Health and Social Care

Baroness Walmsley Excerpts

Thursday 15th December 2016 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, I congratulate the noble Lord, Lord Harris of Haringey, on introducing this debate and I add my condolences to those expressed to the noble Lord, Lord Prior, on the loss of his father. I congratulate the noble Baroness, Lady Chisholm of Owlpen, on the way she has stepped into the breach this week. There has been a lot of health business, so she has been kept very busy.

This has been an interesting debate. The main issues to come out of it have been the independence and funding of Healthwatch England and local Healthwatch; what the Government really want out of PPI; and the difficulty of defining what a good system of service user representation should look like.

Like the noble Baroness, Lady Watkins of Tavistock, I was interested in the King’s Fund’s analysis. I shall not repeat them, but it asked three very interesting questions that need to be answered to look at what would make a good service user system. That was a very useful analysis.

Although highly desirable, user representation has a chequered history. Phoebe Dunn, a policy researcher at the King’s Fund, has observed:

“Local Healthwatch organisations represent the latest in a long line of attempts to give patients and wider communities an effective collective voice”.

Since the 1970s, successive Governments have implemented a series of structures, beginning with the community health councils, followed by the patient and public involvement forums in 1973, with the LINks replacing those in 2008. Interestingly, along with health services, they also covered state-funded social care and were,

“designed to reflect a more integrated approach to social care”.

We are still trying to do that eight years later. Dr Pam Carter and Professor Graham Martin, from the University of Leicester’s Department of Health Sciences, have suggested:

“Successive reforms arguably demonstrate political commitment to, and sustained high-level interest in, PPI in its various organisational forms”.

I am sure we can agree about that, but we do not appear to have achieved it just yet.

Healthwatch’s establishment was part of the coalition Government’s desire to increase public involvement in how the health and social care system worked. The 2010 White Paper, Equity and Excellence: Liberating the NHS, which set out the coalition’s vision for the future of the NHS, stated:

“We will put patients at the heart of the NHS, through an information revolution and greater choice and control”.

I want to comment on what the noble Lord, Lord Lansley, said about that and clarify the situation. The Liberal Democrats indeed wanted local authorities to be involved, but we warned against the funding coming directly from local authorities because, of course, they are commissioners and providers of the services. My noble friend Lady Jolly emphasised that to me a little earlier, because I was not working on health at the time.

Over the years, ways to consult patients and the public have been set up, but they quickly either become subsumed by NHS organisations or are effectively ignored, although their suggestions are always politely listened to. Healthwatch was meant to be far stronger and more influential than those bodies that went before. Part of this intention came in response to the Mid Staffs scandal. The Francis report commented on the shortcomings of the various PPI policies of the past. In the case of Stafford’s main hospital, the report argued that,

“patients and relatives felt excluded from effective participation in the patients’ care”.

It also suggested that the policies that followed the community health councils did not succeed in giving patients a voice. It stated:

“It is now quite clear that what replaced them, two attempts at reorganisation in 10 years, failed to produce an improved voice for patients and the public, but achieved the opposite”.

In the current climate, it is unfortunate that local Healthwatch funding is provided by local authorities because of the drastic funding cuts for local government. It is not surprising, I suppose, that some of the funding provided has not reached local Healthwatch. There is also the cumbersome bureaucracy mentioned by the noble Lord, Lord Harris, which causes some of the money to seep away. Healthwatch is saying all the right things but, without proper funding, even the best policy and the best structure will fail to fulfil its brief.

One good example of the contribution of service users and their carers used to be the Experts by Experience programme, which the CQC uses to augment its independent inspections. These are skilled workers who have personal experience of using health and social care services. They provide the patient perspective to inspectors. Sadly, since three-quarters of this programme was taken over by Remploy, the number of experts used by inspectors has fallen considerably because of serious shortcomings in the way the programme is now run. I know the CQC is looking carefully at that.

A group of Experts by Experience and former experts—some have now given up in disgust—gave evidence to the House of Commons Health Select Committee and this has been published. It makes very sad reading. The contracts in different parts of the country were awarded to two different companies, with the majority going to Remploy. Problems with the Remploy contract have been well documented and I do not have time to go into all of it, but the real victims in this sad saga have been the most vulnerable people in society, whose views are not sought in as expert a way as they should be during inspections, at least in three of the four regions of the country. I am looking forward to the comments of the Commons Health Select Committee on that evidence.

