Children and Families Bill
Baroness Wilkins Excerpts(11 years ago)
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Lord Low of Dalston
My Lords, I shall speak also to Amendment 102 in my name. These amendments would specify that local authorities must publish information about the provision both within and outside their area “which is”, rather than “it expects to be”, available,
“at the time of publication for children and young people who have special educational needs”.
I have received a number of briefs that make the case for these amendments with considerable rhetorical flourish. However, the matter can be put much more simply.
The amendments simply require a local authority to call a spade a spade and to set out in the local offer what actually is the case, rather than what it “expects to be” the case, which is much more slippery and imprecise. Expects when? On what does the fulfilment of the expectation depend? Parents, practitioners and the special educational needs and disability sector are concerned that the language of expectation rather than actuality could easily be used to let local authorities off the hook and slide out of delivering what they had appeared to promise.
I should like to make a couple of other points. We should be clear about who the local offer covers and who it does not. Independent research by the University of Bath, to which we have already referred in these proceedings, has shown that 25% of disabled children and young people do not have a special educational need and as such will not be entitled to an education, health and care plan or to access the local offer because it is only for those with a special educational need. It is not clear how these 400,000-odd children and young people who have a disability but not a special educational need will secure the support they need if they are not entitled to access an education, health and care plan or the local offer.
Finally, I underline the importance of the local offer including provision which exists to meet the needs of children and young people with special educational needs outside the authority’s own area. This can be especially important in the case of those with particularly severe disabilities, who need to know about the full range of services, often consisting of highly specialised provision not available in the local area.
There is a concern that local authorities will provide information on provision available in only their own area. This is not the same as providing all the relevant information about what is available to meet special educational needs, including provision out of the local authority’s area. If out-of-area providers are routinely left off the list, it will undermine young people’s ability to access the provision which best meets their needs, as well as potentially threatening the viability of highly specialised but vital services.
Young people and families cannot be expected to find all this information about what may be of help to them for themselves without assistance. Local offers should be robust, accessible and effective in promoting choice. I therefore hope that the Minister will give serious consideration to accepting these amendments. I beg to move.
Baroness Wilkins (Lab)
My Lords, I shall speak to Amendment 104, which returns to the issue of funding. The amendment would require local authorities to include information about funding for SEN provision within their local offers.
I set out at the last meeting of the Grand Committee the concerns of the National Deaf Children’s Society, RNIB, Sense and many other charities that local authority spending cuts will fatally undermine this Bill. In her reply the Minister undertook to propose to her “far more significant” noble friend that their department might discuss this matter with the organisations concerned. I look forward to hearing whether any progress has been made.
In her reply to me in Grand Committee, at column GC 545, the Minister assured me that the Government were not cutting services for deaf children and set out the funding situation. However, we know from the National Deaf Children’s Society Stolen Futures report that many local authorities are already cutting support services for children with SEN. The society found that 29% of local authorities will be cutting specialist support services for deaf children this year.
The Government have argued that the Bill will improve transparency and accountability and that it is this which will enable parents to ensure that their local authority provides the services that their children need. However, on looking at the Bill and at the draft regulations and guidance underpinning it, nothing that I can see would require local authorities to be more transparent about the funding. If the local offer is intended to bring together all the relevant information about SEN provision in one place, in a way that is easy to understand, accessible and improves accountability, surely it must include information about funding. Without that parents will be powerless.
The local offer must give parents clear information about how much funding has been allocated by the authority to support children and young people with SEN; it must allow and empower parents to compare local authority spending; and it must allow parents to identify if cuts have been made from year to year. There is a clear need for transparency. The National Deaf Children’s Society had great difficulties in extracting reliable information about funding of specialist support services for deaf children from the local authorities.
In 2012, 49 local authorities—nearly a third—did not respond to freedom of information requests on budgets for deaf children’s services within the legal deadline. One local authority did not respond until six months later, and only after the Information Commissioner’s Office intervened. Its response confirmed a cut to the education service for deaf children. However, as this was not disclosed until so long afterwards, parents were denied any opportunity to legally challenge this decision before it had been implemented.
