescence and then into young adulthood, particularly, suffer mental illness on top of the autism, mainly because very simple, straightforward support services are denied them. That downward spiral of despair, when they are unable to access often very basic services, is hardly surprising. Most of us would suffer from mental health problems, if we were on the autistic spectrum, and if by the time we were 25 we had tried very hard to be part of society and the education system and to have relationships with other people but still could not get through that glass wall. Very often, it is through social services and others that these supports are forthcoming but, if they are not forthcoming, there is a serious mental health downward spiral. There is a paucity of support out there among clinicians. Very few psychiatrists, particularly in the provinces, have a working knowledge of autistic people. It can be fine in the big cities, but not so much out in the sticks. If they do not understand the condition, sometimes even the professionals do more harm than good.

I shall give a plug to the National Autistic Society. My noble friend Lord Touhig has worked very hard with the society, and there is an autism hospital passport on its website. It can be downloaded, and I know that people have used it, so that when they are admitted to hospital, the professionals have the information that they need about that individual. It is not the answer to everything, but I recommend those sorts of tools to make sure that people are given the support that is out there. There are now some apps that people can have on their phones, if they are on the autistic spectrum, which is very good.

I hope that the Autism Act, which I must finally mention, will be put into practice. If it were, things such as speedy or timely diagnosis, and some of the problems that have been mentioned today would not still be being raised by Members of the House.

NHS: Winter 2017-18

Baroness Browning Excerpts

Wednesday 18th April 2018 Lords Chamber

[Lord O’Shaughnessy]

I agree with the noble Baroness that we need to beef up the role of pharmacies. Primary care is an area of investment within the five-year forward view. There are, I believe, nearly as many pharmacists as there ever have been, if not more, so their role is increasing all the time and that is part of our conversations for the future.

[Baroness Browning (Con)]

While my noble friend is looking at the expansion of advice from pharmacies, will he look at the same time at insurance cover for pharmacists? My understanding is that, while GPs have been very keen for pharmacists to give advice, for example, to asthma sufferers and to provide the equipment that asthma sufferers need to carry with them, they have run into difficulties in getting insurance cover to provide that level of advice.

[Lord O'Shaughnessy]

I shall certainly look into that issue. We are reviewing insurance across primary care, as my noble friend might know, and I shall look into this specific issue.

Adult Social Care Services

Baroness Browning Excerpts

Thursday 6th July 2017 Lords Chamber

[Lord O'Shaughnessy]

First, I congratulate the noble Lord on the work he did on the Dilnot commission in setting out the challenges we face and the kinds of solutions that we need to put the sector on a long-term footing. I merely reiterate the point that extra funding is going in, at a time when we are still addressing the £150 billion deficit that the Government inherited in 2010. That is enabling real-terms increases. Of course we need to keep going with that, because there are more older people and their care is increasingly complex.

I want to come back to the changes we are making on delayed transfers of care. Making sure that the interface between the NHS and social care is as quick, smooth and suitable for patients as possible is critical. That is why there is renewed emphasis to make sure that the money going in is addressing one of the major problems that is preventing the quality of care that we want.

[Baroness Browning (Con)]

My Lords, will my noble friend consult the CQC on a rather intimate but difficult problem? Elderly people admitted to busy trauma wards with fractures that result in them not being able to weight-bear very often find that, when they press the bell for the loo, they are not able to access a commode and there is no time for a bedpan. They end up being consigned to using adult nappies for an unnecessary long time. That has a knock-on effect on both their ability to rehabilitate and if they subsequently go into nursing or residential care. This is an outrage. Tackling this would save money and give more dignity to elderly people, but it is not something that one hears talked about very much. I have witnessed this happen with my elderly relatives and ask the Minister to take a look at it

[Lord O'Shaughnessy]

I am sorry to hear that my noble friend’s loved ones have experienced that. She is quite right: not only would that inhibit rehab but there is also the question of the dignity of the patient. I shall certainly look at the issue and write to her.

Queen’s Speech

Baroness Browning Excerpts

Thursday 29th June 2017 Lords Chamber

[Baroness Browning (Con)]

My Lords, I refer to my various interests in the register. Following on from the noble Lord, Lord Warner, I begin with mental health. As I think others in this Chamber did, I worked on pre-legislative scrutiny of the last set of changes to mental health legislation, before the Bill itself came before Parliament. Although this is a two-year Parliament, I would urge pre-legislative scrutiny, as this is such a complex and very diverse area.

