Care Bill [HL]

Debate between Lord Rix and Baroness Wall of New Barnet

Tuesday 4th June 2013 Lords Chamber

[Lord Rix]

My Lords, I support Amendment 10, but I should like to clarify one or two points in the wording. It is possible for a person with a learning disability to have a physical health problem. It is also possible for a person with a learning disability to have a mental health problem. But that is not the main cause or even sometimes the basic cause for their particular condition, which is learning disability. I would therefore have preferred the wording of paragraph (a) of Amendment 10 to have been “learning disability”. The same situation arises in paragraph (b) of Amendment 10. People with a learning disability have a learning difficulty. That is natural. However, there are plenty of people who are not learning disabled who also have a learning difficulty. I would like to have seen Amendment 10 include learning difficulties and learning disabilities, but I actually support the general thrust of the amendment. I hope that if it is accepted the wording of a learning disability can be made quite clear.

[Baroness Wall of New Barnet]

My Lords, I support Amendment 12 in particular. It will be no surprise to the Minister that my interest, even my passion, lies in the status of healthcare workers, which is hugely important. We are recognising that even more by the way in which the continuing change in the health service is coming about.

I wish to pick up on the way the Bill reads in the context of the amendment. The clause refers to, obviously, education and training for healthcare workers. It then refers to,

“the provision of information and advice on careers in the health service”,

but to know where your career is going you have to have a start point. The Minister knows that many of us have been asking for, in the first instance, a recognition of the skills that healthcare workers bring to the job. Across any organisation that has opportunities for development, there is always a start point. A healthcare worker would need to know, for instance, what skills they have and what skills they need to go on to the next stage of whatever career they choose. The ambiguity, at best—actually, it is probably even worse than ambiguity—under which healthcare workers currently operate does not help that process. It will be difficult for the Bill to achieve its objectives if we do not start from the point where healthcare workers have that recognition of their skills in a formal way.

--- Later in debate ---

[Lord Rix]

My Lords, I wish to speak to Amendment 24, which explores the benefits of placing a duty on the Secretary of State to consult on the objectives and priorities of Health Education England. In particular, I wish to explore how the Secretary of State will consult vulnerable people, including people with a learning disability, to ensure that education and training provided by this body will create a workforce that meets this group’s needs. Consulting and listening carefully chimes with the Government’s intentions through their response to the Francis inquiry, which stated:

“We will listen most carefully to those whose voices are weakest and find it hardest to speak for themselves. We will care most carefully for the most vulnerable people—the very old and the very young, people with learning disabilities and people with severe mental illness”.

This is a most welcome commitment, as currently people with a learning disability are not receiving appropriate care. On Tuesday 21 May, the Parliamentary and Health Service Ombudsman published its report into the death of Tina Papalabropoulos. Tina was 23 and had a learning disability. She died on 30 January 2009 at Basildon hospital in Essex. The ombudsman found that the hospital did not give her the treatment she needed or even meet her basic care needs. Unfortunately, this is not an isolated incident, and there is substantial evidence that poor care exists across the health service.

Early this year, the confidential inquiry into the premature deaths of people with learning disabilities in the south-west reported on its study of the deaths of 233 adults and 14 children with a learning disability. It found that 42% of the deaths were premature and that 37% would have been avoidable if good quality healthcare had been provided. On a national level, this equates to over 1,200 adults and children with a learning disability across England whose deaths should have been avoidable with good quality healthcare. This comes as no surprise to many. The Department of Health highlighted the issue back in its Valuing People and Valuing People Now strategies, and the excellent report by Sir Jonathan Michael, Healthcare for All, set out a series of recommendations for improving care for people with a learning disability. It is these people whom the Secretary of State should consult when setting objectives and priorities for this most important of public bodies. Without the input of people with a learning disability and their families, we will fail to change a system and a culture that in many cases provide substandard care for the most vulnerable in our society.

I realise that the Minister will probably reply that in order to publish the objectives and priorities for the forthcoming year of Health Education England, the Secretary of State will have consulted the parties concerned. However, as an actor who, years ago, used to drop his trousers for a living, I nowadays prefer the security of belt and braces, and I hope that the Minister will be able to offer this.

[Baroness Wall of New Barnet]

My Lords, I would like to understand what Amendment 14 is suggesting, and maybe express some reservations. If I have read it wrongly, I apologise. It is important that Health Education England takes official guidance into account, but we have this dilemma in my own trust about what the Francis report is saying. To have a national edict about what staffing levels ought to be, and the ratios and numbers of staff as well as the skills mix, is not really ideal from the point of view of people operating in the health service, particularly in hospitals. Times change throughout the day on hospitals and on wards, and different levels of skills and different grades of staff are required at different times. You would have to have a permutation that was so huge that it would be less than helpful to have a national edict. I would be concerned that we should take notice of official guidance, but nothing more than that.

I support Amendment 27 and the view about longer-term stuff. In particular—I am sure this will come up later in our deliberations on the Bill, and it is very much in line with what we talked about for a long time in our consideration of the Health and Social Care Bill—the change that is happening as we speak, the evolution of moving, quite rightly in my view as the chair of a provider trust, from acute hospitals to other opportunities to deliver care, is hugely important.

I will share an anecdote with your Lordships. In a discussion with a previous director of nursing in my own trust, I asked her, with my vision of where things ought to be in the future, with nurses following the patient out to their home, how many nurses working on our wards are equipped and skilled to follow Margaret Wall or another patient out and say, “OK, she is now going home”. Her view was very frank: not many would be. I think that is hugely important, because different skills are required to work with someone at home and they need to be incorporated with the skills of nursing overall. It is important when looking at five-year plans, never mind 10-year plans, that we consider the education process in the sense of how people are going to deliver in different environments, which we are all working hard to make sure happens.