Queen’s Speech

Baroness Hollins Excerpts

Tuesday 15th May 2012 Lords Chamber

[Baroness Hollins]

My Lords, it was encouraging to hear Her Majesty address important aspects of care relevant to those with learning disabilities. I should mention my own interest in learning disability, particularly as a past president of the Royal College of Psychiatrists. I also worked clinically with people with learning disabilities for 30 years until I retired from the NHS in 2008. I have also had policy secondments to the Department of Health to advise on learning disability. Perhaps most importantly, my son is an adult with a learning disability, and many of the issues that I shall refer to today are, or have been, relevant in his life and therefore in mine.

The care and support Bill and the children and families Bill both have the potential to improve the lives of those with learning disabilities, and those who care for and about them. We hear that the care and support Bill will try to simplify the current care system, a system described by the Dilnot commission in 2010 as “complex and opaque”, and more recently by last year’s Law Commission report as an “incoherent patchwork of legislation”. I understand that the care and support Bill intends to replace provisions in at least a dozen Acts with a single statute.

Such simplification could be in the interests of those with learning disabilities and their support networks. This Bill supports another recommendation of the Law Commission report, which was addressed also in A Vision for Adult Social Care White Paper: that of making the system genuinely more person-centred. This also has synergy with ideas in Think Local, Act Personal, the 2010 partnership agreement between local government and the provider sector.

Charities such as Mencap and the Challenging Behaviour Foundation believe that the provision of person-centred, comprehensive local services is central to preventing appalling abuse such as that exposed last year by “Panorama” at Winterbourne View in Bristol. Several different investigations are following up what happened at Winterbourne View and, until the criminal prosecutions have been completed, final conclusions will not be reached. I am sure that noble Lords will join me in hoping that strong recommendations will emerge from this intense scrutiny and that they will be taken note of in the new legislation envisaged during this Session.

In July last year, I asked a Private Notice Question about Winterbourne View. One part of my Question related to the Mansell report, which gives guidance on how to manage and support people with learning disabilities and challenging behaviour in the community, rather than export them a long way from home to private hospitals such as Winterbourne View. Challenging behaviour is complex and requires management by those with specialist knowledge and skills. One of the issues raised by investigations into Winterbourne View was that Castlebeck was using unqualified staff to work with some of the most complex patients in the system.

While being unethical, this is also a false economy. We know that early intervention with expert care at a stage when behaviour first appears is vital if the reason for the behaviour is to be understood, extinguished and prevented from becoming a life-long battle for patients, their families and services trying to help them. Experienced and well qualified professionals are sometimes seen as too expensive, and employers may seek to replace them with cheaper alternatives. However, cheaper often means less qualified, and as Winterbourne View has shown us, this can be severely detrimental to the care of some of the most vulnerable people in society.

When the aim of a care system is to be person-centred, how can this truly be so without that care being portable? I am pleased that other noble Lords have referred to the importance of portability. This issue has been raised by numerous reports and in the Private Member’s Bill of my noble friend Lady Campbell, the Social Care Portability Bill, which had its First Reading in the previous Session. As it stands, a disabled person must negotiate a new care and support package every time they move from one local authority to another. Thus, those with disabilities are denied the freedoms that others can enjoy, partly because of the fear of not receiving equivalent levels of care and support in a new locality.

I recognise the limited value of personal experience, but I shall tell a story about my son. Ten years ago when he moved to his current home, the new local authority appealed to the Secretary of State to try to get a ruling that it had no responsibility for the cost of his care and support. It was unsuccessful, as were many other local authorities facing similar requests to support people who had moved into their area. Ordinary residence rules are now much better established, but there is still no requirement or expectation that, for somebody moving today, the new local authority will honour an assessment conducted by another local authority.

Ten years on, my son again wishes to move house. I have recently spent several hours in meetings and completing assessment questionnaires, knowing that I will probably have to repeat the exercise in a few weeks with his new local authority, with no certainty that his support plan will be honoured. This is happening all over the country. It is a waste of officials’ time, a waste of disabled people’s and family carers' time, stressful and, frankly, discriminatory.

My hope is that the care and support Bill will address the question of portability and adopt the suggestions of my noble friend in her Private Member’s Bill. I would be grateful if the Minister could comment on this point.

The children and families Bill proposes to assist young disabled adults by offering them the opportunity of further education until the age of 25 and to give them the right to a personal budget. The transition to adulthood for young people with special educational needs is notoriously difficult. Those with learning disabilities often benefit from extended time in an adult college, which has the resources to prepare them to the best of their abilities for life in wider society.

The White Paper, A Vision for Adult Social Care, recognised that self-directed support can help to prevent or reduce the risk of harm and abuse. There is also the critical recommendation in the Dilnot report that:

“Those who enter adulthood already having a care and support need should immediately be eligible for free state support to meet their care needs, rather than being subjected to a means test”.

It seems that the children and families Bill intends to secure this entitlement and I welcome it.