Safeguarding Adults with Learning Disabilities

Debate between Catherine McKinnell and Jackie Doyle-Price

Tuesday 17th October 2017 Westminster Hall

[Jackie Doyle-Price]

I totally agree with the hon. Lady. As she says, we have seen that in other cases of abuse. We can look at Rotherham and how the agencies behaved there. It is almost as if there is a view that, “He’s a bad ’un; he doesn’t deserve protection.” That is absolutely not the case. We need to be thinking about the person in a very person-centred way. It was very clear that Lee had a learning disability and did not have the capacity to act as an adult, yet he was treated as one. That is one of the real lessons of this case.

With specific regard to the requests of the family, the whole area of transition is certainly of concern to me. We see this issue in relation not just to learning disabilities, but to mental health. In both cases, families are often completely unable to influence support or care for their loved one; they are utterly powerless because they are in the control of institutions. We need to be learning the very clear lessons there.

We need to raise awareness of hate crime against people with disabilities. Too often, we look at hate crime through the prisms of race and gender. To be honest, we look at hate crime through those prisms because it is the victim of a hate crime who will raise it as such and, frankly, people with disabilities are in less of a position to do so. That said, things are getting better. As I said, it is early days for the offence and prosecution of hate crime, but I am told that in the past year the police have recorded an additional 5,558 disability hate crimes; the number is up by 53%. That suggests that people are more inclined to report it and that the police are more inclined to identify hate crime due to disability, but we continue to monitor the situation and see what else needs to be done to protect the vulnerable.

[Catherine McKinnell]

I appreciate the response that the Minister has given, but the increase in reporting of hate crime is very concerning. There are potentially two issues here. One is that people are more motivated or able to report hate crime, but it may be that there is a significant increase in hate crime as well. It is incumbent on the Government to find a way of monitoring that, so that we can understand whether this is a growing problem or whether there is just more success in terms of the reporting of the crime. We should not confuse the two.

[Jackie Doyle-Price]

That is a fair point. Data is everything, and as time progresses, we will build up more meaningful data, but certainly if crimes are being reported, they are more likely to be prosecuted. Even if the behaviour has been hidden, or if it is on the rise, at least prosecution can happen, but we need to tackle the behaviour first and foremost, to be frank. Prevention is always better than cure.

Under the hate crime action plan launched in July 2016, we committed to providing funding to community-led projects aimed at tackling hate crime. In the first year of the scheme, we funded nine projects across England and Wales covering all types of hate crime. We funded a project in Carlisle involving Mencap. It was to develop an education resource to raise awareness of disability hate crime and how to report it. The great thing about that was that it was created by people with learning disabilities for people with learning disabilities, so it was enabling and empowering the victims. I am advised that three of the projects for the second year of the programme will focus on tackling disability hate crime, but clearly there is more to do.

On 21 August 2017, the Crown Prosecution Service published revised public statements and legal guidance for all strands of hate crime, as well as a support guide for disabled victims and witnesses. One of the most telling things about the speech by the hon. Member for Newcastle upon Tyne North was that it was in the interaction with the criminal justice system that perhaps the most decisive intervention to support Lee could have occurred. Again, we can do more. The Solicitor General is well aware of this matter and, I am sure, is already having discussions with the legal agencies about how we can spread good practice and perhaps look at guidance.

Safeguarding was obviously the real failing in this case. Clearly, we need a system that protects those at risk and acts on issues effectively; that did not happen in this case. As we have heard, once someone becomes an adult, it is very important that it has regard to their feelings and wishes, but the whole issue of mental capacity needs to be determined. In the Care Act 2014, there is a clear legal framework for safeguarding, which gives clear instruction on the responsibilities of local authorities and the rights of adults, but it is also important to involve their families and loved ones as and when necessary. Again, that is a very troubling aspect of this case.

We need to do better. We need to make clear what is expected of the various agencies under the Care Act. We are pursuing Making Safeguarding Personal, which is a sector-led improvement programme that aims to reinforce the placing of the individual at the centre of safeguarding. We are also working with the Association of Directors of Adult Social Services to improve that.

To come back to the issue of the criminal justice system, that was a missed opportunity to give Lee support. During the past two years, we have been working very hard to expand liaison and diversion services. It has been a good news story: more than 71,000 vulnerable adults have been taken out of the criminal justice system and instead put on an integrated health and justice pathway, helping them into health services and away from custody where appropriate. I can assure the hon. Lady that that is still a key part of how we will approach this issue. In fact, I met the team doing that work just last week.

To address the specific recommendations made by the family, the transition from children’s to adults’ services is clearly key. That is where things go wrong; we need to ensure that it is joined up. I always say that if we have a weak link in a chain, we can usually get over that, but if we have a succession of them, that is when things go terribly wrong. As the hon. Lady outlined, there were probably half a dozen in this case.