There are two things at the heart of mental health services. The first is the quality and appropriateness of the services that are provided, and the second, perhaps much more important, is accessibility. At the moment, that is patchy, as has been mentioned. I think my noble friend Lady Cumberlege said this, and it is not just in maternity services but right across the piece. But there is good practice, and I hope we do not feel we have to reinvent the wheel every time we look at these subjects, but identify where good practice is, take it up and implement it as quickly as possible. That of course means resources, and accessibility is about nothing if it is not about resources. Some GP practices have community psychiatric nurses attached to them, who can identify, when a patient comes in out of the blue, that the patient needs a much longer time for diagnosis and for a plan to be put in place. No GP can do that in a few minutes. Where they have a CPN attached to the practice, and that happens, you see the results and it is very good. These are the sorts of examples we should be lifting up and encouraging throughout the country.

I hope we will look at where mental health needs are most prevalent, not least in prisons. I am not talking about people who are in secure units, but our general prison population. We have talked so many times about the need for more mental health service inputs there. It is so important before people leave prison, as is continuity when they come out. I recently visited Feltham prison, which has an exemplary practice in the way it manages people on the autistic spectrum. Autism is not a mental health condition, but I like to talk about autism as often as I can, and people will not be surprised to hear me say that people on the autistic spectrum who go without the appropriate support and package of care—both children and adults—very often spiral downwards into very serious mental health problems. The suicide rate is high. The suicide rate in this country, particularly among young men, is too high per se, and we should be looking very critically at what works and what does not. I will just say to my noble friend on the Front Bench that we produced an Autism Act in 2009, which had an autism strategy. The Government have dragged their feet somewhat in making sure that every local authority is implementing that strategy to make sure that people on the autistic spectrum have that support.

I turn now to social care. The guidance produced by the Government says that the number of people aged 75 and over is expected to increase by 70% between 2015 and 2035, so I declare a personal interest here. I am what is euphemistically described as a baby boomer—looking around the Chamber, I suspect I am not alone. Originally baby boomers were those people born either during or in the decade immediately after the Second World War. The noble Lord, Lord Whitty, referred to the way the younger generation now see our generation of baby boomers, and I must say that I am very concerned at some of the divisive language used—not by the noble Lord, Lord Whitty—to describe the difference between the younger and older generations. Back in the 1950s, if your Lordships can imagine that far back, only 10% of young people went to university. We are not talking about the 50% who go now. There is this idea that it was somehow free for 50% of the population, but it was not. The school leaving age was 15, and many people left school and went straight to work without any training, or further or higher education at all. But we made it none the less.

That age group is very important. If you were to ask people of that age today what they would like most, they would say, “To die and be cared for at home”, but the practicalities of that are very difficult. The noble Baroness, Lady Jolly, has drawn to my attention the concern, which I am sure she will raise later, about people living at home who have carers who need to sleep in, for whom the national minimum wage has become a big issue.

I am a vice-president of the Alzheimer’s Society and conclude with the problem of dementia, because deciding how we shall take this forward is quite a serious matter for the country. The Alzheimer’s Society says that dementia has,

“long been the most discriminated against condition, dismissed as ‘social’ rather than ‘medical’. Unlike many other conditions such as cancer or heart disease, where assistance will be provided free of charge through the NHS, dementia care is social care. The current system demands that anyone with even limited assets is forced to pay for their social care. This is unfair and can lead to astronomical costs for the person and their family. It should not be the case that because you develop one condition over another, you can be left bankrupted by care costs”.

I personally feel that we should all make provision for our old age and contribute towards our care costs but, as the Alzheimer’s Society says, dementia can take virtually every penny you have. I am very glad that the Government are to carry out an in-depth study into how we find some action to go with this challenge.

Social Care

Baroness Browning Excerpts

Thursday 1st December 2016 Lords Chamber

[Baroness Browning (Con)]

My Lords, I congratulate the noble Baroness on bringing this subject to the Floor of the House. I expect I am one of the old faces she mentioned who will be termed one of the usual suspects on this subject. I refer to my interests relating to this debate as set out in the register. Like the noble Baroness, I feel there is a touch of déjà vu about this. We know about demographic trends, the demands of an increasingly elderly population and the whole range of things which cover the gamut of the need for social care, and we have talked about them in this House for decades. Yet somehow, every time we have a debate about this, it is almost as though this is something new that has suddenly come from behind and we are rather astonished to find it is such a problem.

It is now a real problem. There are concerns about care services moving out of the sector. The Local Government Association has raised its concern about people closing down businesses and withdrawing their services altogether at the very time that demand is increasing and we know that it is going to go on increasing. I have a lot of sympathy with what the noble Baroness, Lady Pitkeathley, said about the way in which we look at the funding of this. Funding is at the core of a lot of the challenges we face. Local authorities purchase in bulk. They have the advantage of that negotiation. Self-funders are usually individual people, families who, when mum has a stroke, suddenly find almost overnight that they have to provide nursing or residential care. These are the challenges individual families face almost on a daily basis across the country.