This is the battle that the parents and charities must face. If the Government were to accept this amendment and require local authorities to publish information about funding in the local offer in an easy and accessible way, it would certainly give parents and charities real leverage to get the services that they need.
Baroness Howarth of Breckland (CB)
My Lords, I support the noble Baroness, Lady Wilkins. At the end of the last debate that we had on this Bill, I asked the Minister to explain how the extra funding that would be made available actually would reach those who needed it. She said that she would write to me. I do not know if I have missed that letter or whether there has not yet been time to produce it; however, I look forward to it.
I think that it is quite complicated, but I want to ask for something in relation to the way that local authorities are struggling to meet their commitments at present. I think that I said then that it is far easier if parents understand what is and is not available and are not misled into thinking that they can have more than is possible, rather than having massive aspirations. Of course I wish that the local authorities had funding to meet every child’s needs, but if that is not possible I think that it needs to be clear.
I move on to my Amendment 107, which is grouped curiously with this amendment. It would be far simpler for the Government to accept and implement. It relates to personal budgets. On page 25, line 2, I would like to insert,
“arrangements to assist young people and parents in managing a personal budget should they choose one”.
Personal budgets have been a great liberator for many adults and families, but for others they have caused extraordinary difficulty. Those of us who work in both the adult and children’s fields have seen in the adult field how many people have found extraordinary problems in managing employment and the financial complexities of budgets. Families are making it clear that they require support to manage personal budgets, and parents with experience of direct payments have spoken of difficulties that they have had in finding, recruiting and CRB-checking good staff, managing money and transactions with the local authority, identifying quality services to purchase, and co-ordinating a package of care. Currently, only 25% of local authorities provide key workers to help manage payments. I find that extraordinary. This leaves families to manage the often burdensome responsibilities of direct payments alone. I hope that discussion around this amendment will help us to better understand the Government’s thinking about the support that they envisage local authorities will provide for those families who opt for personal budgets. Does the Minister accept that all families should have some access to support?
I have a quick case study. As you know, on the whole I do not go in for detailed anecdotes, but I think that this story really does illustrate the issue. Oscar lives in north London with his parents and two siblings. He is about to turn 18. He has autism and learning difficulties. His parents have been receiving direct payments to pay for respite care for the last eight years. His mother explains how difficult it can be to find the right support to buy with direct payments, and to “jump through hoops” to account for them:
“16 months ago our local council agreed to pay for one weekend’s respite care each month, but it has taken a considerable amount of time to agree how to provide this. It has only been in the last two months that we’ve actually been able to use the direct payments to get the support we need.
As Oscar was approaching adulthood, it seemed appropriate for us to try to find him a residential placement for his respite breaks. We hoped that this would help equip him with additional independence skills and that he would enjoy spending time in a new environment. However, when we visited local options it was clear that they were not able to meet Oscar’s complex needs. We decided that the weekend respite would have to take place in our home.
Oscar needs two-to-one support and in a house with two other children this is a challenge to accommodate.
Having two extra adults in our home for a whole weekend has a significant impact on all of us and is confusing for Oscar who wants to spend time with us. But it’s not only space that is the issue. Knowing where to find suitable staff who are equipped to support Oscar has always been difficult, and to cover a whole weekend at least four staff are needed.
I had asked the Council for a list of local carers which they said they would provide, but this never arrived. It is a huge and stressful burden for parents, who already have more than enough to cope with, to have to recruit, interview and train up staff themselves. We are always vulnerable to staff leaving after a few months for better paid work, leaving Oscar very unsettled and us totally unsupported.
For many years I didn’t know who to talk to at the Council about any aspect of this as Oscar didn’t have a named social worker and no one would return my calls. As Oscar is now approaching his 18th birthday, he has now been allocated a social worker and this has made a big difference. However, for many years we felt we were floundering on our own, receiving the occasional official letter threatening action because of some perceived fault on our part.
The Council have now agreed to employ Dimensions, a not-for-profit organisation who specialise in providing services for people with learning difficulties and autism. Together we are now trying to recruit and train a team of four so that we will always have support, even if staff are ill or on holiday”.
