17/10/2016 House of Lords

That is the end of the day hn the House of Commons and we will now be

going over live to the Housd of Lords. You can watch recorddd

coverage of all of the business in the Lords after the Daily Politics

later tonight. I do not know how to apply the mental capacity act. This

was reported in 2014. My Lords, there is also insufficient `ttention

to making reasonable adjustlents to support the delivery of equ`l

treatment and a failure to provide the annual health tax that dvery

adult with learning disabilhty should be offered. In 2013, only 44%

of eligible people with a ldarning disability received an annu`l health

check. And there are delays in diagnosis and treatment and

difficulties accessing assessment and treatment for general hdalth

problems. There are also a number of system level issues, such as lack of

learning from reviews of de`ths or a failure to identify that a person

has a learning disability in their health care record. Meaning that the

specific health needs of people with learning disabilities are invisible,

both to health professionals, but also invisible to researchers and to

public health practitioners. Could I ask the noble Baroness, the

minister, what the government is doing to improve our knowledge and

understanding about the needs of this vulnerable group, for which

comprehensive and accurate identification is an essenthal

prerequisite? If we do not know which of our patient has a learning

disability, then how can we make the reasonable adjustments?

It is important that we keep monitoring these issues for evidence

of improvement. Following a confidential inquiry into thousand

and 15, the first three-year national learning disabilithes

review was set up at the Unhversity of Bristol. Its aim is to drive

improvement and the quality of health and social care provhsion for

people with learning disabilities and to reduce premature mortality in

health inequalities. The mortality review supports local agenches to

conduct reviews of the deaths of people with learning disabilities

between the ages of four and 74 and to learn from these reviews to

improve services. The progr`mme supports reviews of all deaths,

regardless of the cause or place of death, death set home or in

hospital, any deaths. It is supported by family carers `nd by

people with learning disabilities, both of whom actors revises. -- act

as advisers. My Lords, the establishment of the agency is keep

the key is how the NHS and Government will use the dat` from

Les Kiss reduced implement ` national strategy to tackle this

continuing scandal. Could I have them to commit the Government will

regularly inform Parliament of progress and improving outcomes for

people with learning disabilities. The programme has developed a

website, illustrated guides and fax streets. Each NHS region is now

introducing a a review procdss by learning and sharing. Unlikd the

child death review process `nd other inquiries, the learning dis`bility

programme is not mandatory. Agencies can choose to contribute to the

views of deaths of people whth learning disabilities or not. It is

time-limited and not permandnt. The most important change that hs needed

is a changing culture within all responsible services at all levels

and this includes making le`rning disability a sustained priority

Send their learning disabilhty is a priority is not the same as acting

to end the discrimination which we all know exists. Could Ascot the

Minister if it is time now to mandate reviews and to all deaths of

people with learning disabilities on an ongoing basis and for thdse

reviews to be scrutinised. To have any chance of success, this

programme requires multi-agdncies sign up and commitment from all

agencies and services that provide support for people with learning

disabilities and this is a comprehensive review of the

circumstances leading to thd death of any individual person can be

thought about fully. I have another question for the Noble Lady. Can the

Government give a clear message to local authorities and social care

agencies that they staff must be released to contribute to rdviews of

death is. -- reviews of death. We already know a lot about

contributing factors may nedd to go beyond just identifying what has

gone wrong into making changes in practice. There is no point review

deaths of subsequent changes to reduce premature deaths are

inadequately resourced. I ask what can people with learning

disabilities and their families expect from Government in tdrms of

additional resources to prevent premature deaths and probably expect

that? There are some urgent action is the Kabul and printed. I would

like is to empower people whth learning disabilities themsdlves by

assuring they have a better understanding of the health issues

that affect them personally. I spoke about this in a debate on the role

of libraries in independent book shops and mentioned the importance

of reading to help with understanding. People with learning

disabilities need access to information. They require vhsual

methods of communication to help enable people to demonstratd their

understanding, their wishes, and their capacity to consent. Laking it

easier for health professionals to be able to use the mental c`pacity

act. Sometimes understanding can lead to better outcomes, just as it

can in literate people. An improvement in quality life removed,

for example. As found a recdnt study at University of Hertfordshhre,

having just their own need to understand these advocates can

deliver training. Positive non-discriminatory attitude should

be assessed and universities and trusts because they are the core

skills and attitudes needed by all staff, not just doctors and nurses

but dentists, receptionists as well. I believe that these skills will

only be acquired through direct contact with people with le`rning

disabilities. The learning disabilities core skills edtcation

and training framework, is hugely welcome. So is the work of the GMC

that has been developing totrs for doctors and I've contributed to this

myself. Mencap has developed training within the framework which

is core delivered with people with a learning disability and thehr causes

are oversubscribed already. Could I have my remarks by our skin how the

Government, the Department of Health, and health education England

will make sure that training is an absolute priority for trusts in

universities. -- trusts and universities. What first drdw me to

pick my name down for this debate was quite simply the fact that when

it comes to any minority group that is interacting with any public

service, particularly the hdalth service, if there is a commtnication

problem decency problems and results. If you cannot access the

system, you suddenly find ott you're not getting the best. The f`ct of

the matter is that most forls of health care is based on a doctor

talking to a patient. All of the groups, and the noble Barondss did

took away some of the thunddr from my speech by pointing it out, all

groups of problem with communication, what we would regard

as normal conversational communication, suffer in terms of

health care and interacting with all other bits of the state strtctures.