I say to the Minister that I still find it bizarre that we have this subsidy in residential care in the care sector whereby self-funders subsidise those for whom the local authority purchases care. There is never any discussion around this. We do not talk about how fair it is. There is no discussion about the fact that individuals who find they have to self-fund are not paying just their weekly fees, but are also subsidising the person in the next room, or possibly even more than one person. I really think it is time that we exposed how the funding system for care works. It is like having a secret tax that nobody knows about. I find that quite abhorrent.

I agree with the noble Baroness about the need to examine what is expected when people have assets. As a Member of Parliament, I will never forget a couple who were quite elderly themselves—in their sixties—sitting in my surgery virtually in tears at the fact that they were going to have to sell mum’s home because she now needed nursing care unexpectedly, when they had understood that that was likely to come to them. In the context of understanding the responsibility of providing for care, I say to my noble friend that there needs to be joined-up thinking across government. I was quite shocked that when the pension rules were changed so that people with private pension pots could draw down huge amounts of capital from what they had saved over the years, although provisos and bars were set in place to make sure that they had enough to live on, there did not seem to be much discussion about how much of their capital assets they would dispose of, and the whole subject of the amount of capital they would need in order to pay for their long-term care did not really seem to be part of any discussion.

I have one other thing I would just ask my noble friend. Joined-up government is so important, and the weakness has always been between health and social services in terms of agreeing who pays for what. Can my noble friend give the House an update on the sustainability and transformation plans, which should be well under way? It seems to me, if I have understood them correctly, that there is potential here, not just in terms of planning but in terms of finding the resources to implement the plans. We hear a lot about these plans, but I am not sure that everybody really understands what contribution they will make to joining up health and social services, and I hope my noble friend will refer to them when he replies.

NHS: Mental Health Services

Baroness Browning Excerpts

Monday 14th March 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, the noble Lord is right: we have committed to support the request of the task force to spend an extra £1 billion by 2021. Perhaps I may write to him about the phasing of that money over the next five years; I have seen it but I cannot recall the exact figures at the moment.

[Baroness Browning (Con)]

My Lords, can my noble friend outline the Government’s position on future in-patient services for children with mental health issues? Given that these are the most severe cases and that a lack of facilities in geographic proximity to where the children live has an effect on the immediate family, particularly parents, how will the Government resolve the problem of children as in-patients miles from home?

[Lord Prior of Brampton]

My noble friend raises a problem which is most acute for children and a serious issue for anyone who requires in-patient facilities. We are committed to reducing the number of children and older people who have to go a long way from home to receive in-patient treatment. We have committed to support the task force’s recommendation to spend a great deal more money on providing crisis resolution closer to home. This should obviate the need for people to go into in-patient facilities.

National Health Service: In-Patients with Learning Disabilities

Baroness Browning Excerpts

Monday 18th January 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, the noble Baroness is right. The national learning disability mortality review programme, which is being hosted by Bristol University, does not have the mandatory basis that other reviews have had. I am not sure why it was not set up on the same basis. It is being funded by NHS England, although it has the support of a wide range of different organisations. I will look into that aspect of the review and write to the noble Baroness.

[Baroness Browning (Con)]

Does my noble friend agree that the failure in hospitals to assess the capacity of people with learning disabilities and those on the autistic spectrum is one of the great weaknesses in providing accurate and timely intervention for people who are in hospital and who have a learning disability? Will he make a particular case for assessing the ability of staff to accurately define capacity? Will he also take another look to see that hospital passports for people with learning disabilities and autism are a mandatory requirement, not just an option, for all inpatients?

[Lord Prior of Brampton]

My noble friend makes a number of very good points. I will draw them to the attention of Mike Richards, the chief inspector for acute care in England, who is about to embark on a thematic review of avoidable deaths. He will look in particular at those with learning difficulties and I am sure that he will take into account the words of my noble friend.

Health: Parity of Esteem

Baroness Browning Excerpts

Tuesday 20th October 2015 Lords Chamber

[Lord Prior of Brampton]

I am not sure that legislation is necessarily the right way forward, but perhaps we can pick up that issue with NHS England to ensure that it is written into the NHS mandate for next year. It is certainly something I will explore with them. It is worth noting that we are spending £94 million a year on IAPT for children, and we have increased spending on tackling eating disorders in young people by £150 million over the course of this Parliament. We are beginning to rectify what has historically been an area of huge underfunding of mental health for young people.

[Baroness Browning (Con)]

My Lords, I support the plea from the noble Lord, Lord Stone, to my noble friend on mindfulness. We have a very active mindfulness group in this Parliament and I hope that my noble friend will encourage all colleagues to sample it for themselves.