The hot topic in health at the moment is the STPs, the sustainability and transformation plans. There was recently an article in the Consultation Institute magazine which gave the views of Paul Parsons, who is actively working with institute clients, considering how best to implement STPs. He believes that some common themes are emerging from conversations with commissioning leaders since the first STPs started to seep into the public domain. First, commissioners are not yet won over to the principle of an open public dialogue about the principles and objectives contained in the plans they have published; secondly, each appears to be concerned with the extent to which they have met their legal responsibilities on public involvement in developing the plans; and, thirdly, there is a range of acceptance of, or resistance to, the concept of formally giving the public a chance to comment on the plans at this stage.

Each of the 44 commissioning partnerships are at different stages in their change process and have different challenges in their area. NHS England recognises that and is keen that the plans involve a range of stakeholders and are all led locally. So it is understandable that guidance does not provide a paint-by-numbers approach to the public engagement requirements of these exercises. But Parsons feels that a lack of specific guidance can create some inertia in the system that prevents organisations wanting to be one of the first to commit to a course of action, including consultation on the plan itself. He outlines the advantages to commissioners of formally engaging on the plans at an early stage with patients and the public. He says that it would, first, give STP partnerships the chance to fine-tune the content and understand the priorities that key stakeholders would apply; secondly, help identify people and groups who want a say in the plans; and, thirdly, give the partnerships an opportunity to reduce the risks of challenge later in the process by documenting that they have met the requirement for public involvement at an early stage.

The noble Lord, Lord Harris, mentioned the NHS Five Year Forward View, which sets out a vision for the future of the NHS. As we know, it was developed by the partner organisations that deliver and oversee health and care services, including NHS England, NHS Improvement, Health Education England, the National Institute for Health and Care Excellence, Public Health England and the Care Quality Commission. I note that that list does not include any patient-centred organisations. I want to ask the Minister why the Government did not insist that it should do so.

Some experts, such as David Gilbert, co-director of the Centre for Patient Leadership, believe that the basic premise is that in the NHS all patient consultations end up with the professionals saying, “Thanks, but now we will go back and decide what to do”. That is very unfortunate, even if it is only the impression of one person. He explained in a recent lecture why he feels we must move forward to a model of patient-influenced change and away from the current model of “them and us” that exists between professionals and patients. The simple fact is that patient involvement results in better services. Does the Minister agree?

Child Sexual Abuse: Football Clubs

Baroness Walmsley Excerpts

Thursday 15th December 2016 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, I start by saying how impressed I have been by the bravery of those footballers who have found the strength to talk about their painful childhood experiences; I thank them for what they have done. We all have a duty to ensure that their suffering has not been in vain. I have talked to some of them, including Ian Ackley and Paul Stewart, and it is clear that their main motivation is to try to ensure that these terrible experiences are not suffered by vulnerable children in the future.

I have long been a campaigner for mandatory reporting. I and many of the footballers feel that if we had had a legal duty to report 20 years ago, someone would have told the authorities about their suspicions—indeed, there were disclosures in some cases—and the abuse would have stopped. This is what children want when they disclose abuse. They want action and they want the abuse to stop. The Government agreed in 2014 to have the public consultation on mandatory reporting, which has recently ended. The responses have not yet been published and, of course, neither has the Government’s response. It took them over 18 months from promising the consultation to actually reporting it. I do not want to wait for another 18 months before they respond to the views expressed. When will the responses be published and when will the Government respond? In doing so, will they take seriously the victims’ demands for legislation to try to ensure that this never happens again? Will the Government now accept that all the guidance, training, professional sanctions and so on have not worked? Not all the cases that the police are investigating are non-recent. It is still happening. Mandatory reporting would include national sporting bodies, so some of this abuse could be stopped before more young people are damaged for life.