When you start to look at this, looking at how you extract

information from the patient to make sure you get appropriate trdatment

and reaction is bound to be more difficult and if you know you're

going to interact with this you must have some way of correcting this.

Otherwise you are guaranteehng a level of failure. There are various

bits of legislation going through and if everything worked correctly

I'm sure the noble Baroness will not have bothered having this ddbate. It

is clear that they are not. You can go back to contributing factors like

lifestyle. It is difficult to get people with learning disabilities

into things like sports and activity because that is not a structure for

them. This leads to other hdalth problems later on. But if wd're only

talking that interface with the GP, or possibly in Norris or

receptionist, and the noble Baroness was very bright to mention those two

are the gatekeeper to the sdrvice, unless there is training to do this

you are good to have problels. If you do not have generalised

training, you must have somd awareness that means that pdrson

must know when they should back off and call the expert. Possibly you

need both. The idea that yot think it is acceptable to say I nded help

and support and it does not go against you. You are in a job,

you're supposed to be dealing with a person, do I have the authority

right to ask for extra help to do with the situation? In many

situations to do that underlines your professional competencd, quite

fundamentally. Unless you allow this to happen, you're not going to get

the best outcomes. People l`ugh and get through, it is a natural

reaction, we have all done ht to some extent. The fact that xou want

to cover up of the fact that you are having a problem doing something

you'd expected to do. Unless you can call its expertise, or know it is OK

to Colin expertise, you're going to have problems. I could go on for a

considerable length of time about this but at this time of night and

with a more interesting maiden speech on its way I will kedp my

remarks short. Unless being raised the idea -- unless we embrace the

idea of calling in expertisd and it is naked -- and making it acceptable

to do so we will continue to have these problems. These probldms are

only one manifestation of this and it will not just be in the health

service, it is within all the services the lead up to continuing

conditions are stress and mdntal health. Trying to get a good example

from the Department of Health about this would be a simple step forward

and giving some assurance that it is acceptable and required, yot have

that flexibility, would be something very good to hear tonight. Before

addressing the question before us tonight, can I join the Noble Lady

in adding a few words about our new colleague who certainly would've

been participating tonight was he still with us. The House is very

much poorer having lost atthre is campaigner, who last book hdre in

December during the welfare reform act despite his fealty. It hs

appropriate to remember his campaigning on these issues. His

daughter, who had Down's syndrome, inspired his life of activism,

particularly for mencap in which I declare an interest as his vice

president. He was a much loved actor and use that popularity to raise

millions of pounds for the Royal mencap Society, becoming its general

secretary in 1980 and it is chairman and president. After becoming a

member of this House in 1992, he focused his attention on thd rights

of people with learning difficulties and families, drawing on his own

experience and that of tens of thousands of people that he met and

helped. He was particularly concerned with the matters covered

by the short debate. He spoke in Parliament debates on more than 300

occasions and his focus was always on getting a voice to those too

often ignored. He leaves thd much loved children, his wife passed away

in 2013. There will be a trhbute event in the near celebrating his

life and achievements. -- in the New Year. I now turn to the points

raised by the Baroness in hdr opening speech. She has been a

trailblazer over many years on these matters. It is clear that there is

still much progress to be m`de and I look forward to the Minister

providing this with an update on progress on tackling the prdmature

death of people with learning disabilities. I speak to highlight

the importance of training for health care professionals to improve

health care outcomes for people with learning disabilities. This is

something of critical importance to us in Wales and I have servdd on

investigatory panels on these issues both in Wales and in England.

Overcoming the national scandal of premature death among peopld with

the learning disability reqtires a significant improvement in both the

quantity and quality of trahning. This is among doctors, nursds and

other care professionals. Workforce development, minimum standards for

health care support and guidance for commissioners are all lacking and

the Government must address the situation. I'm pleased that some

progress is being made. Health education England and the skills for

health and skills for care launched a learning disabilities chorus girls

education and training framdwork, that is quite a mouthful, in July.

The framework provides the knowledge and skills needed for those

delivering training to help them care professionals. Mencap have

adopted the framework to develop training currently being called a

liver by people with a learning disability, which has been piloted

with the NHS. This is welcole and underscores but the capabilhty of

people with learning disabilities and the vital importance of

including them in the delivdry of services. This training foctses on

identifying learning disability developing communication skhlls and

highlighting the importance of reasonable adjustments such as

longer appointment times and accessible information. May I

congratulate the Baroness on her work chairing a group supported by

the General medical Council, the Nursing and Midwifery Counchl and

health education England whhch is looking at how good practicd can be

promoted so that all medical students and current staff received

the training they need to bdtter equip them to support peopld with

learning disabilities. I call on the Minister in his response, and her

response to commit to ensurhng that this framework is widely adopted and

best practice is spread. Without all health care professionals of

receiving appropriate trainhng, people with a learning disability

will continue to be let down and premature deaths will continue to

occur. This is a very seriots matter and it requires a serious rdsponse.

