Baroness Barran
Main Page: Baroness Barran (Conservative - Life peer)
Baroness Barran (Con)
My Lords, it is a privilege to respond to this important debate, and I join with other noble Lords in congratulating my noble friend Lord Borwick on having secured it. I also join him in congratulating the Habinteg Housing Association on its work over the past 50 years. The issues raised by noble Lords on all Benches have highlighted some of the challenges and opportunities not just for the Government but also for businesses, civil society organisations, our communities and our families. In my remarks I will focus on the role of government in responding to the challenges and opportunities—the important rather than the urgent, as my noble friend put it—presented by the changing face of disability in the coming half-century. This is in no way to diminish the vital role of families, carers and civil society organisations. Indeed, government has important judgments to make about how to help them flourish, but also about knowing when to get out of the way.
The past 50 years have seen huge changes in the way disabled people are cared for, supported and regarded by society. Gone are the asylums that kept disabled people hidden from society. Instead, important legislation—which a number of noble Lords have been part of—including the Disability Discrimination Act and the Equality Act, has been passed, creating a platform from which the rights of disabled people can be upheld. In every field of public life, from politics to sport and from academia to the arts, there are powerful and inspirational role models, as raised by the noble Baroness, Lady Thomas, and my noble friend Lord Holmes. They are role models for those with or without a disability—including, of course, in your Lordships’ House. We can contrast this with a time when Roosevelt was President in the US and the Secret Service was reported to have seized and smashed the cameras of journalists who tried to take photographs of him in his wheelchair.
As we have heard from all noble Lords this afternoon, much still needs to be done to ensure real equality for people with disabilities, to remove stigma and discrimination and to offer proper care and protection from threats such as hate crime and the risks of loneliness and isolation. Successful management of such huge changes, of the types that noble Lords have debated requires a clarity of vision. So what are we aiming for? My noble friend Lord Holmes talked about fairness, dignity and respect, not just in relation to appointments in public life but with much wider applicability. I also liked the words of Alex Fox of Shared Lives in his book, A New Health and Care System, in which he wrote that we should be achieving and maintaining well-being for people with disabilities.
Well-being is a core principle underpinning much of the legislation in this area, and government has a role to play in helping to align funding, assets, incentives and regulation to make this happen. We need not just to encourage the provision of services but to foster the relationships that are so crucial for genuine well-being, of which we have heard much today. Organisations such as L’Arche for people with learning disabilities—whose remarkable founder Jean Vanier died this week—have been prophetic over 50 years in emphasising the importance of recognising the gifts that those with a disability offer us all. That must underpin the kind of culture change that the noble Lords, Lord Addington and Lord Faulkner, talked about.
A number of noble Lords, including the noble Baronesses, Lady Thornton and Lady Thomas, highlighted that, despite the progress of the last 50 years, all key indicators still show multiple disadvantages for disabled people—from poverty to educational outcomes, employment, discrimination, isolation and a lack of opportunity. This Government are committed to addressing this across a range of key policy areas including, to name but three, employment, healthcare and transport. I assure the noble Lord, Lord Faulkner, that I will read and share the report from his Select Committee on this.
As my noble friend Lord Borwick described, the shape of disability is projected to change significantly in the next five decades, with a sharp increase in the number of people over 65 to around 21 million and a tripling of those over 80 to 9.5 million. It will be quite a birthday party when it comes. Conversely, important medical advances should presage declines in the prevalence and impact of many cancers and other life-limiting diseases. We have the potential to move from what has been described as a national sick-care service to a national preventive healthcare service.
Regarding prevention, government also has a role to play in understanding and acting on some of the wider factors that can lead to disability, which I think the noble Baroness, Lady Thornton, hinted at in her speech. Research that has shown the impact of adverse childhood experiences on the brain—and on later-life outcomes, not just mental ill health but also physical conditions such as cardiovascular disease and diabetes—needs to inform the response we offer to children growing up today with domestic abuse, parental substance use or parental mental health problems, as well as those living in poverty or with a parent in prison. This understanding underpins the so-called public health response to serious youth violence adopted in Glasgow and London and now being consulted on nationally. The potential for neuroscience to explain some of our health challenges is genuinely exciting, as my noble friends Lord Borwick and Lord Lingfield argued.
Perhaps better understood are the links between diet and exercise and cardiovascular health, diabetes and dementia, where our colleagues in public health services play such a crucial role. For example, we recently announced an ambitious plan to halve childhood obesity by 2030. We also believe in the importance of risk reduction; around one in three dementias are considered preventable. Perhaps the most important task—many noble Lords have raised it today—for government in a rapidly changing world of disability is to keep listening to those with lived experience, their families and their carers. This is not something that Governments of any hue find easy, but that does not make it any less important. Understanding the perspective of people with lived experience is essential for government’s response to address their needs, as well as recognising and celebrating their gifts and talents.
So what do disabled people say are their key concerns? They talk about their health, of course, but also about financial insecurity, weak social connections and a fear of losing their independence. These issues have been raised by many noble Lords today. The noble Baronesses, Lady Campbell and Lady Thornton, raised the importance of user groups; they are vital in this area. For example, patient groups—especially those that are networked—can make a crucial contribution to government policy. There are over 500 groups of stroke survivors co-ordinated by the Stroke Association, over 400 for diabetes and almost 1,000 groups of cancer survivors co-ordinated by Macmillan. These networks offer people with disabilities information they can trust and, crucially, put them in positions of authority, which in turn can be combined with specialist medical input if needed.
I say to the noble Baroness, Lady Campbell, that I would be absolutely delighted to meet the national Independent Living Strategy Group. I am not sure whether the question from the noble Baroness, Lady Jolly—about the young man she talked so eloquently about—is about where he starts or where we start, but we should start by listening.