I am not looking for custodial sentences for those who ignore suspicions of child abuse and fail to report it to the authorities, but I am looking for a criminal offence and a fine, not in order to criminalise people who work with children, most of whom do wonderful work, but to act as a disincentive to the perpetrators. If they know that thousands of eyes are watching and they have a legal duty to report what they know, some will be deterred from acting and many will be caught before they damage any more children. One of the footballers said to me yesterday that if parents realised that no legal duty to report exists—just guidance and professional sanctions—they would be more hesitant about exposing their children to the opportunities that are so readily taken up by paedophiles. Current measures have patently failed to protect children and it is time to go further.

I believe that those who have reported suspicions in the past, and risked damage to their own careers, would be protected by a law that mandates them to report what they know. Mandatory reporting works in Northern Ireland and in Australia, where a seven-year study has been carried out by Professor Ben Mathews. He found that there was initially an increase in reports, but resources must be made available to deal with them. I fear the Government have resisted this for as long as I have been pressing for it because of money. That fact is being disguised by spurious claims that increased reports would prevent services being provided for the worst cases. In the end, MR would save money because of the mental health costs avoided and lives destroyed. Ian Ackley’s late father raised his concerns 20 years ago. I have here all his letters from organisations which passed the buck and said that they could not do anything until the Government acted. Do we have to wait another 20 years before the Government act?

The Government have resisted demands for legislation on MR for years. Ian Ackley was in a supermarket yesterday and was charged 5p for a plastic bag. He says that if the Government can legislate to save plastic and marine life, surely they can legislate to save children. I remind the Minister of how few people used seat belts until it became illegal not to. Legislation is not a silver bullet but it works. Will the Minister agree to meet with me and some of the footballers to discuss how we can move forward?

Surrogacy

Baroness Walmsley Excerpts

Wednesday 14th December 2016 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, I am grateful to my noble friend Lady Barker for raising this important topic tonight and I agree with everything she said. There are, as we have heard, many issues to untangle and I, like the noble and learned Lord, Lord Mackay of Clashfern, hope that the Law Commission will be able to consider what changes need to be made and make recommendations. I hope that the Government will then find time, during a very busy legislative programme, to take up these recommendations and make the necessary changes to bring the law up to date, which is being called for by parents and by judges.

It is desirable that every child is a wanted child, because it means that the child will be loved and that is what he or she needs, much more than a well-filled Christmas stocking. So, for the sake of the children and their new families, I hope we will hear from the Minister some willingness to put right the problems that have been outlined and which beset many couples trying to make a family through surrogacy. As we have heard from my noble friend, there are many reasons why people have to resort to surrogacy and clearly it is growing, so we must make sure that the law is brought up to date, adapts to changes in society and protects all those involved. The first principle, of course, must be the rights of the child and its health and well-being. Secondly, the rights of the surrogates and the commissioning parents must be fairly considered. Even though we have heard about some of its shortcomings, the law in the UK at least gives some sort of framework for this, but rules around the world vary. I hope the UK Government would take a lead in trying to get some comprehensive universal principles adopted, once we have our own house in order.

In preparing for this debate I read the debate in another place from 14 October 2014, and was very struck by the many practical difficulties encountered by MPs on behalf of their constituents. Even though the couples had tried to do everything correctly, they often met a brick wall. Many of the cases cited by MPs were of people who had resorted to surrogacy abroad because accessing it in the UK was too difficult or complicated, getting a passport for the child was slow or they were unsure of the law. There were lots of reasons, but brick walls were encountered. In those cases, it cannot be right that complications and delays in the administrative procedures for bringing the child home should cause a child to be without his or her parents in those first vital few months of life when bonding with the principal carer should be taking place, which is so important for their future mental health. But that is what happened in too many of those cases cited in another place.

We need a transparent structure that is as uncomplicated as possible, we need data—as the noble Viscount, Lord Craigavon, emphasised—and we need clear advice for parents intending to set out on this route to parenthood. Of course, this often happens only when many years have been spent exploring other routes, and failing with all the pain and stress that this causes. Sometimes, parents turn to other countries because they are considered too old to adopt a child in the UK, after many cycles of IVF have failed.

