Welfare Reform Bill

Debate between Baroness Hollins and Baroness Wilkins

Tuesday 17th January 2012 Lords Chamber

[Baroness Wilkins]

My Lords, I support the amendment, which seeks to ensure that the assessment for the new entitlement is fit for purpose and fulfils the Government’s commitment to the social model of disability. As has already been noted, DLA occupies a unique space in the welfare benefits system as it recognises that disabled people face a plethora of extra, often prohibitive, costs as a result of living in our society with a condition or impairment.

We should all warmly welcome the Government’s repeated commitment to the social model of disability, for which, as many of your Lordships know, disabled people have fought long and hard. At the heart of the social model is the recognition that it is our society, not just their bodies, that disables people with health conditions and impairments. However, I fear that the proposed assessment for the new entitlement does not reflect this commitment. Despite the Government’s assurances in Grand Committee, the Minister admitted that the proposed test,

“is not a full social model assessment; it is not intended to be”.—[Official Report, 14/11/11; col. GC 199.]

I ask the Minister in his response to clarify to the House and disabled people why such a commitment was ever made in the first place.

The second draft of the PIP assessment criteria includes some small improvements from the first. However, it does not go nearly far enough. By assuming that a medical assessment will capture social and environmental barriers to independence, the Government risk homogenising the diverse difficulties that disabled people face in their everyday lives. The new threshold document makes many mentions of extra costs and barriers, but only a few of these will be captured by an assessment that looks exclusively at impairment.

It is with this in mind that I support the amendment of the noble Baroness, Lady Grey-Thompson. The assessment for the new entitlement must consider the real social, practical and environmental barriers faced by disabled people with impairments living in our society. I, along with disability charities such as Scope, disabled people’s organisations and disabled people across the country, voice great concern that the Government are reneging on their commitment to the social model of disability. Doing so would undo decades of campaigning for and progress towards a better and more equal society.

[Baroness Hollins]

My Lords, I thank the noble Baroness, Lady Browning, for her honest and enlightening contribution. I speak as a doctor and as a mother; I have two adult children who are in receipt of disability living allowance.

I wish to talk about the medical approach to disability. As a doctor, I have often been accused of being very “medical model”, usually by disabled people. The medical model to disability is reductionist. Many doctors and other health professionals do not understand the social model; they do not understand the social, practical and environmental barriers that people with physical and mental impairments face. I support the amendment, but it would require skilled and sensitive assessments to be available and they would need to be delivered by people who understand the social model.

Health and Social Care Bill

Debate between Baroness Hollins and Baroness Wilkins

Wednesday 16th November 2011 Lords Chamber

[Baroness Wilkins]

My Lords, Amendment 92A is tabled in my name and those of the noble Baroness, Lady Hollins, and the noble Lords, Lord Rix and Lord Wigley. It would make explicit the responsibility of the NHS Commissioning Board and clinical commissioning groups to be compliant with the public sector equality duty, as set out in Section 149 of the Equality Act 2010.

Section 149 states that a public authority should,

“take steps to meet the needs of persons who share a relevant protected characteristic that are different from the needs of persons who do not share it”,

as part of the duty on it to advance equality of opportunity. This essentially makes provision for such public authorities to be subject to making reasonable adjustments for individuals who may have specific or different needs as a result of factors such as age, disability and religion or belief. In the context of this amendment, the healthcare bodies concerned and the healthcare professionals who work in them would be required to take the necessary steps so as to offer appropriate care to people with these protected characteristics.

In particular, I am speaking about the provision of reasonable adjustments for disabled people, particularly those with a learning disability. People with a learning disability will often have particularly complex healthcare needs and therefore require specialist interventions in order to have them appropriately met. These interventions are about health professionals adopting a change of attitude towards disabled patients and not making assumptions as to their quality of care which would not be made towards non-disabled patients. For example, the use of hospital passports can help to provide key personal information about an individual’s medical details and, as importantly, details about how they communicate so that health professionals can better understand the patient’s individual needs and communication requirements. Additionally, learning disability liaison nurses can help to provide specialist support and guidance to medical professionals when treating someone with complex needs.

