Learning Disabilities: Community-Based Support

Earl Howe Excerpts

Tuesday 22nd July 2014 Lords Chamber

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government what action they are taking in the light of the events at Winterbourne View hospital to ensure that people with learning disabilities inappropriately placed in hospital are able to move to community-based support.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, the Government are working with health and care system partners, self-advocates, family carers and other stakeholders to improve safety, quality of care and outcomes for people with learning disabilities, including reducing significantly reliance on in-patient care, by reviewing people’s care and moving them to alternative, community-based support where appropriate.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am grateful to the noble Earl for that. Can he confirm that the Government set a deadline of 1 June for the transfer of thousands of people with learning disabilities out of institutions such as Winterbourne View? The latest figures show that only one in 10 such residents has actually been so moved. Will the noble Earl accept responsibility for this and tell the House what the Government intend to do about it?

[Earl Howe]

My Lords, the Government’s mandate for NHS England in the current year includes an objective which covers Winterbourne View concordat commitments. He is right that the deadline was missed. We are not satisfied with that and we are working very hard with NHS England to set out our expectations for progress and improved rates of discharge from in-patient settings. NHS England is going to produce an action plan this August but, in the mean time, it is doing three things. It is complying with the transforming care and Winterbourne View concordat commitments, which we have tasked it to do. It will set out what progress it expects to make and by when, with milestones, and it will provide real clarity on what success looks like—an important issue if we are trying to hold it to account—and how progress will be measured.

[Baroness Hollins (CB)]

My Lords, is the Minister aware that in the first six months of this year, 544 new people were admitted to assessment and treatment units and only 338 were transferred? Does he agree, therefore, that prevention is as important as discharge, and that in order to achieve both of these, skilled community support and skilled specialist support in the community are urgently needed and need to be funded?

[Earl Howe]

I do agree with the noble Baroness. For people who, with the right support, could and should be living in community-based settings, there is a variety of reasons why sometimes that does not happen. The lack of appropriate housing can be a barrier. For others, we know that clinical decisions are preventing discharge. NHS England is looking very carefully at how to strengthen second opinion to support people in in-patient settings to challenge the reasons for their placement as and when they need to. We are looking at making some capital funding available to support the transfer of people from in-patient care to community-based support.

[Baroness Tyler of Enfield (LD)]

My Lords, given the figures we have just heard about the number of people with learning disabilities being admitted to costly assessment and treatment units rather than leaving them, will my noble friend the Minister say what action the Government are taking to ensure that local commissioners—in both local government and the NHS—have the necessary skills and competence to deliver the high-quality local services that are needed to allow as many people as possible to return to their communities?

[Earl Howe]

My noble friend is absolutely right to focus on the role of commissioners. The Winterbourne View joint improvement programme has already stepped up its activity in working with local areas, including identifying 35 areas for in-depth review. NHS England is engaging with commissioners to reinforce the importance of ensuring appropriate services for people with learning disabilities close to their homes and families. That includes looking at how funding streams can be shared with local authorities so that there is no procedural blockage in the way that money moves across the system.

[Lord Wigley (PC)]

My Lords, on that very point of funding, how will the Government ensure that funding in fact follows the individual and does not, as so often currently occurs, remain locked into the funding of the wrong kind of provision? In asking this, I draw attention to my registered interest as vice-president of Mencap.

--- Later in debate ---

[Earl Howe]

Lessons are being learnt almost by the day by the NHS and local government on how to pool funding and share responsibility in areas of this kind. Admittedly, most of the effort at the moment is on the vulnerable elderly but the lessons apply equally to those with learning disabilities and to ensuring that we do not have any artificial walls forming between the NHS and local government as regards the flow of money. I can tell the noble Lord that this is a major area of focus for both NHS England and the Local Government Association at the moment.

[Baroness Warwick of Undercliffe (Lab)]

My Lords, given the recent resignation of the director of the joint improvement programme, which was tasked with delivering the Winterbourne View action plan only 18 months ago, will the Minister let us know what the future of the programme holds and how it will work with the new group, also tasked in a similar way, led by Sir Stephen Bubb?

[Earl Howe]

My Lords, I have every confidence that the programme will continue as we had hoped it would, and indeed with a renewed momentum. The noble Baroness is right that NHS England has asked Sir Stephen Bubb, the chief executive of the charity leaders’ network ACEVO, to head a new group of experts and advisers to develop a national guide on how we provide health and care for those with learning disabilities. We have every confidence that Sir Stephen, with his immense experience in these areas, will be able to bring everybody together to a good result.

[Lord Laming (CB)]

My Lords, will the Minister assure the House that the only criteria that will be used in making these arrangements is the way to improve the quality of life of the user of the services rather than any bureaucratic processes set by NHS England?

[Earl Howe]

The fundamental principle that must underpin and inform all decisions in this area is about ensuring that we respect people with learning disabilities as individuals who have the same rights as everyone else, including the opportunities to make informed choices about where and with whom they live. The noble Lord is absolutely right.