I agree with many of the demands of the organisation Surrogacy UK, in particular that a parental order should be applied for prior to the birth so that the child is never left without both its parents being known or, as in some cases, left stateless. I certainly agree that there should be no commercialisation of surrogacy. This is a wonderful and generous thing that a woman can do for another or for a same-sex couple and it should not be commercialised, apart from appropriate expenses. That brings me to fears that have been expressed about exploitation of surrogate mothers in other countries. This is a very difficult issue, as many of those who offer to bear a child for others live in very poor countries. There is nothing wrong with ensuring that she and her other children, if she has any, remain healthy, well fed and without stress during the process—but how do you ensure it is limited to that? It is very difficult. Large payments would be bound to lead to women who were not suitable seeking to be surrogates. This would be contrary to the principle that the mother must be protected as well as the child. We need some international standards to prevent that.

Another recommendation is for a clear agreement between the commissioning parents and the surrogate. There are so many things that may need to be decided and things that can go wrong; these need to be laid on the line right from the start. I certainly think that “friends first” is a very good idea.

From the health point of view, it is of course highly desirable that infertile couples get as much medical help as possible and in a timely way, so that surrogacy is not necessary. If that were the case, would-be parents may not have to take that route. Also, if UK surrogacy law were more in line with what is needed in today’s society, people would not need to go abroad. So I ask the Minister to promise us today that the Government will support the Law Commission review and act on its recommendations if it happens.

NHS England: HIV Prevention

Baroness Walmsley Excerpts

Tuesday 18th October 2016 Lords Chamber

[Baroness Chisholm of Owlpen]

The decision on which drugs to prioritise and how it should happen should surely be made by clinicians and NHS England, and not by politicians. As with all new drugs, PrEP needs to be properly assessed in relation to cost and effectiveness to see how it could be commissioned in the most sustainable and integrated way, and how it compares with other cost-effective approaches.

[Baroness Walmsley (LD)]

My Lords, if the court’s decision on the appeal upholds the original decision of the court, NHS England is clearly responsible for providing PrEP. Will the Minister emphasise to NHS England that it should be considering PrEP as a highly effective preventive measure in the same vein as the highly effective vaccinations of babies?

[Baroness Chisholm of Owlpen]

Yes, certainly if they lose their appeal, it goes back into the normal commissioning process. Of course we recognise that studies have shown that PrEP has been a success, but we also need to remember that it is a matter of how it is used. There are several ways that we have been tackling HIV until now, and PrEP is only one in a range of activities to tackle it. We need to remember that, for it to work, PrEP needs to be taken daily, and sometimes it is difficult to get this group always to take it daily.

Disability: Premature Deaths

Baroness Walmsley Excerpts

Monday 17th October 2016 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, like the noble Baroness, Lady Hollins, all of us on these Benches very much miss the late Lord Rix. We miss his expertise on subjects such as the one we are talking about tonight; we miss the inspiration that he gave all of us because of that work; and we miss his wonderful sense of humour. Therefore, I thank the noble Baroness, Lady Hollins, for what she said about him. Of course, we all agree with her.

I also wish to thank the noble Baroness for initiating this debate. She has been consistent in her scrutiny of this issue, having raised the matter every year since the Confidential Inquiry into Premature Deaths of People with Learning Disabilities reported in 2013. That this is necessary demonstrates the enormity of the challenge of ensuring that people with a learning disability have equal access to healthcare that caters to their particular needs and ensures that the reasonable adjustments that should be made for them are made.

I congratulate the noble Baroness, Lady Fall, on her excellent maiden speech and particularly on her use of the word “equality”. As she rightly said, “equal” does not mean the same. Equality of opportunity to enjoy good health and good treatment is what we should aim for. Progress has been too slow, and steady headway is now required from the Minister and her Government.

I would like to raise, in particular, the need to reverse the trend of falling numbers of learning disability nurses. The Royal College of Nursing’s Connect for Change report claims that the total number of learning disability nurses in the NHS has fallen by nearly a third since 2010—a reduction of 1,726. An equally worrying trend is that more senior nurses have been lost in this discipline than any other, with a 40% reduction. We need nurses in all disciplines to be seasoned and expert, particularly in this discipline. The current Government have presided over a reduction in both expertise and quantity. Can the Minister say how her department is planning to correct that?