These measures are more often than not achievable, reasonable and proportionate, and help to ensure that health professionals are treating disabled patients with the dignity and respect they are entitled to. Whether this is for planned or non-planned admissions, it is necessary for the NHS to make adequate provision for patients with disabilities. This can be achieved through better disability and learning disability awareness training for all staff so that they can better understand the needs of such individuals who may be in their care.

A 2009 poll conducted by ICM on behalf of Mencap found that a third of healthcare professionals have not been trained in how to make reasonable adjustments for a patient with a learning disability.

At this point, Baroness Northover continued the speech for Baroness Wilkins.

This can lead to poor treatment and can exacerbate existing healthcare inequalities. The same ICM poll indicated that almost half of doctors and a third of nurses said that people with a learning disability receive a poorer standard of healthcare than the rest of the population. The Mencap report Death by Indifference in 2007 also revealed the premature and avoidable deaths, in the NHS, of six patients with a learning disability. Since then, a further 60 families have been in contact with Mencap with similar experiences to this. It is therefore particularly important for the NHS Commissioning Board and clinical commissioning groups to be fully aware as to their responsibilities and obligations under the public sector equality duty.

It is very important that disabled patients and their families can be expected to be treated in the NHS without being the victims of prejudice and discrimination. The amendment tabled in my name and others’ sets out specifically the requirements on these bodies to adhere to the public sector equality duty. They would safeguard disabled patients against malpractice, mistreatment and neglect in the NHS.

[Baroness Hollins]

My Lords, I am delighted to have this opportunity to support the amendment of the noble Baroness, Lady Wilkins. The noble Baroness has eloquently put forward the case for reasonable adjustments and has given good examples of reasonable adjustments that people need and why they are so important for people with a learning disability. I fully endorse her sentiments on this issue. I am also speaking for my noble friend Lord Rix, who was unfortunately unable to stay this evening.

It is vital, under the new arrangements, that health professionals and the various health bodies that will be created are fully aware of their legal responsibilities when treating disabled patients. As the noble Baroness said, this is particularly relevant for people with a learning disability who continue to experience large health inequalities and who are at a disproportionate risk of experiencing epilepsy, mental health problems and premature death. Not only do people with a learning disability experience poorer health outcomes, but they also receive fewer routine immunisations and blood pressure checks and have poorer access to cervical and breast cancer screening programmes.

In response to an earlier group of amendments to this Bill, tabled in the name of the noble Lord, Lord Rix, on day 3 in Committee, the Minister gave many assurances as to why it was not necessary to mention disability or learning disability specifically in the Bill. He cited NICE quality standards, Monitor, the NHS outcomes framework, Clause 12 of this Bill, clinical advisory groups, the duty of clinical commissioning groups to involve and consult people “appropriately”, the annual report by the Secretary of State and, above all, the public sector equality duty.

My noble friend Lord Rix and I are both extremely grateful to have heard all of these assurances, put forward by a Minister who is both sympathetic and determined to be as helpful as possible. But we cannot imagine patients with a disability, especially those with a learning disability, being conversant with all these facts, and perhaps even having to visit their GP or local hospital with a vast compendium of their entitlements tucked under their arms to place in front of the health professional—who, as we know, may have been inadequately educated in their responsibilities with respect to the requirement to make reasonable adjustments—before they receive adequate and correct treatment.

The amendment of the noble Baroness, in one simple and effective move, would bring together all of the Government’s good intentions in this area and remove any ambiguity or uncertainty, by making it 100 per cent clear as to the importance of public bodies in the NHS meeting their obligations under the public sector equality duty, not just for disabled people, but for all of the protected characteristics.

The Minister stated in reply to earlier amendments by my noble friend Lord Rix that the Government’s starting point,

“is that people with a learning disability are people first”.—[Official Report, 7/11/11; col. 18.]

He will not be surprised to hear that my noble friend and I fully concur with that view.