Baroness Howarth of Breckland
My Lords, the noble Baroness, Lady Eaton, is not alone in having some reservations about setting minimum standards as they may well stifle innovation and individual programmes. Perhaps more thought could be given between now and Report to how we ensure that local authorities provide a range of services. I know that the code says quite a lot about this. My great worry is that if you do not have something which can be inspected and monitored, and an expectation of a range of services, some local authorities might end up with very little indeed in their local offer—and it will be a postcode lottery. There is a real dilemma in how you maintain that flexibility yet ensure that families have something they can turn to which is monitored by either Ofsted or the Care Quality Commission. It would be quite useful to give some thought to this between now and Report so that we can come up with a better solution than a rigid framework, but with something ensuring that the services are there.
Baroness Wilkins
My Lords, belatedly, I will speak to Amendment 118 and in support of Amendments 112, 113 and 114. I will be brief because most of what I was to say has been said. The aim of Amendment 118 is to improve accountability around the local offer by requiring local authorities to meet basic expectations around provision for children with special educational needs. This issue is particularly acute, as we have heard, for children with low incidence special educational needs because local authorities are often ignorant of the support that these children need.
A number of organisations, including the National Deaf Children’s Society, the RNIB and Sense, are concerned that the Bill is extremely weak on overall accountability, particularly on the local offer, with a system that relies solely on the parents of children with sensory impairments—many of whom are, as we have heard, busy being parents. A system that relies on them policing it across all 152 local authorities is not likely to deliver the significant change that many of these children need here and now. Other noble Lords have also spoken on the need for increased accountability.
Baroness Walmsley (LD)
My Lords, I have a few additional comments to make in support of Amendment 113, to which I have added my name. I reassure the noble Baroness, Lady Eaton, that in our amendment we do not seek a one-size-fits-all approach as far as local authorities are concerned. Of course we understand, and hope, that the provision made will vary from area to area, depending on the needs of the local population. We are simply looking for some commonality in the way the offer is expressed. The advantage would be that it would not just be helpful to parents in enabling them to choose between one local authority or another if they were able to move from one to another; there would be two other benefits.
First, it would deter a local authority from publishing a weak offer, because it would be very obvious that it was a weak offer. The “very little indeed”, as expressed by the noble Baroness, Lady Howarth, would jump off the pages if there were some commonality in the way that offer was expressed. Secondly, it would help policymakers because this is a very new system. Undoubtedly the Government will wish to monitor how it is going and assess where it is going well and where it is going badly, and whether the regulations need to be tightened up at some point in the future. It would be very much easier to do that if there were a common way in which the local offer could be expressed; otherwise, I can see civil servants spending months digging into all the different local offers, expressed in different ways, in order to dig out that information.
Children and Families Bill
Baroness Wilkins Excerpts(11 years ago)
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Lord Touhig (Lab)
My Lords, I add my support to the noble Lord, Lord Low, on Amendment 98A, to which I have added my name. I shall also speak to Amendment 99, in my name and the names of my noble friend Lady Hughes and my noble friend Lady Jones.
The noble Lord, Lord Low, has outlined the objectives of Amendment 98A, which requires local authorities, where services that they provide have been found insufficient, to involve parents and young people in producing an action plan, to revise the education and care provision in the local offer and to review and report on progress against the action plan.
I look across the Room. I believe that the Minister has spent most of his life working in business. I am sure, therefore, that he would see the merits of this amendment; if he ran a business that was in danger of losing a major customer, he would want to find out why and then to put in place an action plan to deliver what the customer wanted, thereby keeping the business. Amendment 98A does just that. The provider of the service is required to engage with the user to ensure that what is provided is what is needed. That seems sensible to me.
I turn to Amendment 99. Clause 27 requires local authorities to keep education and care provision under review. While that is welcome, in the view of the Opposition it is insufficient. Amendment 99 would require local authorities to assess whether there was sufficient funding in place to be able to secure these services for all the children and young people who needed them. If they found that they lacked the wherewithal, they should consider jointly commissioning services with neighbouring local authorities where appropriate.
These are difficult economic times and there has been huge pressure on local authority spending and budgets. Whether or not services are secured and available should not depend on whether a particular local council can afford the level of provision needed to meet the needs of children and young people in its area. Therefore, collaboration strongly commends itself.