Learning disability nurses provide much-needed advocacy and support and are a key tie-in to social care. They speak out in the interests of people with a learning disability, provide assistance to carers and family members, and give much-needed advice and support to doctors. The case studies in the report, which I found extremely moving, show clearly what happens when this help is not available.

It cannot be right that with 1.4 million people with a learning disability, more of whom are now diagnosed earlier in life, live longer and possess complex needs, support available only five or six years ago is now no longer available. This fall in the number of professionals also means that people with a learning disability face a lottery as to hospital coverage.

In 2014, the Royal Mencap Society found that few hospitals have full-time cover and some none at all. This sometimes means that people with learning disabilities are unable to make their pain known to those who are treating them. They may not have a traffic light card or a hospital passport-type document, which have proved so useful to many—there are several examples of that in the CIPOLD report—they often become confused in a strange environment and among people who are not known to them; their care home may not be able to send somebody with them because of pressures faced. That is why we need the specialist nurses.

Although learning disability nurses are important, so too, as several noble Lords have mentioned, is the training of other health and care staff. We cannot and should not leave everything up to learning disability nurses, not least because of their dwindling numbers. All doctors, nurses and other care professionals need an understanding of learning disability and conditions such as autism and mental health problems, which might also be a barrier to communication. Understanding how to communicate in both directions is vital to ensuring that patients understand procedures, diagnosis and, importantly, what to do following operations and consultations about their own care and medicines. I am heartened to hear about the good work going on at St George’s, and look forward to hearing how the Government and NHS England will spread and promote that good practice.

People with a learning disability need more support and a proactive policy to ensure that they lead healthy lives. Annual health checks can uncover underlying conditions, yet, as we have heard, less than half of people with a learning disability receive them. Accessible information can empower people with a learning disability to take control of their health; we need that, sometimes with pictures, to help the understanding. The NHS accessible information standard launched this summer could not be timelier, and I wish it well.

Urgent action is needed to ensure that no more people with a learning disability die due to avoidable circumstances. The noble Baroness, Lady Hollins, has been a champion in standing up for people with a learning disability and for access to healthcare. I hope to hear much better news the next time that she raises this issue.

--- Later in debate ---

[Baroness Chisholm of Owlpen (Con)]

My Lords, I congratulate the noble Baroness, Lady Hollins, on securing this debate on an issue of great importance that is rightly of concern to your Lordships and indeed to the Government. I begin by paying tribute to the noble Baroness for her unfailing commitment to highlighting the inequalities, experiences and poor outcomes that people with learning disabilities and their families have faced for many years. I echo her and other noble Lords’ tributes to Lord Rix, who we are certainly going to miss enormously.

I also take this opportunity to congratulate my noble friend Lady Fall on an excellent maiden speech. My noble friend will be a great addition to this House and I greatly look forward to her contributions in the future. Also, let me thank all noble Lords for their contributions this evening.

We know that there are people young and old who die from what are often referred to as avoidable and premature deaths—which, I think we would all agree, need not happen if care, safety and the way in which people are treated were consistently good across the whole of the healthcare system. The Government are clear that the lives of people of all ages with learning disabilities matter. We are working with partner organisations, professionals and people with learning disabilities and their families to respond to issues that are important to, and have a big impact on, people’s lives.

As my noble friend Lady Rawlings mentioned in her speech, we know that people with learning disabilities experience significantly worse outcomes than the rest of the population. Our activity therefore extends beyond health and care and must also encompass the education of healthcare professionals, employment and housing. To this end, NHS England has a wide-ranging programme of work on learning disability designed to transform care and improve outcomes, driving up the quality of clinical and nursing care and reducing health inequalities. The NHS Five Year Forward View highlighted the need to improve learning disability services, with the NHS driving improvements in culture and behaviours towards people with learning disabilities.

The NHS published shared planning guidance in September with the aim of improving learning disability services, including reducing premature mortality, one of only nine “must dos” in the guidance. As my noble friend Lady Rawlings also mentioned in her speech, the clinical commissioning group improvement and assessment framework was launched in March. This Ofsted-style assessment will allow us to see how clinical commissioning groups are performing in key areas. It includes two indicators on learning disability: reliance on specialist in-patient care and the proportion of people on GP learning disability registers receiving an annual health check.