When people present at a GP surgery with mental health problems, there are still far too many GPs who reach for the prescription pad. If we really are to get parity of esteem, GPs need more training in mental health and need to be able to access referrals close to their surgery for talking therapies and other such solutions, rather than just reaching for the prescription pad.

[Lord Prior of Brampton]

My noble friend makes a very good point: reaching for medication is often not the right way forward. I am not sure how much time in the undergraduate syllabus is reserved for mental health training. However, I know that a considerable amount of time is set aside for it, so that people who decide to become GPs will have had some training in mental health before they qualify. Only last week, I was talking to Clare Gerada, who was the president of the Royal College of General Practitioners. She said that she thought the best combination of all was for a GP to have studied psychiatry as well.

NHS: Reform

Baroness Browning Excerpts

Thursday 16th July 2015 Lords Chamber

[Lord Prior of Brampton]

The noble Baroness raises a number of points. Of course, she is right that it is no good just having senior doctors in a hospital without the right back-up, particularly diagnostic specialist nursing. She has just mentioned OTs and physios, and I agree with her completely there.

The noble Baroness mentioned the NHS pay review. There is not an opt-out clause in the Agenda for Change contract. Discussions will be taking place with the RCN and other trade unions later this year. I will have to write to her about the timing of the response on the end-of-life care point that she raised; I do not know it offhand. Digital information will be rolling out progressively over the next five years. I certainly hope that we will have electronic patient record in place for the vast majority of patients over the lifetime of this Government.

[Baroness Browning (Con)]

I welcome my noble friend’s announcement—I hope that he will take some cheer from that. I have too often been an emergency admission at a weekend and know only too well that if you have to wait to see the consultant on Monday you simply end up bed-and-breakfasting for two or three nights in hospitals. I hope that my noble friend will take into account how having a consultant available for those sorts of patient would save a lot of money, free up a lot of beds and achieve what he is describing.

I know that Ministers do not like to micromanage what goes on in hospitals, but with the transition to new contracts for new consultants, I hope that my noble friend will find a way to identify those particular disciplines in hospitals where there are more deaths—he mentioned this—so that attention can be given to consultants with new contracts in those disciplines. An aortic aneurysm needs a consultant standing by the patient, but with other easily identifiable conditions it would be good if the Government could make sure that hospitals proactively recruit consultants on new contracts to ensure that the 6,000 deaths that he mentioned come down as rapidly as possible.

[Lord Prior of Brampton]

I was interested by my noble friend’s comments about waiting until the following Monday when she has been in hospital. That is a good illustration of why we want to bring in seven-day services. My noble friend might be interested to read the report in Future Hospital, written by the Royal College of Physicians, that came out a year ago. I think that we will see over the next few years a significant change in the way that our hospital consultants are trained and deployed, and more generally what is called in America hospitalists, who can have a broader range of disciplines.

When it comes in, the new contract will enable us to differentiate payment for those consultants who are working more anti-social hours, such as A&E consultants who will have to work much more regularly out of hours than others. It will enable us to identify those consultants who may be on call but are more likely to be summoned in, like those that my noble friend just mentioned, at short notice. Depending on the surgical specialty, the on-call requirements can be much more demanding than others. For example, this is more the case if you are a vascular surgeon than if you are a dermatologist, who do most of their work in normal time. I take on board what my noble friend says.

Learning Disabilities: Premature Deaths

Baroness Browning Excerpts

Wednesday 30th July 2014 Lords Chamber

[Earl Howe]

My Lords, the noble Lord makes a good point. Following the recommendations of the UK review of learning disabilities nursing, we have set up an independent collaborative to address that workforce’s needs. We are also working with Health Education England’s 13 local education training boards to develop greater links with the independent and voluntary sector which will help with workforce planning. This year Health Education England increased its national commissions for student learning disability nurses by 4.5%. We are working on a number of initiatives to raise the profile of learning disabilities nursing and promote the profession as an attractive career choice.

[Baroness Browning (Con)]

The report identifies 37% of deaths that could have been prevented. People with learning disabilities and those on the autistic spectrum, some of whom are included in the report, experience communication problems at hospital level. Will my noble friend please put government force behind the issuing of hospital passports for people with learning disabilities and those with autism? The autism hospital passport was launched two weeks ago and is on the NAS website. However, these very important documents can help to prevent death only if clinicians and hospital staff read them, take note of them and act on them.

[Earl Howe]

I take my noble friend’s point. The specific needs of people with learning disabilities are being considered as part of the overall work programme to provide people with online access to their GP practice and GP-held e-record. That is being done in the wider context of the development of a fully comprehensive patient-held record. NHS England plans to hold a meeting later this year to look at developing a national standard for a hospital passport. This will be a patient-held document that will detail key information to be shared with any contact in the NHS.