Learning Disabilities: Health and Social Care Access

Lord Crisp Excerpts

Thursday 26th March 2026 Grand Committee

[Lord Crisp (CB)]

My Lords, it is a privilege to follow four such powerful, knowledgeable and moving speeches. I will briefly discuss five areas.

First, following the powerful speech of the noble Lord, Lord Scriven, I congratulate him on getting this debate and focusing on reasonable adjustments—that kept coming up in all noble Lords’ speeches—and accountability. He discussed the learning disability physicians in Holland. One of their roles is, in a sense, cultural: it is not just what they do as people; it is what influence they have within the wider system. It is significant that there are physicians and doctors in that context and that they are playing a leadership role alongside their nursing and other colleagues. That is an important point, and I hope that the Minister will say something about discussing that at a later point—and not just whether she knows anything about it. Health is almost always about people. There may be other issues, but what happens inside the heads of the clinicians who look after us is really important. It is about how they see the world and how they want to behave.

Secondly, I will pick up on the Mencap briefing, which I am sure we all received. It makes the simple point that the NHS is not well designed to meet the needs of people with a learning disability—it is that simple. Mencap gives examples of that, and noble Lords have mentioned them already. I noticed one in particular that has a ring of truth about it: it seemed that, in many cases, one or two individuals in a practice were driving good practice, perhaps going above and beyond, and that care would fall apart when those people moved on. That is real. I not only see in that the importance of those people; I also bet they were good at beating the system and getting around the systemic obstacles that are in people’s way. That is the reality of what we have here. Accountability and the example of the learning disability physicians are part of that.

There is another issue here. What is good for people who have disabilities of different sorts is good for the rest of us as well. While we may not need the reasonable adjustments that some people need, we will need certain sorts of reasonable adjustments, particularly as we get older. This is about the focus on the individual patient in front of you and understanding that person as a person. All these stories are about not understanding the people that noble Lords have been talking about.

That takes me to the area of professional education. This is a much bigger question than this debate, but I would be interested to hear anything the Minister is prepared to say about it. Professional education has to change. For the people we are educating today—I am thinking about pre-service education—the world in which they will be working will be so different in 20 years’ time. AI is already affecting us in so many ways—but it is not just AI; it is all the other technologies that are around and impacting us.

Health is not just about smart technology; it is about people. When that develops, the leadership roles of professionals will involve picking up on some of the things that we are starting to talk about. I work with a group of young doctors who are trying to change some of this to get more emphasis on prevention and health creation—by which I mean creating the conditions for people to be healthy and helping them to be so.

The third area I have been reminded of is about reasonable adjustments and seeing the patient in front of you. I am not quite sure what the right language is here, but “reasonable adjustments” is what we use in this part of the world. I hope that we will return to professional educational change in the House and try to give it some push. There are lots of people out there who want to make that sort of change.

My two final points are about statistics. There was a wonderful description of the LeDeR results as a “toothless archive of tragedy”—we will remember that. The statistics are pretty awful. As the noble Lord, Lord Scriven, said, this is not about tinkering but about fundamental change. Where do we want to be in five years’ time?

Finally, I will share my personal story, which is not as tragic as those of others. I had a brother-in-law, Gareth, who had Down syndrome. At the end of his life, he suffered from dementia. He had some of the problems that people have talked about but to a much lesser degree than noble Lords have referred to. What we discovered about dementia as he became worse is that very little is known about dementia for people with Down syndrome. Yet there is a genetic connection that suggests that about 50% of people with Down syndrome will end up having some level of dementia by about the age of 60. There needs to be much more research in this area and more development of services. The simple answer is that people did not know how to handle it—it is just another service that did not know how to handle somebody with learning disabilities.

I will end with a point of praise for North Derbyshire. There is a community dementia team there—it is one of the few community dementia teams in the country—and it is first class. Its members were able to be those one or two people who sorted out and beat the system—they knew the back door and the ways to get things done. I have put this on the record before in the House, but I again praise that team. I hope that the Government are listening and will pick up on that in the future.