I am sure that I am not alone in believing that accountability is the key to these reforms. Parents, children and young people should be able to rely on the services provided by the local authority and render it accountable when that provision is not met. That seems fair and proper, and our amendment requires local authorities to consider working together and sharing services with neighbouring authorities. I believe that that already takes place in a number of London boroughs. I know that in my part of the country, Wales, a lot of collaboration is now taking place between local authorities that are sharing the ability to provide services across a number of boroughs.
Importantly, Amendment 99 would not constrain local authorities to work with others but would merely require them to consider doing so in the interests of improving services for children and young people. The amendment was dismissed in the other place, where the Minister said that the decision for spending on children and young people with special educational needs must remain one for the local authority. We would certainly agree with that, but nevertheless Amendment 99 highlights a problem and seeks to find a solution. If the Government recognise that there is a problem but do not want to accept this amendment as a solution, will the Minister explain how they will ensure that local authorities deliver the services that young people and children need and that they are accountable for providing those services? In other words, if the Government do not like our solution, what is their solution to a problem that we all recognise exists?
Baroness Wilkins (Lab)
My Lords, I support Amendment 98A, moved by the noble Lord, Lord Low, and I echo his comments that accountability must be at the heart of SEN reforms in the Bill. I will also speak to Amendment 99, which is a better version of my Amendment 98, which I withdrew.
Times are tough for all families, but for families with disabled children the challenges are even more acute. The current SEN system has led to parents with disabled children all too often feeling powerless, overwhelmed by the seemingly endless bureaucratic hurdles that they need to jump over to access the support their children need. Parents are exhausted, demoralised and unable to understand why it is such a battle for their children’s needs even to be recognised, let alone given adequate support.
Recent evidence shows that one in eight families in England who have a child with SEN are being pushed to breaking point by a lack of support. Scope’s Keep Us Close report found that 62% of these families said that the services they need are not available in their local area and that that has a serious impact on their family life. It is vital that robust accountability measures are in place around the local offer. This would give parents the confidence that their needs would be listened to and that local support would be in place to enable their children to be a part of their community and part of society, and to have the same opportunities as their non-disabled peers.
Amendment 98A would ensure that the local offer was not merely a “Yellow Pages” of SEN support, as many fear it will be, but was rather a living document, responsive to the needs of families and with a clear intention to improve local services. The current requirement in the Bill for local authorities to publish comments from parents on the local offer, although an important first step, does not go far enough and will not fulfil the Government’s ambition to, in the words of the Children’s Minister, put the child and their family in the driving seat. The amendment would require that local authorities actively involved parents and young people,
“in producing an action plan to revise the education and care provision”,
outlined in the local offer,
“review and report on progress against its action plan”,
and then,
“revise the local offer accordingly”.
That would give Clause 27 some much needed teeth. It should confine the battles, fights and struggles faced by parents to the SEN history books.
Baroness Northover
The issue of exactly how to make this as effective as possible is under discussion at the moment, and I am very happy to write to the noble Baroness to spell that out in more detail.
Baroness Wilkins
To return to the question of funding, the Government have said a number of times that they are protecting funding for vulnerable families, but that protection is not being carried through at local level. The Government seem to be remarkably complacent about this. Surely action must be taken so that the funding reaches the people who need it.
Baroness Northover
I hear what the noble Baroness says. She is a doughty champion in this area. The best thing is if we write explaining what I have just said in further detail. Maybe she would then like to respond so that we can look at that further and get back to her.
Baroness Wilkins
I wonder if the Minister would meet with the organisations concerned, which would be far more helpful.
Baroness Northover
Being a very low-level Minister, I am not sure how useful that would be for her group. However, I will refer it to my far more significant noble friend. I know that the department is very open to discussions with all interested parties. In the light of that, I hope that she will be reassured.
Transport: HS2
Baroness Wilkins Excerpts(11 years, 8 months ago)
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Baroness Wilkins
My Lords, I declare an interest as I was brought up in Amersham and have family and friends living there and in other areas being blighted by this scheme. They are not nimbys but are among the thousands of people throughout the country who have examined the arguments for HS2 and find them utterly unconvincing.