The noble Lord, Lord Hunt, and the noble Baroness, Lady Tyler, both spoke about NHS foundation trusts, and my goodness there are lessons to be learned. The Government have asked whether the issues raised in the Mazars report might be found in other providers across the country. The Care Quality Commission’s review into the investigation of deaths includes a sample of all types of NHS trusts in different parts of the country and will assess whether opportunities for the prevention of death have been missed—for example, by late diagnosis or physical healthcare problems. We expect the Care Quality Commission to publish its findings in December.

The noble Baronesses, Lady Hollins and Lady Tyler, asked what the Government were doing to provide full information on an ongoing basis on trends in the age of and causes of death of those with learning disabilities, and how those trends can be monitored. In answer, I can say that the Department of Health is working with Public Health England and NHS Digital to address the lack of reliable data, which are so important to ensuring that the right decisions can be made by healthcare professionals. A number of approaches are being considered, but the lack of progress has been frustrating. Noble Lords will be aware, however, of the wider issues surrounding the safe and secure use of health and care information, and here I cite the work undertaken by the National Data Guardian for Health and Care, Dame Fiona Caldicott, to ensure that the public can make informed choices about how their data are used. The Department of Health ran a public consultation on those proposals and is currently analysing the responses received. In addition, the department sponsored a study in this area undertaken by Public Health England, and the findings were published by the Journal of Intellectual Disability Research in July. They indicate the extent of premature mortality and its major causes.

As noble Lords have mentioned, people with learning disabilities have a life expectancy on average approximately 20 years less than other people. Public Health England also publishes a digest of the most up-to-date mortality statistics in People with Learning Disabilities in England. The 2016 edition of this will appear later this year.

The noble Baronesses, Lady Hollins and Lady Rawlings, asked whether it was time to mandate reviews into the deaths of all people with learning disabilities. Several other noble Lords mentioned this, too. In March 2015, NHS England commissioned the learning disability mortality review programme, which aims to support local and regional areas conduct reviews of deaths of people with learning disabilities and implement any recommendations and plans of action. Every NHS region is testing the review process and by March 2019 we expect every area to have established a mortality review process.

On the important matter of drugs, excessive use of psychotropic medication is known to be a specific factor in the premature death of people with a learning disability. Several royal colleges have signed a pledge to stop overmedication and have developed plans to deliver on the pledge, including issuing guidance for pre-registration nurses and psychiatrists; producing accessible information on medication for people and their families; and publishing guidance for prescribers. NHS England will also look regularly at primary-care prescribing of psychotropic drugs to monitor progress nationally.

As I mentioned earlier, the NHS mandate includes a requirement to reduce health inequalities for people with a learning disability. The noble Baronesses, Lady Redfern and Lady Hollins, mentioned annual health checks, as did the noble Baroness, Lady Walmsley. A key objective of this work is to increase the number of people on primary care registers and to ensure that as many of those people as possible get an annual health check. The ambition is for 75% of people on GP registers to receive an annual health check by 2020. Specific work under way includes: standardised letters to improve advice and guidance on health checks; pre-health check questionnaires; health check templates linked to people’s care records; and health action planning, including a focus on key issues that need to be followed up.

NHS England is working to improve how people with a learning disability access health services. This includes: developing care pathways for health conditions affecting people with a learning disability such as diabetes, epilepsy, heart disease and dysphagia; improving patient experience and outcomes; and sharing good practice to reduce variation in quality and make reasonable adjustments to services.

Education is hugely important and was mentioned by virtually every noble Lord. We have recognised that there needs to be a significant improvement in education of healthcare professionals. Health Education England, together with Skills for Health and Skills for Care, launched in July 2016 the learning disabilities core skills education and training framework, which was mentioned by several noble Lords. The framework provides the knowledge and skills needed for those delivering training to health and care professionals.

The noble Lord, Lord Addington, and the noble Baroness, Lady Hollins, mentioned the difficulties in communicating. Some universities such as St George’s, with the help of the noble Baroness, Lady Hollins, lead the way. Here, students receive training from training advisers who themselves have learning disabilities.