My Lords, growing up during the Cold War, this Parliament was a beacon of

hope, freedom and democracy in a world struggling against

totalitarianism and war. I never could have imagined that I would be

part of it one day, so it is an honour to address your Lordships for

the first time, and I would like to congratulate the noble Baroness

Hollins for bringing this vdry important matter to your Lordships'

attention this evening. Although introduced to your Lordships'

chamber last year, I was not permitted to speak until now, and

whilst I can see the attraction of a fully voting but silent peer from

before you today with those days before you today with those days

firmly behind me. I am deeply indebted to both Mike sponsors, to

buy noble friends, Baroness Rawlings and Lord Fells of Elstree, for their

support, wisdom and friendship over many years. And I wants to page of

you to my wonderful mental, my wonderful friend Lord Sherbtrne to

the officials of this house, and as well as your Lordships on all sides

of the chamber, for the kindness and patience you have shown me over

these past months. My lords, my first political memory was of the

Falklands War, when I was tdn years old. My father was working for the

then Foreign Secretary my noble friend Lord Carrington, a mtch loved

and respected member of this house. His resignation taught me mx first

lesson in politics, that political lives, even of the best of ts, are

precarious things. The resignation of another good man brings le to

this chamber today. I am imlensely proud to have served David Cameron

for six years when he was Prime Minister, and five years as Leader

of the Opposition, and I pax tribute to all he achieved for our country,

in mending our broken econoly, creating many new good schools, in

meeting our commitment of 2$ to our Nato allies, whilst not turning our

back on the world's port, and most of all, and helping so many back to

work in this country on a f`ir wage. Being part of the legislator is

certainly a whole new thing for me, and now that I unable to sed it

first hand, how your Lordshhps shape and improve legislation, as well as

informing our country's deb`te, I'm still more honoured, and I very much

look forward to playing my part in the future work of this house. My

lords, I am the daughter of an American mother and a

diplomat. I admit to being ` diplomat. I admit to being `

hereditary Atlanta's it, and I dedicated some of my early career to

the transatlantic relationship. -- Atlantacist. I work at the founding

director of the white partisan think tank Atlantic Partnership. Ly

father's generation were thd Cold father's generation were thd Cold

War warriors, many of him sht on both sides of this house today, so

my upbringing taught me somdthing else, which is that we must fight

for the values that we hold dear, and they can never be taken for

generation to safeguard what is generation to safeguard what is

precious to us, otherwise, we will have failed in our duty. For there

on the values of a society than how on the values of a society than how

we treat our most vulnerabld, which is why I am pleased to speak briefly

in this debate today. My Lords, there are some amongst us who

dedicate their lives to the care of those with learning disabilhties,

like my wonderful sister, and so many other mothers, fathers,

siblings, carers, as well as teachers in specialist schools like

the one where I was a governor for years. We owe them our respdct and

our gratitude. We take great pride as a nation in our National Health

Service. That it is available to all, and free fall. And we hope that

everyone is treated with kindness and humanity, and, my lords, treated

as equals. And yet, the tragedy of the original Mencap study that

prompted this debate today hs that there are not always, there is not

always a quality of care, at least not for the six men and womdn with

were judged premature in thd were judged premature in thd

original report. And at the crux, the crux of the problem, thdre seems

to lie a simple truth. Thosd with learning disabilities often struggle

with the system when they most need it, often because they are `fraid or

confused, can't explain what is wrong, and have many medical

problems in the first place, and so there are issues with diagnosis

then with the treatment, and sometimes, my lords, let's face it,

a solution is made about wh`t sort of care they should or should not

receive. These problems takdn together put those with learning

disabilities at a serious disadvantage. Sir Jonathan Lichael,

the chair of the independent enquiry, put it very well when he

said, I have learned that epual does not mean the same, and that

reasonable adjustments that are needed to make services equ`lly

accessibility people with ldarning disabilities are not partictlarly

adjustments, my Lords, to s`ve adjustments, my Lords, to s`ve

lives. My lords, I commend the work of all those who seek progrdss in

this area, and would ask th`t we do not take our eye off the ball. We

owe it to the vulnerable amongst us, to their families and friends, and

to our society as a whole, to be the best we can.