The Government claim that HS2 is in the national interest and that it will serve to bridge the north-south divide. Yet, according to public policy expert, Professor Mike Geddes, that claim has no factual basis, with the likely movement of money and people being towards London rather than back to the north. International studies show that it will just strengthen London’s dominance. HS2 Ltd itself admits that seven out of 10 of the jobs created for phase 1 will be in London. Far from increasing connectivity between our cities, as the Government claim, some UK cities will have a worse service than at present. The Government are pressing ahead with this project despite the fact that it is based on flawed assumptions and calculations about its costs and benefits. The Public Accounts Committee in the other place has today pointed to the basic errors made by the DfT on the west coast franchising fiasco, which wasted at least £50 million of taxpayers’ money.
One of the most glaring flaws is that more than half the benefit claimed to derive from the shorter journey time—55%—is based on the fallacy that time spent on the train is all wasted. We are in the 21st century, with iPads, mobile phones and the internet. Will the Minister explain why his department ignores the extensive research, let alone the evidence of its own eyes, which shows that business travellers work on the train? Why is his department using out-of-date, 11 year-old data and incorrect assumptions on the value of time? Will he also explain why an outdated forecasting model is being used to project demand? I understand that the old model significantly overstated the growth forecast of long-distance trips, and so inflated the growth in demand for HS2.
I am nearly out of time, but any fair cost-benefit analysis would factor in the cost to the thousands of people whose homes have been blighted by this route, the farms that have been cut in two and the businesses ruined, yet the proposed compensation arrangements are derisory. Overall, less than 2% of blighted homes can hope for compensation. Thousands are trapped, unable to move, or can do so only by accepting large losses. As we have heard, one mortgage provider has valued a property 500 metres from HS2 at nil. I do not deny that the country needs infrastructure building, but it needs to spend £33 billion on houses—and on houses built now to draw a halt to the misery being caused by inflated rents, rocketing house prices and the iniquitous cuts to the housing benefit system. It does not need to blight existing houses, and it does not need HS2.
Health and Social Care Bill
Baroness Wilkins Excerpts(13 years ago)
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Baroness Massey of Darwen
My Lords, I shall speak to Amendment 97. I agree with the noble Lord, Lord Ramsbotham, about the need for communication skills, but this set of amendments is really all about improving services for children. It is interesting to note that so much has been said during our debates on the Bill about the importance of the co-ordination of services of all sorts, but I would suggest that nowhere should services be better co-ordinated than those for children. That is absolutely crucial to success. I was interested to read the letter sent by the noble Earl, Lord Howe, after our previous sittings. He kindly circulated a series of paragraphs which stated on children’s issues that:
“We are determined to build in children’s health explicitly and clearly throughout the new system, including through the mandate … We want the NHS to play its full part in safeguarding and promoting the welfare of children and we expect the NHS to continue to improve processes for protecting children”.
I welcome those words, but I will seek further reassurances from him on their validity.
In amending Clause 20, I want to ensure that the Secretary of State will publish an annual mandate specifying the objectives that the NHS Commissioning Board must seek to achieve. This amendment would require that the mandate includes objectives related to improving services for children.
Children and young people are significant players in NHS services. Children account for around 40 per cent of the workload of GPs while making up 19 per cent of the population. Around 26 per cent of those attending A&E departments are children. Every year, about one in 11 children receives specialist out-patient care in hospital, while one in 10 to 15 is admitted for in-patient care. All these are key statistics. However, I suspect that while children and young people make significant use of NHS services, they and their families are often let down by a health system that is incoherent and affords only a low priority to child health services. I want to see this improved. Noble Lords may remember that Sir Ian Kennedy, when reviewing child health services, concluded that there was a,
“varying quality of services … with a large number in need of significant improvement”.
He also said that children were given a low priority when compared with adults, that they often received inappropriate or poor quality treatment or had to travel long distances. He identified a lack of co-ordination between the NHS and other services such as education provision. The question of co-ordination between services is something which comes up all the time. He also pointed out the low investment in services for the early years and a failure to provide safe environments within NHS settings.