While noble Lords developed a green thread around the Green Paper, they were perhaps kinder on funding—but funding is obviously a crucial area where government plays an absolutely vital role. This is not just about enough funding, which many noble Lords raised, but about how to use our funding in a way that drives the outcomes that people want and that actively rewards success. I noted my noble friend Lady Browning’s suggestion regarding incentives in the tax system.
My noble friend Lady Browning raised the challenges from the Alzheimer’s Society report that was recently published. She will be aware that the Government published the Dementia 2020 Challenge in 2015, which aims to make England the world leader in dementia care, including in the area of training as well as research and awareness of dementia, and will respond to the Alzheimer’s Society report.
My noble friend Lord Lingfield raised issues around funding for stroke patients. He will be aware that the NHS long-term plan identifies stroke as a clinical priority.
More broadly, noble Lords welcomed the introduction of personal health budgets. I thank in particular the noble Baroness, Lady Grey-Thompson, for her remarks in this regard. The NHS long-term plan set out a commitment for 2.5 million people to benefit from personalised care by 2023. The growing demand for care, which the noble Baroness, Lady Jolly, raised, means that we need to reach a longer-term sustainable settlement for social care. Sadly, I do not have a magic wand at the Dispatch Box, so I cannot give a date for the publication of the Green Paper, other than to say that it will be at the earliest opportunity. But it will aim to address the issues of both sustainability and providing a genuinely human response. Through integrating health and care services, the intention is to establish the right organisational and financial incentives for providers to collaborate in order to deliver preventive, proactive and co-ordinated care for local populations, and, crucially, care that feels human.
A number of noble Lords raised issues around developments in technology. Clearly, a crucial role for the Government is to consider how to encourage innovation and research, manage intellectual property rights for the greater good and share best practice. The noble Baronesses, Lady Meacher and Lady Masham, raised specific questions on that and I will write in response, if I may. The noble Baroness, Lady Masham, also raised very practical challenges around the three Bs, which are obviously important, albeit possibly less glamorous than some of the other areas of innovation.
The noble Lord, Lord Luce, raised the important issue of chronic pain. As he said himself, many patients with chronic pain can be successfully supported and managed through routine primary and secondary care pain management systems. The noble Lord mentioned the existing standards, but the National Institute for Health and Care Excellence is also in the process of developing new clinical guidelines for chronic pain, which are due for publication in August 2020. He also raised the crucial issue of supporting employers.
Issues around employment were raised by a number of noble Lords, including my noble friend Lord Holmes and the noble Lord, Lord Addington. The Government have a key part to play in addressing the financial insecurity that all too often accompanies life for disabled people. This includes creating opportunities for disabled people to gain employment and to stay in employment, as set out in our 2017 plan, Improving Lives: the Future of Work, Health and Disability, which aims to increase the number of disabled people in the workforce by 1 million in the next 10 years. As noble Lords acknowledged, overall employment has been rising, and our goal depends on disabled people fully sharing in this success.
I thank my noble friend Lord Holmes for his work on encouraging diversity in public appointments. The Government are confident that it will help us understand the issues in this area and will respond to his recommendations later this year.
The noble Lord, Lord Luce, raised issues about encouraging employers to play their part in supporting employees who are struggling with their health. Later this year, the Department for Work and Pensions and the DHSC Work and Health Unit plan to consult on measures to encourage employers to play a crucial part. Noble Lords will have noticed the announcement this week from Centrica about giving its employees with caring responsibilities extra days off.
The Government also need to play a supportive role in enabling employers and civil society organisations to strengthen social connections for the disabled. Increasingly, older people will be retired for much longer than their parents and grandparents were. That risks losing the stimulation, the social network the sense of purpose and the income that a job can bring. In our vision document, Prevention is Better than Cure, we set out a number of areas for action, including work and jobs, homes and neighbourhoods, childhood and early years. Included within this will be access to sport, which the noble Lord, Lord Faulkner, raised. I thought that he was no longer in his place but I see that he is now in a more important place on the Woolsack. I was disappointed, given the number of Arsenal fans in my family, that the club did not get a mention in his top six list.
I hope that we can aspire to more than the same miserable journey that the noble Baroness, Lady Grey-Thompson, described, although we can probably imagine it. But I will raise the points that she made with the department, particularly regarding design regulations and co-production.
I am running out of time, as ever. I want to say a word on independence, because that was one of the strongest themes raised by the noble Baronesses, Lady Thomas and Lady Campbell, and my noble friend Lord Borwick. Loneliness can have a huge impact, as we know, on physical and mental health, and the Government have now published the first cross-government strategy on loneliness in England. The action plan to support carers involves six different government departments working together. We are in the process of rolling out a regional stakeholder network, which is a step towards some of the exciting plans that the noble Baroness, Lady Campbell, put forward about user involvement. The noble Baroness, Lady Thomas, also raised concerns about the availability of carers and continuity of care, which I will raise with the relevant Ministers.
As several noble Lords noted, the potential offered by increasing amounts of data brings with it some risks but also important ethical considerations about how we build public trust in our services. Using data to design support for disabled people needs to avoid bias, be accurately targeted and give the individual the greatest possible control. Noble Lords will be aware that the newly formed Centre for Data Ethics and Innovation is playing an important part in shaping our thinking on this area in future.
In closing, I would like to rest on an area that is less one of government responsibility but which is of critical importance to all of us as human beings. In listening to the voice of those with disabilities, we must remember that as human beings we want people to be there with us rather than for us. I am grateful to all noble Lords for their contributions to the debate, and look forward to a world where the gifts and talents of disabled people are fully recognised.