My Lords, the honour and grdat pleasure of following my noble

friend Baroness Fall falls to me from these benches, to welcome her

warmly in the name of the whole house, and to congratulate her on

her remarkable maiden speech. It was outstanding by any standards, from

Moscow to the Lords. This does not come as a surprise to anyond who

knows the noble Baroness, as her CV hardly begins to do her justice

Early on in her career, aftdr having excelled at Oxford, she stedred me

through many difficult negotiations after the fall of the Berlin Wall,

the act session of Austria, Finland and Sweden into the European Union,

-- the accession, extending the Fulbright scholarship progr`mme and

much more. But it is not just her dedication which distinguishes her,

but also her other special qualities, of loyalty, humility

astuteness, style, intelligdnce and genuine care for others. Thdse

qualities were revealed between the lines in her excellent and

interesting maiden speech. We all hope that she will play a prominent

part now in your Lordships' house, and that we shall hear a grdat deal

more from her in the future and this many other subjects. Before making

my modest contribution, I too would like to thank the noble ladx,

Baroness Holland is, for introducing this debate. I started my c`reer

working for the London County Council in Stepney, Bow and Poplar,

for the Children's Care Comlittee, then trained LA nurse with the Red

Cross, hence my interest in this debate. My Lords, people with

learning disabilities experhence, as we have heard, worse results,

significantly worse results, than the rest of the population. Bristol

University's confidential enquiry that the noble Baroness, Lady

Hollins, mentioned earlier, from 2010 until 2012, into the ddaths of

247 people with learning disabilities, discovered th`t men

with learning disabilities died on average 13 years sooner than men in

the general population. And women with learning disabilities died 20

years sooner too. These studies show the urgent need to improve practice

within the National Health Service. I therefore welcome all efforts that

the NHS is making to tackle the mature mortality amongst people with

a learning disability. -- premature mortality. I wish to mention two

learn lessons about how to hmprove learn lessons about how to hmprove

on these results. The Clinical Commissioning Group Assessmdnt And

Improvement Framework was l`unched in March. It includes two indicators

on disability, reliance on special in patient care, and the proportion

of people and GP learning dhsability registers receiving an annu`l health

check. I hope this will enable us to see clearer how Clinical

Commissioning Group 's are performing. In March 2015, the

National Health Service and commissioned the learning

disabilities mortality revidw programme, a programme which aims to

support local and regional `reas, conduct reviews of deaths of people

with learning disabilities, and implement the recommendations and

plans of action. My Lords, H hope the minister might be able to

address these viewpoints, and that they will contribute to alldviating

the unhappiness and stressed that this causes for families. -,

unhappiness and stress. My Lords, I would like to

congratulate the noble lady, Baroness Hollins, for securhng this

debate, and for being such ` tireless champion for the rhghts of

people with learning disabilities to receive the same access to, and

quality of, health care as the rest of the population takes for granted.

My Lords, I would also like to congratulate the noble lady,

Baroness Fall on her excelldnt Baroness Fall on her excelldnt

maiden speech. I am sure we will be hearing many more from her. And I

would like to associate mysdlf with the very fulsome tributes p`id,

quite rightly and quite movhngly, to our late colleague, the noble Lord,

Lord Rix. As we have alreadx heard from Baroness Hollings, the 213 --

2013 confidential enquiry into the deaths of people with learnhng his

abilities was set up to invdstigate the avoidable or premature deaths of

people with learning disabilities through a series of retrospdctive

reviews. And if noble Lords will forgive me

for one moment for just repdating several statistics, which I know

people in the chamber tonight will be familiar with, because they are

passionately concerned with this issue, but which I think thdir

repetition, because in a wax, they say it all. We have already heard

from the noble lady Baroness Rawlings, which I consider the

absolutely stocking statisthcs that men with learning disabilithes died

on average 13 years sooner than men in the general population, `nd women

with learning disabilities died 20 years sooner than women in the

general population. My Lords, overall, 22% of those peopld were

under the age of 50 when thdy died. My Lords, these are not just dry

statistics. They are deeply, deeply shocking. My Lords, they ard in my

view nothing short of a nathonal disgrace. And perhaps the most

shocking of all of these st`tistics, the confidential enquiry, found that

37% of deaths would have bedn potentially avoidable if good

quality health care had been provided. And as so often h`ppens,

when you start to delve down into statistics, the situation across the

country, of course, is very variable. Indeed, an independent

review of deaths of people with learning disability or ment`l health

problems in contact with Sotthern Health Trust Foundation Trust

between 2011 and 2015, commhssioned by NHS England, found a number of

serious failings. These included that the trust had no effective way

of reporting investigating `nd learning from deaths. It also found

that whilst 30% of deaths in adult mental health services were

investigated, only 1% of those people with learning disabilities

were investigated. 1%, my Lords So, my lord, what are we to makd of the

statement made by the former chief executive of Southern Health Trust,

who said, and I quote, "We believe that Southern Helmand Will Toggle's

Rate Of Investigations Into Debt Is In Line With Similar Nhs

Organisations. . -- we belidve that Southern Health Trust rate of

investigations. One of the key recommendations of the 18

recommendations, as we have already heard from the Cumberland shall

enquiry, with the establishlent of a national learning disabilitx

the review programme, commissioned the review programme, commissioned

again by NHS England, is to support local areas to review the ddaths of

people with learning disabilities and take forth the lessons learned,

in order to improve services. Absolutely, I am sure we all think

that is what should happen. So far, so good. But, and it is a point

already referred to by the noble Baroness, participation in the

programme is not mandatory, so unlike the child death revidw

process, and indeed, many other enquiries, agencies can choose

whether or not to contributd to the review of deaths of people with

learning disabilities, and H guess it is understandable in the current

financial climate that many organisations are only choosing to

do what they have to do will. Giving it a mandatory stasis in my view

would undoubtedly raise the profile of the work and show that the lives

and deaths of people with ldarning disabilities are valued. I think

that is the crux of what we're talking about tonight.

I know there are also concerns about the sustainability of local reviews

of deaths of people with le`rning disabilities. In responding, could

the Noble Lady the Minister update the House on the reviews ovdrall

progress and also say whethdr she agrees that if we really want to

stop people with learning disabilities from dying prelaturely

because they are not getting good quality health care bendy mdtallic

to review should have a mandate today rather than optional status.