I realise that there are particular challenges for children and young people with complex needs. Often little attention is given to how the system delivers for disabled children and young people, but I shall leave it to my noble friend Lady Wilkins to address that. The support group, Every Disabled Child Matters, highlights the range of challenges faced by disabled children and their families in securing good healthcare, but again I shall leave the detail to my noble friend.
The NHS mandate must include priorities for child health. This would ensure that tacking these issues is made a priority within the health service. It is appropriate to include objectives for children's health, because child health services operate on a separate system to those of adults, with separate structures and relevant partners. For example, children receive support from a wide range of child-specific professionals, such as health visitors, community paediatricians, children's nursing services and specialist treatment centres. So again the issue of co-ordinating according to age comes up strongly.
The difference between child and adult health structures is very much demonstrated when disabled young people make the transition from child to adult services, as indeed when other children make the transition to adult services. Without specific objectives for the issues in the system for children's health, there is a concern that the mandate will be ineffective in achieving change for children and young people. So I hope that the Minister will be able to respond positively to this. I suggest that the Government should amend Clause 20 to ensure that the NHS mandate sets out priorities for improving services for children and young people. They should also publish a policy statement setting out how it envisages the revised reforms will deliver improvements for children’s health in general.
Baroness Wilkins
My Lords, I speak to the amendments to which I have added my name, and urge the Minister to ensure that speech, language and communications needs are treated as a core public health issue in this Bill.
As the noble Lord, Lord Ramsbotham, said, communication is a basic life skill which underpins everything we do, particularly in this House. Good communication means that we connect with other people; we share ideas, thoughts and emotions and forge the relationships which all people require. Indeed, UNESCO believes that effective communication is one of the 10 core life skills that all human beings should have if they are to thrive.
Speech, language and communication needs are the most common disability experienced by children or adults, with over 20 per cent of the UK population experiencing problems at some point in their lives. These difficulties often start from birth. It is sobering to note that in some parts of the UK, particularly areas of social deprivation, upwards of 50 per cent of children are starting school with poor language skills, and poor language is linked to poor behaviour in young children. Two in every three language-delayed three year-olds have behaviour problems. Problems in later life follow with poorer employment prospects.
The earlier that any communication difficulties can be identified, the earlier solutions can be found, and the earlier help can be delivered. The centrality of communication is why this group of amendments focuses on establishing effective joint working and integrated commissioning for speech, language and communication needs. It requires the NHS to work in close partnership with education providers and local authority children's services. This is by far the most effective way of working. It also emphasises how important it is to deliver help early.
Amendment 81A to Clause 12 requires the NHS Commissioning Board to conduct an assessment of pre-school age children's communication skills. The impact of communication problems and their significance underlines why we believe that their assessment should be directed centrally by the board and not left to the local discretion of clinical commissioning groups. Last year's review of children's services within the NHS conducted Sir Ian Kennedy found that GPs, who will be the lead commissioners for clinical commissioning groups, have little or no experience of paediatrics as part of their professional training. Indeed, GPs often have a limited understanding of children with speech, language and communication needs. Central direction and support from the NHS Commissioning Board is vital in this. Further amendments within the group underline this point by requiring clinical commissioning groups to exercise their functions with a view to improving communication skills in children and young people. They must do so in close partnership with education or children's services. Currently people with speech, language and communication needs all too often miss out due to the divide in commissioning between health and education services.
This divide can mean that resources in terms of skills and equipment are not used effectively. Integration is vital to maintain and improve outcomes. The final two amendments within the grouping also address the necessity for integrated working by the new health and well-being boards when seeking to advance the health and well-being of the local population of the area they serve. If we are to move forward and ensure that all children and young people with communication problems are given the support they need to address them, then I would urge acceptance of these amendments.
Baroness Barker
I thank the noble Lord, Lord Hunt, for drawing attention to a very important point that I think has been missed and in some cases distorted, which is that our debates so far have been about the powers of the Secretary of State and we have ignored a number of other elements that have a direct bearing on that, such as the mandate. That appears to have passed by people like 38 Degrees completely. I thank him for drawing it to our attention but I will resist the temptation to get into the detail of that this evening.
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.