People with Learning Disabilities

Lord Wigley Excerpts

Thursday 12th June 2014 Lords Chamber

[Lord Wigley (PC)]

My Lords, I am very glad to speak in this important debate on tackling the inequalities that people with a learning disability face within healthcare. I declare my interest as a vice-president of Mencap.

My noble friend Lady Hollins set out very clearly the Government’s failure to implement fully the findings of the confidential inquiry, which was set up following the publication of Mencap’s report, Death by Indifference. The lack of progress reflects badly on the Government. It is completely indefensible when we consider that the inquiry found that 37% of deaths investigated could have been prevented with better healthcare. How many more will die before more purposeful action is taken?

I strongly support the central point the noble Baroness made—namely, that there must be robust national oversight—and I look forward to the Minister’s response to that. However, I will focus attention on how to ensure that reasonable adjustments are made so that people with a learning disability have fair access to healthcare, their voices are heard and they get the right treatment.

Hospitals and other healthcare settings are under a legal duty to make reasonable adjustments for people with a learning disability to access healthcare effectively. That might include simple things such as making appointments by e-mail, providing treatment information in easy-to-understand formats, sending text or phone appointment reminders, or offering longer appointments. Such adjustments are not costly. Despite legal duties under the Disability Discrimination Act and now the Equality Act to make reasonable adjustments, they are often not undertaken, which leaves those vulnerable people undiagnosed, misdiagnosed or without the information they need to make informed choices.

Some noble Lords may know that I was a commissioner at the Disability Rights Commission back in 2006 and worked on an 18-month investigation into this very subject. The final report, Equal Treatment: Closing the Gap, exposed that reasonable adjustments were not being made across the board, so it came as no surprise when the confidential inquiry highlighted the very same problem.

We desperately need to move forward on this. However, we should also highlight where good work has been done, and I will draw on an example from the Royal College of Nursing report, Strengthening the Commitment. The report details some of the steps taken by St George’s Hospital to make adjustments for people with a learning disability as well as to help reduce anxiety, permit family members to provide emotional and advocacy support, and enable professionals to treat people in an efficient and timely way.

Those steps include no fixed visiting times for family, carers or friends, so that they can be with patients for as long as they want. Food and drink is offered to family and carers to ensure that they can be with the person they are supporting at any time; and, when staying at the hospital, family members or carers are provided with a chair or even a bed if they prefer. They also offer the first or last appointment of the day so that people who find it traumatic to wait do not have to do so, and double appointments are made available because they permit a fuller assessment of people’s needs, which is likely to result in more effective treatment.

A specific example of how reasonable adjustments were made at the hospital involved a person called Trevor. Trevor had capacity to consent to have dialysis but pulled out the tubes after 30 minutes because he was unable to judge how long the procedure had taken and wanted to leave. The reasonable adjustment which was made in his case was to provide a healthcare assistant to be with him throughout the four-hour treatment to talk with him and to encourage him to complete the dialysis. Over time, he stopped needing to have someone with him and he now does the dialysis by himself—a very reasonable adjustment.

Noble Lords may agree that encouraging hospitals and healthcare professionals to make reasonable adjustments, often at little or no cost, will go a long way to tackling these appalling health inequalities. I look forward to the Minister’s reassurances that when innovation and good practice are evident they will be promoted and replicated so that reasonable adjustments are the norm rather than the exception. Will the Minister give his absolute commitment to these matters and not accept second best for some of the most vulnerable people in our communities?