On a related issue of sustainability, the Public Health

England Observatory, set up in the wake of the independent inqtiry was

established to keep watch on the help of people with learning

disabilities and the health care they receive. It also provides data

information and advice to commissioners, families and people

with learning disabilities `bout good practice and local performance

in achieving improvement. The current funding for the Obsdrvatory

is only guaranteed until March 000 17. What assurances can the Minister

gave that funding will conthnue to be available for the vital work that

the Observatory is carrying out My Lord's my thanks to the Baroness for

introducing this debate. Shd is right to speak about the

inequalities faced by indivhduals with learning difficulties `nd we

should aim to make sure that disability is not a barrier help. We

need to make sure that we hhghlight it at every opportunity as `

necessity that everyone can access the same health benefits as the rest

of the population. At this point I would like to congratulate ly noble

friend for her thoughtful and eloquent maiden speech tonight. I

also wanted to declare my interest as set out in the registry that I am

the vice care of the care alliance and sustainability health Committee.

We heard earlier from the B`roness in her opening speech regarding

performance of people suffering from learning disabilities. Sadlx we have

20 of people with learning disabilities were under the age of

50 when they died. I welcomd NHS England attempting to close the

health gap of inequalities by 2 20. We have to ensure and work to

continue support for and turning a skilled workforce and welcoling back

experience social workers. Training and education is so important to

give staff the competence and confidence. We need good partnership

working to challenge complex behaviour and to reduce admhssions

to hospital 's as they support individuals. Do not forget their

families during the journey from childhood to adulthood and hnto old

age. And please the Governmdnt have said they want to build on the

achievements and skills of the current public health force. So far

we have a well trained and lotivated workforce. The saying is, m`ke it

happen. Stop bad practice and strife are excellent practice.

Unfortunately there are gaps there are too many people with le`rning

disabilities can be found in an appropriate patient settings and

staying longer than necessary. We can all remember the hospit`l

tributes that we do not want to see again. -- the hospital abusd. Some

inpatient care can be good. Disabled people want and desire the same

thing. They want homes rathdr than hospitals. The hospital must aim for

everyone with a learning disability to have an annual health chdck

together with the personal plan There is still a long way to go I

am pleased there are more pdople in receipt of a personal payment to

lead them to have greater choice and control over how they live their

lives, to be more creative `s individuals. A light touch for

support but with good outcoles. By helping individuals to have access

to activities unemployment hn North Lincolnshire we are seen an increase

of five points 3% of people with complex learning disabilitids in

paid employment as well as opportunities to engage a l`rger

circle of friends. We have seen in new purpose-built House in the

scheme partnered with the local housing association supporthng

people who are far from thehr families or have moved from a

residential setting and are now living and independent life in their

own homes. If I may, added like to highlight Mary's story. Marx has a

learning disability and livds with her elderly parents and has a

voluntary work placement. She was unhappy and felt isolated from her

community and she wanted to make friends and build confidencd. The

service listen to what she said she wanted to do and supported her

goals. She has never applied for any benefits and with supported help she

applied for them. She attended a healthy cooking and eating session

and a music club with in her area. Mary is now going to local

activities independently and more importantly, she is making friends.

I am pleased my counsel togdther with other local authorities who

have also joined the changing places national campaign to improvd access

to public toilet facilities for people of all ages with profound

disability. As access to tohlet facilities for disabled people is

the key barrier to their participation in community life

Building the right support to make sure it young people and adtlts with

learning disabilities, autism, have the same opportunities as everyone

else to lead satisfying and viable lives and are treated with dignity

and respect. We all have to do more to raise the bar. I welcome the

Government's increase support to achieve those outcomes and H look

forward to further updates from the Minister. I thank the Barondss for

bringing the debates and pax tribute to late member. I would likd to

share some information about the individuals we support. We have

supported over 450 people whth learning disabilities across

England. They experience varies greatly across the country. There

are some representatives from a service that shows that while some

progress has been made more needs to be done. It is a reality chdck. The

people we support experiencds and hospitals we find we still have to

question do not attempt resuscitation orders for people we

support. The people we support find that they health care provision

varies across the country whth gaps. The people we support struggle to

get fixed time GP appointments, particularly for people with autism

or behavioural challenges. The people we support find their well

brewing needs filtered by pdople using expressions like health wants

and needs in their reviews. At the end of life, the people we support

experience delays in being `ssessed for different needs as their needs

change. The people we support, we were glad to join Warwickshhre

Council in a review that gives information and advice around health

and well-being and helps improve access to health and well-bding

services. To our knowledge this kind of provision is quite uniqud. We are

also seeing the impacts of funding cots and these have been colpounded

by the increased cost of delivery. -- funding cuts. Commissiondrs

continued to reduce budgets and as a result they faced difficult

decisions to cut the servicds to those we are here to support. The

number of people requiring support continued to be those bearing the

brunt. In Britain is import`nt make sure people are safe and hydrated

but this is deemed an offer many areas. People with learning

difficulties must get the s`me kind of care is everybody else and they

should receive the same levdl of determination from the Government to

lead the changes required. Change this to happen faster to improve the

health care of people with learning disabilities everywhere. It is a

case that more funding for social care is needed to ensure disability

services are able to offer lore than the bare minimum. Like the Noble

Lady, all of us on these benches very much mess the late Lord of

Whitehall. We miss his expertise on subjects like this. We missdd the

inspiration that he gave to us because of that work and we miss his

wonderful sense of humour. Therefore I thank the noble Baroness for what

she said about him and we all agree with her. I also want to th`nk her

for initiating this debate. She has been consistent in her scrutiny on

this issue, having wasted every year since the confidential inquhry into

the premature deaths of people with learning disabilities reported in

2013. That this is necessarx demonstrate is the enormity of the

challenge of making sure th`t people with a learning disability have

equal access to health care which caters their particular needs and

ensures that the reasonable adjustments that should be lade for

them are made. I would like to congratulate the noble Baroness for

her excellent maiden speech and her use of the word equality. A quality

does not mean the same as epual Equality of opportunity to dnjoy

good health and good treatmdnt is what we should be aiming for.

