People with Learning Disabilities

Lord Hunt of Kings Heath Excerpts

Thursday 12th June 2014 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I, too, welcome the debate and pay tribute to the noble Baroness, Lady Hollins, both for initiating the debate and for being an enthusiastic champion over so many years of people with learning disabilities. I agree with my noble friend Lady Warwick, who repeated those figures from the confidential inquiry about the poor life outcomes for people with learning disabilities. The fact that men with learning disabilities die on average 13 years sooner than men in the general population and women 20 years sooner is really sobering. I also find it sobering that 22% of those with learning disabilities who died under the work of the confidential inquiry were under the age of 50.

As my noble friend Lady Andrews pointed out, 29% of those who died had,

“significant difficulty or delay in diagnosis, further investigation or specialist referral, and for 30% there were problems with their treatment”.

The report states:

“The lack of reasonable adjustments to facilitate healthcare of people with learning disabilities, particularly attendance at clinic appointments and investigations, was a contributory factor in a number of deaths”.

It points out that:

“GP referrals commonly did not mention learning disabilities, and hospital ‘flagging’ systems to identify people with learning disabilities who needed reasonable adjustments”—

which is a legal requirement—

“were limited”.

There are some very key questions to put to the Minister. First, will he respond to the noble Baroness, Lady Hollins, on why the Government have not published a one-year-on report detailing what progress has been made in implementing the recommendations of the confidential inquiry? Secondly, can he explain where responsibility lies for implementing those recommendations? Is it with his department or is it with NHS England? I ask that because we are all aware of concerns expressed by his right honourable friend Norman Lamb on the failure of the NHS and local government to implement the core recommendation following the Winterbourne View scandal so that all those with a learning disability in inappropriate institutional care are offered community support. It is quite an extraordinary thing when a Minister says that the health service and local government have completely failed to meet that target. What I do not understand is who is responsible. It seems to me that Ministers are evading their responsibilities.

The noble Baroness asked the Minister about the central recommendation that a national learning disability mortality review board should be established. We have all had briefing from the BMA that emphasises the importance of such a review. We are told in the debate that this is now to be set up in the first half of 2015. Can the Minister confirm that? Can he also confirm that, once established, it is to be a permanent mechanism?

Another point that the BMA raised was that:

“One of the barriers to providing joined-up care is the way in which services tend to be commissioned separately, to the extent that co-morbidities fail to be recognised in either process”.

It went on to say:

“The planning and commissioning of services for people with intellectual disabilities, mental health problems, and chronic physical conditions must take greater account of the diverse healthcare needs of these groups. To facilitate this, commissioners need to have the knowledge and skills to understand how best to provide services for people with mental health problems and with an intellectual disability”.

Can the Minister respond to that point? Will he also respond to the point raised by my noble friends Lord Patel of Bradford and Lady Andrews and the noble Lord, Lord Adebowale, about the worrying evidence of health and care workers’ ignorance about the Mental Capacity Act, as identified in the excellent Lords Select Committee report?

I would like to pick up a point raised by the right reverend Prelate the Bishop of Carlisle on hospital services. My former trust—Heart of England NHS Foundation Trust—has appointed a team of specialist nurses in learning disabilities to work with local GPs to map patients’ pathways, enhance communication between community and acute hospitals, develop resource packs and training programmes for staff working in the hospitals and make sure that treatment options are available to people with learning disabilities. A number of noble Lords said that too often people with a learning disability and a physical health issue are ignored by health professionals when it comes to treatment options. I worry that lawful consent to treatment is not given in those circumstances: I rather doubt that it is in many cases. Will the noble Earl encourage other trusts to follow the example of Heart of England NHS Foundation Trust?

The noble Baroness, Lady Hollins, referred to data linkage. That is a very important issue. If the Health and Social Care Information Centre is reluctant to make progress on that matter, I hope that the noble Earl will consider her suggestion that Ministers should take steps to issue a direction from the department to tell that centre to get on with it.

Finally, will the noble Earl confirm that parity of esteem applies to services for people with a learning disability? If he can confirm that, will he say how it is being put into action?