Disability Services

Baroness Browning Excerpts

Thursday 10th January 2013 Lords Chamber

[Baroness Browning]

My Lords, it is a great pleasure to follow the noble Lord, Lord Boateng, who has brought this very important report to the Floor of the House today. At the beginning, I refer Members to my interests in the register concerning various disability charities.

The noble Lord, Lord Boateng, has outlined in his opening remarks some of the core challenges and problems identified by this report, so in the time available to me I would like to focus on some of the recommendations made by the report. I begin with the recommendations for local authority commissioners. It is suggested that there is a need to redesign commissioning contracts to facilitate collaboration between small and large organisations to allow more consistent, wide-ranging care that meets both personal and community needs. This is a most timely recommendation because of the changes that are taking place, as we debate, in commissioning.

It has been my experience that commissioning, whether it is done at a national level by government, by local authorities or through commissioning structures within the health service, almost inevitably follows a pattern. The pattern is usually one where those who are commissioned tend to be larger organisations, for the reason that they are easier to deal with. Larger organisations cover the ground more and the financial control is easier, rather than if the commissioning is based on a lot of small and more independently, but perhaps more accurately, focused and targeted providers.

That is really the challenge in this recommendation in the report. I do not expect the Minister, who will reply to this debate today, to have all these answers, but I will make this request. This is such a timely report at a time of great change for disabled people that if she does not have specific answers to these questions today, I hope she will consult colleagues—this will often need to be across government—on these various recommendations and perhaps agree to put something in writing in the Library. I think that would be very helpful to those of us who are concerned about how practically the Government are going to address the very timely and helpful suggestions in this report.

I turn now to the recommendations related to policymakers in the report. The report states that,

“BME disabled people’s needs and views have often fallen between the two areas of disability and race equality policy. Finding ways to bring these two policy fields together is extremely important for developing effective support for BME disabled people”.

It is almost self-evident that that needs to be addressed, but I think it is a little more complex than the report suggests, because among the disabled community per se there has for a long time been the big challenge of people who have co-morbidities—people with more than one disability. When you bring into that the additional challenge of a range of ages and, as this report addresses, the BME disabled community, you can see that when you look at how you could try to address the needs of those individuals, it is almost inevitable that you will end up with a generic service.

I say to my noble friend at the Dispatch Box today that it is a real challenge to target the services that policymakers produce on individual needs, which will almost certainly be complex. It is a challenge to provide the strategy through the policy as to how to address the myriad requirements of people who have not just one but often a range of disabilities, where two disabilities might mean, for example, someone with an autistic spectrum disorder who also has either a diagnosed mental health problem or a physical disability and is also part of the BME community. Then there are the age concerns to be taken into account.

Of course, when we talk about disabled people, we must think not just of the disabled people themselves but of their family situation. Siblings and the effect of having a severely disabled sibling are extremely important. When you are providing, commissioning and looking at appropriate services, you have to take a more holistic view at the family, the primary carers and, of course—particularly as far as children are concerned—siblings in the same household.

These are therefore complex issues that are not easily resolved, and they are not resolved well at present. We have to do better for this community. I say to my noble friend that in looking at policy-making, some of the recommendations in this report are absolutely critical. These include, for example, a theme throughout the report: involving disabled people themselves, along with their immediate carers, and the BME communities with experience and background in what the needs and solutions are.

Another recommendation for policymakers is the one to develop a national race equality strategy, which includes the needs of BME disabled people. The noble Lord touched on this in his opening remarks. My noble friend will, of course, reply at the end of this debate, but that recommendation was made in the light of the Government’s announcement that we are to expect a forthcoming disability strategy. If it is not the Government’s intention to develop a national race equality strategy, it would be helpful to know exactly what is being done at present—I assume it is being done at present—under the disability strategy. This would reassure the House that this community’s needs are being considered and will be included when that strategy is made public.

There are also recommendations for service providers. A person-centred emphasis is recommended, and I totally agree with that. One can look at a range of disabilities, and there will be a common purpose in the services provided and commonality in the way in which disabilities affect people and in how some particular disabilities, which might be degenerative, are likely to affect people in the future. One does have to look at the individual; no two people are the same. Service providers should look at the individual and take that holistic look at the individual and their immediate surroundings and life chances.

Employment was mentioned. The figures are appalling for people who could carry out paid work or—and I always emphasise this at this stage—voluntary work. I know this is not the flavour of the month. Everyone is going to be in paid work, but for some people with a disability—and I must emphasise this strongly for my noble friend on the Front Bench—just getting them to the stage where they can maintain independent living is a milestone that many would not have achieved without a lot of support. For some people—and it is only some people—to expect them additionally to take on paid employment could diminish their ability to maintain a standard of independent living that is both safe and acceptable.

We all want disabled people, including the BME community on which this report focuses, to have the opportunity for paid employment wherever possible. However, I am old enough to remember, as I am sure other colleagues in the House today are, when the life chances and quality of life of many disabled people meant that they often lived at home with increasingly elderly parents, the inevitability of which was that at some point there would be a crisis in their care when the parents were no longer able to look after them, so that they, as disabled people, had to face decisions about their future at a point of crisis. That is something which I hope my noble friend will consider.