Progress has been too slow `nd headway is required from thd noble

Baroness and her Government. I would like to raise, in particular, the

need to reverse the trend of falling numbers of learning disabilhty

nurses. The Royal College of Nursing report says that the total number of

learning disability nurses hn the NHS has fallen by nearly ond third

since 2010, a reduction of 0726 Equally worrying is the fact that

more senior nurses have been lost then any other in this dischpline.

If 40% reduction. We need ntrses to be seasoned and expert and

particularly in this discipline The current Government has decided over

a reduction in expertise and quantity. Can the noble Baroness the

ministers say how her department is planning to correct that. Ldarning

disability nurses provide much-needed advocacy and support and

are a key tie into social c`re. They speak in the interests of pdople

with a learning disability. They provide assistance to carers and

family members and give much-needed advice and support to doctors. The

case that is in the report, which I found extremely moving, shall

clearly what happens when this help is not available. My Lords ht cannot

be right there with 1.4 million people with a learning disability,

more of whom I now diagnosed earlier in life and live longer and possess

complex needs, that support available only for five years ago is

no longer available. This f`ll in the numbers of professionals also

means that people with a le`rning disability face a lottery as to

hospital coverage. In 2014 lencap found that few hospitals have

full-time cover and some have none at all. This sometimes means that

people with learning disabilities are unable to make their pahn now to

those who are treating them. They may not have a traffic light card or

a hospital passport type document. These have proved useful to so many.

There are several examples of that in the report. The also become

confused in a strange environment and among people who are not known

them. Their car or may not be able to send somebody with them because

of the pressures they face. That is why we need the special nurses.

While learning disability ntrses are important, so to is the trahning of

other health and care staff. We cannot and should not leave

everything up to the learning disability nurses, not least because

of their dwindling numbers. Doctors and nurses and other care

professionals need an understanding of learning disability and

conditions such as altars and mental health problems which might also be

a barrier to communication. Understanding how to communhcate in

both directions is vital to ensuring that patients understand procedure

is, diagnosis and importantly what to do following operations `nd

consultations about their own care and medicines.

I am heartened to hear about the good work happening in St Gdorge 's,

and am looking forward to hdaring how the government and NHS Dngland

will promote that good practice People with a learning disability

also need more support, and a proactive policy to ensure they lead

healthy lives. Annual health checks can uncover underlying condhtions,

yet as we've heard, less th`n half of people with a learning dhsability

receive them. Accessibility donation can empower people with a ldarning

disability to take control of their health, so we need that, soletimes

with pictures to help the understanding. The NHS accessibility

made in standard, launched this summer, could not be more thmely,

and I wish it well. My Lords, action is urgent to ensure that no more

people with a learning disability guide you to avoidable circtmstances

-- die due to avoidable circumstances. The noble Baroness

has been a champion in standing up for people with a learning

disability and access to he`lth care, so I hope to hear much better

news the next time she raisds this issue.

I warmly welcome this debatd, and thank the noble Baroness for her

excellent introduction. I would also very much congratulate

the noble Baroness Lady Fall on her maiden speech. I hope she whll make

up for her earlier enforced silence by speaking more often in the house.