We are determined that young people with learning disabilities will be properly prepared for adulthood. We are looking at four specific areas: employment, good health, independent living and community inclusion. From the way the hon. Lady articulated Lee’s circumstances, I do not think he could have been judged to be meeting all four of those criteria by any stretch of the imagination, so we must ensure that the support network is in place to help to steer individuals through that, for as long as it takes. It can take a number of years, but the end goal is a good one if we are prepared to make that investment. If people are not ready, they must have support to prevent them from being exploited by those who would exploit people who are vulnerable.

Many people think that the Mental Capacity Act 2005 is very complex legislation, and clearly in this case not everyone knew their obligations under it. There was not a clear understanding of how far the family should have been involved when Lee’s mental capacity was clearly not that of an adult. We want to do a lot more work on educating people in this space. In 2015 we established, with the Ministry of Justice, the National Mental Capacity Forum, specifically to develop those messages and good practice across the sector.

We also have to look at deprivation of liberty safeguards. The Law Commission has recently published its report on mental capacity and deprivation of liberty, and I welcome the observations of the hon. Member for Newcastle upon Tyne North in the light of this case. Like all Law Commission reports, it is a very well-thought-out piece of work. It has had lots of investigation and engagement with stakeholders. We need to make sure that the law is proportionate in respecting people’s liberties, but can also be used to protect the vulnerable. That is clearly the test that we will apply.

We have heard that Lee struggled to navigate the system and that agencies did not work well to support him. Another important tool that will perhaps avoid cases like Lee’s in future is having a named social worker who owns the individual and their needs, and makes sure that those have been satisfied. I think that would make a big difference. We have the named social worker pilot scheme so that more people can have that personalised care and support. They can hold every agency responsible under care plans and be really person-centred, recognising that this is an individual with his own personality, needs and circumstances. That is a very important piece of work. It is our response to the 2015 consultation, “No voice unheard, no right ignored”, which sought views on strengthening the rights of people with learning disabilities, autism and mental health conditions, to enable them to live more independently.

The hon. Lady raised the case of Southern Health and Connor Sparrowhawk. I think we agree that sunlight is the best disinfectant, so all NHS trusts are now required to publish estimates of how many deaths they could have avoided had they been better. That includes the deaths of people with a learning disability. From June next year, trusts must also publish evidence of learning improvements that happen as a result of those data. We expect that the leaders of trusts should show some real accountability and leadership in how they deal with their duties under that requirement.

I want to give the hon. Lady plenty of time to speak at the end, because this is clearly a very important subject for her, but I will quickly add that one of the most important things we need to get right in supporting those with learning disabilities is to invest in good quality supported housing. That is central to encouraging independent living and to having the infrastructure in place to protect them from any potential exploitation.

The hon. Lady also raised the issue of costs and challenges. It is to be celebrated that people with learning disabilities are living longer—for a long time they were dying prematurely. That is a massive improvement in justice, but it does bring with it cash challenges, and obviously we are facing cash challenges across the sector. I wish that was easy to fix. It is not, but it is at the top of my in-tray, as I am sure both she and the hon. Member for Worsley and Eccles South (Barbara Keeley) will understand, and we are very keen to address it. On the specific issue of sleep-ins, which I know Mencap is very worried about, we are actively involved in discussions about how we can support the sector to deal with that.

To conclude, what happened to Lee was not the result of a single cause. There were a number of failings, as the hon. Member for Newcastle upon Tyne North articulately set out. I think there are real challenges: how the criminal justice system understands people with a learning disability, how all the agencies can work more effectively together and how we can provide support for people with a learning disability, so that we not only support, but protect them. We are taking action at a national level to address those. The permanent secretary at the Department of Health is about to convene a cross-departmental roundtable to look at how we can deal with this across Government.

I can give the hon. Lady my assurance that people with learning disabilities are a key priority of mine, and I look forward to making sure that we do not have to have a debate like this in future.

Oral Answers to Questions

Debate between Catherine McKinnell and Jackie Doyle-Price

Tuesday 10th October 2017 Commons Chamber

[Catherine McKinnell (Newcastle upon Tyne North) (Lab)]

7. What steps his Department is taking to improve end-of-life care.

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

By 2020 we want significantly to improve patient choice in end-of-life care. The Government’s end-of-life care commitment sets out exactly what everyone should expect. In September we published a report on the good progress that we have made over the first year.

[Catherine McKinnell]

The End of Life Care Coalition has said that it remains deeply concerned about the enduring gap in resources for community-based health and social care services. Meanwhile, Together for Short Lives continues to highlight the unacceptable postcode lottery faced by 40,000 children with life-limiting conditions. What is the Minister doing to ensure that all clinical commissioning groups and sustainability and transformation partnerships will meet the Government’s requirements in full for both children and adults by 2020?