People with Disabilities: Access to Services

Baroness Hughes of Stretford Excerpts

Thursday 16th May 2024 Lords Chamber

Moved by

[Baroness Hughes of Stretford]

That this House takes note of the challenges faced by those with disabilities including access to benefits, work, education, housing and healthcare.

[Baroness Hughes of Stretford (Lab)]

My Lords, according to the Family Resources Survey: Financial Year 2022 to 2023, published recently by the Department for Work and Pensions—the primary measure of disability prevalence in the UK—the number of disabled people has been rising steadily over the last 15 years or so. It now stands at an estimated 16.1 million people—24%, or almost one in four, of our total population—a figure that excludes people in nursing and retirement homes. Is that not a very significant minority of our population, such that we would expect their needs to be a high priority for any Government? When we consider that each of these disabled people is likely to have some family members or carers, the number of people affected by the challenges of disability will run into many millions more.

In two reports this year by the Institute of Health Equity, Sir Michael Marmot and his colleagues found reduced life expectancy, deterioration in health and widening health inequalities in all but the 10% most affluent areas of our country. The report showed that these were the result of cumulative government cuts since 2010 to the essential public services, particularly local government services, that are the key determinants of population health. Another important factor is the failure to tackle serious public health problems, especially obesity. The steady rise in disability rates must be seen in the context of the general deterioration in health and socioeconomic circumstances. Does the Minister agree with Sir Michael that the rise in ill health and disability is real and not the result of a “sick note culture”?

Some 11% of children are disabled, a doubling over the last 10 years, as are 23% of working-age people, which is a 7% increase. Over the last decade, the proportion of disabled people of state pension age has been fairly constant, between 42% and 46%. Apart from among children under 15, where there are twice as many boys as girls, there are more disabled women than men, both absolutely and relative to their respective populations. The Annual Population Survey by the ONS estimated that 9% of people aged 16 and over from a minority-ethnic group are disabled. There is also variation in disability prevalence by nation and English region, with Scotland, the north-east, the north-west and the east Midlands having the highest rates, and London and the south-east the lowest.

Disability prevalence in an area is affected by age distribution and reflects socioeconomic factors: income levels, poverty and health, all of which are of course interrelated. The type of disability reported varies by age group. Mobility is reported most frequently overall, followed by breathing and then mental health. The latter is reported by 44% of the working-age group. The most frequently reported disabilities for children are social and behavioural, at 50%, followed by mental health and learning disabilities.

It is important to say that, although we can summarise the demographic and social characteristics of disabled people, it would be wrong to imply that this population is homogeneous or that disabled people are defined primarily by their disability; they are no more homogenous than the rest of the population. Rather, they have a commonality in experiencing a disability that makes the following more difficult: first, to navigate the activities of daily living essential to us all; secondly, over a longer period, to acquire the assets and resources—for example, in education and employment—which enable them to reach their potential and have a good quality of life; and, thirdly and mostly importantly, to participate actively in social, community and political life. It is the challenges that disabled people have in achieving those ends that we are bringing to the fore in today’s debate.

I am sorry to say that, on every dimension important for a good quality of life, disabled people fare worse, and sometimes far worse, than non-disabled people. I do not want to present the House with a battery of statistics, because that would eclipse the overall picture. The numerical data from which this picture is drawn are available to us all in the excellent briefing from the Library and the references that it cites.

Disability benefit is notoriously complex. We have heard much from the Government recently about the personal independence payment—PIP—and their intention to exclude many current claimants from eligibility, particularly those with mental health problems. The contention is that PIP is too easy to get and that GPs “over-medicalise everyday challenges” and have fuelled a “sick note culture”. It may surprise noble Lords to know that applying for PIP requires the completion of a 36-page form and, often, a considerable wait for assessment, usually undertaken on the phone by a non-medical person. Half of the claims are rejected at that point. However, almost 75% of appeals to a tribunal convened under a judge, and a medical or disability expert, succeed. Perhaps the Minister will comment when he sums up, but this would not seem to support the view that this benefit is too freely given to people who are not in “genuine need”.

It also ignores the impact of long waiting lists for NHS treatment for physical and mental health disorders, and the interplay between the two. I saw one case reported recently of a man who injured his shoulder, causing extreme pain and immobility; he needed intensive physiotherapy. He was on the waiting list for treatment for three years, during which time he could not work, and, understandably, developed anxiety and depression, making his situation much worse. This is not an isolated case. The waiting lists for mental health support particularly, including for children, are in crisis. If people with mental health problems are to be helped into work effectively and humanely as an alternative to PIP, can the Minister say in his response where the treatment and support services will come from?

Of equal concern to me is the language being used by Ministers about disabled people. It is reminiscent of the rhetoric about migrants, fostering division, with a narrative about disabled people playing the system. I am concerned that the real intention of the Government here is to use disabled people to open up another divisive front for the forthcoming election.

Across a wide range of socioeconomic variables, the outcomes for disabled people are consistently poorer. They are much less likely to be in employment, and those with severe learning difficulties, autism or mental illness have the lowest employment rates. This in part reflects lower educational attainment: they are less likely to have a degree and more likely to have no qualifications at all.

Children with disabilities, including serious illnesses and learning difficulties, find it extremely difficult to access support in schools. We know that only 49% of education, health and care plans are completed within the statutory 20 weeks, with consequent delays for months on end in putting in place the support that is needed.

The disadvantages in education and employment, as well as caring responsibilities by other family members, mean that families with a disabled member have significantly lower median incomes. Poverty rates are higher, at 27% compared to 19%.

There are also disparities in housing, with families with a disabled member much less likely to be owner-occupiers and much more likely to be renting in the private or social housing sectors. Disability Rights UK has said:

“The housing sector is a dangerous mess for Disabled people”,


who contend with inaccessible homes and poor conditions.