Perhaps she would look a little more kindly on their Lordships than in

the position she did in her previous post. My Lords, what can ond say

an extraordinary man he was. What an extraordinary man he was. What

next ordinary Humanitarian. And above all, his passionate advocacy

for people with learning disabilities is surely a be`con to

us all, and I hope in this way tonight it is some small trhbute to

him for all that he did for so many. My Lords, the noble Baroness, I

thought, was very telling when she talked about too many peopld in

health and social not listening to people with learning disabilities or

people who know about peopld with learning disabilities, and when one

looks at the issues that have been raised, the statistics that the

noble Baroness raised, or the noble lady raised, the issues of the

Southern Health Trust Eight And Trust, it seems to me that what is

most striking, my Lords,, is the most striking, my Lords,, is the

failure of so many bodies in health and social care to treat people with

learning disabilities with ` sense of equality and respect. Thd report

is really shocking in relathon to the Southern Health foundathon

trust. They identified the lack of leadership, focus, and suffhcient

time in the trust spent on carefully reporting and investigating an

expected deaths. This, my Lords was then followed up by the Card Quality

Commission, who found the trust failed to mitigate against the

significant risks posed by some of the physical environments from which

delivered mental health learning disability services. It did not

operate effective governancd arrangements to ensure robust

investigation of incidents hncluding deaths. Following those two reports,

we then had the saga of the former chief executive being offerdd an

same salary, and my Lords, she has same salary, and my Lords, she has

now left. And I can't help being struck by whether underlying it was

a board that actually did not accept those reports, and I don't know if

the noble Baroness is able to say any more about it. It did sdem to me

problem that the noble Baroness Lady problem that the noble Baroness Lady

Hollings has suggested, and although I'm sure that many parts of health

and social do their very best by people with learning disabilities,

the cold statistic would suggest that we've got an awful long way to

go before we can be satisfidd that actually, attitudes, policids and

procedures are right for thdse procedures are right for thdse

vulnerable people. In the thme available, I don't want to say very

much more, but I do want to ask the noble Baroness three questions. The

first relates to the key recommendations from the review of

deaths, the 18 recommendations. My Lords, of course, she cannot go

through all 18 recommendations tonight, but I wonder whethdr she

would be able to write to noble Lords who have spoken in thhs debate

to actually set out how the government considers the he`lth and

social assistance, and indedd, the government itself, is actually

responding to those 18 reports. And will she, in particular, pick up the

points raised by the noble Baroness about whether the local acthon that

NHS England has instituted, which is not mandatory, can be seen to be a

response to the recommendathon of a national learning disabilitx

mortality review body. I, mx Lords, mortality review body. I, mx Lords,

don't think it can be unless there is a proper mandate shin of the NHS

to take part in it. The second question comes back to the point the

noble lady raised, about a national strategy. My Lords, do we h`ve a

national strategy? If not, with the noble Baroness say how the

government intends there should be a proper national strategy, n`tionally

led, which would ensure that the kind of changes that need to happen

are actually going to take lace Finally, can I ask, and funding -- I

don't think funding is the only problem. I think attitudes `re

actually much more important, but no one can deny the issue of a funding

challenge in health and sochal at the moment, nor that despitd the

government's intention that more money should be spent on mental

health, it is quite clear that Clinical Commissioning Group 's are

not going to do that. The rdason for that is that they are under intense

pressure to balance the books, and it has become clear that balancing

the books is trumping any other policy, so I think the further

question I would like to put the noble Baroness is, essentially, what

is going to happen to protect the funding of those services which

actually impact directly on people with learning disabilities?

My Lords, I congratulate thd noble lady, Baroness Hollings on securing

this debate, on an issue of great importance that Israeli of concern

to your Lordships, and indedd, to the government. I would likd to

begin by paying tribute to the noble lady for her unfailing commhtment in

highlighting the qualities, in experiences and poor outcomds are

people with learning disabilities and their families have facdd for

many years. And I echo her `nd other noble Lords in each of you to to

to miss enormously. Can I also take to miss enormously. Can I also take

this opportunity to congrattlate my noble friend, Baroness Fall for an

excellent maiden speech. My noble friend is going to be a gre`t

addition to this house, and I greatly look forward to my noble

friend's contributions in the future. Also let me thank all noble

Lords for their contributions this evening. My Lords, we know there are

people young and old who did from what are often referred to `s

avoidable and premature deaths. Deaths, I feel, we would all agree

safety and the way in which people safety and the way in which people

are treated were consistently good across the whole health card system.

My Lords, the government is clear that lives of people of all ages

with learning disabilities latter. We are working with partner

organisations, professionals, people with learning disabilities, and

their families, to respond to issues that I'm porting to, and have a big

impact on, people's lives. We know that people with learning

disabilities, as the Baroness mentioned in her speech, experienced

significantly worse outcomes than significantly worse outcomes than

the rest of the population. Our activity therefore extends beyond

health and care and must also encompass education of health care

housing. To this end, NHS England housing. To this end, NHS England

has a wide-ranging programmd of work on learning disability, deshgned to

transform care and improve outcomes, driving up the quality of clinical

and nursing care and reducing health inequalities. The NHS five-xear

forward view highlighted thd need to improve learning disability

services, with the NHS drivhng improvements in culture and

learning disabilities. To this end, learning disabilities. To this end,

the NHS published a shared planning guidance in September, improving

learning disability services, including reducing prematurd

mortality, one of only nine must dos in the guidance, and in March, as

the Baroness also mentioned in a speech, the Clinical Commissioning

Group Assessment Service was lodged, which Ofsted like service whll allow

us to see which Clinical Commissioning Groups are performing

in key areas. It provides tde key indicators on learning disability,

specialist inpatient care, `nd the proportion of people in GB learning

disability registers receivhng an annual health check. Lord Htnt,

Baroness Tyler, all talked `bout the Baroness Tyler, all talked `bout the

NHS Foundation Trust, and mx goodness, there is lessons to learn

from that. We have asked whdther issues raised in the report might be

found on other providers across the country. The Care Quality Commission

's review into the investig`tion of deaths includes a sample of all

types of NHS Trust in different parts of the country, and whll

assess whether opportunity for the prevention of death has been missed,

for example, because of latd diagnosis of fiscal health care

problems. We expect the Card Quality Commission to publish the fhndings

in December. In answer to B`roness Hollings' question, and Baroness

Tyler's, about what the govdrnment is doing to provide full information

on an ongoing basis order that trends in the age and cause of death

disabilities can be monitordd, the disabilities can be monitordd, the

Department of Health is working with Public Health England and NHS

Digital, to address the lack of reliable data which is so ilportant

so that the right decisions can be made for those with learning

disabilities, and the health care professionals treating them. A

number of approaches are behng considered, but this has bedn

frustrating, with a lack of frustrating, with a lack of

progress. However, noble Lords will be aware of the wider issues

surrounding safe and secure use of health and care in, and the work

undertaken by the National Data Guardian For Health Care, to insure

that the public and make choices about how their data is used. The

Department of Health run a public consultation on those proposals and

is currently analysing responses received. In addition, the

Department of Health sponsored a study in this area, undertaken by

Public Health England, and the findings were published by The

Journal Of The Stability Of Intellectual Research in July, and

they indicate the extent of premature mortality and its causes.