We are also taking steps to help people understand and access the right care and support, including by trialling the idea of “named social workers”, and, as part of the transforming care programme, establishing the role of “care and support navigators”. These will also support the aims of integrated and personalised care.

The provision of accessible information and people’s ability to communicate with staff have a key impact on their care, experiences and outcomes. In July 2015, NHS England published the accessible information standard for the NHS and social care services to help organisations identify and meet an individual’s communication and support needs.

As the noble Lord, Lord Addington, and the noble Baroness, Lady Fall, mentioned—the noble Baroness, Lady Hollins, mentioned it in the debate last Thursday on libraries and again tonight—the provision of books beyond words for those who have visual learning but difficulty with words can make a real difference. It is important that every possible healthcare professional has this at their side whenever they are dealing with people with learning disabilities.

I want to make sure that I cover all the questions, because, as always, I am running out of time.

The noble Baroness, Lady Hollins, asked what the Government are doing to improve our knowledge and understanding of the needs of this vulnerable group. GPs, under the quality and outcomes framework, have to maintain a register of their patients who have learning disabilities. The new Care Quality Commission arrangements for inspections for acute hospitals explicitly examine how patients with particular needs, such as learning disabilities or dementia, are identified. As the noble Baroness, Lady Hollins, also mentioned, the Government will regularly inform Parliament of the progress that has been made. I think the noble Baroness, Lady Tyler, also mentioned this. Public Health England’s Learning Disabilities Observatory team review each year and are covered in local and health authority joint strategic needs assessments. This team will continue, funding will continue for this team and the Secretary of State for Health reports annually to Parliament his assessment of NHS England’s progress.

The noble Baronesses, Lady Tyler and Lady Hollins, also wanted to know whether the Government can give a clear message to local authorities and special care agencies about their expectations that staff will be released to contribute to lead reviews of deaths. We agree that there should be the local capacity to undertake high-quality reviews which will yield the best possible learning. However, we have no plans to legislate to make such participation a statutory duty. There is already a strong expectation in the CQC guidelines that providers will participate in relevant clinical audits. Additionally, there is participation in the NHS England-commissioned audit and outcome review programme, which the Learning Disabilities Mortality Review programme is carrying on.

I will have to write to the noble Lord, Lord Hunt, on the 18 recommendations, if that is all right, and on the funding attitudes.

There is work in progress which will, in time, have a positive impact on the safety and quality of care.

[Baroness Walmsley]

I am sorry to interrupt, but when she is writing her letters will the Minister please also reply to my questions about learning disability nurses?

[Baroness Chisholm of Owlpen]

Yes. I am so sorry—I had the answer and I will make sure that I get it to you.

We give thanks to the noble Baroness, Lady Hollins, and people like her who keep pushing the barriers facing this vulnerable group. The Government are focused on making changes happen, stopping variation in care and championing those with learning disabilities being able to live full and happy lives, knowing that support is there when needed. Once again, I thank all noble Lords for taking part tonight. I am sorry that I have not had time to answer all the questions, but I will make sure that the letters get to noble Lords.

Hansard Society: Audit of Political Engagement

Baroness Walmsley Excerpts

Thursday 16th October 2014 Lords Chamber

[Lord Wallace of Saltaire]

The noble Baroness is looking remarkably fit and well. I congratulate her on that after all her effort. The involvement of young people and the very serious approach which young people in Scotland took to the issues in the campaign provide lessons that we all need to think through. It is not possible to introduce voting at 16 in British elections between now and the May election campaign, so it is not an issue we have to consider at the moment, but it is perhaps one that we all need to discuss over the longer term.

[Baroness Walmsley (LD)]

Does my noble friend agree that the alternative vote is a poor substitute for STV as an alternative to first past the post? It is not really proportional representation and STV would engage more people.

[Lord Wallace of Saltaire]

My Lords, we now have a variety of electoral systems across the United Kingdom, of which the oddest is perhaps the London system of the supplementary vote. The question of what sort of electoral systems most engage the public at which level is one to which we need to return.