There are also barriers for disabled people accessing healthcare because of transport difficulties, costs—including for prescriptions—and, again, long waiting lists. Research by Healthwatch shows that disabled people wait even longer than non-disabled people for treatment, and that proportionately more report problems with communication from the NHS. This particularly affects people who have sensory or learning difficulties.

Transport is another major challenge writ large for disabled people. Most public transport—shockingly, even new schemes—is not fully accessible; it lacks step access, and stations are difficult to navigate.

There are other areas of life where disabled people are disadvantaged. They are more like to experience crime, and this is particularly true for disabled children; those aged 10 to 15 are twice as likely to be a victim of crime. Disabled people report lower levels of confidence in policing and feel less safe. Disabled people are more likely to experience domestic abuse, with disabled women being twice as likely as non-disabled women to experience this. Finally, and not surprisingly, disabled people report lower levels of well-being and higher levels of loneliness.

This is a bleak picture, and although it does not mean that every disabled person has a bleak existence, it means that they have to grapple with many more challenges than those who are not disabled. Despite this, a government consultation last year shows that disabled people have high aspirations that public policy on inclusion should go far beyond the fundamentals of employment, education and the like, important though these are. The majority agree that they also want improved access to elected office; inclusion in emergency planning, resilience and climate change work; and access to assistive technology. They want better opportunities for disabled parents, as well as disabled children, including inclusive playgrounds. However, given the opportunity, they also restated the fundamental importance of better funding, accountability, accessibility and awareness in the workplace, better health and social care, and more financial support to help with the additional costs of living with a disability.

Before I turn finally to what the Government have been doing, I want to acknowledge the vital role of the many excellent voluntary and community organisations in supporting and championing disabled people. Noble Lords will know that many have contacted us, and their briefings testify to the invaluable, indeed essential, work that they do.

The multiplicity of complex challenges for disabled people across most areas of life demands from government a long-term national strategy that is multifaceted, robustly led at the political and executive levels, and translated into action plans with timescales, regular monitoring and reporting, holding departments publicly to account, and, most importantly, with the active participation of disabled people themselves. This is what the Government promised with their National Disability Strategy, published in July 2021, when Prime Minister Johnson described the scale of disadvantage experienced by disabled people as “a scandal” and committed to “bridge the gaping chasm” of inequality through regular progress reports. Unfortunately, the strategy hit major problems when, in 2022, it was challenged in the courts by disabled people’s organisations, which claimed that they had had no meaningful input into its development.

The report of the House of Commons Women and Equalities Committee published last December criticised the lack of strategic approach, poor engagement with disabled people, the poor evidence base and a failure to update disabled people on implementation. It called for Ministers to update Parliament and disability stakeholders on specific timescales for delivery of all outstanding actions in the national disability strategy. Can the Minister inform the House what progress has been made on implementing the national disability strategy?

In February this year, partly in response to the House of Commons Select Committee report, the Government published yet another plan, the new Disability Action Plan, promising to involve disabled people centrally in the implementation and review of progress. Can the Minister explain how the new disability action plan will sit alongside the national disability strategy, and how progress on both will be reported to disabled people and to Parliament? Will the Government publish an implementation schedule, with clear dates for delivery and reporting, so that they can be held to account?

Improving the well-being and inclusion of disabled people is a moral imperative for all of us in this House, but it is also vital for our society that we harness the talents of all our citizens, whatever their level of disability or ability, and enable them to participate fully and on equal terms. I argue that, to do so, we need an approach that sees disabled people built into policy development and planning right from the outset, not bolted on as an afterthought, as has so often been the case. I beg to move.

--- Later in debate ---

[Baroness Hughes of Stretford (Lab)]

My Lords, this has been an absolutely extraordinary debate, with powerful contributions from right across the House that have been passionate, challenging and full of insight. I thank all noble Lords who have made their contributions, many from personal experience of living with disability themselves or of having disabled people in their families. Should anyone assume that debates in this House are pedestrian or formulaic, they should read the Hansard record of this debate. I will certainly read it, and I am glad to hear the Minister say that he will, too. I hope that he will take it back to his colleagues, because many of the points made here bear discussion in the ministerial team.

I cannot thank everybody, and it has already been done, but I want to pick out a few themes which are important. We heard powerful contributions about how disabled people feel about how they are treated by the department and their experience of assessments that do not seem to be fit for purpose. I hope that the Minister will take that away. The daily discrimination at every turn in every minutia of daily living, as we heard from the noble Baroness, Lady Grey-Thompson, and others, and meeting barriers in almost everything that we have to do to get through the day, let alone make our way through life, education and employment—this all needs to be heard.

The pre-eminent importance of inaccessibility to good education, employment and transport, the lack of progress in those areas, despite government commitments and the Minister’s comments, and the Government’s failure to follow through, are causing disabled people and families to lose confidence in whether the Government are serious about this. There are also the negative attitudes towards disabled people, their invisibility in public policy and so much of daily life, and the disastrous and sometimes ridiculous consequences of making decisions without input from disabled people. The example of floating bus stops will stay with me for a long time. However, we did have a welcome challenge at least, that if only the Government would stop sticking doggedly to conventional ways of doing things and think creatively and radically about what modern technology offers, many of these artificial barriers would fall.

Overall, the key message raised in my opening speech and by so many noble Lords is that disabled people must be at the heart of policy and implementation. “Inclusion by design and accessible by all” should be the watchwords. This debate has demonstrated, if anybody needs evidence, the profound difference that it makes to have the voice of disabled people with lived experience in the room, and its benefit.

Motion agreed.