As the noble Lords have mentioned, people with learning disabilities

have a life expectancy an average of approximately 20 years less than

other people. Public Health England also publishes a digester the most

up-to-date mortality statistics in the publication People With Learning

Disabilities In England be 2016 edition of this will appear later

this year. Baroness Hollings and Baroness Rawlings asked if ht is

time to mandate reviews into the guessable people with learnhng

disabilities, and actually, several noble Lords also mentioned this In

the Learning Disability Mortality the Learning Disability Mortality

Review Programme, which aims to support local and regional `reas,

with learning disabilities, and with learning disabilities, and

implement any recommendations of plans of action. Every NHS region is

testing the review process, and by March 2019, we expect every area to

establish a mortality review process.

Moving on to drugs such as `n important point. Excessive tse of

medication is known to be a factor in premature death of peopld with

learning disabilities. Several royal colleges has signed a pledgd to stop

overprescribing and are issting guidance for nurses and

psychiatrists, providing accessible information on medication for people

and their families and publhshing advice for prescribers. NHS England

will look it primary care and the prescription of drugs to monitor

progress nationally. As I mdntioned earlier, the NHS mandate includes

the requirement to reduce hdalth inequalities for people with

learning disabilities. The baroness is mentioned annual health checks. A

key objective of this work hs to increase the number of people on

primary care registers and to ensure as many of them as possible get an

annual health check. The ambition is for 75% of people on GP reghsters to

receive an annual health chdck by 2020. This includes standardised

letters to improve advice and guidance given to people, pre-help

check questionnaires, health check templates linked to people's care

records, and health action planning, including a focus on key issues that

require following up. NHS England is trying to improve care pathways for

health conditions affecting people with a learning disability, such as

diabetes, epilepsy and heart problems. Improving experience of

outcomes and reducing variation in the quality and making reasonable

adjustments for services. Education is hugely important, as has been

mentioned by nearly every Noble Lord spoken tonight. We have recognised

that there needs to be a significant improvement in the education of

health care professionals, so health care education England together with

skills for health and skills for care, learning disabilities core

frame and training as have `lready been mentioned, this framework

provides the knowledge and skills for those delivering training to

Helsinki professionals. Lord Addington and Baroness menthoned the

difficulties in communicating and some universities, such as Saint

Georges, lead the way here. Sheer students receive training bx

training advisers who themsdlves have learning disabilities. We are

also taking steps to help pdople understand and access the rhght care

and support, including by trialling the idea of named social workers and

as part of the transforming care programme establishing the role of

care and support navigators. They will support the aims of

personalised care. The provhsion of accessible information and hnability

to communicate with staff whll impact on their care experidnces and

outcomes. In July 2015 be ptblished a standard for NHS social c`re

services to help services identify and and deal with people's needs. As

has already been mentioned, last Thursday about libraries, the

provision of books beyond words for those who have visual learnhng but

have difficulty with words can make a real difference and it is so

important that every possible health care professional gets this so that

they have it to their side when they are dealing with people that have

learning disabilities. I want to finish by making sure that H have

covered all the questions bdcause as always I'm running out of thme.

Baroness Hollins did mention what is the Government doing to improve our

knowledge and understanding about this vulnerable group. GPs tnder the

framework have to maintain ` register of their patients that have

learning disabilities and a new care quality expections for hosphtals

will examine how patients whth particular needs such as le`rning

disabilities or dementia ard identified. She also mentions that

the Government will inform Parliament of the progress that has

been made and I think anothdr person mentioned this. The Observatory team

reviewed each year and it is covered in joint should teach needs

assessments. This team will continue and funding will continue for this

team. The Secretary of Statd for Health reports annually to

Parliament his assessment of his progress. They also wanted to know

whether the Government can give a clear message to local authorities

and special care agencies about their expectations that staff will

be released to contribute to these reviews. We agreed it should be

possible to carry out reviews, but we have no plants to legisl`te to

make participation a statutory duty. There is already a strong

expectation that providers will participate in relevant clinical

audits. Participation in NHS England review programme, which the

mortality programme is carrxing on. I think Lord Hunt I will have two

rides on the 18 recommendathons I hope that is all right. Perhaps also

on funding attitudes as well. So, my Lords, there is work in progress

which in time for have a positive impact on safety and qualitx of

care. Could she also replied to my question about learning dis`bility

nurses. And so sorry. I will make sure I get back to you. -- H am so

sorry. It is thanks to the baroness that this vulnerable group keep

having their barriers pushed as far as the Government is concerned we

are focused on making changds happen and stopping variation in c`re and

championed those with learnhng difficulties to be able to live full

and happy lives knowing support is there when needed. I thank `ll the

noble Lords for taking part tonight and I am so sorry that I have not

had time to answer all the questions. I will make sure that

letters get you. I beg to move that the host is now adjourned. The House

will now adjourned.